EPISODE 12 - Kieran Allen
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[00:00:00] [00:01:00] [00:02:00]
Sharee Johnson : Dr. Kieran Allen is a doctor completing specialist training in psychiatry. He blends his unique experience as a clinician and a patient with his own lived experience, employing storytelling as a tool to share his experiences. Kieran openly explores the challenges of navigating medical practice whilst living with a mental illness.
Kieran challenges the fallacy of the doctor. Patient binary. He illuminates the value of incorporating our whole selves to positively influence systems of care. Dr. Allen shares his personal journey to highlight the reality that mental illness can affect anyone, including doctors. He advocates that these experiences deepen empathy, insight, and connection to ourselves and our patients.
He's particularly interested in reframing narratives around burnout, [00:03:00] promoting early help seeking and creating cultures where vulnerability has value, and we talk a lot about that in our conversation today. Dr. Allen has held leadership and advisory roles across higher education professional associations, and in the not-for-profit sector.
He has served as a representative in diverse governance roles, contributing to conversations about training, wellbeing, and professional culture. His advocacy work is explored through his writing podcast appearances. And public speaking where he seeks to foster a medical culture that values honesty and challenges, an idealized linear view of recovery, promoting diverse paths that doctors can take through healing.
Welcome to Recalibrating with Shere Johnson, Kieran, I think we're going to have a really heart provoking and thought provoking conversation. It's lovely to see you.
Dr Kieran Allen: Hi, Sharee I'm certainly hoping so its good to see you again.
Sharee Johnson : [00:04:00] Let's start with your working life now. What's, what's work look like for Dr. Kieran Allen in 2026?
Dr Kieran Allen: Work is very exciting for me this year. Um, I've come back to full-time work this year after a period of doing part-time, um, and really enjoying my, my job in child and adolescent psychiatry this rotation. It's, um, something quite different, I think from the rest of what I've been doing so far. You know, it sits at this lovely, nexus between treating children and treating their parents at the same time and watching how the family operates and trying to support the whole system, which is, um, you know, something we do do across psychiatry, but I think it's to the, to the pinnacle, um, when, when kids are involved.
Uh, so I, um, tend to balance. Um, the clinical work with some things outside. I, you know, I enjoy, uh, doing writing, doing advocacy work. Um, and I [00:05:00] sit on a couple of different advisory bodies and a governing council. I try to, um, spread the load a little bit in terms of what I'm doing.
Sharee Johnson : Mm-hmm. And, uh, how far along into your psychiatry training are you?
Dr Kieran Allen: Uh, again, I'm in a, a somewhat unique position. I, I have to count sometimes where I'm up to, given that I've had time away and I've had part-time. I think I'm at the end of my third year, at this point, and it's five years for the training. So I'm finishing my mandatory rotations with this child, adolescent one, and then I'll move into, uh, the, the wide world of stage three, which is very much open to however you want to do it, which is quite exciting.
Sharee Johnson : Very exciting. Congratulations on making these hurdles. Thank you. So, um, what about the backstory, Kieran? Can you tell us a little bit more about your life, you know, things, seminal events, things that happened to, to bring you to this stage? Maybe a little bit of your family background and, and the work, the steps through [00:06:00] medical school and, and to this point now?
Dr Kieran Allen: Yeah, so my, my family were very supportive of my move into medicine. They were, they were very excited for me, um, to choose that. I don't think there was a, a pressure as such to do so. But, um, they were certainly very excited when I, when I got in. I think getting into medicine was a unique experience in, in terms of, you know, when we're in, I went straight from my high school to, to medicine and went from being the top of the academic pile to very much the low middle, uh, in, in medical school.
That was a big shift, uh, and a big, adjustment in terms of how I saw myself and I, I found, I found the early parts of medical school to be, um, quite enjoyable. Um, they were preclinical and very, um, academic and, and it was, it was quite a focus on knowledge and knowledge acquisition. And then moving into the clinical [00:07:00] years, I found that much more challenging because the challenges with some of the people who were, teaching and, and trying to, I think in their own way, support, learning, uh, conflicted with my, um, personality style probably, and, and probably for, from the outside, often stretched into more of a bullying type, approach or, or at least a teaching by humiliation and, and teaching by calling people out and making others know that they didn't know things. Um, and, and I don't think I was alone in, in that experience, but I got through that. Um, and moved into, I, I had my first psychiatry rotation in, in my fourth year. I did not enjoy it. I did not like it at all.
Um, and I don't know if that says more about how it was run or, or more about, uh, what I was expecting going into it, but I thought, I'm gonna try this again. Uh, I'm gonna give it a once over and see if it was indeed that's, I did it again in my final year as a, [00:08:00] as an elective. And in that case I did really enjoy it.
Um, and went into internship and, and did another psychiatry rotation then. And I found internship to be, um, kind of a baptism by fire in, in a lot of ways. It was certainly an expectation that I had put on myself that now that I was a doctor, I had to know everything, do everything, take care of everyone, rescue everyone.
All of that, um, came to a head at that point. And I think it took a number of years for me to look back and say I probably wasn't accurate. Um, I probably didn't need to feel that way, but not knowing in that setting. I certainly felt that. And I went from internships straight into a, a year as a resident in psychiatry, um, and did a bit of inpatient work and a bit of community work.
And I thought, this is something that I wanna do. Um, this really aligns with my interests in how people think, how they process [00:09:00] things. I liked , the time in a way that you, you have to think about, people's, approach to things, how they struggle with illness how they struggle within their families at times.
Um, and the kind of reflective practice that I don't know exists in a lot of specialties that that certainly was present. But at the same time, in, in certain rotations it was very, very busy. And that, that ideal practice wasn't always able to be achieved. Um, but I, I, um, had times where I needed time away for, um, being unwell, um, with, with what at the time was, thought to be depression and thought to be a quite a recurrent depression.
And that, that started in medical school. I took, uh, at least, at least two years off, uh, and a research year, which really pushed back my, my training [00:10:00] and it continued into my clinical years as a doctor, and it was, it was very annoying. It very much got in the way of what I was wanting to do, uh, and it, and it just would not go away.
Um, I kept falling into these holes of, of depression and really struggling to get out of them. I was in hospital many times, um, because it was so significant and the risk was so high, um, and could not work out why, uh, this pattern just kept repeating itself. And there were, there were times where, you know, I was, I was doing things that were just out of character for me and, and didn't make sense and seemed to be getting worse over, over time.
Uh, and one of my psychiatrists finally said, no, I think this is bipolar. Um and a lot of things made sense once we looked at things through that lens. Um, but it was tricky to see because [00:11:00] predominantly for me it was depressive. And even when the, um, the manic symptoms were there, they were more mixed and they were, they were covered up by a lot of depressive symptoms.
So it was tricky for anyone to see, I think. Um, but even with that, there was, it was still very difficult to, to get on top of. I had quite a treatment resistant form. Um, I was having multiple episodes a year, and it was meaning that I was having to take a lot of time away from work and training. Mm. Um, and that, that stretched on for, for a long time, um, for a number of years.
