Perfectionism

I've been going for CBT for three weeks now, and I have to say that day by day I am getting better at challenging my negative thoughts. Whether that is due to the CBT, medication or other factors such as being back at work I will never know.

Keeping my little thought diary has shown me how desperate I am to please others and how much I fear criticism or punishment. Yesterday my therapist pointed out that this tendency has its benefits. It drove me to succeed through A-levels and medical school. I have managed to command a lot of respect over the years from people around me. I've won prizes. I have a great CV. But then there's the flip side. The moment when failing to achieve my goals becomes intolerable to me and I give up altogether. Many people with depression and bipolar disorder are very talented and successful when well. Is this why? Are talented people prone to depression when the praise dries up?

I've received so much praise in my life. From the age of five I was reading and writing better than anyone in my class. I was way ahead when it came to maths and languages. OK, so sport was never my strong point, but you can't have everything. The point is – I was constantly told I was clever by both teachers and a pair of loving parents. So when I moved to a bigger school with pupils as clever as me it was a shock. I managed to get over it and climb my way back up the academic ladder. Yet by the time I hit medical school I was definitely mediocre. Indeed, in my current friendship circles I still am mediocre.

My default mindset seems to be that I am a) stupid, b) fat, and c) unpopular. Luckily this mindset tends to be challenged on a daily basis unknowingly by others. I might get good feedback from a senior doctor; I might squeeze in to a small dress and note the fact that my BMI is only 21; I might find myself surrounded by friends and having a good time. When I am well I can get away with the odd reminder that I'm not as bad as I think I am. But when I am unwell I need constant praise and signals from others to stop me from sinking... And life's just not like that is it?  

Is this really hypomania?

My mood's bounced back up in style since yesterday.

Once again I'm up good and early and being "productive" (i.e. trying to take on two many activities and getting distracted every ten minutes). The same thing happened three days ago. On that occasion I woke a couple of hours early, made a cup of coffee but forgot to drink it, started cleaning the fridge but couldn't be bothered to finish the job, went online to check out the news, look at pretty dresses, and checked out flights to various European cities. I almost bought a £300 return ticket to Austria on the spur of the moment, but thankfully had the insight to remember I'd have to check with my employer if I could take time off for this trip.

I never know whether to class these kind of episodes as hypomania or not. The only reason I have a diagnosis of bipolar disorder is because of the times I have been supposedly "high". I say supposedly because I still can't make up my mind whether my intermittent bouts of over-activity are pathological or not. My psychiatrists have thought they are - but then it's their business to spot these kind of things. Certainly when I've looked at information leaflets or online about bipolar disorder, I end up thinking Shit, that Sounds Like Me. But then a part of me questions whether perhaps I am just an intrinsically more intelligent, creative and energetic person when healthy and my diagnosis is all wrong. Or whether all of these psychiatric diagnoses are a product of the pharmaceutical industry wanting us to believe we're all sick and need pills to make us better.

DSM-IV states that true hypomanic episodes should last four days or more. I've had a couple of periods in my life when I have been symptomatic for well over four days (once in adolescence and once in my third year of medical school when I went fucking nuts). Each of these episodes were followed by acute crashes into the world of depression. But apart from that I tend to be symptomatic for less than 24 hours, and in all honesty I'm not sure how apparent these episodes are to other people, perhaps because no one tends to be around at 4am, but also because my sensation that my thoughts are racing aren't really visible to the outside world.

My current psychiatrist says that hypomania can last just a few hours at a time and that what I describe to her fits the bill. Which brings me around to the question - should I be concerned when I start to feel this way? Sometimes the sensation that my thoughts are rushing can be very distressing. But at other times I feel great. It's certainly nice to need less sleep. And booking last minute holidays or being extremely sociable and chatty is fun. Then again I don't really achieve much when I'm like this. Sure I can write, but I can't read or study because I get distracted. I don't finish cleaning whatever it is I've started cleaning. And so on.

So lets say I decide when I feel like this it is a bad thing, what am I meant to do about it? For a while I thought you couldn't do anything because I put it down to brain processes that could only be altered through medication (which clearly my medication ain't quite achieving). But then I found this website they other day that has some really sage advice about the importance of nipping hypomanic episodes in the bud and the best ways to do this. The author advises you to Stop, Isolate and Relax. I won't go into the details - check out the site if you want to know more.

