Winnie's story

Winnie talks about returning to employment after a long period of mental ill-health - about how she has managed to be open with her colleagues and friends, and how her own mental health experiences have helped her in her work as a GP.

"I have had mood swings all my adult life - I think I'm cyclothymic. My periods of energy and enthusiasm meant I could achieve academically, be sociable and enjoy a wide range of interests. Unfortunately these good times were usually followed by downswings, when I would feel exhausted and lose all confidence - all I wanted to do was hide in a hole!

Then in 1990, we moved from London to the south coast and my husband and I took over a GP practice. We only had 3 weeks from getting the job until the start date. At the time we had 3 children under 4 years of age and I was breast-feeding my 2 month old son. I had to work full-time as well as night and weekend on-call duties. After 3 months I broke down and was diagnosed as clinically depressed.

I continued to work hard with short periods of time off when it all got too much. I remained on anti-depressants and later lithium was added. By 2001 I was burned out and advised to take early retirement - at that time with a diagnosis of bipolar II disorder. It was a tremendous relief to take things a bit easier and I settled into a quiet life as a housewife, walking for miles on the downs with my dogs.

I didn't talk to anyone about my illness - it was put down to 'stress' and 'fatigue' by my mother and other family members. My brother has had much more serious psychiatric problems than me, with a schizo-affective disorder which is very disabling. Over the years since he became ill in his teens, our family life has been taken over by pre-occupation with his difficulties; my parents struggling to get adequate treatment for him and contain his destructive manic episodes. I believe that it was this that led to my father's premature death from cancer - he just couldn't go on struggling anymore.

Then in 2006 I became severely depressed and suicidal. I think it was the combination of the menopause and my children growing up and needing me less. I no longer had my career. I felt useless; as though my whole self had gone. It was terrifying and for 3 months I didn't want to go on living. But I had promised my husband that I wouldn't attempt to take my life - I knew what a devastating effect parental suicide can have on children. For a time I went around with 'IT WILL PASS' written on one hand and 'KEEP TAKING THE TABLETS' on the other! A hospital admission was followed by months of care by my husband - he took me everywhere with him, even to work, and looked after me constantly. I wasn't capable of making the simplest decisions and was afraid of being at home. I can never thank him enough for his love and devoted care.

There followed 2 years of trying to find a way forward. I knew that I wanted to get out into the world and do something useful again. I had been away from medicine several years and had to retrain. However the 'Returner Scheme' had been suspended due to lack of funds and my attempts to do supervised work without pay were met with resistance by the powers that be. I did a bit of voluntary learning support work with recovering mental health patients, I helped my husband in his specialist medical practice and then started retraining in family planning. This got me back into seeing patients again and slowly my confidence was returning.

It was reading the work of Julie Fast, an american writer who suffers with bipolar, that really helped me to recover from depression and get on with my life. She helped me to understand the difficulties I was having in my relationship with my husband. For anyone struggling with mental illness and family or relationship issues, her chapter on 'The Bipolar Conversation' in the book 'Take Charge of Bipolar Disorder' (with co-author Dr John D Preston) is amazing - it really changed our lives. In 'Get It Done When You're Depressed', Julie taught me to over-ride negative thoughts, take action and get on and do the things I wanted to do; despite residual depressive symptoms. At the same time I discovered the clinic for health professionals at the Maudsley Hospital. They decided that I suffer from recurrent (or unipolar) depression rather than bipolar disorder and were able to rationalise my medication, bringing about a significant improvement in my functioning.

Over the past year, I have worked really hard at overcoming my low self-esteem and become increasingly determined to do paid work again; to resume some of my former interests, get back in touch with old friends and extended family and speak openly about my difficulties. I've also made lovely new friends; some of whom have had mental health problems too and are particularly understanding and supportive.

I have found that the process of opening-up has been a gradual one; it began with learning what is the real me and what is the depression, then finding out which strategies worked best for me in day-to-day life. Since the better communication with my husband, he has been a great help in reminding me what to do when I start to struggle and I now feel able to tell him how I'm feeling where I would previously try to hide it. The next step was to try to explain my illness to my (now grown-up) children. They have been so patient and supportive, particularly over the last 2 or 3 years when my behaviour must have seemed bizarre and inexplicable. Now that I understand the condition better myself, I have been able to tell each of them how sorry I am for the times I behaved badly, to thank them for all their help and to explain something about the methods I use to keep going and keep well. From there I was able to talk to my mother much more openly about the depression and she now has a much greater understanding of my (and my brother's difficulties) and has been a great support. Then I started to explain a bit to close friends, extended family members and as time went on to be much more open with all sorts of people I've met.

In 2008 some GP Returner places became available and I passed the qualifying exam, cleared occupational health requirements and was offered a part-time placement for 9 months. I'm now in my third week in the new practice - it's been very scary and so much has changed, but it's great to be involved again. My trainer knows about my previous mental health problems and is very supportive. Everyone in the practice is really welcoming and helpful and I'm able to be quite open about my reasons for being out of work for 8 years.

So now to the future. I am determined to continue to work on myself to stay well. I hope to practise for many years, particularly able to understand the problems of those with mental health issues and to speak openly about what it means to be depressed. It is a very disabling illness, but it is possible to manage it, in just the same way that other chronic diseases can be managed. It needs a broad approach, encompassing optimal medication, therapeutic support, self-knowledge and constant vigilance. It seems that the time is right to get rid of the stigma associated with mental (as opposed to physical) illness. If we can do this, then sufferers will at least be spared the misery of being ashamed of being ill."

Dr Winnie Day, February 2009

Read Winnie's blog.

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