Reflection on my psychiatry rotation

As the time for me to bid adieu to my psychiatry rotation draws closer, I really cannot for the life of me figure out where all the time went. From a Covid scare, to spending every waking moment with my friend who stayed with me in the hostel, to pushing the limits of our taste buds with the different cuisines we ordered in for dinner and finally getting the COVID vaccine, you could say that it was an eventful month.  I sure am going to miss it but perhaps what I am going to miss the most is the rotation itself. Not only did we get the opportunity to work under 4 amazing consultants, but we had some interesting patients. There were two patients in particular who made our stay in ward 6B eventful and interesting: David and Mary.

David was a 24-year with alcohol dependence syndrome. He had stayed in the ward for so long that it had become his home. The rest of the patients were his “Homies” and I got the feeling that he felt he was responsible for the people as well as the things in the male side of ward 6B. He would look after the other patients and sometimes answer on behalf of them when we were taking history from them. He was also a pro at giving his own history (because so many people had taken his history) in fact he had written all the points down on a paper so that it would be easy for him to tell his history and at the end would tell us any points that we had missed out on.   

Mary was the patient diagnosed with OCD and bipolar who I mentioned in my previous blog post. We became firm friends with her within the first week, and since then we were assured of an enthusiastic greeting and compliments every time we walked into the female ward. She was also very interested in learning and would come and listen to the ward class and sometimes have a more enthusiastic face than some of my colleagues. Once my friend was reading about schizophrenia in the ward and Mary crept up from behind and started reading it along with her and then went on to discuss schizophrenia with her!

Between Mary and David our stay at ward 6B was interesting to say the least. Honesty when I started the psychiatry rotation, I was a little skeptical but now 4 weeks later I think it is one of the best rotations that I have done so far.

Note: Name and identification details have been changed to protect the privacy of the patients.

Bipolar disorder,electro convulsive therapy, personality disorders – 1st week of psychiatry rotation

The moment I stepped foot into the ward I had an inkling that this rotation was going to be different from the 18 other rotations I had done so far and boy was I right. For starters at the centre of the ward a carrom board surrounded by cushioned chairs was placed, the windows had grills and we didn’t have to carry our stethoscopes. But perhaps the most striking difference was the fact that  our consultant started pointing out everyone’s dominant traits 15 minutes into her class giving us the feeling that we were taking part in an extremely long personality assessment.

During our first week we met 3 interesting patients. One was diagnosed as having both obsessive compulsive disorder and bipolar disorder, the other schizophrenia and the third one was a heroin addict who wanted to get sober. The patient with OCD and bipolar disorder was really interesting to talk to. She was over talkative and highly energetic  (probably attributing to the bipolar disorder, as patients are energetic and over talkative during a manic episode). She loved telling us her story and we really enjoyed talking to her and getting to know her.

It was not only the patients that were interesting, we also learnt interesting things about humans in general. 

Like for instance that all of us have hints of one or more personality disorders. Not the full blown version but one or two traits. This is why many of us feel like we have a personality disorder when we read the description of a certain disorder. That’s perfectly normal as long as it doesn’t hinder your daily activities you don’t have a personality disorder and you needn’t worry.

Apparently most doctors have a ghost of an obsessive compulsive personality for their job requires them to be perfect and have everything in an orderly manner. I must say that I agree with this because my medical school friends and I exhibit traits of obsessive compulsive personality. For example I actually took out my clinical record book to count how many rotations I had done so far to include in the introduction of this post for I had this compulsive need to include the correct number even though I knew there was no harm in using an approximate number.

Another interesting topic we learnt was electroconvulsive therapy. Although we had heard about it before we didn’t know that it was a pretty popular treatment. In our first week alone, 2 patients received electroconvulsive therapy.

Unfortunately thanks to pop culture portrayals when one thinks of psychiatry immediately images of violent uncontrollable behaviour flashes into one’s mind.  While this is true it only represents a minute fraction and extreme cases. Psychiatry is actually much more than that and it’s really sad that people view it in such a negative manner and family members try to sweep these things under the carpet.

Law of laughter

Have you heard about the law of laughter? Chances are that you already have. If you have not well, you can learn it from me and spare yourselves the embarrassment that goes along with learning this valuable lesson. Now I know what you are thinking. How can a medical student teach a lesson that is even remotely close to humour and laughter right? I mean after all yes, you can say it medical students are boring and yes, it is also true that the only humour we know is the humerus bone.

