“There is a qualitative difference between sadness and depression,” she says. “Depression affects your ability to get on with life. You get stuck in a mire and you can’t move forwards. It affects your ability to do the normal things in life. That’s different from unhappiness.”
About 1 billion people out of the 7.8 billion on the planet are living with a mental health disorder, according to the World Health Organisation. The risk is especially high at present during the drawn out coronavirus pandemic. In Hong Kong, the prevalence rates of depression in the city are nearly twice what they were pre-pandemic, up from 10.7 per cent to 19.8 per cent, while anxiety rates have more than tripled, from 4.1 per cent to 14 per cent, says Minal Mahtani of OCD & Anxiety Support Hong Kong.
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Consultant psychiatrist Rebecca Lawrence from the University of Edinburgh in Scotland also understands both positions of patient and psychiatrist.
“It has made me think about being a psychiatrist in more ways; for example, the power balance between patient and psychiatrist can go unnoticed by the latter,” she says. She believes her understanding of mental illness as a sufferer herself “makes you listen more, be more interested and inquisitive”.
Similarly, Mike Shooter, a former president of the UK’s Royal College of Psychiatrists and author of Growing Pains: Making Sense of Childhood – A Psychiatrist’s Story, believes his own experience of “a chronic, intermittent depressive disorder has helped, I hope, in the way I have approached my patients and sufferers in wider society. I have a good idea of what they might be feeling and a sympathy for them that may contrast with the way other people have criticised them and the way they have blamed themselves”.
But there are dangers, too, having sat at both sides of the table, he says. “Just because I have been depressed, does not mean I know exactly how another depressed person feels. There will be symptoms in common, but every depression is unique. The patient is an expert in their own illness, and we need to listen to and learn from them.”
We shouldn’t be surprised that mental health providers themselves experience mental illness. In fact, psychiatrists and psychologists present among the highest suicide rates within the medical profession, Gask says.
“All of us are vulnerable,” Shooter explains. “There is no reason why psychiatrists are protected from psychological disorder any more than surgeons are from bodily complaints. But on top of this, it is only too easy for those who listen every day to the distress of their patients to carry that home with them until their underlying vulnerability is compounded by the sheer weight of unhappiness.”
Being a psychiatrist is a “high psychological stress job”, Gask says; it’s intense, short-staffed and an unpopular discipline. It is “stigmatised even within medicine”, which is why, she says, “it’s harder to look for help as a psychiatrist”.
A recent Medscape survey found high rates of burnout among medical practitioners, including psychiatrists. Yet only 20 per cent of those canvassed sought professional help and 16 per cent had experienced suicidal thoughts. Mental health practitioners also have an increased risk of addiction, Lawrence says.There are many reasons a doctor chooses to specialise in psychiatry. Gask was drawn to the profession because of the “performance anxiety” that came with general practice or surgery. “Putting a chest drain into a patient scared me to death. The anxiety never went away.” But she was not afraid to talk to people, to listen. “You find your groove in medicine, your niche,” she says.
Many people opt to enter mental health professions because they want to examine their own, or their family’s, psychological vulnerabilities. Stephen Hinshaw, professor of psychology at the University of California, Berkeley, is a case in point. He describes his experience in his memoir, Another Kind of Madness: A Journey Through the Stigma and Hope of Mental Illness.
Gask says her favourite book by a mental health practitioner who suffered from mental illness is Kay Redfield Jamison’s An Unquiet Mind. Jamison was criticised for writing about her experiences; in an article in the medical journal The Lancet, she said she had been told “that I had no business writing, teaching or seeing patients, despite the fact that my illness was well controlled”.
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Elyn Saks, adjunct professor of psychiatry at the University of California, suffers from schizophrenia, which she describes in her book, The Centre Cannot Hold: My Journey Through Madness. She says the best way to reduce stigma is putting a human face on mental illness and not just showing that it is a biochemical disorder.
“When clinicians come forward with their stories, it goes a long way toward helping people chip away at the stigma,” Saks wrote.
All these doctors make a profound point: we need psychiatrists to help chip away at a stigma not just as practitioners but as brave patients. In coming forward, they demonstrate faith in treatment, and in so doing, help to further treatment for others: their patients. Us.
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