“How do you pick up the threads of an old life? How do you go on, when in your heart you begin to understand… there is no going back? There are some things that time cannot mend. Some hurts that go too deep, that have taken hold.”
― JRR Tolkein
Although it may appear slightly farfetched that this infamous quote by JRR Tolkein in The Lord of The Rings resonates so much, it’s actually quite simple: the sheer impact of some past experiences cannot be erased. Self-destruction, external betrayal, internal warfare. How can you possibly eradicate that? How can you pretend they won’t hold power over the rest of your life?
I left the UK in 2019 knowing that there was no going back. The hurts of my home far outweigh the benefits. Although some of my most cherished memories remain within the UK (namely proposing to my fiancé and graduating from college), they remain chronically overshadowed. However, because I have detailed many of these negative experiences previously, I will not be repeating them here. Besides, we all have our own Everest to climb.
Fortunately, my fiancé understood this pretty quickly. While I know we could perhaps settle with a return to life there, I worry that resentment will build over time. Not necessarily aimed at anybody, but rather at my own circumstance. I promised myself a ‘forever out’. A permanent reset. Denying this for myself would be a betrayal of my life-long exploration towards potential happiness. It would present itself perversely, with everlasting consequences. Whether I will successfully obtain even a fraction of this internal happiness remains to be determined. Although, a return to my previous life will make this an impossible task.
I credulously believed that the ‘it’s time to move on’ mentality would result in a simplistic erasure of my history, like the neuralyzer gadget from the Men in Black movies. Simple eradication through lack of association. To nobody’s surprise but my own, life doesn’t work like that. Sometimes I feel like a wraith, but instead of being ensnared between life and death, I feel I’m ripped apart by my past, present and consequential futures all at once. Constantly going in circles, with an absence of purpose.
My drive and focus on a future, namely a career in science, has always been enough to facilitate freedom and success. But now, as the playing field narrows and the competition intensifies, I lack any feeling of importance. The academic world is cutthroat, even for those living without chronic mental health issues. Now, the negatives of my present and past are compounding one another. Am I good enough to be a scientist? This feeling of incapability then bleeds over into my personal life: am I good partner? Am I a good person? I used to think so. Now though, I am not so sure.
There are some that would love to be in my position. Yet, I often wish to be anyplace else. Does this lack of gratefulness make me a bad person? Unfortunately, it is a catch-22 scenario as I have no clue what circumstance would make things better, if any. I have only one absolute: a return to the UK remains the worst choice imaginable.
Emotionally, all I know definitively is that I am full of sadness and hatred. Hatred towards the past, sadness about what could have been. Although I should blame others for manipulating and breaking a young boy, all I tend to do is blame myself. Is this not what we all do? When something goes wrong and we are unable to fix it, how many of us turn the blame around onto ourselves? How many of us consider ourselves culpable? I confidently assume this is common, especially for men.
Suicide remains the largest killer of males under the age of 50. Nearly 75% of all those who die by suicide are men. I feel as though there is an annual uproar within the media sphere regarding these statistics, yet nothing seems to be done about it.
Data represents suicide rates in the United States. Data acquired from the Centre of Disease Control:
There are many behaviours that scare me which relate to the increased suicide rates in men. Withdrawal from friends and family, stockpiling of medications, excessive levels of anxiety or agitation, and reliance on alcohol or drugs. It was pills and alcohol for me when I was a teenager. As of now, I have enough pills in my apartment to tranquilize an African bull elephant. Not through stockpiling, but through required and necessary prescription. For many years I have been concerned that, for whatever reason, my past comes back to haunt me. What would that mean for my personal safety?
This is when I started to understand that some hurts are inescapable. I have been trying for so many years to forget the past and move on. Almost attempting to restart my existence and begin life anew. This is just not possible. Some hurts do, indeed, go too deep. Pretending this to be false could be disastrous for any of us, regardless of our ethnicity, gender, or orientation. Conversely, and likely beneficially, accepting it could be an important step in self-preservation, progression, and prosperity. Because I remain a sceptic, this is a hypothesis I need to test for myself.
Though my optimism is clearly lacking nowadays, acknowledgement of my past could be an important life decision. The hurts associated with it continue to re-emerge. Though, I feel acceptance may help prevent being blindsided by sudden and formidable eruptions in self-loathing and revulsion. I am often fearful of my impulses during these circumstances, especially when fuelled by grief, drugs, or alcohol. Perhaps embracing the hurts of the past will help contribute to my own protection and longevity.
Although it is often said that your past should not dictate your future, perhaps it’s not so black and white. Perhaps embracing the hurts of a past-life will help promote happiness in a new one. Do I know this definitively? Absolutely not. However, I do know that perseverance often provides clarity. I hope the same holds true here. I guess, in time, I will find out.
“We are products of our past, but we don’t have to be prisoners of it.”