However, if there is one thing medical students can do (apart from misdiagnosing patients) is teaching and explaining concepts well. So, you can rest assured if you have not already learnt the law of laughter that by the end of this blog post you will have a masters on it.

The Law of laughter goes like this.

The ability to control one’s laughter is indirectly proportional to the importance/need of controlling one’s laughter. Meaning the more important or crucial it is that you control your laughter the more difficult it becomes to control it.

Allow me to elaborate.

Back in school we had this rule where the entire school gathered in the morning for prayers before starting lessons. All the Buddhists had to assemble in the school basketball court for prayers.

One seemingly innocent morning my friend and I were lining up in the basketball court for prayers, when she told me a very funny story. It was very funny because it sent us into fits of laughter. After stifling our laughter with the greatest difficulty, we started telling our prayers like the pious children we looked but certainly were not. Now I have this tendency to replay conversations in my head in my free time like when telling my prayers for instance.

So, you can guess what happened next right?

I replayed this funny story in my head and next thing I knew I burst into laughter in the middle of prayers and then my friend who was next to me looked at me, remembered the story and burst into laughter as well. There we were in the middle of the basketball court among hundreds of students laughing out loud amid prayers.
We were lucky that our laughter was masked by the sound of everyone else praying, for now, at least. The students in our row kept giving us looks that conveyed “can you guys shush; you will get us into trouble as well”.

We needed no look, to tell us to stop laughing. We knew that if the teachers or worse the prefects saw us; it would be game over for the both of us. So, my friend and I made up our minds to stop laughing. I took a deep breath, but it was in vain. As much as I wanted to, I just could not stop laughing in fact it was only getting louder. I could feel my entire body shaking with laughter. I snuck a peek at my friend, and it was the same for her.
I tried to imagine all the worse possible scenarios that could happen to us including getting expelled, but I still could not stop my laughter.

And there in the middle of the basketball court in front of hundreds of other students my friend and I learnt the law of laughter.

Just when I started to think that things could not get any worse the head teacher in charge of prayers came to the front and told everyone to stop telling prayers. Everyone was confused. Everyone except the two of us that is.

She then started scolding us in front of everyone, but the worse part was that we still could not control our laughter so now it looked like we were mocking her. Having finally had enough of the two of us she called us to the front and demanded an explanation for our uncontrollable fits of laughter. My friend was finally able to gather her wits and told her that we were talking about a funny story just before prayers began and remembered it while telling prayers and hence burst out laughing. She was not amused at all and instead said in a sarcastic tone “We would like to know the funny story as well please share it with us.” In my head I was like oh shit. Because the story involved my friend’s boyfriend and somehow, I felt that our teacher would not find the story quite as funny as we did.

Luckily, my friend was able to come up with a censored version for her on the spot. Unfortunately, the censored version was not as funny as the uncensored one. Our teacher looked at us like we were a couple of baboons. “Was this your funny story?” she asked in a confused manner. I guess we responded convincingly enough because to our greatest relief she accepted it, most likely passing it off as having a very poor sense of humour. She then made us tell our prayers in front of everyone as a punishment. Thank god, by this time our laughter had subsided.

Any plans of this story not reaching our family was shattered by the fact that the prefects on duty made it their top priority to convey the message ASAP to our sisters. By ASAP I mean faster than the Lankan Aunty Network. Both our sisters were not at Buddhist prayers as they had duty elsewhere. You know how dear siblings can be. They will forget everything even their prefect’s duties just to witness their siblings getting embarrassed. Yes, the smug look on their faces was more difficult to digest than our teacher’s scolding and punishment put together.

I guess you could say that we paid a big price to learn the law of laughter.

Why slow fashion?

Did you know that the clothes we wear pose a threat to the environment? Did you know that the fashion industry emits more carbon than international flights and maritime shipping combined? Did you know that the fashion industry is the second largest consumer of the world’s water supply? Did you know that every second one garbage truck of clothes is either burned or dumped into a landfill? Did you know that an estimated 17% to 20% of industrial waste pollution comes from textile dyeing and fabrics finishing treatment?

Scary isn’t it? Who knew clothes could come at such a price? At the cost of Mother Nature’s health! 

So what can you and I do to stop this?

By increasing the shelf life of the clothes in our wardrobe and by reducing the amount of clothes we buy per year, together we can decrease the amount of clothes thrown away and in the long run reduce the clothes manufactured per year. In other words switching from fast fashion to slow fashion should do the trick. 

