Part one Out & About- Growing the movement for radical change

First published on Mad in the UK on 28/10/24


It has been a delight to take up opportunities to gather in person at various events this year, particularly after the restrictions imposed by the pandemic. There are various networks of like-minded individuals which have grown up around the country, and around the world, who are determined to improve the care of people who have all too frequently been given the familiar labels of psychiatric diagnoses. Sometimes the focus of these groups is to take an ‘activist’ stance, or it may be a particular way of helping people but the unifying factor is that we all know that the traditional bio-medical model of psychiatry is not fit for purpose.

In September, I had a wonderful day at the AD4E live gathering in Pershore, and met allies who I had seen write or maybe I had heard speak on the many virtual meetings. It has also wetted my appetite for the upcoming AD4E festival on November 8th. There are so many sources of inspiration.

Then in early October, I went to ‘Making New Maps’, my second retreat with Compassionate Mental Health. I hadn’t been to Coed Hills Rural Art space before and it was truly beautiful. The centre is run by a community of individuals who live on-site, in a low impact way, grow food and explore creative expression through the arts and a relationship with the environment; it was just the right sort of venue for this gathering.

‘Compassionate Mental Health’ work with a network of people across the UK and internationally to transform mental health services, and radically change the way we talk about and treat ‘mental illness’. Once again, I found myself meeting people who are part of a growing worldwide movement calling for a more holistic approach.

The power of community is so well demonstrated in groups like these, where any status conferred by a job or position in society is left behind and together we can just be ourselves for who we are and not what we do. While there may be a variety of speakers and facilitators, all prepared to share their wisdom at these events, nonetheless, it remains important that there is no ‘them and us’. I was not disappointed that this retreat was no exception, and we were encouraged to eat together and sit together in the common areas.

It was fascinating to find out about the formal research which is looking at the principles of ‘Soteria’ houses and the funding that has made this possible here in the UK. It was also very interesting to meet representatives from PsyCare UK, and to discover that they have over 1000 volunteers all over the country who provide a safe and supportive environment mainly at festivals, so that individuals can navigate through difficult experiences. How inspiring it was to hear some of their stories.

Whenever I attend these sorts of gatherings, I am always impressed when I meet people and/or the families of those who have experienced what is commonly referred to as ‘treatment’ given by the current mental health services. For many former or current patients, it’s not necessary to give all the detail of exactly what has happened, when there is a common agreement that our experiences could have been better.

For many of us, this has led to our desire to withdraw from traditional psychiatric services, and some of us can give testimony to the recovery that followed.  But we are mindful that this is not always the case and it is important for everyone at every stage of their lives, to be accepted and cared for, in whatever situation and circumstances they are in right now, in the present moment.

Yet, the purpose of meeting was not to denigrate those working in health services – not at all. As it happens, there were some very dedicated NHS staff at the Coed Hills retreat, who were also passionate to improve services for those who seek their help.  Instead, there was universal agreement that there are alternative ways to approach our diversity of need.

Hearing stories from other participants always brings gatherings like this alive. So many had been through agonising times either themselves or with their loved ones. The compassion, love and empathy were tangible when people so courageously shared heart-wrenching accounts of their lives and experiences. We were aware too of the tragedies, the bereavements of people who have died too soon because their pain had been unbearable. Our hearts were touched, and we grieved for the loss of close family members to suicide, many of whom were far too young to go. Yet it was so apparent how the families had turned the bitterness of their loss into impassioned desire to help others and to prevent such tragedies from happening to other people, without in any way diminishing the grief that would be with them for as long as they lived.

People were truly inspiring. Courageous in sharing the depths of their despair, not afraid of their vulnerabilities. The collective talent was awesome, many poets, musicians, artists and creatives, all who in their own way were using these gifts to express or enhance the value of their lived experiences.

Someone said they didn’t like the term ‘survivor’ because it conferred another label on us. Perhaps they’re right in that it gives us another reason to be ‘othered’. But such disagreements on the use of language must never divide our united intention, to make life better for those who suffer the unseen pain of deep emotional or mental distress.

Serious violence and violations had been acted out on many of us as children, while others were ignored, bullied and emotionally neglected. our basic needs going unmet. We recognise our own traumas whether society chooses to recognise abuse, neglect or not -and all too often what happened in early life led to the difficulties which plagued us later life. Whichever way those harms chose to manifest hardly mattered.  Whether our mood was high or low, or fluctuating in between, whether we were excessively anxious or hallucinating – hearing voices or seeing things which others cannot see – whether we acted out against ourselves or others in our despair. We discover that we are not in fact uniquely flawed, and in some cultures, our experiences may be revered, and we might be sought after as shamans and mystics.

As we sat together, united with our desire to do good as we would have done to ourselves, we also learnt to empower one another and enable the choices so many of us desire in this important realm of caring for our emotional, mental or spiritual needs.  I left with renewed ability to respect the sanctity of our spiritual or religious beliefs. knowing that there is no certainty about such things.

This was indeed a gathering of like-minded people who are passionate to improve the care of those who are emotionally or mentally distressed or disturbed, whether they have been given a formal ‘psychiatric diagnosis’ by healthcare professionals or not. There will never be a ‘one size fits all’ approach, just as there never will be a pill that can fix life’s problems.  But here we came together to learn and explore different ways in which we can all be empowered to live our best lives with whatever assets and constraints we are carrying at the current time.

Whenever I leave a gathering like this having dipped once more into life’s richness, I reflect on how little I can do as just one person. It is true none of us can do this alone, but together with our new connections, perhaps the dream can move further down the road as we follow new maps to the provision of good, holistic, compassionate care for all who need it.

Doctors Are Not Trained to Think Critically

https://www.madinamerica.com/2024/06/doctors-are-not-trained-to-think-critically/

 Cathy Wield

I went to medical school in 1977. I was still only 17 years old but it was a great relief after the horrendous years I had spent at an all-girls boarding school. My fellow students and I started our first year ‘pre-clinical’ training with 4 ½ days a week of lectures. We were expected to assimilate a massive amount of information and then to regurgitate it during the end of the year exams. Those who failed would have one chance to re-sit and if unsuccessful, they would have to leave medical school.