That's about all I have to reflect on this morning. But before I stop writing, I just wanted to brag about the fact that my salary is 133% of the UK national average - check out this new BBC tool to see how you fare: http://www.bbc.co.uk/news/magazine-17543356

So much for the European Working Time Directive...

I'm now back at work, albeit without any on-call duties. My main worry about going back was how my friends and colleagues would respond to my absence. Fortunately that hasn't been too bad. My own team are quite understanding and don't ask too many questions. When other people have asked where I've been I've just said I've been unwell and they haven't probed any further. I can't say I'm quite back to my normal social self. I used to enjoy having lunch and chatting to my friends in the doctors' mess. Now it feels noisy to me. I want to escape to the hospital chapel instead.

The thing I am struggling with most is tiredness. Although Occupational Health stipulated that I am not to do any out-of-hours work, the reality is that in medicine or surgery there are no fixed hours. I am supposed to work 8-5pm (which trust me, after a month doing nothing is exhausting enough), but on Monday we finished at 6pm, Tuesday at 6.30pm and yesterday I wasn't done until 7.15pm. That's 4 hours and 45 minutes I've already worked for free this week. I used to joke that I was a full-time doctor, part-time NHS volunteer. I would guess that the extra hours I have worked this year amount to days. So much for the European Working Time Directive!

The long and short of it is that yesterday afternoon I became quite distressed again mentally. I had worked largely on my own in the morning and hadn't had much in terms of a lunch break. My mind drifted to suicidal ideation, as it frequently does when I am unwell and under pressure. I could hear voices telling each other I had jumped under a train. I saw vivid images of myself jumping under a train. I had a strange sensation of being knocked over by a train. Obviously I didn't fall, but the sensation of being hit was there. I rested against the wall, took a few deep breaths and got on with the day with my friends. When I got home I cried. I cried before dinner. After dinner I cried for an hour before bed. I woke up twice in the night, crying. The bedroom is now littered with the toilet paper I was using to mop up my tears.

I loathed myself for doing so, but I decided to text one of my colleagues and say that I wouldn't be in until mid-morning today, rather than 8am. I needed a few hours rest in the morning to collect my thoughts and do some writing. I figured this is the only way I can continue to work – by admitting that I am still unwell and taking small breaks here and there.

That is such a hard admission. I feel weak and pathetic – pathetic because I can see everyone around me “coping” with the hard work and hours, able to come back to work early in the morning after a tough day. But to my knowledge they are not plagued by suicidal thoughts, persistent crying, sleep disturbance or crashing mood swings. Yes I am at work, yes I am now able to work. But my illness is still very much present, and I'll just have to keep judging my ability to function on a daily basis.

On a more positive note, I'm planning to try a new carrot cake recipe on Saturday. Just a day and a half to go...

Dreaming of aubergines...

I'm beginning to think that being a doctor could be a bonus when it comes to accessing treatment for bipolar disorder (once you are able to get over the trauma of temporarily being a patient, not a doctor). On this occasion I seem to have been fast-tracked through the system. Appointment slots have miraculously appeared for me. My GP made it very clear that I was a doctor during the whole referral process... As a result I got myself onto a CBT programme within a fortnight. Whether it will help God knows, but I've never known the NHS to act so quickly in response to mental illness. I'm being treated almost as well as a cancer patient!

In other news, I've just woken from an extremely vivid dream about giving a presentation at the UK's “National Aubergine Conference”. Nice. An hour before I was lying in bed weeping. I haven't been able to leave the house all day. I checked my email and made myself a fantastic lunch (surprise, surprise), but then froze and started to cry endlessly, mainly worrying about my career. Checking out the aubergines at this conference was a real mood booster though. When I woke up I had all but forgotten my woes and had set my mind to thinking about what I could next cook with an aubergine (when I've thought of something I'll let you know). Is that the sort of experience I need to be talking to my psychiatrist about?

When the other half gets home we've planned to cook another recipe from the Kitchen Shrink - grilled trout and toasted sunflower seeds with leeks. Supposedly the fish oils will do me no end of good. Don't get me wrong, I love fish, but sometimes the thought of deliberately cooking something healthy just makes me crave pizza. And not thin, upmarket pizza. Thick, greasy, cheap, pan-friend pizza of the Pizza Hut variety. With lots of meat. Meat and aubergines.  

