Has anyone else been in the position where they're convinced they're about to try and explain to someone what they feel, but somehow got right into it's alright autopilot? I can be having the darkest of thoughts, with the only levity being the thought of potential suicide, and feel like I'm on the cusp of saying something, but just can't. Pretending to be happy comes easy to me. I've learned growing up, that people rarely have patience for the sad, morose and morbid me.
I found that this behaviour was encouraged in a way after going to medical school. We were prominently taught about the biopsychosocial approach to managing patients, but I found that we were encouraged to not acknowledge our own mental issues and physical exhaustion, and most of the senior doctors we trained under doled out abuse like it was part of their job description. At some point, I felt like I couldn't burden my close friends in healthcare or lost the feeling that my peers could empathise - everyone had their own pain to endure in some way. In my first ever practical examination when I was 20 years old, we were each assigned real patients to take a history, do a physical exam and come up with a management plan. The person I was assigned had a stroke, he couldn't talk, and was unwilling for me to complete my examination. It was a particularly difficult week for me personally, and I was overcome with the terror of failing the exam and potentially losing my scholarship. I gave up and stared out a nearby window just crying (which I hardly ever do in public) waiting for someone to pitch up. A complete unexpected coincidence - one of the examiners was related to me (someone everyone in the family respected and looked up to). When he figured out what was up, he said ,"Medicine isn't for quitters", and urged me to continue presenting the case to them. I felt ridiculous, completely depleted and embarrassed. Afterwards, he left to go examine another student, and we never spoke about the matter. Even when we bumped into each other on campus in the years after. I was terrified he would tell someone in my family, and then everyone would know what a loser I was.
After graduation, I found a new level to this. Everyone was stressed, overworked, sleep deprived. Patients and their families can behave atrociously when under stress, and through the worst, I never let it show that it affected me. I just gave them the space to feel what they did, and got on with my job. One particularly bad encounter was a delirious patient who I was trying to put up an IV line on all whilst he was trying to kick or swat me away. I got the IV running, but despite us trying our best to restrain him, I ended up getting a needlestick injury. The family who were all around and witnessed the incident refused to provide us consent to run an HIV test, which lead to me needing to be on a course of prophylactic ARVs (I ended up testing negative). Through it, no one really had the time to talk about how being exposed to HIV (13 years ago) was affecting me, and my manager's reaction was to make me feel like it was my fault.
Non-medic friends would listen to some of these things, but the response initially was shock and fascination, but quickly it was like ,"You're a doctor, you signed up for this". In my immediate family, I was always seen to be the stronger, stable one that was pushed into the role of being mediator and problem solver. There was just never any space for me to fall apart; the one time I did was when I came out as gay when I was 18. It ended up prominently being about them, and even though they accepted me, I still felt like I'd let them down.
The one thing I have pursued through the years dealing with depression is attending regular therapy session with a psychologist, including seeing a psychiatrist when required and complying to the medication they prescribed. I've sometimes casually hinted at suicidal ideation, but working in psychiatry...knew full well how pursuing that line of thought might end. 3 years ago, I finally attempted to kill myself. Eventually ending up involuntarily committed to a government psychiatric facility (despite volunteering to use my private insurance to go to a private facility)...where I learned that these spaces are not actually optimised to improving mental health. Hilariously, one of the doctors on staff training to be a psychiatrist was someone I worked with in my first job...I mustered up the courage to go and say hello despite being mortified- he barely acknowledged me, and proceeded to avoid me where possible. The horrific conditions in the ward and being cut off from the outside world & my comforts only spurred me to pull it together and pretend I was okay so I could be discharged to a private hospital. There was a brief period afterwards where it felt like life made sense again, where I felt there was meaning and purpose. But I soon found myself back to where I am.
I'm fortunate to be able to consult a good psychologist (my favourite so far) once a week for the last 2 years. Last week I was particularly in a bad space- I've been forced to come to my hometown to help my family as my mother has recently become severely ill. I've been doing some serious thinking about methods. I really felt I was ready to mention to my psychologist, partly just needing to tell someone, but also with a small amount of hope that perhaps she might support me should I attempt to apply for assistance via Pegasos. She had to cancel our session an hour before. When we finally met this week, I really felt I was going to start talking about it, but before I knew it, the session was over and all we talked about was my mother's cancer and work.
The one odd thing...I definitely feel I have been objectively more severely depressed before. I felt the physical effects of being depressed much more prominently in previous years (I first was treated for MDD at 21, I'm now 37). But, have never felt more suicidal than I do now. Even three years ago- where I think I only went ahead because I was dealing with some dark stuff (like confronting being sexually abused when I was 6) and being alcoholic, I found the courage after a bottle of vodka for breakfast. I've been completely sober ever since the failed suicide attempt (I've never been this sober for this long since I was 18). I sleep well, have a normal appetite, can enjoy certain things that I like...but the only thing that really keeps me feeling completely hopeless at waking up another day is that soon I might have the control of ending it.
