Mental Health, Pressure, Reality, Stigma

The Importance of Speaking Up

“Our lives begin to end the day we become silent about the things that matter” ~ Martin Luther King Junior

A lot of people become astounded by the courage I show in day-to-day situations, for example speaking up in front of a crowd, challenging a senior or asking the questions that everyone is too afraid to ask. There is of course always the right time to say or do things and too much courage may be overstepping into sheer foolishness, but more often than not, speaking your mind has countless positive effects.

Since being the bullied child at primary school, I have grown to appreciate the importance of speaking up against what I feel is wrong. Whether this means I am confronting my peers, friends, family or seniors, it makes no difference to me. It is imperative that we all stand for what we believe in and being too afraid to speak up for ourselves, or the people around us only makes us just as bad as the perpetrators for standing by and doing nothing to stop it. Of course, direct confrontation is not always the wisest way to approach situations, but something like writing a strong letter, taking part in protests or addressing petitions to the right people can make a big difference. People who prefer to suffer and are afraid to speak up often say that they would much rather ‘avoid conflict’ and cope with the situation. However, adapting to injustice never really solves the problem. Be it an issue in the workplace or challenges in personal relationships, having open conversations and asserting your viewpoint only increases one’s self-respect and demonstrates to others that they cannot get away with maltreating you.

Initially, the consequences of speaking up may well be negative and result in unfavourable situations in the meantime, but in the long-term, the results are completely  worth it. Dissonance, antagonisation, intimidation are some examples of the negative reactions to speaking up. It is important to plough through these temporary difficulties, keeping the main objective in mind, and before you know it, the positive changes will arrive.

Aside from the workplace, I also find it beneficial to be very upfront about my concerns in my personal relationships. Rather than spend long periods of time wondering what other people are thinking, I save myself the torture and pluck up the courage to just ask. Sure, the answer is not always what I like to hear, but on reflection, it really does help me to work forwards and solve any conflicts or misunderstandings.

What is more challenging however, is being assertive around the people closest to you. This is something that I had been struggling with for a while, especially with my own family members. I found it relatively easy to deal with people I was not so much emotionally attached to, but when it came to my parents, or my siblings, I found it difficult to voice my opinions and usually resorted to bending to their wishes. In the long-term it had an extremely negative effect on my well-being and satisfaction in life. Through counselling sessions, I was able to learn that there was a difference between being assertive and being confrontational and I was able to voice my opinions in such a way that I was simultaneously sensitive to the feelings of the people around me. It is a difficult skill to master but it has worked wonders for me.

I feel a lot more free being able to do the things I want whilst also not hurting the people around me. I feel as if I have greater control over my life, and you know what? I feel so much happier.

So speak up, and get your voices heard. You’ll be one step closer to changing things for the better.

Anxiety, Mental Health, Pressure, Reality, Stigma, Stress

The Epitome of Self-Deprecation

It’s difficult when the person you despise most is yourself. I find myself to be someone who always sees the good in everyone around me, but I fail to do so when I reflect on myself. People often compliment me, but the voice in my head tells me, “It’s not true, they’re just being nice”. There was a time in my life where I used to outwardly reject compliments thrown my way, but I soon realised that people often misunderstood me for being rude when that was not my intention at all. So now, out of politeness and to meet others’ expectations, I smile and say “Thank you” in response to any compliment I get, even though I don’t believe it.

I’ve pretty much always had a very low self-esteem. It’s because I’m a perfectionist and achieving my incredibly unrealistic goals is the only thing that gives me a sense of accomplishment. I always find faults in myself and always find targets to work towards. I subconsciously compare myself to others and convince myself that I am not good enough. The worst thing is, however, I also tend to criticise things about myself that I can’t modify. And that is even more demoralising for me.

I never really questioned my perfectionism until a few years ago when I started medical school and it became almost impossible for me to be the best at everything. All of a sudden, I was not achieving the goals I was setting for myself and I started believing that I was hopelessly not good enough. Despite the fact that I was studying at one of the best medical schools in the world, I was not good enough. I was not smart enough. And I felt increasingly worthless.

