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Wow, what a wild week or so it has been. A lot of anxiety with the build up and preparation for returning to the RCGP in person. Booking parking, workout out travel plans, preparing myself mentally to be around so many people again, and running through scenarios. All so much, after a long period of being fully in control of my surroundings and situations. 

After some careful planning, I was lucky enough to find a parking spot, right on Euston Rd, just a few mins walk away from the RCGP, for a very reasonable £19 for the full day. I KNOW !! Bargain or what? Double the price of the train journey, but 1/10th the stress of the journey, and also enabled me to take things with me. In this case, running gear. Deciding to beat the traffic I aimed to arrive for 7am, get parked then head off to Regents Park for a morning run. Then head back to the car, grab a change of clothes, and get changed and freshened up at the RCGP. All went to plan thankfully, a nice 10k run helped me clear my mind of the usual pre session jitters.

Arriving at the RCGP and getting changed with minutes to spare was perfect for my mind. No time to wind myself up, just get my schedule, get my brain into gear, and away we go. Five morning sessions, five afternoon sessions, so quite taxing on the brain, but very little down time in between just keeps things flowing.

The first session or two went OK, the groups interacted well, some nice discussion after the scenario's were finished. A couple after that felt a little less enthusiastic, little engagement after the scenario, so felt a little bit clinical. With the last session of the morning done, I headed off to lunch, refuel, recharge and get my head back in the game. That said, exiting the RCGP onto Euston Rd, at lunch time is hardly the right setting to refocus. So I headed off to Coal Drops Yard. 

What a little sanctuary that place is. In the middle of town, but a couple of streets back from the madness of Euston Rd. Sitting by the canal, taking in the sights, and chowing down on some unhealthy Burger King for lunch, I was at last at one with my thoughts again. Reflecting on the session for a moment, taking time to digest how each group had made me feel, (and writing this now) made me realise how important to me coming out of role at the end of each consult is. If I have sufficient conversation after the scenario, discussing my own mental health, I seem to disengage with the situation a bit better, and it feels a little less "real". 

By that I mean, if you repeatedly go through a scenario, one which is a reflection of a real experience for you, eventually it begins to actually feel real, and current. For example, towards the end of the afternoon session I started to actually feel like I was having a proper consultation, and the answers to the question felt like I was speaking as if I was in a proper consultation regarding my concerns for my mental health. Coming away feeling as if I was about to take the first step of recovery all over again. Not a great place to be I have to say, especially when self induced. 

Obviously, dealing with these things is par for the course, and like any other issue, you first have to identify it. So at least that part is done. Now I guess is how to deal with it. On speaking to a couple of the tutors on Friday, they are open to how the session runs, and I have some input on it. My thinking here is for me to somehow find a way to create an air gap between expert patient me, and roll play me. Just to give my mind a little time to balance itself, and help be keep a clear line of what is real, and what I am role playing. Something to think about for sure. 

As ever, speaking to some of the students, it was nice to see how interested some are in psychology, and mental health in general, and also how naturally some of them dealt with the awkwardness and obstacles of a mental health consultation. I always find it interesting how the level of engagement can differ group to group, and indeed how this seems to be connected to their tutor for the day. Doing two circuits a day, I generally see 10 groups of students, with 5 tutors, so see each tutor twice per day. Within these sessions, I will tend to get similar levels of engagement from each of the groups with the same tutor. I shall explain, tutor 1 through to 5. If the groups with tutors 1, 3 and 4 are positive and engaging in the morning, the next groups with those tutors in the afternoon will be too. While 2 and 5 will be less so, both times. Does that make sense?? I feel like I am trying to explain my symptoms to a student now! 

Hearing how the tutors explain things to their groups is also interesting, and gives an insight into how interactions with GP's in general can differ. Some deeply compassionate, speaking of engagement, and empowering the patient. Others keen to make sure all the safeguarding issues are checked off ASAP, but feeling less involved somehow. None feel terrible, but some certainly feel more empathetic than others, and obviously that in turn rubs off and shapes the up and coming students in a small way. I have grown far more confident these days is disagreeing "as a patient" with things that are said, and making sure I explain how my experiences don't always gel with what is taught as standard. 

Time and time again we cover the stigma of certain topics, and I share my take on them, which of course is not the same for everyone. Mental health in itself has the biggest stigma attached to it, or at least it did have. Now it has another issue, but I will come back to that in a moment. The other stigma seems to be around asking patients certain questions, and how they are tip toed around. The main two being "do you use any recreational drugs" and "have you considered harming yourself or others". In the given situation, neither question should really be an issue these days. 

