On dragons

After watching Game of Thrones, dragons have been on my mind.  It’s really interesting how so many different cultures have dragons in their art or mythology.  They share many of the same features too!  Makes you wonder what animal they were basing their respective creatures on.  Here’s a few I found on the internet!

Drake_på_en_medeltida_vävnad,_Nordisk_familjebok

Dragon on medieval tapestry

 

Metal_dragon_half_frontal_view

Japanese dragon

 

Drachenbrunnen in Schleiz

Dragon fountain in Schleiz

 Images from Wikimedia Commons:

By Nordisk familjebok – Nordisk familjebok (1907), vol.6, p.816 [1], Public Domain, https://commons.wikimedia.org/w/index.php?curid=920625
By Chris 73 / Wikimedia Commons, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=600293
By Doris Antony, Berlin – Own work, GFDL, https://commons.wikimedia.org/w/index.php?curid=28553292

Marijuana legalization

I have believed for a long time that marijuana should be decriminalized.  Alcohol has far greater consequences, yet it is legal.  When was the last time you heard of someone high on weed punching a guy, getting in a car crash, or overdosing?  Sure it might happen, but definitely less often than with alcohol.

Marijuana-related crimes tend to be possession or distribution of the drug.  If we made marijuana legal, police could stop wasting resources arresting and jailing these people.  Instead, they can focus more or respond to violent crimes.  Furthermore, if the government made pot legal and taxed its purchase, they can use that money towards their budget deficits.  Let’s be honest.  How many cities or states have a surplus right now?

Impostor syndrome

According to Wikipedia, impostor syndrome is “a concept describing high-achieving individuals who are marked by an inability to internalize their accomplishments and a persistent fear of being exposed as a “fraud”.

Ever since I started medical school, I have felt this way.

It’s interesting because in college, I did well without much work or stress.  I figured I was coasting along since I picked easier classes, had some good luck, and relying on some kind of innate “talent” or “brains”.

That stopped as soon as medical school began.  Everyone else was so smart – they were at the top of their classes in college, learned much more quickly than me, and just knew everything.  Our grades were pass or fail, determined by a cutoff relative to the class average.  I was doing so poorly I thought I should just drop out and pick another profession.  One that I knew I could be good at.  The only reason that didn’t happen was because I couldn’t think of any.

Being diagnosed with bipolar disorder during medical school didn’t help.  Now it became more than just “what if they find out I’m not smart?? I don’t deserve to be here”.  Thoughts like “what if they found out I’m crazy too? Now they’ll really kick me out!” started entering my mind.

I know it’s all irrational.  I know it’s common.  I just wish I could make it go away.

Black Swan

No I’m not talking about the movie (which I absolutely loved!)

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I’m referring to the black swan events – events that are a surprise and have a major effect.  Unexpected outliers.  But ones that we try to rationalize away as something we could have predicted.

My therapist once had asked me what some of the black swan events in my life had been.  It caught me off guard, and I sputtered out something like getting into med school.  Of course the rest of the session ended up being about my poor self-esteem and impostor syndrome.

Later that day, I thought about it more and realized that perhaps the most important black swan was my diagnosis of bipolar disorder.

My initial episode was unfortunately a manic episode with some mixed features, which landed me in the hospital because no one knew what was going on and ended up with me having to take a leave from medical school.  Definitely a major disruption in my life.  Bipolar disorder isn’t super rare, but it certainly isn’t terribly common compared to depression.  Who knows what the stats are amongst medical professionals, because of course there’s plenty of stigma and no one’s going to admit to having bipolar disorder (or any other psychotic illness) in our field.  In retrospect, I probably was hypomanic in the weeks/months leading up to my diagnosis.  People just didn’t notice, because no one was looking for it.  You know, like a black swan.

I’m sure there are other examples in my life that I could find if I dug hard enough.  But I think the lesson is more that these events aren’t necessarily predictable, and will happen to everyone.  It only matters in how you respond to it.

image source: By Ing.Mgr.Jozef Kotulič – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=1097939

Debt

It’s amazing to me how much tuition has grown over the past decade.  Back when I started college, tuition was in the mid-$20Ks at a private university.  I was curious how much it was now – nearly $48,000 per year!  And that’s not including room and board, fees, books, etc.  According to Wikipedia (I know, I know…), the median household income was $55, 516 in 2015.  That means most people attending college are accruing some significant debt.  And will be spending years if not decades paying it off.

