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When my depression started it was the most physical event of my life, the sensation was like a sharp knife cleaving my brain in half and the feeling of being drained through the soles of my feet.
I was a GP at the time and had been feeling increasingly stressed for the previous 12 months or so, with a plethora of fleeting, yet consistently unpleasant and worrying physical symptoms – mostly gut-related.
I took six months off to deal with my depression in 1986. Everyone in my practice was wonderfully supportive and understanding and I learned a lot about what matters in life.
Relationships and actions had no meaning, leaving only an increasingly exhausted will and lifeless body to force through the motions of day-after-day pointlessness. It also felt like a bereavement, because I had lost my fun-loving and compassionate self.
My psychiatrist was brilliant. His first intervention was a home-visit the very day I had to stop work on which he gave me a huge non evidence-based hug (he was a bear of a man) and told me he had every hope of my excellent recovery.
He said: ‘We will help you put your armour back on, Chris,’ and I knew even in the depth of my sheer fear and hopelessness, that he meant it. I was given hope and the expectation of recovery right from the start.
His support was unstinting and regular. He treated all his patients like this, with frequent visits and cups of tea and diverting conversations about medical dissidents in Russia.
My community psychiatric nurse, Tony, visited me every day, often for up to an hour during the first weeks, once again, tea, biscuits and a walk round the garden were de rigueur.
Recovery takes time and as is often stated is a journey not a destination. In terms of my life and work since 1986, I have learned that you get experience the day after you need it. This is precisely why caring and experienced others are so important in all our lives, especially during periods of distress and illness when our own resources can desert us.
I left general practice in 1999 to work in the mental health third sector, becoming chair of Depression Alliance and setting up the charity Primary Care Mental Health and Education.
I have enduring concern for the health and wellbeing of medical students, doctors and their training in the interventions and practices that will help them to look after themselves for life. Sometimes I wonder if I went into medicine to sort myself out; I do view my ‘version’ of depression as not just a cluster of symptoms or syndrome, but a necessary catharsis to enable ‘me’ to throw out a lot of unrequired junk. I have been even more productive since, which is why I believe that every life is precious and there is always hope.
I hope that as you read this, you will reflect on your own health and its importance to your life and work.
It was my experience of depression that led me to do what I did next in life and I cannot over-emphasise enough the importance of feeling held by compassionate and competent people at such a time. This is why I support the U Can Cope NHS Change Day pledge (see below).
If we can help the most vulnerable in their hour of need and our training and services are designed to help us to do so, then we can help anyone.
Chris Manning is chair of the faculty for mental health at the College of Medicine, a charity which promotes holistic, patient-centered healthcare, and director of UPstream Healthcare.
He was writing in favour of the pledge made for NHS Change Day on March 3 by the U Can Cope campaign, which is supported by Connecting with People, an organisation that provides free online resources and training in building emotional resilience, mental health awareness and suicide awareness.
The pledge says: ‘I pledge to develop my wellbeing and emotional resilience and encourage those around me to do the same.’
Dr Manning can be contacted at: [email protected]
Chris - a heartfelt thank you for sharing your incredibly painful and personal experience of depression with everyone. Your story of recovery is vital to give hope to others - as hope is one of the most important aspects of care I am sure you will agree. Your blog also highlights how compassion is utterly fundamental to care and you so often say to me ‘it may not be rocket science but it is rocket fuel…!’
I am delighted that you are so publically supporting the U Can Cope NHSChangeday pledge and would urge others to do the same. It is particularly important for people working in the health and social care sectors as we do not always look after ourselves. Stress and mental health issues are the commonest reason to be off work in high pressure work environments and the second biggest occupational health problem in the UK after musculoskeletal (back and joint) problems. This is in the context of a global rise in suicide rates. Because there's still a stigma attached to stress and mental health problems, people are often reluctant to seek help in case they're seen as unable to cope. This is particularly so for doctors. This must change and to quote my Expo talk yesterday ‘Not only do we need to tackle stigma we need to eradicate stigma’.
Please join Chris and me in the U Can Cope NHSChangeday pledge!
Thank you for a moving account of your illness. You were lucky to have a supportive team who were willing to offer personal contact. All too often psychiatric colleagues seem to feel that all that is needed is advice to use an antidepressant and then advice to change to another when the first, or second or third is ineffective! Review intervals may be two months, well beyond the time it takes to know if any pharmacological change is effective. The sympathetic management of depression is an ideal challenge for GPs but we could do with some of the resources currently buried in local Mental Health Teams.
