Stress in the South Seas

“Talofa and welcome to Samoa” were the words that greeted me as I disembarked the aeroplane. My 44 hour transfer over, I was now to spend the following 6 weeks working as a trainee doctor in Samoa’s national hospital (as part of my medical degree). Walking along the tarmac I suddenly realised I knew practically nothing about the country I was now in. In fact almost the only information friends could tell me about this South Pacific nation (those who did not mistake it with Somalia that is) was that “the Samoans are the happiest people you’ll ever meet”.

This intrigued me. Could an entire 3rd world nation, where many struggle to afford food, be that happy? A 2006 worldwide survey of lifetime happiness believed so; ranking Samoa a lofty 14th (compared to the UK’s 109th – perhaps it was raining that day?).

Indeed it was not long before I too had to agree to their consensus. Everywhere you looked, people were smiling and laughing and this continued in the capital, Apia, where its roads were full of car horns beeping at each other – not out of rage but rather to greet the next car/ pedestrian that the driver recognised.

This joviality extended even into hospital; where although more subdued; EVERY patient would shake your hand and smile; with many laughing too. At times their happiness appeared quite frankly bizarre; my favourite example being a man I was treating for an amputated hand lopped off in a drunken machete fight. He was still joking with the man who brought him in who it turned out, was both his brother-in-law and attacker! Happiness it seemed was just what it meant to be Samoan.

That was until one evening shift. Mr. TG was a 25 year old waiter who at his turn, like the patients before him; smiled, sat down and shook my hand. But then he cried. After apologising for “wasting my time” he cried some more. Slowly TG described how he was struggling to cope with the pressures of working long shifts for poor pay; all the time knowing that multiple elderly family members were relying on his pay solely to afford food. TG explained that over the last 4 months he was constantly upset, felt emotionally numb and was avoiding people – instead he spent many evenings drinking in bars. He also added that both friends and family were entirely oblivious to his troubles and that he had come to see me in secrecy.

His need for secrecy, I discovered, was because Samoan culture dictates that family members serve their elders without complaint. By even being at the hospital therefore, TG was in effect insulting those he was born to serve; by implying them to be part of the problem. It is from this cultural stress that Samoa can appear such a joyous idyll but can also claim extremely high teenage suicide rate which (corrected for population size) is 4 times larger than the UK’s.

TG was suffering with depression. What makes his case so interesting is that he exists in such a “happy” environment making him, understandably, feel that he was the only man in the country to suffer as such (Samoa’s suicide rates suggest otherwise).

In the UK we perhaps suffer from a similar cultural peculiarity. Although social awareness towards depression is improving, there is still a definite stigma attached to the condition. Thus although our own backgrounds are completely different from TG’s, the same problem exists – sufferers feeling unable to openly seek help. Sadly people feel alienated from society and it is these feelings of isolation that only act to perpetuate their depressive state.

Simply put, depression is a state of continued low mood which interferes with day-to-day functioning. In the UK it is a common malady – 1 in 5 will suffer from clinical depression at some point. To treat depression this low mood needs to be elevated to more normal levels and some of the techniques used to do this can also be employed for people just suffering from a transient periods of low mood; when times are stressful. In both groups of people – functionality will also improve with mood elevation.

For many, the looming exam period is just such a time when our mood can darken and it is no wonder. During revision period we undergo hermit-like transformations, isolating ourselves from friends, family and the wider world whilst obsessing over tomes of half-legible lecture notes whilst the exam date slowly creeps menacingly forward. So in order to keep your mood up and to protect your mental health during this testing time, here are some techniques you can try, which as you will see, TG failed to follow:

Talk about your fears. “A problem shared is a problem halved.” As TG’s case showed, you are NEVER alone in what you are feeling – so do not feel the need to bottle your worries up! Talking therapies are offered to depressed patients and you can replicate this less formally by speaking to others about your worries. Remember that your sounding board can be anyone; housemates, friends, family, university tutors, university counselling etc. Even Nightline is there for you – and they are literally waiting for your call.

Sleep well. Depressed people often suffer with poor sleep patterns. Giving yourself enough sleep improves mood and productivity. Incidentally sleep is actually a requirement by the brain in order to form long term memories – which is the whole point of your revision!

Exercise. Exercising naturally boosts mood and is suggested as an early and effective treatment for depression. Try to exercise (in some form) daily. Not only does this help your mental health but it can act to give you the revision breaks you need. If possible, get out of the house and share these breaks with others. They can remedy the social exclusion you’ve inflicted upon yourself by revising hard. If nothing else, leaving the house is a good reminder that there is still a world out there that does not follow the University’s timetable!

Eat well. Keeping yourself properly hydrated and eating a balanced diet will help your sense of well-being. Also, DO NOT cut out comfort foods completely! They are invaluable when you need that little boost.

Avoid alcohol. Alcohol is a natural depressant and thus acts completely against what you are intending to achieve. Although an odd drink is fine, try to limit its consumption…until after results!

In conclusion, by keeping people involved in your concerns, avoiding alcohol and keeping active (3 things TG failed to do) you can help boost your mood and thus enter those exams having coped with the surrounding stresses in a way more protective for your mental health. It may not improve your exam results greatly but you should be able to go into them as a more normal form of yourself than you would otherwise have been.

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