Transcrição completa de 2016 Disability Lecture: A Psychiatrist's Experience of Depression

invited to speak here in such a beautiful building as well. 66 00:04:43,868 --> 00:04:47,344 I'm going to speak to you without a PowerPoint. 67 00:04:47,344 --> 00:04:51,173 I want to really try and speak to you very much from my 68 00:04:51,173 --> 00:04:55,362 heart rather than from reading through things on slides. 69 00:04:55,362 --> 00:04:56,609 I have some notes. 70 00:04:56,609 --> 00:05:00,438 First of all, I want to tell you a bit more about who I am. 71 00:05:00,438 --> 00:05:05,429 You've heard about my career, but perhaps, a little bit more about me. 72 00:05:05,429 --> 00:05:08,726 I was a clinical psychiatrist for 33 years. 73 00:05:08,726 --> 00:05:12,647 I went straight into psychiatry from medical school. 74 00:05:12,647 --> 00:05:16,477 And I was a consultant for the last 23 years of that. 75 00:05:16,477 --> 00:05:19,061 And I worked in the North of England. 76 00:05:19,061 --> 00:05:23,251 I think the furthest south I've ever lived is Sheffield, 77 00:05:23,251 --> 00:05:26,370 which gives some idea of, I'm a Northerner. 78 00:05:26,370 --> 00:05:29,932 I'm sure you can tell that from my accent anyway. 79 00:05:29,932 --> 00:05:32,605 But my interest, I worked in Barnsley, 80 00:05:32,605 --> 00:05:36,437 I worked in Preston, most recently, worked in Salford. 81 00:05:36,437 --> 00:05:41,604 And Barnsley and Preston are two of the most deprived areas of England. 82 00:05:41,604 --> 00:05:47,130 I've always had an interest in people with common mental health problems. 83 00:05:47,130 --> 00:05:52,032 With depression, anxiety, eating problems rather than more severe 84 00:05:52,032 --> 00:05:55,509 mental health problems such as schizophrenia. 85 00:05:55,509 --> 00:06:00,942 My interest has been in the people who don't, or do, get help in primary care. 86 00:06:00,942 --> 00:06:03,882 Only about 10% or less of people with 87 00:06:03,882 --> 00:06:08,784 mental health problems are treated in the mental health services. 88 00:06:08,784 --> 00:06:13,952 Although, many of my younger colleagues sometimes find it very hard to 89 00:06:13,952 --> 00:06:19,477 believe that GPs treat the majority of people with mental health problems. 90 00:06:19,477 --> 00:06:21,526 So that's been my interest. 91 00:06:21,526 --> 00:06:23,754 And I taught medical students, 92 00:06:23,754 --> 00:06:28,032 I taught junior doctors all of the things one would expect. 93 00:06:28,032 --> 00:06:30,882 But as well as that, I've been a patient. 94 00:06:30,882 --> 00:06:35,872 And I've been a patient in terms of my mental health ever since I was 95 00:06:35,872 --> 00:06:37,209 at medical school. 96 00:06:37,209 --> 00:06:40,862 My problems with anxiety began in my mid teens, and 97 00:06:40,862 --> 00:06:44,071 I had really awful anxiety about my A levels. 98 00:06:44,071 --> 00:06:47,012 I've always had a great fear of failing. 99 00:06:47,012 --> 00:06:51,737 I'm sure that's something that's quite a common experience. 100 00:06:51,737 --> 00:06:55,480 I'm in Oxford where people are high achievers, and 101 00:06:55,480 --> 00:06:57,885 I was a high achiever in my school. 102 00:06:57,885 --> 00:07:00,201 And then I went to Edinburgh and 103 00:07:00,201 --> 00:07:05,637 I was suddenly in a complete lecture theater full of other high achievers. 104 00:07:05,637 --> 00:07:07,597 So it was very competitive. 105 00:07:07,597 --> 00:07:10,716 I have had several episodes of depression, 106 00:07:10,716 --> 00:07:14,637 some of them quite severe throughout my working life. 107 00:07:14,637 --> 00:07:19,449 My first episode was more severe episode was as medical students. 108 00:07:19,449 --> 00:07:24,707 And as you might imagine, given that my problems began around my A levels. 109 00:07:24,707 --> 00:07:26,845 I had problems with my finals. 