Kirstie Pickles

&me Kirstie Pickles

Dr Kirstie Pickles graduated from Glasgow Vet School in 1996. Following a year in practice, she completed a residency and PhD at the University of Edinburgh and then became a Senior Lecturer in Equine Medicine at Massey University, New Zealand. She returned to the UK in 2008 and has since worked in both private practice and academia. Kirstie is currently Clinical Assistant Professor in Equine Medicine at Nottingham Vet School and is passionate about teaching equine medicine and mental health awareness.

I knew I wanted to be an equine vet from age 10 and revolved my life around that decision until I arrived at Glasgow Vet School at 18. I enjoyed vet school immensely but found the transition to practice very difficult. The safety and structure of the close-knit vet school was poles apart from the 3 person, small animal and equine practice where I took a job, which was me and a husband and wife. In retrospect, they needed someone with more experience than a new graduate. My first bitch spay was a fat, 14 year old Bearded Collie with mammary tumours also requiring a mammary strip. I was shouted at for allowing a Collie I had performed a cystotomy on to biopsy a bladder mass to go home without a buster collar which later resulted in an out of hours call for the boss for licking the wound. There was frequently no other vet in the practice when I was performing these operations and I felt completely out of my depth. Unfortunately, I was also far away from friends and family in a small village and felt utterly isolated. I began to dread going to work and would wake up feeling sick and horrified that, after wanting to be a vet for so long, I absolutely hated it. Luckily, I spoke to a lecturer back at Glasgow and she encouraged me to leave as she could see how badly my confidence was being affected and so I handed my notice in after only 6 weeks, leaving after 12 weeks. At the time I was absolutely convinced that leaving my first job so quickly would blight my career. It sounds ludicrous now but at the time I really believed it. I went home to my parents feeling an utter failure. All my vet school friends were full of stories regaling how great their first job was, how they had just done their first calving, etc etc, and I was back home with my parents. My parents are the ‘soldiering on’ type and could not understand why I didn’t just get another job, but I was terrified and could not stop crying, which they were equally perplexed by. Looking back, I think this was probably my first (unrecognised) episode of clinical depression.

After a couple of months, I eventually took another small animal / equine job as I did not know what else to do and my parents were making it clear I was not staying there indefinitely. This was definitely more supportive and a better choice, but I still felt incredibly lonely and was constantly fearful of making a mistake and not knowing enough. It was this latter feeling that led me to apply for an equine residency programme at Edinburgh Vet School a year after graduating. I am eternally grateful that Prof Paddy Dixon saw something in me and gave me the opportunity to work with him. Although I still battled with imposter syndrome, I was back in the safety net of a structured programme and a team working environment. I found I loved teaching and I was excited by research, which led to a PhD after my residency. By the time I finished that, I realised that in academia, I had found my calling within the veterinary profession. I was married to a Kiwi by now and so it seemed perfect when we both landed jobs in New Zealand. I began teaching at Massey University Veterinary School and that’s when my imposter syndrome really kicked in. I had tried to drown it in degrees and had racked up an MSc, PhD and Certificate in Equine Medicine by this point but still felt a fraud and so followed up with a European Diploma. Then I would know enough, surely? It seemed not. I did seek some talking therapy and help via a GP but after 12 months I was really struggling and having frequent panic attacks. At the same time, my marriage was struggling, and I began to self-harm to cope with the overwhelming shame and distress that I felt. I had always been a heavy drinker, enjoying the relaxant effect of alcohol, and now I used it to numb the emotional pain. After a fairly serious self-harming incident which led to hospital treatment, I was referred to a psychiatric service. This led to several months off work followed by a very gradual return and extensive psychological counselling with the most amazing psychologist who I think, quite possibly, saved my life.

When I left NZ several years later, I knew a lot more about myself and my triggers but have still continued to suffer with anxiety and repeated, intermittent, sometimes serious bouts of depression despite medication and much psychotherapy. I now don’t drink at all and find this is a massive help for my mood although I do struggle a lot more socially without it. I am now re-married to an amazingly patient, kind man and am the mother of two wonderful children. I find juggling work and parenting exceptionally hard and find part-time working the best compromise for me. When my daughter was diagnosed with autism last year, I began reading everything I could about it and found I identified with a lot of what adult autistic women described. The anxiety, the feeling different, the saying the wrong thing, being taken the wrong way, having to hide my true self, emotional overwhelm – so much of it resonated with me. I have subsequently been diagnosed as having high functioning autism (previously termed Asperger’s), like my daughter, and now a lot of my past makes a lot more sense. And this is actually very comforting because I now understand why I felt different and struggled all those years and now I can take steps to better protect myself from relapse. Whether my anxiety and depression is solely the result of being autistic in a neurotypical world (it’s tough) or are co-morbidities in their own right is unclear, but everyone is agreed, autism and depression are frequent bedfellows and they do not help each other.

I am very open about being autistic, both to help myself stay well and reduce my triggers and also to encourage other people that it is ok. Camouflaging (masking) autistic traits is very common, particularly in women who do it unconsciously to fit into societal expectations but is incredibly hard work and emotionally draining. I can appreciate that certain autistic traits have helped me get to where I am; incredible focus, attention to detail, good memory (at least until I had kids!), determination, persistence, efficiency and organisation, fierce loyalty, integrity, and a hard work ethic. However, I also now realise that my social anxiety, crippling self-doubt, perfectionism, rigidity of thinking, need for order, and difficulties in understanding some nuances of communication are also part of the deal. I am still learning how best to accommodate my autism in my life. Practice can be difficult for autistic individuals due to the unpredictability of clinical work and out of hours emergencies and I certainly found this very stressful. Academia allows me to maximise my strengths and I work within a great team that value my contribution and tell me so. Perhaps this most of all helps silence (or at least quieten) my imposter syndrome.

