Exam time: the outer rim of hell

It’s the time of the year when I, as a psychiatrist, find myself writing letters motivating for extensions, deferments and more time. Nobody likes exams; it’s hard work and the feeling of being evaluated can be unpleasant. But for some people exam time becomes a psychic hell.

A patient came to me having continuous panic attacks. She was incapable of sleeping or studying. She had been procrastinating with exam preparations; once she started, she was overwhelmed by the sheer volume. She started working non-stop, breaking only to refill her coffee or buy some cigarettes. Initially, she made good headway. The problem began when she was not able to sleep in her carefully allocated five-hour slots. She was too tired to focus, so pilfered some of a friend’s Ritalin to push on. The anxiety mounted. By the time I saw her she was in a constant state of panic, her brain was foggy, and she could not sleep at all. The exam was the next day.

My patient is an extreme example, but by no means the exception. It is very much a cultural norm at varsity to party hard and study hard.  In many ways, young brains and bodies can tolerate this kind of abuse for short periods. However, a heady combination of stimulants (coffee, cigarettes and Ritalin), sleep deprivation and stress is begs for some meltdown.

It would be great if teachers could, as part of their exam preparations, remind students that they are heading for a patch of hard work and long hours. What you want is the edge for endurance.  I always advise my patients when making their study roster that they must prioritise planning for sleep. The brain is very good at working hard, but it won’t just switch off when stimulated for extended periods. You have to give yourself time to wind down between study and sleep. During sleep, memories are consolidated. If you get into a habit of popping a sleeping pill, this does not happen effectively.

A bit of morning exercise will release tension in the body built up from long hours at the books and help maintain general health and vitality. How many people get flu when they are studying?

Food plays a huge part in either energising the system with proteins and low GI foods or leaving one on an energy rollercoaster with refined sugars.

As moms, we can’t write our kids’ exams for them or manage their stress for them. But we can be the ongoing gentle reminders about self-care. Unfortunately, I had to give my patient tranquillisers to help with her crippling symptoms. She managed to scrape through her exams and will need the holidays to recover completely.

Another patient of mine would get through exams, but it took so much out of him that he wondered if he should quit his course. He generally enjoyed the course and did very well with the practical component of it. The studying for long stretches required for exams was excruciating. He would put in long hours and a huge effort but only get through small chunks of work. In exams, he would often “blank” for the first few minutes and only get going when half the time was up.

He recalled that exams were never easy for him, but he would ride his year marks and finish strong. In everyday life, he struggled to structure his day, by evenings he would struggle to focus even on TV. Through careful assessment, we realised that he was struggling with adult ADHD. He managed to get this far in his education because he was bright, determined and until recently had been supported by a very organised mom. Concerta proved to be the breakthrough. He loves studying now and plans to do his honours.

A young lady whom I had been treating for anxiety and depression mostly did very well but would destabilise every exam time. She is a bright and conscientious student, with the marks to show for it. Rather than be proud of her achievements, she would speak of “only” getting a distinction. After every exam, she would go over the paper and endlessly ruminate over her errors. She had a competitive group of friends who would compare how long they studied for each subject. After a few rounds of this, I finally convinced her to go for some CBT (cognitive behavioural therapy). She learnt how to challenge her perfectionistic critical thinking and how to self-talk around her anxieties. She still doesn’t like exams, but now views them as a necessary evil.

Exams are here to stay. They help us engage deeply with the subject matter. Even if they are an anxious torment, it’s worth remembering that after exams come holidays!

(details have been changed to protect identities)








  1. I am a part time tutor of several subjects, so I have learned a bit myself about advising students on how to prepare for exams. Here are two I deem really important:

    Before you even pick up a textbook or notes get hold of the syllabus. Most are available online and if you can’t find a copy ask to photocopy your teacher’s or lecturer’s copy. Look’ at the mark allocation for each section. If you are looking at the matric Chemistry syllabus you will find that Organic Chemistry (35 marks) and Chemical change (25 marks) far outrank any other section. And because both of these sections are relatively easy, getting them under your belt will be much more productive in earning marks than studying disproportionately hard for a small, but difficult to understand section like intermolecular forces that is only worth 5 marks. Usually students receive copious notes and diagrams about the latter because it is so hard to explain but that does not mean you will be rewarded with proportionately copious marks.

    On the day before the exam please do not study. Go to the beach, climb the mountain, do something uplifting and good for the soul. If you have prepared well for your exam, no amount of studying on the day before is going to make any statistical difference to the outcome of your exam. On the contrary if you pick up some discrepancy with what you already know this is likely to cause cognitive dissonance which will manifest as stress and cause you to doubt both sources of information. If on the other hand you are poorly prepared for your exam another day of study is not going to bring together all the information you require to appreciate the big picture, so rather destress the day before and do as best you can with what limited information you have.

    The absolute worst you could do before an exam is to pull an “all nighter”. This will definitely lead to a drop in performance, even if you are well prepared.

    Finally, how about asking a tutor for help? They don’t just explain concepts and give notes, they also do a lot of exam preparation with the aid of past papers. They also have quite a lot of psychological insight into the process of learning and for what they don’t know they can always recommend an educational psychologist.

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