University students are expected to be inquisitive, to ask questions, but at medical school, it was the other way round. Medical students were expected to answer questions correctly to the lecturer or teacher’s satisfaction.

I already felt disadvantaged; one of the lecturers had broadcast that any student who did not have ‘A’ level Physics should not have been granted a place at medical school. I was one of those students. I had done Maths ‘A’ level instead. My school didn’t do physics or chemistry and I had had to cycle to a neighbouring school just to get the mandatory ‘A’ level Chemistry lessons.

I clearly remember the time when I dared to pose a question during one of our lectures: We were learning about asthma, and I asked why it was that I suffered from wheezing after a thunderstorm but at no other time.

“Impossible,” said the lecturer, “grass pollen is the wrong size and cannot provoke any kind of allergic reaction in the bronchioles (small airways in the lungs).”

I felt humiliated—he had just denied my experience in front of 80 students.

It was many years later that I discovered that doctors had observed this phenomenon on a regular basis. It is now understood that aerosolization of pollen in thunder storms can indeed provoke dangerous asthma attacks for hay fever sufferers like me.

This was just one small example of how humiliation of medical students was routine. By the time we got to our clinical studies and spent most of our time rotating around the various specialities in the local hospitals, we were well used to being subjected to belittling treatment at the hands of our superiors. The ward round was a time when the consultant showed his (rarely her in those days) colours. It was not enough to dominate their junior doctors; terrorising medical students was a daily occurrence. We would be quizzed over a patient’s condition and if we failed to give a satisfactory answer, then making personal and derogatory comments to our detriment was considered fair game.

I was not looking forward to my psychiatry rotation. The prospect of spending time in the large institution, Springfield Psychiatric Hospital in Tooting, was scary. Medical students were tasked with presenting written cases on a variety of patients, finding examples to illustrate the most common psychiatric diagnoses. I surprised myself at how much I enjoyed the experience of interviewing these interesting patients. I felt privileged to have the time to sit and listen to the reasons why they were in hospital and discover more about their background and circumstances. I did well and was awarded an ‘A’ grade for my efforts.

However, I wanted to be a surgeon, so my interests lay elsewhere. As it happened my life took an unexpected turn when I became pregnant. I had no maternity leave and had no family help. By the end of the training, when I finally qualified as a doctor, I was exhausted. I was told that my decision not to go straight into work as a junior doctor was tantamount to career suicide, but I wanted to give our little daughter the best chance in life by looking after her myself.

I didn’t start work as a junior doctor until 8 years and 3 additional children later. My husband and I role swapped to enable me to work the grueling 80-100 hours a week required to get my full registration as a doctor. My intention was to become a GP, but just before I reached that goal, I was side-lined into postgraduate training to become an A&E consultant.

At that time, there were only a few brave patients who came to A&E following overdoses, and it was very rare to see any other manifestations of self-harm. The medical profession expressed a global disdain towards these individuals; those diagnosed with a mental health condition were highly stigmatised and considered weak or defective characters.

Admittedly I was tired out. I had been present during some very distressing resuscitation attempts of young children and the memories of my awful, traumatic experience of boarding school had just surfaced. I knew the reasons why I was having an emotional crisis and I went to my GP for help. The GP left little room for discussion before telling me I was depressed. I left the GP surgery feeling utterly bewildered and wondered how on earth a pill like Prozac was going to fix my problems. But I was a doctor and conditioned to believe that the experts knew best. The GP must be right.

I took the Prozac for a while, but it just gave me side effects, so I stopped it. I had no idea that stopping antidepressants precipitously was not a good idea. I had been told they were not addictive and had very few side effects.

My circumstances didn’t change, and I was still very tired, very stressed and feeling unhappy. I became increasingly anxious about the responsibility of treating very sick patients with minimal support from more experienced doctors. When I went back to the GP, I was signed off sick and told I must take the antidepressants and the dose was increased.

At home, alone, with no-one to talk to, things went downhill rapidly. I loved my husband but genuinely didn’t want to burden him with what I felt were unreasonable concerns. After all my profession told me I should be able to cope, and the GP had assured me these pills would soon make me better. I just had to wait it out. But I just kept feeling worse. I couldn’t sleep, I felt agitated, my thoughts were going round and round and then I became suicidal. Being suicidal made no sense. I had a loving husband, four beautiful children. I had a job. There was no reason to want to die.

Nobody understood that suicidal thoughts could be caused by the very drugs which are used to treat depression. When I shared my thoughts with a doctor friend, she was alarmed. I was taken to an emergency appointment at the GP, then an emergency appointment at the department of psychiatry and my husband was told I must be admitted straight away.

That was just the start of the seven-year fiasco, where I was continuously treated with a changing cocktail of psychiatric drugs and multiple ECT treatments. I never improved, instead slowly became worse and worse, as a revolving door patient.

I was given psychotherapy all through this time, but the therapists were not impressed by my accounts of childhood trauma. Apparently, nothing I told them was sufficient to cause the state I found myself in. Nobody considered that the treatment I was having could possibly be detrimental in any way. Nobody understood that the drugs I was taking could be responsible for my deterioration. Instead, I was told that my brain was disordered, that I had a chemical imbalance, and I was seriously ill.

When I started to act out on my suicidal thoughts, self-harming to the extent that my life was in danger, I was sectioned and, in the sixth year, admitted to the secure ward and placed under continual observation. The prognosis was so grim that I was offered psychosurgery. I was desperate to get better. I wanted to be normal, live at home and be a mother to my children. I agreed to the surgery, not really knowing what else to do.

At the point of the psychosurgery, the psychiatrists reduced the cocktail of five drugs at extremely high doses down to two drugs at lesser doses. When I made a spectacular recovery, even the psychiatrists thought it was miraculous. But they could not credit the psychosurgery as responsible for what happened when the ‘light switched on in my head’, nor was the reduction in the number and doses of drugs I was taking ever considered to have any bearing on my recovery.

Eventually I was discharged from the hospital, and I started to take myself off the remaining doses of antidepressants against the wishes of the psychiatrists. When I reported brain zaps, the psychiatrist had no idea what to suggest, other than reduce the dose slowly.