Aside from academics, I have always had issues with my image, from my looks to my weight. And especially at a stage when I thought I was failing academically, these insecurities became even more pronounced in myself. I was scared of looking at my reflection in the mirror. I started using a lot of make-up to cover up my ‘imperfections’. I tried to lose weight, but that’s something that has been and is still a challenge for me. With my depression, my appetite is all over the place. When things get really bad to suicidal point, I neglect food completely. When my mood picks up a little again and to cheer myself up, I tend to binge eat. And that’s why my weight doesn’t budge despite my gym efforts and diet plans. To make things more complicated, I have a very common condition called PCOS which makes it difficult for me to lose weight, and a few of the tablets I take for some other health problems also make it harder for me to lose weight. Being depressed also means that my motivation is at its lowest and without seeing any results after putting in the effort, I feel more demotivated and give up.

I realise however that it’s not really these materialistic things that matter. I can’t help how I look, and perfectionism is a bit of a tall order. But I feel as if I have believed in it for so long, I’ve wired it into my brain that I am just not good enough, or worthy. Some days, I wake up and I encourage myself to feel confident in my own body. It works, but it wears off very quickly. It’s a work in progress and maybe one day, I’ll really be confident. I love everybody else, but I have trouble loving myself.

I know that there are a lot of people who feel the same as I do. There are a lot of factors that contribute towards this, namely environmental influences, parenting and societal pressures. But I do believe that we are not stuck in this way of thinking about ourselves. We are each of us unique and beautiful, albeit not in the ways modelled by society per se, and we have every right to love ourselves for who we are. It’s time we took a step back and cut ourselves some slack, because we most definitely deserve it.

 

Anxiety, Mental Health, Reality, Stigma, Stress

“Are you ok?”

Often we can become so caught up in our own lives that we forget to pay attention to the people around us. Moreover, we have transitioned into a society where awkwardness predominates most situations and prevents us from connecting to those around us. It even hinders us from doing nice things for people, because we are unsure whether we would be acting within social norms. But maybe we shouldn’t worry so much about fitting into social norms especially when it comes to doing good for others.

A couple of weeks ago, as I was making my daily commute to university on the tube, I noticed that a woman sitting opposite me was crying silently, wiping her tears on the end of her sleeve. She was trying so hard to make it look inconspicuous that I genuinely wondered whether she was crying or if she was suffering from some sort of allergy causing increased tear secretion. Once I had mentally confirmed that she was crying, I started becoming concerned and was tempted to ask her if she was ok. On the one hand, it is highly unusual for two strangers to start talking in London and striking up a conversation may make the situation uncomfortable, but on the other hand, I really wanted to make sure she was ok and let her know that she is not alone in the problems she is dealing with. I took the next few minutes deliberating over what would be the most appropriate thing to do. I tried catching her eye contact but she started to close her eyes in an attempt to have a quick nap.

A few stops passed and she opened her eyes, so I took the opportunity to say, “Excuse me, are you ok?” She seemed startled by my question, and gave a flustered response – “Yes, sorry, yes, I’m fine, I’ve just had a bad day.” I continued to ask her whether she wanted some water or a tissue to which she said “no, thank you” as she already had some. I thought I’d give her some passing advice and said, with regards to her crying, “It’s better to let it all out than keep it bottled up.” She smiled at me in gratitude and for the remaining stops of her journey on the tube that morning, she kept on smiling to herself and had stopped crying. She thanked me shyly before she left the train.

What this situation made me realise was that sometimes, it’s enough to just let people know you care by asking them if they are ok. It’s a simple and very overlooked question because it’s become so integrated in our casual greeting, “Hey, morning, you ok?” to which the automatic response is “yeah I’m good thanks”. But asked in the right way, it can show the other person how much you really care. In this case, I feel that me asking the woman about how she is when I was nothing but a stranger to her, made a difference. I know that, were it reversed, I would have appreciated somebody else’s concern incredibly. It just gives you the hope that you are not alone and there is help to be offered. It also helps us humanise the busy commuters around us, who we subconsciously ignore in our morning hustle, and if everyone did the same, we would all be more connected as a population.

