I would like to start this post by letting you know I will be digging into the topic of mental health and try to really talk about it. I will be recounting my own personal experience going through some more difficult periods of my life in order to show that I am not ashamed of talking about this issue. I truly believe that if we do want to end the stigma, we should talk about our own mental health problems openly. As part of the spirit of making ourselves vulnerable, I felt as though it would be a good post to end the anonymization of my blog. While I am known as the Med Student Gunner, my name is actually Reza. I am currently a first year medical student at the University of Toronto who was born in Iran and raised in Canada. It was not easy coming to the decision to expose my own story, and also coming out from being anonymous, however, I feel like to have a greater impact, and to truly share my own experiences in a genuine fashion, going public was the best decision I could make. A mental health crisis or episode should not be a taint or permanent mark on your life and in my opinion, these episodes should be treated with proper self-care and support and not leave a person with a permanent label. I do not have the intention or expect a post like this to solve the mental health crisis or completely eliminate the stigma. What my wish is with this post is that it will contribute to a pool of stories which together, in large numbers, uncover some of the stigmas associated with discussing these topics, while also providing my own anecdotal perspective on it. As with anything anecdotal, this is one perspective from the about 7.5 billion others, and should not be taken as gospel.
Mental health is a big issue right now and while it is something that is somewhat talked about, it is not something, that in my mind, is talked about enough or taken action upon sufficiently. The recent, and frequent suicides that have taken place at the University of Toronto have really struck a cord with me. I also imagine these events are only a snapshot of the whole picture of the mental health issues individuals must be going through with all the cases we do not hear about. If I were to ask my readers, how many of you have heard the phrase “remember to reach out if you need help”, it would most likely be close to all of you. If I were to rephrase it as, how many of you had someone reach out to you and ask you how you are really doing, it would be lower. Organizations are more recently identifying it as a problem and trying to break the stigma and promote resilience in individuals, but the people who need help are not having proper access to it in my opinion.
Before continuing I will disclose that I personally have had the privilege and blessing of not having any diagnosed mental health condition, having any suicidal ideations, or feelings of self-hate. If any of my readers are having these feelings, I would urge you to stop reading and reach out to your local mental health hotlines or resources. I will link some local resources at the bottom of my post so scroll down and find them, if it does not apply to your particular area feel free to contact me and ask me through my contact form, otherwise please do some research on it, these resources exist, and they are there for your use.
Mental health runs along a spectrum. What is healthy, and what is normal is difficult in my opinion to define due to the great deal of individual variation, and since moods depend on numerous variables and situations. There are some clear pathologies regarding mental health, but those are farther along the spectrum. What I wish to focus on is actually the earlier phases, when everything seems fine, but are really deteriorating. This is a group of individuals that I believe are neglected, not enough attention is provided to, and their state can deteriorate and they may fall to a mental state which is much more difficult, if not impossible to escape. I will first disclose that I am not an expert on this topic. I am just providing a perspective of an individual who has experienced the earlier issues regarding mental health and self-worth that managed to improve their situation and be a functional member of society (at least I like to think so).
I will begin by providing my own experiences. Growing up, especially in high school, I had problems fitting in. I am an Iranian-Canadian, and I did not feel as though many individuals at the school I attended shared my background or experiences, so I definitely felt isolated in that regard. I will spare details, but in high school I lacked a good deal of “real friends” who I could talk to about anything. I do not blame anyone for this but myself. I did not go out of my way to make deeper relationships with people that would have clicked more with me and I would have been able to receive the level of support that I should have had growing up. Parties and social events were definitely my priority, and my mental and physical health degraded at the start of high school as a result of this. I hit an all-time low in grade 10 as I found school not as stimulating and at this point in my life I had little motivation for it as a result. I lacked any sufficient extra-curricular activities which I was motivated in doing, so all I had going for me were social events that occurred outside of school. I found myself partying way too much, and not enjoying the positive aspects of life. Lethargy, lack of motivation, self-dismissal, lack of confidence, and generalized dissatisfaction with life. These are just some of the feelings and emotions I had at this time. I started to find my mental health degrading, and I did not like who I was as a person. I envied living the life of many of my friends at the time who seemed cooler than me, since I felt like I could fit in better with my peers. Yet, I did not feel as though any of the services provided to me were meant for me since I was not self-harming or suicidal.
