You Are Not Alone - Episode 1 (Transcript)

Shevonne Matheiken: The Psychiatric Trainees Committee of The Royal College of Psychiatrists is proud to present, You're not alone, a podcast series covering a range of topics on factors affecting the wellbeing of healthcare professionals. There is a lot more talk about mental health and well-being since the pandemic began. However, wellbeing is complex, dynamic, and personal. It is not always something that can be solved with just resilience training or mindfulness. Both those things are excellent but concepts like intersectionality explain why there is so much more to consider regarding the well-being of healthcare professionals. This is what we hope to do with our conversations. Episode 1, Doctors With Mental Illness.

Daniel Wilkes (DW): Hello everybody and welcome to this podcast on Doctors With Mental Illness. My name is Dr. Daniel Wilkes. I'm a PTC Rep from Aberdeen, an ST4 in the Psychiatry of Intellectual Disability, and one of the vice chairs of the Academy Trainee Doctors' Group. I have recurrent depression for which I take Citalopram and I have had psychotherapy in the past using CBT and DMDR. And I know I'm not alone among doctors. 85% of us have experienced some kind of mental health problem. And 1/3 of us have a diagnosable mental illness at some point. Today we're joined by two people who have lived experience of mental illness.

Dr. Linda Gask is Professor Emerita in primary care psychiatry at the University of Manchester, and a retired psychiatrist who has experienced depression. She has written a memoir of her experiences, The Other Side of Silence which our former president Professor Simon Wessely described as a compelling and moving personal account of the reality of depression. Having recently read it, I completely agree. Usama is a final-year medical student at Imperial College London. Following lived experience of mental illness, he wants to share his story in the hope that others who may be going through similar experiences feel less alone.

So welcome to both of you today and thank you for joining us. I suppose I'll ask, I'll ask both of you first and we'll start with Linda, about what-- about your lived experience and what sort of feelings you had about that. Particularly I suppose the thing that we talk about a lot is sense of loss of control or, you know, being on the other side of the curtain.

Professor Linda Gask (LG): I think as a medical student, I simply felt shame that I wasn't up to it in some way, that I wasn't strong enough, and I wasn't going to be able to make the grade. As a junior doctor, yes, there was a sense of control, particularly when I was referred to someone who I'd previously worked for. And I think he managed that incredibly well. He was lovely. There were those moments when you really think is this the end of everything? Is this my career just going down the drain because I'm somehow not up to doing this.

Usama Ali (UA): So for me, I suffered from mental illness from severe depression in my first year of medical school just a few months after I started and I remember starting medical school feeling as though everything was amazing, as though I was on top of the world. And my story is that initially actually I was rejected from medicine. And so as a result of that I ended up feeling as though I'd lost control in that regard. And so when I got my offer from medicine I thought it feels great to have control of my life once again, I'm in charge, I'm dictating.

And then for me to then have depression a few months after that, to once again lose that control, that was something I was very much unwilling to accept. And unfortunately, things progressed from there as a result. I sadly developed psychosis as well a few months later and I ended up finding myself admit in a psychiatric facility in which I felt as there were lots of basic stuff, basic liberties had been taken away from me. And again losing sense of control in that sense was also something extremely difficult for me to deal with.

DW: Thank you. I think that is always one of the concerns. I think as doctors, we like to be in control and we like to control the variables of the human body. We like to  make sure we've got all of our ducks in a row. And I certainly can empathize and sympathize with those feelings from my own experience. I suppose thinking more positively, what one thing did someone else do that helped you the most?

UA: I think I'm quite lucky to say that that's quite a difficult question for me to answer. Purely because I had lots of peers around me who did lots of stuff to help me and so it is quite difficult, I think, for me to narrow it down to one example. But having said that, one example that does stick in my mind is when I was admit[ted to] the psychiatric facility for the first time, to my surprise a surgeon was also admit[ted] there at the same time as me.

And after he found out I was a medical student, he reached out to me, made himself vulnerable in front of me, and shared his own experiences with me as well, and made it clear to me that just because you're a medical student and have mental illness does not mean that you cannot be a doctor in the future. And I think there's lots of discussion that goes on about how useful it is for people to talk about their own lived experiences. But I can say that in my case at least the fact that this surgeon made himself vulnerable in front of me, for him to share his own lived experiences, I'd say that was one of the most useful things for me actually.

