You Don’t Have to be Mad to Work Here by Benji Waterhouse

Reviewed by Liz Dexter

This book is also about me and about why anyone in the right mind would choose to be a psychiatrist. I hope that it serves as a reminder that the person beneath the white coat, or in my case the elbow-patched jacket, is also human. And that the blurred lines which define what we call sanity or mental illness aren’t always neatly divided by a doctor’s desk.

Given that Waterhouse is a stand-up comedian who also works on the front line in the NHS and has written a book that takes us through his speciality training in psychiatry, there are comparisons to be made with This is Going to Hurt by Adam Kay. I haven’t read that book, as it felt like it was going to be a bit too full of gory medical detail for me (but Annabel did here); this has some gory medical detail but the details are mainly based around grim circumstances and psychological reactions to them, so it’s not a read you have to do from behind the sofa, so to speak. 

There are twin narratives here: that of Waterhouse’s journey from junior doctor to consultant and stories of the colleagues and patients he meets along the way; and also his journey through his own mental health struggles and his family background, which is complex and traumatic and needs picking through with his own, rather amusingly described, therapist. This gives interesting angles to the book and makes it more personal, but the two parts are well-balanced in my opinion. We also see Benji’s struggles with relationships and a developing love interest which add depth and also conflict to the book. 

Waterhouse is at pains to show us, through work with inpatients and people in the community, the realities of life with perhaps more serious conditions than those that are being talked about a lot at the moment: we’re talking “chronic, severe labels deemed messier, uglier or outright feared – such as schizophrenia or bipolar, personality disorders or substance-misuse disorders”. He works hard to show us the people behind the disorders and the circumstances which have often conspired to give rise to them and/or make them more critical, whether that’s chaotic families and relationships or conditions of poverty and homelessness. Although there’s a vein of the classic dark humour of the paramedic or mental health nurse, he comes across as humane and caring, worrying when he becomes a  bit more brisk than he used to be in order to clear beds as he realises the state of the NHS. 

By the very nature of his job, and the fact he’s moving around facilities during training, we don’t get a lot of long-term views of patients; however two of the most affecting ones do crop up a few times through the book, giving coherence to the narrative arc. There’s also his potted cactus, of course, surviving offices from windowless cupboards onwards as he progresses through his career. 

Of course the state of the NHS is explored in horrific detail, from not being able to help people immediately to having to ship people off to the other side of the country for treatment or to send them back out on their own before they might be ready. There are a few heart-in-your-mouth near misses for Benji’s patients and devastating events for others. I’d say you might need to be feeling like you’re at a resilient time of your life to read this book, but it should also be required reading for NHS bosses, government ministers or those who have a rosy view of mental poor health treatment in the UK. 

There’s a list of useful numbers at the back of the book for a range of different needs, which is welcome and nicely done. 

Liz Dexter blogs about reading, running and working from home, and is one of the Mental Health Champions for her running club, at http://www.librofulltime.wordpress.com.

Benji Waterhouse, You Don’t Have to be Mad to Work Here (Jonathan Cape, 2024) ‎ 978-1787333178, 336pp., hardback.

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