DOCTOR HEAL THYSELF

Below is an article in the British Medical Journal by an anonymous doctor who explains why he cannot admit to having a serious depressive illness.

WHY CAN'T I ADMIT THAT I AM UNWELL?

British Medical Journal 24 August 2002)

During the past four years I have worked as a full time doctor. I have completed a one year diploma course, trained in two new specialties, and presently have three different clinical roles. I have listened to and counseled many patients, worked with many colleagues, and have a reputation for being efficient, capable, and versatile. However, also during this time, unknown to anyone except my close family, I have had an extremely severe depressive illness.

I have made two serious attempts on my life, which have left me with permanent physical sequelae. I have fought off an attempt to section me under the Mental Health Act, and I have taken a battery of antidepressant/antipsychotic drugs that left me desperately tired and sick. Despite all this, I have remained at work. I have managed by becoming a professional automaton

There are several reasons for this. Firstly, I am and have been too ill to stop. I have a chronic suicidal pain condition, which has been linked with a type of post-traumatic stress syndrome. The main feature of this condition is an unremitting urge to end my life. It has been present in all my waking (and sometimes my sleeping) hours for the last four years. While attempting to maintain a relatively normal exterior, I have been battling with intrusive thoughts, imagery, and impulses to bring about my own extinction. At any moment when I am not occupied, I am at extreme risk of inflicting serious harm upon myself

Secondly, I have stigmatized my own condition as it is a "mental illness." I have been, and am, too ashamed to tell my colleagues. Lastly, and most significantly, I have always considered that it was my place in life to achieve. If I give in to what has happened to me, I will perceive that I have failed, and failure will be terminal for me. I can only liken my existence during this time to a living agony, hell, nightmare, torture in fact there are no words with which I can describe my life adequately. I have woken every day preoccupied with thoughts of killingmyself and yet terrified that I might. I cannot do it. I have two growing children who wave goodbye to me every morning and expect to see me every night. It does not occur to them that while they are at school I might end my own life. I have been, and am, desperate, desolate, lost, lonely. Yet, every day I face friends, patients, and colleagues at work.

How have I achieved this? I have managed by becoming a professional automaton. Every morning at work, I present the expected image and behaviours that I have learnt and depended on over the years, and that have become my professional identity. I have become very good at this. Outside this role I don't really know who I am.

There are several reasons why I needed to write this piece. Firstly, I need people especially my colleagues to know that I am suffering, but I cannot tell them because it is ingrained in me somewhere that doctors do not have these sorts of problems.

Secondly, I wonder how many doctors out there are also carrying on like me, battling from day to day with their problems. If there are many, I wonder why. What makes it so hard for us to admit that we are not well, to admit that we should go a little easier on ourselves? Is it the training? Public expectation? Fear of condemnation from our colleagues? Or are we just driven people? As with most problems I suspect that it is a combination of them all.

Thirdly, part of my need to write this is to thank the people who have devoted part of their lives to me. Although I have not been able to go public, I have been supported by a small group of people who have handled me with untiring care, concern, and understanding, and without whom I would not be here. One of these is my own general practitioner, whose empathy and support have been unwavering and who I have really needed to "be there." Another is my community psychiatric nurse, who has been solidly at my side through many a dark moment, and whose thoughts and ideas have sustained me from week to week. And yet another is my psychiatrist, who has arranged many an appointment at short notice. I also thank my husband and family, who have battled to understand me, and lastly my partner, who has loved me, talked to me, cried with me, and sat awake through many nights with me without complaint.

Writing this has not made me feel any better, as I hoped it would. But if anybody reading this is suffering as I am, then I hope it is a comfort to them to know that they are not alone. Maybe one day I will be able to give myself a break and admit to my colleagues and friends that I have a problem. I am working towards this.

My initial thoughts were to write this story in a dark, humorous way to ensure entertaining reading. But when I thought about it, I realized that it really wasn't funny.