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, 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?

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.

#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.

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.

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.