What exactly is slow fashion?

Slow fashion is based on 4 core principals; Conscious consumption, environmental sustainability, transparency and ethical designs and production methods. Basically it is a conscious effort to move away from excessive consumption.

On the outset this may sound boring and dull right? Aren’t sustainable clothes generally ugly?  I mean wouldn’t it be an absolute bore to wear the same thing? Wouldn’t it mean that I would no longer be fashionable?Also aren’t all these sustainable products super expensive? Not to mention the fact that I’m just one person and one person can’t make a difference right?

Wrong.

Switching to slow fashion doesn’t mean you get stuck with all the ugly and dull clothes, it doesn’t mean you end up looking like a plain Jane and finally it’s not going to break the bank. 

1. Myth – I can’t afford slow fashion without breaking the bank

Fact – Initially it may seem that sustainable clothes are much more expensive in comparison to clothes from a fast fashion company. This is because sustainable clothes are made with the aim of lasting longer as opposed to fast fashion clothes which are generally supposed to last only a few wears. Therefore the quality of sustainable clothes is superior to that of clothes belonging to fast fashion companies. Hence it stands to reason that sustainable clothes would be more expensive. However if you consider the cost per wear you will realize that in the long run sustainable clothes are in fact cheaper and that our brains are just being tricked into believing that clothes from a fast fashion company are cheaper when in reality it couldn’t be further from the truth.  

2. Myth – Slow fashion = Plain Jane 

Fact- There is a common misconception that just because the word sustainable is attached that these clothes must be dull and rusty. After all, do Emma Watson and Anne Hathaway (both leading advocates of slow fashion) dress in dull clothes and designs? Just because you switch to slow fashion doesn’t mean you have to become less fashionable or lose your sense of fashion.

3. Myth – I’m just one person, how can I make a difference

Fact- Remember how little drops of water make the mighty ocean? Without these little drops there would be no mighty ocean. Every single little drop matters. Similarly all of us have the power to help combat the negative effects of the fashion industry on the environment. Everybody’s contribution matters.

While switching from being a fast fashion consumer to a slow fashion consumer cannot be done overnight, it is worth noting that even the smallest effort towards becoming a more conscious consumer can go a long way in making a better tomorrow.

Things medical students are tired of hearing

As medical students there are certain things like for instance the smell of formalin, not always knowing an answer to a question or looking at rashes that are not easy on the eye that we get accustomed to. However, there are certain comments that we get from the non-medical population that despite the many times we hear them our body just refuses to get acclimatized to. Do not get me wrong I do understand that these comments for the most part come from a good place but that still doesn’t make it easier for us to digest it.

“You will be graduating in ……..? won’t you be so old then?”
From all the comments I have heard, this by far has to be my personal favourite. I already know that I would be older than my non medical colleagues when I finally graduate medical school and I think I speak for all medical students when I say it would do all of us a great favour if you’ll don’t take it as your personal duty to remind us about it every time we meet.

“You always have exams; you can never make it”
Sadly, this is the truth almost always we have exams or something or the other that doesn’t allow us to have a lot of free time. But when we are free, we always try to make it. We already feel bad about having to miss out on the fun but hearing it said out loud is just rubbing salt into our wounds.

“So, once you graduate you will treat me free of charge, right?”
The chances are you will be getting free medical services from your medical friend once he/she graduates. So, there is no need to voice it out. In fact, voicing it out makes us feel like that person is friends with us only for that reason.

“Which specialty do you want to specialize in?”
This question is not that bad it really just depends on who is asking it. I am certain that most people ask this question with good intention but even though it does not seem like it on the outset it is a very personal question. Think about it would you ask the same question from someone in the business field? Like for example would you ask your friend working in finance if he plans on doing an MBA? Sounds intrusive right? Secondly some medical students would not like to disclose the field they plan on specializing in. Maybe coz they are undecided, or maybe they just do not want the whole world to know until they are sure. I think that is reasonable.

“Aren’t you afraid of blood?”
Now this is something the fairer sex gets bombarded with. I honestly do not understand why anyone would even ask this question. Now, let’s see if you are afraid of heights you wouldn’t become a skydiver, now would you? So, isn’t the answer obvious?

If you are a medical student, I hope you found this relatable and if you are not well now you know what to avoid saying next time you meet your friends from medical school.

Awake whilst dreaming- lucid dreaming

Note: Originally written for Tiny Medicine. Click on the link below to watch the animated version of this blog post.

