Ethics and coping: My story
Today I want to tell my own story.
We will talk about my childhood and time at school–
–my life as a PhD student in mathematics–
–my life in medical school–
–and the case brought by the Swedish authorities–
–that eventually barred me from all higher education in Sweden.
This is a difficult subject.
While it may not be particularly difficult to describe the observable sequence of events–
–I do believe it is difficult to explain what lies behind these observable events.
But today I want to attempt this.
My goal is to be as objective as I can be.
I don’t want to sugarcoat things.
But I also don’t want to downplay my trauma.
To make this story as comprehensible as possible, I’d like to start by discussing two general concepts.
Sensitivity
A ‘sensitive’ person is a person who–
–reacts strongly to external stimuli.
You may think that this is a rather simple concept.
But it is difficult to precisely define what we mean by a person’s ‘sensitivity’.
It is also not trivial to measure a person’s sensitivity.
Let us compare this with a simpler concept: a person’s height in feet.
We all know what we mean by the ‘height’ of a person–
–and how to quantify this in feet.
We also know how to measure the height of a particular person.
So it is easy to determine if a person is taller than the average person in his age bracket, say.
Suppose you measure the height of every 18-year-old male in a large city.
Then you would get an outcome like the one in this histogram.
However, the concept of a person’s sensitivity is far less straightforward.
Firstly, sensitivity is selective.
Just because someone is highly sensitive to one kind of stimulus–
–does not mean that they are equally sensitive to some other kind of stimulus.
Lisa, for instance, is highly sensitive to harsh criticism, which really gets to her.
Yet, she might be completely unfazed by disturbing news on TV.
Or the other way around.
So ideally, you should have one ‘sensitivity variable’ per category of external stimulus.
But even if we were to employ such a categorisation of ‘simulus types’–
–it would still not be easy to quantify a person’s sensitivity.
It is hard to precisely quantify how sensitive a person is to the stimulus.
Should you consider the probability of a reaction to the stimulus?
Or the duration of the reaction?
Or maybe the peak intensity of the reaction?
And how do you even measure the intensity?
Clearly, ‘sensitivity’ is a complex concept.
It is not really possible to quantify a person’s ‘sensitivity’–
–in any simple and precise way that is still meaningful.
However, if we just remember that each person–
–is only sensitive to certain categories of external stimuli–
–then maybe we can very roughly say if–
–someone is more ‘sensitive’ than ‘most’, for example.
And maybe we could find some way to roughly quantify this.
Then, if you were to measure the sensitivity in a group of people–
–you would probably get a result similar to our height histogram.
Most people are of average sensitivity.
Some are more sensitive, and some are less sensitive.
But what does this have to do with my story?
Well, I think that if you would place me on a scale like this–
–I would end up at the far right–
–which makes life more difficult.
But what evidence support the hypothesis that I am this sensitive?
Well, there is quite a lot and I can give you a few examples.
For example, it is very important to me that people–
–understand and listen to each other.
If I ever observe a conflict between two people–
–who are hurting and not really listening to each other–
–that weighs heavily on me.
This is especially so if there is some form of injustice involved–
–or if one of the parties is especially vulnerable.
When this happens, I will be constantly and intensely thinking about this conflict–
–almost all waking hours for weeks.
What can I do to help these persons?
I just cannot let it go.
I am also profoundly affected by my environment–
–such as the gloom of the Swedish winter–
–when it’s grey and dark outside, the ground is covered by polluted slush–
–and the branches of the trees are like naked skeletons without leaves.
Then I am struck with a strong feeling of unease, even anxiety.
Just thinking of these months can induce this state of mind.
I am also greatly affected by beauty.
I last watched Titanic (1997) a couple of decades ago.
I watched it at night before going to bed.
That night I suddently woke up at three or four in the morning–
–with a profound and almost unbearable feeling of emptiness.
It felt as if all the beauty and happiness in the world had sunk with the ship–
–and all that remained in my world was emptiness and sadness.
It was almost unbearable.
Also a couple of decades ago–
–I did not dare to watch The Phantom of the Opera (2004).
Because if I had watched the film–
–I would have been unable to perform my normal daily tasks–
–for days or weeks–
–just because these tasks had felt so utterly meaningless compared to–
–the ineffable beauty of this film.
Everything else had just felt so meaningless.
I am also sensitive to nudity.
I never go to the beach, but if I would end up there–
–and you would measure my brain activity using electrodes–
–you would see it spike at the sight of all half-naked people.
At least if they were about my age.
It is not that I think there is something morally wrong–
–with that kind of partial nudity.
I just can’t help that my brain reacts very strongly to it.
I’m so very unaccustomed to it.
Even when I’m alone...
I can wear short sleeves–
–but that’s as far as I can go.
I would feel very uncomfortable showing more skin than that.
Later on, we will see more examples of my ‘sensitivity’.
But I think that what we have seen so far already justifies the hypothesis that–
–I belong to the far-right end of the sensitivity scale.
When it comes to the categories of stimuli that I am sensitive to–
–I believe it is fair to say that I am very sensitive.
But even if I belong to the far-right end of the sensitivity scale–
–this does not mean that I am that sensitive to everything.
Because sensitivity is selective.
Just as people’s fears vary, so do their sensitivities.
In some ways, I’m not at all that sensitive.
For instance, the thought of my own mortality no longer scares me.
I have long been well aware of life’s conditions and its temporal limits.
And as for myself, I am not afraid of falling victim to violent crime–
–or of facing war or natural disasters.
Maybe this is because I am not afraid of death–
–but I think the main reason is that–
–all my life I have seen accounts of–
–crime, war, and catastrophes on the news.
These events are not any less horrible just because–
–they happen in some far away country, for example.
I have always known the same things could happen to me.
This is something I have thought about a lot for a very long time.
So I almost feel finished with it.
And as a medical student (as I was) or physician (as I was about to become)–
–I had no problems whatsoever with nudity in patients in the clinical context.
In that capacity, such nudity felt like the most natural thing in the world to me.
Because then I was so deeply immersed in my role as a doctor–
–which is all about helping the patient–
–in the most professional, empathetic, and scientifically sound manner possible.
I was completely focused on the patient as a human being–
–and on their organism and its biology.
In that context, all forms of nudity were like the most natural thing in the world to me.
So while I am very sensitive to many things–
–I am certainly not that sensitive to everything.
Invisible pain
The other subject I wish to cover before we get into my personal story–
–is ‘invisible pain’–
–for example in the context of mental health issues.
Indeed, a person can suffer from intense mental pain–
–even if it is not apparent to others.
However, the consequences of the illness are often readily observed by others.
The affected person may not be able to live up to all of the expectations–
–that others have of their social behaviour and work performance.
If people observe this impaired performance–
–and do not understand the severity of the underlying mental distress–
–they may misinterpret the struggling individual.
They may perceive them as lazy, selfish, or lacking in self-awareness and empathy.
But should they truly grasp the individual’s overwhelming pain–
–they would realise that this person is anything but selfish.
They would appreciate how incredibly strong the individual is–
–remaining as considerate as they are in spite of their agonising inner pain.
It is also important to remember that we are all different–
–and are differently equipped to face the hardships of life–
–all depending on innate biology and life history–
–and this ‘life history’ includes various forms of support networks.
Even if two individuals encounter exactly the same event–
–they may not respond in the same way.
The event may prove profoundly traumatic for one of them–
–while the other is hardly affected at all.
It is perhaps even more important to appreciate that mental agony–
–can exist even if there is not any obvious cause–
–that is readily identified and understood by others.
For example, suppose that Anna experiences an event which is highly traumatic for her–
–even though that same event would not be traumatic for most other people.
Then those around Anna may find it difficult to appreciate her pain–
–because they do not realise that what she has experienced–
–can indeed be traumatic.
It may well be a profound trauma for her–
–even if it would not be so for most other people.
This does not make Anna’s trauma any less real.
I can easily imagine a situation in which Anna and Erik are–
–suffering from exactly the same level of mental anguish after two separate events.
However, the thing that happened to Erik is universally understood to be traumatic–
–so most people appreciate that Erik has suffered a truly traumatic ordeal.
They understand the pain he is carrying.
And they understand that he may not be able to meet–
–all the usual expectations while carrying such a burden.