110 00:07:26,845 --> 00:07:30,676 And at that time, I rang up the consultant afterwards. 111 00:07:30,676 --> 00:07:35,753 I got through them and I rang up the consultant who had taken care of me. 112 00:07:35,753 --> 00:07:40,476 And I said, I wonder what you think about me going into psychiatry. 113 00:07:40,476 --> 00:07:46,536 Because psychiatry it actually being the subject that I was best at at university. 114 00:07:46,536 --> 00:07:50,724 I somehow seemed to be able to understand how people felt. 115 00:07:50,724 --> 00:07:55,002 And he did pause for a moment, there was a perceptible pause. 116 00:07:55,002 --> 00:07:58,297 And then he said, I think it would be a good idea. 117 00:07:58,297 --> 00:08:03,018 And that really changed my life because although I had done very 118 00:08:03,018 --> 00:08:07,830 well in psychiatry, I really thought that because I'd had mental 119 00:08:07,830 --> 00:08:12,375 health problems as a student, I couldn't possibly go and do it. 120 00:08:12,375 --> 00:08:15,226 And my experience follows on from that. 121 00:08:15,226 --> 00:08:16,563 I've now retired. 122 00:08:16,563 --> 00:08:20,841 I retired from the University of Manchester two years ago. 123 00:08:20,841 --> 00:08:26,186 And I kind of hoped that once I retired I wouldn't have any more episodes, 124 00:08:26,186 --> 00:08:28,058 everything would be fine. 125 00:08:28,058 --> 00:08:30,908 And then a year ago I got quite ill again. 126 00:08:30,908 --> 00:08:33,136 So it's been a lifelong thing. 127 00:08:33,136 --> 00:08:38,124 What I want to talk to you about really is a bit more about the subject 128 00:08:38,124 --> 00:08:40,710 of depression and about treatment. 129 00:08:40,710 --> 00:08:45,609 But before I go on to that, I just want to remind us I've been writing 130 00:08:45,609 --> 00:08:50,422 a paper recently about an intervention we did training people in 131 00:08:50,422 --> 00:08:55,057 universities to be better at helping people in acute distress. 132 00:08:55,057 --> 00:08:57,817 And it's hard to find data from the UK. 133 00:08:57,817 --> 00:09:02,006 But the US National College Health

Assessment 2013, 134 00:09:02,006 --> 00:09:07,087 reported 31.1% of undergraduates had felt so depressed at any 135 00:09:07,087 --> 00:09:12,344 time during the previous 12 months, that it was difficult to function. 136 00:09:12,344 --> 00:09:18,407 5.9% had intentionally cut, burned, bruised, or otherwise injured themselves. 137 00:09:18,407 --> 00:09:24,022 7.4% had seriously considered suicide in the previous 12 months and 138 00:09:24,022 --> 00:09:26,429 1.5% had attempted suicide. 139 00:09:26,429 --> 00:09:31,687 And a review of the epidemiology of college student suicide, noted that 140 00:09:31,687 --> 00:09:37,212 the age at which you go to university is a period of great transition on many 141 00:09:37,212 --> 00:09:42,831 different levels, socially, academically, psychologically, existentially. 142 00:09:42,831 --> 00:09:45,060 It's a period of great change. 143 00:09:45,060 --> 00:09:47,198 And it was certainly that for 144 00:09:47,198 --> 00:09:52,901 me because I came from a working class background in the east of Lincolnshire. 145 00:09:52,901 --> 00:09:57,001 And it was quite a shell shock for me going to university. 146 00:09:57,001 --> 00:10:01,635 I was the first person in my family to do that. 147 00:10:01,635 --> 00:10:05,020 I want to say a bit about what depression is and 148 00:10:05,020 --> 00:10:08,228 then relate that to my personal experience. 149 00:10:08,228 --> 00:10:12,060 I'll say a bit first about what it's supposed to be. 150 00:10:12,060 --> 00:10:16,426 I'll say that because if my academic colleagues were here, 151 00:10:16,426 --> 00:10:19,544 I'm sure that's how they would start off. 152 00:10:19,544 --> 00:10:23,109 And then, I'll talk about how it's experienced. 