AN IMPROBABLE PSYCHIATRIST

‘Rebecca Lawrence’s memoir strikes at the heart of our

understanding of mental illness: What is it? Why do some of
us succumb to it? And how best might we treat it? Written with
charm, wisdom, and empathy, we could have no better guide to
unravelling such mysteries: Lawrence is the sort of person you
would want as a friend as much as a psychiatrist. A poignant
and powerful read.’
Rachel Kelly, Sunday Times bestselling author of Black
Rainbow: How Words Healed Me – My Journey through
Depression

‘Dr Rebecca Lawrence always wanted to be a psychiatrist but

became a patient first. She describes the persisting conflict
between those two roles with brutal honesty: the struggles to
continue with treatment, rumination about the justification
for her diagnosis, and having to face the lingering stigma
around mental illness in the medical profession. Most of
all, she provides lucid insight into the curious process of
becoming a “psychiatrist” – questioning the validity of some
of our everyday professional assumptions in a way that those
of us who have been patients too can so easily identify
with, and those who have not would greatly benefit from
reading.’
Linda Gask, Emerita Professor of Primary Care
Psychiatry, University of Manchester

‘This is a compulsive read and a bold, important book for

anyone interested in understanding more about mental ill
health. Dr Lawrence poignantly illustrates her lived experi-
ence of the impact of severe mental illness in the context
of her work as a psychiatrist and her family life. She also
powerfully reflects on the complexities of diagnosis, treat-
ment, and stigma, and their intersection with the messiness
of the human condition.’
Professor Louise M. Howard OBE, Professor Emerita in
Women’s Mental Health, Section of Women’s Mental
Health, Institute of Psychiatry, Psychology and
Neuroscience, King’s College London

‘This isn’t the first account of “my life as a doctor” – to name,

for example, Alastair Santhouse in Head First reflecting on his
family and his journey into medicine, then psychiatry, or
Richard Taylor’s The Mind of a Murderer, which describes his
understanding more about the previous generations as he
developed his career – or a doctor’s reflection on their work –
think Henry Marsh on work as a neurosurgeon or Suzanne
O’Sullivan on neurology – but what stands out in Rebecca
Lawrence’s book is that she is writing about her own psychiatric
history alongside and woven in with an account of her career as
a doctor specialising in psychiatry.
This is raw material, not glossed over but told as much as
anyone can with a real openness about her struggles when her
life seemed almost unbearably hard – on starting work as a
newly qualified doctor, with a new baby, and keeping her
marriage going with a husband who could be pulled to work
on the other side of the world, plus managing parental expect-
ations and, at the same time, her developing a serious mental
illness. Rebecca clearly sets out the struggle to try and fit in
with the healthcare system and its demands and views on
treatment, and her own wish to avoid being held in hospital
under legal powers, a possibility should she refuse to comply,
and if the risks seemed too high to her carers. There is also
the stigma she faces from medical peers. For example, the
doctor she sees for career advice and who warns her off
psychiatry as a choice, or the consultant interviewers who
initially offer her a year’s post, only to reduce this to 6 months
when Rebecca is honest about her psychiatric history. “Would
an endocrinologist do the same with a doctor who has
diabetes?” she asks.
Although the subject matter isn’t an easy read, there is a
feeling of hope – we know at the outset that this book is a
written by a doctor who has a mental disorder, but also she
has her family around her (see the dedication at the start –
“to Richard and our daughters”) and she clearly makes sig-
nificant contributions as a doctor in practice. No mean feat
for anyone to combine all this. And she’s a splendid writer.
The prose is flowing and the vivid descriptions bring her
story to life.
Recommended for anyone with a mental illness themselves,
or in their family, ultimately for the sense of recovery and of
having a future which Rebecca brings, and for anyone
working in the healthcare service, to bring to life a patient
with a particular condition, into a whole person engaged
in clinical work and with a family around her to care for
and love.’
Dr Rosalind Ramsay, Consultant Psychiatrist | Responsible
Officer | Deputy Medical Director, South London and
Maudsley NHS Foundation Trust

‘Rebecca Lawrence’s An Improbable Psychiatrist is a compelling

work that holds a unique place in the mental health literature
genre. The first memoir to be written by a psychiatrist and
mother with bipolar disorder, Lawrence’s gut-wrenching
honesty is riveting. She eloquently depicts her suffering and
triumphs through the extraordinary perspective of a parent, a
patient, and a highly trained psychiatrist. Lawrence offers
hope to readers that no matter how low depression takes
them, they too can transform their lives into one that’s worth
living. An Improbable Psychiatrist is nothing short of a remark-
able journey.’
Dyane Harwood, author, Birth of a New Brain – Healing
from Postpartum Bipolar Disorder
 An
Improbable
Psychiatrist
Rebecca
Lawrence
Shaftesbury Road, Cambridge CB2 8EA, United Kingdom
One Liberty Plaza, 20th Floor, New York, NY 10006, USA
477 Williamstown Road, Port Melbourne, VIC 3207, Australia
314–321, 3rd Floor, Plot 3, Splendor Forum, Jasola District Centre,
New Delhi – 110025, India
103 Penang Road, #05-06/07, Visioncrest Commercial, Singapore 238467

Cambridge University Press is part of Cambridge University Press & Assessment,

a department of the University of Cambridge.
We share the University’s mission to contribute to society through the pursuit of
education, learning and research at the highest international levels of excellence.

www.cambridge.org
Information on this title: www.cambridge.org/9781009515061
DOI: 10.1017/9781009515078
© Rebecca Lawrence 2024
This publication is in copyright. Subject to statutory exception and to the provisions
of relevant collective licensing agreements, no reproduction of any part may take
place without the written permission of Cambridge University Press & Assessment.
When citing this work, please include a reference to the DOI 10.1017/9781009515078
First published 2024
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A Cataloging-in-Publication data record for this book is available from the Library of Congress
ISBN 978-1-009-51506-1 Paperback
Cambridge University Press & Assessment has no responsibility for the persistence
or accuracy of URLs for external or third-party internet websites referred to in this
publication and does not guarantee that any content on such websites is, or will
remain, accurate or appropriate.
..................................................................................
Every effort has been made in preparing this book to provide accurate and up-to-
date information that is in accord with accepted standards and practice at the time
of publication. Although case histories are drawn from actual cases, every effort has
been made to disguise the identities of the individuals involved. Nevertheless, the
authors, editors, and publishers can make no warranties that the information
contained herein is totally free from error, not least because clinical standards are
constantly changing through research and regulation. The authors, editors, and
publishers therefore disclaim all liability for direct or consequential damages
resulting from the use of material contained in this book. Readers are strongly
advised to pay careful attention to information provided by the manufacturer of any
drugs or equipment that they plan to use.
To Richard and our daughters
 Contents

Acknowledgements xiii
Introduction 1
Prologue: 1990s, Royal Edinburgh Hospital 3
1 A Medical Student 7
2 A Junior Doctor 17
3 A GP Trainee and a Patient 27
4 Back to Edinburgh 38
5 A Baby 49
6 Admissions: the Revolving Door 58
7 Recovery? 69
8 Into the Fray 75
9 A Psychiatric Trainee 87
10 Lucy 98
11 Back from the Edge 110
12 The Grey Walls 122
13 A Real Psychiatrist 135
14 Substances 148
15 The Unexpected 162
16 Going Too Far? 176
17 Moods and Medicine 191
Afterword: Richard’s View 203
Afterword: Professor Stephen M. Lawrie 208
Glossary 211
Resources 217
Bibliography 219

xi
 Acknowledgements

I would like to thank everyone who has been part of my life, as

family, friend, patient, and psychiatrist, some as a combination
of several of these. I am grateful to you all for your encourage-
ment in writing this book over the last six years.
I would like to thank Jessica Papworth, commissioning
editor at Cambridge University Press, for all her help and
suggestions, and for believing that this could become a book.
I would like to thank my husband, Richard Tipper, for
everything, and for his thoughtful contribution to the book,
and Professor Stephen Lawrie for writing the afterword. I also
want to thank Professor Lawrie and Professor Douglas
Blackwood for being my psychiatrists over the years and for
never giving up on me. I would like to thank Dr Judith Penny,
my GP until very recently at Bruntsfield Medical Practice, who
has always been so kind to me. I would like to thank everyone
who has looked after me as a patient over the years, with a
particular mention to the ECT staff at the Royal Edinburgh
Hospital, without whom I might well no longer be working as
a psychiatrist.
I would like to thank Monica Chakraverty, industry editor at
Cornerstones Literary Consultancy, for her very useful com-
ments on a first draft of this book, and her ongoing work with
me on my next book.

xiii
 ACKNOWLEDGEMENTS

I cannot thank my friends enough: old friends, work

friends, string quartet friends, eclectic readers of South
Edinburgh, and many others.
Most of all, I would like to thank my husband, our extended
families, and, in particular, our three daughters, who have put
up with so much.

xiv
 Introduction

I started to write this book about six years ago, when I went on
a short trip to South America with my partner. He was
working, and for the first time in many years I had nothing
to do. It just poured out, a chapter a day, and, in the evenings,
we talked with each other about what had happened in the
early days of our marriage, and afterwards.
This is a book about mental illness, something I have
experienced as both a patient and a doctor. After experien-
cing severe mental illness myself, I went on to train as a
psychiatrist. Mental illness is why it was written, but, of course,
it is only one person’s story. Mental illness is highly prevalent,
but there are many different mental illnesses, and very many
different people.
My story is, perhaps, unusual in that I was interested in
psychiatry even as a medical student. But I learnt what it was
like to be a patient, an in-patient on a psychiatric ward, before
I learnt to become a psychiatrist. I always felt different, stigma-
tised, even, following this oddly inverted route. As a patient,
I experienced diagnoses and treatment, and saw others experi-
ence them too; later, I tried to understand them, as a doctor
and a psychiatrist. I have had, and continue to have, many
different medications, and even electroconvulsive therapy
(ECT), and struggle with both the stigma and the benefits.
I have been a psychiatric patient for more than thirty years,
a psychiatrist for slightly less. I have a diagnosis of bipolar

1
 AN IMPROBABLE PSYCHIATRIST

disorder, and I don’t think this will go away, although I am

lucky that treatment keeps me well much of the time. I am also
a mother, who experienced loss and perinatal mental illness.
The desire to be a mother and the feelings of grief when it
went wrong were hard to bear and even acknowledge, and
sometimes I think these changed me more than anything.
I hope my story may be of interest to some, and, even more,
of comfort to others. Being able to write and talk about my
illness and experiences, in the context of being a mother, wife,
friend, and doctor, has brought me great solace over the years.
The memories recounted in this memoir are my own and
may be affected by the passage of time as well as by the experi-
ences described, so may not be wholly accurate.
Some names have been changed.

2
 Prologue
1990s, Royal Edinburgh Hospital

I sit in a grey psychiatric ward where nothing happens. From

the window I see a tall stone wall and a few autumn-coloured
trees, just starting to drop their leaves. Inside, the ward is tired
and uncared for, and the smell of stale food hangs in the air.
My clothes are loose, and my hair straggles past my shoulders.
I don’t want to be here, but there is nowhere else I want to be.
I want to be the person I was before I came to this place. I can’t
speak, I can’t even think. I can’t find the words.
The ward is long and grey, with rooms on either side, most
with six beds, all surrounded by faded curtains. There is a
grimy, sweaty smell, partially masked by disinfectant. I lie on
my bed inside my curtains, willing the time to pass. There is
so much time here, and all of it is thick and empty. I can’t
stay here anymore, so I go into the corridor and pace, up
and down, up and down. There is another patient who paces,
but we don’t speak to each other. I catch the eye of yet
another, who glares at me, and hisses, ‘I’m a person too,
you know.’
There are nurses here, but they don’t wear uniforms. I can’t
read the names on their badges, and I can’t remember who
they are. Some patients have a nurse with them at all times,
and I wonder why. One patient has a nurse who goes every-
where with them, even into the toilet. I am frightened by this –
what could they possibly have done that they need this? Is it to
protect them, or to protect the rest of us?

3
 AN IMPROBABLE PSYCHIATRIST

The nurses don’t talk to me much, but perhaps this is

because I don’t talk to them. I’m not surprised, as there is
nothing to say. What do they think while they watch me?
My thoughts crawl fearfully round the room, but they can’t
see them. They think I am the same as all the others. They are
wrong. Or perhaps they are right.
Later, on that same ward, when I am sitting doing nothing
again, I see a group of visiting doctors, people who had been
in my year at medical school. They are psychiatrists, and don’t
expect to see me. I see sudden surprise and pity, and most of
all embarrassment. I’m not a person anymore, and I’m defin-
itely not a doctor. I’m a patient, a psychiatric patient. I feel the
bitterest shame at my continuing existence and want only not
to be myself. Each bit of me, my voice, my skin, my space – they
are all repulsive to me. The realisation that I cannot leave
myself, that I must suffer every long moment here, is some-
thing that I can hardly bear.
They know that I am a doctor, although not that I wanted to
be a psychiatrist. It is laughable now, and I knew this the first
time I stepped into this ward. It will never happen now.
In the evening I follow the others to get our drugs. We are a
sorry queue, shuffling and sad. The pills we take look small
and clean; different colours for different people dropped into
a plastic cup. Some want them, crave the rest that they can
give. Some, like me, dread them. They dull and numb, they
make me bloated, they constipate, and, worst of all, they
don’t work.
The doctors tell me I must have electroconvulsive therapy
(ECT). They tell me that this will cure my depression and that
there are few side effects. They say that I can refuse, but I don’t
believe them. I go with a nurse, down long corridors to a door,
with ECT suite written above it. The nurse holds my glasses,
and everything is a blur, adding to the fear. I can’t remember

4
 PROLOGUE: 1990S, ROYAL EDINBURGH HOSPITAL

much more, as ECT wipes much of my memory from that

time. I don’t know how many times I go there. But every time
I go back to the ward, all I want is to be somewhere else.
My mind is empty, but little curls of worry whisper round
the edges.
As soon as they allow me to go home, I leave. I wait for my
discharge drugs with frustration, such is my need to get away.
In the end they let me go, down another long corridor, this
time pink and exposed, to pick them up myself, and then
we go.
I go home with my husband, and we feel such relief that
I am no longer in that place, that I am no longer having that
treatment. The days are less grey, almost sunny. I stop taking
my pills, because I never was ill, and the side effects are
intolerable. I don’t want to be a psychiatric patient. Life feels
hopeful. But, as the days pass, things change. My fears return;
I know that something bad will happen. I can’t cope with
looking after my daughter, and the old feeling of dread starts
to build. I don’t eat and sleep eludes me, and soon I am back
there. I am a revolving door patient.
I see the look of pity in my husband’s eyes where there used
to be love. What is pity but a reminder of lost joys? I live in the
anguish of false hopes, the fear of never getting better. And
I am angry and bitter; illness does not make me nice.
Depression is selfish, and so am I. I talk of little else – what is
wrong with me? What future will I have now? What hope
is there?
I sit in that grey ward and have no idea.
This is my story about becoming a doctor and then a
psychiatrist. But it tells another story interwoven with the first,
one of becoming a patient with a severe mental illness. I was
admitted to hospital repeatedly, unable to work, or, more
importantly, care for my baby in the first years of her life.

5
 AN IMPROBABLE PSYCHIATRIST

And there is a further story, about the pain of illness and the
joy of recovery for both me and my family. Against the odds
and against advice, I became a psychiatrist myself, one who
continues to work and live with mental illness, and who has
tried to reflect and share these experiences to help others.

6
 CHAPTER 1

A Medical Student

I was born in London in the late sixties, a first child to youthful

parents. I entered the world left foot first, inadvisable even for
a breech birth, and my brother followed fast on my heels the
following year. It was a bold start to a conventional childhood.
My father was a scientist and my mother a teacher, and
academic prowess was valued and expected in our family.
When I was just two years old we moved north to Glasgow for
my father’s work, rather to my mother’s chagrin. It is fair to say
that the Glasgow of the seventies was not the cosmopolitan place
it is now, and my mother made a bargain with my father: they
would stay for no longer than five years. In fact, they never left.
My mother initially tried to instil in my brother and me the belief
that it was good to be English, but I soon learnt that promoting
your own Englishness is not a good way to get through a
Glaswegian school. I am perhaps not entirely Scottish, but I am
definitely not English, and Scotland is my home.
I did well at school, and my mother considered medicine to
be the only sensible option. I wanted to study history, or
English literature, but she firmly discouraged this. ‘You’re a
good all-rounder, you don’t want to do that,’ she said. ‘You’ll
end up a teacher, like me. Much better to do medicine.’
It wasn’t negotiable. I look back now and still wonder why
I couldn’t defy my mother, but I had never been able to risk
her anger or her certainty about what I should do, or not do.
She had wanted to study medicine herself, but her father

7
 AN IMPROBABLE PSYCHIATRIST

would not allow it, which may have influenced her ambitions
for me. I don’t know if I regret it now or not.
But I did what was expected and went east to Edinburgh,
sunlit, grey, and beautiful. I was young, still only seventeen and
technically underage, but identification was rarely sought then
in student hostelries, and youth was not an immediate prob-
lem. In my first year, I was fortunate to live in student accom-
modation on the Royal Mile, in a building surrounding a
courtyard, leaning down towards old Edinburgh and the
Grassmarket. On the other side, it opened right out onto the
Mound, with views stretching across the New Town, as far as
Fife on a good day, when the colours were clear, and the air
sharp. All around was a feeling of academic endeavour and
romance, but reality soon proved different.
At the time when I studied medicine, the first year was
dominated by anatomy. We proudly wore white coats and
had dissection kits; we also had bags of bones to help us learn
their bumps and insertions. Despite our best efforts with soap,
the smell of the anatomy room lingered on our clothes; we
wandered the streets like pale young ghosts in a fog of forma-
lin, perhaps rather fitting for old Edinburgh.
I was shocked by it all. I had never even dissected a frog,
and suddenly, on the first day, we were expected to start
dissecting a human body. Six students were allocated to each
one, and he or she was kept in formalin-soaked cloth wrap-
pings throughout the year, as we worked our way through the
systems. We started on the upper limb, which was bad enough,
but seeing a leg being carried over to the sink underneath
someone’s arm was almost too much for me. My capacity to be
horrified was whittled away during that year by exposure to far
too much dead flesh.
I never could think about our ‘body’ as a person, though,
and I didn’t want to. I couldn’t imagine him as someone who
had talked and loved and eaten, and, curiously, I never once

8
 A MEDICAL STUDENT

thought of him as having a name. I was never aware of any

disrespect, but to us those faded corpses were no longer
people. I think we became numbed too soon to death.
Some of the teaching approaches were bizarre. The anat-
omy lecture theatre, where we went each morning at nine
o’clock, was a lofty building with hard wooden seats. One
lecturer in particular talked rapidly and maniacally, layering
his chalky diagrams to the point of incomprehensibility, and
referring frequently to ‘my favourite pretty orange colour!’
I did badly in the early exams, which consisted of specimens
laid out around a room, requiring rapid and detailed identifi-
cation, and I felt labelled, from then on, as stupid.
This labelling was at least partly of my own doing. ‘I think
I’m just stupid,’ I snivelled to one of my more confident
friends. ‘I can’t do it, it’s too hard.’
He looked at me in surprise. His exam results were no
better than mine. ‘You just need to turn your mind off to learn
all this stuff,’ he said kindly. ‘Don’t worry about it.’ He seemed
to achieve this with ease and quite a lot of beer.
The following year we moved on to neuroanatomy.
We shared a brain between two students (I realise how that
sounds), and I found memorising all the barely discernible
nuclei and pathways even harder than the previous year’s
work. Our brain had a soft cheesy texture and was unexpect-
edly heavy – it was very difficult to imagine the head that had
once encased it, and I didn’t try. I knew I was never going to
shine at these subjects, and it was a relief to me when the first
two years were finished and passed by the skin of my teeth.
Once the torments of anatomy were over, the next three
years of medical school were largely made up of clinical
attachments, both on wards and in GP practices. It was difficult
being a student in these circumstances, as we were often the
spare parts, with no clear role. We also had to look smart.
As girls, we had to wear skirts in those days, never trousers,

9
 AN IMPROBABLE PSYCHIATRIST

with obligatory white coats worn over, these ones fortunately

cleaner than our dissecting drapes.
I had decided early on that I wanted to do psychiatry, as it
was the only medical specialty that really roused my curiosity.
I wanted to understand why people said and did things.
I wanted to know why minds went wrong, and I had enjoyed
psychology more than any other of the science subjects I had
studied. In third year we had weekly psychiatry tutorials; it was
all very different from medicine and surgery, with much more
of the focus on talking to patients, taking a history, and trying
to understand their mental state. I never remember a time
when I wanted to do anything else, despite my early struggles
with neuroanatomy, which was admittedly relevant to the
brain and mind. I spent some of my fourth-year elective on a
psychiatric ward with an older consultant, who encouraged me
to read Szasz, author of the 1961 book, The Myth of Mental
Illness. The patients had quite a prominent voice on that ward,
and I remember sitting in group psychotherapeutic sessions
and hearing them talk and finding it fascinating.
At the end of my fourth year, I had two formal ward attach-
ments in psychiatry. In the first, I was attached to a rather small
unit; it was a bit disappointing in that there were very few
patients, but I did my best to see some of them, including a
young girl of a similar age to me. She had just been admitted
with a first episode psychosis, a severe illness when people
experience hallucinations and can lose touch with reality.
Some recover fully, but others will go on to develop schizo-
phrenia, and early treatment is important. I spent some time
with her. She was hunched on her bed, looking past me at
times, but seemed to want to talk.
‘I can hear them,’ she said.
‘What do you mean?’ I asked curiously. I had no idea what
questions to ask, despite the previous year’s tutorials.
We learnt the structure but not the reality; that takes practice.

10
 A MEDICAL STUDENT

‘I can hear someone speaking, can’t you hear them? It’s the
plugs, they’re speaking through the plugs. They want me to be
here, they made me come here, they’re talking about me.’ She
looked terrified, twisting round and looking out the window.
I looked too, but I couldn’t see anything other than a tall
stone wall.
I tried to comfort her, holding her hand and muttering some
inanities. I was saddened by her distress but also disturbed by it,
as well as interested. I was pleased to see her a couple of months
later outside a pub, looking well, and although we didn’t speak,
we waved at each other across the garden.
I enjoyed that placement, despite the paucity of patients,
and attended an interesting psychiatric meeting at the Royal
College of Physicians in Edinburgh. The psychiatrists were
friendly and encouraging, and I thought that I could see my
future here.
Unfortunately, when I moved on to the next placement, the
psychiatrist there told me that I had failed that previous one.
He was quite young and seemed rather embarrassed and
didn’t know why I had failed when I asked him. It was a
horrible shock. I could accept that my own immaturity might
have contributed, but why had no one told me at the time?
Had they disliked me, without me even realising? Had I done
something very wrong, and not even known? I was left thinking
that my career in psychiatry had ended before it began.
However, I enjoyed that second attachment in a much
busier ward and remember in particular talking quite a lot to
a sweet, middle-aged woman, with a diagnosis of personality
disorder. I don’t think I really understood what that meant,
then, but I liked her. I passed psychiatry overall, but it left me
with something of a conundrum. The one specialty that I was
drawn to, I had – at least in my eyes – failed. I had done worse
than most of my friends, who didn’t even like psychiatry, and
had no idea what to do instead.

11
 AN IMPROBABLE PSYCHIATRIST

The next year I had another unpleasant experience, this

time with a consultant in general medicine. He decided early
on that I didn’t know anything and started asking me ques-
tions all the time, trying to catch me out. One day he stood by
a bed, in front of a patient and other students, looked straight
at me, and asked, ‘Is digoxin a problem in patients who have
high or low potassium?’
This is a drug for the heart, and I felt sure that the answer
was low. But my hands were sweating, my heart was beating,
and I thought, as you do in such circumstances, that it must be
the opposite. ‘High?’
‘Can we have a word?’ he said, and took me aside. ‘I don’t
think you’re up to this, in fact I think you’re ill. Maybe you
need to take some time out.’ His sympathy was more unpleas-
ant than his previous hectoring manner. I left the placement
in tears and was sent to see the head of the medical school.
He didn’t seem that concerned and said that there had been
personality clashes with this particular individual before, not
to worry, and assigned me to a different consultant, where
I passed the attachment easily. Bullying, or gaslighting, was
alive and well in those days, and was largely ignored.
This left me feeling bad, though, and I wonder, looking
back, whether I was more susceptible to such treatment as a
young, female medical student, in a predominantly male hier-
archy. I was also quite pretty but in an ingenuous, unsophisti-
cated way. And although there is much more awareness now,
I remember one of my recent trainees describing a similar
experience, something I found rather shocking.
However, I also had some very positive feedback during my
final attachment in medicine, and shortly after that I found
that I had passed all my exams and that I had become a
doctor. I could hardly believe it.
Work predominated throughout medical school, but my
love life also had a few ups and downs – I think for many of

12
 A MEDICAL STUDENT

us the maturational processes involved in romance were as

important as the academic, and it was a lot to manage all at
once. During my first term, I fell predictably in love with a
fellow medical student, and I think it is fair to say that I cared
more than he did. He wanted to change me, whereas I wanted
him to be him – for example, he wanted me to be taller
(unachievable) and slimmer (unlikely).
When we inevitably broke up at the end of third year,
I wallowed in my own misery and almost certainly bored quite
a few of my friends to tears in the aftermath. Even now I can
recall that exquisite pain, and the agony of seeing him with
someone else. However, it is impossible to say in retrospect
whether this was a normal reaction to loss, or whether it
triggered a depressive episode. Either way, I didn’t pursue
treatment at that time.
Perhaps life and work were all too much, too quickly, but
I found those last years at medical school difficult, and I began
to feel more and more anxious and stressed, unable to cope
with the competing pressures of studying and working on the
wards. Admitting weakness was not an option in the competi-
tive climate of medical school, and I felt that I simply wasn’t
good enough. And I cut my arms with a razor on several
occasions. I felt lost and anxious, certainly, but more simply
unable to control my emotions. I did it secretly, in the bath-
room, and it made me feel better; it relieved the tension and
the anxiety. I did it more than once because it helped. At no
point was I trying to cause any real damage, and I was not then
depressed. But I fast realised that any relief it gave was quickly
lost and that I was left with marks that I hated. Self-harm of
that visible kind led to stigmatisation, even, or perhaps par-
ticularly, from health professionals.
I thought a lot at that time about an old friend, who had
self-harmed badly when we were at school, something which
made an indelible impression on me. It is quite possible that

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 AN IMPROBABLE PSYCHIATRIST

our friendship, and my reaction to her, triggered my own self-

harm, all these years later. Cutting was probably less common
amongst teenage girls when we were young than it is now, and
I doubt I would have even thought of it had I not known her.
To this day I have no idea why, but she was very troubled. She
never explained.
On the bus going home one day, she asked me out of
nowhere, ‘Do you ever want to just not wake up?’
I was shocked. ‘No.’ I looked away and spoke quickly. ‘What
are you doing later? D’you want to meet up?’
One day at school she showed me her leg, scored by cuts,
old and new. She had bandaged them with makeshift steri
strips. ‘I saw an artery pulsing there,’ she said, pointing to
one that was particularly nasty. She seemed quite calm. I was
shaken and frightened. I had no idea what to do. Self-harm
was rarely talked about at that time. She and I went to the same
university, but I pulled away from her, scared by what had
happened. I heard that she dismissed me too, saying that
I had become interested only in make-up and boys. Some years
after we graduated, I heard that she had killed herself. I still
think of her, her gruff voice and her unarticulated pain.
~
There was happiness, as well, though, in those last years at
medical school. I met Richard, my future husband, at the end
of third year. How can I describe him? In the words of another
friend, he was very trendy, largely because he had a sheepskin
coat, played in a jazz band, and had been to Africa to work for
a year prior to university. I was personally slightly sceptical of
these attributes, but he was certainly far cooler and more
certain of himself than me. He was also tall and had a beard,
and he liked me from the start. He didn’t seem to want to
change anything about me, although I felt that the beard and
I were incompatible. We spent many months as friends, and

14
 A MEDICAL STUDENT

then, just before he graduated, the beard went, and our rela-
tionship flickered into something more. The main problem
for me was his plan to work in Mexico, with no return date.
He had studied agriculture and was far more altruistic than I,
going to work with peasant farmers in Chiapas at the end of
my fourth year.
But, despite this emotional turbulence, the end was in sight
for me at medical school, and fifth year passed quickly. We had
a full month off between finishing university and then starting
work as house officers, and graduation was bang in the middle
of this. I graduated from medical school in absentia, in other
words I was one of the few who wasn’t actually there for the
ceremony, having made the decision to go to see Richard in
Mexico. I knew that if I didn’t, I would probably never see him
again. The flight was to Houston, then on to Mexico City, and
I shall never forget that final descent. It was dark, and the
irregularly lit and waving landscape was like a vision of hell, a
portent of something unknown. But I was overjoyed to see him
again. There were never any regrets.
His mother’s sister, an artist, had married a Mexican, and
we visited the family before going down to Chiapas. Richard
had omitted to mention (I think deliberately) that his aunt,
Susie, was a very beautiful woman, and I felt rather horrified by
my post-exam and jet-lagged state. But Richard always made
me feel beautiful. He had tried to acquire a suntan before
I arrived, by working in the fields without his shirt on. And
I was touched by this, if not by the resultant flake fest.
We went on some perilous journeys during that trip, on
buses boasting flashing crucifixes and quite terrible music, but
San Cristobal de las Casas, where he was living, was a lovely old
town in the south, high in the mountains, where it was cool and
fresh. He also took me to a remote place called Kipaltic, where
he had been setting up educational courses. It was beautiful,
with a colonial church front but rather basic facilities.

15
 AN IMPROBABLE PSYCHIATRIST

‘Where’s the toilet?’ I asked.

He looked a bit shifty. ‘Just over here, don’t worry, no one’ll
see.’ It stood, unimpeded by a cistern, or even a door.
I looked at him in horror. ‘I can’t use this!’
‘Well, I usually use the field,’ he admitted. ‘But come and
look at the swimming pool!’
I wasn’t expecting too much by this point, and even he
couldn’t deny the fact that it didn’t actually contain any water,
although there were quite a few dead frogs.
Fortunately, he wasn’t on pyramid-guarding duty at the
time I was there – I was very taken aback to learn later that
this involved a gun, especially as I don’t think he had too much
training in the use of firearms. More prosaically, there are only
so many refried beans one can eat without horrible conse-
quences, and I was rather relieved to get back to San Cristobal.
It was clear that there was always going to be a pull in our
relationship – Richard towards travelling and adventure, and
me towards civilisation and running water. But, despite this, he
decided to return to Scotland for a short while, when
I started work.

16
 CHAPTER 2

A Junior Doctor

Having started medical school early, I was belched out, a fully

formed doctor, at the age of twenty-two. I may be pushing the
youth aspect, but even then it seemed ludicrous that I was
allowed to practise medicine, armed only with a stethoscope, a
tourniquet, a medical handbook, and a hopeful smile.
As newly qualified doctors, we all had to do what were then
known as house jobs before we could become fully registered
with the General Medical Council, and these were anticipated
and dreaded in equal measure. They do things differently
now, with doctors completing two foundation years after
graduation, but our house year was essentially equivalent to
the current foundation year one. The main difference was that
we did six months in each of medicine and surgery, while our
modern counterparts do six four-month posts over two years,
in a bigger variety of specialties.
I remember my first badge – Dr Rebecca Lawrence!
However, I was soon to discover that life as a junior doctor
was no fairy story. As well as a badge, we were given a bleep.
This proved far worse than the badge and disrupted our sleep,
cruelly and frequently. The mark of a doctor, it hung in our
pockets, calling us shrilly at any time of day or night to attend
to problems that we had hitherto never known existed.
My first post was surgical and was made up of three months
of urology (kidneys and the like) and three months of general
surgery. There were four of us working in the department, in

17
 AN IMPROBABLE PSYCHIATRIST

an old stone building in a big hospital. Our duties included

admitting patients, routine investigations, catheterising unfor-
tunates who could not pee, consenting them for surgery,
writing discharge letters, and fielding phone calls.
I remember how excited we were when we were first phoned
and addressed by our new titles. The excitement lasted less
than a day. There was no involvement in actual surgery for any
of us, the emphasis being more on keeping the patients alive
pre- and post-operatively. It was all rather frightening, with
little in the way of induction in those days. Many of our
patients were admitted urgently in the agony of urinary reten-
tion, unable to pass urine often because of an enlarged pro-
state gland. This required immediate catheterisation, or
insertion of a thin tube into the penis and up into the bladder,
and I quickly became good at this, only jumping back in
horror once when the sudden crescent of urine emerged
bright blue.
I dropped the catheter, staining my sleeves blue in the
process. ‘Oh my God! What on earth?’
The perpetrator was unmoved. ‘It’s been like that as long as
I can remember. It’s a supplement I take, it’s herbal, and it’s
always turned my piss blue.’
But there was often a great deal of understandable grati-
tude at the relief of retention, whatever colour, so I suppose
this provided a modicum of job satisfaction. However, it was all
rather daunting, given our lack of experience. There was a
certain amount of camaraderie, but it was not enough.
I came in one morning to find one of my colleagues dis-
traught. ‘What’s happened?’
She burst into tears. I couldn’t make out much of what she
was saying, but something had gone wrong; a patient nearly
died and, worst of all, the consultant was furious rather than
supportive. ‘I’ll never get a job ever again,’ she sobbed. ‘It’s all
my fault. What’s going to happen to me?’

18
 A JUNIOR DOCTOR

I tried to comfort her but was filled with dread. This could
happen to any of us.
We worked a one-in-four rota to cover nights and week-
ends – actually more, as we also covered each other’s holidays –
and the torture of unpredictable and significant sleep disrup-
tion was hideous. When you were on call, working a night
meant going to work one morning and only returning home
the following evening, sometimes after little or no sleep.
In other words, you were available, or actually working, for
around thirty-two hours. You then had to go to work as normal
the next day.
Weekends were particularly dreaded – you had to go in on
Saturday morning and would come home on Monday evening.
Tuesday morning was work as usual, even if you’d had no sleep
at all over the weekend. There were no days off after working
nights or weekends, so on the occasions when you worked a
weekend, you worked twelve full days – Monday through to the
following Friday, including the nights at the weekend, and any
other nights during the week. It was enough to make a non-
depressed person seriously depressed.
Some were lucky enough to sleep between bleeps, but I was
not one of those. I would lie awake, hypervigilant, sweating,
waiting for that call. It could be anything, from a request to
write up paracetamol to a cardiac arrest. Once I got called
about an elderly woman who’d eaten part of a house plant.
The work was probably less intense than it is for junior doctors
now, but the time spent at work was far longer. In those days
there were no phlebotomists, or nurses trained to take bloods,
and much of our morning was spent collecting blood samples.
Menial tasks usually prevailed unless disaster struck, and long
evenings were also passed making up antibiotics for intraven-
ous injection, something I found strangely soothing. Such
work served as a talisman against the omnipresent threat of
the bleep, of being called to something where you had simply

19
 AN IMPROBABLE PSYCHIATRIST

no idea what to do, and where the consequences could well

be unspeakable.
Possibly I was actually allergic to this job. Shortly after
starting, I developed quite severe eczema over my face and
hands. Ointments and potions were minimally effective, and
my GP prescribed me a course of oral steroids. These raised
both my skin and spirits to a level they had not reached for a
while, and probably beyond. I wonder now whether this may
have bore some relation to my future mood disorder, although
I think steroids can sometimes do this, even without one. Who
knows? I was disappointed to stop them, though, and to
resume my scabby and despondent state.
On the bright side, Richard had come back from Mexico
shortly after I started work. He had planned to stay only a
couple of weeks, but this was thwarted by him turning bright
yellow. He went to see his GP, who declared delight at seeing
someone with a real illness – I wonder what that doctor’s usual
diet of patients was, or how they viewed mental illness?
Anyway, they quickly made a diagnosis of Hepatitis A, common
in Mexico and usually spread by contaminated drinking water.
Having stayed with him in Kipaltic, I was not in the least bit
surprised and thanked heaven for my own rather more obses-
sional attention to hygiene. He recovered quickly, with no ill
effects, and decided to stay in Scotland and start a Master’s
degree in economics.
My second house job, in respiratory medicine, was in a
smaller hospital. I rode a bike to work, slowly but deter-
minedly. Those were the days of no helmets and billowing
skirts, easily lifted by the harsh Edinburgh wind, and cycling
required perseverance and a thick skin.
Most of our patients had severe lung disease, and the bags
of urine at the bedside were replaced by sputum cups into
which patients coughed their worst. These could require a
strong stomach if more than a cursory glance was required.