Sunshine, bluebells and scrambled eggs...

Life seems to be returning to “normal”. I saw my new psychiatrist this morning who was pleased with my progress and am now hoping to return to work next week. Looking back over the past month it's clear that food has helped somewhat: maple syrup, apple and apricot slices, chocolate cupcakes and home-made king prawn soup have all been key to putting a smile back on my face! Animals, museum exhibitions and a variety of healthcare professionals have also played a role.

This weekend London was blessed with sunshine. We went for a long walk in the park, the longest walk I've managed since becoming depressed again. Bluebells are starting to crop up everywhere, and I enjoyed seeing them. I enjoyed having the sun on my face. We even went shopping and I bought a new dress. I enjoyed clothes shopping! Farewell anhedonia, farewell.

Perhaps I am getting overly excited. I can feel that my mood is still fragile and I need to keep life simple for a few more weeks. I have an appointment with Occupational Health tomorrow and will need to secure their blessing before returning to work. As a doctor my biggest fear is being rejected from my profession on the grounds of mental illness. Of being seen to be unfit to practice. That fear is completely unfounded of course, but it is still there at the back of my head. Patients don't want mad doctors after all. But am I mad? Really?

On a positive note, I've discovered a new edible antidepressant: scrambled eggs. Not just any scrambled eggs. Start by frying up a couple of spring onions and a red chilli in pan with a splash of olive oil (get rid of the seeds if you can't take the heat). Once the onions are soft add a bit of butter and scramble in three eggs. Perfect. Plus, it's not unhealthy like cakes are. I had mine with rye bread, but if you're one of these anti-carbohydrate freaks then it ticks all the boxes – although why anyone would turn down authentic German rye bread is a mystery to me...

A day on the farm...

Things are starting to look up.

I managed to take a long walk before seeing my GP this morning. After my appointment I met my boyfriend at Vauxhall City Farm. I've been going there since my second year of medical school when I had a major depressive episode. I used to go and spend time with the same white horse each week which I found really therapeutic. None of the horses were around to pet today, so I spent time with some rabbits, pigs and lambs instead. I found myself laughing with my boyfriend as we walked around the farm. For a moment I lost sight of my sadness. (By the way, if you're keen to help miserable depressives like me you can kindly make a donation to the farm here).

I'm not sure what the evidence base is behind animals as therapy, although Wikipedia gives a brief overview of the subject here. When I was an adolescent I was admitted to hospital for self-harm and depression on several occasions, and twice the children's ward was blessed with a visit from a pair of dogs from Pets As Therapy. Again, during those brief moments of holding and stroking the dogs I forgot the fact that I was in hospital and just enjoyed their softness. A few years later I approached Pets As Therapy to see if I could take my own dog in to hospitals, but it turned out he was too bouncy and excitable. Oh well, he was good enough for me.

I made a decision to ease off on the baking today, mainly because there are still four cupcakes remaining and I don't know whether the psychiatric nurse who comes tomorrow will have the balls to accept baked goods from one of her patients. Instead I turned my culinary attention to making a hot and sour prawn and noodle soup. Oh my gosh it proved to be the ultimate comfort food! Simply put a few chopped spring onions, red chilli, grated ginger, lemon grass and mushrooms into some fish stock. Add a tablespoon each of soy and fish sauce, followed by some egg noodles and raw King Prawns. After boiling for a couple of minutes the prawns and noodles will be cooked through and you're good to go. I got the idea from a cookbook I bought last year called “The Kitchen Shrink”. It was one of the recipes the author suggested for depression. What can I say? It worked.       

Appearances can be deceptive

Failed to get my bake on yesterday. But hey, managed to meet a friend in the evening at My Old Dutch again. Another social encounter with a big fat smile on my face. He must wonder why I'm not working at the moment. Don't exactly appear “unwell” when I leave home and face the world.

