Prostate Cancer: Mental Breakdown

I had taken the news in a fairly detached way and had always believed that I was mentally and emotionally strong, but it was not a good time to get the news. It came after covid isolation and reduced earnings, and online meetings around COP26 discussing the bleak prospects for the human species. My main home was in Orkney but I was still travelling down to Lancashire to work and was staying in an unfinished conversion project. Work had dried up and I had no income and savings that were running out. Although I had some property assets, they were not easily saleable and I owed more than I had in my bank account at the time. My finances had become very complicated and difficult to understand and I was getting unexpected bills that I couldn't pay. It was also the beginning of winter. If the cancer meant that I couldn't work (and my mental state made working difficult) I would be completely broke. I spent a lot of time in bed half-dressed, living on muesli and trying to spend as little money as possible. The skin on my right arm was wrinkling and I though that I was getting dehydrated, although it was probably caused by the cancer entering the lymph system. There were some positive aspects, as I went over my life and had insights into my upbringing and relationships and psychological makeup that had a clarity that I hadn’t found before, so I wasn’t completely delusional.

Friends were concerned to get texts and emails from me and one couple came up from the midlands to see if they could help and were in touch with my cousin. They were shocked to find that I was in a bad way. A friend who lived a long way away from me called the police because he was concerned that I was on my own. I ended up being taken to A & E at the Royal Lancaster Infirmary by ambulance to be checked out. This was the hospital where I had received my cancer diagnosis. I lay sleepless on a trolley under bright lights all night. I remember a nurse sneering at me for wasting their time. I remember being visited at 4am by two mental health workers with a clipboard who started going through a questionnaire of irrelevant questions until I told them to fuck off. I remember the following morning being in a room and being questioned by another mental health worker. I remember telling him that I had just shat myself while standing at a urinal. I was offered no immediate help, other than a referral to community mental health services weeks in the future. No connection was made with my prostate cancer diagnosis and no information was provided about support groups, counselling, Macmillan, or anything else that might have helped me come to terms with having cancer. I was discharged and told to ring for a taxi to take me home. I had just enough money with me to pay for the taxi, and hopefully the covid screen meant that he couldn’t smell me. I can't remember everything that happened at that time, but I had other visits from the police now that they were aware that someone was living in the building, from someone from the GP practice, and from the fire brigade (who fitted smoke detectors despite there being a working fire alarm system in the building). But no help of any kind for my mental health. I was still waiting for a letter telling me when I would be meeting an oncologist to learn of my fate.

My cousin and his wife from Shetland came to my rescue and helped me to get back to my house in Orkney, which was an unfinished building project. The community psychiatric nurse came to see me and did her best by arranging for me to have some practical help, but my mental condition remained poor and was made worse by starting testosterone-blocking treatment for prostate cancer. Initially this was a course of tablets to suppress the surge in testosterone that was likely to happen when given my first injection, then an injection of Triptorelin at the GP surgery. I was not offered any psychiatric help, any information about how it is possible to live with prostate cancer, and I was not warned of the likely side effects of the treatment, which include depression. The GP simply wrote a prescription for an antidepressant, which I was reluctant to take.

My cousin and his wife and son came to my rescue again and took me to their house in Shetland to look after me. This was the start of the Shetland winter. They took me to see their GP but there was a locum on duty who seemed nonplussed and didn’t offer any help. They fed me well and I was eating and sleeping normally.

I had been getting the severe hot sweats associated with androgen deprivation therapy, but on a Friday evening seven days after getting a 3-month dose of Triptorelin I became concerned that I was having some kind of medical episode as my vision was becoming seriously disturbed and I could no longer see properly. I remember going into the living room in an agitated state and telling them that my vision had gone and asking for them to take me to A & E, but they didn't take me seriously and told me that it was too late to do anything that evening. Much later I learned that the disturbed vision is an uncommon but possible side effect of the Triptorelin injection. In fact the Mayo Clinic's web page on Triptorelin states: 'Seek medical care or call 911 at once if you have the following serious side effects: ...Serious eye symptoms such as sudden vision loss, blurred vision...'

I asked to be taken to hospital to be checked out, so my cousin contacted the GP again the next morning and this time she phoned the hospital to let them know that I would be coming. I don't know what he told the GP, but I suspect that rather than telling her that I was concerned about losing my vision the previous evening, he told her that I was acting strangely, which is why I was met by members of a psychiatric team and why they assumed that I had become psychotic rather than suffering from a side effect of the cancer treatment. The hospital was 35 miles away from his house and he seemed a little annoyed about having to drive me. He simply dropped me at A and E and went away again once he saw that someone was attending to me. I wasn't expecting to be admitted and had nothing with me apart from the old clothes that I was wearing. Now that I have seen my medical notes from my time in Lerwick it seems to me that the hospital's account isn't accurate. It suggests that I had a psychotic episode, pacing up and down and getting into a shower fully clothed and that my cousin was so concerned that decided to take me to hospital. In fact, I had become agitated on the Friday evening because I could no longer see properly and thought that something was seriously wrong with me. I certainly hadn't tried to take a shower fully clothed and wasn't psychotic, although I was still very depressed. Being diagnosed as psychotic led to me being drugged with the so-called 'antipsychotic' Olanzapine, which is commonly used to treat schizophrenia and has some potentially serious side effects, as do the other drugs that I was given.