I believe that it's the small things in life that matter. You can improve something by making tiny changes, and by working up from the bottom, you can truly achieve greatness.
The thing with depression is the word is so misused. We all do it, and without thinking about it. And I want to talk about why that matters.
When mental health campaigns talk about depression, I see people think “Well I often feel depressed and I’m alright... why the fuss?”.
The word depression is used in English in many countries to represent a low mood or a bad day. We all have those, days that are overwhelming, intense or leave us feeling fatigued. This is (sadly) normal in life.
Doctors and Mental Health charities use the word depression in a different way though. In medicine and healthcare, “Depression” is a medically defined term with a set of qualifying criteria.
There are a few recognised sets of criteria that are broadly similar. You can see one of these in the World Health Organisation International Classification of Disease version 10 (WHO ICD-10)
Here depression is classified in several entries rather drily titled “F32-F34”.
You can see that depression is clearly defined by a set of symptoms. A bad day wouldn’t count as depression in a medical sense, because it’s time-limited and won’t prevent ongoing difficulties with maintaining the activities of daily living.
And this is why when someone says they are depressed I am both interested as a person (“why are they sad?) and as a doctor (“do they meet diagnostic criteria for a depressive disorder”). A person can have clinically diagnosable depression and also have a depressing day. The words are the same but the meanings are not.
I continue to live with this, every day. A few years on, I have tried to take my own advice, and listen to what my body and mind tell me. I rest more, and I try to take more time for things that are important to me. Saying no is hard, but it has made me feel better. It is very hard to explain the sense of dread I wake with most mornings; I wake and wish I hadn’t most days. I am aware that I have an impact on others around me, but I cannot shake the sense that I have little worth in the world. Scientifically, I probably don’t, but it’s more than that. I suppose it’s a strongly self-critical and unforgiving mindset. The sense of guilt for having these feelings in my very privileged life follows this.
I too have bad or depressing days, and thanks to several factors, I now have lots of really good ones too.
Nothing is more irritating though than when someone confuses the two. It’s similar to someone who sometimes has a tickle cough telling someone with severe asthma that they know how it feels, and also how to make it better.
If I’ve just had a bad day, the advice is welcomed. But thinking that depression can be cured by taking a walk, having a pint or giving me a hug helps is liking blowing in the face of an asthma attack to give them more oxygen.
Like asthma, my depression is endured, not cured. And with a combination of lifestyle and medications, I can minimise the exacerbations and carry on with my day ok. But if I neglect the ongoing work, then I’m more likely to slip.
The key thing about mixing the two up is that it devalues my chronic condition and makes it seem “silly”, or worse than that, a personal failing because “everyone has depression”, and I don’t seem to be able to just get over it.
Time to Talk exists as a campaign in order to encourage us to talk about our health in a constructive way. The stigma of mental health has definitely lessened in the last 5 years, and I’m extremely grateful for that. It’s important that we support our friends on their bad (or depressed) days, and also that we recognise the illness of depression as something distinct, though perhaps related, to that.
So if we are going to talk, let’s talk about how we communicate and what that says about us. Language is so important to me, it’s one of my hobbies. I love how different languages have different phrases and terms for things that help sum up their culture.
I like that Slovenian has a system of changing the ends of words to denote single items, a pair of items and a group; as opposed to most languages which define things as either single or plural. The focus on details is part of the Slovenian mentality of taking time to appreciate the results of your efforts. When you can traverse a country and 3 or 4 different geographical biomes in two hours, there is no need to rush.
There has been a more recent trend to lifestyle advice as a way of living more happily. Christmas 2016 was all about Danish “Hygge”, a term not easily translated to English but meaning something along the lines of “a mood of coziness and comfortable conviviality with feelings of wellness and contentment.” It’s developed so much that hygge became a defining characteristic of Danish culture.
The Swedish term “Lagom” was the Christmas trend of 2017, and rather beautiful encapsulates the Swedish virtue of “moderation” and “balance”.
Both Hygge and Lagom have become global trends in so called developed countries perhaps because we as a society are searching for something that makes us happier and content, and we see that in others. So we want to replicate it for ourselves. The trouble is, that these terms aren’t easily translatable for a particular reason... they represent the places where they come from. In the United Kingdom, we are going through an identity crisis that has yet to have arrived at its solution. We have rejected our European-ness in Brexit. We complain about the lack of respect from others whilst tweeting our complaints to companies that serve us. We bemoan the loss of our communities, whilst embracing the convenience of retail parks and instant delivery of items we want. What is our defining characteristic?
I wonder if it can be seen in our stereotype of queue-loving, tea-drinking, stiff upper lips.
We queue because it seems fair, and we drink tea for comfort as it provides us with solace at difficult times, as well as a way of offering your time to someone else. The stiff upper lip is important, we restrict ourselves from discussing our feelings so as not to burden others. This was important in war time, or perhaps when acting as a colonial overlord, when showing feelings might have been risky, but perhaps serves less purpose now.
Who knows? Nevertheless, finding our UK version of Hygge or Lagom is important, because as a nation experiencing increasing mental illness and distress, we perhaps need to look beyond the individual in front of us to the greater societal concerns that contribute to our growing collective unease, dissatisfaction and mental distress.
I wrote the following a month or two back when my depression took a dip. I didnt share it at the time but as today is World Mental Health Day it seems fitting.
I hope this provides an insight into the mind of someone who is depressed. I'd encourage you to read this imagining a colleague or friend who seems OK. I seemed OK to most when I wrote this... A few close to me realised, but generally I hide.