But even if Anna is carrying exactly the same burden after her ordeal–
–if this is an event that most people struggle to perceive as traumatic–
–then they may not even believe Anna when she speaks of her pain.
They might see her as selfish and lacking in empathy.
They might even punish her, instead of providing support.
Clearly, the specific problem with invisible pain is–
–the invisibility itself combined with the apparent arbitrariness of the causes–
–both of which can lead others to respond in ways that are incredibly counterproductive.
Early years
Now I wish to tell my own story.
I was born in 1987.
There is not much to say about my early childhood–
–except, perhaps, that the social circle of my family was rather limited.
I had no regular contact with anyone my own age.
Most people I met on a daily basis had already reached retirement age.
At the age of seven, I started primary school.
My only interaction with people of my own age was with my classmates.
However, I rarely spent time with them outside of school hours.
I remember that I preferred the company of the girls, rather than that of the boys.
I struggled with the ‘laddishness’–
–that boisterous brashness, that unrefined demeanour often manifested by the boys.
I found it quite uncomfortable.
I much preferred the calmer, gentler, and more considerate demeanour of the girls.
I also found it easier to identify with the girls.
It felt as if they were almost the same kind of being as I was.
I did not feel that way with the boys.
I soon became very fond of one of the girls in particular.
What do I mean by ‘fond’?
Well, probably much the same as what is usually meant–
–when speaking of a child of that age having a ‘crush’ on a classmate.
But in my case, this became a rather profound infatuation.
I felt a strong desire to be near her, to be with her–
–and to receive her attention.
But of course, there was very little actual contact between us.
I did not possess nearly enough social skills to initiate a relationship with her.
And besides, we were only children.
Three years later, I moved up to the next stage of primary school.
At this time, I very seldom associated with my classmates outside school hours.
I felt that I did not fit in.
It felt as if I were a different kind of being than my classmates.
I found it somewhat easier to identify with the adults, such as my teachers.
So I did not feel at home being a child, or a student.
I would rather have been a part of the adult world.
It felt as if that world would suit me better.
By sixth grade, I was always alone during the breaks.
I would stand with my back against the wall, just outside the door–
–simply waiting for the bell to ring.
And a significant part of my mind was occupied by one of the girls in my class–
–a new girl, of whom I had become very fond.
This infatuation dominated my life at this time.
I wanted so desperately to be with her and to have her attention.
But of course, it was not to be.
Three years later I moved up to the final stage of compulsory school.
I was accepted into a class with a particular emphasis on mathematics and science.
And this proved to be a perfect fit.
I soon discovered that I loved everything related to mathematics and science.
I was particularly fascinated by comprehensive, systematic theories such as–
–the theory of chemical bonding and the nomenclature of organic chemistry.
However, beyond my studies, things were going downhill in life.
By this time, I never associated with classmates outside school hours.
I felt absolutely no sense of belonging among my peers.
This made me feel isolated.
I wished that there were some group of people that were like me–
–but I had no idea whether such a group existed, and – if so – where to find it.
I devoted essentially all of my time to my studies.
I made detailed lecture notes, which I would scan digitally.
I spent my summer holidays revising the past year’s courses–
–to ensure that the knowledge remained fresh in my mind.
If ever I failed to receive the highest grade on a test–
–I felt as if I did not deserve to live.
At least that was how I felt for a few months afterwards.
And I am not exaggerating. This was precisely how I felt.
It was also during this period that I began to contemplate existential and ethical questions.
I compiled my observations into documents that I would publish on the World Wide Web–
–which, at that time, was a relatively new invention.
Some of these questions induced a certain disquietude in me–
–for instance, the problem of other minds.
However, the matters that weighed most heavily upon me–
–were ethical questions of a significantly more mundane character–
–particularly issues related to animal rights.
I realised that there was an immense amount of suffering endured by animals–
–including by those kept by humans.
And despite this, animal rights was not considered a foremost political concern.
The awareness of such vast suffering–
–so often disregarded by others–
–was deeply painful and caused me many a sleepless night.
However, what dominated my thoughts during these three years–
–was a new female classmate, of whom I had become very fond.
And this infatuation was obsessive.
I thought about her every hour of every day.
This became but an anguished longing, for – unsurprisingly – we never became friends.
What also proved painful was the realisation that my peers–
–had already begun entering into intimate, physical relationships.
The mere thought of it was immensely painful.
It was harrowing to know that I existed in some parallel universe–
–in which physical intimacy was an impossibility.
All I could do was to observe as my peers formed increasingly intimate, physical relationships.
It was immensely painful.
The only physical ‘intimacy’ I experienced in those three years occurred in a crowded study room–
–when a female classmate happened to brush against me.
It was shortly before the summer holidays, and as we both wore short sleeves–
–there was direct skin-to-skin contact.
To me, this was a momentous occasion, something I would dwell upon for months.
That was the extent of the physical intimacy I received.
Throughout these three years, anxiety was my constant companion.
I lived in a state of perpetual sorrow and unease.
I seldom experienced a day free from a headache.
Following my nine years of compulsory schooling–
–I entered the science programme at upper secondary school.
I loved mathematics and the natural sciences.
I devoted most of my time to my studies–
–and to independent software development projects.
I never spent time with my classmates outside of school.
And even during school hours, my interaction with them was minimal.
Each day, I was the first to arrive at school–
–perhaps half an hour before classes began.
I would stand just outside the classroom–
–my back against the wall, carrying my books and ring binder–
–almost like a royal guard.
In class, I sat by myself, and I ate my lunch alone.
I spent the remainder of the lunch break standing outside the next classroom.
Yet, as always, my thoughts were dominated by a new–
–female classmate, Elin, for whom I had developed a profound affection.
I felt an overwhelming sense of longing for friendship, belonging, and intimacy–
–and I wished that I could get all of this from her.
Yet, as always, this remained but a painful and futile desire.
Having no contact with any of my classmates–
–of course I was not able to form any relationship with her.
One evening, I sat in front of my computer and searched the Internet–
–for Elin’s name–
–and then I came across a few pages from her sports club.
On these pages, I could read about her and her boyfriend.
It was then I discovered she had a boyfriend at all.
And that realisation hurt. It was excruciating.
For the rest of the evening, I paced back and forth in my room in a cold sweat.
Every few minutes, I had to wipe away the perspiration from under my arms.
For hours, I walked in circles, drenched in a cold sweat.
That night I could not sleep at all–
–and the following day, I realised just how profoundly this had affected me.
I had lost all motivation to study.
I could not even enjoy mathematics or science.
It was as if my entire will to live and to learn somehow was derived–
–from some kind of desire to make an impression on Elin.
The following months were difficult, as I could no longer hope for a–
–relationship with Elin.
I was no longer able to sit through my classes.
Instead, I paced the corridors.
A full circuit of the school took only a few minutes–
–and these laps now occupied most of my school days–
–as I tried to ease the anxiety.
After a few months, my condition improved slightly, but not by much.
My final two years of upper secondary school were eventful.
On the very first day of the autumn term, I noticed a new student in the class.
Let us call her Klara.
She was a remarkable and unique person.
On several occasions, she chose to sit next to me during class.
As a result, we became lab partners for the remainder of the year.
She likely saw that I was struggling and wanted to help.
This was incredibly courageous and almost un-Swedish of her.
Never before had anyone reached out to me in that way.
And her hypothesis was, of course, correct: I was in desperate need of help.
It occurred to me, that maybe I could tell Klara about my situation–
–and use her as some kind of emotional sounding board.
Yet, I abhorred the thought of asking a classmate for help with my personal struggles.
I much preferred to be the one helping others.
But eventually I yielded.
I reached out to Klara and asked to speak with her.
I confided in her about my struggles, and she took it all remarkably well.
She suggested that we should go for a walk together some day after school.
I was certainly not prepared for that, but I agreed.
And so, one day we met after school and took a long walk in the countryside.
This was one of the happiest days of my life.
It felt like nothing I had experienced before. It was almost as if I had a real friend.
As we approached the end of our walk, Klara wanted to stop at a supermarket.
This, too, felt extraordinary: it was as if we were a couple doing the grocery shopping.
To me, it felt profoundly intimate.
After the shopping, I was invited to Klara’s home.
As we stepped inside, Klara removed her shoes–
–and went barefoot.
