on mental illness in med school

As mental health awareness comes to an end, I wanted to address something very close to my heart: mental illness and reducing the stigma that often comes with it, especially in health care. I’ve suffered from depression and anxiety for, well I don’t really know how long but I was officially diagnosed with both during my first year of medical school. It was a really difficult time for many reasons and I just couldn’t deal with it on my own anymore and decided to get help. I was really hesitant to do so at first because I was worried about being perceived as weak, that I couldn’t handle medical school and the challenges that come with it. It’s so, incredibly, heartbreaking how many health care professionals we lose, both practicing and in training, to suicide each year. We’ve made progress on dealing with the lack of support for our community when it comes to mental health but we still have so much work to do. So much of why I want to go into academia is to change the way we educate and train our physicians, to do it in a way that doesn’t require us to rob them of their humanity, compassion and ability to empathize with others.

Before I get into how I’ve dealt with both of these diagnoses while in medical school, I want to address how absolutely ridiculous it is that this stigma exists at all but especially in the field of medicine where we know and understand the pathology behind mental illness. We know that there are actual problems in the balance of our hormones. We know that it’s not just laziness or something you just ‘push through’ or ‘get over.’ So the first step in dealing with depression and anxiety in medical school is accepting that there is no shame in having a mental illness.

Think about it this way: anxiety and depression are essentially like having allergies, your body is overreacting to something it perceives to be threatening when it’s not really that bad. With allergies, some people’s bodies think peanuts are the equivalent of poison when there is nothing inherently dangerous about peanuts – as long as you’re not allergic. I’m eating a peanut butter granola bar from Trader Joe’s as I type this and I’m not going into anaphylactic shock – because my body doesn’t perceive peanuts as a threat but for others, it most definitely is. It’s the same with depression and anxiety – episodes can be triggered by things that may not seem that bad to people who don’t have mental illness. Some people’s bodies do not turn on them when they have to take an exam, or have to speak publicly or for no apparent reason. But I obviously would never judge my friend with nut allergies for needing an epi pen or avoiding triggers, right? So why do we do that to ourselves and each other when it comes to mental illness? Let’s just make a commitment to not think of it any differently – when it comes to us or to our friends or our patients.

So now for tangible advice and steps you can take if you are dealing with depression or anxiety – and please keep in mind this advice is from the perspective of someone who has dealt with these issues, not as professional medical advice.

  • Find a therapist you trust and feel comfortable with. This can definitely be tough because it takes a certain level of comfort and trust to be able to discuss what you need to discuss with a therapist. I would recommend starting with counselors at your school if that’s an option since they usually understand at least some of the struggles students face. And I know that it can be exhausting to jump from therapist to therapist and repeatedly telling your story to a stranger but it’s worth it when you find someone you can really talk to. Yelp is a surprisingly great place to read reviews for various therapists. And it’s a good idea to go into each session with an idea of the topics you want to discuss and issues you want to work on. This link has really helpful advice on how to approach your first session with a therapist.
  • Don’t be afraid to try medication. Like we talked about above, there’s no shame in your Zyrtec game and there shouldn’t be with Prozac (or any other medication) either.
  • Prioritize your health and well being. We all know that we should take care of ourselves but how many of us actually prioritize doing so? Because we need to, especially if you’re dealing with mental illness. I find exercising regularly to be really helpful and I’ve recently also started doing yoga (at home with Yoga with Adriene), which has also been great. Prioritize getting enough sleep, especially in the first two years of medical school when you have much more control over your schedule. Pulling all nighters is not a good way to learn and you need sleep to be able to retain everything you spend hours studying. I also find that limiting my caffeine intake really helps keep my anxiety symptoms away so I’ve tried to stop drinking coffee on and off for the past few years. Try limiting it as much as you can! I’m not a fan of cooking so eating healthily can be difficult but I try to buy preprepared frozen meals made by companies like Evol Foods and Sweet Earth Foods because they provide healthier options. And if, even for a second, you start feeling ‘selfish’ for taking care of yourself remember:

    ‘Caring for myself is not self indulgence, it is self preservation and that is an act of political warfare.’ – Audre Lorde