But I was only drug free for a couple of years. During this time, I even managed to get back to work and I was writing my memoir, going through my medical notes to glean the necessary information. The psychiatrist was worried when I reported that I wasn’t sleeping well. He convinced me that this was a sign that the depression was returning. What he said scared me so much that I capitulated and went back on antidepressants.

When my book was published in 2006, I was doing ok, but it didn’t last long. Within a year, I was back to being depressed and suicidal. I felt a terrible fraud having told the world about my successful psychiatric treatment. Once again, I was admitted, this time given ECT. This time, when I was discharged, I was told I must take high dose antidepressants for life. I was also told that I would never fully recover and suffer recurrent relapses. I was therefore advised to avoid all stress and that meant I should never work as a doctor again.

When we moved away and my husband started his training to become a counsellor, I started to hear a different story to the one that I had been taught as a doctor and different to what had dominated my life as a psychiatric patient. I had believed the psychiatrists when they told me I had a very biological depression caused by a chemical imbalance or some kind of as-yet-unidentified brain disorder. In addition to being told that my only hope was to take antidepressants, I was also advised that having any further psychotherapy which went over the events of the past was pointless, and would only serve to further destabilise my precarious remission.

But each day my husband came home from his training and started to drip feed me with alternative ways of looking at things. Maybe feeling stressed and unhappy was a normal response to terrible circumstances. Maybe believing that those supposedly negative emotions were abnormal fed the downward spiral. Maybe hearing society reinforce a message that you should be happy all the time while experiencing the stigma from my profession made it all worse. When the psychiatrist told me time and time again that I was ill and would never recover, maybe it had become a self-fulfilling prophesy.

But could these experts really be wrong? After all, they were highly trained, highly skilled doctors involved in research. Surely while these eminent professors of psychiatry said that I was one of the worst cases they had ever treated, there was no way I could have just been a normal person reacting in a normal way to difficult circumstances. Could I?

When I weaned myself off the sedating antipsychotic drug which had been added to the cocktail of high-dose antidepressants, I felt a lot better. The psychiatrist was not happy. He warned me. If I was to stop any more of my drugs, I might once again find myself back in hospital with a relapse.

When I tentatively started to return to work as a doctor—very part time at first—I was fine.

By 2016, I had seriously started to doubt that suffering awful side effects from taking off-licence high doses of two antidepressants was worth my while. Slowly I started to reduce the doses and I was fine. While I became more confident in the robustness of my recovery, I still remained ignorant about withdrawal. If only I had searched online, I would have known better.

Likewise, I was ignorant that other people who had also been sent away to boarding school as young children also suffered severe consequences as adults. If only I had searched online, I would have discovered these important facts earlier in my life. As it was, left in ignorance, I believed that I was somehow uniquely weak, uniquely flawed and terribly, terribly ill just like the psychiatrists had told me.

I didn’t want to tell doctors about my symptoms during withdrawal. I had no desire to draw attention to what I was doing, and risk being re-diagnosed or medicated again. By trial and error, I discovered that reducing the dose of the psychiatric drugs had to be very, very slow. It wasn’t scientific but I found myself cutting tiny slivers off the tablets and carrying them around with me, to make sure I could take a tiny amount when the feelings like electric shocks became too much. I had to reinstate the other drug when I found the rebound insomnia, the restless legs, the cramps intolerable. But my emotions were alive. I was living in three dimensions after years of feeling like the world was unreal and that I was completely numb. I cried and cried, but I also laughed and felt joy. It was incredibly scary at times, when I felt panic stricken and afraid. Occasionally I had suicidal thoughts, but somehow, I knew they would pass.

One day, it was like the penny dropped and I laughed out loud when I realised that I had been prescribed medication to treat my psychiatrists’ anxieties. They should have been the ones taking my pills.

I found a counsellor and talked over what had happened to me as a child at boarding school. She was amazed. How on earth had nobody taken this seriously all those years ago? I had been through hell back then, and it had been re-enacted by the psychiatric system which re-traumatised me every time I was admitted to hospital. At last, I started to process memories and emotions that had remained suppressed for decades. I had to learn to recognise my survival persona, one who was easily controlled and coerced. One who knew only how to drive herself harder in response to difficulty. I had to meet my inner children and give them the love and comfort which they had been deprived of while I was growing up.

I made a grave error when I decided to go cold turkey on one of the antidepressants – within two days I had severe burning pain and to this day, I still have the symptoms of small fibre neuropathy. I haven’t slept through the night since that time and now I know that these symptoms are very likely manifestations of a protracted withdrawal syndrome.

In the last few years, I have met two educators in different parts of the country. Both were involved in teaching medical students and/or doctors. Neither of them were medical themselves but both qualified teachers and had the academic credentials to be recognised as experts in education. One of them was employed by a medical school, but suddenly their expertise was no longer required to teach ‘problem-based learning’. The other person was also ousted from their role. They are happy to speculate that this is because the students had learned how to apply their critical thinking too effectively. They were becoming bold, asking awkward questions, no longer willing to learn by rote.

Medical research is largely funded by the pharmaceutical industry, papers ghostwritten by the pharmaceutical industry and influencers paid by the pharmaceutical industry. Regulators are not independent either and so it is that most doctors have become pawns in a system, used to deliver the drugs which provide the fundholders with the maximum profit. So far, the system has failed to eliminate corruption and bias, for one reason only, that is there is no such thing as a free lunch.

Most doctors are not capable of critically appraising the research and ‘evidence’ is sold to us as ‘gospel’. Doctors lack time and training, and are part of a historical, culture which trusts in the academic expertise of influential colleagues. My own medical training had simply reinforced the myth that expert doctors knew best. I had denied my own personhood, ignored my gut instincts and succumbed to the traditional biomedical psychiatric paradigm.

There could have been a quicker route to reach the same conclusions as I have now. There was no need for me to have done this alone; there are plenty of other voices out there, plenty of people who can guide the way.

We might think we choose what we believe but it very much depends on what information is fed to us and importantly, what is withheld. We live in a culture which is heavily influenced by social media and the advertising industry. We cannot rely on the medical profession to take the lead.

While some patients may find psychiatric drugs helpful, at the very least all patients need to be fully informed of the risks of potentially dangerous side effects, and the risks of withdrawal.

