Part 4 - Black Dog & The Fear Monkey

First Published on December 8, 2017

Terrible thing to live in fear. Brooks Hatlen knew it.

Knew it all too well.

All I want is to be back where things make sense.

Where I won’t have to be afraid all the time.

Stephen King, Different Seasons

I worked in psychiatry as a health care assistant fifteen years ago, from there I trained as an occupational therapist, I worked on the Kawa Model with Michael Iwama and his team; I set up Kawa Creative (an arts in health organisation) and I now work in education as a librarian. I never really knew where I stood in mental health, I felt that I was always somewhere between patient and staff. One of the most touching moments was when I was approached by a group of patients (they were called patients in hospital, you could say clients, service users or, controversially, “people.”) They requested that I ask the Doctor to arrange some section 17 leave for one of them. This is a section under the mental health act which permits a person being detained to have a period of leave. This is granted by the doctor and is usually used as a therapeutic tool for a staged discharge or assessing a person’s capacity for managing in everyday life. Unfortunately I have also seen doctors use it as a stick to beat patients with when the doctor feels that they have been problematic. For example: “If you carry on shouting like this you will not get your section 17 leave."

I digress, I explained ti the patients that I was not able to make clinical decisions because I was just a lowly health care assistant. One of the group then said, “please Dave, could you try, we know you will do your best because you actually care about us.” This very nearly reduced me to tears. It is one of the most wonderful things anyone has ever said to me, and it was spoken with sincerity and compassion (with a little bit of buttering me up – but hey, we’re all human.) I did try and get the leave for them, but it was refused. I did manage to get one of them a review with the doctor, this may or may not have resulted in the outcome they wanted; history does not say.

One thing that you very quickly learn in psychiatric settings is that becoming unwell, having a breakdown, going nuts, losing it, freaking out and going bonkers (whatever you want to call it) can happen to anyone, at any time for any reason. I have worked with homeless people, teenage skunk fiends, doctors, artists, therapists, accountants and teachers – and they all shared one thing in common when they came on to the ward as patients: they were all absolutely terrified. We all have a mental health, we are all vulnerable in some way, some more than others, I grant you, but it only takes the perfect storm of circumstance vs resources and you can go down, and fast.

I have gone down.

I wasn’t sure whether or not I should write this particular blog, because I knew that if was going to write it, I would want to write the unexpurgated reality that I am currently experiencing – and that my nearest and dearest are suffering. However, after some deliberation I felt that it would be in opposition to my own philosophies regarding mental health to not write this. We should not be frightened of discussing these things and we should not shy away from addressing the hugely damaging issue of stigma. So I suppose this particular blog entry is for all of us, because it is my belief that mental health is one of those linch pins to human evolution, along with Race and Gender Equality, Poverty and The Environment. The struggle to educate the public, governments and professionals about mental health is a revolutionary act, I feel this very strongly.

The ubiquitous “they” say that a little knowledge is a dangerous thing, and I can concur with this premise. Some years ago, after a particularly difficult period in my life I experienced a ‘suicidal thought.’ Wow, dramatic eh? No, not really. Sorry to disappoint, but I need to dispel some myths about suicidal thoughts. First of all, there was no drama. There was no “oh my God I want to die”, “I am worthless”, “I am a nothing” (back of hand on forehead,) “It’s all over.” No. That is not the way, I am not a Hollywood diva, nor should I wish to be. The thought that I experienced was quite simply: “I could die, that wouldn’t be terrible.” It was rational, ordinary and made complete sense to me at the time. the thought came from nowhere, it was injected into my psyche from somewhere near the back of my head by an unseen entity. this thought was not mine, it was more like a suggestion, or the instruction on a wrapper that I had read last week and was just now remembering. Does that make me mad? I don’t think so. I think it makes me human.

The thought itself did not upset me. However, the next thought did. “I am becoming unwell,” chimed in my own consciousness with a far more familiar tone, “this is the beginning of suicidal ideation and I am no longer in control,” said my frontal cortex quite matter of factly.

“Oh shit, oh shit, oh shit,” said my limbic system, stepping up the cortisol and ramping up the anxiety.

“You’d better sit down,” Said my executive function.

“Be careful,” said my vestibular system. My heart began racing, my mind seized up with panic and I was shaking. Anxiety is something that I had experienced on and off throughout my life, and I had always considered it to be an aspect of my personality that I just had to live with. However, this was different, this was debilitating. This was a trigger point for me and over the next few years I had to work through the process of coming to terms with the fact that I needed to recalibrate myself if I was going to be happy and functional.

Of course, one does not go around telling everyone in such words, over a skin latte for example; “Oh yes I was just telling Phil the other day, I think I am going to have to spend a few years recalibrating myself to improve my sense of wellbeing, especially if I want to be happy and functional. Damn suicidal thoughts.” No, one goes around in the raw feeling paranoid, making bad choices, worsening the situation, drinking too much and feeling quite scared and isolated – but not all the time. There were of course times when life was good and I got it right and I felt quite happy. Those times mainly revolved around good friends and doing things that I enjoyed – you can boil this down to relationship and occupation (I have a three hour lecture on this if anyone is interested!) I like to think of myself as a functional loony during this period: somewhere between staff and patient.