20
 A JUNIOR DOCTOR

Calls at night came from a centralised institution known as

the bed bureau. Maria, my fellow house officer, and I grew to
hate it. There was a particular operator who seemed to call us
regularly at 5 a.m. We would blearily reach for the phone and
hear a flat, yet strangely sinister, Scottish voice announce,
‘Hallo doctor, this is the bed bureau. Have you got a bed for
a 93-year-old woman with a chest infection? She’s also got
diabetes, coronary disease, and a bad leg ulcer. She’s got no
one at home, and her memory’s not good.’
It’s easy now to feel sympathy for those poor patients. But
we were exhausted, and all sorts of excuses would go through
our heads. Saying no wasn’t an option, however, and we had to
stagger into yesterday’s clothes, any hope of sleep over.
During this second six months, I became pregnant. It was
pure carelessness, a belief that it wouldn’t happen to me. I was
twenty-three and living in a shared flat with friends in
Edinburgh. Richard was staying with me much of the time,
despite not technically living with me, and our future
remained uncertain. So, I decided not to have the baby, and
it was all very easy. Except that it wasn’t. It is a terrible thing,
ending a pregnancy, legal in this country, yet not really mor-
ally acceptable, not something you can talk about. I remember
walking down a corridor at work, thinking of the baby, of when
it would be born, all the while knowing that it never would be.
I was terrified. I look back now and think – you could have had it,
you would have managed, you had a medical degree, it would have
been far easier for you than some. Perhaps that was part of the
problem; I felt compelled to be a doctor, having come this far,
and I had no idea how I would manage. I knew my parents
would be disappointed and angry, and felt that I would be
letting them down. More importantly, I knew it would be
incredibly hard for Richard. I told him about the pregnancy
as soon as I suspected it and felt his anguish and fear. He did
not want to be a father so soon, but I also knew that he would

21
 AN IMPROBABLE PSYCHIATRIST

have supported me whatever I had done – that almost made

it worse.
So, I didn’t have that baby. Maria, my work colleague, knew
of my decision and was supportive, but it wasn’t something
I could tell others. I felt ashamed; I had never seen myself as
this person. If someone had asked me prior to this – What
would you do if you became pregnant? – I would have said that
I would have the baby, however hard it was; little did I then
understand the reality and the fear. And no one actually ever
said to me – you could have it – and I was too afraid and weak to
believe that I could. I think it was almost assumed by those who
knew, including my GP, that I wouldn’t, and I didn’t know
anyone else my age who had a baby. But ultimately it was my
decision, mine alone. In some ways being a doctor made it
harder – all that training and opportunity that I would throw
away, all that money invested in me. I felt selfish and foolish
whatever I did. I was young, but not that young. And when it
was done, it was done.
Subsequently, I got on with things. I suppose I felt
I couldn’t waste this second chance. I don’t think I was
depressed, but I did feel such regret and yearning for a baby
after that. I finished my job and managed to get a six-month
post as a Senior House Officer in Accident and Emergency, in
Glasgow. I still secretly hoped to work in psychiatry but didn’t
feel I could apply for this after my failed student attachment,
and the easiest option was to do a range of jobs that would
contribute to general practice training.
Moreover, Richard was now embarking upon a PhD, which
meant at least three more years of study and long trips to
Mexico. I think in some ways that lost baby bound me to
him, and not always in a good way. I found his urge to travel
and adventure very hard and wondered if we would ever settle
down together. I admired him; unlike me he was confident,
and also funny, and I was always sure that he loved me, I don’t

22
 A JUNIOR DOCTOR

really know why. Perhaps it was just the way he looked at me?
We shared a sense of humour, though, and he was a good
cook, or at least better than me. That was important!
Working in Accident and Emergency was extraordinarily
useful, perhaps one of the best posts I ever did. I learnt to
suture wounds, plaster broken limbs, and assess patients who
had walked in with many different problems, as well as to treat
them – or at least to send them to someone who could. But the
shift pattern, which involved working days, then late shifts, and
then night shifts was brutal and overwhelming.
There was a particular group of patients who presented
with repeated self-harm, usually cutting themselves. They
would come in with gashes down their arms or worse, usually
at night when we were busy. One woman presented frequently,
and her arms were a mass of scars.
‘Why do you do it?’ I asked, while trying to sew together her
thickened skin. It was a genuine question; I wasn’t trying to
be insensitive.
She winced. ‘Och, I dinnae ken, but it makes me feel a wee
bit better. Doesnae last, though. Thanks, hen.’ This was to one
of the nurses who had brought her a cup of tea.
The nurse looked at my handiwork. ‘That’s fine, you have
your tea, Senga, and I’ll just put a wee dressing on. And you’ll
need to be on your way.’
When Senga had gone, the nurse turned to me, ‘She’ll be
back soon enough. It’s a tragedy. I’ve no idea why they do it, it
never gets them the care they need. But it’s not like she’s
trying to kill herself. Oh well, poor soul.’ She was one of the
kinder ones.
I had no idea why Senga or any of the others did it either.
I wished I could help them, but I didn’t know how. And I had
wrapped my own brief experience of cutting and self-harm
into a little parcel and put it at the back of my mind. After that
brief period at medical school, I never self-harmed again, but

23
 AN IMPROBABLE PSYCHIATRIST

I always felt like one of them when I met patients who did. And
I felt the shame and hurt when people criticised them.
We saw a lot of drunk people too, and the nauseating smell
of stale alcohol and rich blood hung like a miasma on my
clothes after a night shift. Stabbings were not infrequent and
sometimes proved fatal, even if the victim got as far as hospital.
I finished this job with some relief, and we left Glasgow and
went to Mexico together. Richard planned to spend at least a
year there, and I wanted to be with him and also to get away
from medicine for a while. It should have been idyllic, but
I didn’t speak much Spanish at all and found it hard having
nothing to do. I took Spanish lessons, but I had no one to
speak to. Richard spoke fluent Spanish, which only high-
lighted my deficits.
So I felt lost and lonely, and rather aimless. I also felt that
I was lacking in inner resources, and I was unsure whether
I liked what that made me. I wanted to be able to buy contact
lens solution, novels, and even make-up when I fancied.
I realised – again – that Mexico was not a long-term option
for me, and I was anxious that Richard would end up choosing
between me and Mexico. In some ways, I felt sadly miscast in
his particular fairy tale, that I was not the person he saw.
Worse, I thought he probably would choose me, and that he
might end up resenting me for it. Fortunately, the immediate
situation was rescued by my spending a month in Guatemala at
a language school, while staying with a local family. This was a
backpackers’ paradise – learning Spanish, drinking Cuba
Libres, and even attending yoga classes – and it was fun, and
I made friends. I wasn’t a real backpacker, though, and
I returned to Richard and Mexico and realised I would be
quite glad to get back to Scotland. I was bereft to leave
Richard, despite all our doubts about the future, and we
decided then that we would get engaged. I think this was more
important to me at that point than to him. Rightly or wrongly,

24
 A JUNIOR DOCTOR

I wanted to commit to him. Later, when he came back, we

bought a little ring, an emerald with two tiny diamonds, that
I wore with pride (and later lost).
I returned, then, to Edinburgh, to the hospital where I had
worked for my first house job, this time as a senior house
officer in Obstetrics and Gynaecology. This post, like the
Accident and Emergency one, would contribute to
GP training.
The consultants were friendly; the nurses became friends.
The on-call night work remained hard, however, and I never
coped well with the lack of sleep. One night, I was heading to
my on-call room relatively early and looking forward to sleep,
when the senior registrar turned to me.
‘Why don’t we spend the night together?’ he suggested.
My flustered rebuttal was hardly eloquent. I managed, ‘Er,
no, I don’t think so,’ while backing out the door.
‘OK, no problem,’ he smiled.
Being somewhat naïve, I was rather appalled, but fortu-
nately it didn’t happen again. I still wonder if I misread the
situation; I was lucky to experience very little in the way of
sexual harassment in the course of my career, with more of an
emphasis on misogyny, such as that I experienced as a medical
student. That, too, is difficult to describe, though, as it is
inevitably subjective in nature. And no one wanted to damage
their career by offending senior medical staff.
After this I did dermatology – skins – for six months. The
nights were a dream in this job – literally, as I actually got to
sleep. Richard, back from Mexico for a brief visit, brought me
a present – an unlabelled polythene bag containing a brown
powder that he told me could help burns and skin conditions.
He said it was called tepezcohuite, and he thought I could use
it at work. I enquired how he got that through customs –
apparently hidden in his shoe, just in case. Unsurprisingly it
was discovered; very surprisingly they believed him but said

25
 AN IMPROBABLE PSYCHIATRIST

they wouldn’t test it as most powders tested positive for some-

thing. The future could have been very different for us both.
Life outside work was kind to me that year. I missed Richard
when he was away, but I had plenty of friends in Edinburgh,
including my cousin, a medical student. I hadn’t known him
when we were growing up – our mothers were first cousins,
and he lived in England – but, like me, he played the violin, so
we had common ground. We played music with two other
friends, another violinist and a cellist, so I made the move to
the musical dark side and took up the viola, in order that we
could be a proper string quartet. I have always liked playing
the inner parts, those of the second violin and the viola. I like
the sounds that make other sounds beautiful.
Later that year my best friend, Lorna, got married. It was a
wonderful wedding, and I was one of the bridesmaids, dressed
in flouncing tartan taffeta, with a green velvet bodice.
I thought I looked splendid! We had yellow flowers in our
hair, and the sun shone brightly. I played the viola at the
ceremony (unaccompanied Bach, I have no idea how I had
the nerve) and enjoyed myself hugely. The only sadness was
the absence of Lorna’s father, who had died tragically in a car
crash when we were at school.
By now I was starting to think about my own wedding,
planned for the following year. I also wanted to apply for a
general practice trainee year and thought I would like to work
somewhere new.
My reasons for choosing Cornwall were shallow: it had
always sounded romantic, and perhaps I wanted to be the
one who went somewhere, rather than the one who was
left behind.
I applied for a job in Fowey, a town with a name I didn’t
even know how to pronounce. But I visited, liked it, and
agreed to start work.

26
 CHAPTER 3

A GP Trainee and a Patient

Cornwall is a long way from Edinburgh. Yet to echo Rebecca,

Daphne du Maurier’s famous Cornish novel, I often dream
that I go there again. It was beautiful, but my life changed
dramatically during the year that I lived there. Richard came
with me, spending his time writing up his PhD on an
antiquated computer.
Fowey is a strange, ancient town, stuffed with privilege,
history, literature, and clotted cream. I remember the
pasties and the cider, and the slow voices of the locals.
I was no sailor, but I still see the shining sea, the smooth
white houses clustered around the church, and the
dark layered cedar trees high above. The GP partners
were generous and welcoming, and I was also surprised to
find myself liking general practice more than I had
anticipated.
Computerisation was then still in its infancy, and, at the
start of a surgery, I would have a pile of notes stuffed into
cardboard pockets and would press a bell to call the patients
through, often in the wrong order. I had never been good at
facial recognition, and this was challenging.
‘Hello, Mrs Williams,’ after a swift glance through the top-
most note. ‘Here to get your blood pressure checked again?’
An astonished look, ‘No, not me, I’m here for my legs.
Awful, they are.’
‘So, er, who actually are you? Are you..?’

27
 AN IMPROBABLE PSYCHIATRIST

‘Don’t you know, doctor, I saw you last week? I said to my

sister, she’s very young, but she said to me, you should go and
see her.’
I was less fond of home visits, largely due to the time they
took and my notoriously poor sense of direction. They were
also unpredictable and anxiety provoking; I carried a large
case, filled with drugs, but it was swiftly clear that the answers
were not often found within. In addition, there were regular
teaching sessions down in Truro, attended by all the Cornish
GP trainees, which I must have attended, although
I remember little of them.
What was more difficult from the start was the on-call,
something of a recurring theme for me. It was a one-in-four
rota, similar to most of my previous jobs, but was from ‘home’,
in other words, my flat above the surgery. Patients phoned the
doctor directly, with confusing and difficult problems; as a
trainee it was usually impossible to give advice without visiting,
even though there was always a GP partner to call on for
advice. At times it felt very onerous, but, on the whole, I was
happy. I explored Fowey, made new friends, and enjoyed the
sunnier climes and the beautiful clifftop walks.
Richard and I were also due to get married that May, and
there was much to be done, including last-minute discussions
with my parents about the wisdom of this plan.
‘Are you sure about this?’ asked my father, who had clearly
been instructed by my mother to phone me. ‘Richard doesn’t
have much in the way of prospects. How are you going to live?’
‘Stop going on about it,’ I snapped. ‘You got married at this
age. Earlier. He’ll finish his PhD and we’ll be fine.’
My father sounded offended, and I felt slightly bad. Both of
my parents saw Richard as something of a ne’er-do-well with
an uncertain future and a propensity for foreign parts. Despite
this, my mother had the wedding preparations well in hand.
My role was minimal, although she involved me when

28
 A GP TRAINEE AND A PATIENT

necessary – for example, choosing between two wedding

dresses, which she had pre-selected.
The months before any wedding are likely to be tense, but
I was protected from much of this by being in Cornwall, a
source of relief to both me and my mother. Richard hovered
uncertainly at the edge of the activity, awestruck by what
appeared to be required. In the end he wisely organised the
drinks with the help of his father.
The wedding itself was a beautiful day, with daffodils and
sunshine, not guaranteed in Scotland. Disaster was narrowly
avoided at the hairdresser’s when they pinned the flowers
directly into my scalp, but pressure averted the ruination of
my hairstyle. No one was very worried about my poor head.
The sticky mess of blood and hairspray when I took my hair
down later was disgusting, but it looked wonderful in
the photos.
Neither of us was religious, but we were married in the
church in the village where I had grown up. It was one of
those strange days of glimpses and noises and fragments, with
spring weather, and promise and happiness in the air.
The following day we set off for our honeymoon, to north-
ern Portugal, then Spain, and the beautiful mountains of
Asturias. We wandered there through small towns with
markets drenched in sunshine, staying in a hotel overlooking
one of the squares. It was late spring, and the flowers were
blooming everywhere. We had a little room with wooden
floors and high ceilings, and sat on the tiny balcony, drinking
wine and thinking of the future. I wore a purple top that fell
off my shoulders, and a flowered skirt, and my hair shone
loosely down my back. I smiled into the distance, but there
was a niggle at the back of my mind, a thought that wouldn’t
go away.
We talked of the future and what we might do. Would we
stay in Cornwall, or would we go back to Scotland, as we had

29
 AN IMPROBABLE PSYCHIATRIST

always planned? Would we even go to Mexico? The future

seemed wide and bright, but there was this little thing, this
worry that was starting to grow. And as each day passed,
I thought it was more likely – that I was probably pregnant.
I was now twenty-six, and we had been careless in the time
coming up to the wedding. But, foolishly, we had both
assumed that conception would probably take months or
years, and it had never occurred to me that it would happen
so soon. I wanted a baby, but it was still rather abstract; I didn’t
really know what babies involved.
I looked at Richard who was peeling an orange. ‘I just need
to know. I think I am. And it’s a disaster, think of all that wine
I drank at the wedding, and we’ve been drinking here, since.
I just can’t believe it, but I need to find out. Will you get me
a test?’
He looked incredulous. ‘What, here? You can wait till we get
back, it won’t make any difference.’
‘It will to me. I can’t relax. I won’t enjoy anything, it’ll all be
a complete waste. Please?’
He sighed. ‘OK, well I’ll try, but I don’t know where I’ll get
one from, and I don’t speak Portuguese. Or not much.’
But language was never much of an impediment for
Richard, and he came back with one in a paper bag. I took it
to the little bathroom at the back of our room, and waited.
And then I said, unbelieving, ‘I think it’s positive.’
The honeymoon continued – what else could it do? There
was joy as well as apprehension, but for me there were mostly
mounting fears. I was bewildered by my feelings. Had I not
wanted just this?
Shortly after this revelation, we went out to eat in a restaur-
ant nearby. I was anxious, worried about what to eat, fearing it
would harm this very new baby. Richard suggested polvo, assur-
ing me it was Portuguese for chicken, which sounded palatable
for the newly pregnant. I still feel a shiver of horror when

30
 A GP TRAINEE AND A PATIENT

I think of those unexpected suckers that I saw on what turned

out to be octopus – a complete overreaction, especially since
I didn’t actually eat any, and what harm could it possibly have
done? But I saw it as a suckered chicken, and started to think –
what could I eat that wouldn’t harm this baby?
This was a very different honeymoon from what I had
imagined. I was exhausted and unable to enjoy anything.
In the end, we abandoned our holiday and came home early
because of my mounting fears. I stayed in Cornwall to finish
my trainee year but immediately urged Richard to return to
Edinburgh to seek work. I loved Cornwall, and its seas, and air
of literary romance, but Scotland was my home.
Our original plan had, in any case, been to go back there
together once my post ended, but now I was seized by a
dragging terror that we would be destitute, and begged
Richard to get a job – any job. Nothing would go right,
I knew it. Richard was initially rather puzzled. He had not
wanted a baby so soon, but he was essentially an optimist.
He went to a university institution in Edinburgh and, just by
asking, managed to get a job. He also started to look at flats, so
that we would have somewhere to live. I had no belief in him,
fearing that we would be homeless.
And what did I do? I went back to work in Fowey, and I told
Margot, one of the GPs who had been very kind to me, about
the pregnancy. She laughed, pleased for me, as previous
trainees had a tradition of having babies, although admittedly
they were all men. But Fowey had changed; my flat had
changed. I couldn’t make sense of things and was confused
by my fears for the baby. There was no joy in this, only anxiety.
I phoned my parents to tell them. My voice wobbled
slightly, and I was on the defensive straight away. ‘Well,
I think I’d better tell you, Richard and I are having a baby.’
Silence.
‘We’re really pleased.’

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 AN IMPROBABLE PSYCHIATRIST

‘Well, we’ll have to speak more about this. Richard hasn’t

even got a job, how will you manage? I’d better hand over to
your mother.’
She was anxious and angry, and expressed both of these
with eloquence.
At some point we went for a scan – they gave us a little
picture and said that the baby was fine. But what can you really
see on a scan? I thought obsessively about everything. The fact
that I had drunk alcohol at the wedding, when I was clearly
already pregnant. Things I had eaten that had caused horrible
infections and damage, all of which would be undetectable.
There was so much, everywhere, that could hurt this baby; it
was inevitable. In fact, it felt cruel that I had to carry this poor,
blighted baby, who had no hope of survival.
I saw other pregnant women and felt envy – their babies
were growing, plump and healthy. At this point I was still
managing to function at work. It was like being two people,
but the functioning one knew that the other was lurking
within. I felt fear more than depression, and I had no idea
how to talk about this. Bits came out in bursts, but I was trying
hard, very hard, to be normal. Giving up was not an option.
Things did not improve. Richard, trying to sort out work
and housing, was confused by my desperate phone calls. And
I sat in the main room in my little flat, surrounded by beautiful
Cornish skies, unable to leave my seat. I felt safe sitting on the
sofa. I was torn by a fear of eating, thus killing the baby, and a
fear of not eating and killing it. I looked round the room, saw
the television, the table, the windows even, and they assumed
enormous significance. I knew something extremely bad was
going to happen to me; I just didn’t know what. But I was very
sure that it was all my fault.
I spoke to Margot, and she was starting to become worried
about me; I knew that, but I didn’t really know why or what to
do. I started to fear that even she would harm me – I knew she

32
 A GP TRAINEE AND A PATIENT

probably wanted to help, but somehow I couldn’t be sure. She

took me to see a psychiatrist in a large old house that
frightened me. I had no idea what to say.
The psychiatrist was large and fat. ‘How would you feel about
going to stay somewhere for a couple of weeks, Rebecca, just
until you feel better? It would give you a bit of a break.’
‘No, I’m not doing that.’ I knew this was no holiday she
was offering.
The psychiatrist sighed. ‘That’s a pity, and if you change
your mind . . .’ She paused. ‘One other thing, I won’t take any
notes, so none of this should affect your career.’
I looked away. To me this was clear confirmation that what
was happening would indeed end my career. Why, otherwise,
would nothing be recorded? Was it because I was a doctor that
mental illness meant disgrace? I remembered some of the
stigmatising conversations I had heard about staff who ended
up on the wrong side of psychiatry and knew that it was,
indeed, the end. No notes, then.
The days were hard and the nights worse, with more time to
think and worry, and I felt more and more anxious and
agitated. One evening, increasingly desperate, I spoke with
Margot on the phone, and she came round to see me. Poor
Margot, it must have been terrible for her. I tried to tell her
what was happening, and she wanted me to take some medi-
cation; I refused, thinking she wanted to harm me and my
baby, and she became quite upset and said we should go
somewhere in her car. I wasn’t clear where we were going, or
why, but I got into the car. It was a frightening journey for both
of us. At one point I tried to get out of the car, terrified of what
was happening, and she cried, ‘No, Rebecca, we’ll both be
killed.’ I sat, then, and waited, as I didn’t know what else
I could do. I didn’t know what to think.
She drove across the moor to Bodmin, where there was a
psychiatric hospital, and the whole experience assumed an

33
 AN IMPROBABLE PSYCHIATRIST

even more bizarre, nightmarish quality. I knew nothing of this

place, save that it had once been an asylum, with all the
implications that came along with this. When we got there,
I spoke to one of the doctors, who asked me quite a lot of
questions that I didn’t know how to answer.
‘I think you need to come into hospital,’ he said eventually.
‘No, I won’t, I’m not doing that.’ I looked at Margot wildly.
‘Please tell them, I can’t do that.’
She just shook her head and said nothing.
‘I won’t stay.’
‘Well then, I think we’ll have to look at the possibility of
keeping you here under the Mental Health Act. If you won’t
stay voluntarily.’
I couldn’t speak. Margot put her hand on mine, and said,
quietly, ‘I don’t think that will be necessary.’
I had no choice. The Mental Health Act meant that I would
be sectioned, that I would be unable to leave. If this happened,
then everything would be over. Notes would be taken, and
I would never work again. I stayed.
I spent the night in a single room, by myself, unable to sleep
at all. I had only the clothes I had come in – a thin purple skirt
and a buttoned black tee-shirt, nothing else. They gave me
nothing to change into, and no one spoke to me to tell me why
I was there. All I could think was that I needed to get out, and
as soon as possible. In the morning, I didn’t know what to do.
One of the other patients – how quickly one becomes a
patient – asked, ‘What are you in for?’ I didn’t really know
what to answer, as I had no idea. I said, ‘Because I’m pregnant,
and not eating well,’ and moved away. Even then, even to me,
it sounded lame. I still had no clue what I was doing there.
Later that morning, Margot came back and with her, to my
intense relief, was Richard. I begged and begged them to take
me away, and, perhaps surprisingly, they did. I would have
promised or said anything to get out, and probably did.

34
 A GP TRAINEE AND A PATIENT

When we got back I threw out the clothes I was wearing,

contaminated forever by fear and by the hospital. Poor
Richard, he had caught the overnight train from Edinburgh
to Par and was exhausted. He looked at me like he could
hardly recognise me; he had married a clever, pretty doctor,
who, within weeks, had changed beyond recognition.
He wondered if it was him, whether marrying him had tipped
my mind. Like me, he had no idea what had happened, or
what would happen next.
We went back to Fowey. At this point even I realised
I couldn’t carry on working. I stayed with Margot for a while,
and she was very kind indeed, but she had a husband and
young children, and a job. She couldn’t look after me as well.
I was exhausted all the time. I even developed asthma, which
I had never had before, and the climb from the town up to the
surgery was almost intolerable. Was I depressed? I had no idea
what this meant, no idea how I should feel. The psychiatrist,
whom I saw again, prescribed trazodone, an antidepressant,
which I took some of the time. It didn’t seem to do much apart
from make me even more tired. I knew options were limited,
given my pregnancy, and I wasn’t given anything else apart
from a low-dose antipsychotic medication called thioridazine.
We went next to the Isle of Wight, where my new mother-in-
law lived. She was a potter, with a tall white house in Ryde,
overlooking the sea, and I think Richard, having a rather
Victorian attitude to illness, hoped it would be some kind of
rest cure. There were long gardens, front and back, bordered
by hedges, and her attics smelt of the old books of my child-
hood. My mother-in-law was extremely good to me, despite my
fears and Richard’s worries about me. And she was restful,
unlike my own mother, who was panicking. She had cats,
though, rather lovely cats with old-fashioned names like
George and Maisie, and I was terrified of catching toxoplas-
mosis. This is a common parasitic infection, which can be

35
 AN IMPROBABLE PSYCHIATRIST

spread in cat faeces, and very occasionally can cause problems

in pregnancy. Realistically, it was extremely unlikely, but to me
anything bad that could happen was going to happen.
I couldn’t stay too long. I couldn’t stay anywhere long.
So we returned again to Fowey. Things were slightly better,
and I was grimly determined to go back to work and finish my
job. If I stopped then I would never go back, and now there
was this baby, in my mind already damaged, for which I had to
provide. I thought about the baby a lot. I wanted a girl, so felt
certain that it would be a boy. I was quite convinced that the
previous baby, the one I had chosen not to have, would have
been a girl, and that this was my punishment. But very occa-
sionally I allowed myself to imagine that this baby might be
real. I wanted to call her Maud, although Richard was
less convinced.
And I went back to work then, after a fashion. When
Richard was away, I stayed with one of the other doctors,
who was also very kind, but understandably found it difficult
having me there. But I worked and did surgeries, right up until
the end of September. I hadn’t finished the full year, having
been off for two months, although I had tried very hard. But
I was not really well enough to work. No one seemed to know
what was wrong though, and no one told me not to. There was
a conspiracy of silence around what was happening that no
one dared to breach. Mental illness and psychiatry were not
good companions for a junior doctor, but concerns about my
career were not expressed openly. It was far better to brush it
under the carpet.
We left Fowey with sorrow and relief. Even then, there was
some humour. Richard had earlier painted a truly awful and
enormous mural on one of the walls in the flat, and he had to
paint over it before we left. It consisted of two large nudes,
loosely based on ourselves, in the guise of Adam and Eve,
considering the consumption of an apple. For many reasons

36
 A GP TRAINEE AND A PATIENT

the good doctors of Fowey were probably glad to see the back
of us.
Richard had managed to get a flat for us in Edinburgh, so
we had somewhere to live, but I had no idea what would
happen. And I had no idea whether I would ever be a
doctor again.

37
 CHAPTER 4

Back to Edinburgh

I was five months pregnant when we got back to Edinburgh,

and hardly blooming. We lived close to where we had been
students, in a top-floor flat with tall, corniced rooms. It was
light and airy and spacious, with two bedrooms, and a little box
room off the sitting room, where one of us might work.
We didn’t have any furniture, but Richard had acquired the
basics from various junk shops nearby, and we slept on a hard
futon on the floor for the next four years.
The first Monday back, we went together to the university
health centre, where I was still registered as a patient. This had
made it easier for my problems to go unrecorded in Cornwall,
something that could not continue.
Finally, I saw one of the doctors I had previously seen as a
student. We didn’t say very much, but she arranged for me to
see a psychiatrist there and then, in the health centre – the
consultant, Dr Blackwood, did a Monday clinic there with a
couple of his junior doctors. I had never met him as a medical
student, nor did I know either of the others, which was a relief.
Richard and I went up to see Dr Blackwood together, on
the top floor of the building. He was tall and thin, reserved but
kind. He asked me how I felt.
I looked down, anywhere. ‘I don’t know. I can’t explain.’
I knew something terrible was going to happen. ‘When can I go
back to work?’ I knew I couldn’t, I knew I was an awful person.

38
 BACK TO EDINBURGH

Richard said, ‘Rebecca is finding things – well, just not

right. All sorts of things, like things in the room. She can’t
sleep. She’s worried all the time. I don’t know what to do.’
‘Are you pleased to be pregnant?’ Dr Blackwood looked
curious.
‘I don’t know.’ I looked away. ‘People hate me, they’re
probably right.’
‘That’s the illness talking. You will get better.’
Richard looked distraught. ‘I don’t know what’s happened
to her. Will she ever recover? Properly?’
Dr Blackwood looked at him and nodded, ‘She will. She’ll
make a full recovery.’
We spoke only briefly, and Dr Blackwood said, ‘You’re
severely depressed, and you need to be in hospital.’
I found it hard to talk in these consultations and sometimes
felt pushed into saying things I didn’t mean, just to say some-
thing. I didn’t know how I felt, or whether I was depressed, so
why would people ask me? Perhaps I should have tried to be
more polite, but I was, in a way completely alien to my usual
state, simply lost for words. It was as if I couldn’t remember the
normal niceties of communication.
I was admitted to hospital that day. By then there seemed to
be little point in resisting, although my thoughts, such as they
were, veered between horror and resignation. I simply
couldn’t believe that this was happening to me. We went home
to pick up a bag, which was slightly better than the Bodmin
experience, then went straight to the hospital in Morningside,
on the south side of Edinburgh. This was the hospital where
I had been a student; in fact, the ward to which I was admitted
was just up the stairs from the one where I had experienced
my failed student attachment. I had, in the past, hoped that
I might work in this hospital, but this was now a fading dream
which I felt too ashamed to even acknowledge.

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 AN IMPROBABLE PSYCHIATRIST

The entrance was off a square car park, surrounded by

three grey walls and a large grey tower, which was the aca-
demic department of psychiatry. The ward to which I was
admitted was directly on the left as you went into the car park,
although the entrance to the building was through a set of
yellow doors at the far end. Through these doors, one turned
to the left, along a corridor straddled by offices, and up a
staircase at the end. I often wondered what went on in these
offices, what conversations and thoughts.
At the top of the stairs, the ward stretched along a longer
corridor, with rooms off either side. The only sitting area was
at the top of the stairs, in the middle, where there was a low
table with chairs surrounding it, and a nurse always sitting
there, friendly, but wary of escaping patients. I think this may
actually have encouraged potential escapees, but it can be a
hard choice for staff, who can’t risk losing patients.
There was a large stone wall on the outer aspect of the ward
separating the residential area of Morningside from the inner
world of the hospital. I watched that wall through the window.
I felt trapped, that I was stuck on the undesirable side. But it
was also quite a beautiful wall, almost protective, and there was
nothing else to look at. There were trees on our side of the
wall, and their leaves turned slowly as autumn progressed.
Nothing happened fast.
It would be true to say that I felt terrible, and very ill. But it
didn’t fit with what I thought of as depression, of low mood
and melancholia. I just felt empty – lacking – there were times
when I had nothing to say, and couldn’t think how to engage
with anyone, let alone those who wanted to help. I was a faded
version of myself; indeed, not even myself. I lost all my concen-
tration and couldn’t read or focus on anything that would
normally have interested me. I had no interest.
I had no energy either – even to raise myself from a seat felt
like a chore. I had no appetite, and lost weight, although the

40
 BACK TO EDINBURGH

medication I was given seemed to make me eat a little. It also

helped me sleep, which gave some relief. Mornings were
terrible, evenings only slightly less so, perhaps because
Richard or my parents would come to see me. But there were
also many grim times when I simply couldn’t stop thinking and
was bombarded with thoughts. At these times I felt physically
pressured and paced the floors until my feet ached and
throbbed. Once a nursing assistant rubbed my bruised foot,
and, even then when I didn’t think much about other people,
I thought how kind that was.
My thoughts became increasingly difficult to manage and
even to bear. There were many themes, but the baby I had
terminated predominated. She became real, at times malevo-
lent, and I believed that there could and would be no forgive-
ness for what I had done. She was with me much of the time,
and when I was less well this became appalling. Sometimes
I heard her speaking to me.
‘What have you done? You deserve everything. Your baby
will die because of you, what you did to me.’ There was
nothing I could say. I deserved it all.
It is horrible, looking back, to write of this, and to remem-
ber those feelings and thoughts. But I don’t believe now that
the termination was the cause of my illness. It is something
that I have very conflicted views about – it’s no good saying
that I wouldn’t have done it had I known. Known what? The
circumstances of my life that led me to that decision are
irrevocable. I feel huge regret about it, and always will, but
many women have terminations, and few end up unwell as
I did. Continuing with an unwanted pregnancy may in many
cases be more damaging to mental health than termination.
I believe in choice and feel sad that many women feel guilty
and unsupported, having made such decisions. But I do think,
with the benefit of hindsight, that my mood disorder was
precipitated by pregnancy and that psychosis plucks the

41
 AN IMPROBABLE PSYCHIATRIST

darker preoccupations from the back of your mind and turns

them into demons.
My mind roved around, unable to keep with one theme,
and picked up anything else that it could. I became convinced
that I had contracted HIV or hepatitis from goodness knows
what needle stick injury at work, or, worse, completely unlikely
premarital encounters. I found Richard to blame on this
account, too, and questioned him mercilessly. His previous
attack of jaundice rapidly assumed sinister connotations, and
I thought – wrongly – that he probably had one of the blood-
borne varieties, spread by sex and injecting drugs. This was
entirely ridiculous – even had he been so inclined, which he
wasn’t, he had been tested.
I tormented myself regarding my never greatly excessive
alcohol intake, and all possible food or contaminants I could
have encountered. I believed that I would never work again, or
certainly not in medicine, and did not think I was capable of
doing anything else. I felt fairly repulsive in my pregnancy,
which didn’t help. I had two pairs of pregnancy leggings, one
navy, and one green, and the only kind way to describe them
was that they were functional. It felt as though everything was
being stripped away. I was unattractive, pregnant, and hopeless.
During that admission, the decision was quickly made to
give me electroconvulsive therapy (ECT). Dr Blackwood
explained it to me and Richard.
‘It will be fine, quite a lot of people who are severely
depressed have this, and it nearly always helps. It’s particularly
good when you’re pregnant, as it works quickly, and you won’t
need to take as many drugs.’
Richard looked desperate. ‘Will it really work? Won’t it
leave her with problems? Like – will she be the same
afterwards?’
‘People get a bit of memory loss, but it nearly always comes
back. You don’t need to worry.’

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 BACK TO EDINBURGH

‘What will happen? Is it just one time she’ll get it?’

‘No, she’ll need a course, usually two or three times a week,
but we’ll see how she gets on with it. It’s not like in the old
days, you get a general anaesthetic, and they also give you a
muscle relaxant, so you don’t have a proper fit.’
Richard paled. ‘How do they give you the fit?’
Dr Blackwood continued patiently. ‘They have a couple of
electrodes which they put either side of your head once you’re
asleep. She won’t know anything about it. Then they give a
shock which causes the seizure. It needs to be long enough to
make a difference, so they time it.’
‘How can they time it if you have a muscle relaxant?’
Dr Blackwood looked slightly pained. ‘The toes still wiggle a
little, even if the rest of you is paralysed.’
Richard was reduced to silence.
Wiggling toes are no longer usually used to time seizures;
this is now often done by the more sophisticated application of
stickers to the head to enable electroencephalography (EEG)
monitoring, but the mere thought of a seizure being caused by
an electric shock, perhaps especially when pregnant, is bizarre
and frightening. I was both bemused and horrified by it but
felt in no position to refuse. At least, as a doctor, I was not
entirely unfamiliar with ECT and had seen it given as a stu-
dent. But it was impossible to dispel the grim images from One
Flew Over the Cuckoo’s Nest, or even The Bell Jar.
On the morning of my first treatment, two of us were on the
list. One of the nurses called me from my room, and I sat next
to the other girl in the space at the top of the stairs.
‘Debbie, perhaps Rebecca could go first today, she’s not
been before?’
‘Yeah, that’s fine.’ Debbie didn’t actually look too pleased.
‘Come on then, let’s take you downstairs.’
I was walking into a nightmare, where everything looked
ordinary but wasn’t. We went down the stairs, then to the left

43
 AN IMPROBABLE PSYCHIATRIST

along the corridor, then right, and into the ECT suite. The
waiting area was narrow, with a door through to the treatment
room, and we sat there for some time. Finally, a nurse called
me through, and I had to climb onto a trolley, then hand over
my glasses, so all I could see was a blurry mess. Then someone,
the anaesthetist, put a cannula in the back of my hand, asked
me to count backwards from ten, and then nothing. Later, one
of the nurses took me back to the ward, but my memory was so
shattered by the treatment that I never remembered this, then
or later.
There were more treatments, two times a week, and the
times all merged into one. I never knew how long I would wait,
or what the treatment room was like – big, small, square,
round – I had no idea. I never could remember, and each
time it was the same. It wasn’t that unpleasant, just very odd.
I always had to hand my glasses to the nurse, and that made
me nervous – probably another reason why I couldn’t remem-
ber much beyond the door, given my extremely poor eyesight.
I have had more ECT over the years and recently have been
allowed to keep my contact lenses in, something which has
made a huge difference to my feelings of confusion
and disorientation.
The memory problems associated with ECT remain contro-
versial, and some people have very strong feelings about this.
I suspect these are different between individuals and can talk
here only for myself. I didn’t really notice much memory loss
at the time, and it was only afterwards that the gaps became
obvious. Some would say that this might also be due to my
illness, and I’m sure that contributed, along with the fact that
I was doing very little at the time that was worth remembering.
But the whole point is – you cannot remember what you
don’t remember. It was only looking back that I realised that
I had lost so much. I could remember my life prior to ECT
without problems, but the times before and around my

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treatments were completely eroded. And, after this, I never felt

that I could totally trust my memory again. I still have memor-
ies that come and go, of which I am unsure, and they remain
unsettling. Did they happen, or didn’t they? Another question
that I tortured myself over – did I lose any of my ability to
think, and my intelligence? I don’t think so, but it is impossible
to say for sure. And who knows what summits I might have
reached had I not had ECT? Quite possibly none, given that
ECT can be life-saving in severe depression.
What else happened during that admission? Not much,
really. Mostly, I sat around all day, the monotony broken by
drug rounds and meals. There was nowhere to go and nothing
to do. Sometimes, if visitors came, we would go for a coffee in
Morningside, but then there was the pain of returning. Most of
the nurses were kind; a few were probably verging on being
burnt out and uninvolved, but I experienced no cruelty from
anyone. I didn’t talk to them much, as they were busy, and
I didn’t know what to talk about. I also thought that they
disliked me, at least in part because I was a doctor, and should
have known better than to be there. There was no doubt that
my previous life had been more fortunate than that of many
others who had been admitted, and I felt that this made me
weak and pathetic.
I also concluded very early on that I had a personality
disorder and that everyone else thought this too. I heard a
couple of the nurses talking about one of the other patients.
‘There’s a lot of behavioural stuff going on there. I think we
need to set a few boundaries.’
The other agreed. ‘Yes, I heard her with Jill, and I mean
Jill’s really unwell, it’s not fair.’
‘Well, I’ll have a word with Dr Blackwood later. It’s busy
enough here, we don’t want any acting out.’
I was vaguely aware, even as a patient on the ward, that
some people were expected to take responsibility for their

45
 AN IMPROBABLE PSYCHIATRIST

behaviour, but not others. These were the people with person-
ality disorders, and I was one of them. No one said this to me,
but I was convinced.
Personality disorder is a strange diagnosis, and one that is
often used rather slackly in psychiatry. Borderline, or emotion-
ally unstable, personality disorder is a label given to many
female patients, though males are by no means exempt.
It comprises a combination of symptoms, including emotional
instability, fear of abandonment, difficulty with relationships,
transient psychotic features, and self-harming behaviour. All of
these symptoms can also occur in other disorders, which is
confusing. Psychosis can, at times, be difficult to recognise; it is
defined by loss of contact with reality, and people often experi-
ence hallucinations or delusions, when they believe things that
others don’t. Sometimes it is very obvious, but sometimes,
perhaps particularly in people with personality disorder, it
can be something that becomes more subjective; something
that not all staff believe in. It is very difficult when symptoms
and diagnoses become attached to values and beliefs.
Many people who are given a diagnosis of personality dis-
order have experienced trauma or abuse, often sexual abuse,
and some have had unimaginably difficult lives. They have
often learnt ways of living, and of managing their feelings,
which can lead to some of the symptoms described. I think
attitudes have changed somewhat over the years, but there is
no doubt, even now, that it can be a punitive diagnosis. After
all, who wants to be told that their personality is disordered?
Other illnesses, like schizophrenia, bipolar disorder, and
severe depression, are often seen as having a more biological,
or medical, cause, and, as such, are thought to respond better
to drug treatment. But nothing is that black and white.
My understanding of psychiatry at that stage, and in my
state of mind, was rudimentary, to say the least. To me, per-
sonality disorder meant a person with no genuine mental

46
 BACK TO EDINBURGH

illness, behaving badly and disliked by all around them, par-

ticularly by health professionals. To be fair to myself, I had
observed something of these attitudes, both as a student and at
times as a doctor, so the leap to applying this to myself was a
short one. It waxed and waned a little but always returned.
It affected my own view of myself, but also my ability to interact
with staff. Even when they were kind, I assumed
another agenda.
However, I responded quickly to ECT and, after a few
sessions, was emerging from the state in which I had been on
admission. As soon as I could organise my thoughts into any
coherent structure, I wanted to go home. Time moves very,
very slowly on a psychiatric ward, and, when my thoughts were
barely working, it hardly mattered. But now I was desperate to
leave and begged Richard, my parents, the nurses, and doctors
to let me go. I felt trapped, and that I simply could not stay.
Dr Blackwood was reluctant, but I could not be dissuaded.
I started with some passes off the ward, staying overnight and
then returning the next morning to find my bed had been
moved from a single room to one of the dormitories. I tried
not to be annoyed about this, but I was. This happened a
couple of times before I was discharged, after an admission
of about three weeks.
Richard and I were ecstatic and relieved that we had beaten
this thing, this monster, which had entered our lives so unin-
vited. Because I was pregnant, there was no immediate pres-
sure for me to go back to work, and we hoped that we could
get on with life and prepare for our baby.
My consultant obstetrician was a man I had worked for
during my obstetrics job, and he came to see me when I was
in the psychiatric hospital. I was sitting on an old table by the
window in the ward, looking at the wall, and he came over and
hugged me. He treated me like a normal person, which had
become unusual. I suppose the big difference was that he had

47
 AN IMPROBABLE PSYCHIATRIST

known me when I was actually normal – even highly function-

ing. If I ever got any preferential treatment for being a doctor,
rightly or wrongly, it was from him. Not many would have
visited a psychiatric ward to see a patient with a
normal pregnancy.
I had been started on an older tricyclic antidepressant
called amitriptyline when I was in hospital, as they told me it
was safe in pregnancy. They were little dark red tablets with
horrible side effects. The worst were somnolence, making it
very hard to get up in the morning and leaving me with a
feeling of being hungover, and constipation, already a prob-
lem for me in pregnancy. They made me want to eat, which
was fine, but gave me a horribly dry mouth, which made
everything taste nasty.
Dr Blackwood explained that antidepressants take time to
work. ‘You need to take them for at least two weeks, although
that should be OK as you’ve had the ECT. But you need to
take the antidepressants to stay well. It’s really important.’
‘The side effects are horrible,’ I said, looking at the floor.
‘I’m not sure how long I can take these.’
‘It’s really important,’ he said. ‘You need to carry on
taking them.’
Despite his advice, I decided quite early on that this pill was
not for me, and that I hadn’t actually been ill, so it made
complete sense to stop it. Richard was a bit more wary, but
his exposure to mental illness had been brief, and he accepted
my superior medical knowledge. This was, in fact, limited, and
I had always been able to be extremely stubborn and persua-
sive (in a bad way) when I made up my mind. I stopped it, and
within a month we were back to square one.

