Avoidance of self-discovery.

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As of writing, it has been over 12 months since I last sat in silence with my own thoughts. In hindsight, this is rather worrying. In my day to day, I am often overstimulated. I wake up and often check my emails in bed prior to the Formula 1 paced rush of getting ready for work. I should probably begin my preparation the night before by lining out my clothes and packing my bag. Yet, I never seem to do it.

After checking that the cooker is off about 5 times, my eyes focus on my headphones like a predator hunting prey. I never leave the house without my headphones on, embracing their comfort like the return of a long-lost lover. With this, music will play through my consciousness throughout much of the day. It could include mood lifting classics by Bob Marley and the Wailers, something with a bit of swagger like Green Onions by Booker T & The M.G’s, or something a bit more aggressive. However, during the work hours it usually encompasses stuff with a more repetitive tone to help me get into a motivational groove. Dance music in some description usually takes centre stage. Then it’s the – luckily minimal – walk to work. A day in the life of a scientist is always diverse. Creativity can crash through the brain like a tidal wave or trickle like a stream. It depends on the day. Staying up to date with the scientific literature is a crucial stimulant for new research ideas, even if they turn out to be too grandiose for our lifetime (teleporting coffee devices anyone?).

Generally, though, research takes up most of the day. Right now, my focus is aimed on the collection of protein samples following the stimulation of neuroimmune cells with various drugs, ranging from inflammatory inducers to chemotherapeutics. Although experimenting on cells in a dish is hardly reflective of the galactic scale of complexity that the human brain displays – after all, there are more neurons in the brain than stars in the milky way! – it is a crucial approach which can be fundamental to new discovery, including the identification of new proteins, or reporting new functions of previously classified ones. Expansion is possible of course, using stem cells derived from human patients – these cells are special. With the induction of a precise concoction of chemicals – ‘sugar spice and everything nice’ comes to mind… – stem cells can be differentiated into any type of human cell. Liver, kidney, muscular, neuronal. It is an invaluable tool for translatable research. However, when we need to look at systemic effects of disease – our lab primarily works on Alzheimer’s and Parkinson’s disease – whole organism models are vital. As such, mice are often the primary animal of choice, including for my own in vivo work.

Alongside this, additional weekly seminars, reading multiple manuscripts per week, two meeting per-week, preparing ideas for grant proposals, peer-reviewing other researchers’ manuscript while also preparing your own… phew. The time for lunch, let alone self-reflection, is incredibly limited. My music obsession helps me manage my workload more effectively. It assists in preventing my work following me home. Although, returning to lab to finish experiments during the twilight hours is not uncommon.

This passion for music continues into the evening, wherein my main hobby is to sit down and try my hand at making some tracks. While not an expert, I have been lucky enough to have some of my records signed to a few prestigious dance music labels. But what does this all equate to? It means the creativity brain doesn’t really stop. Even in times of physical exhaustion, when the trickling stream has dried up into an unquenchable drought, I try to continue.

So, when do I take time to reflect and process my own thoughts and emotions? Well, I think I have gradually grown to intentionally try and avoid it. A few weeks ago, I decided to give myself 15 minutes to just lay on the couch with some classical music and reflect on the last decade. I turned 30 earlier this year which, obviously, is quite the milestone. I reflected on what I had achieved during that period. I graduated college, twice. I officially earned by PhD and became a doctor – sorry, I can’t help you if your body fails, but I’m sure I could take a crack at a diagnosis. I’ll test my hypothesis in a dish and get back to you in 20 years. I have also lived on three continents, in three cities. I have loved, lost, and loved again. I continue to love. I am grateful that I will always continue to love. Unfortunately, expansion of those emotions towards myself appears limited.

Don’t get me wrong, I am exceptionally proud of the achievements I have collected since 2014. However, there is an overshadowing question that I cannot seem to avoid: Does this self-admiration translate to self-perception?

No. No it does not. Why do I not sit with my thoughts? I think that is the answer. I can sit down and appreciate the life that I have. I love the people around me. I am selective with my ‘inner circle’, as it were. More critically, earlier this year I was resilient and strategic enough to muster the courage to eliminate a toxic shadow that has been plaguing my existence. Though, that is an entirely different chapter.

I have a genuine distaste for my existence at times. While that sounds incredibly morbid – and by most standards, it is – I am not sure what it means. I also do not understand why. I try my best to be a good person, and I do feel like I am one. I treat everyone how I would like to be treated, and I would bend over backwards for anyone I truly love. Yet, not for myself.

A question I have been battling for many years is ‘what makes me truly happy?’ Happy right down to the core… the bones. It remains a question I simply cannot answer. I’m not sure I ever have. I do know that nature has always been a peace inducer. Embracing nature is beautiful. All five senses heightened by humanity’s silence. Appreciating what true beauty looked like prior to our global domination and noxiousness. Don’t get me wrong, I’m not intending (nor do I want to) become a nomad and just disappear into the wilderness and never return. Although, I do think I am truly at peace when I am in and around nature. Like most of us, I need to have a purpose. My work and my fiancé give me that purpose.

So then… what is the issue? The million-dollar question. Unfortunately, I cannot cash that ticket. Will I ever be able to? After all these years, I don’t think so. Although, I have not entirely lost hope. Perhaps it is time I began an excavation of my historical experiences and identify a root cause. Yet, I do not think any individual’s personal battles are as simplistic as this. Compare this, for example, to marriage. Excluding something unforgivably devilish, does a marriage end in divorce because of one singular event? Absolutely not. It often presents as a poisonous aggregation of pathological problems that manifest due to lack of ability, interest, and/or maturity to rectify the situation.

For me, perhaps this is a life-long journey. I know definitively that nobody other than myself will identify these issues. My mind is a chaotic mess of self-defeatism, deflection, frustration, rage, and intensity. It explains why I never tend to sit in my head too often. For example, earlier this week I asked myself: ‘What happens if I develop an incurable disease?’ My immediate response: ‘Phew. That’s a partial relief’. I think I’m so mentally overloaded that on certain days I have just had enough. It’s exhausting.

I need to explore my mind further, although it’s the last thing I wish to infect myself with. Because I spend most of my days keeping so busy, I never actually give myself the chance to initiate this assignment. It is intentional, I’m sure. Although I am beginning to spend 10-15 minutes a week in silence, thanks to the incorporation of a ‘health’ to-do list. During this period, I try to select remnants of negativity and pessimism and piece them together to curate some clarity… a bigger picture. Almost like a psychological jigsaw. Right now, though, it feels like kicking the hornet’s nest. Hopefully things will improve with repetition. Following an infamous quote by Thomas Wolfe: “I have to see a thing a thousand times before I see it once.”

For those of you who also ignore reflection, I impede you to do it. I wish I was better at it. I do truly believe it will help most of us find a measure of solace. For me, every day is a contemporaneous flux of the positive and negative. Which one will win? I guess I’ll find out.

“True ignorance is not the absence of knowledge, but the refusal to acquire it.” – Karl Popper

Bipolar Disorder: Misdiagnosis and Moving Forward.

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When I started writing these pieces, I was in a battle with crippling depression. In fact, it was around 5 years ago when I initially started journaling about my mental health conflict. I hoped that releasing my thoughts into the physical world through penmanship would result in the battles becoming more manageable. While it was successful, it wasn’t until later that I realized my experiences could be of benefit to others. I have tried multiple therapeutic avenues throughout the years. Prozac (fluoxetine) and Cipramil (citalopram) – antidepressants pharmacologically referred to as selective serotonin reuptake inhibitors – provided nothing but unwanted weight gain, fatigue, and self-loathing. Therapy sessions were no better. I was pushed to see a psychologist when I was fourteen. Rather frustratingly, the sessions were littered with patronizing questions and unrelatable approaches. Seven years later, I decided to voluntarily see the university counselor. I was hoping for something different. While she was nice enough, my feelings towards therapy remained the same. I walked out of every session feeling worse than before I walked in. The medical approaches I was informed of to regulate my suicidal thoughts and defeatist attitude completely failed me. For the next seven years, I avoided medication and therapy like the plague. While that could have been the end of it, my internal conflict was finally greeted with some essential external support.

Even when finishing up my undergraduate biomedical science degree, I wasn’t familiar with behavioral psychology. After all, I never studied it. If I did, perhaps I would have considered the potentiality of being misdiagnosed. After my withdrawal from psychological support in my early twenties, I accepted my fate. I always considered myself as a train wreck waiting to happen, often withdrawing myself from social situations as a result. For years I didn’t consider myself worthy of anything. Bad week at work? Yup, I’m not good enough to do my job. Had an argument? It must have been my fault. Drinking was sometimes a great way to release myself from this, but not always. Certain social scenarios made me irrationally angry. I had – and occasionally still have – a ferocious temper. During my time as a graduate student in London, most of my socializing came in the form of a pub rather than a restaurant. I just put two-and-two together, concluding – incorrectly – that alcohol was the likely cause.

