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How To Go To Therapy

Think you don't need therapy? Think again: therapy is for everyone. But there's a right way to do it, and a wrong way.

A lot of people think therapy is only for people who have psychological problems.

Let’s put that stigma to rest. Everyone can benefit from therapy. It’s like going to the gym: going to therapy helps you live a happier, healthier, and more productive life, even if it seems like a drag at the start.


“The biggest misconception about therapy is that you need to have a problem or that there is something wrong with you in order for you to go,” explains Justyna Wawrzonek,  a licensed social worker at the West Hartford Holistic Counseling Center in Connecticut. “That is not what therapy is about. Therapy is basically learning to come home to yourself and be as close to yourself as you can be.”

So even if you think you don’t need a therapist, you should consider making an appointment to see one. It’s an investment into your own wellness every bit as important as eating right, exercising, or the myriad other things people do to improve their quality of life.

But how do you start? How do you find a therapist? And how do you make the most of it?

How to Find a Therapist

First things first. Before you begin the search for a therapist, check with your insurance company.  If you choose to work with a therapist in-network, your insurance company may only cover a certain amount of sessions per year. If you select a therapist who is out-of-network, it is essential to understand your deductible as well as what can and cannot be submitted for out-of-network reimbursement.

Your insurance company’s list of eligible therapists can be overwhelming, so review their specialties. As an adult, you can cross off any therapist that specializes in children or adolescents. Depending on your age, you can either seek out or cross off those who serve geriatric patients. If you are confident that you do not suffer from a specific condition—such as an eating disorder, substance abuse, anxiety, or depression—you can eliminate those specialists as well. However, it’s important to recognize that while you think you understand why you are seeking therapy, once in therapy you may discover there is a different reason entirely.

It’s important to recognize that while you think you understand why you are seeking therapy, once in therapy you may discover there is a different reason entirely.

Once you’ve narrowed down your list, ask your primary care provider for recommendations. You can also check with friends and family if you feel comfortable. Next, rule out deterrents such as location, cost, or lack of appointment flexibility. Then set up initial interviews and ask a series of questions about their approach. This will help you determine if the therapist seems genuine and empathic, if they listen well, and if they ask good questions. During this interview, pay attention to how you two interact: some patients, for example, prefer their therapists to be blunt, while others want their therapists to be more affirming.

What to Expect from Therapy

“In an ongoing therapeutic relationship, you will develop a stronger bond with a therapist,” explains Brian Cassmassi, an adult psychiatrist. “You may not become best friends, but there is definitely a friendlier and easy rapport. Plus, it’s a lot easier to talk about what happened with your days and for the therapist to recall things that may have happened in your past that can clarify a current situation.”

As you become more comfortable with your therapist and continue to learn about yourself, you will develop a growing awareness of the patterns in your life, and how these patterns influence the way you feel and behave. This is what therapy is ultimately about: to gain a deeper understanding of the way everything in your life ties it together.

“Therapy should be challenging and hard—that’s when you know that you are growing.”

“You are the expert of your life,” Wawrzonek explains. “You know where you need to go, what you need to do, and what you want out of life. But you may not know exactly how to get there. It’s the therapist’s job to walk along with the client and help them sort through all the different roadblocks. It is not the therapist’s job to take the client’s hand and lead them somewhere. The client is always in the driver’s seat, and the therapist is using their best judgment as to what may be helpful for their client.”

“Therapy should be challenging and hard—that’s when you know that you are growing,” Wawrzonek continues. “But it also has to have a component of feeling safe, nurturing, and supportive. Without it being hard, safe and supportive, there is something that is missing. All of those components are important.”

What Not to Do in Therapy

Believe it or not, self-sabotage can be common in therapy.

Some of these examples of self-sabotage are obvious. It should go without saying that if you are chronically late or miss the majority of your appointments, you aren’t getting the full benefits of therapy.

But keeping secrets and not being totally honest will also sabotage your therapeutic goals. If your therapist isn’t working with the truth, it’s hard for them to understand what is happening in your life. Therapists aren’t there to judge you or your actions, regardless of their personal beliefs, so don’t be afraid to share.

Your therapist can’t change the world, but they can help you to change yourself.

“If there is a topic that is way too sensitive for you to discuss with your therapist at the moment, but you know it’s important, it may be helpful just to say, ‘there was this rape that happened when I was a teenager, but don’t touch that right now,’” Cassmassi recommends. “During a later session, if you say you were uncomfortable with your boss touching you a certain way last night, the therapist may ask if you want to talk about the rape now or if you still want to talk about your boss.”

Playing the blame game is just as bad. Instead of blaming others for a problem, your therapy should focus on the things you can control. Your therapist can’t change the world, but they can help you to change yourself.

Don’t Be Afraid To Switch Therapists

It’s common to develop a strong connection with your therapist over the years.  Because of this, it may be hard to recognize and accept that you are no longer progressing with your therapist. But if therapy has become a weekly obligation and you are no longer growing, then it may be time for a change.

Remember, therapy is for you, and you should always put yourself first in this relationship. When it is time for a switch, don’t worry about how the therapist will handle the news.

“By the time that somebody is a practicing therapist or psychiatrist, they have gone through thousands of hours of supervision and training,” Cassmassi explains. “While you may think you will hurt our feelings if you leave us, that has been hammered out of us from our training. We are usually well-trained to adapt, and you aren’t going to completely break our hearts if you want to switch.”

Remember: Therapy Is For Everyone

When people haven’t gone to therapy before, they tend to believe it’s only something you do when something is “wrong” with you. But there’s nothing wrong at all with wanting to gain a better understanding of your world, and the tools that therapy teaches us to use—like mindfulness, or coping skills–have broad applications in everything from your career to your love life. .

