Living a dual life

Since starting her own private practice, Dr Philippa East has chosen to work part-time, keeping her clinical work to two days a week. She spends the rest of her time writing. It sounds like this rebalancing was always inevitable.

'Books are in my DNA,' she tells me. 'I grew up without a TV until I was about 11, and read voraciously from a very young age. Strangely enough, although I often wrote stories as a kid, I never considered writing seriously until I was about 30. At this time, I was moving jobs to the Maudsley Eating Disorder Service and I had a true week off with no clinical issues to think about. I suddenly realised I had an idea for a novel. I then spent two years writing it and found myself gazing at the manuscript of – you've guessed it – an atrocious novel. But I enjoyed writing. I joined an online writing group and started writing short stories – a good form to take up around a full-time job, and a good way to experiment with the craft. When I started getting these published in literary magazines and even winning a few prizes, I realised writing was really something I could do. I had tried lots of creative pursuits before – drawing, pottery, photography, music – but I never felt at home with any of them. Writing felt like the perfect fit. Then, when I left the NHS to become self-employed I started writing another novel. For about six months I had a mentor, which was brilliant, and I'm still a member of various writers' groups who support me in the writing journey.'

Philippa says that she writes short stories in any genre. 'I've written ghost stories, speculative fiction, dystopian tales, love stories. At the heart though, I write about relationships, the human condition, how we tick. I'm a slow writer: I write the first draft quickly but then rewrite and rewrite: my novel is on draft 13. It's a process of finding out what you want to say – you start writing for yourself and end up working out what you want to say to others.'

Psychology is rich fodder for fiction, film and other writing. Since novels like The Silence of the Lambs, serial killers and forensic psychologists have been hugely popular figures in crime and thriller entertainment… it's easy to forget that, once upon a time, crime fiction tended to focus on amateur detectives solving murders within families. Publishers even refer to a genre they call 'misery lit', which comprises stories examining the psychological traumas and behavioural implications of abusive upbringing. Philippa offers consultancy to writers seeking to use psychology in their work. 'This is done as informal advice, not as a paid service, but I see it as an interesting bridge between being a writer and psychologist. Let's face it, the stigmas of mental health problems have been strengthened by serious misportrayal in fiction and films, such as the inevitable psychotic killer. Some writers perhaps choose drama over accuracy, or some writers simply don't know enough to realise the mistakes. But many want to get it right and that's where I hope to help. Someone I advised started with a simple technical question "Do they have locks on the bedroom doors of a psychiatric unit?" and it went on from there as he realised how much more there was to know.'

Are there any books that really do seem to get it right? 'A Little Life by Hanya Yanagihara is amazingly accurate in its depiction of complex trauma.'

I wondered where Philippa's journey started. 'There was no psychology at my school. I enjoyed learning and my A-levels – or rather their Scottish equivalent since I spent a lot of my childhood living about 30 miles east of Edinburgh – were in classics and arts subjects. I was originally going to study ancient history and philosophy at university, but the obvious question was "What job can I get with that degree?". I ended up doing a combined degree in psychology and philosophy at Oxford.' Where did the psychology come from? 'I've always been interested in people. In retrospect I'm a human archaeologist. The phrase next to my photograph is my school yearbook was that I was most likely to "have a heart to heart". My Aunt was an educational psychologist, so it's a thread in my family, but the link between writing and psychology shows that trying to make sense of the human condition is always an art as much as it is a science.'

'I saw great links between philosophy and psychology too – the obvious area is the overlap in their concern for philosophy of mind. Writing and philosophy also go very well together. Both disciplines refuse to take things for granted and seek to imagine what things would be like if they were different – the classic "what if…?" question.'

Again, the issue of what job she was going to do came up: '…so I googled psychology jobs and got interested in clinical work. It was fairly competitive to get onto training back then; not as bad as now but still hard. What attracted me was that they offered the chance to take on a therapeutic role while still continuing my interest in academic work. So, I signed up for various voluntary placements at university, roles like being a welfare officer, to build up required experience. After graduating, I got an assistant psychologist role in an outpatient eating disorder service in Southampton and then applied for the doctoral training programme.' Philippa got turned down by three of the four courses she applied for – including at her own university – but got taken on by the Institute of Psychology. 'I had a first class degree from Oxford; maybe they liked my academic record, even though I had very little clinical experience.' The course was CBT heavy 'so I took opportunities to learn about other approaches and had placements in health psychology and eating disorders, where I leant about IPT and CAT. And my interest in writing cropped up again when I wrote my dissertation on the use of therapeutic writing in the treatment of anorexia.'

Philippa says she has a 'two to two-and-a-half-year job cycle – a typical amount of time it takes to complete a novel, funnily enough. My first job was in a community mental health team. That's a good role for anyone newly qualified as it widens your experience of different clients, disorders and approaches. Then I spent time at the Maudsley Eating Disorder Service, where I'd previously had a placement before moving to Lincolnshire – my husband is a psychiatrist and moved here for his work with the RAF.'

After working in a specialist complex case service in Lincolnshire, during which she learnt further therapeutic approaches such as EMDR, Philippa felt confident enough to 'jump the NHS ship': 'I didn't really get on with the NHS in the end, and I've also come to accept that I'm not necessarily a great team player. In addition, after our move to Lincolnshire, I'd gone back to working five days a week… I was
keen to work part-time again.'

What's it like working in a private practice after working in the NHS? 'I can help people better, and I can see people much quicker when they are keen to get going. The delays in the NHS were at times soul-destroying. I can also see a wider range of people rather than specialising, and I can choose more what sort of caseload I want. A downside, though, is that people can struggle to pay for private psychology services.' Did you find it difficult to set up your own practice? 'At the beginning I panicked because I had no referrals. But I pounded the pavements and built up a caseload. You can feel isolated and somewhat exposed. Support and supervision can be a problem, but there are several of my NHS colleagues who are now also in private practice, and we support each other.'

I ask Philippa to sum up her dual life. 'I see my clinical and writing work as complementary, they have a common root. But I don't draw material directly from my case work to use in my writing.' And your plans? 'Well, I hope to secure a publishing deal for my novel in the not-too-distant future. However, even successful writers don't earn much, so I'll be keeping the day job!'