I worked through these issues with a variety of therapies, love from friends and family and getting on with living, and I am pleased to say I have learned a great deal in the process. However, the anxiety that I am now experiencing as a result of a blunt force trauma to the head is off the scale. Not only are these anxiety levels beyond my comprehension, they appear to have no triggers. In the past, when addressing anxiety issues I have been able to identify triggers and set strategies in place, whereas in this instance the anxiety just begins with no reason or warning, and the system that I usually use to regulate these responses is offline. I am driving along quite happily and start to go down hill, I gently apply the brakes as usual, but there is nothing there. The tiniest of bleeds to my frontal lobe has shot the brake line and I cannot stop.

Then I am hurtling off the road and onto a dark path, I experience shortness of breath and miles and miles of Stephen King outtakes un-spooling into darkness, slipping out of sight and sending back snapshots, screams and uncertainty. Pooling in the midst of fearful imaginings, the tarred face of self hate and depressive psychosis spits vitriol and guilt. This hammering of the senses is a poetry of derangement, arranged in stanzas that envelop the psyche in fight and flight with no one to fight and no where to run. So it goes on – an unending diatribe of metaphor, hyperbole and simile, a literary diarrhoea stinking of self absorption. thoughts racing and the brakes are gone. Such is the nature of anxiety.

With this comes guilt at my current “presentation,’ and hyper reality. Oh yeah baby – reality in great stinking clods, like dung shovelled into a gaping wound. Anxiety renders one susceptible to suggestion, and everything takes on an exaggerated meaning. I remember seeing a post by a friend of mine whom I used to work with. She was, and indeed is, one of the most wonderful mental health nurses I have ever met. The post said, “with anxiety there is too much meaning, with depression nothing means anything at all, living with both is hell on earth.” I am probably paraphrasing to a degree, but you get the gist. This is what was beginning to happen to me, my anxiety levels were spiking, I was experiencing darker and darker thoughts which were upsetting, but the sense of guilt that I had about being in this state meant that I was loathe to express these thoughts and feelings.



Loss of meaning,



Blag Dog and the Fear Monkey will fuck you up.

They will tear the skin from your face and laugh in needle sharp injections of hate as you hold it all together, keep it in, keep it locked down because if anyone takes the lid of this then there is going to be an explosion.

Which is exactly what happened.

Yesterday I had cause to go to the hospital (not for me, but to accompany someone else). I had not been to the hospital since the accident. That morning I had lost my temper, I had flown into an uncontrollable rage so I was already shaken. The car that had been hurtling down hill with no brakes had finally crashed. Anger is a hateful thing, it renders one senseless, psychotic, psychopathic, powerful and pathetic at the same time. Blind rage is a projected act of self abuse. I was racked with guilt, and paranoia that i was losing control – and this is the scariest thing of all. Just like the suicidal thought I experienced nearly ten years ago, it is the recognition that this is a symptom of something far deeper that causes such intense fear. The feeling is a prelude to an unknown daemon. I envisaged a black and red mechanical beast unfolding in my mind, molten eyes and foul breath, a monster from the dark come to hold me in a morose embrace.

In the hospital the ghost of me was sitting in a cubicle, rubber skulled from the accident and trying to keep a hold of…what…what was my focus back then? I was hit with the recollection of the accident, a physical force that jolted me with nausea, I have to keep tellng myself that this is real, that I am here, because everything now is a facsimile, i am a copy of myself, a node of who I was, repairing itself, recoding the system back to its former state, or the closest approximation. I am immersed in a world of uncertainty, I may be the same person that I once was, or maybe not, how will I know, and how will this effect my relationships with all the people that I love? My children, my wife, my friends; will I still feel the same about them when this plastic coating of fear is finally removed?

Returning to the hospital was a jolt to the senses. Is this psychosis?

The man in the cafe is frying slices of cerebellum on the hot plate. Everything is brain related now, my whole being is preoccupied with absence, anxiety, mental health and not knowing. My mind is a fine filter, a gossamer system of self regulation and adaptation and the frontal lobe bleed has blasted a hole through it. I can no longer regulate my emotions in the way that I have learnt to. From the outside I am being a dick, to me I am fighting an invisible storm. I know it sounds dramatic, and I probably do appear to be fine, but the anxiety is there, all the time, unregulated, compressing my experience of existence into a two dimensional world of binary options: fight or flight. But there is no where to run because the danger is an unknown future, and I cannot fight a shadow, so I remain, as does the anxiety. I am held in the burning arms of my deepest daemon.



Loss of meaning,



Blag Dog and the Fear Monkey have fucked me up.



Park Wood Farm

Manchester Road


Greater Manchester


+44 (0) 7852 674863

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