So, what changed? Well the biggest shift for me was at the end of grade 10 when I started to exercise. I knew I needed something in my life outside of school, and I also knew my physical shape was terrible at the time. To give perspective, in grade 9 I tried out for the junior boys rugby team and could not run a lap around the park because I was so out of shape. After I started to work-out, I gained internal motivation. I went haywire on my gym routine, completely swapped my eating habits around, and saw huge improvements in my physical and mental health. This was the upswing that led me to the best decision of my life, starting wrestling. The summer after my grade 10 year, I loved the exercising, but I wanted a goal outside of just bodybuilding, which led me to choose to begin a sport. Given my background of no serious sports growing up, I knew it would be difficult to start a team sport where I would not make the competitive team. Even if I did make the team, I would not gain much attention or focus because I did not have that base athleticism or background which the coach could work off of to maximize the team’s effectiveness. This led to my decision to do an individual sport, and given my Iranian heritage, I chose to try out wrestling. This is where I found my first love. I got absolutely murdered when I went to my first practice, and I still remember it to this day, but I loved the drive, I loved the intensity, and most of all, I was fortunate enough that the club I trained at was filled with motivated volunteer coaches who wanted everyone to do their best. They gave me the attention I needed to improve, and I took full advantage of their services. These coaches not only cared about my wrestling performance, but my personhood as well. Several times they would reach out to me and see how I was doing, when I did not do well in some of my tournaments, I would have long talks with them. I remember I had some anxiety before one of my tournaments because I felt very unprepared, so my coach made me a private 1 on 1 practice after their work and beat the crap out of me, while we also talked about working my mental game and keeping my mentality strong going forward. In my 11th and 12th grade years I wrestled and did school; those were my priorities, along with some work to make some money and build experience. I cut back on my partying significantly at this time, aiming to maximize my athletic performance to make up for the missed time growing up. I was training almost every single day during those two years, and I loved every moment of it. Purpose, belonging, and ambition are some of the feelings I had during this upswing period.
What I gained from this sport was not only physical activity for my health, but it gave me a sense of confidence I lacked prior. It reinforced the idea that I do not need to follow the paths of others in my class, and I can do my own thing and succeed. Starting wrestling I was hit with all the jokes you could think about, given society’s perspective on it, but I did not care. I loved it so much I would never give it up because of what other people thought of it, and the fact that it led me to better myself, this experience offered me the sense of confidence to do what I wanted if I knew it was best for me. To this day I carry that ideology that it is best to do what you want if it makes you happy and does not negatively impact others. While other people might bring you down for doing the activity, or not associate with you because of something you do, you have to live with your own happiness 24 hours a day, for the rest of your life, not something you share with any other individual.
Now to contrast high school, my undergraduate education was where I started to feel the most supported. I had several great friendships and ties with individuals that I am still great friends with, and for the first time in my life, I felt connected with people that understood me. I had made friends that I knew would last a lifetime, and these were friends I was not scared to talk to regarding most issues. I am forever blessed for the situations I was put in during undergrad that not only led me to my current career path, but also led me to meet some of the most important people in my life currently. These relationships, along with my new-found confidence from sport, allowed me to “discover” myself, opening up the possibility for me to follow my own path moving forward thus doing what I loved best. During this high I felt confident, supported, respected, and cared for.
