PERSONAL VIEWS
Sleeping sickness of the soul
Someone once told me that by halfway
through the medical course almost
one third of us will have experienced
some form of (clinical) depression. Possibly
not that hard to believe with the pressures of
the course, but would you be aware enough
to recognise the signs in a friend or
colleague?
I used to think that I knew all about
depression through the experience of a
close relative with the illness, but I didn't recognise the signs in myself. It's not as if I woke
up one morning and “bang” I was
depressed, my problems
started so gradually that
nobody noticed until things
ran out of control and treatment was no longer a
simple matter of taking
antidepressants and everything would be fine.
I began to have problems concentrating in lectures and tutorials, was
unable to focus on wards,
unable to revise effectively,
and began to miss meetings and appointments. My attendance at medical school
declined until I hardly went in at all. I
withdrew from my friends and started to
find that even making casual conversation
required too much effort. I actively avoided
any situation that involved “social performance.” Sleep was virtually non-existent and
constant fatigue began to become a prob?
lem. I could not sleep at night and when I
did I woke up many times or was plagued by
vivid nightmares. Any little problem became
a virtual roadblock to continuing my normal
life. Minor things, such as
shaving and the simple task
of getting out of bed,
required an almost superhuman effort. I gradually
found myself unable to
function under any definition of “normal,” became
prone to either overexaggerated displays of emotion
or complete withdrawal
from my surroundings.
My thoughts spiralled
out of my control, negativity and pessimism
constantly running around in my head, everything was black. My thoughts ran down
until they hit rock bottom. Interaction with
anyone became a task more suited to
Hercules. I used to just stare at the walls or
the television, anything to avoid actively
thinking. I felt as if I was at the bottom of
a very deep hole with no way to construct a
ladder to get out and no one was coming
to help.
Suicide. Ending it all. A thought I
couldn't get rid of. Looming large in the
background and rapidly becoming an
option to deal with my feelings. I even
planned out how I would do it. I still have
difficulty ridding myself of these thoughts.
But I didn't do it and I still don't know what
stops me. Perhaps it is still worth fighting to
get my life back. The faint glimmer of the
return of normality is a speck in the distance
that seems unreachable most of the time. I
have good days and bad days.
I now see a psychiatrist and a clinical psychologist in addition to receiving drug
treatment. For a long time, I attempted to
hide this from everyone, especially fellow students. Accepting the diagnosis of a psychiatric illness has
proved to be very difficult
and I probably still haven't
fully come to terms with it. I
was so worried what friends
and colleagues would think:
“He's faking it,” “It's all in his
mind,” “It's not a real illness,”
“It's not like he's got cancer
or something,” “He's just
being overly dramatic.”
Would people really treat me
differently because I had a psychiatric illness?
How would you react if it were a friend?
Would you treat them any differently?
I couldn't revise for most of this year and
my concentration problems are worse. I
failed my exams. The impact of this on my
psyche was of cataclysmic proportions, especially at the time the results were published.
However, if I could take one positive thing
from my depression, it has led me to
re?evaluate my life and the importance I
have placed on things such as academic performance and achievement. Academia is no
longer the be all and end all
of my life. It is still important but not to the exclusion
of all else. I find myself
circumventing my pride
and beginning to confide in
a small group of friends
who are helping me
through this.
I did not write this
article to be self indulgent. I
have tried to give an honest
impression of life as a medical student with depression. Somewhere in
my mind, I know I will get better in time, that
I will go on to complete my studies, and
become a doctor, but this seems a long way
away at present.
I hope in reading this article, you may be
more understanding of colleagues and
friends who perhaps are having difficulties.
One of the hardest things that I have had to
do is admit to myself that I am mentally ill.
The medical student who wrote this article wishes to remain anonymous
studentBMJ 2001;09:399-442 November ISSN 0966-6494
