It’s February 2022: the world has been in a pandemic for almost two years and my life – like that of many others – has been characterized by strict lockdowns, absolute travel restrictions and general anxiety about the coronavirus. On top of this, halfway through my PhD my life couldn’t have looked more different from just before: I had switched from being a physician to being a full-time student, spending most of my days working behind a computer in the lab instead of running around a busy mental health hospital. I no longer lived in the country where I was born and raised (The Netherlands) but somewhere (Israel) where I didn’t even speak the language.

Although I am highly passionate about the topic of my PhD (Post Traumatic Stress Disorder) and love doing my research projects, being a PhD student – especially in a foreign country – comes with many challenges. Some expected, some less so. Some are overwhelming, others somewhat minor. It’s a process of introspection and accepting strengths and weaknesses; of showing vulnerability and accepting help, while also being self-reliant and independent. It’s a journey, and although beautiful it’s for sure far from easy.

The Early Path

For as long as I can remember, I wanted to work in healthcare. My parents – both originally trained as nurses – might have had something to do with that. They never pushed me (or my three younger sisters) into any field but growing up we saw the high level of fulfilment and variety in their work and how the irregular shifts made it possible that there was always someone at home to take care of us. Medicine had always felt like a calling, but – as in many other countries – getting into the medical program at universities wasn’t a given. Somehow, with much luck, I obtained a place.

Going into medicine felt like a dream, but it wasn’t an easy adjustment. During the first year, I failed many exams: I simply didn’t know how to study. The truth is that we didn’t get much support in our adjustment process. It felt more like a “survival of the fittest” type of race, also reflected in the fact that only after two weeks of the first academic year, all students were dropped into the dissection lab. At this point, if you changed your mind about your career, at least someone else could still take your place. The real-life consequence was that we were always under constant stress. See one, do one, teach one: that was overall the message with which we were taught. You don’t complain, you just adjust. The high levels of perfectionism among us medical students (including myself), made that we were constantly trying our absolute best to meet the extreme standards. We were expected to dedicate our everything to medical science and clinical practice: even though it highly impacted mental health, with anxieties and failures sometimes being all we talked about.

And so, the following years were years filled with studying, clinical practice, and a variety of healthcare-related jobs. All of which with as main aim to prepare for having an as good enough CV to apply for residency after the university years. This meant that I always was trying to fit more into my time, making everyday life even more stressful. To cope, I took generous breaks in which I travelled – solo – around the world, sometimes for months at a time. However, somehow there was always this ache to get back into the routine of hospital work. The human contact, the puzzling to figure out health complaints, the hectic nature and unpredictability of the work.

Truthfully I never really gave research much thought. Within medicine, it’s often seen as boring or something that you do to give your CV a boost. But during my last year of medicine, two major things happened: I conducted an exploratory study and loved the research experience, and I travelled abroad for volunteer work and fell in love. Somehow this led me to find a PhD position in Israel.

The Honeymoon Phase

Looking back at the first phase of my PhD, I had no idea what I was starting. It felt like a true ‘shidduch’ (Yiddish for ‘match’). I had doctorate lectures and mentoring once a week, and although given in Hebrew, I was so excited to start the challenge, thinking it wouldn’t be too hard to get hold of the language: after all, being Dutch meant that I had always been exposed to different languages. I was excited about working on the research proposal, completely dedicated myself to literature reviews, and worked to develop the novel lab tools that we’d ultimately be using for the research. I loved the freedom that doing research brought: the flexibility to somewhat shift around my schedule and being able to actually take a break in the middle of a day. Something that in clinical medicine often is a complete luxury. I went to exciting new places, ate new foods, met with new and old friends, and had family visit. I couldn’t believe how I ended up in such an amazing place and felt full of energy, ready to tackle any problem that might come my way.

The Breaking Point

Researchers have found that emigration comes with different emotional stages. After the honeymoon phase, many emigrants or expats experience a sudden culture shock. Typically this shock appears after about a year of living somewhere when the first wave of novelties and excitements disappears and the reality of daily life and difficulties sets in (Oberg, 1960). Yet the psychological optimism bias often makes us think that something negative happens only to others, not to us.

And so, I was convinced that the cultural and practical integration would be smooth sailing; or maybe I simply didn’t give much thought to the fact that I might experience a crisis. It’s hard to say how much my personal circumstances contributed to the culture shock and to what extent I would have experienced a crisis either way. But as the first academic year progressed, my research progress slowed down: I couldn’t keep up the pace I set for myself, I felt unhappy dedicating all my working hours to my PhD, the lab development appeared much more difficult than I had expected, and above all: the coronavirus pandemic hit.

