And now I'd like the Vice Chancellor to introduce your speaker.
>> Thank you.
>> [APPLAUSE] >> Good evening, everyone,
delighted to welcome you to this brand spanking new lecture theater.
I bet for many of you it must be your first time here.
It's quite, quite glorious.
But I'm especially delighted to welcome you all to our second
annual lecture on the theme of disability.
Now, the notion of parody of esteem where mental health is valued
equally with physical health is now enshrined in English law.
But I think many of us believe that there is much to be done if the country
is to stand a good chance of actually achieving this parity.
The British Medical Association has said that what we lack is a clear
range of actions to help ensure not just parity of esteem, but parity of outcomes.
Being open confronting the stigma that has been perpetuated for generations,
and encouraging frank discussion are all important components of the response.
And few are better qualified to inform this discussion
that our distinguished visiting lecturer this evening.
Professor Linda Gask is an Emerita Professor of
Primary Care Psychiatry at the University of Manchester.
And is one of the world's most eminent specialists in the treatment and
understanding of mental illness.
After reading medicine at the University of Edinburgh,
Linda undertook her specialist training in psychiatry in the Northwest of England.
Much of her clinical research has taken place in Greater Manchester.
But the impact of this work has been truly international.
In 2000, 2001, she was a Harkness Fellow in healthcare
policy based at the Center for Health Studies in Seattle.
She's also worked as a consultant for the World Health Organization and
as a regional representative of The World Psychiatric Association.
Today, she's one of the Academy's most respected and
compelling voices on mental health.
She has a long list of publications.
Her most recent being The Other Side of Silence,
A Psychiatrist's Memoir of Depression.
Earlier work was the ABC of Anxiety and Depression.
A short Introduction to Anxiety, the widely adopted Teaching Psychiatry,
Putting Theory into Practice, which offers a globally relevant perspective and
provides practical advice on all aspects of teaching psychiatry.
Other works include Medical and Psychiatric Issues for
Counselors and Psychiatry and Medical Practice.
Over her career as a researcher and clinician,
Linda Gask has acquired deep expertise in researching mental health policy and
practice with a particular focus on primary care mental health.
Her most recent research projects have been concerned with
improving the quality of care for those with depression and
the management of people who are at risk of self-harm.
In this field,
Professor Gask helps you found the STORM Suicide Prevention Initiative.
STORM which stands for skills training on risk management is
a package designed for all frontline health and social care staff.
For those who work within the criminal justice system, and for staff and
voluntary agencies, particularly those working with people at risk of suicide.
But a fundamental component of her life's work
has been her experience of life itself.
Throughout her academic and medical career, Linda has spoken openly and
fearlessly about her own personal experience of both pharmacological and
psychological treatment for depression and anxiety.
Her most recent book is in part a memoir and has been described by
Professor Dame Susan Bailey as a first in bringing together the intricate web and
weave of being simultaneously a doctor, a patient, and an academic.
Ladies and gentlemen, please join me in welcoming Professor Linda Gask
to deliver the second annual Oxford lecture on disability.
>> [APPLAUSE] >> Thank you very much.
And I'm honored to be invited to speak here in such a beautiful building as well.
I'm going to speak to you without a PowerPoint.
I want to really try and speak to you very much from my
heart rather than from reading through things on slides.
I have some notes.
First of all, I want to tell you a bit more about who I am.
You've heard about my career, but perhaps, a little bit more about me.
I was a clinical psychiatrist for 33 years.
I went straight into psychiatry from medical school.
And I was a consultant for the last 23 years of that.
And I worked in the North of England.
I think the furthest south I've ever lived is Sheffield,
which gives some idea of, I'm a Northerner.
I'm sure you can tell that from my accent anyway.
But my interest, I worked in Barnsley,
I worked in Preston, most recently, worked in Salford.
And Barnsley and Preston are two of the most deprived areas of England.
I've always had an interest in people with common mental health problems.
With depression, anxiety, eating problems rather than more severe
mental health problems such as schizophrenia.
My interest has been in the people who don't, or do, get help in primary care.
Only about 10% or less of people with
mental health problems are treated in the mental health services.
Although, many of my younger colleagues sometimes find it very hard to
believe that GPs treat the majority of people with mental health problems.
So that's been my interest.
And I taught medical students,
I taught junior doctors all of the things one would expect.
But as well as that, I've been a patient.
And I've been a patient in terms of my mental health ever since I was
at medical school.
My problems with anxiety began in my mid teens, and
I had really awful anxiety about my A levels.
I've always had a great fear of failing.
I'm sure that's something that's quite a common experience.
I'm in Oxford where people are high achievers, and
I was a high achiever in my school.
And then I went to Edinburgh and
I was suddenly in a complete lecture theater full of other high achievers.
