My Commitment to My Clients

Posted at 10am 18 October 2019.

I’m sitting here writing this just after 9am on the 18^th of October 2019.  In less than an hour, the decision from my NCAT (NSW Civil and Administrative Tribunal) appeal relating to the conditions on my medical registration will be made available to me, to everyone.  Even having sat through the entire hearing and heard all the evidence, I have no idea of what will be in that document.  Honestly, I am not completely ready for it, because the information that decision will be based on is extremely personal.  I haven’t been able to write about what was said, the evidence presented, the Board’s approach, or what may have been missed; that has been hard too.  

I know the task before the panel of four couldn’t have been easy.  There were thousands of pages of evidence.  For every page they had, there were ten more pages they could have had.  I’ve been considering for many months at what point I might be ready to write about the experience of going through the case. Having waited almost three months since the conclusion of the hearing (waiting for an outcome), I realised this morning I am far from ready to talk about the process of going through the case:  It has been, at the very least, exhausting, traumatising and immensely painful.  On the other hand, it has provided me with an opportunity to learn so much about people, the medical profession, our society, our culture, change, and who I am (my values, my worth, and my character).  So, without detailing the experience, I’m going to say I’m glad I’ve had that learning opportunity.  

This morning I realised the outcome doesn’t define me, it doesn’t define who I am as a doctor, or what I have to offer.  The outcome will be something that results from a combination of legal technicalities, caution, the experiences of four people I’d never met before January 2018 (two doctors, a Judge, and a community representative).  Today I decided that something had to matter more than the outcome of the case, that thing that matters more, is me being entirely honest with myself, and other people about who I am as a doctor (not knowing if I will ever practice again).

A lot of people went into medicine to ‘help people’; I did.  I mean, at my interview for medical I elaborated quite a bit on those two words, but ultimately, I did choose medicine (at a very young age) because I saw it as a profession I could go into and help other people.  I didn’t know much about the medical profession.  I don’t come from a family of doctors.  During medical school I discovered the area of medicine I’m truly passionate about and have at least some talent in.  I still want to help people.  And, whether or not today’s outcome allows me to practice medicine again, I’m going to be helping people (whether it is through practicing medicine or working as a disability consultant).  

I’ve been a patient a lot.  I’ve had mental and physical health issues.  There have been doctors who have helped me incredibly, and there have been doctors who harm harmed me.  Who am I as Dr Arlene Taylor?  What’s my commitment to my patients?

Knowing that I can never commit to being perfect, and being aware of my own weaknesses and limitations, I commit to the following with respect to my clients, or possible future patients:

• On each occasion you see me, or I am involved in your journey, I’ll put in my best.  I will take as much care as I can to ensure that the advice and assistance, I offer you is the best advice possible and in your interests.
• When you walk through my door, I will treat you how I would want to be treated in the same situation.  I will ensure that in helping you as a client or patient that I do not forget how vulnerable someone is when they are in that role; or how vulnerable I have been in that role.  
• I will be honest with you if I don’t know what will help you, or whether the solution I propose will work in your situation.  When I don’t have enough information or knowledge to help you effectively, I will try and find you someone else who has that information.
• If I make a mistake, or an error, while trying to help you (in good faith), I will tell you that I made that mistake.  I am human, I know at some stage I will make a mistake.  I will apologise to you for any harm that comes to you even if I didn’t mean for that to happen.  And, by nature of who I am, I will feel bad that something I have done has harmed another.
• Should I realise that something I’ve done in error means I need to improve my own knowledge and skills, I will seek out a person or resource that will allow me to develop that knowledge and those skills.
• In every interaction I have with you, I will be mindful that I am not walking in your shoes, I’m not on your journey, and I have no right to judge you.
• Where you don’t take my advice, I will not be offended or take it personally.  I will respect your right to autonomy in your life and the decisions you make.  If you later decide you would like my help, I will still try to help you if I think I can.
• I will engage with my colleagues, listen to their advice, thoughts and experience and treat them with respect.  Where my opinion differs to theirs, I will review the evidence they rely on and give them the opportunity to review the evidence I rely on.  I will never treat it as a battle of pride, but as a means for identifying what will help you, my patient or client, the most.  
• If I see a peer or colleague behaving in a way that is causing you harm or placing you at risk, I will raise that even if that is not comfortable for me.  I will put aside my own experiences and do what I need to do to ensure your safety.
• If I am unwell such that I can’t function well enough to maintain all these commitments to you (my clients/patients), I will take time out to look after my own health.  I will listen to my treating doctor and allow myself to be vulnerable with them, as you do with me.  When recovered, I will come back and keep trying to help you with your challenges. 

Therefore, not knowing what my appeal outcome will be, that I will be reading in only a few short minutes, I am satisfied within myself that:

• I am a good doctor;
• I am someone who understands they are not and can never be perfect;
• I know the boundaries and when I may need to step back or seek help;
• I know my values, my character, my skills and limitations;
• I know my heart is in the right place; and
• Nothing in the decision can change any of this (only the context in which it is applied).

“I volunteer! I volunteer…” (Katnis Everdeen, Hunger Games)

“I volunteer!  I volunteer…” 

If you can picture Katnis Everdeen saying that as she volunteers to participate in the Hunger Games then you will have some idea of the emotion(s) I felt on 9 March 2017:  But, that’s not where this story really begins.

Everyone has seen the articles about doctors ending their lives, the impact of mandatory reporting, and the desperate need for a complete overhaul of our regulatory system.  So, this is the point where I bring into the discussion a frank account of the lived experience of a doctor with a history of mental health issues, and what happens when AHPRA get involved.

I strongly contest the validity of the following statement made by Professor Anne Tonkin, current Chair of the Medical Board of Australia, in a recent interview. 

“I’m very concerned about people saying that they don’t think they can get help, because the Medical Board is not the slightest bit interested in hearing about anybody who has any kind of health issue that they are dealing with appropriately, and that doesn’t affect their practice. We don’t even want to know.” 

My own experience of AHPRA and the Board, including how my current appeal against imposed conditions that prevent me from practicing clinically is being handled, provides a wealth of evidence against there being any truth in what Prof. Tonkin has said.  It is my intention to progressively address why Prof. Tonkin’s words resonate so far from the truth in a series of posts.  

I surrendered my medical registration in 2015.  At that time, I was completely broken and continuing to fight would have, without doubt, cost me my life.  In the weeks leading up to my decision to surrender my registration one of my closest friends from high school told me that she was afraid that she would lose me in a battle against prejudice.  She told me “I would rather have you alive and working in some crappy, boring, desk job; than live having lost my friend to suicide because you kept fighting an in-just system.”  That message came with a link for a job advertisement in the Public Service. 

At that moment, I wanted nothing more than to be dead.  I didn’t want to wake up and face another day. I was, most certainly, clinical depressed; but, more importantly, I was traumatised.  Traumatised by the impact my mental health had on my career, traumatised by the actions of AHPRA and the Medical Board, and traumatised that I had found out over and over that as a doctor-patient I had no rights to privacy, no rights to treatment, no rights to have a health condition.  I couldn’t bear the idea of waking up one more morning to face the memories of those traumas.  

Less than a month earlier my family had ‘extracted’ me from a toxic situation in Tasmania and relocated me back to our family home, just outside Canberra.  I had just tried to end my life and gone to extensive length to ensure the attempt was successful.  I never expected to wake up and was disappointed, anguished and distraught when I did.  My final thoughts before at that time were not of loved ones and aspirations.  My final thoughts were focused on pure dread that if I woke up AHPRA, the Board and their lawyers would subject me to further torture; nobody should have to think that way.  When I returned to NSW, you could have described me as the walking dead: I was depressed to the point that I didn’t care about anything and, despite still breathing, was destroyed inside.

Like a robot, I applied for the job in the Public Service (APS) that my friend had sent me.  The chances of succeeding in your first application for a role in the APS are slim; particularly when you have a diverse work experience background.  I had no expectation that my application would be successful and applied to appease my friends and family.  What nobody knew was that I had also planned my disappearance and suicide, including a letter with final instructions, and that I was waiting for the confirmation that my application was rejected before I carried out my final plan.  In my mind, while depressed, I believed that if I could say I had at least tried that perhaps the impact of my death on loved ones would be less.  

The conditions imposed on my medical registration at that time were publicly viewable and I worried that if the people assessing my application for a role in the APS saw those conditions that it would jeopardise my prospects of success.  AHPRA had failed to process my registration renewal and my legal support advised me that it was unlikely they would allow me to remain registered; so, I signed a form surrendering my registration.

I will never forget the first appointment I had with my psychiatrist after surrendering my medical registration:  I had no intentions of even reapplying to be a registered health practitioner.  Choked up and struggling to breath, due to the flood of emotion associated with this particular realisation, I burst into tears and said.  

“I don’t know what to say to you:  This is the first time in my life where I’ve been able to attend a psychiatrist and ask for help knowing that I have privacy.  They (AHPRA) can’t go through my files anymore.  They can’t scrutinise everything that is private about my mental health conditions and treatment and throw it at me in my career. I have doctor-patient confidentiality… I don’t have to be scared when I see you now.”

My psychiatrist gave me the time I needed to digest that realisation and then prepared a plan to move forward and get me through the depression and trauma.

Each evening I dutifully took my antidepressant with no expectation of benefit or a positive outcome.  Friends and family continued to cheer me on from the sidelines totally unaware that I had already made my decision and was waiting for the right moment.  Then, I received an invitation to attend a job interview. My emotions were mixed; I was annoyed, but also saw the first glimmer of hope for any kind of future life/career in many, many months.  Consistent with my perfectionist personality style, I decided that it would be wrong for me to attend the interview and give it anything but my best effort.  

January 2016 was when I found out that I was successful in that application.  A number of weeks had passed where I was consistently able to take my antidepressant while also being safe from attacks, hostility and further trauma.  My depression had already begun to lift and suddenly there was a tangible piece of hope that I may have a ‘life’.  By the date I was due to commence my new career, I was safely out of the grips of depression.  Of course, I still had to face the memories and live with the trauma, but I was well and had a way forward.  

My first supervisor in the APS was supportive and a God-send; he made integrating into a new work environment easy and we remain friends even though we are no longer in the same team.  

That brings us to 2017.  By January of 2017 I had well and truly moved on from the traumas of the past. Living back in the region where I had grown up allowed me to rekindle old friendships.  Working in a job role that allowed for healthy working hours allowed me to manage my own health effectively.  I can honestly say that at some point between January 2016 and January 2017 I started to feel and experience genuine happiness again.  