James Glass

&me James Glass

James Glass graduated from the Royal Vet College in London in 1992 and, with his wife Debbie, spent almost 20 years building and running a small animal practice on the edge of the Lake District. In 2018, on the verge of suicide, he was diagnosed with severe depressive disorder and was off work for nine months. He stepped down from clinical work in 2019 and is currently completing an MSc in the psychology and neuroscience of mental health. He wants to encourage colleagues not to suffer in silence if they are struggling with mental health issues as it’s an illness that can affect anyone.

Not at home, not in work. Two years on, as I ran past the spot for the first time, the memory flooded back. “This seems like a good place to die”. The opening apology, the details of the conversation, all sorted in my head. The 999 call-handler certainly didn’t deserve what was coming. And I was clear that it would all be over before anyone arrived.

I had reached 50 without any problems. Easy-going, sociable and used to taking long working hours in my stride, I was always optimistic and never had any issues. I enjoyed my work and had a great bunch of staff and lovely clients. Then a member of staff left, work was very busy, and I was working much more than I should have done. I started to notice poor sleep and the days getting harder. When a close friend, who I had supported through their own mental illness, took his life I felt trapped by grief and I struggled to move on.

I knew I wasn’t well, but my professional pride stopped me asking for help. Husband, father, church member, business owner, employer, trusted vet, how could I possibly let anyone know how dark the cave I had come to inhabit? I lost interest in life and everything became dull and pointless. There seemed no way forward and I was desperate for an escape. I started planning my suicide. Looking back, I realise you don’t come to a point where you think suicide is a good idea, you simply reach a place where you can no longer face how you are living.

A fortunate conversation with my GP (who was also a client) opened the flood gates. He, along with an amazing mental health nurse at Vetlife’s Vet Health Support, quickly realised things were serious and GP care was replaced with daily supervision and support from the local NHS psychiatric service. It would be another four months before my family felt safe to leave me on my own.

Two years on, while I remain on anti-depressants and contend with some poor sleep and occasional dark weeks, things are very different. Running, which I started at the suggestion of one of the psychiatric team, has become an important strategy. The very overweight, utterly unfit bloke is somewhat slimmer and, on long trails in the beautiful Lake District, ran over
1000 miles last year. I have now left veterinary practice and see my future direction in mental health support for others. Life is absolutely worth living again and, while I might not have chosen this pathway, it’s a privilege to use my experience to help others. People need to know that, even with a serious mental illness, there is hope and there is recovery.

Ebony Escalona, veterinary surgeon

&me – Dr Ebony Escalona

Dr Ebony Escalona is a veterinary surgeon who has worked as a Equine Vet for many years. She is also an educator and entrepreneur and previously worked in music television. Within these varied roles she developed a number of transferable skills that opened up a number of non-veterinary enterprises and collaborations. Ebony is passionate about building confidence in others and is a huge advocate of the ‘portfolio career’, simply put, doing the things you love and loving the things you do.

Sometimes I have to laugh at the voice in my head. Like, where have you come from? Who invited you? I can’t find you on my guest list…. That voice dishes out words that you would never dare utter and certainly NEVER give as advice to a friend so why do we listen to it?

Because unfortunately (or fortunately) it’s part of me. Just like the rest of my body. When it’s working and healthy it’s ace. But, when it’s broken it needs help getting fixed. Just like a broken leg needs rest and realignment so does my brain.

Believe it or not, I used to think depressed people had too much time on their hands.

“I won’t get like that – got too much to do”

Can. You. Believe. It?! No wonder there is still stigma surrounding it!

The lava lows of depression

Approximately eight years ago, I experienced my first bout of mental health issues that stopped me in my tracks. I had no idea what was happening to me or why it had turned up on my doorstep. Anxiety and panic left me physically and mentally drained and eventually I could not leave my bed. My gorgeous dog was the only thing I would leave the house for. Thank God for dogs! I experienced what can only be described as eruptions of frequent pain and profound sadness. I had turned into a human volcano of dark and negative thoughts. They consumed me and left me scared to sleep as I could not bear to be left alone with my thoughts. The TV or radio had to be on continually. In fact, I still find the dulcet tones of Radio 4 soothing in the middle of the night, much to the annoyance of my fiancé.

If I look back, it was not something that came from nowhere. In fact, the lava of depression started to bubble up when trying to shortcut my care and please everyone around me. I was feeling incredibly lonely and inadequate in one of the busiest cities in the world.  As a PhD student at Imperial College, my department was filled with genius and I felt like the odd one out, an imposter trying to keep face. I reached out to student services and had some incredibly helpful counselling sessions but they soon ran out and they unearthed some painful memories that made coping impossible. I retracted from all social events, stopped attending university, didn’t answer my phone, I even stopped brushing my teeth. Thankfully I was living in a flat above my incredible step-mum (or “other-mother” as she gets called) and without judgement she scooped me up, held my hand and offered to take me down to my GPs.

Postcode lottery of care. I feel very lucky

I am eternally grateful to the two GP practices and one mental health unit who have supported me on and off over the years in North London. I am aware that not everyone has access to swift and sustained mental health care. I struggled to accept help to begin with, I didn’t want to burden anyone. I had created stories and rules for living such as “It’s best for me to do it myself” and “I have to help others before looking after myself.” When you say them out loud they sound absurd but this was my pattern of thinking and subsequent behaviour. Thankfully the tides began to turn with medication and CBT. The problem was I started to get a little “too well”, high even or experienced numbness. It was hard to get the medication doses right and I spent too much time feeling like a bland biscuit. I decided to take myself off my meds. Was a part of me enjoying the emotional rollercoaster?  I certainly felt more me as a “Party Ring” than as a “Digestive Biscuit”.

Since my initial bout of depression I did pretty well: I completed a PhD, found love again, cared for a sick family member and landed a dream job working for an international NGO. But, latterly I found myself falling into cycles of destructive but often personally enjoyable highs followed by equal and opposite lows. A diagnosis of hypomanic bipolar wasn’t much of a surprise, especially when we pieced together my behaviour and response to treatment. The diagnosis although useful for management left me feeling embarrassed and ashamed. Oscillating between these states is now my norm. Admitting it though was tough. What will people think of me? Will I be employable? Will someone be able to love me? Will people look at me differently? I didn’t actually tell anyone about it for months and in fact my employers were the first to know. This only came about due to the potentially risky nature of development work overseas and insurance. I desperately wanted to keep it a secret.

