An Improbable Psychiatrist

by Rebecca Lawrence

An Improbable Psychiatrist is a powerful and insightful story of mental illness, told through the dual lens of a doctor, who later became a patient. Rebecca Lawrence shares her story of being a doctor and a psychiatrist while living with bipolar disorder. She details her experience of being an inpatient on a psychiatric ward, receiving electroconvulsive therapy, training as a doctor, and navigating the challenges of grief, loss, and family. Through her inspiring story, Rebecca aims to reduce the stigma surrounding mental illness and provide comfort to those who suffer from severe mood disorders and those who care for them. Told through engaging and captivating prose, this book will pull you into Rebecca's world and leave you with the powerful reminder that with the right support and treatment, it is possible to live with severe mental illness. Ultimately, this is a story of hope.

Genres: Psychology, Nonfiction

238 pages, Paperback

Published November 21, 2024

Reviews

[Amy Holstead · Rating 5 out of 5]

Love an autobiography, this one was so well paced and I couldn’t put it down!

There was a really good balance between describing life as a doctor (training, work-life balance etc), exploring personal experiences of mental illness and also just really lovely written prose. While the mental health aspect was insightful I actually found the storyline about career progression through Medicine (particularly through Psychiatry training) the most interesting aspect of the book. I had no idea you had to do members exams or could do post-grad Masters as a doctor. It has made me realise I’m about to start a job as a junior doctor and I have no idea where it’s going to take me, but that’s quite exciting too. Excited to make my own wee story:)

[Karen Goodall · Rating 5 out of 5]

An Improbable Psychiatrist charts the life and career of Rebecca Lawrence, who, at the start of the book, is a young doctor, with a baby on the way and a half-formed leaning towards psychiatry. Her plans are dramatically derailed by a severe perinatal mental health crisis, resulting in hospitalisation. Lawrence describes the sheer grinding efforts required to progress through a career in medicine, while her family grows. At the same time the spectre of mental illness-health pervades the story.

Periods of wellness are brutally interrupted by periods of mental ill-health that are heralded only by a foreboding sense of anxiety and spiralling paranoia. The repeated episodes lead to a coming to terms with the knowledge that mental illness is a companion to be endured, rather than a set of circumstances to be left in the past. Against the odds, Lawrence’s desire to become a psychiatrist grows, rather than wanes. It is from this dual perspective of both patient and psychiatrist that the book is written.

This unique perspective raises important questions about our beliefs about mental illness and its causes and treatments. As Lawrence notes, a doctor with a physical ailment would have no hesitation in seeking care from a trusted colleague, while the same cannot be said of mental illness. Although attitudes towards mental health are changing, there is stigma within the profession, especially towards certain types of mental illness. Lawrence also touches upon debates around ECT, which she credits as being a major part of her recovery from severe depressive episodes.

That said, the book is more than a musing on psychiatry and mental health. Lawrence’s husband is ever-present in the story, as is her growing family. Her story is their story too, and Lawrence is unflinchingly honest with her feelings about how she believes her illness affected them. Ultimately, the book is a narrative about personal and family resilience, with its subtle message that sometimes all we need to do is just keep going. It is both inspirational and hopeful.

[Fiona · Rating 5 out of 5]

A beautifully written, lucid, and sometimes harrowing account, told with candour and generous measures of humour and wisdom. Rebecca’s humanity and compassion shine through the pages. For anyone who cares about mental health and the human condition it is a book to be meditated upon & revisited. Highly recommended.

[Jane Cobain]