153 00:10:23,109 --> 00:10:27,563 And then I'll talk a bit more about my own beliefs about that. 154 00:10:27,563 --> 00:10:32,554 If a psychiatrist was here giving a lecture to you about depression, 155 00:10:32,554 --> 00:10:38,793 they will start off by telling you that there's something called major depression. 156 00:10:38,793 --> 00:10:41,999 And to have this you have to have depression, 157 00:10:41,999 --> 00:10:46,988 low mood and/or loss of interest or pleasure for at least two weeks. 158 00:10:46,988 --> 00:10:51,353 And you have to have at least four of the following symptoms. 159 00:10:51,353 --> 00:10:56,165 Change in sleep, that's sleeping too much or not sleeping enough. 160 00:10:56,165 --> 00:11:01,246 Change in appetite, loss of energy or motivation, poor concentration, 161 00:11:01,246 --> 00:11:05,259 guilt, self-reproach, retardation, being slowed up, or 162 00:11:05,259 --> 00:11:09,359 being agitated, and suicidal thoughts or hopelessness. 163 00:11:09,359 --> 00:11:14,706 And that comes straight out of The Diagnostic and Statistical Manual of 164 00:11:14,706 --> 00:11:20,590 the American Psychiatric Association which is currently in its fifth version. 165 00:11:20,590 --> 00:11:26,205 And they would be telling you about all the biological models of depression. 166 00:11:26,205 --> 00:11:31,641 Anyone who follows the discussion on the web, but particularly on Twitter 167 00:11:31,641 --> 00:11:38,058 will know that there's a constant argument about the monoamine theory of depression. 168 00:11:38,058 --> 00:11:43,230 And psychologists sometimes say psychiatrists are still holding on 169 00:11:43,230 --> 00:11:48,844 to this and psychiatrists will say, no, we stopped believing in that years ago. 170 00:11:48,844 --> 00:11:50,715 But we don't really know, 171 00:11:50,715 --> 00:11:56,510 there's many different theories about the biological causes of depression. 172 00:11:56,510 --> 00:11:58,827 Genes certainly play a part, and 173 00:11:58,827 --> 00:12:03,905 I'll say a bit more about that in relation to my own family in a moment. 174 00:12:03,905 --> 00:12:07,649 The latest theory is it's all about inflammation. 175 00:12:07,649 --> 00:12:10,944 So you just have to say the word inflammation. 176 00:12:10,944 --> 00:12:15,578 And that's the latest theory, theory for most things actually. 177 00:12:15,578 --> 00:12:20,391 And then physical things can cause depression, alcohol and drugs. 178 00:12:20,391 --> 00:12:24,133 You can be depressed because you were drinking and 179 00:12:24,133 --> 00:12:27,697 you can get depressed because you stop drinking. 180 00:12:27,697 --> 00:12:29,210 They both play a part. 181 00:12:29,210 --> 00:12:32,330 Physical illness, chronic illness, cancer, 182 00:12:32,330 --> 00:12:36,966 having an under-active thyroid, tablets that you're taking. 183 00:12:36,966 --> 00:12:42,490 But the theories that most people know are the psychological theories and 184 00:12:42,490 --> 00:12:45,521 almost everyone knows about, I mean Freud. 185 00:12:45,521 --> 00:12:50,155 Freud is kind of parsed into common parlance people have heard 186 00:12:50,155 --> 00:12:51,848 about some of his ideas. 187 00:12:51,848 --> 00:12:57,375 And he very much believed the psychodynamic understanding of depression 188 00:12:57,375 --> 00:13:02,722 is that past relationships have an influence on our lives in the present. 189 00:13:02,722 --> 00:13:07,532 So your relationship with your parents will have an impact on how 190 00:13:07,532 --> 00:13:09,760 you relate to other people now. 191 00:13:09,760 --> 00:13:13,236 And that might result in you getting depressed. 192 00:13:13,236 --> 00:13:17,695 Psychological models also include cognitive models which 193 00:13:17,695 --> 00:13:19,478 are really fashionable. 194 00:13:19,478 --> 00:13:24,378 It's quite hard, in many places, to get any other kind of therapy, but 195 00:13:24,378 --> 00:13:25,805 cognitive therapy. 196 00:13:25,805 --> 00:13:31,328 And that very much comes from the theory that if we think negative thoughts 197 00:13:31,328 --> 00:13:36,585 that can not only cause us to become depressed, but can keep us depressed. 198 00:13:36,585

