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.

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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 🙂

On guns and mental illness

It’s the anniversary of several mass shootings and with the most recent congressional baseball game incident, gun rights has come back into the news.

This topic has always frustrated me.  And here’s why.

The Pew Research Center recently did a survey and found that 89% of their respondents strongly or somewhat favored preventing the mentally ill from purchasing guns.  (link: http://www.pewsocialtrends.org/2017/06/22/americas-complex-relationship-with-guns/ )  In other words, most Americans are associating mental illness with gun violence.  And that simply is not true.

Those with mental illnesses are no more violent towards others than those without mental illness.  Certainly there is the issue of harm towards themselves, but that’s a different topic altogether.  Here we’re talking about people jumping on the “oh he was a wacko/crazy, or he was psychotic, or he had to be seriously mentally ill” bandwagon every time a mass shooting occurs.  Then they try to make laws restricting mentally ill people from buying guns.

Which mental illnesses?  I’m sure lots of people will say schizophrenia or bipolar disorder (due to how Hollywood depicts us), maybe depression, but what about ADHD/ADD, eating disorders, generalized anxiety disorder, autism spectrum disorders? They’re all in the DSM.  If we count every mental illness that is in the psychiatrists’ book, that encompasses way too much of the American population.  Some might say just ban people with “severe/serious mental illnesses” (SMI) from purchasing guns.  SMIs are defined by law anyway (I can rant about this all day too).

How exactly do they expect to check whether you have a “restricted” mental illness before selling the gun?  Demand a letter from a physician? So much for health privacy.  Apparently that only applies to those with real medical diseases.  Let’s perpetuate that stigma against mental illness, shall we?

Don’t get me wrong.  I have absolutely no interest in owning a gun.  I live in the safest neighborhood in my city, but I can understand if people who do not have that luxury (or perhaps like to go hunting) would choose to buy one.

I think everyone who owns a gun should be properly trained, practice regularly at ranges, and pass annual safety tests.  However, I  will not deny someone who has no criminal history the right to purchase a gun simply for having an arbitrarily-defined group of medical diseases.  The ACLU and several other mental health and disability advocates agree with me, but the media and general population seems to have other ideas.  I’ll just leave you with this article from a couple months ago:

http://www.nationalreview.com/corner/444582/no-gop-did-not-just-repeal-background-check-system-or-give-guns-mentally-ill

 

Fête de la Musique

When I visited Paris a few summers ago, I was lucky enough to see the Fête de la Musique.  On the summer solstice, musicians gathered together and performed on street corners, museums, concert halls, and many other venues.  It was wonderful hearing such talented amateur and professional musicians – all for free!

In recent years, the festival has spread to other countries and I made sure to attend a few concerts in my city last year.  Unfortunately, we didn’t have street musicians but they did open up a few of the parks to everyone who wanted to play.  Seeing little kids sit cross-legged on the lawn and watching the musicians intently gives me hope that arts (especially classical music) will continue to play a role in people’s lives.  Music conveys emotion to me in a way that nothing else does, so I can’t wait to see the performances next week!

 

Multilingualism

I met a visiting medical student from Germany this week.  He talked about how he did rotations in France awhile back, and now seeing how the US system works.  It occurred to me that he must be fluent enough to converse to patients in French, German, and English!  Though heavily accented, his English was impeccable.

He asked me if I spoke French, since I had visited for a few months while studying abroad.  Embarrassed, I admitted that I knew very little, as I was in Paris and everyone spoke to me in English anyway as soon as I introduced myself.  (They don’t like us Americans butchering their language I guess…)

I wonder why foreign languages are not emphasized here.  Spanish is incredibly helpful in the healthcare setting, and using a telephone-based translator often results in miscommunication between physicians and their patients.  In some cities, Arabic, Chinese, Polish, and a slew of other languages are spoken by a significant portion of the population.

Public schools already face budget cuts, and “non-essential” subjects such as foreign languages, arts/music, and P.E. are often the first on the chopping block.  Foreign language classes not only teach you reading/writing/speaking, but also the history and culture of those who speak that language.  One of my French teachers was Canadian, but I’ve known others from the many African countries who also speak French.