Then it hit me.  The first article I read about the spate of doctor suicides in NSW and the impacts of mandatory reporting hit me like a freight train:  I actually threw up and sat curled up in a shaking, crying, mess on my bathroom floor for a number of hours.  There was a sudden realisation that the pain, trauma and fear that I had experienced at the hands of AHPRA and the Board wasn’t limited to my case.  Until that point, in an unintentionally self-absorbed way, I had assumed that the traumas I had experienced relating to my own medical registration were limited to me.  Certainly, in all my interactions with AHPRA I was left feeling like I was the ‘worst case’, ‘most terrible person’ etc and, that there could not possibly others they invested similar energies into.  

Suddenly my own resignation from medical practice became unacceptable.  I could live with feeling as though my own career was ‘stolen’ by those with prejudices. What I can’t live with is knowing that others are being subjected to the same processes, the same traumas, the same fears; and, that it is costing lives.  

“I volunteer.”  

On 9 March 2017 I mailed my application for (re)registration as a medical practitioner to AHPRA.  

I volunteer to stand up and fight against a serious flaw of our registration system and regulatory body.  I volunteer to stand up and speak out about how doctors (and other health practitioners) with mental health histories are treated and handled.  I volunteer to have my own history and story laid out publicly for the world to see in the interest of having a real discussion about what does and does not make a health practitioner a ‘risk’, or ‘impaired’.  

I am the perfect ‘test-case’ for a discussion about how we should assess if a practitioner poses a risk because of their mental health.  I have an extensive history of depressive episodes, suicide attempts and hospital admissions:  The details of how misdiagnosis, incorrect treatment, prejudice, and inability to access care without the focus being first on you as a doctor, and my own genetic susceptibility to certain medications played a role in this will most certainly come out in the near future.  Importantly, what I do not have, is any record of complaint by patient, family member, or colleague about my ability to perform well and behave appropriately in a clinical setting.  There are no complaints to AHPRA (or the previous state based Medical Boards) about my performance or conduct in practice.  I have taken time off from practice when unwell. Yet, despite a ‘clean record’ in my actual work as a practicing medical practitioner, I am blocked from working clinically.  

A De Novo hearing of my case goes before a tribunal panel of four members at the NSW Civil and Administrative Tribunal (Sydney) on 15-17 April 2019.  I am appealing the conditions on my registration.  If successful, there will be case law that other practitioners can rely on in their own struggles with AHPRA (that’s the goal, my own return to practice would be a bonus).  If unsuccessful, then we will be able to clearly state that how we assess whether or not a practitioner is a risk is not based on their performance or practice history, but merely on a presence of illness (past, or present); and we will have stayed in a place where stigma and prejudice prevail.  

I am all too aware that a statement like I have written here today opens the door for people to say all manner of things about me, my past, my future etc.  It opens the door for a discussion that may not always be pleasant.  Many people have their own views, and I accept that.  It may have taken me until age 35 to be able to say the following with any degree of integrity, but here it is:  

“I know who I am.  I know my past.  I know my history.  I am a doctor who has experienced mental health problems and made attempts on my own life.  I am autistic, and don’t quite ‘fit the mould’.  Many people think they know my story, or something about me; many people also don’t have the full story or context.  I will not be shamed, and I am not ashamed, for having experienced mental illness, nor for having been a less than perfect patient.  I am a good doctor and a safe doctor, regardless of what the Board’s imposed conditions may imply.  Most importantly, I will not be defined by the words of others, past, present or future.” 

With this in mind.  I start this series of posts about the lived experience(s) of a doctor with a mental health history faced with AHPRA and the Medical Board.  

Moments of Kindness

I’m a doctor and a frontline worker.  My scrubs don’t fit me, and my stethoscope is always at home.  I haven’t seen a ‘patient’ in more than five years!

I am an “Ability Consultant” (often called a “Disability Consultant”).  People wonder why I insist on the naming difference:  The reason is relevant to everyone (whether they identify as having a disability or not).  

I’m not here for people to tell me about their problems.  It is not my job to fix my clients’ problems.  I am an Ability Consultant.  I’m here to help my clients solve their own problems.  I openly tell people that I don’t care what ‘condition’ is causing their problem (sounds insensitive).  I care about what the problems are and what (skills) are needed to overcome the challenge (now and in the future). 

I am a problem-solver, skill-builder, and a mentor.  I have zero interest in focusing on the ‘disability’ and total interest in developing the ‘ability’.  The only time I’m willing to spend talking about what my clients ‘can’t do’, or what’s bothering them, is the time it takes for me to find that out so that we can move on to them saying “I can, I am, and I’ve sorted it”.

Usually, I work with neurodiverse individuals (Autism, ADHD, and learning disabilities etc).  The world doesn’t always accommodate my clients’ needs:  Every day, they’re forced to adapt to a society that expects interactions, communication and relationships to work ‘a certain way’.  Failing to adapt means a reduced quality of life.  

The COVID-19 pandemic (that continues to unfold) has redefined who my potential (and actual) clients are. The huge changes sweeping through communities, combined with the requirements (not optional) to interact, communicate, work, learn and socialise differently, just reclassified the large majority of our population as ‘potential clients’:  Everyone is needing to adapt.

I am autistic and have spent most of my lifetime adapting; by definition that makes me an expert at ‘adaptation’.  Like many neurodiverse people, I’ve made some comments flagging how this pandemic is giving neurotypicals a ‘little taste’ of what it’s like for us neurodiverse individuals every single day.  Those comments are true, but I don’t want anyone to have a ‘taste of their own medicine’ right now; instead, I’m deeply concerned about the impact of that reality. 

Anxiety and depression are far more prevalent in neurodiverse cohorts than the general population.  Research attributes this ‘over-representation’ of emotional distress (predominantly) to the sustained challenges neurodiverse individuals face trying to:

1. integrate and function in systems not tailored to their ‘natural wiring’;
2. communicate their needs and have those needs met; and
3. build meaningful relationships to maintain social connection.

My own challenges in those areas has driven me to make attempts to end my life many times, and it is that lived experience that has me terrified about the impact of this pandemic; COVID-19 has exposed ‘the majority’ to these three critical threats to mental wellbeing that usually impact predominantly on minorities:  The risk to health extends far beyond who catches the virus because the flow-on impacts threaten everyone’s health.  

Being open about how much I have struggled with a life-long requirement to adapt places some burden of responsibility on me to provide insight into how I’ve survived, succeeded, and found joy amidst significant struggles.  I’m strong, smart, determined and pretty resilient; those aren’t the critical ingredient that has allowed me to rise again (particularly when I thought I couldn’t).  

Kindness has been the ‘critical ingredient’; it’s the yeast to my life-loaf.  When I teach my younger clients about the concept of kindness, I tell them this:

“Kindness is doing something that helps someone else and improves their situation.  It’s something you do even when you don’t have to, and without expecting anything in return.  You can choose to be kind.  Anyone can do it.”

The acts of kindness that have been the most powerful, for me, have all served to help me:

1. integrate and function in systems not tailored to their ‘natural wiring’;
2. communicate their needs and have those needs met; and
3. build meaningful relationships to maintain social connection.

These acts of kindness aren’t the ones that usually cost a lot of money, but they are the acts that have consistently operated to reduce the risks to my mental health resulting from being wired slightly differently and needing to constantly ‘adapt’.  They’ve been simple; a smile, a wave, some encouragement, patience, acceptance, or inclusive behaviours.  These are acts of kindness anyone can choose to give, and they will be crucial for our society to come through this period of challenge, discomfort, and adaptation us unscathed as possible.  

Kindness improves the ability of people adapt, to function, and to maintain good mental health.  Just as people are choosing to maintain physical distance to ‘flatten the curve’ and reduce how many people catch the virus (a physical impact), each one of us can choose to look for opportunities to be kind to each other.  None of us will ever know how many cases were ‘prevented’ through our choice to engaging in distancing measures; we also won’t know who we were kind to at just the right moment to provide hope to someone who was struggling.  

I want to add one critical item to the list of things you must do during this pandemic.  It is the most valuable piece of health care advice I think I’ll ever give. 

Please look for every and any opportunity to be kind to someone else.  Please choose to be kind.

Start reading here…

Trigger warning: The follow post raises suicide and may cause distress to some readers.

The letter below was sent to me by a friend who recently died by suicide. He sent it as an attachment to a ‘goodbye message’ that arrived in my inbox a few days after he passed via a ‘scheduled send’. It came with the instructions I should open it and read it should I ever reach a point where I felt overwhelmed and like suicide may be an option (again) in the future. He was clear I didn’t need to be imminently at risk, but should the thought cross my mind as a possibility he wanted me to read it. He said if it helped then I should share it.

He called this letter a safety-net that he wanted to put in place for me, his friend. Today I was overwhelmed and hit a moment of darkness. I read his letter many times. It did help me. I realised we need to put safety-nets in place for our friends before we think they need them (because often it is too late when we realise). Perhaps his legacy will be others installing safety-nets for those they value.

It worked because it was personal. This contents were so real and perfectly lined up with who I am, how I think, and what works for me. No safety-net should be the same for any two people…

This is the safety-net from a dear friend who I will continue to remember and cherish despite his untimely departure:

Start reading here…

Hi [My Name]

When you open this letter you will be feeling like shit.  Read the whole thing from beginning to end.  When you reach the bottom start again if you still aren’t thinking like the real you.

I wrote this for you knowing I’m not going to be there right now when you need to hear this.  I’m sorry.  It’s better this is written down for you to find on your computer when you need it.  I know you too well and you won’t pick up that phone at the critical moment.  You will go to your computer…  I hope you will open the file where you saved this.  

I got my writing tips from you…  Read on, ‘Patch’… [I know you still love the movie even when you say you don’t].

We did not gel when I first met you.  Time changed that and you became my friend.  You also became someone I admire and look up to.  

This is who you are… 

You are an amazing woman!  You’re kind and caring.  When you see someone else is hurt you stop to help try to fix it even if you don’t know how to do it.  You are different and don’t fit in.  You are tough, strong, determined and put up with all manner of crap that comes at you in life.  You bounce back and get right back up when life knocks you down.  You’re smart like I didn’t know people could be and you use those smarts to solve problems other people can’t.  You are brave and courageous!

