Confessions of a depressed mind
For medical students to overcome
depression may mean coping with the darkness, hopelessness and sadness while
hiding the illness from a sceptical medical profession
We laugh about the patient who jumped off
a building because she thought she could
fly. We share stories about the bizarre
voices and delusions that our patients try
passionately to convince us are real. But
do we stop to think about how mental illness is probably far
closer to home than we're comfortable with?
Patients' lives seem a million miles away from our
comfortable lives as students, yet as prospective doctors we
badly need to begin to understand psychiatry from
a patient's point of view. How else can we appreciate the
mystery of an invisible disease that destroys people's lives?
It is not a joke. It is not made up, selfish, or attention
seeking. It is the manifestation of an unwell mind, and we
need to listen and learn.
Carer turned patient
I am a medical student, but I am also a patient. For the past
one year I've been battling mental illness while studying, and
I wish it was better understood by my peers.
There's a secret shame to being a medical student with
depression. You don't want to be labelled as a crazy woman,
as mental, or as lazy, so you try and hide it all, embarrassed
at the diagnosis and yearning to be better and become the
strong and contented doctor you want to be.
It's weird becoming the patient. The first step was
admitting defeat to a general practitioner, describing how I
couldn't cope and acknowledging that something was really
wrong. Then I had to take my prescription to a pharmacy
and accept that I needed to take drugs for a while. Over the
next weeks and months I began to painfully pull out and
analyse my past, and my problems, thoughts, and inner
turmoil with a psychologist, a psychiatrist, and a counsellor.
Depression is hard to explain, and although the
symptoms and signs do summarise aspects of it - lack of
energy; feeling sad, hopeless, and numb; and having
problems with sleeping - they are way too general. They
completely fail to describe how it really feels, and explain the
change in mindset that consumes you and changes you.
My experience
I find some days OK. I have to spend time convincing
myself to face the day and fight off the mess in my head.
Only then can I get on with things and distract myself from
how I feel. I put on a happy, often overly hyper, front to
people and you wouldn't know the suicidal thoughts that
haunt me and the enormity of the effort put into things like
laughing and appearing to enjoy nights out.
Some days, however, are horrific. I just can't get out
of bed, am swarmed with a million thoughts, and feel
disconnected to my surroundings. I feel slow and numbed
to the good things in life and forced into endless depths of
despair I never knew existed. Those days I try to just sleep
and wait for the day to be over, trying hard to avoid the
panic attacks and dissociative attacks that can take over.
The mornings are the hardest. I'm not just talking about
the Monday blues or the fear of a long day of being
humiliated by the consultant of doom; I'm talking really,
really hard. The excitement, apprehension, or even slight
dread of a fresh day that I used to feel, gets replaced by an
overwhelming apathy and darkness.
Glimpses of how I used to be
Every so often I get a brief glimpse of how I used to be and
will be again - feeling excitement, in control of my thoughts,
positive, and empowered. The battle in my head seems a
million miles away. I can't wait to feel better, to have good
days and bad days like I used to, to be able to lift my mood
and have a good cry over things, and feel a bit better at the
end.
I struggle because I still don't understand why I feel like
this, and I feel so out of control with myself. I didn't even
think mental illness was real before this hit me; I guess this
will be a case of "learning from experience".
ANDREW DAVIS/TREVILLION
The pain is only too real
It is a frightening experience for me, and I'm sure for
other patients. I feel like I don't know myself any more, and
have lost the person I used to be. Too often my mind is
swarmed with negative thoughts and internal voices, and
urges to hurt myself or end things seem to come from a
place within me that I just don't recognise. I'll feel like I'm
drowning in my troubled mind, constantly struggling against
negative moods, hopelessness and urges, yet never actually
managing to cheer myself up.
Unhelpful comments
Throwaway comments like, "pull yourself together," "you're
really difficult and moody," and, "its not that bad" plunge
into you like a knife. Do you not think I've tried? Do you not
think I count my blessings? Do you not think I know how
hard I am to live with? Because I live with myself, haunted by
dark thoughts and moods, frustrated so much by not being
able to make it better, and blaming myself because I think
somehow it must be my fault.
What helps? The drugs seem to vary my moods more, but
are in no way a cure. Therapy helps me manage my moods
and deal with my thoughts in a more constructive way. My
friends offer me the love and support that I need, and they
put up with a lot. I really appreciate having people around
to talk to if I want, sit with if I don't, and go out and forget
about it all when I'm feeling OK. At a time that I can barely
put up with myself, having people around me that care is a
real blessing.
Medicine doesn't fully understand depression, and I try to
combat its physical, psychological, and social influences, but
the spiritual ones are so important too. Prayer offers me the
hope and peace that keeps me going through my darkest
times.
Nothing is forever
As for the future, I hope soon to get better; I know these
times don't last forever. Until then I will work around this,
trying as hard as I can to keep up with my studies and doing
clinical placements when I'm OK. I try to keep pushing on,
doing things, exercising, and putting time into friendships so
that I may stay outward looking and not let the depression
take over my life. I have the option to take time out and I
may need to do this before I'm ready for fourth year studies.
Overcome the stigma of mental illness
So to all you medical students - drop the stigma; whatever
the cause is for mental illness we need to acknowledge it and
try our hardest to help. For all you know, the girl next to you
in a lecture, your closest friend, or your next patient will be
silently suffering, and one day you may be, too. And then I
guarantee you'll see just how important it is that doctors are
sensitive, non-judgmental, and willing to understand.
Competing interests: None declared.
studentBMJ 2006;14:309-352 September ISSN 0966-6494