Although the title " An Improbable Psychiatrist " suggests that Dr Lawrence's experience as a Psychiatrist who suffers herself from mental illness is unique or uncommon , this could not be further from the truth. Psychiatry is a medical specialism which has traditionally employed higher than average numbers of both women and doctors who have experienced illness including mental illness.
It is seen as having a slower pace and being more family friendly than for example orthopaedic surgery .Indeed I think it is fair to say it markets itself to young doctors as the ideal speciality for those seeking a work life balance.
The truth about being a Psychiatrist is different. In reality it is an intellectually and emotionally demanding job in which the doctor must tolerate a huge amount of uncertainty. It requires painstaking information gathering and careful analysis of that information. It requires a high level of knowledge of physical illnesses so these can be identified or excluded as causes of the patients illness , as sometimes one masquerades as the other.
Importantly the Psychiatrist must have good knowledge of themselves as a person , their own weaknesses and prejudices and their own experiences of being born and reared, of trauma ,grief ,success and failure and be aware of how they and their life can critically affect their relationship with and ability to care for their patient.
Good psychiatric training requires good trainers to educate and support the Psychiatrist in training to become a doctor with whom the patent can establish a therapeutic relationship in which they feel safe to talk about their lives and the experiences which have brought them to the psychiatrists chair.The psychiatrist in turn needs to make sure that they themselves do not burden the patient with stuff about themselves about which the patient will worry about or feel responsible for.
British psychiatry in particular is a medical speciality in which the doctor is sometimes held responsible or made to feel responsible not just their own actions and omissions but those of their patients as well.So ,if their patient harms themselves or others, the psychiatrist may and maybe should, be held to account.The orthopaedic surgeon does not hold or experience any responsibility for a patient who sustains multiple fractures when driving too fast or engaging in a high risk sport like horse jumping .
The psychiatrist is also given unique powers under the mental health acts to deprive patients of their liberty and to treat them against their will.These special powers should be informed by the principle of reciprocity under which if a right is taken away it must be reciprocated with the highest standard of treatment and care.Unforgivably this does not always happen in our contemporary health care system and some patients deprived of their liberty suffer inadequate care and even abuse.
So psychiatry is not an easy billet in which the modern doctor can combine the stresses of parenting or caring for parents and spouses or dealing with their own chronic illnesses or other challenges. It is no more challenging in this respect than being a social worker or teacher and it is has compensations that social workers and teachers are not privileged to have .But it is a stressful job which to do well requires intellect and ability and nerve.
So not an easy billet , but not without it's compensations but certainly not an easy path to take .
And so enters our heroine .A clever and sensitive young person with a broad range of talents needing to be nurtured. " every scientist should be a writer and every literary man a scientist " , I hope I have quoted CP Snow correctly .Our heroine meets this brief .
However the early passages in her book also describe a girl half formed ,anxious , painfully self critical , afraid and yet often compelled to see danger ahead.So obsessional that at times she is paradoxically careless and almost sets herself up for failure.
A mothers place is in the wrong and our heroine's mother ,a teacher , suggests medical school rather than English Literature or Music at Oxbridge which might have been the more obvious choice.
However ,I suspect our heroine's mother feared that her gifted but sensitive daughter needed an easier route in life than that afforded by an arts degree. As a teacher she would have been aware that medicine at that time had career paths similar to a military academy and once into medical school there would be protections and advantages not available to the ordinary civilian .
Medical school wasn't easy for our heroine, particularly in the pre clinical years, a not uncommon experience amongst medical students who then enjoy their clinical attachments and often go on to become excellent clinicians .

And so enters our hero a swashbuckling agronomist with a sunny disposition who seems to bathe our heroine in the sunshine and warmth she needs to blossom. She views him throughout the narrative with positive regard and strives to support him and perhaps to keep up with him. At times the reader feels a bit irritated by his globetrotting and his clarity of thinking and purpose .But there is something special and precious in their relationship, which maybe the readers envies and which seems to sustain them both throughout the challenges ahead.
So many challenges it almost becomes unbearable. Pregnancy loss is only one of the villains our heroine is ambushed by and then depression , insidious sadness, painful and pervasive not reactive or fleeting but all consuming, eroding her person like ash die back or toxic algae ,ugly and poisoness.
Help is at hand .Her mother and father step in from the wings. The reader is confused .The pantomime witch becomes the nursemaid supporting our hero while he falls down the rabbit hole into the strange world of mental illness and psychiatry .
There are no heroes in this place ,no charismatic or mercurial psychiatrist .But our hero he gets help from a kind academic who seems grey, indeed colourness like unpolished granite .He holds the line in a long war in which our heroine survives many battles .He supports her in wish to be a mother ,have a career and later it seems in her writing. He seems eternally optimistic and has therapeutic enthusiasm. His weapons in the war against our heroine's illness are old and unsophisticated. Electroconvulsive therapy and a salt of the element lithium.He tries new medicines , variations of antidepressants and second generation antipsychotics but they are not great and have have effects which don't help our heroines confidence or sense of self.The old blunderbuss of ECT is the most effective weapon against our heroines melancholic depression and repeatedly enables to her to climb out of the lake of black bile and mount the palfrey our hero keeps in livery ,waiting to take her back to the
life she stays alive for.
The odyssey continues and we have years of plenty in which our heroine exceeds her own expectations ,flourishing in her career , building services for addiction patients and rearing her daughters, the new heroines in the tale .
However with almost unbearable tension the enemy approaches once again .The kind knight ,now old ,has laid down his arms and is replaced by a more modern successor about whom the reader feels a bit uneasy . However, he seems respectful of our heroine in his own way and respectful of the old knights strategies, and he uses the old blunderbuss and later a slightly more refined version of it and our heroine survives .Importantly, he encourages her to tell her story.
A story that needed to be told not just for our heroine but the many other medical doctors who live with and die from mental illness , mainly severe disorders of mood.Sometimes these illnesses are complicated by and made worse by harmful use of substances , alcohol most commonly but also recreational drugs and of course drugs more easily available to medical doctors , benzodiapines and opiates.
Do medical doctors get better treatment than civilians in this war?Yes they sometimes do. Our heroine had mainly the one consultant throughout her illness.He was a constant in her life ,often fading into the background when she was well and busy but available to step out of the shadows when required to.He tried everything available to him to help but importantly wasn't afraid to use what worked for her as an individual despite both ECT and lithium becoming increasingly marginalised and perhaps loathed across the world of mental health.
Our heroine is brave and not afraid to identify the limitations of and iatrogenic harm caused by the more modern treatments she was prescribed too.Neither is she afraid to identify the limitations of talking therapies but like most she is also hopeful they will help.
The problem is that severe and relapsing mood disorders like our heroine's and severe and enduring psychosis like the schizophrenias are still the final frontier of medicine .
We still have very limited understanding of them, and the treatments are still suboptimal. Some work in some of the people some of the time .What helps is a healthy therapeutic relationship between patient and doctor .The doctor must be steady and uncomplicated and create a safe space for the patient to be ill and be supported. Definitive treatment is available but rarely harm free, just like chemotherapy for cancer the benefits must be balanced against the risks.Meanwhile patients 'relationships must be supported too and patients' children and spouses given help and sometimes protection when they need it.
Good psychiatric care takes a village. It needs well trained staff who work together supporting each other to help their patient .It also requires clinical leaders , like our heroine, who are intellectually able and professional ,to continually audit and improve practice. The very traits which make our heroine vulnerable , her self scrutiny and obsessionality are traits which make medicine safer when combined with an ability to critically analyse the information available and which to seeks out more information when it is not known.