I am one of the lucky ones who survived, but others have lost their lives as a direct result of psychiatric drugs. I have written a sequel to my original memoir which reflects the turnaround in my thinking. Unshackled Mind will be published in the coming year. Please join me in speaking out, so that others may be spared from unnecessary suffering and life-threatening risks, all of which may follow an innocent request for help during an emotional crisis.

***

Photo by Dom Fou on Unsplash

The curse of the quick fix

You may be forgiven for equating a fix with the high which becomes part of the addiction cycle; yet our modern, western world seems not far removed from a similar phenomenon whereby short term and transient ‘reward’ has become the norm for the evaluation of so many aspects of our complex lives.

This starts at the top in governments who have their eyes on electability rather than the long-term benefits of their policy making. In health care, the same is true. It has become more attractive to talk about short-term cost savings than the work needed to attain long term goals.

When it comes to doctors spending time with patients, there is increasing pressure for us to see more people, or perform more operations or procedures, while at the same time we are told we must provide quality care. Hard working doctors who are berated for spending too long seeing their patients are far more likely to order tests and investigations or prescribe unnecessary drugs in order to close the patient consultation. This is short-sighted and dangerous, even more so when it comes to patients who have emotional crises, undiagnosed physical symptoms or who are returning to care repeatedly.

This sad approach to pressurising the work force is not new. Even way back, when I was a teenager prior to medical school, I took a holiday job working as a healthcare assistant in a nursing home; I remember the matron constantly on my back telling me to hurry up, when it came to feeding, washing, or dressing the elderly clients.

A few years ago, when I was working for a charity which supported homeless people in America, I encountered a similar attitude from my supervisor who was not keen on me ‘giving clients time’. Instead, he would rather that I didn’t miss out on what he saw as more valuable – giving an extra five minutes to make sure that the homeless clients who cleaned the premises did their jobs.

 Yet my experience was that giving someone time reaped dividends. A memorable example was when a client who had been very abusive and aggressive came to the office door asking for help. I invited her into the room, making sure that she knew that I had time to listen to her.  When we were both seated, suddenly she started to open up and I listened as she related her extremely moving and tragic life story. What happened next was a moment of genuine connection as I held her close, reassuring her that she was neither wicked, nor unforgiveable while desperate sobs erupted from somewhere deep within. It certainly transformed our relationship. A short time later, she allowed me to call for help on her behalf; she was seriously suicidal, and I agreed to accompany her for an evaluation by the mental health team. Unfortunately, the appointment could not have been more disastrous.

The pair of professionals sat at a distance from us, as though she was suffering from a seriously infectious disease. Their body language emanated judgement even before they voiced their dismissal of her distress. What could have been a meaningful and helpful time, instead sent her back to a place where she totally disengaged from the system, and I couldn’t blame her for that. It was no surprised that she simply disappeared off the radar, but I was exceedingly worried for her wellbeing.

It should have been a relief to find out she was alive, but I learnt she had been taken into custody and was now incarcerated in a prison, something to do with being in possession of a lethal weapon.  What a wasted opportunity and a crying shame that one of the most vulnerable members of society had been so let down, and at what cost?  And I am sure it was substantial to keep her locked within the expensive criminal justice system.

But returning to the present day, I can describe an example from only last week. The Emergency Department is always busy, but when an elderly man suddenly breaks down in tears, surely he deserves our focussed attention. He had been triggered and told me of his traumatic experience when he haemorrhaged after surgery.

When I related this experience to a colleague later on, they said “but it’s difficult when there are so many patients waiting to be seen.” I could see the alarm in her face as she worried that I might be advocating to spend more time with patients. Her fears are justified but we also have to be true to ourselves and not rush these precious moments of connection. While it may take longer in the short term, apart from being the good and human response, it will also save time in the long run.

Patients who have not felt listened to, or who feel misunderstood are far more likely to require another visit to the doctor. This may be counterintuitive but the kind of anxiety that leads to health-seeking behaviour is often both strong and pervasive. Either that or they may become angry or disillusioned and fail to report significant issues.

Spending a few minutes more to discover what is really going on with a patient will pay dividends.  But this notion is not popular with managers in the stress-filled NHS urgent and emergency services. They do not prioritise quality over perceived productivity. While personalised care is gaining traction, there is still significant dissonance when it comes to practice. The concept of putting more time and resources into an individual patients’ care in front line services is met with horror and dismay. There is a perception that patients will ‘demand’ more tests and will use services more, rather than less. Furthermore, it will not give the policy makers the satisfaction of more throughput, the truly political quick fix.

The failure of current practice is by no means exclusive to but may be particularly obvious within psychiatric services and in primary care where more and more patients are leaving with prescriptions for psychiatric drugs. Prescribing has multiplied on a logarithmic scale and despite the fact that many more resources have been put into the system, still the work continues to increase with more and more people seeking diagnoses and treatment for their distress. Surely this demonstrates that the system is broken, the drugs are not making people better and there are continual cries, that now is time for change.

What has changed across the board in the NHS, is that doctors are spending less time with patients. Solutions are not being sought in their lives and communities, rather quick fixes are sought, and has become the norm for medical practice.

Yet we continue doing more of the same and now we are reaping the consequences of what has gone before. There are more consultations, more investigations, more drugs prescribed, and more patients being treated than ever before, but the health of the nation is not improving.

June is here

I love May & June! True that it would have been nice to have a bit more warmth but then again the garden has been well watered and the roses are blooming – both spectacular yellow and another one pink…….The courgettes are coming along too. But broccoli sadly got eaten, even before the cabbage white butterflies got to lay their eggs on it. (Below after the storm!!!)

I am the proud owner of an e-bike and I love it? I purchased it on the cycle to work scheme which is a wonderful way of investing in a good, sturdy, reliable and expensive bike.

On Friday, a few days ago, it was the Queen’s Jubilee holiday, the roads were quiet and my ride to work was a clear run and probably my fastest time yet. I was almost there and the e-assist kicked in as I cycled up the final hill.  There’s an ideal spot to dismount, off the road, just outside the fire station before I cross the dual carriageway on foot. But I must have hit the dropped curb at the wrong angle…….. During the split second while I flew through the air, I thought, ‘do not put your hand out to save yourself’- (a common reason for fractures and dislocations of any part of the arm.)  But what goes up, must come down and somehow I must have slid along the ground before I ended up spread eagled on my back with the bike on top of me.  