DW: That's an experience I've had as well from colleagues. And actually it's something I try to replicate with others. I think there is still a stigma attached to mental illness in the medical and psychiatric professions but the only way really to overcome that is to be honest with people. I suppose there's a degree of only needing to do that as far as it is comfortable to do that, you shouldn't feel forced into telling everybody your deepest darkest secrets. But at least being open and saying, "You know actually I don't need to tell you the detail of my depressive illness necessarily but I have been depressed and I do take medicine for that" is actually quite empowering.

And I found it helpful actually in relationships with more junior colleagues as I obviously I'm a registrar so I'm developing a supervisory role, and actually watching the weight lift off junior colleagues when you say, "That's okay, you know, I'm on an antidepressant as well. I know what it feels like." It's actually really liberating and quite pleasing. What are your thoughts Linda about one thing that someone else did that sort of helped you the most?

LG: I think I grew up in a different time from today and I wish I had that support but I didn't much. There was no one who really said it was okay when I was a medical student to have mental health problems. And indeed a couple of people in my year were admitted to a psychiatric unit and everybody knew. And it was just awful. There was a sense of terrible stigma about that. The worst time was in my final year and I was very isolated a lot of the time. But someone did reach out to me. I was on the psychiatric unit actually doing-- In Edinburgh we used to do two weeks in the final year.

And I was on there. And one of the registrars actually asked me if I was okay. I'd been in the treatment room and I'd been crying. I had been hiding really. And he asked me if I was okay and I said, "Yes I'm fine." And I didn't open up. But I remembered him and I remembered that he tried. And I had lunch with him a few months later when I was much better and I didn't talk about it. But I kind of wanted to demonstrate to him somehow that I had got over things.

And then when I was a junior doctor and a similar kind of thing happened when I was in a supervision group. I was in a psychotherapy supervision group, as you are in training with my third—well, first or second long case. And we had a more experienced person in the group who'd actually begun another specialty before she came into psychiatry and she was a little bit older than the rest of us. And she asked me if I was okay when we were on our own. And I told her that I wasn't, that I was really falling apart. I said I actually sometimes feel worse than the patients that I'm seeing, which I did. I started to feel very impatient with people because I thought why can't they just get on with their lives? You know, I'm feeling terrible. Which is an awful thing to feel but that was how I felt about some people.

And she arranged for me to see somebody but that was so helpful because she reached out and she actually asked me how I was. I kind of wish that I'd sought help earlier but when she did reach out to me, it was so memorable, I've never forgotten that moment. And it was the first step to having some therapy that helped me sort things out. I'd failed the membership exam because I've not been at all well when I'd taken it. 

I think that what we haven't mentioned, which I think a lot of doctors are prone to is perfectionism. And I was a serious-- I am still a serious perfectionist. I mean that perfectionism through my work has been a source of many problems for me. And I was working far too many hours and working myself into the ground. And she just reached out. She just was like a voice of sanity when I had lost it. And, yeah, that was important.

DW: It was very interesting that you talked about irritability, the kind of, you know, that kind of frustration of depression that actually, I think we, even as psychiatrists, those of us that are psychiatrists, you often forget that depression isn't just melancholy. No, it isn't. It isn't just that and often it can be an irritable, angry experience for people. And actually, that was one of the things, I mean it was a part of the constellation of things I experienced, but it was certainly a part of it, that frustration, that, "Yes why can't you just get better? Oh God, not another ill person." You know, just you know.

Actually, I found it particularly with physical health problems because it wasn't the first episode of depression I had, but it really became a problem in core training. And it was that frustration with physical health problems, I think, that I was trying to manage. It's like, you know I didn't come into this career to do be doing this. It just really, it really, really pushed a lot of buttons. And you're right, it's a horrible feeling. And it's a horrible thing to think, but it's human nature when you're not well to think like that. You want the pressure, you want the stress to go away.

