The idea of being back on (what I thought was) a mental health ward in the middle of the night was a prospect that filled me with an all too familiar kind of dread. My memories of being on a hospital ward or in A&E during a moment of mental health crisis as notably surreal, particularly during a manic episode, when you feel like there really isn’t anything wrong with you. You’re walking out in the same condition you walked in — or so you assume. I have a distinct memory of feeling invincible. It’s a time of total irreality to be in A&E for feelings of invincibility.
The last time this happened to me I was 19 and living in Newport, South Wales. I remember hanging out in the smoking area — they still had them then — with the drunks and the homeless feeling painfully sober but weirdly elated, like I was out for a night out down the pub with the old boys and the regulars.
This time, the déjà vu of taking yourself to hospital in the middle of the night was palpable but also had an unprecedented lucidity. This time, I felt the full gravity of the situation. I also felt a lot of uncertainty. I didn’t really know where I was going, for starters, and I had no idea what to expect when I got there either.
A few days before, I’d been given some strange equipment — a Fitbit, a pair of orange-tinted glasses and an enormous light therapy lamp. I was told to wear the Fitbit for 10 days and follow the instructions for when to use the other two.
What I was preparing for was a course of wake and light therapy — or “triple chronotherapy”, as I later learned was its official name. My understanding was that it was a new and faster acting treatment for depression based around resetting your sleeping pattern and introducing a new regularity to your daily routine.
The purpose of the trial itself was to build up a big enough data set so that the people in charge of big decisions might agree to start offering it on the NHS. Personally, I was just desperate for some alternative therapy or treatment. The meds were only doing so much and I didn’t give a shit about the CBT I was on some infinite waiting list for. So I jumped at the chance to take part in something new.
And yet this excitement was interchangeable from nervousness. I felt like I was going to go away, like saying goodbye to people, like I taking myself to be sectioned. I felt like it was the end of something.
I got the train out of New Cross and headed for Bethlem Hospital.
The name didn’t ring any bells at the time but, arriving as I did at 11pm and absorbing its somewhat ominous atmosphere in the thick darkness, the lights of the various buildings twinkling in the distance, shrouded in the silence of a distinct lack of activity (by any hospital’s standards, never mind a London one), I slowly and subconsciously realised where I was. This was nothing like King’s College Hospital where I’d been for my assessments. Then the penny finally dropped.
I walked through the gates of the country’s oldest psychiatric institution and found myself feeling suffocated by its calm and its history. Being that time of year, the vixen’s screams echoing on the air didn’t help matters either.
Thankfully, I was greeted by two very lovely therapists — a young woman and an older man. The man was there simply to introduce us to the proceedings and the young woman was our therapist for the night. It was her job to look out for us and make sure we were okay but also, most importantly, to make sure we stayed awake. We waited for a short while before the second attendee arrived and then we were filled in on the purpose of our visit.
Triple chronotherapy is, perhaps obviously, a strange name for a treatment. It’s downright cyberpunk. What are we talking about here? A triplicate time therapy? 33.3 rehabilitations a minute?
As the man explained, we have apparently known for quite some time that keeping someone up all night can have an immediate and noticeably positive effect on their mood. (I don’t know what kind of weird people they’re keeping up — it sounds torturous to me.) It has something to do with the body’s production of melatonin boosting mood significantly to compensate for the disruption to normal sleep patterns. So, whilst there’s a lot of talk about light involved, what is actually being shunted here is time — or, perhaps more accurately, the body clock. Hence, chronotherapy.
Unsurprisingly, however, this isn’t a very stable treatment to put people through. In fact, it might seem downright reckless to some. The suggestion that you should deprive a mentally ill person’s brain of something we typically think of brain’s needing to function doesn’t sound like such a great idea. And so, for a long time, researchers have wanted to know how they could stabilise and regulate the results of this quite unceremonious treatment. They believe they’ve found the best way to do this and this stabilisation process has three parts.
Firstly, they stagger the reintroduction of a normal sleep cycle. So, after staying up all night, I’m not allowed to go to bed until 5pm the following day. I then wake up at 1am and stay up all night again. Then I go to bed at 7pm the following day, waking up at 3am, and the whole process is moved forwards two hours at a time until I am going to bed at 11pm and waking up at 7am.
To make this process easier and to encourage melatonin production at certain times, I wear my very stylish ski goggles for four hours before I plan to go to bed. The orange tint of the glasses is meant to have the same affect as the orange screen setting on your phone. As our resident expert said, it simulated darkness whilst allowing you to get on with stuff during your day, further tricking the brain into producing melatonin and making you ready for sleep.
Last but not least is the light therapy, which has the opposite effect of the glasses. For half an hour every morning at 7am for the next 6 months, I’m meant to sit in front of this light box. I tried this for two days prior to having my sleep cycle reset and it was wonderful. Better than any morning cup of coffee I’ve ever had. I don’t remember the last time I had so much energy first thing on a morning.
Taken together, all these things are meant to act as a rapid treatment for depression. Personally, I think it sounds like a godsend. With SSRIs typically taking from 2 to 6 weeks before having their desired effect and with talking therapies on the NHS having waiting lists that are between 6 and 10 times as long as this, there is an urgent need for a treatment that is broadly effective and acts fast for people in need. And, all things considered, this treatment feels relatively noninvasive for something that promises quick results.
So, whilst I arrived at Bedlam feeling like a bag of nerves, I soon felt at ease. We weren’t on a ward — because, as the therapist humorously pointed out, it would be cruel to tease people who were staying awake all night with the prospect of a bed — and instead we were in a kind of day care centre.
It was a large facility, feeling a lot like a secondary school art department more than a hospital wing. We all started by sitting in the creative art studio and, for the first hour, we got to know each other and spoke about what we do when not depriving ourselves of a good night’s rest.
The young man who was with me on the trial was doing an MA in Manchester and he was doing fascinating research into how CAMHS wards can best support young and at risk children, particularly supporting their transition to and from care back into a school environment. (As I went on to rant about on Twitter, this is an issue very close to my heart.)
After about an hour of talking, the therapist made the first move and went to spend time in the textiles room. The young man and I talked for a little while longer and then he moved to another part of the building as well. In the end I was left alone in the art studio. It was cold and with horribly bright fluorescent lighting so I was happy — there was little chance of falling asleep in there.
This strange space, reminiscent of my old high school but on such well-trodden ground, meant that I spent much of the night reading about the hospital’s history online and did not miss the irony of my over-sharing whilst doing so.
I thought about staying on site until around 10am, if I could, and going to Bethlem’s Museum of the Mind to kill some time rather than heading straight home and being tempted to sleep. This didn’t happen. At present, I’ve never felt more tired in my life and the suggestion seems to be that we cannot nap to make it easier.
Staying up all night is not something that I anticipated feeling so melodramatic about but, now, 30 hours into my Friday, I feel like my entire body is rebelling against me. This is not a state in which to productively reflect on the nature of sleep…
I won’t forget this morning’s fog in a hurry though. The morning walk almost made the whole night worthwhile.
A dual thank you and apology to everyone who put up with / ignored me on Twitter last night as I decided to use it as a stimulant to stay awake for this (lack of) sleep trial.
My own nerves and internal dilemmas aside, this has been a really fascinating experience. It is also only the beginning of it. I hope I have more to say in the near future. Hopefully positive news and feedback about the impact of this chronotherapy.
Right now it’s 12pm and I’m back home, having struggled to stay awake on the train journey(s) back to the flat, maybe succumbing to a very short 15 minute nap which seemed to take the edge off. Now I am staring down the barrel of the next five hours and I feel miserable and shit. Here’s hoping it doesn’t last.