I knew I wasn’t seriously injured but I couldn’t get up! I was so close to the hospital and cars whizzed by ignoring my cries for help. I lay there wondering when someone was going to come past and worried that I was going to be late for work.

At last a passing van stopped and the driver removed the bike which had effectively pinned me to the ground and propped it up against a wall.

“Wow, that’s a heavy bike,” he said.

 Simultaneously an ambulance pulled up; paramedics had spotted the crumpled heap of highly reflective jacket from the other side of the road. I identified myself and fortunately they recognised me, which helped a great deal, when it came to convincing everyone that I really was ok and did not need to be immobilised and checked over. Though I had to sign a form to say I was refusing care and swear blind that I did not hit my head. (Helmets are wonderful things!)

I was very grateful to the paramedics, not least because the control centre, gave them the all clear to ‘convey me’ to hospital which was a much needed lift to work, along with the bike. One of them then wheeled it to the lock up for me, where it will remain in solitary until I am fit enough to ride it back home. With my wounds suitably covered with dressings, it was obvious to one of my elderly patients that I had been in some sort of accident and she asked me what happened.

“I’m glad I have a doctor who understands falling” she said.

I am not sure that is quite the reputation I want right now…..

Needless to say, I am quite bruised and sore but more annoyed with myself than anything. I was getting my fitness back after a mandatory break when I went down with covid, literally an hour after my father’s funeral.

I was so worried that I would have passed it on – It was a very emotional time and I had kissed and hugged the 14 of us who had been able to get to the very short committal. Of course this included my 94 year old mother. Yet at that key moment of potential contagion, none of them went down with the infection. Even Phil was fine! I have to say I do not understand this virus at all. 

Finally Sunday came and a much needed day off, the last day of the Jubilee weekend. Some neighbours had organised a street party so it was disappointing that it was grey and cloudy after a series of thunder-storms overnight. Umbrellas and wellie boots mandatory along with the plate of food for the pot luck. But very England!


SO ENGLAND! Some older residents in the neighbourhood…..

Phil is really enjoying his new voluntary job as administrator of a food bank. He is in his element restoring order and efficiency when the unglamorous but necessary administrative tasks are in disarray. This part is all too often neglected in the charity world when those that volunteer tend to be doing the caring and sharing work.  He’s done it a few times in the past of course, most notably during our time in Thailand…….He works most of the week, taking the ‘referrals’ from agencies and smooths over all sorts of hiccups and crises which occur during the week as he coordinates it all. He’s just the right character to do this, so unflappable and able to quell the anxiety of volunteers who are involved on the ‘front line’, as it were. Literally doing the work behind the scenes that keeps the show on the road. His IT skills help to bring order to the chaos.

We all have different skills and I am very aware for instance that I may be held in high esteem because of my medical degree, but why? I am no different to the person I was who was cleaning the toilets when I worked in Denver.

I actually I loved working with the homeless clients in that job, who didn’t care f*ck what qualifications you had. Sometimes I feel as though we get wrapped in layers like a ‘pass the parcel’ maybe more so in the UK – all part of our social ‘breeding’ and later experiences. I felt very accepted when I lost my layers … whereas in ‘normal’ life, I have often felt exposed when I express my inner self.

But I freely admit I found the organisational ethos of the Denver workplace, completely incomprehensible. NO doubt they thought the same about me…….I was probably viewed as a ‘know it all’ who rubbed everyone up the wrong way! The director used to boast that I was a UK doctor working for them, when she showed donors around. Yet others in the organisation were not receptive when I gave suggestions on infection control for instance – like simple requests for soap and hand washing facilities…….

 I am lucky. There are lots of people the world over who for the sake of political correctness or maybe simply the arrogance of national rules/managers/hierarchy are kept in ‘their place’ under-valued, unappreciated and without any chance to flourish.
I hate the way we forget to value people for who they are, rather than for their occupation. Yet there is no denying that there should be the scope, to enable talented individuals to access educational opportunity or skill development and allow them to grow into the best they can be.

Have you ever wondered what you would really like to do/have done in your heart of hearts? Something that may be could have been developed further……..another life perhaps? It may be easy to look back in regret at lost opportunities or nostalgia at ‘better times’
But I have quite enjoyed thinking about what the ‘real’ inner me, would like to do/ have done:-

I would like to have danced, sang, acted, clarinet in an orchestra or jazz………professionally of course!

OR I would liked to have become a naturalist

OR a novelist

OR a journalist focussing on humanitarian issues

OR used my current medical skills but in a humanitarian setting…….

Not in any particular order!

I guess, once retired, the world will be my oyster for any of the above -apart from ‘performing’ – sadly, I don’t think I will ever make it into the corps de Ballet ……….

I did investigate the possibility of applying to do a stint with Medecins sans frontieres – you have to give 2 years minimum. Not sure that Phil would be too impressed if I push off for that long. Although if we could both go – he could do his whizz kid stuff with the admin……Nah. Probably should stop dreaming. Do I want to live in hardship with feet that don’t like the heat?

OR maybe we could sell up and go and live on an island in the Caribbean? All I would need is a good supply of books, paper and a pen………

Oh darn, I just landed back on earth with a thump but less of a thump than falling off the bike! I guess I’d better appreciate what I have, while I can, which means filling up the bird feeders to encourage the goldfinches, green finches, great tits and anything other than the flippin’ pigeons – they clearly like our garden and have no desire to move on.

October 2021: Women, Mothers and Others as medics

I had my first baby at medical school. I had learnt through my childhood that complaining didn’t do any good and so during the constant nausea of the pregnancy, I carried on.

It was 1982 and even though our medical school had more women than most, being pregnant was not playing by the book. For the most part, it was ignored. As I came up to term, I was on a surgical firm. We were doing a ward round on a female ward and came across an empty child’s cot. The consultant surgeon I was training under, looked straight at me and said “I can see we are prepared for all eventualities.” That was the only acknowledgement of my condition.

