size="30"
Entering a new place and conquering our own personal space, meeting new people, becoming familiar with rooms and corridors and making ourselves known, starting from scratch, is a challenge that all students have to overcome when they get into a faculty. Starting life as a medical student is another big challenge, as it requires a strong working method, focus and keeping up with a degree of demand hitherto unknown. Even those who had always been brilliant students in high school can experience a sense of failure and frustration for the first time. And they will have to continue to prove that they are the best.
If, in addition to all these challenges, the student has to leave his home and family and live in a new city, then the challenge is even greater and can cause difficulties.
Daniel Sampaio, then a Professor at the Faculty of Medicine and Director of the Psychiatry Department at Santa Maria Hospital, was always concerned about the myth that surrounded medical students, seeing them as individuals who had to endure everything, as they were not permitted to be fragile from an emotional point of view. This myth meant that, for a long time, students did not seek help, out of embarrassment. For these reasons, following the challenge set by the Student Association of the Faculty of Medicine of the University of Lisbon (AEFML), Espaço S, was created in 2013, relying on the material and human resources of the Psychiatry and Mental Health Department of the Lisboa Norte Hospital Centre (HSM). After some changes in the service room, in September 2017, and with the financial support of the Direction of the Faculty of Medicine, Espaço S moved into its own room at the Institute for Preventive Medicine and Public Health, relying on the support of a Mental Health Technician, psychologist Rui Martins and on the Coordination of Professor Daniel Sampaio. When necessary, Espaço S seeks psychiatric support in coordination with Santa Maria Hospital, while ensuring that there are no connections to the faculty's psychiatry professors.
His name is Rui Martins and he is the one who welcomes and listens to students who are seeking answers. He graduated in Clinical Psychology from the Faculty of Psychology and Educational Sciences, did an internship at Santa Maria Hospital, in general psychiatry, having access to food behaviour teams and suicide study centres. He is trained in family therapy. With extensive experience working with university students, he was part of a project, Unicidades (Union + University + Necessity), focused on the study of mental health and psychological well-being.
He worked with "peer groups," groups that expressed concern for other students and raised awareness of the other side of the faculty, promoting debates and organizing welcoming receptions for younger students. Bullying prevention was another concern. He has always worked with teenagers and young adults, and he has always been in contact with families and working with them, because parents also go through internal crises.
Sitting in the office while I talk to psychologist Rui Martins, I finally realize that all of us will face moments of family analysis or growth at some point. Going through a crisis is not the problem. The problem is when we pretend not to see it and we don't want to solve it.
Is it possible to find a pattern in the students who seek your support?
Most of the students who come here are second-year students who faced great difficulties with integration in the first year. They recognize that they went through really hard times in the first semester of the first year and they don't want to go through such an excessive phase again. There are key points throughout the course that can lead to crises: the first year because there is a huge change, then the barrier years, that is, those in which all the subjects that were left behind have to be completed, and then there is the year of the Harrison, the final exam that requires them to master a lot of information when they are already working.
There are many displaced students, that is, those who are geographically away from home. They already carry this risk factor and it is not unique to Medicine. They face adjustment difficulties, but in Medicine they have the aggravating factor that they need a lot of time to study and are far from their cities. Many times they don't even live close to the faculty, they live on the south bank, or on the Sintra line, having longer commutes. A student who is living in the family's home studies until dinner time and is only called to join the meal. He or she may help clear up things afterwards, but does not have to stop studying to clean the house. A displaced student has all those extra worries, tidying up the house, making dinner, going out shopping for meals. Then the physical space itself is different, most of them share houses or rooms and all of this makes it more difficult for them to adjust. Additionally, in many cases, this is the first time they leave their parents' home.
Is there an abrupt severing of the umbilical cord linking them to their parents?
This severing should occur gradually in adolescence. The cord should be stretched slowly, until it changes shape. And these students do it very radically, because one day they are with their families, and the next day they are many kms away, facing living conditions, habits and routines that are completely different from those of their family of origin. This is very tough from the emotional point of view. But this is just one risk factor that, when associated with others, can give rise to psychological disturbances. A pattern that can be identified in these medical students is that they are often confronted with their own incompetence for the first time. That is, when they get into Medicine, in 99% of the cases they are brilliant students, they were the best in their schools and then they come here and there is one subject or another that they cannot complete, they fail. As much as they are prepared, many of them find it difficult to feel and receive this new input from the surroundings that tells them, "all that you were able to be and to do, is no longer good enough."