So it was very competitive.
I have had several episodes of depression,
some of them quite severe throughout my working life.
My first episode was more severe episode was as medical students.
And as you might imagine, given that my problems began around my A levels.
I had problems with my finals.
And at that time, I rang up the consultant afterwards.
I got through them and I rang up the consultant who had taken care of me.
And I said, I wonder what you think about me going into psychiatry.
Because psychiatry it actually being the subject that I was best at at university.
I somehow seemed to be able to understand how people felt.
And he did pause for a moment, there was a perceptible pause.
And then he said, I think it would be a good idea.
And that really changed my life because although I had done very
well in psychiatry, I really thought that because I'd had mental
health problems as a student, I couldn't possibly go and do it.
And my experience follows on from that.
I've now retired.
I retired from the University of Manchester two years ago.
And I kind of hoped that once I retired I wouldn't have any more episodes,
everything would be fine.
And then a year ago I got quite ill again.
So it's been a lifelong thing.
What I want to talk to you about really is a bit more about the subject
of depression and about treatment.
But before I go on to that, I just want to remind us I've been writing
a paper recently about an intervention we did training people in
universities to be better at helping people in acute distress.
And it's hard to find data from the UK.
But the US National College Health Assessment 2013,
reported 31.1% of undergraduates had felt so depressed at any
time during the previous 12 months, that it was difficult to function.
5.9% had intentionally cut, burned, bruised, or otherwise injured themselves.
7.4% had seriously considered suicide in the previous 12 months and
1.5% had attempted suicide.
And a review of the epidemiology of college student suicide, noted that
the age at which you go to university is a period of great transition on many
different levels, socially, academically, psychologically, existentially.
It's a period of great change.
And it was certainly that for
me because I came from a working class background in the east of Lincolnshire.
And it was quite a shell shock for me going to university.
I was the first person in my family to do that.
I want to say a bit about what depression is and
then relate that to my personal experience.
I'll say a bit first about what it's supposed to be.
I'll say that because if my academic colleagues were here,
I'm sure that's how they would start off.
And then, I'll talk about how it's experienced.
And then I'll talk a bit more about my own beliefs about that.
If a psychiatrist was here giving a lecture to you about depression,
they will start off by telling you that there's something called major depression.
And to have this you have to have depression,
low mood and/or loss of interest or pleasure for at least two weeks.
And you have to have at least four of the following symptoms.
Change in sleep, that's sleeping too much or not sleeping enough.
Change in appetite, loss of energy or motivation, poor concentration,
guilt, self-reproach, retardation, being slowed up, or
being agitated, and suicidal thoughts or hopelessness.
And that comes straight out of The Diagnostic and Statistical Manual of
the American Psychiatric Association which is currently in its fifth version.
And they would be telling you about all the biological models of depression.
Anyone who follows the discussion on the web, but particularly on Twitter
will know that there's a constant argument about the monoamine theory of depression.
And psychologists sometimes say psychiatrists are still holding on
to this and psychiatrists will say, no, we stopped believing in that years ago.
But we don't really know,
there's many different theories about the biological causes of depression.
Genes certainly play a part, and
I'll say a bit more about that in relation to my own family in a moment.
The latest theory is it's all about inflammation.
So you just have to say the word inflammation.
And that's the latest theory, theory for most things actually.
And then physical things can cause depression, alcohol and drugs.
You can be depressed because you were drinking and
you can get depressed because you stop drinking.
They both play a part.
Physical illness, chronic illness, cancer,
having an under-active thyroid, tablets that you're taking.
But the theories that most people know are the psychological theories and
almost everyone knows about, I mean Freud.
Freud is kind of parsed into common parlance people have heard
about some of his ideas.
And he very much believed the psychodynamic understanding of depression
is that past relationships have an influence on our lives in the present.
So your relationship with your parents will have an impact on how
you relate to other people now.
And that might result in you getting depressed.
Psychological models also include cognitive models which
are really fashionable.
It's quite hard, in many places, to get any other kind of therapy, but
cognitive therapy.
And that very much comes from the theory that if we think negative thoughts
that can not only cause us to become depressed, but can keep us depressed.
And there are also behavioral ideas that when we get depressed we
stop doing the things that we enjoy doing.
We stop doing the things we have to do, and we retreat, and
that we can actually recover by starting to do things again.
The idea of acting better will actually help you to feel better.
And there is social models as well.
What we certainly know is that people who had trauma and
early abuse in their lives are more likely to get depression.
People who have had chronic lack of social support.
And the areas that I've worked with in England,
I guess there's four things that come up over and over again.
I call them the four Ds, debt, disease, divorce and deprivation.
So how do we experience it?
Well, there's a lot of memoirs written about depression.
I've written my own, but there are many others.