And I really lost a lot of, um, a lot of, yeah, I think time's the right word. I, I lost a lot of time that felt looking back was just really wasted. Uh, just can't get that time back. And it's. It's not just the fact that the depression was awful, um, and, and feeling like, you know, ending my life is the only option. [00:12:00] That's horrible enough going through, but then to reflect back and say, well, you know, there, there are years there that, that are gone, you know, that, that will effectively feel like they've been wasted. And to, to not have that time has been very hard. But to come through all of that and process, um, what has been a very complicated illness, um, and get to a place where I've been stable now for over 18 months and been able to get back to full-time work, um, has been something I didn't know would happen.
And, and very, um, that comes with a real sense of relief and joy.
Sharee Johnson : Hmm. I, I imagine you've had the full palette of emotions through all of that time Kieran, there must have been times where you really wondered if it was worth carrying on with medicine.
Dr Kieran Allen: I mean, that goes back to medical school. I, when I had my, I think I had my first episode in high [00:13:00] school, but the first real bad episode was, was in medical school, and that, that was the, um, one of the key things.
Sharee Johnson : Mm.
Dr Kieran Allen: Like I, I don't think I'm cut out to be a doctor. I, I don't think that, you know any, you know, when you, when you fall into such a heavy depression, it, nothing, nothing makes sense the way you think it will. Like, there's, there's this real, it's hard for people to, who have not experienced it, to genuinely understand it.
I think because the people equate depression with sadness as, as a way of understanding. It's like, wow, you must have been really sad.
It's like, yeah, I was, but that's not the whole picture. Like the way you think changes, you can't reason, you can't understand normal things in a normal way. Every little thing that happens in your life, you're looking at it through a lens that just makes it not make sense the way it should.
And therefore, coming to what from the outside [00:14:00] seems like, you know, why, why are you thinking that way? Why, why isn't this making you happy? Why are you thinking killing yourself is a good idea? It's hard to understand. And I think funnily enough, I actually think people have a better understanding of the suicidal part than they do about the, the actual suffering.
Um, because they can see that that's sort of an escape and, and things are so bad that that's the only option, people can understand that. But to say to them like, day to day, I have constant thoughts of just hating myself and hating my life, and it just unrelenting. Um, that, that's, that's horrible. And it's, it's exhausting too.
And to have that go all the way back to medical school and, and conflict with your identity as a professional, as a doctor, it fuels it. Um, and it gets you stuck in a loop, I think sometimes where even when you, you think you're getting out of it, um, that's [00:15:00] not always easy because of the, the fact that, you know, the, the prototypical, um, identity of a doctor is, is the, the strong figure, the figure that makes all the right calls in hard decisions.
And that's, to not be meeting that, is difficult.
Sharee Johnson : Incredibly difficult. I think that, um, you're really touching on something for the people around the person with the depression as well, that they're, they're using a different thinking frame. They, they're, they're thinking through decisions and problems in a different way. And that trying to understand what's happened to your thinking capacity as the person who's experiencing depression is, is confusing.
Dr Kieran Allen: It is and I think it, it goes one, one step further from, from that though, I think, you know, the people around you, people who are, you know, I, I don't like this term, but carers, um, people who are in the carer role and they're, they're often put there by the clinical team.
When people have a psychiatric [00:16:00] illness, they're not supported for one. But even, even if they were trying to explain to someone that this experience that this is, this person's going through is not really them. It doesn't hit home for that person. They look the same. They, they talk the same. Even if it's slower and a bit more monotonous, it's still them doing it.
And so you can't separate that in these people's minds. And, and I think that really comes to the fore with mania. Like when I'm in that state and I'm talking a million miles an hour, and I'm saying, you know, grand plans and stupid decisions that sure, in my mind, in my psychiatrist's mind is a state, but in the people around me's mind, no, no, no.
That's an experience of this person. And you can't separate it from the person and your reaction to it can't be separated either. Mm. And so it's, you know, if, if I'm then talking to someone when they're not in that state to that person, they're like, well that was horrible to go through. But to the person who's in that carer role, it's like, [00:17:00] I went through all of that and you are the same person. And I can't disconnect from that. That's really tricky.
Sharee Johnson : Very tricky. What was useful? What was supportive? What was helpful?
Dr Kieran Allen: I think that's a really hard question to answer because I think when, when I am so sick that I'm at the point of being in hospital, say, I don't know that at that point I'm able to identify anything that can help.
Um, and so it really, I become very much needing those around me clinically or, or family or, or friends, whoever, to guide those decisions. And that can be really helpful. But it, it can also cause problems in the sense of things being done that have the best of intent, but don't necessarily end up with the result that [00:18:00] me, as the person would have wanted.
. The extreme of that obviously is, is when compulsory treatments used. And as far as I can remember that, I don't think that's happened with me, but it's, you know, it's been close to that. Um, it's been sort of, alright, this is the plan and if you don't go along with it, then we're gonna do it anyway. Um, but I, and I think that has a spot, you know, that, that certainly has a role when people are extremely unwell.
But I think most of the things that help have not been around when I've been actually sick. It's been outside of that, it's been the support of work to have flexible working arrangements when I'm coming back from being unwell or my, my family, having the ability to work out how involved to be without being over involved.
And that varies between people. It varies between how, how sick you are and, and that's, that's a hard thing to work out. Um, but I think that the two most important [00:19:00] things are the, the support of my wife has been critical. And I know not everybody is in the position to rely on that, but I have been fortunate enough where she has just been fantastic throughout, um, throughout my journey, but it's been very hard on her too.
Um, and the, the other support is my professional team, my clinical team, and being able to access them routinely when I'm well, so that when I'm not, well, they're there.
Sharee Johnson : Mm-hmm.
Dr Kieran Allen: So having, you know, even if it's infrequent appointments, like every few months or every couple of months, is my psychiatrist or acknowledging the value of, um, and it doesn't have to be therapy like I'm doing, like what your role is for a lot of people, which isn't, you know, it's not a therapy role, it's a coaching role, but it's, it's having that support as an ongoing thing, it normalizes the fact that we can get value from that even when we're not [00:20:00] unwell and being unwell, then it's easier to access. You've got an established relationship, you've got someone you can turn to.
So I found that really helpful.
Sharee Johnson : Oh, I think you're pointing to something very important, which is this deep trust that you have a, a group of people. It doesn't matter if we look at the Harvard Happiness Study or, you know, it doesn't really matter which study we look at. It's all pointing to having people that we can rely on that we have some level of intimacy with.
We don't need lots of them, but we probably do need more than one each. And uh, I think um, it might've even been you who said it. I heard someone speak years ago who said You need your 3:00 AM friend that you can call. Did you say that? Is that thing you, that said?
Dr Kieran Allen: I don't remember. That sounds like something I'd say.
Sharee Johnson : A lot of people, especially in coaching, we talk about this idea of the hero's journey. That we go through a struggle that we're sort of in the dark, we can't find our way, and that we need the guide on the side, or we need to find somebody to help us.
And it's very often about building skills and competence. It can be also about, [00:21:00] um, relationships and autonomy, but it's really principally, I think about skills. And I know when we were talking yesterday, you raised some questions about this idea of the hero's journey. Can you, can you share a little bit about your reflections on that?