I was taken aback, and I had to make an effort not to look down at the floor.
It is not that I consider it morally wrong to expose that much skin.
Not at all.
I was just so utterly unaccustomed to such intimacy–
–with another person, particularly a peer of the opposite sex.
Exceedingly unaccustomed.
I stayed for about twenty minutes and then I began my walk home.
We had planned to go for more walks.
And we did so one more time, but then it never happened again.
Several times we made arrangements to meet–
–but those plans were always cancelled at Klara's initiative.
This was a struggle for me, considering my mental state.
From my perspective, she was the sole source of relief available to me.
And one day I found out the reason why–
–she had repeatedly cancelled our meetings.
It turned out that–
–her boyfriend was not feeling well–
–and so she wanted to be there for him.
That was the time I learned that she even had a boyfriend.
Then I shattered completely.
The pain was beyond description, and I was immediately taken to–
–the child and adolescent psychiatric clinic in Eskilstuna.
My time there was a bleak period.
I was unable to sleep at night, and I could not bring myself to eat.
And time passed incredibly slowly.
Watching the minute hand of the wall clock make a full circle–
–was like enduring a mental marathon.
And circle after circle it went.
It was here that I was first prescribed an antidepressant–
–in the form of a selective serotonin reuptake inhibitor (SSRI)–
–namely, escitalopram, i.e., the one with only the active enantiomer.
After a few months, my condition had improve slightly.
But my underlying stressors remained as present as ever–
–and after a few more months I sank back into the abyss–
–even though my SSRI dosage had increased even further by then.
Once again the anxiety, fear, panic–
–anguish and hopelessness–
–bacame virtually unbearable.
And I had no idea what I could do about that.
What happened was that I wrote a large number of letters to Klara–
–in which I pleaded for more contact, friendship, and warmth–
–to such an extent that I far exceeded the threshold of emotional blackmail against her.
Then I was admitted to the adult psychiatric clinic in Katrineholm–
–were I also spent my 18th birthday.
I was discharged after a few months.
However, I was not permitted to return to the school grounds–
–due to the incident involving Klara.
Instead, I was allowed to complete my studies there remotely from home.
Linköping Institute of Technology at Linköping University
Immediately after graduation, I enrolled at–
–the Linköping Institute of Technology at Linköping University.
I joined the physics programme, a five-year curriculum leading to–
–a Master of Science degree.
You were able to pick courses quite freely–
–and I chose to study at least as much pure mathematics as physics.
I loved mathematics and physics. I learned primarily by reading the–
–(typically superb) textbooks from cover to cover at home–
–well before each course had even begun.
I still attended the lectures–
–which, for me, served as a form of repetition or a source of new examples and ideas.
They became a kind of recreation, enjoyed with a good cup of coffee.
During my third year, I began working as a teaching assistant–
–at the Department of Mathematics.
My role primarily involved instructing engineering students in mathematics.
And this turned out to be the most rewarding thing I had ever done.
I loved the subjects, I loved to teach–
–and I thrived in the role of an educator.
I would spend my evenings at home, preparing my lectures for the following day.
I could hardly wait to go through all the fascinating and subtle details.
Teaching gave me a sense of joy I had never known before.
I decided right then that this – teaching university-level mathematics –
–was what I wanted to do for the rest of my life.
But outside of my studies and teaching, I was not doing very well.
I had no friends and felt deeply isolated from the rest of society.
This was especially true regarding–
–romantic relationships and physical intimacy.
The mere thought that people my age–
–were already experiencing–
–intimate, physical relations–
–was profoundly painful.
It felt surreal, almost unfathomable to me.
It was like a gut punch every time I was reminded–
–that such things actually occurred among my peers.
Consequently, I began avoiding newspapers–
–television, and public spaces–
–simply because it hurt too much to be reminded–
–that I was living alone in some kind of parallel universe–
–in which friendship and physical intimacy was an impossibility–
–something that I could only observe in others, in their world–
–but never experience for myself.
I recall that I one evening watched a video clip on the Internet.
A group of adolescents were socialising at someone’s home.
One of them sat on a sofa–
–but he was not sitting upright, with his feet on the floor.
Instead, he had his feet on the sofa.
Then one of his female friends sat down next to him.
And then his feet came into contact with her left leg.
He was not wearing shoes–
–so this implied direct body contact.
I imagined that they would respond by pulling their limbs towards them–
–to restore the physical distance between them.
But they did not: they just remained like that.
To me, this felt utterly strange.
It felt surreal that there were people having–
–friendships so close–
–that this type of physical contact, albeit accidental–
–seemingly was deemed perfectly natural.
This was as far from my world as you could get.
Of course, I knew that it was I who departed from the norm–
–and that the film merely depicted normal behaviour.
But I also knew that ...
–most people were not even aware of the existence of people like me–
–or of the kind of challenges I faced.
For this reason, I repeatedly wrote letters to the editor–
–trying to explain that people like me actually do exist.
But not once was such a letter published.
To me, this felt as if society wanted to silence me–
–to ensure that my kind of struggles remained unknown to the public.
Mathematics PhD student
After five years, I completed my Master’s degree, as planned.
At the same time, I could no longer continue teaching–
–as my position as a teaching assistant was limited to three years.
As a result, I found myself without an occupation and any source of income.
And to me, that was a problem.
Because I am exceptionally bad at elbowing my way through the labour market.
To succeed on this market, you need self-confidence, motivation–
–a certain measure of egoism, and some pragmatic level of dishonesty.
I am about as good at elbowing my way through the labour market–
–as a drunk five-year-old is at driving a manual car.
So I chose the option that required the least amount of mental friction.
And that was to apply for a PhD position–
–at the very same Department of Mathematics that I had just left.
I was not allowed to choose my research topic freely.
Instead, I was given three options to choose from.
One project concerned water waves–
–and another the elastic properties of blood vessels.
I do not recall what the third topic was.
I did not find any of these particularly interesting.
I was more drawn to pure mathematics–
–rather than applied topics as narrow as these.
But I particularly did not want to work with blood vessels–
–as I knew that such a topic would have made me sad.
It would have reminded me of the fact that I was not a physician–
–a profession I had always considered to be a ‘good’ one.
Consequently, I applied for the PhD position about water waves.
I was accepted almost immediately.
On my very first day, I was informed that I would, in fact, be working on blood vessels.
I do not know why and I did not ask.
The very first thing I did then was to order a dozen textbooks–
–on human physiology and anatomy.
Because to me, competence and integrity have always been sacred–
–and I felt that if one is to conduct research on blood vessels–
–even at a strictly mathematical level–
–one should be thoroughly acquainted with the underlying biology.
And so, I devoted a couple of months to reading these volumes from cover to cover.
During this time I probably studied as much physiology as in medical school.
Perhaps even more than that considering that–
–I focused on the fundamental science and not on its clinical application.
And I fell in love with these subjects.
I found human physiology and molecular cell biology to be immensely fascinating.
After these two months I had to proceed with the more regular aspects of my PhD position.
It consisted of three components.
The first component was completing PhD-level courses in mathematics.
The second component was teaching: I was allowed to continue as an instructor.
And the final component was the actual blood vessel research.
I was very fond of the PhD-level courses.
I was able to study subjects ranging from topology and graph theory–
–to functional analysis, algebra, and measure and integration theory.
I very much enjoyed this part.
And, obviously, I was thrilled to be able to teach again.
In fact, I ‘happened’ to spend my first two years as a PhD student–
–solely on PhD courses and teaching–
–i.e., the first two components of my position.
Consequently, after those two years, only the blood vessels remained.
I had, so to speak, cherry- picked the parts that I liked.
And I did not find this research particularly engaging.
It did not feel relevant.
And at the same time, my mental health was poor–
–for all sources of joy in my life, particularly my teaching duties–
–had disappeared by then.
All that remained was my loneliness and ever-present sense of isolation–
–and the research on blood vessels, a topic in which I found no interest.
I realised that I could not continue as a PhD student–
–for it did not feel ethical to accept a salary from the university–
–when I was unable to fulfill my duties.
Consequently, I resigned.
At the time, I was unaware that one could–
–be granted medical leave for mental health reasons.
Before I resigned, I did ask the university if I could have–
–a position with only teaching duties.
To me, it would have been a dream come true to have a position–
–with a 150% teaching load for 80% of a full-time salary.