Riding the highs and learning the triggers

Mental health stories aren’t all doom and gloom though, quite the opposite in my case. The highs are filled with liberating disinhibition, euphoria, racing and creative thoughts, wild and wondrous nights out and watching the fruits bloom from some of the ambitious projects I kicked off when feeling high.

But these manic thoughts and behaviours are unsustainable and lead to overexertion and falling back into the volcano. All of a sudden there are voices saying; “what have I done, what was I thinking?” Self-sabotage starts all over again. This is exactly what happened around VSGD LIVE! and it nearly ended my relationship. I had become almost impossible to live with. I had a complete loss of insight as to the effect my behaviour was having on others. Drink became my go-to and I was seeking out busyness to drown out the voices again. I had become volatile even at work and found myself being encouraged to have time off from my very supportive employers. Crying uncontrollably and ashamedly to my GP on the phone, the cycle started again.

I am now a freelancer so I feel even more responsible for my conduct and self-care. Over the past year I have worked alongside an incredible psychologist and psychiatrist duo to help identify my potential causes and triggers and devise practical ways to manage my moods. My fiancé has also joined me for some of these sessions as he struggles to understand this part of me. This is ok, one person cannot be the Swiss army knife to all my needs. The F word has also been raised (family), but if I am honest I am scared that if I cannot look after myself, how can I look after someone else? What if I pass on this pain? This conversation is a work in progress.

Wounded healers need help too

As healthcare professionals I think this voice has an added dimension. We feel that as the care-givers and healers we cannot afford to be sick. Having attended the NHS Wounded Healer Summit, this phenomenon happens in all caregivers. The doctor turned comedian and author Adam Kay summed it up nicely: “We have failed to acknowledge that we are human. Doctors are humans who make mistakes, get sick and get sad. This needs to change.” Many echoed this sentiment but also challenged the stigma that we as professionals also might bring into the room. I certainly can vouch for the stigma that I will have undoubtedly created in the past, albeit unknowingly.

“Before we are doctors we are people. We bring in our prejudice and stigma. Mental health is our last taboo. We need to look at our views and beliefs too. We have failed to acknowledge that we are human. Doctors are humans who make mistakes, get sick and get sad. This needs to change,” delegate at Wounded Healer Summit.

At times I feel fortunate to experience what I do in my mind. Some of the rainbows after the rain as I like to call them. By feeling and experiencing what I have, my empathy for others has grown. The manic highs can often be part of great things such as founding Vets Stay Go Diversify. They remind me that I’m beautifully human and I’m not a robot and that big mental health moments have acted as important pivot points for me to reevaluate what I want to do and why. Be them in the phases of my hypomania or my depression.

I lost a tooth somewhere between the highs and the lows and now every day I notice the gap between my teeth. A constant reminder that self-care comes first. Not long ago I had my last session with my psychologist. I didn’t want our session to end and held back my tears as I thanked her. Could I really cope without her unwavering professional support? With her kind eyes welling a little too, she said, “You’ve got this” and do you know what? I think for now I have.

Serena Heywood

&me – Dr Serena Haywood

Dr Serena Haywood (MBBS BSc FRCPCH MSc MA)– Consultant Paediatrician, Guardian of Safe Working Hours, GMC Associate Assessor, BMA Doctor Supporter, London Women’s Leadership Network Mentor, Trust Health and Wellbeing Champion, Resilience blogger (Recalibr8), theatre producer and playwright.

When your bio is longer than your story there’s probably a thing going on….

My story is that I have depression (including postnatal), anxiety, post-traumatic stress disorder (PTSD) and a LOT of jobs. In my very doctory way, I work through my mental distress by doing more and more. Which means I’ve gathered a lot of titles along the way. On the surface then, I’m a mental health success story. Still a doctor. Climbing my way up the physician pole without overly frightening the horses.

But working harder and harder might not always be the healthy option. Workaholism is not unusual in doctors. I like to think that I take it to the next level. When I’m feeling low, I start another degree. I’ve had to be wrestled to the ground recently from starting a PhD. Why do this?  I am terrified of stopping. I am a deceptively functional individual, successful by most measures, cheerful and good company. My friends say I make everything more fun and also ‘things/drama’ tend to happen around me. I love drama in all senses which is why I am a playwright and theatre professional as well as a doctor but this reflects my beginnings as the daughter of an alcoholic. Our collective behaviour is often one of cheerful calm, conflict avoidance and control at the expense of our own wellbeing whilst craving a maelstrom of emotions around us in order for things to make sense. I am a supporter and giver from childhood, absorbing others’ distress but that has not always been a healthy position and my familial tendency to maladaptive behaviours has taken the form of working sometimes to the point of exhaustion.

I had depressive symptoms from late adolescence triggered by my parents’ abusive domestic situation, which continued through medical school, culminating in my first significant depressive episode. Seeking help was not always easy and the support I received was often patchy and sometimes very peculiar; being told by a general practitioner (GP) to treat myself with plentiful relationship-less sex was a colleague low point. My trainee peers were fantastic but the oddness of responses over the years from bosses continued, with responses ranging from curtness, being patronised and, frankly, fear. The lesson that I therefore learned, was that doctors did not let the side down (particularly as a woman, heaven forfend) and the rules were: don’t blub, be super profesh and ‘just get on with it’. 

When I experienced an extremely traumatic experience in paediatrics twenty years ago and was essentially left to deal with the emotional fall-out on my own (‘You’re fine are you? Good’), I did just that and more. My response was to keep my head down, shut down and emotionally blunt. This resulted in the insomnia, intrusive thoughts, hyper-vigilance and self-blame that I was later told were classic signs of PTSD. I came close to taking my own life. It was only in finding peers in Australia who told me this wasn’t ‘normal’ that I looked outside of the hard shell I had built up around myself and started my psychotherapy journey (via MedNet, now the Practitioner Health Programme in the UK) that I continue today. This hasn’t always been easy and, in part, I continue to make life challenging for myself by refusing medication and time off. This changed when another awful event four years ago triggered me into an emotional black hole and I conceded that I needed two weeks off. The fear and isolation of this event led me to take the risky decision to start talking about my mental health as much as I could to as many people as would listen. I was advised not to but did it anyway. And my life changed from there.

