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Harjit: Welcome to the Bundle of Hers. And today we thought we would talk about something that I think isn't addressed very often. I think it's a difficult conversation even to have with our own friends, and that is mental health and like kind of our thoughts around it. Especially being people that are pursuing the education in medicine where mental health kind of ties back to all physiological diseases I would say, because you know, we're all complete human beings and everything ties with everything else.

Bushra: I think I was reading something that said that physicians are more likely to be depressed than any other profession.

Margaux: So that is true, Bushra. I read an article too that actually said suicide rates among medical students is getting higher as well. And I think it's the nature of the program that we've chosen is very stressful, and there is a lot of unnecessary stress placed on us either through ourselves or through the system. And I think that depression, feeling down or anxious is just a natural part of that we don't always admit or want to admit we feel, but I think most people do feel it at one point or another.

Bushra: I also think that mental health takes a back seat to studying and doing well in school. I think that's our number one priority. And so I think that manifests its way into, you know, our lives. We get depressed, we get anxious, we deal with all these different things, but we're still focused on trying to be good students when we should be focused on trying to take care of ourselves and trying to be well.

Harjit: Yeah, I think one thing around mental health that I really kind of discovered is, because the symptoms aren't very like characteristic, we as people always want assurity, right? We want to know what's going on. And like, because things aren't specific, things are different depending on a different person, like these manifest in so many different ways, I think that kind of brings that whole thing around mental health where it's almost like a taboo topic because no one knows what it is, right? Because it can be so many things, you know? And I think again, tying that back to us as med students, I think we like to feel sure about things, you know? And having that assurity around like, why am I feeling this way, these are kind of difficult emotions to process, so we put them to the side, at least I do. I put them to the side and then I do my studying, but then they come back to me like much, much later.

Margaux: Yeah, I'll definitely admit that this morning, when I was walking into campus after our tests yesterday, I was feeling a little anxious that I didn't study enough and that for the next test I'm going to have to study more. But I also have this research project that I need to finish, and it just seems sometimes so overwhelming. And I just recognized that I had that feeling of anxiety in my stomach, and I kind of had to tell myself, you know what? It's okay. I've got this, and it's okay to feel anxious. There is a lot of pressure on me right now. And I was thinking about who I could talk to, which of course is you guys, just to help me through that. And I think just recognizing that that is a feeling that I have and that is a normal feeling and that I can talk to somebody to help me through it is very valuable to me.

Bushra: I think, Margaux, what you just said is kind of key because I feel like when, at least I'll speak for myself, when I am anxious, when I'm not feeling up to doing anything, when I'm feeling depressed, I feel like I'm the only person in the world that's feeling that right now, right? And so I don't want to talk to, I don't want to talk about it. I don't want to do anything. I just kind of want to like want everything to just like go away, and I just need some peace of mind. But like I realized, especially over the last year, like talking to you guys and, you know, seeking help and like trying to actively work on my mental health has been great for me. And I think that that's something that people should know that they're not alone when they feel like that. That's completely normal.

Harjit: Yeah, I definitely agree with that. I kind of like want to tell y'all my story about my experiences with depression. So when I started medical school, I remember that I was really excited. I finally made it to med school. I worked really hard. It took me a long time to get to this journey. You know, I was excited to meet so many new people, like learn from everyone.

I failed my first quiz, and I remember after that I was like I don't know if I deserve to be here. I don't know if this is something I can do. I don't know if I can last, you know? And also, I didn't really talk about it to other people. Like who wants to share, like, they failed a quiz, right? You just want to like go along. Also, because I was with a lot of new people, I just felt like I couldn't voice my opinions. Harjit, stay quiet. Stay to yourself. You don't know how people will react to you.

So I was quiet. I just failed my first quiz. I didn't know if I deserved to be here. And for two months I was like, you know, I was just sad all the time. I was sad every day. I didn't know, like I just felt like I wasn't who I was. Like even, Bushra, I think I started talking to you, I think I was towards the end of my like depression when I started talking to you. That's when we first met. But like I was really just keeping to myself.

Also, I used to talk to Leen at that time, so we both were kind of having feelings of like adjusting to a new environment and stuff. I just remember feeling that time that I didn't want to tell anyone that. I didn't want people to know that like I couldn't handle med school. It had just started.

I will say now that I'm like so far away, I actually even had a fear that I'd be depressed again in the beginning of this year, but so far everything's been good. But I honestly go through lot of like highs and lows. So I also feel like depression isn't a constant state and that's another reason why it's hard to define because you just don't know. It happens sometimes. It doesn't happen sometimes. You know what I mean? Yeah. It is difficult. It's difficult to have those conversations with my family. I mean it's good. Like I have you guys, y'all, and I can talk to you all about it, but it's like difficult.

