BOOK REVIEW

An Improbable Psychiatrist, by Rebecca Lawrence (2024)

Cambridge University Press, ISBN 978-1-009-51506-1

 

Psychiatrists place a high premium on phenomena. This is a valuation shared with philosophers of the phenomenology school – it is indeed possible to trace the lineage of contemporary descriptive psychopathology via Karl Jaspers to thinkers such as Edmund Husserl. This mutual interest centres on the thingness of a situation or experience – for instance, beyond the fact of being blue – think of this as a colour or a state of mind – the blueness of blue, the internal experience or what it means to be blue. For philosophers, this fascination often gives birth to thought experiments. For psychiatrists, empathy is a cardinal trait as it involves the ability to take upon oneself, within the limits of objectivity, the lived experience of another.

The ultimate experience of phenomena is the fact of embodiment – one step above an empathetic response to the situation of another, to actual incarnation, which is what we get from this account by Rebecca Lawrence, a trained psychiatrist who also has lived experience of bipolar disorder. She takes us through her childhood, medical school, onset of illness, marriage and motherhood, General Practice training, sickness relapse, eventual improvement on lithium, and psychiatry training. Evident in the narrative is the importance of good support, provided primarily not only by her husband Richard but also by parents and colleagues.

Poets love phenomena too – this is captured nicely by the American paediatrician and imagist poet, William Carlos Williams, ‘no ideas but in things’. We can understand the enduring interest of Kay Redfield Jamison – a faculty member in psychiatry at Johns Hopkins, who has also written about her lived experience with bipolar disorder (The Unquiet Mind), and what might be classed a ‘clinical biography’ of another great 20th Century American poet, Robert Lowell (Setting the River on Fire). I am currently reading Robert Lowell’s classic poetry collection, Life Studies; like Jamison, I am drawn to ‘Walking in the Blue’, a poem about one of Lowell’s admissions at McLean Hospital: ‘My heart grows tense/ as though a harpoon were sparring for the kill. /(This is a house for the “mentally ill.”)’ For Lawrence, the poet she turns to, after the loss of a pregnancy at 22 weeks, is William Wordsworth. Pregnancy, childbirth, childcare, motherhood – these are intimately linked with the natural history of mood disorder, and they feature prominently in this account.

Beyond the fact of her illness, Lawrence, after all, has become, with the passage of the years, a seasoned psychiatrist, and she shares nuggets of wisdom. This is a tangy tale of lemons and lemonade – her reality is of shape-shifting between psychiatrist and psychiatric patient, examining the discourse of one with the actuality of the other. It is apparent, for instance, when she reflects on her diagnostic journey, highlighting the consistency of her two managing consultants even in the face of her uncertainties. The chapter on ‘Moods and Medicine’ is a remarkable self-formulation.

The book also offers the bonus of other voices, notably her husband Richard, who contributes a chapter rich in the insights of a loving caregiver. He takes us from an early life in which mental health is taken for granted through a lifetime of balancing career aspirations with holding his family together. We get a rare peek into the complex emotions, practicalities, and lifelong learning. We also get to hear from Professor Lawrie, an enduring presence from the emergence of symptoms through the triumphs and tribulations.

Lawrence writes in clear, accessible prose – a ‘plain, unvarnished tale’, to echo Othello and Mungo Park. Nevertheless, in the crystalline prose you do find gems, like her description of Fowey in Cornwall, ‘a strange, ancient town, stuffed with privilege, history, literature, and clotted cream’, and her description of one of those rare moments of respite in life’s travails, ‘like climbing a steep and uninviting mountain and finding a grassy meadow, soft, and sunny, where we could at last lie down and rest’.