Talking and sharing really helps me. But my experience is just that... Mine. Like any illness, mental health is individualised to the person, and one person with depression might not resemble someone else with it.
I dont post seeking sympathy, for a pat on the back or to make out that I represent anyone but myself. But I do hope that I can help others understand.
Im currently in a dip. My mood has taken a turn and I'm working through it.
It's hard to describe my thoughts, but I wonder if it's helpful to try.
I'm currently sat in a coffee chain, actually trembling. This is partly my own fault... Ive had a coffee and the caffeine has obviously added to my own circulating adrenaline. I'm hyperacutely aware of everyone around me. If I let my thoughts start to drift, I start to imagine that I am being looked at. I imagine that people look at my hair and wonder why it isn't cut, at my overweight stomach, at my acne scars, the fact I'm sat alone and all sorts of things.
Intellectually I know that they couldn't care less who I am or what I'm doing. And so I have these two conflicting thoughts in my brain... I feel like I'm listening to an argument at times, except it's me vs myself.
(When I read this to check spelling etc, it feels as if there are two strangers with their chins on my shoulders watching me, it such an overwhelming feeling and I am forcing myself not to turn and confirm that they aren't there)
Why don't I just turn it off? I wish I could. Last night I watched YouTube, Netflix, read, got up, walked around, had a tea and all sorts to try and help me sleep, but every time I stopped distracting myself, my brain floods with thoughts. I tell myself that my whole life is a waste of time, that I am a waste of space and waves of guilt come over me for being so selfish and arrogant. I am so lucky... I have been gifted so much in who I am and I hate myself for not appreciating it, and in a weird triple-paradox, hate that I hate myself for it when I could just accept I'm alright.
My own brain concocts the denigration I give myself... It doesn't exist outside.
The trouble is, when I'm like this, I start to become irrational, so that my ability to laugh off or sensibly process just disappears. I worry that I offend a bus driver for not having the correct change, or my neighbour for not putting my bins out. It's almost like I look for reasons to justify why I hate myself, to reinforce the falsity.
I start to see meanings in things that are just coincidence. For example, a load of new songs have just been released that feel like they just fit how I'm feeling. They are melancholy so just feed the beast!
Someone threw a cigarette out of a car and it hit my window yesterday. It felt like a warning of some kind, but I couldn't tell you what.
At my worst I have bizarre dreams like where I offer to become a live organ donor (why?!) but all my organs are rejected as I'm too poor quality to give to unwell people. Dreaming is a warning sign for me... When I'm well I don't tend to remember my dreams.
Dont get me wrong, I am not hearing voices or believing that any of these things I'm describing are real. They aren't. I know it's my own brain. And I know that with perseverance I will somehow return to normal. It will happen and just click.
The effort required though feels overwhelming and impossible. I know that I need to go and exercise, but I find any excuse not to. I know I should see my friends and family, but I hide away.
Work really helps. I have a focus and I'm lucky enough to be in a job where I help people. In each of my jobs I have wonderful colleagues who lift me. I'm never sure how much to say when at work... I feel alright when there so it just seems odd to make a deal out of things.
Putting on my customer service face is bit like when someone makes you smile... It tricks you into believing you are ok, and then suddenly you are!
Following a recent "Day in the Life of..." article for The Guardian, their editors asked for other GPs to write to them about a typical day. I'm not aware that they have used mine, but as I wrote it, I thought I would share. For context, I work in a medium to large sized GP practice in the North West of England, in a fairly deprived area. However, the set up of my practice is pretty good, and compared to local colleagues, I think we have it pretty good!
GP Life
One of the things I find hardest is that you have to remind yourself so often that you are in fact doing a good job.
The very nature of patients is that they come to see me when they aren't well, or at least if they "consider themselves to be unwell" which is the description given to my potential client-base in the GMS contract; the contract that defines what GPs should do. This means they aren't their usual selves and often take their frustrations with the NHS, Social Care, or just life in general out on you. Even though I have nothing to do with these things, I have to try and and empathise with say, how poorly they perceive the communication about their care by my hospital colleagues; their dislike of the below-minimum wage home care assistant to do everything they want; or that their employer won't give them time off for their child's funeral.
I find people of my own generation (I'm 33) tough to deal with because their expectations are wildly unrealistic. They perceive any illness as abnormal, and often a failure of me as a doctor to somehow prevent. The notion that any treatment I can provide might take more than one dose to fix is unacceptable to some. The human body ages and things don't work as well as it gets older. Unfortunately, it's not like a lease car that you can replace with a new model every 3 years - you're stuck with it and that sometimes means living with a condition.
Then again, the older generation are some of the most entitled. The number of times I am asked to visit someone at home, purely for their convenience, rather than an inability to come to the clinic, where all my kit and their usually extensive notes are. It's not uncommon for us to be asked to schedule our visits around, "when they are out"... it's a stark reminder of how unvalued I am as a professional that the hairdresser appointment warrants a taxi but I don't. I'm frequently told that GPs used to visit their parents all the time when they were sixty years old, to stop and have a chat or whatever. They forget that the average life expectancy is way higher now, and there simply isn't the time to socialise anymore. It's sad, because I enjoy that, but whilst the patient only has to think of themselves, I am potentially thinking about 10000 other registered patients at our practice, any of whom might be needing me more urgently. Sme of the older generation seem oblivious to the fact that their visit takes at least 3 times as long as a standard appointment, and is usually done instead of my midday meal.
