Last week I received a text from my GP letting me know that I should book my COVID-19 vaccination. Confused, I visited the government website, and the priority groups had changed on 30th December 2020 to include those with “severe mental illness”. After a little more digging I discovered that this category covers psychotic disorder, bipolar disorder, which I have, and severe depression, with the UK one of only four countries expanding their vaccination programme to cover those with these diagnoses. I knew that those with bipolar were under more psychological stress during lockdown from what I’d heard from my pals and from a variety of research, but what I had failed to consider was the physical impact severe mental illness has on a person, and I was shocked to discover that the severity of outcomes for those with these conditions was in the same range as the highest risk groups. In a paperpublished on The Lancet in February, researchers outlined that those with severe mental illness were at a significantly increased risk of being hospitalised by or dying from COVID-19, with outcomes similar to those with cardiac, pulmonary, or autoimmune diseases.
What I had failed to consider was the physical impact severe mental illness has on a person, and I was shocked to discover that the severity of outcomes for those with these conditions was in the same range as the highest risk groups.
This was all a lot of information to take in from my bed. I’d got COVID-19 as a beautiful New Year’s Eve gift to myself and had thought I’d overcome it by the middle of January, referring to it to friends as a “bespoke flu”. Now over two months later, I’m covered in a mystery rash, have bloodshot eyes, I’m incredibly tired, I’m still short of breath, and I’m unable to walk some mornings due to joint inflammation. After some emergency blood tests my doctor concluded that I have reactive arthritis, which has developed in patients a few weeks after contracting coronavirus. Thankfully anti-inflammatories seem to be helping despite the medication making me vomit some mornings.
Bipolar sufferers often struggle with breakups, and I wasn’t an exception, freshly single, back in October. Although bipolar affects everyone differently, the disorder is characterised by extreme mood swings and episodes of mania and depression. These episodes can be as short as a few days or last for months. My bipolar is comorbid with borderline personality disorder, meaning my episodes are sometimes less distinct and can change by the minute or by the month. While they are separate disorders with some overlapping symptoms, comorbidity can result in these symptoms intensifying. Ultimately, it means that my life is an incredibly unstable and unpredictable one, making it difficult to maintain any sort of routine or keep on top of looking after myself.
Lack of sleep and food can be symptoms of both depressive and manic episodes. In October I was cycling through episodes quicker than I ever had previously – neglecting most of what my body needs to survive. Those with bipolar are more likely to experience disordered eating and during this tumultuous time my history of disordered eating had resurfaced in new manifestations. I was in a cycle of no sleep, binging and purging, and hadn’t really thought about the impact that was having on my physical health. One evening I decided to dye my hair with henna, in what I now think was a manic period, despite knowing I was grossly allergic to the substance, with risky behaviours again a typical bipolar manic episode symptom. Fast forward a week I had chemical burns covering my scalp, an almighty histamine reaction, swollen everything, and minor anaphylaxis. I then also had a similar reaction to perfume I previously wasn’t sensitive too – with blisters appearing on my wrists. My doctor had warned me to avoid coronavirus at all costs but of course, that is when I contracted it. I had forgotten the impact my poor mental health could have on my physical well being, and I was facing the virus with an immune system completely compromised from a month of difficult bipolar/borderline personality disorder symptoms and bad hair-related decisions.
While it’s great that conversations around mental health are significantly more commonplace than they were when I first accessed support a decade ago, the discussion still frames poor mental wellbeing as a result of bad physical health, and rarely the other way around, ignoring the manner in which the physical and the mental continually interact with each other.
It’s so easy to forget the physical implications of poor mental health. In the past my hair had fallen out, I’d developed an arrhythmia, I’d been anaemic, but lack of awareness around severe mental illness and COVID-19 had left me completely clueless to the fact that I was in a high-risk group. While it’s great that conversations around mental health are significantly more commonplace than they were when I first accessed support a decade ago, the discussion still frames poor mental wellbeing as a result of bad physical health, and rarely the other way around, ignoring the manner in which the physical and the mental continually interact with each other. Many organisations have written guidance for looking after your mental health during the pandemic, includingthe government, which often mention exercising as a way to improve mental wellbeing. While this might be helpful, the government weaponises physical remedies to distract from the role harmful policies play in the rise of mental illness while also failing to consider the physical impact of being mentally unwell. Perhaps the most damaging symptoms of my poor mental health could be the effects it has on my body.
There are multiple reasons why those with severe mental health difficulties are likely to have a harder time with COVID-19. 56% of those with bipolar have struggled with addiction to alcohol or drugs in their lifetime,the highest rate of any psychiatric disorder, making them more susceptible to health problems. At least 14% of bipolar sufferers also grapple with an eating disorder, resulting so frequently in long term damage to the immune system. Bipolar people often find it more difficult to care for their body and as the last few months have shown, I am no exception.
It was apparent to me that my mental health had dipped over the last year – I’d started making myself sick, had lost a lot of weight, and September was lost to a long manic episode involving blackouts and hallucinations – with the emotional turmoil of a relationship ending pushing my body to its limits by the end of the year. Although COVID is still impacting me now, with little knowledge of when those symptoms might subside, I still wouldn’t like to live without bipolar, even though the disorder can leave my body particularly vulnerable. I don’t wish to romanticise the disorder, but I do love how deeply I feel, even if that bites me in the ass when normal life things, like breakups, happen. However, I definitely have to be more aware of the impact severe mental illness has on my overall health. My friends were all super concerned I’d harm myself in the autumn and I didn’t directly, but now I understand my body was put through a lot of harm due to my erratic moods. If you suffer with bipolar or any other psychiatric disorder, I’d urge you to be conscious when making decisions, particularly during this pandemic, and know that your immune system is likely to be less efficient and that this virus and any other could hit you significantly harder. I’d also encourage you to get registered with your local GP to get that vaccine as soon as possible. It’s difficult to tell someone with bipolar not to engage in risky behaviours, but if I’d have known I was high risk, I definitely would have been at least a little more careful, both in my social activities and in how I looked after my body.
Having said all of this, I am still hopeful that recovery is ahead. I have managed to gain a substantial amount of weight and I feel a lot stronger than I did a month ago. I have now had my first vaccine shot, with early research suggesting that the jab improves the symptoms of long COVID. Once I’m done with the anti-inflammatories too I’m able to get started on antipsychotics and receive therapy on the NHS for as long as I need. Both my physical and mental health will improve and my flop era can finally end.
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