Because you don’t fit in people sometimes hate or fear or dislike you.  Your differences are part of you.  They are not bad.  They are good.  You are not broken.  You don’t have to be like everyone else to make this world a better place.  You already have made the world a better place.

I said you get back up every single time you get knocked down.  I’ve seen you get up and push through countless times.  Even when you’re totally broken you power on and reach the finish line.  Girl, you’ve got guts!  Tough cookie…

Nobody tells you what’s right or what you should think.  You decide for yourself and you stick with it when others challenge you because its different.  You get out there and fight for what is right even when it cost you everything you have.  You don’t let injustice slip past, you don’t excuse it.  Good.  Keep doing all that.  It’s hard.

You are someone who needs to be here.  You have influence.  You have a purpose!

I’ve told you who you are.  Now I’m telling you where I know you are if you’re choosing to read this letter…

Right now you are tired.  You’re exhausted.  Emotions are running high and you feel overwhelmed.  I know you.  You’re using your amazing memory against yourself remembering all the things that have hurt you.  They’re still hurting you.  You are busy because I’ve never known you to not be busy and have too much on.  There’s a high chance you’re about to miss some sort of deadline.  I know you hate being late.  You’re in pain.

When you reach this point you isolate yourself and push people away.  You’re probably doing everything you can to push away people who do care.  They want to help.  They aren’t perfect.  They might get it wrong.  Don’t let your traumatic memories stop them from caring for you right now.  You’re the queen of doing it all by yourself but you don’t have to.  I know you don’t know how to trust right now but I want you to try.  

You’re catastrophising everything.  Its another thing you do better than everyone else so stop being so good at everything.  Catastrophising is not something you need to be good at.  

You only get to the dark place when you can’t solve a problem.  Whatever it is you can’t solve today you will solve tomorrow.  Think back at the times when you pulled through then found solutions.  It will happen again.

Everything you tell others about how they can care for themselves you’re ignoring right now.  Listen to your own advice…  Help yourself how you help others!  

I know you love pharmacology and toxicology.  That passion causes risk when you’re broken.  If you’re planning creative cocktails or starting to calculate minimum lethal doses I want you to stop.  You probably have access to something dangerous.  Don’t open the bottle.  We had a laugh about the Happy Pills you bought the other week and how they have messages in them.  That’s a good strategy so overdose on them instead.  I know you are going to love opening each capsule.  Just do it…

You criticise yourself more than anyone else can or will.  That means right now you feel like a failure and a hypocrite.  You’ll be doubting your abilities skills and whether you have worth.  Yes you do!  The doubts are unfounded.  

People have slammed you for appearing impulsive.  You are not impulsive but you do finalise and rationalise big decision too fast when you feel overwhelmed.  You think and act fast.  That’s fine in an emergency but not fine when you’re feeling this bad.  I want you to think through all relevant information when you decide.  Do not just focus on the bits that confirm how you feel.  Put your logical brain on and treat it like a maths equation.  You are good at maths so that point should sort this whole mess out.

You need a plan because you’re all about actions…  Instructions below…

Choose the Happy Pills and overdose on the messages inside.  Cry because you can.  Write it all down because you write well.  List all the information just like in your assignments.  Try to let others reach out to you and let your guard down a bit.  Fuck the deadline if there is one because it can wait and you caring for you can’t.  Drop the F-bomb at whoever is upsetting you then say sorry later when you feel better.  They’ll get over it.  Cuddle Hope.  Watch A Little Princess.  Vent online.  Get some sleep.  Keep on going.

I hope you wake up tomorrow feeling stronger.  I hope you keep fighting.  I want you to keep being out there showing the world what different can achieve.  Keep fighting for the people who can’t.  

Don’t let the bastards get you down!  

You’ve got this girl…  You’ve always had it…

Start at the beginning again if you need to.

Your friend, 

Dr [name removed for privacy reasons]

I am enough: an open letter to my colleagues.

Trigger warning:  Blog-post raises ‘suicide’ and ‘physician mental health’.  It’s also brutally honest about physician mental health and the impacts of medical regulation on that.

Yesterday the status of my personal medical registration changed.  It took 2 years, 7 months and 9 days from when I posted my application for registration to the point where I received registration that allows me to practice clinically as a doctor.  I knew what I was getting myself into when I sent the application off in an express post envelope.  Truthfully, I wasn’t sure if I was ready for it, or if I could handle it.  I wasn’t totally unprepared, but I also didn’t know exactly where the journey would take me:  It didn’t take me where I thought it would.  

Where I’ve landed is a better place than I could have imagined, and I need to explain why.  I have a very ‘black-and-white’ thinking style; comes with being autistic.  When I started this journey, I thought the only outcome I would be happy with, or find acceptable, would be ‘unconditional medical registration’.  I wasn’t delusional; I knew that would be the “Disney movie” ending to the story.  Life’s not a Disney movie and the story didn’t end with yesterday’s decision:  We’re just at the next point in a much longer journey.  I’m 36 years old.  I’m glad I’ve learnt the things I did on this journey this young.

The decision and outcome relating to my medical registration very much have the potential to be viewed by doctors (and other health practitioners) as evidence that their careers may suffer if they are identified as having experienced mental illness (or another disability); obviously that concerns me (I’ve blogged about it before).  Fear impacts on people’s decision-making process when they are faced with deciding whether or not to seek help.  That fear has impacted my decisions when trying to decide how I deal with episodes of depression and any suicidal tendencies associated with that:  The impact fear had on those decisions has been to my personal detriment every single time.  The fear of what may happen to my prospects as a medical practitioner has driven me to:

• Plan suicide attempts far more carefully than I otherwise would have (increasing the likelihood of a poor outcome);
• Engage in higher lethality suicide attempts than I otherwise would have (having a special interest in toxicology is already quite unhelpful when entertaining suggestions from the Black-Dog);
• Run from people who may have had the potential to help me recover, when I otherwise would not have (it doesn’t matter whether they would have been ‘effective’ or not, I made the decision to ‘run’ before I knew); and
• Judge the performance or actions of those involved in my care (including any delays in recovery or iatrogenic harm that resulted) based on the overall impact of my illness, and how that has played into my journey as a medical practitioner.

My fears were not unjustified (for the most part), but, I hope that in sharing why I feel the outcome relating to my own registration status has left me in a better place overall, that I can provide a foundation for others which may help alleviate the fear of seeking help when they need it.  

I can’t tell people reading this that stopping, asking for help, and engaging in treatment, definitely won’t impact negatively on your career progression and professional reputation; it may (and that could be very distressing).  If you experience illness in a particular way, or with a certain level of severity, the evidence is that regardless of your conduct and performance as a practitioner, you may still end up with some kind of restriction.  Even three days ago, I hoped I would never have to write that; for fear that someone who thinks the way I previously did, sees it and makes a decision that places them at risk.  

Based on prior experience, I was fairly certain of a few things I’d face on the registration application, and appeal, journey.  Those things included that:

• Questions about my entire mental illness history would be raised and discussed (potentially very publicly);
• I’d probably be on my own regarding legal support (by way of the wording of my professional indemnity policy, and personal financial situation);
• There was a very real potential for personal and family relationships to suffer (because of how sensitive and intense the subject matter is);
• Any outcome regarding my registration would have the impact of potentially influencing how other doctors feel about seeking help (particularly for mental illnesses); 
• The privacy (that I hadn’t already lost) with respect to my mental illness history, diagnosis of autism, and related matters would probably be lost for good; and
• My worth, credibility, and safety (in some people’s eyes) as a medical practitioner would be assessed, primarily, on my health history and disabilities rather than my performance or conduct.

With those things in mind I made a decision that I should apply, and I should allow the progression of the story to be open and public.  At the very least, I knew that being open and transparent would open the doors for others to do the same, and hopefully provide some clarity about what can happen to a practitioner who is flagged as potentially impaired.  

I was right with respect to most of those points above:

• My mental illness history has been publicly discussed.  I am not ashamed of having experienced mental illness (and being a highly challenging patient).  Not being ashamed doesn’t mean that the exposure and those discussions doesn’t have an impact.  Sometimes, the individuals participating have put forward claims of ‘knowing’ ‘more details’ when the truth has been that they’ve never treated me, and they have based their very hurtful, defamatory and speculative comments on second-hand gossip.
• Legally, I was on my own.  It was suggested to me that a ‘free lawyer’ could be provided (somewhat late in the process), however the voluminous nature of my history made it easier to handle the matter as a self-represented litigant.  More importantly, being self-represented gave me the opportunity to actually put me, and my story, before the very people responsible for the ultimate decision in an honest, frank, and detailed way that I haven’t experienced in the past:  I didn’t want to be a name on many pieces of paper.
• The process was not only taxing on me, but it contributed to family tensions and distress.  Those closest to me suffered through the most challenging and traumatic parts of the ordeal with me.  Difficult conversations that may not have been had, needed to be had.  Disclosures about things I may have wanted to keep private occurred just in case I was asked about them while giving evidence (because there are some things you want the people you love the most to find out in a private environment and not a court-room).  The night before the final day of the appeal hearing I thought I’d single-handedly brought my parents’ 46+ year marriage to an end (I didn’t):  But, that’s what went through my mind the majority of the time I delivered my own summations in the case.
• The outcome of my application is so fresh that I won’t know for some time the real impact of the decision, I can only hope that when people read it that they also read this, and that they realise the fear of career damage/delay holds too much power over people in our profession.  Your life, your health and your mental wellbeing is worth so much more than being viewed as that perfect doctor who has it all together:  You are worth more than any career, and, you are enough without your career.
• My personal privacy was further shattered.  That was through my own doing, but also through the approach of the medical board.  One of the reasons I was slightly more accepting of the inevitable loss of privacy was that I already had publicly available decisions about my mental health.  People have breached my privacy repeatedly since medical school.  From my perspective, I had less ‘privacy’ to lose during an ordeal like this than a doctor whose peers know nothing of their personal illness, someone not already exposed.  Knowing the profound impact that the loss of my privacy with respect to highly personal events and information has had on me over the years, I completely agree that no practitioner (no person) should ever be subject to the invasions to privacy that I have experienced repeatedly, intensively, and without repercussion for the individuals involved. 

I was wrong about my final assumption about what the journey would mean:  My worth, credibility, and safety (in some people’s eyes) as a medical practitioner were not assessed, primarily, on my health history and disabilities rather than my performance or conduct.  Where I have practiced and performed well, and safely, that has been acknowledged.  My clean record, with respect to conduct and performance as a practitioner was also acknowledged.  There are some limitations on registration that are in place, they (in my reading) are not reflective of any decision that without these limitations I will be a dangerous doctor, nor pose a risk.  