And I've often encouraged my students to go away and
read about people's experience rather than starting from the nine symptoms.
Go away and find out how people actually feel when they're depressed.
Let's start from there.
And there are some well-known ones.
There's a very, very good book called Darkness Visible,
which was written by William Styron.
He was the author who wrote Sophie's Choice.
And a more modern one that I found particularly affecting was by Tim Lot,
the journalist and writer.
Who wrote a book called The Scent of Dried Roses, and
that was about getting depressed following the unexpected suicide of his mother.
And he talks very much in that book about how depression can affect
the sense of who we are.
But I would say that they're all different,
because I think that people's experiences of depression are different.
One person may relate to a memoir and
another person may find it very difficult to.
So what do people experience?
What did I experience?
Well, for me it's much more than sadness.
There's a great or many people who think that depression is just unhappiness.
It's much more than that.
It's a loss of vitality, it's a loss of joy, it's a sense of utter despair.
And when I get depressed, I can't think clearly.
My brain seems to shut down.
I'll give you a small quote here from something I wrote about when
I was very depressed, when I was having major problems at work.
And I think it gives you some idea of the kind of cognitive experience.
My mind seemed at last to disintegrate into small, sharp-edged,
monochrome pieces.
I was unable to think with any clarity.
I sank down in front of the sofa.
I sat down on the sofa in front of the fire and wept.
I just couldn't think.
And the other thing is that it's a very physical experience.
And that, again, is something that is not unhappiness.
You don't feel physically exhausted, and
like there's a weight pressing down on your chest when you're unhappy.
That's what I felt.
At the same time as the same episode I wrote,
the terrible weight pressing down on my chest.
Which became lighter when I cried or talked, but only for a while.
When it returned, it was as if an invisible demon that loaded ten more
pounds on each side of a bar.
I was unable to push it off my chest.
Maybe this is where the expression getting it off your chest comes from,
only I couldn't.
The talking didn't work anymore.
And for me, there was a point where talking therapy stopped working.
And I'll say more about that later.
I've not only thought about my own experiences.
I've done some research interviewing people about the experience of depression.
And what's clear to me is that it is a bio psycho social experience.
People experience what's going on in their life as the cause and
most of the time it is.
But they experience emotional and physical symptoms.
And depression has social consequences.
Living with someone who's depressed is very difficult.
Keeping your job when you're depressed is difficult.
Just functioning in a relationship is very difficult.
And so there's a secondary loss.
There's not just the loss that caused you to become depressed in the first place.
There's the impact on your life.
So I don't think there's a nice, simple,
single depression like DSM would have us believe.
I think there are many different types of depression.
And I think some of them are more caused by physical causes.
Some of them have more psychological and social causes.
People have very common experiences in terms of symptoms, but
they all have a different story.
And my patients, over the years, have told me many different stories.
They've told me about being very frightened, they've told me about loss.
They've told me about trauma in their lives,
particularly sexual trauma, need to be loved.
Everyone needs someone.
Feeling very lonely, difficulty in trusting others.
And a common experience for me is that of unresolved grief and
that was a very personal one for me.
And I don't there's a single cause.
What I've learned over the years and
I guess I learned this partly from working very much in primary care, but
working with Professor Sir David Goldberg who was my supervisor in my PhD.
I use the vulnerability and stress model, and I'll say more about that in a moment.
And then I'll talk about it in relation to my own life.
Genes are important, but they aren't the whole story.
It's the interaction between the genes and the environment,
which is important, temperament is important.
I think temperament is partly inherited, but
your early life is also absolutely crucial.
Your early life experience of conflict, trauma, and neglect.
I would meet mothers when I worked in Salford who had five year old children,
and those children had been exposed to the most awful lives.
And I knew, even by that point, that a great deal of damage had been done.
It was almost almost too late, but not too late.
Physical health is really important.
If we get chronic physical illnesses, and for
the last two years I've been diagnosed with chronic kidney disease.
And about 50% of people with chronic kidney disease get depressed.
Age is important.
The older we get, the more susceptible we are.
And social deprivation is obviously very important.
But the stress that triggers it off are life events and they are commonly loss.
So for me that begins to explain why not everybody gets
depressed when something awful happens to them.
It depends on your vulnerability.
Some people are remarkably resilient in the face of those
life events because they have had a different experience of life.
They have different genes.
They have different health.
And some of us are not as resilient.
And I guess that's one of the reasons why I don't find resilience
a terribly helpful concept.
Because I'm not sure I could undergo four hours of resilience training.
I actually think a great deal of my resilience depends on what
happened to me earlier in life.
What I could undergo is some training in some coping skills and
actually rethinking how I cope with stress.
I've mentioned loss and grief.
And grief is a remarkably common experience and it's not just about death.
