Doctor's orders

Liz Miller was a successful surgeon when depression hit. Now the Mind Champion of the Year wants the medical profession to take mental health seriously. By Mary O'Hara
Liz Miller
Liz Miller: "In medicine we live on this myth that illness is for other people." Photograph: Anna Gordon

When Liz Miller is told that a blogger recently described her as "a cool chick" and "an inspiration to the public and doctors", it takes some time before she stops laughing and says: "Really? Someone said that?"

It is four weeks since Miller was voted Mind Champion of the Year for her campaigning on mental health issues, yet the award and the praise that has come with it still don't seem to have sunk in. "It came totally out of the blue," she says. "I thought, 'Who's going to vote for me when there's all of these big names?'"

Miller, a GP who specialises in occupational health, has been a well-known figure in the medical and mental health sectors for a while, but she first came to broader public attention in Stephen Fry's 2007 documentary series, The Secret Life of the Manic Depressive. "I think that programme was fantastic," she says. "It stood out a mile from other stuff."

Miller was a central figure in the programme, which garnered awards for Fry and its producers. She spent three days filming with Fry, during which she talked candidly about being sectioned three times and about her diagnosis with bipolar disorder. She spoke of how the mania that came with the illness impacted on her demanding career - when her first manic episode happened in the early 1990s, Miller was working in the highly competitive field of neurosurgery - and of how she rebuilt a life for herself despite the difficulties. "I'd been wandering around thinking, 'I've failed at neurosurgery,'" she explains. "I went mad. I failed. In those days, I was kind of the only female neurosurgeon in the UK, so you had to be 10 times better than the guys."

The mania crept up on Miller. There was no sudden realisation that something very serious was wrong. "You think you are a bit anxious, but you don't necessarily know there's anything wrong," she says of the time leading up to being sectioned for the first time. Being a doctor didn't help, she says. "The thing is, in medicine we live on this myth that illness is for other people. Doctors don't get ill. Illness is for the patients. And so I'd swallowed it - the whole medical thing."

Coming from a high-achieving family, "with enough doctors to staff a small hospital", meant giving up neurosurgery was both a public humiliation and a personal wrench. "Neurosurgery was the first time I felt I was getting some respect in the family," Miller says. "In the past, I'd prided myself on my brain. I could get by on my wits. And suddenly your mind goes, and it actually goes to the core of who you are. It says something about you as a person. You ask yourself, 'Why me?'"

As many people diagnosed with bipolar disorder do, Miller fell into a long depression. "I was depressed for three years," she recalls. "Every time I was alone, I wept. The thing about mental illness is the awful isolation. You think you are the only person there. And you're so ashamed of it. There's the external stigmatising behaviours from society, but there's also the internal shame. How could you let yourself do this? I was so ashamed. You can't talk to anybody about it."

But for all the hardship during this period of trying to come to terms with the fact that her future was no longer mapped out, it also provided the catalyst for her future campaigning.

Miller was far from satisfied with the quality of care she was getting. "The psychiatrists I've seen have not been that helpful," she says. "You get to the end [of the time in hospital] and they say, 'You've got manic depression, now take these [pills].' And I took them."

While sectioned for the third time, she became aware that there were other doctors on the ward. "I finally realised it wasn't just me." She approached the psychiatrist who ran the ward and asked if she should join the charity the Manic Depression Fellowship. "He said, 'Yes, but don't make a career out of it,'" Miller recalls, descending into a long, loud peal of laughter. "[That's] more psychiatric advice I haven't taken. If anyone's made a career of it, I have."

Liz Miller receives her Mind award from Lord (Melvyn) Bragg Liz Miller receives her Mind award from Lord (Melvyn) Bragg. Photograph: Martin Usborne

Soon after, Miller co-founded the Doctors Support Network (DSN). "I saw an advert in the British Medical Journal from another doctor," she says. "It was asking if any other doctors had mental health problems, and I answered. Maybe 20 or 30 other people did, and we set up this group."

