Psychotic depression

This is a truly moving and motivating journey Dr. Lawrence that you have shared with us. The struggle and the strengths of your personality are not concealed at all. Every episode that you’ve mentioned, seemed just enough to stop everything for you, but you took it as a mere break and moved on with vigor, repeatedly, and succeeded on every step, an example not too common indeed.

It certainly is a journey with many different dimensions to it. Though I do not have firsthand knowledge of any psychiatrist in such a situation, but when one of my admitted patients told me that the unit’s staff was talking about them, I wondered if it is part of the disorder or just the truth. It is not uncommon in our setup either to discuss patients, for purposes other than learning, and the insensitivity sparkles through these conversations, and this is not limited to the mental health care providers. Very frequently, admissions of severely disturbed patients are refused by their families, due to the presence of other comparatively less disturbed patients in the ward - our child’s illness will worsen under their influence, say parents of patients with mania, for example. Yes, mental illnesses are stigmatized, but do we not contribute to it? One thing that needs to be learnt and taught in its true sense is empathy, and this should come naturally if we can imagine being in patient’s shoes for a moment, if not more.

Very frequently in our early years of training, we try to find the textbook presentation of different disorders in our patients, and more often we come across those who have the vaguest complains. It used to leave me pretty frustrated when I won’t have my core symptoms at hand to make a diagnosis. But reading through your experience reinforces the fact that the feelings(whether suffocation, sinking, or blackness) need to be addressed, not only during an episode but also later, as the guilt which we may be looking for, to help us reach a diagnosis, may prevail later on as a reaction to what was actually lost or missed during illness and burden the patient immensely.

I am delighted to hear of Rebecca’s success story. I too experience recurrent major depression with psychotic features but have a very different story to tell. I worked as a senior SHO in paediatrics when I became ill and needed time off from work and eventual admission to a psychiatric hospital close to my home. Because of my previous depressive episodes as a teenager I was unable to get income protection and was forced to consider all my medical subscriptions. I made the worst decision of my life at that time. I took my name off the GMC register to save money. I was assured I would be able to register again within a week of me applying so it seemed a sensible move. However, on re-applying I told the GMC of my depressive illness. I was forced to go before a panel to assess my medical fitness for work. I was declined re-registration despite NEVER having had any problems with my work. I believe the GMC took on, wrongly, the role of the occupational health physician. I ended up being out of work for four years due to this, after which time my knowledge and skills were rock bottom and I struggled to survive in work despite a very supportive senior colleague. I was forced to retire from NHS practice as a result. I believe, had I been able to return to work sooner that, while the transition back into the workplace would have been difficult, it would have enabled me to catch up and enjoy the vocation I felt called to. While I am pleased to hear of this story I wonder whether the GMC looked at Rebecca’s case in the same way that they assessed my own.

Dear Dr Lawrence

I would like to commend this very amazing account of your experiences as a consultant, a trainee, a mother, a wife, a service user and most importantly, as an individual. I commend your being able communicate the insecurities, confusion and key experiences that we unfortunately sometimes miss as physicians in the care of our service users. I also commend your success in pursuing your desire to be get to the top of your career as a consultant despite potential concerns about prejudices among colleagues. Well done to the support network of your husband, your family members and your care team.

Your account would definitely contribute to improvements in my practice: well done

In fact Mike Shooter, whilst still president of the college of psychiatrists, published an acount in BMJ June 14th 2003 which included a description of his own experience of depression. It must still be a very personal decision though, people need to weigh up their own circumstances when the possible consequences are still all too predictable for most. It is also the case that individuals have different needs for privacy in general and do not feel comfortable about disclosing areas of private lives. The college as an institution is probably not going to lead the way as shown by the need to set up exclusive and better facilities for their own members. Obviously when anybody is unwell they want the best they can get but it hardly helps to break down the 'them and the rest' barriers.