Tag Archives: Mental health

Drawing myself back together

I wrote the blog below as part of a series curated by the London Arts in Health Forum, on art and culture, health and wellbeing. I and the other Trustees are already excited about 2017’s Creativity and Wellbeing Festival which will take place 12-18th June. Excitingly, an edited version of my blog was picked up by The Guardian, who have published it as part of their #BloodSweatTears series. You can read the article on The Guardian website.

The original blog follows.

Talk of low morale and burnout abound in healthcare [1,2]. ‘Resilience training’ has been proposed, to ’toughen up’ workers like soldiers in battle, to reduce sick days and enhance staff retention [3]. But as individuals, institutions and the public at large face the fact that healthcare is incredibly stressful work, that our services are stretched far beyond comfort, and that merely telling those involved in intense physical and emotional work to be more resilient doesn’t work, how can we truly support those who care for us to care for themselves?

Last year I gained some personal insight into this question. As a hospital doctor I am used to working under pressure, and had always felt I thrived on it. But whilst taking time out of clinical training to pursue a PhD, I found that I was intensely unhappy and suffering a range of surprisingly physical symptoms: palpitations, early morning waking, nausea, severe headaches, poor appetite, diarrhoea, dizziness, breathlessness and tremors. My day was constantly interrupted by intrusive negative thoughts; I once walked for 30mins with “I hate my life, I hate my life” on a loop of internal monologue that I feared had no end. I listened to podcasts and audiobooks fanatically but could not drown out these thoughts, and no rationalisation of all the wonderful things I have in my life could make them stop. Admitting that I was not merely unhappy in a job was a struggle. Having ‘depression and anxiety’ branded on my medical file, and acquiring a sick certificate, came as a shock. And after taking the very difficult decision to leave the PhD things did not immediately get better. I was convinced that I had ruined my career, and my life, and that nothing would ever be the same again. I felt that everything was pointless, and daydreamed about getting a terminal illness, or caught up in a terrorist incident. I didn’t want to die, but it no longer seemed like such a threatening possibility, and the option to opt out was appealing.

I wanted to get better and get back to a version of myself that I recognised, and I sought help from everywhere I could. I saw family and friends, and cried with many of them. I made appointments with my GP, an occupational health advisor and a career coach. I was pointed in the direction of a service specifically for doctors, the NHS Practitioner Health Programme [4,5], and embarked on a course of CBT, alongside regular sertraline. And I cancelled every commitment in my diary in an attempt to reset and gain some perspective. I woke up one morning at 4.30am and realised I had no commitments and no deadlines, and I asked myself ‘what do you want to do today?’ The answer, it turned out, was to walk, to watch, to draw, and to knit.

I have always loved to draw and make things. As a child I could entertain myself for days on end with paper, pens and scissors. Creativity is a part of myself that I had suppressed and ignored, viewing it as an inconsequential, frivolous hobby. But giving myself time away from work, both physically and psychologically, I made space for the things I love. I went on long walks through the city and took pictures of streetart and architecture. I went to galleries and lost myself contemplating contemporary art. I spent a weekend with my Mum knitting matching hats, sharing the intense joy of making pom-poms and then proudly wearing our creations. I made christmas cards and decorations and gave them to friends. I sketched and doodled, cut, stuck, sewed, crocheted and collaged. As I reaffirmed to myself the fact that I am more than my work, my internal voices of negativity and fear became quieter and I started to recognise myself again.

I am now back at work, and will be full time from April. I am incredibly grateful for the help I received, and cannot recommend SSRIs and therapy highly enough. But I also suggest finding space in life for creativity. I now rarely have a whole day free to make salt dough sculptures, or master cable knit, or learn how to rag-rug. But I do have time to take a photo, to doodle, to complete 5 knit rows of my latest hat, or to write a sad story using only 3 words. Participating in 64million artists January creativity challenge [6] demonstrated that I could weave creative tasks into my hectic work days. They not only activated a different part of my brain, they activated a different part of myself. With the ability to rise above the minutiae of my day and find more joy in simple things, I became more balanced, more empathic and more content.

Having worked hard to restore my positive outlook and some self worth, I am anxious to prevent a relapse. And so I have made myself a number of promises: I will not give all my emotional energy to work; I will take all my annual leave, however difficult it is to find cover; I will say ‘no’ more often to extra work tasks; I will value activities that make me happy but do not have ‘outputs’; I will make space for creativity every single week; I will schedule art in my diary during my time off and will not cancel due to work; and I will continue to talk about how I feel, as this shows strength not weakness [7]. I see these as essential for my self-preservation, but also essential for my effectiveness at work. By making time for the things that recharge me, I am now more effective – a better colleague and a better doctor.