I went into labour while assisting in the operating theatre. I bore the contractions silently and timed them on the theatre wall clock. I managed to get to the end of the operating list without letting on and went from there straight to the labour ward.

I had no official time off for the birth of our daughter. My husband was working and we had no family to help. I did have a childminder arranged but I hadn’t expected to be overwhelmed with maternal feelings. I wanted more than anything to be with my baby and by the end of the year and my qualification as a doctor, I knew that I could not leave her for the minimum 80 hour average week of pre-registration house jobs.

Almost 8 years and 4 children later, I started my surgical house job. I knew that I had to do well, extraordinarily well. Two consultants had interviewed me; it was after they told me that I had not got the job, having been out of medicine too long that they asked me what I was going to do – my answer changed their minds and they decided to give me a chance.

I set out to be the best. I put up with the snide remarks and the gendered references – once in theatre, I was left holding a bowl filled with the contents of an obstructed bowel. The consultant surgeon was laughing at me, asking whether this was better than changing nappies.

However at the end of the 6 months I was rewarded – both of the two consultants who interviewed me also paid me the compliment, that I was the best houseman they’d ever had. In retrospect, the consequences weren’t quite as positive as I thought they were at the time.

I had created a situation where I expected perfection from myself at work and also back at home; I tried so hard to be a really good mother to my 4 children and make up for the time when I was away at work. I moved on from house-jobs; the plan was to become a GP, then at least I could be part time.

 On my first day in paediatrics, I was left to resuscitate a neonate without assistance when the consultant mistook the fast bleep as a ‘test’ bleep. As an A&E SHO, the only doctor in the department at a peripheral hospital, I found myself dealing with a 4 year old child in cardiac arrest all on my own – these situations are unthinkable today. There was no debrief, no counselling, I just carried on working; but it hit me hard -perhaps more so, since I had young children.

Despite or maybe because of the way I had handled the paediatric arrest, I was encouraged to pursue A&E as a career and I did really enjoy the speciality -it all seemed to being going well;  flexible training was on the horizon and so it seemed that my working life would improve considerably with a reduction in hours.

I was lucky in that my husband and I had role-swapped when I went to work – it seemed the only choice when I was doing the average 80 hour week, 1 in 4 and he adapted well. He was unusual at that time, which meant that there were few people he could relate to and he was not readily accepted by other ‘stay at home’ women, who were also caring for young children. The attitudes of other men also changed towards him. In social situations, when he told them he was looking after our children – they would turn away disinterested…..

But I felt his rejection – it reflected on me. I was the cause of the trouble. I internalised my feelings. I was also getting tired. Everyone else’s needs came before my own and the stress and vicarious traumas from work, began to take their toll. Then a situation arose in our family that provoked memories of my own traumatic childhood and finally I had an emotional crisis. My repressed emotions came to the surface and once activated, it seemed that that nothing would stop them. There’s a long story in the years that followed the diagnosis of depression……

Eventually I returned to work where I had left off, this time as a flexible SHO in Emergency Medicine. I completed my Membership exams (now titled MRCEM) and was now set to apply for SpR posts. Candidates were expected to visit the A&Es where I would potentially work on the rotation.  One of those visits was particularly memorable. The consultant I met, a man, spelt it out to me. Even though, I was not going to go off and have more babies, I was too old for the job. I would not give back enough years to the NHS, so it was not worth while training me.

I was shocked, but there was more to come. I was told something similar by one of the powerful male consultants in the A&E where I was currently working. He did however, assure me, that if I wanted a permanent staff grade job there, the door was open.

I was infuriated and also determined. Thankfully I did well in the competitive interview and was given a training number on the rotation.

If only fate hadn’t intervened……my children were teenagers now and two required funding for university, my husband was back working. We were dependent on both our incomes and then suddenly, without warning, his company was taken over and he was made redundant. He tried to get another job locally but without success. After much thought, we decided to be positive and move to an area where housing was cheaper and decrease our outgoings. Naturally I was limited to areas where I could get an inter-deanery transfer.

I made enquiries. Initially I was told that ‘economic migration’ was not a good enough reason to move but then my husband found a job. An inter-deanery transfer was agreed for that area.

I flew up to Scotland to visit the new A&E department where I would be working. It turned out that the flexible training dean was also one of the A&E consultants. I sat in his office and discovered the harsh reality of joining this particular deanery, where they had not agreed to the EWTD. (European Working Time Directive which limited average working week to 48 hours.) Even though I remained a flexible trainee, my new part-time hours were to be 39 per week without any increase in my pay. (The full timers worked 65 hours). In addition to this, I was to be expected to do the full 7 night-shifts in a row. I would be required to be resident for 18 months at another hospital over 100 miles away as part of the rotation, never mind the fact that I would be separated from my family. I couldn’t believe what I was hearing – none of it made sense. I knew what I was required to achieve to satisfy the A&E curriculum and it wasn’t necessary for me to go to yet another hospital. I explained why I found working more than 4 nights so difficult since the illness and the fact that I was a flexible trainee to protect my health. But he was insistent-none of this was negotiable. One of the existing SpRs showed me round the department.  He also explained the ‘culture’ of this particular A&E to me – it was supposed to be reassuring to know that this consultant, the flexible training dean, whose office I had just left, would pick on me and make my life miserable until I swore at him in public. The SpR told me not to mind – “it is nothing personal, he does it to every new SpR.”

I decided I couldn’t work under such conditions and resigned my training number. I thought I was fortunate to get another post, working in Psychiatry as a staff grade. There were no anti-social hours at least. But I was a fish out of water and soon realised I had made a terrible mistake.

I went back to the flexible training dean, humiliated, defeated and asked if there was any way I could come back to A&E. I said I was willing to be an SHO again, or a staff grade. He was incredibly rude and he brought up the subject of my mental health and used this against me. His final words were that he would never let me work in A&E either at this hospital or anywhere in the region.

I reported him. He had broken every rule under the sun. I did not know where to turn. Even the BMA were little help. Occupational health were no help either – they told me, I should never have taken the job in psychiatry……….. Once again, my world was crumbling. I didn’t know what to do; the crisis earned me a diagnosis of ‘relapse’ – I thought they must be right. I went off sick.