Recreational drugs are more prevalent in todays society than ever before. People openly use certain drugs, talk about them and ever seem to promote them in certain situations. Cannabis for example being popular to help with depression as well as other things. So being asked in a confidential environment if you have used anything like that really doesn't cause much embarrassment for many these days I would not have thought.

As for self harm, well.... Suicide is no longer something people are not aware of, or believe only affects a few people. It is common knowledge now that certain groups of vulnerable people in society are at much greater risk from thoughts of suicide. The word is used on TV, billboards, magazine and online advertising etc. It is not a forbidden word anymore, and should not be treated as one. I asked a number of the groups in post scenario conversation, could they ask their friends in general conversation if they had ever considered self harm. Most said they didn't see why not... To which I replied, "what's the difference then". Sure, you have a mentally vulnerable person in front of you, and you are trying to help them, but mentioning suicide is not going to encourage them to consider it, put ideas in their mind, or make it any more likely. If the thought is there, they may or may not tell you. I would think some would be relieved to tell someone that they are thinking that way. Someone who is finally listening and asking those questions.

Coming back around full circle, mental health has another issue these days, and it's not stigma anymore, it's "popularity". Once upon a time people didn't like to talk about anxiety and depression. Mothers coped with it in silence, fathers drank themselves under the table, and any other stereotypical coping mechanism story you can think of. Then of course there were the Prozac mums, around the 90's (guessing here) it seemed that it was the done thing to pop some pills, forget about your worries, and life in some cases. But now we have moved on a bit, and people actually identify having mental struggles, and seek help over it. In more recent times A-list celebs have also started to talk about their battles, and I think that is almost where the problem starts. 

At times, I really do believe that certain conditions, especially mental health and brain related, can be fashionable. Of course a rise in awareness will help some identify with certain conditions, however I get the feeling that some identify with the sense of belonging, more than the actual condition. Now I am in no position to tell anyone they are not struggling in any way. I have only my own experiences to guide me on my understanding of anxiety and depression. A couple of weeks ago I was privy to a session hearing about other conditions, and have to say I was somewhat humbled at hearing what others go through. So I am no expert on mental health at all. 

That said, sometimes when speaking to people, you get the "I know how you feel" line, or the "oh me too", followed by a story of a very basic negative experience, which somehow left them feeling a little bit let down. Nothing much more, and the conclusion of the story will probably confirm that later that evening, all was well again. A far cry from a simple experience triggering a few weeks of isolation, self loathing, and feeling of complete and utter rejection and failure. 

Of course, we are all individuals, and experience things differently, so one persons bump in the road is a catastrophic car crash of the mind for others. So I try not to judge. But sometimes, you just can't help but feel that there is SO much of a certain condition, just a short while after it became popular. Which in turn puts a massive load on the system, and drains resources away from those who need it the most. 

Every time I speak to a friend who has experienced the true lows of life and the mind first hand, I have a little more of a feeling of normality, and it is always nice to reflect with someone in the know, and compare experiences, to learn a little more, and gain a greater understanding of the whole situation. Being able to understand, and then take that back to groups such as the RCGP, and help others understand, just feels like some sort of validation for me. 

So.... as you can see, a quick 8 hour session at the RCGP gave me a lot to think about, and truly mentally exhausted me. Thankfully I had the foresight to book Monday off work also, so I would have a little more time and space to reset. Heading to the coast on Saturday, to let the wind howl in the hollow between my ears, and a long bike ride on Sunday just to get back into the rhythm of things. For my day off on Monday I decided to go for a nice half marathon distance run along the Thames Path. Switch off for a bit, and exhaust myself physically. It certainly seems to have done the trick. 

After a short bike ride with a friend yesterday I was all but spent, and decided today was a good day to do nothing. No training, no running, no cycling, just popped to the shops, and then did some work.  The rest of the week is a bit full on, but that is probably a good thing. Days like today remind me that I need to keep my mind occupied, as time alone with my thoughts is not always a good thing. In fact, writing this reminds me that regular blogging is also great exercise for me too. Something I need to do more of for sure.


Right, I will leave it there, I have already started rambling! 

Thanks for reading, and as ever, look after yourself, and look out for others.  

It has been a long time since I last wrote an entry here, and for the most part I would put that down to the vastly improved state of mind I have had over the past year to 15 months. There have of course been lows, but nothing in comparison to what I would usually go through in my yearly rollercoaster ride of mental state. 

So much has happened in the past year, I really don't know where to start, so in no particular chronological order, I will break it down into pieces, and have a ramble. 

