Dr Tan is a consultant child and adolescent psychiatrist at Aneurin Bevan University Health Board. She is one of 25 women to be highlighted as part of a special project that celebrates the stories of 25 amazing women psychiatrists.
Dr Tan's story
I am a first generation migrant, naturalised and living in the UK for the last 25 years. I was born in Singapore, the fourth child of parents who were themselves first generation Singaporeans, committing to build a new nation when it traumatically left Malaysia and became independent. My father was a cardiothoracic surgeon and my mother was a cardiologist. Both my parents were high achievers and well known in Singapore. In hindsight, I think I came to the UK in order to plot my own course outside their shadow and without the advantages of riding on their coattails.
Struggle and courage are embedded in my family DNA. A highly motivated, perfectionistic and driven individual, my father came from a humble background to be the first doctor and indeed graduate in his family and became a high achiever. My mother was the main carer for us children but also supported him in setting up a new surgical unit and became a specialist physician herself through an unconventional training path. She set up a charity and special educational schools at a time when many people saw those with special needs as not worth educating. This was inspired by her direct experiences caring for family members with complex additional needs. She then became one of the first women Members of the Singapore Parliament for the first time in 25 years. I saw my mother as a superwoman – and I still don’t feel I am as good as she was.
We weren’t rich growing up because my father had to send money home to support his brother through medical school. But I had a happy relaxed unprivileged childhood attending neighbourhood schools, with down to earth parents who loved me. Although it is common for Chinese Singaporean parents to aspire for their children to become doctors or lawyers, my parents never pressured me to follow a particular career. In fact, my mum was concerned that I wasn’t tough enough to be a doctor. Actually, she was right – I wasn’t tough enough and I bear the scars to prove it.
I had always been interested in minds, since the age of 13 when my mother bought me an American undergraduate textbook of psychology and I tried – and failed! – to create a directory of personality types. I went into medical school in Singapore because I wanted to do the Art of Medicine but was nearly crushed by the sheer drudgery and mindlessness of the way the Science of Medicine was then taught. I lost my way and became depressed, so I got out and read Philosophy and Psychology in Oxford instead, my “fun degree”. It reminded me what I wanted to do with my life, and I deliberately chose to go back to medical school to be a psychiatrist rather than a psychologist, also because I wasn’t going to be defeated by medical school.
I have struggled at least three times in my life with depression and count myself among the walking wounded. The first time was in medical school. The second was soon after I arrived in the UK in 1995. Emphasis was placed on my perceived ‘cultural differences’, and there was a lack of support for my newness. I experienced bullying, but coming from a deferential culture, I did not know how to stand up to such behaviour and became depressed instead.
Recent conversations about conscious and unconscious race bias have been important to my reflections on the high level of difficulty I experienced in these early years in the UK. What I learnt was not to show weakness, that I needed to work 10 times harder than the average white male to get even as far. I have succeeded in this, but I do count the personal cost, and it is only now, several battles and 25 years later, that I have learnt to challenge negative self-talk and be kinder to myself.
I have an unusual background – I have degrees in Philosophy and Psychology (BA then MA from Oxford), Child Health (Masters with Distinction from Warwick University) and Sociology (DPhil from Oxford University) in addition to my medical qualifications. I have had a difficult, meandering career path, often having detours but always following my passions. From my second year of psychiatry training, I started to conduct empirical ethics qualitative research on capacity, under some amazing supervisors who gave their time for free. I began this at a time when psychiatrists did not do qualitative research, ethicists did not do fieldwork, and capacity was not duly considered in the use of the Mental Health Act.
Qualitative research is now commonplace, the voices of patients and carers are valued, and the Mental Capacity Act has established the importance of capacity. But when I started this research it was generally considered a waste of time and not even proper science, and publication proved highly challenging for over a decade. As a result of working in an ethics unit rather than psychiatric academic unit, I also lost my Mental Health Officer status. I then found it very hard to find any clinical academic jobs because of my subject area. Applying for an academic post, I was told, “I wish you were an epidemiologist”. This lack of fit was exacerbated when I arrived in Wales in 2007 with a new baby and an unconventional CV. It took six years to find a post, during which time I continued to serve unpaid. I still work part-time in order to enable me to engage in leadership and research as I wish, unpaid.
My unusual multidisciplinary background as well as my personal experience of vicissitudes has enabled me to relate well to patients and families, and to be creative and look beyond clinical medicine for methods and solutions. I love teamwork with people from a range of backgrounds and employ a very pragmatic, realistic and creative approach to thorny ethical problems, which both the public and clinicians can relate well to and which provides a material service to all. This unusual approach has its rewards. After thousands of hours sitting listening to and talking with people with eating disorders and their families about how eating disorders impact on decision-making, I became intimately familiar with eating disorders. I developed a more real-life model of decision-making capacity than the binary approach most people use. I remain one of the few international experts on this. My deep respect for the voices of patients and families pervades everything I do – in running the Welsh Government’s Eating Disorder National Service Review, I built the vision chiefly around the public’s views, while also taking other stakeholders’ views into consideration. I trusted the public, and I was right to do so. I am now doing the same for the Scottish Government with my co-leads. My lack of fit has had its price as well – I have struggled, and continue to struggle, to find posts which use my range of skills, and have signally failed to follow the standard academic career trajectory.
On a personal front, I am no stranger to loss and frailty. I struggled with fertility and endured seven rounds of IVF to have my sole miracle child. I have had major surgery, breast cancer, multiple bereavements and become visually disabled. 2020 has been another year of struggle and reflection. My entire family caught Covid and then I went on to have Long Covid for the rest of the year and am still recovering.
The Black Lives Matter movement has helped me reflect on the hidden barriers of my colour, gender and foreign accent. I have only been racially abused twice in the UK, and I do not suffer the daily indignities and abuse that many of my black colleagues endure. It doesn’t mean that I haven’t suffered bias, nor had to work harder to prove myself; in fact, some of the institutional biases are so subtle as to be difficult to identify or challenge, yet they must be called out. My Christian faith is a great comfort and source of strength, it lights my way, and my husband is a rock and endlessly supportive. The greatest struggle that I now have is finding ways to deliver the many projects I undertake within the constraints of my energy and physical limitations.
I have a motto I live by: “Never Waste Suffering”. I do still struggle with imposter syndrome and it is hard not to compare myself with other women with amazing unruffled personas and charmed lives. I don’t invite or enjoy vicissitudes but I now try to reflect and learn as much as I can from each experience, and choose to grow stronger rather than bitter. I have been told I’m inspirational and it feels good to be able to believe this now. I think that at 55 I am finally feeling confident and grounded enough to speak publicly about the vulnerability that can lie behind the glossy front, to encourage the next generation of inspirational women.