I wrote in my book, we can grieve for the loss of a person we love,
a job which means a great deal to us and for
the loss of our health when we become chronically ill.
And when I was given a diagnosis of polycystic kidney disease,
I did grieve for my health.
We grieve the loss of our dreams for the future, and
the lost opportunities we'll never have.
And Darien Lee Leader, the psychoanalyst who has written about depression.
I don't agree with all of his views, by any means.
But I think he has written some very interesting ideas about
depression and grief.
And he cites the ideas of Freud saying that in mourning we grieve the dead.
But melancholia we seem to die with them.
And that's how it feels.
It feels like a part of you, that you have also died.
That you have taken in the dead person and you are dying as well.
I say that with a great deal of feeling because one
of the big problems in my life was an inability to grieve.
So how can I fit that to my own experience?
I'm just going to have a little bit more water.
Well, I come from a family which, Have mental health problems,
still does have mental health problems.
My mother had chronic anxiety.
My father, I'm fairly sure, had episodes of depression for
which he would never dream of asking for treatment.
He was certainly extremely socially anxious.
My mother had to go and he wouldn't go into shops.
My mother helped bring things home for
him, which was the sort of thing that you could do in a small town.
But I can't imagine in Oxford you're going into a shop and
asking if you take all the clothes home for your husband to try on.
But that was how he was.
He would only go around shops at night when there was no one around.
My brother had and still has severe OCD.
Now that started at the age of seven.
So I find it hard to believe that biological factors don't play a part.
It was very early.
And he's never had really effective treatment.
Mental Health Services, tried all sorts of things which so unimpressed
my father that I'm sometimes relieved he didn't find out I became a psychiatrist.
Because he did used to refer to them as trick cyclists.
But he really had nothing but contempt for
the people who'd tried to help, because they really got nowhere.
And I think a lot of that though was to do with the fact that
the effective treatments for OCD hadn't yet been described.
But by the time my brother got effective treatment in his 20s,
it was really too late.
So I grew up in an extremely tense and anxious household.
And when my father lost his temper, he would hit, and
I was physically hit on occasions.
But I was also aware that I was pretty good at getting him angry
because we were remarkably similar in terms of temperament.
I got on well with him when I was younger, but not when I was a teenager.
He didn't know how to cope with me.
So my early life experience wasn't easy.
But I went to university, and,
You would have hoped that things would have improved.
But that vulnerability left me very open to particular stresses.
And I had a tremendous desire to please my father,
because he always wanted me to do well and to go and to do well at school.
He was one of those people for whom 99% wasn't good enough.
And so I got very anxious around the time of exams.
And I was always, I think, still trying to please him.
I sometimes wasn't entirely sure who was it who decided that I
should be going to higher education, him or me.
So stresses have played a big part.
And the stress that causes most damage is the stress that seems to fit into you,
like a sort of key going into a lock.
So you can imagine when I failed my membership examination of
the Royal College of psychiatrists, not only had I failed in my chosen
career that I thought was right for me, but I had failed, I thought, completely.
And that was a terrible blow.
And it was around that time that I really started to seriously
think that something major was wrong with me.
That was after the problems at medical school.
So I've experienced vulnerability and stress.
Now, how do we approach helping someone with depression?
Well if you go and see your GP, he will have the guidelines from NICE,
National Institute of Health and Clinical Excellence.
And he will start off by following those.
And they suggest that severity is a great pointer in
terms of how we should treat someone.
So there is a whole spectrum of depression from unhappiness
through to suicidal depression.
So severity is very important.
But I think one of the things I've learned as a clinician from
being a person consulting doctors.
And I've had the, I think, disconcerting,
perhaps sometimes more for the doctors than for me,
if consulting doctors who know me and that's quite interesting.
But what I'm aware of is that within my own profession there is
a disturbing tendency to think about people as it.
So there's I, it encounters.
I'm going to look at this person and try and
decide what diagnosis they have and where I can fit them into my system.
Rather than actually thinking of you as another person that is
remarkably similar to you.
And that's was one of the reasons I started to write my book really.
Because throughout my career, I had realized that the lives of my
patients really weren't so terribly different from mine.
Except that awful things that happened to them, or
they came from families where life was difficult, or
they came from families with a history of severe mental illness.
But there were parallels, their stories were very similar to my stories.
I have periods of unhappiness because I failed in things.
I had periods of unhappiness and
depression because of failed relationships.
So did they.
So I think it helped me to be a more understanding doctor.
I did have times when my patients would say to me, mm,
you've been asking me these questions.
Have you suffered from this as well?
And I would say, well, yes, I have.
But this time is for you, not for me.
What's really important, I think,
is how well we engage with the people who are helping us.
And those of you here who are therapists, and there may be some of you,
but people who in a supporting role will know that.
