"After all this time might I be Bi-Polar rather than still suffering from PTSD?" was the question I posed to Anton Kruger, my psychologist, in March of this year.
The reasoning for my question was that it is coming up for 14 years since the train crash which is a significant amount of time. Surely I must be over it by now? Yet I still suffer from occasional bouts of acute depression, along with other symptoms such as flashbacks and nightmares. However, in between these few episodes I am, in the main, happy and contented, full of energy, positivity and have a zest for life. Could it be possible that my PTSD might have metamorphosed into Bi-Polar?
Another reason for my question is that those closest to me have noticed just before an episode of depression I am super energetic, super happy, talking ten to a dozen and the epitome of 'life and soul of the party'. Then I hit the wall at full pelt and down my personal deep, dark well I fall. This was more the behaviour of a bi-polar sufferer wasn't it?
"No, you still have PTSD" was Anton's answer. He then introduced me to the mental health industry's internationally recognised reference library called DSM 5.
DSM 5 looks horribly complicated to a layman such as myself. There are so many categories of disorders, including exclusions and schizophrenia and each of these categories are further broken down into specifics, symptoms and other diagnostic factors which seem to constantly overlap and intertwine on a regular basis. A cursory look at DSM 5 was enough for me and I immediately felt a new respect for the poor clinicians who have to pick their way through the enormous variants to arrive at a confident diagnosis. And my deep sympathy was stirred to think that there are so many sufferers from all the differing categories, a large number far more severe than my complaint.
However, having seen that many of the mental conditions listed shared quite a few symptoms in common, I appreciated what Anton then advised me: The traumatic event of the train crash was the trigger for me having PTSD and, because I did not receive treatment at its onset, the condition became chronic. The DSM 5 pays close attention to the behavioural symptoms that accompany PTSD and proposes 4 diagnostic 'clusters'. Re-experience (nightmares/flashbacks), Avoidance (distressing memories), Negative Cognitions and Mood (a myriad of feelings mainly negative) and Arousal (aggression, reckless or self destructive behaviour).
What Anton believes has developed over time is 'mania' before a depression episode which is also present in many of the other disorders and not exclusive to any particular one. The rushing around, being hyperactive and the excessive elated mood. A chemical precursor? My way of trying to avoid acknowledging the depression symptoms? Or even attempting to 'pull my socks up' and defy it? Whatever the reason the mania is in my case harmless and is just another symptom to be aware of and make allowances for.
By delving into and trying to understand my own condition and treatment in a practical way, via these articles, I think I have come to a new appreciation and compassion for numerous forms of depressive mental illness. I am certainly no expert, I wouldn't pretend to be. I just hope by sharing my experiences with you it might encourage anyone who might be suffering in silence to see it is nothing to be ashamed of and that there is help out there if you want or need it.
Pam's book 'From Behind the Mask' tells the inspiring true story of Pam's experience before, during and since the Paddington train crash. Get your author signed hardback copy or download the eBook now from Pam's website: www.pamwarren.co.uk.