Medical school, Medicine, Mental Health, Relationships

Why I Stopped Writing

For the few followers of my blog, all of whom I am incredibly grateful for – you may have noticed that I stopped writing for almost 3 months. You may also be wondering why. When I started this blog, I aimed to write something at least every week, and I think I did pretty well (apart from the time I was severely unwell and overdosed). Writing has always been a great way for me to de-clutter my thoughts, rationalise my ideas and to release some emotion whilst attempting to help somebody out there. Before my blog, I wrote in my diary almost religiously from the age of about 10, and it did wonders to help me deal with a lot of things I was experiencing. But from time to time, I lose momentum and stop writing for months at a time.

The main reason I usually do that is because I want to do all I can to run away from my thoughts and feelings, rather than try to understand them. We’ve all probably experienced it – it’s when you have so much on your plate that even thinking about a problem, or facing an issue becomes too emotionally draining. Rather than feeling relieved, I start to feel extremely upset. So that turns me away from writing and I go into my “pretend-everything-is-fine” mode. There are pros and cons of this of course. On the one hand, I am able to give myself a false sense of security that everything is fine when it is in fact very far from fine. But on the other hand, pushing things to the back of your mind also causes it to build up slowly over time, until you eventually burst. That part isn’t really too fun.

Also, for the past few months, life happened – I had all my exams to do but with zero concentration and hypersomnia (excessive sleeping) as side effects of my medication; family troubles; financial struggles; friendship struggles; rejections from job interviews; yet another rejection from a romantic interest (I might tell you about these one day, should you be interested); my rejections of romantic interests in me (life is funny) – you name it. Everything happened at once. And obviously that meant my mental health was at an all time low again with my anxiety levels sky high and the return of suicidal thoughts. Wa-hey.

However, I can happily say that some of those things mentioned above have improved since. For example, I somehow managed to pass third year and am going into my fourth year of medical school in a few months’ time (yay!). Also, amongst the thousands of rejections, I did manage to find a short part-time job to give me a financial boost. And my anxiety levels are generally lower, though I’m still struggling with them immensely even now that most of the external factors are gone.

It has literally taken me 3 weeks to convert my thought of wanting to write again, to actually writing again, despite having plenty of time to do so. So you can imagine to what extent my motivation is lacking. I’ve also become very bad at remembering to take my medication which really messes me up because I keep switching from insomnia to hypersomnia and also gives me nightmares. My moods are also all over the place. It’s all a bit dishevelled really but I’m hoping that this will all change with a bit of positive thinking.

Here’s to mental health and writing.

 

Anxiety, Medical school, Mental Health, Relationships, Sexual abuse

Am I Overreacting?

Suffering from anxiety, I often have to take a step back and assess whether I am overreacting to a situation or if my worries are justified. And taking that step back is difficult because I usually don’t know if I am simply ‘reacting’ to a situation or if it would be classified as potentially overreacting. It’s a thin line, and not an easy one to distinguish. What makes it all the more difficult is that the act of overreacting is very subjective. What’s normal for one person, may not be so normal for another person. For me, I hate to be perceived as having overreacted to something, so I usually have to check in with the people around me.

It was a lot easier when I had the opportunity to discuss issues on a regular basis with my counsellor. She usually put things into perspective for me from a more objective viewpoint and that made it easier for me to know if I was overreacting or not.

Since having finished my counselling sessions, things are a lot more difficult as there isn’t just the one person I can check in with. Now, I usually have to ask my family and friends about their opinions on the situation, and I usually gather a range of different viewpoints and make my assessment. If the majority says that I am justified to react in a certain way, then I usually go with the majority and vice versa.

However, my fear of overreacting has led to situations where I possibly haven’t reacted enough. These situations normally involve reacting to behaviour that makes me uncomfortable. As you can read on a previous post, I had trouble dealing with sexual abuse as a child and my fear of falsely raising an alarm overrode my instinct to seek help. Similarly now, I have come across a few individuals over my time at medical school who have made me feel uncomfortable but I wasn’t sure if it was significant enough to raise an alarm. The last thing I want to be is ‘the boy who cried wolf’.

One of these individuals was an older medical student who made me feel uncomfortable within minutes of meeting him by displaying quite controlling and intense behaviour towards me. I felt uncomfortable as he summoned me with a beckoning gesture, after which he expressed his desire to marry soon; a desperate bachelor. The closeness with which he was standing next to me also made me very anxious, almost as if I was trapped. In my head, alarm bells were ringing but when I mentioned this individual with a few friends, some told me that there was no reason for me to be scared of him, whilst others asked me, “Why didn’t you just slap him around the face?” It’s in situations like these when I still struggle.

