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.

Pressure, Reality

You Can’t Make Everyone Happy

Following the end of my counselling sessions this year, I thought I would discuss one of the main lessons I walked away with. At the end of my first counselling session, I was told, “You can’t make everyone happy. And trying to make everyone happy is what’s making you unhappy.” And it reminded me, funnily enough, of a quote by Robin Williams:

“I think the saddest people always try their hardest to make people happy because they know what it’s like to feel absolutely worthless and they don’t want anyone else to feel like that.”

~ Robin Williams

Making others happy is a natural human tendency. For as long as I remember, I’ve always been the one in my family to keep everyone together, solve all our problems, and make everyone happy. I never saw any fault in that. In fact, seeing my family happy gave me a false sense of fulfilment. In some way, I’ve felt that my purpose had been to use all my efforts to stop the people around me from breaking down. But what I hadn’t realised is the toll it had been taking on me.

The main obstacle to thinking that I have to ‘fix everything’ or ‘please everyone else’ is that a lot of things are beyond my control. No matter how hard I try, I may not be able to do anything personally to resolve the situation. And by relying on others’ happiness for my sense of fulfilment was therefore highly impractical. My counselling sessions made me realise that.

I was also brought up by my parents to be anything but selfish. Hence, selfishness has to be the trait I most deeply detest, and in my efforts to make everybody else happy, I felt I was succeeding at not being selfish. But there should always be a limit to our selflessness. When we become so selfless and start living for the people around us, we can often lose or suppress our personal desires which hinder the formation of our identity and our growth towards independence. This is essentially what had happened to me. I have always done as my parents have told me to, because I thought it would make them happy. But I slowly realised that doing what others want me to do has never really made me happy. I lost sight of what I really wanted to do, and I ended up suppressing any desire I had which would object with my parents’ wishes, because I didn’t want to disappoint them for my ‘selfish’ causes.

My counsellor taught me that it’s ok to say no. It’s ok to be assertive. It’s ok for me to think about myself. It’s even ok for me to put myself first. I’m still working on getting that right, but I feel that I have made progress.

And you know what? I do feel happier doing the things I want. I finally feel as if I’m leaving my nest and discovering what kind of person I am, albeit at the age of 20.

It’s a start, but focusing on myself might just help me on my road to find happiness.

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, Reality

To trust or not to trust? 

For the past few years of my life, I have struggled greatly when determining who I can trust and who I cannot. From a young age I was taught the basic, “don’t trust strangers”, and yet I’ve found myself to be most able to communicate with my counsellor, who is essentially a stranger to me. I still don’t know a single thing about her, but she knows my deepest darkest secrets. I value her advice more than the advice of pretty much anyone else. And I definitely trust her. 

Earlier today, a middle aged woman approached me outside Subway and begged me to buy her a sandwich saying she was starving. I had no change on me and I really felt sorry for her so I agreed. I told her to select her subway sandwich whilst I waited away from the queue. She chose her sandwich fillings and once it was time to pay, she turned around and asked me to make the payment, and I did, whilst she thanked me and hurried away with her food. I wonder now – what if I’d walked away just before the payment? How did she trust me to keep my word? How did I know whether she was lying about not having any money for food? We were complete strangers to each other. But there was definitely an ounce of trust between us. 

A similar situation occurred with me a couple of days ago. I left for the gym with my car and parked inside a shopping mall car park. I thought I had my purse with me, but when I felt in my pocket for my purse, it was empty. I started to panic because without any money, I wouldn’t be able to pay for my parking ticket and I wouldn’t be able to leave the shopping mall. I called home and nobody could find my purse. I thought I’d lost it somehow and I was distraught. I was at the payment meter and there was an elderly couple who were paying for their parking ticket. I turned to them and told them how I had lost my purse and couldn’t pay for my parking. They nodded their heads and took one look at me then asked how much money it was that I’d needed. They gave me the £1.50 I asked for and left. I was incredibly grateful at the time, but I do wonder now how they knew they could believe me. It really fascinates me.

On the other hand, I’ve had some very negative experiences with trusting friends and family. In the past, I made the mistake of trusting a couple of friends with some personal information that I did not wish to be divulged. I thought they could be trusted because they had also supposedly told me some of their secrets. However, the moment that our friendship had turned sour as a result of a disagreement, it didn’t take them a second to divulge my secrets to other people, which I had told them in confidence. Similarly, I’ve experienced a betrayal of trust when a close family member of mine made a fool of me by making me think they were telling me the truth, when in actual fact they had been lying to me for a few years. So is it always true that we can’t trust strangers? Sometimes the most deceptive people are those closest to us – similar to Judas’ betrayal of Jesus. 

I spoke to my counsellor recently with regards to my challenge in knowing if I can trust my friends. A useful piece of advice she gave me was that it’s a good idea to test a friendship by telling them a very non-serious/false secret and over time observing whether they end up breaking their word to you. If they don’t, it’s a good indication that they can be trusted. 

Remember however, everybody lies. As cynical as it may seem, there is probably no one you can completely trust, but we must bear that risk of betrayal in all our relationships whilst trying to minimise the possibility. It’s easy to break someone’s trust, but it’s a hell of a difficult job to rebuild it.