I told them that, but they could not accommodate such a request.
And so, I left the Department of Mathematics–
–once again finding myself without either employment or a source of income.
And being the drunk five-year-old behind the wheel of a manual car that I was–
–I once again chose the option with the least mental friction.
And that was to apply to the medical programme at Linköping University–
–an act that required but a few keystrokes on my computer.
Medical school
In January 2015, I was enrolled on the medical programme at Linköping University.
I was not at all looking forward to the start of the semester, for several reasons.
First, I knew that I would be financially unable to complete the full programme–
–because I had very little financial aid remaining.
I realised that I would run out of money within a couple of years.
This financial conundrum could likely have been resolved in one way or another.
But given the poor state of my mental health–
–and my difficulties navigating the bureaucracy of society–
–I realised that I would not be able to do this by myself.
Hence, I realised that my medical education most likely would culminate–
–in some form of tragedy within a few years, as my funds were exhausted.
I was also suffering from a profound identity crisis.
Because my entire self-concept–
–was based on mathematics and my role as a teacher.
Without this foundation, I no longer knew who I was.
It was as if I no longer had a personality.
My identity was based on being a teacher.
Now I was instead a student again.
And I have never felt comfortable in that role.
I also felt a deep sense of grief at leaving the field of mathematics.
Moreover, I was worried that I would lose much of the–
–mathematical knowledge and proficiency–
–that I had spent quite a few years cultivating–
–now that I no longer practised it on a daily basis.
Prior to the start of the semester, we were asked–
–to complete a questionnaire from the student union.
I was brutally candid, providing a detailed account of my state of health.
I had hoped that this would trigger some form of support mechanism–
–but my disclosure met with no response whatsoever.
Finally, the day of the formal roll call arrived.
And this was to become one of the worst days of my life.
To begin with, it was a pitch-black January day.
I carried the burden of knowing about my financial predicament.
I had the identity crisis and absolutely no self-esteem.
And, inevitably, I immediately found myself not fitting in among my classmates.
Matters did not improve once the curriculum commenced.
I felt that the quality of instruction was quite poor.
I also found the pace to be ridiculously slow–
–and the academic requirements to be remarkably rudimentary.
The medical programme had adopted a pedagogical framework–
–known as ‘problem-based learning’ (PBL)–
–which suited me very poorly.
This approach severely limited the individual student’s freedom to learn–
–in their own pace and in their own preferred ways–
–because one was constantly forced to ‘synchronise’ with one’s peers.
To me, who already had a quite profound understanding of human physiology–
–and also loved this scientific subject in its own right–
–this was a profoundly frustrating experience.
Compounded by my identity crisis, this process became a trauma in its own right.
Implausible as it may appear, to me, this was indeed a traumatic experience.
Still, I did love the science itself.
Physiology and molecular cell biology.
During the first semester I read the MBoTC textbook from cover to cover–
–about 50 pages per day, learning most of it by heart.
And I truly loved this book; indeed, I still do.
This is perhaps the finest scientific textbook I have ever encountered.
An extremely fascinating topic–
–presented with remarkable clarity, exquisite typography–
–and amazing micrographs and illustrations.
So this, at least, was a source of joy.
Medical school: Third semester
A year into the programme, the initial shock had, for the most part, subsided.
In addition, the curriculum had now shifted its focus from physiology to pathology–
–a field that was new to me.
This made the programme feel considerably more relevant to me.
And my classmates were indeed very nice people.
They were agreeable and sympathetic–
–very much the kind of people you enjoy being around.
Indeed, my social alienation was by no means the result of–
–any deliberate exclusion on their part.
Rather, it was the inevitable consequence of–
–a life situation that had long since spiralled out of control–
–which ideally should have prompted some social support measures long ago.
I also felt at home in the role of a physician.
We had a fair amount of patient contact–
–through our clinical placements at healthcare centres.
I may have been on the level of a one-year-old–
–in terms of informal relations with peers–
–but I felt genuinely comfortable in a professional leadership capacity–
–and particularly in the role of the physician.
The role that is all about helping the patient–
–with nothing but good intentions, a scientific mindset–
–and a vast amount of unconditional empathy.
In this role, I felt at home.
It gave me a new identity after my departure from mathematics.
Fourth semester
The fourth semester began in August of 2016.
While the first weeks of it were rather uneventful–
–major storm clouds could be spotted on the horizon.
To begin with, it was now that I ran out of student grants and loans.
It was now that the balance on my bank account began to plummet.
Another exceptionally heavy burden was–
–a conflict involving two parties I knew outside the university.
It was a profoundly painful and acrimonious dispute.
One faction consisted of two individuals, the other of a single person.
The two parties took turns hurting each other.
And I could really see how the lone party, in particular–
–was being systematically destroyed by the ordeal.
The two parties had likely never had any working communication between them–
–and now they invariably misinterpreted each other’s emotions and intentions.
The situation would have been bordering on the farcical–
–had it not been so deeply distressing.
I spent hours each week trying to get the parties to–
–understand each other, and, in particular, to persuade–
–the ‘stronger’ part to temper their hostility towards the solitary one.
But this was all in vain.
It was like attempting to breach a concrete wall by beating one’s head against it.
It had been invaluable–
–had I had someone to turn to for emotional support during this time.
But barring the two parties of the conflict, I knew no one outside the university–
–so I had no one to turn to.
Therefore, I had to heal by myself after each escalation in the conflict.
I was not thriving among my classmates either.
I still felt like an outsider.
Every day I observed as they socialised.
Sometimes they would walk hand in hand.
At other times, someone would receive a gentle touch on the arm.
Things that could not happen to me.
Furthermore, the curriculum’s focus had now shifted–
–to sexually transmittable infections (STIs).
Lecturers emphasised that individuals in my classmates’ age bracket accounted for–
–a significant proportion of all casual sexual encounters.
It was exceedingly painful to hear all this, and even to think of it.
This pain lodged itself inside me, and became chronic.
It truly felt as though–
–I inhabited a different planet within the solar system–
–and was only able to passively observe the inhabitants of Earth–
–as they engaged in friendships and physical intimacy.
All while they remained entirely unaware of my very existence.
Finally, someone had put up posters all over campus.
They read, ‘Having sex tonight?’
It was a campaign promoting safe sex aimed at students.
Seeing these posters was excruciating.
I just wanted to die.
Alleviation
The pain had become unbearable.
I felt a desperate need to explain my situation, to have someone understand it.
Thus, I reached out to two female classmates–
–with whom I had previously collaborated.
I told them about my situation–
–and I told them about my longing–
–for friendship–
–and intimacy.
They agreed to meet me that very evening, almost immediately.
And I received a hug from each of them.
This acted as a bolus of morphine–
–alleviating some of the acute pain.
Nevertheless, I remained terrified of what the future might hold.
Matters did, however, begin to improve.
Because from that day on, I was invited to accompany–
–these two classmates between lectures.
I was even allowed to join them for part of their journey home each day.
Consequently, I, too, would linger for a few moments after the final lecture–
–as they said goodbye to their circle of friends.
On those occasions, I too was included–
–receiving a number of parting hugs from their female friends.
Combined, this meant that I was receiving far more–
–physical intimacy from female peers than ever before.
Naturally, this triggered a strong psychological reaction.
To me, these events were life-changing and almost incomprehensible.
These moments were constantly on my mind, every hour of every day.
There was also a strong physiological response–
–in the form of massive bulbourethral hypersecretion–
–to such an extent that cleansing was required several times an hour.
After a couple of days, I also began to experience pain on my right side–
–likely as a result of this rather extreme exocrine hyperactivity.
Concert apprehensions
One day, the two classmates asked me–
–if I wanted to join them and some of their friends–
–for a concert they were planning to attend.
This was a remarkable initiative on their part.
It was a brave and constructive act, admirable in every sense.
Because this was precisely what I needed: an explicit invitation.
However, there was one problem.
What did they mean by ‘some of their friends’?
Upon inquiry, they clarified that these were male friends.
I realised there was a significant probability that this included–
–their respective boyfriends.
And this would have been somewhat of a problem.
Because if I had joined them for the concert–
–and then been forced to witness–
–their interactions with their respective partners–
–with possible public display of affection–
–I would, in all likelihood, have suffered a total breakdown.