Firstly, I would like to thank Chris for describing his depressive episode. Working in the field, I can confidently say that a very important, good prognostic outcome is support. Simple activities of daily living seem like enormous tasks. Continuous reassurance , support and psychological interventions are of paramount importance in addition to an antidepressant. However on the N.H.S waiting list it takes on average 12 months if not longer to see a psychologist. Since management of all people with a mental disorder require this multidisciplinary approach it's not always available. When reviewing a patient after 2 months, like Dr Shaw mentioned, a Psychiatrist will think of an alternate antidepressant, if the first had no effect since 'the ideal' treatment at the time when most needed is not available. So unless a professional has worked with the demands on Psychiatrists, I don't think it's fair to equate prolonged morbidity of people with a mental disorder to a Psychiatrist's abilities and capabilities.
I thank Chris Manning for all the excellent work he has done.
From my perspective as a GP in North London, the very idea of a lovely psychiatrist visitng a patient, and regular contact with a CPN is a pipe dream. let alone walking in the garden and cups of tea. Our mental health services have been reconfigured to death in recent years, and the mental health workers need more support than the patients they are supposed to serve. You are very lucky if you receive the care you need in my locality. We think long and hard before referring as the patients have to be quite robust to negotiate the increasingly desperate and hostile system.
A great piece - a big chunk of yourself that will help others to get help and to learn to help themselves. Supporting overwhelmed and over stressed colleagues who are often tasked with meeting increasing demand and expectations with a constant smile.
Thank you for your honesty and for your inspiration and for giving people hope.
Bravo, well done Chris, and thank you for standing up for the doctors of the future, the bright young medical students and young doctors, those fun loving, younger versions of ourselves full of hope, excitement, enthusiasm and compassion.
Doctors not coping is the elephant in the room. It gets tossed from pillar to post, from committee to committee, no-one stands up for them. They soldier on from day to day, seeing less of their families, sitting in their offices late at night, coming in at weekends to sort out administration, struggling to fit the important parts of their lives into the shrinking bits at each end of the day, Then even a minor interpersonal crisis coming from left field can totally imbalance them. Can we sort this out? We can, and we can do it now, and people like Chris can lead it. Part of the solution is more recognition of the needs for all those in training and in practice, particularly GPs to be supported in understanding and developing their own wellbeing throughout their professional lives rather than all the resources being poured into a referral model which will not engage most patients. If the doctors understand the factors and the neurobiology underpinning resilience recovery and wellbeing they then see it working for their patients and then they will infuse this understanding into the 60% of their consultations which have elements of emotional distress most of whom never will see a mental health professional, and everyone will win.
More doctors need to share their experiences like this, because there is awful stigma especially against doctors and a lack of support at work. Some occupation health departments are terrible depending on the hospital.
I wish there were people who would visit you every day and make you tea. I don't know where you live but I have certainly never heard of that. Can I have his name and number?
A powerful piece - heartfelt and painful, yet hopeful. Thank you so much.
We must all do whatever we can to smash through the stigma that surrounds both mental illness and doctors experiencing ill health. For our patients and for ourselves. We must also campaign for an Occupational Health service for General Practice that is supportive, responsive and compassionate. Provision is currently at best patchy, at worst (such as in my local area) nonexistent.
I concur entirely with Alastair's comments above. Learning how to build emotional resilience and mental health awareness are essential skills for life that in my view cannot be addressed early enough in a doctor's career. Perhaps starting at Medical School and also incorporated into training for all doctors. Especially pertinent to GPs due to the professional isolation we often experience and the sheer volume of illness, stress and distress our patients present us with every day.
I join you in the U Can Cope NHSChangeday pledge.
Thank you for writing this. I also suffered from depression as a junior doctor, however I probably did not get as much support although my GP was brilliant.
I walked out after a 48 hour shift in 1993, could not stop crying and was signed off and never went back to clinical medicine. I was lucky enough to have very supportive family and friends.
I think I look back with a bit of sadness, as I realise that there must be many more out there who have left clinical practice as they were not fully supported.
I went to Africa on a holiday and was visiting relatives in a village....they found out I was a doctor and brought an array of people/children to see me . I did not prescribe anything, but I could tell them more about their diagnosis and look at the medicines they had been prescribed and tell them how they work. It made me feel it was such a waste of all the knowledge I had. The tannoy announcement of "is there a doctor on board?" always gives me a feeling of guilt if I don't answer.....I wait to see if anyone else turns up...I have been useful on every occasion.
The stigma does remain, I tried a few times to go back to clinical medicine , but the barriers seem insurmountable especially when told "you might get ill again". I was mortified when a secretary told me in an open office, " your job offer will take time to process as you will need to go to occupational health due to your mental illness" ....so confidentiality is an issue ......I celebrated when 5 years passed and I no longer had to declare depression/stress on the form...so yes I have been affected by the stigma....
