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Becky Hirst

&me – Becky Hirst

Becky Hirst is a consultant in Palliative Medicine in South Yorkshire. She has had two episodes of moderate to severe depression, the first as a specialty registrar in 2004, both of which required significant time off work. In 2007 she won the BMA News writing competition writing about her experience, and was also interviewed on Radio 4’s ‘All in the Mind’ in a programme about doctors’ health. She feels strongly that although the statistics are that one in four people will have an episode of mental illness, in fact one in one of us are vulnerable.

Below is the piece she wrote for the BMA News writing competition:

What I learnt from that episode of depression

I always hoped that I was a ‘good doctor’ when it came to looking after people with mental illnesses. I’d spent six months working in Psychiatry as part of my GP training scheme. Certainly, it wasn’t always easy – my consultant once accused me of treating her patients like horses, making sure they were fed and watered but not much more – but I did my best. In General Practice it was a standing joke that while the other female partners in the practice did the Well Woman Clinic on a Tuesday morning, I did the Weepy Woman Clinic. I spent a lot of time reassuring people that depression was a real illness; that it was a chemical imbalance in the brain; that antidepressants work by correcting that imbalance; that yes, it was hard because if you’d broken your leg then everyone could see the plaster cast…

And then I got sick. I went from being a relatively competent specialist registrar in Palliative Medicine to nothing in a couple of days. I spent the first couple of weeks asleep. I would manage to have a shower and then I would have to go back to bed. I felt like a shell of my former self, and it surprised me sometimes when I looked at my hands that I didn’t just see straight through them. I had lost everything that made me who I was and I despaired of ever being reunited with my sense of humour. Listening to re-runs of radio 4 comedy programmes at 4am, I could appreciate intellectually why things were funny but it didn’t make me smile. Nothing did (my face hurt if I tried). My concentration was non-existent. I could read, but put the book down briefly and I wouldn’t have clue what the story was or even who any of the characters were (“Losing the plot” said the psychiatrist with a twinkle in his eye). I would be paralysed in the supermarket unable to choose food to eat, struggling not to abandon my trolley and leave. I couldn’t trust myself to judge when it was safe to turn right on to a main road in the car. “If I can’t choose which biscuits to buy,” I said to my GP in despair, “I don’t think I’m well enough to be deciding how much diamorphine to put in a syringe driver”. He laughed nervously and wrote me a medical certificate for another month.

I learned so much – about myself, about how depression distorts your reality and your thinking, about how a lot of people perceive people with depression. I learned that when we tell patients blithely that it will be “two or three weeks” before the antidepressants kick in, that every day of that third week is a lifetime. I was amazed at how physical an illness it was – to begin with the smallest exertion left me breathless and shaking. I had pain all over my body. Verging on the psychotic, I would have terrible, graphic visions of seriously hurting myself. These were frightening as they seemed to come from outside me and I worried I might act upon them as I did not feel in control. More frightening was when I got a little less unwell, so that I was functioning better but still felt dreadful, as I couldn’t see the point of continuing in this robot-like state if this was all life had to offer as suicide seemed a rational outcome. With my poor concentration, I wondered if this was like early dementia – within minutes of taking my tablets, I hadn’t a clue whether I had or not and would have to count how many were left in the packet and how many days until the next GP appointment in an effort to work it out; having ‘Can’t Remember What You’ve Gone Upstairs For’ syndrome so badly that I would get from the kitchen to the end of the hall and not know what I was there for.

So two years, a lot of counselling, antidepressants and a chocolate Labrador puppy later and I have regained most of myself, though I’m not who I was before I got ill. Such an illness is like going through a refiner’s fire – one is definitely changed, I hope for the better. Nevertheless, a bit of me grieves for the old ‘me’, whom my current partner has never met. There have been other bereavements – I still struggle with not working full time; I should have become a consultant a couple of months ago but now it will be 2010 at least. They teach you about Kubler-Ross’s six stages of grief at medical school, but nobody tells you that at times you might be doing three or four of them simultaneously, and I’ve never been so angry. It has helped me appreciate what losses my patients might be facing, and also to empathise with those suffering depression. Sometimes I share a bit of my own experience if I think it might help.