My colleagues have been universally accepting, my Trust (employer) has been supportive both in occupational health and managers and I have felt better. I have been supported in talking with junior doctors about resilience and that has led me to talking with other healthcare professionals, doctors returning to work, GP trainees, IT workers and on one notable occasion, Her Majesty’s Treasury Office. I support doctors dealing with the GMC via BMA Wellbeing and they in turn support me to be a better listener and learn more about the mental health of others. I blog as recalibr8 as part of my mental health journey and teach the skill of writing to support others to develop resilience using amazing actors in workshops. Doctors asked to do improvised comedy are hilarious! I also write plays which are performed in fringe theatres around London, Manchester and the Edinburgh Fringe Festival.

My wish is that if only one person can read this and take the exceptionally brave step to seek support from other professionals as a result that is job done. If it also helps reduce the stigma of healthcare workers coping every day with mental health difficulties, even better (job done plus…yes, OK, always the extra step!). I rely on my friends, my family and exceptional kids, my colleagues and, importantly myself, to notice when my depression comes back. I know it will, it always does. But I’m learning to be kind to myself, to know when to stop if I need time out so I can give the best to my patients and actually and literally say no. I tell myself that I do recover from the dark moments and to know that my sense of failure that sets that off is often misplaced. I am on a sobriety journey now which is tougher than I thought but I am hoping to use that experience in my next writing project. Do come, tickets available soon (always the shameless plug!).

Meghan Conroy RVN

&me – Meghan Conroy

Meghan Conroy is a registered veterinary nurse who qualified in 2013. Since then Meghan has worked in both first opinion and referral practices and is now head nurse of a group of practices in Southampton. Her passions include medical nursing, emergency and critical care and raising clinical standards for general practice nurses. 

I always knew I had the black dog of depression with me, lurking in the shadows. I had grown up watching a close relative tackle anxiety and depression everyday. That relative was a warrior but I knew I didn’t ever want to face what they did on a daily basis and I was determined not to acknowledge my struggles. Determined not to be deemed weak and incapable.

It was a dark day in January when I first felt the pain of discrimination due to my mental health. After years of battling and coming to terms with my mental illness, I never thought that my beloved veterinary profession would turn its back on me, but it did. Opportunities given to others, being slowly pushed out of a job you love because of your mental health. Using the excuse of not wanting to ‘stress’ you. I had watched this happen to the same family member as above before and I could feel my world crumbling. A job I loved slipping through my fingertips because of my mental health. Eventually, for my health I left the job I loved, putting my ego and shame into a box and off to find a practice that embraced me with all that entailed.

It was difficult at first, I was ‘too honest’ at interviews. I told my potential employers about my experiences with depression and anxiety and how I felt that made me a stronger nurse. I wanted to be honest but maybe all I wanted was acceptance. I even had one potential employer openly tell me my mental health impacted her decision. After a few more interviews with me holding my tongue I found a job at Brook House veterinary surgery in Southampton part of a group of four practices known as the Southampton Hub. The head nurse and practice manager were great from the get go. Supportive, embracing and approachable.

Within those first few months my confidence grew and my experiences were acknowledged. The healing had begun but I knew my challenges were not over. In January 2018 I was promoted to Head nurse for the Hub of practices and had volunteered for BSAVA Southern region and congress committee. I felt on top of the world. I was married in July 2018, the best day of my life. But then suddenly, my black dog was upon me. Everything from the last eighteen months crashed down on me like a tsunami. Everything I had pushed to the back of my mind came flooding back. This is when I truly started to change how I viewed my mental health.

Before it was a dark, damning secret that I was ashamed of. Now I had supportive colleagues who genuinely just wanted me to get better. After five weeks off work, medication and starting counselling I was ready to give work another go. I remember taking my first blood sample, shaking and tears filling my eyes. I didn’t think I would ever be whole again. Eight months on from my last episode, I feel stronger than ever, I fought every day until one day it became easier. My employers at the Southampton Hub and wider CVS have been incredible. Giving me the tools I need to help myself and allowing me great opportunities.

Hopefully this year I will be starting my graduate nursing diploma and continuing on my journey of self worth. I’m now head nurse of five practices and still volunteer for BSAVA. We talk often about what our mental health takes away from us but what has my mental health given me? It’s given me a greater understanding and empathy towards others. My mental health is a part of me, but it does not define me. Certainly not as a nurse.

Veterinary surgeon, Allisdhair Mcnaull

&me – Allisdhair McNaull

Allisdhair has been a vet for 34 years and suffered with depression and anxiety for over 20 years before he sought help. Getting help was the best thing he ever did, it has changed his life. He is sharing his story in the hope that it will help in removing the stigma of mental health issues and show that there is light at the end of a very dark tunnel.

&me aims to encourage senior people within the healthcare professions to come forward with their stories to show that we all have mental health, and that a mental health problem does not exclude people from achieving leading roles in healthcare. I have previously shared my story at the Wellvet Weekend and more recently at the BSAVA Congress as part of the Mind Matters stream and am now presenting here.

I qualified as a vet in 1985 and have spent my entire career in small animal practice in a variety of practices, including the charity sector, a two-vet practice, a large multi-branch practice and the corporate sector. I have held a number of positions, from assistant to clinical director, but throughout my career I have found the stresses of everyday practice difficult to deal with. I particularly found being on-call very difficult and had a constant feeling of not being good enough and that every other vet knew more than me and was more skilled at everything. However, I felt that it had been my choice to become a vet and that there was nothing else that I could do and just had “to get on with it”.

