This brave memoir by a psychiatrist with severe mental illness shows how lost and confused psychiatry and its patients have become. Future readers will be surprised, we hope, at how poorly we have understood and how ineffectively we have treated the troubled mind.
Rebecca Lawrence experienced recurrent and terrible depressions throughout her life, interspersed with periods of elevated mood. Despite multiple breakdowns and hospitalizations, her determination and resilience, along with the support of her remarkable husband, Richard, enable her to survive and prosper, becoming a consultant psychiatrist and mother of three.
And yet Lawrence’s vivid descriptions of her hospital stay, her electroconvulsive therapy, and the effects of various drugs indict the treatment model she both endures and administers.
While driving to her final psychiatry exam, Lawrence listens to review tapes that contain “vast amounts of information about psychiatric diagnoses from my ICD-10 (International Classification of Diseases) book… It was actually surprisingly relaxing and sleepy,” she writes. No wonder. The ICD, like the infamous Diagnostic and Statistical Manual of Mental Disorders used by American psychiatrists, groups a bunch of symptoms under a diagnosis and recommends drugs to treat them.
It is possible and common to take home a psychiatrist’s salary by fitting patients into broad categories and trying various pills on them. No need to think. There is no need to try something difficult, new or progressive. No need to read the latest research. Many people who contact me seeking mental health advice report this experience of psychiatry, which I also encountered during a breakdown five years ago. When Lawrence joined the Royal College of Psychiatrists, she says, “I never needed to sit another exam again, ever.”
Lawrence’s strength and Richard’s support are touching to witness, especially since her psychiatrists are so messed up. Prof Lawrie takes over from Prof Blackwood, whom she has seen for decades: “‘I think your diagnosis is depression, psychotic depression. Prof Blackwood thought you had bipolar, but I’m not convinced…’ I wasn’t sure what I was supposed to say. ‘Oh. OK. But don’t you think I have a personality disorder. This is what you thought before. That’s what you think.’ “It’s not what I think…”
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Here’s the system in a nutshell: comically, the consequences for patients weren’t that catastrophic. No one in this story distinguishes between symptoms of mental distress – which medication suppresses at best – and causes that medication cannot address.
Lawrence’s psychiatrists are so committed to treatment by category that they miss what seems obvious to the reader: she is almost literally dying for trauma therapy. Richard and her friends see and say that her “strict and controlled” upbringing, by parents who apparently saw her struggles as embarrassing, contributed to her problems.
She has some ineffective ones cognitive behavioral therapy (CBT)the standard NHS go-to, cheap and easily delivered. But as one of my fellow patients told me: ‘I don’t need strategies for tomorrow, I need help with what my father did when I was a child.’ Indeed, Lawrence makes a strong unintended argument for a system-wide replacement of overmedication and CBT with trauma therapy. But there is no mention of proven treatments such as e.g eye movement desensitization and reprocessing (I’m a fan because it changed my life), of Open Dialogue – which would treat Lawrence’s entire network, including her family – or of psilocybin and ketamine.
You can only despair of the system surviving Lawrence. The brutal symptom-suppressing psychiatry she describes is criminally ignorant and shockingly limited. Many, less strong and less fortunate than Lawrence, died as a result. Fortunately, that’s not the whole story. I hope Lawrence looks at trauma and recovery; with the honesty and bravery she displays here, she could write a touching book about it.
