October 9, 2020, by School of Medicine
50 at 50: Mental Health and Medical Students
I’m Issy and I’m a fourth-year medical student. Going into the 50th year of medicine here at Nottingham, obviously a lot has changed from that first cohort to my own, with cohorts in between producing doctors that have even treated me! Even since I started in 2017, there have been changes. Particularly close to my heart are changes in the way that mental health amongst medical students is perceived, both by students themselves and the wider profession. I’ll use myself as an example.
When I arrived in Nottingham for the first time, I was determined I was going to reinvent myself, leave the past behind and be a new me. I wasn’t going to worry about anything, I was going to be a happy-go-lucky fresh-faced teen about to embark on, quite literally, the career of a lifetime. Let me confirm to you now, aside for the last 11 words of that sentence, that was most definitely not how first year went for me. I think the key lesson I learnt that year was that reinventing yourself to be someone you aren’t is just not productive: it’s a waste of time, and makes an already overwhelming year of change much harder. But for me, I felt I had so much to hide and pack away into the depths of my personality.
I guess I’ve struggled with my self-esteem since primary school. I preferred sitting in the corridor watching the birds in the courtyard or curled up with a book in the library than playing outside. At that age, I already noticed the ways my body was different to others: my hair never fell straight; I wore bigger sizes of clothes, had bigger shoes. I felt I stuck out like a sore thumb, so found comfort in my own little world instead. I had one close friend who I was happy to let into that imaginary solace, but never understood if they picked someone else to be their partner in PE: already, I had that nagging feeling in the back of my mind of just not being quite good enough.
I clearly remember a lesson on self-confidence. We all had a post-it note and three people had to write something they liked about you on your note. My friends got ‘pretty’, ‘funny’, ‘best friend’ on theirs. I got ‘intelligent, smart, clever’. At the time, I was delighted: it was validating something good about myself. However, fast forward through the minefield of secondary school and I started beginning to notice that more challenging concepts were difficult for me to get my head around – others were better than me. I felt I was losing the only thing I thought valuable about myself, and began to struggle emotionally.
I made the decision after GCSEs to do medicine. It seems so young, looking back. I was only 16 and filled with the general torment that teenage hormones put us through: I count my lucky stars that it appears I made the right decision. However, I was wrong about one thing: I assumed in order to stand out at interview I had to make myself appear the strongest person I could in every way – I completely neglected to address the state of emotional turmoil I was in.
I managed to juggle my way through medical school interviews, and even found myself with multiple offers to choose from: this seems ideal, but looking back at it, I can see it fed my belief that I was only accepted because I appeared mentally robust. So, that’s the impression I tried to maintain, and we find ourselves back in 2017 and my first year.
I never disclosed to anyone just how difficult I was finding everything, and therefore never got the support I desperately needed. I was torturing myself with the pre-conceived stigma that I would be kicked off the course without a second thought if I so much as had one bad day.
I wish I had realised then that my mental health did not – and does not - affect my ability to be a good doctor. But, that is what it seemed like. I had read about medical school being like survival of the fittest; horror stories of people being kicked out because they had a mental health condition like mine. I didn’t know of anyone else like me, so I kept quiet. It was my little secret and I wanted to keep it that way.
It wasn’t until May of my first year that the additional stress of exams pushed me to my limits and I told someone how I was feeling. I’m so glad I did. There’s truth in the saying ‘talking is the best therapy’. It was a weight off my chest – pretending to be someone you’re not is exhausting. I was made aware of the myriad of people within the school and wider university to talk to – and that I was most certainly not alone.
For the first time, I felt free to express myself without fear of reprimand – but that was never going to be the case. There is a stigma surrounding mental health within the healthcare profession – the misconception that we must be ‘strong’ and never express negative emotion to be good doctors. In fact, I would argue the opposite. I feel that the experiences I have been through make me more able to empathise with patients during consultations, picking up on the subtle hints that there might be something more going on emotionally for them than their presenting condition. Furthermore, being able to seek help has made me ‘stronger’ than ever, and have a drive to help change things for my peers.
I wrote a piece for this blog 2 years ago about dealing with anxiety as a medical student. That was a humongous step for me, and the first time that many of my friends found out about my condition. The amount of support I received was, quite frankly, overwhelming. People messaged me saying they related to my experiences, how they were so glad someone spoke out. It made me realise, even though I didn’t have anyone myself to look at and see that it was okay to be a medical student with a mental health condition, I could try to be that person for the students to come after me.
I became MedSoc’s 2019-20 welfare officer, being sure to talk about my own experiences as part of my role, to foster an attitude of openness in one of the university’s most influential and active societies. I continue to make an effort to speak up for the concerns of my peers, and recently set up a termly publication alongside my friend Nic, to give students a free and open platform to discuss what they feel passionate about.
Perhaps my biggest steps have been to talk about things in the wider world: I was asked to be a regular contributor on BMJ Student’s ‘Sharp Scratch’ podcast and I also wrote a piece for the MDU – significant for me as it was the first time I explicitly mentioned my struggles with depression as well as anxiety.
It’s not just me doing this. Since 2017, I’ve noticed an influx of the use of social media and campaigning to emphasise the importance of mental health and wellbeing both in our university community and in the wider NHS, which is heartening to see. I honestly hope that current first years will realise that looking after their mental health is just as important as their academic results in medical school – the two go hand in hand. And, if only a small change in 3 years, imagine the size of changes that could happen within the next 50 years.
Well done Issy. This is a courageous and articulate blog. Good for you! I am sure you will carry these experiences forward into your professional career as a sensitive and well-rounded doctor.