Children are another difficulty. I despair at "awareness" campaigns on TV and on Facebook, because I know they will lead to increasing numbers of requests for emergency appointments to review children for rare conditions they don't have. Whereas grandmothers and groups of mum friends would previously mutually reassure each other, now they spread panic. I disagree with the old adage "You can't be too careful"... I think we are now at a stage of such learned helplessness that the future of publicly funded healthcare is no longer viable in its current form. The NHS simply wasn't geared up for and is certainly not funded to see children every other week "in case their cold becomes meningitis". What happened to the family structure and trusting ones own instincts? It's rare I see a parent who hasn't been terrified by one campaign or another into doubting themselves and wanting a second opinion from me.
As a GP I can't predict the future, and unfortunately some people will get serious illness whatever anyone does to try and prevent it. Society appears to think differently, and has zero tolerance for any drop below 100% functioning.
I sometimes watch TV programmes like BBC1s Doctors or Ch5 Behind Closed Doors. The latter is quite good, but I still feel comes nowhere near portraying what it is like to be making potentially life changing decisions at 10 minute intervals or less.
It's hard for patients to grasp that I can't "just have a quick look" because what they actually want is for me to reassure them that they don't have something serious. GPs don't possess magic powers, and being thorough enough to reasonably exclude scary diagnoses takes a few minutes. No one thanks a GP for missing something, and in reality, you are taught as a trainee that that you will in fact miss things - medicine is an art as much as it a science. However, GPs are expected to be instantaneous and yet flawless. It's impossible.
On a typical day I will see up to 30 patients in 10 minute appointments. I built extra time into my clinic as I just can't manage 10 minutes anymore... this time is my own and isn't paid any extra, but it allows me to breathe, and more importantly, to sometimes spend 2 or 3 valuable minutes extra with someone.
That's 5 hours of direct contact a day.
I'll then speak to at least 6 patients in telephone appointments, which are usually follow up appointments of people I have already seen, typically taking about 45 minutes.
I'll usually visit 2 patients, taking about an hour. If someone is dying, the administration required to ensure good quality care is in place can easily take 2 hours to arrange. If someone needs admission to hospital, I can spend 45 minutes on the phone trying to organise the hospital and transport there.
On a typical day I also review about 40 blood, laboratory or x-ray results. On a good day, I might just need to file them, but potentially all 40 might require me to create an electronic task to an administrator, perhaps to arrange an urgent or routine appointment, a repeat test or a prescription. This takes about 30 minutes, but I can often do these 1 or 2 at a time as patients I'm seeing walk down the corridor.
In addition to blood tests, patients requesting their repeat medication need these arranging. I will look at around 50 prescriptions a day. This takes time, as I need to check that the medications are safe, that any necessary monitoring or reviews have been arranged, and there are often notes from patients asking for additional medications, each of which needs individually checking and prescribing. As a prescriber, I'm legally responsible if something bad happens and no one will take into account that I was busy or the patient was demanding a medication that I thought unsafe.
After tests and medications, I then read around 50 letters a day. These range from outpatient appointment letters, letters to request medication, letters detailing a patients hospital inpatient stay or anything really. I have to be good at scan-reading to find details... often there is vital information buried in a letter that I need to act on, such as a medication dose change or a referral request.
Some days I will also be "on call" or the "duty doctor". This means that in addition to the above, I need to deal with all queries patients make. This means every phone call where someone wants to discuss something, patients turning up asking for emergency appointments or prescriptions or other health professionals asking us to do something. People are often surprised that we can't "have a quick chat" or "do a quick prescription" at the drop of a hat, because they don't see what's happening behind the clinic room door.
Once the daily tasks are complete, I need to do the referral letters. This can take a surprising amount of time as many departments insist on us completing their own particular forms.
It's worth noting that this work takes between 10-12 hours per day, which is why many GPs appear to be "part-time" - in 3 days a GP can have worked a standard working week.
And lastly is the administration of a practice. The Department of Health, the Care Quality Commission and other agencies require practices to produce reports and data to ensure we are doing our job well. A large chunk of GP pay comes from managing long term conditions to targets, which is why GPs want patients to have blood tests "again" or to see them and review their conditions.
There are often local initiatives too, such as trying to see older vulnerable people to put anticipatory care plans in place. These need time to arrange.
GP practices are usually private businesses, whom the NHS contacts out to do certain tasks. In the past GPs would often do extra, unfunded work simply because they enjoyed it. We don't have time for those luxuries anymore. As the funding for general practice stays static but the needs increase, it can be hard to keep the business afloat. I've heard it said that GPs could simply be paid less, but this seems unfair, especially when more and more work is being moved from hospitals to GPs with no change in the funding proportions. And frankly, if I'm going to give up large parts of my life to be a GP, it has to be worth it. No other profession is expected to work for free, and given the hours and responsibility we take, I don't think it's unreasonable to earn the same as a say a plumber or a solicitor.
The responsibility we shoulder is undescribable. Everyone, from other doctors, nurses and clinics, to parents, social workers and the media thinks GPs should do more, be more available, make fewer errors and detect more cancers whilst simultaneously not over prescribing, wasting resources or keeping people waiting.
At the end of a day, I am usually burnt out with decision fatigue and a desire to take no responsibility for anyone or anything. Choosing what to have for my tea can sometimes be a bridge too far!
