Driving

Every year the DVLA sends me some forms to fill out. Every year I feel a frisson of fear as I do so, knowing that my psychiatrist will also be asked for his answers to these questions. No lying possible, no bending of the truth. So far, I have been issued with a licence each time, a one-year driving licence. I don’t remember when this started – I passed my test at twenty-two (having sat it once a year from the age of seventeen – don’t ask), and I’ve never liked driving. But I’ve had to do quite a lot over the years, and my only scrapes have involved stationary cars and large yellow pillars (several times), so I’m not too bad. I don’t remember ever being told to inform the DVLA (although I could have forgotten), but I do remember doing so some years ago as I emerged from a depressive episode. I think this was less about being a good citizen and more about lingering paranoia, but ever since then I have had short-term driving licences. This is what happens when you have bipolar disorder – plus a sensible stipulation that you must stop driving if unwell, and only resume after three months of stability.

As a psychiatrist working in addictions (and chronic pain, where some of the prescriptions can make you catch your breath), I have also had a lot of conversations with patients about the same. Some are remarkably blasé, turning up to appointments half-cut and dangling their car keys; some reassure you earnestly that they only ever drive after a night of abstinence (just at the point when their seizure might occur). Whatever the starting place, these conversations are rarely easy. The fact is, that if you are alcohol dependent, you require a year off the road, six months if problem drinking – this is the law, not made up by me, and there are similar rules for drugs. I hate telling people this. They will often rail that their livelihood is at risk, they will be isolated, that they would never have sought treatment had they known this. I am sympathetic, I can’t help it – but I have to stick to my guns. I tell them that they must not drive, that they must contact the DVLA, and that I will have to do so myself if they don’t. It’s a funny rule – I have had people ask whether this would all have been avoided had they denied driving when first asked. The truth is – yes, but it would still have been illegal. And someone might, possibly, have been killed. People think that this is so unfair, as they, personally, will never drink again – the fact is many do. This rules are to protect the general population, not them. 

Some practitioners bemoan the effect these rules have on the therapeutic relationship, and I share that pain until I think of a child being hit by a drunk driver. The pain palls at the horror of that thought.

But these situations are actually quite black and white, if unpleasant to manage. I find the greyer areas far harder, and there are more than you would think. Take, for example, the hypothetical person who tests positive for cannabis, whose only misfortune is to have been screened. Technically, I suppose they should be advised to contact the DVLA, but this is realistically unlikely to happen, and cannabis is used by many in the population. It just happens to also be largely illegal, and I don’t think anyone would recommend it while driving. 

Many people are also on prescribed medication that renders them not exactly at their best. The packets cleverly cover themselves – “may cause sedation, don’t drive or use machinery if so”. Very, very subjective. The thing is, I don’t think you always recognise when you’re sedated. I’ve been on sedative antipsychotics – quetiapine and before that olanzapine – and I often didn’t realize how sedated I was until I’d stopped them (usually against advice, but that’s a different story). I hate being sedated, it really pisses me off, but it’s not always obvious. After a reduction I may think that I’m quite the thing, when in truth I’m a few reflexes short compared to normal. And I’m extremely stubborn – my only saving grace is my natural disinclination to drive, and the fact that I live somewhere well served by buses and my feet. Even then I don’t happily drop my keys for the requisite time, but I do it. 

Following my own experiences – is driving routinely discussed? We are very aware of it in addictions, but even then it can slip the mind. Do people with common psychiatric disorders get told routinely of DVLA regulations when applicable? It is very difficult, not least because of the aforementioned therapeutic relationship, and the uncertainty around milder conditions and treatments. It will be the same in many other areas of medicine – there are probably other clearer conditions (like epilepsy), but many can be nebulous.

And for many of us, there are the aging relatives, who are often far more challenging than a patient. My own parents are still able at the wheel, but I truly dread the thought of ever having to tell my father that he should not drive. But, if I have to, I will. If I had to, I would even tell the DVLA. I have come to the conclusion that, as far as driving is concerned, I’m ok with being the bad guy. In fact, as my seventeen-year-old daughter drove me across town today, I reflected that one day she may well be telling me, and I vow to take notice!

Given all this, I look forward very much to driverless cars. In the meantime I will continue to bang on about the DVLA. I feel for my patients, but there’s no getting round it. I’ve also felt at first hand the fear of the forms, albeit I’ve been fortunate enough to hold onto my keys – for now. Driving is not a right.