2016 Disability Lecture: A Psychiatrist's Experience of Depression

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And now I'd like the Vice Chancellor to introduce your speaker.

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>> Thank you.

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>> [APPLAUSE] >> Good evening, everyone,

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delighted to welcome you to this brand spanking new lecture theater.

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I bet for many of you it must be your first time here.

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It's quite, quite glorious.

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But I'm especially delighted to welcome you all to our second

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annual lecture on the theme of disability.

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Now, the notion of parody of esteem where mental health is valued

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equally with physical health is now enshrined in English law.

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But I think many of us believe that there is much to be done if the country

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is to stand a good chance of actually achieving this parity.

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The British Medical Association has said that what we lack is a clear

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range of actions to help ensure not just parity of esteem, but parity of outcomes.

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Being open confronting the stigma that has been perpetuated for generations,

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and encouraging frank discussion are all important components of the response.

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And few are better qualified to inform this discussion

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that our distinguished visiting lecturer this evening.

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Professor Linda Gask is an Emerita Professor of

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Primary Care Psychiatry at the University of Manchester.

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And is one of the world's most eminent specialists in the treatment and

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understanding of mental illness.

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After reading medicine at the University of Edinburgh,

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Linda undertook her specialist training in psychiatry in the Northwest of England.

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Much of her clinical research has taken place in Greater Manchester.

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But the impact of this work has been truly international.

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In 2000, 2001, she was a Harkness Fellow in healthcare

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policy based at the Center for Health Studies in Seattle.

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She's also worked as a consultant for the World Health Organization and

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as a regional representative of The World Psychiatric Association.

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Today, she's one of the Academy's most respected and

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compelling voices on mental health.

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She has a long list of publications.

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Her most recent being The Other Side of Silence,

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A Psychiatrist's Memoir of Depression.

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Earlier work was the ABC of Anxiety and Depression.

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A short Introduction to Anxiety, the widely adopted Teaching Psychiatry,

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Putting Theory into Practice, which offers a globally relevant perspective and

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provides practical advice on all aspects of teaching psychiatry.

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Other works include Medical and Psychiatric Issues for

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Counselors and Psychiatry and Medical Practice.

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Over her career as a researcher and clinician,

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Linda Gask has acquired deep expertise in researching mental health policy and

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practice with a particular focus on primary care mental health.

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Her most recent research projects have been concerned with

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improving the quality of care for those with depression and

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the management of people who are at risk of self-harm.

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In this field,

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Professor Gask helps you found the STORM Suicide Prevention Initiative.

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STORM which stands for skills training on risk management is

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a package designed for all frontline health and social care staff.

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For those who work within the criminal justice system, and for staff and

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voluntary agencies, particularly those working with people at risk of suicide.

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But a fundamental component of her life's work

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has been her experience of life itself.

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Throughout her academic and medical career, Linda has spoken openly and

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fearlessly about her own personal experience of both pharmacological and

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psychological treatment for depression and anxiety.

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Her most recent book is in part a memoir and has been described by

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Professor Dame Susan Bailey as a first in bringing together the intricate web and

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weave of being simultaneously a doctor, a patient, and an academic.

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Ladies and gentlemen, please join me in welcoming Professor Linda Gask

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to deliver the second annual Oxford lecture on disability.

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>> [APPLAUSE] >> Thank you very much.

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And I'm honored to be invited to speak here in such a beautiful building as well.

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I'm going to speak to you without a PowerPoint.

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I want to really try and speak to you very much from my

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heart rather than from reading through things on slides.

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I have some notes.

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First of all, I want to tell you a bit more about who I am.

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You've heard about my career, but perhaps, a little bit more about me.

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I was a clinical psychiatrist for 33 years.

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I went straight into psychiatry from medical school.

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And I was a consultant for the last 23 years of that.

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And I worked in the North of England.

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I think the furthest south I've ever lived is Sheffield,

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which gives some idea of, I'm a Northerner.

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I'm sure you can tell that from my accent anyway.

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But my interest, I worked in Barnsley,

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I worked in Preston, most recently, worked in Salford.

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And Barnsley and Preston are two of the most deprived areas of England.

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I've always had an interest in people with common mental health problems.

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With depression, anxiety, eating problems rather than more severe

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mental health problems such as schizophrenia.

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My interest has been in the people who don't, or do, get help in primary care.

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Only about 10% or less of people with

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mental health problems are treated in the mental health services.

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Although, many of my younger colleagues sometimes find it very hard to

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believe that GPs treat the majority of people with mental health problems.

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So that's been my interest.

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And I taught medical students,

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I taught junior doctors all of the things one would expect.

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But as well as that, I've been a patient.

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And I've been a patient in terms of my mental health ever since I was

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at medical school.

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My problems with anxiety began in my mid teens, and

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I had really awful anxiety about my A levels.

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I've always had a great fear of failing.

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I'm sure that's something that's quite a common experience.

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I'm in Oxford where people are high achievers, and

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I was a high achiever in my school.

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And then I went to Edinburgh and

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I was suddenly in a complete lecture theater full of other high achievers.

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So it was very competitive.

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I have had several episodes of depression,

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some of them quite severe throughout my working life.

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My first episode was more severe episode was as medical students.

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And as you might imagine, given that my problems began around my A levels.

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I had problems with my finals.

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And at that time, I rang up the consultant afterwards.

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I got through them and I rang up the consultant who had taken care of me.

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And I said, I wonder what you think about me going into psychiatry.

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Because psychiatry it actually being the subject that I was best at at university.

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I somehow seemed to be able to understand how people felt.

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And he did pause for a moment, there was a perceptible pause.

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And then he said, I think it would be a good idea.

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And that really changed my life because although I had done very

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well in psychiatry, I really thought that because I'd had mental

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health problems as a student, I couldn't possibly go and do it.

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And my experience follows on from that.

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I've now retired.

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I retired from the University of Manchester two years ago.

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And I kind of hoped that once I retired I wouldn't have any more episodes,

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everything would be fine.

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And then a year ago I got quite ill again.

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So it's been a lifelong thing.

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What I want to talk to you about really is a bit more about the subject

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of depression and about treatment.

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But before I go on to that, I just want to remind us I've been writing

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a paper recently about an intervention we did training people in

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universities to be better at helping people in acute distress.

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And it's hard to find data from the UK.

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But the US National College Health Assessment 2013,

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reported 31.1% of undergraduates had felt so depressed at any

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time during the previous 12 months, that it was difficult to function.

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5.9% had intentionally cut, burned, bruised, or otherwise injured themselves.

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7.4% had seriously considered suicide in the previous 12 months and

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1.5% had attempted suicide.

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And a review of the epidemiology of college student suicide, noted that

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the age at which you go to university is a period of great transition on many

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different levels, socially, academically, psychologically, existentially.

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It's a period of great change.

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And it was certainly that for

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me because I came from a working class background in the east of Lincolnshire.

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And it was quite a shell shock for me going to university.

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I was the first person in my family to do that.

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I want to say a bit about what depression is and

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then relate that to my personal experience.

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I'll say a bit first about what it's supposed to be.

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I'll say that because if my academic colleagues were here,

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I'm sure that's how they would start off.

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And then, I'll talk about how it's experienced.

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And then I'll talk a bit more about my own beliefs about that.

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If a psychiatrist was here giving a lecture to you about depression,

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they will start off by telling you that there's something called major depression.

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And to have this you have to have depression,

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low mood and/or loss of interest or pleasure for at least two weeks.

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And you have to have at least four of the following symptoms.

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Change in sleep, that's sleeping too much or not sleeping enough.

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Change in appetite, loss of energy or motivation, poor concentration,

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guilt, self-reproach, retardation, being slowed up, or

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being agitated, and suicidal thoughts or hopelessness.

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And that comes straight out of The Diagnostic and Statistical Manual of

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the American Psychiatric Association which is currently in its fifth version.

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And they would be telling you about all the biological models of depression.

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Anyone who follows the discussion on the web, but particularly on Twitter

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will know that there's a constant argument about the monoamine theory of depression.

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And psychologists sometimes say psychiatrists are still holding on

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to this and psychiatrists will say, no, we stopped believing in that years ago.

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But we don't really know,

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there's many different theories about the biological causes of depression.

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Genes certainly play a part, and

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I'll say a bit more about that in relation to my own family in a moment.

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The latest theory is it's all about inflammation.

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So you just have to say the word inflammation.

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And that's the latest theory, theory for most things actually.

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And then physical things can cause depression, alcohol and drugs.

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You can be depressed because you were drinking and

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you can get depressed because you stop drinking.

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They both play a part.

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Physical illness, chronic illness, cancer,

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having an under-active thyroid, tablets that you're taking.

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But the theories that most people know are the psychological theories and

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almost everyone knows about, I mean Freud.

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Freud is kind of parsed into common parlance people have heard

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about some of his ideas.

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And he very much believed the psychodynamic understanding of depression

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is that past relationships have an influence on our lives in the present.

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So your relationship with your parents will have an impact on how

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you relate to other people now.