So a long review. But a great book which needed to be written and now read , not just by doctors and patients but by parents especially.

A final note , our heroine who somehow I think of as Titania , has a mischievousness and playfulness that I hope we will see more of in her future writing.She is above all a writer and I can't wait for more tales from her of travel and music and fun as well as this wise commentary on motherhood , medicine and mental illness.

[T Wilton · Rating 4 out of 5]

I wanted this memoir to be a source of new perspective for me. In reading the life story of a psychiatrist who had her own personal struggle with severe mental health disturbance, I was eager for the wisdom and insight a memoir can provide.

I was in the mental health field myself for over four decades, most of that time as a registered psychologist. I, too, had a period of life when I would’ve met criteria for what the mental health diagnosticians would term a Major Depressive Episode. Anything from this memoir that could deepen my perspective would be welcome.

An Improbable Psychiatrist traces the career and intermittent mental health difficulties of Dr Rebecca Lawrence. She tells the story dutifully, following her particular sequence of situations and struggles. This memoir is courageous. It is unflinchingly honest in recounting how the author experienced those struggles. The reader is privy to the doubts and fears that plagued her life.

Lawrence shared the circumstances and events of her adult life from the perspective of the presence or absence of psychiatric symptoms affecting her functionality. Other aspects of her life are also recounted: experiencing loss, having children and being a mother, being married to a Nobel prize winning partner, international travel, playing violin in an orchestra. All are told from the perspective of whether she was ill or well psychiatrically at the time. Lawrence documents her periods of being ill with a disciplined objectivity. There are times of wellness too, especially as she moved further into her career and her family grew. But for this memoir the thread connecting her experiences of life was bound by those terms: she was either ill or well.

What I craved to hear was the ways Lawrence’s illness had equipped her to better understand the suffering of her patients, how it had heightened her compassion and sensitivity. And, in corollary, I had hoped that the life experience of her patients had given her a broader perspective than just the illness / wellness model, allowing her to develop a wisdom that could supersede her traditional professional activities.

Professional duty of confidentiality would preclude sharing the details of her patients’ lives. What could have been shared though is the personal insight and deepening that working with those suffering mental health disturbance had on Lawrence. Perhaps that compassion, sensitivity and wisdom did happen for her. We can’t know whether or not it did. If it did, Lawrence decided it wasn’t a focus for her memoir.

Lawrence, as a respected practicing psychiatrist, works in a profession that cultures for itself objective detachment over compassion and knowledge over wisdom. Lawrence toes that line in telling us the story of her life. Perhaps the improbable in all this is whether one within the profession could rise above psychiatry’s objectifying stance to embrace a broader understanding of the human condition. I guess we just have to hope one can.

[Jean Davison · Rating 5 out of 5]

This is an extraordinary and fascinating memoir. The author is a practising psychiatrist who has achieved success in her career while struggling with severe health problems which led to many ECT sessions, and drug treatment. It is clearly a brave and painfully honest account straight from the heart. It is skillfully written, moving, powerful, informative and disturbing, all seen from the perspective of being both a doctor and a patient.

I once was a patient albeit a long time ago and in very different circumstances. My experiences have informed my strongly critical views about psychiatric diagnosis and treatment, rightly I believe, but we can both be right; psychiatry helps some, harms others. Inevitably, parts of this book triggered me but that’s good as reading it has been a learning experience which has increased my understanding through reflection.

By sharing our experiences, I believe we can learn a lot about our own lives, each with our differences and similarities. We need memoirs of this kind to encourage constructive debate and action, and to reduce stigma by talking openly about what once was seen as a taboo subject. Thank you, Rebecca, for having the courage to write a valuable and thought-provoking memoir that is well worth reading.

[Maria · Rating 5 out of 5]

Completamente viciante.