It was interesting talking about how people opening up to you and coming to support you stayed with you and has made a difference in your recovery. And actually Linda, you saying about how actually that first person coming to you didn't fix the problem and it's not going to but that actually you held onto that and I think even in your depressive mindset, you could see that person wanted to help you. And that gave you some value. Because the problem I think with depression particularly, I suppose all three of us have experienced that is the sense that you have no value, people don't care, not only don't they care, they shouldn't care.

It's quite powerful when people take action to demonstrate that your negative cognitions are wrong, that they are not accurate. And that actually you do have value, people do care about, you deserve to have, you know, to live and to have a good quality of life as well.

Actually, it was interesting Linda, that at the end of what you were saying as well, you talked about how you wish you'd moved a bit sooner and that you'd responded to those signals you were getting from other people and that support that other people were offering. I suppose that brings us nicely onto the next question I wanted to raise. We know that there's data that shows that recovery is likely to be better if people seek help earlier, but still doctors delay seeking help for mental health problems. What barriers do you think that they face with those?

LG: I think that we're so used to not regarding ourselves and not taking care of ourselves. I was thinking about this not so long ago when-- I mean, this may seem nothing to do with depression but as a junior doctor, I did not take care of myself physically or mentally. I just worked. Now, I have problems with my teeth. And if I had had all my teeth seen to perhaps better when I was younger, instead of going for something like two years, I think, without having any dental care at one point, I might be better. My mental health is much the same. You work all hours, you put off arranging to see anybody. You never put yourself first in that sense. And you think that that's what being a doctor means, that that's the sort of life that you have to have or that's how it was for me.

I think at medical school we were told, you know, this is a lifestyle decision that you're making, this is a vocation, and this is the way you will live. I'm not sure it's quite as bad as that. Now I think it has improved, but I still hear about people working all hours. And, you know, I think I would have trouble coping with shifts because of how sleep affects my mood, but I just didn't ever consider that there was room for me. I had to make room to actually seek help. And I'm sure that's one of the things that's really hard for people. It had to become a priority.

And when I went for therapy later, this was a bit later, I was a consultant then, and I had to-- I actually dropped down a session a week so that I could go for therapy.

And I had to tell people I wanted to drop down a session a week because I had to travel from where I was working over to Leeds for therapy which was like a 40 mile drive. So it was an afternoon. And you have to find space to do these things, which isn't, it's just really hard. And in a schedule where you're taking exams, you have a family. And I think for me, you know when people complain that people are not motivated, well, you know, motivation a lot of it is to do with just think about how motivated we are to take care of ourselves. We put everything else first.

DW: It is a shame, it is a shame, Linda, because I presume in dropping a session, you have to take a financial [hit] as a result-

LG: Yes. I did. And it was a tremendous relief actually. There was a relief in somehow saying, "I can't do this job as it's designed and it's not good for me." And I never went back to full time. And I made arrangements to not do on-call eventually as well. And that was part of actually being honest with my boss who said, "Well, when I was a senior lecturer I did on-call." and I thought well, I'm sorry, but, you know, I have mental health problems and I can't cope with this. But I had to have that conversation. I had to brace myself to have that conversation.

DW: You're you and I'm me. Isn't it?

LG: Exactly.

DW: Yeah. People are different. I suppose I was lucky. I was very lucky as a core trainee actually when I was in child adolescent psychiatry. So I'd had- once I'd had the major problems in an earlier placement but it was towards the end of that placement. So I'd moved into child adolescent psychiatry. And actually, my supervisor was there who said simply, "Just take the time you need for this, that, you know, if you need to go therapy during your, that's fine. We'd rather have you working some of the time and well than unwell and not working any of the time because we're trying to you know make you stick to a rigid timetable." 

I was, you know, I think I have been very lucky in that respect. I was even more lucky that the place I went for psychological therapy, it was next door to the center for child health. So that was, I would say slightly bizarre but it worked very well and it was awfully convenient.

I suppose we talked about whether that pressure still exists and we have, you know, somehow we have the perfect representatives. We have a medical student. Is it the hidden curriculum or is it the real curriculum that says you know, this is a vocation, this is a calling and you must sacrifice your life to the gods of medicine?