Quite possibly, I would have ended up needing emergency psychiatric admission.
I confided these apprehensions to them–
–and we agreed that I should not join them.
My decision not to join them might appear utterly foolish.
I probably appeared like one of those difficult individuals–
–who simply cannot be appeased–
–because even when granted (seemingly) exactly what I wanted–
–in my case, an explicit invitation–
–from two female classmates that I liked–
–I remained malcontent.
This, if anything, can make people lose their patience with–
–and motivation to help the ‘difficult’ person.
Yet, to this date, I do believe that this was–
–the right decision to make.
For if I had joined them–
–and had witnessed intimacy and public displays of affection–
–I most likely would have broken down and maybe caused a scene–
–and I would probably have required psychiatric care.
And that would have served no one.
So, even to this date, I do believe that I did make the most responsible call–
–when I declined the offer.
Even if this proved to be the final nail in the coffin–
–of my classmates’ motivation to help me.
No more relief
It soon became apparent that I had become a significant burden–
–to my two classmates.
So we severed our ties.
From that point, my condition deteriorated rapidly.
I was admitted to the psychiatric ward as an emergency case.
I remained there for a few days.
Prior to my discharge, I was prescribed a new medication, Atarax (hydroxyzine)–
–intended to facilitate my presence among my classmates.
I would take a pill before every lecture and then–
–seat myself in the very front row of the theatre–
–ensuring my classmates remained out of sight.
As soon as the lecture concluded, I would bolt for the exit.
However, this strategy only held up for a week or so.
The letter
Thereafter, I spent my days confined to my flat–
–in a more or less constant state of cold-sweat panic.
I could neither eat nor sleep.
One day, I decided to write a letter to my classmates.
I felt a desperate need to explain my situation, to finally be understood.
I wrote to roughly half of the class–
–detailing my situation and my longing for–
–friendship and closeness.
I mentioned my longing for physical affection, for hugs and the holding of hands.
I sent the letter solely to my female classmates–
–as they were the ones–
–with whom I sought a connection.
I had absolutely no need for male companionship–
–because I had not been able to–
–obtain any kind of comfort or support from such a relation–
–however strange that may seem. That was how my brain was wired.
I was, of course, aware that this letter carried the risk of expulsion.
But since I was very soon to be forced to withdraw from the programme anyway–
–due to both my financial situation and my failing health–
–I did not view this–
–as a problem, at all.
However, I feared that the recipients of the letter might feel–
–distressed or frightened–
–so I made a sincere effort to express myself as dispassionately and gently as I could.
A few days later, I was summoned to the university official responsible for the semester.
He shouted at me, declaring that it was–
–‘utterly inconceivable’–
–that anyone would offer me a hug only because I needed one.
He appeared genuinely appalled–
–that I had even entertained the possibility.
After that meeting, I was at a total loss.
Suicide was the only thought that occupied my mind.
Yet, as I realised, there are few reliable and ‘safe’ ways to go about it.
And so, I spent my days wandering the streets of Linköping–
–in a state of constant panic.
One evening, as dusk fell, I noticed that Ågatan–
–suddenly surged with life–
–as the bars and nightclubs opened.
I had never before set foot in such an environment.
I had witnessed scenes like this in films–
–but now I found myself in the very midst of this nightlife.
I entered a bar and ordered beverages containing ethanol.
I was twenty-eight years old and had never consumed alcohol before.
Now I hoped the spirits would alleviate my anguish.
And they did.
However, a few hours later, the police, fearing a suicide attempt, transported me–
–to the psychiatric emergency ward, where I was admitted for the night.
And this would become my new reality.
I would spend my days wandering the streets aimlessly, in panic.
At night, I would ease the pain by consuming spirits.
On a handful of occasions, the police intervened and transported me to hospital.
The miracle at Pitcher’s
One evening, while I was consuming spirits at a table in Pitcher’s–
–the bartender approached me and initiated a conversation.
She remained with me until her presence was again required at the bar.
At the same time, the police called and expressed their concerns for me.
They wanted to take me to hospital again.
Consequently, I approached the bar to settle my bill.
Then I–
–asked the bartender–
–if I could have a hug.
To my disbelief, she agreed.
She stepped out from behind the counter and gave me a prolonged embrace.
Shortly thereafter, the police arrived and took me to hospital.
Sitting in the waiting room–
–I noticed that I did not feel–
–the slightest bit sad, anxious, or depressed.
Every trace of distress and despondency had vanished.
I felt happy, almost indecently so.
I had to make an effort not to appear too cheerful–
–out of consideration for the other patients in the room–
–who looked profoundly distressed and sad.
After a brief wait of only an hour, I was seen by the physician.
It proved to be a most peculiar consultation–
–as I had nothing to report.
I felt as though I had no reason to be there.
So, after a brief exchange with the doctor, I was on my way home.
On my way home, I decided to buy a thank-you card the next day–
–and give to the bartender–
–because she had made such a huge difference to me.
But when I woke up the following day, I noticed that–
–the effect had almost completely worn off.
The apprehension, anxiety, and panic were all beginning to resurface.
But I still went to the supermarket and purchased a thank-you card.
I wrote something to the effect of, ‘You have no idea what a difference you made.’
My intention was to stop by Pitcher’s and hand the card to her in person.
However, the anxiety became overwhelming. In a state of panic–
–I published a desperate post online.
I then headed out into the city–
–aimless yet instinctively moving towards Pitcher’s.
At that moment, the police called me, inquiring about my whereabouts.
Shortly thereafter, a police car intercepted me.
Perhaps some five hundred metres from Pitcher’s.
I told the officers about my plan–
–and they surprised me by offering to drive me to Pitcher’s.
And so, they gave me a lift to the pub.
The policewoman asked if she could accompany me inside as I delivered the card–
–which I of course did not mind.
We entered, but unfortunately, the bartender from yesterday was not there.
Instead, I left the card with a colleague who promised to pass it on.
Afterwards, the police transported me to hospital once more.
This serves as a prime example of my experience with the Swedish police.
The vast majority of those on the force do a truly outstanding job.
I believe this incident truly shows–
–how amazing the Swedish police really is.
A preliminary decision
This time I spent a week in the psychiatric ward.
During my stay, I met with the ward physician on a couple of occasions.
These encounters were not typical doctor–patient consultations.
Instead, they were more like ‘conferences’.
The physician was accompanied by several nursing assistants–
–and a medical student, a fellow student from my programme.
We were all seated around a large table.
The ward physician declared that my letter to my classmates ‘proved’–
–that I was unfit to practise medicine.
He also saw fit to broadcast a deeply private (and mostly irrelevant) detail–
–he had found in my medical records–
–something I had confided to a previous doctor–
–almost as if he took pleasure in doing so.
Immediately following this week-long admission–
–I had a meeting with the leadership of the medical programme.
I met with the chair and the vice-chair of the programme.
They explained that I had ‘ruined’ their programme–
–and that their ‘official stance’ was that my conduct was ‘utterly unacceptable’–
–and that–
–the university intended–
–to seek my expulsion.
The chair explained the statutory grounds for dismissal.
A student may be expelled if they, firstly, suffer from a mental disorder–
–and, secondly, constitute a danger to other students or to university property.
Immediately following this meeting–
–I had an appointment with a new psychiatrist.
He stated that, given the severity of my transgressions–
–there was virtually no prospect of me continuing my medical studies.
He also wished to offer me a piece of ‘friendly’ advice.
He suggested that I should refrain from saying–
–that I wished to become a GP.
Instead, I should say that I wished to become a pathologist–
–that is, a physician who does not see living patients.
In his view, this was a more realistic objective for someone like me.
By this, I assume he meant someone lacking social skills and empathy.
I am certain he meant well.
Yet, if words could kill, I would have died right there in his office.
Because the role of the physician was the last one in which I still felt comfortable.
Had he witnessed my meetings with patients at the health centre–
–I seriously doubt that he would have made these remarks.
Not by a long shot, I think.
But the narrative was no longer being shaped by those who–
–knew and had actually been there.
Instead, history was now being written by those in positions of power.
I went to pieces and was once again admitted to the psychiatric ward.
There, again, I met the ward physician. He explained to me that the hospital–
–was not a hotel, and that he did not actually want me there–
–but I was allowed to stay for the night.