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 metruly 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
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.
Fleming L, Jacobsen K. Bullying and symptoms of depression in Chilean middle school students. J Sch Health. 2009;79:130–137.
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.
Liang H, Flisher AJ, Lombard CJ. Bullying, violence and risk behavior in South African school students. Child Abuse Negl. 2007;31:161–171
Kim YS, Koh YJ, Leventhal B. School bullying and suicidal risk in Korean middle school students. Pediatrics. 2005;115:357–363.
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.
Fitzpatrick K, Dulin A, Piko Bullying and depressive symptomatology among low-income, African-American youth. J Youth Adolesc. 2010;39:634–645.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
For the majority of us, grief is an inevitability.
If you have ever experienced grief, you may be familiar with questioning your own sanity… ‘Did I just fleetingly see my loved one wade through a crowded street?’
In some circumstances it can even result in us questioning our own reason for living. Whilst disturbing, these thoughts usually diminish over time, becoming less consuming and intense. However, sometimes these thoughts can pass the line into pathology, wherein treatment may be required to help alleviate and remove the developing problems.
Pathological grief disorder (PGD) is a condition which is a fairly new addition to what has been dubbed the ‘bible’ of psychiatric disorders – referred to as the Diagnostic and Statistical Manual of Mental Disorders (DSM). This disorder is commonly known as traumatic or prolonged grief, wherein it typically lasts for longer than six months. However, the addition of the disorder to the DSM has been a fairly controversial one. The reason for this being because it allows for medical treatment of grief related depression within the first few weeks following a bereavement. Diagnosing someone with depression so quickly after a significantly traumatic event is, in my opinion, not the correct decision.
Grief is a natural response the naturally diminishes over time. This is particularly pertinent to individuals who believe the ‘strong’ and ‘stable’ approach for other family members following a fatality – primarily being men. In 2017, Prince William discussed the destructive nature of the ‘stiff upper lip’ mentality, admitting that it had taken a devastating toll following the death of his mother, Princess Dianna. Thus, relying on medication to potentially numb the emotion of someone in grieving may only exacerbate the issue, especially when the medication is eventually withdrawn. If that was me, I would probably start to believe that prescription drugs were the essential crux for any potential happiness. Whereas in actuality, any recurring negative emotions would have likely reemerged due to not having sufficient time to process the death prior to pharmaceutical intervention.
Whilst immediate medication is not advised, it is crucial to identify signs of chronic psychological distress following a bereavement. Here are a few PGD symptoms to be aware of:
Concentrating on little else apart from the deceased loved one
Extreme focus on reminders of the loved one or excessive avoidance of reminders
Intense believing that life has no meaning
Inability to enjoy life or reminiscence on positive experiences with the loved one.
Wishing to die to be with the loved one.
Pathological mourning is not a new concept, with publications discussing its commonality and treatment options in the 1980s. The primary problem is that the DSM does not discriminate PGD from intense ‘normal’ grief, thus likely yielding huge false-positive diagnoses from psychiatrists. This is likely to cause additional stress to an already vulnerable individual.
A major reason for this is because the signs between PGD and ‘normal’ grief are practically identical. However, in PGD the symptoms are considerably more prolonged, debilitating and intense. Numbness and detachment can last for over six months, and perhaps extend considerably longer. It is in considerable contrast to feeling sensitive after being exposed to emotional triggers of that loved one – for example, videos and photos or anniversaries.
Nevertheless, ignoring any type of grief is potentially an extremely hazardous choice. The severe consequences of losing a loved one can, without intervention, manifest in post-traumatic stress disorder (PTSD). Whilst primarily associated with individuals who have worked within the military, PTSD is common amongst various groups, including the bereaved. A recent study looked into the rates of PTSD in 132 people who had lost a close relative due to cancer. Strikingly, at one month 30% of the volunteers were rated as having PTSD, with another 26% displaying pre-clinical signs of the disorder.
Interventions for pathological grief disorder
Because the diagnostic criteria for PGD is lacking, many suffers are instead diagnosed with major depressive disorder and are ‘treated’ with antidepressants. Whilst this is sometimes beneficial for the patient, evidence is lacking as to whether this is successful for PGD sufferers.
On the other hand, grief counselling is available. Therapists for this type of support are widely knowledgeable and understand that each experience of grief is entirely unique, complex and emotional. Your culture, personality and individual experience will all affect the grieving process. A ‘one size fits all’ approach in terms of medication is unlikely to help the majoring of us. Grief counsellors on the other hand will intricately tailor treatment to meet your specific needs.
I would strongly recommending reading about grief counselling if you believe there is a loved one who requires it. Communication with health professionals (alongside loved ones) is absolutely crucial for healing and recovery. Unfortunately, grief is a normal and upsetting part of life. Instead of immediately jumping towards medication as a potentially damaging crutch, take the right initial steps following a bereavement: Emote and communicate with friends and family. But remember, never be ashamed to seek guidance and support if you think you need to.
