'Doctors can't be depressed'
What happens when a medic has a mental health problem? Dr Liz Miller found out the hard way
Tuesday 13 October 2009
Liz Miller was a doctor. Then she became a patient. No surprises there – people from all walks of life fall ill. But if you are a doctor it is different, and if it is a mental illness you are suffering from, it is doubly different. There is a sense that you have let the side down. When a doctor falls ill, the medical profession closes ranks and goes into collective denial.
"Doctors are brought up to think that they are different from patients. You have to believe you are not going to catch the diseases you are treating. It was part of the macho attitude in medicine – the attitude that a doctor who fell ill had breached a tradition, fallen from grace. It simply wasn't done."
Dr Miller's illness, manic depression (now known as bipolar disorder), struck in her late 20s and has shaped her life. But what has shaped her career was the way the medical profession responded to her illness – with incomprehension followed by rejection and denial. She responded by setting up the Doctors' Support Network for others in her position, and by writing a book – a guide to avoiding mental illness without the help of doctors, by noting your feelings and acting on them – something she says the medical profession signally failed to do for her. "If they had been nice to me, I need not have done any of this. It would have saved me all the trouble," she says.
Liz was 28 and training in neurosurgery in Edinburgh when she had her first breakdown in the mid-1980s. She was doing research on sodium metabolism, speaking at international conferences and had a promising career ahead of her. One professor called Liz "the brightest young thing in neurosurgery" in a decade.
"That was when things went belly up. It was a combination of things – I was the only woman in neurosurgery, I had found it difficult to settle in Edinburgh, my brother was going through a divorce, all my support network was swept away. I got depressed. Looking back I probably always had a tendency to depression and had not realised it. That was just how it had always been. Then I became manic, I stopped going in to work and I got sectioned. I ended up in Edinburgh Royal Infirmary."
It was the first of three breakdowns that led to Liz being placed in a locked ward in one hospital after another for her own safety. Her career in ruins, she struggled for a decade to get well and back into work, working as a locum GP and as an accident and emergency doctor, before the next breakdown put her back in hospital. It was a bleak time.
She ended up in the Bethlem Royal Hospital, one of the last true asylums in England, set amidst several acres of parkland in Kent. There she met for the first time other doctors with mental health problems like her own. It was a revelation. She realised that she had been colluding with the profession to deny her own illness, because that was a way of getting back to work and carrying on. Meeting other doctors afflicted by mental illness helped put her own problems in perspective.
"If there is a stigma and prejudice against mental illness in the outside world, it is 10 times worse in the medical profession. A doctor in a mental asylum is like a policeman who gets sent to prison, or an accountant caught fiddling the figures. I had always been proud of my brain, my ability to think on my feet and to know what to do regardless of what was going on around me. But having a mental health problem goes to the core of who you are. If you break a leg, that's a problem with your leg. If you have a mental illness, that's a problem with you." Liz was helped by what she says were the first truly empathetic psychiatrists she had come across in her perambulations around the mental health system.
"Psychiatrists tend to observe patients – they don't engage with them. I have met nice psychiatrists. One was a junior doctor called Raj Persaud – before he became well known as a writer and broadcaster. He was good at talking to patients and engaging with them. He was a good communicator and he tried to put things in context."
Feeling, possibly for the first time, safe and accepted, she finally acknowledged that she was ill, that her medical ambitions were dust and that she might never be able to work again. "Everything I had worked for had gone up in smoke – I had blown everything. Depression seemed appropriate," she said.
Liz's route to recovery began with the establishment of a self help group for doctors like herself. It was the mid-1990s and she and a colleague, Soames Michelson, put an ad in the British Medical Journal with a telephone number. They got scores of replies but when they went to see the Royal College of Psychiatrists to enlist the college's help, they were brushed aside.
"We told them lots of doctors were affected but they replied, 'Oh no, I think you'll find you are the only ones.' The profession was in complete denial," Liz says.