A definite decision
A few weeks later, I received a letter from the leadership of the medical programme.
They had decided to formally request my expulsion through–
–the Higher Education Expulsions Board (HAN).
They asserted that I lacked the capacity for empathy.
‘His conception of empathy is to place himself at the centre.’
Furthermore, they concluded that I suffered from a mental disorder–
–and constituted a danger to my fellow students–
–rendering me profoundly unfit for the medical profession.
The emotions following that meeting cannot be described in words.
I was immediately readmitted to the emergency psychiatric ward–
–where I again met the same physician, who discharged me after a day or two.
The following weeks or months–
–I was gripped by panic, either at home or wandering the city.
I tried to ease the pain with spirits.
A number of times, the police transported me to the psychiatric emergency ward–
–because they feared I would take my own life–
–or simply because I was too intoxicated to care for myself.
Aurora
In the evenings, I would go looking for the bartender at Pitcher’s.
I asked the staff about her–
–but she had apparently left her job there.
One of the new staff members I spoke with–
–was a woman around my age, or perhaps slightly younger.
Let us call her Aurora.
One evening, I asked Aurora for a hug.
She struck me as a remarkably–
–jovial and sympathetic person–
–and she agreed as if it were no trouble at all.
She gave me a long embrace.
It felt like–
–a dose of morphine–
–numbing the worst of the acute pain–
–an effect that lasted for a few hours, perhaps even days.
From that night on, I would visit Pitcher’s every evening–
–hoping, of course, that Aurora would be there.
During my thirty-minute walk to Pitcher’s–
–I would intensely and repeatedly tell myself–
–that the probability of her not being there was significant.
I carefully visualised that scenario in my mind.
I thought to myself, ‘Probably she is not there.’
This was a means to attempt to ease the shock–
–should I arrive only to find out that she was not there.
It was an example of coping in practice.
About half of the time, she was there.
Upon arrival, I would order a Coca-Cola – no more spirits.
I would sit at a table for an hour, or two, or three.
Merely being in this environment, with all the sensory inputs–
–had a small soothing effect.
Then, after a few hours, when it was time for me to head home–
–I would approach Aurora if she was there–
–and receive an embrace before I left.
It really was as if I had this very intense, chronic physical pain–
–and the only thing that would ease it–
–was these brief encounters with Aurora–
–which I was granted maybe two or three times a week.
I had difficulties sleeping at night.
It was like a tug-of-war in my mind–
–between positive and negative emotions.
I would look back at my most recent encounter with Aurora–
–replaying the memory over and over, trying to immerse myself in it–
–to give the positive feelings room to breathe.
But this was indeed a tug-of-war–
–against an immensely strong and almost infinitely enduring adversary–
–in the form of all the negative emotions and the anxiety.
If I fell asleep, I would often wake up an hour later gripped by sheer panic.
This was my new reality.
I spent my days at home in a cold sweat.
Each night, I would head to Pitcher’s hoping for another dose of warmth.
A few months later, Aurora left Pitcher’s.
She was gone, but all my struggles, of course, remained.
After winter, I did not attend the roll call for–
–the fifth semester of the medical programme.
Consequently, I lost my place on the programme.
In spite of this, the university chose to proceed with their petition to HAN.
They justified this by stating ...
They wrote that they feared I might otherwise reapply to the programme–
–or seek admission at another university in Sweden.
By having me formally expelled, they ensured those possibilities were eliminated.
This was the beginning of a multi-year legal battle appealed through several instances:
the Administrative Court, the Administrative Court of Appeal, and the Supreme Administrative Court.
In the end, the university prevailed.
An explanation
I have now told most of my story.
By now, it is likely apparent that a major cause–
–behind my struggles has been an exceptionally high sensitivity–
–a highly unusual skill profile with unexpected peaks and valleys–
–and an equally unusual profile regarding interests, fears, and needs.
However, I likely need to clarify this specific need–
–for female friendship and closeness.
Was it friendship or sex that I was seeking?
Answering this question is not entirely straightforward–
–primarily because standard Western terminology–
–simply does not fit my experience.
Thus, there is a major risk of misunderstandings.
I shall attempt to explain why.
It is clear that I have lacked friendship.
I have often longed for–
–someone who was always there for me–
–someone in whom I could confide.
Someone to bounce ideas off–
–or simply spend time with.
It had been of great value, had I had a friend to consult–
–when my funds ran out during medical school.
And I most certainly needed support during the family feud.
However, it is also true that I have lacked physical intimacy.
The linguistic problem arises because these two needs–
–in my brain, are not nearly as demarcated–
–as they tend to be for most people.
Most ‘normal’ people have two separate needs:
The need for friends and the need for a partner.
For these ‘normal’ individuals, the following principles apply:
You can have any number of friends simultaneously–
–and there are no major restrictions regarding age and gender.
And in a friendship, there is no sexual attraction whatsoever.
On the other hand, there is typically an exclusivity to a partner relationship:
You have at most one partner at a time.
And there are often strict requirements regarding the partner’s age and gender.
And, finally, there is a sexual component.
However, my brain is not wired this way.
For me, even the need for ‘normal friendship’ has been–
–subject to strong preferences regarding age and gender–
–requirements identical to those of a partnership.
I have never felt a need for male friendship–
–and I have always found it difficult to derive any sense of–
–security or belonging from a relationship with a male peer.
On the other hand, I have always felt a profound need for female friendship–
–and the security and connection in such relationships.
And in these instances, there has often been a longing for physical intimacy as well.
One could summarise this by saying that while most ‘normal’ people have–
–two separate needs, I have a single, unified one.
Alternatively, one could say that I too have two separate needs–
–but that these two needs in my case target the same set of people.
This, naturally, is a major source of misunderstandings.
The theme of physical intimacy and ‘sex’–
–also presents linguistic difficulties.
While it is apparent that I have a longing for physical intimacy–
–almost everything associated with ‘typical adult sex’–
–is entirely foreign to me.
Consider how ‘sex’ is typically portrayed in popular culture or on the Internet.
A search of the Internet reveals countless images–
–emphasising breasts, gluteal regions, and external genitalia–
–‘strange’ clothing and behaviours–
–activities involving repetitive aggressive body movements–
–unnaturally large lips, and so forth.
To me, all of this feels utterly foreign and truly unpleasant – even disturbing.
The ‘physical intimacy’ I long for is something different.
It is the closeness itself, and the physical touch.
Hugs, holding hands, gentle caresses.
Simply the sensation that there is another human being who is–
–willing to be close to me, or could imagine being so.
Who could imagine touching me.
I sometimes say that I am on the level of a small child–
–when it comes to things like sex.
I believe this may be one of the most pedagogical ways of describing my situation.
While the sexual desire and longing are both present–
–everything related to ‘adult’ sex feels utterly foreign to me.
Furthermore, physical intimacy from a female peer carries–
–immense emotional significance for me.
It is almost existential: The sensation that there is another being in the universe–
–who is like me and who would consider being with me and physically touching me.
I think it is that very sensation which is most important of all.
The restaurant
During the spring, I discontinued all my medication (namely escitalopram)–
–as I wanted nothing whatsoever to do with–
–the Swedish healthcare system or Swedish physicians.
I also had to register with the Swedish Public Employment Service.
I was assigned an employment officer specialising in job seekers with disabilities.
Her task was to secure me a position as a cleaner at Samhall. [a state-owned company employing people with disabilities]
Otherwise, I spent my days at the restaurant–
–where I had long been a regular.
A waiter at the restaurant had personal contacts and tried–
–on his own initiative, to help me with my employment situation.
I was soon introduced to a type of ‘private recruitment agency’.
After a few meetings, they offered me a position as a software developer–
–at a local firm in Linköping.
I accepted the offer.
This resolved my acute financial issues–
–but not my remaining health problems.
Especially not as the legal proceedings initiated by the university–
–would continue for another couple of years.
This legal case would be appealed through multiple stages.
A couple of times a year, a packet would arrive from the court–
–containing statements, rulings, and the like.
It was never pleasant reading.
The university’s characterisations of me as an individual were deeply painful to read.
In one of the statements, some of my classmates had provided accounts of me.
I panicked and boarded the first available train to Copenhagen.
My intention was to head for the continent, live on the streets–
–disappear, and die – hopefully before long.