My mood is swinging so much right now. I feel depressed, yes. I cannot concentrate, cannot make decisions. I am constantly exhausted and sad. I think of ending it all every single day, or at least harming myself to the point of being in a coma. I don't want to die, but equally being awake can be mental agony at times. I woke up in the early hours of the morning and have been awake since, unable to focus on anything in particular, unsure whether to take a small overdose of sleeping pills to silence my mind. Then a few hours later I bounce back. A few hours later I can manage an evening out, or a trip to the cinema, although it's exhausting.

I am seeing a new psychiatrist in a few hours. Lucky, lucky him. Lucky number six. For that is how many I've got through over the past ten years.

I will survive. I admitted to my partner yesterday that I fully intend to bake and eat my way out of this hell hole. Is that unhealthy? I eat in moderation and my weight has been stable recently. I am a size 8-10. I guess I need to keep an eye on it, but adding a daily muffin or brownie to my normal diet of wholegrains, low-fat dairy products, lean meats and fruit and vegetables isn't exactly going to tip the scales.

Finally concluded an hour ago that my next stab at baking will be black bottomless cupcakes. I've only just become aware of the Joy of Baking website. It's American, so I'm going to have to get myself a cup measurer (why can't the morons use grams and kilograms like the rest of us?)

Talking of American, I've recently got into imported Pop-Tarts. Brings back memories of summers spent in Florida as a child. I've got American blood in me, something as a Brit I've always been strangely proud of. But I'll save that for another post some time...  

Thought for the day: I wish I were better at anatomy...

So yesterday was somewhat crap. Spent most of the day in bed, but thankfully managed to get up in the afternoon to have my first shower in three days.

Today my anhedonia briefly resolved enough for me to enjoy more pancakes and maple syrup, this time at Jacks (my favourite local breakfast place). Before you jump to the conclusion that my only comfort in life is food, I should also add that I enjoyed going to a Leonardo Da Vinci exhibition at Buckingham Palace today as well. I booked the tickets some time back, long before my depression took hold. The exhibition shows Leonardo's anatomical drawings. I assumed they had been brought over from Italy, but it turns out the Queen owns them. Lucky her.

The drawings brought back not-too-distant memories of dissection at medical school. My anatomical knowledge is shocking. When I started University I thought I would drift towards psychiatry as a speciality, so didn't pay much attention during dissection. That kind of attitude comes back to bite you in the butt when you're working though, especially now I'm on a surgical rotation.

It's now approaching midnight and I'm planning what to bake tomorrow. I wouldn't do this blog justice if I didn't share at least one recipe a week. Last week I made apple and apricot slices, but have managed to palm them off on friends and family so there's only one left. I'm thinking something chocolatey this time, but not sure. Will have to wait and see...

Thought for the day: maple syrup goes well with everything

It's a strange thing to say, but one of the things I struggle with most is the moments when I feel "normal". Yesterday it was so hard to get out of bed. I managed to get to an outpatient appointment with my mental health nurse who seemed very concerned about my welfare. I am due to see a psychiatrist in a few days and am still not fit for work. And yet despite the horror of this situation I have hours when I break free from the clutch of depression, when I manage to grasp hold of joy and pleasure.

Today I derived a deep and sinful pleasure from maple syrup; my sister visited me and we made a trip to My Old Dutch on the Kings road. I cannot recommend this place highly enough. Pancakes are the new pizza in my life. While my sister went for an amsterdammer I opted for an asparagus pancake with added chicken and chorizo. Luckily for me my sister shared her maple syrup. 

I discovered that the combination of chicken, cheese, chorizo and maple syrup is better than your bog-standard antidepressant will ever be. 

Welcome

So here's another blog by a patient writing about their depression. This time the patient is a doctor.

Perhaps it's because I'm tired of emailing the Samaritans all the time...

I was signed off work last week after breaking down at work. Since then I've pretty much just been bumming around at home in my underwear.

A few weeks ago a good day involved successfully putting in a chest drain under supervision. Now my “achievements” have included managing to walk to Asda to buy some cereal. Oh how the mighty have fallen.

I've been through this all before. Every couple of years I enter this darkness. The one thing I'm grateful for – if there is anything to be grateful for – is that I don't lose my sense of humour when I'm depressed. Nor do I lose my ability to write or bake cakes. If I get to that stage I'll need to be sectioned.

So I will write and bake my way out of this hole, perhaps throwing in a witty observation from time to time.

Enjoy x