Being a Doctor
It wasn’t until after I quit working in the HSE, that I realised I had been profoundly depressed. My tiredness, poor sleep and bad appetite were things that I attributed to my extensive overtime and amount of work. I thought that working 12-15 hour days would do this to me, and I should expect to always feel tired, sad since everyone says that training is full of long days and nights and sick patients. But now I see that should not necessarily be the case.
Take a professional athlete who spends each day training. Every week, they improve little by little until they reach their peak, and then they maintain this peak. Yes they will be tired at the end of the day, but this is often accompanied by measurable improvements. Apply this to anyone’s work, with time things should become easier, more streamlined and at the end of the day, you should see improvements and finish your work earlier. That just wasn’t the case for me or my colleagues. No matter how much streamlining, learning, improving I did, the work never decreased. It just meant there was more I had to do during the day.
I think I was depressed for most of my college years. I really am constantly surprised by how bright colours really are. Tastes, sounds, touch are really much sharper than I can remember in a very long time.
There were a few times I noticed that I was really depressed. I would have passive death wishes, some invasive thoughts of crashing the car, wondering really would death be so bad. Those times I “rationalised” it to be just morbid curiosity. But the thoughts didn’t go away, and one time I came home from work, fell to the floor in the kitchen and cried until I fell asleep. After that time, I certainly confirmed to myself that I was depressed and that something needed to change.
In psychiatry, the key to lasting improvements for mental health is with a “biopsychosocial” approach. “Bio” - meaning biological - encompasses changing the physiological/chemical changes in the brain in states of depression. The most common intervention in this category is pharmacological with anti-depressants. However biological doesn’t only relate to the brain. The rest of your body responds to states of depression. More cortisol is produced, greater inflammatory state, decreased sex hormone production. It’s a vicious cycle that exacerbates itself.
Medication is used to manage the “bio” side of things, antidepressants, anxiolytics, etc. Changes in your daily life and routine should have a lasting impact that extends beyond the difficult time. Eating healthily, getting a good amount of sleep, doing some exercise have big impacts on the “Bio” side of things. Having a routine of sorts also breaks you out of any rut you may be in. Just like a notification can break your concentration on a particular task, having something you must do can break your concentration on negative thoughts.
Next part is “psycho” - psychological part of the intervention. Probably the best known intervention is something called “Cognitive Behavioural Therapy” or CBT, however there are dozens of other therapies that address specific psychological needs. Once again, this part doesn’t just mean attending therapy with a psychologist. If you look at it mathematically, if you go to therapy often say 3 times a week for 1 hour sessions, that’s just 1.7% of the hours in a week. The rest of the time, you have to spend with yourself. This is why success really does come from practice, we can be given the tools needed to help ourselves during that 1.7% of the time and for the rest of the 98.3% we need to use those tools until they become a part of us.
My psychological tools have been philosophy, meditation and I think my medical education and work experience. This blog is a part of it. Once a crisis hits, I’ve come back to this and to meditation, but have so far been bad at maintaining a good mental habit. When things are good, you forget about the bad or about protecting yourself. Things fall by the wayside, you pick up more projects and say you’ll do things “later”. In my experience, later often ends up never, and never leads to dark moments. I’ll try my best to improve my habits.
The final part is “social”. This is almost self explanatory but also the most intimidating. Everything up until now has been looking at the individual, what the patient can do for themselves by themselves. Social encompasses the rest of the world! Despite being the only known life filled tiny speck of dust floating in the indifferent space-time field that is our universe, to us it is still huge and daunting. Over 7 billion other people with their lives beliefs and trajectories.
I’m incredibly fortunate that I had my parents nearby. I wasn’t looking for solutions from them, just their presence. There is this ephemeral feeling of family love that waxes and wanes and is different from anything else.
Well, the social side of things really took a beating this year. To be a responsible young person and do my part in trying to bring this pandemic down, I’ve had to isolate myself from my friends, family, girlfriend and even co-workers. Losing at least 33% of the tools to manage something is definitely a challenge…
This post isn’t a guide. There are so many things I’m fortunate in knowing and having. Food, water, a roof. A job available almost at any point. Family that I get along with. Friends. Knowledge of what depression is, how it presents and what to do about it. What I wanted to do with this post is to highlight to myself that it has passed by for now. It took me years to fully realise that it was a part of me, and probably will be again in the future. But to me, covering something up is not the way to treat it. History repeats itself and so it’s possible to prepare yourself for the future. A big difficulty lies in recognising a scenario to one that has happened before. I suppose that is part of the reason why I’m interested in learning about stoic philosophy, it’s almost ancient CBT wrapped up in a nice historic package with some cool quotes to remember.
I haven’t finished writing here, I’ll add bit by bit as time goes on.