If it wasn’t for my girlfriend, I would have likely spent the rest of my life without knowing any better. What if I spent the next fifty years believing that I was a total catastrophe? What if I continually propagated false notions of insufficiency with regards to my colleagues, friends, and family? Until recently, these were considerably common thoughts. Alcohol also had the ability to amplify this irrational toxicity. Several drinks were sufficient to elicit an internal fury. While it often didn’t present itself externally to those around me, it had the ability to destroy me psychologically. Self-harm was a common thought that would swirl around my head during these periods of berserker-like rage. I would eventually calm down, but only when I was left to my own devices. As such, I often fled social situations to quench and pacify the emotions. Unfortunately, this was usually after smoking and drinking in excessive quantities. Music helped, but it was always in tandem with unhealthier habits.

At the start of this year, my girlfriend stressed that the shifts in my mood were significant. They also appeared to be semi-regular. As a scientist, I should have materialized a hypothesis many years earlier; a pattern was evident. Extreme irritability and irrational anger would usually be present over a week, but not necessarily every day. This was often accompanied by several weeks of lethargy, apathy, and depression. While exercise could help stabilize these emotional disparities, it was always a temporary solution.

I think she was aware of that fact. Despite the positives of exercise, it wasn’t sufficient to fix the problem. What was the alternative? In her mind, therapy appeared an attractive option. Regrettably, I never truly relayed my experience to her with regards to therapists. I was apprehensive and lingered against the idea, but it was her persistence and determination that eventually persuaded me to give it a shot. Woohoo! A return to therapy. The reemergence of a condescending dick was imminent.

As you may have expected, I hated it. The best part was that it was over a virtual conference call. See, even the coronavirus didn’t want me to see a therapist. Almost identical to my experience as a teenager, I felt like I was being repeatedly patronized. However, the therapist was nice enough and easy to talk to. The experience provided an avenue for me to project my concerns to someone who was analyzing me through an objective lens. While I will always hate it, therapy can be brilliant for that. The key is to find the right therapist. This was something I accepted in my early twenties, but it is an approach that has never suited me. I always feel worse after a ‘therapy’ session, with those negative emotions often lasting for several weeks. This was only further confirmed following these new sessions. I would argue that they made things worse for me. Despite this, they did change my life forever.

My therapist identified something that many before had missed. ‘You are describing many symptoms commonly associated with bipolar disorder.’ While aware of what bipolar was, I had never really familiarized myself with the key symptoms associated with it. How would you initially describe bipolar disorder? What would you associate it with? For me, I immediately think of intense mania. Manic episodes often result in reckless decisions. During periods of mania, you never really care about the consequences of your actions. As such, dangerous driving, excessive gambling, and unprotected sex with multiple partners are commonalities for people who suffer with bipolar. What I didn’t know however, was that bipolar disorder is separated into two distinct classifications. The first is Bipolar I disorder, which is defined by episodes of depression and at least one episode of mania. In some cases, mania can trigger psychosis. As such, hospitalization is common for Bipolar I patients experiencing a manic episode. In contrast, Bipolar II patients commonly experience hypomanic episodes rather than full-blown mania. Common symptoms associated with hypomania include hyperactivity, agitation, a decreased need for sleep, and increased distractibility. Though, this is not an exhaustive list. Individuals with Bipolar II rarely require hospitalization due to a hypomanic episode. As such, clear differences between the disorders exist. But despite these differences, depression is evident in both conditions. As such, medical intervention is often required for patients irrespective of their disorder classification.

A few months after seeing a therapist, I was diagnosed with Bipolar II by specialized psychiatrist. I have always preferred conversing with a psychiatrist, as they are more likely to use their medical knowledge to treat patients, rather than using psychotherapy techniques to address abnormal behaviors. We also often share common interests in neuroscience. I do not regularly get the opportunity to discuss my career in depth outside of the working environment, so this was a welcome change. It took him two sessions to confirm the diagnosis.

I felt psychological relief for the first time in almost ten years. It became incredibly obvious why antidepressants didn’t work for me – they are not particularly effective for those who have bipolar. In fact, antidepressants can make bipolar worse, and even triggering a manic episode. Instead, I was prescribed a medication called Lamotrigine (Lamictal). Lamotrigine is an anti-epileptic drug often used to help prevent and control seizures. However, it is also a mood-stabilizer commonly used for bipolar II, delaying bouts of depression and hypomania in patients. Strikingly, I noticed a difference within about four weeks.

Before my diagnosis and new medication regimen, I was extremely defeatist. If something went wrong, I would often hit an extreme low point. This doesn’t gel with a scientific career, wherein failure is incredibly common. If you are unable to develop a thick skin during grad school, it can be difficult to stay motivated. In contrast, since taking my bipolar medication, I have developed a startlingly rational mindset. Now, if something in my life goes wrong, instead of accepting the worst-case scenario as an inevitability, I can conceptualize alternative pathways and learn from potential mistakes. Now, I feel like I can approach any challenge. I feel refreshed and revitalized. But the most amazing thing? – I want to learn about my psychological trauma. I want to learn how to regulate it. For the first time in my adult life, I feel like I could control my mental health, rather than allowing it to control me.

This process hasn’t just miraculously cured me, though. My irritability remains debilitating. Depression can also still take hold, with suicidal thoughts flooding my mind at least once every six weeks. They’re quite dangerous, as I welcome them due to pure fascination; I am terrified of death, so I want to understand and rationalize this paradox.

Nevertheless, I feel empowered to move forward, and I hope that I can help others through the sharing of my own experiences. We all face challenges in our lives, but that doesn’t mean we should let them rule over us. So, are we going to let them, or are we brave enough to challenge them? We are all strong enough to challenge our inner demons. We are all strong enough to not only survive, but to thrive. Trust me when I say this: If I can do it, you can do it too.

“Though nobody can go back and make a new beginning, anyone can start over and make a new ending.” – Maria Robinson

Mental Health in the Work Environment.

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Whether you love it or loath it, work is one of life’s inevitabilities. As you may expect, the entire experience is often littered with plenty of peaks and troughs. The highs of being offered a promotion contrasted with the lows of missing a crucial deadline. For the majority of us, we will experience both at least once. However, as with many of life’s experiences, the negative can dramatically decelerate and impede our abilities.

Unfortunately, work related stress often debilitates our executive capacity. This usually manifests as a self-propagating cycle, wherein stress can catalyse emotional instability and nervousness, which in turn further inflames stress and inhibits our concentration. For me, I often associate these feelings with being purely and utterly overwhelmed. Naturally, this can have disastrous consequences for our work life. For many of us, we may just accept this as part and parcel of a busy career. Externally, the term ‘suck it up and deal with it’ flies around more commonly than in should. However, do we actually have to deal with this as a condition of normality? No, we do not. 

Workplace stress is common and widespread, often aggregating prior to big presentations and important deadlines. It piles up on us as the workload gradually reaches a tipping point.

this is to be expected, especially for an intense work position. However, feelings of depression and anxiety shouldn’t be developing in these circumstances. If they do, we may need to take an important physiological and psychological health check.

At any given time, approximately 17% of working-age adults display symptoms associated with mental illness1. Women are disproportionately affected, being almost twice as likely to have a common mental health issue compared to men2. Further, around 20% of people are reported to take a day off due to stress, yet 90% of these individuals cite a different reason for their absence3. Thus, the fear of any judgement regarding poor mental health clearly remains. This is despite the fact that in the UK in 2019, stress, anxiety and depression were responsible for over 50% of all work-associated illness and 55% of all workdays lost due to ill employee health4. This likely correlates with 2019/20 estimates indicating that 828,000 UK based workers were affected by work-related stress, anxiety or depression4, which increased from the 602,000 reported cases in 2018/195. Why are these numbers so high? There are many potential obstacles which may contribute to these worrying statistics. 

A 2017 report highlighted that employees with a long-term mental health condition are twice as likely to lose their job than those who do not. In the UK, this equated to around 300,000 individuals2. While mental health awareness has been increasing considerably over the past decade, these numbers really underline an urgent need to amplify national efforts, especially due to the considerable health burden of psychiatric disorders. Salomon et al., first reported on this way back in 2013. In a study which was published in The Lancet, the authors asked over 60,000 participants from all around the world which diseases, injuries and disorders they considered to be the most disabling6. A disability weighing scale (0.00 to 1.00) was then curated representing the severity of the disease (1.0 being the highest). As per the report, the disorder with the highest disability rating was schizophrenia (0.778), with an untreated spinal cord lesion (0.732) and severe multiple sclerosis (0.719) following closely behind. Startlingly, severe anxiety (0.523) and depression (0.658) were considered to be more disabling than moderate multiple sclerosis (0.267), a moderate-to-severe amphetamine dependence (0.486), and severe chronic obstructive pulmonary disease (0.408). Further, moderate psychological problems were also reported to be considerably debilitating. For example, moderate anxiety (0.133) was reportedly more debilitating than a concussion (0.110), while the disability weighting for a moderate depressive episode (0.396) was higher than that for anorexia nervosa (0.224) and tuberculosis (0.333). Despite this worrying numbers, it is crucial to emphasise here that this data was based on general public surveys. As such, the data will display inherent variation. However, I do believe that the study underlines a clear association between mental health disturbances and our quality of life. 

What can I do?