48
 CHAPTER 5

A Baby

Back to that grey car park, with its walls and tower. Back
through those yellow doors and up that staircase. The same
thoughts, the same despair, and a baby due in a couple of
months. This next admission was less of a novelty – no longer
could we be so certain that it would never happen again. I had
another short course of electroconvulsive therapy (ECT) and
restarted those drugs that I so resented taking. But at least
I was out of hospital for Christmas, which we spent with my
parents. My mother had bought me a maternity frock, blue
and red, which was prettier than my vile leggings but made me
look like a housewife from the fifties. I looked in the mirror
and gaped. It was also the first time that I actually saw myself as
pregnant, something which felt bizarrely sudden. It was just as
well, really, the baby being due in a few weeks.
Amidst all this mayhem, the joy of preparing for a new baby
was rather overlooked. We had a little wicker crib that
Richard’s mother had given to us, with a red and white mat-
tress and facings, and my parents bought us a car seat and
travel system. I had never heard of such a thing, but it proved
to be an unwieldy frame which converted the car seat into a
buggy. This was challenging for those of us without a mechan-
ical bent, and it was heavy, given that we lived in a top-floor
flat. We acquired a cot at some point, but that was later.
Some of the staff from the medical practice in Cornwall
where I worked had sent me a lovely box of white hand-knitted

49
 AN IMPROBABLE PSYCHIATRIST

baby clothes – little matinee jackets, bonnets, gloves, and

bootees, three of each in different patterns. I was thrilled by
them; they were so tiny and beautiful, like dolls’ clothes, and it
made the baby seem more real. Neither I, nor my mother nor
my mother-in-law – nor any of the men in the family – were
knitters in any way, so it was just as well. We did get some basic
baby clothes, mainly vests and sleepsuits, and my mother also
bought some prettier little outfits, so I suppose we were well
enough equipped for ignorant first-time parents.
Fortunately, I was fairly well at the time that the baby was
due, having been recently discharged from hospital.
I didn’t have much of a birth plan; in truth, I think the only
thing that I put down was a desire to have an epidural as
soon as possible. That may seem a cop-out, but I felt that
nothing had really gone right so far during this pregnancy,
and I wanted, in as much as one can, to have a reasonable
birth. The thought of a wholly natural one frankly
frightened me, but I wanted to be alert and present, and
not distracted by pain – and I had no idea at all what labour
pains involved.
I had seen a few births, though, and suspected that they
were rather unpleasant. When I was a medical student, it was
mandatory for us to deliver six babies, from the start of labour
right through until the bitter end. It was actually one of the
most moving experiences during the whole of medical school,
and we were privileged to get to do this, especially considering
our lack of any useful skills. I was brought to tears at the first
one and noted all ‘my’ babies’ names and birth dates in my
diary. But it made me realise that the whole process was rather
more prolonged and painful than a quick watch of Casualty
would have you believe. Oddly, my obstetrics job did not offer
the opportunity for any more deliveries, but I became adept at
dealing with the aftermath of episiotomies, which was hardly
more encouraging.

50
 A BABY

In fact, things went quite well. We were driving back from

my parents’ house, a couple of weeks before my due date,
when I started to get contractions. Later that evening they
speeded up a little, and I went to sit in our narrow avocado
bath to see if that would help. I had never fancied a water
birth, but the bath provided astonishingly complete relief for a
little while. Eventually, an hour or so after midnight, we
decided to go to the hospital. I still remember that nocturnal
drive across town, during which I became increasingly
uncomfortable.
We arrived at the Meadows, and Richard slowed down to
stop at a red light.
‘For God’s sake,’ I shouted. ‘Go through the bloody light!
We’re having a baby, you idiot! You don’t know how sore this
actually is!’
Richard said, ‘Well there’s no point in getting stopped by
the police, is there? That would slow us down.’
I resisted the urge to punch him. He often liked to remin-
isce about his university holiday jobs delivering lambs, but
I suspect would have drawn the line at delivering his own baby.
Fortunately, despite our traffic light differences, we made it
down to the hospital without his skills being required.
I was expecting to be told that I was making an unnecessary
fuss and to go home, but, to my surprise, they told me that
I was around four to five cm dilated and I was quickly hooked
up to the electronic monitor, which recorded foetal heart rate
and uterine contractions. All went swimmingly, and little
Madeleine, our beautiful daughter, was born within three
hours, impressive for a first baby. I had my epidural in plenty
of time, rendering the process practically pain-free, and for
me the delivery was probably the least traumatic part of the
entire pregnancy.
Not so for Richard, and I felt very bad about this afterwards.
He had no idea what the foetal monitor tracings meant;

51
 AN IMPROBABLE PSYCHIATRIST

neither did I, really, but I knew enough to know that there

were no obvious problems. He was convinced with every dip
that the baby was about to die but didn’t want to tell me at the
time, lest I panic. I hadn’t realised this, so hadn’t reassured
him. The staff had tended to talk to me throughout, and,
knowing I was a doctor, probably hadn’t explained as much
to either of us as they would otherwise have done. It turned
out that delivering lambs was not a good preparation for
hospital obstetrics.
But then they handed us Madeleine, our new baby, which
was a lovely moment. She was quite small, only six pounds
three ounces, with a tiny fluff of light hair, and her little chin
pulled in, in that way of very new babies. She had blue eyes like
Richard and didn’t look quite how I had expected – I can’t
imagine what I did expect! – but she was my baby, and I loved
her immediately. I was also overcome that she was a girl, as
I had felt that I would never have a daughter. We had a couple
of name choices for her, and I uncharacteristically let Richard
choose between them. Exhaustion can make one behave in a
way that is quite out of character, but I loved both names, so all
was well.
Richard called all of our parents, early that morning, ‘You
are the proud grandparents of a beautiful baby girl!’
My father characteristically thrust the phone at my mother.
‘Speak to Judith, speak to Judith!’ They came over that
afternoon, delighted.
I had a single room on the postnatal ward, which I’m pretty
sure was down to having worked with the consultant, and it was
also the days prior to cuts, when a five-day stay in hospital was
normal for mothers with first babies. I managed to breastfeed
Madeleine without any problems, and I was very happy to be
able to do this. There was a stark contrast with that other
hospital where I had so recently been a patient – here I had
many visitors with gifts and smiles and flowers. I know it is

52
 A BABY

different when you have a baby, but it really could not have
been more so.
One of the psychiatrists also visited me before I was dis-
charged to check that I was remaining well, but I was. I didn’t
need to see him, and I was glad. Some of my contamination
worries had started to resurface due to a not entirely clean
bathroom, but they didn’t at that point reach the levels of
conviction that they had previously, and I was able to manage
them without any real difficulty. I certainly didn’t mention
them to him. My parents were delighted with their new grand-
daughter, as was my mother-in-law, who visited soon after
Madeleine and I were discharged, and I think everyone
thought – this is it, it was all just to do with hormones, now
we can get on with life and forget what happened. If only that
had been the case.
Madeleine and I came home on a cold and snowy day in
January, collected by my mother as Richard was at work, and
we settled in to start our new life as a family of three. I was
twenty-six, nearly twenty-seven, and hoped that I would be able
to be a good mother now, that we could begin again. Little
Madeleine was a lovely baby, very sweet and happy. She slept
well at night in her tiny crib, just waking for feeds, and, despite
all my prior worries, even I thought that she seemed a dear,
healthy little girl. All should have been well.
Sadly, my memory is very poor for the months after
Madeleine’s birth, and all that I can remember is quite
fleeting and muddled. There was no immediate relapse, but
a gradual deterioration in my mood started very soon after she
was born. We were all so determined that it wouldn’t happen,
and I was so determined to stay well and to breastfeed
Madeleine – and not to take medication – that it was hard to
know or admit.
My friend Jennifer got married when Madeleine was still
very tiny – it was a lovely day, and she was a beautiful bride.

53
 AN IMPROBABLE PSYCHIATRIST

I wore a flowered dress, not at all my usual style, but it had

room for my body, which was still changed after the birth.
So much had changed. I tried to smile, but I felt brittle and
unconnected to the joy around me. I don’t look like me in the
picture I have.
Looking after a new baby is easy for very few first-time
mothers, and I was perhaps simply too fragile to cope. I was also
very much on my own, having no friends with babies. Richard
had to work, as there was no paternity leave in those days, and
my mother was also working full-time, so could only spend
limited time with me. Richard’s work still involved trips to
Mexico, and he had to go out there early that year, something
I dreaded, and even resented, now that we had a baby. Left on
my own, my mood slipped, then plummeted, and the old unrea-
sonable thoughts returned. I was quite bewildered and even
confused on this occasion, probably due to disturbed sleep.
I went to see my GP with little Madeleine – some common
sense prevailed – and was immediately admitted to hospital
again, this time with her. There was no dedicated mother and
baby unit at that time, so we were admitted to the ward
downstairs from the previous one, which was that of my failed
medical student attachment. I was very upset by that, and it fed
into my paranoid beliefs about all that was happening, but
otherwise that admission is largely a blank in my memory.
Staff must have been worried about the baby, and about my
care of her, and I don’t know how I looked after her in that
gloomy old psychiatric unit, or how it was assessed. I don’t
think that there was any social work involvement, which seems
surprising, but I was still a doctor (of sorts), and I was good at
saying that things were fine, even when they weren’t, as was my
family. Given my complete memory hiatus, I think I must have
had ECT again this time. I was also started on medication,
although the fact that I was breastfeeding Madeleine had to be
taken into account.

54
 A BABY

Many years later, I was told by a member of staff who had

been working there that there was a lot of disagreement about
whether I should be allowed to continue breastfeeding and
that there was indeed concern about my care of the baby. She
told me in a hushed and horrified tone that I nearly dropped
her, but I can’t remember that. It might also be difficult to
stop someone feeding their baby when they are determined to
continue, and I found this puzzling. I wasn’t detained under
the Mental Health Act, so how could they have stopped me?
Feeding her was the only really positive maternal thing that
I had been able to do, and I didn’t want to stop at that point.
This admission then assumed the usual pattern of partial
recovery and as quick an exit as I could manage. There was
little subsequent support other than out-patient medical
appointments, and I resumed my probably rather inadequate
care of Madeleine. I stopped breastfeeding shortly afterwards,
but more from ignorance than anything else, as I didn’t think
anyone fed their baby for more than three or four months,
such was my knowledge then of babies and their care.
It is horrible to admit, but I was not at that time a good
mother to my little Madeleine. Perhaps I wasn’t bad enough to
be a very bad mother, but I was not good, or even good
enough. She was, I hope, largely protected during those first
years of her life by Richard, and by my parents, who were
devoted to her and spent a lot of time with her, providing
something of what I could not. We were very lucky that she
had a sunny personality and seemed easily happy – but she still
didn’t have the mother that she should have had.
And to be fair on myself, I also missed something import-
ant, the experience of being a real mother to her when she
was a baby, and this was a huge source of sorrow and shame to
me. I loved her, and I knew that I would never hurt her in any
way, but I just felt quite passive and was devoured by my own
thoughts and feelings.

55
 AN IMPROBABLE PSYCHIATRIST

Mental illness is very selfish – it takes everything and leaves

nothing, not even for a mother and her baby. It made me
selfish too, and perhaps this is why my parents at times viewed
me as lazy and unhelpful. I am less sure that telling me so was
particularly motivational, but they probably felt quite desper-
ate. At times it was more than I could do to get up, never mind
care for another person, even my own baby, and yet I hadn’t
been lazy before. But depression made me so, and the pills
even more so.
Poor little Madeleine was sent to nursery at a very young
age, when Richard realised that I couldn’t look after her while
he was working. The nursery was close to our flat, and she
seemed happy there, being a naturally sociable child, but it felt
very wrong for a non-working mother to send her baby to
nursery. I felt stigmatised and inadequate when I picked her
up after my empty days. But it enabled us to carry on, and for
Richard to work despite my problems, and I am grateful to
that nursery. They were good to her there.
For me, the truly sad thing is that I can remember so very
little of Madeleine’s first two years. I have lots of pictures which
I look at sometimes, of a beautiful little girl with a big smile,
dimples, and white-blonde hair, and I wish it had been differ-
ent. I often feared that I would be unable to recognise her.
I used to pick her up from nursery and worry that I would
collect the wrong child. I never did, but it was a horrible,
shameful fear.
I did very little from day to day during the months after that
admission, or indeed during the couple of years after
Madeleine’s birth. It was a period of time that seemed to pass
with crippling slowness, yet, looking back, I did nothing, noth-
ing at all. The National Childbirth Trust (NCT) group that we
had joined before Madeleine was born was not something
I could go back to – I felt ostracised, a false mother. Richard
told me that one or two of them tried to come round to the

56
 A BABY

flat to see me but that I refused to see them. I felt very

ashamed, and at times I believed that people only came to
see me to gloat at my despair and failure.
Richard didn’t really get much support from anyone either,
despite what he was trying to shoulder.
A woman visited the flat to speak to him on one occasion.
‘This must be really difficult for you, is there any help that we
can give you?’
Richard thought about it. ‘Well, I’m really struggling to
keep everything going, looking after Rebecca and
Madeleine, and working. I could really do with some help with
the housework,’ he said hopefully.
‘Oh, we can’t do that sort of thing. I was meaning more
chatting about things.’
Rightly or wrongly, Richard saw no benefit in just talking
about the grimness of our situation. I continued to go to my
out-patient appointments, interspersed with my horrible car-
ousel of admissions. My treatment had a nasty sameness about
it, with intermittent antidepressants, and antipsychotic drugs
like thioridazine. I didn’t take anything for long, and I didn’t
stay well.
This was a particularly bleak time. In a sense, the urgency of
my illness during the time when I was pregnant and immedi-
ately afterwards had gone, and I was left in a chronic and
impaired state. I was never completely well, although I could
sometimes put a good face on things at better times. I was
adapting to being unwell and starting to lose aspects of my
former personality. I was a psychiatric patient – it was all that
I was seeing and what I was learning, and I couldn’t see any
real alternative. Yet a part of me wanted to keep trying,
despite everything.

57
 CHAPTER 6

Admissions: the Revolving Door

A horrible pattern was emerging. The many electroconvulsive

therapy (ECT) treatments make it hard for me to remember
the sequence of events, but Richard has since described it to
me – the stopping of medication, the subsequent drop in
mood, and increasing distress and discomfort, agitation, and
pacing. Then becoming convinced of various unlikely ideas,
growing anxiety, paranoia, and a desperation to hold it
together. My sleep would deteriorate, I would try very hard
and struggle on for a few weeks until I simply couldn’t, and
then there would be a rapid drop, when Richard said I would
become desperate, even suicidal. He said that I would often
just curl up and stop speaking to people, barely eating or
drinking. Then I would end up back in hospital. Richard
found visiting me torturous.
‘D’you think I’ll get better? Ever?’
Richard took me in his arms. ‘You’ll get better.
Dr Blackwood says that you will.’
‘But are you sure? I don’t think I’ll get better. And I’m
never going to work again. Everyone thinks I’m useless. You
don’t like me, you think I’m useless.’
‘I don’t, I love you. You’ll get better.’
‘I won’t, I’m not ill anyway. Everyone knows I’m a fake. You
know I’m a fake. You’ve got to get me out of here, I can’t
bear it.’

58
 ADMISSIONS: THE REVOLVING DOOR

It was very hard for Richard, and I only stayed in hospital

when I did because I feared being detained under the Mental
Health Act. The concept of being ‘sectioned’ was a dark one,
more akin to being held by the police than by health profes-
sionals. The mere thought terrified me; being a psychiatric
patient was bad, but the thought of being kept in hospital
against my will was truly appalling. I could not imagine how
the stigma of this could possibly be overcome, and I was quite
sure it would be the end of my career, indeed, of everything.
I had seen other patients on the ward being forcibly injected
with drugs, and it was horrible.
However, agreeing to admission because one feared deten-
tion was hardly better, a form of de facto detention that had
no right of appeal – because it wasn’t protected by the law.
I was in that situation more than once.
Sometimes I had ECT during those admissions, sometimes
not. I was treated with amitriptyline, and with low-dose thior-
idazine for agitation. After a couple of weeks, I would start to
get a bit better and would start to insist on discharge, which
usually happened within a week. I don’t think I could ever
have been described as well at these times, but Richard said
that I would claim afterwards that it hadn’t been that bad, and
that I quickly forgot what had happened. I know that I was
usually unable to remember feeling low, or even why I had
gone into hospital.
He told me that it came across to him like some sort of
dream state that I was repeatedly experiencing and that each
time he could see the ongoing erosion of my confidence such
that recovery was less complete. Following an episode, I could
then be reasonably well for as long as two to three months,
maybe taking medication for the first six to eight weeks.
I would then stop it, be OK for a month, and then the cycle
would begin again. Even now, Richard is not completely

59
 AN IMPROBABLE PSYCHIATRIST

critical of me; he could see that, whatever good it did, the

medication rendered me knocked off and unlike my usual self,
so had some sympathy for me when I wanted to stop it. But
I was also obstinate and insistent and held the medical card.
It must have been terrible for him.
My parents also found the situation very difficult. They were
living in Glasgow, over an hour’s drive away, and both were
working full-time. The additional burden of a mentally ill
daughter was outwith their experience, and very hard for
them to cope with. At the start they talked a lot, to both
Richard and me, largely about my behaviour, which they
thought I should be able to make more effort to contain.
If not, they said that I should, at the very least, keep my
concerns to myself. They did also talk to the doctors but found
it hard to understand, or accept, that this could be down to
illness. Even if it was, they felt that I was being unreasonable in
how I expressed it and saw me as lazy. I felt that I was a huge
disappointment to them, and they seemed embarrassed, both
by me and by my situation.
They were also acutely worried about the potential damage
to my career and to my relationship, thinking that Richard
would leave me, and they voiced this a lot, adding to my own
anxieties. At times, when I was beginning to improve, they
would immediately start asking about my plans to get back to
work, and they would try to encourage me to do therapeutic
activities, such as classes, that I found both difficult and
depressing. They were critical if they saw me sitting around
reading what they viewed as rubbish, rather than doing some-
thing more constructive. I felt that being able to read anything
was an achievement and that they wanted me to run when
I could barely walk.
My mother got drawn into my anxieties, and at times col-
luded with them, which didn’t help either of us, especially as
she tended to catastrophise. Both my parents thought that it

60
 ADMISSIONS: THE REVOLVING DOOR

should be possible to talk things through and solve them that

way and that I just wasn’t trying hard enough. When talking to
me failed, they turned to Richard.
‘If she could just be reasonable – we just can’t understand
why you let her stay in bed?’
‘It’s difficult for her, she’s only recently out of hospital.’
‘Well it still can’t be healthy doing nothing, can’t she do
something constructive, something she could look
forward to?’
Richard just shook his head. It was hard enough for him to
manage, without this.
To me, it seemed that my parents neither believed in this
illness nor thought I had it, and this, in turn, affected my own
view of my plight, and my culpability. Because there wasn’t a
clear test or scan, I could not be ill. My mother once asked the
doctors if I had chronic fatigue syndrome, as this might be a
more acceptable diagnosis. They also pushed for me to have a
brain scan. They wanted a physical cause to be found, perhaps
because it could be cured, but possibly also because it would
be more acceptable.
It is, of course, easy for me to be critical of their stance, and
I know it was very hard for them. People with mental illness are
often extremely difficult to be with, and I am sure that I was
intolerable at times. They provided us with a lot of practical
and emotional help, and they wanted me to get better. They
also knew what I was like when I was better, unlike the doctors.
However, I can’t say that they have ever comfortably discussed
my diagnosis and what happened to me, even in
subsequent years.
There is also no doubt that, in their youth, mental illness
was even more stigmatised, with a definite ‘us and them’
mindset. My mother’s father was born in the grounds of the
Stanley Royd Hospital in Wakefield, previously a pauper luna-
tic asylum. He was a first and only child, born to older parents,

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 AN IMPROBABLE PSYCHIATRIST

and it occurred to me recently that he might not have been

their biological child – those were the days when young preg-
nant girls were admitted to lunatic asylums, and there would
have been many a baby passed over to the empty, yearning
arms of the childless. Speculation, I know, but even my mother
didn’t completely dismiss this theory as I thought she would,
and there is no way of testing it out now, as all those involved
are dead. This was truly chilling, given my own illness and
pregnancy, and thoughts such as these may have fed into my
mother’s horror at me being admitted to a
psychiatric hospital.
There is good evidence that a susceptibility to mental illness
can be inherited, and, retrospectively, my father’s relatives
were a poster family for mood disorders. My grandmother
had a lot of health anxiety and was clearly depressed at times,
and my cousin has a mood disorder. It is my view that my
father has an obvious cyclothymic personality, in that his mood
varies quite markedly, although perhaps not quite to the
degree that would merit a diagnosis of bipolar affective dis-
order. There are others in that family that I know of, and
almost certainly those that I don’t.
My mother’s side of the family is less clear-cut, although her
own mother was a very anxious person, who may have self-
medicated with more than the occasional gin and it.
My mother’s brother was always viewed as having a difficult
personality. However, he also had long periods of depression,
and irritability combined with ludicrous spending at times, so
who knows? He may have had bipolar disorder.
Richard’s mother was quite accepting of our situation and
would have liked to provide us with more support, but, living
so far away, she had little day-to-day contact with us. His father,
who was twenty years older than both Richard’s mother and
my own parents, also lived in the south of England, and was
rather an extraordinary person. As an older man, born just

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 ADMISSIONS: THE REVOLVING DOOR

after the First World War, one might have expected him to be
more prejudiced. However, he had a niece with severe bipolar
disorder and provided her with a lot of support over the years.
He was not a man to question why things had happened and
seemed able to accept them as they were.
What of our friends? We had a number who were very
supportive, particularly Lorna and Jennifer, my two best
friends from school, who had been my bridesmaids. There
were also a number from university, although we had cata-
pulted ourselves into marriage and a baby, so we were living
different lives from most. I think the hardest thing for me, and
possibly for Richard, was the need that many seemed to have
to find their own explanations for what was happening. There
were a lot of ropey psychodynamic theories put forward, based
largely around my parents and my marriage. Interestingly, it
was those who had known me at university who went down the
route that it was all about my parents and my upbringing –
rather than those who had known me at school, and who
actually knew my parents.
Some people expressed the thought that Richard and
I were just not suited – again, this had an air of convenience,
and of explaining things after the horse had bolted.
Ultimately, everyone will have some issues in their lives and
relationships – or if they don’t, something very peculiar is
going on. I had been living a relatively normal life that had
gone catastrophically wrong. Nothing happens in a vacuum,
and retrospective formulations do not always help, sometimes
being very hurtful.
But our friends, like our families, helped us in many ways,
and Lorna and Jennifer were also a great support to Richard.
I think they always believed in me, even at the difficult times.
I know that I was not easy to help and that I could be quite
angry and rejecting, but I never managed to kill off those
friendships. Jennifer was a fixer and gave Richard literature

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to read, which he found helpful (I would still like to know what

it was). And they also took him out on the town, which he
probably needed. We still had some good moments together
when I was in a better patch, but I was never completely well at
that time. I never gave it long enough. It is a cruel thing with
mental illness, that if you even feel better for a minute, you
cannot understand what you felt like before. I thought that if
I felt well for a minute then I must be a fake.
The doctors on the ward, and those whom I saw in the out-
patient department, became a stark and important part of my
life, particularly as there wasn’t much else going on in it at that
time. I was suddenly hugely dependent on these brief encoun-
ters with psychiatrists, and each time I saw them I was both
hopeful and resentful. I sat in a room filled with patients,
waiting my turn, and I hated it. I hated the fact that the
appointments had become so important; yet there was also
anticipation – each time I thought that something would
finally change, and I would be myself once more.
There were times when I felt furious and let down by those
psychiatrists. In those early days I had a huge amount invested
in being cured by them. I had no idea how it would happen,
and my expectations were entirely unreasonable, so I usually
came away disappointed. I also wanted them to tell me what
exactly was wrong with me. I never really accepted the depres-
sion diagnosis, and I was probably trying to push them into
saying that I had a personality disorder, thus vindicating me in
my view that nothing was wrong and that it was all my fault.
Then I could at least have been angry with them – and myself –
with justification, but they never would say this.
Dr Blackwood was my first consultant, tall and thin and
softly spoken. He had the look of someone who had their
mind on higher things, or even simply other things than those
he was faced with in the travails of day-to-day life. I found him
a bit intimidating at first, so ended up usually seeing his senior

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 ADMISSIONS: THE REVOLVING DOOR

registrar, but Dr Blackwood always came across as a very kind

man. He was an academic and sometimes seemed a bit other-
worldly, but he was always good to me. Compared with others
at that time, he was also more positive about my prognosis,
saying that I was depressed and that it was ‘eminently
treatable’.
This was lost on me, and I didn’t believe it anyway, but it was
a comfort to Richard, who held on to those latter two words in
particular. Dr Blackwood gave the impression of experience,
that he had seen it all before, and that there was nothing that
would especially surprise him.
His senior registrar, Dr Lawrie, was a research fellow, and
clearly a high-flyer. I felt both more and less uncomfortable
seeing him. He was only a few years older than me and ambi-
tious. Seeing him put my own achievements, or their obvious
lack, into stark contrast, and this was particularly difficult,
given that my hopes of becoming a psychiatrist myself had
been so cruelly dashed. I was painfully aware that I had passed
no postgraduate examinations at all, and that this would make
any path back to work harder, as well as feeding into my
diminishing self-esteem.
But, on the other hand, I thought that someone who could
be a contemporary would be more sympathetic and that he
would see my situation with a more understanding eye.
He looked like a psychiatrist, dark haired and bespectacled,
with a tendency to tweeds and cardigans, which also made me
a bit more hopeful. But I found it difficult to talk to him,
perhaps because he seemed very confident and sure of him-
self, and it was disappointing that communication with him
was no better. Yet again I felt let down, even though I am not
clear what he could have done differently. I was the
common factor.
There was one really unfortunate occasion, when he met
my mother in the hospital car park, and she asked him what

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 AN IMPROBABLE PSYCHIATRIST

my chances were of getting back to work. To give him his due,

he was probably forced to give an answer that he did not want
to give. But what he said was fifty-fifty. My mother was most
upset and unable to keep this from me – I was fairly destroyed
by it. It was not even the statistic itself, but to me it meant that
I would never get back to what I was, quite apart from getting
back to work. I would never again be that person that
I had been.
I suspect one of the difficulties for him and for others was
that they had never known me when I was well, so were quite
unable to imagine what that might be like. But it also fed into
my personality disorder obsession, for if I had a mood dis-
order, like severe depression or bipolar disorder, would this
not respond to treatment? Would I not get better? That was
what I had been told, and what I wanted to believe. It was my
belief that he thought that I had a personality disorder, some-
thing that was not an illness but a reflection of my character
and behaviour. Something that I should have control over,
something that was my fault.
We also had a brief foray into cognitive behavioural ther-
apy, Dr Lawrie and I. If not keen, I was at least willing to try
something which might help me, and that was not a pill. But it
didn’t go especially well and was of no real benefit to either of
us. We sat in a little room at the top of the student health
centre, where he explained the basics – that actions and
thoughts and mood can all affect each other. I couldn’t see
the point of any of it.
‘Just try to focus on your thinking.’ He looked patient.
‘I don’t know what you mean. I’m not thinking anything.’
He tried again. ‘Just focus on what you’re thinking right
now. You must be thinking something.’
I stared at him. ‘I’m thinking I don’t like your tie.’ I was
immediately appalled at my own rudeness. In my old life it
might have been funny, but not now. But the sad fact was that

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 ADMISSIONS: THE REVOLVING DOOR

it was true; I had been thinking that, and I couldn’t possibly

see what use any of this was.
I felt equally guilty at my total lack of ability to complete the
homework that is essential for this type of therapy. Even the
word ‘homework’ put me off, and I didn’t manage to do the
simple tasks or experiments set. We abandoned it – another
failure. Psychotherapy was not otherwise a part of my early
treatment, even when I was in a better period. I probably
wouldn’t have got on particularly well, judging by this, but it
simply wasn’t available, as far as I could tell.
Dr Lawrie saw me as an out-patient between admissions, but
others replaced him when he moved to a different post. One
of them, obviously finding conversation with me very frustrat-
ing, suddenly asked me how old I was, mid-interview (twenty-
eight). I’m sure I was annoying, but it cut me down to feeling
like a primary school child. I hardly wanted to be like this, and
it was crushing.
I mingled little with the other patients on the ward, during
the times that I was there. I hope I was never rude, but I never
knew what to say to them. I got to know a few, as many seemed
to come back, again and again, a bit like me. There were a
couple of girls with eating disorders, one very young.
I remember her saying to me, quite admiringly, ‘You’re very
thin, have you had anorexia?’
I looked at her dangling, slender wrists with horror. ‘No.
No, I’ve never had that.’
It was quite shocking to me that someone might think that,
even more so that they would see it as something to
be emulated.
There was another girl, also young, whom I saw a few times
after discharge; she had seemed very odd on the ward but
rather sweet when we met afterwards, and I was sorry to lose
touch with her. I remember another who probably had schizo-
phrenia, whom I saw again and again around the hospital,

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 AN IMPROBABLE PSYCHIATRIST

looking a little worse each time. I did not know the diagnoses
of most of them; it was quite odd in a way, as those were the
reasons for our being there, the glue that drew us together.
Those with anorexia were obvious, the others more opaque.
There was a certain mystery about it all that echoed my own
uncertainties – what was wrong with us? Were we ill? There was
a board with everyone’s names in the nurses’ office, and also
what observations we were on. Roughly, you were either on
general (you could go anywhere), close (someone kept an eye
on you), or special (within arm’s length). It was impossible not
to wonder why people were on special observations – what had
they done? What level of awfulness could require this?
There was also a note of whether patients were detained
under the Mental Health Act, which was again a puzzle to me,
when so many of them looked so ordinary. I saw detention as a
certain end to any dying ember of the hope that I once had to
become a psychiatrist, and I agreed to anything to avoid it.
I stayed in hospital for the least time I could get away with, and
being forced to remain there for longer was a nightmare that
I couldn’t let happen.
I am however fairly certain that I was briefly detained on at
least one occasion, and I am very grateful indeed to ECT that
I can’t actually remember anything about it. Sometimes
memory loss is a mercy. But by that time I don’t suppose
I cared very much.

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 CHAPTER 7

Recovery?

The pressure to return to work became gradually more acute

in the months after Madeleine’s first birthday, perhaps espe-
cially from my parents. They equated getting back to work with
getting better, and, by extension, so did I. I was becoming
increasingly desperate, believing that neither of these would
ever happen, and was quite unable to allow myself time to
enjoy looking after, and getting to know, my baby. I saw my
fellow medical students, now doctors, pressing on with their
careers and passing exams, and I saw myself as a
terrible failure.
At times I felt pitied by people. My friend Jennifer, also a
doctor, tried very hard to encourage me. ‘You could do bene-
fits work, Rebecca. It’s just reports, you could do that, it would
be part-time, and there’s probably other things like that.
You’re a doctor, doctors are always needed.’
I just shook my head. She wanted so much to help, yet
I knew very well that she herself would not want to do this
type of work, that she was really trying to think of things that
someone without further training and experience could do.
In fact, I knew quite well that I couldn’t have done even that
type of work. A medical degree without postgraduate training
and exams doesn’t equip you for very much, and I didn’t have
any other skills or talents. Mental illness makes it hard to work
at any time, but the added stigma – to me – of being a
psychiatric patient made it even worse.

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 AN IMPROBABLE PSYCHIATRIST

And so I entered into a most unpleasant period of actively

trying to get back to work. It felt like my last chance. Mental
health problems were not always readily recognised or sup-
ported then, and it seemed to be quite hard to get jobs at the
best of times. General practice training, which I had not yet
completed, was overseen by the Scottish Deanery, and was
quite competitive, perhaps more than now. I went there to
speak with someone about my situation, however, and they
were actually quite helpful. I had missed two months of my
year’s training in general practice, and it was agreed that
doing an extra six months part-time would be enough to
complete this.
I was quite happy with that, and it only remained to find a
practice which would take me on. The Deanery identified one,
and I started, briefly. However, when it came to it, I just
couldn’t do it and had to stop after a couple of days. I then
tried taking up locum hospital posts, in both paediatrics and
geriatrics, but neither time could I cope. I was frightened of
speaking to patients and worried that electroconvulsive ther-
apy (ECT) had destroyed all my medical knowledge. The
anguish and humiliation of not being able to manage
was overwhelming.
It was around this time that I took a couple of overdoses of
amitriptyline, a dangerous drug which is not sensible to take in
overdose. People often wonder, or speculate, whether an over-
dose is a serious suicide attempt, self-harm, a cry for help, or
even straightforward manipulation. I don’t think this was any
of those. I had just lost hope and no longer really cared if
I lived or died. I knew amitriptyline was dangerous. I wasn’t
determined to die, or I probably would have, but neither
could I carry on like this. I saw one of the hospital psychiatrists
in the Infirmary afterwards and told him any old rubbish to get
him off my back. It was an awful experience, and I saw myself
reflected in peoples’ eyes, as the self-harming, personality-

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 RECOVERY?

disordered doctor, who no one really believed was ill. I didn’t

think things could get much worse.
I am still filled with horror that I ever attempted this. Like
other actions, I can’t look back and say I wouldn’t do it now, as
unfortunately that was where my life had led me, and that was
what I did. But I am extraordinarily thankful that I didn’t die,
and that my family, and especially my daughter, was not left
with that terrible legacy. Dying never stops for those who are
left behind. Who could wish that on anyone?
I had reached rock-bottom by this time, with nowhere left
to go. I saw Dr Blackwood, and he suggested I might start
lithium.
‘Isn’t that just for people with manic depression?’ I asked
suspiciously. ‘And doesn’t it damage your kidneys?’
‘It is used for people with bipolar disorder,’ he said, ignor-
ing my use of the older term, ‘but it’s also used for people with
severe depression. It helps to augment the antidepressant.
And it won’t damage your kidneys if you get regular blood
tests, to check your levels.’
‘I’m not that keen. It won’t help,’ I said. To me, taking
lithium felt like a confirmation of a lifelong, severe mental
illness, probably manic depression, whatever he wanted to call
it. It also meant three-monthly blood tests, and perhaps kidney
failure further down the line. It is, in fact, a very effective drug
for both bipolar disorder and severe depression that is often
under-prescribed, precisely because of these necessities.
But Richard interrupted. ‘You have to do something. I can’t
cope with this anymore. I can’t cope with your mood being all
up and down, it’s terrible. And it’s not fair on Madeleine.’
I knew I was out of options. I was very reluctant and didn’t
think it would work, but I agreed to try it.
And then the most surprising thing happened – I started to
get a bit better. After the amitriptyline fiasco, my antidepres-
sant had been changed to paroxetine, a selective serotonin

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 AN IMPROBABLE PSYCHIATRIST

reuptake inhibitor in the same family as Prozac, which was

safer in overdose, and maybe this worked better with the
lithium. It didn’t seem to have worked without it. Or possibly
this was a natural end to a long episode of depression,
who knows?
Even more surprisingly, I had almost nothing in the way of
side effects with lithium. I knew some people gained weight, or
felt a bit dulled, but I didn’t. I did have to get blood tests every
three months, but this was hardly a burden.
So gradually I improved, little by little. Richard was plan-
ning – yet again – to go to Mexico to work in the late autumn,
and I asked if Madeleine and I could come too, something
I would never have suggested during the previous year. It felt a
bit precarious, as I had become quite dependent on mental
health services, but we decided to go. We flew to Mexico City,
then down to Chiapas, and back to San Cristobal, where we
rented a room in a rather beautiful house owned by friends of
Richard’s. There were gardens, all surrounded by rooms, so it
felt safe and contained.
I was still struggling a little with looking after Madeleine, so
Richard arranged for her to be looked after by a local woman
in the mornings. But we were happier than we had been, and,
far from Scotland, I started to see myself as a person again, to
pull together the fragments of what I had become. We went
down to the Pacific Ocean for a holiday, spending time on the
beach, and I even ventured in to go swimming, trying to get
fitter again. It wasn’t always easy, as my Spanish remained
rudimentary, but we started to feel just a little bit like a family
at last.
We returned home for Christmas and to life. I am not
particularly proud of what happened next; in fact, I greatly
regret it due to the pain caused to Richard. I was feeling better
and wanted to put everything behind me, to erase it all. I think
I wanted to pretend that none of this had happened, to start

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 RECOVERY?

again in the life that I had before I became ill. I loved Richard,
but not what I had become, and I couldn’t see how he could
possibly still care for me.
It was, for me, a brief internal struggle, but a cruel one.
I told him that I wasn’t sure if I wanted to remain in our
relationship, and he left for a week with little Madeleine,
now almost two years old, to go down to his mother’s house
in the Isle of Wight. My parents were, on this occasion, under-
standably furious, fearing that he would keep Madeleine, that
he would probably take her out to Mexico, and that they would
not see her again. My father told me that he would not want to
see me again, should that happen. I think it was a threat, but it
still hurts.
Richard came back, and, after discussion, we decided to go
to marriage guidance counselling. Depending on your view,
we were either lucky or unlucky in our choice of counsellor, as
only one session convinced us that staying together was a
better option than attending any more.
It started badly. ‘Rebecca, do you think you are attending to
Richard’s physical needs?’
I tried not to snigger. ‘Er – I try to.’
Undeterred she turned to Richard. ‘And you, Richard, do
you think Rebecca has physical needs that she can’t share
with you?’
‘I hope not.’ Richard was not one to get pulled into this
type of dialogue, and I was concerned that Madeleine was
sitting in the corner. Even at two she didn’t need to listen to
this sort of nonsense.
We left shortly, and went, with Madeleine, straight to a
nearby cafe, where somehow our shared sense of ridicule drew
us together. I don’t think that I ever would have left Richard,
but I had become bitter about his role in my life. He had
become my carer rather than my husband, something he,
too, strongly resented. Harder to admit, he was also

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 AN IMPROBABLE PSYCHIATRIST

succeeding in his career, and I was jealous. I don’t know how

this brief and unkind desertion affected him; he has often told
me that his brother, in whom he confided, was furious on his
behalf, and maybe that was his way of telling me of his own
anger and upset. The balance in our marriage was very diffi-
cult at that time.

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 CHAPTER 8

Into the Fray

Shortly after this, I somehow managed to get a job as a Senior

House Officer, doing geriatric medicine, in one of the hos-
pitals just out of Edinburgh. I was twenty-nine and had fin-
ished my general practice post in Cornwall over two years
previously, when I was twenty-six. There was no supported
route back into hospital medicine at that time, so I had just
applied to an advert in the British Medical Journal.
This was a proper training post for six months, that would
count towards my general practice training. There was very
little induction, and there was no phased return or formal
support for me, despite the fact that I was back from such a
lengthy period of sick leave. I had no idea whether I was going
to manage it or whether it would end with the same miserable
collapse and failure as had previous attempts. I was full-time, as
there was no option to work part-time, and I had to do on-call
from the start (it was a one in four), which was resident at
the hospital.
Like all the other hospital jobs that I had done in the past, it
was a very junior post, with duties including admitting patients,
taking bloods, investigations, and managing day-to-day ward
work and care of patients. This was all work that I had man-
aged before I became ill, but I no longer had any confidence
at all.
On the very first day, I went to take blood from a patient
and failed. This was hardly surprising, given that I hadn’t

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 AN IMPROBABLE PSYCHIATRIST

worked for so long, and it was nearly three years since I had
last done this, but to me it spelled the start of complete failure.
I left the ward for the office, close to tears, and bumped into
one of the senior doctors.
‘What’s wrong?’ he asked, looking at me curiously.
‘I just can’t do it,’ I sobbed. ‘I’ve been ill, I’ve been off work
for a couple of years, and I can’t even take blood. It’s no good.’
‘Take a minute,’ he said. ‘Now, let’s go back to the patient.
You show me, and I’ll give you a hand if you need it.’
I took the blood. It was probably nothing to him, but it was
one of the kindest and most supportive things he could have
done, at a time when things could have gone either way.
Perhaps I should take a little credit myself – unlike on previous
occasions I accepted help, rather than abandoning the situ-
ation – but it does depend very much on there being someone
approachable that you can ask. He was a quiet, and, for me,
necessary support throughout that job. The consultants were
present but less available, but the other junior doctors were
all friendly.
I had a tendency at that time to over share about my mental
health problems, which may have embarrassed some, but it
was hard to explain what I had done over the previous couple
of years without doing so. Reminders were everywhere – there
was one particularly sad young patient, in one of the attached
wards there, who had catastrophic brain damage following an
overdose. Their path had ended in permanent twilight, while
mine was moving slowly back into the sun. I did manage the
job, though. It was difficult at times, but I got through it. It was,
indeed, a glimpse of light.
The changes in the seasons were unusually vivid to me
during those six months. No one would ever describe me as
a person particularly at one with nature, but it meant some-
thing more than usual. I drove to work, and every day I would
see the green pushing past a cold winter, the daffodils

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 INTO THE FRAY

emerging from their shoots, and the trees blossoming.