Dr Kieran Allen: Yeah, I think, I think when, when we talk about something like the hero's journey, it's, it's a nice way of framing what we would like the journey to be. I think that's, that's a, it's reasonable and it's a good way to hope for, and I think what you've just mentioned, focusing on the development of skills and things like that is a really useful way of using it.
I don't think a lot of people do use it that way, though. I think a lot of people frame it in, in a way where it's, um, an individual is exposed to stress, becomes unwell and falls into, you know, a, a challenge, a depression, whatever it is, burnout and seeks to climb back [00:22:00] up the hill to get back to where they were in recovery.
Um, and I don't know if it's as explicit as that, but I think it's incorporated a lot into, um, how we subconsciously view mental illness in, particularly in the workplace. There's a recognition organizationally across most health services I think now that burnout is a major problem and it's not, and, and it's probably getting worse.
Uh, from my experience, quite good at identifying some of the reasons for that, but not as good at identifying how to fix those reasons. And, and there are good reasons for that. There are complicated reasons that are systemic and difficult. The thing that I think upsets most of my colleagues when I talk about either burnout or the response to it and that journey we, we seem to be pushed towards, is that the focus on trying to acquire skills and [00:23:00] trying to develop resilience is not a bad thing.
They are good things to put in place, but they, they're pedaled sometimes as the only ingredients and they're the focus on the workplace promoting those comes across as hollow because the actual underlying systemic causes are not being addressed. Or if they are, they're not having the effect that the organization are wanting them to.
On the other end, though, it also idealizes, what can be seen as a state of recovery, as, you know, rather than viewing that journey as the valuable thing. The, there's almost this sequestration of people in this little hole that we don't talk to them, we don't, you know, we might touch base every now and then, but they sort of sit there until they get better.
And once they get better, we celebrate that. Wow, you must have been through something really hard, well [00:24:00] done for getting back, but there's this subtle pressure to stay in that role and to not fall down again. And you've got people who are going back into the very same system that caused them to feel that way.
Probably not even back to where they were when they're coming back. And so the likelihood that there will be a relapse is high for a lot of people. And that might not happen immediately. People might, you know, get back in and the workplace might be really supportive in terms of letting them come back part-time for a while and supporting them through that.
But you've got a situation where those skills are helpful in terms of coping with stress, in terms of managing, workload and advocating for yourself. But a lot of people are not able to easily implement them in a system that still causes the same problems.
Sharee Johnson : Mm-hmm.
Dr Kieran Allen: When you're heavily stressed, you, you revert to a survival mode. And it's impossible, in a lot of those [00:25:00] settings to use a lot of those skills, when you are so distressed. And even at that like baseline of distress, it's hard to do. You're just pushing through and surviving with that little voice going, you're gonna get unwell again, this is not going well. You know, that, that might happen. And it's just constantly telling you that.
And there's this shame sink around people who, within people, who do fall into that and who do sort of fail to adhere to a preferred narrative. And I, I experienced that myself. You know, getting back early on was very difficult, at the very start of my, uh, you know, in my intern year in particular, and starting to do work around advocating for the mental health of doctors.
Um, you know, I, I was lauded for that and, and, you know, given, you know, registrar of the Year and, you know, things like that. And then when, the shit hits the fan, so to [00:26:00] speak, you really see who's supportive and who's not. I mean, it's easy to support someone when they're well and to say, you know, we're, we're championing supporting mental illness and we're not stigmatizing, there's no discrimination, all of that until the challenge comes. Because once you become difficult, that's when the actual discrimination comes out. Um, and, and that is particularly bad, I think, for people who don't stick to that hero's journey or that ideal of it anyway.
Sharee Johnson : Mm-hmm. Or even perhaps people who take too long to get through the hero's journey.
Dr Kieran Allen: Absolutely.
Sharee Johnson : There's too much complexity for too long. If you, if you have, you know, one incident and you get it together and you get the skills and you come back better. You know, we like that as humans. Yeah. We like that simple. It's kind of straightforward.
Dr Kieran Allen: Yeah. It's neat.
Sharee Johnson : Neat. Yeah. Yeah. I, I think you're really pointing to, I, I wanna go back a little bit to you talking about the connection with your clinical team all the time, not just when [00:27:00] things, when the shit's hitting the fan, but just all the time, generally speaking. I, I just wanna kind of amplify that for a minute and , remind us both and anyone who's listening probably, that I think there's such power in this and when you look at workplace wellbeing, um, traditionally organizations, not just in health, have had, EAP and sort of crisis response management.
And that's been the focus. I think now we have evolved a little bit to thinking about psychosocial wellbeing at work all of the time. I think we still a lot of work to do, but at least we are talking about that language now and we are talking about, you know, good work is good for wellbeing. People who have work that helps them feel like they're contributing. It gives meaning to their life. It helps them feel like they're valued, is really great for our mental health, as a general statement. You know, long-term unemployment is better for us for our mental health than a toxic work environment or an unsupported work environment.
So, um, you know, I think the research is really clear about that, but we seem to be very slow about [00:28:00] activating it. And, uh, I think I mentioned to you before that I like the phrase of having some redundancy in the system. So
Yes,
you know, I'm thinking about, uh, we, we want the capacity to have heroes journeys individually some of the time, if it's about skill building and, increasing our competence, we also need this systemic response. And, and it's much more complex just 'cause there's more moving parts. Where's your thinking at just now about things that systems can do or things that you've seen, leaders do that have made a difference in our systems?
Dr Kieran Allen: Yeah, that's a good question. I think it ties into what you said before about, um, one of the key problems, uh, is when people take too long to get better. Mm-hmm. Um, because it, it interrupts those systems.
Sharee Johnson : Mm-hmm.
Dr Kieran Allen: You know, we're, we're caught between so many moving parts in, in medicine, particularly in the training pipeline, where, we've got more doctors graduating than ever, and [00:29:00] importantly, we don't have enough doctors, but we haven't seen the same rise in training places.
Uh, so they've got nowhere to go. And even those who are in training get stuck, um, without the problems of taking time off due to their mental ill health, trying to find places for rotations we have to do, things like that, makes it really tricky. This is massively compounded in the rural setting where the access to those positions is just often not there.
Or if it is, it's very hard to put people in who then need to take time off. Mm-hmm. Um, it delays everybody. Um, and that's not the fault of the individual, but it often is framed as such. And so when, when a system is so rigid that it can't tolerate, it can't tolerate someone taking time off, and it doesn't even have to be mental illness.
People get, you know, pregnant with kids. People wanna take long service leave, like to, to force people into that rigidity and say, no, we [00:30:00] can't do this. We can't fit those things in. It's a massive structural problem. So when we talk about redundancy, I think part of that is, you know, saying let's get more doctors and get, get the capacity for people to fill holes when they come up.
But it's also a responsibility of the colleges, I think, because when they have rigid training requirements, they, they are important. You know, it's important for me, for example, to do, to be doing child and adolescent psychiatry. That's a critical thing to understand, I think. But to have so few positions to be able to do it, and so few, supervisors to be able to supervise it, it really makes, any of those flexibilities, difficult.
And it's not just saying, oh, well, we'll change the structure of the training program. Like, okay, but we still need that experience, even if you make it a bit more flexible. So how do we get the supervisors? Well, you need more consultants. How do we get more consultants? We have to train them.
