Some of the most successful people I meet as a psychiatrist are also some of the most dissatisfied with life. They don’t necessarily look unwell. They are executives, entrepreneurs, doctors, lawyers and high achievers. They run companies and families. They are the people others depend on when something goes wrong. Often, they are exceptionally good at coping. Until they aren’t.

Holly* came to see me after years of depressive symptoms and worsening substance use, both of which she had largely managed to conceal from family, friends and colleagues. Her GP recommended a residential treatment program. In her early 40s, she held an executive position in a demanding organisation. She was ambitious, respected and known for her extraordinary work ethic. She was also exhausted.

Outside work, things were beginning to unravel. She was struggling to sleep and increasingly used alcohol to switch off at night. There were periods of profound sadness and numbness. But Holly kept working.

In fact, work was the one place she still felt energised. She would often be in the office 12 hours a day. She told me that when she was busy, she didn’t have to think. There was always another meeting, deadline or problem to solve. Achievement gave her a sense of control and, temporarily, a sense that she was........

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