It wasn’t a particularly special spring, but I never saw one like
it. It was a spring that I thought I would never see.
Despite this new spring and its tiny shoots of tentative
confidence, I found full-time work and on-call exhausting
and looked forward to my next job, which was the half-time
general practice post that I had originally been unable to
manage. Under the circumstances, I was very grateful to the
practice for offering this to me again, but the job proved very
hard. I was determined to complete my general practice
training but was sorely tested. I think there was possibly a
personality difference between me and my supervisor, one of
several general practice partners working there. He may have
hoped to support some damaged, but gentle and grateful,
individual, and was instead faced with someone who was still
struggling, angry at what had happened, and not inclined to
be gentle at all.
But I also had a feeling that I never really had before, that
my mental health problems were being taken into consider-
ation when my work was assessed. On one occasion, he
observed a consultation that I did with a patient, and after-
wards we discussed it. I was very nervous but thought it had
gone reasonably well.
He looked at me. ‘How do you think that went?’
‘Well, it was OK, I think. She seemed quite happy when she
left.’ I shifted in my seat.
‘I suppose. But I think the way you laughed was a little
inappropriate when you were asking her about her pain. I’m
a bit concerned about this, given, well, you know, your history.
Are you actually doing OK right now?’
I was stunned. I always tried to be friendly to patients to put
them at their ease, and being observed was quite stressful. The
patient herself had recognised and acknowledged this, and
I was pretty sure that we wouldn’t be having this conversation

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 AN IMPROBABLE PSYCHIATRIST

had it not been for my history of mental illness. If anything, it

would have been recognised as nervous laughter and dis-
missed. There is nothing you can do when you feel like that,
though, and I knew it. Anger or upset would be seen as a
symptom, and any denial as confirmation.
So I kept my head lowish and got through the rest of that
job, and my supervisor agreed to sign me off at the end. I don’t
think it was just my imagination that he seemed a
little reluctant.
During these six months, I attended the compulsory gen-
eral practice educational course, similar to the one that I had
attended in Cornwall. People were friendly, but I don’t think
that I had realised just how hard I would find new social
situations, particularly with other doctors, given how different
things were for me than when I last worked in general prac-
tice. It was less of a problem with existing friends. There was
quite a bit of socialising on this course, and I tended to drink
slightly more than I usually would, just to cope with it. I found
talking to new people extremely difficult.
I became part of a study group that was also a source of
tension, although I never really understood why. We were five
trainees, and one had previously been part of my old string
quartet, although neither of us were playing music now.
Another had been in my year at medical school, although we
barely knew each other then, but the other two were com-
pletely new to me. I was still consumed by my own illness and
its aftermath and was probably not always particularly sensitive
in picking up on others’ problems. I was puzzled when people
did not appear to like me, but resentful rather than curious.
The purpose of the study group was to increase our chances
of passing a postgraduate exam for Membership of the Royal
College of General Practitioners (MRCGP). You could still be
a general practitioner at that time without passing it, but it
helped a great deal to have the exam and later became

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 INTO THE FRAY

compulsory. Many doctors would also do various diplomas,

particularly in child health or obstetrics and gynaecology.
I had previously avoided these, and I was increasingly and
painfully aware of my complete lack of postgraduate qualifica-
tions, seven years after graduation. Not only did this render
me less employable as a doctor, but it reinforced my medical
school view of myself as slightly stupid.
I was also in an awkward position, as I was increasingly
convinced that I did not want to be a general practitioner.
Even before my illness I had drifted into general practice
training rather than making any purposeful choice, and my
reservations about it had now been confirmed. I also thought,
probably correctly, that no general practice would take me on.
At that time posts were quite competitive, practices were busi-
nesses, and I had chronic health problems.
I was never actually resentful of this, as I thought it would
probably be the same for someone with any chronic condition,
rather than a particular problem for mental illness. I had enjoyed
at least some of my time working in Fowey, but my experience
back in Scotland had finally put me off. I was very sure it was the
right thing to complete my general practice training, as I needed
to show that I could do this, but I had started to think again
about my lost dream of becoming a psychiatrist.
A lot of people around me seemed to think that this was a
bad idea on very many levels. Richard had absorbed some of
the grimmer aspects of psychiatry and could not understand
why I would even consider doing it, and my parents shared his
views. There were various suggestions from friends about
whether I might be trying to cure myself. I cannot begin to
understand this. No one would deter someone with diabetes
from becoming an endocrinologist, even if it was slightly
motivated by the desire to gain some greater understanding
of their own condition, but this seemed to be a particular issue
for mental health problems.

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 AN IMPROBABLE PSYCHIATRIST

I was of course worried about how my plans would be

viewed, though, and I decided to seek advice from one of my
previous treating psychiatrists, Dr Lawrie. I thought, being
younger than Dr Blackwood, that he would better understand.
He very kindly met me in his crowded office in the old hospital
tower and heard me out.
It was bizarre meeting him in these circumstances. There
were books everywhere, and he moved some off a chair so
I could sit down. ‘I’ve been thinking,’ I began. My mouth was
dry, and I stopped. ‘Well, what I mean is I’ve actually always
wanted to be a psychiatrist, and I just wanted to know what you
think.’ My hands were clenched, and I slowed down. ‘Like
I wanted to do it before I was, you know, ill. And whether
I could be, after everything.’ I didn’t like to say much more.
I felt rather humiliated.
He looked quite taken aback. This clearly wasn’t what he
had been expecting. ‘Well, I don’t know,’ he began cautiously.
‘It would be difficult for you.’ He was never one to mince his
words and went on, ‘The fact that you’ve been a psychiatric
patient shouldn’t stop you, but I honestly think it would be just
too stressful for you. The training’s long, and you’d have to do
the exams. I’d advise sticking to general practice, it’ll be
easier.’
Surprisingly, I was not put off by this – or perhaps it was just
the impetus that I required. I think I also rightly felt that my
current options were few, and I had little to lose. So given that
I had no immediate prospect of a job in general practice,
I looked around to see what the possibilities in psychiatry
might be.
Psychiatry as a medical specialty for junior doctors is
broadly divided into core and higher training. At that time,
the jobs in core training were referred to as senior house
officer (SHO) posts and lasted six months each. Trainees were
required to do around six of these posts, perhaps more, and to

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pass the Membership of the Royal College of Psychiatrists

examination, before they could apply for higher training,
which then took a further three years. All of these posts would
be supervised by a consultant, and only after successful com-
pletion of training would it be possible to apply for
consultant posts.
Core training jobs are now managed within regional
training schemes. In some ways that would have been easier
for me, as the process of applying is much more anonymous
and might have afforded less potential stigmatisation, but in
those days, there were a larger number of more local schemes,
and shortlisting and interviewing was carried out by the clin-
icians who worked there.
For me there were four realistic possibilities: I could apply
to Edinburgh, where I had been a patient, or to one of three
more peripheral areas that were within commuting distance.
The only disadvantage of these – and for me it was quite a big
disadvantage – was the amount of driving involved.
I never liked driving. I spoke once, much later, to a nurse
who had looked after me as a patient in those early years. She
asked me why I had stayed locally to train, why I had not gone,
for example, to England. I was slightly taken aback by this, by
the assumption that I might have been better leaving the
country rather than working in or near Edinburgh, but replied
with the truth, that my husband was working in Edinburgh,
and my family was there. It is possible that Richard would have
agreed to a move, but I felt that I had asked him to do too
much already. I had to manage within the parameters of
our lives.
I applied for the Edinburgh scheme and was not in the least
bit surprised to be rejected; I think I would have been rather
bemused had I been accepted. I was not even offered an
interview. In many ways it was a relief, as it would have been
very hard for me to walk near that hospital, never mind work.

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But a little internal voice did say to me, even then – ‘You
must be at least as qualified as many others who applied,
perhaps more. Why did they reject you?’ I did not have a
particularly academic record, but I had nearly finished general
practice training, and a lot of trainees were accepted with less
experience. Completing general practice training was usually
seen as a positive factor for acceptance into psychiatric
training. It was hard to believe that the reason that I was not
even shortlisted could be due to anything but my history of
illness. Yet it would have been relatively easy to find me place-
ments in different areas to those where I had been treated.
I found this quite difficult to think about and decided not to
dwell on it, given my own misgivings about working there.
I then applied for one of the peripheral posts and was
invited to interview. It was for a job that would last a year
and the interview went well. At the end I said, ‘Look, I need
to tell you this, I have been a psychiatric patient myself, I’ve
even been an in-patient, I just thought I should say, in case it’s
a problem.’
The two psychiatrists who had interviewed me looked at
each other. Then one of them spoke. ‘No, I’m sure that’ll be
fine. But I think in view of that we’ll just offer you the job for
six months rather than a year, we can see how things are
going then.’
I was rather disturbed by this. I didn’t think that a diabetic
trainee would have been offered a shorter contract by
an endocrinologist.
There was another post advertised in the Scottish Borders,
which was a longer drive, but again I applied and again went to
interview. This took place in Dingleton Hospital, previously
the Roxburgh Asylum, an imposing old building at the top of a
hill, and close to Melrose, a beautiful Borders town. I arrived
and was sitting in the lobby next to the fish tank, waiting to be
called, when one of the current higher trainees walked past

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and looked at me with surprise. He was one of the psychiatrists

whom I had seen in the latter part of my illness, the one who
had asked me how old I was. That did not bode too well, but in
fact I had nothing to fear. It was quite possible that there were
no other applicants, but I didn’t care.
After the interview, I gave the same faltering explanation
about my psychiatric history. They seemed quite surprised that
I had felt the need to do so, and one of them spoke straight
away. ‘That’s not a problem, don’t worry. We’ll be delighted to
have you join us.’ There were no provisos in their offer. I felt as
though I had been given a second chance and accepted with
alacrity, despite the long commute.
I wonder, looking back, why I felt that it was so necessary to
tell prospective employers of my own psychiatric illness, even
at interview. But I also think it was a good thing for me, in that
there were no major secrets, no untalked of shadows lurking in
any cupboards. It may even have helped me to identify the
right place to go and work. And I think all this demonstrates
how mental illness, unlike physical illness, can affect the way a
person and their attributes are viewed.
Has this changed? I don’t know. There is now far more
emphasis on talking about mental illness or mental well-being,
but sometimes I wonder if the noise of this talk actually makes
it harder to hear.
I did pay a visit to the one other hospital within my radius,
which was in Fife, and spoke to one of the consultants there.
I recognised him, as he lived close to us, and his daughter was
at the same nursery as Madeleine. He was a man of few words
but listened carefully and patiently to mine, which were also
few, and which concluded with my offer from the Borders.
He said, ‘Well, I think you should take that job, then.’
He was quite right, as it would have been a great mistake to
have abandoned the job in hand for a less certain one in the
bush. He was later to become a close friend, and I wonder how

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things would have worked out, had I pursued the option of

trying to work there. Possibly quite badly, as there are times to
meet people and times to work with people, and I still don’t
think that I was at my best.
I was extraordinarily relieved to leave my general practice
post, just before my thirtieth birthday. I now had a new job, in
psychiatry, which would last for at least a year, and this was a
huge weight off my shoulders. Much of my view of myself as
damaged goods was my own. But my recent experiences sug-
gested that that view was shared by some and that the medical
profession was not always terribly forgiving. I use that word
deliberately, as at times it felt like I needed some form
of absolution.
Soon after starting my psychiatric training, I went to a
lecture by a psychiatrist who said: ‘If you have mental illness
as a medical student you’re finished as a doctor; as a junior
doctor your chances are not good; as a higher trainee you may
get through; as a consultant you will probably be fine.’ As a
junior doctor with a mental illness, this was hard for me to
hear. Anyone who said this now would probably be weeded out
themselves; however, I do wonder how much stigma lingers in
the medical profession. And while it is right that such senti-
ments should be criticised, I sometimes wonder whether we
are then rendered less cognisant of others’ views. Anyone can
pretend to be empathetic; how do we know what they are
really thinking?
In fact I still sometimes wonder if I should have been
weeded out, as my life would probably have been easier, but
it is difficult once you are a doctor to stop being one. There is
no being replanted in an alternative flower bed; one is ripped
out, dripping with guilt, and carted off to the compost heap.
I had not been a very ambitious medical student, although
I had always regretted my lack of academic endeavour, and
I had drifted rather aimlessly through my general practice

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training prior to my illness. But now, once I had my shaky grip

back on the medical ladder, all that changed. I was very driven
indeed as a psychiatric trainee, not only through a love of the
subject, but because I felt that I had to do twice as well as
others to be accepted. This didn’t leave me for years, if ever.
I was also desperate to contribute to our family coffers, aware
that Richard had been forced to work far harder than he
should have to keep the whole edifice afloat.
I was reasonably well at this point, and still taking lithium,
although I had misgivings about it. I had stopped my anti-
depressant some time previously, which was fairly stupid, given
that the lithium was supposed to augment it. But I never liked
taking selective serotonin reuptake inhibitors, one major
aspect being the sexual side effects, and the consequent
dampening effect they had on any bedroom activity. I would
guess that a lot of people stop them for that reason and are too
embarrassed to say, particularly as many doctors don’t ask.
They also tended to make me feel rather agitated, which
I didn’t like.
I had hardly experienced a single side effect on lithium,
and, although I did not like the idea of taking it, I had always
felt quite normal on it. It is surprising how one can ‘forget’ to
take medication with adverse effects, but I thought that con-
tinuing something might be helpful, especially at this time.
Madeleine was now three, and I felt very sad that she had no
sibling, and no obvious prospect of one. I had always hoped to
have three, or even four, children, but knew I was fortunate to
have one. She appeared to be thriving and was a strong
presence at nursery, with close friends whom she loved. She
also continued to be very close to my parents and was a much-
doted-upon little girl. To me she was very beautiful, and
I wanted very much to work less, so that I could make up for
lost time with her, but there was no possibility then of doing
part-time training. Richard’s work remained uncertain, and

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I needed to work, financially, as well as for my own shaky

self-esteem.
I felt inadequate as a mother, though, as I had gone straight
from doubtful recovery to full-time employment, and either
way she had lost out. Many of her little friends had siblings,
but this hardly seemed an option for us, given what had
happened last time. I think we thought briefly about adoption,
but we would never have been approved with my history of
mental illness.
At that time we had a little ornament in the bathroom with
three figures on it, given to us by my mother-in-law – it read
‘Daddy, Mummy and Madeleine’. I knew we were unbelievably
lucky to be this little family of three, but I hungered illogically
for another baby, to make things complete.
We were never actually told not to have another baby,
probably because nobody thought we would even consider it.
I was recommended not to conceive while on lithium, though,
as this was thought to raise the risk of cardiac abnormalities in
the infant. But I avoided conversations with professionals
about future pregnancies, largely because I was certain that
I would be advised never to have another child. I think that
was Richard’s firm opinion, with or without advice, and who
could blame him after what we had been through? He also
had a very reasonable fear of the effect on Madeleine, should
I become ill again, especially as she would be older and
more aware.
I had a new chance and a new job, and the little baby
thoughts that were creeping in needed to be suppressed.
I bought some new books about psychiatry and drove down
to the Borders through snow and wind, to start work.

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 CHAPTER 9

A Psychiatric Trainee

The Scottish Borders is quite a large area, geographically,

speckled with little towns, some picturesque, some rather
more functional. There are several main roads down from
Edinburgh, depending on where you want to go, and the A7
and the A68 became my usual routes. You could take the A1 to
go down to Eyemouth and the coastal areas of Berwickshire,
which also became familiar. Dingleton Hospital was best
accessed via the A7, but my first post, which was in general
adult psychiatry, was largely based in Duns, in Berwickshire,
reached through some smaller cross-country roads off the
A68. All of these journeys took at least an hour each way.
The climate was a little different from that up in the city.
It was mostly rather beautiful, and we once held a ward round
in the gardens, but during the winter the snow tended to be
heavier and to drift, and occasionally whole areas would be cut
off. I had my trusty little Peugeot 205, popular in those days,
but not really equipped for such conditions.
On my very first day at work the snow started to fall, and
I was worried that I would be trapped there, unable to get back
home to Edinburgh. I was hardly enamoured of a snowy
sleepover on this, my first day, and I managed to get home
by a circuitous route via Peebles. Even had my little car been
up to it, the A68 and A7 were often closed in such weather,
with large gates pulled across the roads, so I was lucky.
On another occasion, I remember driving through a winter

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day to Duns, having no idea where the verges were, or indeed

the sheep, so heavy was the snow.
How can I describe Dingleton? I think I fell in love with it a
little. It was originally built in 1872 as the Roxburgh District
Asylum, one of many district asylums established in Scotland
in response to the Lunacy (Scotland) Act of 1857. It later
became famous as Dingleton Hospital, largely due to the work
of Dr Maxwell Jones, a pioneer and leader of the concept of
the therapeutic community. Even prior to this, its doors had
been unlocked at an earlier stage than many other asylums,
and when I worked there, at the end of its life as a hospital, it
was very different to the hospital I knew in Edinburgh. Rather
than attempt to describe it, I will quote from The Border
Advertiser from May 1872:

The house stands on a sloping spur of the hill, 600 feet above
the sea-level, and 300 feet above the level of the Tweed at
Melrose, and is about half a mile from the railway station by
the Dingleton Road, which has been widened and improved as
an access. The site and grounds comprehend some 26 acres . . .
The situation is very fine, commanding a stretch of the vale of
Tweed from Melrose to Gala-foot, where the Abbotsford woods
cuts off the fine view farther up the Tweed . . . This extensive
view must have a cheering effect on patients under depression,
and we question whether there be one in the whole view of the
Tweed giving as much extent, variety, and soft beauty. It must
be exquisite with a fine sunset.
(Dingleton, 1872–1972)

When I worked there, things had obviously changed some-

what, and it was run as a standard psychiatric hospital. Yet it
seemed to hold onto the echoes of its past, and there was a
peace about it that I never noticed when I was a patient in
Edinburgh. People were still admitted in great distress, and

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there can be no doubt that mental illness exists everywhere,

but there was kindness and tolerance in those old walls.
There were six consultant psychiatrists working there, and a
similar number of junior doctors, some of them psychiatric
trainees, and some GP trainees doing psychiatry as part of
their training. When on-call we were resident in Dingleton,
but this was slightly less frequent than in my previous jobs, and
any reduction was welcome. The facilities where we stayed
were old-fashioned, and there was a large bath rather than
the usual shower. Despite the antiquity, I personally preferred
a bath when working, as being pelted by running water while
trying to keep your ears patent to hear a bleep is a
tense business.
The on-call work had its own challenges, however. Rather
than patients being brought to the hospital to be seen, we were
expected to drive to the patient, sometimes with only a very
junior member of nursing staff. This could be a long way, and
at any time of night, with Eyemouth and Hawick, for example,
each being an hour’s drive from Dingleton, but in the oppos-
ite direction from each other. Sometimes we would bring the
patient back with us for admission, but more often not.
For insurance reasons we would use hospital cars, which
could have their own surprises. I remember once near the
start of a drive thinking, there is something very wrong here,
but not being able to put my finger on it. I was mortified when
I realised that the mirror was missing. Overall, it was hard
work, but the intensity of patient contact was diluted by so
much time spent on the road.
During the day, we worked in various offices and buildings
across the Borders, depending on which team we were with.
I had never heard of Duns, where I was first placed, and those
were the days before Google Maps. Not that there was much
mobile reception anywhere in the Borders, something that
could be a problem, as we had two large old-fashioned mobile

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phones that we carried for on-call work. One was always

charging, the other in use. As when I worked in Cornwall,
I accumulated a sheaf of paper maps and gradually learnt my
way around, at least enough to manage, if never well enough
for real confidence. I never enjoyed driving but preferred the
country roads to city ones.
Despite my determination, that first post was a dramatic
switch from being the psychiatric patient to being the psych-
iatrist, however junior, and it wasn’t the easiest start. I needed
to learn the basics – taking a history, examining a mental state,
formulating problems, and making diagnoses. The team had
what seemed to be a very flattened structure – everyone was
equal and undertook the same duties. For example, the very
first patient that I saw, I visited with an experienced occupa-
tional therapist. We drove to the patient’s house together and
introduced ourselves.
‘Can you tell us a bit about what’s been happening?’
I thought that was a good start.
My colleague interrupted. ‘Now, let’s all get a cup of tea,
and we’ll sit down and have a chat about things. Is that OK?’
The patient and I nodded mutely.
It went fine as supportive chats go, but it wasn’t like any
mental health assessment I had ever come across as a doctor,
or indeed a patient. There was no real risk assessment, given
that the patient had self-harmed. It was a strange combin-
ation – an occupational therapist and a completely inexperi-
enced junior trainee psychiatrist – and I wasn’t too sure what
my role was, or what I was supposed to do.
The consultant in that area was kind but not always the
easiest to work with. Later on in the job I had to take a couple
of days off with a viral illness, and, when I told him, he said,
‘Ah, a bit stressed, are you?’ It was a very irritating assumption,
but again a situation where argument would have achieved
nothing except to confirm his opinion.

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Most of my supervision in that post was fortunately with

another consultant, whom I found easier to relate to, and
who was supportive as regards my mental health history. One
day she gave me an article to read, written by a doctor with
illness, and for the first time I realised that others had experi-
enced similar troubles, and had got through them. It was just a
glimpse that perhaps I was not alone, and maybe I was not
even such a bad person, or doctor.
I found seeing psychiatric in-patients troubling at first, if
there were any particular triggers – even just similar age or sex
to myself. But I learned to separate such feelings and to think
about it only afterwards. I also started to realise that you feel
differently about different patients, in the same way that you do
about friends and acquaintances, that this is normal. Sometimes
this is due to their mental health, and sometimes it isn’t. But
psychiatric patients are no different to other people, in that
they have friends, families, work, and lives. I realised with a jolt
that I had all these things too. I was a person, as well as a doctor
and a patient. Like all psychiatric trainees, I had an hour of
supervision with a consultant once weekly, when I could talk
about such things. I really valued this.
Perhaps the most difficult thing for me, during this period,
was attending what was then known as the MPhil (Master of
Philosophy) course in Edinburgh. The Borders training
scheme, although separate, was allied to Edinburgh, and all
psychiatry trainees had to attend for two half days each week
before they could sit the Royal College of Psychiatrists mem-
bership examination. I commuted an hour both ways to work,
and there was the obvious advantage that this shortened my
day by bringing my commute home forward on those days, but
it also meant going back to the hospital where I had spent so
many difficult times.
The course was taught in the university tower, which
increased my chances of bumping into any of my previous

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treating psychiatrists, hardly a positive for me at that time. I felt

acutely anxious going near that hospital and that tower – my
heart would race, I would feel sick, I would shake. The tower in
particular assumed great menace, an ugly building with all its
empty windows looking down at me. But avoiding this was not
an option, so I made myself go, and it did get a bit better, with
time. It never left completely, though.
I felt envious of the other trainees, most of whom were
based in Edinburgh, although a few were in Fife. I was happy
in my own job but very aware that I had been rejected for an
Edinburgh post, so to me they all seemed better, cleverer,
more confident. This was a ridiculous assumption, but
I remained preoccupied by my own problems, and probably
quite insensitive to those of others. Even now that I was back at
work, shame about my past as an in-patient consumed me.
Some people wore their problems, not with pride, but with
dignity. Mine were secret, crumpled, hidden hastily away.
My desire to tell people was largely to expunge the guilt and
to try to wash away that humiliation. If I told them, they
wouldn’t find out.
Despite all this, the course was interesting, and it was a
chance to meet other trainees. They were very different to
the GP trainees, edgier in dress and speech, and more of them
were smokers. I started to make friends with one or two,
despite my diffidence, and also to enjoy the teaching. Exams
would have to be taken, so this was useful. We had a test at the
end of that first six months, and I was surprised to do quite
well in it.
There was also a clinical exam, though, and I did badly in
this. It involved seeing a patient and then presenting the
history and mental state examination to one of the higher
trainees. At that time, I had no system for gathering or pre-
senting information, something which was essential, and I was
even more nervous because that higher trainee had been in

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my year at medical school. But I didn’t let my poor feedback

get me down, as I might have done previously, and rather
resolved to learn how to do this properly, which I did in my
next post with the help of my new supervisor.
I was continuing to meet with my old general practice
study group, something that was becoming less and less
enjoyable. The dynamics of the group were increasingly
odd; in addition, I no longer intended to be a GP, which
alienated me a little. But I knew that passing the general
practice membership exam could help to make me more
employable, even as a psychiatrist. And at this point I still
had no idea whether psychiatry would work out for me, so
I needed all the advantages I could get. There was also my
dented pride and low self-esteem, both of which would
improve if I could pass it.
So I worked very hard, in the little box room in our flat,
learning facts, practising questions. I had decided that I would
sit it only once, despite the fact that postgraduate examin-
ations sometimes take a few tries or more. They are also quite
costly. But I couldn’t keep working at this while also training in
psychiatry and still trying to spend time with Richard and
Madeleine.
It was a horrible exam, with several written papers and an
oral. I didn’t find the oral easy and came out of it feeling less
than hopeful. The results were due on an early summer’s day,
and they were posted up in London, at the Royal College of
General Practitioners. You could either go to look there or
wait for your letter to arrive, and Richard asked his brother,
who lived in London, to look for me.
I had a large unwieldy mobile phone, the first one I ever
owned, which rang as I was on one of the highest points of my
journey home, coming down into Edinburgh. I wasn’t very
hopeful and pulled in to answer, my heart in my mouth.
‘Well? Did he look?’ My voice was shaking.

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The phone crackled loudly around Richard’s reply. ‘He

did.’ More crackles. ‘..passed.’
‘What? What did you say?’
‘You passed! Congratulations!’
‘Are you sure? Are you sure he looked at the right name?’
But I had! I couldn’t quite believe it! It was another of those
moments, pulling me back from the cliff edge, another little
tuft of grass caught firmly between my fingers, saving me
from falling.
It was also doubly important to me as an academic achieve-
ment after all the electroconvulsive therapy (ECT). I still wor-
ried that my brain had been damaged by it, and to me this was
some proof that it hadn’t. Now, for the first time, I allowed
myself to think that I might carry on working; that even if the
psychiatric training all went wrong, someone, somewhere,
might employ me as a doctor.
And while all this self-absorbed striving was going on, what
of Richard and Madeleine? Given my long commute to and
from work, I often missed seeing Madeleine at night, and we
decided to rent a little cottage in the Borders, not far from
Dingleton. We didn’t use it very much, but it meant that I had
longer in the evenings with Madeleine, and they could both
stay when I was on-call. Richard was still travelling regularly to
Mexico, and my parents would help out with childcare; how-
ever, as they lived and worked in Glasgow, they would tend to
take her over there when he was away, and I missed her. A few
of our friends were starting to have children, though, so we no
longer felt quite the only oddities amongst them.
But I did feel torn between the want and need to carry on
with my career and the desire to spend time with Madeleine.
As time went by, I started to resent my commute more and
more, as well as the fact that there was no option to work part-
time. It also worried me that many commuters had accidents;
I once stopped at a fatal accident where one of a middle-aged

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couple had died. There was other help there, and all I could
do was hold the hand of the survivor, something I never
forgot. The roads were treacherous at times.
The longing for another baby had not decreased, either,
and, sometime in the early summer of that year, I found out
that I was pregnant again. True to form, we had not made a
definite decision to have another baby, but nor was it entirely
an accident, and I was astonished but very pleased. I can only
imagine what Richard thought, but he put a good face on it.
I suppose there was cautious optimism all round, but
I thought – this will be the pregnancy that will go well, I will
not be ill, and Madeleine will have the little brother or sister
that she wants.
It felt so different from the start – I was able to carry on
working and being a normal mother and I so wanted to have
the pregnancy I hadn’t had the last time. I would even have
attended National Childbirth Trust (NCT) classes if it would
have made me more normal. I remember driving around the
Borders and thinking about this little baby, happy thoughts.
I thought that it would probably be a little girl, a sister for
Madeleine. At first I thought that I might call her Jessica, but
then I settled on Lucy, a name that I have always loved.
The only worry was that I had been taking lithium, although
I stopped it as soon as I realised that I was pregnant. Lithium
was not recommended in pregnancy, as there was a very small
chance of heart defects in the baby, and in view of this I was
advised to have a detailed scan at twenty weeks. However no
one seemed to be particularly concerned, so I put it out of my
mind as much as I could.
We decided to move to a bigger flat, largely due to the new
expected baby. We were gathering something of a surfeit of
life events, but nice ones for a change. We looked at a couple
of flats but ended up moving just up the road, to a ground-
floor flat with three bedrooms. The idea of dragging a buggy, a

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small child, and a baby up three floors was too exhausting

even to think about, and this flat was spacious, with its own
front door. It was much darker than the previous one, though,
and was decorated in dubious taste, with a nasty green carpet
and Laura Ashley floral wallpaper throughout.
But it also had a beautiful old fireplace in the sitting room,
with warm shining tiles. The woodwork, including the large
shutters, was stained dark, and the sitting room was a little
smaller than our previous one, but it still had a wide bay
window, and it managed to contain all our old furniture.
There was a long L-shaped hall, and a very lovely bay
windowed bedroom at the back for us; there was a room at
the front for Madeleine, and another room, decorated for a
small child, next to ours.
I don’t think Madeleine liked it very much at first, as she
had had a fresh light bedroom in our old flat, and this did
seem darker and more enclosed. But I remember lying in our
new bedroom at the back and seeing the roses at the window
and feeling very happy. You never saw roses three flights up.
That summer we went to my brother’s wedding in England,
which was a very joyful occasion. Madeleine was a little flower
girl, dressed in a lovely floral frock, and carrying her basket of
flowers. She was only three and sat down in the aisle when she
got tired, just behind the two adult bridesmaids, picking her-
self up quickly when she saw people smiling at her. It was a
scorching day, spent talking to relatives rarely met, and, for the
first time in many years, I felt that my news was all good.
Someone congratulated me, and I said, ‘What for?’ An exam
passed, a new house, and best of all, a new baby.
I have a picture of myself at that wedding – I rather suspect
I might have been having a row with my mother, but I still look
radiant, wearing a scarlet silk jacket, a hat with a red flower,
and with eyes that shone and lived again. No dullness, no
deadness, just happiness. We also spent some time that

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summer on the Isle of Wight with my mother-in-law, by the

beach. As a junior doctor, it was hard to get longer than a
week’s holiday at any one time, but I may have had a bit more
on that occasion.
Perhaps this was something of a false idyll. My job was still
very hard, with long hours, night work and commuting.
Richard continued to travel to Mexico regularly for work,
and, as a result, we didn’t have enough time together with
our little daughter. But, compared with what we had been
through in previous years, it was a life that we had never dared
to hope for. It was like climbing a steep and uninviting moun-
tain and finding a grassy meadow, soft, and sunny, where we
could at last lie down and rest.

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 CHAPTER 10

Lucy

My second post in the Borders started hopefully. I looked

forward to the work, and my life was the happiest it had been
in many years. The post was in rehabilitation psychiatry, and
we looked after patients with severe and enduring mental
illness. Typically, these included people with schizophrenia
and bipolar disorder, but also with severe personality dis-
orders. I was beginning to realise how little I knew about
psychiatry and that being a patient doesn’t actually equip
one to assess and manage other patients. This does not, in
any way, reduce the importance of what one can learn from
being a patient, and, in addition, all of us can, and should,
learn by listening to patients. But we also owe it to them to
learn as much as we can from books and study, so that we can
offer the best treatments available. This may be limited by
resources, but at least we should be aware of this.
My new supervisor was a very experienced psychiatrist, who
was more than able to guide and teach me. I learnt that there
was a clear structure to taking a history from a patient – the key
was to gather all the information required without the process
being too rigid. To allow the patient to speak, to hear what
they say, but to be able to arrange and analyse the informa-
tion. You could listen for two hours, but if you couldn’t get the
right information and put it together, you might not have
helped very much. Or rather, you might have helped by
listening but not as a psychiatrist.

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It was also necessary to examine the patient’s mental state –

to look at them, to hear how they talk and react, to assess their
mood, and to ask about psychotic phenomena. These last were
usually hallucinations and delusions, and they could be both
easy and difficult to elicit. Some patients would tell you right at
the start, but with some you had to probe quite deeply.
Hallucinations were interesting and controversial – how
could one ever really know what someone else was experi-
encing when you couldn’t see it yourself? It was not uncom-
mon to hear clinicians refer to patients’ experiences as
pseudohallucinations, especially those patients who had a
diagnosis of personality disorder. Again, the very name
seemed undermining. How could the clinician know?
Pseudohallucinations were often described as being qualita-
tively different to ‘true’ hallucinations, perhaps more in the
mind than truly external. They might be linked to psycho-
logical trauma, and be very distressing, but were not always
seen to be as valid as ‘true’ hallucinations. Yet did we refer to
pseudo back pain when we were less than sure of the reality of
someone’s experience? I didn’t think so.
Ultimately, it was probably more important to get as much
information from a patient as you could, and to describe it,
rather than to jump to hasty conclusions. It was sometimes
easy just to fit the facts to the desired diagnosis, discarding
those that contradicted it, and that was, without doubt, a
big mistake.
For me, as a novice, the main thing was to ask as much as
possible, to get detail beyond what I needed, because then
I found things out. And to always ask the patient – ‘Have I got
this right? Is this what you mean?’ – because then I made fewer
mistakes. My new supervisor started to teach me these things,
and I started to read books about psychiatry. I started to learn.
I was quite open about my pregnancy; I doubt that I could
have contained myself, and the team were very kind to me.

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This team was based in Dingleton Hospital itself, so there was

marginally less driving than during my previous post.
My supervisor also encouraged me to do things that I would
never have thought of doing, such as writing a letter to a
journal, which was published, and starting a small research
project.
I had never seen myself as the kind of person who pub-
lished anything, with the result that I had never actually tried,
and I was quite excited. Suddenly, it seemed that there were
interesting things one could do beyond day-to-day work and
that these things were within my grasp, not only for other
people. Our project involved analysing the meetings we had
with GP practices, and although it was small, it was engrossing
and was also published.
My pregnancy progressed without trouble, and I had a little
picture from the dating scan. I hardly looked very pregnant,
but then neither had I with Madeleine until quite late on, and
I had always been fairly slim. We went to the twenty-week
anomaly scan with some understandable anxiety, but our baby
was wriggling around on the screen, and all seemed to be
present and correct. We were very relieved by this, as there
had always been the shadow of the lithium in the background,
but now it looked as though we really would have our little
baby in the new year. I had stopped the lithium as soon as
I realised I was pregnant, because it was thought then to be
associated with a heart defect called Ebstein’s anomaly, and
this was a worry. In fact, this association is rare and uncertain,
but it was enough to make most people anxious. We had also
hoped that they would be able to tell us the sex, but the baby
was facing the wrong way, and this was only a
minor disappointment.
Shortly after this Richard was due to fly out to Mexico
again – we were well into autumn now, and we both thought
that it was better for him to go sooner rather than later, given

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the pregnancy. I was a little worried in the week before he left,

as I had not felt much in the way of movement, so we went to
see our GP, who used a Sonicaid device to check the baby’s
heartbeat. It was a bit difficult to hear due to all the other
sounds (my heart and the usual swooshing internal noises) but
all seemed to be fine.
Reassured I went back to work, and Richard went off to
Mexico. A few days later, I drove around the Borders after
visiting a patient in a nursing home, thinking of the baby and
listening to music. It was magical. Later that same day, one of
the nurses in the team commented, ‘You’re really starting to
look pregnant now,’ which made me feel very happy. It was
all real.
I had a friend who was an obstetrician, and at that time she
was working in the Borders General Hospital, quite close by.
We were chatting, and I told her that I would have liked to
have known the sex of the baby. She immediately volunteered
to do another scan herself to find out, so I headed over to the
hospital later that afternoon. I was now twenty-two weeks
pregnant. There was the usual cold jelly routine, and the slight
oddity of a friend doing the scan, and then the silence began.
It can’t have been a very long silence, but it moved from her to
me, and then she had to say those terrible words – ‘I’m so
sorry, there is no heartbeat.’
My poor friend – she will have said those words to others,
but she cannot have expected to have to say them to me that
day. I was very shocked; I had been slightly worried, but I had
no thought that my baby was dead. I was at work; Richard was
in Mexico; I had no idea what to do. Our fragile little edifice
was crumbling.
In the end I phoned my father, at work in Glasgow, to tell
him, and he and my mother drove over to Edinburgh.
My friend drove me back home to Edinburgh; she also con-
tacted the obstetrics department at the hospital and organised

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everything that needed to happen. Nothing would have made

this bearable, but I was so very glad that she did that scan, not
someone else. Not for her, but, selfishly, for me and for my
baby. I was glad it was someone who would not forget us.
I sat in my flat, my new flat for four people, and numbly
played my piano, the only way I could manage my feelings.
I could never again listen to the music I had played so
recently in my car, when I thought my little baby was still
alive. Later, I went with my mother over to the hospital, to the
obstetrics department. Madeleine stayed at home with
my father.
There is no good place to go to deliver a baby that has died,
certainly not an obstetrics unit. But, unfortunately, the people
who know how to look after you work there, so that is where
you have to go. I was in a slightly separate room, quite a big
room, but it was a horrible reminder of what should have
happened. Babies were being born here, living babies with
shrill, new born cries. I was numb and frightened; my poor
mother tried her best, but I suspect it was too painful for her,
and she struggled to know what to say or do.
The whole process was undignified at best, appalling at
worst, and involved pessaries and a long wait, as, despite its
tiny size, the baby was not born quickly. It was painful too,
although they are generous with the painkillers when the baby
can no longer be harmed. I was given injections of diamor-
phine, which made me itch, then antihistamines to counteract
that. At one point I left the room, unable to bear it, and a
junior doctor tried to help, looking at me with such pity. What
use was pity, then?
The baby wasn’t born until the next morning – somehow it
got a bit stuck – but the consultant came in and delivered her.
Because it was a girl, a little, tiny, lost scrap of humanity that
would never know her mother, or her father or her sister.
I never saw her, and no one suggested that I should.

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My mother did, briefly, and commented, ‘You wouldn’t have

wanted to have seen her, better not.’
This remark was meant well, but it was one that I found very
difficult to bear, and that still haunts me. I think the problem was
that she had died days, or even a week or so, previously, so her
skin had softened and broken down. But it meant that I had no
little picture of her, save for her scan pictures, no tiny footprint,
no gentle memory. I never saw her; I never held her. They said
that there was nothing obviously wrong with her, but her tiny
little body was taken for post-mortem and that was that.
I remember lying on that delivery table afterwards, com-
pletely devastated. One of the midwives washed me, like they
do after you have had a real baby, a great kindness. I couldn’t
think straight or process what had happened at all, but I do
remember thinking of Madeleine, my little girl, and wanting
her. I couldn’t understand why she wasn’t there, and I became
convinced that she had died too. The unthinkable had
happened and nothing made any sense at all. Dr Blackwood
came to see me in the hospital, which seemed most bizarre,
and he arranged for me to be transferred over to the psychi-
atric hospital. I went there with my mother, then she left me
there, all alone.
People were very kind, but I was in a state of shock, and
unable to take anything in. I was admitted to a single room in
the downstairs ward. I recognised one or two of the other
patients and was outraged with one of them who stayed on
the phone for ages when I wanted to call my father. To me her
conversation seemed unutterably triviaI, and I was furiously,
and unreasonably, irritated. I wanted to kill her. Later my
parents brought little Madeleine in to see me; she cannot have
had any idea what had happened, but I remember her little
blonde head. My thoughts settled down a bit, having seen her,
but I couldn’t stand being in the hospital. How would lying
here help anything? How could anything help?

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Later that evening I told the nurse I wanted to leave, and

they phoned the on-call junior psychiatrist, whom I knew
slightly. None of this was ideal, and this doctor wasn’t helpful.
I tried to remain as calm as I could, which wasn’t very. ‘I
need to go home. I need to see my daughter. I need to go
home.’ My voice was rising.
‘I don’t think you should, you’re not well enough, and you
need to stay here.’
I was getting increasingly furious. ‘Call Dr Blackwood.
I want to speak to him. I want to go home.’
‘Well, you know what will happen if I do that, Rebecca . . .’
The threat of detention under the Mental Health Act hung
there, between us.
I flung my shoes at him, the closest I have ever come to
assault; fortunately for my unblemished record, I always had
an atrocious aim. And Dr Blackwood was called, and he spoke
to me and my father, who had come in, and he let me go
home. I came back to see him the next day, with my mother.
I think we saw Dr Lawrie in passing while we were waiting, who
looked rather oddly at us, probably believing that I had moved
on from my previous unfortunate psychiatric career, and sur-
prised to see us back.
Mental health aside, there I was at home with my empty
arms. I had my little Madeleine, and poor Richard had been
contacted in Mexico by my parents – what a terrible message
for them to give and for him to receive. He came home as
soon as he could, and I met him in our dark hallway. I felt that
I had failed him, that I had lost our little baby after all that he
had done for me; and he felt that he had failed me by not
being there. I was occasionally cross with Richard about his
frequent flying, but I never, never felt any anger with him
about that. How could he have known?
It was a terrible time. My milk came in after a day or two,
which seemed cruel, although I was given bromocriptine, a

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drug to minimise this. My GP was a bit annoyed about that, as

there is apparently a risk of psychosis as a side effect, and she
clearly felt I was well in with a chance. I doubt that it made
much difference, and I wasn’t sure that I needed to know that.
As a patient, it isn’t helpful to hear professionals criticise their
colleagues, not unless something very disastrous has
happened. I prefer to think they like each other.
One thing that is very hard when you lose a baby at less than
twenty-four weeks is that it is not officially counted as a still-
birth, or at least not in the UK. No loss compares with any
other – which is worse, for example, a childless woman of forty-
four having an early miscarriage, or a younger woman with
three healthy children having a stillbirth? Neither, context is
all, and what seems simple may not be. But I did find it
difficult; to me this was not a miscarriage, it was a stillbirth.
An early death, yes, and there would have been no hope of
survival whenever she died, but that was what it was to me.
Symbolism may not always seem important, but having a
birth certificate, or a little photograph, had it been possible,
would have meant something. The hospital did give me a
certificate, to which they added her name, Lucy Rose, but it
seemed makeshift, and I didn’t keep it. If I could have seen
her, or even held her, it might have helped, but this was not
possible, and I sometimes wondered how terrible she could
have looked, or even whether she had truly existed. I wanted
her to have done so, for it to be OK to talk about her and
remember her, but I knew that would never be the case. It may
be sentimental, but what comforted me a little were some of
the lines from Wordsworth’s Lucy poems, about her death and
what it meant to the poet. Quite a different scenario, I’m sure,
but the name was the same, and it helped a bit.
And I knew, even then, that although Richard would
remember, it wouldn’t be in the same way. I remember her
birthday, every year, but no one else does.