RCGP. I have been working with them again this year, helping medical students better understand the presentation, diagnosis, and treatment of anxiety and depression. It never ceases to amaze me how natural some are with the situation, and show genuine compassion. While others struggle a little, almost suffering from reverse stigma, and feeling uncomfortable about discussing someone elses mental health. It is those I hope to make an impression on the most. This years sessions have been very different, moving to online Teams consultations. Which in itself has taught me a lot about myself, whilst making life a whole lot more comfortable. Mainly because it avoids the commute into town to the RCGP, which in itself is hugely stressful for someone with social anxiety.

Working from home has been a complete game changer for me, I should have started with this really, as it could drag on, but here goes anyway. 

Being quite and introvert and socially anxious person, personal interactions with others can be quite draining. Over the past year or so, I have felt much more alert, and fresh throughout the working day. Not spending mental energy on social things that actually have no impact on my working day, and rather spending the extra energy I find myself with, getting stuck into projects at work. The physical aspect of getting to the office has never been an issue for me, in fact I enjoyed my daily 10 mile each way commute by bike, as it gave me time and space to prepare myself for the shift ahead. The more exhausting part was being in an office, and that was purely mental exhaustion.

That is just the tip of the iceberg for working from home for me. There are SO many pros, and at best a sprinkling of cons. Being able to work whatever hours the day demands is no longer a stress. Getting a call to say there is a sickness, or something is up and I am needed in ASAP, once meant rushing my routine (which is very important to me) and driving into work. This was always the start of a bad day. Now, the same call means walking into my home office and logging in. Be it for 5 mins, or the rest of the day, I am in effect "on call" whenever needed. 

As far as mental wellbeing goes, I can honestly say, in 15-16 months now, I have had one dip. It lasted about a week, I had a lot going on at home too at the time, and at worst it meant a slight lack of focus for me, nothing more. Even through the winter months, which we have effectively had 2 cycles of during WFH now, I have been much better than I can ever recall being in many years gone by. The much expected low simply hasn't arrived. I have no doubt in my mind whatsoever, that working from home has been the key to this massive shift for me. 

Although as I write this, I am more than aware that the end of June is just over a month away. This is the date for the next "checkpoint" for the UK Government, and indeed my employer to consider, and detail the next stages of what is to come for the "new normal". This in itself has probably wobbled me more than anything in the past year or more. The uncertainty of what comes next. Will it be all back to the office, will there be a choice? Flexible working from home and office throughout the week has been mentioned. As has the "choice" of home or office. Personally, for me, home is the best way, and the only way I can stay on this level. 

I know it is expecting way too much, and it is far from a demand. Having worked for the company for over 20 years now, I know how important oversight is for management, and appreciate the trust put in us to work from home, and be trusted to go the best possible job we can. But you cannot ignore the fact that during the pandemic, while it has suited, it has been OK. The idea for certain departments to work from home in the past was simply out of the question, and not a discussion even worth starting. However I think, if the recent events have shown us anything, it is that it IS possible, and the outcome is probably more a more productive, coercive workgroup.

I think it is clear from the paragraphs above, what my feelings are on returning to an office environment. I simply don't want to. I am happy to be checked up on, visited at home, or whatever other measures are required to keep me safe and alone in my home office. Which I have to say is a lot better equipped than my office based desk was. Mainly through buying things at my own expense, but something I am quite happy to do in the longterm. Heck I would even consider a pay freeze for a while, How's that for an offer?

Anyway, enough about working from home, for now at least.

In other areas of life, the fresher state of mind for me has allowed me to look after myself physically too. Cutting out a lot of the junk food, which was mainly whilst in the office at work. Taking the time I would have spent commuting to take better care of myself. Getting back into running has been huge for me. Since Xmas I have gone from doing Couch to 5K, to running a half marathon distance. A distance I have never achieved before, so to day I am feeling good is an understatement. That on top of working out, and still getting as much cycling done as I can, and that all rounds up to another huge tick in the box for this new normal.

I think one of the strangest parts of the whole thing has been the social isolation. Something I crave most of the time, suddenly became something everyone was doing. No longer was it a fight to get personal space, in fact it was insisted upon. It has been quite incredible, and I know that there have been other friends of mine who have found it equally as much of a relief.  That is not to say the isolation for many has not been crippling. 

I am not going to sit here, and selfishly say how great things have been. The pandemic has been horrific on so many levels. Losing loved ones to a cruel virus, being kept apart from those we crave to be with, for long durations, business collapses and so many other horrible effects from it all. The pandemic is not one of those things this generation will ever forget. But on the flip side, some people learned what it is like to feel detached from society, unable to engage, as much as you would love to. A greater understanding has been found of what social anxiety feels like. In this case, afraid to go out in case of catching the virus, but to many like me, the same anxiety is found simply by going out and interacting with others, even when they are perfectly healthy, and of no threat.