You're stuck in this loop [00:31:00] where there's no easy solution to it. Um, and I think trying to break that open and see how do we, how do we adjust it? How do we fix it? I don't have the answer to, because I think I, and I worry that no one does. It's, and when, when that happens, all we do is we go into crisis mode when we're trying to support someone.
There's this, there's this phenomena I think where, um, I think people in sort of middle management who are often the ones making the decisions around how to support doctors when they do become unwell, um, get stuck in this adherence to policy and practice, and this is how we do it. This is how we have to do it without almost being scared that whoever's above them is not going to agree if they, if they shift and there's this protection of that system from within.
I don't think that's unique to this. I think we, we do it in medicine all the time with [00:32:00] like holding people to, no, you have to do this, you have to do this. Um, it's, it's a part of the profession, I think. Um, and it's a, a part of our, you know, risk averse, um, compliant nature. Um, but I, I, I think we do, we do need to look at, at all of those factors in terms of what, and, and to be fair, to my own colleagues, they are trying to look at all of this in terms of redoing a curriculum, you know, but that's.
That's planned for four years from now. Um, who knows how the system is going to look in four years time and then the implementation beyond that.
So, I don't know how to do it now. It needs to be brighter minds than mine to be able to look at this, but there seems to be a lack of capacity within that system to do so with so many moving parts.
Sharee Johnson : I think you're highlighting this challenge that people often, um, say, well, the doctor wellbeing has to be secondary to the patient's safety. I don't agree with that. I think they need to be equal because we know that when the, [00:33:00] the doctor is well, and the doctor has support and is value, seen, heard. They do better work.
We know that the patients have better health outcomes.
Dr Kieran Allen: Mm.
Sharee Johnson : And they have better health experience. Their, their experience of being in the health system generally is, is rated better when they feel like they're connected to the doctor and there's empathy. And the doctor is, is if you're like, well enough to be, present to, to the patient.
So I, I think this sort of binary or this dichotomy that people talk about a lot, that, well, it's either the patient safety or the doctor's wellbeing. It doesn't make sense to me. I guess is this the short version? And I think that's part of what you are talking about, that we need protocols and we need these, um, slow moving processes for training.
We need to make sure that doctors have the skills and the competence and the, the time to develop the skills that they need. And we also need psychological flexibility. We, we need a way of being able to say, [00:34:00] how do we respond to this bottleneck with lack of supervisors so that we can get more doctors on the ground?
I also find myself thinking while you are talking about, um, I guess the territories, I, I know that's a bit of a provocative word, but, you know, can nurse practitioners do some of the work of general practice? For instance, in, in New Zealand they do in Australia, there's much more resistance to that from the GP community.
Um, you know, can other mental health workers somehow support or complement in new ways what psychiatry does? I, I wonder if we look at that broader landscape, what kinds of things we might notice? Any reflections there?
Dr Kieran Allen: I think you touched on some very complex points. Um, and you're right, there are so many, um, small modifications that people seek to make that face real stiff opposition politically.
You know, the college of GPs and the nurse [00:35:00] practitioners is a, it's a good example. And, and the opposite where, you know, pharmacists prescribing has, has come in.
Sharee Johnson : Mm-hmm.
Dr Kieran Allen: Um, now I would compare that to the, the College of Psychiatrists had a choice when it came to the management of ADHD.
Whether they really knuckled down, said, no, this is our territory. Or maybe they read the tea leaves here, I don't know. But they chose to engage with the College of GPs and said, how do we do this best? How do we adopt a shared care model that is going to improve access, uh, whilst maintaining safety? We will train you how to do this well, we will offer that training to you and let go of, you know, our thousand dollar an hour ADHD clinics.
And made that decision for a better positive outcome overall. Because what happens is if you don't, if you don't do that. Someone else comes in and does it for you. And that's typically the government. And that is, I [00:36:00] think, what has happened a lot with the pharmacist prescribing, for example, the engagement with GPS has, has been either great or terrible depending on who you talk to.
Um, but the, the, the lack of willingness to adopt a model that would be effective has led to the government to saying, well, this is what we're doing. The profession faces that. And I think the, the college of psychiatrist made a, a clever decision in doing what they did. Um, so there's, there's parts of the system that can improve.
You know, I, I even got, um, invited to a panel the other day, which was, should psychiatrists lead from the inside or the outside or along, along those lines. And my, my question to the, to the, um, to the panel host was. There's a problem with the question because it, it predicates that psychiatrists are the right leaders.
Like it's, are they, what evidence is that, that I'm not saying they aren't, but prove to me that they are. Or do we need a different model that, um, [00:37:00] you know, has different input, to support the clinical leadership? You know, who, who teaches you how to be a, a, a manager?
It's like they don't, you just learn it on the job and you pick up whatever skills you can. That's not right. Training, that's not the right way to do that. So it's, it's tricky when you've got these encampments, these entrenched roles that people feel like they have to defend. Um, and it makes it really difficult to shift anything.
And there's a lot of rivalry. I think, even within medicine. I think that's most particularly seen when I was doing consultation liaison. There's the between teams, between the medical teams and the nursing staff, between our, our team as the CL team and the medical teams and who owns patients. And it's, it's a, it can be a mess sometimes.
And, and there's, there's a, there's a lack of collegiality, I think.
And it permeates that, that, that culture permeates through to the individual who feels that, um, [00:38:00] well they're attacking me, not just they're, you know, being nasty to my team or else Yeah.
Sharee Johnson : Oh, as a newcomer, when I first came into talking to doctors and thinking about these questions, it was really shocking and surprising.
All of these things you are describing to me, I think as a member of the community, people have no idea. You know, we don't need to know. So we don't know, um, what, what the machinations are that are going on to keep the health system alive. And you're really making me think about the people in survival mode don't behave like people who are thriving.
People in survival, survival mode are protective, are defensive, you know, are, sometimes working to rule, because that's how they can manage to show up again tomorrow. And so I think that, yeah. These, these are huge challenges. I, I'm, uh, I'm aware that in our conversation we've met a number of, kind of recalibration points for you where you've had to recalibrate and rethink and, and reset.
I, I wonder if we just pause here [00:39:00] and if you can notice what skills or, or what, belief systems or, what's helped you know, that you can recalibrate or that you, you need to recalibrate, that some new information has come in that's interrupted, I suppose, your thinking system or your beliefs. What's, what's that process? How can you help our listeners think about that?
Dr Kieran Allen: One of the things I, um, like about having that ongoing therapeutic relationship, um, in, in terms of the psychological work has been that it's. It's really helpful for trying to get to those points. Um, because I don't think for most people it's, it's gradual.
I think there's, there's usually a thing that happens and they're like, okay, I was wrong. The way I was looking at this was completely wrong. Um, and I think in the moment when you are unwell, things like, you know, utilizing CBT is a good approach. Um, it's, you know, it's very directed. It's [00:40:00] very clear what the goals are.
Um, but it's also, it's also not getting, I think, a lot of the time to the underlying issues. And, and it shouldn't at that point, probably because people are not in a state where they're able to do it. So when you are outside of that, that acute phase, there is the space to start to work on things that might open up those recalibrations.