--> 00:13:41,397 And there are also behavioral ideas that when we get depressed we 199 00:13:41,397 --> 00:13:44,427 stop doing the things that we enjoy doing. 200 00:13:44,427 --> 00:13:48,435 We stop doing the things we have to do, and we retreat, and 201 00:13:48,435 --> 00:13:52,801 that we can actually recover by starting to do things again. 202 00:13:52,801 --> 00:13:57,433 The idea of acting better will actually help you to feel better. 203 00:13:57,433 --> 00:13:59,928 And there is social models as well. 204 00:13:59,928 --> 00:14:04,026 What we certainly know is that people who had trauma and 205 00:14:04,026 --> 00:14:08,483 early abuse in their lives are more likely to get depression. 206 00:14:08,483 --> 00:14:12,225 People who have had chronic lack of social support. 207 00:14:12,225 --> 00:14:15,700 And the areas that I've worked with in England, 208 00:14:15,700 --> 00:14:20,154 I guess there's four things that come up over and over again. 209 00:14:20,154 --> 00:14:26,035 I call them the four Ds, debt, disease, divorce and deprivation. 210 00:14:26,035 --> 00:14:27,906 So how do we experience it? 211 00:14:27,906 --> 00:14:32,095 Well, there's a lot of memoirs written about depression. 212 00:14:32,095 --> 00:14:35,481 I've written my own, but there are many others. 213 00:14:35,481 --> 00:14:39,402 And I've often encouraged my students to go away and 214 00:14:39,402 --> 00:14:45,195 read about people's experience rather than starting from the nine symptoms. 215 00:14:45,195 --> 00:14:50,362 Go away and find out how people actually feel when they're depressed. 216 00:14:50,362 --> 00:14:52,145 Let's start from there. 217 00:14:52,145 --> 00:14:54,818 And there are some well-known ones. 218 00:14:54,818 --> 00:14:58,916 There's a very, very good book called Darkness Visible, 219 00:14:58,916 --> 00:15:01,590 which was written by William Styron. 220 00:15:01,590 --> 00:15:04,888 He was the author who wrote Sophie's Choice. 221 00:15:04,888 --> 00:15:10,145 And a more modern one that I found particularly affecting was by Tim Lot, 222 00:15:10,145 --> 00:15:12,106 the journalist and writer. 223 00:15:12,106 --> 00:15:15,849 Who wrote a book called The Scent of Dried Roses, and 224 00:15:15,849 --> 00:15:21,911 that was about getting depressed following the unexpected suicide of his mother. 225 00:15:21,911 --> 00:15:26,811 And he talks very much in that book about how depression can affect 226 00:15:26,811 --> 00:15:28,414 the sense of who we are. 227 00:15:28,414 --> 00:15:31,622 But I would say that they're all different, 228 00:15:31,622 --> 00:15:37,061 because I think that people's experiences of depression are different. 229 00:15:37,061 --> 00:15:39,734 One person may relate to a memoir and 230 00:15:39,734 --> 00:15:43,031 another person may find it very difficult to. 231 00:15:43,031 --> 00:15:45,170 So what do people experience? 232 00:15:45,170 --> 00:15:46,774 What did I experience? 233

00:15:46,774 --> 00:15:49,713 Well, for me it's much more than sadness. 234 00:15:49,713 --> 00:15:55,506 There's a great or many people who think that depression is just unhappiness. 235 00:15:55,506 --> 00:15:57,376 It's much more than that. 236 00:15:57,376 --> 00:16:02,723 It's a loss of vitality, it's a loss of joy, it's a sense of utter despair. 237 00:16:02,723 --> 00:16:06,199 And when I get depressed, I can't think clearly. 238 00:16:06,199 --> 00:16:08,159 My brain seems to shut down. 239 00:16:08,159 --> 00:16:13,061 I'll give you a small quote here from something I wrote about when 240 00:16:13,061 --> 00:16:17,516 I was very depressed, when I was having major problems at work. 241 00:16:17,516 --> 00:16:22,595 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]