Fear, noun: an unpleasant emotion caused by the threat of danger, pain, or harm.
Does that sound familiar to you and your experiences? Perhaps it may. Anxiety is often coined to be a particular type of persisting fear, wherein we worry about potential future outcomes associated with specific events. In fact, the way we feel when either frightened or anxious are extraordinarily similar, because the basic emotion for both remains the same. So, despite not being in any immediate danger, anxiousness can result in similar symptoms to that of fear: increased heart rate, feelings of sickness and/or dizziness, and a loss of appetite. For many, new social situations can be a common trigger of these symptoms, often termed as social anxiety.
Social anxiety: what is it?
Also labelled as social phobia, social anxiety presents itself as a long-lasting fear of being humiliated or scrutinised by others. It is sometimes (and incorrectly) compared to general shyness. However, whilst shyness often manifests for many prior to an unfamiliar situation, this usually dissipates following exposure to the new social situation. This is not the case for social anxiety. The latter often manifests during adolescence, when the opinions of friends and peers become increasingly important. This impairment can continue into adulthood, wreaking havoc on a wide variety of important life events. Separating social anxiety symptoms from those of general shyness is thus essential before discussing management and treatment options.
The symptoms
Symptoms of social anxiety (as with any form of anxious behaviour) can be wide ranging, and it is unlikely that any one individual would experience them all. All anxiety disorders can be associated with the symptoms mentioned previously. However, common identifiers for social anxiety usually include the feeling of dreading everyday activities, such as starting up conversations with strangers, speaking on the phone to unfamiliar people, or even going into work. As a consequence, social anxiety can result in the avoidance of many social activities such as eating out or going to parties.
Can social anxiety effect my health?
Because of the primal need for social interaction between humans, the consequences of social isolation on both physical and emotional health can be catastrophic. A recent meta-analysis – a statistical approach which combines data from multiple studies – identified that a lack of social connections can heighten health risks as much as smoking fifteen cigarettes a day or having an alcohol consumption disorder. The analysis suggested that social isolation can significantly increase the risk of premature mortality, with the magnitude of risk exceeding that of other common leading health threats. A recent study in 2019 analysed the data from more than 580,000 adults, finding that social isolation increases premature death risk for every race.
The negative impact on both mental and cognitive health is also apparent. Evidence supports a link between social isolation and adverse health effects including poor sleep quality, depression and accelerated cognitive decline, the latter of which is associated with problems in memory, language and judgement. A 2018 study also discovered a clear association between loneliness and dementia, increasing a person’s risk of developing the latter by up to forty percent. Examining data from more than 12,000 U.S. adults aged fifty or older, participants rated their loneliness and social isolation alongside completing a battery of cognitive tests every two years for up to ten years.
Do you think this applies to you?
As reported by a 2018 survey, loneliness levels have reached an all-time high. Of the 20,000 U.S. adults approached, nearly half reported feeling alone, with the youngest generation being the loneliest of all. However, isolation is also well characterised in the elderly. According to Age UK, over two million people in England over the age of 75 live alone, with over one million stating that they go for over a month without conversing with a friend, neighbour or family member10.
It is essential to determine whether social anxiety and/or loneliness applies to either yourself or a loved one, and then take appropriate action. It is important to try and communicate with friends and family where possible. However if this is hindered, it is imperative to seek out advice from a qualified medical professional.
“After all, what is happiness? Love, they tell me. But love doesn’t bring and never has brought happiness. On the contrary, it’s a constant state of anxiety, a battlefield; it’s sleepless nights, asking ourselves all the time if we’re doing the right thing. Real love is composed of ecstasy and agony.”
This quote really stuck with me. Love is an incredible thing. Whether that feeling is for a significant other, or perhaps for work or even an environment, it is an emotional rollercoaster. You appreciate how fantastic that person/thing is. However, at the same time, it can cause a sense of worry and sadness. What happens if things change? How certain is the path that I currently walk on? What if change detrimentally alters my current position or relationships? Continue reading “Anxiety: How it links to our future.”→
Self-criticism. It can be one of the most disabling components of our psychological wellbeing. Unfortunately for most of us, we will always be our own worst-critic. Relationships, friendships, work progression; self-critical thoughts can make us second guess our ability and worth in all of these areas. Continue reading “It is time to crucify the self critic.”→
I am sure we can all relate to this. Whether it’s insecurities which have built up as a direct consequence of our scrambled society, or perhaps due to previous exposer to a singular toxic perpetrator; self-criticism can cause undeniable havoc and internal conflict. The constant flux within our culture, alongside a concurrent addiction to unrealistic expectations has led to the manifestation of many young individuals feeling like they will neverbe good enough. Continue reading “The disaster of getting inside your own head.”→
This is mental health. 