You have just won the lottery and you’re about to spend it on buying all the luxuries you ever wanted. Alas suddenly you become aware that it’s not really happening and only a dream. But instead of leaving your dream you choose to stay or dwell in it and better yet control and manipulate it according to your heart’s desire. This phenomenon is known as lucid dreaming. Seems farfetched? Surprisingly a large proportion of adults, 55% to be exact have experienced at least one lucid dream in their lifetime. Doesn’t seem so farfetched now does it?

A normal sleep cycle consists of 4 cycles. The first three stages consist of non rapid eye movement (NREM) sleep. While the fourth stage consists of rapid eye movement (REM) sleep. Lucid dreaming typically happens during rapid eye movement (REM) sleep and believed to be originated from non lucid dreams.

So what is the difference between normal dreaming and lucid dreaming?

The first and most important difference between the two types of dreaming is that the dreamer is conscious or aware that he is dreaming during lucid dreaming while the dreamer is not conscious or aware that he is dreaming during normal dreaming.

The second difference between the two is that during lucid dreaming increased activity in the dorsolateral prefrontal cortex, the bilateral frontopolar prefrontal cortex, the precuneus, the inferior parietal lobules, and the supramarginal gyrus of the brain similar to that of the levels observed while awake can be seen. All these areas of the brain are related to higher cognitive functions including working memory, planning, and self-consciousness when awake. Therefore lucid dreaming is sometimes referred to as hybrid sleep wake cycle.

Thirdly research has demonstrated that during a lucid dream, “levels of self-determination” were similar to those that people experienced during states of wakefulness.

How are Lucid dreams initiated?

 There are two means of initiating a lucid dream:

• Dream induced lucid dream (DILD) – This is when something within the dream triggers the dreamer to understand that they are dreaming.
• Wake induced lucid dream (WILD) – This is where the dreamer moves from states of wakefulness to dreaming with no loss of awareness.

Reality testing, maintaining a dream diary, mnemonic induction of lucid dreams (MILD), wake back to bed method, are some of the techniques used by people to induce lucid dreams.

An important point to note is that lucid dreamers can only control limited aspects of their dream at once. 

Lucid dreaming has shown to help reduce anxiety, improve motor skills and problem solving ability as well as increase creativity. At the same time lucid dreaming has shown to reduce quality of sleep, have negative impacts on mental health as well as make it difficult for some to distinguish between lucid dreaming and real life.

For this reason most researchers are in two minds about whether lucid dreaming is beneficial or harmful to one’s health. Therefore lucid dreaming should be approached with caution.

COVID-19, a Wakeup Call?

Note: Originally published in MEGHA- (In)visible lines of creativity in trilingual expression. Click on the link below to access the E-book

https://www.kdu.ac.lk/department-of-languages/

The air was filled with excitement and euphoria as the countdown for the New Year began, for this time when the clock strikes 12 it wouldn’t just be heralding another year but also the dawn of the new decade. Mankind had huge plans for the “Roaring 2020s”. Maybe this would be the decade that we finally send human missions to Mars? The possibilities were endless and each more exciting than the other.

We were all prepared to have our minds blown away but Mother Nature had other plans and we were given a rude wakeup call in the form of COVID -19. This disease caused by the 2019 novel coronavirus has singlehandedly brought humanity to its knees. Today we have realized that despite walking on the moon, having developed nuclear weapons and made significant advancements in healthcare we are still vulnerable as we were when the black plague broke out in the 14th century. That a wee virus still has the potential to wipe us off the face of the planet.

We are facing unprecedented times. We are embroiled in a totally different war; A war where fighting in the frontlines are not soldiers armed with guns and explosives but health professionals armed with facemasks, gloves and anti virals. It is a war where nuclear weapons have been replaced by disinfectants and hand sanitizer
as lethal weapons; a war where instead of fighting against each other we have to come together to fight a common enemy.

Lockdown has given many of us some much needed solitude as well as time to stop and smell the roses. It has given mother earth time to heal and recover from all the damage and destruction caused by us, but more importantly it has shown light on the cracks in our lifestyle.

The path back to pre COVID times is a long and winding one, but not one that is impossible. The real question is, is it advisable? After all that is what got us here. We have none to blame but ourselves for all the problems we are facing today be it global warming, be it the pandemic or be it resource depletion. Mother Nature has pressed the reset button presenting us with a golden opportunity to reinvent ourselves.
We still have time and we can undo our mistakes. So what can be done in order to reverse our past mistakes as well to prevent another pandemic? It begins from starting with the man in the mirror.