Today, a Friday, my 3 colleagues and I saw multiple additional and complicated patients all afternoon, in numbers and complexity way above normal. We left work several hours after the last scheduled appointment, because seeing patients who say that they are emergencies comes first. I haven't done my correspondence reading or all the prescription requests for today because I was asked to visit two patients late in the afternoon. We don't really have capacity for these, so I have to do after I've finished work. Both were older people, and one the result of the local hospital deciding to send someone home without adequate arrangements in place, meaning I had to sort it. I spent just under 2 hours in total on the telephone or visiting to manage this patient, but ultimately, by doing my job well, I managed to cover up the failings of others. I won't get, nor do I expect praise for simply doing what the public expects. Holding the lady's hand and reassuring her as she closed her eyes in bed after a long day is a privilege I'm afforded and don't take lightly. I am allowed into the hardest bits of peoples lives and I'm grateful to those who put their trust in me. I think most people want to feel needed and useful, and I'm lucky to have the opportunity to be in the position to help.
I keep a thank you card with me that a young patient made for me because I took time to explain her eczema to her. This took longer than 10 minutes, and in the grand scheme of things I'm pleased, because I hope to empower that little girl to be a teenager and then a woman who looks after herself. It would have been far quicker for me to just prescribe something and send her on her way to figure out herself. But I didn't. That small token is why I do the job, for a sense that I can make a difference. And so, whilst on a performance management level, it made the next patient late and irritated, I tell myself that it's worth it.
Without these fleeting moments of gratitude, I don't know that I could go on.
I've agonised about whether to write this, and then whether to post it. It's vital for me that the effect of this is positive for others, and not draw attention to myself. As a doctor I'm torn between wanting to help educate but also ensure my needs don't overshadow those of my patients. I hope I achieve that.
It feels like the right Time to Talk for me. I'm incredibly lucky. My job as a doctor has given me a wonderful resource in terms of patients and how they have dealt with their mental health problems. I've learnt a lot, and suspect I'll continue to do so. The suffering of others closer to me still has really made me think about how we as a society treat mental health, or indeed how we don't.
I have depression and anxiety. I have since I was a teenager, not that I knew it at the time. I'm currently in the midst of my 4th major bout of symptoms. It feels odd to summarise myself like that.
Depression isn't just days of feeling a bit down or stressed (although I have these too) but the clinical diagnosis of ICD-10 F33 Recurrent Depressive Disorder.
Language is so important: it is "normal" for everyone to have periods of low mood, fleeting suicidal thoughts and heightened anxiety, and in English we use the word depression to cover the spectrum from a shit day right up to peri-suicidal. As I doctor, this differentiation is so important, because for many that I see suffering with symptoms of a clinical affective disorder, they have already tried to rationalise their symptoms based upon others' comments that "they get depressed too". When I use Depression or Anxiety as words I use them as diagnostic terms, I mean the carefully constructed diagnostic labels that describe clear symptoms over a specific timeframe. If you're so inclined, take a look at the World Health Organisation International Classification of Disease volume 10 criteria (WHO ICD-10) at http://www.who.int/classifications/icd/en/bluebook.pdf.
I don't mean to denigrate those who have bad days or occasional symptoms, but merely try to help define the differences, as confusion leads to inappropriate treatment or lack of treatment.
As an example of the former, I see many teenagers brought to me by parents during exam time, worried that they are depressed. Few are, but have expected behaviours and thus "normal" reactions to high stress. These don't need medicines (which I've found some parents are alarmingly keen for me to prescribe), but a supportive atmosphere and time; once the exam period has finished they are fine. (There are obviously a few for whom depression is the diagnosis, but this diagnosis is best made carefully, based on several observations and not on the first day of upset)
As an example of the latter, I see many men with longstanding depression, which they have started self medicating for with alcohol, cannabis or harder drugs. They have wrongly assumed that because "everyone gets depressed", that they don't have a treatable condition. Psychotherapy and/or medication often makes a big difference here.
There are usually, but not always triggers to my depression. Most recently, I've really realised the effect of winter and in particular, low exposure to light, on my mood. I would happily hibernate; and I struggle with oversleep, increased appetite and lack of positivity in wintertime. I've started taking Vitamin D supplements and used a SAD daylight lamp this year with I think good effect. I try and go somewhere sunny in January, which helps too.
Throughout the year, exercise has a positive impact on my mood. I will often walk to events when I can, as I haven't found an activity which I can regularly participate in and enjoy. I like running, but this took a hit in 2015 when my knee prevented me doing much. My anxiety makes attending a gym really hard. I feel incredibly self-conscious being surrounded by others. It's the enclosed space, my self-denigrating body-image issues and the presence of others whom I feel threatened by (I think being bullied by bigger and sportier kids at school has never really left me). Sometimes I can handle it, but when I'm at my worst mood wise, and would most benefit, it's hardest. I once had a patient in floods of tears when she injured her knee cartilage as it was running that "kept her sane" and it was only when similar happened to me that I really appreciated her reaction.
My nervous energy is helped by bursts of activity, hence my skipping or running whilst at work. At home, I'll often dance around.
I'm sensitive, and that is my personality. I'm also quite pessimistic as an attitude. This surprises many people I know, because I've learnt to recognise it and try to combat it. I set low expectations and look for the smallest of successes. I genuinely believe that the world and life itself is generally a more negative, stressful and upsetting place than it is a good place, and so it's vital to grab onto anything good that you can, to try and balance things out. I still struggle to receive compliments, again, I think a holdover from school times where doing well in anything usually led to bullying. It also means I don't tend to trust people very quickly.