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There was a small funeral, up at the crematorium, and

Richard carried her, just that once, in a little white box.
I nearly didn’t go, such was my distress, but changed my mind
that morning. It was right to go. The music playing was Bach,
the Agnus Dei from the Mass in B Minor, about which I was
glad, and we said a last goodbye to our poor little baby.
Whenever I pass that crematorium, or see its name, I think
of her. My little baby, who wasn’t a proper baby.
Some weeks later we met with the obstetrics consultant to
discuss the results of her post-mortem, but they were unfortu-
nately inconclusive. She only had one kidney, which surprised
me, as they clearly mentioned two on the detailed scan
(I never had the same touching faith in scans after this) but
so do quite a few of the unknowing population, and this was
not necessarily lethal. Sadly, they had been unable to analyse
her chromosomes, so could not tell us whether there had been
a chromosomal cause. It was difficult to know what to say to
Madeleine, who had been so looking forward to having a
sibling. My mother told her that the baby would have been
disabled had she lived, and I’m not sure that this was a good
message. But what could she say? What could any of us say?
We didn’t know.
I wasn’t very well after this, but I was determined to get back
to work. At least that way I thought that I could salvage some-
thing of my life; I was determined that things would not revert
to the awfulness of previous years. My work colleagues had
been very kind and sent flowers, but I was afraid that if
I missed too much time, this post would not count for training.
It is strange what becomes important when nothing is. So,
I went back after about a week, which was certainly too soon.
I struggled on, and my supervisor gave me largely non-clinical
work to do, but it was no good. On one occasion I went to see a
patient with a nurse and realised that I could not actually
speak. Even I knew then that I could not work. I saw my GP,

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and also met with my supervisor, but ultimately, I ended up

back at the hospital in Edinburgh, seeing Dr Blackwood with a
psychiatric nurse.
I had by this point lost touch with reality, although whether
this related to illness, losing the baby or both, I don’t know.
That very first baby, the little one I hadn’t had, again assumed
enormous importance in my mind, and I believed that she was
responsible for Lucy’s death. I believed that I deserved this,
and I also believed that she was trying to poison me now
through medication so that I would not ever have another
baby. Hardly an edifying constellation of beliefs, and it was
no surprise that Dr Blackwood wasn’t too happy.
He and a nurse spoke with me for a long time trying to
persuade me to take chlorpromazine, an antipsychotic, which
in the end I reluctantly did. They then arranged for me to be
admitted, but through in Glasgow, the reason being that I was
now working as a psychiatrist close to Edinburgh. The drive
over, with a couple of psychiatric nurses, seemed interminable,
and, when we finally arrived, I was admitted by a disinterested
junior doctor.
By the time the consultant saw me I was knocked flat by the
chlorpromazine, so he stopped it and started me on one of the
other older, but less sedating antipsychotics. At least I was able
to stay awake, but it gave me horrible akathisia, a feeling of
restlessness which is both physical and mental, and quite
intolerable. I was unable to concentrate or do anything;
I couldn’t even read a children’s book. I was also unable to
sit still and unable to sleep at nights but was forced by staff to
lie in bed. Staying up was not permitted, even if wide awake.
I didn’t like it.
Despite this, the hospital in Glasgow was in some ways a
slightly better experience, but only in that they had more
daytime activities organised for patients, which at least broke
up the terrible monotony of the psychiatric ward. We went to

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visit an art gallery that I had last visited when at school, and it
had exactly the same feeling of naughty charges being taken
out on a trip. At least I didn’t have to write up a project on it
this time, something which had put me off galleries for life.
The whole experience seemed like a dream, strange and
separated from my real life. The charge nurse was kind and
quite dynamic and kept insisting that I had what she called a
one-to-one with her. I didn’t remember that kind of term
being used in Edinburgh when I was previously an in-patient,
but essentially it was a chat, so no different. She also kept
saying that the higher trainee psychiatrist on the ward would
see me soon, and how great and fantastic she was; I found this
slightly irritating after a while, particularly as the higher
trainee never did put in an appearance.
I didn’t want to be there; I failed to see how it would help,
and, although my thoughts had not really changed, I realised
that telling people about them was not going to help either.
Perhaps medication had at least taken the edge off my anxiety
and agitation, even if my mood remained low. I was allowed
out at the weekend to go to my parents’ house, and I cried,
and even wailed, when I had to go back. Regrettably,
Madeleine was there, and this was very upsetting for her. But
finally, after yet another junior doctor had threatened me with
detention, I was discharged, albeit on medication. I went back
to work the very next week, again a mistake, but I didn’t really
know what else to do or how else to keep going.
I can only say now that I was wrong in trying to work when
I was clearly unwell, and I don’t think there has ever been
another period when I have done this, other than when I was
first ill, in Cornwall. I understand why I felt pressured, but it
was unrealistic, and it was a mistake. I got away with it, in that
no patients were harmed (largely as I was working with a very
protective team who were aware of the problems), and in that
my health and mood gradually improved, and my faulty

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thinking settled, but it took a few months. In addition to

medication, I had some sessions during this time with a private
psychotherapist (this was not available on the NHS), but
I don’t think this made very much difference to me, and it
was probably not a good time. But I completed my job in
rehabilitation psychiatry, after a fashion, and then moved post
to old age psychiatry.

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Back from the Edge

Old age psychiatry was not an area that I planned to work in in

the longer term, but it is an important specialty, and all
psychiatric trainees are required to do a six-month post.
Sometimes the posts can be difficult and even depressing, or
overly medical, but I was very lucky with mine. My new con-
sultant supervisor was a gentle man, with a new baby. I found
being around pregnant women, babies, and talk of babies very
difficult, but I was aware that his path to this precious baby had
not been straightforward either, and I couldn’t help but feel
happy for him.
Early on, he took me aside and said, ‘I know what happened
to you, it must have been so difficult, but it would be really
hard for me not to talk about my baby. Will that be OK
for you?’
I was overcome by his sensitivity. ‘Of course it will, I would
hate you not to talk about her just for me. You must talk about
her. I won’t mind.’ And he did, and it was fine.
Again, I was working with a lovely and supportive team, and,
despite my own ongoing unhappiness, I enjoyed the job. Much
of the time was spent visiting elderly people at home, talking to
them, their relatives, even their budgies. Although a lot of the
work was with people with dementia, there were also older
people with psychosis, and many with depression – or indeed
combinations of all of the above. The elderly depressed
people moved me, as they clearly did my supervisor. There

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was often so much loss, and yet shining resilience, in lives that
had been lived over many decades. Older people did become
very depressed and sometimes even killed themselves, and it was
such a terrible thought that a long life could end that way. And
they often responded well to electroconvulsive therapy (ECT).
What should have been Lucy’s due date came and went,
and I coped with that, glad when it was over. Then I became
pregnant once more, briefly as it turned out. We were hoping
to conceive again, but it was both a joy and a fear when it
happened, and at the first scan there was no heartbeat, an
early miscarriage. At this point I just lost it, or perhaps it could
better be referred to as an acute stress reaction. In any case,
I had picked myself up too soon after the last loss and had
never really allowed myself to recover properly or grieve. I had
been holding things together, and this final kick in the teeth,
with which I would normally have coped, was just too much.
I saw one of the psychiatric trainees at the obstetric hos-
pital – he was a nice man, whom I knew, working in liaison
psychiatry. He tried very hard to reassure me. ‘It’ll be all right,
Rebecca, we’ll give you some diazepam for over the weekend,
and you’ll be fine.’
I was crying. ‘I won’t, I’ll never be fine, you don’t under-
stand. I’ll never have a baby. I can’t have a dead baby inside
me, I can’t.’
He leant towards me, distressed by my distress. ‘It’ll be OK.
And I won’t tell anyone else I’ve seen you, please don’t worry.’
I never thought he would, but I wondered why he was
telling me this. I just wanted to get things over with as regards
this doomed pregnancy, but they said I needed to come back
for another scan before this could happen, something which is
normal so early in pregnancy, in the unlikely event that there
still is a living baby.
I didn’t cope at all, despite being supplied with fairly large
amounts of diazepam to calm me down, and I was convinced

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that the best thing to do was to kill myself. This was bizarre, as
it was relatively low down on the Richter scale of events that
I had recently experienced, but I just temporarily, but com-
pletely, lost the ability to cope. Possibly getting paralytically
drunk would have got me through that couple of days, and it is
easy to see why people employ this strategy to get through very
stressful situations. But it might have made things even worse,
and I didn’t go down that route.
Our friend, Katharine, also a psychiatrist, was living with us
at that time, and neither she nor Richard could manage the
situation, or the risk that I would hurt myself. The course of
events is confusing to me, looking back, but sadly, I ended up
back in the psychiatric hospital, either detained or under
threat of such. I absorbed massive amounts of diazepam over
the weekend, then was transferred over for my scan, and for a
dilation and curettage to end the failed pregnancy, on the
Monday. After this I recovered very quickly, and, despite mis-
givings from others, was well enough to go back to work very
soon. We went back to see the consultant obstetrician again,
only to learn that this baby, too, would have been a girl and
that there was no obvious cause for the miscarriage.
I felt ashamed by this whole incident, and by my own
reactions. I thought I should have coped with an early miscar-
riage, which was fairly commonplace. But, in an odd sort of
way, it helped me to move on from Lucy’s death. It was a more
normal loss, and it also proved that I could still get pregnant,
that my body was not damaged as I thought it might have
been. I still felt sad, but more at peace.
Madeleine was now four, and due to start school the
following autumn. We were happy enough in our new flat
and gradually started to lighten its darkness, firstly by taking
up the green carpet in the hall, then by painting the walls a
warmer apricot. I thought that I had better start thinking
about taking the psychiatric membership exams, which

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consisted then of two parts, each with both a written and a

clinical component. Again, I joined a study group with a
couple of the Edinburgh psychiatry trainees, and I decided
that I would try to sit Part One the following autumn.
I couldn’t say that my foray into psychiatry had so far been
as unblemished as I had hoped, but giving up was not an
option, if only because there was little alternative. I also
decided that I would try to do an MPhil (Master of
Philosophy degree) in psychiatry. Despite the name of the
MPhil course, few of the trainees actually did one. It was a
lot of extra work, but I thought that it might lift me back to the
intellectual level of the other trainees, that it might finally
make me good enough. Hardly a great reason for doing it,
and there was a significant risk of failure, and making things
worse. It involved finding a project and a supervisor and then
writing up a thesis. I thought it very unlikely that I would
complete this, as it was usually impossible unless you passed
both parts of the membership exam the first time, something
that I was unlikely to achieve. There were also many problems
with doing research, a major one rightly being ethics.
At that time, Dingleton Hospital was drawing towards its
end, with a new build planned for psychiatric in-patients up
the hill from the Borders General Hospital, and there was a lot
of interest in the archives, which would all need to be
rehoused when the old building was sold off, probably for
flats. I hit on the idea of doing a study of admissions at the
end of the nineteenth century and making retrospective
diagnoses.
Although it would require a lot of work, the heavy leather
books were all there in the basement of the hospital, contain-
ing all the admissions and notes from that time. Not one
person’s admission note was missing, which would be extraor-
dinary today, but this was due to them all being bound
together, in those books. Another advantage was that no

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ethical approval was required, given that these people had

lived and died so long ago.
There was also a lot of other material about the old asylum,
to which I had easy access. Quite possibly none of this would
have come to any fruition, as my ideas were poorly formed, but
my supervisor, an academic in Edinburgh, had, by chance,
done an almost identical study in Fife, under the supervision
of the consultant I had met there before starting psychiatry.
She was very encouraging and helpful, and it all looked like it
could happen.
I remained desperate for a new baby – or rather for the
baby I had lost – and by summer I was pregnant again. My life
was something of a rollercoaster at that time, what with
hormones and work and family, but I wouldn’t give up.
Losing the baby had changed me though, in a way that the
years of poor mental health had not. Depression had not
made me a particularly nice person, rather the opposite.
I don’t think it made me entirely selfish, but I was very
focussed on myself, on getting better, on getting back to
work. I was very stubborn, which got me through things
which I should perhaps not even have attempted, but
I didn’t always think of the needs of others, especially
Richard and Madeleine.
But now, with the loss of Lucy, my eyes opened a little.
I didn’t become an instantly nicer person, but I became a little
better at recognising my own failings, and at seeing the per-
spective of others. I had, for example, found it very hard
seeing either of my two best friends after the loss of the baby,
as both were pregnant – but I was able to recognise that that
was normal, and to wish them and their babies well, even
though I didn’t want to see them at that point. And I started
to look at other people, and to realise that I had no idea what
was going on for them, what sorrows or joys made up their
lives. Their smiles might hide terrible hardship or grief.

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In my own life, I had been looking at young families or

pregnant women with resentment, with no thought as to what
lay beneath. It was perhaps fine not to enjoy the smug-
appearing, pregnant lady patting her belly, but it was not fine
to make assumptions. Who knew what had happened to her?
It wasn’t immediate, but it gradually changed the way
I thought about people – friends, patients, colleagues alike.
I don’t think anyone would have described me as a particularly
tolerant person at that time, but my thoughts were becoming
increasingly more tolerant, and I hoped that was reflected in
my interactions with others. And I hope I have become kinder
over the years.
So, here I was, pregnant again, back to where I had been a
year ago, albeit somewhat battered. Pregnancy would never be
a happy, glowing time for me, and I knew that now, but I still
hoped that I might have another baby, and I hoped that
I might stay well. We told Madeleine, who was still eager for
that elusive sibling, although I suspect what she had in mind
was an elder brother rather than a mewling baby.
She started school in August that year, a dear little thing in
a navy pinafore, with her beautiful smile and her little white
socks. She was only four and a half, really too young to start,
but we, as naïve first-time parents, had no idea that many
children that young are kept back. She was filled with enthusi-
asm, a kind little girl, but too young to concentrate properly,
and her teacher wasn’t very tolerant of this. I was sure even
then that she was bright, but she struggled at times. She was a
lovely artist from an early age, which impressed me greatly,
something that was clearly gifted from Richard’s side of the
family, not mine. One of my own more memorable school
reports had stated, ‘Rebecca’s fertile mind is stifled by a
paintbrush.’ True, alas.
I changed post once more that August, to work again in
general adult psychiatry, this time in Hawick, which is about as

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far away as you can get in the Borders when driving from
Edinburgh – a good hour and a half. I struggled with this
drive, but, again, I had a straightforward and helpful consult-
ant supervisor, who was also a great teacher, which made all
the difference.
We had bought a new car, a sleek (at the time) green
Peugeot 406, which we embarrassingly named Eric, and which
helped with the commute. For a brief period, we also had an
old gold Beetle, in which I don’t think the windows ever
entirely shut – a good-looking car in many ways, but imprac-
tical, and not great for regular trips to Hawick. I continued to
work for my Part One exam and slowly started to look more
pregnant, something which both excited and appalled me this
time. The fear during a pregnancy after a loss, especially a late
one when people tend to tell you that things are safe, is
universal. I found a book, published by SANDS (Stillbirth
and Neonatal Death Society), in which people described their
experiences, and it comforted me very much, and let me know
that what I felt was normal.
The scans were terrifying each time and reassured us only
briefly, but we were lucky enough to have an experienced and
very kind midwife who saw us whenever we wanted, to check
that our little baby was still alive. Just knowing that we could
ask to see her anytime made a huge difference. We also had a
new consultant obstetrician, who was very understanding and
suggested inducing the baby at around thirty-eight weeks. Two
weeks’ less anxiety was like a lifebelt to me, and I clutched it
gratefully. The baby began to kick when it was supposed to,
and then continued to kick – little nudges of hope. Sometimes
at work I would panic that it had become silent, but I was
usually able to go and sit somewhere quiet until a little kick
reassured me.
I sat the written paper of my Part One exam, then had to go
over to Dykebar Hospital, near Glasgow, to sit the clinical.

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I bought a rather horrible maternity suit – I was glad of the

need but slightly worried about what the examiners would
think of a pregnant trainee. Fortunately, I had a nice straight-
forward case, a pleasant young man who told me all that
I asked, but the examiners gave nothing away, and I had no
idea if I had passed or not. The results took a month or more
to come out and were posted at the Royal College of
Physicians in Edinburgh. I asked Richard to go and look, as
I would be on my long drive to Hawick at that time. The phone
call came on my unspeakable brick phone, and I pulled in.
Coverage was never good in the Borders. ‘You’ve . . .’ was all
I heard. Passed? Failed?
I resisted speeding all the way down to Hawick and phoned
him back.
‘You’ve passed.’ I could hear him smiling.
I could hardly believe it. Neither of my study group friends
had, a strange and sudden inversion for me. I was actually
quite shocked, as I had seen them as far brighter and more
fortunate than I. But one, in particular, faced a great deal of
trouble in life, which only became apparent to me later.
Christmas passed, and I was still pregnant. We prepared
little for this unlikely baby, although we had Madeleine’s old
crib and cot. I bought a few little vests and suits, hardly daring
to believe I would need them, and fearing I was tempting fate.
Madeleine’s fifth birthday passed in January, and we tottered,
somewhat jaded, into February, when I stopped working.
I had asked my employers in the Borders whether there
would be any possibility of part-time work after I came back,
but it was a very small training scheme, and they reluctantly
said not. I was by this time quite unsure that I could manage to
continue working full-time, while taking my next exam, com-
muting, and looking after two small children, so contacted one
of the trainees on the Edinburgh scheme, who was currently
on maternity leave, and planned to come back in the summer.

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I felt that I had a bit of a cheek, given that I was not actually on
that scheme, but she was also very keen to come back part-time
and to consider a job-share which was the only way we could
do it, and this gave me a bit of hope.
Later in February, I went into hospital for the birth to be
induced. I felt safer there, with monitors attached, but again
under-estimated the fear they aroused in Richard. Poor
Richard, delivering lambs had been a walk in the park
compared with watching his own babies’ births. It took a little
while for the labour to start, but once it did I had my epidural,
which helped a lot, although not as completely as on the
previous occasion.
At a few minutes past midnight, little Isobel was born, with a
dark swirl of hair and an angry look. She had perhaps planned
on having another couple of weeks’ peace before venturing
into the world. Richard was slightly taken aback that she wasn’t
a boy – I was overjoyed. Worried, he gazed at our tiny new
daughter and asked the midwife, ‘Shouldn’t she cry?’
She replied, ‘I can make her cry if you want,’ and did. It was
one of the most beautiful sounds I had ever heard.
She was perfect, six pounds thirteen ounces, bigger than
her sister. I never heard the term at that time, but she was a
rainbow baby, if a rather yellow one, a baby born after a
previous loss.
Sometimes it can be hard when you get exactly what you
want, however, especially after a long wait, and that was the
case after Isobel’s birth. None of us had really expected this
outcome, and it was almost too much to cope with. The night
of her birth, I lay until morning watching her as she lay next to
me in the ward. She didn’t cry much, but a nurse took her
away to clean her up at one point after she was sick. I worried a
lot after she was born, and I worried that this nurse had
swapped her with another baby. I worried, but I knew that it
wasn’t really true; it was very different from some of my

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previous experiences when I had been quite convinced of

things. This was more about anxiety than erroneous beliefs,
or psychosis.
Madeleine came in the next day to see her new sister and
was both excited and overwrought. This had been a long time
coming for her, too, and all she got was this baby, slightly
jaundiced, and completely unable to play with her.
Madeleine, like most five-year-olds, loved playing; she had a
war cry then of, ‘Let’s play!’ and she quickly realised that this
baby might be a hindrance rather than a help in her plans.
Isobel and I came home from hospital that same day, and at
night we placed her confidently in her little crib. She took one
look at us and let rip a menacing scream. Unlike Madeleine,
who had been an easy baby, Isobel was not happy during those
first six months and rarely lay contented. Madeleine was at
school, so I spent the days with my angry little baby, sometimes
singing to her, often feeding her, and taking her out in her
pram for walks.
She thrived and gained weight but seemed to be extremely
hungry, all the time. There were strict instructions given to
mothers about caring for babies, and it was recommended
then that they were exclusively breastfed for the first four
months, so I was determined to do this. I might have been
better off looking at my other healthy daughter, who had been
given solids at three months, but I was not to be deterred.
When Isobel started on solid food, I again noted the
instructions in my baby manual, which said she could only
start with one or two spoonfuls, and then very gradually
increase over days and weeks. Early on in this process, we were
staying with my parents, and I gave her to my mother who had
offered to feed her. After a few minutes, I heard her call to me
from the other room, panicking slightly, saying, ‘She’s had ten
spoonfuls and she wants more, what should I do?’ Trust your
instincts, probably. Isobel did improve with food.

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I did not relapse into illness in the six months after Isobel
was born, probably to everyone’s surprise, and my own great
relief. But I did become very sleep deprived, Isobel’s own sleep
being so atrocious. She had an extreme aversion to being put
down, and we required a rota to look after her at nights: either
I would sit feeding her, or Richard would wheel her round the
flat in her buggy, not ideal for any of us. She wouldn’t lie on
her own in her crib, and I worried that I would squash her
overnight, just by falling asleep while holding her in bed.
One night when Richard was away, my parents came to stay,
and exactly that seemed to have happened. I woke suddenly to
silence and frantically searched under the duvet – no baby.
My father, hearing her raised voice, had come and collected
her while I slept on. Such was my level of exhaustion.
Somehow, I managed to do some work on my MPhil project
during that relaxing six months’ break from work. I had been
allowed, rather surprisingly, to bring the old admission ledgers
home, and spent time, when I could, collating forms and
entering information into a database on my computer. It was
remarkably restful and therapeutic compared with looking
after a baby.
I also met up with my fellow trainee on maternity leave, to
sort out our job-share, which had been approved. It was
agreed: we would each work five sessions (twenty hours) a
week, although we would also have to attend one of the
MPhil course half days in our own time (an additional four
hours). I didn’t care; I was ecstatic that I could carry on
working but with fewer hours and without the commute.
I liked the other trainee and thought it could work well.
We went to see Fiona, a consultant psychiatrist in Edinburgh
who was also the training scheme organiser, and I explained
my situation and background, including my illness. It did not
appear to faze her at all, and, with her own pregnancy very

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obvious, she seemed quite matter of fact and accepting of

the situation.
It was agreed that we would work what were called split jobs,
the advantage being that we could simply do half each. For
example, our first job was designated half in a ward, half in a
day hospital, so we would simply do one each for six months,
and then swap around. The main issue for me was that I would
have to work in the hospital in Edinburgh, and I had very
mixed feelings about this. On the one hand, if I could do this,
maybe I could rid myself of my demons; on the other hand –
could I?
I still felt hugely nervous when I came anywhere near the
hospital or wards, and I didn’t know whether this would help.
The tower terrified me. I had felt comfortable in the Borders,
where, despite all my troubles, I had felt liked and valued. But
there was a problem for me if the main teaching hospital in
the area induced panic attacks, and even my basic psychiatric
training told me that the only real solution was not to
run away.
Fortunately, this particular ward, while close, was located in
a different block from the ward I knew so well; two friends
from my study group were also working there, and I would
have a lot more time with Madeleine and Isobel. Isobel was
starting nursery, the same one that Madeleine had attended,
and Madeleine was going into Primary 2. In her very first term
at school, when I was working such long hours, she had had to
attend the after-school club. She was the tiniest little girl there,
and it didn’t feel right. At least now I could pick her up much
of the time – and join the competitive school gate scene.

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 CHAPTER 12

The Grey Walls

I under-estimated just how hard it would be for me to come

and work in that hospital in Edinburgh. I had nothing but bad
memories, first of my ignominious medical student attach-
ment, and then of my own unhappy stays on the wards. I had
managed to attend the MPhil course, in the grey tower across
the car park, but, even then, shame and anxiety had been my
constant companions. I felt sick and tremulous passing that
ward where I had spent so many days and weeks; I tried to tell
myself not to be so stupid, but with limited success. Another
problem reared its head, which I should have anticipated, and
that was the inevitability of meeting staff around the hospital,
particularly nursing staff who had looked after me as an in-
patient.
This was compounded by yet another problem, which was
my long-standing difficulty in recognising people. I had other-
wise always had a reasonable memory (except when I didn’t,
due to electroconvulsive therapy (ECT) and drugs), but it
often didn’t kick in until I started to speak with people, some-
times even people whom I had met several times before. This
difficulty with facial recognition is called prosopagnosia, and
many people have it to some degree. The nurses I work with
now are well aware of it, and will kindly identify patients for me
when required. I don’t think I have it particularly badly, and it
is usually easy for me to compensate by noting and remember-
ing particular features, such as hair, glasses, or anything

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unusual. But if I don’t make that effort to remember someone,

there is little chance that I will recognise them next time.
In my case, I am fairly sure that it is due to having been
extremely short-sighted from early childhood, and not wear-
ing my glasses for much of the time when growing up. I didn’t
learn to recognise faces properly because I couldn’t actually
see them. Contact lenses were a revelation, and I am eternally
grateful that my mother organised these for me at the rela-
tively early age of twelve. The first day I wore them is etched on
my mind, or rather on my visual cortex, in particular the sharp
edges of tall buildings, and the clarity of the air. It is a strange
thing that even empty space seems clearer with corrected
vision. Even the dark looks different with my contact lenses in.
But although my twelve-year-old self was happy just to see,
and not to wear glasses, the problems with facial recognition
persisted. It can cause me to have difficulty following films with
lots of people in them, as I can’t remember who everyone is,
making me an annoying companion at the cinema. If people
change or cover their hair, or shave off a beard, I am left
uneasy and confused. I also have a very bad sense of direction,
something which I have heard may be connected, and
I become very anxious about finding my way out of a building
if I haven’t been there before. Or sometimes even when
I have.
When I had been a patient, I hadn’t always made a huge
effort to recognise the often-changing staff, and sometimes
hadn’t even worn my glasses; so now, although there were a
small number that I did know, I was in the difficult position
that anyone I bumped into in a corridor might, for all I knew,
know me as a patient. I am sure that some did.
Of those I did recognise, some were unfailingly pleasant,
always smiled, and would even exchange a few words. There
were others who looked surprised, occasionally a little horri-
fied, and there were some who never referred to it (I think).

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This could be tricky, as I was never quite sure whether they

really had been involved with my care or not, but it actually
worked well as I got to know them – it was as if we had tacitly
agreed that I was now someone different, and we would
start again.
As it turned out, there were at least a couple of nurses on
the ward where I had just started to work who had nursed me –
one I recognised, and the other I had no idea, until she raised
it. It wasn’t an easy start.
My new supervising consultant was an affable man, who
seemed very accepting of my situation. The work itself, on an
in-patient ward, was reasonably straightforward. I had dreaded
the on-call work, but this was actually easier, and certainly
more supported by senior nursing staff, than in the Borders.
This came as a surprise to me, as there was something of a
myth about working in the larger teaching hospital separating
the men from the boys, so to speak. There was certainly a
bigger volume of work, but it was contained within the hos-
pital, rather than scattered across a wide geographical area,
and there were more staff to deal with it.
Many of the patients had sad and moving stories, and
I always felt just a whisper away from their side of the river.
I remember young women, at that time not greatly younger
than myself, with serious illnesses: one with schizophrenia,
terrified by nothing, and hiding under a bed, and another
with bipolar disorder who had sustained horrible injuries
while unwell. I remember one of the nurses, very warm and
gentle, trying to persuade her to take medication, even though
she didn’t want to due to weight gain.
There were those who had experienced complex trauma,
awful abuse as children, with hollow eyes and nothing to hold
onto but their psychiatric admission. There was often little that
could be done; you knew you were sending people out to
dreadful circumstances, poor housing, and minimal support,

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but what was the alternative? People couldn’t live in the hos-
pital. We were quite lucky at that time, in that there was a
lovely day hospital attached to the service, on the other side of
town, where my job-share partner was working. This made a
big difference to what could be offered post-discharge but has
long since closed.
Unsurprisingly, the hardest part for me at that time was
being called out of hours to review in-patients on the wards
where I had actually been a patient. It happened infrequently
but, when it did, was impossible to avoid. I dreaded seeing
staff, who might think that I should not be working there, and
the very structure of the building still brought fear to my mind.
I was attending the MPhil course again but had moved to
the year below after my maternity leave so had a new set of
people to get to know. I still felt like the outsider, but many of
the other trainees may have felt the same. Perhaps for differ-
ent reasons, and my face probably smiled too, to them, but
I was still quite unaware of this at the time.
There were a few interpersonal difficulties among the
trainees on the ward where I was based, but, on the whole,
we got on fairly well. However, I was struggling again. I think
there was a difference, though, to previous occasions, and that
was that I knew I was. I had stopped breastfeeding Isobel on
my return to work, probably to her relief as she was now
thriving, and my own weight was plummeting. I couldn’t eat
or sleep well, the latter adding to my six months of postnatal
sleep deprivation.
I knew my mood was low, and I felt angry with myself; I had
all that I had wanted, so how could this be? But I couldn’t deny
it, and I saw Dr Blackwood again, who by that time had
become Professor Blackwood. I was prescribed antidepressants
again, an SSRI, and I also saw a very nice lady working within
the liaison psychiatry department, to try again to do some
cognitive behavioural therapy (CBT).

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She began with the basics. ‘Now you’ve done some of this
before, haven’t you? What’s your understanding of it?’
I thought back to my disastrous attempt with Dr Lawrie.
‘Well, it’s when you look at your mood, and you try and
connect it with your thoughts and what you do, to make you
feel better. It didn’t work when I did it.’
‘Maybe you didn’t do it properly. You need to do the
homework and the tasks set to get any benefit.’
I winced. ‘Homework just makes me feel a total idiot, like
I was still at school.’
She maintained a smile, but I could see her vision of success
fading. ‘Well, what we need to start with is for you to record
your mood and your thoughts for a few weeks.’ She gave me
some sheets. ‘Then we can get an idea of how they’re con-
nected. After that we can try some behavioural experiments.’
She saw my eyebrows lift. ‘That’s just like when you do some-
thing, like you going into the tower, which you said you’ve
been avoiding. And finding out that you can do it, that you
don’t run away.’
There was far more to it than this, but for some reason
I never got much out of it. At the same time, one of my fellow
trainees had some serious problems of her own, which
impacted on me quite a lot, and we weren’t able to support
each other very well. I was probably right to pull back from her
at that time, but much later I greatly regretted that I had not
been able to help her more. None of this helped my half-
hearted efforts at CBT.
What happened then was that my mood became rather
elevated, for a week or so. It is hard to say, looking back,
whether this had happened previously, but I could certainly
recall quite a few odd periods of pressured mood, usually
associated with agitation and irritability. I would not myself
have described these as hypomania, often thought of as a less
severe form of mania, although Richard told me that he had

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previously noticed episodes of elevated mood (actually he said

silly and giggly) after my low mood had lifted, with either ECT
or antidepressants. But on this occasion, I definitely felt happy
and full of unrealistic ideas, or so I realised afterwards.
I assume it was precipitated by the antidepressant, as this
can happen.
Severe mania is more easily recognised, as people are usu-
ally very unwell, often with delusions, for example, that they
are very important or talented, and hallucinations, again often
in line with their raised mood – for example, telling them that
they are wonderful. They may also be very speeded up and
incoherent, behaving in risky ways, and unable to function
normally. Hypomania is essentially less severe and lasts less long
but can also be very debilitating, and both can be experienced
as part of bipolar disorder. It can also be difficult at times to
distinguish these from agitated depression. It is never quite
clear whether someone experiencing high mood as a result of
treatment has bipolar disorder or not, but, if it only happens
with taking antidepressants, it is often thought not to be the
case. It could, however, be seen as a risk factor for a later,
spontaneous manic or hypomanic episode, and a subsequent
diagnosis of bipolar disorder. Perinatal illness, or a mood dis-
order during or after pregnancy, such as I had experienced, is
also a risk factor for developing bipolar disorder.
There is no doubt that some psychiatrists have a lower
threshold for diagnosing bipolar disorder, and I don’t know
if this is good or bad. The main advantage of correct diagnosis
is to get the right treatment, but, as patients, most of us would
rather not have doctors arguing over us, in a way that can feel
quite punitive, as they try to decide between depression and
bipolar disorder. This can also feed the fear that some of us
have of the ever-looming personality disorder diagnosis.
In my case, the antidepressant was stopped, and shortly
afterwards my mood crashed down, to a non-agitated, lying-

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in-bed kind of depression. I didn’t experience much in the

way of irrational ideas at that time, though I was vaguely
paranoid about what people thought about me. I was not
restarted on lithium at that time, even though it might have
been an obvious choice. Lithium, for me, had taken on a
rather sinister aspect; I thought it possible that it had contrib-
uted to my baby’s death, and was a little annoyed that none of
my doctors agreed, and that it had not been reported as such.
I was not keen to take it again.
What did happen, bizarrely, was a semi-admission, in that
I spent the days in the old ward where I had been a patient,
going home in the evenings, as Richard did not want to leave
me on my own, and Professor Blackwood thought this would
be safest. I felt confined to lying in bed, however, as I didn’t
want people to see me. This wasn’t helpful, and I was most
embarrassed when my supervising consultant – very kindly –
came to visit me. The arrangement lasted a week until, with
typical obstinacy, I forced myself home and back to work at the
earliest opportunity. I was moderately depressed for a few
months but kept grimly on, hiding it as much as possible.
This may have been easier, given the lack of any psychotic
symptoms on this occasion. I don’t think any of this was
surprising – a new baby, a stressful situation, and a difficult
job. But I wasn’t kind to myself.
The second six months of this post, in the day hospital, was
light relief compared with the ward. It was lovely and airy, with
friendly staff, and patients who were less acutely ill. A lot of my
work involved reviewing people there, but I also did a weekly
clinic seeing new out-patients, which was supervised by
the consultant. The work was more ordered than it had been
in the Borders, with the opportunity to present patients for-
mally, and this was very helpful to me. I had learnt a huge
amount in the Borders, but this new method leant itself to
exam preparation.

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There were also larger case conferences at the hospital

where we, as trainees, were expected to present a case, includ-
ing a video of an interview that we had made with the patient.
Mine sticks in my mind to this day – someone who had experi-
enced a sudden and clear traumatic event and had developed
horrible post-traumatic stress disorder (PTSD) as a result.
A key sign of this is hypervigilance, or being very on edge,
which he displayed to an extraordinary degree when I drove
him to the hospital to make the video. He jumped with every
bump we went over, and, while my driving may not have been
the best, it wasn’t that bad. He also had anxiety, flashbacks, low
mood, and insomnia. I felt unbelievably sorry for him, and
although the video was commented on very positively,
I couldn’t cure him, and I don’t know if anyone ever did.
I spoke to my consultant supervisor about my illness during
this post, and he was very supportive, both then and later.
I remember him saying that he thought it was very clearly
biological, in other words, a proper mood disorder rather than
a reactive or even a behavioural problem. In some ways, this
was absolution from my worries that I had a personality dis-
order and was perhaps his way of saying that none of this was
my fault. I was cautiously pleased, as maybe it meant that I was
a reasonable person, after all, but also rather troubled. It was
only his opinion, after all.
But it also confirmed my fear that if I didn’t have a proper
biological mental illness, if any of this had been due to my life
or behaviour or personality, then he would not think so well
of me. I was starting to think more and more about those
poor people without so-called biological disorders. Did this
make them bad people, attention-seeking, and unworthy of
kindness and help? They often got short shrift in hospital,
unless their behaviour was so extreme that they simply could
not be discharged. It seemed very clear to me that there were
diagnoses that were more acceptable than others. Even now,

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when I am comfortable to disclose my diagnoses of depression

and bipolar disorder, would I be happy to say that I had a
personality disorder? I don’t think so, yet it is a very distressing
and debilitating condition.
That spring I went down to Guildford to do a revision
course for my MRCPsych Part Two exam, in order to expen-
sively elevate my chances of success. We had friends who lived
there, with whom I stayed, and Richard joined me at the end
with the children. It was a good course, but my main memory
was of spending time with another of the Edinburgh trainees,
whom I knew by sight, but with whom I had not previously
spoken. She was interesting, and I liked her very much – again,
she had experienced her own difficulties, which I would never
have guessed.
But what struck me particularly was her prior impression of
me – as the one with the babies. She didn’t put it quite like
this, but I think there was also something of the slightly
annoying smug mother with babies. It was a revelation to me.
I had been seeing myself as the substandard mentally ill
doctor, who couldn’t even manage to have children properly,
but this was evidently not how I always came across. I needed
to know this, both for me and for others. She also talked me
into sitting the exam that autumn, rather than waiting until
the spring. I was unsure about this, as I didn’t feel ready, but
I could see the advantage of getting it over with.
Later that summer, when Madeleine was six and Isobel was
one, we went to France. To us, it felt like our first real family
holiday with both our children. It was still impossible for me to
get more than a week’s holiday off at any one time, so
Madeleine went early for an extra week with my parents, and
Richard, Isobel, and I drove down to the south of England to
get the ferry over at the start of my leave. In fact, we nearly
missed it due to thick traffic, and we had a horrible night in
the cabin after the relief of getting on the boat. Isobel had

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improved greatly and was now normally a good sleeper, but no

self-respecting baby could be expected to sleep in such cir-
cumstances. Richard needed his sleep as he was driving, so she
and I were awake for much of the night, crushed together in a
narrow berth.
But we drove off the next morning and had a wonderful
week away, with Madeleine and my parents. Madeleine was at a
lovely age, chatty and happy; Isobel was at a rather determined
age, and one of my abiding memories of that holiday was of a
peahen trying to extract a biscuit from her hand. She held on
for grim death, and it left, a hungry peahen. It would be fair to
say that the age gap was too wide for the children to interact or
play much together, and at times it was hard for Madeleine,
who had previously been an only child, and probably still
felt like one for much of the time. She both wanted and
resented Isobel.
My job-share partner and I changed jobs in August, and
again took up a split post that could be worked for six months
in each component. Her post was in psychotherapy, and
I started work in adolescent psychiatry. I had no desire to work
in child and adolescent psychiatry as a specialty in the future,
but it was necessary to have experience either in this or in
learning disability, to complete core psychiatric training.
The adolescent service was situated in a funny little building
set back from the main hospital. At that time, a new and better
building was in the process of being constructed, for both in-
and out-patients, and was opened soon afterwards, but the
current building was limited to out-patients. Any young people
requiring in-patient treatment were admitted to the adult
ward down by the car park, the same ward where I had been
an in-patient.
Again, I very much liked my fellow psychiatric trainees,
although I felt that I was quite a lot older than them. This
was true, but it was compounded by the fact that I was married

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with children, so also at a different stage in life. It was a

marked contrast to my early years after graduation, when
I had always been one of the youngest. There was also a
tendency for some of the staff to dress rather youthfully, and
some would come in with their hair in pigtails. In my view, this
was a step too far, but it was easy to see why you would, working
there. It was very different working with young people, and
quite challenging. History taking involved a lot more develop-
mental detail, and it was of course important to speak with
family, school, and anyone else involved.
We had some training in systemic family therapy,
which was interesting, although I am not sure that any of
us made much progress. This was a type of therapy which
involved two of us speaking with the family, watched by the
rest of the team, through a one-way window (the family
was aware of this). It was fascinating, seeing the dynamics
between family members, and helped us come up with all
sorts of formulations and ideas about their problems.
Whether it actually improved things for the young person
or for their family was harder to say, given our limited
expertise.
Other than that, we saw all sorts of people, middle-class
schoolchildren to young truants. Once I saw a young person
with attention deficit hyperactivity disorder (ADHD), who actu-
ally climbed out the window and left in the middle of my
pontificating, although I must emphasise that it was a ground-
floor room.
I saw another young girl, sullen, distressed, and unable to
say much about what was happening inside her head.
We thought she had a first-onset psychotic illness and admit-
ted her to hospital, to the ward where I had been a patient.
I was very concerned about her. I was also very reluctant to go
to the ward where she was being cared for, but was, rightly, not
able to get out of this. While there, I saw a patient whom

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I knew from my own previous admissions, who shouted very

loudly at me, ‘What are you doing here? You were a patient
like us, now you’re a doctor! What’s all that about?’
I was with other staff and felt quite mortified. I tried to
brush it off, but it wasn’t a great moment, and there was little
I could say to explain it away.
There was another oddity about that post, and I was never
sure whether it was entirely coincidence, whether the depart-
ment was particularly stressful, or indeed whether it actually
supported staff with problems better so that they felt able to
talk about them. But there seemed to be a higher proportion
of people with mental health problems working there than
I had come across elsewhere. Suddenly, I was not unique.
My nose was even slightly out of joint.
There were, however, a few useful things that I discovered.
Firstly, although I do like to support other people and see it as
very important, it can get very boring continuously talking
about mental health problems, and I felt retrospective sym-
pathy for my family and friends.
Secondly, people whose mental health is wavering badly,
and who work in the field, should always consider staying off
work and be supported to do so. I don’t mean that a slight
drop in mood should lead to immediate cessation of work, nor
do I mean that they are in any way dangerous; just that if it
becomes too much of a preoccupation, they cannot effectively
work with or support others.
Thirdly, it is probably not a good idea to talk about one’s
own mental health in appointments with patients. I have never
done this, although I know others may disagree, and think that
it can at times be helpful. But this appointment is about the
patient and should not be hijacked. One might feel that one’s
own experiences will help one to understand another’s; this
may be possible, but I remain unconvinced that they should be
shared. Listen to them, rather than talk about yourself.