Margaux: It's interesting because we were in the same test group in that first semester, and I do remember after we did the group quiz where we all, after we take an individual quiz, we all graded together in a group of four or five students. I did notice that you became very quiet and shut down after that. And I just want to ask you now in retrospect, we were friends, but if I had reached out to you in that moment, would you have felt more comfortable talking about it?

Harjit: You know, like I think every person's different, and I actually like talking about my feelings. I'm a very like talkative person, so I like sharing how I feel and I like sharing how I feel when people in front of me aren't like making assumptions about me or in other words judgments. Like I just want you to hear my story and I don't want you to be like, oh, making your assumption. Like does Harjit deserve to be here or not? You know? And I think that's where a lot of the fear comes in of bottling everything up. We don't want to tell people because we're afraid they're going to judge us.

Margaux: So what could I have done in that moment having recognized that you maybe were not yourself after that group quiz? What would have been most comforting for you?

Harjit: I think just, okay, there's two things. I think, one, when other people are going through something and they just shared they too are not feeling good, it just makes you feel like, oh, I'm not the only one.

Margaux: Normalcy.

Harjit: Right. And I think the second is just like checking in on people. But I do want to say that when you do check in on a person, it's up to them if they even want to talk about something or not. Because sometimes people, like in the moment, they don't want to talk about what's going on in their life. What do you think?

Bushra: I'm not like Harjit. I don't like talking about feelings and stuff like that. I only open up when I feel comfortable around someone and I feel comfortable with our friendship and then I'll be more likely to go into it. But if it's like someone who I don't really talk to and like we're friendly, but not really friends, it's kind of harder for me to open up about stuff like that.

But I think something that I've had like support, a supportive group of friends, and so I think that's something that's helped me along the way. And I have my family, like my sisters, even my mom, like she's starting to understand a little bit because like she actually uses the word depressed, the English word, depressed. Like she's starting to understand it and she tries to understand like where I'm coming from, even though she's led a completely different life than I have. So that's kind of comforting too. And then just knowing that like I'll still be okay in the end. I'll still be okay. I'll still have my friends. I'll still have my family.

Harjit: Yeah. Also, like what happened this weekend in Charlottesville. I think that these kinds of things, they really impact us. I remember last year, Bushra, actually, we both had a test on a weekend. And what had happened? It was the travel ban, right? So I think a lot of the times people don't realize this, but people are connected to certain issues for different reasons and some are tied to them more strongly or personally than others. And then that impacts you and that impacts your performance.

Bushra: Yes, 100%. Because as much as I need to study, as much as I should study, it's kind of hard to stay focused when it feels like your whole life is being attacked. And so I guess it's like . . .

Harjit: It's we're more, right? We're more than just one thing and that translates.

Bushra: Yeah. It's like I think the thing that bothered me the most is that it was like business as usual. Like nobody talked about it and so I had a hard time processing that. I don't even know what to say.

Harjit: Okay. Depression isn't just like a single moment in time as well. Like as I said, it's a million things that's occurred to you in your life, in my mom's life, in my dad's life, in their family's life, in my friends' life.

Bushra: Exactly. The fact that, behind the scenes, there are things that I care about more than passing an exam. Like that's not what's on my mind right now. You know what I mean? And so I didn't feel like I could express that at school, especially of all places. So it was an interesting time of my life, and I think I still like every once in a while, it still gets brought up. Fears that I have about like what's going to happen within the four years that I'm here. I almost feel like it's uncertain and I'm not worried about the school aspect of it. I feel like if it was just that I can handle school. I've handled school my entire life. It's school on top of what's going on politically on top of like family life on top of like feeling like you're safe and secure. Stuff like that.

Harjit: Yeah. It's even the smallest things. It's as small as will I be able to talk to Bushra tomorrow?

Margaux: Right. Do you think it would have been more helpful and in this situation after the weekend be more helpful if we have more discussions amongst our classmates?

Bushra: Absolutely. I think it will be more helpful, because I feel like a lot of people think that I am not involved in any of that so I shouldn't have to say anything. But I feel like staying silent is worse.

Harjit: I agree.

Bushra: I feel like being silent is almost being complicit. You're allowing it to happen. I think the most powerful thing that you can do is to speak out and to show people where you lie on an issue like that. Something that's so divisive. Something that rocks people to their core, right?

Harjit: Yeah. Because even if it's an opinion you don't agree with, that's something you could talk about. At least you know.

Bushra: Say that. "I don't agree with that." That would make me feel so much better.

Harjit: Yeah. I agree. And I think that again, coming back to mental health, mental health is like something kind of at the core of us. I know people don't believe in like soul, but you know like soul body is like mental health is a part of you. You can't separate the two.

Margaux: No. It totally is. And to the point where you can't focus on school because you feel unsafe or distracted by these greater issues that are your core. It affects your success in school and therefore is part of school.