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And that might result in you getting depressed.

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Psychological models also include cognitive models which

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are really fashionable.

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It's quite hard, in many places, to get any other kind of therapy, but

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cognitive therapy.

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And that very much comes from the theory that if we think negative thoughts

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that can not only cause us to become depressed, but can keep us depressed.

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And there are also behavioral ideas that when we get depressed we

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stop doing the things that we enjoy doing.

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We stop doing the things we have to do, and we retreat, and

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that we can actually recover by starting to do things again.

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The idea of acting better will actually help you to feel better.

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And there is social models as well.

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What we certainly know is that people who had trauma and

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early abuse in their lives are more likely to get depression.

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People who have had chronic lack of social support.

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And the areas that I've worked with in England,

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I guess there's four things that come up over and over again.

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I call them the four Ds, debt, disease, divorce and deprivation.

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So how do we experience it?

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Well, there's a lot of memoirs written about depression.

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I've written my own, but there are many others.

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And I've often encouraged my students to go away and

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read about people's experience rather than starting from the nine symptoms.

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Go away and find out how people actually feel when they're depressed.

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Let's start from there.

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And there are some well-known ones.

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There's a very, very good book called Darkness Visible,

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which was written by William Styron.

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He was the author who wrote Sophie's Choice.

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And a more modern one that I found particularly affecting was by Tim Lot,

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the journalist and writer.

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Who wrote a book called The Scent of Dried Roses, and

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that was about getting depressed following the unexpected suicide of his mother.

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And he talks very much in that book about how depression can affect

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the sense of who we are.

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But I would say that they're all different,

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because I think that people's experiences of depression are different.

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One person may relate to a memoir and

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another person may find it very difficult to.

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So what do people experience?

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What did I experience?

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Well, for me it's much more than sadness.

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There's a great or many people who think that depression is just unhappiness.

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It's much more than that.

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It's a loss of vitality, it's a loss of joy, it's a sense of utter despair.

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And when I get depressed, I can't think clearly.

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My brain seems to shut down.

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I'll give you a small quote here from something I wrote about when

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I was very depressed, when I was having major problems at work.

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And I think it gives you some idea of the kind of cognitive experience.

242
00:16:22,595 --> 00:16:27,318
My mind seemed at last to disintegrate into small, sharp-edged,

243
00:16:27,318 --> 00:16:28,745
monochrome pieces.

244
00:16:28,745 --> 00:16:31,507
I was unable to think with any clarity.

245
00:16:31,507 --> 00:16:33,733
I sank down in front of the sofa.

246
00:16:33,733 --> 00:16:37,294
I sat down on the sofa in front of the fire and wept.

247
00:16:37,294 --> 00:16:38,988
I just couldn't think.

248
00:16:38,988 --> 00:16:43,444
And the other thing is that it's a very physical experience.

249
00:16:43,444 --> 00:16:47,276
And that, again, is something that is not unhappiness.

250
00:16:47,276 --> 00:16:50,396
You don't feel physically exhausted, and

251
00:16:50,396 --> 00:16:55,742
like there's a weight pressing down on your chest when you're unhappy.

252
00:16:55,742 --> 00:16:57,167
That's what I felt.

253
00:16:57,167 --> 00:17:00,284
At the same time as the same episode I wrote,

254
00:17:00,284 --> 00:17:03,670
the terrible weight pressing down on my chest.

255
00:17:03,670 --> 00:17:08,304
Which became lighter when I cried or talked, but only for a while.

256
00:17:08,304 --> 00:17:13,293
When it returned, it was as if an invisible demon that loaded ten more

257
00:17:13,293 --> 00:17:15,252
pounds on each side of a bar.

258
00:17:15,252 --> 00:17:17,746
I was unable to push it off my chest.

259
00:17:17,746 --> 00:17:23,004
Maybe this is where the expression getting it off your chest comes from,

260
00:17:23,004 --> 00:17:24,252
only I couldn't.

261
00:17:24,252 --> 00:17:26,747
The talking didn't work anymore.

262
00:17:26,747 --> 00:17:31,649
And for me, there was a point where talking therapy stopped working.

263
00:17:31,649 --> 00:17:34,233
And I'll say more about that later.

264
00:17:34,233 --> 00:17:37,798
I've not only thought about my own experiences.

265
00:17:37,798 --> 00:17:43,949
I've done some research interviewing people about the experience of depression.

266
00:17:43,949 --> 00:17:48,850
And what's clear to me is that it is a bio psycho social experience.

267
00:17:48,850 --> 00:17:53,663
People experience what's going on in their life as the cause and

268
00:17:53,663 --> 00:17:55,176
most of the time it is.

269
00:17:55,176 --> 00:17:59,187
But they experience emotional and physical symptoms.

270
00:17:59,187 --> 00:18:02,218
And depression has social consequences.

271
00:18:02,218 --> 00:18:06,408
Living with someone who's depressed is very difficult.

272
00:18:06,408 --> 00:18:10,419
Keeping your job when you're depressed is difficult.

273
00:18:10,419 --> 00:18:14,430
Just functioning in a relationship is very difficult.

274
00:18:14,430 --> 00:18:16,836
And so there's a secondary loss.

275
00:18:16,836 --> 00:18:22,806
There's not just the loss that caused you to become depressed in the first place.

276
00:18:22,806 --> 00:18:25,211
There's the impact on your life.

277
00:18:25,211 --> 00:18:28,152
So I don't think there's a nice, simple,

278
00:18:28,152 --> 00:18:31,806
single depression like DSM would have us believe.

279
00:18:31,806 --> 00:18:35,729
I think there are many different types of depression.

280
00:18:35,729 --> 00:18:40,005
And I think some of them are more caused by physical causes.

281
00:18:40,005 --> 00:18:44,104
Some of them have more psychological and social causes.

282
00:18:44,104 --> 00:18:48,649
People have very common experiences in terms of symptoms, but

283
00:18:48,649 --> 00:18:50,966
they all have a different story.

284
00:18:50,966 --> 00:18:55,866
And my patients, over the years, have told me many different stories.

285
00:18:55,866 --> 00:19:01,302
They've told me about being very frightened, they've told me about loss.

286
00:19:01,302 --> 00:19:04,600
They've told me about trauma in their lives,

287
00:19:04,600 --> 00:19:07,898
particularly sexual trauma, need to be loved.

288
00:19:07,898 --> 00:19:09,681
Everyone needs someone.

289
00:19:09,681 --> 00:19:13,514
Feeling very lonely, difficulty in trusting others.

290
00:19:13,514 --> 00:19:18,059
And a common experience for me is that of unresolved grief and

291
00:19:18,059 --> 00:19:21,979
that was a very personal one for me.

292
00:19:21,979 --> 00:19:24,653
And I don't there's a single cause.

293
00:19:24,653 --> 00:19:27,415
What I've learned over the years and

294
00:19:27,415 --> 00:19:32,671
I guess I learned this partly from working very much in primary care, but

295
00:19:32,671 --> 00:19:39,534
working with Professor Sir David Goldberg who was my supervisor in my PhD.

296
00:19:39,534 --> 00:19:45,505
I use the vulnerability and stress model, and I'll say more about that in a moment.

297
00:19:45,505 --> 00:19:49,424
And then I'll talk about it in relation to my own life.

298
00:19:49,424 --> 00:19:53,346
Genes are important, but they aren't the whole story.

299
00:19:53,346 --> 00:19:57,892
It's the interaction between the genes and the environment,

300
00:19:57,892 --> 00:20:01,281
which is important, temperament is important.

301
00:20:01,281 --> 00:20:04,580
I think temperament is partly inherited, but

302
00:20:04,580 --> 00:20:07,788
your early life is also absolutely crucial.

303
00:20:07,788 --> 00:20:12,155
Your early life experience of conflict, trauma, and neglect.

304
00:20:12,155 --> 00:20:17,678
I would meet mothers when I worked in Salford who had five year old children,

305
00:20:17,678 --> 00:20:22,044
and those children had been exposed to the most awful lives.

306
00:20:22,044 --> 00:20:27,031
And I knew, even by that point, that a great deal of damage had been done.

307
00:20:27,031 --> 00:20:31,753
It was almost almost too late, but not too late.

308
00:20:31,753 --> 00:20:34,517
Physical health is really important.

309
00:20:34,517 --> 00:20:37,814
If we get chronic physical illnesses, and for

310
00:20:37,814 --> 00:20:42,894
the last two years I've been diagnosed with chronic kidney disease.

311
00:20:42,894 --> 00:20:48,064
And about 50% of people with chronic kidney disease get depressed.

312
00:20:48,064 --> 00:20:49,312
Age is important.

313
00:20:49,312 --> 00:20:52,519
The older we get, the more susceptible we are.

314
00:20:52,519 --> 00:20:56,442
And social deprivation is obviously very important.

315
00:20:56,442 --> 00:21:02,142
But the stress that triggers it off are life events and they are commonly loss.

