Retired from clinical practice after more than 30 years as an NHS psychiatrist, Linda Gask first trained in medicine in Edinburgh. Now Emeritus Professor of Primary Care Psychiatry at Manchester University, she has worked as an advisor to the World Health Organisation in the management of depression, anxiety and other mental health problems in primary care. She also helped found the STORM suicide prevention initiative. She lives partly in Orkney, where she wrote large sections of the book, and partly in Yorkshire.
A subtly moving, informative and hopeful testimony, Gask’s The Other Side of Silence is subtitled A Psychiatrist’s Memoir of Depression. Her aim is to show that, whether you are caught deep in the jaws of” depression and low mood, or care for someone who is struggling and unable to recapture a sense of hope, “there is always a way forward.” The title comes from George Eliot’s Middlemarch: “If we had a keen vision and feeling of all ordinary human life, it would be like hearing the grass grow and the squirrel’s heart beat, and we should die of that roar which lies on the other side of silence.’
When one in four experience mental health problems, this book could perhaps be prescribed as bibliotherapy. But that would underplay the strengths of a memorable book worthy of wide acclaim and more accessible to a general readership than some of the current classics in the field. It explains in simple terms how the complexities of ordinary life can be overwhelming when combined with specific vulnerabilities, and illustrates this through Gask’s own story.
We follow the trajectory of her career and her illness over many years as tales from her childhood and adult life are interwoven with examples of her therapeutic work with patients and concise descriptions of various conditions and treatments. This is done so cleverly and with such a light touch that I didn’t even notice until well into the book the pattern whereby a key experience of Gask’s is followed immediately by a perfectly balanced patient scenario covering almost identical psychological ground from the ‘other’ side. Writing as good as this doesn’t come across as contrived, but as elegant. The effect is to emphasize with compassion how similar we all are and how common these problems can be. And yet mental illness can appear extraordinary and be accompanied by stigma, shame and isolation despite the many good efforts that are made to reduce these.
I found Gask’s own story engrossing. She shows how the help of psychologists, psychotherapists, psychiatrists, medication and learning about our own vulnerabilities and how to cope with anxieties all have a role to play. At the same time, much depends on individual circumstances and the skills, training and personal empathy of those providing support and help. This is a measured professional speaking candidly about her work as well as her depression. When she criticises the medical profession for various failings, you know exactly why she is doing it (although she concedes that depressed people may sometimes react in ways that colleagues and loved ones can find difficult). She doesn’t rant even where it is clear that she has strong views and is calling for change – for example when she hears that roar from the other side of being silenced in her own head and challenges managers after a patient is sexually abused by a member of staff on a psychiatric ward.
Gask refers in passing to Kay Redfield Jamison’s Classic An Unquiet Mind which is her account of suffering from manic depression (now known as bipolar disorder), while working as a psychologist and professor of psychiatry. Gask’s writing may not soar, like Jamison’s who penned other major books in the field, including Touched with Fire and Night Falls Fast: Understanding Suicide. But her memoir is still spellbinding at times, as well as having some twists and turns that show, once again, that truth can be stranger than fiction.