Don’t ruminate, or Don’t keep chewing over negative thoughts!
Born into a doctor’s family, Lucie’s future career was laid out from childhood. Her daughter is also now preparing for Medicine entrance exams. Professor Motlová Bankovská has been working at Charles University’s Third Faculty of Medicine continuously since 1993. She is currently teaching Psychiatry and Medical Psychology and leading the Medical Psychology Department, while also carrying out the role of Vice Dean for external affairs, and developing academia and social affairs. She works as a Senior Researcher at the National Institute of Mental Health.
We meet numerous times at meetings of Charles University’s Commercialisation Council. Each of my meetings with the professor is like honey for the soul. She is softly-spoken and listens with empathy and her whole demeanour is calming. Our interview was focused on the mentally ill, destigmatising mental illness and the opportunities offered by collaboration between the academic and commercial sectors.
Professor, you work in training future doctors, and you teach psychiatry and medical psychology. What message have you got for your future colleagues?
The mental health of medical students and doctors is a major topic. In my private practice, it is doctors who come to me dissatisfied with their lives, displaying signs of mild and more severe mental disorders. To a certain extent, all doctors are workaholics. Just applying for a difficult medical degree suggests the buds of workaholism are already within you, subsequently making you more vulnerable to mental issues in future. Furthermore, doctors do not respect long-term rules which allow you to perform to a high level at work in the long-term. As a doctor, you begin your career at 25 but you are expected to work for 40 to 50 years in a field which is difficult, fast-evolving and tends to swallow you up. And even in the series of interviews you have held with my colleagues, I have noticed that these have taken place slowly in stages to accommodate their high workload. A busy doctor who never has time has slowly become synonymous for a good doctor. But permanent pressure and overwork inevitably leads to a risk of mental illness.
What can be the outcome of this overwork?
Let’s deliberately begin with the most negative outcome. Statistics from the USA show higher suicide rates amongst female doctors compared to women in the general population. This is the tip of the iceberg and many causes behind it may be uncovered. It is then found that many women suffering mental illness have not been treated. They have simply ignored their mental health issues. Here we encounter the problem of psychiatry as a field subject to stigma, and also the downplay of mental health and mental welfare in general. When a surgeon breaks his leg, one can assume that he is not going to continue operating and will take time off work. But when a doctor is suffering from anxiety or depression they’re still going to go to work.
Going back to those alarming statistics, can one say then that women cope with stress worse than men?
You can’t say that. Currently 70% of students in our faculty are women. Women make up the majority in healthcare when you include nurses and other staff. But it is particularly hard for women to combine their professional career with looking after their family while still having time for a personal life. Women often work in teams led by very busy men who end up setting the standards for the others. This might sound heretical, but an enlightened head doctor should ensure that his colleagues are not overworked. Care for young or junior doctors should include not just the transferal of specialist knowledge and skills, but also care for mental health. This care should also include the opportunity to ventilate problems they come across while carrying out their duties, e.g. informing patients of bad news. But this is just a general recommendation which disregards the reality of Czech healthcare which suffers from a lack of doctors and medical personnel.
Your insights and expertise come from the medical sector, but can what you say be applied to other fields and spheres, such as the corporate world or consultancy?
Yes. I think that the working environment is heavily influenced by a male perspective on matters and a male perspective on what leadership and the traditional superior-subordinate relationship should look like. I’m not an expert in management, but I continue to perceive a lack of empathy towards female employees, who are mostly in subordinate roles. Furthermore, many women still want to carry out a caring role within their family in some way and don’t want to delegate this function to anyone else. Unfortunately, the day only has 24 hours and this means there really is no time left for oneself after all that.
Let’s move on to specific key recommendations for ensuring mental wellbeing.
I’ll start with two fundamental recommendations. Picture a traditional tripod with three legs of the same length which make it extremely stable. Work is one of these legs, family life is another and our hobbies are the third leg. If someone is unable to balance these legs out over a long period of time, they become susceptible to problems. Yes, hobbies, interests and a social life comprise one whole significant part of life. Working women are those most frequently missing this leg.