I wanted precisely to come to this point to ask if we can establish a pattern for the medical student. And the pattern is saying that they were all excellent students and they know it. But in this new stage, someone shows them that no, they are not all excellent. Does this cause emotional damage?
There are many changes from the point of view of autonomy and this has to do not only with getting external things done autonomously, but also with the ability of managing changes internally. Most of them get here and are well structured from an emotional point of view, but there are others who are in the middle of this process, whose own family background has already involved some difficulties. Some of them get here and are not emotionally prepared for that reality check. This is hard to feel because they don't know what they have to change to be very good again and they often insist on the same strategies and keep using the same study techniques they used in their teens. For example, many of them were used to studying alone in their homes, for hours and hours; everything was protected and taken care of. They come here and they understand that they need to intensify this pattern, spend more hours studying at home. They are alone, there is no family to encourage them to engage in extra-curricular activities and when the first symptoms of depression appear, such as insomnia, lack of concentration or feeding difficulties; studying turns into a painful process. Their heads are spinning and their feel increasingly isolated, frustrated and anxious, because they feel insecure. When they try to pass a subject they have failed before, they reach very high peaks of anxiety.
How can you help them?
It has a lot to do with discussing these strategies with them. There is an objective and behavioural intervention, focused on solving problems. We find out what is wrong with their behavioural patterns and then we try to change those strategies in their everyday lives. We suggest that they create study groups and join other colleagues who are experiencing the same difficulties. Sharing helps a lot. It is not studying in a group, but there is a factor of social control; that is, when I am distracted and have a colleague who is focused in front of me, then I also manage to focus more rapidly and there is less dispersion. Then there is a sense of belonging: these young people, especially the ones who are displaced, find it more difficult to feel a sense of belonging because they feel that the people from their home town were closer and friendlier. But, in fact, these students are experiencing identity problems, because they will obviously have to choose new patterns, new lifestyles.
When do you feel an alert that your patient, in this case the student, needs extra support, namely by turning to Psychiatry?
Our model is based on a short intervention therapy. Our goal is to have interventions that are few and far between; we cannot have weekly interventions. The most serious clinical situations need weekly follow-up. We have 5/6 sessions to identify the problem, outline strategies and put them into practice.
After some time, we do a follow-up to find out how the students are feeling, but always leaving the door open so they can come back whenever they feel the need to. The most serious cases are referred to Santa Maria Hospital or to a referral hospital in the student's geographical area. In the case of a referral to Santa Maria Hospital, there is the risk that the doctor may become the student's professor so, at this point, we are seeking to ensure that the psychiatrists are not connected to the Faculty. This was one of the issues: the students were assisted in Psychiatry, where there were classes, and there they passed by their colleagues and felt uncomfortable. That is no longer happening, as they as being assisted in a different building (Preventive Medicine). In the first appointment I make the clinical history and a diagnosis to understand the severity of the situation and after realizing the options available for that situation, we either make an intervention here or refer the patient to another facility.
Has there ever been a case where you had to call the student's parents?
It has not been necessary yet, but it is not a possibility we disregard, because often the family itself is going through difficult times. The family goes through dysfunctional life stages, parents whose children are becoming adults, parents whose children are leaving their homes, many of them single children who were the only focus of the family. Parents could come and talk to me for a bit, yes.
Is there a normal dysfunction in families?
It is normal for families to go through phases of imbalance. When a baby is born and everything is disorganized, when the child goes to school and has to study and do homework, when the child leaves home and goes to university, or when there is an illness in the family. So families go through dysfunctional phases in which they become disorganized, but they often have resources with reorganizing and rebalancing capabilities. Going through a difficult period doesn't mean that the family has a problem. The problem only exists when the family cannot make the transition to another organized phase. The journey to individual and collective growth is made of chaos.
To schedule an appointment with Psychologist Rui Martins, you simply need to send an e-mail to
espacos@medicina.ulisboa.pt - with the following details:
Full Name, Date of Birth, Academic Year, Telephone Number,
This e-mail will only be accessible to the Psychologist, being entirely confidential and not accessible to any other person outside the Espaço S Working Group.
Espaço S is based at the Institute for Preventive Medicine, next to the Egas Moniz building, office 71, and is available during the following working hours:
Tuesday | Wednesday - 9.30 a.m. to 12.30 p.m. // Thursday - 2.00 p.m. to 6.00 p.m.