UA: Well, I do think the stories I've heard from people like Professor Gask, I do think things are a bit better now compared to perhaps how they were a few years ago. Having said that I think that there is still some of that culture that exists. So for example, I'm thinking of when I was preparing for my medical school interviews many years ago, I think in medical school interviews, you are trained to make medicine your lifestyle, you're trained to make it your priority. And when that's drilled into you as a young 18-year-old, you end up believing that as well. And so I ended up having similar feelings as well. In my first year of medical school I felt as though I needed to put medicine before anything else and that did make things much more difficult for me.

DW: There is an internal drive, perhaps isn't there -- So I think there perhaps is a hidden curriculum. And I think some of our more vulnerable peers and teachers and supervisors want to instill a quite old-fashioned and tough sort of work ethic. But I think some of it does come from those perfectionistic tendencies that medicine selects. And if we, you know, if actually people can be pleasantly surprised if they do as Linda did and go and seek changes to their work schedule or changes, you know, and change the way that they're working.

Actually, as you progress your medicine, you do have rather more flexibility than I think the more junior doctors will experience in terms of when I work, where I work and how I work. And actually, the pandemic has given some interesting opportunities to change that as well. 

Moving on, how did colleagues react to your mental health problems and did any particularly bad experiences stay with you? I think we've talked a bit about the good experiences. So I suppose we do have to talk about what didn't go quite so well. So, Usama, have any particularly difficult reactions stayed with you?

UA: Yes. Unfortunately, there have been some rather difficult reactions. And I think the most difficult reactions that I have got have been in relation to the psychosis that I experienced several years ago. So I remember, for example, there was one occasion in which I was with some friends and, unfortunately, I ended up having some type of hallucination. And essentially, that story, it got out for other people at the medical school as well. And I remember one night I was sitting in my accommodation alone and then I received a Facebook message from someone who I had never spoken to before. And the content of the message itself. There were no words or anything, but rather it was just an image that that person sent resembling the hallucination which I had once- which I had once experienced in front of my friends. You know, it was extremely difficult for me to deal with because for some people, this had clearly become some form of entertainment, you know, I mean, my own suffering, my own mental illness had become entertainment for other people. And I think the fact that it was medical students as well, future doctors who were involved in that, it made me feel even worse actually. And I mean, it's been years since that happened, but even now I have not forgotten that. And it's something which does, which does upset me still to this day.

DW: I think that's no surprise that it has stuck with you and it's a horrible thing to happen and it's a horrible thing for somebody to do. And it's, I mean, I don't necessarily, I don't always like bandying the word unprofessional around cause it's often used as a stick to beat behaviours that we don't like with, but this I mean, it's horribly unprofessional. It's just a horrible thing to do. I mean, you wonder what possesses people to think that getting entertainment out of somebody’s distress in that way is -- it's almost inhuman. It's really just horrible. Linda, I don't know, have you had any experiences that have been as difficult or unpleasant as that?

LG: I had difficult experiences when working couple of times, mostly related to irritability. When I get depressed, I can get very irritable and I can get angry, really, really angry, difficult. And it is indicative of my mood. And, I think it's one of those things where I've seen this with my patients. I know that it's one of the reasons why people get angry with receptionists, you know, because they lose their patience. But I got very angry with the health service manager and I was then threatened with disciplining by someone I thought was a colleague and friend and who knew perfectly well I'd had mental health problems and I think should have picked up that this was related to my mental health problems. And in fact, I did go off sick at that point and I was off for several months. I should have gone off earlier before that happened.

It was like-- I was like a time bomb waiting to go off. I was going to have a big argument with somebody and I had it with a manager, and this was reported back. I do find it interesting the way that, you know, you can work within a mental health organization, but the mental health of staff is not kind of picked up on in the way that you might pick up people in your clinic. But it was fairly obvious, I think at that point to my secretary at the time wasn't well. And I think she kept telling me to have some time off, but I wasn't for it. And most of the time, I learned to get away before something like that happened, but I haven't always been successful. And I don't-- I've never been psychotic, but when I get depressed, I can get quite paranoid about the world and that really doesn't help either. Because then, I start to get even more angry. So that, you know, that was a career changing incident really. And that's happened more than once with with people who I would have thought should have been able to pick up, given their express concern for people with mental health problems. But somehow it's different when it's someone you work with.