For me, it was through parts work. My psychologist really shifted my mind from this. Essentially I had this binary where I had this, this good part of my identity clashing with this bad part and trying to suppress it and, and it, it coming out in, in ways I didn't like. Um, and the shift in my mindset when she broke all that apart and basically said all of these parts, part of whatever you're calling the good part, part of whatever you're [00:41:00] calling the bad part, let's look at them.
Let's look at why are they doing what they're doing and what purpose is that serving? And it took away the moral judgment of it and said, no, no, no. These parts have needs and they're seeking to fulfill them in whatever way they can. Um, and by doing that, I was able to look at my mind and, and my way of acting in a totally different way.
That was really helpful because it took so much shame away from it purely being. I am bad, I am a bad person, to being, I have different parts that have different needs. How do I balance that?
Sharee Johnson : Mm-hmm.
Dr Kieran Allen: Um, and it doesn't have to be through therapy to get to that sort of thing. Like I think even in a, a workplace setting, having really effective supervision has been something I've found really helpful as well.
And I think Psychiatry's lucky in the sense that it's booked in to our, um, training program. It's a mandated one or two hours per week. [00:42:00] Um, and this is why I think supervisors hold such an important role because they, they can make or break people. Um, they, they can really, support people to feel like they're really building their skills and becoming not just better doctors or better specialists or whatever it is, but to becoming better people in a way. And it's like, I know that's not the primary role, the primary intention of the role, but it does have that effect. You are helping someone move from a nervous, shy, junior doctor into a more confident, more settled and stable in the sense of knowing who they are, , doctor, throughout the training. I think that's a, a really important role. And we have mentors as well that are nonclinical and I think they, they serve a similar purpose. May maybe a better purpose in, in that sense.
Sharee Johnson : Lots of doctors have asked me why don't doctors have supervision like psychologists do? And I think it's a great question.
I [00:43:00] I, I haven't heard it, heard it distilled so beautifully in terms of the training program. I, I'm having a little fantasy just right now of imagining every training doctor that has supervision with a skilled supervisor once a month throughout their training. When it comes to leadership, I truly believe I'm not the only one, that the foundation is self-awareness.
And so, you know, I think the foundation of being able to connect with other people and help them move towards some developmental thing, whether that's the, the cause or the project or themselves, we need to have gone there ourselves first. It's sort of leaping out as me as, oh, so obvious Kieran, thank you for distilling it as you have.
Dr Kieran Allen: And I think the important point there is self-awareness does not equate to doing it yourself. It's, they're not the same thing. You can be helped into that. Um, but you need to seek that. Help yourself.
Sharee Johnson : Yeah, totally. And for listeners who don't understand the parts theory that Kieran's talking about, this is Internal Family Systems, is the name of the type of therapy and the theory.
Richard Swartz is the [00:44:00] founder and he has a very easy book, I think for lay people as well to look at, which is called No Bad Parts. So we'll put all of that in the show notes and if people are interested to learn some more about that, that's readily available and accessible.
Dr Kieran Allen: Um, it's a great book.
Sharee Johnson : It is a really useful book, I think. I wonder if we might go, into this question of suffering and awareness and stigma, Kieran because I know that you've talked a lot about the stigma of mental illness and mental ill health for, I think in general, when we are talking about the health professionals who, who are providing the care, who are, you know, so-called, supposed to know what to do, um.
And what's that like to be in that role, to have that identity and also be carrying these, these questions of stigma because of your own health
Dr Kieran Allen: Stigma is a very big topic that I could talk about for hours. It, it is, I try and focus my, my thoughts though. It, it plays out [00:45:00] differently in different settings and it's dynamic and it's time dependent and person dependent.
It depends how tired you are when you wake up the next day. The one of the, you know, you talk about those, those points where, where you are, you're thinking just shifts. I realized that stigma is not inherently a bad thing and I didn't think that for a long time. So stigma. Stigma is bad. Okay. Pull the moral judgment away from it for a moment and let's look at what it actually is.
Stigma is a combination of a biological and a sociological and a psychological, mess at times. And it leads to us feeling certain things through an unconscious bias towards someone. It's like, okay, that sounds like a bad thing. It's like, hang on a minute, it's unconscious. So let's just hang on that for a second.
Like, there are reasons beyond your control that that is happening. But what is important is you are able and have a responsibility to recognize that if you let it play out as behavior, you are causing harm. So you may not [00:46:00] have control over the stigma, you may not have control over the bias unless you work on that in the background, but in the moment that it happens, you have a choice.
And even if you are minimally aware of that choice, you know what's sitting there. It, it's, it's guiding your behavior. Um, and as a result, I think people reject the idea that they stigmatize and say, well, stigma is bad, therefore bad people stigmatize. Therefore, if I stigmatize, I'm bad, but I'm not bad, so I don't stigmatize.
And it's this logical fallacy that just, it doesn't stand up to any kind of scrutiny because you look at it and it's like, well, what if it's not bad? And it's like, well, suddenly I could stigmatize and I recognize that I do. It's, it's that first step of saying you can't do something about anything until you recognize it.
If you recognize that you do, let's do something about it. So why, okay, why is there, I'm scared. I'm scared of the person who's here. I'm scared of what they mean to me. I'm scared of what I might fail [00:47:00] with response to them, that that's all coming in. And so we, we come to this point where we act upon that stigma in a way that is sometimes deliberately harmful, but mostly un unknowingly harmful.
Um, so personally. I know, looking way back in my training, the first time I met a psychotic patient, I was terrified of them. I, I was so scared, I'd never seen someone so thought disordered and so, um, paranoid and it was, it was divorced from reality to me. Uh, I'd never seen it before. And so I had that fear reaction and I've thought about that moment for a long time, and I, I thought, I wonder how much of that was me being scared of them doing something, or is it more me being scared of me becoming that?
And the reality is, all of us could, we can all fall into depression, psychosis, anyone can, but we don't like to look at that. And so [00:48:00] it's easier when we stigmatize to put people as another, and that's what we're doing. We're putting people as the other, and we're treating them differently as a result. Now, being on the receiving end of that as a patient is awful.
It really is because I think I'm in a unique spot where most of the time the people who are doing it know that I'm a doctor. And so I know that I'm experiencing it differently to how another patient would. Having said that, it still happens and it plays out in ways that are, are, are quite nasty. You get little snide comments, you get, um, preemptive judgements of what you should do, you get threats, you get told if you don't do something, then you're going to be put under the act, you know? But it doesn't just apply to mental health either.
We do it in, in health more broadly. You know, we see people of a different culture and we presume things about them. Or we see people who are non-English speaking and think, that's too hard. I can't [00:49:00] be bothered getting an interpreter. It, it plays out into discrimination and people get worse outcomes as a result.
And if we care about the fact that our care should be positive and equitable and lead to good outcomes, the best outcomes we can for people, and acting out that stigma as discrimination gets in the way of that.
Sharee Johnson : I feel like I wanna say here, here. We see in the training, surveys and so on every year that this is a live issue. This is a very live issue for people of color, for people with, gender other than male it seems, although I certainly worked with some male, uh, doctors who've had these kinds of issues for other reasons as well so I don't want to other them either. Um, there's a beautiful Buddhist practice, uh, that's called Just Like Me, and it's as simple as that, as remembering to yourself that this person is just like me.