If Miller dreamed that campaigning would open the eyes of the medical establishment to the difficulties of doctors dealing with mental ill-health, she was quickly brought back down to earth. "We went to see the British Medical Association, the General Medical Council [GMC], and the Royal College of Psychiatrists. We thought, 'This will be a good thing.' And the universal answer from all of these sources was, 'Doctors don't have mental health problems. Good luck to you. You need it.'" Miller says she and her new colleagues were "gobsmacked".

There is a tinge of toughness about Miller, and this comes into sharp focus when she talks about the injustices she believes the medical establishment unleashes on doctors in her situation. "It really put fire in my belly," she says. Even though there have been improvements in the decade since DSN was established, Miller believes many doctors continue to be treated as outcasts, and she lays most of the blame at the door of the GMC. "The GMC is medieval in its treatment of mental health problems."

Inhuman procedures

Even now, after a decade? "Still. There is a complete lack of understanding. Their procedures are inhuman. It's like going through a tribunal." She offers a hypothetical situation. "Maybe you once had a touch of depression. Someone falls out with you, and reports you [to the GMC]. It has to investigate and you end up with a situation where you are being interrogated by two GMC psychiatrists. It's a bit like dunking witches, because if you survive the process you are obviously quite mad because you have no contact with what's happening to you. And if you sink …"

She quotes statistics. "In 2003/04, nine of the 215 doctors under GMC investigation [for mental health problems] died. It is a process that makes the illness worse. It's so unjust."

Miller puts the GMC's attitude down to "hundreds of years" of entrenched bureaucratic defensive posturing. "They do not track what happens to doctors who have been through their procedures. I don't believe the burden of being investigated [for having a mental illness] by your regulatory body does not have an impact."

But if the problems encountered by doctors with mental ill-health galvanise Miller, in many ways it is the plight of patients that has shaped her career and propelled her into campaigning on a much wider range of issues. She retrained as a psychologist, but now mostly works in occupational health, dealing in many instances with patients struggling to get the kind of help and support they need.

"I sort of think doctors don't like their patients," she says. "There is a contempt for the patient." Doctors can become "de-humanised" to a degree in order to survive being confronted day in day out with sickness, and this might lead some to be less sympathetic, Miller suggests. But she insists that this culture should and can be challenged, especially when it comes to dealing with vulnerable people with mental health problems. "A lot of occupational health is now about mental health," she says. "It's about stress."

But it is not just down to doctors being inconsiderate or overworked, Miller argues. Employers have a big part to play. Miller says "it is absolutely in their financial interests" to work with staff with mental health problems. "A lot of people I see are coming from dysfunctional workplaces. Workplaces have become unbalanced."

A regular blogger, Miller has embraced the internet as a pivotal way of getting her many messages across. She uses blogging to explore issues ranging from intellectual arguments around new systems of psychology to her more prosaic preoccupations, such as patient-doctor interaction. Whatever the subject, however, her blogs are accessible and straightforward. She says this is a deliberate attempt to demystify mental health, and to arm people with information that might help. "Because of the internet, ideas can just spread," she enthuses. "I've been lucky. I've had access to the information to make the most of it."

Unlikely champion

For all her success and recognition, Miller still sees herself as an unlikely champion. "Before I went through all this, my attitude to medicine was if you can't stand the heat get out of the kitchen," she explains. "Mental ill-health was for softies."

So what drives her? "It's injustice. If someone's hurting, I'm compelled to help." Looking slightly embarrassed, she laughs. "Does that sound a bit icky? The thing that annoys me about psychologists is they say, 'Oh, you're a serial rescuer.' And I say, 'Yeah, that's it.'"

· This article was amended on Monday June 23 2008. Homophone corner: "He said, 'Yes, but don't make a career out of it,' Miller recalls, descending into a long, loud peel of laughter". This has been changed, of course, to 'peal'.

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