Harjit: And I think as like future physicians, we're going to have patients who've been through a lot.

Bushra: And who are worried about more than just being healthy. They're worried about like survival.

Margaux: Safety, survival.

Bushra: Safety, like all these things that we don't take account of. Like we get a history and a physical exam, but the patient's more than diagnostic tests, more than their history of illness, more than their physical exam. They are a person who is out there living their own life, and we don't know the story behind that. I think like the social history is probably my favorite thing to take for a patient because it lets you kind of into their world a little bit, right?

Harjit: Yeah. And their mental well-being affects their whatever.

Margaux: Their health outcomes.

Harjit: If they have diabetes, if they have blood pressure, you know. If they have cancer, like all these. Yeah, their health outcomes. I think that the sad thing is we're med students, we are depressed and we just can't talk about it.

Bushra: Agreed.

Harjit: Okay. So we have in the studio, a friend of ours, Edwin. He is doing his PhD. He's an MD PhD candidate. He's in his second year of his PhD. He was just here listening to us, and I feel like you also have important insight into this issue.

Edwin: If I could comment a little bit about mental health and the medical student, I would say that we're, at least in the preclinical years, living in this really artificial environment. It's a high stress, high stakes situation. Everything is a metric used to measure you. Every quiz score, you know, step one, step two, you know, what memberships do you have? What scholarships did you get? Everything is, I mean it's like one of those dog competitions where everything is held either for or against you and all that can accumulate and result in stress.

On top of that, people have this overarching expectation that when you go to the doctor, the doctor's supposed to be your reservoir for emotional health. How can the doctor himself or herself also have these emotional issues? Like you never want to admit that because you're supposed to be the last stop. So even being able to simply admit that, you know, we're human, every human deals with these emotional issues, and in this type of high stress environment, this becomes exacerbated. And when your whole measure of success is how many facts can you memorize on a biweekly basis, any detriment to your emotional state would affect that.

Margaux: I do want to piggyback off of Edwin's comments that it is important to recognize that depression is an issue for both men and women. Any gender, any person can feel it at any time and so do not think that you're immune from it, and if you're feeling that way, do you not feel like you cannot ask somebody because of who you are and how they may perceive you. There are many resources on campus, specifically Dr. Michelle Vo, who heads up the wellness department for medical students is an amazing resource. We offer free counseling. So if you feel like you can't talk to your peers, you can definitely talk to them and just send them an email and they will set up an appointment for you as soon as you need.

Harjit: Also, Margaux, I've actually, I did therapy a couple of times first semester, and we do want to say it is actually liberating to sometimes to talk to someone who doesn't know anything about you. They aren't a part of your life. They have no bearings in, you know, what's going to happen to you because then you can just like say whatever, you know. And sometimes that just feels good and it helps you process what you feel. Because for me, I need to verbalize things before I know what I feel about things. When a person's depressed, I feel like they're not fully there. They're fully not with you. Does that make sense?

Margaux: Yeah, it does.

Bushra: I think is what's interesting . . . let me ask you this question. Is there a word for depression in your language? In Punjabi?

Harjit: No.

Bushra: There's no word for depression in my language either. And so I think the word or thinking about what depression is, is a foreign concept. I'm Somali, so I'll speak about my own culture because that's the only culture that I have experience in. We've never talked about it. We don't know how to talk about it. We don't have the vocabulary. We know that people don't feel okay and there are things . . . they have this term, it's called like feeling dead behind the eyes kind of thing. And I think that's like quantitating what depression is, but it's never been realized as a real issue. It's just kind of like, oh, this person is not feeling well, but it's more than that.

And so like us as first generations coming to this country, getting educated, having a Western education, we start thinking about things and we start thinking, hey, maybe it's time to process our own things and start, and then we start thinking about things that happened in our lives and then we start thinking, okay, like when have I been depressed, or am I depressed right now?

Harjit: But it's hard to admit.

Bushra: And it's hard. Yes. It's hard to admit and it's hard to talk about too.

Harjit: Like I don't want to tell people that I'm depressed because I almost feel like it's something that makes me less than. Because, one, there was no words for it, and second, it's like, you know, this isn't my best self. This isn't who I am. It literally takes away from my personality, but it is who I am, you know?

Margaux: No, it totally is. And I find it fascinating to have just learned that there's no words for depression in each of your languages. So it's a paradox that we have a word for depression in English, and yet many of us feel like we can't overcome it or speak it even. And so I just think that now the next steps is to overcome this barrier altogether.

By sharing our experiences with you today, I hope that we've encouraged you to reach out to your friends or someone you trust and share your own feelings or similar experiences. Together we can start to break down these barriers. Thank you for listening to the Bundle of Hers. Please join us next time.