Please do not allow the ‘stigma’ and previous cultural norms discourage you from seeking help. If our negativity and depressed feelings transcend both our work and personal lives, it is important to identify and/or actively seek out a supportive network. While discussing mental health within the working world is becoming more common, we can often worry about the opinions of others. Before speaking up, I was concerned that my colleagues would view me as incapable of successfully doing my job. A such, my anxiety was compounded by the paranoia of potentially being fired as a direct result of asking for help (despite this being illegal in many countries). Now, when my mental health inhibits my ability to work, I will immediately discuss it with my employer. After all, how can an employer adapt and adjust to our needs if we refuse to speak up? I appreciate this can be daunting, but it is absolutely crucial. If it concerns you, perhaps consider communicating with human resources instead. 

Developing a coping mechanism can also be critical. This could be anything easily employable to help you through a stressful workday. For me, I often go to the gym during my lunch break. Any negativity that I was dragging around due to a stressful morning is often eradicated following the exceptional endorphin hit I get from an intense workout. If that doesn’t sound enjoyable or you would prefer to just have some time to relax and unwind, then do so. I also sometimes find a quiet spot to read a book or go for a walk; both of which really help clear a busy mind for the afternoon ahead. Regardless of what you decide, I emphatically encourage you to take all of your lunch break. While this isn’t necessarily straight forward for some jobs, be strict with the time and make sure you give yourself that opportunity. 

If neither of these helps, I would also potentially consider seeing a therapist or psychiatrist. While some people report having bad experiences (myself included), this is often due to a clashing of personalities. This shouldn’t be surprising, as we will never fully connect with everyone we meet. I see a psychiatrist once a month and it really helps me put things into perspective. It can take some time to find a specialist which suits you, but it is often incredibly beneficial to supplement alongside some of your own coping mechanisms. 

If you feel as if all is lost despite implementing some of these strategies, consider finding a more supportive work environment. It is difficult to admit when a job doesn’t fit properly, but we will never be able to force pieces into place which are not meant to go together. Do you remember the last time you were happy at work? If not, perhaps it is time to talk to some friends and colleagues regarding your current situation. If others feel your work life hinders your happiness, perhaps it is time to move on.

In summary, while some individuals may gaslight us into self-blame, often spitting hateful thoughtless comments such as “we all get depressed sometimes”, or “be careful not to play the victim card”, the majority of people – including employers –  are empathetic, and they are there to listen to you. If any negativity comes out of you stepping forward, then perhaps that will provide you with an answer of what to do, regardless. 

References:

  1. Moran P, Rooney K, Tyrer P, Coid J. (2016) ‘Chapter 7: Personality disorder’ in McManus S, Bebbington P, Jenkins R, Brugha T. (eds.) Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. Leeds: NHS Digital.
  2. McManus S, Bebbington P, Jenkins R, Brugha T. (eds.) (2016) Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. Leeds: NHS Digital. 
  3. https://www.mind.org.uk/news-campaigns/news/work-is-biggest-cause-of-stress-in-peoples-lives/[Accessed 28th March 2021].
  4. https://www.hse.gov.uk/statistics/causdis/stress.pdf [Accessed 28th March 2021].
  5. https://www.hse.gov.uk/statistics/overall/hssh1819.pdf [Accessed 30th March 2021].
  6. Salomon JA, Haagsma JA, Davis A, de Noordhout CM, Polinder S, Havelaar AH, et al. Disability weights for the Global Burden of Disease 2013 study. Lancet Glob Heal 

Bullying, depression and suicide.

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In 2016 the New York Post reported that Danny Patrick, a 13-year-old boy from Staten Island, took his own life after he was mercilessly bullied at Holy Angels Catholic School1. The following year Rosalie Avila, a 13-year-old girl from California, hanged herself in her bedroom after months of relentless bullying from her classmates2. In 2018, Amy Everett, a 14-year-old girl from Australia also took her own life as a consequence of cyberbullying3. Her father invited the bullies to her funeral, saying on Facebook: “if by some chance the people who thought this was a joke and made themselves feel superior by the constant bullying and harassment see this post, please come to our service and witness the complete devastation you have created.”

These are three prolific cases of an increasingly common phenomenon: bullying, victimization and suicide. This increased emergence is a worldwide phenomenon, with research groups based in Chile4, Finland5, South Africa6, South Korea7, the United Kingdom8 and the United States9 all reporting associations between bullying, depression and suicidal thoughts in students. A more recent study published in 2020 examined the risk of suicidal behaviours in bullied students between the ages of 12 and 15 in 83 countries. Strikingly, the authors reported that the overall prevalence of suicidal ideation – defined as the formation of ideas or concepts surrounding suicide – suicidal planning and suicide attempts were 16.5%, 16.5% and 16.4%, respectively10. An increased prevalence of bullying was also associated with higher risks of suicidal behaviours. In Africa for example, the overall prevalence for suicidal ideation, suicidal planning and suicide attempts among students were 19.9%, 23.2% and 20.8% respectively, while bullying prevalence was 48%. These statistics were the highest for any of the 83 countries recorded. Why is something so unimaginable happening so frequently? Is there anything we can do about it? If we decipher the social and psychological factors responsible for the long-lasting consequences of bullying, we could successfully protect the Danny’s, Rosalie’s and Amy’s of the future. 

Of course, we all acknowledge that victimization is cruel and entirely unacceptable. However, do we truly understand the bully-victim dynamic? As you are likely aware, bullying involves aggressive behaviour and is associated with either a real or perceived power imbalance. This behaviour is often repeated over time and can take various forms, including rumours, threats, and verbal or physical attacks. It is crucial to emphasise that this kind of emotional manipulation and dysregulation can have serious consequences. For example, it is probable that prolonged reductions in one’s self-esteem due to persistent bullying is responsible for increased depression prevalence in adolescents11. However, depressive symptoms also appear to manifest in preadolescent children. A Netherlands based study of 1118 children aged 9-11 measured victimization associated with bullying alongside a range of psychological and psychosomatic – a physical disorder often made worse due to mental factors, such as stress – symptoms including poor appetite, bedwetting, sleeping problems, depression and anxiety. The authors reported that victims of depressive behaviours had significantly higher chances of developing psychological problems when compared to children who were not bullied12. In some instances, the psychosocial symptoms actually preceded bullying victimization, with children who already displayed depressive symptoms having a greater chance of being newly victimized. 

There is also a credible body of evidence which underlines potential life-long consequences as a result of bullying and victimization at a young age. In 2015, The Lancet published a study which analysed adult mental health consequences of maltreatment and bullying during childhood from two independent cohorts: the Great Smoky Mountains Study (GSMS) in the USA and the Avon Longitudinal Study of Parents and Children (ALSPAC) in the UK. Firstly, I should note here that a longitudinal study involves repeated observations of the same variables over a period of time. For example, monitoring weight loss or depressive symptoms over a 2-year period. In the GSMS, annual parent-child interviews were incorporated and bullying repeatedly assessed between the ages of 9 and 16. In contrast, the ALSPAC study assessed bullying with the inclusion of child reports at the ages of 8, 10 and 13. Overall, data from 1420 children in the GSMS and 4026 children in the ALSPAC were acquired for data analysis. The authors reported that children bullied by their peers were more likely to develop mental health problems as adults13. Even more startling, the development of mental health problems was higher in individuals who had been bullied when compared to those defined as being maltreated, which involved either physical, sexual or emotional abuse by an adult caretaker. What makes this study particularly pertinent is the utilisation of two independent cohorts from separate countries, emphasising that the association between childhood bullying and developing mental health problems as an adult is independent of differences in both social environments and cultural factors.  However, the correlation between bullying types, severity and mental health problems needs to be further explored. 

What about cyberbullying?

Comparatively, cyberbullying is a bit more difficult to define. While several definitions exist, Kowalski and colleagues succinctly defined it in 2014 as “the use of electronic communication technologies to bully others.14” Unfortunately, the global increase in social media presence over the last decade is directly responsible for the uncontrolled aggregation of cyberbullying which has also manifested. Unlike regular bullying which is often limited to school or college, cyberbullying is a constant barrier that many young people face. Further, because anonymity is easily attainable, more people may feel compelled to spit hatred towards others, knowing all too well it would be difficult to be punished for their actions. As a result, cyberbullying is why Amy Everett and so many others take their own life.

Research studies provide considerable evidence to the association between cyberbullying, mental health deficiencies and suicidal tendencies. For example, a 2018 meta-analysis – a type of study which examines data from a number of independent sources on the same subject to determine overall trends – of 26 independent studies identified that children and adolescents who have been victimized through cyberbullying were almost 2.5 times more like to self-harm, 2.15 times more likely to have suicidal thoughts, over 2 times more likely to display suicidal behaviours, and 2.5 times more likely to attempt suicide15. It wasn’t just the victims however, as bullies themselves were 20% more likely to exhibit suicidal behaviours when compared to non-perpetrators.

Perhaps unsurprisingly, cyberbullying appears to also correlate with substance abuse in adolescents. A longitudinal cohort of almost 3,000 students in Los Angeles completed surveys at the beginning of the study (10th Grade, mean age = 15.5), with a 12-month follow up also being incorporated. The study identified five cyberbullying roles at baseline: (1) no involvement, (2) witness only, (3) witness and victim, (4) witness and perpetrator, (5) witness, victim and perpetrator. At follow up, the investigators examined substance reliance over the last 6 months, including alcohol, marijuana, prescription stimulants and prescription opioids. Startlingly, over 50% of the students were involved in more than one of the aforementioned cyberbullying roles, with all four active roles being associated with increased odds of substance abuse at follow-up when compared to students who were given the ‘no involvement’ classification16. The study strongly stresses that cyberbullying can have detrimental consequences not only for the victim, but also the bully and even the witnesses.