For me “getting on with it” meant accepting the stresses as normal and my coping strategy was to try to supress emotions. I ignored the fact that I did not feel happy but took on more responsibility in my professional life thinking that was what I should do, but all it meant was that I experienced more difficult situations and more stress. I was also increasingly anxious and my mood was low, but it is only now that I recognise this. Even when I consulted with my GP and found myself crying during the consultation, not knowing why, I still did not recognise that I was depressed.

When you do not address stress, when you suppress emotions and when you do not recognise the warning signs your body is giving you, it is inevitable that something will give. For me it was finding myself shouting in a consultation, pent-up emotions and stress have a tendency to burst out in unexpected and inappropriate anger. It was at this time I realised that I needed help. It had only taken me 25 years to come to this realisation.

So, I went back to the GP who got me to fill in the questionnaire that is used to assess levels of depression. I scored well, but in this test the higher the score, the worse the result, so perhaps the first lesson in recognising perfectionism is not a good thing. I was prescribed medication, signed off work and was recommended to undertake talking therapies. Fortunately, I had health insurance and there was a Priory hospital close to home and I took the decision to get myself referred there.

After an initial assessment, my psychiatrist recommended three half-day sessions as an out-patient. I was asked how I felt about group therapy. I had no idea how I felt about group therapy but approached treatment with an open mind putting myself in the hands of the experts and seeing what happened. Group therapy was interesting, as I listened to other people’s stories I thought “you thought that?”, “you do that?”, “that’s not going to be helpful”. But as I reflected on what I was hearing, I realised that I did the same things and I was able to recognise problems in others but not in myself. 

Talking therapies are surprisingly tiring, at the end of the sessions I was exhausted, but I stuck with it and did my homework which was lots of self-reflection and understanding my unhelpful behaviours, how thoughts affected emotions and, in turn, mental and physical health. Through the combined treatments of cognitive behavioural therapy and mindfulness, I learned how to monitor my thoughts and recognise they are just thoughts as well as how to recognise the voice of my inner critic who would constantly tell me that I was not good enough, that everyone else knew better than me and that my opinion was not worth a thing.

Over time I have learned to ignore my inner critic which has increased my confidence and self-esteem and opened a whole new world to me of new opportunities. I am getting more from my professional life, and genuinely feel that I am a better now than I ever have been. I also have allowed myself to explore other interests as well, particularly in producing fine art photography and poetry, and this creative outlet perfectly balances my work life. 

I do not believe that I am cured of depression and anxiety, but with the toolkit mindfulness has given me I can ensure that I remain in remission and get more out of my life now than at any other stage. So if you are feeling low and cannot see how things can improve ask for help, it may be the best thing you ever do.

Becky Hirst

&me – Becky Hirst

Becky Hirst is a consultant in Palliative Medicine in South Yorkshire. She has had two episodes of moderate to severe depression, the first as a specialty registrar in 2004, both of which required significant time off work. In 2007 she won the BMA News writing competition writing about her experience, and was also interviewed on Radio 4’s ‘All in the Mind’ in a programme about doctors’ health. She feels strongly that although the statistics are that one in four people will have an episode of mental illness, in fact one in one of us are vulnerable.

Below is the piece she wrote for the BMA News writing competition:

What I learnt from that episode of depression

I always hoped that I was a ‘good doctor’ when it came to looking after people with mental illnesses. I’d spent six months working in Psychiatry as part of my GP training scheme. Certainly, it wasn’t always easy – my consultant once accused me of treating her patients like horses, making sure they were fed and watered but not much more – but I did my best. In General Practice it was a standing joke that while the other female partners in the practice did the Well Woman Clinic on a Tuesday morning, I did the Weepy Woman Clinic. I spent a lot of time reassuring people that depression was a real illness; that it was a chemical imbalance in the brain; that antidepressants work by correcting that imbalance; that yes, it was hard because if you’d broken your leg then everyone could see the plaster cast…

And then I got sick. I went from being a relatively competent specialist registrar in Palliative Medicine to nothing in a couple of days. I spent the first couple of weeks asleep. I would manage to have a shower and then I would have to go back to bed. I felt like a shell of my former self, and it surprised me sometimes when I looked at my hands that I didn’t just see straight through them. I had lost everything that made me who I was and I despaired of ever being reunited with my sense of humour. Listening to re-runs of radio 4 comedy programmes at 4am, I could appreciate intellectually why things were funny but it didn’t make me smile. Nothing did (my face hurt if I tried). My concentration was non-existent. I could read, but put the book down briefly and I wouldn’t have clue what the story was or even who any of the characters were (“Losing the plot” said the psychiatrist with a twinkle in his eye). I would be paralysed in the supermarket unable to choose food to eat, struggling not to abandon my trolley and leave. I couldn’t trust myself to judge when it was safe to turn right on to a main road in the car. “If I can’t choose which biscuits to buy,” I said to my GP in despair, “I don’t think I’m well enough to be deciding how much diamorphine to put in a syringe driver”. He laughed nervously and wrote me a medical certificate for another month.

I learned so much – about myself, about how depression distorts your reality and your thinking, about how a lot of people perceive people with depression. I learned that when we tell patients blithely that it will be “two or three weeks” before the antidepressants kick in, that every day of that third week is a lifetime. I was amazed at how physical an illness it was – to begin with the smallest exertion left me breathless and shaking. I had pain all over my body. Verging on the psychotic, I would have terrible, graphic visions of seriously hurting myself. These were frightening as they seemed to come from outside me and I worried I might act upon them as I did not feel in control. More frightening was when I got a little less unwell, so that I was functioning better but still felt dreadful, as I couldn’t see the point of continuing in this robot-like state if this was all life had to offer as suicide seemed a rational outcome. With my poor concentration, I wondered if this was like early dementia – within minutes of taking my tablets, I hadn’t a clue whether I had or not and would have to count how many were left in the packet and how many days until the next GP appointment in an effort to work it out; having ‘Can’t Remember What You’ve Gone Upstairs For’ syndrome so badly that I would get from the kitchen to the end of the hall and not know what I was there for.