316
00:21:02,142 --> 00:21:06,151
So for me that begins to explain why not everybody gets

317
00:21:06,151 --> 00:21:09,717
depressed when something awful happens to them.

318
00:21:09,717 --> 00:21:12,213
It depends on your vulnerability.

319
00:21:12,213 --> 00:21:16,491
Some people are remarkably resilient in the face of those

320
00:21:16,491 --> 00:21:21,303
life events because they have had a different experience of life.

321
00:21:21,303 --> 00:21:23,264
They have different genes.

322
00:21:23,264 --> 00:21:25,314
They have different health.

323
00:21:25,314 --> 00:21:27,808
And some of us are not as resilient.

324
00:21:27,808 --> 00:21:32,709
And I guess that's one of the reasons why I don't find resilience

325
00:21:32,709 --> 00:21:34,759
a terribly helpful concept.

326
00:21:34,759 --> 00:21:40,106
Because I'm not sure I could undergo four hours of resilience training.

327
00:21:40,106 --> 00:21:44,651
I actually think a great deal of my resilience depends on what

328
00:21:44,651 --> 00:21:46,878
happened to me earlier in life.

329
00:21:46,878 --> 00:21:51,511
What I could undergo is some training in some coping skills and

330
00:21:51,511 --> 00:21:54,719
actually rethinking how I cope with stress.

331
00:21:54,719 --> 00:21:57,037
I've mentioned loss and grief.

332
00:21:57,037 --> 00:22:02,564
And grief is a remarkably common experience and it's not just about death.

333
00:22:02,564 --> 00:22:07,017
I wrote in my book, we can grieve for the loss of a person we love,

334
00:22:07,017 --> 00:22:10,046
a job which means a great deal to us and for

335
00:22:10,046 --> 00:22:13,966
the loss of our health when we become chronically ill.

336
00:22:13,966 --> 00:22:18,512
And when I was given a diagnosis of polycystic kidney disease,

337
00:22:18,512 --> 00:22:20,383
I did grieve for my health.

338
00:22:20,383 --> 00:22:24,035
We grieve the loss of our dreams for the future, and

339
00:22:24,035 --> 00:22:27,155
the lost opportunities we'll never have.

340
00:22:27,155 --> 00:22:34,700
And Darien Lee Leader, the psychoanalyst who has written about depression.

341
00:22:34,700 --> 00:22:38,366
I don't agree with all of his views, by any means.

342
00:22:38,366 --> 00:22:43,066
But I think he has written some very interesting ideas about

343
00:22:43,066 --> 00:22:44,758
depression and grief.

344
00:22:44,758 --> 00:22:50,398
And he cites the ideas of Freud saying that in mourning we grieve the dead.

345
00:22:50,398 --> 00:22:53,500
But melancholia we seem to die with them.

346
00:22:53,500 --> 00:22:55,380
And that's how it feels.

347
00:22:55,380 --> 00:22:59,140
It feels like a part of you, that you have also died.

348
00:22:59,140 --> 00:23:03,934
That you have taken in the dead person and you are dying as well.

349
00:23:03,934 --> 00:23:07,788
I say that with a great deal of feeling because one

350
00:23:07,788 --> 00:23:12,112
of the big problems in my life was an inability to grieve.

351
00:23:12,112 --> 00:23:15,214
So how can I fit that to my own experience?

352
00:23:15,214 --> 00:23:18,786
I'm just going to have a little bit more water.

353
00:23:18,786 --> 00:23:24,896
Well, I come from a family which, Have mental health problems,

354
00:23:24,896 --> 00:23:27,998
still does have mental health problems.

355
00:23:27,998 --> 00:23:30,348
My mother had chronic anxiety.

356
00:23:30,348 --> 00:23:34,860
My father, I'm fairly sure, had episodes of depression for

357
00:23:34,860 --> 00:23:38,808
which he would never dream of asking for treatment.

358
00:23:38,808 --> 00:23:42,380
He was certainly extremely socially anxious.

359
00:23:42,380 --> 00:23:46,140
My mother had to go and he wouldn't go into shops.

360
00:23:46,140 --> 00:23:49,148
My mother helped bring things home for

361
00:23:49,148 --> 00:23:53,942
him, which was the sort of thing that you could do in a small town.

362
00:23:53,942 --> 00:23:58,548
But I can't imagine in Oxford you're going into a shop and

363
00:23:58,548 --> 00:24:03,530
asking if you take all the clothes home for your husband to try on.

364
00:24:03,530 --> 00:24:05,222
But that was how he was.

365
00:24:05,222 --> 00:24:10,298
He would only go around shops at night when there was no one around.

366
00:24:10,298 --> 00:24:13,306
My brother had and still has severe OCD.

367
00:24:13,306 --> 00:24:16,032
Now that started at the age of seven.

368
00:24:16,032 --> 00:24:21,484
So I find it hard to believe that biological factors don't play a part.

369
00:24:21,484 --> 00:24:22,800
It was very early.

370
00:24:22,800 --> 00:24:26,560
And he's never had really effective treatment.

371
00:24:26,560 --> 00:24:32,106
Mental Health Services, tried all sorts of things which so unimpressed

372
00:24:32,106 --> 00:24:38,592
my father that I'm sometimes relieved he didn't find out I became a psychiatrist.

373
00:24:38,592 --> 00:24:42,728
Because he did used to refer to them as trick cyclists.

374
00:24:42,728 --> 00:24:46,018
But he really had nothing but contempt for

375
00:24:46,018 --> 00:24:51,000
the people who'd tried to help, because they really got nowhere.

376
00:24:51,000 --> 00:24:55,418
And I think a lot of that though was to do with the fact that

377
00:24:55,418 --> 00:25:00,212
the effective treatments for OCD hadn't yet been described.

378
00:25:00,212 --> 00:25:05,100
But by the time my brother got effective treatment in his 20s,

379
00:25:05,100 --> 00:25:06,792
it was really too late.

380
00:25:06,792 --> 00:25:11,116
So I grew up in an extremely tense and anxious household.

381
00:25:11,116 --> 00:25:14,970
And when my father lost his temper, he would hit, and

382
00:25:14,970 --> 00:25:17,602
I was physically hit on occasions.

383
00:25:17,602 --> 00:25:22,396
But I was also aware that I was pretty good at getting him angry

384
00:25:22,396 --> 00:25:27,096
because we were remarkably similar in terms of temperament.

385
00:25:27,096 --> 00:25:32,266
I got on well with him when I was younger, but not when I was a teenager.

386
00:25:32,266 --> 00:25:34,898
He didn't know how to cope with me.

387
00:25:34,898 --> 00:25:38,094
So my early life experience wasn't easy.

388
00:25:38,094 --> 00:25:41,760
But I went to university, and,

389
00:25:41,760 --> 00:25:45,896
You would have hoped that things would have improved.

390
00:25:45,896 --> 00:25:50,972
But that vulnerability left me very open to particular stresses.

391
00:25:50,972 --> 00:25:54,732
And I had a tremendous desire to please my father,

392
00:25:54,732 --> 00:26:00,090
because he always wanted me to do well and to go and to do well at school.

393
00:26:00,090 --> 00:26:04,884
He was one of those people for whom 99% wasn't good enough.

394
00:26:04,884 --> 00:26:08,644
And so I got very anxious around the time of exams.

395
00:26:08,644 --> 00:26:12,498
And I was always, I think, still trying to please him.

396
00:26:12,498 --> 00:26:17,386
I sometimes wasn't entirely sure who was it who decided that I

397
00:26:17,386 --> 00:26:20,864
should be going to higher education, him or me.

398
00:26:20,864 --> 00:26:23,496
So stresses have played a big part.

399
00:26:23,496 --> 00:26:29,512
And the stress that causes most damage is the stress that seems to fit into you,

400
00:26:29,512 --> 00:26:32,144
like a sort of key going into a lock.

401
00:26:32,144 --> 00:26:36,938
So you can imagine when I failed my membership examination of

402
00:26:36,938 --> 00:26:42,296
the Royal College of psychiatrists, not only had I failed in my chosen

403
00:26:42,296 --> 00:26:48,124
career that I thought was right for me, but I had failed, I thought, completely.

404
00:26:48,124 --> 00:26:50,286
And that was a terrible blow.

405
00:26:50,286 --> 00:26:55,080
And it was around that time that I really started to seriously

406
00:26:55,080 --> 00:26:58,558
think that something major was wrong with me.

407
00:26:58,558 --> 00:27:02,130
That was after the problems at medical school.

408
00:27:02,130 --> 00:27:05,890
So I've experienced vulnerability and stress.

409
00:27:05,890 --> 00:27:10,214
Now, how do we approach helping someone with depression?

410
00:27:10,214 --> 00:27:15,290
Well if you go and see your GP, he will have the guidelines from NICE,

411
00:27:15,290 --> 00:27:19,614
National Institute of Health and Clinical Excellence.

412
00:27:19,614 --> 00:27:22,716
And he will start off by following those.

413
00:27:22,716 --> 00:27:26,758
And they suggest that severity is a great pointer in

414
00:27:26,758 --> 00:27:29,578
terms of how we should treat someone.