The limitations on my practice are clearly there to provide a safety-net and reassurance that allowing me to return to clinical practice, in the context of having a pre-disposition to illness and a 5-year absence from clinical work, will not result in a situation where I am inadequately supported and guided as a medical practitioner.  It also protects me from returning to practice in any setting where there is no opportunity for those who have more experience than I do (in medicine) to identify whether I may need any extra help or training (either because of my disabilities or duration away from clinical work).  

Nobody said I’m not highly capable, or that I’m not worth having in the profession.  Nobody said I won’t be able to succeed.  It seems to me that those making the decision have said the opposite; with the right supports, opportunities and guidance, I will be an asset to the profession in the future, as I have been in the past (albeit while dealing with some challenges that other practitioners may not have to consider).  

While my conditions don’t give me licence to walk off and do whatever I want (in terms of freedom to engage in clinical practice), they’re entirely reasonable giving full consideration to the circumstances (training level, experience, past practice settings, absence).  For that, I am incredibly grateful to the four people who made the final decision regarding my registration:  Between them, they have far more insight and experience into the journey, training and support needs of young medical practitioners than I do.  Their decision facilitates for me a return to practice, if I choose to go through that door, that will ensure I have support at the ground level if, and when, I need it; it’s not punitive, it’s more logical and healthy than the outcome I practically begged them for.  

While I am very talented in a highly specialised area of medicine, I’m not ready to immediately dive into being a sole practitioner offering specialised medical advice in that area (pharmacogenomics).  I know the technical and medical knowledge side of it well enough to provide sound clinical advice to anyone with respect to that field, but practicing as a solo practitioner involves far more than simply ‘knowing the subject matter’:  This is something I have learnt relatively recently since electing to establish myself in a more professional setting with respect to the disability consultancy work that I do.  The skills I have in pharmacogenomics are not going to disappear if I am not immediately providing specialist advice in that area.  While it took me an hour to process why I wasn’t just not upset with the outcome that I received yesterday, but was relieved, I realised how glad I am that there is absolutely no pressure for me to fly solo in that capacity in the immediate future (I can’t, it’s not even an option – thank you).  

The unexpected, highly welcomed, realisation that means I can honestly say to anyone who asks that I am genuinely pleased with my current registration status, and the outcome of the appeal that brought me there, is this:

“I am enough.  I am good enough.  I am finally, for the first time in my life, in a place where I accept that I have worth and value even while appreciating that I am not perfect and have faults.”  

I have self-esteem (that’s new), where historically I have only had self-confidence.  They’re quite different.  Actually, today I realise that I now have self-esteem, but I have less self-confidence than when I previously had no self-esteem:  Probably because a reliance on self-confidence was about all that kept me going at some points and it was a little overinflated to compensate for the complete absence of any self-esteem.  You can’t buy self-esteem.  You can’t give it to someone as a gift.  Ultimately, this registration application journey took me through stages, events, and processes, that all acted in combination to help me develop self-esteem.  On reflection, it happened gradually, but the realisation of what has happened only occurred yesterday.  It started a few hours before I knew what my registration status would be, and it concluded when I pin-pointed why I wasn’t the crying, sobbing, mess that I thought I would be regardless of the outcome.  I was prepared for the ‘mess’, and I expected it in response to all possible outcomes, including unconditional registration:  Without self-esteem, I would have still been a crying mess with unconditional registration because of the relief that particular outcome would have provided me if I was still in any way basing my worth as a person or medical practitioner on my registration status or the wording of the decision that told me the outcome.

I can laugh today:  I was genuinely confused when I didn’t find myself sitting at my computer in a flood of tears.  I was calm, and I found myself sitting there feeling reasonably pleased and satisfied (but I didn’t understand why).  My poor father, who was in the near vicinity and allowing me the space to discover the outcome in my own time, was probably similarly confused when I emerged in a rather relaxed fashion to scavenge for food in the fridge:  I think I left him confused for a few hours when I left the house for a while (Sorry, Dad).  The big moment of understanding didn’t happen until some 9 hours after I read the decision.

Plenty of people in my life have told me “I am enough”.  There is a very big difference between being told it and knowing that to be true in your own heart.  I took on the cognitive truth of that concept well over two years ago; I couldn’t have posted my application for re-registration without knowing that cognitively.  The acceptance of that beyond mere cognitive understanding was what made it real and what gives it power in my life.  If I had to pinpoint the moment ‘being enough’ moved from being a fact of cognitive acceptance to something my heart knows to be true, I am not 100% sure I could give you the date and time.  I can assure you that it was after the final day of the appeal hearing and before 10am on 18 October 2019.  

Maybe it was the day I turned down two offers for roles in clinical medicine (for 2020) that I could actually do given my new registration status.  Maybe it was the day I decided I didn’t need to dive back into clinical practice immediately even if I was suddenly able.  Perhaps it was my 36^th birthday when the lease on my consulting suites started, allowing me to more effectively provide services to those I try to assist in my capacity as a disability consultant.  Maybe it was the day I decided to take action on another matter that required a firmer approach than I had been taking.  Maybe it was the day I accepted my own limitation and allowed myself to use assistive technology in a setting where I previously would have felt ashamed. It could have been the day that I decided I wasn’t ready to move interstate again for next year.  I don’t know.  I just know that the reality of self-acceptance and the acquisition of self-esteem has happened for me.  It was the last thing I thought would ever come out of this type of process, and it’s the thing that means I can sit here and tell you that I got the best possible outcome.  

For those who read about the change in my registration status, and the associated decision, I’d like you to remember these points:

• Don’t let fear stop you from getting help if you need it;
• You may end up somewhere unexpected on your journey, that doesn’t make you a failure, it doesn’t make your journey ‘tragic’, and it doesn’t mean you won’t be satisfied;
• Risk is not a reason to avoid challenge, it’s the reason you push harder when you’re in the midst of the challenge;
• You are not defined by your job, career, financial status or where you live:  You’re defined by who you choose to be, your intentions, and how you choose to engage with the world.  Please don’t sacrifice your life and who you are for a career;
• Perfect is not what it takes to ‘get there’.  “Being enough” is what you really need to aim for.  We are only human.

Today, I sign off knowing that “I am enough”; my talents, faults, quirks and all.  I sign-off knowing that I do my best and that is enough.

Kindest Regards,

Dr “Do Your Best”

Stigma, prejudice, mental illness, and the harsh reality about what causes more harm.

Today is October the 10^th, World Mental Health Day.  I’m up early to make sure I get to my workplace in time to do my small part in setting up a morning tea arranged in support of World Mental Health Day.  Why does it mean so much to me?  Why am I a Peer Ambassador for SANE Australia?  Why do I think it’s important to be honest about my own journey with mental illness?

“1 in 5 Australians are affected by mental illness, yet many don’t seek help because of stigma.”

World Mental Health Day is about making a promise to shed a more positive light on mental health issues.  This blog post is about highlighting what stigma around mental illness is, the level of harm it causes, and how we can start to change that:  This may be one of the toughest posts I ever write, because it means being candidly honest about who I was, and how I thought, before I experienced mental illness.

I grew up in a household where mental illness was viewed as personal weakness, a sign of poor character, and a choice.  Beyond that, I grew up being fed various pieces of information that suggested mental illness was some kind of spiritual failing or demonic possession that could be ‘prayed away’; and, if it didn’t go away, then you hadn’t prayed the right way.  That was my foundation in terms of my view of mental illness – not a great starting point. 

To add to my own incredibly prejudicial views of mental illness, I came from a position of privilege:  My family never struggled to meet my basic (or even non-essential) needs.  Beyond a very basic understanding that some people don’t have access to the same opportunities and resources that I did, I had no appreciation of the impact of privilege, nor its absence, on people’s lives and how they turned out.  For me, empathy is a cognitive task; one that is made much harder when I have no comparable experience to the person I’m trying to empathise with.  Beyond my background of privilege and difference in ‘empathy processing’, another critical building block in my own foundation of prejudice against those who experience mental illness was the fact I have never had difficulty succeeding academically (which, up to the end of school, is very much a measure society uses to define an individual’s worth and success – something to be reflected on in another post).  

With that foundation and prejudice, I started medical school and began my journey to become a doctor.  I had the right intentions and so much compassion, but I also had no appreciation of how damaging my own assumptions and attitudes could be.  So, today, nearly 18 years after I started my medical degree, I’m sitting at my computer writing something I never would have imagined could have come from me.

“I’ve experienced mental illness.  At times it has been severe.  And, I am glad and grateful, for those experiences now being part of my journey.”

Wow.  Who would be grateful for experiencing any kind of illness or suffering?  Me.  I am.  I am grateful for the experiences that have provided me with the armoury of information I needed to challenge, and destroy, the strong foundation of stigma and prejudice that I held towards mental illness and the people it affects when I was a young adult.  I am grateful that I learnt those lessons in my young adulthood, before I could do too much harm by propagating stigma and prejudice further.  I am grateful that I have lived experience that allows me to highlight for others what stigma and prejudice really are, and what they do (and how we can stop them).  And, I am grateful for organisations like SANE Australia, who strive constantly to eliminate stigma and prejudice towards those with mental illness and who encourage those with lived experiences to be ‘Peer Ambassadors’.

I’ve recently reflected on my own lived experience of mental illness and the impact it has had on my life.  My medical career, and life in general, has been interrupted repeatedly, taken detours, and at times been completed halted, because of the mental illness I’ve encountered.  Through my reflections, I’ve come to a painful and alarming conclusion.

“Stigma and prejudice around mental illness have caused me far more harm and damage than the mental illness itself ever could have or did.”

I don’t say that to minimise the experience of mental illness:  The clinical experience of severe depression, anxiety, and suicide attempts has been profound.  The symptoms can be crippling and steal from you the time and energy you need to recover from them; it’s vicious, and painful.  But, it’s still nothing in comparison to the stigma and prejudice you face when you become ‘someone with a mental illness’.  

Stigma is the association of disgrace, failing and shame with a particular characteristic/experience.  Prejudice is the harm, injury, and negative action directed at a person or situation because they’ve got a particular history or characteristic.  