Are there any data discrepancies?

With any data, it is crucial to examine both sides of the proverbial coin. As such, it is important to note that a few longitudinal studies have found no associations between bullying, victimization and depression development. One Finnish study examined the correlation between childhood bullying and suicidal ideation17. The study included 2348 boys, all of whom were born in 1981. Bullying information was acquired from the parents, teacher reports and the children themselves at age 8. Depression and suicide ideation were then assessed through participant self-reporting during their Finnish military call-up examination at the age of 18. The study reported that bullies themselves were more likely to be severely depressed and report suicidal ideation when compared to boys who were not identified as bullies during their childhood. Conversely, for boys who were only victimized, the authors did not report any increase in suicide ideation incidence17. While this might seem contradictory to other studies, I need to crucially underline here that self-reporting often opens the door to bias. Firstly, 10 year follow ups may result in participant memory bias, with individuals often choosing to selectively ignore negative experiences from their past. I know this is something I have done on multiple occasions. Further, as an 18-year-old man in 1999, when mental health discussions were still shrouded in stigma (especially for men), would you have wanted to openly talk about victimization and depression associated with bullying? In addition, would reviewing such a circumstance become an issue for the military selection process? Victims in this study may have avoided discussing these negative experiences due to fear of potentially being classified as unsuitable for military selection. There are many confounding factors here that the study does not take into consideration.

What about the bully?

Most of the studies available which analyse the association between bullying and depression focus on the depressive symptoms of the victim. However, there is an increasing concern regarding the mental health of the perpetrators. Multiple cross-sectional surveys have reported elevated depressive symptoms amongst adolescents who report bullying their peers9,18. Cross-sectional studies incorporate a type of analysis which is taken at a specific time point; for example, at a particular age. Interestingly, in another study which compared self-reporting and teacher reported bullying status of students, self-reporting was associated with increased depressive symptoms whereas teacher reported bullying was not19. This study is particularly important, as it suggests that self-identification of bullying behaviour could result in the manifestation of shame, self-blame and guilt, all of which could be instrumental into catalysing an emotional spiral towards depression.

An increased risk of depression and suicidal thoughts appears to be particularly pertinent for teenage girls18. Research by Brunstein and colleagues identified that girls who reported bullying others more frequently may be at a higher risk for depression and attempted suicide when compared to boys18. This perpetrator-depression link appears to also hold true in children, although a study from the Isle of Wight reported that the probability of presenting psychiatric disturbances were highest amongst male bullies, presenting a 9.5-fold increased risk, followed by male bully-victims (7.9-fold) and female victims (4.3-fold)20. The study also reported that children who bullied others had a 5-fold increased chance of being in contact with mental health services compared to non-bullies. A more recent study by Dr. William Copeland and Dr. Elizabeth Costello from Duke University provides additional credence to these findings, wherein they repeatedly examined 1,420 children between the ages of 9-16 over several years, determining whether bullying could predict psychiatric issues and suicide. The authors reported that both victims and bullies alike had an increased risk of depression and panic disorders, alongside behavioural, educational and emotional issues21. Thus, social interaction and development may have stark implications for the development of mental health difficulties associated with the bullying-victim-perpetrator dynamic.

Summary

I wanted to emphasize here that bullying has devastating consequences, with mental health problems often manifesting for both the victims and the perpetrators. In many circumstances, bullies themselves undergo episodes of considerable unhappiness, frequently resulting to substance abuse and suicide, not dissimilar to that observed in victims. As a community, we need to identify this and help educate the youth of our society so they can learn become the best of us. It is time that we helped them learn from our mistakes. We owe it to ourselves to help them do better.

If you yourself want to learn more about the presence of bullying, depression and suicide within the youth, the CDC have an informative online booklet which is easily digestible. It provides insights into what school personnel can do to help, alongside providing links to further information for those who seek it22.

References

  1. https://nypost.com/2016/08/13/staten-island-boy-takes-his-own-life-after-ripping-school-bullies-in-suicide-note/
  2. https://abcnews.go.com/US/family-13-year-california-girl-committed-suicide-months/story?id=51820650
  3. https://www.bbc.com/news/world-australia-42631208
  4. Fleming L, Jacobsen K. Bullying and symptoms of depression in Chilean middle school students. J Sch Health. 2009;79:130–137. 
  5. Kaltiala-Heino R, Rimpelä M, Marttunen M, Rimpelä A, Rantanen P. Bullying, depression, and suicidal ideation in Finnish adolescents: school survey. Br Med J. 1999;319:348–351.
  6. Liang H, Flisher AJ, Lombard CJ. Bullying, violence and risk behavior in South African school students. Child Abuse Negl. 2007;31:161–171
  7. Kim YS, Koh YJ, Leventhal B. School bullying and suicidal risk in Korean middle school students. Pediatrics. 2005;115:357–363.
  8. John A, Glendenning AC, Marchant A, Montgomery P, Stewart A, Wood S, Lloyd K, Hawton K. Self-harm, suicidal behaviours and cyberbullying in children and young people: systemati review. J Med Internet Res. 2018: 20: e129.
  9. Fitzpatrick K, Dulin A, Piko Bullying and depressive symptomatology among low-income, African-American youth. J Youth Adolesc. 2010;39:634–645. 
  10. Tang JJ, Yizhen Y, Wilcox HC, Kang C, Wang K, Wang C, Wu Y, Chen R. Global risks of suicidal behaviours and being bullied and their association in adolescents: School-based health survey in 83 countries. EClinicalMedicine. 2020;19:100253.
  11. McLaughlin K, Hatzenbuechler M, Hilt L. Emotion dysregulation as a mechanism linking peer victimization to internalizing symptoms in adolescents. J Consult Clin Psychol. 2009;77:894–904.
  12. Fekkes M, Pijpers F, Fredriks A, Vogels T, Verloove-Vanhorick S. Do bullied children get ill, or do ill children get bullied? A prospective cohort study on the relationship between bullying and health-related symptoms. Pediatrics. 2006; 117:1568-1574.
  13. Lereya ST, Copeland WE, Costello EJ, Wolke D. Adult mental health consequences of peer bullying and maltreatment in childhood: two cohorts in two countries. Lancet Psychiatry 2015;2:524-31.
  14. Kowalski RM, Giumetti GW, Schroeder AN, Lattanner MR. Bullying in the digital age: a critical review and meta-analysis of cyberbullying research among youth. Psychol Bull. 2014;140:1073-137.
  15. John A, Glendenning AC, Marchant A, Montgomery P, Stewart A, Wood S, Lloyd K, Hawton K. Self-harm, suicidal behaviours, and cyberbullying in children and young people: Systematic review. J Med Internet Res. 2018; 20:e129.
  16. Yoon Y, Olivia Lee J, Cho J, Bello MS, Khoddam R, Riggs NR, Leventhal AM. Association of cyberbullying involvement with subsequent substance use among adolescents. J Adolesc Health. 2019;65:613-620.
  17. Brunstein Klomek A, Sourander A, Kumpulainen K, Piha J, Tamminen T, Moilanen I, Almqvist F, Gould MS. Childhood bullying as a risk factor for later depression and suicidal ideation among Finnish males. J Affect Disord. 2008;109:47-55.
  18. Brunstein Klomek A, Marrocco F, Kleinman M, Schonfeld I, Gould M. Bullying, depression and suicidality in adolescents. J Am Acad Child Adolesc Psychiatry. 2007;46:40-49.
  19. Wienke Totura C, Green A, Karver M, Gesten E. Multiple informants in the assessment of psychological, behavioral, and academic correlates of bullying and victimization in middle school. J Adolesc. 2009;32:193–211. 
  20. Kumpulainen K, Räsänen E, Puura K. Psychiatric disorders and the use of mental health services among children involved in bullying. Aggress Behav. 2001;27:102–110.
  21. Copeland WE, Wolke D, Angold A, Costello EJ. Adult psychiatric outcomes of bullying and being bullied by peers in childhood and adolescence. JAMA Psychiatry. 2013;70:419-26.
  22. https://www.cdc.gov/violenceprevention/pdf/bullying-suicide-translation-final-a.pdf

Bullying: a victim’s perspective and experience.

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Take a second to close your eyes and visualize your life, from childhood right up until this morning. Try to focus on your most principle experiences, associating these specific events with particular feelings and emotions. Now, what did they mean to you? What feelings do you cling onto the most? It is sadness? Happiness? What about regret? Upon reflection, it is often easy for us to linger on the negative. During our childhood, this is especially true if we were plagued by bullying. The innate ability of our peers to manipulate the direction of our social development and emotional stability is really quite impressive, many times cultivating a negative mentality not dissimilar to an overgrown weed. A pest, often too difficult to remove.

Overall, my childhood was pretty good. Until around the age of eight, I lived in a small street called Church Leys in Harlow, Essex. I was pretty lucky in that many other families in the neighbourhood had kids around my age. This was before the development and widespread accretion of the internet, cell phones or social media. Thus, the other kids and I would usually spend the majority of our spare time together, trading Pokémon cards, playing football, or glued to the Nintendo 64. A distant time, void of any pertinent obstacles. 