OK, my brain is a little fried from this sudden outburst of expression, so I am going to leave it there for now. But will come back to this soon, and carry on my catch up on how things are. 

Thanks as ever for reading.

Take care


You may recall last year I did a few sessions with the Royal College of General Practitioners in Central London. Working as an "expert patient", I assist with role play scenarios, giving the students the chance to interview, assess and mock treat me.  For anyone not in the know, I have a long history of anxiety and depression, and was asked by my local GP if I would be interested in helping with teach the future generation of GP's better understand the conditions by doing these sessions. 

So, after last year, I thought it was all over with, and heard that there would be no more session. However to my delight and surprise I received an invite a couple of months back, to do a session in September 2019. Needless to say, I booked the time off work, and last Friday I went along. 

I should say before I go on, that these days in the past have proven to be quite mentally exhausting. With the travelling at peak times, to Central London, then doing 8-10 sittings with students, re-enacting the presentation of the condition, it all starts to become a little too real by the end of it all. So facing rush-hour on the way back home, can sometimes be almost a step too far. 

With this in mind, for this session I decided to switch things up a bit. Rather than presenting with anxiety, which is quite a high energy feeling, I decided to go with depression this time. Strange as it sounds, and in no way saying it is easier to cope with, the energy needed to present as depressed is far lower, so far less taxing on the mind. With 10 sessions to do on this day, it was the right decision. It probably worked out better for the students too, as this was their first few weeks as Year 3 students, and many have not even touched on mental health. Win win you might call it. 

Seeing the difference in reactions between the groups of students, presented with something that has no physical manifestation to examine was quite interesting, and secretly a little amusing. Their faces as the presentation started showed a fresh thought process was  underway. Each time I presented I would switch up the language used, the prompts given, and the assistance with the flow of the situation. I was delighted to see that none of the students felt they were entirely comfortable or confident in running through the whole scenario without the assistance of their colleagues and tutor who were all in the room. Not to proud to ask for a time out and see what others thought, very refreshing. 

To help matters along, my own state of mind was good this time. In the past I have wound myself up about the whole event, and started the day on a downward spiral, and finishing the day a lot lower than I started. On this day, due to good self management, finding my own time and space, and a smooth running session, all was well. For the first time, I didn't stay in for lunch, but instead opted for the fresh air and scenery of Tottenham Court Road. Not wanting to get caught out with a low battery on the phone, I had taken a portable power bank with me. Complete with the WRONG USB lead! £15 for a USB type C lead was somewhat upsetting, but needs must, and it kept me sane, so money well spent... I guess!

By the end of the day, I was fresh as a daisy, and ready to do battle with the commuters on the way home. Luckily for me, we were out a little before the main event of Friday rush hour in London begun, so by the time I got to Highbury and Islington for my train home, a seat awaited me. It was nice to be on a train at the start of a journey for once, and get a seat, while seeing others stand as they got on later into the journey, boarding at stations I have joined at in the past while commuting.

While at the RCGP, I connected with a few new people, one of which who co-ordinates other similar role play days for students etc, so I am hoping to hear back from her, and see if I can offer any help on other matters in due course.  I have been quite slack in my drive to help others fighting mental health issues, for numerous reasons, none of which are particularly astounding or worthy, so it feels good to have done another one of these sessions, to at least do a little bit to help. 

Til next time... Take care all. 


After a bit of a wobbly morning, and a nice long 3 or so mile walk at lunch, it was time for the afternoon session.

I have been trying to drip feed the info a bit more this time around, as the first time I was here, I felt I was giving it all away a little too easily

Morning sessions were all positive, great interaction with each of the students doing their differential. However this afternoon, I have just come out of the first session and am genuinely blown away by the approach  professionalism and thoroughness of the first student.

Her approach was spot on, as if she has done this 100 times already, however it turns out it is just her first  time doing mental health this week. Calm, interactive, patient led and compassionate. You can't teach that sort of persona.

This is not to detract from the other brilliant students I have interacted with already today. Each one of them is fantastic in their own right. Simply for being in the line of education they are in, they get my full respect. Not to mention how each one has been brilliant in diagnosis and patient interaction

But sometimes one person really stands out, and this was the one this time around.


Just come out of the second session, and again, amazing! Empathy in gallons, understanding, and all the right questions and replies. 