That sometimes you have to make a real extra
effort to engage emotionally with someone.
And that's probably the most important thing in recovering.
It's probably more important than whatever model of therapy you have.
You have to find someone that you can click with.
The therapeutic alliance has to be strong.
I've had four periods of psychotherapy in my life.
Three of them on the NHS and one privately, no, two of them on the NHS.
I've lost track now, I'll remember in a moment.
But on one occasion, I did go and see a therapist.
And I simply did not click with him at all.
And I've known patients who've stayed with people that they
don't click with feeling as it's somehow their fault.
When it isn't necessarily, it's that the two of you just don't gel.
And I think that's really important that a first effort getting
help shouldn't be, although it often feels like it, very important.
I'll just tell you, I saw this man for three months.
And during that time, he would sit with his arm hands like this.
And he was a very psychoanalytic in his model.
And I was actually doing quite a lot of psychotherapy training at the time.
The first 1ten 0 years of my career, I did psychotherapy under supervision.
And I finally, after three months,
summoned up the courage to say I didn't want to see him anymore.
And I've written it wasn't his qualifications and
curriculum vitae I wanted to purchase from him.
First and foremost, I wanted to feel that he cared whether I lived or died.
In the absence of this basic humanity, my visits to him have become to feel
like a kind of chore at best, and at the very least, rather poor value for money.
The emotion he'd evoked in me most was anger at a wasted opportunity.
We never really reached any deeper than this.
But then I'd experienced a strange and
paradoxical kind of pity for him, so I let him off lightly.
I said, it's me, not you.
I'm not ready.
And I think one of the things I've learned about talking to people
who are really in severe distress is the importance of really
trying to get in to understanding what's going on for them.
Too often in life, people try to reassure us.
They try to reassure us by saying, well you've got everything going for you.
You're doing well, you got a nice husband, you got a great home.
That has nothing to do with it.
It's how you feel inside that's important.
And when someone feels that suicide is the only way,
you have to try and understand why that is.
Because they've got a peculiar kind of logic that you've actually got to try and
work out rather than say, it's not the only way.
There are other ways to cope.
I'm gonna talk a bit now about coming to terms with depression.
And I think that if you're interested in this topic of finding out about
people's experience the sociologists have written a lot about it.
But the one in particular that I find very impressive is David Karp,
who's an American.
Who experienced depression and
wrote an entire book where he interviewed people with depression.
And what he described was, first of all,
a feeling of distress inchoate feeling, you can't put a name to it.
And then coming to terms that something is really wrong.
And I can remember that feeling very powerfully when I was a medical student.
I knew that something was wrong, but I couldn't work out what to do about it.
I went along to see one of the student counselors and I didn't gel with her.
And it kind of carried on, I didn't know what was going on with me.
I was very, very afraid that I was going to develop the kind of
mental health problems my brother had.
And I did, in fact, become quite obsessional.
And then there's a crisis.
And that's the point where you just kind of feel you've got to do something.
And it was at that point that I went along to see the GP at
the Student Health Center and he referred me to see someone for my mental health.
And I've seen many people when they've been in crisis.
And I just want to read you something which I think for me reflects
how people often imagine that they can plan their career out and plan their life.
And I suspect that will resonate with some of you here because I
was a high achieving student at my school, I went to university.
I thought I had my life mapped out and it wasn't.
I've seen many people in my career who almost believe it's really
impossible to magically plan out how your life will turn out.
And they try to plan their children's lives, too.
Sometimes it seems as though they can because nothing terrible
has ever happened to them in their lives thus far.
Everything has gone as expected, then they experience a loss.
And the closer this loss relates to their sense of who they are and
where they see their lives going,
the greater the difficulty will be in coming to terms with it.
In failing the examination, I temporarily lost the plot.
I thought I'd safely sketched out for the story of the rest of my life.
No one else created this plan.
I was quite sure it was mine.
I disregarded any thought that I might have still been trying to
please my father in some way, even though my father was dead and gone.
I realize now that I was effectively papering over the cracks
which had threatened to appear after my father's death.
At the time, it merely seemed as though I temporarily lost my way and
found it again.
But I failed to understand that coming off the preordained track of my life,
might have been what I really needed.
I've learned that sometimes those moments of chaos when life careers is off
the rails hold important messages about things we need to change in our existence.
And the rigid expectations that we, and
others, have of us that we need to challenge before it's too late.
If we address these,
we can start to move forward once more towards achieving our own goals.
If we choose the goals ourselves, we have a better chance of success.
My father died when I was halfway through my house jobs,
the one year I did after qualifying as a doctor.
And we had become quite estranged after very difficult
adolescence when I'd been really close to him as a child.
And I didn't grieve.
I was doing a two in three on call as surgery, that worked out as one night
first on call, one night second on call when you couldn't leave the building.
