AMA Victoria - Vicdoc August/September 2019

August / September 2019 Vicdoc | 11 I have a mental illness... and one day I might be your doctor Few forces exert such power in our society, influencing our subconscious mind and invoking our innate, self- protective responses. This is the power that stigma holds over us all; those who suffer mental illness and those who don’t. Stigma is fuelled by fear and a lack of understanding of what mental illness truly is. Stigma creates a chasm between those who struggle with mental illness and those with the good fortune not to have been dealt a bad hand in life. Of course, we bemoan stigma and may even claim to be above it. I, as a sufferer of mental illness, could even claim to be immune from its effects. To assert any of these beliefs, however, would be a vain attempt to delude ourselves. Every fleeting thought, each subtle comment, every little doubt is stigma rearing its ugly head. Yet perhaps the most damaging form of stigma is that directed inwardly by those suffering from mental illness. This is the stigma we rarely see: the irrational shame, the self-doubt, the relentless fear of relapse. As doctors, we are not above such stigma, despite soaring levels of psychological distress in our profession. Doctors continue to take their own lives at alarming rates despite years of awareness campaigns. We employ words like ’burnout‘ and blame systemic failures of an ageing population with complex health needs, the ever increasing paperwork, inadequate sick leave cover or punishing on-call rosters. These challenges are genuine avenues for significant change to improve doctors’ mental wellbeing. But for a moment, let us consider our own biases. Many of us still guardedly believe that fellow doctors who are brave enough to seek help for their mental illness are somehow failing, particularly if they do not immediately recover. Beliefs that those with a history of mental illness are somehow less competent, less reliable and less trustworthy still perpetuate. I recall being asked some years ago whether I agreed that, “A doctor who gets sick all the time can’t really ever be a good doctor to their patients”. This was not the dated perspective of an ageing doctor in their twilight years, but rather those of a bright-eyed medical student, with their whole career ahead of them. Attitudes like these must end if doctors are to feel safe in seeking help for their mental ill-health. As a psychiatry registrar, what I have found most striking, and the most difficult to communicate to my non-psychiatric colleagues, is the profound grief and loss suffered by those diagnosed with a chronic mental illness. ’Schizophrenia’, ‘bipolar disorder’, ‘personality disorder’. These are terms that invoke fear, indeed terror, at times, in those who hear them in much the same way that hearing the word ‘cancer’ might. The range of responses to these diagnoses are as varied as the illnesses themselves: denial, bemusement, even aggression. I am often witness to patients who completely shut down on hearing a psychiatric diagnosis. It pains me to see patients’ attempts to negotiate, to bargain, to rationalise the incomprehensible nature of their illness. Of course, where a diagnosis like cancer differs to psychiatric illness is in the true, bitter isolation. The cold feeling of having to secretly suffer after being hit with a psychiatric diagnosis. Each time I educate a patient about their newly diagnosed illness I feel, in some small way, a shared Did you feel that? That little jolt in your stomach as you read the headline? Perhaps, your muscles tensed for just a moment? Maybe your heart skipped a beat, or a mild sense of fear came over you. What was that? An insignificant flutter? A meaningless moment to shrug off in your busy day? Perhaps that fleeting feeling is explained by looking to the stigma that pervades our culture, known all too well to sufferers of chronic mental illnesses. understanding of their grief and pain. Only through this have I been able to give meaning and learned to accept my own illness. In some small way, my own illness allows me to empathise in a way I may never have been otherwise able. Fear has dictated that I, and others, hide our emotions and thoughts, lest our secret ‘unwell’ identities be known to those whom we work with or treat. We are one person to our friends, another to our patients and yet another to our colleagues. For many years, my world was controlled by this fear – a fear that my professional life would fall apart if people knew my secret. I feared looking pathetic and weak and that I would be seen as unable to cope with the pressure of medical study and practise. I felt an unspoken obligation to my peers and superiors to present a bravado and confidence hiding what is a daily battle to remain well. On the first Friday in June, doctors celebrate #crazysocks4docs day. For one day each year, we celebrate the change we are driving within our profession with the simple, yet brilliant, act of wearing odd socks. Twitter lights up with an assortment of quirky foot-art as we smile and laugh at the various colours and patterns, enjoying a brief moment worthy of celebration. For too long, the wounded healer has battled on, overworked in an under-resourced system (with boring matching socks!). On this day, we celebrate doctors’ mental health and wellbeing and call out the challenges leading to burnout, stress and depression. We shine a light on the need for systemic change to ensure doctors have the best chance to remain well and celebrate our tentative early steps toward genuinely supporting one another. However, through the thousands of bizarrely unmatched soles, sporting spots, stripes and shades dotted around hospitals and clinics across the globe, we must not forget that which matters most. Doctors’ mental health is so much more than a hashtag. For many, it is a daily battle. Today, I win this battle, but sometimes I do not. Today, I say that the time has come for doctors who struggle with mental illness to step out of the darkness. Today, my cloak is dropped, the secrecy thrown out in the hope that others feel a little safer to do the same. I also ask you to celebrate your imperfection. Take a moment to pause. Maybe, even laugh at yourself. To paraphrase Winnicott’s seminal work on the “good enough mother”, I ask you to be the “good enough doctor”. Share your struggles, even if only with a friend. It is time for us all to hear of the struggles of doctors at all levels. But, critically, do not forget to interrogate your own beliefs about mental illness. Only then can we hope to foster a greater understanding, tolerance and acceptance that mental illness need no longer be something to be kept hidden and ashamed of. And only then can we hope to reduce the scourge of doctors’ suicides. Before I forget, I have one last thing to say to that doubting medical student of years past… Today I say, yes, I have a mental illness. And I might just be a better doctor for it. Dr Kieran Allen Psychiatry Registrar AMA Victoria Council Member DiT subdivision @kidsankyran 10 | Vicdoc August / September 2019