Another similar situation which occurred more recently involved somebody from my year who I met on my medical placement at hospital. He showed an interest in me, and we started joking with each other within a few hours of knowing each other. He ended up asking for my Facebook details, and after we parted that day, he immediately started messaging me on Facebook. A few messages in, he asked for my Snapchat, which I gave, but I got the feeling that he was moving a little fast, considering I had only met him that day. The messages then continued on Snapchat all the way until a good night message. The next time I met him, he ended up divulging very private details about himself and his family, which I would personally only divulge to someone when I trusted them implicitly, e.g. a very close friend. He started to make jokes that made me uncomfortable like saying he’d steal my duvet from my room when he felt cold at night, and so on. The messages continued and I felt quite overwhelmed at this point. I received a phone call from a relative and he was still messaging me but I didn’t reply. After I finished the phone call, I saw that he’d already started apologising to me for unintentionally doing something wrong as I hadn’t been replying. I was a bit surprised, but still unsure whether this was all normal. I talked about this to a few friends. Some of my friends joked about it, saying he was clearly seeking more than friendship, but my best friend got worried and told me to be careful in case he was a stalker. This definitely made me anxious. I contacted another friend, telling him about the situation and that I was starting to feel creeped out, and when I told him who it was, my friend laughed it off and said I didn’t need to worry as he was pretty sure the boy was gay. I felt a bit stupid at that point for making such a big fuss, but I don’t feel as if it was completely unjustified for me to have felt overwhelmed and scared.

So what have I learnt from all of this? It is definitely worth taking a step back to assess if you’re overreacting but at the same time, there’s nothing more reliable than our instincts. It’s always better to be safe than sorry, so the best thing to do is to react when your alarm bells are ringing. If you overreact, then you look stupid of course. But if you don’t overreact and things are as bad as they seem, the consequences may be even more grave unfortunately.

 

Medical school, Mental Health, Pressure, Relationships

When No One Understands

It can be the loneliest feeling when no one understands you, how you’re feeling and what you really want. You can be surrounded by all the people in the world, but when no one understands you, you feel as if you are indeed alone.

This is something that I have difficulty coping with most days. When I am feeling low and I come back home after a long day, I don’t have the energy to converse with my family or give them the ‘quality time’ that they want. It means I’m quieter than usual but often my family members mistake that for me being reclusive and I am suspected of ‘hiding’ something from them. When they ask me “What’s wrong?” and I respond saying that nothing is wrong but I am just tired, they often don’t believe me. And not having someone believe me is the most frustrating thing.

Recently, I have been making an effort to attend all my scheduled teaching at placements and also to participate in extra teaching from older years in preparation for my upcoming OSCEs (a viva exam for medical students). I am also taking part in some extra-curricular activities this term to keep my spirits up, which means that I am home for very little time. My parents misunderstand this for me trying to avoid them, but I really do all of this to make myself feel productive and keep myself distracted from my low moods. It has been helping, and even if I feel unwell, I force myself to go because once I break the pattern, it can become so easy to give up and not go in the next week, and the next, etc. Unfortunately, my parents don’t seem to understand this and rather than encouraging me, I receive a lot of discouragement, especially for non-academically related events, which they don’t see the point of.

So what can I do in this situation? It really upsets me when the people closest to me fail to understand me, but at the same time no one can fully understand you, except for yourself. So I think acceptance of this fact is key. I try to accept that I can’t expect to be understood all the time, so sometimes I just have to deal with it and go on as I must. When I used to receive counselling, my counsellor really helped to put things into perspective for me, which was certainly liberating and empowering. However, now that my sessions with her have ended, I try to envisage what she would have said to me, and I try to assess my situation with as objective a view as possible. It is extremely difficult for me to do, but it is doable.

Other things I have tried in the past include keeping a diary of my thoughts, especially at times when I felt the loneliest. Of course there was no response from the diary, but it felt good to get my feelings out and it gave me the impression that I was talking to someone who was listening. And that was enough to make a difference.

We all feel the need to be heard sometimes. It is simply human nature. Talking to the people around us can help of course, especially if they are willing to listen and understand, but in the instances they are not, there are other ways to cope.

Anxiety, Medical school, Medicine, Mental Health, Reality, Stress

The Magic of Creativity

Most days, I don’t feel like I have the energy or motivation to do anything but curl up on my sofa, binge-watch trashy TV and mindlessly munch on processed junk until I fall asleep and the cycle repeats itself. So when I went to my first CBT (cognitive behavioural therapy) session a few months ago and the therapist suggested I engage in enjoyable activities and rekindle my hobbies, I honestly thought, “what rubbish”. I felt so drained of energy that even getting to the CBT session in my pyjamas was an achievement for me.

