The previous chapters illustrate how intertwined physical and mental health, economic and social circumstances, and personal lives can be. Difficult economic circumstances have had a particular impact on the population’s mental health. These factors contribute to a complex working environment for healthcare professionals and a heavy emotional load, combined with the impact of the many changes required as a result of external policies. The chapter is written with GPs in mind, but the same principles apply to other health care professionals.

Being a doctor is not always good for your health. The statistics for burnout, depression, substance abuse and suicide indicate that, despite the socioeconomic advantages of the profession, doctors are at risk. Doctor support services report that the age of people contacting them has decreased in recent years. Doctors are late to seek help and it may only be when there are concerns about fitness to practise that problems come to light. There does seem to be a need to encourage clinicians to be more aware of what is happening to them, and much sooner. Many organisations are concerned about this topic, as illustrated by the resource list at the end of this chapter. There are succinct summaries of the reasons for concern, so rather than repeat these, we would like to focus on issues of vulnerability and resilience, and offer you a space to think about yourself as an individual, in relation to your work. We bring the perspectives of a recently retired GP with an interest in mental health, and a psychiatrist, now practising as a psychoanalytic psychotherapist. We have worked together as co-leaders of a GP Balint group. What follows is the result of several conversations in which we have tried to answer these questions:

• Why do some people seem to be more vulnerable to the impact of their work pressures than others?
  
• Why is it so difficult for doctors to ask for help?
  
• Can resilience be developed, or are we just the way we are?

Why do some people seem to be more vulnerable to the impact of their work pressures than others?

Maybe we should start by thinking about what draws people to become health professionals, despite it being an arena of illness, trauma and death. There will be a variety of conscious reasons, such as parents’ profession, early experience of health settings either personally or through family illness, through to interest in science and people, and a desire to make a difference to others. A psychoanalytic perspective suggests that there are less conscious reasons, which may contribute to vulnerability or resilience. It is worth stating here that what follows is simplified to make a point, and that there are many factors governing how we ‘turn out’.

The development of our internal world, or what is in our conscious and unconscious mind, can be thought of as happening in the presence of a maternal, nurturing influence and a more intellectual, world-orientated, critical paternal one. These do not have to be actual parents, or indeed specific male or female figures. For a healthy, balanced internal world, infants need to experience responsive caring such that they are not left feeling inadequately ‘nourished’. They also need to be kept ‘safe enough’, physically and emotionally, so that they can develop the confidence to pursue developmentally appropriate challenges, accepting that frustrations and mistakes will occur. In time they will be able to reflect upon, own and understand their limitations without undue recrimination of themselves or others. Many of us can hear that over-critical voice inside us, or ‘self-talk’ as it is sometimes described, and occasionally remember where that voice originated from. ‘You must try harder’, ‘I expected better of you’, ‘Failure is not an option’, as opposed to ‘You can’t get it right every time’, ‘You tried your best’, ‘OK, that was a silly mistake, but you will know better next time’ or ‘Have another try’.

What can happen if we do not feel adequately ‘nourished’? We may then seek nourishment from others, for example in close relationships. Or, we may be drawn into situations of caring for others. By looking after others, we are actually looking after a part of ourselves. This might work, but there are risks. One is that there is confusion between the needs of the other person and our own needs. Another is that we desire gratitude and evidence of success in order to make us feel good, or ‘nourished’. It is easy to see how in the real world of healthcare practice, where many problems do not have solutions that we can influence, or the other person will not or cannot offer us gratitude, we are going to be disappointed.

Let us imagine two fictitious doctors with contrasting emotional worlds. The first GP is quite emotionally articulate, in contact with their feelings but at risk of these becoming ‘too much’ and may be perceived by others as over-involved with ‘needy’ patients. This doctor grapples with excessive guilt, an overdeveloped sense of responsibility for things beyond their control and identification with vulnerable and dependent patients. The pressure to collect data in consultations so that practice targets can be achieved adds to their internal conflict. This may lead to long hours, difficulty in saying ‘no’ and problems with boundaries.

Related posts:

Anxiety and Depression in Adults Introduction Anxiety and Depression Bereavement and Grief Anxiety, Depression and Ethnicity Psychosocial Interventions in the Community for Anxiety and Depression

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