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I sat my Part Two membership examination that autumn.

I took the written paper in Edinburgh but had to go down to
Bedford to take the clinical exam. Given that I was uncertain
as to Bedford’s whereabouts, Richard kindly drove down with
me to provide moral support, although he probably regretted
this when he realised that I had taped vast amounts of infor-
mation about psychiatric diagnoses directly from my ICD-10
book (International Classification of Diseases, WHO), and
planned to listen to it throughout the entire journey. It was
actually surprisingly relaxing and soporific.
We stayed in a hotel that I wished I could have enjoyed
more, given that it was a rare night away, and the next day I sat
my exam. There were horror stories about being assigned
mind-shatteringly complicated patients who would refuse even
to speak with you, but, as with my Part One exam, I was lucky.
I spoke with a lovely patient, who gave a clear history, and had
some interesting physical signs to boot. The examiners on this
occasion were also friendlier; the questions became more and
more complicated, and when I finally stumbled, they smiled
and said that it didn’t matter. The other part of the exam, a
discussion of patient management problems, also went as well
as I could have hoped, and, unusually, I left thinking that if
I had failed, I might as well resign myself to never passing.
The results came out some weeks later. By that stage, they
were available electronically, on the College website, but I was
in a clinic, with no computer access, so Richard checked them
yet again. I knew when the phone went that it could only be
about that, so excused myself, answered, and heard the won-
derful words, clearly this time – ‘You’ve passed!’
I allowed myself a brief, internal moment of joy, then
turned it off to continue the consultation. But I was very, very
happy. I was now a member of the Royal College of
Psychiatrists (or would be when I paid my membership fee),
and I never needed to sit another exam again, ever.

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 CHAPTER 13

A Real Psychiatrist

Passing my exam was a true watershed. Up until that point

there had always been doubt: doubt that I would pass, doubt
that I would ever get to be a real psychiatrist. I had been very
lucky. I did work very hard, because I knew that I could not
allow myself multiple attempts – that would simply not be fair
on my family – and I was grimly determined to get through
both parts first time, if possible. I continued to push myself,
thinking that I needed to achieve more and be better than
others, just to stay on the level.
Some doctors, particularly those with families or other
commitments, very reasonably decide that studying and
higher training are too much, and you can become what is
called a specialty doctor without necessarily completing the
exams. These are permanent posts and experienced doctors
often carry a lot of responsibility in them. You can also avoid
management responsibilities, an advantage for many. I had
always thought that this might be a good option for me, but
now that I had passed my exam, I decided that I would apply
for higher training. In my defence, it is paradoxically a lot
easier being a higher trainee than a core trainee. There are no
exams to sit, no residential on-call, and far more certainty
about where you are going. There are a number of dropouts
at core training level but far fewer afterwards.
I had also finished and nearly submitted my MPhil thesis,
which had been enjoyable but ultimately quite a sweaty grind

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to complete. My supervisor had been very supportive, and

I had also got to know Allan, the consultant in Fife whom
I had met briefly back at the start of my training, and who
had, himself, undertaken a great deal of work into the history
of psychiatry. He helped me a lot with my thesis, in particular
undertaking to do retrospective diagnoses for a proportion of
my long-deceased subjects, to ensure that mine were valid.
I also occasionally saw him or his wife at the school gate, and
we became friendly.
I am not sure that I was otherwise a great success at the
school gate forum, not least because I had always worked so
much. It can be difficult when you are not a playground
regular, and it can also be a nasty reminder of one’s own
school days and social incompetence. I worried about
Madeleine, who seemed happy but who was finding school
more difficult than I felt she should. It was becoming increas-
ingly obvious to me that we had sent her too young, but
I hoped it would get easier as she grew older, and the
gaps narrowed.
At some point we had decided to get her violin lessons, as
she was keen to learn. I wasn’t playing at all then but still had
some idea of how to do so, and she had lessons with a Suzuki
teacher for a while. This didn’t seem to suit her, but I wasn’t
sure how to find her another teacher, until we met Heather at
a Hallowe’en party of mutual friends. Our entire family was
dressed as characters from the Wizard of Oz, and Heather was
a very fetching witch, who turned out to be a violin teacher
and also lived close by. She had two children of a similar age to
Madeleine and Isobel (as well as several older ones) and
started to teach Madeleine shortly after. Her daughter, a little
younger, was to become a close friend of Madeleine’s, and
these lessons were warm and positive, with none of the fear
that I associated with my own childhood violin lessons. My own
teacher used to famously reduce big boys to tears, and

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I remember sitting in a pale-faced line outside her door. But

I sat in Madeleine’s lessons and listened and marvelled at
Heather’s own playing. Without going to those lessons,
I doubt that I would ever have played again myself. More
importantly, Heather knew how to teach children, and how
to make them feel good about themselves. Compared with
some teachers, I think she actually liked children, and those
lessons were very important for Madeleine.
I started to apply for higher training posts in psychiatry
straight away after passing my exam. There are a range of
options that aspiring trainees can apply for: general adult,
old age, child and adolescent, learning disability, forensic
and psychotherapy. I have always thought it odd that the
first five are defined by the patient group, and psychother-
apy by the treatment, but that is how it is. I had no great
desire to do any of the other specialties, so thought that
I would apply for general adult psychiatry, possibly
with psychotherapy.
I was unsuccessful as regards psychotherapy but was prob-
ably just unlucky, in that I was up against people with both
more experience and more qualifications, and, while disap-
pointed, I did not feel any huge regret. We had decided that
we would go to Mexico that Easter for a holiday, with the girls
and with Richard’s mother, whose sister lived there. Richard
had to go before the rest of us to work, and we would join him
for an unheard-of two-week holiday.
Unsurprisingly, perhaps, I then found out that I had a job
interview for a higher training post in general adult psychiatry
during the first week that we would be away. What to do? I felt
I had to attend the interview, and, as it was only a couple of
days into our holiday, we decided that my mother-in-law would
fly out with Madeleine at the pre-planned time. They would
stay with her sister in Mexico City, and Isobel and I would join
them a few days later, after my interview. I was on my own at

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home, as my parents were also away, visiting my brother who

had recently moved to California.
I went to the interview, then returned back home to wait for
the phone call, which came that evening after I had collected
Isobel from nursery. I was offered a job! I couldn’t quite
believe it, and it felt most peculiar, having only an uncompre-
hending two-year-old with whom to share the fabulous news.
Mobile phones had shrunk from the brick that I had previ-
ously but were hardly what they are now, and Richard had, in
any case, a very parsimonious attitude to phone calls, such that
calling him was not an option. But at least shortening my
holiday had not been in vain. I regret that I was reduced to
performing a rather tragic victory dance in the hall of our flat
while Isobel looked on, bemused.
We flew out to Mexico the following day; a long-haul flight
with a two-year-old is no joke, but she was very good, other
than ordering me to fetch her more food at frequent intervals,
and Richard said he would meet us at the airport. In fact, he
was nowhere to be seen, as he was sitting in a bar having a
beer, but the Mexicans are very nice to mothers and children;
we were whisked to the front of the customs queue. Eventually,
we found him and went back to meet the others at his
aunt’s house.
Our holiday in Mexico was thus shortened, but also
enhanced, by this success. A day or two in Mexico City,
followed by a flight to Oaxaca City, then a stay in Richard’s
aunt’s house on the Pacific coast. It was a beautiful trip, full of
light and pyramids and lovely food. Then back home, to finish
up my adolescent psychiatry job and embark on higher
training. I was a real psychiatrist, at last.
I knew now that I would not return to general practice, and
that was an enormous relief to me. General practice is a great
career for many, but it wasn’t right for me. I felt huge pride, as
well as gratitude to my family, to have obtained my general

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practice as well as my psychiatry membership exams. I had –

and continue to have – anxiety dreams that I didn’t actually
pass any of it. But, prior to this, it had been Higher Physics,
taken at school, that had haunted my academic nightmares, so
this was, overall, an improvement.
Higher training in psychiatry lasts for three years and is
made up of one year in general adult psychiatry, another year
in general adult psychiatry or one of its sub-specialties (liaison,
rehabilitation, or addictions), and a final year in anything else
you choose, within reason. Higher trainees can usually choose
their placements, unlike core trainees, who have them allo-
cated, and I decided to do a year’s general adult psychiatry in
one of the hospitals just outside Edinburgh. It was a popular
place to work, with good experience, and would get me away
from the Edinburgh hospital, which I felt would be better for
me. On-call would no longer be resident, making life
much easier.
I liked my consultant supervisor very much, the first –
indeed the only – female supervisor that I ever worked with
during my training, and I enjoyed the work. I had decided to
work full-time, as I felt that this was manageable with no more
exams to sit, and I was starting to be aware that I had been a
trainee for a long time. Most of my medical school compatriots
were now consultants. Other than vaulting ambition, I looked
forward to the time when I would have a permanent job, and
we would no longer have the spectre of a significant move
hanging over us.
Shortly after I started this post, I went for my viva for my
MPhil thesis. This took place in the university tower, which
induced predictable anxiety. The Head of Department waved
me to a seat just outside her office, and I sat, quaking. She had
a voice reminiscent of Miss Jean Brodie and proceeded to have
a boisterous row with some poor soul on the phone. ‘What do
you mean there’s nowhere for them to stay, that is not

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acceptable.’ Silence followed. ‘Well, you’re going to have to

find somewhere.’ More silence. ‘That is not my problem, just
sort it out.’
She then emerged, smiling, which was even more terrifying,
and asked me to come in. I am confident that she knew of my
history of illness, but there was no effort to dispel my anxiety.
Viewing this more positively, this was probably her usual style,
so she may have been paying me the courtesy of treating me
like anyone else.
There was another professor present, as an external exam-
iner, much more softly spoken, and the viva itself was fairly
painless. She did refer rather condescendingly to my ‘rather
slim volume of work’, but I passed with minor corrections.
I didn’t care how slim she thought it was, I was delighted to
have a postgraduate degree!
Life was good, better than it had been for ages, and I had
now been well for quite some time. Inevitably, a thought had
started to creep in – why not have that third baby? It sounds
like the most incredibly stupid thing I could have thought of,
looking back. Why rock the boat? On the other hand, I had
always wanted three children, and, in many ways, this was
perfect timing – had it not been for all the previous problems.
A lot of trainees had their babies during higher training, when
there were no exams and no consultant responsibilities, and it
was quite easy to go part-time, as there was funding for this at
that level.
Richard and I spoke about it, and I convinced him that this
time it would definitely be a boy, and he agreed that, with this
proviso, we would go ahead. Looking back, he was
remarkably gullible.
Despite my less-than-impressive obstetric history, I had
always become pregnant very easily, and so I did but then
miscarried immediately. I became pregnant again soon after
and this time began to bleed at six or seven weeks, with

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miscarriage again confirmed on scan. Surprisingly, I was rela-

tively unaffected by these experiences; I don’t think that I was
necessarily more resilient, but the circumstances were differ-
ent, and we had two healthy daughters. But I wasn’t ready to
give up and conceived again at the turn of the year. This
one stuck.
I was anxious, as always during pregnancy, but not
depressed. In fact, I was very anxious, but I managed to carry
on working, although I suspect I was slower and in need of
more support. I was also very determined to deny both anxiety
and any change in mood. But then many women are anxious
during pregnancy, especially those who have lost babies, like
I had. I had registered with a new GP, who was kind and
patient with me and was an ongoing source of support,
which helped.
I was thirty-five by then, hardly old, but definitely more
mature than during my earlier pregnancies. Madeleine was
eight, and Isobel almost three. We went down to Newcastle to
have a nuchal scan done, as I was concerned that I would be at
more risk of chromosomal abnormalities, given my age, and
this was not then available in Edinburgh. This is a special scan
that measures thickness at the baby’s neck, which, combined
with other factors including the mother’s age, can give an
estimate regarding risk of Down’s syndrome and some
other abnormalities.
It was strange, really, as I would not have terminated that
baby, or any other I had conceived, despite that previous
decision with my very first pregnancy. Nor would I have had
an amniocentesis, even had I been deemed high risk, given
the very slight risk of miscarriage. I often dwelled on that, and
what circumstances had led me to make that choice more than
ten years ago. The person I was now would not do it, but I was
also the person I was then, and that person had done it. I still
believed strongly in choice and was not religious; there was no

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rhyme or reason to my thoughts. But I wanted to know if this

baby had any problems so that we could prepare for it, and, as
it turned out, the results were very reassuring.
Given my history, I saw another psychiatrist during that
pregnancy, one of the liaison psychiatrists who was based at
the general hospital. He was a man who saw quite a few
doctors and health professionals, so that they would not need
to be seen at the psychiatric hospital. I am not quite sure
what I think of that, as it does rather smack of stigma
feeding stigma.
He was interested and pleasant, but my mood was stable,
and he did not see me unwell. I was simply very anxious, and
he spent more time looking at psychological and background
factors, and whether these were at the root of my troubles.
With him, I saw the power of listening, and he was very kind,
which helped. I’m not sure what his opinion was, though, as he
never really said. I still worried that he thought that I had a
personality disorder – this fear never left me.
But I kept working throughout that pregnancy and com-
pleted my year in general adult psychiatry. I saw a lot of
patients and remember a few of them. Some of the clinics
were long and trying, starting with new patients, and ending
late with patients that had been passed from doctor to doctor,
and never seemed to get well. I am sure some of these people
were depressed; some had other illnesses, and some were very
unhappy people with desperate lives.
There is a temptation, as a psychiatrist, to do something
new whenever you see someone, to be that one person who
finds that elusive drug that will banish all their troubles. And
while going through drug treatments systematically has much
to commend it, sometimes you just have to stop. Reassess and
confirm diagnosis, but don’t continue to throw drugs at
patients, just to be seen to do something. It is difficult not to,

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though, especially as a trainee, and also because the patient

expects it. But it rarely works.
Psychological treatments and interventions may be more
helpful for some, particularly where there is previous trauma
or cruel life experiences, but they are often limited by
resources. I looked after one patient in particular that year,
who was admitted with depression. That patient had electro-
convulsive therapy (ECT) and had severe memory loss, far
more than I remembered experiencing myself. I have no idea
why, or whether other factors contributed. It was very much a
lesson that people are not all the same, although it did make
me wonder uneasily how much I had lost when I was treated,
as this patient had little idea of their deficit.
I had also started training in cognitive behavioural therapy,
on the South East Scotland course. This might seem strange,
given that my own attempts at this therapy had ended so
ignominiously, but, even despite this, the theory behind it
always appeared to make sense to me. I wanted to learn some
psychotherapeutic skills, as these might well be applicable to
future work. My supervisor on the course was a consultant
psychiatrist in psychotherapy, who worked mainly with people
with eating disorders, or those who had experienced trauma.
He had set up treatment centres for these conditions and was
a charismatic, intelligent, and charming man, whose own keen
interest in others attracted many trainees, as well as all sorts of
professionals, to work with him. I decided that my next job
would be with him as my consultant supervisor, and I started
there for just a month before going on maternity leave.
The baby was due towards the end of August. Richard was
more or less resigned to her feminine gender, which had been
revealed on the twenty-week scan, and I was secretly relieved
that we knew so that his face would not fall when she was born.
It was the first time that we had known the sex of our unborn

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baby, and we planned to call her Lottie. We were more organ-

ised for her arrival, and Madeleine and Isobel were looking
forward to their new sister.
I was still of the view that live babies had to be seen before
they could be believed, but I was, very cautiously, hopeful.
I went into labour shortly before her due date, and we went
to the hospital that morning. Much to Richard’s disgust, we
got a parking ticket, as the machine was broken, and it took
almost the length of another pregnancy to negate this. But
things were fairly straightforward on this occasion, at least
until I got my epidural. The anaesthetist put a line in my
arm and noticed the very minimal old self-harm marks.
He almost recoiled, and looked at me with horror, reigniting
that old shame, hardly something I wanted at that point. It was
a sad moment for me.
Later, there were further problems in that my blood pres-
sure plummeted, which can apparently happen with an epi-
dural. Richard told me afterwards how terrified he was.
‘I thought you were going to die.’ He was ashen
and trembling.
‘Well, I’m fine,’ I said, cradling Lottie. I smiled at him. ‘I
didn’t realise how much you loved me!’
‘Oh, it’s not that,’ he said, still pale. He gazed at Lottie. ‘I
thought I was going to be a single parent with three
daughters.’
‘Ah,’ I said acidly. ‘Well you’ve certainly got three
daughters!’
Little Lottie was born easily, slightly larger than her sisters
at seven pounds three ounces, a beautiful baby. She had a
delicate mouth, painted on like a Cupid’s bow, and no hair at
all, and her eyes were a soft tadpole grey, like Isobel’s had
been before they darkened to brown. We stayed briefly on the
ward, long enough for Madeleine and Isobel to come and
meet their new sister. But we left earlier than planned, as it

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was so busy that it was counter productive being there post-

delivery. One young girl, who had had a Caesarean section,
kept trying to get up to breastfeed her baby with minimal help
from staff, who were simply stretched too thin. Unsurprisingly,
she gave up very shortly. An old-timer like me could hardly
expect any help, and it was good to get home.
This was the point at which this hitherto textbook preg-
nancy and birth (for me, anyway) came crashing down. Lottie
was a disastrous feeder. At first, I thought my milk just needed
to come in, but the days passed, and she got thinner and drier.
It is probably not fair to blame her entirely – we were referred
to as a breastfeeding dyad, so the fault may well have been
mine. I am very loath to criticise health professionals, as there
are usually good reasons, often systemic, for any problems, but
I think that we were let down by the visiting midwives, who
simply didn’t spot her deterioration.
Eventually, we called out our GP, who admitted her imme-
diately to hospital, where she was found to be severely dehy-
drated but fortunately otherwise unharmed, and she was sent
home after a couple of days of intravenous fluids. The only
upside to this rather terrifying experience was reconnecting
with one of my close friends, Catriona, whose two-year-old
daughter had also been coincidentally admitted to the same
hospital. Despite her bouncing golden curls, I think she was
rather more unwell than our Lottie, but fortunately she too
made a full recovery.
Obviously, we were now feeding Lottie formula milk, but
I was not prepared to give up on my feeding. The rules for
babies had changed since I had Madeleine, or even Isobel, and
it seemed that they were now best breastfed for a year.
We hired a frightening-looking electric breast pump off the
internet, and I embarked on restarting my milk. I have never
felt so cow-like as when attached to that horrible machine, and
I simply couldn’t bring myself to do both sides at once, as

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recommended, but it did the trick. By the time she was eight
weeks old, I had achieved my breastfeeding dream – I don’t
think Lottie would have cared either way, as long as she
got fed.
But it did make life easier. Although Isobel was still at
nursery, I had reduced her hours there so that I could be with
her more, and we spent a lot of time wandering the streets,
going to the pond and feeding the ducks, and, our favourite,
going to the museum. We used to watch the fish there, sadly
long since gone, and listen to the Millennium Clock, and stuff
ourselves with scones and cake. There is no doubt that the lack
of any need for bottles was a boon.
I took nearly a year’s maternity leave after I had Lottie,
perhaps better called normality leave for me. My career was
on track, I had no more exams to sit, no more MPhils to write
up, and I had three beautiful daughters and a fantastic hus-
band. I wasn’t unwell at all during this time, which was won-
derful and frankly unexpected. Nobody can pretend that
looking after a baby is easy, but I stayed well. I even made my
own Christmas cards that year, which for someone with my
abilities at arts and crafts was probably bordering on the
ridiculous, but I was really very happy.
Madeleine was eight years old when Lottie was born and
found her arrival much easier to cope with than that of Isobel.
She knew what to expect, being older herself, and seemed very
proud of the new baby. We had made the decision to hold her
back a year at school, with her acquiescence, and she was now
in a year that was far more suitable age-wise. Unfortunately,
I think it was a lot more difficult for her than we realised at the
time, and she may, as a result, have been the victim of some
unkind taunts from some of the other children. It might have
been better to have changed her school completely, but it is
very easy to be wise retrospectively, and it would have been
difficult to manage when Isobel started school.

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We did consider spending some of that year abroad, as

there was a possibility of Richard working for some months
in Switzerland, but, in the end, this didn’t happen, and it
would probably have been difficult for me on my own with
the children. But we spent a week in Germany in the spring,
which was very lovely, with castles, snow, and beautiful
sunshine.
I went back to work that summer, with Lottie safely
ensconced at nursery. She was rather indignant about this,
unlike her sisters, who had gone younger and knew no better.
Lottie was a bouncing, bonny baby, still with hardly any hair,
and not much in the way of teeth. Although I still had both,
she was otherwise far more like me to look at than the others
had been; I would look at her and feel a sudden bolt of
familiarity that was almost visceral. I didn’t want to leave her,
but paradoxically it was easier, as I felt that I had done my best
by her during my maternity leave.
For the rest of my higher training, I worked part-time, first
returning to the cognitive behavioural therapy post that I had
started just prior to Lottie’s birth. I enjoyed this but realised
fairly quickly that I was not going to be a medical psychother-
apist without undertaking the full training, so needed to look
for other options. My default position was general adult psych-
iatry, but I was always aware that this might be hard for me,
given my own illness, and I could not escape a slight reluc-
tance. The one area about which I knew absolutely nothing
was substance misuse or addictions, and I had noticed that
such problems frequently arose, in all of the specialties in
which I had so far worked. I decided that this would be my
next post.

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 CHAPTER 14

Substances

At the time when I started to work in substance misuse in

Edinburgh there were two distinct services, one for alcohol
and one for drugs, although they inevitably overlapped. As a
trainee, I worked first in the drug service, later moving on to
alcohol. What can I say about the drug service? It was popular
with many trainees, who would work there briefly, even if only
to acquire some experience of a very different specialty to
general psychiatry, but a few, like me, worked there for a
full placement.
It was based in an elderly Victorian building that always
looked to me like a swimming pool with no water, although
many of the rooms where we saw patients were even more
subterranean. Some of them, windowless, seemed very deep
indeed. It was the kind of building you love but know is poorly
suited to its purpose. There was also an underground car park,
with unhelpfully positioned yellow pillars, which soon
matched some of the dents on my car.
There were two consultant psychiatrists working there,
Malcolm and Fiona, whom I gradually got to know well. Both
were kind and hard-working, and each slightly eccentric in
their own way. I worked first with Malcolm, a thoughtful,
academic man, who managed teams in a way that I hoped to
emulate. He always included staff in decisions, while still
taking overall responsibility for patients. Many consultants
don’t do that – it can be their way or the highway. He was

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inclusive and fair but also friendly and humorous. I think he

was a little shy, as I was, and it took some time to get to know
him, but I found him an invaluable support and friend.
Fiona was, for me, initially more of a figure in the back-
ground, as she was the service manager rather than my super-
visor, but she, too, became a good friend and mentor to me.
She was a larger-than-life presence, leather-wearing, bike-
riding, and opera-singing, sometimes all at once, and
I became very fond of her.
This may all sound a little sycophantic, and probably is, no
one being perfect. I do many things differently to them. But
they both came to mean something important to me – not
only did they work in substance misuse, where I quickly real-
ised that I, too, wanted to work, but they were the first consult-
ants with whom I did not, initially, discuss my psychiatric
history. This was not a considered decision, and I suspect
I would have done so had the occasion arisen, but it just
didn’t.
Malcolm was fairly formal in his approach to supervision,
often typing on his computer as we talked, such that I would
not have felt entirely comfortable bringing it up, and after a
while it seemed irrelevant. Fiona was not my supervisor, and
although I had in fact spoken with her about it some years ago
when I started my job-share, I don’t think she remembered
this; perhaps not surprising as she must have seen many
trainees. I felt normal, no axe to grind, nothing to prove.
I hadn’t particularly expected to like substance misuse, but
I almost immediately realised that I did. The service that
I worked in was called a drug service but was really an opioid
service, although quite a lot of our patients also used benzodi-
azepines, such as diazepam, easily available on the street.
It had been set up in response to the tragic HIV outbreak in
Edinburgh in the 1980s and early 1990s, and the philosophy
was very much to reduce harm by substitute opioid

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prescribing, and then to provide as much support as possible

to patients once they were stable.
The main reason for prescribing was, and is, to stop people
injecting heroin – shared injecting equipment being one of
the principal sources of virus transmission. But, once stable,
we also provided input for both physical and mental health
(certainly the latter, as we were psychiatrists), as well as trying
to get help for our patients with housing, social care, and
anything else that was required. We largely prescribed metha-
done, which is a long-acting synthetic opioid, although there
were a couple of alternatives.
I liked the patients. Many had experienced awful lives, some
had done awful things, and they told lots of lies, but that was to
be expected, lying being an essential part of the problem of
substance misuse. In an odd way, knowing this made things
clearer. Some lies could be proven – we could, for example,
take a urine drug screen and objectively demonstrate what a
patient had taken – but not all.
Lying was one of the aspects that I found most difficult to
accept at first, but ultimately it is one of the most integral and
important aspects in addictions, and it needs to be understood
to be able to help patients. Patients would lie to friends, family,
and even themselves, as well as to staff. It was also common for
people to say that they were using more heroin than they
really were, just to get you to prescribe more methadone.
I think this can be seen as part of the illness.
Some of the patients could appear quite threatening. One
of them, a big man with mental health problems as well as
drug use, was always unfailingly courteous to me. One day
during our appointment, he became enraged about some-
thing that had happened. ‘I’m so angry, I don’t know what
I’ll do. If I see them I’ll not be responsible.’ He leant closer to
me, rather too close. I could smell his fury.

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‘It’s OK, I can see this must have been really difficult for
you.’ I was edging closer to my bag, which had my alarm in it.
‘I’m totally going to.’ He suddenly stopped and looked at
me. ‘Did I frighten you?’
‘Well, not really, but.’ I tried to compose myself.
He looked distraught. ‘I would never hurt you, I would
never hurt a woman. I’m just so sorry.’
I believed him, and I do think that being a small, and hope-
fully unthreatening, female was actually quite protective. A male
doctor might have been more at risk in such circumstances,
especially if they had come across as at all confrontational.
But you always have to be wary, working with this patient
group – foolishly putting yourself at risk could lead to grief of a
different kind for both you and the patient. Quite often I was
the one saying, ‘No, you can’t have that drug or this prescrip-
tion,’ and I didn’t take the subsequent anger personally. I was
rarely frightened by a patient, but there was one other young
man whom I dreaded seeing. I couldn’t really identify why, but
there was no warmth coming from him, and I think I was right
to trust my instinct. I never saw him on my own.
Methadone is a drug with much baggage attached, and this
put some of my experiences of taking psychotropic drugs into
perspective. It is a poisonous green in colour so is hard to
mistake, which was of course a good thing, as it is extremely
dangerous in overdose. But many patients found taking it very
stigmatising, especially if it was supervised at the pharmacy,
which it often was when people were unstable, in order to
reduce chances of diversion. It often had to be prescribed by
our service, not just when people were using other drugs, but
even after they had stabilised, as not all general practices
would prescribe it.
But all this took time for me to learn. At the beginning
I liked the fact that there were clear biological and

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psychological aspects to addiction, as well as considering the

social problems experienced by most patients. It was interest-
ing on so many levels, and one other thing that I found unex-
pectedly useful was my old general practice training, given the
high levels of physical problems. There were a number of
general practitioners as well as psychiatrists working in the
service, and initially I experienced a bit of role uncertainty.
Was I a general practitioner or was I a psychiatrist? Which did
my patients need most?
Ultimately, though, I realised that I was there as a psych-
iatrist, but that a broader background in other medical spe-
cialties was helpful. So, I learnt how to prescribe methadone –
and when not to prescribe it – and I learnt how to talk to a
whole new group of patients, with whom I would have previ-
ously felt quite deskilled, and I also started to become this new
person, who had definitely never had any psychiatric problems
herself. I grew in confidence.
Research is an established part of higher training, but
I undertook very little at this point; I think I rightly put all
my spare energies into my family, but I did manage to eventu-
ally complete a project that I was quite proud of, looking at
mental health stigma in support workers. It took about six
years from start to publication, which was a useful lesson in
itself. We also had a small group of trainees who met up for
support, and ostensibly to carry out research. We published a
piece on the difficulties experienced by higher trainees doing
research, which rather says it all.
The girls continued to grow and thrive. Madeleine was
doing well at school now, and she produced a winning
Christmas card in her final year at primary school, consider-
ably superior to the ones I had produced when on maternity
leave. I could hardly contain my pride. She had plenty of
friends but at times still seemed unsure of her place in the
world, and occasionally resentful of my overprotectiveness,

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which I think was probably fairly normal for the uncertain

mother of an eldest child. She continued her violin lessons
with Heather and was very good.
Around this time I started playing the violin again myself.
I had a few lessons with Heather but decided to join an
amateur orchestra as the only way to play regularly – and
rigorously. When I joined, I said that I could play the viola as
well as the violin, as viola players are often more in demand.
This was probably wishful thinking on my part. I did indeed
possess a viola, but I had completely forgotten how to read the
clef and hence the notes, and there were several seasons of
humiliation before my playing started to coalesce.
Isobel started school at the point when Madeleine was
nearing the end of primary school, and she settled in well.
We had learnt from our mistakes, and she was five and a half,
quiet but confident. She also had an unusually lovely group of
children in her year, and she was generally very happy. Their
parents turned out to be quite nice too, and I started to get on
a bit better in the war zone that is the school playground.
Richard’s brother got married in Italy that summer, when
Madeleine was ten, Isobel five, and Lottie nearly two, and we
all went out for the festivities. It was one of the most beautiful
weddings I have ever been to, and a very happy, and very
Italian, event. It had also become much more straightforward
getting holiday leave, and I was no longer limited to one week
at a time, which made a huge difference.
Halfway through my substance misuse training, I switched
to alcohol, which was, for many reasons, a very different
experience. The department was geographically separate from
the drug service, with an in-patient unit in the main hospital.
Nearby terraced houses were used to see out-patients and
provide other input, such as groups or therapies. The in-
patient unit was directly opposite the ward where I had been
admitted, separated by the car park. It was a fairly comfortable,

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pleasant ward, at that time used exclusively to detox people

dependent on alcohol, and I never minded working there,
despite its location. The patients tended to congregate in an
unpleasant little smoking room, stained nicotine brown over
the years, unwilling to give up this addiction even while they
sweated and shook through their alcohol detoxes.
The out-patient work could be difficult; unlike people who
are opioid dependent and want their methadone, attendance
was often poor, and motivation questionable. The consultant
with whom I worked in this post was both experienced and
renowned, and taught me a lot. Supervision was slightly
marred by the deep chairs in his room, from which I found
it hard to physically extract myself, but it was worth it for what
I learnt.
I soon found that the lying was a bit different in this patient
group. Many drinkers denied their level of consumption des-
pite clear evidence, for fear of the consequences.
These consequences can vary, as I discovered seeing a very
jaundiced man.
‘So what’s made you decide to give up the alcohol?’ I asked,
looking at him with concern.
‘Well, my wife’s been on at me, I don’t know why, she drinks
quite a lot herself.’
‘Is there anything else, d’you think?’ I was squinting at the
yellows of his eyes.
‘Well there’s been a wee bit of trouble with work, but that
can be sorted.’
‘Are you driving?’ I very much hoped he wasn’t.
‘No, well I lost my licence, but I’m hoping to reapply for it
soon. I really do need it for work.’
‘Are you not worried about your health? Even just a bit?’
I was sure this would be his main concern.
‘No, I’ve been fine, I’ve seen my doctor and I’m good.’

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I wondered if he’d looked in the mirror, but the truth was

that some people were able to deny all problems, even to
themselves. Sometimes it was very shocking.
I saw many patients, all different. There was one young
woman who had what I can only describe as intractable alco-
holism, however politically incorrect that may sound. She was
beautiful and likeable, and it was a terrible shock and lesson
for me when I realised the extent of her illness and how well
she hid it. I had believed her, and, in my naivety, was once
more upset that she had lied to me. My being upset was no
help to me or her, though, and I had to learn to expect
patients to conceal their difficult truths and still to try to
help them.
There were many deaths, often as a direct result of alcohol
use but also occasional suicides, and the mental effects were
clearly at least as toxic as the pervasive and serious physical
ones. Even then, I realised that there are many that you cannot
save, but it still hurts.
In addition, alcohol is a substance that is used by many, and
this can include staff as well as patients. I can say, hand on
heart, that I have never used drugs; indeed, I have never even
managed to inhale a cigarette without choking, somewhat to
my chagrin as an adolescent. But alcohol is a familiar sub-
stance to most of us, used by many, and entirely legal. When
I started working there, I felt appalled by what I was seeing and
hearing. I was disgusted by the smell of stale alcohol and gave
up drinking completely for around six months. I suspect that
this is quite a common reaction, and I did resume, probably
after I became more desensitised to the whole experience.
Working with people who drink can be challenging,
though, and the normality of having a drink on a Friday night
after a hard week becomes loaded and uncomfortable.
I definitely questioned my own drinking, which had never

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been particularly excessive, but at times of stress had some-

times become more regular than I would have liked. Anxiety
was far more likely to make me drink than depression; indeed,
I rarely drank at all when depressed. However, I was aware that
alcohol misuse commonly coexists with mood disorders, both
depression and bipolar disorder, and I had to acknowledge
that I might be at increased risk.
I have friends who have been alcohol dependent, and one
comment made is that they have always been able to drink
more than other people but that it was still never enough. I am
quickly floored by large amounts of alcohol, so for me it is
probably about ensuring that I don’t succumb to regular
drinking, which might increase my units beyond either what
I would like or what would be good for me.
Later during my training, the alcohol and drug services
joined together, and around that time one of the consultants
took a few months off for very sad personal reasons. As a result,
I was asked to ‘act up’ as a consultant. This was something you
could do in the last year of training, and was an excellent
experience for me, although I wished the circumstance had
not arisen. But I knew now that I definitely wanted to continue
to work in substance misuse – it was just slightly unfortunate
that there were no imminent consultant posts on the horizon
in Edinburgh.
But then it came to my notice that the Scottish Borders,
who had hitherto had a nurse-led substance misuse service,
were looking for a part-time consultant. I had misgivings, as
I knew what the commute was like, but I thought that perhaps
I could manage. It would be part-time with no resident on-call,
and I phoned one of my previous supervisors there to enquire.
Within a very short time, they advertised this half-time post,
and I applied and was interviewed and, to my great delight,
was offered it. I had now reached the pinnacle of medical
training and was a consultant psychiatrist!

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There were moments throughout the ups and many downs

of my training when I had dared to dream that this could
happen, but it had always been hard to believe. I felt through-
out that someone would find me out and say that I was unsuit-
able, given my own illness. There was also the relief of having a
permanent job at last. I had feared that I might have to ask
Richard to consider moving, both during my training and
afterwards, and now I saw life unfold ahead of us, staying in
our flat, the children staying at their schools, and a perman-
ent, and part-time, job whereby I would be able to help sup-
port us financially.
I started this job back in the Scottish Borders on a cold
February morning at the age of thirty-nine, nine whole years
after I had started there as a junior doctor, and it was some-
thing of a shock. It is very different being a consultant to being
a trainee, when you fit in and learn, and there is always
someone else to carry the can. Suddenly I was the person
everyone was looking to, to manage difficult cases and make
decisions. There were a number of issues with prescribing in
the team when I started, and I felt that the process was not
entirely safe. Methadone is a long-acting drug – increase it too
quickly, and you may be very unlucky and kill someone, par-
ticularly if they made the mistake of continuing to use illicit
heroin on top.
In fact, this was almost inevitable and needed to be taken
into account when prescribing. You could never be sure of
anyone’s tolerance, as people lied, got sold drugs that were not
what they thought they were, and everyone’s bodies vary in how
they metabolise and excrete drugs. All these factors could con-
tribute to a potentially lethal outcome, and I refused to continue
the current prescribing practice, which did not account for any
of this. The team was very fed up with me, and I felt universally
disliked for the first few months, but gradually things settled,
and I started to really enjoy working with them.