I found that this behaviour was encouraged in a way after going to medical school. We were prominently taught about the biopsychosocial approach to managing patients, but I found that we were encouraged to not acknowledge our own mental issues and physical exhaustion, and most of the senior doctors we trained under doled out abuse like it was part of their job description. At some point, I felt like I couldn't burden my close friends in healthcare or lost the feeling that my peers could empathise - everyone had their own pain to endure in some way. In my first ever practical examination when I was 20 years old, we were each assigned real patients to take a history, do a physical exam and come up with a management plan. The person I was assigned had a stroke, he couldn't talk, and was unwilling for me to complete my examination. It was a particularly difficult week for me personally, and I was overcome with the terror of failing the exam and potentially losing my scholarship. I gave up and stared out a nearby window just crying (which I hardly ever do in public) waiting for someone to pitch up. A complete unexpected coincidence - one of the examiners was related to me (someone everyone in the family respected and looked up to). When he figured out what was up, he said ,"Medicine isn't for quitters", and urged me to continue presenting the case to them. I felt ridiculous, completely depleted and embarrassed. Afterwards, he left to go examine another student, and we never spoke about the matter. Even when we bumped into each other on campus in the years after. I was terrified he would tell someone in my family, and then everyone would know what a loser I was.
After graduation, I found a new level to this. Everyone was stressed, overworked, sleep deprived. Patients and their families can behave atrociously when under stress, and through the worst, I never let it show that it affected me. I just gave them the space to feel what they did, and got on with my job. One particularly bad encounter was a delirious patient who I was trying to put up an IV line on all whilst he was trying to kick or swat me away. I got the IV running, but despite us trying our best to restrain him, I ended up getting a needlestick injury. The family who were all around and witnessed the incident refused to provide us consent to run an HIV test, which lead to me needing to be on a course of prophylactic ARVs (I ended up testing negative). Through it, no one really had the time to talk about how being exposed to HIV (13 years ago) was affecting me, and my manager's reaction was to make me feel like it was my fault.
Non-medic friends would listen to some of these things, but the response initially was shock and fascination, but quickly it was like ,"You're a doctor, you signed up for this". In my immediate family, I was always seen to be the stronger, stable one that was pushed into the role of being mediator and problem solver. There was just never any space for me to fall apart; the one time I did was when I came out as gay when I was 18. It ended up prominently being about them, and even though they accepted me, I still felt like I'd let them down.
The one thing I have pursued through the years dealing with depression is attending regular therapy session with a psychologist, including seeing a psychiatrist when required and complying to the medication they prescribed. I've sometimes casually hinted at suicidal ideation, but working in psychiatry...knew full well how pursuing that line of thought might end. 3 years ago, I finally attempted to kill myself. Eventually ending up involuntarily committed to a government psychiatric facility (despite volunteering to use my private insurance to go to a private facility)...where I learned that these spaces are not actually optimised to improving mental health. Hilariously, one of the doctors on staff training to be a psychiatrist was someone I worked with in my first job...I mustered up the courage to go and say hello despite being mortified- he barely acknowledged me, and proceeded to avoid me where possible. The horrific conditions in the ward and being cut off from the outside world & my comforts only spurred me to pull it together and pretend I was okay so I could be discharged to a private hospital. There was a brief period afterwards where it felt like life made sense again, where I felt there was meaning and purpose. But I soon found myself back to where I am.
I'm fortunate to be able to consult a good psychologist (my favourite so far) once a week for the last 2 years. Last week I was particularly in a bad space- I've been forced to come to my hometown to help my family as my mother has recently become severely ill. I've been doing some serious thinking about methods. I really felt I was ready to mention to my psychologist, partly just needing to tell someone, but also with a small amount of hope that perhaps she might support me should I attempt to apply for assistance via Pegasos. She had to cancel our session an hour before. When we finally met this week, I really felt I was going to start talking about it, but before I knew it, the session was over and all we talked about was my mother's cancer and work.
The one odd thing...I definitely feel I have been objectively more severely depressed before. I felt the physical effects of being depressed much more prominently in previous years (I first was treated for MDD at 21, I'm now 37). But, have never felt more suicidal than I do now. Even three years ago- where I think I only went ahead because I was dealing with some dark stuff (like confronting being sexually abused when I was 6) and being alcoholic, I found the courage after a bottle of vodka for breakfast. I've been completely sober ever since the failed suicide attempt (I've never been this sober for this long since I was 18). I sleep well, have a normal appetite, can enjoy certain things that I like...but the only thing that really keeps me feeling completely hopeless at waking up another day is that soon I might have the control of ending it.