DW: You and I Linda have had similar, I think, experiences in that regard. I think, well, I think I am more of an irritable person when I'm depressed. So I think that people are less forgiving of that. I think they're more forgiving-

LG: I think they are.

DW: Yeah, I think there is a big stigma attached to psychosis. And I think Usama’s experienced that, and I think there is also a difficulty in seeing that that the sort of brittle irritability can be a depressive presenting feature as well.

LG: Yeah. I should add that this was almost 20 years ago now. And I'm sure that everybody, perhaps it isn't remembered as clearly by them as it is by me, but those are the moments that stay with you.

DW: And it is unfortunate. But I suppose that's part of the nature of depression that the negative incidents do stay with you more. That's probably part of the mechanism by which people become depressed in the first place. And I have had, you know, I've seen myself, I've had positive-- perhaps you have had positive experiences as well, but also negative experiences that aren't dissimilar to that.

LG: I think for me, that's just an indication of how important it is to listen to people around you who are saying, you need a break and when you go on too long and you carry on trying to work when you're not, well, not only is it bad for your patients, it's bad for your career as well. You know, that was-- if I had been junior, I think I would have had a lot more problems with that situation, but I was able to sort things out in my life and make a fresh start, but it's so important to listen to people around you who are saying, you are not very well, you need a break.

DW: I agree. And actually, that is something I was going to say that is a skill. I mean, it is a skill that needs to be that needs to be learned. And it's something that, you know, nobody's perfect, and actually, we won't always get right. And I suppose that it does bring us on to talking about mental illness, and for good, or ill, speaking up about having mental illness as a doctor is still seen as something that's a brave thing to do. Do you think it should be regarded as a brave thing to do? I suppose that sounds quite a challenging question. And what did make you decide to speak up publicly about this campaign against stigma?

LG: I wanted to talk about it because I was aware that there was a part of me I had really tried to conceal for most of my career about which I had a lot of knowledge, which was about my own mental health and about the experience of having a mental health problem. And I had largely concealed it. My immediate colleagues knew about it. I had to talk about it every time I have an appraisal. I had to mention that I was receiving care, but it was a source of knowledge about what it's like to be a doctor with a mental health problem, that it's real, that you might need help, but you can actually get through it.

I have managed to get through a career where I was pretty successful despite struggling at times. And I didn't hear anybody else much talking about it at that point. So I really felt we needed to. I also felt it was to do with the voice of psychiatry, not just always being about experts, talking to patients, but saying actually, you know, I'm supposed to be an expert, but I'm also a patient. I've experienced both sides of this.

DW: Usama, what are your thoughts? I mean, what made you decide to speak up publicly.

UA: For me, I think speaking up publicly came from remembering just how alone I felt a few years ago when things did really go quite bad. I do remember quite clearly feeling really miserable, really upset. And I remember trying hard to find any other medical student who was in a similar position to me. It seemed that no matter how hard I tried, I could not find any other medical student who was also speaking up about these things and that made me feel quite alone as well.

And so eventually, when I did get a bit better, I thought to myself, why don't I try to be that medical student who tries to be a bit more open about these things? And so that's what I do now. I don't know how helpful people find it or how unhelpful people find it. I do hope though that if people do listen to my story, they might end up feeling a bit less alone knowing that others have been in the same position. I mean, I would not wish mental illness on my worst enemy. You know, it's something which is so difficult to deal with. And so I really hope that by sharing my story, people can feel a bit less alone, and that's what drives me to share- to share my experiences.

DW: Mm. It feels brave, doesn't it? It is, uh, I wish we were in a world where it wasn't, but it does still feel-- Even talking about my experience a bit today, I still feel a bit of anxiety about it, and, you know, how will people respond to that even though I am, you know, with people I know and work with, I'm fairly open about the problems I've had.

Looking back, is there anything that you wish in your journey you'd done differently? I can think of with my own experience, I wish I had recognized the problem sooner. I definitely had an untreated depressive episode in my teenage years. It's mainly thanks to the joy of homophobic bullying at school and I didn't really do anything about it then. And I had another episode, I'm sure I had another episode, which I had a bit of counseling in university and I didn't go to my GP about it. I didn't think it was serious enough. And then it came back and really caused major career problems when I was a core trainee.