Adopting an eco friendly lifestyle
An eco friendly lifestyle is no longer a choice but a necessity. In the last decade global warming has gone from becoming a thing of the future to a matter of the present. While many agreements were made to combat climate change, a disparity still exists between what countries have pledged to do and what should be done in order to turn the tide against climate change. It is imperative now more than ever to reduce, reuse and recycle. Lockdown has shown us how schools and universities do not need to meet up every day in order to function efficiently and how working from home is feasible. Virtual meetings and virtual classrooms enable classes as well as business meetings to be conducted at the comfort of our home. Think about all the automobile and aviation gas emissions we can reduce. As individuals, it is our duty to make a conscious effort to reduce, reuse and recycle. As a state, school and university curriculums should be upgraded and developed in a way that infuses traditional methods of learning with virtual learning so that students do not have to commute everyday, but also do not miss out on hands-on-learning and important social skills that traditional classrooms offer. In the same way, businesses should also be encouraged to carry out majority of their work virtually by providing incentives such as easy internet payment packages.

Becoming self-sufficient
With lockdown restricting importing of products and purchasing of goods locally, we have learnt to become self-sufficient at both an individual and state level. Considering the fact that most pandemics are caused by zoonotic diseases, it is advisable that we try and limit importing products. At and individual level we can turn to home gardening, while as a state we can take steps to produce products locally as well to encourage people to engage in home gardening by providing low-cost fertilizers and specialized grants.

Health is the greatest wealth
COVID 19 doesn’t discriminate. It doesn’t matter whether you are rich or poor, black or white, gay or straight – we all have an equal chance of contracting the disease. This pandemic has made us realize that health is indeed the greatest wealth in our life. It has also brought to light the shortcomings of the healthcare system. It is our responsibility both as individuals and as a state to give priority to our health. As individuals we should eat healthy meals, take time to engage in physical activity and lead a healthy life. As a state we need to allocate more money to the health sector so that hospitals can be adequately equipped to meet the growing health demands as well as carry out awareness programs to educate the public on leading a healthy life.

Preparing for the future
This is not the first pandemic, nor will it be the last that we will face. With glaciers melting thanks to global warming, new viruses are being discovered making us more vulnerable. To face pandemics successfully states should give more importance to biological researchers. Researchers can be encouraged and motivated to predict the newly emerging diseases and find cures, new vaccines and drugs by providing financial incentives. A program should be launched to research the possibility of a link between nuclear weapons and technological advancements and the outbreak of
new viruses and if proven laws and regulation should be introduced. Artificial Intelligence used currently can be improved and utilized in fighting future pandemics. Lastly, disaster management units that have been set up in the wake of COVID -19 should continue after its resolution and operate to educate the public on preventing and facing pandemics and other disasters.

As Chief Seattle said “The earth does not belong to man, man belongs to the earth. All things are connected like the blood that unites us all. Man does not weave this web of life. He is merely a strand of it. Whatever he does to the web, he does to himself”. So we have no right to disrupt the delicate balance of the eco system. It is clear now more than ever that we do not own this planet and that Mother Nature is still in charge. We are mere inhabitants, just like the animals and plants. It is time that we respected Mother Nature and lived in harmony with the other inhabitants of planet earth.

After so many years of living life a certain way, one might wonder is it possible for us to change our lifestyle. After all, old habits die hard. Homo sapiens have lived for centuries facing and overcoming many challenges and the key to their survival has always been their ability to adapt to changes. Look at how we are handling the present crisis. People all over the world have changed their lifestyles, resulting in working from home, having virtual meetings, virtual classrooms, virtual shopping and virtual socializing becoming the new normal. It all boils down to how willing we are to adapt.

As every dark cloud has a silver lining, this pandemic has opened our eyes to our destructive way of living and given us an opportunity to redefine and reinvent ourselves. So grab it. If not now, when? Mother Nature has pressed the reset button. Now is the time and we must seize it. The clock is ticking. Don’t hit the snooze button. For when you next wakeup it might be the end of the world.

When the mirror lies: Body dysmorphic disorder

Note: Orignally written for Tiny Medicine. Click on the link below to watch the animated verison of this blog post.