The Trust (hospital) Medical Director agreed that we should meet – just the 3 of us. It was my word against that of the flexible training dean – he denied everything. I couldn’t help myself and broke down in tears. I knew that I would not get work as a doctor where we lived, I had burnt my bridges.  After the meeting was over the Medical Director validated what I had reported to him – “I believe you” is what he said. But without evidence, there was little anyone could do, so I didn’t work again until we moved back to England.

Yet another gap in my career and this time, it was not my own children I was caring for but a baby grandchild…….but I wanted to go back to work in A&E. There was no such thing as a ‘return to work’ scheme, so I did it myself -I was an ‘observer’ on an unpaid honorary contract but after a day, I became part of the work force, just making sure that I presented every patient to a senior. Thankfully before too long, the department offered  me an ST3- LAS and then I became a ‘trust registrar’.  However the possibility of career progression to Associate Specialist had gone – the 2008 contract put paid to that.

I wanted to return to training. There was a glimmer of hope, when a scheme called DRE-EM arose. On closer scrutiny, it was little different to starting all over again as a CT1 and once again, there would be an impossible commute – this time I would have to work at the base hospital for 18 months, including twilight shifts finishing at 2 am. It seemed like the gods were against me, yet, I couldn’t envisage being stuck at the top of the trust registrar pay grade where I had landed and keep going without any potential for growth.

I was acutely aware that there was little respect for me or my opinion within the medical profession, once my job title was known. I had also witnessed how derogatory others were towards SAS doctors in general. How could I have let myself get to this? I spoke about the possibility of the DRE-EM training to one of the consultants I knew and respected in my department. I was completely shocked by his advice. He told me he thought I was capable and could pass the final exams (FRCEM) but he also told me that I was not the ‘type’ to become a consultant – I was the ‘wrong’ sort of personality. I was not aggressive enough, not loud enough. I was a good follower, but not a leader. He advised me to forget it.

Opportunity arose for us to get a green card and emigrate to the USA. It seemed the answer -I studied and passed USMLE and was given the golden certificate – the ECFMG – the Eligibility Certificate for Foreign Medical Graduates, granting me the right to apply on the computerised matching scheme for residency programmes………..Finally I would be able to complete my training in Emergency Medicine.

 Filling out the on-line applications for ‘the match’ was arduous, requiring considerable detail. It was costly too. There was a fee to pay for each programme you applied to. Finally -press submit – it kept pinging back. I couldn’t understand what the problem was.  

My heart sank when I found the reason…….all residency programmes for every speciality in Colorado, where I now lived, required that your primary medical school qualification had to be within the last 5 years – if this stipulation was not met, your application was automatically rejected. I looked through every document I had been sent, every relevant email, there was nothing about this anywhere. I searched through all the advice sent to International medical graduates……no mention and yet, I could not find a single residency program in the USA for Emergency Medicine to which I could apply. I tried other specialties in Colorado but to no avail. I met with University of Colorado medics. I was given contacts and had meetings with numerous people. It was hopeless. Nobody could help me. My dream had come to an end -I gave up medicine- this time for ever.

Here I was a bona fide resident (green card holder) in the United States and none of my British qualifications including my BSc were recognised – the best I could hope for, was a job which only required  high school graduation. I earned $11 an hour when I worked at a charity for the homeless. It was tough, but I enjoyed it, until I was subject to an unprovoked assault. Once I recovered, I realised that it really was too late in life to start an alternative career and living in the USA without a steady and at least moderate income was not likely to end well. We were living below the federal poverty line, yet, unable to get any state benefits because we were immigrants who had not been in the country for more than 7 years. Time to move on.

It was hard returning to the UK, leaving friends and family behind. But at least I found it relatively easy to slot back into Emergency Medicine, once I overcame the initial anxiety. But I suppose I am a veteran at ‘return to work’ and this time, there was proper support. It felt like riding a bicycle and here I am, this time for life, a SAS doctor back in Emergency Medicine.

I am strong. I am a survivor. I am a woman who has battled against the odds in a world where I was discriminated against firstly because of my gender and then because I had been ill. I have learned that though I have made mistakes in my career, I have also been the first to recognise and rectify them. I should not have been treated the way I was and I hope very much that others do not have to go through similar ordeals. The hierarchy within medicine is breaking down because there are more women within the system, however we must make sure that the fight we have gone through to get to our positions, does not harden our own abilities to be supportive and empathic towards others who come after us.

I am happy to still be working when most of my medical school peers are entering retirement. I can look back at my life and wish it had gone more smoothly and that I had attained my career goal to become a consultant in Emergency Medicine. However, I am where I am and not a lesser person because of it. I have proved that a neat, straight line, career trajectory can be broken, not just once, but a number of times and still lead to a fulfilling life and provide a service to our patients. Those who say otherwise are merely reflecting their own limitations.

February 2021

Life this year is stressful the world over, but more so for those who are caught up in the various political and economic fiascos resulting from the pandemic.

I want to step away from that subject right now as I am starting an ambitious writing project. I promised myself a few years ago, that I would set the record straight about what I believe really happened to me back in 1994 at the start of the period when I was first given a diagnosis of depression. The sequelae from then on are all too easy to understand given the psychiatry paradigm that has been around since the publication of the first edition of the American DSM (Diagnostic and statistical manual), which made the American Psychiatric Association millions of dollars.

I had no idea of the falsehoods that were presented to us as research, defining mental illness diagnoses and the treatments, which were supposedly evidence based. There is plenty of argument to be had to this day and of course it will be a battle to convince the majority mainstream psychiatric profession to change their views, particularly if it means doing themselves out of a job.

The current situation is that there is more and more hype with regard to the rising numbers of people suffering with traditional mental health diagnoses like anxiety and depression and therefore the perceived need for increasing the mental health workforce.

I completely agree that there are many people suffering from emotional or mental distress at the present time. There are many who have been recently bereaved or have suffered in all too familiar ways as a result of being ill themselves or knowing those close to them who have been seriously unwell with covid. I believe the mistake is in medicalising the normal response to difficulty and suffering. Not only that, there is also the worrying trend for people to be prescribed medication for these normal reactions and those very same drugs have a complex and bewildering effect on the way our brains function.