“Stigma and prejudice go hand-in-hand.  They come together to hurt and damage.  They support each other’s survival so they can live another day and continue on their destructive path.  They promote a mentality of ‘them and us’, they build false esteem for those who rely on them and they cut away at the self-worth of those they target.  Where stigma and prejudice are, empathy cannot be present.  When they leave, the people they’ve touched, their relationships, and their lives are damaged.  The biggest weakness that stigma and prejudice have is that they can’t survive without each other; they’re co-dependent.”

In my own journey I can identify clear instances where it has been the stigma and prejudice associated with my mental illness experiences that has harmed me (not the illness).  Stigma and prejudice have resulted in judgement and criticism (often unfounded).  Relying on them, people have made assumptions about my character, intentions, capability and worth.  People have made determinations about my future, without any consideration for time and the impact of effective treatment and intervention.  I’ve listened to stigma and prejudice, then based on their advice/impact made decisions for myself that have changed my life course.  Stigma and prejudice have served to make me less desirable in many contexts than those with serious criminal records.  They’ve led people to believe I am dangerous, not trustworthy, or otherwise unsafe.  They have given people permission to suggest I am less valuable (in many ways) than if I had not experienced mental illness.  They have chewed into the credibility and respect people extend to me.  And, most importantly, they have wounded relationships with friends and family, which has in turn served to sustain stigma and prejudice so they could survive another day.  These are all outcomes and challenges I’ve faced due to having experienced mental illness that have not been associated with my experience of physical illness/disability (which is not insignificant).

The shame that has been projected onto me as someone with a complex mental health history is something I have needed to actively combat.  It’s taken hard work and persistence to re-claim self-esteem, self-confidence, and self-respect that stigma and prejudice stole from me.  It’s taken courage to stand up and tell others that I am not willing to be shamed, nor prejudiced, for having experienced the mental illness that I have:  It’s a tough gig standing up and honestly telling people what you’ve experienced, but also telling them you’re not ashamed of it, and you won’t embrace any shame they project onto you.  

With these realisations comes responsibility.  Sometimes we don’t realise when we act/speak in a way that fuels the survival of stigma and prejudice.  You cannot go through life assuming that simply because you don’t mean to support stigma and prejudice that you therefore will succeed in not propagating them; it has to be a conscious decision, you need to monitor your thoughts and actions for the very food sources that stigma and prejudice rely on.  Here’s my little checklist that you can use to identify when you’re feeding the toxic, co-dependent, entities known as stigma and prejudice.

1. Are you thinking differently about someone’s word, actions, abilities etc because you know they have, or have had, a mental illness?  Would you think that way about them if they had a physical disability?
2. Are you fearful of a someone because you have knowledge of their mental illness, or suspect mental illness?
3. Have you allowed yourself to believe that you are more controlled, or more successful, than someone you know with a mental illness?
4. Do you attribute any blame onto a person with mental illness for their situation (homelessness, financial troubles, lack of academic success etc)?
5. Do you view the person you know as someone who has experience mental illness as ‘potentially mentally unstable/unwell’ even after they have recovered?
6. Have you ever considered not giving someone an opportunity, or not giving their opinion as much weight as someone else, because they have (or have had) a mental illness?

The biggest litmus test to see if you’ve been impacted by stigma and prejudice towards those who experience mental illness is this question.

“If you were diagnosed with a mental illness tomorrow, and needed treatment/therapy, would you be less comfortable telling your friends, family, colleagues, employer or anyone else than if that illness was physical?”

It’s everyone’s responsibility to breakdown stigma and prejudice towards those with mental illness.  With 1 in 5 Australians experiencing mental illness at some point in their lifetime, we are all going to come across someone who has been impacted; and, one day you may be that person.  

Happy World Mental Health Day…  

The Weight of the World…

I thought long and hard about whether or not I published this blog post.  I decided to, out of integrity and honesty, with regards to a situation.

You only have to read my opening post on this blog to find out that I have a battle going with the Medical Board of Australia.  

I’m a doctor who has experience severe depression, made attempts on my life and taken time off when impacted by the black dog.  I’m a challenging patient (I won’t deny it).  But, despite the severity of my episodes of illness, my ability to practice has never been impacted.  I’ve matched, or bettered, the performance of my peers.  I’ve never had a complaint from a patient and never had any notifications about my conduct or performance.  

Next year I’ll be a PGY12 (my 12^thyear out of medical school).  Right now, I am applying for PGY2 roles; yes, you read that right.  I’ve had interruptions to my clinical career to the extent that if I ever want to achieve my career goals, I’m faced with returning to practice as a PGY2.  Most people I graduated with are now fully-fledged consultants…  But, that isn’t what this post is about. 

I’m fighting in NCAT to have conditions that are currently on my medical registration removed.  The conditions completely block me from clinical practice, despite a clean record. I made a decision to fight the case publicly; that wasn’t easy.  It means being willing to have anyone, from anywhere, listen into the sordid details of my state when I have been impacted by mental illness.  It means allowing people to discuss my mental health history and speculate whether or not they think I should be allowed to practice. That’s not easy.  That has to be the most vulnerable situation I’ve ever been in, and I am, in some respects at the mercy of the Responding party (the Medical Board of Australia) when it comes to how they choose to deal with my mental health information.  

The decision to fight this publicly was easy.  There hasn’t been transparency, historically, regarding assessments of doctors with ‘fitness to practice’ concerns raised about them. AHPRA and the Board are very good at ‘encouraging’ those impacted by these investigations to stay ‘hushed’, for ‘their own benefit’; really it is for the benefit of the regulator and their lack of accountability in the process.  But, shaming people, and putting the fear of being publicly stigmatised if the alleged ‘dirty laundry’ of their mental health history is aired publicly works well; it’s a very effective way to keep people quiet. Unfortunately, silence and hiding leaves people who choose to in a position of relative power; it means they’ve succeeded in stigmatising an illness, and the impacts of that illness.

Fighting this appeal publicly means we can finally have an open and transparent look at how AHPRA and the Board handle these issues.  With someone willing to have their own case openly examined, we can look at the processes.  So, I’m not hiding any of it.  Anyone who wants to can ask me about my mental health history.  I’m not ashamed of it.  I’m willing to discuss it.  I know I am not a lesser person, or a riskier candidate to provide clinical care, than any other person without that history.  

I’ve become pretty vocal on social media over the past year.  I genuinely believe that it is necessary for us, as a profession, to keep being open and talking about these issues; well, if we want things to change.  

I lodged my application for registration on 9 March 2017. I knew how AHPRA and the Board would approach it; they proved me right.  I knew an appeal was likely.  I also knew how they’d approach the appeal (and, unfortunately, to date I have been proven right).  I lodged my application after hearing about the run of junior doctor suicides in NSW. I was physically ill when I realised that I wasn’t the only one subjected to the horrendous and inhumane processes of AHPRA and the Medical Board, when they’re ‘concerned’ about a doctor’s mental health.  The realisation that it wasn’t ‘just me’ came with the realisation I had a responsibility to stand up and do something about it.   So, I prepared to fight.

In 15 days’, the NCAT appeal Hearing will be over.  We’re returning, the Board, me, the Tribunal Panel, and my faithful four-legged assistant, for four more days between 16 and 19 July.  At this time, in 15 days, the Hearing itself will be complete and the Panel will be left to decide whether or not I pose a risk to the public.  

Although the law doesn’t stipulate the next part as what the Panel will be making a decision about, by the very nature of the case and the appeal, they will also be making a decision as to whether or not we have case law in Australia that says “Even if you’ve had shocking illness (mental or otherwise), if it hasn’t impacted on your practice and isn’t likely to, then we won’t take your career away.”  That is a far more significant decision than just the career of one 35-year-old doctor, who if allowed to practice will be joining the ranks again at the equivalent level of someone who is one year out of medical school and has just completed their internship.  

Right now, I’m still preparing my evidence (it’s a constant process) and I’m still thinking through what I may or may not have to address, how I will address it etc.  As someone who wasn’t fond of English in school, I’ve had a good ‘literacy intensive’ this year while self-representing in this case.  I take my hat off to those studying and practicing law.  

Right now, I also have the weight of the world on my shoulders. 

In the lead up to this final instalment of my NCAT appeal, that’s how I feel.  Having publicly stated that this is an ideal test case as to whether a doctor can lose their career for seeking mental health care, I have taken a big risk.  A positive outcome for me, in the final determination, is clearly going to be a change-maker for the situation doctors currently face; it would be case-law that others can rely on to say ‘it doesn’t affect my practice, therefore, you can’t destroy my career’.  But, the other side of the coin is that if the Tribunal for some reason follow the current ‘pattern’ that AHPRA, the Board and other Tribunals have followed (in imposing conditions based on speculation because mental illness is seemingly scarier than physical illness) then the message that gets sent to the medical fraternity is ‘Yes.  You can lose your career over a mental illness that doesn’t impair you in practice.’  No doubts that kind of outcome would increase the fear doctors already have in seeking mental health care and potentially lead more to believe that suicide is a better option than engaging in care.  

Imagine not knowing the outcome of your own case.  Imagine knowing it would have been easier to get your conditions removed by simply waiting a couple of years and quietly approaching AHPRA.  Imagine knowing that you’re out-gunned in terms of legal representation and resources.  Imagine knowing that your efforts to ‘create positive change’ in a particular space could backfire horribly and that you have no control over that outcome; the decision sits with four panel members.  

That feeling is one of having the weight of the world on your shoulders.  The intensity of that burden is greatly heightened having heard about more recent doctor suicides in the very State (NSW) where you’re fighting the battle.  

I felt ill, and I fell to pieces inside when I read the recent Sydney Morning Herald article about the recent doctor suicides.  I didn’t know them.  I don’t know their families.  I do know the fear and sense of trepidation and debate that they may have faced when considering suicide versus seeking help.  To the families and friend of those doctors, my heart breaks with yours and I am so deeply sorry for your loss.  

For me, seeing that we’ve lost more of our profession in the context of a regulatory system that could have been changed before now to ensure those individuals felt safe seeking care, and recovering, then going on to live health and happy lives, felt like I’d lost the ‘appeal’ already.  

I’m being totally open here, wisely or not, about just how terrifying it is considering what the implications of various decisions in my case will mean for others.  I don’t think it is a reason to make it any less public.  But I do want to openly say I know I’m taking a risk here…

It’s not a Disney movie.  I don’t know what the outcome is going to be.

