My relationship with my psychiatrist ended suddenly last year. He finished it, not me. Now if this sounds adolescent, it probably is.
I first met him over thirty years ago, and he was my psychiatrist for many of these years. I didn’t choose him, but I didn’t reject him either, which I suppose I could have done. When I say ‘my’ psychiatrist, it sounds quite possessive, but I also refer to my dentist, my optician, my friends, my colleagues, my partner. They all have me in common, but there is something different about a psychiatrist, which I’m still trying to understand.
Firstly mental illness is a profound experience – frightening, at times horrifying, selfish, boring, occasionally illuminating, stigmatising. I grew up in an era where it was definitely something you feared; something that few had, and fewer admitted to. It’s more open and more accepted now, which is good, but I think still possesses that ‘other’ that eludes us; it still makes you feel not right in the world.
When I first became ill, I thought my life was over. I think it is fair to say that I had parents with expectations, and they steered me into a medical career for which I was poorly equipped, and had little aptitude. My mother once said that I always put huge pressure on myself, but I don’t think a child can do that. I wanted to do what they wanted me to do, I felt my life and love was conditional on this, and when I couldn’t do it, I, and they, were devastated. I have never really felt that they believed in mental illness (despite a clear family history), and, even if they did, they were unable to accept that this could happen to me. Even later, I felt that they could not believe that I could have emotions, thoughts, feelings, that were not under their control. They never asked me how I experienced life and illness; in later years they never even acknowledged my illness or treatment. I felt, and still feel, that they did not believe in me, that they saw me as a fraud.
It’s odd, some people will see a psychiatrist once, and never again, and it may still be an experience they remember. Some, with an ongoing illness, will see someone over the years, as I have, and it is often an important relationship in their life. Psychiatrists should not underestimate their effect on their patients, quite apart from any treatment they offer. The first psychiatrist I saw was a gentle man, quiet and kind. I don’t know what he thought of me, but he encouraged, without pushing. I didn’t feel any pressure from him. I liked him, and I was sorry when he retired.
He arranged to transfer me to my recent psychiatrist, who had seen me when I was first ill, and in and out of hospital. That was a time of humiliation for me, of realisation that I would never manage to be a doctor, and that I wasn’t even a very good psychiatric patient. I can’t dwell on specifics, as it’s hard for me to remember them, but I felt different, alien to both doctors and patients.
I think being female and a doctor was still a problem then for some, plus I felt acutely embarrassed about being a privileged failure. For context, my parents were English, not something that mattered, but I don’t think my mother ever wanted to move to Scotland; I think she was frightened by it, and this made her over pushy about being English. Our family was small, a bubble with no surrounding family or community, and she discouraged Scottishness. We weren’t posh, but she would have liked us to be. My father wanted me to be interesting, but largely by being good at things that interested him. Even in my twenties, I was small and young-looking, doll-like, and I liked to read books and play the violin. I didn’t fit in, but not in a good way, not in a fitting in way.
What does any of this have to do with my psychiatrist? Well, a relationship is two-way, he must have reacted to me, as I reacted to him, though I never thought much about it. I don’t know what he was like; oddly, despite knowing him for so many years, I don’t know him at all. I have no idea how I would have reacted to him if I’d met him as a friend, or a colleague.
From the start, I felt criticised by him. Curiously, this sat quite well with me, it was what I was used to. Don’t misunderstand, I am not saying that he did criticise me, but this is what I felt. I felt that he did not believe in my illness, and we ended up having quite oppositional discussions about this. My behaviour was childish at these times – I would say that he thought I had a personality disorder, he would get exasperated and say that he didn’t. I think we could have had better conversations, but sometimes it felt that I could only make my point by adolescent provocation. There was an inevitable power imbalance, and, rather than try to address it, I became powerless.
I don’t know whether I liked him. I didn’t at first, but it was fraught for me, and I think I felt it should be. I was looking for someone to tell me I was wrong, to tell me that I should pull myself together, do something different, and I made him do this, or tried to. He might not have wanted to, but somehow could not always resist what I wanted him to say, or so it seemed to me. Compared with when I first saw him, when I was entirely hopeless about my future, I was now a consultant psychiatrist myself, but he, of course, was now a renowned professor. His work and status enveloped our relationship; mine sat somewhere else. Perhaps things changed with my writing, particularly when I published my book. Unlike my parents, he appeared to value my work, to think it was worth doing.
Almost a year ago, he disappeared. He had told me he might be retiring, and had arranged for me to see someone else when this happened. It was a surprise, but I felt grateful to him for thinking about this. I couldn’t imagine not seeing him, though, and he was rather vague about when he would go, although did arrange an appointment for us to meet up with the planned, new psychiatrist. But then he never turned up to this meeting, and my boss told me he was off ‘for the foreseeable’. I assumed he had died; and although I discovered this was not the case, in an odd way I mourned for him, for this person I never knew.