Medicine’s stigma of mental illness made me hang up my stethoscopeBMJ 2022; 376 doi: https://doi.org/10.1136/bmj.o331 (Published 07 February 2022) Cite this as: BMJ 2022;376:o331
- ex-paediatric ST5,
- currently working as a primary school teacher
- Twitter @doc_bipolar
I was a paediatric registrar driving home from an afternoon spent carrying out child protection examinations. At the traffic lights, the red light turned to green and the driver behind me honked their car horn aggressively. Jolted awake, I chose to ignore the fact that I had now fallen asleep at the wheel four times in the past two days. I was in the midst of a depressive episode and plagued with anxiety, but I went to work with a smile. I was fine. I had to be. Two weeks later, I was signed off of work by my psychiatrist. As I left the appointment, I mentally listed the endless reasons why I couldn’t possibly take time off. The shame and sense of failure I felt were overwhelming. I phoned my clinical lead and explained the situation. His first words: “When will you be back?”
Like many doctors, I had tried hard to conceal my history of mental health problems at work, preferring to live in silence than to risk professional prejudice and disgrace.1 Passing comments I had heard during patient handovers and derogatory phrases used by doctors such as “crazy,” “mad,” “attention seeking,” or “psycho” had made me recoil even more from disclosing my struggles. In all the areas of medicine that I had worked in, an undercurrent of stigma attributed a level of blame to those with mental illness, as though it was somehow self-inflicted.2 Not knowing how else to manage these attitudes, I internalised them, growing to believe them to be true. I was weak and should indeed be ashamed.
Self-stigmatising views are well documented among doctors and form a major barrier to returning to work after time off with physical or mental illness.3 This was no different for me. Three weeks off sick turned into 11 months, during which time I convinced myself I would never practise medicine again. I became the patient: therapy, medication, appointments. Yet with support and a well planned phased return, I successfully went back to paediatrics. I worked regular shifts with no out-of-hours for a year, proving to myself that I could indeed be a doctor again. Yet in order to complete my training, I was required to recommence night shifts and change hospitals—things that I knew were not good for me. Feeling undervalued and unfulfilled, I began to contemplate a career outside of medicine.
Like many doctors, I found it hard to imagine a different life for myself; my training had been so niche and my language was so full of jargon. Yet as medics we have a multitude of transferable skills, and so in 2019 I hung up my stethoscope to retrain as a primary school teacher.
In March 2020, along with the 15 000 other doctors who had left the GMC register or given up their licence in the past three years, I was asked to reinstate my registration in order to provide medical assistance during the covid-19 pandemic. I was halfway through my teacher training and knew I was not emotionally resilient enough to return to a completely overwhelmed NHS so I opted out. Guilt and cowardice consumed me. Instead, I homeschooled my children and continued my studies, watching the well documented emotional and physical toll that the pandemic was taking on my medical colleagues.45
There is no doubt that my experience as a paediatrician has shaped the way I teach and communicate with pupils and their families. The relationships that I have with the children reflect the empathy that I showed to my patients, and colleagues have commented on how pupils with additional needs benefit from my medical background. Although I now have a new career, being a doctor is still inextricably part of who I am. This core sense of “medical self,” described by Clare Gerada in her book Beneath the White Coat,2 is and always will be part of my identity.
As we begin to emerge from what has hopefully been the worst of the pandemic, I find myself contemplating returning to medicine. Yet I worry about whether my mental health will survive in a culture where stigma still prevails.
At a time when more healthcare staff than ever are likely to be emotionally and mentally depleted, we must focus on creating safe environments where health professionals can be supported to talk and reflect on how they feel. There are resources and guidance out there on how organisations can reduce stigma and encourage conversations about mental health, including tackling ignorance, opening up the conversation, and using personal testimonies to normalise mental health struggles.6 Several services also provide NHS staff with online, confidential peer support groups that are facilitated by an experienced practitioner, which have proven successful during the pandemic.78 NHS trusts and other healthcare organisations should highlight these services to their staff and continue to find ways to promote an open culture about mental health.
This pandemic should put an end to the myth that our healthcare workers are somehow invulnerable to the frailties that are an inevitable part of being human. We are not, and never were, superhuman. Talking was what saved me. And by revealing a more vulnerable and honest version of myself, the people around me felt able to share the parts of their lives that, up until then, they had chosen to conceal. Many healthcare staff will be feeling grief stricken and defeated by the events of the past two years, yet workplace stigma around mental health will only make this worse. It is only by talking that we can start to break down these barriers and begin to heal.
Competing interests: I have received care from NHS Practitioner Health.
Provenance and peer review: Not commissioned; not peer reviewed.