It’s a tough gig being that person that says ‘go ahead’ look at anything, look at everything, I’m not ashamed.  Even if I am not ashamed, there is still stigma and prejudice out there. I dare say, we wouldn’t be seeing this appeal if there wasn’t.  So, my own lack of shame is not in itself ‘protection’; people can still choose to target me with that knowledge once its public.  To the Panel engaged in my Hearing, I say this:  I know that people can try and use this against me and I’ve made a decision that I am ok with that, just please don’t let this become another case with no transparency and no accountability.  It’s my story, and if I am willing to have it told, please respect that and let me. 

If there is something, I have learnt from the amazing army of advocates screaming out on social media for some much-needed cultural change in medicine, that it is to ask for support when you need it.  The case is lonely, it’s tough, it’s daunting, and it is so highly and deeply personal.  The support I need in that Tribunal room, particularly coming towards the end of the case, is to know that I’m not the only one who’s willing to stand up and fight for change in this space.  It’s not overly interesting listening to evidence being presented to a Tribunal Panel; even I ‘nodded off’ briefly during one of the sessions in April.  I don’t need people to agree with me on everything, or even to have decided in their own minds what the outcome of my case should be.  I do need people to be willing to stand with me (or in this case ‘sit’) and say through their presence “we know this needs to change”.  Even if you’re just there for a few hours, I’d be grateful.  Personally, I’d suggest the 19^thof July, because that’s the final day and the ending is always the best bit, right?  

Who? Anyone who is available, even briefly, and believes we need change in the way health practitioners with mental health issues are handled and treated.  Anyone who believes that doctors should have the same rights to accessing health care as those we care for.  

When? 16-19 July 2019

Where?  NSW Civil and Administrative Tribunal (NCAT), John Madison Tower, 86-90 Goulburn Street, Sydney.

What? If you do come, consider wearing #CrazySocks4Docs, at least then we’ll have some colour in the room and I’ll know who wants to see change.   

Finally, asking for support is hard.  Whether you’re asking people to publicly support something, or you’re asking someone to help you in private (like a GP or psychiatrist).  It’s hard because asking for help and support makes you vulnerable; people don’t have to respond, and you can’t control their response.  Today, I’m choosing to be that vulnerable.  

No more time-share between Plan-A and Plan-B!

I think I just blew my own mind. Sitting and mulling. Considering. Pondering…

For the past 15 years, since I entered the mental health system, I’ve been telling myself “I always have to have a Plan-B”… Not just that I need to have that Plan-B, but be actively preparing for it. Why? So that if anything happens, and someone or something attacks or sabotages Plan-A, I will be ok.

I am unable to measure the amount of energy I have put in to ensuring my Plan-B will be adequate and survivable over the years… I know when it started. It started when people told me over and over “you can’t be a doctor and have mental health problems”, “you don’t belong in medicine”, “you’re different and you’re not one of us”, “you’re not worthy of a career in medicine”, “you’ll never be a safe doctor because you’ve had mental illness”. Those were not quiet messages, they have been the prevailing messages I received throughout medical school and my career thus far. Some people are still trying to send those messages.

“We should scrutinise you more harshly because you’ve experienced something we are not willing to entertain we may also be vulnerable to experiencing…”

I’ve done myself an injustice in my ignorance and naivety. Sometime in the past 3 years, I realised those things were bullshit. I realised I didn’t have to let people who know less about me than I do, and who haven’t walked my path, dictate to me what my future is limited to. The problem was, until today, my brain was still operating in defence, in preparation for attack and failure. I’ve kept pouring effort into Plan-B preparation and engagement.

Wrong approach.  

Recently I started, without realising, pouring all that energy into Plan-A again… Signing up for the extra study courses I will need to succeed in Plan-A… Applying, against the odds, for jobs that will let me progress through Plan-A… Asking for opportunities that will help make Plan-A possible (not just opportunities that are visible, but seeking to create ones). But, most importantly, I am now allowing myself to believe in my own mind, and visualise, the actuation off Plan-A: Seeing Plan-A as reality sometime in my future.  

For fear of pain, suffering, heartache and disappointment, I haven’t let myself believe in Plan-A enough to fight for it. Yes, I have to fight harder than some others for the same thing (in this setting). But, I am fighting for it. I am appealing in NCAT. I am owning my story. I’m standing up and calling out the people who are so very wrong about who/what I am.

I am planning to make it possible. I’m relearning some things that were forgotten and strengthening new skills I have learnt on this pathway.

Today, I realised I’ve let people put me in a position where it wasn’t just them stealing from my future; it was me too. By giving power to their judgements and their words (most often made with no evidence) I let them convince me that Plan-A could never happen. I let them motivate me to invest more heavily into preparing for Plan-B than into fighting for Plan-A.  

Now, I am not. No more! I’ve already learnt that others do not get to define who or what I am, or where my story goes. 

I am actively investing in Plan-A and will make it happen. I am going to stop wasting my resources preparing for Plan-B, just so that it hurts less if I face a set-back. And, I’m going to see set-backs for what they are; set-backs. They’re not final endings or conclusions, not final chances…  

Screw Plan-B! I’m resilient and capable.

Plan-A deserves my efforts and Plan-B is simply the acceptance of other people’s attempts to put me in a box and dictate who I am, what I’ll be, and where I’ll go.

From Critical Mass to A Nuclear Chain Reaction

Trigger warning – post makes reference to suicide.

Today is #CrazySocks4Docs Day 2019; it’s wonderful.  This movement, started by Geoff Toogood, has spread around the globe.  We have doctors and other health professionals all standing up to speak out and say, “We aren’t going to accept a professional culture that stigmatises those who experience mental illness.”

From where I am, it seems like we’ve reached a major turning point in the culture of medicine.  Those who are standing up, donning their #CrazySocks and saying, “We simply must do better.” are not just the people who have experienced mental illness, but their ‘well’ peers who recognise that it could have been them and may be them in the future. 

We’ve reached a critical mass of voices in unity.

Is it too early to call this a critical mass?  No, I don’t believe so.  According to Wikipedia, “critical mass is the smallest amount of fissile material needed for a sustained nuclear chain reaction.”  For a high school physics nerd like me that feels pretty exciting!  But what does it mean for this issue?  Can we now expect an automatic flow-on out of the critical mass of real-time changes that will support our peers who are impacted by mental illness?  Will the changes we need in order to reduce the incidence and impact of mental illness in our professional simply occur?  The answer to that is, no.  The critical mass of people standing up in unity is the crucial ingredient, the foundational step, and an immeasurable achievement: For a nuclear chain reaction, we need to do certain things with that ‘critical mass’.  It doesn’t stop here.

Those who have advocated along the way and helped bring us to this point should be proud beyond words.  I have no doubts that #CrazySocks4Docs 2020 (and in the years after that will continue to grow exponentially).  I’m certainly on the lookout for some super crazy socks I can add to my collection before then.  But what happens tomorrow?  What am I going to do in this space to ensure stigma around mental illness has no place in the profession I chose?  What action am I going to take to ensure any remaining stigma has no mechanism to survive? What action are you all going to take to ensure the stigma we’re screaming out against is genuinely thwarted and becomes a sad part of the medical profession’s history?

Mental illness doesn’t discriminate.  Doctors, and other health professionals, face situations that place us at an increased risk of depression, anxiety, and trauma.  We can’t afford to keep losing peers from our ranks because they experience these difficulties.  We need to take out critical mass and actively implement strategies that support stigma reduction.  

What does that look like?  

Time travel back 10 years with me to 7 June 2009.  I was about halfway through my internship and had started my third rotation on a busy surgical unit.  Before graduating I had experienced severe depression and made attempts on my life.  However, I had been travelling pretty well for a sustained period and was not unwell… My medical registration was subject to conditions based on the assumption that someone who had experienced mental illness would be a risk to the public without those conditions.  I also had fairly serious physical health challenges that made long hours an impossibility; but I was capable of working the full-time hours for which I was contracted.  On this day, 10 years ago, I was not ‘clinically depressed’; ten days later I was in an intensive care unit, barely alive, after having taken a high-lethality overdose. How did that happen?  

The attempt on my own life, on 17 June 2009, wasn’t rooted in an episode of clinical depression.  That attempt was a very much a reflection of a training system and a medical culture that did not allow for good self-care (mental or physical).  On that day I was isolated, trapped, feeling helpless without any way forward, and utterly exhausted.  To put it frankly, I was so overwhelmed by the situation and could see no way of surviving.  Sounds a bit like ‘depression’, so I’ll explain why it wasn’t.

In the months leading up to the commencement of that surgical rotation I flagged with the internship coordinator that, physically, I wasn’t managing the 16-hour days (sometimes several in a row depending on the roster). I explained I was getting physically sick as a result and requested the hospital assist in organising my roster so that I was still meeting my full-time obligations (80 hours a fortnight), but not rostered on for up to 120 hours (plus non-rostered overtime).  The proposed solution was totally unacceptable to me; it involved simply redistributing my excess hours among a handful of my peers who were already burdened with similar hours.  Needless to say, I told my Director of Intern Training that I could not accept that solution.  I don’t want anyone to see this openness as a criticism of that Director of Intern training; I don’t think there was a solution because we simply didn’t have enough bodies to fill all the hours.  That particular Director of Intern training is one of the kindest, most genuine, surgeons (and people) I’ve come across; he just didn’t have a magic wand and the situation was just as much out of his control as mine.  There was nobody more senior to flag it with because our hospital was temporarily without a Medical Director.  

In the email trail there was ‘administrative gaslighting’; to this day I don’t think the author realises that’s what was it was.  It was suggested that any intern who needed to work any ‘extra hours’ required remedial training in time management:  This wasn’t the case for me, or any of the other interns that I worked with that year.  We were all pretty capable and efficient.  If you added up the hours, we were all rostered on for over the course of that intern year you’d probably find the hospital could have employed 60 interns with full-time hours rather than the 40 interns we had.  The reality was, we had more work to do than hours in the day. The expectation was that we would pretend that wasn’t the case and work the excess rostered hours, plus any additional un-rostered overtime needed to get the jobs done for our patients.  At one stage hospital administration even asked us not to document our un-rostered overtime on timesheets.  It was implied that anyone documenting un-rostered overtime would be ‘pinged’ in their performance assessments for a ‘lack of efficiency or organisational skills’; that was motivation enough for many to simply plough on through.