My most recent hump in mental health was the process of moving to Toronto, living alone, and adjusting to my medicine life. There were a lot of personal shifts that occurred, and the transition was not easy, and continues to be learning process. Part of the problem at first was the lack of knowing people in my program on a deep level that I could connect with, but this is improving now as I am solidifying friendships and finding my steady-ground, which I hope will continue to improve with time. Being apart from my friends in undergrad was very difficult since I did not realize until I moved away how much I really relied on them for mental balancing. It was not until I was alone, and realized how hard it is to be isolated, that I started to really internalize all the talk that was said in the public about the importance of taking care of your mental health and reaching out for help. I reached a low point during the semester where the loneliness was the overwhelming feeling felt. To help myself cope with it I began being more proactive about it. Some of my own personal coping mechanisms included writing my thoughts in a journal or speaking them out loud to allow for these problem thoughts to change medium and not just being trapped in my mind but be expressed in another form. I also would call one of my friends relatively frequently and we would keep each other sane by having brief talks with each other. These really help to keep me sane, and while I do not know for sure if any of these are scientifically proven to work, they anecdotally worked wonders for me. These coping mechanisms really did wonders, and I can say that my mental health at this point is significantly better. Thanks to improving relationships and friendships in my current program, while continuing to get support from my undergraduate friends, I definitely not only feel normal but am currently blessed to be at a state where it is elevated above what is has been in the past. You could say I am currently at an all-time high for now. Through this experience I have learned about the importance of having interactions with friends and having individuals to reach out to. Supported, satisfied, and content are some of the feelings I am currently (at the time of writing this) feeling.
Mental Health in Medicine
Most of my readers are looking to go into medicine. Medicine is not an easy career even before you get in. The grades necessary to get into a medical school are high. Premeds know this, and knowing this can lead to some unhealthy behaviours, and hard times especially at the start of undergrad when everyone is first adjusting. For many, undergrad is the first time they get something other than an A, or they fail for the first time. It is a very different environment than high school and requires a big adjustment. Many also move away from home for the first time, live on a tiny residence with a roommate they do not know, and are trying to make new friends. It is a very difficult time, and with it come many stressors that can probe a mental health episode.
One thing I do want to reiterate, is while I preach the importance of grades, and will continue to say that grades are important if you want to get into medical school, grades do not reflect your self-worth or necessarily say if you will make a good or bad doctor. Grades are just a measure that schools use to see if you will be able to handle the stressors and difficulties of medical training. Medical school is intensive, and there is lots of information you need to learn in an efficient manner, and you will continue to be tested essentially until you retire. If you do get a bad grade, then I encourage you to read my previous post on bad grades & self-care, which in a nut shell tells you that you should try to find novel ways to change your habits so your grades can improve, and always look to set new goals for yourself.
Another issue that many premedical students have, and I was guilty of this as well, is their thought that they need to be a doctor, or their life is over. As much as medicine is a rewarding career and I would recommend it for all that are considering it who know what it truly entails, it is not the only career that will make you happy. As with anything else as well, it is just a career and not the entirety of your life. Do not let a career choice dictate your happiness and take control of your thoughts. Unless you believe in reincarnation, we only have one shot at life, and even if you do believe in reincarnation you only have one shot in the exact situation you are in as you, so make the most of it. Enjoy the process while working hard. If you are not enjoying what you are doing, then find ways to change it to be enjoyable. We live in a society that is free and provides you the opportunity to do what you want.
Once you are in medical school, there is a big shift in your mentality. While externally it seems like “you’ve made it” and your life is smooth sailing from there, this is but a mere perpetuated lie. As with anything else in life, there are several other stressors associated with it.
Medical school is expensive. Not only is tuition crazy expensive, but there is this expectation that since most medical students have access to a line of credit, and most physicians will make a good living in the future, it is OK for them to pay for everything. “Put it on the LOC” is a common saying here. I will make a future post on finances, managing them and how to set yourself up early, but I just want to reinforce the point that life is expensive, especially since the workload of medical school is enough that you cannot feasibly work enough to make a significant impact during it without a measurable sacrifice from your life to help finance yourself. What this leaves is a burden of debt on the shoulders of medical students. Medical students then have to make an early decision on what residency they would like to enter and the next four years to stress about matching this residency program with the ever-dropping match rates. We hope that we can then find a job when we are done residency even though the job market is completely different than when we began our medical training and entered a residency program about 5-10 years earlier. We enter a black box of a job market and pray that we will have something that will help us pay off our debts.