One of the most difficult lessons was learning to be kind to myself, that if I didn’t look after myself there was no way I could care for others. It’s easy to get swamped by the needs of others – patients, team members, family – and to feel guilty if we take time for ourselves. When I was first ill, my psychiatrist friend advised me to do one chore and one nice thing each day. I vividly remember how proud I was the day I washed the kitchen floor for the first time for a year. Depression is a horrible illness. I wouldn’t wish the experience on anyone, but I could not have gained such insights into the world and myself without it. Depression leaves a stain on your soul, even when you fully recover, but that scar serves to remind me of the journey I’ve made and be grateful.

This piece was the 2007 winner of the BMA writing competition.

Stephanie Walsh holding a cat

&me – Stephanie Walsh

Stephanie Walsh is a senior first-opinion veterinary surgeon at Rutland House Veterinary Hospital.

I qualified as a veterinary surgeon in 2004, and spent three and a half years in mixed practice before moving to small animal practice. I am now senior vet at a busy, multisite first opinion practice, involved in the British Veterinary Association as regional representative for the North West, and co-chair a veterinary wellbeing group.

Compared to many of the experiences shared through the &me campaign, mine may seem quite minor, but if I hadn’t been in the lucky position to have amazing and supportive colleagues and friends and family around me then maybe things would have been different.

I initially visited my GP because I thought I had a chest infection as I was struggling to breathe. The GP asked me if I was sure it wasn’t anxiety, but I was adamant it must be something physical. I thought anxiety was a weakness, something that effected other people.

Several weeks later, as I slid down the wall in my consult room to sit on the floor crying, unable to do anything, it became apparent it was not a chest infection. I was lucky as I only needed a short period of time away from work, and talking therapy worked well for me.

There is increasing evidence that early intervention for mental ill-health can reduce the need for time away from work, reduce the risk of relapse and lead to improved recovery.

Hopefully by sharing my story, we can work to reduce the stigma, and open early channels of communication to help look after the mental health of ourselves and others.

Rebecca Lawrence

&me – Dr Rebecca Lawrence

Dr Rebecca Lawrence is a consultant psychiatrist and clinical director.

I have had a long career in psychiatry, which has been intertwined with my own mental health problems. The latter started relatively abruptly with a puerperal psychosis prior to my psychiatric training, and I have had many episodes over the years, involving hospitalisations and electroconvulsive therapy, as well as drug therapies. Talking therapies have been of limited benefit when unwell – and have seemed less relevant when I’m well.

I have a diagnosis of bipolar affective disorder, which I find hard to accept. My psychiatrist tells me that doctors are the most self-stigmatising patients that he comes across, and that he knows I’m becoming unwell when I start to talk more of having a personality disorder. However, I try to follow his advice, and am fortunate that I have had long periods when I have been well.

I have been very lucky with family, friends and colleagues – and those involved in my treatment – and am still surprised by my life and how it has turned out.

I have been a consultant psychiatrist in addictions for over ten years now, and have been clinical director since last year. I also work in the chronic pain service, having recently completed a masters in pain management, and do as much teaching as I can. I have a wonderful family, and play music in what spare time I have left.

What advice would I give to others? I am realistic that my illness is unlikely to go away. I used to try to fight it – which was helpful at times – but it does affect my life and will continue to do so. It hasn’t stopped me doing what I want to do, but I do have to adapt at times. It does affect me, like any chronic illness would.

And that, ultimately, is what I would say – adapt if you need to because of the illness, but never because of the stigma of the illness, whether self-stigma or otherwise.

Rebecca has previously written a personal view piece for the British Medical Journal.

Steve Carter

&me – Steve Carter MAVetMB CertVA MRCVS

Steve Carter is a Director at Priory Veterinary Surgeons in Reigate, Surrey.

I can honestly say that my life has been enriched by the lessons I have learnt from having mental illness. The aspects of my character and the feelings that I have been made to confront and examine closely have made me a much better and a more grounded person. That has only been true once I had come out of the other side of several pretty sad and difficult periods of depression, spread out over two decades.

Here I am aged 58, owning my own vet practice with over 40 staff members in it, still enjoying the variety of small animal practice four days a week, including the emergency out-of-hours work – I am writing this while being on call – and I am still learning new things to add to my skills. And when I go home I have a wonderfully supportive and stimulating family of which I am very proud. I have lots to look forward to – that has always been the case, but when I was depressed I just didn’t see it that way at all.

