So today I broke down for the first time in a while. Its been a long six weeks, working flat out at the Hospital alongside revision (including revision and taking one exam, and now another.) Made a little mistake today and it broke me for a while. A lesson;

It is not uncommon that we carry stress, and as a result of our need to cope begin to blur the lines between what is self-care and compensation. I have dedicated so many extra hours to addressing and holding the anxiety and sadness of my patients that I overran my defenses.

In one way, this has helped me as a doctor. I have better understood the pain (although I know it well,) and meant I have been much better at my job as a mental health doctor and an advocate. On the other, it meant I was building an emotional debt.

The mistake was trivial, and to be honest not worth discussing. But that little puncture opened things up, and before a few minutes I saw myself back where I was years ago, and thankfully my consultant saw it. This led to a long conversation about balance.

I came home and slept 5 hours straight. The usual anxiety dreams. I had not let myself really see how much pressure I had been under. Watching not just for my patients, but the other staff, keeping an eye on everyone's health, turning it all into me,everything needed to run by me

I would get home and just collapse in bed, then revise, stay up late unable to sleep and then do it all over again. My weekends became a struggle, mainly sleep and then indifferently watching Netflix between more revision

Today reminded me that although I try to be a superhero, I am not one. This emotional debt caught up with me, and we can all learn from this error. Balance is important, and sometimes we martyr ourselves for a cause. The cause is worthy, but can be done in a healthier way.

I carried too much emotion, worked too much containment, and my defensive mechanisms went into overdrive. It kept me going, like adrenaline in danger, and this is the crash. All doctors will know this one. And I am not sure we speak of it enough.

So what is this tirade? I suppose it is sublimation, trying to turn my pain today into something good, or perhaps it is reaching out, for once to ask others for to see that I cannot always be the strong one, not all the time. Beneath this handsome exterior lies some fragility.

So, what can I ask? If your other, friend or family is carrying stress, make time for them, let them know you are there, spread the load, give them time and space. Alone in London I don't have that, most of you I hope will.

For those alone, make sure to check in with your emotions, know that its okay to take some time, do not see this as a weakness, or carry more than you should for too long. What is adaptive in the instant can become maladaptive in the long run. 6 weeks was enough for me.

Ill be fine, so don't worry about that, just remember that all of us need help once in a while.

TLDR Psychologists:

High internal expectations congruent with external validation by control
Internalised paternalisation role secondary to poor perception of external support
Maladaptation of intellectual defense mechanisms
Trigger point, externalisation, catharsis
sublimation