My turning point was definitely in the weeks following my suicide attempt. After seeing the effect that it had on my family and friends, I was determined to get better and get out of the vicious cycle of depression I was stuck in. I decided that even if I felt life was not worth living for me, it was definitely worth living life for those who loved me. And yes, I knew life was not going to be all flowery – in fact, ever since my attempt in November, things have most definitely not been going my way or in my favour – but it was worth going on for the few minutes that I made my baby sister smile, or for the moments I spent cradled in my mother’s arms, or for the times that my friends tried cheering me up with their banter. So I decided that it was time for me to start getting up from that sofa. It was going to be anything but easy, but with the support from friends and family, I could do it.

The first thing I decided to do was to try and rekindle my hobbies as my therapist had suggested long ago. For me, art and singing have always been my favourite activities – they were both hobbies I’d pretty much given up on because I didn’t feel as if I had the willpower or motivation to do them. So I decided to audition for a singing part at a society-run university play (which required much support and encouragement from a good friend of mine) and ended up getting the part. I also decided to get back into sketching and painting which, I have to say, has been INCREDIBLY effective at providing me with a productive form of distraction when I’m feeling low.

On days that I feel extremely depressed, time doesn’t seem to pass. It’s difficult for me to pick up a pencil or to practice my singing, but once I start, it gets easier and easier. It gives me something to focus on, and I don’t even realise how quickly time flies. Sure, right now it doesn’t really help with my procrastination issue, but one step at a time. The logic is that if our daily average enjoyment levels increase to a sustainable degree, then motivation also increases and the possibility of achievement does too.

It’s always difficult to take the first step, and progress is not nearly as quick as we’d like, but I guess every little helps. I’m not back to my extra-motivated, focused, organised, efficient self yet (nowhere near it, in fact), but at least I’m spending a little less time moping on my sofa staring at the TV screen. And maybe one day, I’ll even be able to get back to being productive with my work and feel more of a sense of achievement.

Anxiety, Medical school, Mental Health, Sexual abuse, Stress

The Nightmares that Won’t Leave

For the past couple of years, I have been struggling with daily, vivid nightmares which have significantly reduced the quality of my life. Being a natural vivid dreamer, I am accustomed to seeing the odd nightmare once in a while, but I have been continuously battling my fears every night. For most people, nightmares are a thing of the past, something that they associate with childhood. Other people I’ve talked to tell me that when they do have the odd nightmare, it’s something like “falling down” from a height for example. That’s how it used to be for me, and life was a lot easier too that way.

Surprisingly enough, my nightmares have a lot of impact on my daily life. Especially because I remember every single one, and they are so life-like, that they could easily get confused for being memories instead. Some of my nightmares are situations that occur between myself and those close to me – ranging from an emotional and abusive argument to losing someone. Other nightmares involve really intense and frightening situations, for example watching a serial killer kill the people around me in the most disturbing ways (the images are very graphic and detailed in my head to add to the horrific gore) and me trying to escape being killed; I’ve dreamt several times of me being forced into marriages to unknown men by my parents; and just last night, I dreamt of being raped by two men who I didn’t know and being traumatised in the aftermath of the situation.

The thing is, I don’t really think about any of these things consciously during the day. Whilst they may be a reflection of my inner fears, to me they seem quite random. Almost every nightmare I have wakes me up drenched in sweat in the middle of the night and I find it difficult to fall asleep again because I end up remaining traumatised right after.

Recently, I’ve found a coping mechanism which has been to sleep with my Mum. I never thought it would work, but my Mum insisted so I tried it out, and I think that just having the reassurance that I have someone with me when I’m sleeping helps me to recover from any dreams, and sometimes even prevents me from having my nightmares. I’ve also now been told that I talk in my sleep, and it is usually a reflection of whatever nightmare I’m having.

The reason why I feel these nightmares affect the quality of my life is not only because of the content of these nightmares, but also because of the poor quality of sleep I get. My sleep is usually very broken and I often actually get very little as I am unable to fall asleep again. This adds to my fatigue during the day and triggers my migraines. Low energy also negatively affects my depression which worsens and brings on the suicidal thoughts again.

I have tried various sleeping pills which are fabulous for making me sleep (despite making me incredibly drowsy the next day), but I still see the nightmares. My doctors have told me that the cause is most probably my high anxiety levels, and this is something I am to be talking about during my CBT sessions in future.

For now, it’s a relief knowing that my nightmares are only dreams after all. When they’re not real, what’s the worst that can happen?