And when we're working with our groups, we teach that if you have a reaction to that, if you say, [00:50:00] no, no, they're not this, I would never behave this way. It's nothing like me, then there's work to do there. Um, that's, that's your indicator that there's work to do there.. And if you say they're just like me, and it, uh, stimulates a compassionate response, then you know, you're available now you can connect and work with the person, whoever they are.
So I think that's, um. I just offer that to the listeners as something that we can do, because as you rightly say, it's unconscious. We can't see ourselves, we don't know we're doing it a lot of the time. And once we notice it, we can actually intervene and, and interrupt that, make a conscious choice about how we want to behave.
And you know, as far as I remember, doctors take a, some kind of oath to be, um, provide care to everybody who comes in front of them. So this practice of just like me is, is very helpful. Do you feel like, these experiences of stigma kind of stack up? Is there a cumulative, how do you make sure, or how do you, I guess it's partly your supervision, how do you make [00:51:00] sure that this doesn't stack up into something like resentment or anger or, or something unhelpful.
Dr Kieran Allen: I, I think it does. I think it does to the point of becoming presumed. And that's the sad part. I think self-stigma is a part of that, but I, it's almost like a learned helplessness. Like you just, you're resigned to the fact that you, you're just gonna feel that people are just going to do it. And whether that provokes more, I'm not sure, but it, it's quite demoralizing. It's quite sad to just think, I'm just gonna be treated differently. And, and that's happened to me like, not, not just in a clinical setting, but in, in a workplace setting where you're just like, this is only happening because of my mental illness.
And, and it's like, well, and it's happening again and again. And it's like, okay, just, I just expect it at this point. It's like, you know, and it's, I don't think most of the time, um, behaviors that lead to that stacking are inherently malicious. I, I think [00:52:00] it's, people trying to do their best in a system that doesn't tolerate, sickness, doesn't tolerate time away, doesn't tolerate any of that.
But with our patients, I think it's similar, like the, the most obvious one within psychiatry is people with borderline personality disorder. That is a, whatever you say about the validity of the diagnosis, it's a harmful diagnosis because it, it causes people to be treated differently. As soon as those three letters, BPD are written on a piece of paper.
It's one of the most stigmatized illnesses in medicine, in psychiatry. And you're already dealing with people who are traumatized for the most part, and that experience of stigma and discrimination and retraumatization compounds, and it makes them clinically worse. They, they, they absorb that idea that they deserve to be treated poorly, which is often something they have preexisting from their, from their trauma [00:53:00] from younger years as they were actively causing iatrogenic harm to people through the enactment of that stigmatizing attitude.
Um, and I think it, it occurs across people, you know, it's not, oh, the same person's doing it to me again and again. No, it's actually worse. I think when, um, you see it repeatedly through a system as a, as a patient and you see that there could be one way of doing it and it's not done and it's not done to you.
And it's like, well, why, why is everyone treating me differently? And the sad presumption for most people is that it's because there's something wrong with them because they're bad. If you bring it back to doctors who, who are not achieving that goal of wellness immediately, that's the presumption too. When you've got a system that struggles to support you, it doesn't look like that when you're through it, it's not about struggling. It's like, I am being treated differently. I'm being harmed in this process. [00:54:00]
Sharee Johnson : Mm-hmm. It's, it's very easy to see the evidence when you're feeling like, is it me? And there's this repeated evidence. You, you're also touching on that the thing about linear, we talked a bit before about, you know, that life is not linear and
Dr Kieran Allen: mm-hmm.
Sharee Johnson : Medical training is not linear, you know, it goes in all directions up and around and backwards and forwards and backwards and forwards. And you're touching again on that expectation that, if a person, any person, including doctors and nurses, in allied health, have an illness, they get better and they come back to work. That's simple. It's easy. But those who have, you know, people who have chronic illnesses, physical chronic illnesses can do this too, where they're at work and then they're not at work, or they need extended time off, or they need slower returns to work.
I wonder if there was one invitation that you wanted to send out into the world from this conversation to, to all of us in health about how we might respond to that in a more psychologically flexible way, a more compassionate, curious way. What, what's the invitation that you would make to people?[00:55:00]
Dr Kieran Allen: I think one of the more helpful ways of looking at it is to reject that binary of well and unwell. It's not helpful. It's not helpful in the sense that it doesn't capture where people are at over time. It doesn't capture people who are somewhere in the middle and getting better or getting worse.
And it, it idealizes a state of wellness that can prove counterproductive and, and quite dangerous for people. So I think recognizing that people are on a, a journey of ups and downs. Everyone is, everyone struggles through things. Um, and not needing them to fit within a certain identity of well or unwell or fracturing that identity into, this is my clinical self and I'm struggling with the rest of my life over here, and neither the two shall meet.
These , binaries are, are harmful, I think. And to, to get away from those is, is critical. It goes even further. I mean, I, [00:56:00] I mentioned that fracturing, the, the idea that, um, we have to aspire to a single identity, um, is inherently problematic because it means that we try to repress parts that we don't like, the bad parts.
Those binaries are good and bad, like I was saying before, start to become real sources of tension for people and quite distressing for people.
Sharee Johnson : You've used the word state quite a few times, and I dunno if that's a particular thing because you're a, a training psychiatrist, but it's, um, it's evident in, in the way that you're talking, and I, I, I wonder if it's useful to just talk about what a state is.
'cause I think maybe that's helpful for people in, in terms of thinking about this, this state of flux that we're all in all the time that we're, you know, we are dynamic. Can, can you say a little bit about that to help our, our thinking?
Dr Kieran Allen: I think I perceive that as almost like a moment. When you're in a certain state, you, it's looking at, you cross-sectionally in one moment.
You have all of these things going on in [00:57:00] your life. Um, and today, on a Friday at one o'clock, this is how you're feeling right now. That may predict to a degree how you're going to be feeling at five o'clock or on Saturday , but we don't know. And that's, that, that state isn't, is a, is an insight into probability, but it doesn't actually tell us what's gonna happen.
But we have to work with what we know. And so if we know that your state has been deteriorating, the probability is that it's probably gonna keep deteriorating. We have a responsibility to intervene and for ourselves as well.
Sharee Johnson : Mm-hmm.
Dr Kieran Allen: But it also means that that can improve to a, a different state, a better state.
Um, but the fact that it's in flux is okay too. We don't need to sit in a permanent state of wellness now. In psychiatry, the bane of my existence is, is risk assessments. I have a lot of colleagues, a lot of clinicians who are obsessed with doing risk assessments and thinking that, you know doing one [00:58:00] three weeks ago and sending that through as a referral is, is somehow relevant to today, because things change so much for everyone, that state changes. Um, and we may, as I said, we may be able to predict from it, but we need to look at how we are in the now and how we respond in the now. A lot of anxiety that I see is because of not knowing what's gonna happen or not knowing how to control it.
And there's that false sense of control of the future state of being like, if I worry about it somehow I'm in control of it, you're not. But it feels like you are.
Sharee Johnson : Mm-hmm. Yeah, that's the paradox of anxiety, isn't it?