The Doctors' Support Network was the result which has now been helping doctors in difficulty for more than a decade. It has also contributed to a changed attitude within the profession, she says. Nowadays mood disorders are talked about more, both within and outside the profession, and there is a greater acceptance that doctors are prone to them like everyone else.
There is still, in her view, more to do. She is critical of the General Medical Council , the doctors' disciplinary body, which recently reformed its fitness to practice procedures. "In the past, doctors whose health was affecting their work were siphoned off into a separate stream by the GMC for assessment and treatment or removal from the register. Now, they have put them all together, examining whether their performance and skills are up to scratch, whether their behaviour is appropriate and whether their health is OK – and I think they are very different.
"Three friends of mine committed suicide while under GMC provisions. They were among nine doctors who took their own lives out of 214 who were under GMC provisions in 2004. If that had been an intensive care unit there would have been an investigation. I don't think that needs to happen. There has to be a better way."
Liz's own recovery – once she had accepted what she had lost, which was the hardest part – began when she joined the Manic Depression Fellowship, now called the Bipolar Organisation. She started as a volunteer, doing one morning a week. Then with the encouragement of the chief executive, Mary Fulford, she got involved in the self-management programme – which she describes as "the single greatest advance in the management of bipolar disorder since the discovery of lithium". The breakthrough came when she was asked to write a column for the Fellowship's magazine, Pendulum. "That was a lifeline. It enabled me to feel useful again. I hated medication, it always made me feel bad, and I wrote about looking for non-medical therapies. They were scientifically researched but not drug-based. At the same time I was setting up the Doctors' Support Network, talking to people, having parties and writing. I looked at my life and realised that I was doing everything I wanted to do – I just wasn't getting paid for it."
From those beginnings she gradually rebuilt her life. She taught herself how to manage her moods, and has not taken drugs for her condition for eight years. The key was accepting that she was responsible for them, she says. She now works as a part-time occupational health doctor and GP. She was supported by her husband, Richard, of whom she speaks with affection and gratitude for the support he showed through her illness. But eventually the couple separated and for the last three years she has been living with her new partner – a key factor, she admits, in her new-found equilibrium.
In 2008, Liz was voted Mind 'Champion of the Year' by the mental health charity, in recognition of her work at the Manic Depression Fellowship and her writing in Pendulum. She was also a central figure in Stephen Fry's documentary series The Secret Life of the Manic Depressive and now counts him as a friend along with the doctor and comedian Phil Hammond, who has supported her efforts "from the beginning".
Her book's message to the public and to the medical profession is that the way to mental health is to spend a little time focusing on how we feel and why we feel the way we do. Only then can we start to do something about it.
"I would dearly love to have that in the culture. It would help to give people control of their mental health instead of going to see counsellors or getting drugs from the GP. Understanding this has given me the tools I needed to change my own life."
'Mood Mapping', by Dr Liz Miller, Rodale, £12.99. To order this book for the special price of £11.69, with free p&p, go to Independentbooksdirect.co.uk
Heal thyself: Learn mood mapping
Dr Liz Miller explains how she learnt to take control of her mental health.
"Mood mapping involves plotting how you feel, against your energy levels, on a chart. I started asking myself how I felt because I wasn't good at understanding my moods. It is much easier to manage your moods while you are mildly upset than when you are seriously distressed. I wrote a diary four times a day and found what really mattered, how good or bad I felt, and how much energy I had. That gives you four moods – action, anxiety, depressed, calm.
"These are in turn influenced by five key factors: your surroundings, your physical health, your relationships, your knowledge, and your nature. If you are aware of your moods, when things start to go wrong you can do something about them. I realised that mood disorders are extreme variations of mood, rather than being separate from normal experience.
"Moods need to be balanced and managed. If you are not managing your own mood the chances are that someone else is, whether it be your boss, your partner, the Government or the advertisers who catch your attention at every turn. Getting control of your moods is uplifting and empowering – keeping control of them is life enhancing."
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