There have been a few times when I have ended up breaking down on the tube and on the bus, crying uncontrollably. Despite the people around me noticing, nobody asked me if I was ok. I don’t blame them because we often fear the shame of being awkward so much that we forget to do what is more important. When I was having a breakdown, a simple “are you ok?” may have made a lot of difference. Sometimes I forget that I am not alone, sometimes I feel as though there is no one to help me. But a simple reassurance from a fellow human being is enough to make a difference.

So let’s make that change. Overcome the awkwardness, and ask that question.

Anxiety, Medicine, Mental Health, Stigma

Am I Insane?

I ask myself over and over again, “Am I insane? Am I crazy? Am I unstable?” As strange as it sounds, I am haunted by myself. The thoughts that run like obsessions through my mind and my gradual estrangement from ‘normality’ make me question my sanity. I often scare myself so much so that I cower away in the corner of my room and keep repeating to myself prescriptively “I’m ok, I’m ok, I’m normal, I’m ok,” rocking back and forth as comfort, in my attempt to convince myself that I am not insane. Counterproductive? Maybe.

There are a few reasons why I often feel as if I’m going insane. The first has to be my constant struggles with suicidal thoughts. Every day, they creep up on me insidiously, especially when I am alone, and they keep getting stronger and stronger, until they develop into well-thought out plans. The temptation to implement the plans becomes unavoidable, and just as I am about to do it, I stop. I re-think and play devil’s advocate. I think about my family and friends. I think about the knock-on effects. I step back. Then it happens all over again, like a video on repeat.

The thoughts and planning tire me out so much, that I feel completely exhausted. It’s as if I am constantly fighting myself, and it takes its toll. It disrupts my normal concentration, I always feel drowsy and weak, and my motivation drops even more than it’s normally low level. Often after these episodes, when I just about avert the implementation of my suicidal ideation, I break down completely.

With severe depression and anxiety also comes increased irritability and mood swings. I often lash out at the people closest to me, for the smallest reasons. I may say some hurtful things without thinking, and I immediately regret doing so. I apologise, but we can never take our words back, and I feel even more angry at myself for being so incompetent. I just feel as if I am no longer in control of myself. I don’t know how I will react, I don’t know where my thoughts will take me, I can’t do anything that anyone expects of me, I can’t even predict if I’ll still be around a few hours later, or if I’ll end up taking my life before then.

Although not as bad as some sufferers, I have had brief episodes of auditory and visual psychosis in the past which terrified me and made me more convinced that I had essentially ‘gone mad’. It’s scary because sometimes I no longer know if something is real or if I’m just imagining it. This haunts me for sure.

What doesn’t help is also being made to feel alienated because of my mental health. I don’t like being branded or being treated differently, because it makes me feel abnormal. The stigma in society relating to mental health problems is what fuels this alienation. I am lucky to have friends who do their best to treat me like myself whilst being sensitive at the same time. It makes a massive difference to not be shunned but understood. But of course, not everyone is like that. My friends are all medical students which make them naturally compassionate and understanding compared to the rest of the population.

Today, I was at my Medical Ethics and Law lecture on the Mental Health Act 1983, and we were taught that patients with ‘mental disorders’, such as schizophrenia, depression, anxiety, personality disorders, etc, are not to be considered competent of making their own medical decisions, and may need to be ‘sectioned’ if they are deemed to be inappropriately refusing treatment. Reading this made me feel as if I was an incapable outcast. Although I am depressed and anxious, I would always want to have the right to decide what happens to me, even if it doesn’t quite synchronise with the widely accepted definition of ‘my best interests’. I strongly feel that should I be in the position where I need to make a medical decision for myself, I am able to understand both sides, know the consequences of my actions and am prepared to take any risks with either opting or refusing certain treatment. Basically, I still have competence. To be stripped of that right simply because of my mental health state seems wrong to me.

Maybe I am insane. Or maybe we should re-define insanity.

 

Please note: If you are feeling low or thinking about suicide, please contact the Samaritans helpline on 116 123. They are open at all times and are there to listen.

