My reflections on returning to medical school after recovering from depression

Thivyaa reflects on taking time out of medical school and how it gave her the opportunity to refresh her perspective and gain valuable life experiences.

To say that medicine is intense is an understatement. Sometimes it is so overwhelming that even pausing to take a breath can feel like a luxury we cannot afford. But as I have learnt over the past few years, the consequences of neglecting our minds and bodies are too dire – for both ourselves and our patients – for us to continue in this way. Here, I would like to share what I have learnt during my journey of recovering from depression, reflect on what it is like to take an interruption of studies (IoS), and highlight the importance of self-care.

During the academic year of 2018-2019, I took time out of medical school. The previous few years had been a disaster with regards to my mental health. I had become too unwell, but in an attempt to ‘be strong’ I had continued with second year, only to then fail. And so I was advised to have a ‘break’ and come back to repeat the year in 2019-2020.

Going on an interruption of studies was daunting

I had not heard of people taking years out of university. Did this make me an even bigger failure than I felt myself to be already, for struggling internally? Would my employers use it against me? A career in Medicine is already a long journey, so wouldn’t an IoS prolong it even further? Moreover, I was effectively leaving the year group and (potentially) the new friends I had made, not to mention signing myself up to endure the marathon that was second year once again. Furthermore, suddenly there was a time limit by which I ought to be better (within the next year) and who could predict the course of my health? Besides these, my biggest fear was how I would function without the structure that medical school had given me, even if it had been difficult to follow; if I took a year out, there was the potential that my days would become even bleaker and that I would become more depressed. How would I survive?

Now, when I speak to other students who are struggling, I realise that I was not alone in these thoughts. The fears that come with being advised to take an IoS are entirely valid and actually lead many students to actively avoid seeking help. However, in my experience, taking a year out from medicine is the best thing one can do.

Here’s why: Not only did the IoS give me the time to engage in the self-care habits that I had neglected since starting uni (like sleeping on time, eating healthily and partaking in hobbies), but also crucially, it gave me the time to reflect and work through my past experiences and emotions. In doing so, I have been able to develop a stronger relationship between my mind and my body – a sense of self-awareness and connection to my subconscious that otherwise would not have been possible.

Artwork created by Thivyaa: (L) A painting of a sculpture that Thivyaa used to walk past to her clinical placement during her IoS in Germany; (R) Leaves collected during Thivyaa’s first weeks to and from therapy

A large part of ‘working through things’ undertook the form of intense weekly psychotherapy. Dissecting one’s emotions is no easy feat, for they can dig up memories that are sometimes easier to hide from. Indeed, when the mind is pressed with other stresses, like deadlines, we can feel too drained to divert energy into thinking about personal matters. Yet given how dominant our limbic system (the ‘chimp brain’) can be, often we can end up subconsciously projecting these unresolved issues onto others, and even ourselves.

It is thus of utmost importance that we spend time in trying to understand and befriend ourselves, to be more emotionally in tune and aware of the recesses of our minds. For me, the biggest stressor (and revelation), which had underlain my depression, was the fact that I was a refugee. Yet until I started psychotherapy during my IoS, I had not been fully conscious of this.

Thivyaa recites a poem she wrote called ‘On Being Uprooted’ for Refugee Solidarity Week.

Accepting our differences

When I entered the entirely different realm of Imperial, suddenly I noticed startling differences in culture, class and even between my childhood and the lives of my peers. My life seemed peculiarly different to everyone else’s around me. I found it hard to relate to others, form connections and most painfully of all, I felt that I did not belong – neither at Imperial, nor as a medic, nor as a Tamil, nor in this country. As I had come to the UK as a baby, I had never quite attributed these jarring life experiences to the fact that we were refugees. Survivor’s guilt and transgenerational trauma were things I had felt and experienced but never given a name to, and for the majority of my life they had never posed a significant problem, for I had always had a great support system that had kept me afloat this sea of deep-seated issues. At university however, experiences of bereavement, heartbreak and loneliness, not to mention the stress of the course itself, acted as catalysts for a depressive existential crisis.

In a dystopian reality, becoming mentally unwell could have terminated my career. But as my therapist often says, pain and pleasure are balanced on a razor blade, and the contrasts that life gives us are complex, and so it was for me that the black hole resulted finally in an awakening of light.