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It was a difficult job, though, and needed more time allo-

cated, quite apart from the immense amount of travelling
involved. Previously when I had worked in the Borders, I had
only ever been in one of four areas, but now it was just me for
drugs and alcohol, right across the county. I was also on-call
for general psychiatry, around one in six nights and weekends,
but this was from home and was usually very quiet. In addition,
I had a small in-patient commitment in the new unit above the
Borders General Hospital; I only had two beds to look after,
but this was quite hard to manage, as the patients required
input little and often, and I was part-time and rarely able to
visit more than once weekly.
We had a particularly nice holiday, in the months after
I started my consultant post, a week in Paris, and met up with
Allan, my consultant friend from Fife, and his family. We went
to Euro Disney one day, and Madeleine and Isobel went on
some stomach-turning rides with seeming equanimity, but
Lottie and I stuck to the teacups, which were more than
enough for both of us. She was three and very sweet, still with
scant hair, but with an extraordinarily beautiful smile and a
very loud voice.
Madeleine finished primary school that year and started
high school. A combination of factors contributed to our
becoming concerned about her, and, rightly or wrongly, we
changed her school, which was very difficult for her. She
certainly considered that we made the wrong decision, which
may well have been true. Suffice to say that you worry hugely
about your children, especially your first child, even more so
with my remorse about her early years.
I had a great backlog of guilt that she might have been
adversely affected by my illness, and my consequent lack of
availability to her as a small child, and this had been com-
pounded by our mistake in sending her to school too young,
and then holding her back a year. In many ways, she had been

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very resilient in coping with all this, but she was starting to
grow up, starting to rebel in small ways and to examine the
decisions made by her parents. Unlike her sisters, she had
remained blonde, and she was a pretty girl, slender and
already slightly taller than me, although that couldn’t really
count as tall. She went to her new school but wasn’t very
happy; I worried about her, especially given that I was working
so far away.
But I carried on working that year, commuting to and from
the Borders. Despite my convincing and ongoing recovery, my
mood dropped at one point, and I went back to see Professor
Blackwood, and went back on antidepressants. On this occa-
sion I was more anxious than depressed and was very sceptical
of potential treatment, but there was no doubt that things
improved, and within the expected time frame. And it was all
manageable, no deterioration to catastrophic thoughts and
disaster, no days off sick. I didn’t really consider it much of a
problem although was annoyed to have to take antidepressants
for all the usual reasons, and, true to form, I don’t think
I actually took them for long. A tiny bit of me did start to
wonder, though, whether it might not actually be quite
reassuring to know that there might be drugs that did help,
should I become depressed again.
Looking back, what did I think then about my mental
health problems? The truth was that I thought they were in
the past, that I had beaten them, and that any further prob-
lems would be minor. Professor Blackwood had previously told
me that it was his opinion that I had bipolar disorder, but
I thought he was just wrong, and never really accepted it. I was
just about prepared to accept depressive disorder, but even
then, only as something in the past.
It was my view that if I had really had these conditions,
I would not have had the periods of good health that I had
experienced recently. I simply didn’t think that I would have

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remained well. Richard and I no longer discussed my ill

health. In past times of illness, and the difficult months that
had followed them, I had ruminated endlessly and no doubt
tediously, but now I kept silent, and so did Richard, probably
relieved. I don’t think I could really remember the hard times,
and I told myself that they had been greatly exaggerated. This
was not deliberate; it was as if that suffering had been in
another life, experienced by another person.
I was, however, finding the commuting hard, and just over a
year after I had started, an unexpected opportunity came up
for a part-time consultant job in Edinburgh, working with my
old colleagues in substance misuse. It was hardly ideal, leaving
a first consultant post at this early stage, but on the other hand
it was highly desirable for me, and I felt that I could not pass
up this chance, as it might not arise again for years. I spoke
with the lead consultant in the Borders, as I needed a refer-
ence, and he was very understanding, which was a relief.
I then went about that application like a military operation,
even taking holiday to attend an interview course, to learn how
to sell myself more effectively. There were three applicants
interviewed, including me, and I was pacing the floor in my
flat, waiting for Fiona’s call.
When it came, my hand was sweaty round the phone. ‘Hi,’
I said.
‘Hello, is that Rebecca? Well, I’m really glad to say we’d like
to offer you the job. Congratulations!’
I was lost for words. My mother and Madeleine were with
me, and both were thrilled. I felt terrible telling my Borders
team, but they were very pragmatic, and, in some ways, things
worked out better for them, in that subsequently a full-time
consultant was employed, as was clearly needed.
I worked my notice there and then started back in
Edinburgh that summer, working between the drug service
and the in-patient alcohol unit. I was supposed to be half-time

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but quickly acquired a couple of additional sessions in one of

the areas just outside Edinburgh; as I was saving a great deal of
time not commuting, I thought I could do this. I was also on
the general psychiatry on-call rota, which didn’t happen very
often, was not very onerous, and was, again, from home.
My life had gone full circle several times since those dark
years as a psychiatric patient. I had achieved what would then
have seemed completely impossible – I was a consultant psych-
iatrist in the very hospital where I had been an in-patient.
Those days of being a patient had faded in my memory, a
sepia photograph of someone else’s life.

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 CHAPTER 15

The Unexpected

Life continued apace over the next year or so. Lottie, my

youngest daughter, turned five and started school at the same
time that I came back to work in Edinburgh, and I unearthed
my old bicycle so that I could take her there, perched high up
on the saddle, then afterwards ride the five or ten minutes to
work. Now that I worked so close to home, I was able to collect
both her and Isobel from school two or three times a week,
although Madeleine was thirteen and walked home from her
new school herself.
The little girls were happy at school with their friends and
their play, and I didn’t worry about them at all. On Friday
afternoons they went to ballet classes, sweet and pink and
clutching their little shoes, and I would sit in a café with
friends and eat cake, which was equally sweet and pink.
Isobel took dancing seriously from the start and was very good,
although for Lottie it was always more of a social affair.
Richard was still working hard, and travelling, but his trips,
although more frequent, were usually shorter than they had
been in the past. This, combined with my exceedingly reduced
commuting, made life easier.
We acquired a pair of cats, disdainful and greedy, but loved
by the girls. The very day that we brought them home they
escaped, and we thought they were lost under the floorboards;
they were found, bound together in sleep, in one of
Madeleine’s drawers. But Madeleine remained less than

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happy, just not quite fitting in, angry at times, unable to

express her thoughts and feelings, certainly not to us. Other
than my worries about her, I was quite content and enjoying
work. It was quite different working with a group of experi-
enced consultants to being on my own in the Borders, and
I felt that I was very much the junior colleague, but this suited
me at that time, and I was happy.
When did things change? It is hard to remember exactly,
but a year or so into starting this job I began to feel more
anxious again. The only new thing that I had taken on was
some additional work with the General Medical Council
(GMC), which involved assessing and monitoring doctors with
mental health or substance misuse problems. The latter, sadly,
is not uncommon, and several of my colleagues already did
this work and had encouraged me to apply, addiction psych-
iatrists being generally in short supply. The assessment process
involved quite a rigorous and nerve-wracking interview in
London, where I was observed interviewing a couple of simu-
lated patients; one of these was an actor feigning a manic
episode, who told me afterwards that I was the only person
to manage to keep him from leaving the room, a dubious
attainment from any perspective. Later there was some helpful
training provided, but the work was very intermittent.
I saw my first doctor-patient quite early on, someone who
had been caught drink driving. This doctor was more junior to
me, perfectly pleasant, and the interview was fine, but some-
how it left me feeling frozen. Nothing went wrong, but I felt
anxious and inadequate, and the light started to get a little
darker for me. I asked some advice about the case from one of
my senior colleagues, who expressed surprise at my queries,
further jolting my diminishing confidence.
I carried on working, but I became gradually convinced that
everyone knew I was a terrible doctor and that my colleagues
would report me to the GMC, and that I would never work

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again. This was doubly painful in that all that I had worked for,
all that I had put my family through, would be in vain. I had a
higher trainee working with me at that time, and I felt acutely
shamed that I was letting her down, thinking that she might
fail her attachment and it would all be my fault. My sleep was
failing, and all was hopeless.
I carried on for a while but eventually was unable to keep
things from my colleagues, as I was so certain that my job was
at risk. They took it well, given that they had no idea of my past
history of illness, and sent me home, repeatedly emphasising
that there were no concerns as regards my job, something
I didn’t believe at all. I saw Professor Blackwood again shortly
after, who rightly thought that I was depressed once more.
I have been extraordinarily lucky to have had continuity of
care over the years as regards my psychiatrists, and I am aware
that this is something that can be quite unusual. Most people
will see their GP for first-line treatment – rightly – then pos-
sibly be referred for secondary care. But there are long waits,
and many patients will be seen by a psychiatric nurse or other
team member, rather than a psychiatrist. Or they may be seen
by a junior psychiatrist who rotates post every six months.
Neither of these options are necessarily wrong, and there are
times, when I have been ill, when I have wished that I had the
regular input and support of a community psychiatric nurse.
But I did see the same psychiatrist for many years, who knew
me, and knew my background, and that made a big difference
to me. As before, when my spirits were waning, he always said
that I would get well. He may possibly have thought otherwise,
and his heart may have sunk when he saw me, but he was
unfailingly encouraging, both to me and to Richard.
The array of available antidepressants had expanded since
the early days of my illness, as there were more options. I took
venlafaxine (a serotonin and noradrenaline reuptake inhibi-
tor), other selective serotonin reuptake inhibitors, and even

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agomelatine, a newer drug. None of these drugs was pleasant,

and I was reluctant to take them. The venlafaxine possibly
helped a bit, but agomelatine did nothing at all, and
I stopped it. I don’t think my compliance was quite as bad as
in the very early days, but my thoughts were the same – I’m not
ill, I have a personality disorder, I don’t need these drugs –
and things did not go particularly well.
There is always an element of trial and error with anti-
depressants, even for a very experienced psychiatrist, although
there are also guidelines available to follow as regards what
drugs to take, and for how long, what to change to, and what
one might add. Professor Blackwood did his best.
I lurched on, improved a little, and went back to work, but
was still not quite well, and was greatly supported by my
colleagues in keeping going. I hated being at home, off sick.
I couldn’t think what to do with myself, sitting dwelling on my
woes and my guilt about past and present misdemeanours, and
ruminating about my failures.
Many people find it very difficult being off work with mental
health problems. For me, if I felt better, even for an instant,
I would immediately ask myself what I was doing off sick;
I could not understand why I could not control my thoughts
and feelings. I could not even remember what it was like to
feel different. Take the analogy of thinking about feeling hot
when you are cold – it is almost impossible. This fed my
paranoia about being a fake, and it is certainly hard to imagine
what one should feel when unwell, given that this is something
no one can really confirm as they can never experience
being you.
Richard and I talked about my problems; indeed, I was
obsessive, and many of my old worries and ruminations had
resurfaced. But it was otherwise very much the elephant in the
room, as always. People were kind but often spoke without
naming my illness, sometimes in slightly hushed tones.

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It doesn’t help. We went on holiday that summer, to Italy, and

I tried to put on a good front, but it was a struggle. Madeleine
was clearly unhappy, which was even more of a worry, and
I was operating through a fog.
Things deteriorated rapidly when we got back, and I had to
stop work and see Professor Blackwood again. I could not see
any way out of the dank and crippling mess I was in, and
I could see no possibility that I would get better. To my horror,
he suggested admission, but, given that I worked in
Edinburgh, to one of the peripheral hospitals. I was admitted
to the in-patient unit down in the Scottish Borders, where
I had very recently been a consultant.
The consultant psychiatrist who looked after me there was a
personal friend and previous colleague, and that is the only
time during my illness that this has been the case. The other
area that was suggested was Fife, where my friend Allan
worked, and I knew that I did not want him to see me like
this. There are not massive numbers of consultant psychiatrists
in and around Edinburgh, and when you are one, you tend to
know most of them, either personally or by reputation.
If you were a cardiologist, or an endocrinologist – or even
an obstetrician – requiring to see a fellow specialist, you would
simply choose from among your friends the one that you
thought was best. But a psychiatrist is different – they know
things about you that you might not tell your friends, and they
see you at your worst, indeed when you are hardly
even yourself.
Friendship can be a problem. I might recommend a friend
with depression to see a particular psychiatrist if I admired or
liked them, but I might not feel inclined to see them myself.
So, this was awkward, or would have been if I had had any of
my wits about me, but I didn’t. It was probably far worse for my
friend than for me, and I am very grateful to him. He said
afterwards that he would have detained me if I had insisted on

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leaving, which would have been the right decision, and was a
very brave admission. Fortunately, I did agree to stay, and he
was not faced with that horrible decision.
I remember only fragments of this admission, mainly
because I had electroconvulsive therapy (ECT) again. The last
time I had this was when Madeleine was very small, more than
ten years previously. This took place down at the Borders
General Hospital, and I vaguely recall the brief drive down
there, which was a matter of minutes, then the cannula in the
hand, but nothing more. I remember that the psychiatric in-
patient unit there was a nice place to be, on the hillside,
surrounded by grass. I had a single room, and I remember
the dining area, largely because I couldn’t stop eating.
I had been started on olanzapine even before I was admit-
ted. It is an antipsychotic that also works both to augment
antidepressants and as a mood stabiliser, and it greatly stimu-
lated my appetite. I put on the most weight that I had ever
gained when I was taking it, as much as a couple of stone,
which was a lot for someone of my stature, and was really very
obvious. This type of weight gain was particularly uncomfort-
able, as it mostly settled around my waist, but food, when
taking olanzapine, is irresistible. Anyone who tells you that it
is just a matter of self-control and exercise is definitely lying.
I was also restarted on lithium, and so, by the time of my
discharge, was fat, sedated, and fairly full of drugs. But admit-
tedly less depressed.
There is one memory that I have during that admission,
which was of a lady, who may or may not have been one of the
nurses, putting hot stones on my back. It is easy to ridicule
alternative therapies, and neither I nor anyone else would
claim that hot stones cure a mood disorder, but it was my best
memory during that admission. Does that not count for some-
thing? It is so easy to be focussed on measurable outcomes,
and of course they are important, but making people feel

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better can sometimes get forgotten amongst the figures. She

also came to see me when she said she would, to do what she
said she would. I am probably as guilty as many, but appoint-
ments of any kind assume enormous importance during the
tedium of the psychiatric ward, and so often are kept tardily,
or not at all. It takes little to phone and say if lateness
looks likely.
After my discharge, I was off for a couple of months before
going back to work, which was just as well. My memory was
shot to pieces, something that I could not then understand or
appreciate. Looking back now, the periods when I had ECT
stand out like great fuzzy lacunae in time. However, I had,
then, no real awareness of this, and I was protected from any
knowledge of my hopefully temporary impairment by having
absolutely nothing to do. Even when I went back to work,
I remained less than entirely well, but I was certainly much
better than I had been prior to the admission.
At some point around this time, I had a few months of
psychodynamic therapy. This is very different to cognitive
behavioural therapy, and is more of an exploration of past
and current relationships, and an attempt to understand pat-
terns, undertaken with an experienced therapist. Professor
Blackwood referred me to the local NHS service – I’m not
sure why but think that I may have requested some kind of
talking therapy, and this had never been tried. It was certainly
very interesting, particularly as it was very much about how you
relate to the therapist, something I hadn’t really thought of
much before. I don’t think it made much difference to my
mood, but it helped me to have a slightly better understanding
of how I responded to doctors – and patients – and this was
probably another of those unmeasurable outcomes that can
easily be ignored or dismissed when planning services.
Meanwhile, Madeleine continued to struggle. I am quite
sure that my illness and its recurrence played a role in this,

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and she was angry with me, completely understandably. She

found her family trying, in some ways both a burden and a
blessing, and other relationships intense and difficult. Things
were not as easy then for her as for her sisters, but she showed
extraordinary determination and got through those years.
After a difficult start, she did very well academically. Another
moment of extreme pride – seeing her acting a major part in a
play in her last year at school. She was remarkable! But I felt –
and still feel – enormous guilt at what I put her through,
although dwelling on it is probably self-indulgent, and will
help neither of us. She showed incredible resilience despite
everything and went on to work very hard to achieve
great things.
Around this time, we moved house. It was a sad time, as
Richard’s father had died suddenly, just short of his ninetieth
birthday. But his was a life well lived, and he swam in the sea
regularly right up to the end, an achievement that few can
claim. It was sad for all of us, and a great sorrow for Richard.
But our new house felt like a fresh start. It was modern, unlike
the flats we had lived in, and set on a hill. It was something of
an impulse buy, rather unsuitable, and not quite big enough
for all of us, meaning that we embarked on some complicated
extension plans. But it was bright and light, with a view right
across Edinburgh, and also had a garden, leading to a further
impulse buy – a dog.
This dog was a rather stupid but lovely natured, brown
spaniel; later we acquired another spaniel, a rescue dog of
slightly superior intelligence but notably poor coordination.
I would not want to impose pet therapy on anyone, and I don’t
believe that dogs can cure a mood disorder, any more than hot
stones can. But they raised our spirits, and walking them was of
benefit to us all. They made a difference to the girls, and
definitely to me, even though I must admit that Richard always
did the majority of the walking. The main difficulty with the

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dogs was their complete inability to get on with the cat (whose
brother had by now sadly met with an unfortunate end), but
an uneasy truce was eventually reached, with cat on one level
and dogs on the other. The cat was vastly more intelligent than
the dogs, and, when not trying to steal food from his dispen-
ser, spent much time staring down the stairwell in great dis-
dain at the spectacle of spaniel hysteria.
At some point soon after my admission to the Borders,
Professor Blackwood told me he was retiring. This was quite
devastating to me; although I knew nothing of him personally,
he had been there for me from the beginning, a rather aloof
but kindly presence, whom I had always known I could con-
tact. I felt cut adrift, and rather lost. He suggested that I see
one of two of his colleagues, the first a man I knew only
slightly, and the second being Dr Lawrie, now Professor
Lawrie, whom I had seen on my very first admission, and for
a short period afterwards.
I had been vaguely aware of Professor Lawrie over the years,
as a rising academic, but the main, indeed immediate, decider
for me was that he had known me when I was first unwell.
There would be no need to explain it all again, as he knew
much of what had happened, and no new person would have
to learn my history, of which I remained very ashamed. The
thought of more people knowing was just too difficult. I was
quite nervous about seeing Professor Lawrie again, as I had
always found him more challenging than Professor
Blackwood, perceiving him as critical at times, but I didn’t
think that there was really any alternative.
Seeing him again, was, as expected, difficult. He was an
outwardly confident man, with a slightly wry manner of
speech, and seemed to have abandoned the tweedy look for
that of the eccentric professor. His room, with its abundance
of books, was no tidier, but he smiled when he saw me, and
ushered me in.

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‘Well, it’s been a while,’ he said, breezily. ‘So you’re still

married?’
‘Yeah,’ I said, unsure what the response should be to this.
A reasonable question, maybe, but one that made me feel
that he was surprised that I had managed to retain a husband.
I am sure this was not the case, but it fed my latent paranoia.
For a while, it felt like I had gone back to the old, dark days
when I was a patient, but there was a difference, in that I was
now a consultant psychiatrist, whereas previously I had been a
failed GP trainee. He had also seen me around the hospital, as
a psychiatric trainee, when I was well, and this probably made
a difference to both of us. He was very much more experi-
enced than I, and highly thought of in academic circles.
This was, however, a period when I remained depressed on
and off for some time, and drug treatments seemed to help a
little, then no more. I was now on fluoxetine (an SSRI), which
I never liked, and quetiapine, a different antipsychotic, added
in to help sleep and augment the antidepressant. I ended up
on a very high dose of quetiapine, which was sedating, and
induced weight gain, although not as badly as olanzapine,
which I had not been prepared to continue. I remained over-
weight, though, which I did not like at all.
Some people will say that an improvement in mental state
offsets even quite considerable weight gain; there is clearly
always a balance, but I am less than sure. Weight gain itself
has an effect on mood and physical activity, and, very seriously,
on physical health. It is well recognised that psychiatric
patients have increased problems with physical health, even
dying prematurely. This may relate to many factors, including
illness itself, but smoking and being fat must play a role. The
effects on self-esteem of being fat may also not be taken
seriously enough, wrongly in my opinion. There can be no
doubt that people stop their pills due to weight gain, and this
in itself is hugely important.

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Professor Lawrie and I had a number of arguments about

my long-term diagnosis, which for me remained a moot point.
At times I could accept depression, but, even then, I was
convinced that personality disorder played a part.
‘I think your diagnosis is depression,’ he said. ‘Psychotic
depression. Prof Blackwood thought you had bipolar, but I’m
not convinced, I’ve never seen you manic.’
I wasn’t sure what I was supposed to say. ‘Oh. OK. But don’t
you think I have a personality disorder. That’s what you
thought before. That’s what you think.’
‘That’s not what I think, and I’ve never said that.’
He looked mildly irritated.
‘Well, I know you think it, even if you won’t say it.’
We had this conversation a few times. I agreed with him that
bipolar disorder was unlikely, but this unfortunately encour-
aged my personality disorder beliefs, as I knew my mood
fluctuated in a rather unhelpful fashion. That did not quite
match my view of straightforward depression, so there was
clearly something else wrong. But I only tended to see him
when depressed, so we did not discuss it further, which was
a relief.
In any case, I didn’t really get better then and descended to
a point where depression overcame me, and I was tormented
by suicidal thoughts. Such thoughts were truly awful; mostly
I felt that I simply could not do that to my daughters, but there
were times when they became overwhelming. I thought that if
I were to end my life I would need to do so in my office at
work, to run no risk of my family finding me (little thought
here for domestic staff ) and ruminated endlessly about this.
Neither Richard nor I wanted me to be admitted again if it
could be avoided, as it would be too difficult in Edinburgh,
and horrible to be away from the family. So eventually we
spoke to Professor Lawrie, and he agreed to organise a course
of out-patient ECT for me. This would still involve people that

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I knew, and it might be hard for trainees included in my care,

but it felt like the only way.
I came to the hospital twice a week to have the treatments.
It was very odd, as I had to go first to the ward where I had
previously been a patient, and then to the old ECT suite. But
I still don’t know what lies within, as my memory was, once
more, fairly mashed by this course of treatments. Again, there
are a few moments that remain, but even they are blurred,
with the aspect of a dream. The initial discussion and decision
to proceed with treatment have both entirely gone, and
although I thought afterwards that I was remembering individ-
ual treatments, I think I actually merged them all into one.
The time towards the end and the subsequent couple of
weeks were the most distressing. On one occasion, Richard
told me that I had woken up from a treatment unsure of who
I was. I sent some rather pathetic, and later embarrassing,
emails to my colleagues – one, for example, asking which areas
of the service we all covered. Pretty basic, really, especially
coupled with insightless pleas to end my sick leave early and
return to work.
I later discovered a notebook where I had written down my
family’s and my own dates of birth and ages (even then, I took
a few years off my own; either I had really forgotten, or vanity
can win out, even in the depths of despair), in an attempt to
retain them. Another curious, although to me less harrowing,
result occurred towards the end of the course, and just after
finishing treatment. I bought a lot of things, mainly online and
largely consisting of clothes and other non-essential personal
items. The upshot of this was that I kept subsequently discover-
ing clothes that I didn’t know I had, or that I thought were my
daughter’s, which was clearly very irritating for her. I even
bought the same jacket twice – it was horrible both times.
Entertaining in a way but difficult to monitor, given that
I could not remember buying anything.

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Richard had some concerns but told me later that as

I hadn’t ordered, for example, a new car, he didn’t feel he
needed to take any action. He also said that he had noticed
this happening before, both after treatment and during recov-
ery. Of more concern to me now is that I did not properly
appreciate my ongoing impairment in the month or so after
treatment. I should have done – I could not remember my
trainees’ names (that was when I remembered I had trainees),
and more worryingly I was unable to clearly remember what
I did at work.
I had word-finding difficulties, both writing and speaking,
and could not remember when I had done things or told
people things. Fortunately, there was considerable improve-
ment over that month or so before I actually went back to
work. I would like to think that I was completely back to
normal by then, but I now realise that I only recognise
improvements of deficits after they occur, so it can be hard
to know, even much later.
Despite all this, if I became severely depressed again,
I decided then that I would accept ECT. It worked for me, as
it clearly does for many others. I would also recommend it to
any patient in a similar situation. Even if my memory never
fully recovered, it was better than continuing in a state of
crushing depression. But the actual experience of cognitive
impairment, if it occurs, is a far cry from the description of
temporary memory problems often quoted. In truth, I had
never really understood it properly before, and it may have
been the experience of out-patient treatment and an ill-
thought-through early return to normal life that highlighted
it for me on this occasion.
It is for having ECT, and for the subsequent cognitive
problems, that I would consider making an advance statement.
The most important aspect of this would be a stated minimum

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 THE UNEXPECTED

recovery time before returning to work or making any major

decisions. Yet, when well, I lose the will to do so, which is a pity.
Happily, following this treatment, things gradually
improved. I stayed on the medication for a period, and then,
as usual, discontinued it. Russian roulette, maybe, but I stayed
well and started to feel better and look better. I very much
doubt that Professor Lawrie was impressed by my approach to
medication, but I think he was glad to see the improvement.
It took quite a long time to recover from it, though, and the
weight remained a hefty burden long after I had stopped it all.

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 CHAPTER 16

Going Too Far?

Following those difficult years, there began a period during

which I was not only happy but remarkably productive, per-
haps more so than ever before. There are often good reasons
for happiness, but prior to this they had frequently been
sabotaged by my health. Richard was doing very well at work,
but previously I had seen this through a veil of despair. The
fact that he had a Nobel Peace Prize hanging on the wall,
which he had received for his work as part of a panel working
on climate change, had somehow escaped me, although not
the girls’ friends. They were very impressed indeed, and could
be found taking photos of it when they came to parties. But
once I had noticed it, I took full advantage of my glory by
association, including a photo or two myself.
Richard had started a new company, which was steadily
increasing in size, and was far from the sombrero-wearing
Mexican roamer he had once been. He still liked to go to
Mexico, though, and was expanding his repertoire of coun-
tries to various others in South America and beyond. The girls
were all doing well, and Madeleine was starting university,
studying arts, and working very hard. She had overcome con-
siderable adversity on her way, and I was extremely proud of
her. The other two seemed less touched by my difficulties and
appeared more confident, Isobel being quiet and determined,
Lottie always more boisterous. Despite this, I will never take
their happiness and health for granted – it is so easy to slot

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one’s children into roles in the family that they do

not recognise.
From dragging myself to work, and forcing myself through
the days, I had recovered all my enthusiasm and joie de vivre,
and much more. I was still working less than full-time, but only
just. We were expanding options on the in-patient unit, admit-
ting patients with drug problems as well as alcohol, and I had
also started working in the chronic pain service, which
I enjoyed immensely. Our clinic provided pain management
for people with drug problems, a group who are often stigma-
tised and neglected as regards their other health problems.
We also offered a service for those who had become addicted
to prescribed painkillers, an increasing scourge.
My main colleague in the clinic was an academic, and was
inspiring, and we did quite a lot of innovative work across the
addictions and pain services, which was very exciting. In fact, it
was so exciting that I decided to do a Master’s degree in the
clinical management of pain – I studied this online over three
years, and it was a lot of work, including a systematic review,
which caused me much sweat and anguish, but which we also
published. I graduated with distinction and a prize, surprised
not that I was capable of this kind of endeavour but that I had
not done it before. I was enormously proud to attend my
graduation with my parents and husband, the first one I had
actually been to, and not long after my daughter’s, at which
I was even more proud!
Addiction to painkillers, my new professional interest, was
something I had not previously thought much about, and it
made me think of my aunt, my father’s elder sister, whom
I barely remembered. She had been a nurse and had experi-
enced intermittent problems with prescription drugs, dying at
thirty-four, indirectly as a result of this. It was known, yet
unspoken of, a long secret in our family, and I don’t know
the truth about what troubled her. But it was the other side of

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suffering, what really happens in a family rather than in a

clinic. I wish I had known her.
I thought quite a lot at that time about stigma, particularly
in relation to the experience of mental illness in health pro-
fessionals and others. If one cannot speak out as a doctor, then
who can? I had written pieces before, during my training, but
had been discouraged from seeking publication – ‘Leave it
until you’re old and grey,’ one consultant advised me.
Interestingly, Professor Lawrie and Professor Blackwood, as
my treating psychiatrists, were always far more positive about
writing. But, as a trainee, there was the unspoken threat that it
could affect my career progression, which was difficult for an
unconfident junior doctor with a family to support.
I didn’t consider myself particularly old and had no inten-
tion of going grey any time soon, but I wrote an article with
Professor Lawrie about my experiences as a patient, that we
published in the British Medical Journal. It was a good article,
and I was delighted to publish it, and, in some way, ‘come out’
about my problems, but I felt that it was, of necessity, very
much a sanitised version. Something so short could hardly be
otherwise. It described the process, without really any of the
content, none of the despair and anguish, the lost babies, and
the struggle of the family who had borne all this. I was pleased
but also felt that people were starting to see me as someone
brave and courageous, something I wasn’t. This actually made
me feel quite uncomfortable. You have no choice when you
become ill, or when difficult things happen – you get through
it or you don’t, and no one who loses the ‘battle’ should
be criticised.
There was a lot of very positive feedback about this article,
including a few individuals who contacted me for help or
advice, saying they had experienced similar. There was also a
small amount that was rather peculiar, including a few profes-
sionals, who clearly wanted to put the whole sorry affair of my

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illness down to psychological factors. While I had no objection

to the consideration and inclusion of psychological factors –
indeed I felt strongly that biology and psychology interact to
lead to illness or breakdown – I did object to people trying to
develop formulations about me from a brief piece, without
ever laying eyes on me.
There was plenty of other work for me at that time, mainly
with students and trainees, and I even won another prize, for
an article that I wrote about Novel Psychoactive Substances
(legal highs). I went to the Royal College of Psychiatrists
annual meeting in Birmingham to get my prize, and wore a
new green dress and a jacket that my daughter lent me.
I shook hands with the President and felt very pleased with
myself. Later, looking at a photo, I realised that I was still a
little overweight following my experience with medication,
which I had obviously by that time completely stopped as it
clearly wasn’t necessary. Even more surprisingly, I then man-
aged to successfully shift the weight by taking up running, a
pastime that I would previously have mocked. I never ran very
fast or very far, but it worked and made me feel even better.
Those years were wonderful, and even now I don’t know
why. Perhaps, as an established consultant, I was less stressed –
but I quite enjoyed stress and had even once had a discussion
with Professor Blackwood as to whether it was stress, or lack of
stress, that might precipitate my illness. Other than pregnancy,
I cannot really say what has contributed, and any factors that
are identified after the event are open to doubt.
Shortly after I finished my Master’s degree in pain, I was
appointed clinical director of the substance misuse service
after my colleague, Fiona, retired. This was not something
I had really wanted to do, but for various reasons I felt
I must apply, and I was successful. It is a curious thing within
the medical hierarchy that promotion often involves moving
into management, unless one goes sideways into academia,

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which is in itself very competitive and probably needs commit-

ment at a younger age. The very thing that we are trained for –
clinical medicine and looking after patients – no longer seems
to be the pot of gold at the end of the rainbow.
Management was not my talent, or indeed that of many
doctors, and many of us have neither the aptitude nor the
training. I did my best, but management seemed to me to
relate to dealing with difficult and emotional interpersonal
issues, or mundane, yet somehow vital, administrative details.
I had to work harder and found myself getting irritated by
things that I would previously have tolerated.
I formed a few theories around that time about my illness
and how to manage it. One, that was fairly sensible, was that if
I continued to exercise, I would never get ill again. I kept up
the running, as well as dog-walking. Getting to the gym always
tended to be wishful thinking where I was concerned, but I did
try at times.
The other main theory revolved around my teeth, which
had proved troublesome. I had periodontitis, gum disease,
which can be genetic, and is made worse by smoking. I have
never smoked, but both my grandmothers were toothless, and
my maternal grandmother had a clear history of gum disease.
There was yet another family myth that put her gum problems
down to drinking from a dirty glass in a pub, an unlikely story
that may say something interesting about her, but hardly about
her teeth. My mother also had some problems with her gums,
but mine were far worse, and I feared imminent tooth loss and
experienced recurrent nightmares of edentulism.
After some brief and sloppy research online, I decided that
my mood problems were all down to inflammation resulting
from my gum disease. Not completely impossible, but equally
likely that taking psychiatric medication could itself have been
the trigger for the gum disease – which I might anyway have
inherited. The drugs made my mouth very dry, which probably

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did make things worse, and I developed a vulgar gum-chewing

habit in an attempt to counter this. This, in combination with
my trusty electric toothbrush, may be the reason that I still
have most of my teeth, but it became a preoccupation at times.
The girls were busy, and family life was, on the whole,
happy. I looked at my friends, and I thought – I am a real
mother, just like them. My daughters seemed to like me, in as
much as daughters ever like their mothers, and the difficult
times were forgotten. I played in my orchestra, every week, and
had also started playing chamber music regularly. I played
string quartets on Monday mornings, with Heather and two
other friends. It is no false modesty to say that they were all
better than me, something which was greatly beneficial to my
playing. I played in another quartet rather less frequently, and
we were very sad when our well-loved violinist died suddenly.
I was also a member of a particularly good book group,
which not only met regularly and consumed books and pro-
secco but went on occasional jaunts to Paris. I had many other
friends, and I loved seeing them. I was a real person, the
person I was meant to be. Potentially even slightly annoying
to others, but I didn’t care, I was on a roll.
It was therefore not in the least surprising that it all eventu-
ally came clattering down once more. But it didn’t clatter
quite as badly as before, and that may have been down to luck,
time or natural progression. My own view is that I had, after
many years, become slightly more aware of my mood changes,
if not what one would call fully insightful, and that I sought
help earlier. I had an advantage over some others, as I could
contact Professor Lawrie directly and he would see me quickly,
and many are not in that position.
But I could email him, and that was also easier for me, as
I doubt that I would have managed to phone, being rather
phone-phobic at the best of times. The email aspect was tricky,
as staff are not allowed to email patients; however, as a patient

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no one could actually stop me from emailing him, and I think

he knew by the content of the emails whether I was unwell or
not. Or by them being sent at all, as I would be mortified to do
so when well, and always felt mortified subsequently. But
rather than email me back with advice, he could and did
arrange to see me, which was helpful.
I had a slightly strange relationship with Professor
Lawrie – from first being my psychiatrist, he had become a
leading academic in the psychiatric world, before also
resuming the former, coveted role. In addition, we had done
a few pieces of work together, quite apart from our British
Medical Journal article. These were not clinical, mainly involv-
ing students and research, but our names feature on at least
one other publication. I found it odd speaking to him at
these other times, and it was as if I am a different
person entirely.
I used to use my married name for everything except work,
which helped me to define myself as two different people, yet
I am only one. Professor Lawrie and I have even ended up at
the same psychiatry-related social event on occasion; it is a
surprise to me to realise that he probably is a real person, with
his own thoughts and feelings, and that these have nothing to
do with me. But the relationship for me can become all-
consuming when unwell, with everything invested in it; it fades
back into the periphery when I recover.
We were interviewed once for an article about doctors for
doctors and spent a long hour or so being photographed in his
room, the place where I see him as a patient, which was
peculiar. We were both appalled by the result, a most unflat-
tering portrait, which sadly appeared in a national newspaper.
I would be interested to know more about what it is like for
him, treating me as a fellow psychiatrist, but I suspect it might
be difficult for him to say. I have treated other doctors, and
I think this is particularly challenging in psychiatry.

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Richard and I had largely managed to break the silence that

had stopped us from discussing my illness. By this I don’t mean
at times when I was ill, when we had often had much discus-
sion, but which tended to be repetitive and unhelpful. Instead,
we talked when I was well about what happened when I had
been ill, to try to help us both to understand it better. And
although I have described my illness entirely from my own
perspective, it was very interesting to hear his view.
He said that many of my episodes, although not all, began
with euphoria, which was then followed by agitation and anx-
iety. When I then became depressed, it was often quite sudden
and tended to linger. He used the word ‘catatonia’ to refer to
some of the worse times, when I could hardly speak. As the
depression lifted, he said that I often became confused and
anxious, maybe as a result of treatment, and that when my
mood did improve I usually had limited memory of episodes,
even without electroconvulsive therapy (ECT). He said that
I could become euphoric again at this point, possibly due to
treatment, and that recovery was always gradual, even though
I wanted it to be fast. He was at pains to point out that this
cycle tended to repeat itself if I stopped treatment. He also
said that when I was well, I was positive and good humoured
but that I tended to overcommit and got stressed as a result.
But he thought that I usually coped well with moderate, or
acute short-term, stress, which was encouraging to me.
My health deteriorated soon after I became clinical dir-
ector, possibly due to stress, although this was never entirely
clear. At times when I was ill, I would discover that all sorts of
things were threatening or distressing, even though these
things had not seemed so when I was well, so it was hard to
say. I had a couple of episodes of low mood, surrounded by
periods of what I would have previously dismissed as pressured
and agitated mood but was probably elation. I was restless,
agitated, and unable to sleep.

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I remember being overcome by the need to keep moving,

resulting in late-night walks and daily runs. I didn’t do any
stretches, and this ill-advised and unusual exercise brought my
running career to an unfortunate end. Ironically enough,
given my work, I was left with chronic pain. I also listened
obsessively to music, largely opera, and more obscure German
Lieder, which moved me in a way well beyond which they
normally would. Even more striking was a sense of extreme
and pervading irritability, directed quite unreasonably at
various individuals.
I had always had a tendency to write, when things were either
good or bad, and an even stronger tendency, born of embar-
rassment, to delete what I had written when the feelings passed.
However, I found some notes from that time, when my mood
was rather elevated, and have pasted them here, although with
some of the rather more embarrassing bits taken out. I also had
to doctor some of the grammar, as the original wasn’t very
readable. It was all written on my iPad during the night when
I couldn’t sleep and demonstrates something of my state of
mind, but now sounds like complete rubbish:

I am in control, because it’s all in my head, and nothing is real outside.

Therefore it follows that I have total control of what is happening -
much is clearly extraneous detail to make me think it is real, but that’s
ok. E.g. The lights coming on. There is no philosophical argument
because there is no philosophy. I can’t upset people because they do not
exist. There is absolutely no argument that anything exists except in my
head as I have no proof of it other than blind belief. You might say it’s
the same for you but you cannot prove it. Which means there’s no real
need to do anything, but it’s incredibly hard not to do anything

What is mood? Of you do not have it you cannot have a mood disorder
and the same could go for personality except I think it’s different.
S personality essentially. you or what? I cannot have a personality

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disorder if it cannot be defined. I am in control though, that’s clearly

important and means that persona
It’s is all within my head not other people’s, although the concept of
other people is not one that works. What will happen? There is no point
in thinking what other people will think because they are all me
thinking – I know but I just do not now I know. Which also means
there is no guilt because all the bad things I am responsible for as well as
the good, which is a huge relief. Which also means that there is no
injustice as we all experience all the same things all the time, we just do
not know we are.
I wonder if R is real? It would be nice if he is. But does not really matter
as he’s there even if he is not. Or if I am him.
Seeing flashing lights as I try to sleep? Are they real it not.
Thoughts for the day, I do not know if I have any real thoughts. I do not
know what’s happened to them or why. I’ll think about bowing, why
some bowing almost does not hit the string and it almost breathes. I can
see myself and I look strange, not quite how I would expect. What I can
see, that is. I look normal in the mirror but then that’s a back to front
image so who knows. Things are in the right places but still look wrong
and too still. It’s so unlikely that they would be where they are and not
somewhere else
Do the right things. And nothing will ever be exactly the same again
which is very sad

I cannot get thoughts out properly. But out of what.

The order of notes is extraordinary, how could they be invented. And
how do some orders speak and make you listen over and over again.
What is triangulation? What is anticipation?
Maybe I am ordinary but I doubt it. I am everyone. So not guilty.

I am me though not the person you want me to be although I could know

that.

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Thoughts now stuck. They need loosened.

Emotions experienced create reality so things happen over and over
again
Are all cups of tea drunk the same or different

How can anything possibly be captured so that it emotes time and time
again, what happened to familiarity breeding contempt? Some things
grow on things becoming more each time, for example that first time the
order of the notes makes no particular sense but then becomes righter
and righter so it could not be any different. But why is that? What brain
chemistry responds and is it the repetition that makes it that way? And
what is it about a time of a voice a scratch of a string that catches?
We are humans why are we affected so? Is it the meaning or the sound?
I nearly understand then it slips away. Is it all down to me? I would so
so like to be in someone else just for a short time but then the whole things
is that I am but unaware, and they are unaware of me.
Unheard sounds – are they really sounds? I’m surrounded by stuff and
I do not know how real it is. I wonder if R is real or just my thoughts.
And when I find out that he wasn’t real will I mind? Or will I know
that I knew all along that he wasn’t so it will not matter. Can you miss
people who never where?
Nothing nothing nothing

An easy life – good or not. Without sorrow. Can you feel pain without
sorrow?
Just like yesterday. Until on high shining wings, the changing time.

Starting to see some flashes again but no noises

The middle of the night is very dark and very very quiet. Every time
I think I might go to sleep I do not. Why not? I have not murdered sleep
and I’m one person, not three. What will happen? I feel like I might
disappear and then where would I be, I hear a dripping or a drinking
noise. A rustling noise but maybe it’s inside me. No smells. I do not

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know if my body will hold together. My thoughts seem to be coming from

each ear and moving into the centre of my head. I do not know why I’m
writing this, it’s all rather pointless, but at least it’s clearer written
down. The road to ruin or I think it’s actually hell is paved with
goodish intentions. My intentions are very very good, but I have no
idea what to do. I should not be awake, I should not even be thinking.
My mind seems to be going blank a bit. What does that mean?
Thoughts and things, nothing matters, except auto correct without
which thus would be rubbish. I wonder occasionally if I might not be
getting something. How do I know I’m not depressed? No weight, my
body feels light, moving is easy. Will I know what I’m thinking again or
is it too late? This is not normal, I think I may be going a bit mad.
I wish it was morning, I want to go out. What is the point of anything?
Where is the flow? I am in control still, and I know that I am in control
of what is happening. And what people are saying to me. It’s all a front.
If only I could get behind and know for absolute definite I would be very
happy. Very very happy. They will try to catch me out but it will be ok.
I hope R is truthful
How would I know?
Nothing you see is as you see it, no false complacency

I just want to be normal whatever normal is (prince Charles). Who

knows? He does not. What am I supposed to do or think? I’m an
embarrassment to myself which I suppose takes some doing. Am I getting
things slightly wrong I’m not sure really. But not my fault. I really
cannot be blamed for my own personality defects if you go along with a
deterministic view of life and no real need to blame anyone else either.
Fuck knows, really.

I’m not sure these quetiapine pills are really working any more, not what
you might call hugely sedative though I do not want to write about pills,
it shows a certain lack of taste. Well anyway I’m not going to place my
personality and behaviour at the bipolar altar, mood disorder maybe.
But it’s not to blame or rake the credit indeed for everything or anything.