And one night off when we usually just went to the pub next door,
and that was my life.
And that was a really good way of avoiding having to deal with the loss.
I went to the funeral.
I even remember telling myself that it was easier that he'd
gone because he was so difficult.
And it was five years before I actually started to grieve for him.
And that was after my first psychotherapy.
And I started to grieve for him, strangely enough,
when a relationship I'd had broke down.
And I was crying, and
then I realized I wasn't really crying about losing that man.
I was crying about losing my father.
I thought my life was planned out,
that I would go to university and become a doctor.
And then I thought I found my place in psychiatry and then I made a mess of that.
But I did manage to pass the exams and I did manage to carry on.
I've kind of, I guess,
I've come to terms with having what David Karp calls an illness identity.
I know that I have episodes of depression, but it's really hard for a lot of people.
Some people don't have repeated episodes.
Some people only have one episode and
they they want to be absolutely normal again afterwards and that's fine.
But I have had recurrent episodes.
What I've tried to do is always to not let that define who I am.
Yes, I get depressed, but that's only one part of me.
The rest of the time I can function reasonably well.
There are just times when I don't function very well.
And I have to rely on my husband and when I was at work,
my colleagues, to tell me when things were going astray.
Because they would usually notice the signs.
I would be repeating the same questions over and
over in an attempt to reassure myself.
I would find it very hard to get out of bed in the morning.
I'd start to lose weight.
And I think I'm at the point now of defining
my depression as a condition that I can get past.
I've talked a bit about my experience of therapy.
I've had psychodynamic psychotherapy looking at my relationship
with my father and also my rather difficult relationship with my mother.
Which was part of the reason why my father and I became estranged,
because my mother came between us, I think, in many ways.
And then later, when I was having difficulty at work,
I had some cognitive behavior therapy.
So I've had both types of therapy.
And they were helpful at different times for different things.
Because I found that CBT actually helped me cope
with the everyday stresses of work.
I learned how to manage my constantly repetitive thoughts and
that was really helpful.
I worked with a therapist that was an expert in anxious ruminations and
he was enormously helpful.
But it was entirely different experience from my first experience of therapy.
He wasn't interested in me talking all about my life.
We had to just get down and talk about now.
And that was completely different.
And I don't think that would have been right for me when I was trying to grieve.
I've also taken a great deal of medication.
And I know that there are a lot of people who are antagonistic to
the idea of antidepressants.
I know that there are some people who think they don't work.
I know there are some people who think they're dangerous.
I have colleagues who've written about that.
I can only say that the depression at the severe end of the spectrum,
which mine is, they can be helpful.
And I've now been on antidepressants continuously for the last 22 years.
And I don't think they've done me any lasting harm.
Although, you may think otherwise, I don't know.
But they've kept me alive.
I've had to have them changed from time to time.
When I've gone down to one, I've had to go up to two again.
I've had a whole range of different substances.
At the moment, I'm on a combination that seemed to suit me.
And they've kept me really very well for the last 18 months,
and I hope that's going to carry on.
But a lot depends on what's happening in my life, or
how much stress I put myself under, and that's part of the problem.
If you're an ambitious person, as I have been, but
you also are vulnerable, then there's always going to be difficulties.
And you've really got to try and plan your life out, so
that there are safety nets, and I have those safety nets in place, I hope.
I've talked about a psychological therapy that didn't work, and
I would say that for me, the most important thing in psychological
therapy is that you can trust the person that you're talking to.
And one of the concerns I have about the NHS at the moment is its
sheer in flexibility.
It's not about finding what's right for the patient.
It's finding about where the patient fits in.
And do you fit into my particular niche?
And if you don't, well, I can't help you.
And that's always made me very angry, because I had therapists that
went out of their way I know in order to provide what I needed at the time.
And it's really, really important when you're looking for therapy,
to make sure that you find people who are properly registered, properly supervised.
There are ways to check that out.
But there are always risks of harm, and psychological therapies,
we've talked about side effects of medication,
of which I've experienced most of them.
But psychological therapy can have its problems as well.
So I think it's important to be realistic,
it's hard work, and it requires quite a lot of participation.
It isn't something that people do to you, you have to work,
and it can be very painful.
And sometimes, just getting week to week can be very painful.
I've had a lot of side effects on antidepressants,
which is one of the reasons why I didn't originally want to take them.
But I had an episode when, as I said, the talking stopped being effective.
What people tell me is they're worried about being independent on them,
they're worried about the side effects, what to tell other people.
I've often made a point of getting my tablet out of breakfast when
I've been in the company with a psychiatrist, and seek how they react.
And there are some that look away with embarrassment,
which I always find really amusing.
Because you would really expect that wouldn't be the case, but
I can tell you, psychiatrists are as aware of stigma as everyone else.
