The Bastard Noose: The Public, the Private & the Internal


"It's a facade, and it's exhaustive"

I'm aware this is another one from the ED, and is a bit of a wandering piece- but my more concise draft got deleted accidentally (by me) and I wanted to post during Mental Health Awareness Week.

The Bastard Noose's first section was always meant to be a series set in the ED, a long form story told piecemeal, with one revelation intended for later being that the ED wasn't a stop gap. It wasn't the brief transition between crisis and care. I spent eight, interminable, odd, yet at times very loved days in that booth. Trying to recover or remain or whatever the hell I was there to do while daily being told about the awful bed situation for mental care was taxing, I won't lie. Eight days. That was supposed to be a reveal in a few posts, but it didn't feel right to keep dragging it out.

Once I'd told the ED part of my tale, plan was to do similar with my time on the ward and (ongoing) experience with home treatment.

The Emergency Department is not a place for privacy and that is what this post will focus on, slightly abstractly. A twenty four hour a day public forum, populated largely by drunks, the injured and the mentally ill. Or any combination thereof. It's like trying to sleep in an airport Wetherspoons.

With only a curtain between me and countless others, I was made to tell and retell and say how I felt. It was incredibly hard work. I’m still having to do it, both with medical professionals, and to be honest while writing this too. That carrot of care dangled above me, the hope of a ward bed (a suitable one) while the reality of the rapidly crumbling infrastructure of the NHS kicked me in the nuts.

Get used to evaluations if you're unwell. Any kind of sickness requires NHS box ticking, multi-departmental paperwork and you acting like a desperate dog after a treat. Performing for care. Now roll over. How many evaluations have I performed? Scores, now. It is a performance. It is degrading and demoralising. Each one is a drain on my or anyone's desire to improve, to get better. Forms and performing. The metaphorical two steps back. I hate them, and I question my ability to hide that.

If you've ever been delusional, depressed and desperate, you'll know the torment which pushes through dignity. Sometimes clawing at the walls for help feels a thousand times worse than simply hiding away. I am yet to work out why. Perhaps that's why I am a patient not a psychologist.

Possibly less people might also know the feeling of shame which comes after any showing of what feels like a poor hand. Everyone hates being aware of what they feel are their failings and hiding them it is not a fun border to be at. This is why the Eminem quote hit a nerve with me, it's a facade, and it is exhaustive. Indulge me here, please.

I have long held the belief, based on my own experience, that there are three faces to most people with mental illness. Specifically in my case, depression.

The public, the private and the internal. To explain.


This is the face plastered on like a mask. The fake smiles, laughs, or even just functionality. Sometimes easy, but during a dip of mood increasingly harder to wear. Eventually detrimental to the point of destroying the person wearing the mask. You. Me. It is utterly fatiguing. A lead weight around your soul. This mask, the public, is the hardest to maintain simply because it is the one which has to be wheeled out to the most people, when you feel the worst.


A void. An uncomfortable chasm. The mask can come off, but is still being carried. Perhaps this area is communicable, to some people or one trusted person. For me it was sometimes, but as I got worse crashes were more extreme. I tend to just be more of a arsehole when I'm down, rather than throw out an olive branch. If you're lucky, there are mates and family who in this state you can at least say “I'm not great” to. No more needed.

If you think you aren't that lucky, to have someone, you are. Trust me. Even if it isn't someone you can name-  there are CALM, Mind and the Samaritans. Doesn't matter if you know the person, if you've worn the mask and it is too heavy to hold up, share the burden.


This one is hardest, to explain and quantify. The internal is something even I can't talk about in depth; despite having tried to work it out with medical professionals. It is within me, you. I am still holding the mask up to the outside world, but I exist away from it. This is where those bastard demons tease, crippling you. The inner dialogue one cannot hide from.

Whatever it is, the internal is the crux, the thing which feeds the private and public masks which weigh heavy. This is the unique part of each of our personal strife.
Hancock on Face to Face: public introspection which was hugely damaging to his mentality
My hero Tony Hancock (who yes I know killed himself- but he was still funny) used to talk about chasing away the tigers. Some friends of mine refer to the black dog at the door. I just felt like I got tired of chasing my tail. Chasing my tail non stop, and trying to smile for people as I was doing it.

The internal is the bit of you that looks in at you, rather than the bit of you you push out. Now residing in a place with literally no privacy, either physical or mental, this felt like something appropriate to share, for what it’s worth.

Having been sold on the idea of staying in for a week or two as a voluntary (though strongly recommended) inpatient, I swallowed my pride and agreed. Pride. I know. Here I am, tubes out my arse, talking of pride. Sorry, that was meant to say arms. Tubes out my arms. Dick jokes on the way people, don't give up yet! I didn't, not to emotionally blackmail you or anything, but I didn't.

On the doctor's advice, and because going home now would not only be a faff but more of an admission of defeat, I elected to stay in the Emergency Department until a bed was found for me the next day. Little did I know then that I was being put in stasis. Frozen in the system.

I'd not slept properly in weeks- having been using Jim Beam as a sleep and mood aid. I was advised against this in the hospital. Besides, they didn't sell it. Welcome to the 21st Century, can’t even get a booze in hospitals now. They used to have a Burger King here, I would have genuinely murdered for a Whopper that first night. I still would and I'm out now. My brother works in advertising and he assures me that a mental patient promising to kill for one of their burgers is unlikely to secure sponsorship. Shame.

It's odd, because my whole time in hospital was spent with doctors and nurses telling me how serious my situation is, was, whatever. How I see it is that if I'd died, I wouldn't be around to give a shit. What I have learned is that maybe I need to give a shit. Maybe.

What is it about death which is so taboo? It happens to all of us, most people don't choose their date and method of departure, but there is logic in the ability to do so. My fiercely independent great aunt decided enough was enough.

Ninety two, blinder than a 1960's BBC safeguarder and fed up of falling over in her flat which had become an un-navigateable prison cell, a torturous maze for a woman as sharp as she remained. While it was upsetting, she was very happy in her choice. So much so that her final conversation with Dignitas, allegedly, went something like this.

“What would you like done with your remains?”

“I don't give a shit.”

My aunt made the right choice for her, but many don't. What bothers me still is wondering if I made the right choice. I didn't choose anything about me, but have I made the right choice in trying to die? It fluctuates, but I am OK today.

Let’s end on a joke to lighten the mood.

What’s got two legs and bleeds?

Half a dog.

I promise a more upbeat post next time!


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