But when the worst of the shock had subsided, I returned to Linköping–
–where the police were searching for me.
I soon became terrified of finding packets from the court in my letterbox.
Therefore, I essentially began to live at the restaurant.
I would wake up at seven in the morning and head straight for work.
After work, I would go directly to the restaurant–
–where I would stay until they closed.
I would remain while the staff prepared the dining room for the following day–
–leaving only when the last of the waiters finished their shift–
–often after midnight.
The only thing I did at home was sleep.
The restaurant became like a home to me–
–and the staff like a family.
I was allowed to help out in the dining room and was included in staff activities.
During this period, I had some contact with priests and deacons–
–from the Church of Sweden.
Whenever I spoke with them and the restaurant came up–
–I struggled to hold back my tears.
The people there meant so very much to me.
The final packet I received from the court, after two full years–
–I opened at the restaurant, together with the staff.
It was the final verdict, and it was in favour of the university.
However, the shock was eased by the presence of the staff.
It was the first time in my life I had experienced genuine social support.
The shock was actually alleviated by their care and engagement.
But in spite of all this, my time at the restaurant–
–was still primarily a ‘palliative’ period.
I was constantly sad and anxious, feeling as though I had no future.
It felt, essentially, like a palliative existence where all I could do was–
–attempt to ease the pain of the moment.
And even that was largely in vain.
Singing and viruses
I did, however, contact a singing teacher during this period–
–perhaps as a desperate attempt to find something worth living for.
Six months later, I contracted an upper respiratory tract infection–
–that made it impossible for me to sing.
Common respiratory tract infections usually resolve within a couple of weeks–
–and one is typically fully recovered within a month or two.
But my pharyngeal discomfort lingered.
After two weeks, I visited the health centre–
–and the GP concluded that I was ‘perfectly healthy’.
However, my issues persisted.
Weeks turned into months, and months turned into years.
By the time of the final packet from the court (i.e., two years later)–
–I still experienced pharyngeal discomfort, every single day.
By that stage, however, I was forced to concede that it was–
–psychosomatic in nature.
During this period, I developed an intense fear of respiratory infections.
Merely hearing someone cough twenty metres away–
–was enough to trigger a panic–
–causing me to lose focus on everything else for hours afterwards.
To this day, if I sense even the slightest discomfort in my throat–
–or if I notice that my voice is not quite right, I can still be seized by panic.
Breakdown
Clearly, 2018 and 2019 were not happy years for me.
Although I felt a certain degree of support from the people at the restaurant–
–all of my fundamental problems remained.
Each and every one of them.
And my time at the restaurant was not an unmixed blessing, either.
Because there I was constantly surrounded by people:
Staff and guests.
Consequently, I was reminded on a daily basis–
–that other people had friends and partners–
–and physically intimate, perhaps even sexual, relationships.
It was particularly difficult when the staff consisted of younger people.
I remember one evening when a 20-year-old waitress–
–was working alongside a 17-year-old trainee.
They were chatting behind the bar–
–while I sat just a metre away on the other side.
I was the only ‘guest’ remaining that day–
–so they conversed as unrestrainedly as if they had been entirely alone–
–because to them, I was more like a member of staff than a customer.
Indeed, this was something which I appreciated deeply in general:
That I was ‘one of them’.
But this particular conversation was not pleasant for me to listen to.
They were discussing the 17-year-old’s boyfriend and her sexual activities with him.
They also touched upon the 20-year-old’s partner and her sexual activities with him.
To me, this served as an extremely clear reminder–
–that I lived alone in some parallel universe that no one else even knew existed.
This was unimaginably painful–
–and I could do nothing but sit there and listen.
Walking home that night, I actually felt a certain pride–
–in having endured it all without anyone noticing a thing.
But I was also profoundly exhausted.
Then, one day in January 2020, came the final straw.
A waitress and a waiter, both relatively young–
–were planning to meet on the 25th of that month.
It wasn’t exactly a ‘date’, but it sounded very much like one.
Throughout the month, they made their plans and preparations for this meeting–
–while I sat in my front-row seat at the bar, forced to listen to it all.
It was then that I broke completely–
–and was once again admitted to the emergency psychiatric ward.
After that, I never had any contact with anyone from the restaurant ever again.
A new beginning
A catastrophe does not always lead to something positive–
–but on this occasion, it did.
I saw a new psychiatrist–
–and returned to SSRIs–
–not escitalopram this time, but sertraline.
I was also signed off on 50% sick leave–
–meaning I only had to spend four hours a day at the office.
At the same time, the new coronavirus appeared–
–and with it the COVID-19 pandemic.
COVID-19 was an immense tragedy that brought much pain and suffering–
–and had I been omnipotent, I would have stopped it.
But for me, personally, life became easier because of the pandemic.
To begin with, I had a severe phobia of respiratory viruses.
Thus, the social restrictions imposed during the pandemic–
–came as a relief to me.
The pandemic also had an impact on the public mood.
It felt like a state of emergency, filled with uncertainty.
This mean that the mood of the average person–
–suddenly became much more similar to mine.
In a way, I felt less like an outsider.
In addition, now that I no longer spent my days at the restaurant–
–I spent all my free time at home, by myself.
So I was no longer constantly reminded that other people–
–had friends, partners, and physical intimacy.
That source of pain had been removed.
Consequently, now that I was entirely alone–
–I felt much less alone.
These four circumstances acted synergistically:
The SSRI, the sick leave, the pandemic, and my new, solitary everyday life.
Together, they led to a significant improvement in my health–
–during the spring of 2020.
And since then, I have been in better health than ever before.
Granted, I am still something of a wreck–
–feeling slightly nervous most of the time–
–sleeping through most of the day–
–always with aching fingers–
–and suffering from ‘throat attacks’ every other week.
But for me, this level of health is nonetheless excellent.
Internet dating?
By now, many of you are likely wondering–
–whether ‘Internet dating’ might have been an option for me.
I have tried it over the last twenty years–
–but it has never worked for me.
I am too sensitive and too ‘different’.
Just consider the language barrier.
In the context of Internet dating, one is usually looking for either–
–something ‘casual’ or something ‘serious’.
But what is it that I am looking for?
Well, on the one hand, I am not necessarily looking for someone–
–to spend the rest of my life with, in total exclusivity.
That is not a realistic goal for me.
Neither the exclusivity nor the permanence is crucial to me–
–or even important.
In this respect, what I am looking for appears to be ‘casual’.
However, when most people think of ‘casual’–
–they imagine relationships that are not based on much emotion–
–and certainly not on anything deep or profound.
This is not the case for me.
In my case, it involves an extremely intense, almost existential need–
–for closeness, safety, and belonging–
–with consequences for my health in both the short and the very long term.
Consequently, whether I say I am looking for something ‘casual’ or something ‘serious’–
–I am bound to be misunderstood.
The same applies to the question of whether I am looking for ‘sex’.
On the one hand, I certainly am, as I feel a profound need for physical intimacy–
–with a clear link to reproductive physiology.
On the other hand, I am not, because almost everything associated with–
–‘adult sex’ feels utterly strange and alien to me.
I want no part in it.
So, whether I say I am looking for sex or not, I am bound to be misunderstood once again.
In spite of all this, over the last twenty years–
–I have spent a lot of time and money (tens of thousands of Swedish kronor)–
–on Internet dating services.
Needless to say, it has not worked out very well.
If I reached out to a hundred people, I was lucky if even one of them replied.
And when someone did reply to me–
–it was usually someone wanting to mock me–
–or, as is most common nowadays: a standardised fraud attempt.
However, once I actually met a real and interested woman.
It was recently, perhaps in 2022.
We met once for a walk.
There was physical intimacy in the form of holding hands.
To me, this was a momentous event.
If you had measured my brain activity, you would likely have seen a massive surge.
For one thing, it completely demolished the wall I had erected–
–to protect myself from the knowledge that–
–others have friends and intimate relationships.
The plan was to meet again–
–with even more physical intimacy to follow.
However, for various reasons, things were delayed and time just dragged on.
She also happened to mention–
–that she was interested in someone else as a partner.
She assumed it was understood that a partnership was not on the cards for us–
–which in itself was perfectly fine by me–
–but the conversation nonetheless triggered a host of painful memories.