I laugh at myself a lot as a protective mechanism. If I can do it before you, I remain in control and you can't hurt me. As I've aged, this has developed into a personality where I will often initiate conversation, be quite frank and inquisitive. By projecting confidence, I believe it, much like smiling makes you feel happier!
I don't think I've had a particularly hard life at all, indeed, I'm incredibly lucky and privileged, and I think that's important to say. Perhaps if I was a starving adult in the developing world, I'd have different things to worry about, but the nature of depression is that it's hard to see out, and small things can really seem to matter. It's all relative, which is why people who have nothing can be depression free, and those with seemingly everything feel totally hopeless.
There are days where I can't leave the house, or even my bed. It feels as if the world is just so terrifying that I don't know how to handle it. At my worst, I've really struggled to do things like go shopping, because I can't handle the people, and the sense that I'm being watched and judged. I go through phases of avoiding all news, because I can feel so guilty watching tragic news that I will pray that God (whom I don't even believe in) will take my life from me to give to someone more deserving.
This widely shared video really helps explain how I, and many others, feel:
I think that others reactions to my sexuality has contributed to my development of depression. As a teen, the bullying about being gay came about before I even knew I was. I've been hit in the face and knocked to the ground simply for walking out of Canal Street and had a glass bottle thrown at me for holding a boyfriend's hand. These are landmark events, but it's also little things, like assumptions people around me make, the reactions of those close to me and the media portrayal of gay men that add to a sense of unease that becomes my normal baseline. It's also the reaction I get as a non-"traditional" gay man - many typically gay venues which could be my safe space just aren't welcoming to a nerdy, average-looking person like me (and many others like me!). I'm torn about "Pride" events - why should I be proud? I just am.
I know many LGBTQ people suffer with depression, and there's an awfully long way to go before societal change removes the additional pressure we suffer, even in a forward thinking country like the UK.
When I'm getting more depressed, I start becoming more irritable, and tend to start pushing those I care about away. Some of my closer friends now recognise this, and warn me.
My sleep becomes erratic - I'll usually sleep more yet feel more tired as I think the sleep is broken, I know this as I start remembering my dreams.
My appetite goes, and I'll start going a few days at a time eating very little.
Anxiety tends to build, and I'll struggle to leave the house to see friends.
My work often improves; I'll become more efficient and people at work will think I'm happier. I think it's because I find it helpful to put on a persona when I'm working than when I'm socialising.
I might start drinking more alcohol, and in the past, would start smoking tobacco.
My thoughts become increasingly negative, and I will become very self critical. I sometimes will self-harm.
I become numb and start to care less about the world, yet simultaneously feel like everything is my fault. I'll cry a lot, and more easily; sometimes it will take just a few bars opening a particular song, or someone saying something nice.
I've never tried to kill myself, but there have been some occasions where I've gotten close. I'm lucky that I've always had someone to turn to. I once drove to Sale Water Park after one too many days working as a junior doctor completely exhausted, unsupported and out of my depth at a hospital. I wanted to die there, having already considered other possibilities and discounted them. I have always liked water, and it seemed fitting. And on the practical side, I figured that it would be easier to recover my body from an artificial lake. I had written long letters of apology to those I cared about, and one of vitriol to the hospital trust (with a copy to a newspaper). In the end, I couldn't do it, and came home to shred the letters. I resigned not long after.
I regularly have suicidal thoughts. These are different, and almost like a reflex response in my brain to overstress. They dissipate quickly, usually. Sometimes my own mind turns against me, and I mentally self criticise to the point of upset. I've not acted on these thoughts of suicide, although I've sometimes in the past I used self harm to manage them. From a physiological point of view, I suspect inflicting physical pain on yourself has a similar effect to exercise, by encouraging adrenaline and clearing of thoughts. I definitely think exercise is a much more productive way of achieving this!
I'm nervous of drugs, including alcohol. My experiences with these have rarely been positive, although I am generally able to enjoy a few drinks of alcohol from time to time. Cannabis caused me to believe I could fly and I could have tested that theory by jumping from a bridge. It's also caused me to become extremely paranoid and hurt people I cared about. I don't usually have a problem with alcohol intoxication, and am a friendly drunk, though in the past I've ended up in dangerous situations which I really regret. The difficulty I have now is that I tend to be much more anxious and sensitive in the 2-3 days after I drink, so I need to plan carefully. I find it impossible to avoid alcohol and feel pressured in many social situations to have some when perhaps I'd rather not. It's easier when I'm around people I really trust.
I currently take Escitalopram 10mg a day and have been in this for a year. It has really suited me, by working quickly with minimal side effects. I do yawn a lot more and the biggest problem I've had is with appetite and my weight... I've gained a fair bit in the past 12 months through eating poorly as I never really feel satisfied. But with some discipline I think I can learn to manage this, especially as I feel so much better now.
I've previously taken citalopram and sertraline, both of which had side effects I couldn't manage.
What's most helped me is talking, both informally with friends and family, in a more structured way with medical friends, and also in 3 sets of counselling and CBT (cognitive behavioural therapy) I've had. I've also had the benefit of initial psychotherapy training from my jobs in psychiatry.
My brother has been phenomenal. We have very different personalities but he accepts me, listens and has always helped in my worst times. I sincerely believe I'd have had more severe episodes than I have if it weren't for his support.
I've several friends with similar problems, or experience of them, and they too have provided viewpoints, encouragement and advice. And a kick up the arse when I've needed it... I started Escitalopram after one friend recognised things had gotten out of hand. We are good at supporting each other, recognising symptoms and knowing the right things to say,and not to say!