COVID-19 meant that the country could go into full lockdown at any time from one day to the next. And over the course of the two years the pandemic has lasted, this is exactly what has happened on multiple occasions. Things that I really looked forward to, such as my best friend and parents visiting, face-to-face collaborations and conferences, and inclusion of patients for the clinical phase of the study, suddenly were out of reach or further away than initially planned. In addition, I wasn’t allowed to come to the lab, sometimes for months at a time. This significantly slowed down the research process and meant that I had to adjust to working from home. Adjusting to working from home wasn’t easy. Instead of having my days and weeks planned out either by the university or an employee (as was mostly the case when in clinical medicine), suddenly I had to get myself to work. Every day, every hour of the day. Finding motivation for long-term tasks, not being able to really interact with my colleagues and sometimes just clueless on how to tackle certain tasks. Slowly but surely the initial motivation I had felt turned into somewhat of a dreadful feeling.

Further, my language skills weren’t progressing, and besides this being a major frustration, I also had to cope with many instances when I simply wasn’t able to express myself at all. Basic tasks of everyday life, such as going to the supermarket, the gas station or the post office, suddenly appeared as huge hurdles. I had to mentally prepare myself for going, rehearsed potential conversations in my head, and completely blanked out if things didn’t go according to how I pictured it. With normal social life under major restrictions, and us sometimes not being allowed to move further away than 200m from our house, I got further and further into a negative spiral of frustrations, anxieties and insecurities. Without me realising really what was happening, I developed substantial anxiety for social interactions. All of a sudden, from being an independent and outgoing person I found myself home dreading to put myself out in unfamiliar places. 

The Acceptance Process

Like anything, sometimes we have to come to a breaking point before we realize something isn’t working out and we need to take steps to change the situation. For me, it came down to the point where I just couldn’t deal with daily tasks anymore out of fear of not being able to communicate, as well as feeling completely overwhelmed with cultural differences. I felt uncomfortable, homesick and insecure. I couldn’t continue like this: I had to refocus. I had to accept that things sometimes simply work differently in other countries than what we are used to from where we grew up. And that doesn’t mean one or the other is better: it simply means it’s different and that we sometimes have to step outside of our comfort zone, open our eyes to dealing with things that are different and acknowledge our vulnerability and unfamiliarity.

In addition, there were certain things related to being a PhD student in general that needed to be dealt with. I had to accept that being a researcher was something I wasn’t necessarily trained to do. So why wouldn’t it be ok to sometimes not know exactly how to tackle a problem? I decided to stop focusing on perfection and start appreciating the small milestones. Whether it was reading a few research articles, writing 200 words on an academic paper, or attending a lecture, it was still progress. I had to start accepting that unexpected delays always lay underneath the surface and start breaking down my daily goals in small, manageable steps.

My mentor, Prof. Sarah Rosenblum (who is an occupational therapist) had addressed the need to set yourself small milestones to achieve, yet I simply hadn’t implemented her advice. Why? I don’t know, maybe I thought I would be able to keep the focus without it.

As PhD students we are often pushed in a certain direction, regarded or even required to give our everything to research and academia, to keep pushing ourselves and forget about the challenges that may arise in our often stressful and demanding careers. Yet, we all go into academia with personal motivations and specific objectives. Along the way, it’s often difficult to stay focused on the person and drown in the workload, especially when you find yourself in an unfamiliar environment or are dealing with anxieties and insecurities. However, to get the most out of this time that you set aside for your professional and personal development, you have to stay true to yourself, otherwise it will most definitely negatively impact your mental health. You have to find your own path and spend time on things that you feel are important. That makes you as unique as you are. 

Conclusion

If there is one thing that I wish I had realized sooner, it’s that a PhD is completely different from doing any other academic degree. It’s a highly individual journey towards becoming an independent researcher. You are the master of your own time. In my experience, when moving to another country, you must give yourself enough time to adjust. If you are having a hard day and struggling to focus on a single task, take the time to do something else for a while then go back to what you were doing. If struggling with social anxieties, it is okay if you just choose one big task to complete each day. Finally, when on certain days you feel completely overwhelmed, you have to take some time off: don’t doubt it. And give yourself credit for the progress you have already made, because I’m sure that if you compare yourself – at any given moment – with the earliest days of your PhD, you can’t help but appreciate and feel proud of anything that you have already achieved.

References

Oberg, K. (1960). Cultural Shock: Adjustment to New Cultural Environments. Pract. Anthropol. os-7, 177–182. doi:10.1177/009182966000700405.

Dr. Janne L. Punski-Hoogervorst is a Dutch-Jewish medical doctor and third-year PhD candidate. After graduating from Leiden University (The Netherlands) she worked in psychiatry, before moving to Israel to persue a PhD at Haifa University and Technion – Israel Institute of Technology. Her research focusses on PTSD and psychotrauma, within the frame of occupational therapy and behavioural neuroscience. Furthermore, Janne is an independent Holocaust researcher, op/eds writer with words in i.a. the Times of Israel, and member of the communication committee of the Dutch Psychotrauma Association (NtVP). You can find Janne on Twitter @JanneLissaMd or visit her website http://www.jannelissamd.com