For the past few days now, I've been in, frankly, a crappy mood. Partly, I blame it on the fact that I just finished a rotation in a medical specialty I thought I would thoroughly enjoy. - However, I found the experience un-fulfilling and it was bothersome to continually squelch the itch to discuss diabetes counseling or address a patient's major depression. Then there's boyfriend issues, best friend issues, family-wants-to-come-to-me-with-their-issues issues. And I'm pretty sure that I just ovulated. The whole experience again revived the "what should I do with my life?" conversation that places me in a chronic state of worry - save for those precious hours of sleep. I feel like everyone and their mother has settled on a career choice, while I found that mine was still somewhat up in the air. I was frustrated, I was moody, and I wondered - why me, why me?

Two things helped. Prayer, followed by incessant worrying, certainly did not. First, I needed someone to identify the problem. Boyfriend enters stage left. Sometimes, when I am so obsessively self-focused, I fail to realize that the fundamental problem is my reaction to the situation before me. Noticing and bearing the brunt of my foul mood, my boyfriend - let's call him Mr. P for being so sickingly positive all the time - wanted to know whether my worrying had solved any of my problems. No, it hadn't it only worsened them and prevented me from attacking the pressing needs of the day. I get it. The first step to solving a problem is naming it.

Second - and I know sounds incredibly corny - was to develop an attitude of gratitude. Perhaps, surviving my third year of medical school with a somewhat hazy idea of my future goals, is perhaps not the worst condition to be in. I hesitate to dwell on the notion - "well, at least I'm better off than..." Not the most effective strategy since usually, for every person I can say that I feel more well off than, there are hundreds out there somewhere relaxing in some luxurious island resort sipping on chilled mojitos. Instead, I remain thankful for the fact that where I am today is much better than my yesterdays. Much, much better. I am also thankful for the future I have to look forward to, and I am thankful for my support system which keeps me sane in the present.

During our psychiatry lectures we were intimated on the idea that one of the many contributors to depression is an excessive self-absorption. Although I cannot yet identify a period in my life in which I was depressed for more than a two week stretch of time (dysthymic, yes), I find that holds true, personally, at times. Gratitude, in a number of studies, has been linked to an overall sense of well-being, life satisfaction, and thankfully, better sleep. A brief review article on gratitude and well being can be found here, which also includes a six-item questionnaire. Of course, in the case of true major depression, addressing gratitude and other thought patterns may be a small component of one's overall treatment plan, which may include formal psychotherapy and medication.

Personally, I have tried to be more conscious of those quiet moments which provide ample opportunity for worry to sneak in. In their stead, I try to not only to refocus on some other task, but remember those things for which I am thankful for. The article provides several recommendations on incorporating gratitude into one's self-care regimen. Here are some along with others I found elsewhere.