I had CBT twice at University. It was really helpful for me as I'm quite psychologically minded and helped me recognise how to manage my naturally occurring negative thoughts, and how to manage them. I still use the techniques now, In my last bout of depression, I had counselling, which helped as the trigger was much more reactive, and so gave me an outlet to simply talk freely.
My training in psychotherapy has helped me understand others, and thus my own thought processes. Humans are not perfect, and we are products of our environment; understanding and accepting that helps me.
It frustrates me that accessing talking therapies is rarely that easy for patients because I think they are the key to long term recovery. Many doctors give up and just prescribe medicines, which I don't think are ever that useful on their own, at least in the long term (short term they can be immensely helpful in building to motivation to change).
I'm not sure what we can do about that. Supporting mental health charities, such as Mind (www.mind.org.uk) and the Time to Change campaign (http://www.time-to-change.org.uk) , are a start. For those suffering, I'd say don't forget those around you - so many of my patients have never told anyone else how they feel, and things often improve when they start to share.
As a patient, and a doctor, I want us to be in a place where we talk about depression like we do diabetes, heart attacks or cancer. There is no shame in sharing your difficulties, although the nature of the illness makes it feel so. If you suspect a friend, colleague or family might be struggling, ask, and don't accept "I'm fine" as answer. Use your GP and local mental health charities to help, I'll add some links to web resources and support available where I live and work as a start.
This video should be useful if you're not sure how to help someone you care about:
Most of all, start up a conversation with someone around you. Who knows what you'll find out, the new friend you'll make, the secret you'll share, the joke you'll giggle about, the tragedy you'll support each other through. It's Time to Talk.
Note: I deliberately don't talk about the methods I would use to self harm or commit suicide, as evidence suggests that reports of these can lead to increases in copycat efforts. My self harm or suicidal thoughts are my own, they don't represent necessarily what others might define as them, and they aren't meant to represent everyone, just as this article doesn't represent anyone but me or anything but my experiences and beliefs.
Also, and I hate that I feel the need to say this,but yes GMC, I am fit to practise medicine. I look after myself and take charge of my health.
EDIT ( 2134 04/02/2016): I wanted to correct a few spellings, embed the videos and add the links to useful resources; see here:
Mhist - Mental Health Independant Support Team (Bolton)
The SanctuaryExperienced staff and volunteers with personal experience of mental health issues provide a range of support including managing panic attacks, offering a space to talk and assistance with coping after the initial crisis.
Apologies if you've read a zillion of these. If you're a junior doctor - you probably already know this, but consider sharing. If you're a member of the public - this might be for you.
Background From 0800 on Tuesday 12th January 2016 until 0800 on Wednesday 13th January 2016, NHS-employed junior doctors will strike. Depending on who you ask, and what you read, will differ in what you think the strikes are about.
The British Medical Association (BMA) is the doctor's union. It is non-political - that is it does not support any particular colour of government - and reflects the views of its members. They say:
"In December 2015, the BMA suspended the industrial action and the
government suspended their plans to impose a new contract, so that we
could negotiate. Unfortunately we have been unable to reach agreement on
some major points in sufficient time. Therefore despite our best
efforts we cannot agree to a new contract and must lift the suspension
of the industrial action. "
MYTH 1: HOSPITALS and GP SURGERIES REMAIN OPEN AS USUAL Despite constant rhetoric from our Government that gives the impression patients will be left with no service, in tomorrow's strike, and the one that will follow, the NHS will look pretty much like it does on any weekend day or night. YOU WILL BE ABLE TO SEE A DOCTOR IF YOU NEED TO. Jeremy Hunt has deliberately misled the media and public by stating:
"...patients will
be put at risk because doctors are "basically saying 'we won't be there
for you in life-threatening situations'." "
This is nothing more than an outright lie - the BMA and doctors themselves have worked to ensure that any strike action does not risk the lives of emergency patients. Manchester Evening News: Junior doctors strike: what to do if you're ill and everything else you need to know The Telegraph: Jeremy Hunt warns junior doctors strike will harm patients MYTH 2: DOCTORS ARE RISKING PATIENTS' LIVES BY STRIKING Nope. Research suggests that actually you are safer on the day of a strike. That's probably due to a few factors. Elective work (that is, anything scheduled in advance, such as some outpatient surgeries or clinics) doesn't take place (so hospitals are less busy, allowing focus on emergencies) and doctors must make sure that arrangements are safe to be both morally and legally able to strike. Jeremy Hunt has deliberately misled the media and public by stating:
"We will do everything we can to keep every A and E department open but
junior doctors are the backbone and that will depend on finding
consultants who can step in."
This is nothing more than an attempt to mislead. If he had bothered to read the easily available BMA guidance to doctors, he would see that doctors who participate in solely emergency work (like A&E) will have more limited availability to strike:
The planned model of strike action with emergency cover would
not apply in my speciality, as nearly all of my work is emergency. What
action can I take?