I was beyond exhausted.  The physical cost of the extra hours was huge.  I barely had time for basic self-care.  I needed every moment of rest I could get.  Grocery shopping, cooking healthy meals, and even cleaning my home or doing laundry, all became ‘luxuries’.  My roster rarely allowed me to attend much needed medical appointments with my GP and specialists.  If I elected to take the weekly ‘afternoon off’ that we were allowed to take, I would inevitably return the next day and face criticism for that absence, even when I had communicated appropriately with my seniors before leaving.  My monthly infusions of immunoglobulins would normally have required one day off a month; interns can only take 20 days off in a year, or you fail on attendance.  I found myself having my infusions via the Baxter-bottle antibiotic infusion pumps, connected to my port-a-cath, while I did my rounds with everyone else. When my port needed replacing, I was back at work on a 16-hour shift the following day because I couldn’t get leave for more than the one-day needed for the procedure.  I’m able to look back now and judge myself far less for having become so broken during that time.  It was a lose-lose situation.  

My mental health issues in medical school were fairly widely discussed and gossiped about.  The majority of students knew ‘stuff’, but few really knew what was going on, the details, the facts, and few asked:  I guess it was easier to simply assume.  Senior staff in the hospitals and medical school participated in the gossip and the message was out there; it was totally acceptable to engage in that kind of behaviour because I had experienced a certain type of illness.  It wasn’t everyone, but there were a large number. Stigma and prejudice were alive and well.  I knew about the back-chatter.  I knew about the breaches in privacy and ongoing inappropriate access to my clinical records where I had been treated for mental health issues.  I knew that many of my intern colleagues, at least those who went to the same medical school as me, viewed me as ‘less worthy of being in the profession’.  

At our graduation ball when the ‘joke awards’ were being handed out people asked, “Who is the least likely to be in medicine in 10-years’ time?”: Someone shouted out my name and the room went silent.  If I had not been sitting at a table located so far from the door that an exit from the building would have been visible to everyone, I would have left within seconds: Instead, I sat there and acted like it didn’t matter.  The majority of my graduating class knew that I had faced a fitness to practice investigation from the Medical Board the previous year.  The actual answer to the question was meant to be the name of a classmate who had diligently completed their medical degree at their families request while wanting to set up a bakery.  That moment was the embodiment of stigma, and it hurt; actually, it still hurts to write about it (publicly) more than 10 years later.  That stigma was isolating.  

Having been unsuccessful in trying to negotiate safer working hours, having been repeatedly berated when I did take time to engage with my health practitioners, I was in a tough spot.  Add to that the extra scrutiny I was under as a doctor with conditions on their registration and facing stigma for a mental health history that was fairly widely discussed; I felt trapped.  How could I possibly ‘win’?  I couldn’t do what I needed to look after my health.  Any criticism of my performance was likely to be attributed to ‘a mental illness’ by the Medical Board and potentially used to further restrict my registration; the reality is, I am a human, and was in my first year as a doctor just like everyone else.  Isolated by the stigma, and absolutely exhausted beyond the point of being able to make good decisions, I broke.

The story above highlights how various factors can bring someone to that breaking point without there even being an underlying clinical depression. I’ve also reflected back over the years and wondered whether I would even have been in a position to recognise if I had been clinically depressed; I don’t think I could have.  

How do you assess a change in your appetite when you’re too busy and tired, to really think about food and just grab whatever you see at the hospital’s cafeteria, or the Hungry Jacks drive thru?  How do you assess a change in your sleep, and weigh up the cause, when you’re barely getting the sleep you need, and your hours require you to frequently deny yourself sleep, or wake up from your sleep, while you’re still tired?  How do you tell if you’re overwhelmed because you’re becoming depressed and coping less well than normal, when the stressors you’re facing are all quite significant and could be overwhelming to someone who isn’t depressed?  How do you tell if your anxiety is above and beyond what is expected of a junior doctor desperately trying to pass, succeed and secure referees so they’ll still have a job the following year?  How do you let your doctor know you’re finding life tough when you can’t even attend an appointment without criticism from your seniors?  Even if you do get an afternoon off each week, how do you book an appointment when you don’t know in advance which afternoon? These are all relevant questions. 

How can we expect doctors to look after the health, mental or otherwise, when we’re putting them into a situation that makes that close to impossible?

It’s my personal belief that while we still have rosters and attitudes that don’t allow for good self-care that we actually still have stigma; or we’re at least leaving the foundation there for stigma to regrow.  By having a situation where we are essentially looking at ‘survival of the fittest’ we create a situation where those facing other issues ‘drop-behind’ or appear less capable when they can’t meet the excessive demands for whatever reason.  Maybe they’re physically sick, maybe they’re experiencing depression, perhaps they have young children and family commitments, maybe their elderly parents need their help:  They’re not less capable, but they may not have the same time resources available to meet the demands of ‘more than full time’ employment expectations.  The likelihood is that they’re just as good a doctor as the person who seems to work their 70-hour week with relative ease.  

I’ve been very open about a very dark moment in my history.  Some may see it as blaming…  I hope most will see past that and realise that any of us could end up facing a moment of being overwhelmed, helpless to change our circumstances and trapped.  We need to be taking action to change our professional environment so that these factors are not there.  We need to take the passion behind wearing our crazy and loud socks today and actively seek out ways we can re-work our medical culture so that the risk factors for mental health problems are minimised, so that our peers can discuss mental health as openly as a broken leg, and so that we can recognise warning signs of serious mental health conditions (because the warning signs aren’t masked by system issues). 

For those who are wearing their craziest socks today (and in all the lead up events this week), Thank you!  My challenge to each of you is to think of 3 things you can action in your own workplace to bring about a change in the circumstances that give stigma its foundation.  Can you change the rostering?  Can you help your staff plan their time off so they can use that effectively for self-care if they need it?  Can you take a team coffee break and let everyone know that its ok to come forward and ask for assistance or understanding?  Can you show your own vulnerabilities to your colleagues to they know they can show theirs when they need to?  

Let’s take this critical mass and drive it towards a sustained change in our medical workforce and culture.  #MH4Docs  #CrazySocks4Docs.

Doctors, Broken Systems and Stockholm Syndrome

Over the past few years we’ve seen a dramatic increase in public discussion and media coverage of issues impacting the ability of doctors to provide safe medical care.  You’d only have to spend a few minutes on Twitter scrolling hashtags like #MH4Docs and #MandatoryReporting to see the loud acknowledgment from the profession that the issues are there and need to be addressed. 

Doctors are scared to seek care for health issues, particularly mental health concerns, because of mandatory reporting laws and the risk of career damage.  Not only is seeking care problematic, the exposure to risk factors for mental health issues are significant; long hours, bullying cultures, victim blaming and endless competition for training and job opportunities are rife in medical workplaces.

Despite the profound levels of discussion and advocacy around effecting positive change in these areas, you’ll still find comments that are seemingly negative and critical of attempts to improve the system(s).  

Why is that?  These individuals are frequently health professionals also facing these issues.  Why wouldn’t they want to see change implemented?  I have not found one negative comment or criticism of advocacy in these areas that actually denies the issues exit:  There is a resounding agreement that they most certainly do. The criticisms and negativity appear to be focused on the hurdles and challenges that will need to be overcome to successfully overcome these endemic system problems.

There’s the group that are advocating for changes and striving to take steps towards better systems, that will be safer for doctors and patients.  There’s the group that are too drained and thwarted by the very systems that need changing to do anything more than watch the advocacy and efforts of others, hoping that change will occur.  Then, there’s the group that seem to discourage the advocates, loudly proclaiming the awful realities of the hurdles that have to be overcome before change can occur; and, at times, implying that those hurdles are impossible to get over.

The final group are sometimes assumed to be trolls on social media platforms.  However, after some serious consideration I’ve decided that as frustrating as their defeatist attitudes may be, they aren’t trolling. These individuals are evidence of just how damaging the systems we are seeking to change are.  They’ve moved past being overwhelmed by the traumas/dangers of working in these systems, while still holding onto threads of hope that the issues will eventually be addressed, and they’ve moved into a place where they believe the situation can’t be addressed because it’s just too hard. It is the final group who are sometimes identifiable through comments like “That’s how it was when I went through” and “It worked for my generation”.

The advocates aren’t blind to the immense challenges associated with pushing for change; but choosing to give those challenges too much power steals away the chance of taking even small steps towards system(s) improvement.  

In a way, the defeatist group, have developed a form of Stockholm Syndrome to the very systems that have stolen their own health, relationships and hope.  Accepting system problems as facts and realities that are unable to be addressed for one reason or another provides a level of self-protection: If you accept that the problems can’t be changed then there is no inner turmoil associated with not addressing them.  Agreeing, and sympathising, with the administrators and organisational power holders who say “we can’t fix that because…”, they’re almost defending the perpetuation of these issues which are affecting each new generation of health professionals who graduate into these systems.

When I consider the defeatist group with this perspective, they become less like ‘thorns in my side’ as I join with others in doing everything I can to bring about change, and more like ‘fragile, broken reminders’ of what the outcome for for many more doctors will be if we don’t succeed in changing these systems.  And, I realise, that for several years I was one of them…

With that perspective, the urgency and importance of fixing our broken systems becomes even greater. Those of us who are able must push hard, and with strategy, to ensure that we do not become the next cohort of defeated and accepting broken professionals.  We must fight for those who are not yet broken, but currently swimming upstream against such powerful system issues that all they have capacity for is their own survival (I dare say, that is probably the majority of junior doctors – it was definitely me).  And, we must fight for change and hope that even small steps forward will bring those who have been defeated back from complete brokenness (and acceptance of the systems that broke them), to a place where their wounds can heal and allow them to nurture future generations.

In no way should this post be taken to be a criticism of those who have suffered through the current systems to the point of being broken; I am only sad that the changes we are pushing for now were not there before they, and I, became so damaged.  

History isn’t my strong point, but I can’t identify any moment in history where great change began with someone saying “This is too hard” or “It isn’t possible”.  Change is rarely easy and rarely cheap.  It doesn’t happen overnight, and it takes unity and alliance to truly implement.  

Knowing that, I’m committed to continuing to try and effect change in our broken medical systems for the safety of doctors and our patients (two cohorts with equal importance).  If I see a hurdle, I’ll acknowledge it, but only so that I can try and identify a way to overcome it.  

Staying on Your Feet

I have a very strong focus on advocating for improved mental health, particularly for doctors.  Aside from trying to do my part to reduce stigma and prejudice against those who experience mental illness, I am always looking for strategies that I, and others, can use to not just improve mental health, but to maintain it.  After all, why climb a mountain only to fall off a cliff as you reach the summit. 

Last weekend I had one of those moments of realisation that we sometimes have in life.