Unfortunately, negative emotions often cloud positive thoughts. My experience with secondary school and sixth form was the parasitic catalyst for this prolonged negative outlook. Many days were unpleasant, and the emotions associated with those moments often mean I forget to appreciate the enjoyable experiences in my past and present. Retrospectively, I often forget how enjoyable both my childhood and my peers could actually be. Instead, I attached myself to the disapproval I was relentlessly fed by others. This was a direct outcome of persistent peer-associated bullying.

I was an incredibly introverted and pretty weird kid. As such, I was probably an easy target. Slightly overweight, I was fat-shamed practically every day. I also had long curly hair similar to Slash, the guitarist from Guns N’ Roses. As cool as I thought it was, I was often coined the ‘yeti’ or ‘sasquatch’. Otherwise, ‘tramp’ would resonate in the days someone wanted to shake up the name-calling schedule. Eventually, these insults metamorphosized into commonplace nicknames. Understanding that resistance would likely result in further ridicule, I attempted to wear them like a badge of honour, despite being necrotic in nature. 

Eventually, I was gifted a reprieve. I managed to make some of my bullies snigger during an English class, while my teacher glared at me with absolute distain. It was a lightbulb moment. While quite depressing in reality, I realized my way out of constant victimization and shame presented itself before me; position myself as the class clown. My agenda? Disruption, disobedience and disorder. My goal was to ruin every fucking class for the teacher so the popular kids would hopefully view me as three-dimensional and interesting. While it didn’t stop the bullying entirely, it put a muzzle on it for a while. As you might expect, this shift in behaviour resulted in educational penalties. I was switched into lower class sets because my teachers thought I was apathetic about my tutelage. To their credit, that did appear true. In actuality, because my mental health and self-esteem were so devastatingly damaged, my interests aligned with being in favour of my bullies rather than developing my academic abilities.

I almost ruined my education because of this manipulated mentality, all because a few insignificant bullies were flinging their own mental health and insecurity problems towards me. I adapted to fit into their crowd of callous clowns, attempting to avoid further harassment. Not dissimilar to a chameleon, I blended into my new social surroundings, but the ramifications were severe. Peer-pressure got the better of me. At the age of fourteen, I ended up being rushed to hospital due to alcohol poisoning. To impress my bully-perpetrating peers, I decided drinking a bottle of vodka would make me look dangerous, daring and most of all, sufficient. The worst thing about the entire experience? It wasn’t even these ‘peers’ that dialled for an ambulance. Instead, it was a stranger in the street who witnessed me repeatedly collapsing at a local park. I will never forget that feeling of utter loneliness and isolation upon understanding a stranger cared more about my health and safety than the people I associated myself with. I was rushed to hospital, wherein I woke up the next morning. Informed that I spent the majority of the night before throwing up on the nurse, the doctor explained how lucky I was to be alive. The hammer hit home for my mum when he turned to her and explained the situation would have been considerably worse if I was smaller in size. After this declaration, it should have been a turning point. Instead, the notion of being a smaller kid reverberated around my head. Irrationally, I extrapolated his conclusion to mean that I was obscenely overweight. The socially developing brain, huh? What a fun fucking ride. Hey, what did it matter? Nearly killing myself got me in their good books! As an insecure, vulnerable and lonely kid, I managed to turn this into a twisted positive. 

Obviously, this ‘respect’ didn’t last long. In fact, the harassment expanded. In my later years at secondary school (I’d say between the ages of fourteen and sixteen), I was bullied in my morning and afternoon registration group, and the prospect of a reprieve appeared bleak. After about twelve weeks, I identified a way out. For the majority of my childhood, I lived alone with my mum. I used this to my advantage and started bunking off school. My mum would often leave for work after I left for school, so I began hiding in the nearby woods until I witnessed her drive off into the distance. My truanting lasted for approximately two weeks before my brother dropped by to collect something. Because I lacked any real ability to provide a show stealing performance in lying aptitude, he quickly put two-and-two together. 

I became so mentally disenfranchised that I gave up on the entire education process. As a result, I coasted through my penultimate year, often attempting to nullify my chronic negativity through self-harm and emotional withdrawal. I began to disrupt practically every class wherein a potential bully was also present. Talking, throwing stuff and swearing at the teacher were all commonalities in my troublesome approach. The result? About 180 detentions in a single academic year. I think I received five or six a week on average, surmounting to an hour each day after school. I intentionally skipped out on the majority of these, resulting in extended ninety-minute detentions instead, as was the rule if you missed any. Clearly, I wasn’t making the wisest of decisions at the time. Looking back, I find that entire detention process infuriating. Teachers could have allocated detention time to force students to carry out class activities focused on the core fundamentals: English, Maths and Science. If standard protocol, perhaps I would have identified my passion for the latter far earlier. 

Eventually, a lifeline presented itself in the form of my drama and performing arts teacher. Patrick Walker was always cool, calm and collected. His approach commanded authority, but in an unthreatening and empathetic way. Dedicated to helping his students’ development, he understood that belittling someone would only result in revolt and rebellion. My mum and I were called in for a meeting with him once, as he also had a crucial role in the senior leadership team. He emphasized that I was at an inflection point. The choices? Continue on my current path, ruining my life as a result, or actively apply my academic ability towards bettering myself and my future. As a direct consequence, I began to focus on my classes, rather than my bullies. While the victimization continued, I learned to ignore it for the most part. My newly found focus towards education helped me realize I attained genuine enjoyment from science, performing arts and computing. This alone was the spark responsible for a miraculous turnaround; I developed a hard-working mindset. But despite this newly discovered surge of motivation, I was unable to reach the goal I desperately set myself; an A grade in science. In fact, I mostly received C grades across the board. As such, that prospect of a better tomorrow rapidly mutated into uncertainty, depression and inescapable self-doubt. 

I scraped into sixth form. By this point, the feeling of negativity and worthlessness felt permanently engraved into my brain. Instead of thankfulness and pride due to acceptance, I assumed the school took pity on me. I felt inadequate and expected to fail. While my hardworking mindset remained, my insecurity was rife. Life became study-centric. I did have friends during my time at sixth form (many of which remain my friends today), but I didn’t actively see them all that often outside of class. Because my mentality was infected with so much rotten self-doubt and paranoia, I never allowed myself to enjoy some of the better moments during those years.

Many of the bullies at my secondary school performed poorly in their exams, decided to take a different career path, or both. I didn’t see them again. Instead, I exposed myself to new bullies: the cool-intelligent crowd. Do you remember that kid that always got straight A’s despite never paying attention in class? All while taking the piss out of how hard you worked or how weird you were? Yeah, that came to ahead here. Around the same time, emotional withdrawal became second nature, but I considered it a positive thing. Facilitating me to work non-stop, it helped me to shrug off the snide comments from others. The work ethic I developed helped me attain the grades I needed for acceptance into a top-tier university. However, the social sacrifice was severe, and feelings of insufficiency aggregated once again.

My experience with university was better. Upon arrival at my dorm, feelings of acceptance and belonging really took over. On the most part, I met a range of different individuals from all walks of life who shifted my world view significantly. Regrettably, a small number of privileged students would often make snide comments, but fortunately they were located in a separate building. I recall that prior to moving in, there was a Facebook group set up by the university for the different accommodations located around London, so all incoming students had the opportunity to engage with others prior to arrival. For someone as timid and shy as I was at the time, this was a social security net. Though, I remember some individuals mocking me for my apparent eagerness on the group. While university is often distinguished as a potent primer for maturation towards adulthood, this association was clearly lost on some. Instead, they ridiculed me for being lonely and wanting a fresh start.

My first year as an undergraduate student made me realize that anyone has the ability to become a bully, regardless of their previous circumstances. I also began to understand that chronic bullying often results in long-lasting consequences, with depressive experiences in both childhood and adolescence resulting in life-long effects. For example, I still feel overweight to this day despite exercising four times a week and eating healthily.  The consequences of fat-shaming during my adolescence really came to a head during my first year at university. I decided that my body was unbearable, so I employed a crash diet. I think my daily food regime was two slices of brown bread, a tin of baked beans and a roasted chicken breast, which is far from ideal for an active university student. The result? I dropped around 5 stone (70 pounds) in as many months. I was underweight and unhealthy.

After that initial year, things changed. I was selected to participate in an exchange program for my second year, wherein I decided to study at the National University of Singapore. The experience was the catalyst for priming the development of who I am today. It flipped my preconceptions and assumptions about myself, fuelling endless ideas of what I could potentially be. I still suffer with body confidence issues, but now I understand where it stems from. I take the time to rationalise my insecurities, target their original source, and remind myself that those feelings often manifested due to negative situations. While it remains to be completely effective, this approach to acknowledgement and acceptance helps me to rationalise my issues, allowing escape from an otherwise inescapable chokehold. 

