Anxiety, Mental Health, Reality, Relationships, Stress

Paranoia or Reality?

Most of these days, I am struggling to understand whether I am just feeling paranoid or if my suspicions are justified. It may be closely linked with my anxiety, and my constant fear of losing people around me but my question is, how do I know for sure if I’m right?

My paranoia has affected my friendships before, and on reflection, I feel I misinterpreted their preoccupation with their work for indifference towards me and I ended up confronting them accusingly which brought about a great deal of friction between us. When I discussed situations like these with my counsellor last year, she had advised me that if I feel suspicious, the best thing to do is to ask openly without letting the suspicion brew in my mind. So, for example, if my friend hasn’t answered my text in a while and I feel she is ignoring me, it might be worthwhile dropping her a message to say, “Hey, I haven’t heard back from you in a while, is everything ok?” Or even if that doesn’t solve it then something as direct as, “Hey, I’ve kind of got the feeling that you’ve been ignoring me – have I upset you somehow?” And in fact, doing this has helped to sort out my suspicions and worries. What’s helped more is being open with my friends about my paranoia and letting them know that I might have to ask them directly if we’re still ok, and they’ve all been extremely understanding about it.

However, my more recent difficulties have been with my parents. Sometimes I feel as if they are upset or angry with me and when I ask them directly, they pass it off as being busy or tired. Having always been especially close to my Mum, I often feel that she becomes a little cold with me. It could obviously be because she is stressed out, but I really just don’t know. I then feel as if she’s lying to me when I ask her directly about it, just to avoid confrontation.

Another constant suspicion I have is that my parents are talking about me behind my back. I’ve tried eavesdropping but I’ve never heard anything of that sort, but whenever I see them talking quietly to each other, I feel as if they’re saying things about me. It could be completely unfounded of course, but I can’t help but feel paranoid.

When I think about where these paranoias stem from psychologically, I feel as if they are strongly related to my low self-esteem and my desire to always please people around me, which makes it difficult for me to face criticism. Maybe, if I can work on these aspects a little more, the paranoia may weaken because it would simply not matter to me what people are thinking or saying about me. I’m not sure at this moment as to how I’m going to go about doing that, but it’s worth thinking about.

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, 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, 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?

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.

#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!

Junior doctors' contract, Medicine, Mental Health, Patient care, Reality, Stress

Coming to terms with Medical School

Studying at medical school had always been my dream, and I’d envisioned that finally achieving my goal would reward me with an eternal feeling of accomplishment and satisfaction. However, I couldn’t be further from the truth. I felt like my entire life thus far had been tirelessly spent on getting to this exact point in time, and once I had arrived there, I had no idea what I was doing anymore. It was almost… anti-climatic.

Most of my time, I felt lost and confused. I wasn’t sure why I was at medical school, and realised that all the tough competition I’d endured to get myself there was apparently only so I could do it all over again at medical school. And the prospect of maintaining the same level of endurance to do well and pass my exams for the rest of my life, in my pursuit to become a doctor made me feel exhausted. I was surrounded by insanely intelligent students from all around the world, who suddenly made me, the ‘all-A*-pupil’, feel like an absolute idiot. There was no way I could compete with them, and suddenly I went from getting 90% and above in my exams in sixth form, to just about scraping a 40% pass in my medical exams.

To say this whole experience was demotivating, would be an understatement.

After coming to medical school, I finally realised why the admissions process is so bloody difficult. It’s because getting through the workload at medical school is meant to be even more stressful, and the stress of being a doctor surpasses all of that put together. As this realisation hit, I really lost all enjoyment of studying medicine. Sure, it it was ‘a-dream-come-true’ which supposedly should have made me grateful as a lot of people never get there despite their best efforts, but I suddenly envied all those who weren’t studying medicine.

About the same time that I got into med school in 2015, the whole junior doctors’ contract controversy erupted, which made me even more doubtful of my happiness in working as an NHS doctor in 6 years’ time. Would all my efforts be worth it in the end? I robotically sat through my lectures for the first 2 years, fighting the overpowering urge to fall asleep on my laptop. I destroyed my social life before it had even had a chance to bloom so that I could prevent having to fail and retake any of my exams.

Don’t get me wrong – I still loved the idea of being able to be an important part of the medical team to care for patients as a doctor, but I was worried more about the implications the whole process was having and would have on my health and wellbeing. Although the vast majority of doctors are inherently altruistic, doctors do what they do for a living – and realistically not earning enough to purchase simple commodities is frankly depressing. What is even more depressing is not being able to take enough time off work to see family, friends, or even the walls of your own room for days at a time. And the more I learned about the real struggle that junior doctors face in the NHS, the more fearful it made me of my future.

My first 2 years at medical school really dragged me down. I got through them because I felt I had no option, but my motivation had dropped significantly since coming to medical school. What reignited the original interest I had for wanting to become a doctor, was not the draining lectures from 9-5 everyday; it was the experience that I’d had with real patients on wards. During clinical placements, I was able to really connect with the patients I would talk to, and although I was meant to be taking medical histories from them, I confess that most of the time, I was just chatting to them about their interests and having a laugh. And that made me (and still makes me) so happy. Bonding with them makes me see the reward in going through all the hard work I’m doing now. One day, I might be the person who helps bring them back from the jaws of death, or help make them as comfortable as possible whilst they pass away.

That’s what keeps me going now.