Martha had been an extremely competent teacher who passed up on being a head because she preferred the day-to-day interaction with children that classroom teaching involved. So she remained a highly respected department head in her secondary school, which got glowing reports from Ofsted. But then something happened that, for the first time, made her reconsider whether teaching was a profession she could stay in. It was an event that led her to the Maudsley hospital. Her GP referred her to me after she had taken two months off on sick leave.
Martha had taken Cathy, a bright 15-year-old who was predicted to get excellent GCSEs, under her wing. She was encouraging Cathy to pursue her dream of becoming a doctor - a career previously unheard of in Cathy's tough, working-class neighbourhood. Then, one day, Cathy's parents came to a meeting with Martha and the head to explain that Cathy had been diagnosed with leukaemia and the prognosis wasn't good - doctors had said she was unlikely to survive another year. But this news had been kept from the girl, and Martha wasn't sure this was a good idea. She got into a tense argument with Cathy's parents and the head about how it was all being handled.
It soon became apparent that something was seriously wrong with Cathy as she lost weight and her hair. Martha held special classes where leukaemia was discussed so her classmates could gain a better understanding of what was happening to Cathy. But it upset Martha all the more when Cathy spoke so naively and bravely about what she wanted to do with her life after leaving school and getting her qualifications.
Martha found announcing to the class the details of Cathy's frequent readmissions to hospital extremely draining. And her husband, an accountant who had long felt that Martha was over-involved with her pupils, was unsympathetic and unsupportive: he believed her family life was frequently being sacrificed for her teaching.
Martha helped organise home tuition for Cathy when she eventually became too ill to make it to school, and liaised with the clinic and the hospital ward when Cathy was admitted to help her complete some of her assignments.
Classmates visited Cathy in her last days, but Martha was caught in a conundrum - seeing her star pupil emaciated in bed was too much to take and she stayed away from the hospital towards the end. Again it fell on Martha to tell the whole school - and first Cathy's class - when she died. She felt unprepared for the task. Again she was in deep conflict; should she show how upset she was or be strong for the children, who needed her most at this time?
Unable to concentrate on work, Martha reluctantly accepted the head's admonitions to take some time off. It was the first time she'd done so in her life but, oddly, once she was at home, she began to wonder if she could ever return to school as she realised she found her relationships with her pupils too stressful. It was at this point she was referred to me by her GP, concerned at her deepening depression.
Recent research by Bob Spall and Grace Jordan of the North Staffordshire Healthcare Trust has highlighted the problems teachers have in dealing with loss among their pupils. Teaching is widely acknowledged to be extremely stressful, but one neglected issue is that good teachers often form strong bonds that may end tragically - one UK survey suggests almost one in seven teachers will experience the death of a pupil. One of the big issues for educators is that the other children in the class usually turn to their teacher for support, so teachers have to act as emotional props for a large number of others just when they themselves need psychological sustenance.
Even outside the particular strains of bereavement, trusted teachers often find that pupils confide in them a wide variety of issues they are unable to share with their parents. This involves careful handling: the child's trust must not be violated, but the family also needs to be encouraged to create the kind of atmosphere where the teacher is not the first port of call in a crisis. So teachers often find themselves becoming a kind of surrogate family therapist, as well as shouldering all the other responsibilities of teaching and administration.
This turned out to be an important issue in therapy with Martha. She was used to being a highly proficient teacher but found her perfectionism became self-punitive when she had to deal with Cathy's terminal illness. It was useful for her to see that there are no right or wrong answers when it comes to these confused and chaotic emotional issues. She'd tried to perform in the arena of child support as she had as teacher, which was impossible. She had also possibly shouldered too much responsibility for making Cathy's life turn out well, a common issue with many good but over-involved teachers.
Martha came to see that it was all right to appear upset in front of her pupils when having to tell them Cathy had died. In fact, she had done magnificently in difficult circumstances, as she maintained enough control for her class to come to her afterwards for individual support.
She also learned that she had relied on her success as a teacher as reassurance that things were all right in her life, and she needed to divert some of her energies to improving her relationship with her husband.
She needed to have confided more in him about what was happening, and he needed to be more sympathetic.
Martha eventually returned to school. She came to see in her therapy with me that it was not just Cathy who deeply needed her, but all her other pupils too.
* Teachers' health, Talkback, page 26
Professor Raj Persaud is a consultant psychiatrist at the Maudsley hospital and senior lecturer at the Institute of Psychiatry in London. He is a fellow of University College London, and author of From the Edge of the Couch published by Bantam Press, pound;12.99. His weekly column returns in Friday magazine next week