Book Review: Beneath the White Coat: Doctors, Their Minds and Mental Health.

By Clare Gerada (ed.), Routledge, 2020.

‘There is no such thing as a baby.’ … if you show me a baby you certainly show me also someone caring for the baby..’ Winnicott, D.W., 2013. Collected papers: Through paediatrics to psychoanalysis

This is an excellent, beautifully written, and valuable book, in which Clare deepens the thinking and understanding of the vulnerability and needs of the medical profession. To provide care we need to care for the carers. This topic has, until very recently, been absent from the discourse within medicine. The tide has recently changed, due in no small amount to Clare’s determination. There is now acceptance, from both within the medical profession and wider society, that doctors are both vulnerable and in need of support.

Clare has made a wide-ranging constructive impact on the sustainability of the medical profession through her Practioner Health Programme (PHP), the ever growing, now nationally rolled out, support service for doctors and dentists. This book is highly readable and condenses the wisdom of a career treating over 11,000 doctors into 27 chapters, 20 of these Clare has written herself. Her brave and compassionate voice, well known to the Group Analytic community, can be heard clearly throughout.

Clare discusses the rise in mental illness, psychological crisis, and unhappiness of doctors and suggests this is due to the combination of:

• The personality structures of those who become doctors, including their difficulties in seeking help and acknowledging vulnerably.
• The demands of their “group of belonging”.
• The increasing external pressures from their organisations, pathological NHS processes, regulatory bodies, and society.

The book is divided into 4 sections each addressing a particular area of the journey from Doctor to Patient and back again.

In Section 1 The Making of the Doctor the ‘The Medical Self’ is examined – that being a doctor ‘is not something you do, it is something you are’ and how this identity can become rigidified at the expense of personal development. The risk of this occurring is increased by the denial of vulnerability in medical community. Clare developed her thinking about this further in her group analytic paper ‘The making of a doctor: the matrix and self’ (2019. Group Analysis, 52(3), pp.350-3610). Section 2 concentrates on different presentations of Doctors and Their Illnesses with a focus on substance misuse, autism, burnout, suicide and the contemporary challenge of Covid-19. Section 3 attends to Doctors as Patients and how very difficult it is for doctors ‘to cross the divide’. This section advises techniques for resilience and discusses talking therapy with an emphasis on group treatment. The final section focuses on When Things go Wrong and provides empathetic understanding of how, and why, boundaries are crossed. It provides advice and support in surviving complaints, regulatory processes, and serious incidents.

I recommend this compassionate book written by a woman who in my opinion is unarguably the most important sane voice in medical leadership at the current time. The insights in this book will be of interest to all group analysts, not just those in the medical profession, who are concerned about the challenges and pitfalls of working in a caring profession.

Rachel Gibbons