The wellbeing of workers is a subject that is gaining attention. Companies such as Google are renowned for their perks: free food; games areas; gym memberships; massage credits; time for volunteering; and time to pursue ‘passion projects’ [8]. Those of us in the public sector look on enviously as we routinely work unpaid overtime, struggle to do three people’s jobs in one person’s time, try to do more and more with less and less resource, and remember lunch breaks as a distant memory. But some individuals and organisations are taking a proactive approach: workplace choirs are on the rise [9]; and staff wellbeing programmes are increasingly part of hospital Trust strategies and are gaining recognition through the Mayor of London’s Healthy Workplace Charter [10]. There is growing recognition that burnout not only harms workers, but also compromises the quality and safety of healthcare provision [11]. The Royal College of Physicians have produced a number of reports demanding leadership and action, noting that “investment in NHS staff is not an optional extra, but a vital investment in safe, sustainable patient care” [12, 13]. There is good evidence for the effectiveness of the arts in supporting wellbeing [14], and certainly more evidence than there is for resilience training [15, 16]. Intelligent organisations would do well to embed opportunities for arts engagement in career development and staff retention strategies if they want to maintain productive, compassionate, loyal workforces.

 

So, whether you like to write, to draw, to paint, to knit, to carve, to sing, to sew, to jive, to strum, to film or to yodel, I urge you to value your creativity and make space for it in your life. Celebrate the quirkier parts of yourself, and give them the time and respect they deserve. Be kind to yourself, and stay well. I’ll try to do the same.

  1. Doctor’s low morale ‘puts patients at risk’. BBC News, Oct 2016. http://www.bbc.co.uk/news/health-37777679
  2.  Rich, Antonia, et al. “‘You can’t be a person and a doctor’: the work–life balance of doctors in training—a qualitative study.” BMJ open 6.12 (2016): e013897. Available at: http://bmjopen.bmj.com/content/6/12/e013897.full
  3. Doctors need resilience training like soldiers in Afghanistan, GMC head says. Pulse, Jan 2015. Available at: http://www.pulsetoday.co.uk/your-practice/regulation/doctors-need-resilience-training-like-soldiers-in-afghanistan-gmc-head-says/20008855.article
  4. The NHS Practitioner Health Programme: http://php.nhs.uk/
  5. Gerada, C. “The wounded healer—why we need to rethink how we support doctors.” BMJ Careers (2015). Available at: http://careers.bmj.com/careers/advice/view-article.html?id=20022922
  6.  http://64millionartists.com/
  7. Time to Change’s Time to Talk campaign: http://www.time-to-change.org.uk/about-us/about-our-campaign/time-to-talk
  8. An Inside look at Google’s best employee perks. inc.com, Sep 21 2015. http://www.inc.com/business-insider/best-google-benefits.html
  9. Setting up a workplace choir: resources from Gareth Malone and BBC2. http://www.bbc.co.uk/programmes/articles/4TnMw8yMb2Fhf0bT6Z6hH5X/setting-up-a-workplace-choir
  10. Staff wellbeing programmes recognised through the London Mayor’s Healthy Workplace Charter: https://www.london.gov.uk/what-we-do/health/healthy-workplace-charter/award-winners-healthy-workplace-charter
  11. Salyers, Michelle P., et al. “The Relationship Between Professional Burnout and Quality and Safety in Healthcare: A Meta-Analysis.” Journal of General Internal Medicine (2016): 1-8. Available at: https://link.springer.com/article/10.1007/s11606-016-3886-9
  12. Work and wellbeing in the NHS: why staff health matters to patient care. Policy and Public Appears at the RCP, Oct 2015. Available at: https://www.rcplondon.ac.uk/guidelines-policy/work-and-wellbeing-nhs-why-staff-health-matters-patient-care
  13. Keeping medicine brilliant: improving working conditions in the acute setting. Mission: Health Policy Unit at the RCP, Dec 2016. Available at: https://www.rcplondon.ac.uk/guidelines-policy/keeping-medicine-brilliant
  14. The evidence base for arts in health: a resource of the National Alliance for Health and Wellbeing, available at: http://www.artshealthandwellbeing.org.uk/resources/research
  15. Leppin, Aaron L., et al. “The efficacy of resiliency training programs: a systematic review and meta-analysis of randomized trials.” PloS one 9.10 (2014): e111420. Available at: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0111420
  16. Balme, E., C. Gerada, and L. Page. “Doctors need to be supported, not trained in resilience.” BMJ Careers 15 (2015). Available at: http://careers.bmj.com/careers/advice/Doctors_need_to_be_supported,_not_trained_in_resilience

A scarf, a suicide and a sense of perspective

I went out last night. It was cold, and just before I left the house I picked up my favourite scarf from the hat-stand. It’s my favourite for many reasons but predominantly because Miriam, who gave it to me, was wonderful.

