Starting Today

Illustrated by: Yu Xin Zeng

After graduating from WashU, I entered an MD/PhD program. As most students who decide on this path, I was excited and eager. With strong academic achievements and even stronger hopes and dreams, nothing could stand in my way. Yet, in only three years, I have witnessed multiple students (some with better grades and bigger dreams) delay progress. A few have left the program. One got dismissed. The common thread? Mental health.

Mental health is something that we are told to work on. Unfortunately, we are often not given too much guidance or resources to do so. Most Universities and programs are seeking to improve mental health amongst their students and some take pride in their happy community (1,2). But how do we tackle something so large and as amorphous a concept as “mental health”? I’ve wrestled with this question for years until I came across a peculiar thought: how could I hope to achieve a state of being healthy without a means of accurately assessing how far I’ve come? Perhaps a good place to begin is to ask whether we can more accurately assess our mental health state beyond Good or Bad.

To assess tangible things is often simple. Since a young age, we have been given marks to assess achievement. Starting with stars in kindergarten, to grades throughout college, and ultimately awards, publications, and salaries as we graduate, we are surrounded by quantitative means of measuring success. But when it comes to mental health, we may not be as experienced. In fact, accurately measuring mental health is a scientific problem (and one that researchers are actively working on!). Some of these questionnaires are being used clinically, such as the PHQ9 questionnaire to screen for major depression and suicidal thoughts. However, those usually catch more severe symptoms of major depression (3,4).

Why is measuring our mental health so important? Because for a task as large as improving mental health, we need an accurate way to assess progress. There are mental health screenings, though they have varying degrees of success (5,6). This may be due to the fact that the definition of baseline mental health is subjective and personal. The point of all of this is to say that if we want to improve mental health, we need to be able to measure how we are progressing, and this scale is something that we have to determine for ourselves.

What would a scale look like? When defining a scale, use indicators such as certain concrete behaviors or patterns of thought. On a given “good” day, write down some thoughts and compare them with those on a “bad” day. Those are some baseline thoughts. Then analyze behaviors. What are some routines? What causes habits to change? Finally, ask what mentally health looks like you, specifically? Is it making time to run? Calling your parents? Two measures I have: when I am happy, I look forward to making dinner and I am more likely to listen to sad music before I even realize I am down. In other words, we discover our scale by being cognizant of our behaviors and thoughts. Once we have organized our thoughts and behaviors, it becomes easier to identify when something changes. The earlier we can identify that something is wrong, the more empowered we are to tackle it. 

These practices have helped me throughout stressful transitions to medical school and then to graduate school. Both present with their own set of challenges. Being cognizant of changes in my behavior helped me know when to seek help from various peers and mentors who helped me workshop possible solutions. I’ve found that relying on friends and mentors has helped me through most of my concerns, as long as I reach out. Lastly, do not be afraid of seeing your healthy mental state change. As we take more responsibilities, our scale will change, but the goal is to be at a healthy state of mind despite high workloads. 

Defining a baseline for mental health can be very hard to do on your own. Additionally, some problems cannot be solved by peers or mentors. For those instances, consider reaching out to experts such as counselors, psychologists, or psychiatrists. Many universities have free mental health services and screenings (7,8). Seeing an expert regularly (even when things are going well) is a great habit to develop. No matter what career we choose, having the experience and available tools will serve us well. For readers, a great resource for those struggling with depression is the book Feeling Good: The New Mood Therapy by David Burns (9). It covers a number of cognitive distortions and warning signs for depression particularly well (which have helped me greatly). WashU has improved their efforts greatly since I have graduated. They have introduced better mental health services, such as Let’s Talk (free walk-ins for appointments with MHS counselors) and TAO (Therapist Assisted Online – an interactive web-based program to help overcome common mental health concerns) (10,11). Take advantage of these structured programs when they exist, but seek to develop your own long-term system. Choose something sustainable you can lean on even in times of great stress.

Each of us is traveling a long journey, often winding in unexpected ways. To tackle challenges along the way requires constant effort. The earlier we start thinking about how we measure our own unique happiness and sadness, the earlier we can identify issues and seek the remedies to solve them. Why wait?

Edited by: Daniel Berkovich
Illustrated by: Yu Xin Zeng


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