Hello, I’m one of the junior doctors working for the team looking after you. Can we have a chat?
A doctor with mental health problems. Who’d have thought? In fact, studies show that up to a third of clinicians suffer from depression, a quarter from anxiety, and a fair number experience post-traumatic-stress disorder, often work-induced. But, realistically, these numbers are likely to only represent a fraction of the people experiencing difficulties. The phrase ‘Physician, heal thyself’ is often misinterpreted as ‘Physician, push your problems to one side and plough on through’. Doctors make the worst patients, and we have little insight into our own health, physical or mental. Despite efforts to raise awareness about mental health in doctors, I’d be surprised if you found many who will happily confide about their mental instability.
Doctors are bred from high-achievers. Whether we admit it or not, once upon a time we were all the geeky kid at school, our lives consumed by those all-important A grades (or A* grades nowadays), instruments, sports teams, after-school clubs. We did everything we could to be the best. To stand out from the crowd. All in preparation for that day in mid-August, when shaking hands open the envelope in front of hopeful-looking parents and... SUCCESS, you’ve done it, you’ve got the grades and your future is cemented. Proud parents and grandparents tell anyone who’ll listen that their dearest is training to be a doctor. You smile smugly at your siblings who resign themselves to another decade of living in your shadow. You’re on top of the world. You’re going to be a doctor. How amazing is that?!
The joy, the elation, the smugness, and the pride, lasts all of a few weeks. You arrive at medical school, potter along to the tame ‘booze-free-welcome-social’ to get know each other, and realise your place. When once you were the top of the class, captain of the football team, and lead in the school play, you are now just... you. Surrounded by more people like you. You’re nothing special. Your achievements count for nothing. You might have come third in the county cross-country race but the guy sat to your right in the lecture hall? He came first. You volunteered at a care home making tea for six months, but your placement partner was a health care assistant for a year. The first lecture begins, anatomy, and the lecturer asks for a show of hands. Who here studied Latin at school? You snort – Latin’s a dead language, right? You look around, expecting to see similar expressions of bewilderment, yet you find more than half the room has raised their hands. Your A grades count for nothing here.
“Medical school is unforgiving. Monthly, even weekly assessments, the slightest hiccup could cause you to fail the module, repeat the year, or get kicked off the course.”
And so, it continues. Day-on-day you compete, and you perfect the art of appearing caring and supportive whilst subtly reminding your peers that one day you’ll be a better doctor than they will. I’m so sorry you failed the exam, I can send you my notes if you like? My result was in the top 5% of the year. Deciles are introduced so that everyone knows where you’re at, who looks likely to get that first-choice job in central London, and who’ll be lucky to get a job in any of the three Scottish towns they’ve heard of in the deanery that is ‘Scotland’. Medical school is unforgiving. With monthly, even weekly assessments, the slightest hiccup could cause you to fail the module, repeat the year, or get kicked off the course.
And I haven’t even started on the patient side of things.
I think that narcissist traits and perfectionist traits are evident in the personalities of all medics to some degree. I remember this being pointed out to us in lectures and small group sessions on a number of occasions, and in different ways, such as looking at our personality types, based on the Myers–Briggs Type Indicator (MBTI), an introspective self-report questionnaire with the purpose of indicating differing psychological preferences in how people perceive the world around them and make decisions.
Many medics appear to have a constant need for praise and self-edification; medical training is very feedback-heavy with peers being directly compared on a regular basis and I believe that medics are (often secretly) happy for others around them to perform poorly, as it means that they will appear more competent by comparison. I think these two personality traits have two impacts on mental health. First, it often means medics have a negative attitude towards mental health, perceiving mental illness to be a sign of weakness. It therefore becomes either ignored if you’re the one suffering, or used as reassurance that you're performing better than someone else if you're a peer of the sufferer.
Second, these traits make medics more prone to experiencing mental health difficulties. A strive for perfection manifests itself in anxiety, eating disorders, issues with control, while narcissism develops a ‘head in the sand’ approach to mental health concerns, which further reduces the likelihood of people seeking help and support. Unfortunately, those same qualities that get us to where we are often turn against us and manifest themselves as mental health problems. Not only that, but they stop us from acknowledging them, or seeking help. What if someone thinks I’m unsafe, and I lose my job? What if someone thinks I’m too crazy to be a doctor? What if my consultant thinks I’m weak? What if I take too many days off and I have to repeat the year?
