Wellness Recovery Action Planning in action! Identify your triggers and make a plan!

In WRAP Planning we learn to identify what triggers our episodes of difficulty with our Mental Health.

The article below shows evidence of the effectiveness of identifying our triggers and learning coping strategies to manage them.

“My illness will not come back, because now I know what the triggers are”

Dr Liz Miller, a former high-flying neurosurgeon who developed bi-polar disorder, talks to Elizabeth Grice.

By Elizabeth Grice

Dr Liz Miller - bipolar disorder

Dr Liz Miller Photo: MARTIN POPE

Medicine is an unforgiving profession. You don’t easily bounce back after taking a career break as an in-patient in a series of psychiatric hospitals. Dr Liz Miller, a former high-flying neurosurgeon who developed bi-polar disorder, did just that. She was sectioned under the Mental Health Act three times, yet rebuilt her career after each setback and then went on to help other doctors grappling with the stigma of mental illness.

“In medicine,” she says, “we live on this myth that illness is for other people. Doctors don’t get ill. Illness is for patients. Nor does psychiatry understand the idea of a cure. If I have learnt one thing, it is that the brain heals if you give it what it needs to heal.”

And she is living proof. Effervescent, recklessly open and convinced that her illness (also known as manic depression) won’t return because she knows how to recognise its triggers, Miller, 52, is back working as an occupational health physician and in demand as a speaker on self-management techniques. She was a compelling central figure in Stephen Fry’s award-winning documentary series The Secret Life of the Manic Depressive. For her work in co-founding the Doctors’ Support Group, she won Mind Champion of the Year 2008.

She blames the febrile, male-dominated field of neurosurgery for tipping her into manic depression. “In those days, I was the only female neurosurgeon in Britain so you had to be 10 times better than the guys. My attitude then was that mental illness was for wimps: what do you mean you’ve got feelings?”

There was no clear moment when she realised she was losing it. “The problem with bi-polar disorder,” she says, “is that, as your energy and activity go up, your judgment fails. When I got up, I wanted to save the world. There is a belief that the highs are enjoyable. Not necessarily. With my manic episodes, there were always sinister overtones – like they are coming to get you.”

Her delusions started in small ways while she was working in Edinburgh. She says every time she used an Underground ticket machine, the screen switched from “exact money” to “change given” – and vice-versa. “You read things into something like that rather than dismiss it as coincidence.”

She stopped turning up for work and was “just wandering around being loopy” when a local GP stepped in and arranged for her to be sectioned. “In the mental hospital, it was a week before anyone told me where I was. In my paranoid delusional fantasies, the KGB had picked me up.”

In six months, she never saw a psychiatrist. “They said, ‘You’ve got manic depression. Take these’, and gave me a small bottle of lithium [used to treat mood disorders]. You don’t have a choice with drugs: you either take them or you are injected.”

Once out, there was no chance of returning to neurosurgery, or to her home in Edinburgh, so she went back to live with her parents in Bedford and started doing locums. “You can’t go back to the neighbourhood from which the police have taken you. Everyone knows. It totally destroys your place in the environment. Giving up neurosurgery was both a public humiliation and a personal wrench. One of the problems with mental illness is the shame that goes with it. I’d always prided myself on my brain [she is the author of a dozen research papers]. Stigma isn’t just what other people think about you: it’s what you feel about yourself.”

Two-and-a-half years later, she had another breakdown. Then another, after a similar interval. “I was beginning to look like a revolving-door psychiatric patient.”

She ended up in the Bethlem Royal Hospital, where she noticed that there were other doctor-patients. “That was when the penny dropped. I started to accept my condition and to read about manic depression.”

Soon after leaving hospital she answered a request in the British Medical Journal for doctors with mental health problems to come forward. Those who answered became founder members of her Doctors’ Support Network (DSN), which now has 500 members.

She points out that in 2003-04, nine of the 215 doctors under investigation by the General Medical Council for mental health problems died. “It is a process that makes the illness so much worse. The GMC’s procedures are inhuman. They add to the tensions.”

Mind’s chief executive, Paul Farmer, says that Miller is a “fantastic role model”, working in a demanding profession yet finding time to be a passionate mental health campaigner.

Between her second and third manic episodes, Miller trained in general practice, a remarkable feat of self-renewal. Later, she qualified as a psychologist. Emerging from her final spell in hospital, she married but it was not a success. “I got married when I was very depressed and when I cheered up it just fizzled out. I didn’t need that level of support. We are still good friends.”

How on earth did she get back to medicine after the third bout? “Slowly. It is harder each time, because you do get battered. Mental health rehabilitation needs to be done slowly. A lot of doctors come back part-time. Stress is a physical illness. People come to you when they are physically damaged, with non-specific symptoms like dizziness, gut aches, headaches. It’s not the kind of damage you pick up on orthodox medical investigation. The tests come back normal, but they are ill.”

Miller’s occupational therapy work takes her beyond sick doctors to sick workplaces. Companies are all too keen to exclude people with mental health difficulties, she says, but they are the canaries in the coal mine. “If they are going off sick, it means you have problems in your company. Getting rid of the people does not solve those problems.”

In a new book called Mood Mapping, to be published later this year, Miller will demonstrate how people can manage their own mental wellbeing, based on her experiences of the past 10 years. She has not taken medication for six years now. “I used to go off sick because I was ill. Now, I go off sick to stop myself getting ill,” she says. “My illness will not come back because I know what the triggers are and I have support networks. No one’s going to ruin my day again.”

drlizmiller.co.uk; dsn.org.uk It is believed that a complex set of physical, environmental and social factors are involved. Stress is thought to play a large part and the role of the stress hormone cortisol on the brain is being researched. Stressful events are common triggers, including sexual or emotional abuse in early life, grief, loss, trauma and neglect.

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