415
00:27:29,578 --> 00:27:34,278
So there is a whole spectrum of depression from unhappiness

416
00:27:34,278 --> 00:27:36,816
through to suicidal depression.

417
00:27:36,816 --> 00:27:39,166
So severity is very important.

418
00:27:39,166 --> 00:27:43,960
But I think one of the things I've learned as a clinician from

419
00:27:43,960 --> 00:27:46,686
being a person consulting doctors.

420
00:27:46,686 --> 00:27:49,788
And I've had the, I think, disconcerting,

421
00:27:49,788 --> 00:27:53,736
perhaps sometimes more for the doctors than for me,

422
00:27:53,736 --> 00:27:58,812
if consulting doctors who know me and that's quite interesting.

423
00:27:58,812 --> 00:28:03,700
But what I'm aware of is that within my own profession there is

424
00:28:03,700 --> 00:28:07,554
a disturbing tendency to think about people as it.

425
00:28:07,554 --> 00:28:09,716
So there's I, it encounters.

426
00:28:09,716 --> 00:28:13,100
I'm going to look at this person and try and

427
00:28:13,100 --> 00:28:18,552
decide what diagnosis they have and where I can fit them into my system.

428
00:28:18,552 --> 00:28:23,440
Rather than actually thinking of you as another person that is

429
00:28:23,440 --> 00:28:25,508
remarkably similar to you.

430
00:28:25,508 --> 00:28:30,678
And that's was one of the reasons I started to write my book really.

431
00:28:30,678 --> 00:28:35,660
Because throughout my career, I had realized that the lives of my

432
00:28:35,660 --> 00:28:40,266
patients really weren't so terribly different from mine.

433
00:28:40,266 --> 00:28:44,120
Except that awful things that happened to them, or

434
00:28:44,120 --> 00:28:48,162
they came from families where life was difficult, or

435
00:28:48,162 --> 00:28:53,144
they came from families with a history of severe mental illness.

436
00:28:53,144 --> 00:28:58,690
But there were parallels, their stories were very similar to my stories.

437
00:28:58,690 --> 00:29:03,108
I have periods of unhappiness because I failed in things.

438
00:29:03,108 --> 00:29:05,646
I had periods of unhappiness and

439
00:29:05,646 --> 00:29:09,218
depression because of failed relationships.

440
00:29:09,218 --> 00:29:10,064
So did they.

441
00:29:10,064 --> 00:29:14,388
So I think it helped me to be a more understanding doctor.

442
00:29:14,388 --> 00:29:18,242
I did have times when my patients would say to me, mm,

443
00:29:18,242 --> 00:29:21,344
you've been asking me these questions.

444
00:29:21,344 --> 00:29:24,070
Have you suffered from this as well?

445
00:29:24,070 --> 00:29:26,326
And I would say, well, yes, I have.

446
00:29:26,326 --> 00:29:28,864
But this time is for you, not for me.

447
00:29:28,864 --> 00:29:31,496
What's really important, I think,

448
00:29:31,496 --> 00:29:35,726
is how well we engage with the people who are helping us.

449
00:29:35,726 --> 00:29:40,896
And those of you here who are therapists, and there may be some of you,

450
00:29:40,896 --> 00:29:44,750
but people who in a supporting role will know that.

451
00:29:44,750 --> 00:29:48,134
That sometimes you have to make a real extra

452
00:29:48,134 --> 00:29:51,518
effort to engage emotionally with someone.

453
00:29:51,518 --> 00:29:56,312
And that's probably the most important thing in recovering.

454
00:29:56,312 --> 00:30:01,858
It's probably more important than whatever model of therapy you have.

455
00:30:01,858 --> 00:30:05,524
You have to find someone that you can click with.

456
00:30:05,524 --> 00:30:08,814
The therapeutic alliance has to be strong.

457
00:30:08,814 --> 00:30:12,762
I've had four periods of psychotherapy in my life.

458
00:30:12,762 --> 00:30:17,744
Three of them on the NHS and one privately, no, two of them on the NHS.

459
00:30:17,744 --> 00:30:21,410
I've lost track now, I'll remember in a moment.

460
00:30:21,410 --> 00:30:24,982
But on one occasion, I did go and see a therapist.

461
00:30:24,982 --> 00:30:28,084
And I simply did not click with him at all.

462
00:30:28,084 --> 00:30:32,972
And I've known patients who've stayed with people that they

463
00:30:32,972 --> 00:30:37,296
don't click with feeling as it's somehow their fault.

464
00:30:37,296 --> 00:30:42,560
When it isn't necessarily, it's that the two of you just don't gel.

465
00:30:42,560 --> 00:30:47,636
And I think that's really important that a first effort getting

466
00:30:47,636 --> 00:30:52,806
help shouldn't be, although it often feels like it, very important.

467
00:30:52,806 --> 00:30:56,660
I'll just tell you, I saw this man for three months.

468
00:30:56,660 --> 00:31:01,360
And during that time, he would sit with his arm hands like this.

469
00:31:01,360 --> 00:31:04,838
And he was a very psychoanalytic in his model.

470
00:31:04,838 --> 00:31:10,572
And I was actually doing quite a lot of psychotherapy training at the time.

471
00:31:10,572 --> 00:31:16,494
The first 1ten 0 years of my career, I did psychotherapy under supervision.

472
00:31:16,494 --> 00:31:19,032
And I finally, after three months,

473
00:31:19,032 --> 00:31:23,920
summoned up the courage to say I didn't want to see him anymore.

474
00:31:23,920 --> 00:31:28,056
And I've written it wasn't his qualifications and

475
00:31:28,056 --> 00:31:31,722
curriculum vitae I wanted to purchase from him.

476
00:31:31,722 --> 00:31:37,268
First and foremost, I wanted to feel that he cared whether I lived or died.

477
00:31:37,268 --> 00:31:42,908
In the absence of this basic humanity, my visits to him have become to feel

478
00:31:42,908 --> 00:31:48,736
like a kind of chore at best, and at the very least, rather poor value for money.

479
00:31:48,736 --> 00:31:54,094
The emotion he'd evoked in me most was anger at a wasted opportunity.

480
00:31:54,094 --> 00:31:57,572
We never really reached any deeper than this.

481
00:31:57,572 --> 00:32:00,674
But then I'd experienced a strange and

482
00:32:00,674 --> 00:32:04,998
paradoxical kind of pity for him, so I let him off lightly.

483
00:32:04,998 --> 00:32:06,690
I said, it's me, not you.

484
00:32:06,690 --> 00:32:07,818
I'm not ready.

485
00:32:07,818 --> 00:32:12,988
And I think one of the things I've learned about talking to people

486
00:32:12,988 --> 00:32:17,782
who are really in severe distress is the importance of really

487
00:32:17,782 --> 00:32:22,388
trying to get in to understanding what's going on for them.

488
00:32:22,388 --> 00:32:25,678
Too often in life, people try to reassure us.

489
00:32:25,678 --> 00:32:31,506
They try to reassure us by saying, well you've got everything going for you.

490
00:32:31,506 --> 00:32:36,206
You're doing well, you got a nice husband, you got a great home.

491
00:32:36,206 --> 00:32:38,462
That has nothing to do with it.

492
00:32:38,462 --> 00:32:41,940
It's how you feel inside that's important.

493
00:32:41,940 --> 00:32:45,888
And when someone feels that suicide is the only way,

494
00:32:45,888 --> 00:32:49,084
you have to try and understand why that is.

495
00:32:49,084 --> 00:32:55,476
Because they've got a peculiar kind of logic that you've actually got to try and

496
00:32:55,476 --> 00:32:59,048
work out rather than say, it's not the only way.

497
00:32:59,048 --> 00:33:02,714
There are other ways to cope.

498
00:33:02,714 --> 00:33:07,602
I'm gonna talk a bit now about coming to terms with depression.

499
00:33:07,602 --> 00:33:13,242
And I think that if you're interested in this topic of finding out about

500
00:33:13,242 --> 00:33:18,506
people's experience the sociologists have written a lot about it.

501
00:33:18,506 --> 00:33:23,676
But the one in particular that I find very impressive is David Karp,

502
00:33:23,676 --> 00:33:25,180
who's an American.

503
00:33:25,180 --> 00:33:27,718
Who experienced depression and

504
00:33:27,718 --> 00:33:32,888
wrote an entire book where he interviewed people with depression.

505
00:33:32,888 --> 00:33:35,802
And what he described was, first of all,

506
00:33:35,802 --> 00:33:40,878
a feeling of distress inchoate feeling, you can't put a name to it.

507
00:33:40,878 --> 00:33:45,202
And then coming to terms that something is really wrong.

508
00:33:45,202 --> 00:33:51,124
And I can remember that feeling very powerfully when I was a medical student.

509
00:33:51,124 --> 00:33:56,858
I knew that something was wrong, but I couldn't work out what to do about it.

