Some patients stick in your mind. When I was a medical student, I remember talking to a patient who had just come into hospital, who was quite unwell, and could make little sense of their experiences. Neither could I—hallucinations and odd beliefs were alien to me—and all I could do was go through my list of things to ask. I was sympathetic and interested, but I couldn’t fathom what they were going through. I’ve never forgotten that patient, and sitting with them in that little grey room.
Six years later, I was the one sitting in that room, quite possibly the exact same one. I was the one who couldn’t explain my thoughts, my fears, my beliefs. People asked me questions and wrote things down, and none of it seemed to make any sense. I felt displaced—I was a patient where I should have been a doctor. Some of the patients talked of us and them, and it was almost like two tribes, you couldn’t be both.
As a patient, I didn’t know how to communicate, and I was frightened of saying anything that might make things worse. Some people went through a list of questions, and some people were very kind. I was in and out that hospital for more than two years, and felt I was a failure, both as a doctor and as a patient. I was no good at either.
I was diagnosed with psychotic depression, and later bipolar disorder, and still, many years later, find this hard to fully understand. Depression to me is an absence of feeling, and an inability even to move; mania, or hypomania, is the opposite. I can see this in other people, but it’s much harder in myself. Why can’t I just stop being depressed, if I can recognise it? Why do I forgive other people, but not myself? I’m not alone in these beliefs, as I’ve heard other doctors say that they fear they are “putting it on” when unwell. I think we over-estimate our own locus of control, but it’s hard to imagine another state, when we can only ever experience being ourselves.
I was lucky that I did, eventually, recover enough to work again as a doctor, and to start training as a psychiatrist. This may seem a bizarre decision, but I thought that perhaps I would understand things better, having been on the other side. You have to learn a lot to specialise as a psychiatrist, about neuroscience and illness, about medications and psychology. These things are important, but little use without communication. As a junior psychiatrist, I worked very hard, but there was always that question in my mind—am I a doctor, or am I a patient? I felt I understood what some of them had been through, and what it was like to be depressed or be a patient on a psychiatric ward.
There is a temptation, however, to say to people—”I know how you feel” or “That happened to me.” We don’t. I realised this quite suddenly at a time of personal loss, that actually no-one knew exactly how I felt, and that I could never assume that I knew this about others. I think it is one of the things that has most coloured my thinking and practice, and has helped me to meld together my identities as both doctor and patient. I usually use one at a time, but I think they inform each other more—although I rather suspect I am a better doctor than patient.
Listening to people and hearing what they say are, for me, the most important things I have learnt. I can’t ‘be’ them, but I can try to listen and understand as well as I can. I think this is also true for me as a patient, and I hope I listen to advice more now.
Ultimately, I don’t think that many people will remember what medication I prescribed them, but I do hope that some remember that I listened. I believe that people are more likely to take that medication, and to come back to see me if I do, but it’s not just that. There is comfort in talking, that can’t easily be measured. I hope, if and when I am ill again, that someone listens to me.
Rebecca Lawrence is a consultant psychiatrist and a Royal College of Psychiatrists fellow. Lawrence gave a talk at the Royal College of Psychiatrists’ International Congress this week on “How to be both: psychiatrists’ lived experience of mental illness.”
Competing interests: none declared.