So I know I wish I had moved sooner. I don't know, do you feel similarly, is there anything else that, you know, as somebody, you know, do you, is there anything you wish you'd done differently?

UA: Honestly, I feel the same as you feel as well. I wish that I [sought] help earlier as well. I think I was very unwilling to accept that I might be ill because around me, everyone seemed to be fine, everyone seemed to be normal. And it's only now that I've realized that actually, that almost certainly was not the case. It's almost certainly the case that everyone around, well, a lot of people around me were also struggling as well, but were also feeling similarly to how I myself was feeling. And so I think not seeking help early as a result of that, I think negative feelings ended up bottling up inside of me as well.

And we've talked about irritability and anger, and I very much had the same as well. I remember feeling really negative. The negativity would turn into irritability, turn into anger, and I'm quite ashamed to say that I ended up taking that out on some of my peers as well around me at the time. Um, and I think that had I sought help earlier on, maybe all of that could have been avoided, maybe things like my admission could have been avoided as well. And, you know, I mean, hindsight is a wonderful thing, but I'm hoping that if this does happen again in the future, I'm hoping I might be better at recognizing this type of stuff.

DW: Linda, what do you feel about-about your journey and if-if there's anything you wish that you'd done differently with the joy of 20-20 hindsight, which has just, it's too perfect and life isn't perfect, we know that.

LG: Well, in many ways I've done the things I should have done. I did get help. I did have therapy, quite a lot of it, at different points. I did take medication when I needed it. Although I think I would have benefited from it quite a bit earlier than I had. But when I look back at my after medical school, the period after medical school, I did have problems with the loss of my father, during my, what would be now my F1 year, it was my house year. And I had a difficult relationship with him and that should have been a warning sign that I was probably going to have difficulties with bereavement, but I didn't seek help when I should have done, I think.

I just think it's interesting how we often end up being interested in the kind of problems we know about. And I had a lifelong interest in helping people with complicated bereavement because that's something I had myself. And I know what that feels like. And people often, they're often quite dismissive of it just being normal grief, but something that lasts and turns into depression and lasts for three or four years isn't really normal. It's significant suffering. And I think I should have sought help sooner and that might have changed the course of things considerably.

DW: It's interesting cause we, I get the sense we have, all three of us have said that we feel we should have done things sooner, that we should have sought help sooner. Although the CBT therapist in me, you know, is keen to sort of jump on the word "should" and say, well, you know, we're human beings, we're complex systems, we have complex thoughts and beliefs and emotions and we don't always do what with hindsight we wish we had. And perhaps using the word should isn't the best way of thinking about it.

But I suppose the positive I take from the idea of, "gosh, I wish I'd moved sooner" is that the reason I think all three of us say that is that actually it wasn't nearly as bad as we thought it was going to be when we did take action, the, you know, the boil was lanced and was a lot less painful, the plaster was removed, you know, removed quickly and it, you know, the pain of taking action was much less than we imagined it would be.

I think that's what I take from that. I suppose if I was to think about things I also wish I had done, not just about seeking help sooner, but being kinder to myself. And I think at the beginning, Linda, you mentioned that right back at the beginning of our discussion, you talked about us not being kind enough to ourselves. And certainly one of the issues that has maintained my depression in the past has been issues with self-esteem. Junior doctors, and I suppose there've been possibly even more senior doctors, often experience imposter syndrome and a sense that we, you know, we're not as good as we should be, again, going back to perfectionism or that, you know, others are a lot better than us and that they would do our job a lot better than we do it. I mean, is that something, or issues of self-esteem and imposter syndrome, are they some things that speak to you, Linda?

LG: Absolutely. And I don't think it's just junior doctors, I think it's people at the top of their career who think that on a regular basis, I've met them at times when people are being honest to each other. I think the way we try and bolster our self-esteem is one of the problems because medicine actually says being perfectionist is a good thing, but the problem is that it also has serious downsides in terms of preventing, or making it difficult for you to make space for other things in your life. And taking care of yourself is crucially important, and I'm still not terribly good at that. I'm still learning how to do that even after all these years.