Most of us are guilty of not being satisfied with the man in the mirror but when this dissatisfaction becomes an obsession it’s highly likely that you’re not just being vain but in reality suffering from body of dysmorphic disorder. Keep on watching to find out more about this interesting condition.

What exactly is body dysmorphic disorder?

Body dysmorphic disorder is a mental disorder where one is unhappy with their appearance resulting in an obsession with their flaws thereby hindering their ability to lead a normal life. This flaw could either be a figment of the victim’s imagination or when actually present is less significant than it is perceived by the victim. The obsession can be focused on any part of the body but is more commonly focused on the face, hair, stomach, thighs, or hips. Sufferers of BDD on average may spend around 3-8 hours per day thinking, repeatedly checking and comparing the perceived flaw.  BDD usually starts in adolescence and affects both men and women equally. 

In an attempt to hide their “flaw” victims of BDD may resort to excessive grooming techniques as well as avoid social contact. Some may even seek dermatological treatments or cosmetic surgery which generally doesn’t resolve the distress.  Due to the distress caused by the flaws some victims of BDD experience depression, social anxiety and suicidal thoughts. In addition they may also experience delusions that other people are constantly talking about their flaws.

The cause for BDD is thought to be an amalgamation of genetics, environmental, psychological, biological, social and cultural factors. 

BDD has also been associated with visual processing abnormalities and executive dysfunction. Meaning a victim of BDD has a bias for analyzing fine details rather than looking at the big picture. For example they focus on the flaw in their face (mole) and cannot see beyond it and are unable to see what the face looks like on the whole.

The Goal of treating BDD is to minimize the false beliefs about the defects as well as minimize the compulsive behavior that follows as a result of it. As BDD shares features with Obsessive compulsive disorder the treatment of BDD is similar to OCD and is treated with a combination of medication and cognitive behavior therapy. At present there isn’t an FDA approved drug to treat BDD but antidepressants and antipsychotics are prescribed in order to treat the symptoms of BDD.

BDD is not a quest to increase one’s appearance but a quest to normalize the appearance.

How to deal with Exam stress

Note: Originally written for Tiny Medicine. Click on the link below to watch the animated version of it.

Exams, the dreaded 5 letter word in every student’s vocabulary. Just the mere mention of it is enough to induce stress; every student’s worst enemy. Hold onto your adrenaline and don’t get stressed for we have got you covered.

 So what is the science behind getting stressed?

The amygdala located in the brain senses potentially stressful situations and activates the hypothalamus which carries the message to the pituitary gland. The pituitary gland then in turn activates the adrenal gland which results in secretion of the hormones adrenaline and cortisone. These hormones are responsible for inducing the fight or flight response in the body. When stress levels get too intense it results in negative symptoms.

Keep on watching to find out the best ways to deal with exam stress and how you can transform it from your worst enemy into your friend.

1. Plan ahead

One of the key factors contributing to stress during exams is the massive workload. The best way to tackle this is to start studying well in advance so that the study material can be dealt in small doses instead of one mega dose avoiding the volcano effect. This will not only help in dealing with the stress effectively but also help in retaining more information.

• Take frequent study breaks

Studying for long periods without taking breaks has been proven to be ineffective. Furthermore psychological studies have found out that the average human brain can only concentrate on one task effectively for 45 minutes. Therefore it is important to take frequent breaks not only to optimize studying but also to give the brain it’s much required rest. You can either take small 5 minute breaks every 45 minutes or follow the Pomodoro technique. The pomodoro technique is very effective if you are trying to fight off procrastination as well.

 Of course for many of us a 5 minute break ends up becoming more than 5 minutes and next thing you know it’s time to sleep. This brings us to our next tip which is sure to help you in combating this problem.

• Make a time table and stick to it

Preparing a time table with slots for the study material you are planning to tackle for the day, study breaks and whatever else you have in store for the day not only helps in keeping your breaks in check but also helps in making maximum use of the day. Yes we all know that making a time table is easy but sticking to it is easier said than done. Some tips that will help you in sticking to the timetable you have made for yourself is making the time table the previous day and making it as realistic as possible by setting realistic goals and breaks.

• Get enough sleep

Most of us are guilty when it comes to this one especially during the exam season. But not getting enough sleep actually does more harm than good for your exams. Sleep is an important human function and is instrumental in recharging the brain and body. Decrease in quality and length of sleep leads to increased stress levels. Therefore it is important especially during exam season to not compromise on your sleep. Young adults require a minimum of 8 hours of good quality sleep to function optimally.

