How did I make that leap from them to us, or us to them? I was a patient, a not very active patient, but I had become part of that community. It was better than being part of nothing, and I was no longer working as a doctor, with no obvious prospect of returning. My options were limited.
To put it in context, I was a medical student by the age of seventeen and a doctor on the wards by twenty-two. I had always wanted to do psychiatry, but – and this is one of the hardest things for me to admit – I had failed my psychiatry attachment. I never knew why, and no-one ever explained; there was a possibility that there were some personal reasons around this, but I rejected that idea and decided that I was no good. So I trained in general practice without any problems, and was in my GP trainee year when it all went rather horribly wrong. I became pregnant, developed psychotic depression both before and after giving birth, and ended up an in-patient in the same unit where I had undertaken my ignominious medical student attachment. I had ECT, and took and untook various psychiatric drugs. For a while I was a revolving door patient, with a nasty This is Your Life feel to it. I thought I had a personality disorder; my doctors said not, but find me a person with a major mental illness who doesn’t develop resultant personality problems (especially when they have to stay in an in-patient unit), and I’ll be very surprised. Personality disorder should not be all or nothing – in my view, it would have been very useful to have acknowledged my less than helpful coping mechanisms and to have provided support for them. Denying things does not provide reassurance.
There was limited therapeutic optimism about my return to work, and I had a few aborted attempts, which reinforced this. However, after two and a half years I did recover sufficiently to get back. The jury is still out as to why – it could have been lithium, it could have been luck. But I applied for a junior hospital medical post and got it. No support, no phased return, full on-call. I can’t pretend it was fun, and I hope things are better now, although I don’t think this is always the case. I survived, and finished a further grim six months as a GP trainee – done! Except I didn’t really want to be a GP, and had a sneaking suspicion that no practice would take on such a risky financial proposition as me. I didn’t even bother applying.
I was sad, angry, devastated at what had happened to me. I suppose I’d reached an unanticipated personal rock bottom, and felt that I had nothing really to lose. This was the unlikely point at which I decided to cross over from patient to psychiatrist, or at least to try to. It wasn’t made particularly easy; my family was dubious (having seen psychiatry up close), and one of my treating psychiatrists advised against it. I applied for a local job, and wasn’t even short-listed. Rock bottom was starting to look as though there was a little more to scrape out. But I applied for a few more posts, all of which would involve commuting, and was offered a shorter contract than usual in one, and the normal length of contract in the other. I told both panels at interview about my illness; it won’t be a surprise that I took the second.
I don’t want to be too dramatic, but even I am surprised that I got through the next two years. I had a little child, I was working full-time (no other option), I was commuting an hour each way, and on the full on-call rota. I was also working for exams, and lost another pregnancy at twenty-two weeks, less than a year into the job. That was a terrible time. But I was stubborn and determined, and I didn’t want to fail. In many ways it would have been better – for everyone – if I had given up and done something else. It wouldn’t have been failure, but I couldn’t see it then. I am glad now that I got through, but I was too hard on myself, and on my family.
After this, life got a bit easier. I passed my exams, and was able to work part-time closer to home. This was a stroke of luck, involving a job-share. We each had to work six sessions so that we could attend the compulsory educational course, but were only paid for five – I am glad to say that that would not happen now. But at the time I would probably have worked for much less, as this closer job was in the hospital where I had been a patient, and I felt that I didn’t really deserve to work there, and that staff would think this too. I don’t know whether I was particularly over-sensitive, or whether others have also experienced this, and I would be very interested to hear. I have one particular memory of seeing a patient on a ward, who shouted – “she’s a doctor, but she used to be a patient, how’s that?” I had no idea what to say.
But I was lucky in the end, I have had great colleagues and friends, as well as family, and I have been able to become a psychiatrist. I felt shame, embarrassment, humiliation, but I stuck with it, didn’t avoid things, and it got easier. I don’t know what I would advise others – that it can be done, I suppose, but also that you don’t have to do it, and that it’s different for everyone.
A happy ending, perhaps, but it’s not been a one-way journey. My illness has continued, although I am fortunate that I am well between episodes. I live as a pendulum, suspended between patient and psychiatrist, moving one way and then the other. I still think it’s very hard to be both.