Abstract
Madness and medicine
Much Madness is divinest Sense –
To a discerning Eye –
Much Sense – the starkest Madness –
’Tis the Majority
In this, as all, prevail –
Assent – and you are sane –
Demur – you’re straightway dangerous –
And handled with a Chain –
Emily Dickinson
It has long been observed that some of the greatest writers and painters have also been the most mentally unstable. Some have estimated that poets are 20 times more likely to be institutionalised or commit suicide than the general public. Famously, Vincent van Gogh managed both. Recently, celebrities such as Stephen Fry, David Walliams and Catherine Zeta-Jones have all discussed their mental illnesses with a candour and sensitivity that has helped to take it out of the realm of taboo. It is now, thankfully, much more acceptable to admit to a mental illness.
Personally, I have no aspiration to be a world renowned artist, a poet or a movie star, but I do have a tendency to doubt my own sanity on a regular basis.
On hearing that a GP friend had entirely forgotten an important referral, I resolved to check through all my consultations since returning from maternity leave to make sure that I had made all the appropriate referrals. I have not managed this – obviously – I only just keep on top of my daily paperwork before rushing off on the nursery run, without searching for even more. I have, however, started checking through all my consultations at the end of each surgery. This takes about 8 minutes. Added to this, I have a system of writing down anything that comes up in my ‘little purple book’ and putting a square next to it that gets filled in when I know the job is complete (just as I did as a surgical house officer). I also tell patients to get in contact with us if they have not heard anything within a couple of weeks, explaining that neither I, nor the system, are infallible. Does this sound excessive to you? To me it all seems pretty sensible.
I sometimes wonder, however, if I might have a mild form of obsessive compulsive disorder (OCD). I certainly get extremely anxious about certain aspects of work, even waking up from sleep on occasion and writing them down so that I can address them when I am next in. I also check my actions in a repetitive way and can get quite upset if I am unable to perform my checks. At other times, I am stunned by how poor my short term memory can be. (I recently forgot meeting someone and introduced myself again 40 minutes later.) Maybe all my checking and rechecking is merely compensation. Maybe it is a rational response to the beginnings of dementia.
Please do not think that I am trying to belittle true sufferers from these terrible diseases. I am not trying to make you laugh at OCD or dementia; I am pointing out how close my own mental state is to many who might be considered ill. In truth, I think that some of the aspects of my behaviour that take me to the far reaches of sanity are actually assets that make me a good GP. I believe I am conscientious and empathic and my self-doubt means that I rarely assume I am right if something I have done is queried.
So, if you are reading this, thinking that I resemble a character from a Woody Allen movie and wondering if I am fit to practice as a GP, take heart; I wonder the same thing fairly regularly. If you are reading this thinking I resemble you; take as much heart as you can from me. We self-doubters may be divinely sane.