I had a complete breakdown.
She became frightened and cut off all contact.
I believe this incident confirms my hypothesis:
I am too sensitive and too ‘unusual’ for–
–these mainstream Internet dating services.
It is not a safe environment for me–
–and by being there, I likely make it a less safe place for others as well.
Actually, it is even more difficult than I have so far made it out to be.
When I was a child, I was interested in females my own age–
–classmates, for instance.
But after upper secondary school, something happened.
While my own age continued to rise–
–my ‘preferred partner age’ levelled off.
So, even today, it is the 18–22 age bracket, say, that I am interested in.
Not with any hard borders, of course.
It’s likely a Gaussian distribution or something of the sort.
And in my case, these boundaries are important.
For instance, I could definitely not imagine any kind of intimate relationship–
–with a woman in her 40s–
–any more than I could imagine such a relationship with a man in his 70s, say.
Why my brain is wired this way, I do not know.
Perhaps it is a consequence of my–
–having daily contact with my peers until the end of upper secondary–
–at which point I abruptly lost all regular contact with my age group.
Maybe that plays a part in it; I don’t know.
Now, I am sure there are those who think I am a ‘horrible’ person–
–because of this age preference.
But you should keep in mind that this is not something I have chosen for myself.
If I had been able to choose–
–the curve would not look like this at all.
Buying physical intimacy
In 2018, I hit upon the idea of travelling to Copenhagen–
–as it is legal there to buy physical intimacy.
These establishments do not appear to be primarily aimed at people like me.
At least not judging by their marketing–
–which is full of images emphasising–
–breasts and gluteal regions–
–‘strange’ outfits, postures, and behaviours.
I find their marketing quite unpleasant.
It has a purely deterrent effect on me.
But I understood that behind those unpleasant images were ordinary people.
And so, I travelled to Copenhagen a few times that year nonetheless.
Each time, I was met by a woman who was almost entirely naked.
I found this nudity rather uncomfortable, even slightly daunting.
I would have much preferred it if she had been wearing ordinary clothes.
The very first time, I was petrified with a mixture of terror and delight–
–lying completely motionless in bed as she performed various activities–
–which included (mild forms of) ‘adult sex’.
While I did not find this disturbing or frightening–
–it was maybe not quite what I was looking for.
Subsequent trips went a little better.
Even though I was still extremely nervous–
–I nonetheless managed to convey my own level of experience.
So these encounters ended up more suited to my needs.
90% of the time, we simply lay next to each other talking–
–holding hands and sharing a gentle touch, mostly me being caressed.
To me, it is an almost religious experience–
–to be that close to a living, breathing woman.
It is an indescribable, mind-blowing, out-of-this world experience–
–being that close to her–
–holding her hands and having her touch my body.
Still, I only made a handful of trips that year–
–primarily due to the high cost.
A trip to Copenhagen, including a couple of hours at such an establishment–
–runs to between ten and twenty thousand Swedish kronor.
The journey takes at least five hours, making an overnight stay necessary–
–which of course adds to the overall expense.
There are also other circumstances that–
–make me less inclined to go on these trips.
Although the establishments provide photos of the practitioners–
–they never show their faces.
So a significant part of the practitioner’s appearance–
–remains unknown until you arrive–
–which doesn’t feel entirely reassuring.
It has also happened that I have travelled to Copenhagen only to be informed–
–that the practitioner had fallen ill and our meeting thus had been cancelled.
That was a bit of a disappointment for me.
On the whole, however, I must say that the two establishments I’ve visited–
–feel very safe.
Safe and professional.
The manager has always been a middle-aged woman–
–and they have always had well-thought-out rules–
–that guarantee the safety, integrity, and security–
–of practitioners and clients.
No exceptions are ever made.
Medical safety is a prioritised issue.
Again, no exceptions are made that would compromise this.
There are also clear rules of conduct that all guests are required to follow.
The practitioners have always struck me as being very outgoing, strong, and cheerful.
I am under the impression that they have received some specialised training–
–given how professional, confident, and psychologically astute they are in their manner.
Several of these establishments also offer specific services–
–for people with some form of disability–
–who may find it difficult to find physical intimacy on their own.
Another factor that contributes to the sense of security–
–is the stringent way in which these establishments–
–comply with applicable laws and regulations.
During the pandemic, for instance, they fully adhered to the guidelines–
–issued by the Danish health authorities, which included specific protocols for–
–people with disabilities.
These certainly are establishments that do not hide from the police and the authorities.
Instead, they cooperate with them fully–
–in a way that feels perfectly natural from a Danish perspective–
–and utterly incomprehensible from a Swedish one.
So, while I may not belong to the typical clientele of these establishments–
–they nonetheless provide me with a legal and ethical means–
–of receiving physical intimacy.
The story’s purpose
I have now told my story as concisely as possible–
–under the condition that the picture presented–
–remains reasonably comprehensible, clear, and nuanced.
What, then, is my purpose in telling this story?
For one thing, I want to show that there are people like me–
–who face these kinds of challenges.
More generally, I want to broaden the horizons–
–of people at large, politicians, policy- makers, and healthcare professionals–
–to make them more aware of these difficulties–
–and other situations where individuals are marginalised and misunderstood.
Looking at my story, one can see numerous conflicts–
–and profound personal suffering for all those involved.
As an outsider, it is easy to dismiss this account–
–by concluding that it is all my fault and that I only have myself to blame.
Some of my classmates at medical school took this very stance.
While that may be simple and convenient, I do not believe it is a constructive way–
–to approach problems of this nature.
But what, then, do I believe society could have done for me?
Imagine if everyone had been like my classmate Klara from upper secondary.
She was truly unique in her desire to help the vulnerable in a practical, hands-on way.
Had everyone been like her–
–there would be very little room for marginalisation and alienation in the world.
But to expect everyone to be like her is, of course, not realistic.
A much more realistic alternative would have been early, specialised–
–intervention from public services.
By my final years of compulsory school, my problems had become quite obvious.
Imagine if I had been able to see a specialist in these types of difficulties–
–once or twice a week.
We could have discussed everything related to friendship and physical intimacy.
Perhaps such a specialist would have grasped–
–just how profound the need for physical intimacy was for me–
–exactly how traumatic it was, and could become–
–and just how badly things might go without the right support.
Perhaps they could have offered practical advice that actually worked.
Perhaps there could even have been an association–
–for people facing similar challenges.
Even without such early intervention–
–I believe public services could still have helped me.
It would, for instance, have been a tremendous help to receive–
–some form of support during my university years.
Ideally as early as my time as a doctoral student in mathematics.
And at the medical programme, I had very much hoped to be seen.
The physicians there represented not only the Swedish medical profession–
–but also the state.
They, above all, should have had both the motivation and the competence–
–to see me for who I was–
–and to help me in a mutually constructive way.
This was especially expected given that the medical programme in Linköping–
–emphasised a scientific approach–
–and awareness of cognitive biases.
Reading fiction was mandatory.
There was a significant focus on clinical communication skills–
–and on a holistic perspective of the human being in its social context.
Yet, I saw no trace of any of this when the faculty leadership addressed my case.
Rather, it felt as though they were acting as representatives of the state–
–intent on implementing a state ideology–
–even if it required them to deviate from established ethical and scientific principles.
I believe it was primarily a matter of ignorance.
Perhaps a degree of fear and peer pressure.
Ingrained preconceptions.
But above all, ignorance.
Regarding physical intimacy, I wish I could–
–access it in Sweden in a safe and secure manner.
Ideally, it would be offered through the healthcare system.
It could be offered to individuals with a clinically confirmed–
–difficulty to form such relationships on their own–
–if, in addition, the lack of such intimacy has a profound–
–adverse effect on the patient’s health and quality of life.
Under such circumstances, society could provide various forms of contact–
–including physical intimacy–
–facilitated by well-trained volunteers of various genders and ages.
This may seem like a preposterous idea–
–and it is easy to dismiss it as nonsense–
–if one is unaware of the struggles faced by people with these kinds of difficulties.
Again: my intent is to show that such people do exist.
On a more personal note, I suppose I have a great need to process trauma.
I also harbour a profound wish to one day live in a society–
–that accepts me for who I am.
One that believes what I say.
And, ideally, one that can offer some form of support.
Someday, I would like Sweden to be my country.