I, I think fatigue is perhaps one that people, most people can get hold of pretty easily.
If we think about, our state of energy or our state of fatigue, is something that's, most people have some experience of that over, say the course of a week or, or a month or a year, people can relate to, oh, I was so fatigued and I can see that my decision making was poor or, or, you know, I, I needed to have that day off because I was [00:59:00] becoming dangerous in some way or other, in my medical decisions.
Or is there anything you can reflect on, perhaps around this idea of state and also about fatigue and burnout and moral injury that kind of whole, let's call it a spectrum?
Dr Kieran Allen: Yeah, I think fatigue's a really good, um, analogy for, how one is feeling more broadly because, it's not perfect to hang your hat on, because you can deny it, but you can see it a bit easily, a bit more easily.
You feel it like you tired, you have to sleep.
Sharee Johnson : Mm-hmm.
Dr Kieran Allen: Um, and so as, as a reflection of how one is feeling more broadly, it's probably a good tool.
As a bit of a, an early warning sign. But I think noticing those sort of things is, uh, is I think a bit of a responsibility of yourself , as a clinician, but also looking for that in your team.
I was chatting, not long ago to a few colleagues, and I could see they were stuffed. They were so tired, I don't know that they could see that. [01:00:00] And I, I just sort of said, I'm worried about you. I can see that you're working a lot and you seem really tired. And they sort of went, oh, I'm fine.
But it at least opened the door to a further discussion. And I think having, having the willingness to, to do that and not be scared that the person's not going to engage or gonna reject you or any of those things, would be a really useful tool.
Sharee Johnson : Thinking about, this state of fatigue and what role that might have or, or using that as an example to think about our awareness of that in relation to burnout or moral injury.
Dr Kieran Allen: , As I said, it is one of those early warning signs that we can look at and, , whilst, whilst burnout strictly is not a mental illness as such, it feels like it when you're going through it.
Um, and I think it, it tells us that something's wrong and that early sign of fatigue is a, is an alert that something's wrong.
Sharee Johnson : Mm-hmm.
Dr Kieran Allen: Um, once we start to explore, oh, what could [01:01:00] it be? Then we start to get into, well there's all these stresses going on that are leading to me feeling like this and I can't do anything about it. The part that you can do something about is answering the question, do I need to pause? Do I need to use this fatigue warning sign as license to pause? And that's a hard thing to allow yourself to do. But I think the more we explore this, um, across healthcare, the more we acknowledge that it, it can be reasonable to jump in at that point and to try and head off getting to the point you're taking two months off because you're so, you're so burnt out and sick. Then I think they're useful tools.
Sharee Johnson : Mm. I wanna just, touch on the idea of, empathy and compassion fatigue before we move to wrap up our conversation. It is a misnomer to talk about compassion fatigue. It's a bugbear of mine that the research has really shown us that it's empathy fatigue, empathic burden rather than compassion [01:02:00] fatigue.
So, that's my own little soap box, but I, I wonder if you might make some comments before we finish, Kieran, about empathy and, and compassion and the, the roles that they might play, both in taking care of better care of doctors systemically, and also in being a doctor.
Dr Kieran Allen: Yeah, I think you mentioned moral injury before, which I didn't touch on that, that comes into this. The desire to provide care and empathetic care and compassionate care, I think it's there for most people at baseline. Most people want to do that, but the stuff that gets in the way makes that harder. It makes it so that gets relegated to a secondary consideration. Time is the biggest one.
We just don't have time to do it well,
Sharee Johnson : yes, it's,
Dr Kieran Allen: um, and so we feel stressed, we feel exhausted, but if patients feel like they don't care, they've been here for two minutes for a ward round that I didn't know what time they were coming for, you know, and [01:03:00] it's, it's interpreted in a totally different way to what we see it.
That doesn't make it any less valid. That's their experience. They've got this illness that they're experiencing. They have no idea during the day when anyone's coming, they're eating garbage food probably. Um, and being poked and prodded by nurses all day. And then to have the person who's making decisions about their care come and spend two minutes with them because they have to and because they have no more time to, everybody suffers in, in that dynamic.
And the doctor suffers because of that moral injury. And it's like, well, what do you mean by that? It's the, we know what we want to do to affect good care. I know, for example, that discharging someone to a supported environment, even if they have to have ongoing treatment, is going to be much more likely to continue their hopeful state of wellness that we've gotten close to in the inpatient unit.
But the number of times where I have had to discharge [01:04:00] people to a car or to the, to the street, knowing how dangerous that is, and knowing that they are not going to stay well if I do that, but there being no other choice. That hits home, that hits hard because it's like, I am choosing for this person to experience that, um, because there's no other option.
Um, or, or there feels like I can't access any other option anyway.
Sharee Johnson : Mm.
Dr Kieran Allen: And I think what one of the reactions to that is, is to shut off and to, and to become numb about it. And that comes through to, to patients. There's, there's this detached, oh, we're just doing this. Um, and I think the danger too is when we are truly empathetic, we, we actually move from being an authority to an advocate.
And, and we, we shift a little bit to being able to support patients with providing them the expert opinion, the expert advice that we have to [01:05:00] make a decision that's best for them. And we, we struggle with that because we struggle to connect with the fact that that might be different to what we think is the right decision.
And if we've been truly empathetic, we need to connect with why, why do they want that?
What, what is the value to them of, um, engaging with a decision that is different to what is me medically recommended? Um, and again, it disconnects us from being able to be compassionate because we feel like they're being bad or, they're making a bad decision.
And the danger too is you'll often see that's where coercive treatment comes in. Where, and not just in psychiatry, I mean like on, on the medical wards where no one questions someone's capacity until they disagree. And as soon as that happens, that's when the capacity question comes up. And it's like, well that's not truly being compassionate or empathetic. That's, you know, bringing out a legislative tool when they don't agree with you.
Sharee Johnson : It's in some ways managing time.
Dr Kieran Allen: Yeah, [01:06:00] exactly.
Sharee Johnson : Or other resources.
Dr Kieran Allen: I think part of it comes from a true desire to do what is best for the patient. And, and sometimes that crosses over into, um, telling the patient that they're doing the wrong thing or, or forcing them to do something they don't wanna do.
Sharee Johnson : Mm-hmm. Mm-hmm. We could talk all day, I suspect, I just wanna touch on one thing, that's in your bio, this beautiful expression of, how can we create cultures where vulnerability is valued? And I wonder if you'll speak to that about this phrase of valuing vulnerability. It seems a very powerful idea to me,
Dr Kieran Allen: I think it is because it, it shifts our current goal from supporting people who are experiencing difficulties or, or experiencing, struggles within the workplace to, not just how do we get them back to where they were and um, get them back to functioning doctors, functioning healthcare professionals, but [01:07:00] taking an approach that has been used by the lived experience movement, and in mental health, and saying, what I have gone through is valuable in and of itself.
From their point of view, I don't need to be a clinician for this to have value. I think appropriating that is, is quite useful because it's not the same, obviously as I said before, me being a doctor patient in, in, in a medical environment is not the same as being a patient. Um, but it comes with unique insights that someone who has not been through that won't understand until that is shared.