For doctors working in some specialities, such as emergency medicine,
your ability to participate directly will be more restricted and you may
not be able to participate at all in the emergency care only model of
action.
http://www.sciencedaily.com/releases/2015/11/151125233018.htm BMA: Industrial Action FAQs MYTH 3: DOCTORS ARE JUST PROTESTING ABOUT PAY Not true. It would be easier to just believe that, but its more complex. Is there anyone who isn't used to Governments using confusing numbers to mask the truth. Doctors look very likely to face a pay cut as a result of the reforms suggested. Far from whinging about not getting enough, doctors (and other NHS staff, and the average UK salary) have seen their pay diminish in real terms as it hasn't increased with inflation since 2008. The graph below shows that (as well as MPs pay, which somehow has bucked the trend and accelerated way beyond inflation-rate rises. Doctors working now are earning 10-15% less than they would have done 8 years ago - no-one has moaned about this. They've taken it on the chin, for the good of the NHS. The latest reforms look to alter how doctor's pay is calculated and so whilst the Government are quite happy to shout about the "11% rise in basic pay" they aren't so vocal about the fact that the plan to reduce the proportion of pay calculated from the number of anti-social hours means most doctors look to receive a real-term pay cut.
So let's be clear, when Jeremy Hunt has deliberately misled the media and public by stating:
"We want to bring down weekend pay rates and make up for it with an increase in basic pay of around 11 per cent."
This does not mean a pay rise for doctors. It means a reshuffling of pay that will make it much easier to pay less to doctors doing the same work as they do now.
MYTH 4: WHY SHOULDN'T DOCTORS WORK WEEKENDS? They do already. Emergency care always has been 24/7/365 in the NHS. That doesn't mean you can bob down to your local hospital when you feel like it for a routine test - which is what Jeremy deliberately misleads at every opportunity about. If we, as a UK population, decide we want our NHS to work more like Tesco and be open more for routine work, we have to accept that it will cost more. Perhaps some members of the public feel doctors should work for free in order to provide this, but there are few, if any professions, where this would be acceptable. We could all pay more tax to fund routine work on a 24/7 basis. Keeping the NHS as a "everyday-emergency and weekday-routine" model keeps it from costing more, when there is little evidence that suggests people genuinely want to pay more for this increased pseudo-convenience (You'd have to accept that your outpatient appointment might now be at 10pm on a Sunday night) Jeremy Hunt deliberately misleads the media and public by stating:
"'We have a situation where
every weekend in the NHS we have lapses in care, that we are not able
to promise NHS patients the same high-quality care every day of the
week. And you can't choose which day of the week you get ill on."
You can in fact promise the same emergency care 24/7/365. Which is why junior doctors don't want to muck about with the emergency rota in order to allow more elective work at weekends. Unless Jeremy is planning on bringing in new staff, or working the current staff more, there is simply no logical explanation for how he plans to increase staffing. Junior doctors are prepared to work more weekends, but not for free/slave labour, not as extra hours, and not at the cost of affecting care on weekdays.
MYTH 5: MORE DOCTORS MEANS BETTER HEALTHCARE This is easier to bust. There is no point having more doctors without all the other staff that support patients in too. We haven't heard yet how Jeremy plans to do this - will nurses, porters, radiographers, pharmacists, physiotherapists, social workers, canteen staff, public transport staff, midwives, health visitors, operating department practitioners, cleaners and the rest also be asked to work more evenings and weekends for the same money? This plan just isn't thought through, unless the goal isn't really for patients' benefit, but simply to cut doctor's wages and make it seem like they are whinging about nothing.
If after reading this, you still think 98% of junior doctors might just be having the population of England on, and trying to fleece them, whilst Jeremy Hunt nobly tries to stop them ask yourself just one question:
Who do you think is more likely to be lying? #juniordoctors #juniorcontract #BMA BMA FAQs: http://www.bma.org.uk/iafaq Twitter: @TheBMA
OK, so we've waded through the semi-finals together, but there's still more. Several countries progress straight to the final - these are the so-called "Big Five" contributors to the Eurovision budget, plus the host, and for this year only*, Australia, who have been invited as a special guest to participate in this 60th Eurovision Song Contest. (*if they win, and odds suggest this is quite possible, then they will co-host next year with another European country, so there will be no Sydney 2016).
So... who are these Final 7?
Australia
I'm led to believe Oz is all excited about this opportunity, and whilst names like Kylie were bandied about for a bit, they've gone for Australian Idol Guy Sebastian (whose name I thoroughly approve of) with this anthemic song that makes its message clear: WE WANT TO COME BACK. Forget geography, this song is a refreshing change of pace that channels Bruno Mars and stands out. Perhaps that's why its being courted as a potential winner...
Genre of music: Funk-Jazz How much of this can I remember? The chorus stays with you and you want to dance along Better than last year's entry? It's their best ever... (no really, it is)Best lyric: "Let's do tonight again" Current reviews: "The track is bouncy and warm with lashings of smooth brass and an
addictive "woah-ooh-ooh" refrain that will have Europeans waving their
flags." (DigitalSpy) Will I be listening to this in a year? Hell yes! Anyone fanciable? He's my kinda Guy (*groans*)
Arbitrary Eurovision style score: 10
Italy
This is also being touted as a potential winner and I've been trying to like it. The fact I can't suggests it will do well (I often back the losers!), but it's great to have a song in a non-English language do well. The trio sing their vaguely operatic song to a video recreating famous love scenes from films like... er Back to the Future? Anyway, they're easy on the eye with voices like syrup, and this will sound great in the arena for sure.
Genre of music: Popera How much of this can I remember? "Grand-ay amorrrrrr-ray!" Better than last year's entry? I prefer last year's song La Mia Citta.Best lyric: "Tu sei il mio unico grande amore.../You’re my unique great love…" Current reviews: "Grande Amore has the same classy, dramatic orchestral
arrangement while benefitting from layer-upon-layer of spine-tingling
moments. The lads even make the low-key moments dramatic!" (ESCtips) Will I be listening to this in a year? Not for me Anyone fanciable? Here they are. They are definitely Italian.