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  • Get a furchild. This obviously isn’t for everyone but have Kohl in my life has made the struggles of 2016 so much easier to deal with it. There’s something about a tiny kitten purring on your lap that makes you feel like it’s all going to be okay. So if it’s something you can do, consider adopting a kitten or puppy. It’s amazing how they just know when you’re not doing well or need extra cuddles. He’s been the source of my sanity through studying for remediation and boards.
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  • Spend time in places that inspire you. This can be as simple as going to your local coffee shop to study or planning a weekend getaway with your significant other/a group of friends. Changing where you are makes coming home feel so sweet and reenergizes you to continue doing what needs to get done. And making time for fun things is so important – you need it to recharge.
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  • Work hard when you feel good. The thing with both depression and anxiety is that they can sneak up on you. You can have an objectively good day and still feel completely miserable. So in a way, it’s important to ‘prepare’ for these episodes by being extra productive when you are feeling well. That way if you have an off day, you won’t fall behind because you prepared for it. I always have a game plan for studying for each block but because I know that some days are going to be better than others, I plan goals for each week (rather than each day). So when I have a day when I’m feeling down, I’m not really falling behind as long as I spend the day caring for myself and getting recharged so I can tackle tasks the next day and still stay on schedule. Having this flexibility has been really great for me and also reduces the guilt of ‘doing nothing’ on the days when I really can’t.
  • Spend time in service of others. There’s something so incredibly fulfilling in giving your time or skills to help others. If you’re in healthcare, a big part of why you’re here is because you have that innate need to be in service of others. So stay in touch with that by volunteering with your local free clinic or mentoring youth from underserved communities. Doing these things also really helps bring your purpose back into perspective. It helps you remember why you’re spending so much of your time studying and making so many sacrifices.
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  • Don’t be afraid to reach out to your classmates or friends. I can’t tell you the number of messages and comments I read every week from others in this field who share that they too are dealing with depression, anxiety or both. Don’t feel obligated to share this part of your journey if you don’t feel comfortable doing so but please know that you’re not alone. And if you do decide to share, realize that your recovery is going to look different from others’ so try your best not to compare. In this age of social media, it’s easy for us to think that everyone’s life is so much easier and better than ours but realize that most people just show the pretty parts. We’re all going through difficult times.
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  • Be kind and patient with yourself. This is something that I still struggle with. It’s so easy to fall into the trap of comparing yourself to others who seem to be much more productive or being angry with yourself for ‘being lazy.’ But realize that type of thinking is not productive in any way. You’re only prolonging this episode of deeper depression or anxiety by doing so. Your body is clearly telling you it needs a break or a change so spend an hour or so taking care of yourself and come back to your work. Treat yourself with the same compassion you’d show your patient who is struggling with similar issues.
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So much of why I started this blog and started speaking about my journey on Instagram is because I did not want anyone else to feel alone in the struggles that come with this journey. You are not alone. You deserve the best out of life and while we make many sacrifices on this journey, you should not sacrifice your health and well being in order to care for others. It takes some courage to seek help and take the steps towards recovery but it’s well worth the effort. You deserve a life where happiness is the norm, not the exception. You deserve a life that does not feel like a burden. If you won’t do it for yourself, do it for your future patients because they deserve a healer who has spent time healing themselves.

12 thoughts on “on mental illness in med school

  1. So you would say depression is caused by being highly sensitive to some environmental stimuli? Do you see your emotional reactions to regular stimuli as detrimental to accomplishing more in your life?

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    • I’m not sure that I completely understand your question. Depression and anxiety are caused by imbalances in neurotransmitters and that can lead to being highly sensitive to various triggers and seemingly random episodes. There are definitely times when I wish I didn’t have to ‘deal’ with mental illness on top of everything else but I definitely think that dealing with illness myself will make me a better physician. And being sensitive to the world also allows me to be more empathic towards the struggles of others. It can be painful at times but I wouldn’t trade this perspective for anything.

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  2. I started following you cause of your honest stories about medical school.

    Thanks for writing this piece! Not sure how to email you except through this comment section, so feel free to delete once you read this.

    Just wanted to share a project I’m working on to destigmatize mental illness. I’m sharing stories written by medical students about their person struggles with various forms of mental illness.

    http://asiamsemicolonproject.tumblr.com/

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    • Thank you for sharing David! This is such an incredibly important topic. I didn’t touch on this in my post but talking to my parents about my depression and anxiety was a strange experience because it’s not really something that’s acknowledged in Pakistani communities. But I’m so glad that I started that conversation with them. And I hope your project inspires others to start these conversations too. Sending you good vibes and positive energy!

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  3. All great points Anum! So proud of u for sharing your experience. Your IG and blog have undoubtedly inspired other students to open up and have validated the struggles of many ❤. And I love the peanut allergy analogy 😊

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  4. I love this line, “You deserve the best out of life and while we make many sacrifices on this journey, you should not sacrifice your health and well being in order to care for others.”

    It’s really hard for me to accept but I know it’s important. How am I supposed to give myself fully to my career if I’m physically and mentally not okay.

    Awesome post Anum, I’m so proud of you.

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