510
00:33:56,858 --> 00:34:02,592
I went along to see one of the student counselors and I didn't gel with her.

511
00:34:02,592 --> 00:34:07,480
And it kind of carried on, I didn't know what was going on with me.

512
00:34:07,480 --> 00:34:12,086
I was very, very afraid that I was going to develop the kind of

513
00:34:12,086 --> 00:34:15,094
mental health problems my brother had.

514
00:34:15,094 --> 00:34:18,384
And I did, in fact, become quite obsessional.

515
00:34:18,384 --> 00:34:20,452
And then there's a crisis.

516
00:34:20,452 --> 00:34:26,374
And that's the point where you just kind of feel you've got to do something.

517
00:34:26,374 --> 00:34:30,604
And it was at that point that I went along to see the GP at

518
00:34:30,604 --> 00:34:38,312
the Student Health Center and he referred me to see someone for my mental health.

519
00:34:38,312 --> 00:34:42,636
And I've seen many people when they've been in crisis.

520
00:34:42,636 --> 00:34:47,712
And I just want to read you something which I think for me reflects

521
00:34:47,712 --> 00:34:53,916
how people often imagine that they can plan their career out and plan their life.

522
00:34:53,916 --> 00:34:58,804
And I suspect that will resonate with some of you here because I

523
00:34:58,804 --> 00:35:03,598
was a high achieving student at my school, I went to university.

524
00:35:03,598 --> 00:35:07,264
I thought I had my life mapped out and it wasn't.

525
00:35:07,264 --> 00:35:12,528
I've seen many people in my career who almost believe it's really

526
00:35:12,528 --> 00:35:17,228
impossible to magically plan out how your life will turn out.

527
00:35:17,228 --> 00:35:20,988
And they try to plan their children's lives, too.

528
00:35:20,988 --> 00:35:25,970
Sometimes it seems as though they can because nothing terrible

529
00:35:25,970 --> 00:35:29,730
has ever happened to them in their lives thus far.

530
00:35:29,730 --> 00:35:34,430
Everything has gone as expected, then they experience a loss.

531
00:35:34,430 --> 00:35:39,506
And the closer this loss relates to their sense of who they are and

532
00:35:39,506 --> 00:35:42,044
where they see their lives going,

533
00:35:42,044 --> 00:35:46,744
the greater the difficulty will be in coming to terms with it.

534
00:35:46,744 --> 00:35:51,068
In failing the examination, I temporarily lost the plot.

535
00:35:51,068 --> 00:35:57,930
I thought I'd safely sketched out for the story of the rest of my life.

536
00:35:57,930 --> 00:36:00,186
No one else created this plan.

537
00:36:00,186 --> 00:36:02,254
I was quite sure it was mine.

538
00:36:02,254 --> 00:36:07,236
I disregarded any thought that I might have still been trying to

539
00:36:07,236 --> 00:36:12,406
please my father in some way, even though my father was dead and gone.

540
00:36:12,406 --> 00:36:17,200
I realize now that I was effectively papering over the cracks

541
00:36:17,200 --> 00:36:21,618
which had threatened to appear after my father's death.

542
00:36:21,618 --> 00:36:26,788
At the time, it merely seemed as though I temporarily lost my way and

543
00:36:26,788 --> 00:36:27,916
found it again.

544
00:36:27,916 --> 00:36:33,744
But I failed to understand that coming off the preordained track of my life,

545
00:36:33,744 --> 00:36:36,564
might have been what I really needed.

546
00:36:36,564 --> 00:36:42,580
I've learned that sometimes those moments of chaos when life careers is off

547
00:36:42,580 --> 00:36:48,972
the rails hold important messages about things we need to change in our existence.

548
00:36:48,972 --> 00:36:51,980
And the rigid expectations that we, and

549
00:36:51,980 --> 00:36:56,962
others, have of us that we need to challenge before it's too late.

550
00:36:56,962 --> 00:36:58,466
If we address these,

551
00:36:58,466 --> 00:37:03,918
we can start to move forward once more towards achieving our own goals.

552
00:37:03,918 --> 00:37:09,088
If we choose the goals ourselves, we have a better chance of success.

553
00:37:09,088 --> 00:37:13,318
My father died when I was halfway through my house jobs,

554
00:37:13,318 --> 00:37:16,890
the one year I did after qualifying as a doctor.

555
00:37:16,890 --> 00:37:21,214
And we had become quite estranged after very difficult

556
00:37:21,214 --> 00:37:25,632
adolescence when I'd been really close to him as a child.

557
00:37:25,632 --> 00:37:27,230
And I didn't grieve.

558
00:37:27,230 --> 00:37:32,682
I was doing a two in three on call as surgery, that worked out as one night

559
00:37:32,682 --> 00:37:38,604
first on call, one night second on call when you couldn't leave the building.

560
00:37:38,604 --> 00:37:43,398
And one night off when we usually just went to the pub next door,

561
00:37:43,398 --> 00:37:44,902
and that was my life.

562
00:37:44,902 --> 00:37:50,260
And that was a really good way of avoiding having to deal with the loss.

563
00:37:50,260 --> 00:37:51,858
I went to the funeral.

564
00:37:51,858 --> 00:37:56,558
I even remember telling myself that it was easier that he'd

565
00:37:56,558 --> 00:37:59,096
gone because he was so difficult.

566
00:37:59,096 --> 00:38:04,078
And it was five years before I actually started to grieve for him.

567
00:38:04,078 --> 00:38:07,368
And that was after my first psychotherapy.

568
00:38:07,368 --> 00:38:11,128
And I started to grieve for him, strangely enough,

569
00:38:11,128 --> 00:38:14,230
when a relationship I'd had broke down.

570
00:38:14,230 --> 00:38:15,734
And I was crying, and

571
00:38:15,734 --> 00:38:20,528
then I realized I wasn't really crying about losing that man.

572
00:38:20,528 --> 00:38:24,758
I was crying about losing my father.

573
00:38:24,758 --> 00:38:27,296
I thought my life was planned out,

574
00:38:27,296 --> 00:38:31,056
that I would go to university and become a doctor.

575
00:38:31,056 --> 00:38:36,978
And then I thought I found my place in psychiatry and then I made a mess of that.

576
00:38:36,978 --> 00:38:41,584
But I did manage to pass the exams and I did manage to carry on.

577
00:38:41,584 --> 00:38:43,182
I've kind of, I guess,

578
00:38:43,182 --> 00:38:48,916
I've come to terms with having what David Karp calls an illness identity.

579
00:38:48,916 --> 00:38:55,214
I know that I have episodes of depression, but it's really hard for a lot of people.

580
00:38:55,214 --> 00:38:58,598
Some people don't have repeated episodes.

581
00:38:58,598 --> 00:39:01,512
Some people only have one episode and

582
00:39:01,512 --> 00:39:07,246
they they want to be absolutely normal again afterwards and that's fine.

583
00:39:07,246 --> 00:39:09,878
But I have had recurrent episodes.

584
00:39:09,878 --> 00:39:14,578
What I've tried to do is always to not let that define who I am.

585
00:39:14,578 --> 00:39:18,432
Yes, I get depressed, but that's only one part of me.

586
00:39:18,432 --> 00:39:22,380
The rest of the time I can function reasonably well.

587
00:39:22,380 --> 00:39:26,516
There are just times when I don't function very well.

588
00:39:26,516 --> 00:39:30,464
And I have to rely on my husband and when I was at work,

589
00:39:30,464 --> 00:39:34,694
my colleagues, to tell me when things were going astray.

590
00:39:34,694 --> 00:39:38,172
Because they would usually notice the signs.

591
00:39:38,172 --> 00:39:41,932
I would be repeating the same questions over and

592
00:39:41,932 --> 00:39:44,846
over in an attempt to reassure myself.

593
00:39:44,846 --> 00:39:49,076
I would find it very hard to get out of bed in the morning.

594
00:39:49,076 --> 00:39:51,050
I'd start to lose weight.

595
00:39:51,050 --> 00:39:54,434
And I think I'm at the point now of defining

596
00:39:54,434 --> 00:39:59,604
my depression as a condition that I can get past.

597
00:39:59,604 --> 00:40:03,458
I've talked a bit about my experience of therapy.

598
00:40:03,458 --> 00:40:08,816
I've had psychodynamic psychotherapy looking at my relationship

599
00:40:08,816 --> 00:40:14,456
with my father and also my rather difficult relationship with my mother.

600
00:40:14,456 --> 00:40:19,438
Which was part of the reason why my father and I became estranged,

601
00:40:19,438 --> 00:40:23,574
because my mother came between us, I think, in many ways.

602
00:40:23,574 --> 00:40:27,522
And then later, when I was having difficulty at work,

603
00:40:27,522 --> 00:40:30,530
I had some cognitive behavior therapy.

604
00:40:30,530 --> 00:40:33,162
So I've had both types of therapy.

605
00:40:33,162 --> 00:40:38,050
And they were helpful at different times for different things.

606
00:40:38,050 --> 00:40:41,810
Because I found that CBT actually helped me cope

607
00:40:41,810 --> 00:40:44,536
with the everyday stresses of work.

