Mirror mirror...

Post 2nd year PhD review selfie :)

It has been 6 months since I was diagnosed with dyslexia and dyspraxia. 

This followed a marriage break up due to physical and emotional abuse, a difficult divorce (with bullying and intimidation) and subsequently developing depression and anxiety. 

I tried to deal with my difficulties using non-medical interventions. This included counselling, self-directed mindfulness etc. Despite this my mood and emotions felt like a roller coaster. The lows were really low. Sometimes I felt okay, other times I would wish I didn't exist. I would think about how no one would care if I wasn't around.

I had enough insight to recognise that these thoughts were part of the depressive illness rather than my own. I only decided to go on a course of antidepressants when I acknowledged that the depression was getting worse. I had even called in sick for an on-call because of how low/anxious I was feeling for the first time in my 8 year medical career.

Feeling like I am doing a good job with the PhD is very important to me. I was worried that I wasn't doing it justice, my supervisors thought I was a waste of space, and everyone thought I was stupid.

When I had my PhD transfer (mini viva to assess whether I had enough research to at the end of my first year) last year, I had a mini anxiety attack mid presentation as I had intrusive thoughts. I kept thinking 'their faces show they are not happy and they think i'm stupid'. I became so overwhelmed I had to stop to compose myself. At the time I didn't recognise it as anxiety. I just thought I was nervous. However,  I had delivered many presentations in the past without needing to stop.

The counsellor I used to see on a weekly basis emphasised that I lacked confidence and self esteem. She told me this is to be expected following an abusive relationship as each 'episode' would chip away at my overall worth.

I used to sit there thinking the counsellor is just saying this because I've portrayed something that isn't correct. The marriage wasn't that bad, I'm just 'exaggerating' things to 'justify'/ make myself feel better. He wasn't really an 'abusive' husband.. he never had issues with me going to work, going on holiday with my friends, and I was never beaten black and blue.

I was told it is not about what happened, it is about how you feel because of it. I would feel this is a 'cop out' answer to justify how I was reacting to a relatively minor thing as really I should be happy that my life is now better.

She brought up my need to set 'ambitious and unrealistic' goals to validate my self worth. I was asked to think about why achieving a goal was so important to me, and my reaction once completed.

Usually when I set a goal, I'm happy for a short period before moving on to the next one. Sometimes I decide the next one before finishing the first.

For example, even though I haven't even done the Manchester marathon, Ive already decided my next goal is to achieve a 20 minute 5 km and 45 minute 10 km. 

When I accomplish  a goal, I frequently dismiss my achievements. For example passing my post graduate paediatric exams (MRCPH) 19 months early in ST2 wasn't a big deal as I had only 'scraped' a pass in my final exam and I had only passed because I sat the exam at Dewsbury Hospital (rather than the ‘challenging’ Great Ormond Street) . These thoughts would justify negating any celebration of achievement.

Another example is completing my 30,000 word thesis for my MSc, which I did whilst going through the divorce and working as a registrar. Even though I recognised I worked my butt off (I didn't take any annual leave for a year and would go to university to work on it before starting a night shift), I felt I wasn't worthy of celebrating the MSc as a personal accomplishment as I had to ask my friend/supervisor to proof read it. If it was truly mine, then I should have completed it with as little supervision/ input as possible. Would I have even passed if it wasn't for their input?

I never saw my personal targets as a 'negative' personality trait. I don't think I would have been a doctor/finished my exams early/do my first marathon otherwise. When I brought this up with her, she said whilst goals are a good thing, the way I respond was the issue .. 

Not achieving a goal is a huge disappointment and I would perceive it as a huge personal failing. I spent a fair amount of time during counselling discussing how rubbish I felt about the PhD and wanting to feel satisfied that I am giving it 150%. It would be the only way I could look back and be proud of what I accomplished. She told me I put an immense amount of pressure on myself, give more self love, and  it is okay to not do anything perfectly. I struggled to accept what she said (still do if i’m honest). In my head this equates to 'do within your means because you are not capable enough' i.e a personal failing.

To me, getting diagnosed with dyslexia and dyspraxia was a failing. I  believed (still do) that it has only become apparent as I cannot perform to the expected standard. What is the difference between this and failing an exam? Even worse than failing an exam, is failing despite working your very hardest (a bit like when I sat mechanics for my AS level module in maths. I revised my butt off but still got a D, it still bothers me 13 years on.!) At least if you failed because you didn’t try hard enough, it reflects disinterest/ lack of self discipline rather than a lack of raw intelligence (which is what I believed of myself). I perceived working your butt off and failing means to mean you're simply not good enough.

The educational psychologist who assessed me said 'it is remarkable that I had completed my school education, medical degree and MSc without it being picked up'. He reported that I 'should be commended for what I have achieved despite my learning disabilities'.