Do they have long-term effects?
Who's the real me?
Is this the real me on medication?
Or if I stop the tablets, would that be the real me?
Well, it will be another version of me.
But my husband says he remembers that other version of me, and
it was a bit up and down.
There's two ways to problems we have to go through when you take tablets.
Alice Malpass in Bristol wrote a very nice paper about this.
She talked about the moral career of experiencing treatment.
That what the doctors tell you is you have a duty to be well,
that when you take the tablets and
get well, then you won't be stigmatized, you'll be better.
And then you can get back to work, and then you can get on with your life.
But what you're experiencing inside is you're
experiencing the stigma of seeking help.
And then there is a double stigma when you actually have to take treatment.
And then you start to say well, is this the real me?
And then you worry about being independent on them, and
those are the kind of questions that go around in people's heads.
I haven't mentioned much more about social factors either.
And I think that, particularly for students,
that's a big factor, financial problems, housing problems.
I think one of the first times I, well, when I first went to see the counselor
at university, it was because I was late applying to Edinburgh.
Because I had not met the requirements, and
I didn't expect to get an offer from them.
But they took me anyway.
So I didn't get into halls of residence,
and I found myself sharing a room in digs with an extraordinary
woman who was the [INAUDIBLE] competition drinking champion.
>> [LAUGH] >> And
had an entirely different approach to socializing and relationships to me.
And I had to share a room with her, and I was desperate to get away from her,
because I was lying on my bed trying to revise anatomy, while she was socializing.
And loneliness is a big factor leaving home homesickness.
So I'm just gonna say a bit more about how we get into therapy,
and how do you get into treatment?
And I've done quite a bit of research on that myself
with groups of people who find it hard to get into treatment.
And I'll reflect on my own experiences of that in a moment.
First of all, you've actually got to recognize that you need it,
and that's a big issue.
Then you've got to find your way there.
So that means there's got to be sufficient information
around the university to get you there.
Then you've got to physically get there, and
talk to someone about things that are very personal to you.
And then they've got to make a decision if they can help you,
and/or whether someone else needs to.
All of those steps are difficult.
And I would always encourage any of you who are in that position as therapists
to really think, how does this person come to be in the room with me?
And how much do they understand about what you need to do to feel better?
And I don't think we pay enough attention to how ambivalent people are.
And ambivalence, for me, is one of the core feelings.
I've experienced it with my patients.
I've seen people who say, I don't want to live, but I'm afraid of dying.
And there's a very wonderful little book on ambivalence
that some of you may have seen by Kenneth Weisberg.
And I'm just going to quote something from it on ambivalence,
which describes this for me really powerfully.
Ambivalence lies at the core of who we are.
It's something more subtle, and more devastating than human frailty.
Weaknesses can be remedied.
Ambivalence comes rather from too much ambition.
Desire begets dissatisfaction, and vice versa.
Optimization becomes a fetish.
Wanting the best means that we must have both or all.
And we're reluctant to give up any option, lest we pull up the roots of our desire.
That's why ambivalence is so hard to confront, understand or
master, and why it can be so disastrous.
Most of us know this, yet we continue to deny it.
Many people who are seeking help are experiencing that powerful ambivalence.
And unless we acknowledge that, it can be very hard to deal with.
I, as a doctor, doctors are supposed to be strong, so
I'm not supposed to have emotional problems, even in psychiatry.
So that is that is fighting against my desire to get help.
So when I want to be me, but I want to get help, I want both.
But I have to give up something in order to go and get help.
I have to risk that people will see me in the waiting room.
And one of my psychiatrists used to say you can come and
sit in here if you want now, so I actually set her on one occasion.
No, I make my patients sit in this room, I'm going to sit here.
And I'll sit here watching property programs with the sound turned down,
just like everyone else does in the waiting room.
About the worst possible thing you can watch actually if
you're poor is property porn on the TV.
But people often get told that they're not motivated,
and I think there's all sorts of things about being motivated.
You might find it hard to attend regularly,
because you've got to tell someone that you've got to miss a lecture.
You got to tell someone that you've got to miss workshops.
You might not understand what therapy's all about,
because no one's really explained it.
You might find it really hard to go to therapy,
because your life's in complete turmoil.
You don't really know whether you're going to be sober tomorrow
morning after you've had another argument and drank a lot the night before.
And you might feel so hopeless and
lacking in energy, that you can't get out of bed to go.
So when I hear that people have been offered something, and
then they've been discharged because they haven't turned up.
It always makes me want to say well, how hard have you tried to get them there?
And that has been my experience of treating doctors and
other people in health professions, but also students as well.
I'm going to come to an end now, and I want to just say a few things.
What I've learned from experiencing depression, and
also being a psychiatrist is that there's no single answer.