So two years, a lot of counselling, antidepressants and a chocolate Labrador puppy later and I have regained most of myself, though I’m not who I was before I got ill. Such an illness is like going through a refiner’s fire – one is definitely changed, I hope for the better. Nevertheless, a bit of me grieves for the old ‘me’, whom my current partner has never met. There have been other bereavements – I still struggle with not working full time; I should have become a consultant a couple of months ago but now it will be 2010 at least. They teach you about Kubler-Ross’s six stages of grief at medical school, but nobody tells you that at times you might be doing three or four of them simultaneously, and I’ve never been so angry. It has helped me appreciate what losses my patients might be facing, and also to empathise with those suffering depression. Sometimes I share a bit of my own experience if I think it might help.

One of the most difficult lessons was learning to be kind to myself, that if I didn’t look after myself there was no way I could care for others. It’s easy to get swamped by the needs of others – patients, team members, family – and to feel guilty if we take time for ourselves. When I was first ill, my psychiatrist friend advised me to do one chore and one nice thing each day. I vividly remember how proud I was the day I washed the kitchen floor for the first time for a year. Depression is a horrible illness. I wouldn’t wish the experience on anyone, but I could not have gained such insights into the world and myself without it. Depression leaves a stain on your soul, even when you fully recover, but that scar serves to remind me of the journey I’ve made and be grateful.

This piece was the 2007 winner of the BMA writing competition.

Stephanie Walsh holding a cat

&me – Stephanie Walsh

Stephanie Walsh is a senior first-opinion veterinary surgeon at Rutland House Veterinary Hospital.

I qualified as a veterinary surgeon in 2004, and spent three and a half years in mixed practice before moving to small animal practice. I am now senior vet at a busy, multisite first opinion practice, involved in the British Veterinary Association as regional representative for the North West, and co-chair a veterinary wellbeing group.

Compared to many of the experiences shared through the &me campaign, mine may seem quite minor, but if I hadn’t been in the lucky position to have amazing and supportive colleagues and friends and family around me then maybe things would have been different.

I initially visited my GP because I thought I had a chest infection as I was struggling to breathe. The GP asked me if I was sure it wasn’t anxiety, but I was adamant it must be something physical. I thought anxiety was a weakness, something that effected other people.

Several weeks later, as I slid down the wall in my consult room to sit on the floor crying, unable to do anything, it became apparent it was not a chest infection. I was lucky as I only needed a short period of time away from work, and talking therapy worked well for me.

There is increasing evidence that early intervention for mental ill-health can reduce the need for time away from work, reduce the risk of relapse and lead to improved recovery.

Hopefully by sharing my story, we can work to reduce the stigma, and open early channels of communication to help look after the mental health of ourselves and others.

Rebecca Lawrence

&me – Dr Rebecca Lawrence

Dr Rebecca Lawrence is a consultant psychiatrist and clinical director.

I have had a long career in psychiatry, which has been intertwined with my own mental health problems. The latter started relatively abruptly with a puerperal psychosis prior to my psychiatric training, and I have had many episodes over the years, involving hospitalisations and electroconvulsive therapy, as well as drug therapies. Talking therapies have been of limited benefit when unwell – and have seemed less relevant when I’m well.

I have a diagnosis of bipolar affective disorder, which I find hard to accept. My psychiatrist tells me that doctors are the most self-stigmatising patients that he comes across, and that he knows I’m becoming unwell when I start to talk more of having a personality disorder. However, I try to follow his advice, and am fortunate that I have had long periods when I have been well.

I have been very lucky with family, friends and colleagues – and those involved in my treatment – and am still surprised by my life and how it has turned out.

I have been a consultant psychiatrist in addictions for over ten years now, and have been clinical director since last year. I also work in the chronic pain service, having recently completed a masters in pain management, and do as much teaching as I can. I have a wonderful family, and play music in what spare time I have left.

What advice would I give to others? I am realistic that my illness is unlikely to go away. I used to try to fight it – which was helpful at times – but it does affect my life and will continue to do so. It hasn’t stopped me doing what I want to do, but I do have to adapt at times. It does affect me, like any chronic illness would.

And that, ultimately, is what I would say – adapt if you need to because of the illness, but never because of the stigma of the illness, whether self-stigma or otherwise.

Rebecca has previously written a personal view piece for the British Medical Journal.

Steve Carter

&me – Steve Carter MAVetMB CertVA MRCVS

Steve Carter is a Director at Priory Veterinary Surgeons in Reigate, Surrey.

I can honestly say that my life has been enriched by the lessons I have learnt from having mental illness. The aspects of my character and the feelings that I have been made to confront and examine closely have made me a much better and a more grounded person. That has only been true once I had come out of the other side of several pretty sad and difficult periods of depression, spread out over two decades.

Here I am aged 58, owning my own vet practice with over 40 staff members in it, still enjoying the variety of small animal practice four days a week, including the emergency out-of-hours work – I am writing this while being on call – and I am still learning new things to add to my skills. And when I go home I have a wonderfully supportive and stimulating family of which I am very proud. I have lots to look forward to – that has always been the case, but when I was depressed I just didn’t see it that way at all.

I have a family history of depression, not that I understood that until the illness hit me out of the blue. My life up to 2002 was one long line of apparent success up the ladder of education (though I did have an exam anxiety wobble one summer), and a steady professional development, including a partnership in the practice. I have a strong work ethic and take pride in achieving goals. I had a young family and was working very hard.

I went to Devon as part of the veterinary team dealing with the Foot & Mouth Disease outbreak of 2001 – it was like a war zone in many ways, and I think I had a sort of PTSD mixed in with physical exhaustion. My performance in the practice ground to halt in 2002 and I lost all sense of purpose.

My partners were generously supportive – I think they saw it coming before me – and I had two months off work. Gradually my depression lifted and after going to visit my friend’s practice to see if I could cope with being in the thick of it again, I went back to work. That was scary because before this episode I felt no anxiety about work at all, and thrived on its challenges; now it felt more like a burden that could easily tip me into depression again.