Mental Health, Reality, Sexual abuse, Stigma

“Boys don’t cry”

It is a well-known stereotype that ‘masculinity’ encompasses the criterion of being ‘emotionally resilient’, and thus it is misconceived that seeing a man crying is effeminate. Society has an expectation of men to be ‘strong’, funny and void of low moods. We also use phrases like, ‘stop crying like a girl’, which is frankly demeaning to both sexes. But until we stop feeding these stereotypes, a safe space for men’s mental health cannot be created.

My youngest sister is three years old and a few days ago, she came back from nursery and said to me, “boys don’t cry”. I was quite shocked. If anything, at home, my middle sister and I try our best to negate any societal stereotypes and challenge them – we never automatically opted for pink clothes for her just because she is a girl, we never stopped taking her to the car and robots section of ToysRus simply because they were boys’ toys. In fact, we encouraged her to play with a football and her cars, alongside her dolls and toy kitchen set. So to hear something like that from her took me aback.

That day, I realised how much this stereotype is really ingrained in our society. I presumed that this was an idea that she picked up from her peers at school, and children always learn from adults. Clearly, if we don’t change the way we think and act, children will only follow in our footsteps and reinforce the stereotypes, albeit subconsciously. It took me a lot of convincing to persuade my sister to believe that boys can cry too. She insisted that it was a ‘girly’ thing to cry.

Unfortunately, the large majority of men feel ashamed to open up about their mental health because of the expectation of them to be so ‘resilient’. Some of my closest male friends have divulged that it’s embarrassing to talk about it, so they often keep quiet and that leads to not being able to seek help. According to statistics, males are 3.5 times more likely then females to commit suicide. There is a shocking number of domestic violence incidents against men by women, but this is very hardly advertised. It is estimated that depression rates are much higher amongst the male population than the statistics suggest because most of them never talk about it or seek help. Sexual abuse is another topic that we never really much about from men – not because the incidence of sexual abuse amongst men is very little, but because of the strong stigma attached to it. We instinctively think of women as the victims when we think of sexual abuse, but I have personally heard some disturbing stories from men regarding their experiences of sexual abuse.

Whatever sex a person may be, it should never be shameful to talk about mental health issues. We need to stop indulging in the roles set by society for men and women and start accepting that everyone is human, and it is only human to cry, to be depressed or have any other mental health issues. Violence and abuse are not exclusively carried out by men, and we need to stop generalising behaviours and assigning them to a certain sex. There is no shame in talking about these difficult issues, for men or women, and we can overcome the taboo by opening up and opening the eyes of everyone else around us.

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. 

Anxiety, Mental Health, Sexual abuse, Stigma

#MeToo

Sexual abuse and rape are difficult topics to talk about even today. Over the past few weeks we’ve heard some inspirational stories of celebrities who have suffered some form of sexual abuse, and the #metoo hashtag has helped many other victims all over the world to open up about their experiences too. For me, it highlighted just how many people had kept quiet about their ordeals, owing to the huge stigma associated with opening up. Infuriatingly, it is often more difficult for the victims to deal with the aftermath of disclosing their stories than the perpetrators themselves. And this is what fuels the horrendous stigma, and it becomes a vicious cycle.

I thought I would also take this opportunity to tell everyone my story. I too, like many others, have always feared opening up in case I am judged or treated differently. But I don’t think that matters to me anymore. 

I was sexually abused for about 2 years by a distant family member from the age of 9. He was a much elderly individual – I saw him as someone who would be my grandfather’s age at least. It started from the first time my family and I went to his house. I was wearing a cute blue T-shirt with pictures of ice-cream all over it, and of course I was wearing my faded blue jeans with gems at the pocket seams because they were my favourite. I was a bit of a chubby 9-year-old but was not yet pubescent. I was also extremely naive and innocent – I didn’t know anything about sex – I was more preoccupied with making pretty friendship bracelets and getting myself ahead in advanced algebra. 

