Intended for healthcare professionals

Practice A Patient’s Journey

Psychotic depression

BMJ 2012; 345 doi: (Published 24 October 2012) Cite this as: BMJ 2012;345:e6994

Re: Psychotic depression

Reply to: A patient’s journey – psychotic depression. BMJ2012;345:e6994

Rebecca, your words alone are sufficient to reveal that your personality should be celebrated (1). I am happy if that is all I get across in this reply.

You have been able to describe most eloquently your experience of serious illness. Having once suffered severe depression I have taken to filmmaking to try and explore this. Not uncommonly, I have found that doctors have remarked that it is inappropriate for a professional to show any side of his real life. Here, the medical profession adopts a detached but ‘unreal authority’ (2). I feel that as a filmmaker and a doctor I can respect boundaries and still be authentic to myself and the world I face.

The psychiatric profession still teaches the subjective-objective divide (3). However one particular aspect of that training troubles me: that the description of symptoms by the patient (“subjective”) is less valid than the interpretation (“objective”) by the expert interviewer. Your story, jointly submitted with Professor Lawrie, reminds us that it could never be ‘wrong’ to reveal the patient-side story.

‘In Another Light’ the Scottish novelist Andrew Greig writes “sometimes you go to do something wrong knowing its right.” (4) Perhaps ‘wrong’ is not the right word, but it is certainly difficult, and risks the disapproval of some medical colleagues, to be open about one’s experiences as a ‘patient.’

I hope that your account will encourage healthcare professionals to examine how their own reactions and assumptions can contribute to stigma, which is the one aspect of illness which continues when you are not ill.

(1) BMJ2012;345:e6994 A Patient’s Journey - Psychotic depression Published 24 October 2012

(2) Gordon, Peter, Window Tax. Mental Health and social Inclusion VOL. 16 NO. 4 2012, pp. 181-188 (will appear in print in November 2012)

(3) Beveridge, Allan, Time to abandon the subjective-objective divide? Psychiatric Bulletin (2002), 26, p101-103

(4) Greig, Andrew In Another Light Published Phoenix; New Ed edition (2005)

Competing interests: No competing interests

27 October 2012
Peter J. Gordon
Consultant Psychiatrist for Older Adults
Forth Valley