Was.

She’s not here anymore. She committed suicide.

We were not best friends. We weren’t even really very close. She was my boyfriend’s best friend’s girlfriend. We would often be at the same social events, would sometimes have tea together over breakfast, and spent a lot of time together waiting around for ‘the boys’. Miriam was a medical student. One day, in the run up to end of year exams, she left the library where she had been studying, went home and killed herself.

Her death was a huge shock. For a long time it didn’t feel real. Even after the memorial service it still didn’t seem possible that she was really gone. I didn’t know how I was supposed to feel, what I was supposed to do or what I was supposed to say. I couldn’t work out how upset I was supposed to be, and what other people would think if I cried or didn’t cry. I couldn’t work out how upset I actually was. I was angry at her for not placing enough value on her own life. I was angry at myself for not having seen her distress. I wasn’t sure if I was close enough to her  to have a legitimate right to grief. I didn’t want her close friends or family to think I was over- or under-reacting. I had no idea how to support my boyfriend or his best friend who had been the ones who had found her and called the police. All I knew was that this was all wrong.

My feelings were coloured by guilt. I am a doctor. Many of those close to her were doctors and medical students. Shouldn’t we have known? Shouldn’t we have seen the signs? Shouldn’t we have been able to do something? When I thought about it rationally I told myself that Miriam didn’t exhibit the classical warning signs. She was an outgoing, popular, successful, busy, kind, generous woman who appeared to be happy. How could we possibly have known? But rationalisations felt weak and pointless.

I recently came across a video in which Kevin Betts  articulates some of these feelings better than I ever could. In it he makes  “the toughest speech of his life” for World Suicide Prevention Day, reading a letter to his dad who committed suicide. Kevin’s message to his Dad is  “I won’t stop.” He means it: to raise awareness about mental health and suicide he ran 52 marathons in a year. In his speech he says he loves his Dad, but also is disappointed in him as he “chose not to be here.” I struggle to know how I feel about this statement. Miriam “chose not to be here” but was it really a choice? How much control did she have over her thoughts and actions? I don’t know.

Estimates based on WHO data indicate that 1 million people a year die by suicide. The data is complex as suicides may not always be recorded as such due to social, cultural and societal reasons. Suicide attempts and suicidal ideation are far more common with 5% of people attempting suicide at least once in their life. The lifetime prevalence of suicidal ideation is estimated at 10-14%. Reports from the  ONS and Samaritans show that in 2010 there were 5,608 suicides in people aged 15 years and over in the UK, with rates highest in those aged 45–74 at 17.7 per 100,000 for men and 6.0 per 100,000 for women.

These data show that suicidal thoughts and actions are astoundingly common. It is likely that we all know someone who has had suicidal thoughts at some point in their life. Yet stigma, fear and misconceptions mean few of us realise this, and still fewer ever talk about it.

Something I found striking from Kevin’s speech was that he felt let down by health and educational institutions. I have treated countless patients in hospital who have tried to kill themselves. I feel like I let them down every time as I am so helpless  as a physician. I patch them up, make sure whatever poison they have taken doesn’t do too much damage and pass them onto the mental health team. I do not think I’m of any relevance to their life, and wish I could do more.

Kevin felt no-one wanted to talk about his Dad’s suicide. But he did want to talk, and continues to do so.

Suicide is not shameful or selfish. It is just a way to die

I think of Miriam often and can’t get past the feeling that if she could only have got through that day, and talked about how she was feeling, she would still be here. She taught me a valuable lesson: suicidal thoughts and actions are not something experienced by patients – they are experienced by people. I hope I never forget that. 

If you are experiencing suicidal thoughts, or know someone who is, please call the Samaritans on 08457 90 90 90 (UK) or Mind on 0300123 3393 (UK).  More information is available at Grassroots suicide prevention