Maybe some of the xenophobia or distrust of anyone who looks “non-American” could be prevented if we exposed children to more cultures through language classes. I wonder if the multilingualism in Europe helps promote acceptance of others.  I think we are a little spoiled being native English speakers, with English being almost a universal language around the world.  It’s so much more challenging to learn a second language as an adult, and I really hope that the next generation of kids will have the opportunity to do so.

Work and smartphones

Cell_phones_2005Remember these?? It’s amazing how technology has improved over the past decade.  I remember growing up with corded phones and dial-up internet, and computers were these slow clunky things.  Now everything can be accessed from a single smartphone.  Google tells you the answers to everything.  You can sync your music, or your fit bit.  You don’t need a physical map to navigate a new city.  Sounds great, right?

Well, all good things in life seem to come with a catch.

Instant accessibility is great – until you don’t want to be accessible 24/7.  We love our smartphones today because we can text, email, or call anyone anytime.  Chances are they have their phones with them all the time and will reply quickly.  But what if it’s your boss?

I received a message from my supervisor at 11pm last week.  I wasn’t at work, but it had to do with a work-related issue.  Can I ignore it and pretend I never saw it until the next morning?  Or does it need to be addressed immediately?  (FYI, I saw it and responded within an hour). Our medical school actually sent out an email a while back explicitly stating that it was our responsibility to check our school emails regularly, and reply in a timely manner.  But what does that mean?

The line between work and life has become blurred.  In the past they had to call you at your house phone and probably leave a message on your answering machine.  They couldn’t expect you to be at home waiting for a little red light to start flashing.  Now they know that they can reach you on your cell phone in an instant.  Work now follows you, wherever you are and at all hours of the day.  When I check my email in the evening after work (or morning before work), I usually have 5-10 emails waiting in my inbox.  I am constantly connected.

Sony_Xperia_Z

Certainly, in the old days (and even in more rural areas now), physicians had always been on call virtually 24/7.  Maybe they had a partner so they can split the evenings 50-50.  However, anything outside “normal” work hours was reserved for urgent matters and didn’t occur every day.

Now I find myself reading messages from work all the time.  It might be just a little note, or a reminder, or a question from someone.  But they quickly add up.  Sometimes I  wonder what would happen if I just shut off my cell phone after I get home.  Would the world fall apart? Probably not.  It has become ingrained in our heads that we must check our emails at least 2-3 times a day, and for me, that usually means work- or school-related emails.

So what do we do about that?  I honestly don’t know.  We all want things, and we generally like to have them quickly.  Smartphones let us achieve that.  I don’t think we should go back to the old phones where talking was the only available function (though I could write an entire post about how this generation no longer talks on the phone anyway).  Besides, I like the internet.  A lot.  Our society as a whole has become dependent and addicted to our smartphones, and I doubt that will change.  But I wonder if there isn’t a way we could disconnect, so that we can experience and enjoy the rest of our lives outside of work without distraction.

Image from Wikimedia Commons:  (top)Cell phones 2005, By Larry D. Moore, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=30478111  (bottom) Xperia Z By Clivejb – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=25178264

Graduation

This time of year is always exciting – with people celebrating finishing high school, college, or grad/professional schools.  But it’s bittersweet.

Graduation_Thinker_LuMaxArt

I’m happy for all my friends who graduated this year, of course, but I am equally sad that I have to say goodbye to them.  It seems like every four years, I become friends with many wonderful people, but then I have to start over when I (or they) move away.  Staying connected on Facebook just isn’t the same.  And phone calls?  What’s that?  So antiquated…

Graduation ceremonies also remind me that I’m not done with my training (but others are).  Obviously it’s not a competition to see who gets there first, but there’s always that tinge of disappointment.  Compared to my classmates, I’m old.  I also took time off during medical school to deal with mental illness.  Sometimes I regret doing so, because it meant I wouldn’t graduate with the classmates I started with.

Oh well.  I’m super proud and happy for all of them and will miss them greatly, but I wish them the best on the next journey of their lives.  I’m sure they will become wonderful surgeons, pediatricians, internists, or physicians in whatever specialty they matched in.  Maybe someday our paths will cross again.

Image: “Graduation thinker” By lumaxart – EbonyG00052_LuMaxArt, CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=3590827