608
00:40:44,536 --> 00:40:49,424
I learned how to manage my constantly repetitive thoughts and

609
00:40:49,424 --> 00:40:51,304
that was really helpful.

610
00:40:51,304 --> 00:40:56,850
I worked with a therapist that was an expert in anxious ruminations and

611
00:40:56,850 --> 00:40:58,918
he was enormously helpful.

612
00:40:58,918 --> 00:41:05,028
But it was entirely different experience from my first experience of therapy.

613
00:41:05,028 --> 00:41:09,164
He wasn't interested in me talking all about my life.

614
00:41:09,164 --> 00:41:12,266
We had to just get down and talk about now.

615
00:41:12,266 --> 00:41:14,992
And that was completely different.

616
00:41:14,992 --> 00:41:21,008
And I don't think that would have been right for me when I was trying to grieve.

617
00:41:21,008 --> 00:41:24,392
I've also taken a great deal of medication.

618
00:41:24,392 --> 00:41:29,280
And I know that there are a lot of people who are antagonistic to

619
00:41:29,280 --> 00:41:31,536
the idea of antidepressants.

620
00:41:31,536 --> 00:41:36,142
I know that there are some people who think they don't work.

621
00:41:36,142 --> 00:41:40,780
I know there are some people who think they're dangerous.

622
00:41:40,780 --> 00:41:44,411
I have colleagues who've written about that.

623
00:41:44,411 --> 00:41:49,661
I can only say that the depression at the severe end of the spectrum,

624
00:41:49,661 --> 00:41:52,240
which mine is, they can be helpful.

625
00:41:52,240 --> 00:41:58,258
And I've now been on antidepressants continuously for the last 22 years.

626
00:41:58,258 --> 00:42:02,364
And I don't think they've done me any lasting harm.

627
00:42:02,364 --> 00:42:06,088
Although, you may think otherwise, I don't know.

628
00:42:06,088 --> 00:42:08,189
But they've kept me alive.

629
00:42:08,189 --> 00:42:11,914
I've had to have them changed from time to time.

630
00:42:11,914 --> 00:42:16,307
When I've gone down to one, I've had to go up to two again.

631
00:42:16,307 --> 00:42:20,129
I've had a whole range of different substances.

632
00:42:20,129 --> 00:42:24,617
At the moment, I'm on a combination that seemed to suit me.

633
00:42:24,617 --> 00:42:29,486
And they've kept me really very well for the last 18 months,

634
00:42:29,486 --> 00:42:32,256
and I hope that's going to carry on.

635
00:42:32,256 --> 00:42:36,267
But a lot depends on what's happening in my life, or

636
00:42:36,267 --> 00:42:41,423
how much stress I put myself under, and that's part of the problem.

637
00:42:41,423 --> 00:42:45,243
If you're an ambitious person, as I have been, but

638
00:42:45,243 --> 00:42:50,879
you also are vulnerable, then there's always going to be difficulties.

639
00:42:50,879 --> 00:42:55,079
And you've really got to try and plan your life out, so

640
00:42:55,079 --> 00:43:02,051
that there are safety nets, and I have those safety nets in place, I hope.

641
00:43:02,051 --> 00:43:07,305
I've talked about a psychological therapy that didn't work, and

642
00:43:07,305 --> 00:43:12,462
I would say that for me, the most important thing in psychological

643
00:43:12,462 --> 00:43:17,524
therapy is that you can trust the person that you're talking to.

644
00:43:17,524 --> 00:43:22,391
And one of the concerns I have about the NHS at the moment is its

645
00:43:22,391 --> 00:43:24,111
sheer in flexibility.

646
00:43:24,111 --> 00:43:28,410
It's not about finding what's right for the patient.

647
00:43:28,410 --> 00:43:32,041
It's finding about where the patient fits in.

648
00:43:32,041 --> 00:43:35,097
And do you fit into my particular niche?

649
00:43:35,097 --> 00:43:38,151
And if you don't, well, I can't help you.

650
00:43:38,151 --> 00:43:43,500
And that's always made me very angry, because I had therapists that

651
00:43:43,500 --> 00:43:49,038
went out of their way I know in order to provide what I needed at the time.

652
00:43:49,038 --> 00:43:54,483
And it's really, really important when you're looking for therapy,

653
00:43:54,483 --> 00:44:01,073
to make sure that you find people who are properly registered, properly supervised.

654
00:44:01,073 --> 00:44:03,556
There are ways to check that out.

655
00:44:03,556 --> 00:44:08,618
But there are always risks of harm, and psychological therapies,

656
00:44:08,618 --> 00:44:12,440
we've talked about side effects of medication,

657
00:44:12,440 --> 00:44:15,593
of which I've experienced most of them.

658
00:44:15,593 --> 00:44:20,081
But psychological therapy can have its problems as well.

659
00:44:20,081 --> 00:44:23,425
So I think it's important to be realistic,

660
00:44:23,425 --> 00:44:28,200
it's hard work, and it requires quite a lot of participation.

661
00:44:28,200 --> 00:44:32,688
It isn't something that people do to you, you have to work,

662
00:44:32,688 --> 00:44:34,693
and it can be very painful.

663
00:44:34,693 --> 00:44:40,902
And sometimes, just getting week to week can be very painful.

664
00:44:40,902 --> 00:44:44,914
I've had a lot of side effects on antidepressants,

665
00:44:44,914 --> 00:44:50,358
which is one of the reasons why I didn't originally want to take them.

666
00:44:50,358 --> 00:44:55,897
But I had an episode when, as I said, the talking stopped being effective.

667
00:44:55,897 --> 00:45:01,629
What people tell me is they're worried about being independent on them,

668
00:45:01,629 --> 00:45:08,412
they're worried about the side effects, what to tell other people.

669
00:45:08,412 --> 00:45:13,666
I've often made a point of getting my tablet out of breakfast when

670
00:45:13,666 --> 00:45:19,110
I've been in the company with a psychiatrist, and seek how they react.

671
00:45:19,110 --> 00:45:23,312
And there are some that look away with embarrassment,

672
00:45:23,312 --> 00:45:26,082
which I always find really amusing.

673
00:45:26,082 --> 00:45:31,048
Because you would really expect that wouldn't be the case, but

674
00:45:31,048 --> 00:45:36,395
I can tell you, psychiatrists are as aware of stigma as everyone else.

675
00:45:36,395 --> 00:45:38,975
Do they have long-term effects?

676
00:45:38,975 --> 00:45:40,407
Who's the real me?

677
00:45:40,407 --> 00:45:42,986
Is this the real me on medication?

678
00:45:42,986 --> 00:45:46,710
Or if I stop the tablets, would that be the real me?

679
00:45:46,710 --> 00:45:49,576
Well, it will be another version of me.

680
00:45:49,576 --> 00:45:54,352
But my husband says he remembers that other version of me, and

681
00:45:54,352 --> 00:45:57,598
it was a bit up and down.

682
00:45:57,598 --> 00:46:03,328
There's two ways to problems we have to go through when you take tablets.

683
00:46:03,328 --> 00:46:08,010
Alice Malpass in Bristol wrote a very nice paper about this.

684
00:46:08,010 --> 00:46:12,882
She talked about the moral career of experiencing treatment.

685
00:46:12,882 --> 00:46:17,369
That what the doctors tell you is you have a duty to be well,

686
00:46:17,369 --> 00:46:20,042
that when you take the tablets and

687
00:46:20,042 --> 00:46:24,626
get well, then you won't be stigmatized, you'll be better.

688
00:46:24,626 --> 00:46:29,970
And then you can get back to work, and then you can get on with your life.

689
00:46:29,970 --> 00:46:33,887
But what you're experiencing inside is you're

690
00:46:33,887 --> 00:46:37,135
experiencing the stigma of seeking help.

691
00:46:37,135 --> 00:46:42,960
And then there is a double stigma when you actually have to take treatment.

692
00:46:42,960 --> 00:46:46,683
And then you start to say well, is this the real me?

693
00:46:46,683 --> 00:46:50,981
And then you worry about being independent on them, and

694
00:46:50,981 --> 00:46:56,139
those are the kind of questions that go around in people's heads.

695
00:46:56,139 --> 00:47:00,915
I haven't mentioned much more about social factors either.

696
00:47:00,915 --> 00:47:04,353
And I think that, particularly for students,

697
00:47:04,353 --> 00:47:09,033
that's a big factor, financial problems, housing problems.

698
00:47:09,033 --> 00:47:14,762
I think one of the first times I, well, when I first went to see the counselor

699
00:47:14,762 --> 00:47:19,633
at university, it was because I was late applying to Edinburgh.

700
00:47:19,633 --> 00:47:22,974
Because I had not met the requirements, and

701
00:47:22,974 --> 00:47:26,221
I didn't expect to get an offer from them.

702
00:47:26,221 --> 00:47:28,035
But they took me anyway.