He used an analogy to describe what I experienced- 'You've had to work extra hard to get to the same standard as everyone else. Whilst everyone else works from this level, you have had to work from a much lower level'. Whilst he said these things to complement my determination and hard work, it made me feel utterly (excuse my language) shite. I sat there feeling dumb, stupid and a failure. I was embarrassed that I had to work harder and this had actually been picked up.

I started to question everything. I can't even sustain a marriage, do a good job of the PhD, am I even good/worthy to be a paediatric doctor?!

I voiced some of my concerns externally and received varying opinions. However, a few practically destroyed me. Some suggested I reconsider my whole career: both academic and clinical because of these disabilities. Suggestions were made from highly intelligent, successful and 'open minded' people. I couldn't disregard these opinions due to 'ignorance' and 'narrow mindedness'. I was devastated. Not only am I questioning my self worth as a doctor, others also questioned it.

I started experiencing anxiety attacks at work (something I had never had before). It was actually the thoughts of believing I wasn't a good doctor that prompted me to call in sick. To this day i’m still disappointed that I had to do this. Being reliable, not putting burden/stress on other doctors oncall is hugely important to me. I had intended to never call in sick for an oncall. Even though I know I wasn't well, it was the safe, and appropriate thing to do, I still feel upset when I think about it, and see it as a personal failing.

My self awareness has improved and I recognise these negative thoughts are the anxiety rather than my own belief and  manage to keep them at bay when working. I have always had good feedback from colleagues and supervisors.  Two previous supervisors said I was the 'best SHO' they had worked with. Another stated 'I was the best middle grade, and it was a shame I was leaving clinical training to go to the academic world'. At my current department, one consultant has told me she thinks I'm an excellent doctor, have a lovely manner with patients and families, and cope well under pressure'. Another told me they think i'm a competent registrar and they have piece of mind when I am oncall and therefore check on patients less frequently then they would with other registrars. One consultant thanked me for 'teaching' her something (see my previous post 'quest for self worth'). 

I needed to remind myself most of my feedback was extremely positive and something I am proud of. It is normal and human to  get 'negative' suggestions. It is  part of life and 'growing up'. I don't need to take on board every suggestion given to me, I have my own opinions and know myself better than anyone else. I simply needed to 'man up' and not take critism (constructive or not) so personally.

However, despite this reasoning my confidence with the PhD worsened. I stressed about sending emails, manuscripts and anything involving writing or articulation.

An identification spelling mistakes/ misconstruction of sentences was very distressing. I hit rock bottom and struggled to see any light for progress. I battled along and tried my best for some months.

Whilst at rock bottom I decided the only way to deal with this was to tackle things head on. Crap at writing? start a blog, write more, and learn as much as I can about dyslexia and dyspraxia 'think I am disorganised?' micro-manage my time and work. Not worthy of academic self-worth? Submit a manuscript for publication as a sole author. Bad short-term memory? carry a note book and jot everything down.

I started implementing my strategies and began feeling better about things. Yes I know I'm a crap writer, but the shame isn't consuming me. Its something I just need to work on.

Yesterday I had my end of second year PhD review. I delivered my presentation, didn't fluff any words or had an 'anxiety melt down'.! I got grilled on the research I had done, my output and what I plan to do. One of my supervisors, said I have 'progressed leaps and bounds', presented very well and have excellent knowledge. She said she was 'proud of me'.!

Despite being told I had 'plenty of research', 'excellent knowledge in my field' and 'very good output', I was told I need to think of a better PhD title and make my output 'work like a story' better.

Even a few months ago this would have upset me. I would have took it as a failing of my character. I probably would have become very upset and it would have affected me for weeks.

This time, I actually walked away ecstatic and relieved. I was so happy they didn't see me as rubbish nor did I feel it. I'm still happy today.! Yes there are some constructive comments, but this is not because I am 'stupid' its merely to help guide and improve my research. I will go away and take on board the suggestions.

I reflected on my feelings following the 1st and 2nd year review.

I realise other people mirror your own thoughts and feelings.

If I’m feeling rubbish about myself, others will too, If i'm feeling good about myself, others will too.

It's time to start believing in myself and give myself to permission to celebrate my successes rather than perceiving it as being arrogant/excessive or feeling like I don't deserve to feel proud of what I have achieved.

I've started a new strategy. Every day I will write 6 things I am proud about. This can be as big as 'I am proud to be a paediatric doctor' to 'I woke up at 6am'.

Sounds a bit 'fluffy' but hopefully positive reinforcement will help improve my confidence and self worth. I will carry it everywhere with me. Every time I feel a bit shit/insecure/ have a negative thought I will read it.

Watch this space.!

“To love oneself is the beginning of a life-long romance”

Oscar Wilde 

The positive journal