Of course, there are some coming from more affluent families who are willing to help with costs, at least in part (*raises hand*).  And also lots of grants and scholarships (*waves both hands*).  But not everyone is so fortunate.  The worst thing is with so many people choosing to go to college (whether community, public, or private), employers can rule out those without college degrees in applications, even if that education isn’t required for the job.  With the interest rates these loans have, most 1st jobs after graduation will hardly cover payments.

Doctors are lucky in that very few are unemployed (assuming they match into and complete residency) and salaries are high.  Still, I see physicians paying off their debt well into their 50s, especially if they chose to have children or get a mortgage for a house right after they finish training.  At my medical school, tuition alone will net you about a quarter million dollars in debt.  No wonder our students shy away from lower-paying specialties like family medicine.  I don’t know what the solution is, but I know I’m lucky to have a full scholarship and able to consider fields like family med, pediatrics, psychiatry and many others without worrying about my financial future.  Maybe there should be more programs like the military services where you get to school for free if you serve for a certain number of years.  Regardless, debt from higher education is a real problem and I always encourage any future college or medical students I meet to choose the offers with the most financial aid over the “prestige” of the school.  I firmly believe it’s worth it in the end.

 

 

Crying

Crying is one of the most frustrating things I’ve tried to and failed at fixing.

I have a tendency to break out into tears at the most inopportune times.  It’s not even in response to criticism or anger towards me.  (In fact, compliments make me want to cry much more often). Maybe it’s just stress.

For example, I have been in situations where I have to give an important presentation.  I’m nervous, but otherwise completely fine during the talk.  Then when I finish and thank people for their time and attention, I start tearing up.  It’s horrible.  All I needed in order to save myself from embarrassment was a few more minutes – enough time to answer questions from the audience then walk back to my seat.  But I can’t hold them back.

I’m not normally an emotional person, so it always shocks people who know me. Fortunately I’ve gotten good at dabbing my eyes inconspicuously.  They aren’t tears of sadness.  Or of hurt.  I wish people didn’t associate crying with weakness.  I just want to tell them that it comes on its own accord, but it will pass in a minute.  Please ignore it.

Am I sick?

“Do you think you are sick?”

My outpatient shrink asked me that at my first visit.

It’s an interesting question, loaded with potential implications.  I don’t view bipolar disorder as me.  It’s not a huge part of my life.  I just have a label.  A diagnosis.  And since it’s not manifesting itself in any way, I am not currently sick.  I just happen to take a pill every day to keep it away – almost as a preventative measure, rather than as a treatment.

Despite being diagnosed with bipolar 1 (the supposedly more “severe” version), I don’t always identify as someone with mental illness.  At least not on a day-to-day basis.  In the middle of an episode? Perhaps.  I think that’s why I have a hard time relating to many of the people on popular bipolar and depression forums such as Reddit, even though we have the same disease.  Some of that is certainly self-selection.  People who are more ill may be more likely to browse these forums for support, at least compared to people who are stable.

I think for some people, bipolar disorder is part of their identity.  In other words, the ups and downs are part of who they are.  In the arts professions, there is this thought that bipolar-ness contributes to their work, and that their creativity stems from this disorder.  I think this is a very valid point.

However, I feel the opposite.  I see my “manias/hypomanias” and “depressions” as manifestations of the illness, but when I’m euthymic, I consider myself well or not sick.  I know most doctors believe that bipolar disorder is a chronic illness, and that it can’t be cured – that it can only go into remission and requires maintenance medications for the rest of one’s life.  In other words, forever sick. With the huge caveat that I’m not a psychiatrist or psychologist, I’m not sure if I entirely subscribe to that.

Think about it.  Unipolar depression isn’t necessarily viewed as a chronic illness (though for some people it is and they do stay on anti-depressants forever).  We don’t know enough about the biology of depression and bipolar disorder to know if they are mechanistically on the same spectrum, but there is often genetic links based on family history or genome sequencing.  So what’s to say bipolar disorder is any different?  Most of us have more depressive episodes than manic episodes anyway.

So back to the doctor’s question – are you sick?  I wonder what the purpose or intent of the question was, and I wish I had thought to ask.  Was it to see how exactly how I viewed my illness? If it was a part of my identity?  Or was it to ask if I was currently sick and having symptoms? Or was it to determine if I have anosognosia and don’t believe I have bipolar disorder at all?

Regardless, I answered that although I have an illness I don’t see myself as sick and yes, I take my pills every day (or at least try to). I hope I got the point across 🙂