703
00:47:28,035 --> 00:47:31,187
So I didn't get into halls of residence,

704
00:47:31,187 --> 00:47:36,153
and I found myself sharing a room in digs with an extraordinary

705
00:47:36,153 --> 00:47:41,310
woman who was the [INAUDIBLE] competition drinking champion.

706
00:47:41,310 --> 00:47:42,456
>> [LAUGH] >> And

707
00:47:42,456 --> 00:47:48,473
had an entirely different approach to socializing and relationships to me.

708
00:47:48,473 --> 00:47:54,008
And I had to share a room with her, and I was desperate to get away from her,

709
00:47:54,008 --> 00:48:00,311
because I was lying on my bed trying to revise anatomy, while she was socializing.

710
00:48:00,311 --> 00:48:04,896
And loneliness is a big factor leaving home homesickness.

711
00:48:04,896 --> 00:48:09,670
So I'm just gonna say a bit more about how we get into therapy,

712
00:48:09,670 --> 00:48:12,247
and how do you get into treatment?

713
00:48:12,247 --> 00:48:16,353
And I've done quite a bit of research on that myself

714
00:48:16,353 --> 00:48:21,032
with groups of people who find it hard to get into treatment.

715
00:48:21,032 --> 00:48:25,616
And I'll reflect on my own experiences of that in a moment.

716
00:48:25,616 --> 00:48:30,582
First of all, you've actually got to recognize that you need it,

717
00:48:30,582 --> 00:48:32,396
and that's a big issue.

718
00:48:32,396 --> 00:48:35,452
Then you've got to find your way there.

719
00:48:35,452 --> 00:48:39,942
So that means there's got to be sufficient information

720
00:48:39,942 --> 00:48:42,998
around the university to get you there.

721
00:48:42,998 --> 00:48:46,532
Then you've got to physically get there, and

722
00:48:46,532 --> 00:48:51,116
talk to someone about things that are very personal to you.

723
00:48:51,116 --> 00:48:55,793
And then they've got to make a decision if they can help you,

724
00:48:55,793 --> 00:48:58,851
and/or whether someone else needs to.

725
00:48:58,851 --> 00:49:01,430
All of those steps are difficult.

726
00:49:01,430 --> 00:49:07,541
And I would always encourage any of you who are in that position as therapists

727
00:49:07,541 --> 00:49:12,602
to really think, how does this person come to be in the room with me?

728
00:49:12,602 --> 00:49:18,141
And how much do they understand about what you need to do to feel better?

729
00:49:18,141 --> 00:49:23,775
And I don't think we pay enough attention to how ambivalent people are.

730
00:49:23,775 --> 00:49:27,689
And ambivalence, for me, is one of the core feelings.

731
00:49:27,689 --> 00:49:30,746
I've experienced it with my patients.

732
00:49:30,746 --> 00:49:36,284
I've seen people who say, I don't want to live, but I'm afraid of dying.

733
00:49:36,284 --> 00:49:40,868
And there's a very wonderful little book on ambivalence

734
00:49:40,868 --> 00:49:44,783
that some of you may have seen by Kenneth Weisberg.

735
00:49:44,783 --> 00:49:49,655
And I'm just going to quote something from it on ambivalence,

736
00:49:49,655 --> 00:49:53,381
which describes this for me really powerfully.

737
00:49:53,381 --> 00:49:56,627
Ambivalence lies at the core of who we are.

738
00:49:56,627 --> 00:50:02,168
It's something more subtle, and more devastating than human frailty.

739
00:50:02,168 --> 00:50:04,365
Weaknesses can be remedied.

740
00:50:04,365 --> 00:50:08,281
Ambivalence comes rather from too much ambition.

741
00:50:08,281 --> 00:50:12,007
Desire begets dissatisfaction, and vice versa.

742
00:50:12,007 --> 00:50:14,491
Optimization becomes a fetish.

743
00:50:14,491 --> 00:50:18,502
Wanting the best means that we must have both or all.

744
00:50:18,502 --> 00:50:24,804
And we're reluctant to give up any option, lest we pull up the roots of our desire.

745
00:50:24,804 --> 00:50:29,676
That's why ambivalence is so hard to confront, understand or

746
00:50:29,676 --> 00:50:32,636
master, and why it can be so disastrous.

747
00:50:32,636 --> 00:50:36,169
Most of us know this, yet we continue to deny it.

748
00:50:36,169 --> 00:50:42,377
Many people who are seeking help are experiencing that powerful ambivalence.

749
00:50:42,377 --> 00:50:47,247
And unless we acknowledge that, it can be very hard to deal with.

750
00:50:47,247 --> 00:50:51,066
I, as a doctor, doctors are supposed to be strong, so

751
00:50:51,066 --> 00:50:56,224
I'm not supposed to have emotional problems, even in psychiatry.

752
00:50:56,224 --> 00:51:00,617
So that is that is fighting against my desire to get help.

753
00:51:00,617 --> 00:51:04,721
So when I want to be me, but I want to get help, I want both.

754
00:51:04,721 --> 00:51:09,113
But I have to give up something in order to go and get help.

755
00:51:09,113 --> 00:51:13,505
I have to risk that people will see me in the waiting room.

756
00:51:13,505 --> 00:51:17,800
And one of my psychiatrists used to say you can come and

757
00:51:17,800 --> 00:51:22,667
sit in here if you want now, so I actually set her on one occasion.

758
00:51:22,667 --> 00:51:27,250
No, I make my patients sit in this room, I'm going to sit here.

759
00:51:27,250 --> 00:51:33,075
And I'll sit here watching property programs with the sound turned down,

760
00:51:33,075 --> 00:51:36,895
just like everyone else does in the waiting room.

761
00:51:36,895 --> 00:51:41,384
About the worst possible thing you can watch actually if

762
00:51:41,384 --> 00:51:44,440
you're poor is property porn on the TV.

763
00:51:44,440 --> 00:51:48,737
But people often get told that they're not motivated,

764
00:51:48,737 --> 00:51:53,704
and I think there's all sorts of things about being motivated.

765
00:51:53,704 --> 00:51:57,047
You might find it hard to attend regularly,

766
00:51:57,047 --> 00:52:02,587
because you've got to tell someone that you've got to miss a lecture.

767
00:52:02,587 --> 00:52:07,171
You got to tell someone that you've got to miss workshops.

768
00:52:07,171 --> 00:52:11,279
You might not understand what therapy's all about,

769
00:52:11,279 --> 00:52:14,336
because no one's really explained it.

770
00:52:14,336 --> 00:52:17,870
You might find it really hard to go to therapy,

771
00:52:17,870 --> 00:52:21,214
because your life's in complete turmoil.

772
00:52:21,214 --> 00:52:26,468
You don't really know whether you're going to be sober tomorrow

773
00:52:26,468 --> 00:52:32,485
morning after you've had another argument and drank a lot the night before.

774
00:52:32,485 --> 00:52:35,158
And you might feel so hopeless and

775
00:52:35,158 --> 00:52:39,263
lacking in energy, that you can't get out of bed to go.

776
00:52:39,263 --> 00:52:43,847
So when I hear that people have been offered something, and

777
00:52:43,847 --> 00:52:48,910
then they've been discharged because they haven't turned up.

778
00:52:48,910 --> 00:52:54,735
It always makes me want to say well, how hard have you tried to get them there?

779
00:52:54,735 --> 00:52:59,128
And that has been my experience of treating doctors and

780
00:52:59,128 --> 00:53:03,999
other people in health professions, but also students as well.

781
00:53:03,999 --> 00:53:10,491
I'm going to come to an end now, and I want to just say a few things.

782
00:53:10,491 --> 00:53:14,791
What I've learned from experiencing depression, and

783
00:53:14,791 --> 00:53:19,567
also being a psychiatrist is that there's no single answer.

784
00:53:19,567 --> 00:53:25,204
There are all those self-help books that people have on their shelves,

785
00:53:25,204 --> 00:53:28,163
and they've each got a single answer.

786
00:53:28,163 --> 00:53:33,318
And you might find the one that suits you, but none of them actually

787
00:53:33,318 --> 00:53:39,048
say there's no single answer, because that doesn't make for good sales.

788
00:53:39,048 --> 00:53:41,817
So for each person, on each occasion,

789
00:53:41,817 --> 00:53:47,263
the parts played by the different dimensions of biology, psychology,

790
00:53:47,263 --> 00:53:52,325
and life circumstances will be important to a different degree.

791
00:53:52,325 --> 00:53:56,050
And that's true at different points in my life.

792
00:53:56,050 --> 00:54:01,400
As I'm getting older, it feels like biology is playing a bigger part.

793
00:54:01,400 --> 00:54:04,551
My brain isn't as hot as it used to be, and

794
00:54:04,551 --> 00:54:09,423
I've also now got chronic kidney disease, which is inherited.

795
00:54:09,423 --> 00:54:15,438
But fortunately, I didn't know that I had it until I was just had just retired.

796
00:54:15,438 --> 00:54:17,347
The help and support and

797
00:54:17,347 --> 00:54:23,365
treatment required may be different at different times in a person's life.