I now know what it is like to be a patient

If it hadn’t been for Imperial’s belief in me, I may not have had the chance to get better, build my sense of identity, nor draw meaning from what I went through. Though those days were unspeakably dark, they have influenced every aspect of me now – from being more grateful to my mind and body for the little things, to shaping the way I interact with my patients. Being on the other side of the consulting room, it has forced to me to think about what it is like to be given a diagnosis, to walk away with a label for one’s symptoms, and deal with the unbearable sudden changes which accompany illness. Those years of depression have taught me so much more about what it is like to be a patient than textbooks ever could. And so, feeling equipped with this new armour of ‘life experience’ (and feeling stronger within myself), I was excited to come back to medical school this year, but boy was I afraid!

Re-exposing myself to an environment of stress could act as a major trigger and result in relapse. Besides, would I fit into a new year group with students in a different lifeboat to me? What if I became as parched from loneliness as I had felt previously? Another massive concern of mine was memory – I had been out of education for the first time, not to mention that with depression I had suffered what felt like quite severe memory loss; I doubted whether my mind was capable of submitting itself to intense study. I had no recollection of my previous attempt at second year besides the fact that I had missed nearly all the lectures, tried to study in the library and ended up frequenting Costa to compensate for my exhaustion and inability to concentrate. I anticipated something similar this time round.

To my surprise however, the past year has been anything but! Thankfully, I found myself able to keep in balance using the habits I had established during my time out (like reading before bedtime, exercising regularly, and making time to play the cello (something I had picked up during my IoS). The work was definitely hard, but certainly not unmanageable, and now that I had more space in my mind, not to mention a thirst for knowledge, I could finally appreciate the nuances of what we were learning without succumbing to changes in mood. Having reached the end of such an enjoyable year, I reflect with awe at how much my life has changed, and how lucky I am to be given the opportunity to continue with medical school.

Thivyaa’s vision board

My return to medical school

Many people, both within and outside of Imperial, have supported my return this year and I am grateful to every single one of them. Firstly, I am indebted to my personal and senior tutors, both of whom have checked up on me regularly and been there for me to discuss both the highs and the lows. Knowing that they really do care about my welfare has made me more confident in reaching out to them, which in turn has positively transformed my experience of uni. Secondly, I am grateful to my professors, lecturers and anatomy demonstrators who have treated me no differently, despite seeing my face several times in the same learning environment. They have made me feel unashamed of what I have gone through and have re-infused me with enthusiasm for medicine.

Thirdly, I am grateful to my new year group who have welcomed me with open arms and befriended me as though I have been part of their cohort since first year. The friends I have made have coloured my days with laughter and joy and made the weight of revision so much more bearable. Similarly, I am indebted to ICSM’s music society for welcoming me into their orchestra despite me being an amateur at the cello. The family I have found in this society, not to mention the academic support they have provided, has been absolutely amazing. Last but not least, I am indebted to my friends and family outside of Imperial who have supported me during my darkest days, retained faith in me and continued to support me through my return. Without them, I could not have made it through.

Looking back, I remember thinking that I’d never see the other side of depression. But further still, I never imagined that it would become part of my story, one that fundamentally shapes my approach to life, my patients, and even my career decisions (I’d love to become a psychiatrist and go into refugee psychiatry).

Talking about mental health problems is difficult, particularly when one comes from a culture where there are no words in one’s language to even describe it. Still, the more we are open about it, the easier it gets. We are lucky at Imperial to have an amazing support system – from the welfare reps in our year, to the welfare team, the tutors and even the disability advisory service. Help is out there and it is not weak to ask for it. If anything, I have learnt that there is bravery in being honest and there is strength in making time to look after oneself. In my personal experience, taking time out gave me the opportunity to rejuvenate myself, refresh my perspective and gain valuable life experiences. But looking after oneself need not be put aside until things go terribly wrong; simply peppering our days with self-care, be it in the form of going for a walk to observe the leaves, doing some art, or calling a friend, can help us keep afloat and boost our sense of wellbeing, not to mention our resilience.

Amidst all the time we spend learning to care for our patients, we must remember to care of ourselves too. After all, it is only if we can treat ourselves with compassion that we can even begin to treat our patients with kindness. And it is only if we destigmatise talking about our own mental health issues that we can truly expect the same from society. At Imperial College School of Medicine, I think we have started to make those change, and I am proud to say that I belong to such a wonderful family!

Gayathri Thivyaa Gangatharan has recently completed her second year of MBBS Medicine at Imperial College School of Medicine.

Support and resources for current students are available on the Student Support Zone

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