#relationships, Medical school, Mental Health, Reality, Stress

Letting People Go

Letting people go is no easy feat. The closer you are to the person, the more difficult it becomes to move on. Whether it’s the end of a relationship, or dealing with a loved one moving away, it can leave us with immense feelings of loss. But letting people go can leave us feeling emancipated. The more we dote on lost causes, the more unhappy we become in life. Letting go and moving on is the only way we can escape the negativity and make our lives better.

One of the challenges in being able to “get over” someone is that often even after the end of the relationship, we may still encounter the person over and over again. And surrounding ourselves with reminders of the person often reignites our feelings and draws us back to the relationship. Possibly the most difficult part of overcoming the end of a relationship is withdrawing from the strong emotional dependence we have on the other person. Whether the relationship is romantic or non-romantic, we often rely on the other person on an emotional (and possibly physical level). And when things end, we lose our source of emotional strength. If I medicalised this, I would be calling this period the ‘withdrawal’ period – likened to the tortuous symptoms of weaning from an addictive drug. Medical weaning however takes place in stages, decreasing the dosage in increments until complete weaning occurs. However, the end of a relationship is often sudden. And to let go of the other person becomes extremely challenging.

It is possible however, just like everything else. In the earlier stages, to prevent “relapse”, it is often better to, as much as possible, isolate yourself from all things that may bring back memories and reignite feelings. This may involve removing or hiding away triggering objects and possessions, unfriending them on social media and avoiding messaging them altogether. It may seem a harsh step to take, but doing so usually helps during the difficult initial phase, and coming to accept the situation.

Distractions and spending time with other friends and family can be extremely rewarding. Engaging in new activities can help at this stage too. However it is important to make sure that you keep a good balance between social/leisure activities and being able to get on with work and necessary chores, as difficult as it may be.

With ample time, it becomes a lot easier and tolerable to think about the other person without triggering strong emotions. This may take a lot of time, possibly years, but you will get there through perseverance.

The saying that ‘people come and go’ could not be closer to the truth. Nothing is ever permanent. Although we may not realise it, we often end up in very toxic relationships which do us more harm than good. We don’t see it because our emotions for this person clouds our objective judgement. But if being around this person makes you ‘feel like crap’, it’s a pretty good sign that the person is toxic and you are better off letting them go. Of course it may not be as clear cut, but it’s worth thinking about and re-analysing your relationships.

I recently decided to let go of a close friend who I’ve known for 3 years. It was a difficult decision, but I realised that the relationship was very one-sided and I often ended up feeling more negative about myself following a conversation with this friend than I did before. The dynamic of the friendship had definitely changed over the course of the 3 years and after much deliberation, I decided that the disagreements between us were too great to recover from. And you know what? I feel so much better. I feel more confident and I feel free. Sometimes it’s just better to trust your instincts because no one knows you better than yourself.

So do it. Let them go.

Anxiety, Medical school, Medicine, Mental Health, Reality, Stigma, Stress

First impressions of CBT

A few months ago, I was referred by my GP to the IAPT service which provides talking therapy for patients suffering from depression, anxiety and severe sleeping disturbances (I suffer from all three unfortunately). After telephonic assessment in August, I was deemed suitable to receive Cognitive Behavioural Therapy (CBT) which is aimed at altering the way people think in order to prevent harmful behaviour or distressing physical symptoms. Yesterday was my first appointment, and to be honest, I was quite nervous about the experience, despite having had 8 counselling sessions at my university already. I was also quite cynical of CBT because of some negative feedback I’d heard from people, so it took quite a lot of motivation for me to give it a try. My main rationale for trying CBT was that I couldn’t get any worse than I was now, so there would be no harm in trying, and  even if there was the smallest possibility that my quality of life could improve and I could potentially stop my continual suicidal thoughts, it was worth a try.

Just to give you a bit of background, I was formally diagnosed with severe depression and anxiety in March this year. I also suffer from insomnia and regular nightmares which often wake me up in sweats. I was prescribed Sertraline in March – a form of SSRI anti-depressant – and even after six months on the maximum dose possible, my condition did not improve but worsened*. Recently, I have been started on a different type of antidepressant, an SNRI, called Venlafaxine, but it is too early days to know how efficient it has been. It is only understandable however that despite my efforts, and medication and counselling, I wasn’t getting better. So when I received a phone call last week to arrange an appointment, I was kind of relieved that there were still other things left for me to try.