My colleagues were very supportive and treated me normally and kindly without any sense of me being “damaged goods” – I was very fortunate in that respect. It was only me who thought that I was damaged, but that view has changed for me, although it took a long time to get to that point.

My therapy over the years has been a mixture of medications, psychoanalysis and other counselling, as well as the self-learning involved in looking after myself properly. I know that reaching for help and talking to others in confidence was key to my becoming well. The single most important realisation for me was that I am always going to be vulnerable and it was necessary to come to terms with that “weakness” whether I liked the idea or not.

I still take medication to balance out my mood, which tend to swing. I now feel that the positive mood swings are the times when I am most productive and useful, and they are when I feel the most fulfilled, but I know that there will be periods of lows when it is hard to get motivated. I have gradually learnt from others, including my wife, how to recognise the signs of impending depression and I then find ways of taking the pressure off myself and making myself feel more optimistic inside.

Not only do I feel more knowledgeable and more gentle about myself, but on top of this I have become much more understanding and empathetic of the states of mind of the people around me. I recognise in others many of the difficulties I have experienced. At work, that has been a great help in improving how I go about supporting the staff of the practice, for example, providing group and one-on-one wellbeing, resilience, and counselling sessions for those who want help.

I am proud that these initiatives have arisen from my personal journey of adversity –  I have come to realise that all experiences are learning experiences and there is something worthwhile to come out of the grimmest situations, so that what can feel like an intolerable burden can be turned into a stimulating challenge to be solved, and one can then move on to other things. When something makes me laugh or sing spontaneously, nowadays it has a special meaning for me.

Susan Atcheson

&me – Dr Susan Atcheson

‘My name is Susan, I am a senior GP and I have a history of depression.’

Dr Susan Atcheson is a senior GP and a member of the DSN committee. Read her story in GP View.

Cathy Wield

&me – Dr Cathy Wield

Dr Cathy Wield successfully returned to work in emergency medicine in the UK after two bouts of major depression, which included hospital admissions and brain surgery.

Cathy is passionate about speaking out and reducing the stigma around mental health and has written extensively about her experience of being a doctor with depression (her books are Life after Darkness: A Doctor’s Journey Through Severe Depression and A Thorn in My Mind: Mental Illness, Stigma and the Church). She notes, however, that there is still room for improvement in the way that we respond to mental ill-health. Cathy is currently exploring a new medical culture, having recently moved to the United States.

Cathy says: “It seems that recovery from mental illness is not enough. Well, that’s the impression I get from our stigma-filled world. It was really bad when I was suffering from depression – when you have low self-esteem as a result of your brain chemistry, then often those who you know well, like family and friends, unwittingly betray their ignorance with ill thought-out advice or banal platitudes.

“Most of us try to do the right thing and seek advice from our GP and/or various other health professionals. Even then we cannot guarantee that we will be treated with the dignity and respect that we deserve. I was fortunate in that respect for most of the time during my illness, with the exception of some of the nursing staff during my inpatient stays and, of course, the various different specialities that I had the misfortune to come across after bouts of self-harm.

“There is still a long way to go to eliminate not only the stigma of current mental illness, but also of the past. While I worked in A&E until August last year, I did my utmost to be open about myself and to educate my colleagues. We are whole people, the mind and body are not separate entities and we all deserve respect and care regardless of our past or present symptoms, or what brought them about. But changing attitudes takes more time than I first thought.”

Jamie Hacker Hughes

&me – Professor Jamie Hacker Hughes

Professor Jamie Hacker Hughes is a consultant clinical psychologist, psychotherapist and supervisor currently working in independent practice in central London and leading a religious order as the newly elected Minister Provincial of the Anglican Franciscan Third Order.

Five years after qualifying as a clinical psychologist, Jamie was diagnosed with Type 2 bipolar affective disorder after 20 years’ experience of anxiety and depression. He has been on Lithium prophylaxis ever since.

After his diagnosis Jamie gained a consultant post with the MoD, becoming head of healthcare psychology and travelling to Bosnia, Kosovo, Afghanistan and Iraq, gained three fellowships and four professorships, established a research institute and has just finished a term of office as President of the British Psychological Society.

He has published and lectured widely and edited two books, the first of which was Battle against Stigma.

Jamie says that it is really important that people at the top of the profession speak openly about the fact that they are human too!

Rob Pettitt

&me – Rob Pettitt

Rob Pettitt is a Senior Lecturer in Small Animal Orthopaedics at the University of Liverpool.

My life ‘rapidly’ changed a few years ago when I had a serious mental illness. I say rapidly as it resulted from an elongated period of high stress at work and the breakup of my family life. I had always been a ‘get on with it’ person who could always be relied on to make deadlines, organise and generally be someone who you would turn to in a crisis. My previous career in the Royal Navy was very much about putting on a brave face in adversity – ‘it pays to be a winner’ was much quoted during my time.

Trying to balance a clinic with ever-changing staffing levels and my home life, in particular maintaining as normal and happy a life for my children as possible, eventually took its toll on my mental health. One morning I woke early and was physically unable to leave my bed. It was the weirdest and scariest feeling I can ever recall. If anyone had said to me that I would be unable to get out of bed I would have given them a look – how difficult could it be? After phoning in sick, I lay in bed for hours – it was mid-afternoon before I even tried to get a drink.

When I look back now the first thing that set me on the road to recovery was a friend of mine from work who had very similar problems. She rang me as soon as she heard and within ten minutes was at my door. Having someone around at that time was invaluable – she organised a doctor’s appointment, contacted all those who needed to know and basically ensured I was not alone. The GP was very helpful and signed me off work for four weeks initially, and started me on antidepressants. I also sought counselling in the form of a life-coach in order to get the balance back into my life – what I can’t understate is the feeling of being a failure at that time. The counselling allowed me to steadily believe in myself again.