Arbitrary Eurovision style score: 8
Austria
So the hosts are up next and how do you follow bearded lady extraordinaire Conchita. Apparently with three bearded men. The Makemakes sing this mid-tempo song that doesn't capture the glory of its predecessor, and sets the tone of the melancholic theme of the year; although the lyrics are fairly positive the tone isn't Genre of music: Blues How much of this can I remember? It's not a stand out Better than last year's entry? Obv notBest lyric: "You’re a lesson that I love learning, So any time that you’ve got a yearning" Current reviews: "The piano-led track broods into a swaying soft-rock number that hears Dodo's vocals crackle in just the right places." (DigitalSpy) Will I be listening to this in a year? Nope. Anyone fanciable? Hmm, if I'm in the right mood and they're in the right light...
Arbitrary Eurovision style score: 5
Spain
Spain made a really big deal about their selection of popular singer (and girlfriend of Manchester United goalie David de Gea). She sings about the "Dawn" and features as a fierce tigress in her promo video. Spanish sounds great in powerful songs like this, and she's proved her ability to command the stage with this. It's one of the better power ballads this year
Genre of music: Pop How much of this can I remember? You'll all be "EEEieEEO"-ing before the end. Better than last year's entry? It's hard to choose between this and magnificent Ruth Lorenzo.Best lyric: "Mi corazón, Me susurró, A mà no vuelvas sin su amor/My heart, He whispered, To medo not come backwithout yourlove" Current reviews: "Amanecer is a dramatic 3-minutes, but it’s difficult to isolate a particular passage that stands out and leaves a lasting impression." (ESCtips) Will I be listening to this in a year? Yes! Anyone fanciable? Edurne is front runner to win the unofficial Eurovision Top Model crown, and her man ain't bad either. What beautiful babies they'll have...
Arbitrary Eurovision style score: 10
France
France obligingly enter year on year, although often with a sense that their heart isn't in it, even more lackadaisical than the UK in their choice of entry. Lisa, however, sings quite a poignant war-related song that resonates even if you don't parle Français. It won't win, and may not trouble the top of the scoreboard, but perhaps it should, as more than any other song, it embodies the very reason Eurovision started 60 years ago. Bonne chance a la France.
Genre of music: Power ballad How much of this can I remember? I actually realise I know more than I think every time I listen Better than last year's entry? It's a better quality entry than TwinTwin but not quite as fun. Best lyric: "Je ne suis qu'une blessure
Un cœur sans armure/I am but a wound, A heart without an armour" Current reviews: "N'oubliez pas is an honourable ode
to the men and women who served in past wars. It's a delicate track that hits a deep resonance with
Eurovision's 60th anniversary, considering the competition was created
to reunite a war-torn continent." (Digital Spy)Will I be listening to this in a year? I think I will actually Anyone fanciable? Her stylist does a good job.
Arbitrary Eurovision style score: 8
Germany
Awkward. Ann Sophie is representing germany after the entrant selected by the public turned down the chance in a live show after he "won". No matter, this song borrows from Germany's most recent winner Lena to sing a pop song with quirk. yet again, it borrows from this year's unoffical brief that songs be about difficult break-ups/misery/melancholia, though manages to be upbeat for the most part.
Genre of music: Soul-pop How much of this can I remember? I could step in for one of the backing singers. Better than last year's entry? This is better than too-quirky Elaiza.Best lyric: "And when you call me baby, what's that supposed to mean
I don't know who you are, how long can we pretend" Current reviews: "Co-written by English chart topper Ella Eyre, “Black
Smoke” would have been the perfect UK entry for the likes of Duffy or
The Noisettes. Britain’s loss is Germany’s gain. After last year’s
misfire, the land of Lena has upped its game with this sassy stomper of a
tune. Retro without feeling dated, it injects some much needed attitude
into the 2015 contest. " (Wiwibloggs)Will I be listening to this in a year? I won't skip it... but I won;t skip to it either. Anyone fanciable? meh Arbitrary Eurovision style score: 5
United Kingdom
Lastly, its our own entry. This was trumpted to a big fanfare... joke. It was revealed hidden on BBC Red Button. I think someone realised that this wasn;'t the amazing idea they thought it was and decided to hide it away. To be fair, it is original, in a style not seen before and does manage to be very British, evoking the Charleston with some fun lyrics and even some scat singing. The performers are competent, but Electro Velvet are unlikely to last beyond Vienna, having been packaged for this event. When will the UK look at what the rest of the entrants do and start picking from great existing acts, whether upcoming or established? Depending on how many ballads of melancholy sandwich this entry in the running order will largely determine how it does - if positioned well it will be remembered as the fun entry that stopped you slitting your wrists. Lets keep our fingers crossed.
Genre of music: Electroswing (no, really this is a thing apparently) How much of this can I remember? It's an earworm alright, but leaves an aftertaste you can't decide if you like. Better than last year's entry? No. Molly was a good departure from the OAPs of UK, this feels a step back. Best lyric: "Don’t go out in the pouring rain, You might get wet I’d be upset" Current reviews: "It’s an interesting, postmodern approach to Charleston and the melody is
fun and catchy, but the uneven delivery and the ridiculous lyrics are
off-putting. Moreover, the chemistry between the two singers is wanting.
" (Wiwibloggs)Will I be listening to this in a year? Probably yes Anyone fanciable? Judge for yourself