798
00:54:23,365 --> 00:54:29,287
So when we have things where everyone is offered CBT, that's just not right,

799
00:54:29,287 --> 00:54:34,636
because you need different things at different points in your life.

800
00:54:34,636 --> 00:54:37,979
Sometimes you just need someone to talk to.

801
00:54:37,979 --> 00:54:42,564
You don't need someone who's going to immediately give

802
00:54:42,564 --> 00:54:46,765
you an exercise book and say go and do these exercises.

803
00:54:46,765 --> 00:54:52,592
My life's been profoundly affected by my experiences and mental health.

804
00:54:52,592 --> 00:54:56,698
It hasn't turned out how I thought it would turn out.

805
00:54:56,698 --> 00:55:02,140
When I was at school, I think one of the reasons I went to medical school

806
00:55:02,140 --> 00:55:07,107
was that at my grammar school in the east coast of Lincolnshire,.

807
00:55:07,107 --> 00:55:11,688
If you did well in A levels, you seem to end up as a teacher and

808
00:55:11,688 --> 00:55:13,216
come back and teach.

809
00:55:13,216 --> 00:55:16,846
So I was determined that wasn't going to be me,

810
00:55:16,846 --> 00:55:20,663
I was going to get away, and I was going to have a job.

811
00:55:20,663 --> 00:55:25,628
Where I would have, I was going to do a degree where I'd have a job,

812
00:55:25,628 --> 00:55:28,971
and be able to be financially independent.

813
00:55:28,971 --> 00:55:31,740
And I have managed those things, but

814
00:55:31,740 --> 00:55:36,133
it's just not quite worked out quite the way sometimes.

815
00:55:36,133 --> 00:55:40,908
I was never going to get married, and I managed to do that twice.

816
00:55:40,908 --> 00:55:44,249
Life never does work out the way you expect.

817
00:55:44,249 --> 00:55:49,119
But I believe it's making a more capable and empathic doctor.

818
00:55:49,119 --> 00:55:52,748
I know what it's like to sit in the other chair.

819
00:55:52,748 --> 00:55:56,283
I know what's going through people's mind.

820
00:55:56,283 --> 00:56:00,868
I know what it's like to have those questions asked of you.

821
00:56:00,868 --> 00:56:06,217
I sometimes think of some of my colleagues knew how much time people

822
00:56:06,217 --> 00:56:12,522
spend thinking about what they're going to say in response to those questions,

823
00:56:12,522 --> 00:56:17,774
they wouldn't take it all for granted, that this was just the truth.

824
00:56:17,774 --> 00:56:21,595
Because it's very easy to lie in a consultation.

825
00:56:21,595 --> 00:56:26,371
It's also helped me to be a more enlightened teacher as well,

826
00:56:26,371 --> 00:56:31,242
because I've been able to work out I think what people needed.

827
00:56:31,242 --> 00:56:35,063
And it's certainly make me a better researcher,

828
00:56:35,063 --> 00:56:38,694
because I've found something that suited me.

829
00:56:38,694 --> 00:56:43,183
Which was about trying to improve the quality of care for

830
00:56:43,183 --> 00:56:48,149
people with mental health problems out there in the community,

831
00:56:48,149 --> 00:56:50,631
the people that don't get help.

832
00:56:50,631 --> 00:56:54,737
So a couple of last quotes that I'm going to read you.

833
00:56:54,737 --> 00:56:58,368
Depression is a profoundly personal illness.

834
00:56:58,368 --> 00:57:04,382
It burrows into the soul, and damages our sense of who we are, and our reason for

835
00:57:04,382 --> 00:57:09,632
living in the way a worm makes its way to the core of a ripening apple.

836
00:57:09,632 --> 00:57:14,501
We all have to find our own ways of managing the damages pauses,

837
00:57:14,501 --> 00:57:18,511
but I know from my own experience, that it can be done.

838
00:57:18,511 --> 00:57:22,234
Despite what some people may say, asking for and

839
00:57:22,234 --> 00:57:26,151
receiving help is really nothing to be ashamed of.

840
00:57:26,151 --> 00:57:27,679
Thank you very much.

841
00:57:27,679 --> 00:57:29,208
>> [APPLAUSE] >> Okay,

842
00:57:29,208 --> 00:57:33,791
I'd like to invite Dan Holloway to give the vote of thanks.

843
00:57:33,791 --> 00:57:40,953
Dan is a member of staff, a mental health activist, and a performance poet.

844
00:57:40,953 --> 00:57:46,113
>> Vice Chancellor, Catherine, Caroline definitely one disability

845
00:57:46,113 --> 00:57:50,890
advisory service, members of the disability advisory group.

846
00:57:50,890 --> 00:57:53,277
Everyone at the Blavatnik, and

847
00:57:53,277 --> 00:57:57,862
throughout the university who has made this event happen.

848
00:57:57,862 --> 00:58:00,632
Question is thank you.

849
00:58:00,632 --> 00:58:03,306
Stigma is the thing with branches.

850
00:58:03,306 --> 00:58:08,367
The miserly that will not shed its spines in winter.

851
00:58:08,367 --> 00:58:14,479
The hollow hinterland that matches the horizons where the eyes of reason and

852
00:58:14,479 --> 00:58:16,676
compassion will not follow.

853
00:58:16,676 --> 00:58:21,164
Then to thank you, for lighting a path into the wilderness,

854
00:58:21,164 --> 00:58:24,985
that the wilderness of passions dressed in dust.

855
00:58:24,985 --> 00:58:29,284
Fashion from half started lives now carcasses of rust,

856
00:58:29,284 --> 00:58:33,584
ashes from the lists of everything we thought we'd be.

857
00:58:33,584 --> 00:58:38,455
For caressing from the shards of carbon filaments of empathy,

858
00:58:38,455 --> 00:58:41,034
from which tomorrow built a nest.

859
00:58:41,034 --> 00:58:45,138
See, I can fly, but sometimes, I need you to give me wings.

860
00:58:45,138 --> 00:58:51,728
My heart is full of song that I sometimes need your love to me when I sing.

861
00:58:51,728 --> 00:58:55,931
Sometimes, people reel off lists of things I've done.

862
00:58:55,931 --> 00:59:00,229
Jobs done, ,medals won, ultramarathons run, poems told,

863
00:59:00,229 --> 00:59:05,574
him stories spun, and I wonder if I'm in a minority of one when I say me.

864
00:59:05,574 --> 00:59:09,298
Hardest thing I've ever done was get out of bed,

865
00:59:09,298 --> 00:59:13,785
but down the pillows, pick up some clothes, and face the sun.

866
00:59:13,785 --> 00:59:18,270
And all they can say is the least you could do is put on a tie.

867
00:59:18,270 --> 00:59:20,371
>> [LAUGH] >> And I think, look,

868
00:59:20,371 --> 00:59:21,994
you can have me shine.

869
00:59:21,994 --> 00:59:25,814
Well, okay, not shine, but at least get by light this,

870
00:59:25,814 --> 00:59:28,773
or you can have the last light in me die.

871
00:59:28,773 --> 00:59:32,497
It's easy to say we care, and that's not enough.

872
00:59:32,497 --> 00:59:37,939
It's easy to say we want the best for everyone, and that's not enough.

873
00:59:37,939 --> 00:59:43,671
It's easy to write beautiful mission statements, and that is not enough.

874
00:59:43,671 --> 00:59:46,441
It's easy to put faces on our walls.

875
00:59:46,441 --> 00:59:50,069
It's easy to celebrate the ones who did it all.

876
00:59:50,069 --> 00:59:55,036
It's easy to embrace a culture of support and till we're full.

877
00:59:55,036 --> 00:59:59,141
And we must do all those things, but that is not enough.

878
00:59:59,141 --> 01:00:04,489
We talk globally of a human cost, as though we know the world that will

879
01:00:04,489 --> 01:00:10,124
not change becomes a junkyard, where depositories of genius are tossed.

880
01:00:10,124 --> 01:00:11,747
But this is also hope.

881
01:00:11,747 --> 01:00:17,478
Damped down, it's smoking embers of a dreams dumped out like cigarettes.

882
01:00:17,478 --> 01:00:21,394
It's kisses choked before they leave the throat.

883
01:00:21,394 --> 01:00:24,833
It's everything that adds up to a life lost.

884
01:00:24,833 --> 01:00:29,131
Will not be stigma with celebrations of high flyers by

885
01:00:29,131 --> 01:00:33,525
filling dreaming spires with quires of good intention.

886
01:00:33,525 --> 01:00:38,589
Idolizing outliers by glamorizing myths of brilliant madness,

887
01:00:38,589 --> 01:00:40,978
or fetishising funeral pyres.

888
01:00:40,978 --> 01:00:46,038
Victory is simply this, that you are known not by a label, but a name.

889
01:00:46,038 --> 01:00:49,094
My wish, my dream, my right is for the same.

890
01:00:49,094 --> 01:00:51,560
>> [APPLAUSE]