From the bottom of the abyss

So I know MSO doesn’t usually let people talk about their medical problems on here, and fair enough. But I’ve consulted with Isuru, who feels it’d be ok. I want to write about something that’s largely swept under the table by the medical profession as a whole. I think changes are being made, but even in 2013 it feels like somewhat of a taboo topic in the medical profession: The mental health of its members. Well, I want to change that. I want to tell my story of mental illness, and I want it to be real, and not toned down.

Just to make it very clear: I am NOT a registered health professional, and any advice I give here is my own (lay) opinion only. If you think you, or someone you know, is having problems of this sort, seek help from your GP, or a mental health professional. Also, please do not post comments on this blog asking for, or giving, advice on dealing with mental illness.

So: I’ve been diagnosed with having a Major Depressive Episode, and Generalised Anxiety. For a few weeks (ok, most of the year) I’d been feeling pretty low, but I’d brushed it off as general stress –being a medical student, an RA, and a boyfriend has meant I’ve had a lot on my plate. Sunday night though, it all really hit the fan. I turned the light out, and lay there, really agitated. I’d been weirdly preoccupied with death for a while, but had just assumed it was simple academic curiosity. But then, thoughts of suicide sort of appeared out of nowhere, and they scared the crap out of me, enough that I dragged myself out of bed at two in the morning, and sobbed and shivered my way to the ED.

I don’t really remember much of the walk to the ED, but I do remember one bit in particular: I was walking past the critic office, with the music playing, and I had to use up every ounce of will left in me to stop myself lying down and just listening to the music they have playing there. In my very depressed state, I could imagine them picking up my body from there in the morning, and the idea actually seemed appealing.

I managed to present myself at the ED, which was simultaneously the best idea I’ve ever had, and the most embarrassing thing I’ve ever done. Telling a total stranger behind a desk, in a not-empty waiting room with people sitting close enough that you’re pretty darn sure they can hear you, that you’ve spent half the night thinking of ways to kill yourself, is horrendously embarrassing. Fortunately the nurse came and got me pretty quickly, and moved me.
I lay in the ED bed in sort of a shut-down state, like my brain refused to believe what was going on. A few hours later, a nurse came in, and led me to the emergency psych services rooms. He was nice. He did the whole ‘history’ thing, in a bright, white room that looked exactly like the psych interview rooms in every movie ever. Then he took me to another part of EPS, to another similarly movie-esque room, and let me ‘sleep’ on the couch there until the psychiatrist could see me. By this stage it was about 6am, and it took me about another hour to get to any kind of sleep. So when the psychiatrist woke me at about 9, I was certainly not in a good state.

Didn’t like the first psychiatrist. He spent a lot of time telling me that I’d have to dump my girlfriend if I wanted to succeed in medicine (which neither I, nor any of the doctors I told afterwards, could work out), that it only gets tougher from here (the implication I took from this was that it was apparent to him that I’d ‘cracked’, and wouldn’t be going much further in medicine), and that I’d probably have to repeat third year. Even the medication he charted ended up getting changed by the other doctors. About the only thing he did right for me was give me the option of going to the psychiatric hospital. He also got my parents in contact with the medical school, which I had reservations about (even in the more ‘open-minded’ medical system of today, mental health issues come across as something liable to sink your career), but have come to accept was a good idea.
So I lay on the couch till about 3pm, a few bouts of tears (mostly after ringing mum) and a lot of staring at the wall with a very blank mind later, and I was in a car, off to hospital. I felt like such an idiot walking into the ward. I’m a medical student for goodness sake, how on earth was I finding myself being admitted to a mental hospital? It was good, though. I felt safe. The blue polar-fleece blanket was warm, and I don’t know why, but it made me feel safe. Anyway, so mum and dad came and got me a bit later on. They sorted everything with the my boss, and the medical school, and it even looks like they’ve found me a place to live for the rest of the year.

I wanted to write about how I’m ‘feeling’ during all of this. The problem there is that I’m not. I’m not feeling anything. Don’t get me wrong, I feel lousy, just generally ‘down’ (yeah, I know that description isn’t going to win any creativity prizes). I’m just sort of watching everything happen to me, like it’s a movie. I think it’s best summed up as per Allie Brosch in ‘Hyperbole and a Half’, where she says (summarised) : Not giving a f*** is usually considered a good thing in a lot of ways. But in depression, the difference between ‘not giving a f***’ and ‘not being able to give a f***’ becomes fairly obvious fairly quickly. Which totally contradicts what I’m about to say, and yet for some reason they’re both cohabitating inside my head without seeming to care that they’re mutually exclusive: I’m anxious as. Everything that I’ve ever done wrong seems to be popping up in my head, and my brain is inventing a heap of possible outcomes where the past ‘wrong’ (inverted commas necessary because at the moment I’m not sure my brain is really differentiating ‘wrong action’ from ‘normal action’, and is just assuming everything I’ve ever done is wrong because I’m a total screw-up). So for a while just then, I lay here feeling simultaneously absolutely nothing, and a total terror that my life was ruined.