And I, I think how do you do that? I've reflected on that for a long time. I think you have to be able to use tools that allow people to connect with that. I think, well, what, you can't just say, oh, this person, you know, they've gone through this and look at them. Now they're, they're doing so well, that that's not real.
I mean, sure, that's the point they're at now, but that's not the journey they've been through. And so I think it's much more [01:08:00] about sharing the stories of people who have experienced real distress and the impact of how the system reacted to that, that's most beneficial. And I think of two people who have done that, really, three people who have done that really well.
And the first really kicked off my, my interest in this, and that was Geoff Toogood. Watching his, so he was the founder of Crazy Socks for Docs. So watching his, speech about his experience of suicidality was profound. It, it, it was life changing for me, hearing that, um, because it was so raw, he was sharing in excruciating detail. I felt every moment of that speech.
And the same thing applied when I read, Steve Robson's piece, who was the former a MA president. He wrote about, his very close [01:09:00] suicide attempt on the ward. Um, and was stopped by some of his colleagues who knew that he was not in a good place.
That was about 30 years, 35 years ago now. But he didn't tell that story for a long time because he felt like he couldn't, but when he did, it hit home so hard for people because it was just, again, a moment in time that he was in complete distress and felt in despair and couldn't find a way out of it.
And it, it was just so powerful. But then even in a, in a more medical sense, I've been listening recently to, um, a audio book from a doctor who formally had, um, bowel cancer before he got into medical school. So it's Dr. Ben Bravery. He, um, who I think you did a panel with sometime ago.
Sharee Johnson : Ben's coming out to uluru with us for our
Oh, fantastic.[01:10:00]
Heart of Medicine. Yeah.
Dr Kieran Allen: Yeah. , I think listening to this as an audio book really had a, a, a powerful effect beyond just reading it because I felt so connected to his journey through treatment, through medical school. It was, that rang true for me so much. But his, his experience through treatment in particular just hit on so many points that patients value and experience and are not done well, that it just.
For a doctor to be talking about those experiences and for me, having experienced some of them myself, like that is so validating and, and it's more than just validating to me, it's valuable to understanding how we engage with patients more broadly. And that's where the value is. It's not just, oh, hearing the story makes me feel good.
no, what do I learn from this?
And if I'm learning that, you know, I gave the experience of the ward round, things like that and actually doing something [01:11:00] about it, that's where the value comes from. That's where we're actually able to use these stories, use these experiences for positivity and for improving healthcare.
And that's exactly why I think being able to blend one's clinical experience with what we have experienced in our lives, that doesn't necessarily even have to be ill health, but that's the example I've got, can be powerful for how we engage with patients and make healthcare a better experience.
Sharee Johnson : Mm. Well, I think you are certainly in that list, Kieran.
I mean, when I heard first learned of you, I think that was through the Gathering of Kindness, probably six, seven years ago, sharing, you know, sharing your story. I think that, you know, these stories are powerful. That's what we resonate with. That's how we understand our own experience and other people's experience.
I think there's some research to say that people who read more fiction books have, uh, more, more empathy because they're, you know, learning about characters and how people respond to things and to each other. [01:12:00] So, you know, I'm just deeply grateful to you and to the, the other three people that you've talked about.
I've been lucky to, to learn about all of their stories too. And, and again, we'll put all of that in the show notes. I think maybe it's a, a good place to kind of come to our finishing where I think you used a lovely, uh, phrase when we were preparing for our conversation today, talking about that, um, that we don't want doctors to be some sort of beige version of humans.
I, I love that expression that we don't want our doctors to be, this kind of beige, I mean, let's, let's work with the robots if that's what we want. And we know that we don't really wanna work with the robots. We wanna work with human beings. And so, um, you know, you've done a just incredibly beautiful, generous job today of showing us a lot more of your humanness and, and your whole story.
And I think that, um, you know, shifts not just other doctors and other healthcare professionals impression of who they can be and what their identity or self might be in relation to their work or including their work. But it also can help the general population think about who's this [01:13:00] person that I'm meeting?
I think, um, lots of doctors have experience of aggressive patients, not because of mental illness or any other thing, just because of Dr. Google, you know, this sort of, I've got more rights kind of, uh, way that we are in the world now. I think it serves us all well to have a more grounded idea about two people, three people, 10 people meeting together in a room to have a conversation about a shared purpose or a shared outcome.
I think we all can benefit from that. Do you have, something that you say to yourself that helps you keep going when, things are tricky as they are? What are the things that you can say to yourself to help you keep going, um, not so much to push through, but to keep going in, in useful, kind, self-sustaining ways.
Dr Kieran Allen: I think what I learned when I was really, and multiple times, in the, the depths of suicidality was the [01:14:00] thought that this will pass. It's a time thing, I'll be okay. Mm-hmm. It's not saying it fixes it, but it gives me space to press pause and let things just be okay for a moment.
Sharee Johnson : Mm-hmm.
Dr Kieran Allen: When you are in that bad a space where you wanna act on it, time can be critical.
Sharee Johnson : Mm-hmm. Yeah. Well, I kind of wish that this moment wouldn't pass. I've really enjoyed talking to you this morning, and I really appreciate the open, sharing and, and the really thoughtful, um, you've been on this journey of thinking about how health works for everybody for , a long time, and I really appreciate you sharing your wisdom today.
So thank you for being here with us.
Dr Kieran Allen: Well, I really appreciate the, the opportunity. I hope people get some value from it.
Sharee Johnson : There's really a lot to think about when, you listen to Kieran talk about his clinical experience and his lived experience of health and illness. I think we make a lot of assumptions, and we talked a [01:15:00] little bit there about stigma, about what, uh, the other people are going through, whether whichever role we're in, whether we're in the patient role or the health caring role or the colleague role or, you know, probably the executive and the college.
There's a lot to think about. If these issues were simple, we would have resolved them and wouldn't have any cause to talk about them. I really love Kieran's idea of valuing vulnerability. I think that's a beautiful extension of, the Brené Brown work around vulnerability. And thinking about rather than these binary ideas or these train track ideas about how we push people through or how we push through ourselves, what about if we were pausing and, and noticing and naming that this is a moment of vulnerability, or my state at the moment, to, to use Kieran's language, is of vulnerability.
And what do I need in this moment? And this humility that Kieran represented of when he was [01:16:00] very unwell and saying, "Well, when you're in hospital with deep depression, you really need other people to make those decisions." And wow, doesn't trust become incredibly important in that moment?
Kieran also pointed to this, prevention idea of having a clinical team or having a support team, might be language you prefer, that you're relating to all of the time, that you're building relationships with all the time. It might be your GP, your psychologist, your psychiatrist, uh, your speech therapist.
Could be any professional person. Might also be your family and friends who you trust and disclose a bit more to. "I'm so exhausted. I don't think I can keep doing my clinical work. I need a break. Um, I'm frustrated with the complex systems I work within. I feel like they undermine my capacity to deliver the care I want to deliver."
Saying these things out loud to people before [01:17:00] there's a crisis allows us to see ourselves, to understand ourselves, and to have the ready support if we need it. I hope you've enjoyed this conversation with Dr. Kieran Allen, psychiatrist in training, um, generous human being. And I look forward to seeing you next week.
And until then, may you be well
