This site is intended for health professionals only

Illness below the waterline

Marie had been abused as a child. The abuse had been passive rather than active. She’d been ignored most of her childhood and on occasions, when the mere fact of her existence had irritated her parents they had locked her in a cupboard.

The slip became a fall

Denied access to the external world, she had taken the only other option available and retreated into her own inner world.

Despite this inauspicious start in life Marie had done well academically and after finishing school had gone on to study mathematics at university. After graduation she had secured a good job as an actuary and had, by most people’s standards, made something of herself.

It was in middle age that the clues appeared. By nature a reserved character, she had started coming home uncharacteristically jolly and excessively talkative.

She would arrive home later and later as ‘evening meetings’ became more frequent.

Then there were the vodka bottles hidden in the bottom of the recycling bins and the small sachets of white powder, which when challenged, she would insist were ‘just something off the internet to help me concentrate’.

The slip became a fall and frequent absences from work became long-term sick leave which led to early retirement on health grounds.

Marie disappeared one day and despite the best efforts of her partner was not found for six months. In her coat pocket were dozens of tickets for return train journeys across the country. Marie had spent the final months of her life travelling the same route back and forth before she sadly ended her own life.

Marie had only ever seen her GP for the most routine of reasons and it had been only her partner who had had the briefest of glimpses into her inner turmoil. I never met Marie, but I heard her story, related in several instalments from her partner, while I was treating her for depression.

Marie’s story is particularly sad as despite her ability to function at a high level, she lacked the tools to express her inner angst, even to those closest to her.

We are taught about the clinical iceberg at medical school – like the bulk of the iceberg below water, most illness and disease will never be seen by a doctor – Marie’s story epitomised this fact. Her cries for help had been infrequent and muted. Even if they had been heard would anybody have been able to help?

Marie’s early experience of life had been to distrust others, even those you should instinctively trust and she had shut down and learned to rely on herself alone. When self-reliance failed she self-destructed.

We are getting very good at treating the big visible illnesses like heart disease and cancer, maybe the next big challenge for us as a profession is to treat the illnesses hidden below the waterline.

Dr David Turner is a GP in west London

Other writing competition entries

(Winner) Dr Renee Hoenderkamp: ‘I knew I was breaking every rule’ 

(2nd place) Dr Helen Cotton: My son’s call for help saved me

(3rd place) Dr Richard Cook: ‘I tried to speak, but no words came’

(Under-35s winner) Dr Heather Ryan: Sometimes you need to break rules to be kind

(Runner-Up) Dr Celine Inglis: Being a doctor puts you in a strange position for tragedy

The best of the other entries