My second piece of advice touches on physical exercise. It has been demonstrated that physical activity prevents depression from developing and is sometimes used directly as a method of treatment. At least 30 minutes of brisk walking three times a week is a key piece of advice doctors should give their patients, while also applying it to themselves. Don’t forget that exercise also prevents ageing. Going beyond these basic recommendations, then my next piece of advice would be to get sufficient sun. This winter may have seemed long and dark, but getting sun can also involve just being outside in the fresh air. Next in line is the well-known nutritional advice on the importance of health-promoting unsaturated fatty acids and consuming fish and fish oils.
My final piece of advice would be: don’t ruminate. A great word which can be translated as meaning not getting bogged down in cyclical repeated negative thoughts or catastrophic scenarios, instead focusing on specific solutions and actions to take.
Your specialisation is destigmatising the mentally ill. We treat a broken leg, but we deny a broken soul. I recently read a book which describes balls which were held in Paris at the end of the 19th century in institutions for the mentally ill to draw attention to their problems. How much progress have we made in terms of destigmatising mental illness?
In the 19505, the discovery of chlorpromazine, an antipsychotic drug, marked a revolution in psychiatry. The fact we now had drugs available which had a positive impact on the lives of the mentally ill meant we somewhat forgot about methods of rehabilitation and those balls you mentioned. There is space for both these approaches in modern psychiatry. We can’t treat serious mental illnesses without drugs, but on the other hand we mustn’t forget other methods for returning our patients to their lives. In this regard I would like to mention family psychoeducation. Family psychoeducation is a method in which we talk to the patient and their family about their illness, what it does, what to do and what not to do. It’s a kind of education in which skills for adapting to the particular illness are learnt. But these methods require a lot of skill and time from the doctor. While medical students learn about the effect of medicines and psychotropic drugs, they do not find out about rehabilitation methods such as family psychoeducation. This is a pity, because patients’ families are just as stigmatised as the mentally ill themselves. Stigma is transferrable, literally contagious; if we look at the mentally ill with suspicion then we tend to look at their whole family in the same way. Once the family has gone through this training, they are better able not just to communicate with the patient, but also to face up to the pressure and response of their surroundings. Here I’m talking about serious illnesses such as schizophrenia and bipolar affective disorder.
There are currently quite a lot of destigmatising campaigns and activities. Where does progress still need to be made?
I’d like to mention the Z první ruky (First hand) project which we organise here at the Third Faculty of Medicine. We invite patients and students to take part and look at various aspects of illness. Medical students are generally taught at the bedside of the acutely ill. Students then do not learn about what life with the illness brings, what happens following discharge, at home, how to find work and so on. Studies suggest that it is not just people in the patients’ surroundings who look with suspicion at the mentally ill, but often also doctors themselves. Care for physical ailments is worse for the mentally ill than those who are not being treated for mental illness, yet their diagnosis is the same. Last year, we undertook a study on how medical students’ relationship with the mentally ill evolves. We observed that it is from Year 4, when students begin to study psychiatry, that their relationship with the mentally ill improves. There are studies which have been undertaken abroad which have shown the opposite.
Year after year, you are assessed as amongst the most popular teachers. How do you personally perceive the young generation of students?
I look forward to seeing my students; I think the process of becoming a doctor is an adventure. You start learning medicine at 18 and leave at 25 years of age as a doctor who will be looking after the public. I am very well aware of how much attention needs to be paid to professional competencies. Our teaching curriculum teaches students how to diagnose illnesses, but not how to care for and treat the sick and make them better. There just isn’t enough time. That makes it that much more important to transfer this skill, e.g. during medical psychology. It is we who are creating the young generation, or at least we should be endeavouring to do so. You can see how medical students absorb the manners of doctors and are very sensitive in assessing any abuse from senior doctors.
My final question is about our joint work in Charles University’s Commercialisation Council. Where do you see potential for co-operation?
I see potential and space for co-operation both in technical and humanities fields which are a little underappreciated by the private sector. I was pleased that a number of successful projects in the phase of applying for patent protection were presented to the Council. Within my own field, I see an opportunity for various detectors which sense deteriorating patient condition, in particular for patients with chronic disorders which go through cycles. In the context of an ageing and stressed population, such products could be used for maintaining good mental health even for people not suffering from any disorder.
By Linda Štucbartová