A simple truth

We spoke to Caroline Elton about her new book Also Human: The Inner Lives of Doctors (William Heinemann).

How did you first get involved in working with medical doctors?
It happened quite by chance – a textbook example of John Krumboltz’s theory of ‘planned happenstance’. In 1998 my youngest child had just started primary school and I was wondering what to do with my career. Idly flicking through the jobs pages of The Guardian (back in the days when hundreds of jobs were advertised each day), I spotted a vacancy with the then South Thames Department of Postgraduate Medical and Dental Education. The essential requirements were somewhat random and included a PhD (which I’d recently finished) as well as teaching experience (which had been my original career). I applied, had the toughest interview of my life and was duly appointed.

You write movingly about the psychological difficulties many doctors face. What do you hope will be the impact of your book?
I want the reader to appreciate the psychological demands of medical work – to see the pressures that doctors work under (made significantly worse by the current state of the NHS), the hideously difficult things we ask doctors to do, whilst providing minimal or no emotional support. I also want the reader to understand the length of training, the years of moving between jobs as a trainee, the insidious corrosion of sexism and racism, and how the professional culture of medicine rejects doctors who become sick or disabled. Above all, I want the show how we have lost sight of the simple truth that doctors are also human.

Thinking about the saying ‘Physician, heal thyself’, have you found doctors especially resistant to seeking psychological help?
I’m an occupational and counselling psychologist who specialises in career counselling, so the doctors come to me for help making career decisions. For example, clients might wonder whether they have chosen the right specialty (there are over 60 of them) or whether they are actually suited to being a doctor. But a high proportion of the doctors I see are also experiencing mental health difficulties – most frequently depression and anxiety. I know from what these doctors tell me and also from the literature that doctors with mental health issues can be particularly stigmatised. Unsurprisingly, this makes them resistant to seeking any form of psychological help. 

Are doctors easier or more difficult to engage with than other types of client?
I often feel that I have to earn my spurs with medical clients. Their initial assumption can be that as I am not a doctor myself, I couldn’t possibly understand their working lives. But having counselled hundreds of doctors over the last ten years, they quickly realise that I do seem to have a good sense of what their work entails. At that point there can be a marked shift, characterised by tremendous relief that they can speak openly about the difficulties they are experiencing without fear of being judged.

What about your own inner life? What keeps you going?
I begin my book with a quote from the psychiatrist Christine Montross, who describes how working with people in distress is like walking out on a frozen lake, to somebody who has fallen through the ice; although you can reach out one hand to the person who has fallen into the ice, you also need to make sure that your other hand is anchored to the shore. The things that keep me from falling through the ice include spending time with family and friends, balancing client work with other stuff – writing and teaching, for example – walking for an hour a day, playing the piano and, of course, regular supervision.

- Find out more about the book.

BPS Members can discuss this article

Already a member? Or Create an account

Not a member? Find out about becoming a member or subscriber