We all had some tea in the living room after which everyone but myself and this relative left the room to help prepare food in the kitchen. He called me to sit on his lap and asked me to sing a song for him. I wasn’t really comfortable doing that but I’d always been taught to be obedient so I did as he said. After I finished the song, he praised me and started squeezing and kissing my cheeks. He proceeded to start biting my cheeks which hurt and I wanted to shout for help but I was so scared that I couldn’t speak. Whilst biting me, he started groping my breasts and I was silently crying and trying to escape but he was too strong. This continued for a few minutes until we could hear footsteps coming towards the room, which is when he finally let go of me. I was still crying and felt traumatised, and when my mum came in the room asking me what happened, I just didn’t know how to answer. He was laughing and smiling, prentending as if nothing happened. 

For the next two years, he kept finding opportunities where he could get me alone and abused me. A lot of people will ask – well, why didn’t you just tell someone? And believe me, I hated myself for a long time because I asked myself that. It’s a lot harder than you think. Especially when you’re a 9-year-old and you’re taught to always listen to your elders and that your elders are always right so you should never question them. I was really confused about what was happening. I knew what he was doing was not right and I was traumatised from the inside out. From that first time he abused me, I felt as if my childhood had been snatched away. I had trouble sleeping at night, I was always paranoid and scared that he would find me during the day. If I did get some sleep at night, it would be filled with nightmares. And my bad sleep started affecting my health to the point that I started getting severe migraines. I lost a lot of weight because I’d lost my appetite, and soon I started fainting due to severe low blood pressure owing to not eating. 

When my parents eventually found out about this, they were devastated and they stopped going to his house and stopped him from coming to ours. My dad spoke to him in private, and I’m guessing some strong words were exchanged, but I still don’t know what he said. However, my parents never reported him to the police. Although we stopped meeting him for a while, about 5 years later everyone acted as if nothing had happened and we resumed going back to his house. By this point, I was mature enough to stand my ground and thankfully, he didn’t have the courage to abuse me again. But what no one realised was that the damage had been done.

A lot of people think that victims of abuse can completely get over their experiences with time, but unfortunately that is not true. We get better at coping, but it’s something that ends up staying with us. As of a couple of years ago, I thought I’d recovered from the trauma of the abuse, but apparently I still haven’t. Since then, I have found it very difficult to make physical contact with people, and often when I’m hugged by others, I experience a feeling of suffocation and acute anxiety. I always need people around me to be at a certain distance and if they get any closer, I start panicking. I have mild claustrophobia too, and whenever I am in a situation I don’t like (e.g. in a boring teaching session) I get panic attacks. 

I am now receiving therapy to help me cope with my anxiety and I really think that it’s helping me. The point I wanted to raise by sharing my story is that it’s ok to talk and there is no shame in it. It is too often the case that victims are shamed more so than their perpetrators which discourages people from speaking out. But we can overcome this by raising awareness and telling people that it is NOT ok to shame us. We may be wounded but we are anything but weak.

Introduction, Medicine, Mental Health, Stigma

Medicine, Mental Health and Me

The decline of mental health in medics across the globe has been and still is a growing issue. As two medics studying in the heart of London, we’ve decided that the irony of healthcare providers putting their wellbeing on hold should no longer be a stigmatised issue, but one that is spoken about unashamedly. On this blog we hope to share with you our own experiences in the medical field, our beliefs and our opinions in hopes to break down these walls and make dealing with a declining mental health, as a healthcare professional, easier.

Alongside our insight into the medical field as  first and fifth year medics, we bring with us our personal journeys involving experiences with dysfunctional families, domestic violence, bereavement and sexual abuse which we wish to shed a light on in order to help those who have suffered similar, or more traumatic events, to speak out, without the fear of stigma. As women, especially coloured women of South-Asian descent, we also feel strongly about feminism, women’s rights and overcoming  various cultural barriers involving the stereotyping of women.

We will be writing under the names Arya and Maya bringing you a new article from us each week. We hope that you can join us in our campaign against mental health taboo, gender inequality, abuse and trauma and gain something from it – whether that be a deeper insight into an issue or helping yourself through your own journey.

Please exercise caution when reading our articles since they may contain sensitive and potentially triggering content and please seek help if you find yourself struggling.