For this topic, I wanted to highlight my own personal experiences with victimization and bullying to really drive home that it can have immense implications. To this day, I still find it difficult to accept a compliment, and this had negative implications for previous relationships. For me, it was primarily due to bullying. Today, the only compliments I can really recognise are based on my previous successes. For example, I can accept the notion of someone referring to me as articulate, based on the fact I managed to navigate the PhD process and emerge with a doctorate. However, I still find it difficult to accept compliments associated with my appearance, my cultural taste or my social skills. Thus, I just hope that people become more aware about the consequences of long-term bullying, whether in childhood, adolescence or adulthood. There is a fine line between good-hearted ‘banter’ and just being degrading and hurtful. Locate the line, be mindful of it, and it will have long-lasting benefits for the mental health of yourself and your peers.

Please, always remember that random acts of kindness are far more rewarding. 

The toxicity of social media.

tedwickstead1 Comment

Over the past two decades, online social networking has revolutionized the way we communicate and interact with one another. Friends and relatives separated through vast geographical distances are now able to interconnect with technical ease. Overall, it has been a masterstroke in technological advancement. However, these changes may affect particular aspects of human behaviour, perhaps even contributing to, or entirely causing the development of psychiatric disorders. 

Excessive use of social networking sites such as Facebook and Instagram appear to be associated with the development of low self-esteem, especially in children and younger adolescents. This doesn’t appear to be straight forward though, as evidence is available to support the opposite. As a result, the impact of social media on our mental health has been a controversial topic for many years. Due to this potential link between ‘social’ interactions online and our mental health, I feel it is important to lay out my thoughts. I believe that excessive social media use can likely result in insecurity, feelings of depression and anxiety, and contribute to the development of unrealistic expectations towards other people, and the world we live in.

One of the first studies which indicated that general internet use significantly affects social relationships and community participation was published over 20 years ago, in 1998[1]. The authors highlighted that for participants who spent more time online, a reduction in communication with family members was observed. In addition, the user’s social circle also diminished – a social change which can contribute to loneliness, which in turn is associated with the development of depression[2]. Worryingly, a further study published in 2000 suggested that increased internet use may have negative effects on the social development of children[3]. An obvious point to note here is that when these studies took place, the majority of the social media platforms available today did not exist. For example, Facebook was not founded until February 2004, and thus internet usage was likely infinitesimal compared with today. 

Since the development of social media platforms, the time children and adolescents spend online has exponentially increased. Although they enable us to easily interact with a large number of people, these interactions are often shallow and will unfortunately never replace face-to-face communication effectively. In a study published in 2012, investigators reported a positive correlation in a high school population between social media usage and depressive symptoms[4]. Conversely, in a 2013 study sampling university students, researchers failed to find a similar correlation[5]. These conflicting studies therefore put forward the idea that children and young adolescents may be more susceptible and negatively affected by social media compared to older teenagers. This could be linked to different responses by different age groups to social media content and challenges. Importantly though, those sampled at university in 2013 may have grown up when social media wasn’t really a considerable factor in their lives. For example, when I was between 8-14 years old (2001 to 2007), I did not really care for social media. Instead, my friends and I would see each other face-to-face daily, often playing sports or various other games to pass the time. Thus, my social development and interactions occurred in a natural interpersonal setting. 

Then, Windows Live Messenger happened. Previously known as MSN messenger – which was developed in 1999 – it rebranded in 2005. It eventually took over the brains of the adolescents. Instead of meeting up after school, many kids would go home and spend their entire evening on Windows Live Messenger, talking to people FROM SCHOOL, many of which they would barely speak to in person. This shift resulted in the development of online cliques, and it sucked the life out of strong interpersonal relationships. It wasn’t all bad however, and I think in some situations it provided some positives. For me, I was terribly shy at school. Online messaging allowed me to talk to people I thought were interesting, and it facilitated me to ask questions about their interests without me seizing up with anxiety and fear.

More recent studies, wherein social media has become a central part of the majority of young people’s lives, further strengthens the argument that it could cast a shadow over our mental health. The first, published in the Journal of Social and Clinical Psychology in 2018 asked 140 undergraduate students at the University of Pennsylvania to either continue regular use of Facebook, Instagram and Snapchat, or to limit their use of each to 10 minutes per day – i.e. 30 minutes total. To confirm the conditions were being met, the participants provided data from their phones to show their precise overall app usage throughout the day, rather than relying on memory – an often unreliable feature for scientific investigation. After the three-week study period was completed, the participants filled out a questionnaire to help the researchers understand how they were doing psychologically, with particular interest in depression, anxiety, loneliness and “the fear of missing out”, often abbreviated as FOMO. Perhaps unsurprisingly, the study reported that participants who limited their social media usage to 30 minutes per-day felt significantly better, reporting reductions in both loneliness and depression[6]. This change was particularly pertinent for those who came into the study with higher levels of depression. Interestingly however, both FOMO and anxiety were reduced in both study cohorts, suggesting that the participants might have had the resulting benefit of improved self-monitoring. “Some of the existing literature of social media suggests there’s an enormous amount of social comparison that happens. When you look at other people’s lives, particularly on Instagram, it’s easy to conclude that everyone else’s life is cooler or better than yours,” said study author Melissa G. Hunt.

This is further supported by a 2019 study conducted at York University in Canada. 120 undergraduate women were asked to use either Facebook or Instagram to find a peer that they perceived to be more attractive than themselves or a family member who they didn’t believe to be, and then leave a comment on their post. Interestingly, the women who interacted with a post of someone whom they perceived as more attractive felt worse about themselves afterwards[7].  “Even if they felt bad about themselves before they came into the study, on average, they still felt worse after completing the task,” said study author Jennifer Mills. It is important to note here however that the women may have felt generally happier engaging with a family member compared to a peer, and this could complicate the data presented in this study. Nevertheless, it is important to note that making any kind of comparison – not just people that we consider more intelligent or attractive, but also people we consider less intelligent, smart or anything else for that matter – is associated with poorer wellbeing. A 2014 study linked this association, reporting that the connection between social media and depression was largely mediated by social comparison[8].

Social networking and self-esteem

As we should all be aware, self-esteem is a crucial factor in developing and maintaining a good quality of life. In a 2006 study, when compared to adolescents with high self-esteem, poor self-esteem in young adolescents resulted in overall poorer mental and physical health, often contributing towards higher levels of criminal behaviour and worsening economic prospects during adulthood[9]. The authors emphasized that the long-term consequences of self-esteem changes could not be explained by adolescent depression, gender or socioeconomic status. Thus, low self-esteem in young adolescents can have negative real-world consequences upon reaching adulthood. Whilst this study underlined that the consequences of poor self-esteem appeared independent of adolescent depression, low self-esteem is associated with the development of various mental illnesses including anxiety, depression and eating disorders[10-12]. 

Why is social media contributing towards reductions in self-esteem? One possible relationship between these social networking platforms and emotional destructivity appears particularly pertinent: narcissistic behaviour. So, what makes someone a narcissist? Someone who displays narcissistic traits often has a grandiose sense of self-importance, regularly displays a sense of entitlement and also requires constant praise and admiration. On the other side of the coin, a narcissist often intimidates, belittles and bullies others. As you may have already guessed, social media platforms are perfect breeding grounds for this sort of behaviour. Unfortunately, numbers of followers, comments and likes can all contribute to the inflation of one’s ego. As an example, I can say with confidence that many social ‘influencers’ are awfully narcissistic, and they often harbour millions of followers. The problem here is that

many of these followers are often young, impressionable and easily manipulated. 

Is social media a toxin or an escape?

Overall, I think the impact of social media on our self-esteem and mental health is considerably complex. Whether negative or positive, it entirely depends on who we interact with and what we follow. For example, a young teenager only following models on Instagram – who will often have their pictures photoshopped before posting them – will result in the development of a false sense of realism. Following motivational and educational accounts however, may not have the same negative impact. As an example, think about following Kim Kardashian and Michelle Obama on Instagram. Who do you think will be more likely to post things with a positive message? 

Because of this, moderating social media usage of the younger generation may be a valid option. Not to inhibit their freedoms, but just to check on their health and wellbeing, and determine whether any negative changes are directly due to what is seen on the internet. From experience when I was a teenager, I know that seeing ripped and well put together men online really knocked my confidence in my physical appearance. So much so, it still occasionally bothers me today. However, I learned to understand just how irrational I was being, but it took me a long time.

We do need to look at the other side of the coin, however. Something we should immediately consider is correlation versus causation. Social media usage may indeed be directly associated with the development of mental health disorders. Nevertheless, it is crucial to distinguish this from the potential that adolescents increase their social media presence due to poor mental health itself, perhaps as some form of digital escape from the real world – e.g. socioeconomic status or bullying at school. Conducting longitudinal studies – whereby you follow participants over several years – on psychiatric patients and healthy volunteers, comparing those who regularly use social media to those who do not would be a strong experimental study to definitively determine whether social media can be associated with declining mental health.

Another important consideration is that not all social media platforms are created equal. For example, Facebook is focused around updating personal profiles, wherein users can create comments and status updates, alongside uploading pictures and videos. Twitter on the other hand is primed towards the posting of short messages (“tweets”), often expressing thoughts and opinions. This doesn’t mean that Twitter users are less likely to be mentally affected though, it means that study comparisons should be made regarding mental health changes and the utilization of Facebook, Twitter, Instagram and various other social media sites. It is important that these studies also present exclusion and inclusion criteria for participants. In some circumstances, people with personality disorders will spend more time on social media compared to the general population because computer-associated communication can enable them to become more socially successful. This could complicate the data, wherein it may become unrepresentative of the population.