Along with the issues of money, jobs, and matching a residency, there are the stresses associated with medicine itself. You realize you are in a privileged position of caring for the lives of other members of society who have a trust in you, and as with any other human being on the planet, you are prone to the possibility of errors. The training itself is intensive so as to prepare you to minimize errors and maximize your effectiveness, but it is inevitable that individuals will make mistakes. Outside of mistakes, there are the long hours and overnight shifts, unreasonable expectations, being called in when you are supposed to be with family or asleep, and the lack of time to care for yourself. Medicine is not an easy profession, and I have realized that it will continue to get harder along my training. I am currently in the easiest spot in my career with the most time, which offers me the ability to write blog posts where I talk about issues such as this. I have not experienced the real hardships of medicine that are just waiting for me, so I cannot offer much perspective on that front yet, but hope that as I do experience these hardships, I can provide more insight down the line. As you move into clerkship (3rd and 4th year of 4-year programs), residency, fellowship and as a staff physician, your responsibilities continue to increase, expectations rise, and your workload piles up. This is part of the reason the medical school admission’s process is so difficult. Obviously, it is super competitive so there are many people fighting for the same job, but they also want to make sure that not only will you be a competent physician, but they also want to ensure that you really want this. The life is not easy, and it requires dedication beyond the desire for money or job security, it takes a certain level of craziness that they are looking for in students.
If you are looking at ways to help reduce mental health problems and simply better the life of people you know and care about, take the time and reach out to friends. Ask them if they want to meet over coffee/tea/lunch. Ask them how they are doing and if your relationship is at the appropriate level, dig into their life and really get messy with it. This should go without saying but keep everything mentioned between the two of you so they feel comfortable talking about things they might not be comfortable sharing with other individuals. The difference a single conversation can make is substantial. While it most likely will not prevent a person from committing suicide when they have reached that point, it could at least better the day of someone you consider a friend, and maybe it will strengthen your relationship and you might learn something more from that person.
Relying on other people is important, but make sure it goes both ways. Do not overburden a friend without asking them about themselves. It is important that these relationships are a two-way street and that both people are able to lean on each other in some respect, that is what keeps the relationship healthy and strong, and also gives you the perspective from being on the other end.
If talking with friends is not working, always remember that there is nothing wrong with seeking out professional help. Whether this is taking advantage of counselors at school or in the community to have someone to vent to and speak your mind, while also gaining some potential advice on how to navigate it. Meetings are confidential, and while there is still a stigma towards it, I truly believe that most, if not everyone, can benefit from a meeting with a counselor, even if you are just going through a predictable rough patch, having a stranger to listen in a non-judgmental manner can be very therapeutic, even if you are not seeking specific advice. Obviously, there is currently a huge difficulty with access to these resources since many are financially straining, and the services that are provided can often have long wait times in non-emergent situations. These act as clear barriers for mental health services to reach the target populations it should reach.
If you are feeling down, remember to make decisions that set you up for the future. Take well needed breaks for your own sanity, go to the gym, study and spend time with the people you care about. Make sure to always keep interests outside of work and school and maintain a healthy diet. Small consistent positive steps can go a long way, and while they are not the cure for something like depression or mental health problems, at least they can help provide you with some sense of worth and give you something to drive for which may better your life.
That is the end of this post. I hope you have enjoyed reading it, and I hope through reading it you realize that if you are going through a phase, or a mental health episode to know that you are not alone and remember to try to reach out to friends or external resources for help. Be proactive about your mental health like your physical health and live the best life you can.
In case of an emergency call 911
This is a non-exhaustive list that I just quickly put together for quick access. If you go to a University that I did not mention the services for, please do a quick Google or ask someone at the University since almost all should have some form of these services. If you are not in school going to speak with your family physician is always a great starting point since they can provide you with more resources than I have provided, but you are always able to do some research on your own. The internet is an amazing resource to take advantage of.
PARO 24 Hour Helpline (1-866-435-7362)
Good 2 Talk (1-866-925-5454)
Distress Centre of Toronto (416-408-4357)
Peel Region Distress Line/Spectra (905-459-7777)
University of Ottawa Student Academic Success Service (SASS) (613-562-5101)
Carleton University Counseling Services (613) 520-6674
McMaster Student Wellness Center (905-525-9140 ext. 27700)
University of Western Ontario Student Psychological Services (519) 661-3031