There are all those self-help books that people have on their shelves,
and they've each got a single answer.
And you might find the one that suits you, but none of them actually
say there's no single answer, because that doesn't make for good sales.
So for each person, on each occasion,
the parts played by the different dimensions of biology, psychology,
and life circumstances will be important to a different degree.
And that's true at different points in my life.
As I'm getting older, it feels like biology is playing a bigger part.
My brain isn't as hot as it used to be, and
I've also now got chronic kidney disease, which is inherited.
But fortunately, I didn't know that I had it until I was just had just retired.
The help and support and
treatment required may be different at different times in a person's life.
So when we have things where everyone is offered CBT, that's just not right,
because you need different things at different points in your life.
Sometimes you just need someone to talk to.
You don't need someone who's going to immediately give
you an exercise book and say go and do these exercises.
My life's been profoundly affected by my experiences and mental health.
It hasn't turned out how I thought it would turn out.
When I was at school, I think one of the reasons I went to medical school
was that at my grammar school in the east coast of Lincolnshire,.
If you did well in A levels, you seem to end up as a teacher and
come back and teach.
So I was determined that wasn't going to be me,
I was going to get away, and I was going to have a job.
Where I would have, I was going to do a degree where I'd have a job,
and be able to be financially independent.
And I have managed those things, but
it's just not quite worked out quite the way sometimes.
I was never going to get married, and I managed to do that twice.
Life never does work out the way you expect.
But I believe it's making a more capable and empathic doctor.
I know what it's like to sit in the other chair.
I know what's going through people's mind.
I know what it's like to have those questions asked of you.
I sometimes think of some of my colleagues knew how much time people
spend thinking about what they're going to say in response to those questions,
they wouldn't take it all for granted, that this was just the truth.
Because it's very easy to lie in a consultation.
It's also helped me to be a more enlightened teacher as well,
because I've been able to work out I think what people needed.
And it's certainly make me a better researcher,
because I've found something that suited me.
Which was about trying to improve the quality of care for
people with mental health problems out there in the community,
the people that don't get help.
So a couple of last quotes that I'm going to read you.
Depression is a profoundly personal illness.
It burrows into the soul, and damages our sense of who we are, and our reason for
living in the way a worm makes its way to the core of a ripening apple.
We all have to find our own ways of managing the damages pauses,
but I know from my own experience, that it can be done.
Despite what some people may say, asking for and
receiving help is really nothing to be ashamed of.
Thank you very much.
>> [APPLAUSE] >> Okay,
I'd like to invite Dan Holloway to give the vote of thanks.
Dan is a member of staff, a mental health activist, and a performance poet.
>> Vice Chancellor, Catherine, Caroline definitely one disability
advisory service, members of the disability advisory group.
Everyone at the Blavatnik, and
throughout the university who has made this event happen.
Question is thank you.
Stigma is the thing with branches.
The miserly that will not shed its spines in winter.
The hollow hinterland that matches the horizons where the eyes of reason and
compassion will not follow.
Then to thank you, for lighting a path into the wilderness,
that the wilderness of passions dressed in dust.
Fashion from half started lives now carcasses of rust,
ashes from the lists of everything we thought we'd be.
For caressing from the shards of carbon filaments of empathy,
from which tomorrow built a nest.
See, I can fly, but sometimes, I need you to give me wings.
My heart is full of song that I sometimes need your love to me when I sing.
Sometimes, people reel off lists of things I've done.
Jobs done, ,medals won, ultramarathons run, poems told,
him stories spun, and I wonder if I'm in a minority of one when I say me.
Hardest thing I've ever done was get out of bed,
but down the pillows, pick up some clothes, and face the sun.
And all they can say is the least you could do is put on a tie.
>> [LAUGH] >> And I think, look,
you can have me shine.
Well, okay, not shine, but at least get by light this,
or you can have the last light in me die.
It's easy to say we care, and that's not enough.
It's easy to say we want the best for everyone, and that's not enough.
It's easy to write beautiful mission statements, and that is not enough.
It's easy to put faces on our walls.
It's easy to celebrate the ones who did it all.
It's easy to embrace a culture of support and till we're full.
And we must do all those things, but that is not enough.
We talk globally of a human cost, as though we know the world that will
not change becomes a junkyard, where depositories of genius are tossed.
But this is also hope.
Damped down, it's smoking embers of a dreams dumped out like cigarettes.
It's kisses choked before they leave the throat.
It's everything that adds up to a life lost.
Will not be stigma with celebrations of high flyers by
filling dreaming spires with quires of good intention.
Idolizing outliers by glamorizing myths of brilliant madness,
or fetishising funeral pyres.
Victory is simply this, that you are known not by a label, but a name.
My wish, my dream, my right is for the same.
>> [APPLAUSE]