Chihirochild, it makes sense to me what you are saying - about how you feel so fed up with always doing your very very best but still feeling terrible. In a way wanting to say "Stop the ride, I need to get off?"

I think the truth is that the career you have embarked on IS very demanding, and doesn't leave a lot of space for prioritising your needs in terms of scheduling therapy (as you alluded to) or being able to have "off" days. That is really why people who work as doctors are perceived as successful - because it does take a lot - you have to work these 60 hour weeks, you can't just take a few days or weeks off if you're having a difficult time, if you are going to be a doctor you have to somehow be able to push through it and still be on top form in terms of work, never making serious mistakes, etc. You've done very well to get to where you are. no doubt it is a demanding thing to do and there's not a lot of space for not coping or not being ok.

I guess people who manage these things, along with coping with mental illness, work out where they can find some slack and what can be prioritised or deprioritusef in life. So for example you mentioned that at present, the only way to get consistent therapy (as your pdoc doesn't reallly do therapy) would be to pay out of pocket, 10% of your salary. Perhaps in the balance of needing to be stable in your mental health, AND achieving a career in medicine, the thing that has to give is finances and you decide to make that financial sacrifice in order to keep the other two things afloat.

I feel like I understand where you are coming from a bit, although I'm not a doctor, but I have friends who are. But I also work in quite a demanding career, which could be seen as high-stress, and I also struggle with anxiety, depression and complex PTSD. I think I got to where I am mostly through sheer willpower and pushing through - I've had times of going to work shaking and crying, or having not slept at all, which is far from ideal. Doesn't usually happen any more, thanks goodness. But I also spend 10% of my salary on therapy - in the past it used to be more like 20%. I reckon it is definitely worth it as it allows me to live the happiest and most fulfilled life I can - also in terms of my career, I wouldn't have got to where I am, I think, if I hadn't had therapy, so in purely financial terms I think it pays itself back over the long term. The other thing I have learned is to use annual leave to support myself - to schedule breaks and holidays for times when I am really struggling as far as possible - and then just to order my life to promote my health and relieve my stress as far as possible - always taking a lunch break, spending time with friends, that kind of thing.

I've also had the experience of wanting to communicate that I was really not ok. On one occasion, my T was on the verge of calling an ambulance for me. This would not have been the end of the world of course, and I think ambulances in the UK at least are very used to dealing with mental health crises nowadays. But it would have meant - I have to take time off work - I have to tell my boss what's going on since I have to explain why I'm not at work - I might get sent to see some mental health professionals on the NHS which means no choice over appointment times so more having to take time out of work and having to share info with my boss. As I said it would not have been the end of the world, but it's something I would rather not do, and I think the fact that I've always somehow managed to avoid this is good for my self esteem and therefore good for my mental health.

I hope it's useful but sorry if it's not useful or even annoying - what you wrote resonated with me which was why I wanted to share my thoughts.