For those who don’t know me that well a bit of background will help.  Last year I became a part-time wheelchair user, not long before turning 35 (which I still think is young).  I have Ehlers-Danlos syndrome which, for me, means my joints are quite hypermobile. After losing 75kg of excess weight during an 18-month period, I developed a significant amount of muscle weakness. Given the stability of my joints is heavily reliant on good muscle strength and coordination, this became a big problem; my joints started dislocating more frequently and recurrent hip dislocations took a toll on my mobility.  The introduction of a wheelchair came after careful consideration and we hoped it would reduce falls.

To an extent, using a wheelchair does help; clearly, I can’t fall over when I am not walking.  But, as they say, “If you don’t use it, you lose it.”  It became a choice whether I became more reliant on my wheels or worked harder to ‘stay on my feet’.  It’s a love-hate relationship I have with my wheelchair:  It is a blessing on days when I am in considerable pain or extremely tired, however, I am naturally inclined to run around, and it cramps my style. I’ve chosen to focus on option number two – ‘staying on my feet’.  

Towards the end of last year, I was working very hard on improving strength and coordination to minimise dislocations and falls; but I wasn’t really getting anywhere.  I was definitely more tired, and my joints and muscles felt well used:  Despite doing everything I could with the exercise physiologist and a personal trainer, I kept on falling.  For a few months I resigned myself to a permanent decline in mobility and was, to a degree, grieving that loss.  My treating team (now changed) appeared comfortable with a lowered expectation of what my mobility status would be in the future. My own resignation to using my wheelchair most of the time didn’t last long; I am simply too stubborn.  If there is anything I’ve learnt from growing up autistic with parents who always focused on my abilities, not my difficulties, it is that other people’s expectations of what you can or will achieve don’t have to limit you; and the limitation is often more related to how much you believe those assessments of your capacity vs the actual impact of any disability.

My wheelchair is named “Franklin” after the former American president Franklin D. Roosevelt who stood up out of his wheelchair and said, “Don’t tell me it can’t be done.”  Matthew Wilder’s song “Break My Stride” crept up towards the top on my regular play list and I found myself humming “Ain’t nothing gonna break my stride… Oh no …I’ve got to keep on moving.” as an hourly mantra.  And yes, I felt the need to put it on repeat while writing this blog post.

I booked in with a new physiotherapist who had some great reviews on google and whose practice offers tailored Pilates rehabilitation programs. I always thought Pilates was glorified pseudo-exercise where you play with those awesome giant exercise balls (I standcorrected).  My new physiotherapist did something entirely logical, but unexpected.  During her assessment she pulled out an ultrasound machine and scanned over each muscle that should activate and contract during each movement to assess whether or not it was pulling its weight.  The logic behind this had me questioning my own competence for not asking someone to do this sooner.  We have multiple muscles around each joint, and each muscle has a purpose; it makes sense to check they’re all working…

From all muscles we observed, only my gluteus maximus was doing any work on the left side, and the right-hand side wasn’t far behind.  Those gluts were working very hard; compensating for all the others, to whatever extent is possible.  No wonder when my unstable joints were facing possible dislocation I just kept falling.  There was a single ‘safety net’ stopping dislocations, and if that safety net ‘failed’ down I went.  There started a program that looks easy to an observer but is mentally and physically hard; it is focused on reactivating and retraining all those weak and atrophied muscles around my joints to start working again and do their job (that and training the muscles that have been doing all the work to ease up and let others have a chance).  The program takes effort and concentration; Pilates with the physio, hydrotherapy with the exercise physio, personal training at the gym, daily exercises for at home…  I’ve got sore muscles where I didn’t even know I had muscles (anatomy was definitely not my strong point in medical school).  

The moment of realisation came while attend one of my favourite conferences.  I stood up quickly while turning (high risk for me) and there was a notable wobble; the horrendous feeling right before I usually feel my hip pop out and fall to the ground. But I didn’t fall.  I was stunned.  Right at the moment when I would usually feel a complete loss of control in the joint, I felt something tighten and hold things in place and I was able to regain my balance without a dislocation or subsequent fall; the gluteus medius muscle kicked in and I saw the first tangible improvement from my new exercise program.  A colleague noticed the wobble and said, “You nearly fell”.  I paused while the reality of the situation sank in and then responded “Yes, I did nearly fall.  But, I didn’t.” – that statement was as much for my benefit as theirs.

A subsequent review with my physiotherapist indicated that those muscles are starting to activate more when I try certain movements.  I felt an enormous sense of achievement and pride based on a solid investment of time and effort into changing my mobility status.  Now she is faced with being the ‘fun police’ at times while I enthusiastically eye off the more entertaining looking pieces of equipment in the Pilates gym; who wouldn’t want to play on a giant wobbly surf-board! (I’m told the surf-board may be in my ‘future’ dependent on further improvement). 

Not falling over with a hip dislocation is a pretty objective measure of an improvement in functioning.  But how to we measure things like this when it comes to mental health.  How can I apply what I’m learning with my visible disability to the less visible entity of mental health improvement and maintenance?

The key things I can identify from my loss and partial (ongoing) regain in physical mobility is:

• Sometimes things happen that damage or weaken our safety nets; those things are not always in our control (muscles supporting already vulnerable joints became weak with rapid weight loss)
• If you don’t use it, you lose it (sitting in my wheelchair all the time was never going to improve the muscle strength and coordination around my joints)
• You absolutely do nothave to settle for other people’s expectations of what you are capable of; the older I get, the more I realise nobody else has the right to define the limits of what I can or cannot achieve based on their perception of my disabilities.
• Staying ‘on your feet’ requires multiple muscles to work; you need more than one safety-net, you need a team of muscles to keep those joints stable.
• Strengthening and retraining weak and atrophied muscles takes time, effort, strategy, concentration and commitment; you can’t just keep doing things the same way, you need to try new movements and learn new skills.
• Developing and training muscles might hurt a bit, especially at first.
• You have a right to feel proud of yourself for small gains, achievements and even minor progress.  Use it to motivate yourself to go further and as encouraging evidence that you can improve.

Now let’s consider how all of this applies to mental health.  My “uh huh” moment last night was while lying in bed, struggling to sleep.  I was thinking about the sense of achievement and pride I felt when I realised that I had succeeded in beginning to improve certain muscle functions, and my physiotherapist confirmed the progress.  Then, I felt confusion and guilt.  Over the years I have invested countless hours into self-development, into strengthen my resilience, coping skills, mental health, communication skills, and emotional intelligence.  I lay there wondering why I hadn’t ever felt that sense of achievement and pride when attending an appointment with a psychologist or psychiatrist (or someone else helping me work on improving my mental health).  

In contrast to the sense of self-pride and achievement I felt with my physio this week, on many occasions my feelings when working on improving my mental health have been better described as shame and failure (even when I’ve made positive progress).  Those negative feelings have certainly not been attributable to projection of negativity from the treating specialist (at least not in the context of my own private long-term treaters, in the public system I can’t say that’s always true).  I pondered whether those negative feelings and the absence of a sense of pride and achievement were a possible indication that I have some unconscious prejudice towards mental health problems; I decided I do not.  After careful consideration I recognise that perhaps my own feelings of shame and failure when faced with working on the improvement or maintenance of my mental health is a reflection of the rampant stigma that we still have in society towards individuals with mental health problems.  

Somewhere along the road, to some degree, I have bought into that stigma and prejudice:  I have allowed myself to feel shame and failure for even needing to ask for help for depression, anxiety and trauma.  I have not allowed myself to celebrate small or big gains in mental health improvement and maintenance despite having invested significant efforts into those gains; I haven’t mentally allowed that because somewhere along the road I started believing the projected stigma that says “you are a failure if you needed to work on those things in the first place”.  

This morning I can sit here and say that it is not true. Needing to actively work on strategies to improve and maintain your mental health in no way makes someone a failure.  Having mental health problems does not make someone a failure.  Small and big improvements in skill sets, coping strategies and independence should be celebrated with the same enthusiasm and gumption as gains in mobility.  Now I am determined to approach my own mental health from that same perspective.  

I do see a psychiatrist regularly, sometimes just to check in and update him, and other times to seek extra assistance in managing anxiety or depression.  In the past, I have also spent many hours with psychologists working on coping skills, emotional intelligence, self-awareness and communication skills. In my private time I regularly seek out resources for self-development to improve resilience and ensure I can maintain my mental health.  Doing those things, and gaining benefit from them, does not mean I was weak or defective in the first place.  

Here’s how my checklist is going to translate into mental health improvement and maintenance:

1. Certain events and factors in life can cause insult/damage to our mental health.  I’m going to acknowledge those things when they pop up and understand that if something has acted to damage my mental health that I may need to invest extra time into it to improve my mental health and bring it back to a point where it is being maintained.  I am also not going to view myself as a failure from now on when something external impacts on me negatively; requiring that extra effort.
2. The skills and tools I develop to improve and manage my mental health I am going to deliberately choose to practice even during times when I seem to be travelling along just fine; because if I don’t, they won’t be there when I need them to stop me from ‘falling’.  That means having a support network in place, knowing myself well, maintaining a healthy life balance (including exercise, good diet and sleep hygiene).
3. I will not accept other people’s projections and assumptions as to what I can or cannot do based on their knowledge of my mental health history:  Other people do not get to define my limitations and capacity (especially not based on stigma/prejudice).
4. Identification of a variety of skills that I can use to improve and maintain my mental health is going to remain a priority.  I won’t be focusing on just one avenue to protect this important part of who I am; I’m going to deliberately explore options that may seem less appealing but will give me extra safety-nets when those insults to mental health occur.
5. The time I invest into developing these skills, and applying them in my daily life, is going to be something I view as important as my ‘daily 30’ (of exercise); it cannot be viewed as a waste of time, or an optional extra.  In order to maintain health you have to invest into it.  Perhaps I will call it my ‘daily 30 for mental wellbeing’.
6. Finally, I will call myself out on any occasion in the future where I am self-critical for needing to take time to manage or improve my mental health, or for needing to ask for someone else’s assistance or advice in managing it.  That commitment is about actively living out my belief that mental health issues should not be treated any differently to physical health issues; I am going to celebrate the gains and improvements the same way I celebrated not falling over.

For me, realising that I had let other people’s prejudices towards mental health impact on my own perceptions of personal attempts to self-care seems like a critical step in moving forward in the future.  I hope that in the future fewer people buy in to these negative views on mental health improvement and maintenance so that as a society we can be mentally healthier and happier.