• Exercise

Apart from improving your overall health and your sense of well being, exercise has the added benefit of being a stress buster. Exercise pumps up your endorphins, helps relax and calm the body and mind and improves sleep. It is also a great way to break the monotony of the day.

• Eat healthily and stay hydrated

Your health should always be your number one priority. We usually tend to neglect our physical health during exam season. This is a big mistake. Eating well, drinking lots of water, providing your body with the essentials and a bit more, goes a long way in helping you during exams and keeping stress at bay.

• Talk to someone

Sometimes talking to someone close to you might help you in dealing with exam stress. Maybe it is just hearing their voice or maybe it is their faith in you or even their encouraging words. Either way speaking to a family member or a friend can motivate and empower you to rise above the exam stress.

Exams are a part of life for students. There is simply no way in getting around it. But that doesn’t mean you should let exam stress take over your life.

The desire to be disabled: Body integrity identity disorder

Note: Originally written for Tiny medicine. Click on the link below to view the animated version of this blog post

Ancient Roman Poet Virgil very rightly said “health is the greatest wealth” but did you know that there exists a small fraction of people in this world who desire to be disabled? So intense is their desire that some may even undergo voluntary amputations or try making themselves blind or deaf in a bid to fulfill this desire. Such people are said to be suffering from body integrity identity disorder.

While the Greek myth says that king Oedipus blinded himself as a result of the remorse he was feeling for his past actions, the desire for people with body integrity identity disorder to become disabled stems from a medical condition rather than guilt.

So what exactly is body integrity identity disorder?

Body integrity identity disorder (BIID) also known as  Body integrity dysphoria, amputee identity disorder and xenomelia  is a disorder characterized by a desire to be disabled or simply being uncomfortable with being able bodied. This desire arises due to a mismatch between one’s ideal body image and the actual physical appearance. As a result victims of BIID believe a part of their body does not actually belong to them. This belief often leads to their desire to amputate the offending limb which is healthy and working properly or to become blind or deaf. BIID is kind of similar to Gender dysphoria. While in Gender dyshoria one wishes for a change of gender, those with BIID wish to exchange their normal body with an incomplete one. People with BIID often refer to themselves as transabled just like how people with gender dysphoria refer to themselves as transgender.

 Apart from the intense desire to lose a limb or a sense (sight, hearing) people suffering from BIID often feel anxious and depressed. The anxiety and depression is generally due to the discomfort caused by being able bodied. Although it may seem that BIID is a psychological condition it is actually a neurological condition.

As this condition is an extremely rare disease there isn’t much research available and a definite cause for it hasn’t been identified yet. The most popular theory for the cause of BIID is the theory that the brain isn’t able to provide an accurate plan of the body. As a result of which the brain sees the offending limb as being foreign and not actually a part of the person, hence the desire to have it removed. Research has also shown that those desiring amputations have brain damage in the right hemisphere. Some other plausible causes for BIID put forward by researchers are

• Childhood trauma
• Obsessive compulsive tendencies
• Exposure to amputees at a young age

The wish to become an amputee or to become deaf or blind begins at a very young age, and usually begins between the ages of 8 and 12, although they seek treatment when they are much older.

So how do we treat BIID?

Sadly there is no cure for this condition. Most doctors prescribe cognitive behavioral therapy and antidepressants with the aim of reducing the anxiety, distress and depression caused by living with BIID. Treating the symptoms of obsessions and compulsions has also been proven to be successful in reducing symptoms of BIID.

Even after years of psychotherapy some people still wish to be disabled. Some may act out their desires by pretending that they are amputees using prostheses and other tools like canes in the hopes of easing their desire to be one. Some even resort to self amputation while some damage the limb sufficiently that an amputation becomes necessary. However the latter two are extremely rare.

While the obvious and most logical treatment for BIID may seem like to make the patient disabled. This is not done for many reasons.

• Amputations have only been shown to have a 70% success rate of resolving the symptoms of BIID
• The ethical  concerns related to amputating a healthy limb

 An interesting fact is that most victims of BIID are males, with an association with gender identity disorder, and certain personality disorders like borderline personality disorder. There also doesn’t seem to be a preferred side for the unwanted limb or any history of trauma to the unwanted limb among the prevalent cases.

Although it may seem impossible for us to wrap our head around the idea that someone would want to voluntarily become disabled, BIID or the desire to be disabled is a very real medical condition causing great distress to its victims.