In all I had eight weeks off work – I knew I was getting better as towards the end I was raring to go back. My employers were fully understanding and gave me a phased return with a reduced administration load to allow me focus on fully returning to health. I continued on the antidepressants for a number of months before I gradually phased them out and to date have had no need to restart them.

So what message would I give to others? Work and life are stressful and feeling stress is natural. What is important is to develop strategies in order to cope with these stresses. Communication is essential – talk to friends, relatives and people at work. Mental illness is sadly still taboo in many areas which is wrong – we would not hesitate to tell people if we broke a bone; the same should apply to mental health. What surprised me was the number of people who have been affected and you will always find someone who has been there – support from others is invaluable in those difficult times so you do not have to suffer alone.

Malcom Kinnear

&me – Malcom Kinnear

Malcolm Kinnear graduated in 1990, but had not completed his psychiatric training when he went on long-term sick leave with depression in 1997.

He joined the Doctors’ Support Network in 1999 and became active in organising its Scottish activities from 2004 as his mental health very gradually improved.

In 2009, he attempted to return to clinical practice, initially struggling to find a way back as no official route existed, but obtained a specialty doctor post with NHS Fife in open competition on the basis of his work with DSN as well as his independent continuing professional development (CPD).

Malcolm resumed full-time practice after a period of shadowing and part-time work. He applied successfully to re-enter higher psychiatric training in 2014 and obtained his Certificate of Completion Training in adult psychiatry in February 2017. He was then appointed to a substantive consultant psychiatrist post with a community mental health team in Dundee, with sessions in the Tayside specialist adult autism team.

Malcolm has actively advocated for better healthcare for doctors and is currently involved in a multi-organisation working group to set up a Managed Clinical Network for doctors with mental health problems in Scotland.

He has an honorary teaching position with the University of Dundee (twice nominated for a Faculty of Medical Educators award) in which capacity he reminds medical students to look after their own health and to remember that doctors can find themselves patients too. He also finds that having taken some of the medications he now prescribes can be rather helpful in terms of understanding their effects!

David Bartram

&me – David Bartram’s speech – House of Commons &me launch 31 January 2017

DB:   ‘No’, ‘Never’, ‘What, you?’, ‘We had no idea?’, ‘Why didn’t you say something?’

Just a few of the responses I received from friends, family and work colleagues when I explained to them why they hadn’t seen or heard from me for a while. I’d been in hospital following a suicide attempt. That admission to hospital was the first time anyone, including the medical profession – and me – knew I was unwell. My marriage had broken up several months previously. I was devastated and finding it hard to cope.

But I chose to tell no one, probably for two reasons: I was ashamed that my wife had left me; and self-stigma – I didn’t want to appear to be struggling emotionally. After all, I had always had good physical and mental health. I was successful – top of the class at veterinary school and after a short spell in practice was now thriving in a demanding role in the pharmaceutical industry. And I had coped with other challenges I had encountered. I was a coper – I believed it and I’m sure most others would have thought it. But those challenges were changeable situations for which addressing the problem itself was sufficient. I had never appreciated the importance of emotion-focused coping strategies to regulate feelings in situations that were unchangeable, like the break-up of a relationship.

I just thought I was stressed – after all, who wouldn’t be in those circumstances? But in fact I was becoming progressively more unwell. What started as worry, early waking and palpitations – which I recognised – led to patterns of thinking of which I did not recognise as being disordered. I felt trapped and worthless – suicide was the only escape. From a medical perspective, my biological, social and psychological risk factors had converged and tipped me into major depression.

That was the first of multiple suicide attempts and several prolonged stays in hospital. Over a three year period I spent twelve months as a psychiatric inpatient. I was treated with antidepressants, antipsychotics, mood stabilisers, talking therapies and electroconvulsive therapy.

But now, thankfully, I am well – and I have been for fourteen years. I still take antidepressants but I suspect I don’t need to – I know the early warning signs and how to act on them to prevent worries potentially escalating into ill health. The medication is my security blanket – I derive comfort from the thought that it may help prevent me ever becoming that ill again.

To what do I attribute my recovery? A mixture of medical treatment, psychological therapies, supportive friends and family, rest and time – they all contributed, probably in similar measure.

What did I learn that I can convey to others?

  • Talk to someone. Confide in trusted friends, family or colleagues or a support helpline about your troubles and worries.
  • If your distress persists, seek professional help – as with physical illness, the longer you leave it untreated the more severe and potentially more treatment-resistant it becomes.

I firmly believe that if I had confided and sought help early I would not have become unwell.

Don’t worry that disclosure may affect your career – it should not, and your health must come first.

After a phased return to work, my career has continued to progress, I have gained additional professional qualifications and moved into roles of increasing responsibility. Enlightened employers are increasingly recognising the diversity and transferrable skills that people with lived experience of mental health problems can bring to the workplace. My episode of mental ill-health by no means defines me but it’s an important part of me and, although I would not wish it upon anyone, I think it has changed me in a positive way, both personally and professionally.

  • No one is immune – it can happen to anyone – including those for whom you would least expect it – including you.
  • Complete and sustained recovery is possible. And finally…
  • The best prevention? Be connected. Forge and nurture confiding relationships with trusted friends and work colleagues – and make sure you use them, early. It really is ‘good to talk’.

Thank you for your attention.

Caroline Reed

&me – Dr Caroline Reed O’Connor

Caroline is a senior trainee psychiatrist and psychotherapist working in South West London. She had recurrent episodes of depression throughout her twenties and when she experienced periods of high mood in her early thirties she was diagnosed with bipolar disorder.

Her mental illness hasn’t stopped her from getting her dream job and has fuelled her passion for working in the field of doctors’ health.

Caroline says: “The worst stigma I’ve experienced over the years was the stigma I put on myself. Speaking out about my illness has helped me to feel less ashamed – I now feel incredibly proud of my experiences and the way I manage my mental health.

“I am open with everyone about my illness – it helps me and it helps them. From individual private conversations to speaking to a room of over 300 trainee doctors… I’m passionate about encouraging all doctors to talk more openly about our day-to-day struggles. Sharing really does kill stigma.”