Going back to me for a bit. This morning was a little draining. Feeling situational anxiety I think would be the right way to put it. As expected, the slight drain on my energy levels of late has had an impact  However it has also taught me something about myself too.

Situational anxiety, is not the same as general clinical anxiety. They may present the same, but bounce back from situational is instant, where as being clinically anxious and going through a full on episode is completely different  thank heavens! I can understand more now when people say they feel anxious for a moment, and can better relate to what they mean by it. I have felt it many times before  but this is an eye opener for me, and I can now feel the difference.

Similar with depression really, although my feelings of genuine depression are a whole lot lower than when I feel, what I call "down". But I can understand when people call it being depressed about something all the same.

I do love a situation where everyone is coming away with new knowledge, and today is certainly one of those times. Last time I said I thought I felt anxious about talking about anxiety, and presenting with the symptoms again. I can confirm this is the case again. Reliving the visits to the doctors really does bring things to the front of your mind and can start to feel really real. However I won't stress as I know how it passed last time, and will again this time.

Well, here I am. Just got here on a rather wet an woeful day. Thankfully I have slept a little better over the last few nights, after having had a cold and struggled earlier in the week.

Currently sitting on the floor away from the group of actors and other real life patients, partly because I am still full of germs, and partly because its just nice to have some space after spending an hour on public transport

Second time around is a lot easier for sure, far less nerves about what to expect. That said, anxiety is knocking at the door, but in a very calm and gentle way. I got this! I have my rota for the day, and no quick escape this time. Rathe than a free session at the end of the rotation, I am in with a group, so my escape is delayed. Hopefully (and my biggest concern right now) I can get on a train and on the way home before the mad evening rush starts. Last time worked out just right.

Took a different route here today too, a little bit of variety is good for the soul  and keeps me trying new things, rather than sticking to the known all the time. Got to keep on top of things eh. Thankfully the longer section of my journey home starts at the first station  on the route, so the chances of a seat are much higher, especially as its London Overground. Fingers crossed eh. To get there is one stop on the Victoria line, which was rammed this morning, urrgh..

I travelled to London Bridge earlier in the week too, again around peak time, so if I say so myself, I have done well with the whole travelling thing. I think the hardest part has been the whole feeling crappy thing. Sniffles and travelling do not go well together.

Right, better get my head in the game, and think about my scenario for the day. Maybe the same as last time? That seemed to work out OK.

Oh no! I gave myself plenty of room here on the floor, away from the hustle and bustle of everyone else. But just like parking spaces, one person in an open area seems to attract others, so now people are setting up around me. Doh.

Not the end of the world, I am just making it out to be more than it is. Anxious thoughts, creating anxious feelings. Calm down Michael, its all OK. We will hopefully be going in for the briefing soon, then onto the sessions. I am straight in at 9.30 today, so time to calm down, prepare and do my thing.

Here goes...

Have a good day all.

The clock is ticking down on my next session at the Royal College of General Practitioners on Friday, and I have to say the suspense and stress is building. It will be my second rush-hour trip to Central London in the week, which never bodes well with me even at the best of times.

The first session I did was a real eye opener, and while it was fun, it was quite draining too. That was starting from a nice high spot in my mental cycle. This time around I am somewhat lower than I was before, so it will be interesting to see what impact that has. Whatever the cost to me, the important thing is being able to help the students understand the presentation of anxiety and depression.

On the plus side, the whole day is a known thing now, it is not full of surprises and uncertainty, so that will help enormously I am sure. I will just get there nice and early again, missing the majority of the morning rush, and have a little wind down walk before getting started.

I will have to put some thought into the scenario for this time too. I am quite happy with the original, but it is good to mix things up a bit. As much for my sanity as theirs. Really is quite draining mentally, recalling events from your life, and playing them out in a scenario over and over for a day. By the end of the day you are mentally exhausted. I kind of envy the actors who also participate in these events. Surely it is much easier to pretend to suffer with something you don't already struggle with. Maybe I am wrong, who knows.

Either way, as I say, the main thing is the students come away from it all with a better understanding. I really do want to have more time to answer questions, and help in any way I can. With so much work being done to raise awareness of mental health issues, it is only right to make sure it can be identified and caught nice and early, so help can be given before the issue worsens for the patient.

Which reminds me actually, I have got to read back through my emails, and do a submission to the BMJ as suggested by Niki. It may come to nothing, it may be the beginnings of being able to do something more positive, time will tell. Not like I don't like writing now is it!

Right, better get my head in gear and thinking cap on, ready for the (next) big day.

Thanks for reading.

PS, students, you can now find all my MH writings on my new website (if you are not already reading this entry there)