Maria hardly ever came to the doctor’s. So, it was surprising when, out of the blue, I took an urgent call from an occupational health adviser. Maria, he said, was sitting in his office, having been referred for an assessment by her employers. In the course of the interview, she’d disclosed that she was contemplating suicide. The adviser sounded rattled. He wasn’t prepared to let her leave unless he knew I was going to follow her up that day. I duly fixed an appointment, and told him I would take it from there.
So began a two-year relationship. Initially, I saw Maria at frequent intervals to develop an understanding of her situation. She had been suspended from work following an alleged breach of duties. She felt powerless against the juggernaut of disciplinary action that had been unleashed. Divorced some years earlier, and with volatile relationships with her parents and siblings, she had little social support. Suicide had come to seem the only way out as her world tumbled around her.
I started her on antidepressants, but more importantly I set about shoring her up. She was in a trade union, so I encouraged her to get assistance. I referred her to the mental health service, which allocated a key worker with time and expertise to come alongside. They put her in touch with an employment support team. Fairly soon, she was surrounded by an array of professionals, all of them fighting her corner.
Over the next five months the conflict with her employers polarised irretrievably, and eventually the union negotiated a severance deal that allowed her to walk away with a reference. Still more torrid times lay ahead as she sought to rebuild her confidence to seek new employment. Every so often there would be a new crisis in her personal life to complicate matters: various family members would cut off relations with each other or with her. Her mood fluctuated between guarded optimism and despair.
Then came the breakthrough: a job at a department store. It was seasonal, so not a permanent contract, and in many ways that seemed ideal, allowing a time-limited try-out of a new environment. And once she’d overcome her initial fear it went swimmingly. She enjoyed the customer contact, and found the return of structure and income positive. It was fantastic to see her happier again, and all the work of the preceding months seemed to have borne fruit.
As the temporary post drew to a close, she became despondent at the prospect of leaving. Her managers were evidently pleased with her and there was talk of a permanent contract. But, crushingly, it came to nothing.
That proved to be the last straw. What confidence Maria had regained, disintegrated. Over the ensuing year she became ever more entrenched in the sick role, the professionals around her now merely validating her fragility, rather than helping her move forward. I continued to certify her unfit so that her benefits were maintained, but persisted with our cognitive work, encouraging small steps, my memory of how transformed she had been when she worked at the department store still fresh. Maybe that was a misjudgement: she began to attend our appointments with a support worker in tow, almost as a symbol of her incapacity.
Eventually Maria was summoned for an independent medical to assess her ability to work. She was placed in the “support group”, meaning the benefits agency accepted that she was long-term unfit. I tried to establish how she felt about this, but couldn’t work out if it was a relief, or whether deep down it felt like being consigned to the scrapheap.
Shortly afterwards, she left my list and registered with a neighbouring practice. Perhaps she blamed me for her redundancy; or maybe my reluctance to give up hope was no longer compatible with how she saw herself. Either way, the rejection hurt – an inkling, perhaps, of the way Maria herself experiences the world in which she lives.
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This article appears in the 03 Feb 2016 issue of the New Statesman, Putin's war