The Long Dark Tea-Time of the Soul

In an earlier post, I spoke briefly about the depression that I went through after moving home for medical school.  While that was by far the worst, it wasn't the only depressive episode I've been through in my life.  I've experienced at least two other episodes:  the first when I moved out of my parents' house for the first time, and the second when I moved away for graduate school.  I didn't seek any treatment with the first two episodes, which I regret in retrospect after experiencing how helpful treatment was with the third.

I hesitate a bit to talk about this, particularly in a place that's as public as a blog, as it seems shameful to admit to having been depressed.  I worry that, if potential employers were to read this, I'd be less likely to be hired.  Or that if patients were to read this, they'd be less trusting in the care that I provide.  Or that if my brother, who thinks Facebook is too public, were to read this that he would come over immediately to kick my ass.  But I think it's vitally important to talk about because it's such a common thing.  Since starting medical school, I've seen multiple people around me struggle with depression and other mental health issues, some to the point of potentially not being able to complete their training.  By talking about it, my hope is to make people who are dealing with mental illness feel less alone.

One of the most fundamental things that changed for me when I went through my most recent (and hopefully last) depression was my perception of happiness.  Up until then, I'd believed very much that happiness was dependent on one's situation, that certain things needed to be present for a person to be happy.  At the top of that list of things was a romantic relationship, but there were other things like weight and appearance and money on there as well.  It took a conversation with a psychologist for me to realize that my list of supposedly important things wasn't required for happiness.  Years later, I still view that conversation as one of the most significant ones of my life.

As a result of that conversation, I started looking for ways to create happiness in my life, even without the relationship and all the other things I had thought I needed.  I worked harder at building relationships and connecting with the people around me.  I made sure that my life had time in it for pleasure, despite the feeling that I should be spending every waking minute studying.  I put a stop to the endless negative self talk that said that the universe had treated me unfairly and that I'd gotten a bad deal in life.  And it worked.  Although certainly not without difficulties and loss, the last four years have been some of the best of my life.

Which brings me to now, and my reason for writing this post.  Being a resident has been another major change for me, and although the experience has been mostly good, I can feel elements of my much less happy former self starting to reappear.  There are so many reasons for this that I can't even begin to capture them all here.  A big part of it is my Dad being gone.  He was the person most like me in the world, and he was always very attuned to how I was doing.  Any time I struggled or started to think negatively, he had a knack for saying or doing just the right thing to help pull me back.  While I love my Mom dearly and know that she always means well, her knack is often for saying the wrong thing and making things worse.  I wish that I could bring my Dad back for just a few hours here and there so that he could make things better again.

Another part is realizing, really realizing on a gut level, just what I signed up for when I started medicine.  The sacrifice of medicine isn't just for the four years of medical school or for the five years of residency - it's a lifetime of having to put my career and other people before myself.  Even if I pick the most lifestyle-friendly subspecialty, I will have to be on call and have a messed up sleep schedule that leaves me feeling tired.  And while I'm doing this, while I'm digging deep into my reserves to do the best job I possibly can, I'll have to deal with other physicians, and nurses, and patients, and patients' family members who will give me shit for not doing a good enough job.  I love the work I do, I honestly and genuinely do, but it's also very hard.  And that's something that I still grapple with.

Another part is that I've been cutting myself too much slack lately.  I've been feeling sorry for myself because of how much I've been working, so I've "treated" myself far too often to nights in front of the tv, and takeout dinners, and time off from studying.  While I know that there's a place for all of these things in my life, I've given them way more time than I should.  Being lazy all day makes it harder for me to sleep at night (hello again insomnia), which just makes everything worse by making me tired the next day.  Too many takeout dinners make me feel like I'm incapable of taking care of myself and add to my anxiety about the inconceivable pile of debt that I'm accumulating.  Not studying is probably the worst of all, because it leaves me feeling incompetent at my job and feeds into my fear that maybe I'm not actually good enough to be a doctor.  I also have a licensing exam in two weeks, and while it's reputed to be easy, I don't want to bet the ridiculously large exam fee that it's easy enough to pass without studying.

So, some of these are things that I can change and others things that I can't.  First and foremost, I think I need to really acknowledge the mental space I'm in and start working on getting through it.  And I need to get off my butt and start doing some of those things that make my life better, even when I'd rather eat Thai food from a tinfoil container while watching America's Next Top Model.  Happiness is really not as elusive as it may seem.

Edited to add:  I just read a post over at Stumbling Towards Nirvana, and apparently today is the WHO's World Mental Health Day.  Talk about perfect timing!