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I suppose it can coexist if it has to. I do wonder if I’m being humoured

and why but honestly who cares? As long as I get to drink nice cups of
tea. I’m boring myself god knows what I do to others.

Reading this now, I am incredulous, and tend to agree with

Richard’s assessment, which was that it resembles adolescent
drivel. It is beyond embarrassing. This is not the way I either write
or think normally. I wish I had kept writings from times when I was
depressed, but they were too painful, and I deleted them. Or they
were on previous computers that thankfully deleted them.
I had become increasingly aware that fluoxetine, my usual
antidepressant, often made me feel agitated. It sometimes
helped when I was depressed, but I would often need to take
quetiapine to reduce the agitation. Quetiapine itself has
unpleasant side effects, particularly weight gain, constipation,
and somnolence, and I hated taking it. I would be the first to
admit that I would take any opportunity to stop any pills, but
these adverse effects made it even harder to know whether my
reasons for stopping them were genuine or not.
Around this time, Professor Lawrie decided that my diagno-
sis was almost certainly bipolar disorder and started me back on
lithium, which he thought I should take long-term. I didn’t
know how long I would take it for, but one good thing was that
it had few side effects. I had no idea whether it stabilised my
mood, as I didn’t know what I would be like without it, but
taking those little white tablets was currently bearable.
Richard thinks I am better on lithium. Once, in the bad old
days, he told me I was boring on it, which perhaps suggests
that my mood was more stable on it. Certainly, now he has
concluded that boring is good. Taking antidepressants has
never been particularly tolerable for me, and I have always
tended to put that down to side effects. While that may well be
the case, I wonder now whether they also tended to destabilise
my mood, and whether that may have contributed to some of

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the agitation I felt when unwell. I even wonder whether some

of that destabilisation may have contributed to my feelings and
view of myself as having a personality disorder, as there have
been times when I have just felt out of control, and unable to
manage my feelings. I don’t feel like that on lithium. I don’t
want to take it, and I worry sometimes about the long-term
kidney effects, but I will take it for now.
I had a further severe episode of depression about a year
after starting lithium, despite dutifully and unusually taking my
pills, again requiring out-patient ECT. The old hospital was
being gradually rebuilt, and so this took place in a shiny new
ECT suite in the new building. It was administered by some of
my consultant colleagues, which was difficult – I might have
liked to have known beforehand who would be doing it, even to
have spoken to them, although I was possibly not well enough.
Speaking to them about it afterwards would also have helped
dispel some of the awkwardness for me, and perhaps for them,
but that didn’t happen, although they were very kind to me.
Unless, of course, I forgot.
I had a long course of treatment, and my memory was
decidedly decimated this time – I couldn’t remember much
of the preceding months, and perhaps it was surprising that
I did remember those who administered it. When my mood
finally lifted, I had a look at my emails in the period leading up
to it, and discovered various things, including that I had
resigned from my clinical director role, which was quite pos-
sibly a good thing, and also from GMC work. My manager told
me later that I had asked her not to let me resign from my
consultant post, as I must have known that this was a danger
and that I would regret it.
I couldn’t remember my PIN numbers (probably a good
thing) and had marked word-finding difficulties. I couldn’t
read books, or indeed music coherently – I tried to go back to
my orchestra quite quickly as something to do during my sick

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leave, but I simply couldn’t manage to either read the music or

coordinate my fingers and had to pull out of the concert.
It was quite bizarre trying to put things back together, but,
on this occasion, I was much more open about my memory
loss, and people were very forgiving. Professor Lawrie was also
much clearer that I needed a reasonable amount of time off to
recover, for which I felt both gratitude and some resentment.
But it was the right thing.
However, the one thing that was very different on this
occasion was the support from my daughters. As they were
older, we protected them less, and talked to them more, or at
least Richard did. They were all supportive, and Madeleine
even took me to ECT on one occasion and collected me
afterwards. It was also possible for us all to laugh a little at
some of the conundrums as I recovered, particularly in rela-
tion to my memory difficulties. I couldn’t say that the episode
was anything less than grim for all of us, but a little bit of
humour can go a long way to help everyone.
My illness has continued, on and off, in recent years, des-
pite taking lithium and quetiapine, and short courses of anti-
depressants. There has of course been the pandemic, and
I was rather proud to be well enough to work as a vaccinator.
But I have had time off work over the last year, and am
currently undergoing ECT again, unilateral on this occasion.
In unilateral ECT the current is passed only across the non-
dominant cerebral hemisphere, rather than across the whole
brain, and memory loss is usually less. I am hopeful – my mood
is much better, my memory is far less badly affected than with
bilateral treatment – and I have recently started back at work,
while still having maintenance ECT once a week. My main fear
at present is that I will relapse when it stops. And I know that
I must listen to my psychiatrist and my husband, I must take
their advice.

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 CHAPTER 17

Moods and Medicine

These are a few of the moments in my life, moments that

I remember. My family and friends appear around the edges,
just a little, but this is the story of my life as a psychiatrist and as
a psychiatric patient. Which of these am I, do I move from one
to the other, can I be both at once? In some ways I separate
them quite sharply, sometimes even using different surnames
for each, but of course they creep across and touch each
other, often when least expected. I am an argumentative
patient, at least in my own head, and sometimes with those
who treat me.
What is my diagnosis? Does it matter? I think it does, and
I also think it can be very hard to decide, sometimes impos-
sible. As psychiatrists, we make diagnoses using groups of
symptoms, groups of signs. But we see them subjectively, how-
ever much we might like to think that we are objective. What
you think is anxiety, I might think is elation. This might not
always matter, but sometimes it does, both for one’s own
understanding and belief in oneself, and also for treatment.
Sometimes it may be very obvious what is wrong – my own
specialty of addiction psychiatry is easier in some ways, with
breathalysers and drug screens to confirm our suspicions. But
even then, there are other more elusive diagnoses that tag
behind the obvious ones, and they can be very hard to get
right. They are often even harder to treat.

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Looking back, I think that it is clear even to me that I had a

psychotic illness before and after having my first baby.
My mood was predominantly low but with intermittent periods
of marked pressure and agitation. I thought at the time that
this was not a perinatal illness because it started before I had
my baby, but I was wrong about such time restrictions. I have
since had many episodes of low mood, some of irritable and
agitated mood, and a few of high mood, some, but not all,
when on antidepressants. I know, looking at that list of unfor-
tunate events, that a diagnosis of bipolar disorder cannot
really be denied, but I still want to. I don’t want any diagnosis,
and I really don’t like the idea of this being something that is
beyond my control. I think that is one of the main problems –
this disorder is what you feel and what you are, and because of
this I have always felt that I should be able to control it.
My treating doctors, the two main ones being Professor
Blackwood and Professor Lawrie, have always been crystal
clear in their message to me that I have a mood disorder.
They have moved a bit between depression and bipolar dis-
order, but they have strongly resisted all my arguments for
other diagnoses, usually personality disorder. Changing diag-
noses can be a problem for many patients – you’re just starting
to believe in a diagnosis when someone else suggests some-
thing different. It is, of course, incredibly important to keep
diagnoses under review, but it’s also vital to think what that is
like for the patient to experience, and how it may affect
their treatment.
Bipolar disorder doesn’t exist in a vacuum, though, it is part
of any person, with all their differing complexities, and there
are a number of disorders that often coexist.
One of these is anxiety disorder, which comes in a number
of guises, and which for me has been lifelong. There were high
expectations placed on me as a child, and perhaps I reacted to

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this by raising my own expectations of myself beyond a reason-

able level, something that may have contributed. On the other
hand, there are plenty of anxious people in my family, and
who can say whether my anxiety was caused by biology, psych-
ology, learning, or a heady combination. But I was always
anxious, particularly socially, and I also have a degree of
obsessive-compulsive disorder, another common friend to
mood disorders. I have a lot of rituals that I perform; they fall
off when I am well, although they never actually disappear,
and then they re-emerge when I become ill. Much of the time
they cause me little in the way of problems, but sometimes they
make it hard for me to do things.
People with bipolar disorder also have an increased rate of
substance use disorders, as do people with both anxiety and
obsessive-compulsive disorder. So, the odds are somewhat
stacked against me here, and perhaps I am lucky that I don’t
have a substance use problem, but it is my opinion that I will
always have to keep an eye on my alcohol intake, to stop it
creeping up.
The main thing with all these different diagnoses is acknow-
ledging that they can all exist together, and not trying to
attribute all past symptoms to the most recent diagnosis. If,
for example, I did develop an alcohol problem in the next five
years, it is very possible that a doctor who did not know me
might assume that my previous mood symptoms had all been a
result of alcohol use. This is not an unreasonable question to
ask, but it is a very unreasonable assumption to make. And,
once recorded in my notes, it might become irrefutable, par-
ticularly if I did not know it was there.
There are many very messy aspects to psychiatry, and noth-
ing quite fits into neat slots, however much we want it to. The
personality disorder slot is one I have thought much about
over the years. Many of my most damaged patients fit that

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diagnosis, but the important thing is that it should be a diag-

nosis of sympathy and understanding, not one of exclusion
and criticism. The difficulty is that we often lack the resources
and skills to provide the therapy that might help these
patients, and, like many of my colleagues, I truly regret that.
So, although I have often said that I have a personality
disorder, I feel ashamed of this now, in that I am actually
perpetuating the dismissive and critical attitudes that can
attach themselves to it, even if only to myself. It is a sad
reflection that I am choosing the most self-critical diagnosis
I can find to castigate myself with, even if it is not something
I would do to my own patients.
In fact, the stigma of mental illness and the different values
attached to different diagnoses are a problem. Self-
stigmatisation is common in doctors and other health profes-
sionals and may reflect their own hidden views, or the way they
have heard others talk. Stigmatising views are hopefully held
by a minority in the profession, but they are the ones that
patients more often hear, and ruminate on afterwards.
We don’t always hear the positive things that people say about
us, particularly at times of great vulnerability.
The other problem with the bipolar diagnosis is its univer-
sality, and its connection to various well-known figures. Many
of these have been great ambassadors for mental illness, but
I think that there can be confusion in the general public, some
of whom then see any form of mood swing, however brief, as a
type of bipolar disorder. Even amongst psychiatrists, there are
those who are well-known for making this diagnosis in situ-
ations where others would either be cautious or would with-
hold it. But it can be very upsetting and invalidating for a
patient if the diagnosis is subsequently unmade or discredited.
More worryingly, the treatments for bipolar disorder are
not without their harms. There is lithium, with its long-term

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effects on thyroid and kidneys, and there are the antipsycho-

tics, such as quetiapine and olanzapine, which are sedating
and have many long-term metabolic problems, not least
weight gain. It is a diagnosis that should be made but should
be made carefully. It is possible that early treatment can affect
the course of the illness, and poor compliance, like mine, is
probably not a good idea, possibly increasing frequency and
severity of episodes.
There will be people who ask if my illness is not entirely
psychological, not an illness, but a reaction to circumstance
and to my background. I have asked that question often
enough of others, and of myself. No one is just a burst of
biology. I mentioned my anxiety above; I was a naïve, overpro-
tected child, bright but not exceptional (unlike my brother – a
definite issue!) who felt huge pressure to perform, and I saw
myself as a failure when I could not.
My parents would not consider that they put pressure on
me, but the very atmosphere we lived in was all about work and
academic success. My mother always said I put pressure on
myself. I would disagree – a child learns from their parents
and adapts to their expectations. But humans are soft and
imperfect, not machines, and I could not always deliver what
either of my parents seemed to expect. I didn’t do particularly
well at medical school, and, although I didn’t actually do
badly, I felt that I was a failure.
Yet, despite all this, I had good friends who have remained
good friends, good relationships, and I have managed to get
through life relatively well. It is easy to look back and regret –
which of us could say our life was problem-free? Such a life
would in fact be both bizarre and damaging, as how would one
develop any skills to cope in a hostile world? Perhaps I was
predisposed by my early life to developing mental ill health,
but I will never really know.

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There is no doubt that the ending of my first pregnancy

when I was twenty-three left me very conflicted. How could
I reconcile my beliefs about choice and my own, very per-
sonal, regret? Prior to that, I would never have thought that
I would ever be in such a position, but it is hard to describe,
and even to clearly remember, the intense fear of an
unplanned pregnancy. The very ease of ending it made it
hard not to do so; I would have had to step very actively out of
this course of action. But despite this ease, it was, and is,
shrouded in shame, not something about which one can talk.
I very much wish that it had not happened, but it did. Some
might well think that was the precipitant for my illness, but
I don’t believe so myself. It was rather that my thoughts about
it became very hard to bear, and also quite different in form,
when I was so ill.
My own subsequent work as a psychiatrist must have been
influenced by my experiences as a patient. I chose not to work
in general adult psychiatry, at least partly to avoid over-
identifying with patients. This is my view, and I know that
others might prefer to work in the same field where they had
been a patient, and that they would see this as an advantage.
It is interesting working in substance misuse, as a fair number
of our staff are in recovery from various addictions, and are
quite open about this, if not always to patients, then certainly
to peers and staff, and often use this very effectively in teach-
ing students and others.
Some would say that you can only really understand
something if you have been there and experienced it your-
self, but I would dispute that. One can never really under-
stand what something is like for anyone else; even if you
have abused the same drug, are of the same sex, and have
worked in the same job, there will be those little differences
that make up a life. I believe that my experience of stillbirth

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was far more important in shaping my understanding of

others’ suffering than anything else, but it is generic, and
not confined to those who lose babies. I think depression
just made me selfish.
What about medication? People often crave sedation or
escape from life, and many psychiatric drugs do just that,
quickly and effectively. The tricyclic antidepressants, any of
the sedative antipsychotics like quetiapine and olanzapine,
and the older ones like chlorpromazine – all of these do.
I hate the feeling of being sedated, but I know now that if
my sleep shortens, this is often a precursor to illness, so I take
quetiapine for as short a time as I can get away with. I don’t
like doing this, but the alternative is worse. It’s harder than
people think to stop, though; I always get rebound insomnia,
which is very unpleasant, as well as risky in terms of relapse.
There are other side effects, which vary from person to
person, but weight gain and agitation are two others that
I have hated.
Because of this, I am quite careful with my prescribing, but
I would never withhold a drug because I didn’t like taking it
personally. But I hope that I am better at telling people about
side effects, rather than avoiding these discussions, due to
either embarrassment or uncertainty. Perhaps I can also
understand why people sometimes find taking certain drugs
unbearable, and I hope that I ask them why, and look at
alternatives rather than wonder why they are sabotaging their
treatment. When I am at work, I rarely think about the drugs
I take myself. I prescribe antidepressants whenever I think
someone might benefit, despite my own problems and experi-
ences with them.
My work with other doctors, some of it within the General
Medical Council (GMC), has been interesting and difficult.
There have been times when I have thought – why them, why

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not me? The GMC strikes fear into doctors, and I don’t know
how I would have coped had I been referred to them myself.
After the early times, when I was lucky, I never worked when
very unwell, probably through having sensible colleagues
rather than having any great level of insight. I have also been
able, albeit reluctantly, to ask for help. But the doctors that
I have managed have all been very brave and very determined.
Some have had substance misuse problems, but not all, and
one certainly reminded me of myself. I want to carry on
supporting other doctors in the future, whether as a peer, or
as a treating doctor.
Sometimes I wonder whether it has all been worth it,
whether I needed to become a consultant psychiatrist, or
whether it has all been to prove something that I had no
real need to prove. I can’t deny that that might be a possi-
bility, but when I look back to that young girl at medical
school, before anything went wrong, I have to say that she
really did want to be a psychiatrist. Was it so wrong to want
to pursue that path, just because I had become a psychiatric
patient myself? Some people might describe me as driven,
and there is truth in that, but it was one tiny step at a time
when I started work again. There were no sudden leaps.
I had no idea that I would be able to achieve what I have
when I forced myself through that final bit of GP training,
or when I started work as a junior psychiatrist in the
Scottish Borders.
I would have much preferred to work part-time throughout,
and to be with my children more, but that was not an option
initially, not back then. I think things are easier now, in that far
more psychiatric trainees are able to work part-time, and
health reasons would be an acceptable reason to do so, even
without children. In addition, Richard’s work, well-established
now, was more precarious back then, and we really needed me

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to work. I had no skills other than medicine, and no idea what

else I could have done.
I would still like to work less, or I think I would like to, but
I am very bad at managing to reduce commitments. I like to
work hard, and to do extra things that interest me, and I am
not always very good at stopping when I should, or saying
no. I did yet another Master’s degree during the pandemic,
and I have plenty of ideas and plans, probably too many.
I have recently managed to increase my musical commit-
ment to two orchestras, and occasional extra concerts, as
well as my chamber groups. I think I might even be in two
book groups. We have a dog with Addison’s disease, a rare
condition in canines. And this is all on top of normal life,
family and feeble attempts at domesticity. My only worry is
the risk of everything falling flat on its face if my
mood drops.
And sometimes I wonder if this is part of having bipolar
disorder, the upside, so to speak. It is often thought of as a
cyclical disorder, with swings up and down, but normal mood
between times. This may often be true, but there are some very
unfortunate people who remain chronically unwell, a tragedy.
My severe episodes have been very obvious, but I have long
been aware that I have had some lengthy periods when I was
mildly depressed but not badly enough to seek help. It has
occurred to me lately that I have also had similar lengthy
periods when my mood has been mildly elevated, again not
in any way a problem, or not for me. In fact, these periods have
been particularly enjoyable and productive, and the very last
thing I would want to do at these times would be to see
a psychiatrist.
In a recent meeting with Professor Lawrie, I told him that
my normal mood was good, around 6.5 on a scale of 1–10,
where 1 is as low as one can imagine, and 10 very elated.

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I don’t actually think that I was truthful, as it hasn’t always

rested there, even between episodes, but I am happiest when
at that point. Around 6.5 is where I enjoy life, am productive,
manage to spend time with both friends and family and do my
job well. The problem is that there is no way of setting one’s
mood, no medication that can be titrated to get that number
right. I wish very much that I could have some sort of
implanted moodostat that could be set from my mobile
phone. I would keep it at 6.5. I don’t think I usually get much
above 5.5 when taking lithium, and that is rather disappoint-
ing, but probably not a good reason to stop it.
Ultimately, and despite my misfortunes, I have been very
lucky, with a loving husband and three lovely daughters.
My parents have also been supportive, despite their difficulties
understanding my illness. My life has been something of a mix
but also filled with unexpected happiness. I have often asked
myself these questions – Has this illness enriched your life?
Do you wish it had never happened? – and I’m not sure of the
answers. If it had never happened, would I have been this
person, and would I be living this life? Quite possibly not,
but I have no idea whether it would have been better or worse.
I don’t think it has enriched my life, though, not in any way,
and for the sake of Richard and my daughters, I very much
wish it had never happened. Indeed, had I understood the full
implications of my illness, would I even have had more chil-
dren after Madeleine’s birth? I think the answer to this has to
be yes, but it is a very selfish yes. It is very difficult to have a
major mental illness and have children. There are of course
the direct risks to the children – genetics will have given each
of my daughters around a 10 per cent chance of becoming ill
themselves at some point, with a major mood disorder or a
perinatal illness – but I would never not have had them
because of that. That would smack of eugenics, of people with

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mental illness being better not born. It is more the sheer

selfishness of the illness, pulling you away from them when
they need you, and altering your interactions that really hurts
and damages.
The future, for me, will remain uncertain. Sometimes, I feel
I am on borrowed time, and that I will not be able to continue
living as I currently do. I am fairly confident that I will become
ill again – it is, after all, a cyclical illness, and each time that
I have thought – Never again! – I have been wrong. Even if
I continue to take lithium, it does not guarantee protection
against illness, most particularly not against depression, and
given the very real risk of kidney problems, I cannot see myself
taking it long-term.
I have often wondered whether one can live a preventive
lifestyle – sleep, healthy food, music, friends, exercise, and
dogs, in my case – but I don’t really believe that even that is
foolproof. It probably helps but not enough. I wonder whether
working too much puts me more at risk, and then I also
wonder whether the same would go for not working enough.
I am terrified of having another severe episode; although
some of those I have experienced recently have been milder,
my last episodes have been more severe, requiring ECT, and
this remains a risk. Professor Lawrie has told me that my illness
may worsen over the years, adding to my dread.
I fear the medication not working. I fear losing control,
I fear psychosis, and I fear most of all that I might kill myself if
I become severely depressed. That, I must say, would be
entirely the result of the illness, as I have everything to live
for, and no wish to die. But these thoughts come quickly when
depressed and can seem very logical then. I would no longer
be a burden, and people would be relieved. It is unbelievable
what the brain can do, and when I think about these thoughts,
I wonder then how I could ever believe that this is not an

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illness. If I were my doctor, I would tell me that it is, and

I would be incredulous that I could ever doubt it.
I am a mother, a wife, a daughter, a friend, and a psych-
iatrist. I also probably have bipolar disorder and a whole load
of awkward personality traits. I will continue muddling
through, and I will never beat this thing. But that’s OK, I think.

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 Afterword
Richard’s View

When I think of the day that I heard Rebecca had first been
admitted to a psychiatric hospital, I recall a haze of confusion,
anxiety, and helplessness. I had no experience or knowledge
of dealing with mental illness. I had been brought up in a
family that took good health very much for granted, where
positive, easy-going, emotional states were pretty much the
norm. I had almost no understanding of what was going on,
or how this was likely to unfold in the coming days, months,
and years.
Within weeks of our marriage, Rebecca had become
increasingly anxious about how we were going to manage once
the baby arrived. We were living in Cornwall then, and it was
starting to dawn on me that my plans for an academic career
in tropical agriculture might well be subsumed by more press-
ing needs and responsibilities. In view of this, I took the train
up to Scotland to see if our old university town had anything to
offer an aspiring environmental economist.
As luck would have it, I arrived at the Department of
Forestry in the University of Edinburgh on the day a new
programme of international forest science had been
launched, and they needed someone to help with aspects of
coordination and outreach. It was one of those defining
opportunities that would set my career in a certain direction.
I was clearly desperate, and they needed someone to start
within a week, with no complicated application process. I felt

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sure that Rebecca would be pleased and relieved. She might

even relax a bit and start looking forward to the rest of the
pregnancy and the next few months of GP training.
But instead of a reassuring conversation with Rebecca,
I found myself talking to one of her GP colleagues and trying
to absorb the news that my wife was in hospital. How could this
have happened? What did it mean? With no experience of
psychiatry or mental illness, I had this feeling that if she was in
hospital there must be a physical cause – a driving accident or
something wrong with the baby. The train journey south was a
sickening blur.
Looking back, it has taken many years to come to terms with
dealing with mental illness in my partner, and I am still learning
how to cope. At the start, there was the feeling that this was
surely just a glitch, a one-off aberration caused by a combination
of stress and hormones – an unexpected pregnancy on top of a
demanding job with onerous on-call, plus tests and exams, and a
new husband without a job, halfway through a PhD.
This gave way to desperation as recurring cycles of anxiety,
deep depression, and nervous energy strained our emotional
connection. It was as if someone was swept out of your grasp by
a strong current. You try to hold on. Share the fears and the
worries; pull them back from the brink. But depression is like
quicksand, and you are starting to submerge.
At times of recovery, I found myself aloof, reticent to recon-
nect. Rebecca’s recoveries following short courses of ECT were
often quick – almost miraculous. The person I knew was back
again, as if awoken from a tormented dream but with little
recollection of the anguish or the agony. ‘Surely I wasn’t that
bad?’ she would say. She found it difficult to believe it was a
real illness and convinced herself it was some kind of collapse
brought about by a weakness of personality.
At other times I tried to stand back, to rationalise, and to
avoid getting drawn in. I felt I had to stay strong to look after

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the children, remain employed. I reasoned that Rebecca

would not remember any of this once she recovered.
I became a dispassionate carer.
As things progressed, people would ask how I coped, how
I remained hopeful. I think that in large measure this was
because I could see that, as a result of treatments, particularly
ECT, Rebecca emerged quite quickly from the deepest depths.
The psychiatrists were also reassuring that this was a treatable
illness and that full recovery and a normal life were to
be expected.
The in-between times were perhaps the most difficult: both
post-recovery, when Rebecca’s mood and mind were mostly
restored but her confidence was shot and she could not really
accept the diagnosis, and those times when the tendrils of
anxiety started to pull at her, after a period of normality.
Initially, these would be rational anxieties, slightly magnified
beyond the usual range. Gradually, they would become more
persistent and intrusive requiring repetitive reassurance and
eventually preventing sleep.
During these times of either recovery or partial relapse,
going to work was always stressful as I would never know how
Rebecca would be once I got home. Would she be up and
about, keen to socialise, or exhausted in a heap or full of
worries, or worse? In the early years of Rebecca’s illness, these
changes seemed to be particularly acute as she would try to
conceal her thoughts and moods until things were no
longer bearable.
Blame was often an issue that took a lot of discussing,
particularly around Rebecca’s early episodes of illness.
Rebecca usually blamed herself for what was happening,
whereas I tended to focus on her rather strict and controlled
upbringing. I also wondered whether I might be partly to
blame – my interest in travelling, to visit and understand rural
economies in the developing world certainly elicited concern

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in Rebecca’s parents, and I can see now that my casual belief

that a career would sort itself out caused a lot of concern.
There was certainly a lot of guilt and stress rattling about the
family in the early years, and, while this still surfaces from time
to time, there is now a greater acceptance that this is some-
thing that fate and biology have brought upon us.
Dealing with periods of elevated mood was also challenging.
Rebecca would be full of pent-up energy and sometimes chan-
nel this into specific projects. Much of the time, this could be
interpreted as reasonable joy at having recovered from a period
of depression and wanting to catch up on things missed out,
such as music, physical fitness, or academic interests. Such
periods often extended for several months and even now it is
difficult to say whether this was part of an illness, since it looked
from the outside like a sort of hyper-wellness. After dealing with
a long period of depression, I was probably just swept along for
much of the time, enjoying Rebecca’s new-found energy and
interest in the world. I think the children found these periods
quite disturbing as she would also take an increased interest in
their hobbies and schoolwork. Sometimes these elevated
periods would settle – a good sign of durable recovery, but at
other times the energy levels increased, and Rebecca’s mood
would become brittle, her sleep disturbed, and her need to
discuss feelings and frustrations increasingly frantic. These were
usually signs that things were about to come crashing down,
and when they did it almost felt like a relief.
In times of extended recovery, a particular difficulty was
stepping back from being hyper vigilant to slight changes in
mood and anxiety levels to a more normal kind of relation-
ship, where fears and joy can be shared and not monitored.
The other big challenge has been how to talk about what is
going on with the children at various stages of their lives.
I almost certainly got this wrong, in being either too evasive
or too blunt, and sometimes submerging myself in work as an

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alternative to emotional engagement. I am amazed at how well

they seem to have coped with all this.
Has all this given me faith in psychiatry? That’s difficult – for,
while the professionals have often been wonderful, and the
treatment has definitely been life-saving, it is impossible not to
notice the creaking health service, the lack of support following
discharge, and the crudity of maintenance treatment (largely
drugs). In some cases, a bit more support between times might
have avoided a deeper episode leading to admission. It is diffi-
cult to be certain, though; indeed, it is difficult to know what
sort of support would have made a real difference. I’m not sure
how receptive Rebecca would be to a home visit from a nurse or
support worker, when in the depths of despair.
One thing that does seem to have improved over recent
years is the increased awareness and reduced stigma associ-
ated with mental illness. When this all started, I found it
difficult to describe what was happening to work colleagues
and our wider family. There was certainly a perception
around that illness, particularly mental illness, equated to
weakness or deficiency of some kind. That didn’t help
with recovery.
Another big change has been the move from in-patient to
out-patient administration of ECT. This has enabled Rebecca
to avoid several admissions. I have doubts that this is always the
best and safest approach to treatment, but, with limited avail-
ability of hospital beds and the difficulty of being a patient on
a ward in the hospital where Rebecca works, it has certainly
reduced one of the traumas of being treated.
Is there a secret to how we got through this, and continue to
do so? Apart from persistence, and support from many dear
friends, I don’t think so. In the end, I sort of muddled
through, as did the rest of the family, and that is how we
survived and eventually recovered a fairly normal and
fulfilling life.

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 Afterword
Professor Stephen M. Lawrie

In this frank and powerful memoir, Rebecca writes about her

life with a severe mood disorder, which ultimately revealed
itself to be bipolar disorder. People may be surprised to read
of the difficulty in making the diagnosis and wonder why it
wasn’t clear from the start. The answer is that this is quite
common. There are often several episodes of depression
before a ‘high’, and this can, in any case, be difficult to distin-
guish from the ‘hyper-wellness’ of the release from depression.
In addition, these pages give a revealing account of what it
is like to train as a doctor and work as a psychiatrist, particu-
larly in the late twentieth and early twenty-first century.
It wasn’t long ago that mental illness could be career-ending,
both by interfering with training and because of stigma within
the medical profession.
The stigmatisation of mental illness and its treatments must
be challenged. Prejudice and discrimination against the men-
tally ill, and those associated with them, seem to boil down to
our human tendency to see what is ‘mental’ as somehow
distinct from the ‘physical’. Sometimes, the need to seek and
proffer only psychological explanations for severe mental ill-
ness can add to the difficulties commonly faced by people
experiencing it, and this can be the result of ignorance and
bias. Doctors rarely cure anything in medicine, but, in severe
mental illness, medication and psychotherapy can work
together to reduce symptoms and improve outcomes. Even

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when psychotherapy does not seem to be of great benefit, it

can provide support, and an opportunity to reflect on life.
Severe depression, whether part of bipolar disorder or not,
is an awful illness for the sufferer and their family – especially
if the patient does not appreciate that they are ill. Rebecca
writes that the psychiatric treatment she has received over the
years has saved her life, and I am inclined to agree. Side
effects, which have included temporary memory impairment,
are worth it to keep living a full life, as well as working as
a doctor.
The one thing I have observed is that doctors with depres-
sion are less likely than average to accept that they have a
mental illness, more likely to think that it is at least partly their
fault and yet also wonder if they have some undiagnosed
physical problem. I tend to think that this is something to do
with medical training and practice, rendering some doctors
even more stigmatising of mental illness than general, despite
their education. It was therefore intriguing to read that
Rebecca had these concerns because she was not ill all
the time.
It is often said that doctors make the worst patients. I,
however, am not aware of any particular difficulties treating
Rebecca or doctors in general. Perhaps I am in blissful denial,
but my doctor-patients are not particularly awkward, maybe
even the reverse. Rather, difficulties arise if the treating doctor
starts to do things differently – such as not taking notes or not
writing to the GP. Many problems can stem from that. Perhaps
some doctors do not like being questioned by a doctor-patient
about their diagnosis and treatment, but I like to think that
I can justify my ‘evidence-based’ advice. All my patients,
whether doctors or not, can be seen in our dilapidated but
homely ‘ivory tower’ and all can contact me whenever they
want. I do however have a much smaller caseload than my full-
time NHS colleagues, and perhaps I also have an advantage in

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being a ‘Prof’ in reinforcing the inevitable and arguably essen-

tial imbalance of power in the doctor–patient relationship.
I am sure that anyone who reads this book will find it
informative and indeed entertaining, and that those with
severe mood disorders, and those who care for them, will find
it affirming and comforting. No doubt it will also contribute to
the slow but steady success in dealing with stigma. There is
nothing like encountering people with lived experience of
mental illness for reducing stigma. Perhaps the perspective
of a doctor-patient may do so even more?

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 Glossary

Mental health conditions

The following are links to many different mental disorders.
www.rcpsych.ac.uk/mental-health/mental-illnesses-and-mental-health-
problems
www.mind.org.uk/information-support/types-of-mental-health-
problems/

Severe and enduring mental illness

People with schizophrenia, bipolar disorder, and personality disorder may
develop severe mental and physical disability, often with associated
stigma. They may be cared for by mental health rehabilitation services.
www.gov.uk/government/publications/severe-mental-illness-smi-phys
ical-health-inequalities/severe-mental-illness-and-physical-health-
inequalities-briefing
www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/mental-
health-rehabilitation-services

Self-harm and suicide

Further information is available here: College Report 229, July 2020
(Royal College of Psychiatrists)
www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-
policy/college-reports/college-report-cr229-self-harm-and-suicide
.pdf?sfvrsn=b6fdf395_10

211
 GLOSSARY

ICD-10
ICD-10 is the International Statistical Classification of Diseases and
Related Health Problems (World Health Organisation). As psych-
iatrists, we use it to help us make and, more importantly, code mental
illness diagnoses. It was replaced by ICD-11 on 1 January 2022, and we
are slowly catching up with it.

General Medical Council (GMC)

The GMC is a public body which maintains an official register of doctors in the
UK. It independently regulates doctors and protects patients.
www.gmc-uk.org

House Officers and the Foundation programme

Until 2005, all newly graduating doctors in the UK were required to do
one year as a pre-registration House Officer. They would then gain full
registration with the General Medical Council (GMC), and most
would then work as Senior House Officers for a few years. These were
all supervised training posts.
From 2005, all medical graduates undertake a two-year Foundation
Programme (FY1 and FY2), made up of 6 four-month posts. Like their
predecessors, the House Officers, they are only fully registered with
the GMC after FY1. After completing the Foundation Programme,
they can apply for training programmes, for example in General
Practice or the different specialties.
https://foundationprogramme.nhs.uk

The Royal College of General Practitioners, General

Practice training and the MRCGP examination
Doctors training as GPs are usually required to work in training posts for
at least three years following completion of the Foundation
Programme. 18 months will be spent in a GP training practice, the
rest in hospital or community specialties. They will also be expected to
pass the membership examination of the Royal College of General
Practitioners. Further information can be found here.
www.rcgp.org.uk/membership

212
 GLOSSARY

The Royal College of Psychiatrists, Psychiatry training and

the MRCPsych examination
Doctors training as psychiatrists will work for at least three years as core
trainees in hospital and community psychiatric posts. These will
include general adult psychiatry, old age psychiatry, and some of child
and adolescent psychiatry, psychiatry of intellectual disability, and
more. They will also undergo training in psychotherapy and learn
how to give ECT. After passing the membership examination for the
Royal College of Psychiatrists (Paper A, Paper B, and CASC), they can
apply for higher training in the various specialties (general adult, old
age, child and adolescent mental health, intellectual disability, foren-
sic, psychotherapy), which lasts a further three years. On completing
this, they can apply to be on the GMC specialist register and can work
independently as a consultant.
Throughout psychiatry training, all trainees have an hour of supervision
weekly with a consultant.
It is also possible to work as a specialty doctor without completing higher
training, and many excellent doctors choose this route.
More information can be found here.
www.rcpsych.ac.uk/become-a-psychiatrist/choose-psychiatry/how-to-
become-a-psychiatrist

On-call and shift work

Doctors are required to be on-call (available immediately by phone) or work
shifts to ensure high-quality care at all times for patients. The European
Working Time Directive has protected all doctors from working excessive
hours from 2004. However, shift work remains difficult, perhaps espe-
cially for doctors and other health professionals with mood disorders.
www.bma.org.uk/pay-and-contracts/working-hours/european-
working-time-directive-ewtd/doctors-and-the-european-working-
time-directive
https://pubmed.ncbi.nlm.nih.gov/31955278/

Mental Health Act (MHA)

The Mental Health Act provides legislation that allows people to receive
assessment and treatment for mental disorder, when their decision-
making is impaired due to this, and they would otherwise be at risk.
The legislation also allows them to appeal in some circumstances and

213
 GLOSSARY

it protects their rights. It is different in Scotland to England and Wales,

and further information is available in the following links.
www.nhs.uk/mental-health/social-care-and-your-rights/mental-
health-and-the-law/mental-health-act/
www.mwcscot.org.uk/law-and-rights/mental-health-act

Psychotropic medication
Medication mentioned in this book, some both taken and prescribed by me:

Antidepressants: trazodone, amitriptyline, paroxetine,

fluoxetine, venlafaxine
Antipsychotics: thioridazine, olanzapine, quetiapine,
chlorpromazine
Mood stabiliser: lithium
Sedative: diazepam
Opioid methadone (prescribed in the addiction
substitute: services)

Information about these and many more medications, as well as risks,

benefits, and side effects, can be found in the following links.
https://bnf.nice.org.uk/drugs/
www.nhsinform.scot/tests-and-treatments/medicines-and-medical-
aids/types-of-medicine/antidepressants/
www.mind.org.uk/information-support/drugs-and-treatments/medi
cation/about-medication/

Electroconvulsive Therapy (ECT)

Information is provided here from the Royal College of Psychiatrists, and
the Scottish ECT accreditation network standards.
www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/ect
www.sean.org.uk/docs/SEAN-Standards-Final-Version-190122.pdf

Psychotherapy – CBT, systemic family therapy,

psychodynamic
The British Association for Counselling and Psychotherapy gives links to
the types of therapies mentioned in the book.
www.bacp.co.uk/about-therapy/types-of-therapy/

214
 GLOSSARY

Perinatal illness and psychiatric services in pregnancy

More information is provided here about the different types of illnesses
experienced before and after pregnancy. There is also a link to the
preferred service provision at those times, which is a Mother and Baby
Unit.
www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/mental-
health-in-pregnancy
www.rcpsych.ac.uk/mental-health/mental-illnesses-and-mental-
health-problems/postpartum-psychosis
www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/mother-
and-baby-units-(mbus)

National Childbirth Trust (NCT)

The National Childbirth Trust provides support to parents and families,
before and after birth. More information is available here.
www.nct.org.uk/about-us

Sands – stillbirth and neonatal death charity

Sands is a charity supporting bereaved families. ‘When a Baby Dies: The
Experience of Late Miscarriage, Stillbirth and Neonatal Death’, a
book written by Nancy Kohner and Alix Henley, in conjunction with
Sands, was a great comfort to me.
www.sands.org.uk

215
 Resources

Support for mental distress and mental illness may often be

best accessed locally. However, a small number of resources
are included here, which may be able to provide either infor-
mation and/or support in the UK. This is not a comprehen-
sive list and does not endorse any particular service.

General

General Practice – contact in working hours.

Community mental health services – services offered may differ
depending on area.

NHS 111 services (https://111.nhs.uk) – call 111 for urgent phone
advice (in an emergency, consider going to A&E).

A&E departments – attend or call an ambulance (dial 999) in an
emergency, especially if your, or someone else’s, life is at risk, or you
cannot keep yourself safe.

Samaritans (www.samaritans.org/) – for support at any time call 116 123.

Mind (www.mind.org.uk) – for information and online peer support.

Scottish Action for Mental Health SAMH (www.samh.org.uk) – provides
many types of community support.

Royal College of Psychiatrists Mental Health information (www.rcpsych
.ac.uk/mental-health) – provides information about mental health for
patients and carers.

For doctors and healthcare professionals

Practitioner Health Programme PHP (www.practitionerhealth.nhs.uk)
– confidential NHS primary care mental health and addiction service
that treats health and care professionals.

217
 RESOURCES

Psychiatrists Support Service PSS (www.rcpsych.ac.uk/members/work

force-wellbeing-hub/psychiatrists-support-service) – provides free tele-
phone support, psychiatrists to psychiatrists.

British Medical Association (BMA) counselling and peer support
services – (www.bma.org.uk/advice-and-support/your-wellbeing/well
being-support-services/counselling-and-peer-support-services) – call
0330 123 1245 to talk to someone.

Doctors Support Network DSN (www.dsn.org.uk) – peer support for
doctors and students.

In pregnancy

General Practice – contact in working hours.

Local midwifery services and secondary obstetrics services.

Contact NHS 111 for urgent advice; call an ambulance or attend A&E in
an emergency.

Sands (www.sands.org.uk) – for miscarriage, stillbirth, and newborn
death support.

218
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Chapter 8
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Chapter 10
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Chapter 11
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Chapter 12
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Chapter 15
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National Institute for Health and Care Excellence. British National Formulary/
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Chapter 16
Cai V, Peng Ng C, Zhao J, Siskind D, Kisely S. A Systematic Review and Meta-
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Illness. Psychosom Med. 2022;84(7):836–47. doi:10.1097/PSY.000000000000
1102.
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2024, www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/ect.

Chapter 17
Coleman JRI, Gaspar HA, Bryois J. Bipolar Disorder Working Group of the
Psychiatric Genomics Consortium; Major Depressive Disorder Working
Group of the Psychiatric Genomics Consortium, Breen G. The Genetics
of the Mood Disorder Spectrum: Genome-Wide Association Analyses of
More Than 185,000 Cases and 439,000 Controls. Biol Psychiatry. 2020;88
(2):169–84. doi:10.1016/j.biopsych.2019.10.015.

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