Personal Views

Tackling stress in ourselves

BMJ 1996; 312 doi: (Published 23 March 1996) Cite this as: BMJ 1996;312:784
  1. None Given

    I can still see the headline on the front page of the paper, “Local doctor on drugs charges.” My father was in court charged with obtaining diamorphine by deception. He pleaded guilty. It was just a step along the way, almost mid-point in over 10 years of chaos. Looking back, it is hard to see when his problems started. Some things in his background made it more likely that he would come to grief—distant parents; unhappy years at public school; wild student days playing rugby and drinking hard; the culture of the officers' mess during national service. Then, with a young family to support, came the pressures of general practice. There was no vocational training. He plunged straight into full clinical responsibility with busy nights on call. He soon felt out of his depth. The senior partner did little work but took the lion's share of the profits. It was not long before my father found the strain too much. He turned to alcohol for relief. When that was not enough he had easy access to narcotics.

    I was about 12 when I first became aware of how bad things were. Erratic behaviour, mood swings, and arguments were the first signs of the downward spiral of his life. My childhood was coming to an end. There was no room for a rebellious teenager in our house. The father I loved and had been so sure of was no longer there.

    His partners gave no support. If they knew what was happening they kept quiet. After a spell in the alcohol and drugs unit of a neighbouring hospital he resigned. We moved away, leaving behind lifelong friends. He found a desk job as a civil service doctor—less stress, no on call, but dull and boring. It did not help. Things had gone too far and his addiction was out of control.

    The next few years are a blur as crisis followed crisis. Some vivid scenes are imprinted on my memory. I remember him in a casualty department, being restrained as he tried to climb out of a cot, drugged and confused, and crying for my mother. Later he shivered in the acute admissions ward of a huge Victorian mental hospital, surrounded by psychotic patients shuffling through the corridors. Long weeks in smoke filled units followed. He would struggle to sobriety only to crumble again when faced with real life. My mother's loyalty and love never wavered. She was the one solid support for us all.

    Drugs were less easy to come by in the civil service. His colleagues became suspicious. They offered no help but called the police. The magistrate gave him a suspended sentence. As he was having treatment again the General Medical Council took a tolerant view.

    By the time the case came to court I was at medical school. The relief of being away from home was almost overwhelming. Calls from home still drew me back. My father tried a variety of unsatisfactory jobs, near home and abroad. He crashed in and out of hospital with depression, drugs and drink problems, and finally a suicide attempt. His liver, perhaps toughened by years of abuse, survived the attack of 200 paracetamol tablets.

    Since then, so far as I know, he has never drunk alcohol or taken drugs again. Our relationship remained strained. He continued to depend heavily on my mother. Before she died last year my father found the strength to nurse her through her short but awful illness. Sharing our grief at losing her, we have begun to talk again. For the first time we have looked back at the past together and, perhaps, begun to understand how we felt.

    Now I am a general practitioner, experiencing the stresses of work and family life. I have been lucky in my choice of practice. My partners are friends and we have always tried to support each other through bad times. But I know from colleagues and press reports that others are less fortunate. It seems that little has changed. Too often we stand by while our colleagues and their families struggle to survive. We spend out working lives caring for others, but neglect ourselves. Fear of losing the respect of their partners and of being forced out of work inhibits many from admitting their problems. Help is often hard to find. There is a confusion of helplines, volunteer counsellors, and advisers. We need a new approach.

    As part of our professional training we should learn to recognise and tackle symptoms of stress in ourselves. Doctors need the support of their peers and easy access to professional help. It will require a widespread change in attitudes.

    The National Counselling Service for Sick Doctors is a confidential independent advisory service for sick doctors. Access to the service's advisers by sick doctors and their colleagues is through the national contact point on 0171 935 5982.

    The BMA has set up a pilot 24 hour counselling service for doctors, which will begin operating on 9 April.

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