Dr Graham is a specialty registrar in child and adolescent psychiatry (soon to be a consultant child and adolescent psychiatrist) at Avon and Wiltshire Mental Health Partnership NHS Trust. 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 Graham's story
I was 25 when, after completing a degree in American Studies and embarking on a promising career in Marketing & Public Relations, I moved to Bristol to begin again. I’d gone to a comprehensive school in a working-class town in the North, and becoming a doctor hadn’t been on the careers menu. But, in my mid-20s when underlying beliefs that I needed to do something that mattered hadn’t gone away, I started medical school with the sole intention of becoming a Child and Adolescent Psychiatrist.
Although most medical students don’t know where they want to end up, I knew from the very beginning. I’d always found mental health fascinating, even before I realised it! When I look back on my first degree, I wrote about it at every opportunity – my final year dissertation, for example, was a 9,000 word essay comparing the presentations of mental illness in the novels ‘The Bell Jar’ and ‘Fight Club.’ Then when a close friend at University was sectioned and I visited her in a psychiatric hospital, I realised this was the field for me. I also knew I wanted to work with young people, because I’d spent a few years mentoring Care Leavers, and loved it.
Medical school was a challenge, because although I was bright, I didn’t feel scientifically minded, and I struggled to see how much of what I was learning translated into real-life practice. What was more challenging though was the constant feeling that no matter how much I studied, it would never be enough, alongside the scrimping and scraping as a mature student, just as the careers of my non-medic friends were really taking off and they had salaries and lifestyles to match. What was I doing?
It got easier though, after finals, when I finally felt (just about) clever enough, and I was able to shape my choices more. Having travelled previously, I didn’t feel the need to go abroad for an elective. Instead, I spent the time with a local community CAMHS team where I met my tribe: the most inspirational multi-disciplinary colleagues. Some of them I am about to start working alongside again as I transition into my first consultant post, and two of them I have become very close friends with, so much so that I couldn’t have got through more recent years without them.
Knowing where I wanted to end up eventually made it easier to choose projects that were going to be not only useful to service development, but also to progress my career. Probably the most lauded project I got involved with started out small and grew into such an enormous beast that I started to wonder if I should ever have taken it on! It felt very demanding of my time until the last moment when it all came together, and then it was worth its weight in gold. Not only was it helpful for many of the families and professionals I was working with, for me personally it also fulfilled all the necessary training needs too, from quality improvement projects and research, to leadership and service user participation. Almost six years on, I think it went a long way to securing me my first consultant post too.
The project involved producing a short film with funding from NHS England and Barnardo’s about eating disorders, which took viewers on an emotional journey, and embedded psychoeducation from professionals into the local care pathway. This meant it was useful both for families referred in, and healthcare professionals who needed to refer young people. Luckily, the project management skills I learned in my previous career were invaluable in bidding for the funding and writing project reports, recruiting young people and families to share their stories, and liaising with everyone from the professional filmmaker to the trust communications department.
When it was finished, it went up on the Trust website alongside a whole host of media resources we’d created with the excess narratives we’d gathered, we held a launch party, and I ended up on the local evening news talking about it as part of a wider debate about the provision of eating disorder beds nationally! Afterwards I was able to use the resources to develop my teaching and presenting skills, talking about it at local, regional, national and international forums. We managed to get it endorsed by the College’s Child and Adolescent Psychiatry and Eating Disorder faculties. It even ended up getting me shortlisted for a number of prizes too, including RCPsych’s Core Trainee of the Year and Junior Researcher of the Year, and the Patient Experience Network’s National Awards in the 'Access to Information' category.
However, it’s not the piece of work of which I am most proud. That would be the nearly two years of psychodynamic psychotherapy I provided to a patient with prolonged grief. From a personal point of view continuing the therapy took a great deal of stamina, and a lot of my learning was about tolerating my own difficult feelings so that my patient could learn to tolerate his. However, my patient and I worked through this challenge, and our work together opened up a ‘mindspace’ for him. He was able to develop an emotional language, which in turn reduced his previously high level of risk.
We spend a great deal of our week with our patients, and we give so much to them, sometimes at a cost to ourselves; but what is talked about less is what we gain, and how we take this with us and use it with our other patients. From this man I learnt so much about pain, distress, how isolating it is, and how much courage it takes to sit with these feelings and simply let them be. This experience inevitably fed into the way I worked with families when I became a higher trainee, but what I could never have known is how much it would help me in my personal life too, when I became a mother.
A few years ago, after months of anxiety and being very kindly but quite firmly dismissed by professionals, my young daughter was diagnosed with a rare neurodegenerative condition. The grief was almost unbearable, and in many ways it is ongoing, but my experience with this one patient and in the psychodynamic psychotherapy I’d had myself a few years earlier, have held and continue to hold me in a way I wouldn’t previously have thought possible.
What’s more, despite the fact that I can’t put it on my CV, this personal experience has undoubtedly become integrated into who I am as a psychiatrist too. I have become a very reluctant Expert by Experience, from sitting on the other side of the (now virtual) waiting room. It is with this new capacity to understand feelings of hopelessness, desperation, frustration, sadness and loss that I embark on the next part of my career journey. And while the increase in pay gives me the opportunity to work part-time and to take back some precious space for myself (something I have craved since having children and the inevitable battle to be ‘good enough’ at both doctoring and mothering), I now find myself re-energised, with an increased appetite to try to make more of a difference.
I think this comes partly with the freedom I now face to truly be myself. As trainees we are in the unique position to be able to mine from our supervisors the sparkling nuggets we most like the look of, and to leave the rest behind. It isn’t until after we finish training that we have the opportunity to present patients with a more authentic psychiatrist, who has tried on and discarded different white coats, and eventually crafted a bespoke one, stitched together with the golden threads of the patient narratives we’ve cherished the most. It is for this, that I can’t wait to start my consultant career!