Maybe the best way to describe it is that the emotions happen to me, rather than me actually being actively involved in the feeling of said emotions. I can recognise when anger, sadness, anxiety, etc, are there, but I can’t really ‘feel’ any of them. There are small bouts, where I suddenly properly feel all the sad that’s been built up, but then my brain leaps in to protect me and shuts me back to zombie-land.

I purposefully didn’t mention ‘happy’, or any ‘positive’ emotions above. One, because they’re not really a happening thing right now. Two, when they do happen at the moment, they’re over strange things. Like the blue polar-fleece blanket at the hospital. It’s not real happiness, it’s just random things that my brain choses to latch any remaining shreds of positivity onto.

It’s weird. I’ve been sick before, but at least I could still think. Even after a night on the town, I at least still had the knowledge my brain was intact under everything. But now it’s not. Now I’m scared I’m losing the one thing I’d always prided myself on: my brain. Which is only serving to make me even more psychologically fragile.

Update: So now it’s about four weeks (and two more hospital stays…) later, and I’m feeling… Well, something. Still struggling somewhat to shake off the feeling that everyone with a positive attitude needs to be lined up and shot, but no longer quite so sure about that. I even almost think there might be some positive things out there. I don’t know what they are, but now that I can at least acknowledge the possibility of their existence, I kind of want to keep going long enough to find them. And that’s good enough for now.

The main thing that’s getting me now is the number of people who keep saying they ‘understand’. The fact that you have been sad before does not give you the right to tell a depressed person that you ‘understand’. You do not understand. However, thanks to the unfortunate fact that the word ‘depression’ has been so over-used in everyday life (eg: All those ‘I’m so depressed because by boy/girlfriend dumped me’ facebook statuses), people think they know what you’re going through. Because of this, they think they have every right to tell you how to deal with it. They do not. Going for a walk doesn’t help, ‘looking on the bright side’ is impossible, and nothing makes you happy. Telling a depressed person to try and make themselves feel better is like telling a quadriplegic to run a marathon. If ‘looking on the bright side’, and doing ‘enjoyable’ activities was a legitimate cure for depression, the anti-depressant pharmaceutical market would not be a billion-dollar industry.

The worst thing you can do for a depressed person is tell them you understand. Unless you actually do (ie: You’ve been there).
So the above is an edited version of what I wrote about a week after all of this. I’ve tried to leave it close enough to what I wrote at the time to give a realistic idea of what it was like, but I’ve had to change quite a bit of it to make it make sense to people who aren’t me. My concentration, motivation, and general mood still are still rubbish a few weeks down the track, but they’re not at the depths they were when this was all happening.
Basically, I wanted to post this not to say ‘feel sorry for me!’, but because this isn’t just my problem. From what I’ve read in the literature, over 15% of medical students at any given point in time have symptoms of moderate to severe depression, but far, far less than that number ever seek help. It does suck. It isn’t easy to talk about. But it’s better to seek help and be told you don’t need it, than to not seek help when you really do need it. And if there’s one thing I’ve learned from this, it’s that your fears of being judged are pretty much entirely unfounded. Practically nobody thinks less of you because of it, and those that do, well, they tend not to be people who really matter to you.
Unfortunately, other than ‘get help’, and that you DEFTINITELY need to inform your school (they can’t do anything for you if they don’t know you’re in trouble) I don’t have much by way of advice. I’m still battling with this myself, blankly staring at textbooks/my bedroom wall and wondering how the hell I’m going to pass this year. I can’t afford not to pass (both financially, and because if I did, that’d send me spiralling even lower). But I think it’s (slowly) getting better. With the help of friends, tutors, and family, I can possibly even do this.
Watch this space.
F**k mental illness.
Contact details for help with depression and anxiety:
Australia: Beyond Blue, http://www.beyondblue.org.au/ , Ph. 1300224636

New Zealand: The Low Down, http://www.thelowdown.co.nz/ , FREE text 5626, OR;
: www.depression.org.nz/ , Ph. 0800 111 757