I have a family history of depression, not that I understood that until the illness hit me out of the blue. My life up to 2002 was one long line of apparent success up the ladder of education (though I did have an exam anxiety wobble one summer), and a steady professional development, including a partnership in the practice. I have a strong work ethic and take pride in achieving goals. I had a young family and was working very hard.

I went to Devon as part of the veterinary team dealing with the Foot & Mouth Disease outbreak of 2001 – it was like a war zone in many ways, and I think I had a sort of PTSD mixed in with physical exhaustion. My performance in the practice ground to halt in 2002 and I lost all sense of purpose.

My partners were generously supportive – I think they saw it coming before me – and I had two months off work. Gradually my depression lifted and after going to visit my friend’s practice to see if I could cope with being in the thick of it again, I went back to work. That was scary because before this episode I felt no anxiety about work at all, and thrived on its challenges; now it felt more like a burden that could easily tip me into depression again.

My colleagues were very supportive and treated me normally and kindly without any sense of me being “damaged goods” – I was very fortunate in that respect. It was only me who thought that I was damaged, but that view has changed for me, although it took a long time to get to that point.

My therapy over the years has been a mixture of medications, psychoanalysis and other counselling, as well as the self-learning involved in looking after myself properly. I know that reaching for help and talking to others in confidence was key to my becoming well. The single most important realisation for me was that I am always going to be vulnerable and it was necessary to come to terms with that “weakness” whether I liked the idea or not.

I still take medication to balance out my mood, which tend to swing. I now feel that the positive mood swings are the times when I am most productive and useful, and they are when I feel the most fulfilled, but I know that there will be periods of lows when it is hard to get motivated. I have gradually learnt from others, including my wife, how to recognise the signs of impending depression and I then find ways of taking the pressure off myself and making myself feel more optimistic inside.

Not only do I feel more knowledgeable and more gentle about myself, but on top of this I have become much more understanding and empathetic of the states of mind of the people around me. I recognise in others many of the difficulties I have experienced. At work, that has been a great help in improving how I go about supporting the staff of the practice, for example, providing group and one-on-one wellbeing, resilience, and counselling sessions for those who want help.

I am proud that these initiatives have arisen from my personal journey of adversity –  I have come to realise that all experiences are learning experiences and there is something worthwhile to come out of the grimmest situations, so that what can feel like an intolerable burden can be turned into a stimulating challenge to be solved, and one can then move on to other things. When something makes me laugh or sing spontaneously, nowadays it has a special meaning for me.

Susan Atcheson

&me – Dr Susan Atcheson

‘My name is Susan, I am a senior GP and I have a history of depression.’

Dr Susan Atcheson is a senior GP and a member of the DSN committee. Read her story in GP View.

Cathy Wield

&me – Dr Cathy Wield

Dr Cathy Wield successfully returned to work in emergency medicine in the UK after two bouts of major depression, which included hospital admissions and brain surgery.

Cathy is passionate about speaking out and reducing the stigma around mental health and has written extensively about her experience of being a doctor with depression (her books are Life after Darkness: A Doctor’s Journey Through Severe Depression and A Thorn in My Mind: Mental Illness, Stigma and the Church). She notes, however, that there is still room for improvement in the way that we respond to mental ill-health. Cathy is currently exploring a new medical culture, having recently moved to the United States.

Cathy says: “It seems that recovery from mental illness is not enough. Well, that’s the impression I get from our stigma-filled world. It was really bad when I was suffering from depression – when you have low self-esteem as a result of your brain chemistry, then often those who you know well, like family and friends, unwittingly betray their ignorance with ill thought-out advice or banal platitudes.

“Most of us try to do the right thing and seek advice from our GP and/or various other health professionals. Even then we cannot guarantee that we will be treated with the dignity and respect that we deserve. I was fortunate in that respect for most of the time during my illness, with the exception of some of the nursing staff during my inpatient stays and, of course, the various different specialities that I had the misfortune to come across after bouts of self-harm.

“There is still a long way to go to eliminate not only the stigma of current mental illness, but also of the past. While I worked in A&E until August last year, I did my utmost to be open about myself and to educate my colleagues. We are whole people, the mind and body are not separate entities and we all deserve respect and care regardless of our past or present symptoms, or what brought them about. But changing attitudes takes more time than I first thought.”

