In the late 1990s, when she was training to be a GP, Rebecca Lawrence “became unwell very quickly”. Newly married and with a baby on the way, she was diagnosed with psychotic depression and later bipolar disorder. She would spend the next two years in and out of hospital.
It was a difficult time, being a new parent and undergoing treatment. Following her recovery she went back to train as a GP, but then she decided to become a psychiatrist.
“Those first years were extremely difficult. At the time, I just thought I have to do this,” she tells Spotlight. She found it challenging to deal with people who reminded her of herself. “You can’t help, I think, but compare your own experiences [to theirs],” says Lawrence, who now specialises in addiction and substance misuse.
Mental health campaigners have long advocated the importance of listening to patients as voices of “lived experience”, with mental illness sufferers encouraged to take up roles such as peer mentors and support workers, where their experience can help others. That openness rarely extends to more clinical roles, however, despite research estimating that 45 to 75 per cent of mental health professionals have used mental health services.
“I like talking about it because I think stigma needs to be broken down,” says TS, a mental health support worker. TS had a high-flying career working for a large international pharmaceutical company and went on to set up his own business. “To say that I had a bad work-life balance is probably the best way to put it,” he recalls.
The 20-hour days, bad diet and intense lifestyle eventually caught up with him. “It all kind of came crashing down really and I went into mania,” he says. “It was a happy mania, like I wasn’t sleeping for days on end.” A friend of a friend called the police, who were “very, very rough”, he recalls, and the experience tipped him from “happy mania” over into a “florid psychosis”.
He was detained under the Mental Health Act and given a diagnosis of bipolar disorder. The medications he took over the next two years did little to help, plunging him into a suicidal depression along with other side effects. Eventually, he was able to start taking charge of his recovery. Better sleep, a healthy and nutritious diet, and exercise all had a profoundly positive impact for him.
“Once the medication has done its job, I think, then something else should take over. And that’s how I tried to work. I’ve seen great successes with people,” he says. He doesn’t tell every client about his experiences, but, he notes, sometimes it unlocks the relationship “because there’s always a dynamic of professional and service user”.
Ahmed Hankir, a psychiatrist, performs a one-person show using his experiences as a patient to tackle stigma. It’s called The Wounded Healer after the archetype used by Carl Jung to describe analysts who are compelled to treat others because they themselves are “wounded”.
“I always wanted to be a doctor; I didn’t always want to be a psychiatrist,” says Hankir. His parents migrated to Belfast from Lebanon in the 1980s at the height of the Lebanese Civil War, but it was the 2006 conflict between Israel and Lebanon that turned the then medical student’s world “upside down”.
“I saw harrowing and horrific images of dead bodies,” he recalls. This was the trigger, but not the only factor, for an episode of “psychological distress”. Although his recovery was a long and painful process, he never gave up on his medical studies. “Debilitating though the symptoms of psychological distress are, it was the stigma that was far worse,” he says.
“The moment someone labels you as having a mental health condition or mental disorder, then it feels like people blame you and not the system,” Hankir says. Structural factors such as racism and discrimination, or interpersonal issues like bullying and harassment, are downplayed, he says.
“I felt suicidal,” he continues, something that is taboo both in society at large, but particularly, he adds, in the Muslim community to which he belongs. “I think for a long time I was in denial,” he says. It was his imam who persuaded him to seek professional help, and Hankir credits his faith as playing an important role in his recovery and ongoing resilience.
The profession “must listen” to people receiving psychiatric care, says Hankir. “We must… amplify their voices and consult them for advice on how to design, develop and deliver better mental health care”.
The profession has started to recognise the value that mental health professionals with lived experience bring to their practice. In 2020, the clinical psychology division of the British Psychological Society issued a statement highlighting the “unique and valued contribution” of clinical psychologists living with mental health difficulties. Lived experience “can help to enrich practice and improve service provision”, it said. The American Psychological Association recently published a special edition of its journal with a focus on clinicians with lived experience of mental ill health, noting the challenges of stigma and bullying for clinicians who are open about their health histories.
Meanwhile, in the Netherlands, the mental health system incorporates more of the “experiential knowledge” of clinicians. While the hypothesis that openness improves patient-clinician relationships and care in mental health is still the subject of research, there is evidence that it improves the attitude medical students have to mental illness.
Lawrence is now a senior consultant. She also gives talks to trainees about her experiences in an attempt to break some of the stigma around mental health.
“I was inspired to do it by my colleagues in addiction, who quite often will tell their stories,” she says. Lawrence still comes across people who remind her of herself, and her experiences do inform her work, but they are not something she would disclose to a patient.
“The one thing that I think one has to be very careful with,” she says, “is not to assume that your experiences are like anyone else’s… You shut everything off with that.”