It’s come round again, and so have all those feelings which made me feel so ashamed last year. Ashamed, but also slightly uneasy (a bad combination); and it may just be that the cape acquired at grumpyoldwomen.com is fitting me rather better. But crazy socks for docs has this effect on me, and I’m not sure why.
On the surface of it, it’s a great initiative, started in Australia, to raise awareness of mental illness in doctors. On a particular day in June, you wear your craziest, most colourful socks, and start conversations about mental health when others ask why.
So let’s start at the beginning – crazy is not a good word to use. There are plenty of words in the field of mental health which you just wouldn’t use when talking about patients, and to me this is one of them. If students referred to patients as crazy you would take them aside, and explain that this was not appropriate; you might be quite taken aback. It’s possible that crazy sounds better in an Australian accent than it does in Scotland, but it still somehow lacks respect. I speak here as a patient, rather than a doctor – at times when I have been ill, the idea of people wearing “crazy socks” to support me actually sends shivers down my spine. It is not a good thought. I realise this may be an overreaction, but, even when well, it feels wrong. I don’t want someone thinking that wearing ludicrous socks once a year is going to make any difference to all those years of a really quite devastating illness (and I am one of the lucky ones, I am able to work). It makes it trivial, a things of jokes and banter.
Now I know that this is not the intent, and it may be my nature and advancing years that make me see it so, but I still think we need to be careful about buying into these trends. There is some great work going on out there to support doctors as well as others with mental illness. Stigma is being eroded, although not washed away – it still has a firm grip and a shifting form, and we must remain alert to its manifestations.
There is also the question of what these socks are actually challenging. Mental illness has always been experienced by some, and doctors are no exception. Some will develop schizophrenia and other serious conditions that might have happened whether or not they’d entered doctor territory. These people need to be identified, helped and treated; and the barriers that stop this happening (often worry about being weak, inadequate, stigmatised) need to be removed. Some of them are people who might be seen by a layman as crazy, and I’m not sure those socks will change that. Some are people who may don “crazy” gear when ill, and supporting them by wearing hypomanic socks seems to me to be in dubious taste.
But maybe the socks are looking at other issues, including the well-recognised workloads and conditions under which many doctors work. Shift work is the enemy of mental health, and the burdens placed on these young and highly achieving people are often too much. There is huge pressure to succeed, to pass what can seem to be unpassable exams, and a system that tosses them around the country, depriving them of their support systems. These conditions create stress that can be intolerable, and, if combined with other factors and vulnerabilities, can contribute to mental distress and illness, that in the worst cases may lead to suicide. Work stress can be the final straw for some of these doctors, and that is beyond tragic. Anything that can be done to change this must be welcomed. If I thought that wearing crazy socks could really do this, I would create an entire outfit of non-matching socks and wear it, head to toe, every day. But it’s not just my lack of suturing skills that stops me – I don’t really believe that it will. There is a danger that a campaign can become more about the campaign itself than about making changes – and there are too many “days” for this and “weeks” for that for them to remain meaningful.
Do these socks raise morale amongst those who sport them? I think this may be true, and, as such, positive. Chats about mental health may result, either good or bad. Good is supportive, and breaking down barriers; bad may be ill-informed views (even amongst psychiatrists) and anecdotal tales.
And one of the starkest truths is the fact that wearing your socks won’t get you better treatment. It might enable you to ask for it, but you may be left even more disillusioned when you realise just how underfunded mental health still is. The therapies you might want and need, the support you may crave – as health professionals we will try, but we are faced with an ever-increasing tide of distress. Those who are very unwell will get treated (socks probably not a requirement), but anyone viewed as moderately or mildly unwell is likely to face long waits, or deflection back to primary care or other services.
Ultimately, I think those who will be wearing crazy socks will do it for the best reasons, and I know this. I am being grumpy and I know this too. In truth, I support anything that may raise the profile of mental illness and reduce stigma amongst all, including health professionals. This campaign may contribute, although I think the mechanism is uncertain, and the outcomes unmeasurable.
But there was one other thing that was puzzling me a lot, and that was – why June? Woolly socks? I regret that it took me a while before I remembered that it would be winter in Australia, and hence entirely reasonable. So, if this is to continue, my suggestion would be that it is adapted for the northern climes, with either a change of date or garment – and please drop the word crazy.