Regardless of what you think of social media, all platforms – especially Facebook and Instagram – forcefully incite constant self-evaluation on a daily basis, often resulting in unnecessary competition and comparisons of one’s accomplishments with those of others – in some circumstances, people we may not even know. To top it off, social media directly results in the incorrect perception of physical, psychological and social characteristics of others, often resulting in the manifestation of jealously and frustration. If you personally feel like social media contributes towards your own negative feelings, try to take a week away from it, perhaps more. You’ll be surprised by how much better you can feel when you aren’t constantly worrying about what other people are up to. 

References:

  1. https://pubmed.ncbi.nlm.nih.gov/9841579/
  2. https://pubmed.ncbi.nlm.nih.gov/30933717/
  3. https://pubmed.ncbi.nlm.nih.gov/11255703/
  4. https://pubmed.ncbi.nlm.nih.gov/22447092/
  5. https://pubmed.ncbi.nlm.nih.gov/23260846/
  6. https://guilfordjournals.com/doi/10.1521/jscp.2018.37.10.751
  7. https://www.sciencedirect.com/science/article/pii/S174014451730517X
  8. https://guilfordjournals.com/doi/abs/10.1521/jscp.2014.33.8.701
  9. https://pubmed.ncbi.nlm.nih.gov/16569175/
  10. https://pubmed.ncbi.nlm.nih.gov/24039896/
  11. https://pubmed.ncbi.nlm.nih.gov/23421697/
  12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878202/

Fear of the unknown.

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Fear of the unknown.

Many of us are creatures of habit. If everything is going according to plan, we feel in control. Unfortunately, this status-quo often degenerates when a curveball presents itself. In some circumstances, this kickstarts a fear response. In the eyes of many, this is often considered an uncontrollable thought process. Fear has often been described as a self-protecting mechanism, through elicitation of the scientifically characterized ‘flight-or-fight’ response, which prepares the body for action. Whilst this is beneficial in many situations, such as being confronted with a potentially dangerous scenario, it can also become crippling for many of us. In some instances, this crippling fear associates with the uncontrollable. In fact, several anxiety disorders including social anxiety and panic disorder share an underlying trait: increased fear of the unknown. However, the manifestation of fear is becoming an increasingly common trait within society, often associated with what has been coined the ‘victim mentality’. It is an acquired personality trait, wherein a person often considers themselves a victim of the negative actions of others, despite all the evidence to the contrary. For many years, I thought this. I truly believed I was the victim of some cruel universal joke. 

Due to negative and destabilizing life-events that I neither acknowledged nor dealt with, I assumed the worst in many situations. This was especially the case for scenarios I had absolutely no control over. As you may have guessed, I feared the unknown to a disconcerting extent. I feared the future. I was scared of the uncontrollable. I have always been meticulously organized and driven when it comes to work. Because of this, I would often eat myself alive when fear disrupted my flow and motivation. The worst thing? Fear would consume me about scenarios that I either had no control over, or worse… things that may not arise. I feared things that did not yet exist! Future career aspirations, ending of relationships, death of family members. Why was I so consumed by these destructive thoughts and fears?

Fear of the unknown is an acquired trait. It is learned. Because of that, we all have the ability to unlearn it. For many of us, we often allow the past to dictate our opinions on the future. We apply previous worst case scenarios to new situations, often assuming that the past will inevitably repeat itself.  ‘I was in a relationship once… they broke up with me. I had a job interview like this before… they didn’t want to hire me.’ Why should any of us believe that it will not happen again? This thought process can often lead to chronic indifference and lethargy about the potential progression in our lives. We can lose all interest in skill development because of the manifestation of fear. How is that a good life? That isn’t living at all. 

For the best part of a decade I let fear dictate my path. On several occasions I decided to choose security over the prospects of greatness. Why? Was it the fear of embarrassment? The fear of failure? I think it was a combination of the two. I was heavily bullied in school, so when I was in my late teens, if there was any instance whereby I would potentially embarrass myself, I would avoid the situation entirely. The fear of failure had become more prominent during my early twenties. Truly believing failure would extinguish any potential success, I would often avoid new scenarios in which the potential for failure manifested. Because of that, I missed out on some incredible opportunities. 

Things in life which are worth having are never easy. If they were, then we would all have them. I think this is crucial to underline. Does stress contribute to your fear? If aligned, it is important to approach and manage challenges in bitesize chunks. This makes tackling a new situation far more manageable and may consequentially help suppress the development of an exaggerated fear response. Are you worrying about the long-term consequences of failure? In many instances this is an entirely pointless process, often fueling fear, anxiety and unmanageable stress. Focusing on fear linked to things you cannot immediately control is a fruitless endeavor. 

“Fear and anxiety many times indicates that we are moving in a positive direction, out of the safe confines of our comfort zone, and in the direction of our true purpose.”

– Charles F. Glassman

In some circumstances, fear manifestation can lead us to develop the ‘if it is meant to be, it is meant to be’ mentality. Relying on this internal monologue results in the manifestation of laziness and reluctance. Dedicated and consistent hard work is required for success. The universe will not run that race for us. Because of this, fear in many ways is our mortal enemy.  If unharnessed it has the potential to inhibit our ability to strive forwards. So, what can we do about it? I have listed a few different approaches that may help.

How to tackle our fear.

Limiting exposure to uncontrollable situations. Many of us can get worked up by situations we cannot directly or individually resolve. In terms of global issues, newspapers and news websites are the perfect ingredient to whip up a fear storm. For example, whilst I have been living in the United States, I can say with utmost confidence that Donald Trump has exclusively installed anxiety and fear in the hearts of many Americans. His off-the-wall opinions and abuse of power have many people anxious about their futures. Unfortunately however, the presidential situation can only be resolved on election day. For now, it eludes our control. Excessively worrying about things like this during a period wherein you cannot do anything about it is psychologically and physically draining, and it’s definitely not good for anyone. Focus on the things that you have direct control over. The world is too big to worry about everything.

Seek support. Communicating with others who may feel similar bouts of fear and anxiety can be beneficial. I quickly realized that I was pretty good at giving advice to others about their own anxiety. However more importantly, these conversations helped me understand that I was ignoring my own advice. Eventually this changed, and it has assisted beyond description. 

Reflect on past successes. How many times have we all worried about something only for it to totally work out? Whether that was studying for exams, preparing for a job interview, or organizing travel preparations, we often like to dramatacise and imagine the worst-case scenario. Whilst a realistic approach often helps avoid excessive disappointment if something doesn’t go out way, this thought process is imminently heading towards pessimism. When fear hits you regarding a new opportunity, remember to look back at your previous successes. I hope this reflection will help you realize and understand just how suitable and ready you are for this next experience.

It is important to remember that fear is an entirely natural response, especially when we enter a situation we are not immediately comfortable or familiar with. That doesn’t automatically mean that it should be considered a negative emotion. Many of the best things in life are on the other side of fear. Harness it. Embrace it. The unknown may be terrifying, but it is also totally magnificent. 

Social isolation and mental health.

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Humans are social creatures. If there was any doubt in that before, the current isolation that many are facing solidifies this fact. We only need to look at chimpanzees, or the relationship between a mother and her child for verification as to where this characteristic manifested itself from. It is unsurprising then that isolation can have severe negative connotations. Currently, with the unprecedented global COVID-19 pandemic, scientific experts and the majority of world leaders are highly recommending that everyone practice social distancing. This means staying approximately six feet away from others not within your household, alongside keeping public trips to an essential minimum (i.e. to get food if you cannot get it delivered). Whilst this may be an inconvenience to many, it is necessary to reduce viral transmission, protect the physically vulnerable and reduce the pressure on international health services. However, social isolation may have detrimental effects to those who are psychologically vulnerable; a category that I myself unquestionably fall into. 

Social isolation has definitely led to serious consequences. However, in psychology the term ‘social isolation’ is difficult to define. What matters the most is whether an individual actually feels lonely. Scientists have coined this ‘perceived social isolation’, which can have negative effects both physically and psychologically. In young adults (18-27 years of age) for example, loneliness has been associated with poor sleep habits, depression and suicide. In addition, social isolation may increase the risk of illness and death due to cardiovascular disease. In the United States and United Kingdom, heart disease is one of the most prevalent killers of middle-aged and elderly individuals. At first glance then, these alarms should raise considerable concern.

However, things are never that straightforward. Researchers determined that isolated mice (which are highly social animals) have an increased risk of obesity and the development of type 2 diabetes. In some people, psychological distress can be associated with particular eating habits. For example, a bad diet is often associated with an increased risk of depression. This often results in a self-propagating cycle: depression facilitates a poor diet, and self-hate manifested as a consequence of this diet can fuel the fire towards further negativity.  

