Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK.
I have just read your book – or, should I say, it completely captivated me. I couldn’t put it down. What a compelling life story. When you lectured about depression at those Masterclass lectures I chaired years ago I was so impressed with your grasp of the topic, your understanding of the difficulties facing family doctors, and your overall approach to managing the condition. You had such a clear understanding and appreciation of depression and the difficulties of treating it in practice. And, you were so assured, confident, on top of your subject. I had chaired many similar sessions but yours were outstanding. There wasn’t even the slightest hint that your understanding extended so far into your personal experience.
You had me on the first page. Sharing your life journey, I was with you every step of the way. Perhaps it was because we qualified in medicine round the same time that I could identify so closely with your first jobs as a junior doctor- the anxieties, uncertainties, dependence on nursing colleagues, and that overwhelming feeling of being barely in control. You reignited memories – I could still feel that gut-gnawing discomfort. When you went on to describe those institutional mental hospitals with their token modernization, I was haunted by memories of visits to patients in similar places; I could see those rooms, smell the same smells, hear the sounds, and sense the same hopelessness of those high ceiling wards.
You described depression, but it wasn’t a checklist from a psychiatry textbook – it was a real-world interplay of vulnerability and life events that resonated so much with life within and outside the consulting room. How you painted the matrix of life, family experience, background, anxieties, and personality so vividly. The interwoven narrative of your own fears, uncertainties and vulnerability was so powerful. Coping with the real world is a struggle for everyone and the transition to depression is a function of background, circumstance, life events, and pressure points. It could be any of us.
When you described your patients, I was with you in the consultation. I had seen those patients too, and many like them, as a general practitioner. I shared your worries and concerns. I, too, had had those skirmishes with management, tried to change the system, struggled, battled, and failed.
As a family doctor, I never felt I did a good job managing depression. I always felt inadequate and just muddled through as best I could. Through your description of patients you had managed, I began to appreciate that perhaps I hadn’t been as bad as I thought. Patients don’t always get better; sometimes just being there is what matters, and perhaps just talking about it helped them in ways I didn’t appreciate. As a doctor I was happier sorting things out – and I always felt I could have done more. But, in the world you described there are always loose ends. Perhaps I expected too much. Maybe I was too hard on myself.
Through reading your book and sharing your life, I learned so much about that vague nebulous ever changing multi factorial and very personal experience that we box as depression. And, I learned so much about vulnerability. You made me much more aware of what happens in the minds of others and how, despite the outward shell of coping and competence, many of us share the same uncertainties, anxieties and worries. We may manage better as we get older, but it never quite goes away. But, it was more than just your journey, I also learned a lot about myself. Thank you.
Editor’s note: Linda Gask is Emerita Professor of Primary Care Psychiatry at the University of Manchester and worked as a consultant psychiatrist for the last 25 years. An accomplished academic with an international reputation, she has published a wealth of academic papers, several textbooks, and achieved national recognition for her teaching. Her book, “The other side of silence” is an autobiographical account of her life, her work, and her personal struggle with mental health.
The other side of silence, by Linda Gask, was published in 2015 by Vie Books, an imprint of Summersdale Publishers Ltd. UK (ISBN 978-1-84953-754-4)