Dr Shevonne Matheiken is a higher trainee (ST4) in the East of England, and is the current Vice-Chair of the Psychiatric Trainees Commitee. 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 Matheiken's story: Psychiatry – the one thing in life I was sure about
I grew up in the southern state of India called Kerala, which prides itself on 100% literacy. Education was always given the utmost importance, irrespective of your social class. Back then, the most desirable career options were limited to medicine or engineering, although things are thankfully changing for the better these days.
I had four aunts in the immediate family who were Catholic nuns, and a great uncle who was a priest. He was an inspirational man by all accounts, and started a number of charitable institutions. These included a psychiatric hospital (which he designated a ‘psychomedical centre’, most probably to address stigma) with an attached rehabilitation centre in a rural village. It was run mainly by the nuns from my aunts’ congregation, many of whom were qualified nurses. They only had a psychiatrist visit from the city one or two days a week, to supervise ward rounds and medication changes.
My earliest memories, which might have played a part in my choice of career, are quite vivid in my mind even now. Every time we visited my aunts, we also popped in with sweets to meet the patients at the hospital and the rehab centre next door. There was no age restriction for visitors, unlike in the UK, so I interacted with the patients up close even as a young child, accompanied by a staff member. As the years went by, I realised that many of the women in the rehabilitation centre seemed to be living there forever. When I enquired, I was told that although they came there for a respite admission for their relatives, many families intentionally never came back for them.
These women then ended up living there long term, and it evolved into a therapeutic community. Each person had a role depending on their mental and physical ability; they had leisure activities and routines, and they looked after each other with the nuns overseeing matters. I have memories of visiting orphanages as part of our catechism school, where compassionate staff members and volunteers were struggling to care for the large number of children with cerebral palsy, autism or intellectual disability in each setting.
While the wider society’s stigma towards mental illness and intellectual disability played a big role in these situations, it is important to reflect that not all families in such cases were abandoning their relatives for selfish motivations; for some it came down to decisions around protecting other siblings, or financial difficulty. For example, arranged marriages are still largely the norm in India, and were even more so back then. If there was a mentally unwell person in a family, the marriage prospects of their siblings would be severely affected, due to the presumed heritability of mental illness and also general mental health stigma.
So, that’s how I came to start medical school with the sole intention of becoming a psychiatrist. In medical school, despite a fleeting fling with surgery and loving the feeling of being in the operating theatre (my Dad and brother are both surgeons), I stuck with psychiatry. I have always had a keen interest in people and understanding the human psyche, and with psychiatry the potential felt endless. After I got married, we moved to the UK, with a short-term plan in mind. After I got into psychiatry training quickly, we decided to stay on.
Now two kids and an MRCPsych1 qualification later, I find myself thinking back over the last few years. The challenges of being an International Medical Graduate (IMG) and then being a woman with young children stand out. It feels like a few years of living in strictly survival-mode. Visa-related stress, acculturation, and my husband initially being in a different city were some of the factors that made things difficult, but maybe not as hard as for many IMGs who have no family at all to support them when they relocate to the UK. Although I had always lived in India, my parents and brother had moved to the UK before me and that made the transition easier.
It was only after I finished my psychiatry exams and got my Indefinite Leave to Remain in the UK that I got more involved with RCPsych work and started networking widely with my peers. I am lucky to have many support systems now, including social media peer groups, work friends and mentors, all of which take years for an IMG to establish. Not everyone makes it unscathed through those harsh first few years of being new to the UK. That is a real shame considering the shortage of doctors in the NHS. International doctors bring a wealth of expertise with them; experiences of working in different healthcare systems and other cultures, much of which would help bring about positive change in the quality of care for our very diverse patient population, if there are people willing to listen to them.
So here I am today, training in general adult and old age psychiatry. But like many medics with young children, most days feel like an exhausting juggling act. I am developing an interest in physician wellbeing, transcultural psychiatry and digital psychiatry. When the COVID-19 pandemic hit, I was working in an old age psychiatry ward, part of which had to be converted to become the COVID-19 wing for patients with dementia who contracted the virus. Those were tough months with peak uncertainty and information overload.
During this time, I also got involved in a voluntary virtual support group for over 250 stranded IMGs who had come to the UK for the cancelled PLAB2 exams and got stuck here with no support, under the wings of BAPIO (British Association of Physicians of Indian Origin). It was an amazing feat to be able to help these stranded doctors as part of a small team, led by my colleague Raka Maitra (whom I am delighted to see is also one of the 25 women). However, with everything else that I was carrying at the time, it also completely drained me emotionally and led to me learning about moral injury and compassion fatigue in the context of physician wellbeing and burnout. My stress levels were also amplified by the ethnicity-related concerns around mortality in the early phases of the pandemic - 94% of the doctors who died in the first wave were of BAME backgrounds. My brother, my husband, my aunt (a nun and psychiatrist in her 70s) and I were four BAME doctors working on the frontline, and my retired Dad was shielding owing to being clinically vulnerable.
I guess we have all thought about our own wellbeing and mental health more than ever before since the pandemic began. I am glad there are so many more conversations about these vital topics happening, even amongst colleagues of other specialties. Maybe this will also help shift the professional stigma we face as mental health professionals in the wider medical world. I feel that there is so much to learn about stigma — not just from our patients, but also from our peers who have lived experience. We have lots to learn about how to bring compassion and kindness into our clinical practice that positively supports patients in their recovery. I am also learning that being kind to yourself is the hardest type of kindness, if you’re anything like me. I am slowly trying to replace cultural and societal expectations of being a good doctor, wife and mum all at the same time, with dollops of ‘this is good enough’. I was a doctor before I became a wife or a mum, so I think I will always be a little biased towards my patients!
Sometimes I feel that as women, we can be our own enemies. Some of my female acquaintances who were doing less (by choice) than me career wise, have expressed pity for my kids, making assumptions that I was a worse mum in comparison to them. But if we were to rewire these gendered expectations, we could move mountains by supporting one another, showing willingness to learn from each other’s experiences, thus being role-models to the next generation of women in medicine.
We would all do better if we could judge less, be kind, and lift each other up as we climb. That’s my closing message, and thank you to everyone who took time to read this ☺
- Membership of the Royal College of Psychiatrists, allowing progression from early to higher specialist training.
- Professional and Linguistic Assessment Board exams are taken by doctors trained overseas to demonstrate readiness to work in the UK.