Journey of Life and Hope

In this essay I will cover my personal experience with mental illness, and my understanding both as a patient and as a clinician around mood and anxiety disorders. More specifically, on what it is and who is affected, ways to spot the problem, how it is treated and dealt with, and what will happen afterwards.

Who is affected

For the purposes of writing this, I have simply defined "mental illness" as any illness affecting brain function - amongst other thing, this includes memory, planning and problem solving, emotions and emotional regulation; whereas "mood disorders" point to the subgroup of mental disorders that significantly impact a persons emotional being and mood. I have taken the liberty to add the caveat that the illness must be causing either distress or affecting someone's daily functioning.

The crux of mental illness is that these are illnesses - meaning there are processes involved in the brain and body that causes it and that it is not made up or less real than any other illness (e.g. diabetes). Like most other illnesses, there are complex factors leading to them, but more importantly, noone chooses to have a mental illness - the same way that noone chooses to have any other illness. In that regard, assigning blame, either to a person with the illness, or to anyone else, is not only wrong but also counterproductive as it does not help with finding a treatment or solution and will likely increase guilt/shame/embarrassment leading to a lower chance that the illness will be admitted (by the patient or anyone else) and treated appropriately.

The chance of someone getting diagnosed with a mental disorder is high, with over a third of people in most countries reporting sufficient criteria to be diagnosed at some point in their life. In practice this means that noone is "immune" from having one - there are protective factors but no "vaccine". It can happen to anyone, including you, and chances are you personally know someone who has a mental illness or has had it in the past. I have it and am recovering from it.

Spotting the Problem

The DSM IV criteria for depression and anxiety is listed elsewhere, and is the criteria that is applied by clinicians worldwide - but in practice it can be difficult to recognize in yourself and in other people.

Some signs to look out for include

- Loss of hope, loss of faith in mankind/self/world/others

- Pessimism and cynicism, the tendency to catastrophize

- Withdrawing from activities and/or interaction with others

- Moodiness, irritability, increased fluctuations in mood - and then just apathy

- Lack of self care - including not eating or not sleeping

It can not be emphasized enough that thoughts of suicide should always be explored.

My experience with depression and anxiety was a slow build up of unease, tension and nervousness which in hindsight probably occurred over at least months, if not years (essentially throughout medical school and into the first year of work), culminating in not being able to function mentally one day - when I needed to take time off work as I was unable to process or do anything useful. The process happened so slowly that it was only until things came to a head that I actually realized and accepted something was not right in my thinking and emotional regulation mechanisms.

Over medical school, despite having little difficulty with the subject matter - i.e. I knew that I had the memory and problem solving/processing skills to learn about medicine and do it well, damnit, and I did pass - there was an increasing sense of inadequacy and of being a fraud. Which I dealt with by pretending that I could not have done better (the slide into "passes were good enough") together with finding the obstacles to doing well ("the system was flawed"), an unhealthy dose of self-recrimination - ("I can't adjust, I couldn't find friends, I just didn't fit in") and becoming isolated from my family, peers, friends, and the wider world ("so what's wrong with staying in my room the whole day?").

Somewhere along the way I lost my joy in doing medicine, the enjoyment of learning and gathering knowledge, skills, the capacity to truly care about myself and others, and the trust in my own judgement. Things were about me, but I was never allowing myself to just "be me".

The feelings and thinking patterns only intensified when I started work. Added to that was the jolt when I realized that I was now a "proper doctor" and the abrupt changing of responsibility. And the (self)expectation that things would be difficult so I took it as a matter of fact that this happens to everyone and I should just "deal with" the emotions and "get on with the job". It was a weakness to need help and I was quietly and then openly terrified of both having responsibility and admitting that I could not responsibly manage certain situations on my own. The more I soldiered on the more cynical I got, and the less efficient, but I was grasping at the gain I made (getting better at organizing, and presenting, and the technical aspects of doctoring) and did not see or believe that there was anything wrong.