I think my feeling is " surely I could be trained to do something useful?"....something which would help out other busy doctors.....I used to go to the life support training given by the BMA yearly and get so proud when told I was good at it .....I seriously considered nursing as they seem to have more opportunities
My dream on leaving university was to become a pathologist, but again, I needed to do more time as an SHO.
Due to that episode of depression, my life took a different turn. In the NHS I have done various data , audit, clinical guidance, trials jobs - The difficulty is , I take on these jobs , but my thought processes issues like a doctor.
have also worked in a shop, been a carer, a translator for families going to hospital, met people I might never have met. I have done courses in retail, marketing, I.T. medical law, project management, GCP, Ethics and training. I now working on a helpdesk for a hospital system (another totally new learning curve) . This may sound good to some , but it is such a waste....and they were mostly low paid admin jobs ...and I often do wonder if I had got the support Career-wise earlier on, that I would not be in a more secure specialised position.
I have seen recently in the BMJ (which I still get) many debates about over medicalising depression. I think different approaches work for different people ...I took a pill for 2 years and got better .... it gives me a sense of comfort that it worked before so it could work again...
.......Anything which reduces the stigma is good ... I support you and wish you the best.....
Thanks Chris for walking the talk: ‘I pledge to develop my well-being and emotional resilience and encourage those around me to do the same.’ Your inspiring work helps us all. We are just back from a three week trip to California and an Enneagram Intensive run by Emeritus Professor of Psychiatry at Stanford David Daniels that creates the framework, with Helen Palmer and Peter O'Hanrahan, that sees the gentle breaking down of the outer armour of acquired personality as opening us up to releasing our true gifts in our life. Highly recommended. I am moved by the experience of Dr H Mohamed, where his experience of living with the stigma of depression, is a barrier to living his life more fully with a medical qualification. 'Such a waste' sums this up. And there is ample evidence that living with a predisposition to depression and avoiding further illness is achievable. The key as Chris shows is knowing how to self care and knowing how to avoid the 'down slope' of the performance arousal curve where symptoms and signals predictively arise that we avoid by taking better care of our emotional and physical needs. When will medical staff and others in front line health positions receive supervision? And this provided and developed as part of their work. Wounded healers are a gift, and can enable others to support self development skills and reduce the effects of sustained stress within medicine.
Hope and expectation...key points in any therapeutic interaction, be it doctor, nurse, allied health professional, or the wider support network.
25 years in the NHS giving compassionate 'whole person' care, ended in the blink of an eye due to NHS reorganisation. This took it's toll on me and my family's well-being and health to a very serious point, but 2 years on, a humanitarian visit to a developing country, and completing a MSc degree we are getting back on track.
The whole experience has left me with a passion to research health beliefs and how to harness the power of belief to improve health and well being.
Thank you Chris for your determination...
Thanks Chris for sharing your experiences.I am now 68 yrs of age and retired as senior partner last year in Oct.In the last five months of my retirement,I have gone through my entire professional life of 40 yrs, sitting peacefully in a corner.I have come to the conclusion that I started depression at the age of 24 yrs and it has always been with me perhaps even to day.This is the first time,I am sharing my problem with some one else.Would you suggest that I should see a psychiatrist?,take an antidepressant? or it is just my own natural personality.
As always Chris, you make the most difficult experience a positive opportunity to learn and share.
We have both been to dark places with depression but know that with the support of others we do not need to live there permanently and that, while living with the possibility of depression is not always easy, it does not define us nor what we can do.
Dissociation / association
I thought when I got to the foot of the first page I would be able to finish this. The first page was then deleted.
This is something all doctors should be taught to protect their mental health.
My BP is 120 / 70 at 81 years and never any mental problems after 39 years in GP.
Let me know if you want me to redo it
Tel: 01357 238095 if you want to discuss it.
Thanks Chris, and all above, for sharing your experiences.
Going through it myself at the moment, and not having much fun currently. In the hands of an excellent counsellor (CBT) and marvellous liaison psychiatrist, not to mention a stellar GP (sadly retiring).
Hoping for a productive meeting with management and HR this week - I agree with Dr Mohammed above - I feel I still have much to offer, just not in my current environment.
I could wish for a little more enlightenment amongst my colleagues, but as my therapist reminds me, "that's their issue, not yours". Stigma remains a problem.
Keep on keeping on, to all my compadres out there, and for the "haters" -1:4, dudes, that's all I'm saying.