DW: It is interesting. It makes me reflect on finding it difficult to say no, and sort of accruing, you know, clinical director jobs and accruing representative pace, and accruing you know, always wanting to be doing things and building the portfolio, but actually it is for some people. Some people are incredibly resilient and you know, it's not a word I always like but I think those people are probably pretty rare. I think most people have a limit and medicine, if you're not careful, will push you to your limits and get you to take on lots and lots of responsibility. What do you think Usama about about self-esteem, about imposter syndrome?

UA: Yeah. Imposter syndrome is something which I very much have struggled with throughout medical school as well. And I've just completed my medical school finals a few weeks ago and I think the levels of imposter syndrome then were absolutely huge. You know, I think perfectionism is something which I myself have struggled with. So for example, I remember during my medical school finals, when I was revising for them, if I'd get a question wrong, it was of some like a really rare disease, I'd beat myself up really badly about it and make myself feel really bad about it. Even though in reality, it's a very small thing, it does not mean, it's not the end of the world to end up missing something like that. But nevertheless, I think you're taught on ward rounds as medical students to always be right, to say things in a particular type of way, if you say it in a different type of way, that's the incorrect way to say it. And that makes things a lot more difficult. And I think in many ways, it also made me find it quite difficult to seek help early on as well for the reasons we've mentioned previously.

DW: It's interesting that you talk about teaching styles in medicine. And actually, I think it is gradually getting better but there are still people, actually some relatively young junior people who still engage in that sort of, you know, the term I believe is "pimping" which isn't just the Socratic teaching methods, it's more aggressive than that. It's really, really being quite negative about people if they don't know the answer to your esoteric question about the course of the recurrent laryngeal nerve, for instance. I mean, I think it is getting slightly better because I think medical education is becoming more of a specialty in its own right and there are more training programs and opportunities to do the postgraduate certificate in medical education. But I suppose it is a danger of the way we teach medicine that we get people who aren't teachers necessarily to teach it.

We talked quite a bit about what we wish we'd done differently or, you know, that we wish we'd sought help sooner but I suppose there is a place for other people to pick up problems too and to offer support to colleagues. So I wonder what message you would have for colleagues who are not sure how to support peers struggling with their mental health. Linda, what do you think about that?

LG: I don't find that easy to answer but when I think about my own experiences, both as supporting other people and being supported myself, the most important thing is listening, not telling people what to do because you can always find some reason for not doing what people tell you to do. So listen and don't tell, be there, be available, be honest, be yourself and don't try and be a doctor.

DW: I would possibly add don't necessarily try and be a manager either. You know, try and be human and be, you know, be a friend. Usama, what do you think?

UA: I would echo for us to follow what Professor Gask has said. We talked about control and it's not nice feeling as though you've lost control of your life. And then if you do have someone who is trying to dictate things to you, that can worsen the problem in many ways.

I would also like to share a story, I think, of how one of my colleagues helped me, in the hope that it might inspire other people as well. So when I was really depressed a few years ago, I remember there was a stage in which I was not eating, not drinking, not looking after myself, not doing basic things necessary for human survival even. And what happened was one of my friends at medical school, she found out about this. And then what she did was every single day, whenever she would have lectures in any 15, 20-minute break that she had, she would walk all the way from the lecture theater to my accommodation, bring me food, bring me water and keep me company. And to this day, I'm so grateful to her for doing that. I mean, she literally saved my life in many ways by doing so. So if you are able to support people in ways like this, it can make a huge difference and they will not forget it.

DW: Thank you both Linda and Usama so much for talking today to us. It's been a pleasure and I think we've had a really interesting discussion. And I hope that those listening find it helpful. If you want more, there's going to be information on alongside this podcast, further reading for you to take a look at. There's also an opportunity to engage with Linda and Usama. Linda has got a new book coming out soon and she's on Twitter as @suzypuss, that's S-U-Z-Y P-U-S-S and Usama tweets as the DepressedMedStudent and his Twitter handle is @usycool1 which is U-S-Y-C-O-O-L-1.

Thank you for listening to the first episode of You Are Not Alone. And we hope that you'll join us again for future episodes.

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