I have been there. Yet I also know how hard it is when you have desperate people in severe emotional distress begging for some kind of relief and you as a doctor are so unable to give them the necessary time to really listen and understand what is going on. However, knowing what I do now, I would be extremely reluctant to go down that path.

 Our culture is such that we have developed a very low tolerance for suffering and we have lost the ability to discriminate what is normal from what is pathological. Yet we are the same human species that has been on this planet from time immemorial and managed our societies with varying degrees of kindness and compassion for one another. If we have learned anything, then surely it is that accepting our differences and managing our expectations of one another with as much tolerance as possible, is a healthy way to live.

In some ways, the anti-stigma campaign that I fought so hard to promote has made things worse. More and more of our children and young people are being diagnoses with a mental illness and their behaviours labelled as abnormal. It’s only a few years ago, the very same youngsters may well have been dismissed as just manifesting a stage in growing up. The truth is, that the latter is much more healthy for all of us. But it is hard when social media has become so dominant and learning dysfunctional behaviour from others is easy.

When I was at school, I never heard of anybody hurting themselves. I did not know anyone who had completed suicide. Of course these things were not talked about because there was a general feeling that to do such a thing was selfish and weak. Families were ashamed and it was not long ago that a suicide attempt was a criminal act. I am glad I did not know that I could have used a variety of behaviours to draw attention to my plight.

I was an unhappy child for many reasons, but despite the misery, I made it. I came through and got myself to university. I know how things could have been better for me, but also I believe that if I had been a child in today’s world, it would have been a whole lot worse and I very much doubt I would have arrived at medical school before my 18th birthday as I did then.

I can easily see the connection between what happened during my childhood and  the crisis I experienced later in my life when I was diagnosed as being depressed. I saw it then but was told I was wrong. If they had maintained an open mind and the connection recognised as significant by the psychiatric community, then it is highly likely that my symptoms could have been seen as normal.

Normal doesn’t exclude support or help. I am not suggesting that I could have carried on with the life I had as a junior doctor then, without being able to replenish my energy and strengthen my inner being or that I could have made it without psychological support. But I know that being given a label of major depression and being told I was seriously ill opened the gateway to the acceptance of treatment. I wanted to get better. I was treated with drugs that changed the way I could respond to psychotherapy, as well as gave me terrible side effects, which the doctors told me were further evidence of the depression; drugs which were likely responsible for my suicidality. I had numerous ECT treatments and finally irreversible brain surgery. It was not just me who was harmed, so was my family. We continue to pay the costs to this day, almost 30 years later.

I have no wish for others to have their lives ruined by the same lies that caused my well- intentioned doctors to give me such treatments without any credible evidence base behind them. It is about time that the real story was told and I am currently writing a new book to correct the fallacies which I had accepted to be true, at the time I wrote ‘Life After Darkness; a doctor’s journey through severe depression’. I was duped by so called experts, just like millions of others the world over. Unless we do something now, there will be many more casualties. Our time has come, the bastion of traditional psychiatry must fall beneath our scrutiny.

November 2020 – renewed perspectives

I decided a few months ago that I would re-write my first book ‘Life After Darkness; a doctor’s journey through severe depression.’ It’s not that my story is inaccurate but if I had received a different response on the first occasion I asked for help, I believe I would have avoided the 7 year nightmare that followed.

  Of course, life has moved on; it’s almost 20 years ago since my sudden and inexplicable recovery from an illness where I gained the diagnostic label of ‘treatment resistant depression’. So why would I want or need to write any further about this?

Sadly it has taken me a long time to unpick what happened to me and to discover the truth about the erroneous diagnosis, the well intentioned but completely wrong treatments I endured and the pseudo-science that led me to believe that I was in the safe hands of psychiatry. It was a shock when I first met somebody who challenged the diagnosis of depression. Yet once I was able to allow myself to contemplate that these learned, highly trained professors of psychiatry could simply put, be wrong, I felt as though my experience started to make sense.

The paradigm that I had had a severe, serious and prolonged depression which had not been amenable to standard treatment, which could relapse in the same way had a profound and lasting hold on my life. I found it difficult to be confident when I started to break away from the advice that my esteemed doctors had given me. It was very scary and anxiety provoking. But the rewards have been considerable.

I started to feel alive again after almost 25 years of high dose antidepressants but more importantly I am no longer afraid. I can be myself, free from worry about losing my foothold on life, free from the concern that I might once again be forced into hospital or given drugs or even ECT against my will. I can relish the fact that I survived and that I can work as a doctor and know that I am not a poor, vulnerable individual who is likely to succumb once the pressure gets too much.

I never was that person originally, though I became so when I was made a psychiatric patient. The label follows me on my medical record but I delight in defying the trajectory that the cynical and pessimistic mental health profession, unwittingly lays out for their patients.

 I have been fighting against the stigma of mental health problems since 2001 and now I wonder whether that has been the right battle to engage with. I do not want others to medicalise their traumas in the way I did and to look to doctors for answers. I know that it did me a great disservice and even today, the potential for harm is great.

Instead I would rather focus my efforts to encourage individuals who have had particularly difficult or traumatic encounters, especially as children to see themselves in the context of their experiences.

We are not weak when we have emotional turmoil. Our requests for help in processing the past are indicators of the strength of our purpose. We are survivors and we will be strengthened through compassionate understanding and in this way we can be those who break the cycle of dysfunction that only too often has the potential to repeat itself in future generations. For this very reason, I have to be grateful to be where I am today.

My family did suffer and I cannot speak for them. I can only hope that in time, there will be a realisation that I would have done anything to avoid that. Yes, I was a victim but thankfully, I passed from that passive state to one where I was able to take back control of my own destiny.

The challenge I have today, in my working life is to re-empower those who have lost their ability to determine their own future. Clearly this is never going to be absolute, but to live life to the full, self determination without prejudice or judgement will enable the best chance of recovery. Medics like myself have to give up on the idea that we are there to fix peoples’ lives and then, maybe our patients may start to view us as fellows who inhabit the same human struggles as everyone else. That should not take us away from the ability to be compassionate helpers when the ‘chips are down’, rather we must hold on to the hope, that each person will have the strength to survive the darkest night and awaken to the opportunity of a new day.