It took me about an hour to find the right place yesterday for my CBT appointment. It was in the most inconspicuous location with poor accessibility and getting lost in the dark only made me more anxious. I don’t know if it was this hospital in particular or if this applies to all mental health hospitals, but it was really difficult to find (despite my usual poor navigation skills!). I suppose it may be intentional so that patients don’t feel embarrassed walking inside for fear of stigma from the general public who may see them walking in. Once I did go inside the building, I felt like I was inside one of the really old hospitals they show you in horror movies. I took a photo which you can see at the top of this post, but it was terrifying to walk inside. I could not see anyone around, the ‘reception’ was closed off with newspaper coverings all over the window, the lighting was eerily dim, the signboards were out-of-date and I was lost once again. After walking around for ages, often just going around in circles, I managed to find somebody in the hospital who was kind enough to direct me to the right place. However, I have to point out that more needs to be done to improve the aesthetics of mental health departments and hospitals, especially because the patients going in are already in a very anxious state of mind, and as research has shown, environments can influence heavily on the mental health of people. I feel that the poor state of mental health departments is a consequence of the severe lack of funding towards mental health by the government. I strongly feel that this MUST be addressed.

On the other hand, after meeting my therapist, I have to say that I was made to feel extremely comfortable. She had a spark in her which made me feel as if things could get better for me, and she reassured me that she would work through my problems with me throughout the forthcoming sessions. I found her to be extremely helpful and caring and I really do look forward to our sessions in the future. Yesterday was an assessment and summary of how things were going to work, and I will see her again for a formal session in 2 weeks’ time. Maybe things will change for the better, we just have to wait and see.

If you have any comments or suggestions, please feel free to leave a comment as I would love to hear them!

* Please note: Just because an anti-depressant did not work for one individual does not mean it will not work for another. Everyone is different and often it is a ‘trial and improvement’ process. My mother has been on low dose Sertraline for her depression and anxiety and it has worked wonders for her, whereas it has had little effect on me. 

Consultants, Intimidation, Medical school, Medicine, Mental Health, Pressure, Stress

Consultant-induced Consternation

Before starting my clinical placements for my third year at medical school, I’d heard horror stories of terrible consultants, but I never expected to feel intimidated by my own. Although the vast majority of consultants at my hospital are incredibly helpful and  supportive, I have been made to feel like rubbish by a particular consultant unfortunately. Thankfully for me, the situations were not nearly as traumatic as some of the things I’ve heard, but it did nonetheless damage my self-esteem a good deal.

As outlined previously, I have been suffering from severe depression and anxiety this past year, and I have been finding it difficult to cope with the stress of my hospital placement which is a 2-hour journey from home. Most days, by the time I reach the hospital, I am in a mess, having had a 2-hour journey to feed, nurture and breed my anxiety levels, so getting on with the rest of the day (approximately 8 hours) is a real struggle. Because of my severe low moods, when I get home from placements, I have no energy or motivation to read up on conditions and cases so I look like an absolute idiot when I’m questioned by the consultant the following day.

Therefore, it is understandable for my consultant to feel quite frustrated at me for not meeting up to his expectations. However, he had been informed of my situation beforehand, so if anything, I would have appreciated it if he could be mildly sensitive towards me.  One Monday afternoon, he was particularly annoyed at me for not being able to answer all his questions correctly, and he remarked – “If you don’t remember everything I’ve just told you the next time I see you, I will personally speak to your college and bar you from studying medicine again.” Ouch. Other comments included things like, “you don’t deserve to be a medical student” and “I have no idea how you got into medical school”. 

I do appreciate that my consultant may have had a waning patience because of his tiredness from excruciatingly long shifts, but if the professionals for whom sensitivity is in the ‘required’ section of the job description start doing the exact opposite, it is quite surprising to say the least. Most medical students have very little self-esteem, if any, and to receive demotivating remarks from consultants really makes us question whether we’re good enough. I am not alone in this – many of my friends at med school have shared very similar stories of being felt bullied by the consultant.

Personally, I had great difficulty in coping with the aftermath of these remarks, and felt completely useless and inadequate. I contemplated giving up on medicine because ‘what’s the point if I’m not good enough’. It was because of my family and friends that I didn’t give up and tried my best to keep going. But I still feel so anxious when I am around this consultant, because of his naturally patronising disposition.

At one point, I felt that I needed to talk to my consultant about how I felt, so I took the initiative of writing up an email requesting him to be patient with me because I was trying my best, even though my best wasn’t the same as my best from a few years ago. Fortunately, his response to my email was supportive and the next time I saw him, I could tell he was really trying hard to be sensitive (though it was very obviously forced), but that was enough for me to keep on going. It hasn’t stopped me from fearing his intimidation, but at least I have made him aware of my perspective, which will hopefully make things improve in the long run. Of course, if it doesn’t, I know who I can take it up with, but I hope it never comes to that!