Lizzie Miller is a founding member of the Doctors' Support Network. She spoke to Peter Cross about her medical career and her victory over bipolar mood swings

"Some mornings I'd wake up and think, 'shall I kill myself today?' I thought everybody made that decision before they got out of bed. It was only later that I realised that it was probably depression."

Lizzie Miller felt like this during the eight years she worked in general surgery and neurosurgery. She didn't realise that she had been depressed since childhood. She feels: "I've always been depressed, but I assumed this was normal." Remarkably, these symptoms didn't affect her ability to work: "I could always work. And I think this is true of a lot of doctors--the one thing that doesn't get affected is their ability to work, or is the last thing to go."

Initially, Lizzie didn't want to go into medicine. She wanted to be an artist (and still paints), but medicine was in her genes. Her father, grandfather, and great grandfather were all doctors, so becoming an artist was inconceivable. So she trained in medicine at King's College, London, and qualified in 1980. She describes her time there as being a bit rebellious, but she had no health problems.

"I did my house jobs," she said, "and found that I hated medicine but found surgery interesting." "From then on," she explains, "it was neurosurgery or nothing." She liked the discipline and the thoroughness, in particular "spending a lot of time with a few people." Another advantage was that patients were involved with decisions: "Normally in surgery you need X operation, and that's it. While in neurosurgery it really would be an in-depth discussion with patients and relatives about all possibilities of what would happen if you did or didn't operate."

Despite her low mood and suicidal thoughts, Lizzie was never treated for depression. She confesses: "I never told anybody. I assumed it was normal." Her first experience of psychiatric services was when she was sectioned in 1989 after her first episode of hypomania. "I believed that the IRA were in the attic," she recalls. Being admitted to a psychiatric unit was an eye opener. Nobody told her where she was for the first 24 hours.

Lizzie's first admission lasted five months. It ended her career as a neurosurgeon. She began retraining in general practice but a further breakdown and subsequent admission put a stop to her fresh start. After working her way through a few specialties, she eventually moved to occupational health, where she still works: "The upside is that it brings together all my experiences. It brings together all the threads. It is where physical and mental health come together. It doesn't matter how good a surgeon you are if you can't go back to some kind of life." She believes, "At every stage of the process in addition to skill you need to have concern, which is often neglected."

She sees occupational health as a way of helping people make sense of what has happened to them so that they can get back to work or make the right decisions about returning to work. She believes: "You can make sure that the treatment was right and they were getting the rehabilitation they should." She stresses that it is important to keep your medical skills and knowledge up to date and that you need to understand what has happened to people in order to help them.

But Lizzie thinks that the most worthwhile thing in her career is the Doctors' Support Network (DSN). About six years ago, three years after her last breakdown, she became one of 30 founder members of this network. The DSN is a self help peer support group with meetings in London, Bath, and Scotland and soon to start in Wales. As far as Lizzie is aware the DSN is unique; there are no other self help peer model groups for doctors in the world.

"Meetings are completely confidential, so we always say at the beginning you can say you've been here but you can't say who else has; you can say what you've said but you can't say what other people have said. We discuss things like work issues and how to talk to family about these things. We also talked about medical identity as doctors identify with their jobs to the extent that the rest of their life and person is swamped by it. That means that you are very vulnerable to any career crisis."

The most fundamental aspect of the DSN is knowing that you are not alone. "You're not the only doctor who has been through this kind of hell," says Lizzie. "One of the most valuable things is that we offer support."

What is inspiring about Lizzie is her unwillingness to surrender and become a victim of a serious psychiatric condition. Manic depression may have cost her careers in several medical specialties, but she remains positive and finds ways of using the skills and knowledge she gained from past jobs in her current one. She talks about her life in a matter of fact manner, implying she really has left the bad bits behind and moved on. When she says she knows she will never get ill again, you know it is no idle boast. Rather, the considered thought of someone who has been through hell and lived to work another day.