Jamie Hacker Hughes

&me – Professor Jamie Hacker Hughes

Professor Jamie Hacker Hughes is a consultant clinical psychologist, psychotherapist and supervisor currently working in independent practice in central London and leading a religious order as the newly elected Minister Provincial of the Anglican Franciscan Third Order.

Five years after qualifying as a clinical psychologist, Jamie was diagnosed with Type 2 bipolar affective disorder after 20 years’ experience of anxiety and depression. He has been on Lithium prophylaxis ever since.

After his diagnosis Jamie gained a consultant post with the MoD, becoming head of healthcare psychology and travelling to Bosnia, Kosovo, Afghanistan and Iraq, gained three fellowships and four professorships, established a research institute and has just finished a term of office as President of the British Psychological Society.

He has published and lectured widely and edited two books, the first of which was Battle against Stigma.

Jamie says that it is really important that people at the top of the profession speak openly about the fact that they are human too!

Rob Pettitt

&me – Rob Pettitt

Rob Pettitt is a Senior Lecturer in Small Animal Orthopaedics at the University of Liverpool.

My life ‘rapidly’ changed a few years ago when I had a serious mental illness. I say rapidly as it resulted from an elongated period of high stress at work and the breakup of my family life. I had always been a ‘get on with it’ person who could always be relied on to make deadlines, organise and generally be someone who you would turn to in a crisis. My previous career in the Royal Navy was very much about putting on a brave face in adversity – ‘it pays to be a winner’ was much quoted during my time.

Trying to balance a clinic with ever-changing staffing levels and my home life, in particular maintaining as normal and happy a life for my children as possible, eventually took its toll on my mental health. One morning I woke early and was physically unable to leave my bed. It was the weirdest and scariest feeling I can ever recall. If anyone had said to me that I would be unable to get out of bed I would have given them a look – how difficult could it be? After phoning in sick, I lay in bed for hours – it was mid-afternoon before I even tried to get a drink.

When I look back now the first thing that set me on the road to recovery was a friend of mine from work who had very similar problems. She rang me as soon as she heard and within ten minutes was at my door. Having someone around at that time was invaluable – she organised a doctor’s appointment, contacted all those who needed to know and basically ensured I was not alone. The GP was very helpful and signed me off work for four weeks initially, and started me on antidepressants. I also sought counselling in the form of a life-coach in order to get the balance back into my life – what I can’t understate is the feeling of being a failure at that time. The counselling allowed me to steadily believe in myself again.

In all I had eight weeks off work – I knew I was getting better as towards the end I was raring to go back. My employers were fully understanding and gave me a phased return with a reduced administration load to allow me focus on fully returning to health. I continued on the antidepressants for a number of months before I gradually phased them out and to date have had no need to restart them.

So what message would I give to others? Work and life are stressful and feeling stress is natural. What is important is to develop strategies in order to cope with these stresses. Communication is essential – talk to friends, relatives and people at work. Mental illness is sadly still taboo in many areas which is wrong – we would not hesitate to tell people if we broke a bone; the same should apply to mental health. What surprised me was the number of people who have been affected and you will always find someone who has been there – support from others is invaluable in those difficult times so you do not have to suffer alone.

Malcom Kinnear

&me – Malcom Kinnear

Malcolm Kinnear graduated in 1990, but had not completed his psychiatric training when he went on long-term sick leave with depression in 1997.

He joined the Doctors’ Support Network in 1999 and became active in organising its Scottish activities from 2004 as his mental health very gradually improved.

In 2009, he attempted to return to clinical practice, initially struggling to find a way back as no official route existed, but obtained a specialty doctor post with NHS Fife in open competition on the basis of his work with DSN as well as his independent continuing professional development (CPD).

Malcolm resumed full-time practice after a period of shadowing and part-time work. He applied successfully to re-enter higher psychiatric training in 2014 and obtained his Certificate of Completion Training in adult psychiatry in February 2017. He was then appointed to a substantive consultant psychiatrist post with a community mental health team in Dundee, with sessions in the Tayside specialist adult autism team.

Malcolm has actively advocated for better healthcare for doctors and is currently involved in a multi-organisation working group to set up a Managed Clinical Network for doctors with mental health problems in Scotland.