I first sought help for my mental health during my fourth year of university. In hindsight, and with the wonderful clarity it provides, I'd been having problems for many years. I could probably trace it back to twelve-year-old me with a kitchen knife at midnight wondering whether it would be so bad to use it on my throat. The prolonged insomnia spells at 15 when Mum had to give me antihistamines at night to help me sleep. The rash decisions and drinking to stupor at 17, the promiscuity and self-loathing at 18, or even the self-harm at 19. But no, at 21, my housemates performed an ‘intervention’, dragging my smoking, drinking, sorry state from my locked bedroom to the local GP.
I suppose it’s just unlucky that the first GP I saw that day was not particularly understanding. What year are you in?, she asked. Oh, your finals are next month? It’s normal to be stressed. Here’s some Zopiclone to help you sleep, stop you waking in the night. You’ll be fine.
Needless to say, my housemates were furious, and a week later insisted I saw another doctor. By this point I’d not only discovered the wonderful combination of cheap wine and benzos, but also revisited self-harm to try to redefine the numbness and fuzziness I felt day-in, day-out. This GP was much more appropriate, and was conveniently a pastoral tutor at the medical school. I was put on medication, signed off placement for six weeks, and enrolled on a course of cognitive-behavioural therapy (CBT). The medical school kept tabs on my progress and things started to improve.
The Big Ugly World
Despite my best efforts, I have yet to develop a means of stopping life from giving you shit when you’re so desperate to harvest just lemons. I’d love to say that after medical school things settled down, that my new-found stable relationship was enough to keep me on an even keel whilst the promise of a monthly paycheque made the hideous hours bearable. But, mental health doesn’t work that way, and a large proportion of those with depression will experience recurrence and relapse at some point in their life. For several years my depression would come along in four to six-monthly ‘bouts’, each apparently precipitated by not much in particular.
The worst dip in mood I’ve had, however, was just four months into my job as a Foundation Doctor. A number of incidents at work involving unsupportive seniors, awful patient interactions, and one too many diagnoses of cancer in my patients (and I will call them my ‘patients’, as the registrar I worked for refused to explain to the patient what ‘inoperable mass in your duodenum’ meant in real-person terms, citing that ‘the FY1 can do it instead’. But let’s not dwell on that) left me feeling broken, hurt and helpless. And here the spiral began. I became catatonic, drank daily, and isolated myself from the world. My world was dark, I could see no hope, and I planned my suicide to an extraordinary level of detail. My last shift at work was in the emergency department, where I was part of the medical team seeing patients because the hospital was full, and I spent an entire shift in a daze. I was numb. I went through the motions but avoided my colleagues and patients. I decided not to prescribe IV antibiotics to a patient as it would mean me putting in a cannula. I was becoming unsafe, so I left.
“My last shift at work was in the emergency department...and I spent an entire shift in a daze. I was numb.”
And when I say left, I meant for good. I was signed off sick for three months and I handed in my resignation. I relinquished my General Medical Council registration and, just like that, I was no longer a doctor. Of course, the deanery had something to say about it, and a token offer of some counselling and the opportunity to restart training the following year was presented to me, but by then I was beaten. I was broken. I kindly refused, much to their despair, and following a reassuring chat with the careers advice support worker, I was free. No longer a doctor. No longer responsible for anyone else. Just me.
My story doesn’t end there. Naturally more ups and downs followed; if there’s one thing perfectionist, high-achieving narcissists hate, it's the feeling of failure and wallowing in self-pity, things which newly-found unemployment allows plenty of time for. I got there in the end though, and I spent a few years working in admin, living the 9-5 Dolly Parton dream. Then I returned to medicine, like a criminal returning to the scene of a crime. This time though, I was prepared. Armed with an openness about my mental health difficulties, a successful medication regime, and a part-time contract, I was able to do the job I dreamed of doing, whilst making sure I did more than just survive. Right now, I’ve got career plans in place, I’m considering returning to full-time work, and I leave work (nearly) every day with a smile on my face. Don’t get me wrong, the job is still awful at times. The job didn’t need to change, though; I did.
If I could offer one piece of advice to people working in healthcare, then it’s this: don’t be afraid to hold your hands up and say ‘I’m struggling’ or ‘I’m done’. Just knowing that the option to bail-out is there will do wonders for your peace of mind. Being a doctor is like being on a treadmill, and sometimes you’ve got to slow down the pace so that you make it to the finish, otherwise one day you’ll fall.
Oh, and speaking of running, get a hobby. Remember that life outside of Medicine.
You could even learn that Latin you missed out on.
Follow Sophie on Twitter: @sophe_mose