Work became a slog - a list of tasks to mechanically get through, a series of never ending duties. Getting up was a chore. Eventually I was working and thinking through a fog. Added to this was the growing panic that I was not doing my job well, but it was hard if not impossible to clarify in what sense to my colleague and my seniors, and the suspision and guilt that I was putting other people's lives at risk but froze, procrastinated, justified against doing it when I needed to ask for help. One day my brain quit working altogether. At that point I left work on sick leave, and sick leave continued for weeks and months.

Journey to Recovery

In medical school they teach the standard way to answer questions relating to psychiatry is the "bio-psycho-social" model - in short, the causes and solutions to mental (or any) illness are in the realm of biology and physiology, psychology (thinking, emotions, reactions), and social (family, friends, society).

An important step however, is acknowledging and accepting that the mental disorder or the problem exists, and that it will not easily disappear without changes in all three domains. And that it is an illness, that noone is at fault for causing it. This journey is extremely personal but at the same time impossible without help and support from other people. Human beings, after all, are social animals.

The time off work for me was a time to reassess and reevaluate - during the initial stages of it on some days even getting out of bed was a major undertaking. I had pills to dampen and diminish the effects of spectacularly bad moods (hopelessness, anxiety, a pervasive feeling of doom), but the bulk of treatment was working together with my psychologist to equip myself with a set of tools and a way of thinking and managing my emotions, feelings and reactions.

The process I underwent had elements of cognitive behavior therapy (changing thoughts will change emotions and reactions to situations will change behavior) as well as the acceptance and commitment therapy getting to know unpleasant feelings, then learning not to act upon them, and to not avoid situations where they are invoked). It was and is hard. The rewards from it - the sense of peace, the sense of self - more than justify the efforts.

The first steps involved being more aware of my emotions by labeling how I was feeling using descriptive terms and getting to know the nuances of it without trying to change it. I spent time expanding my emotional vocabulary and recognizing how I was feeling - being as specific as possibly with adjective words (sad, happy, satisfied, anxious, jittery, gloomy, scared, uneasy, uncertain, worried). Not trying to fix anything, just learning to sit with the emotions.

With help, I then moved to tracing the source or roots of the emotion - what circumstances and thoughts I had to trigger the emotion - again, in as specific a manner as possible, down to recreating the tone of voice that my mentalspeak was using to myself. Being able to recognize which thoughts led to which emotions and evaluate how rational or helpful the thoughts were. There was times where the process would trigger more unhelpful thoughts ("why did you ever think like that you idiot") but I needed to be able to unravel the train of situation, thoughts and emotions before I could sensibly and incrementally change.

Changing involved a few things - relearning my problem solving skills and applying it to self and not trying to solve situations that were unsolvable or out of my control/responsibility and learning to ask for help, recognising and celebrating each skill learnt, congratulating myself with what progress I made, modifying my internal commentary, and realising, truly believing in shared humanity - that everyone is flawed, including me, and truly believing in myself, measuring it against the yardstick of what I valued ethically (honesty, joy, learning, peace, growth).

I could not have done it without the help and support from numerous people – family, friends, colleagues. I was exceedingly fortunate to be already embedded in a few community activities in Auckland and have the chance to get involved in more pursuits throughout the process – including the symphonic band, the badminton group, tai chi, and my newest obsession, Ingress.

What happens next

For me? Life is on the mend and it is a wonderful adventure once more. I'm still working on improving my mindset and my abilities but at the same time I am balancing the duality of continuous self improvement and progress with the enjoyment of the journey. I am where I need to be at the moment, but I am also moving towards being more true to myself and my values.

I am still on a return to work program (unpaid sick leave) but now the difference it that I am enjoying being at work. Yes there are hard days and tiring days - but even on the off days there is something that I appreciate, that I value. I am continueing to take my medication and this will be reassessed after I am on it for 6 months to a year.

Conclusion

If nothing else, this is the message I would like to share.

1) Mental illnesses or disorders exists, just the same as physical illness.

2) Recognizing the problem is tricky, but watch for changes in behavior, mood and outlook and never ignore any suicidal or "not worth living life" thoughts

3) It is treatable.

4) The journey is difficult, but extremely rewarding and joyous.