He has an honorary teaching position with the University of Dundee (twice nominated for a Faculty of Medical Educators award) in which capacity he reminds medical students to look after their own health and to remember that doctors can find themselves patients too. He also finds that having taken some of the medications he now prescribes can be rather helpful in terms of understanding their effects!

David Bartram

&me – David Bartram’s speech – House of Commons &me launch 31 January 2017

DB:   ‘No’, ‘Never’, ‘What, you?’, ‘We had no idea?’, ‘Why didn’t you say something?’

Just a few of the responses I received from friends, family and work colleagues when I explained to them why they hadn’t seen or heard from me for a while. I’d been in hospital following a suicide attempt. That admission to hospital was the first time anyone, including the medical profession – and me – knew I was unwell. My marriage had broken up several months previously. I was devastated and finding it hard to cope.

But I chose to tell no one, probably for two reasons: I was ashamed that my wife had left me; and self-stigma – I didn’t want to appear to be struggling emotionally. After all, I had always had good physical and mental health. I was successful – top of the class at veterinary school and after a short spell in practice was now thriving in a demanding role in the pharmaceutical industry. And I had coped with other challenges I had encountered. I was a coper – I believed it and I’m sure most others would have thought it. But those challenges were changeable situations for which addressing the problem itself was sufficient. I had never appreciated the importance of emotion-focused coping strategies to regulate feelings in situations that were unchangeable, like the break-up of a relationship.

I just thought I was stressed – after all, who wouldn’t be in those circumstances? But in fact I was becoming progressively more unwell. What started as worry, early waking and palpitations – which I recognised – led to patterns of thinking of which I did not recognise as being disordered. I felt trapped and worthless – suicide was the only escape. From a medical perspective, my biological, social and psychological risk factors had converged and tipped me into major depression.

That was the first of multiple suicide attempts and several prolonged stays in hospital. Over a three year period I spent twelve months as a psychiatric inpatient. I was treated with antidepressants, antipsychotics, mood stabilisers, talking therapies and electroconvulsive therapy.

But now, thankfully, I am well – and I have been for fourteen years. I still take antidepressants but I suspect I don’t need to – I know the early warning signs and how to act on them to prevent worries potentially escalating into ill health. The medication is my security blanket – I derive comfort from the thought that it may help prevent me ever becoming that ill again.

To what do I attribute my recovery? A mixture of medical treatment, psychological therapies, supportive friends and family, rest and time – they all contributed, probably in similar measure.

What did I learn that I can convey to others?

  • Talk to someone. Confide in trusted friends, family or colleagues or a support helpline about your troubles and worries.
  • If your distress persists, seek professional help – as with physical illness, the longer you leave it untreated the more severe and potentially more treatment-resistant it becomes.

I firmly believe that if I had confided and sought help early I would not have become unwell.

Don’t worry that disclosure may affect your career – it should not, and your health must come first.

After a phased return to work, my career has continued to progress, I have gained additional professional qualifications and moved into roles of increasing responsibility. Enlightened employers are increasingly recognising the diversity and transferrable skills that people with lived experience of mental health problems can bring to the workplace. My episode of mental ill-health by no means defines me but it’s an important part of me and, although I would not wish it upon anyone, I think it has changed me in a positive way, both personally and professionally.

  • No one is immune – it can happen to anyone – including those for whom you would least expect it – including you.
  • Complete and sustained recovery is possible. And finally…
  • The best prevention? Be connected. Forge and nurture confiding relationships with trusted friends and work colleagues – and make sure you use them, early. It really is ‘good to talk’.

Thank you for your attention.

Caroline Reed

&me – Dr Caroline Reed O’Connor

Caroline is a senior trainee psychiatrist and psychotherapist working in South West London. She had recurrent episodes of depression throughout her twenties and when she experienced periods of high mood in her early thirties she was diagnosed with bipolar disorder.

Her mental illness hasn’t stopped her from getting her dream job and has fuelled her passion for working in the field of doctors’ health.

Caroline says: “The worst stigma I’ve experienced over the years was the stigma I put on myself. Speaking out about my illness has helped me to feel less ashamed – I now feel incredibly proud of my experiences and the way I manage my mental health.

“I am open with everyone about my illness – it helps me and it helps them. From individual private conversations to speaking to a room of over 300 trainee doctors… I’m passionate about encouraging all doctors to talk more openly about our day-to-day struggles. Sharing really does kill stigma.”