So, could this become a serious problem during viral-induced self-isolation? Should we be worried about people who are living alone, and for people with a history of mental health problems? Yes and no. From my perspective, I feel a bit stir crazy. However, I am otherwise fine. I have suffered with major depressive disorder for my entire adult life. I have lived on the razor’s edge for many years, attempting to take my own life on several occasions. As you can imagine then, my mind is often akin to a bag of f***ing cats. Despite that, my mental health during isolation has been relatively manageable. It is important to note that I do live with my long-term girlfriend. Nevertheless, I often prefer being entirely isolated. Many people who go through depressed episodes often want to be left alone. So being in close-quarters with the same person for so long with no reprieve could be considered as quite the challenge. That is partially true. I think the one thing for me which has helped me rationalize the situation and keep my mental health in check is pretty obvious: there is a global pandemic. We are all affected by the current situation. Because I can appreciate that, I think it removes some of the stress and self-destruction that would have otherwise lingered. I am not isolating and hiding away whilst others are out and enjoying themselves (unless you are being a selfish p***k). All of my friends and family are doing the same thing: watching terrible television and investing in toilet paper as their new international currency. 

In association with this pandemic, if you do not suffer with a pre-diagnosed mental health condition, please do not try and raise your arms up in solidarity with those who do, declaring you ‘now totally understand’ the difficulties associated with psychological illness. From a personal standpoint, it is patronizing beyond explanation. A few months of isolation is not even remotely comparable to the years of self-disregard and harm (whether physical or psychological) that many people may have (or currently are) dealing with. I am not taking aim at anyone specifically here, either. I just believe true empathy is more helpful to those in need. For me, I prefer it when people show genuine care. Talking about your mental health revelation on social media doesn’t help anyone. If you truly empathize and you believe someone is in need, why not call them? What about sending them a surprise gift in the post? Knowing that someone is thinking about me through direct displays of affection reduces that ‘perceived social isolation’ quite remarkably. 

That is what I want to accentuate. Just because someone is physically isolated, does not mean they have to become emotionally and psychologically isolated, too. Talk to your family and friends regularly. Organize an online pub quiz, play video games together with some headsets. How about sending pictures from the last time you saw each other? Perhaps even make plans for the end of the year when you can see each other again. Start preparing things you can look forward to. 

I do appreciate the concern for people struggling, but I also fully understand the risks if social distancing rules are not followed. Unfortunately, I have lost all my grandparents. I know the heartache. I would not want to see that happen to anyone close to me, but this virus appears to be particularly fatal in the elderly. Strikingly, of the people who were hospitalized in the New York City area, around 88% of patients on ventilators have died due to COVID-19. For some, this solidifies the virus as being a death sentence. Is isolation comparable to this for those who suffer psychologically? No. Just because I am unable to physically interact with the people I love does not mean I am unable to communicate with them. I am pretty isolated right now, geographically speaking. I live in the United States, whilst my family are back home in the United Kingdom. If one of them were to get sick, I would not be able to fly home due to flight and VISA travel restrictions. Whilst that is upsetting of course, I am determined to keep to a routine. I stick to activities that I know make me feel good: exercise daily, make music and of course, write these articles. 

I do acknowledge that some individuals may be particularly fragile during this time, such as a recovering self-harmer, alcoholic or drug addict, all of which may find self-isolation unendurable. These are the people that we must prioritize; protecting those most vulnerable in our community. This is no time for a ‘ME’ mindset. Selfishness is not needed or warranted here. It is time everyone started to develop a ‘WE’ mentality. With that in mind, please focus on the health of yourself and your loved ones during this difficult time. However, do so with some physical distance. If you stand in solidarity with those who suffer with mental illness, I would like to say thank you. Nevertheless, please do not paint everyone with the same naïve brush.

Do not let our insecurities define us.

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Insecurity is something that we all face. It is an inevitable part of life. Whether it is a physical or personality trait, it can be something that hinders us from progressing forward with our daily lives. It is inherent to the human condition.

To this end, I wanted to emphasise to my readers the commonality of insecurity and inhibition. To do this, I asked people of different ages and job descriptions to open up about their biggest insecurities, so I could accumulate their responses anonymously, before posting them here.

However, I feel it important to first open up about my own biggest insecurity. For as long as I can remember, I have had this intrinsic yet entirely irrational hatred towards myself. I am not entirely sure when it manifested, but it is something that I just cannot shake. I am 27 years old, and a post-doctoral neuroscience researcher.

Here are individual responses:

“I would say my biggest insecurity is my shyness, especially when meeting new people and starting conversations.” – Age: 19, Profession: DJ.

“I think it’s the lack of being confident in the work I produce and being nervous about what people say about my work.  It’s mainly the confidence and uncertainty that play with my mind when it comes to work. Hence why I haven’t applied for bigger jobs or positions. It is a ‘am I good enough’ to push onwards and upwards.” – Age: 26, Profession: Graphic Designer.

“My biggest insecurity has always been other people’s perception of me. Whether that be friends, family or another professional.”
– Age: 25, Profession: Clinical Animal Behaviourist. 

“I would say my greatest insecurity is “imposter syndrome” or the constant feeling I’m not actually capable of being where I am, and that I have deceived everyone into thinking I have, or it is chance.”
– Age: 22, Profession: Trainee Accountant.

“I do not like my lips. It is where my eyes immediately go in every picture.”
– Age: 26, Profession: Public Relations.

“My biggest insecurity is probably me not achieving enough. No matter how much I do in a day, I berate myself internally, telling myself that I could/should have done more. This is tied in with the constant desire to be productive, which can be harmful, as I know rationally that it’s important for our mental health to not be ‘productive’ all the time.”
– Age: 27, Profession: Composer.

“I have body confidence issues.” – Age: 37, Profession: DJ.

“I got good grades in school and university, but I am not sure I’ll ever do anything that makes a lasting positive impact on this world. I am also afraid that people doubt my intellect, either because of my gender, race or job. They do not hand out grades when you are an adult to prove you are smart, and my job does not actually require intellect.”
– Age: 24, Profession: Advertising.

“I would have to say that I am very insecure about whether people like me or not.” – Age: 25, Profession: Lecturer in Bioscience. 

“I work in the beauty industry so I would say body image. I’m constantly around beautiful, almost perfect looking people. It can sometimes make me feel like I’m lacking something.” – Age: 25, Profession: Aesthetician. 

“Whilst I have many insecurities, there are two main ones. My first is constantly suffering with my body dysmorphia, no matter what I do I’m never satisfied about how I am. Second, I always feel inadequate, again this is because of number one. It is a constant cycle.”
– Age: 26, Profession: Warehouse Assistant.

“I am worried that I will go nowhere, and I won’t succeed in my chosen career and will not achieve my aim in life.”
– Age: 24, Profession: Medical Systems Specialist. 

The commonality of insecurity within society is undeniable. It is important that we all communicate more openly about what inhibits us, as this may eventually help to set us free.

The science behind SAD.

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Because I am British, it probably comes as no surprise that I unequivocally understand the heartbreak of traditional rainy weather. An indestructible stereotype of the UK, bad weather has never really manifested the ability to catalyse happiness during the morning commute. Whilst the occasionally odd shower is often welcomed, consistent wind and rain provokes noticeable negativity in people – have you ever been in central London during commuting hours? Yikes. Why then, for many of us, does our mood shift in association with the weather? Interestingly, science may have the answer! This discussion is dedicated to what has been coined seasonal affective disorder. Here I will survey some of the evidence surrounding the condition and describe what we may be able to do to fight back against it!

Seasonal affective disorder: what exactly is it?

Seasonal affective disorder is a form of depression otherwise referred to as SAD or seasonal depression. As you may have guessed, people who suffer with SAD tend to experience mood changes and symptoms similar to depression. These symptoms appear to correlate with the changing seasons, primarily beginning in the autumn and winter months, before alleviating during the arrival of spring. With this in mind, it is important to note that SAD is more than just “winter blues”. The symptoms can be distressing, debilitating, and can significantly interfere with daily functioning. Nevertheless, various treatment options are available.

Causes

Unfortunately, the biological cause(s) of SAD is still relatively unknown. However, some evidence suggests that it is related to the body’s level of melatonin, a hormone secreted by the pineal gland. Melatonin regulates the sleep-wake cycle, and darkness is known to stimulate its production, preparing the body for sleep. Because more melatonin is therefore produced during the winter months (when sunlight hours are diminished), people tend to feel sleepier and more lethargic. 

In addition, research suggests that some people who develop SAD may produce less Vitamin D. Interestingly, Vitamin D has been suggested to play a role in serotonin activity, a key mood regulating neurotransmitter which is reduced in some depressed patients. 

Treatments

Interestingly, human clinical trials have identified that both cognitive behavioural (e.g. talk) and light therapy improve the symptoms of SAD, wherein the latter may be more effective for reducing four key signs of the disorder: early insomnia, anxiety, hypersomnia, and social withdrawal. So, if you needed a sensible reason for an expensive winter holiday to the Bahamas… you are most certainly welcome. However, more practical approaches to tackling SAD symptoms include taking care of your general health and wellness, which involves (yep, you guessed it…) regular exercise, good nutrition and getting enough sleep. Spending time outside and rearranging your office space so that you are exposed to a window during the day may also be of benefit.

Does blindness contribute?

From a scientific perspective, there are many interesting questions arising from SAD research. For example, is it more common in people with serious visual impairment? Does the likelihood of developing SAD increase as eyesight progressively degenerates? What about people who are blind and have been since birth; do they develop symptoms of SAD? These are all interesting research avenues which are currently being investigated.

It is important to seek help

Whilst it is thought-provoking topic to discuss, please remember that If you feel like you or a loved one has experienced depressive symptoms for an extended period of time, contact your nearest doctor for support.