This brave memoir by a psychiatrist who has severe mental illness shows how lost and confused psychiatry and its patients have become. Future readers will be amazed, we must hope, by how poorly we understood and how ineffectively we treated the troubled mind.
Rebecca Lawrence has experienced recurrent and horrendous depressions throughout her life, mixed with periods of elevated mood. Despite multiple breakdowns and admissions to hospital, her determination and resilience, alongside the support of her remarkable husband, Richard, enable her to survive and prosper, becoming a consultant psychiatrist and mother of three.
And yet Lawrence’s vivid descriptions of her hospital stays, her electroconvulsive therapy and the effects of different drugs indict the treatment model she both endures and administers.
Driving to her final psychiatry exam, Lawrence listens to revision tapes containing “vast amounts of information about psychiatric diagnoses from my ICD-10 book (International Classification of Diseases) … It was actually surprisingly relaxing and soporific,” she writes. No wonder. The ICD, like the infamous Diagnostic and Statistical Manual of Mental Disorder used by US psychiatrists, groups a splurge of symptoms under a diagnosis and recommends drugs to treat them.
It is possible and common to take home a psychiatrist’s salary by matching patients to broad categories and trying various pills on them. No need to think. No need to attempt anything difficult, novel or progressive. No need to read the latest research. Many people who contact me seeking advice on mental health report this experience of psychiatry, which I also encountered during a breakdown five years ago. When Lawrence joins the Royal College of Psychiatrists she comments: “I never needed to sit another exam again, ever.”
Lawrence’s strength and Richard’s support are moving to witness, especially as her psychiatrists are so muddled. Prof Lawrie takes over from Prof Blackwood, whom she has been seeing for decades: “‘I think your diagnosis is depression, psychotic depression. Prof Blackwood thought you had bipolar but I’m not convinced … ’ I wasn’t sure what I was supposed to say. ‘Oh. OK. But don’t you think I have a personality disorder. That’s what you thought before. That’s what you think.’ ‘That’s not what I think … ’”
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Here is the system in a nutshell: comic, were the consequences for patients not so catastrophic. No one in this story distinguishes between symptoms of mental distress – which medication, at its best suppresses – and causes, which medication cannot address.
Lawrence’s psychiatrists are so wedded to treatment by category that they miss what comes to seem obvious to the reader: she is almost literally dying for trauma therapy. Richard and her friends see and say that her “strict and controlled” upbringing, by parents who seemed to find her struggles embarrassing, contributed to her problems.
She has some ineffective cognitive behavioural therapy (CBT), the standard NHS go-to, cheap and easily delivered. But as one of my fellow patients said to me, ‘I don’t need strategies for tomorrow, I need help with what my father did when I was a child.’ Indeed, Lawrence makes a strong unintended argument for a system-wide replacement of over-medication and CBT with trauma therapy. But there is no mention of proven treatments such as eye movement desensitisation and reprocessing (I’m a fan because it changed my life), of Open Dialogue – which would treat Lawrence’s whole network, including her family – or of psilocybin and ketamine.
You can only despair of the system Lawrence survives. The brutal symptom-suppressing psychiatry she describes is culpably ignorant and shockingly limited. Many, less strong and less privileged than Lawrence, have died as a result of it. Thankfully, this is not the whole story. I hope Lawrence looks into trauma and recovery; with the honesty and bravery she displays here, she could write a gripping book about it.