“One of the things I often hear is, ‘why didn’t someone tell me this in elementary school so that I had this defense skill in my repertoire when I became an adult?’” Cassmassi recalls. “When people finally go to therapy as an adult, they feel like they wish they had at least known a simple trick to help them get through their teenage years. Patients also say, ‘I wish I had that under my belt when I was going through all of this. Maybe those skills would have helped me with some of the minor things, and I would have felt slightly less anxious.’”

“The most important relationship in your life is the one you have with yourself.”

And, it provides a safe place for you to learn and grow under the guidance of a professional who has your best interest in mind.

“The most important relationship in your life is the one you have with yourself,” says Wawrzonek. “And when we can nurture and foster and grow and have a healthy relationship with ourselves, that is going to mirror every other relationship that we have in the world: work, family, and friends. The deeper you get to be yourself, be okay with yourself, accept yourself, love yourself, and be your own best friend, that greatly benefits every area of your life.”

Profiles

President Of The Drowning Girls Club

With her popular series of designs symbolizing issues such as anxiety, depression, and PTSD, tattoo artist Fidjit is helping people like her struggling with their mental health.

On the underside of her chin, tattoo artist Fidjit Lavelle has the words “I don’t scare easy” inked in bold black letters. While most of the tattoos that cover her arms and legs reference things like loved ones, childhood memories and favorite films, her neck piece touches on another major part of her life: the debilitating phobia she’s struggled with since she was 8 years old.

The now 28-year-old artist, who only tattoos in black ink in a process known as blackwork, began her first tattoo apprenticeship at the age of 19, right at the tail end of an awful two-year period where her phobia was so intense she couldn’t leave the house due to intense panic attacks.

“It was very difficult in the very beginning,” she says, “There were a lot of times I would make excuses for not going in, leave suddenly, or just feel terrible the whole day while at work.” After the first year, things began to improve, which she credits in large part to hypnotherapy, and she became used to having to wait out feelings of panic and dealing with them after she left the studio.

Tattoo artist Fidjit Lavelle.

Today she’s based in Southend, England and frequently works in studios in London and abroad, having attracted a large following who often identify with the personal and feminist themes found in her work.

In talking about her own mental health, Fidjit points out that while she has Tourette’s, which is a neurological condition, it comes with a number of comorbid conditions like OCD, OCB and PTSD. She also experiences difficulty in social situations, sensitivity to sensory overload, dissociation and mixed personality problems.

“A lot of my work is based around mental health problems because that’s really quite a big part of my life.”

“A lot of my work is based around mental health problems because that’s really quite a big part of my life,” she says, describing her flash sheets (pre-drawn images that anyone can ask to have tattooed) as a visual diary. “I don’t have any interest in just drawing pieces that have nothing to do with my brain or me personally. I’m lucky in that a lot of my clients are on the same wavelength, so they’ve specifically picked me because something I’ve done has spoken to them in a certain way.”

One popular image that still strikes a chord with many of her clients first appeared three years ago in a flash sheet inspired by the suicides of female authors. Adapted from a painting Fidjit had made based on the death of Virginia Woolf, the drawing shows the top of a woman’s head peeking over stylized waves.

One of Fidjit’s blackwork tattoos, which often symbolize mental health issues.

Since then over 1,000 people have gotten variations of the tattoo, members of what she now calls “The Drowning Girls Club.” She says that while some versions are sarcastic or have light-hearted additions like party hats, many clients get them for reasons related to their mental illness or the struggle of keeping their heads above water. Whether people ask for the original drawing or add personalized details, she loves that the image has resonated with so many and that a community has formed around it. “I think that people really like feeling part of something, part of a united front despite whatever problems that they have,” she says.

Recently she’s found herself working on a new series of custom tattoos based on mental health. Like with the drowning girls series, it began with a flash sheet, but this time with drawings inspired by her own experiences with dissociation, panic attacks and an eating disorder.

“One person got one of the pieces done and I wrote what it was about [on Instagram] and then someone asked me to do a custom piece about dissociative disorder,” she explains. After posting that second tattoo and a brief description online, more and more requests came pouring in from people wanting to have their own conditions turned into tattoos.

“I think that people really like feeling part of something, part of a united front despite whatever problems that they have.”

The tattoos, often framed with radiating lines that almost vibrate around the central figure, give viewers a sense of the full-body sensations that accompany many mental conditions. A tattoo depicting panic attacks, for example, recreates a feeling of claustrophobia as seven detached hands reach at a floating head, the character’s distressed face half in shadows as lines emanate along their profile.

“There’s obviously so many different reasons why people get them, but I think there’s an ownership element,” she muses, talking about how people often place their trust in her when coming up with a design but the process is still a collaboration and conversation about how they personally picture their condition.

Capturing often overwhelming experiences in simple visuals, each piece is a unique window into how a specific person experiences and understands their own mental health. Just as putting a name or diagnosis to a condition can be validating, so can creating a representation of your relationship to it.

There are over a thousand variations in the Drowning Girls Club series.

She says that for many, “It makes them feel more in power of something that’s maybe hindered their life in a certain way, because when it’s invisible and kind of floating about it seems a bit harder to take control of. If you have a visual representation you can look at it and remember that’s what it is. It’s just that. I think sometimes it’s quite a nice reminder that is just one part of you and it’s not something that necessarily that needs to rule you.”

“It’s odd, because it’s just a tattoo, but it really does help,” she adds, reflecting on her own piece. “Sometimes if I feel very overwhelmed, I think about the tattoo for my phobia underneath my chin and it makes me feel like I’m more in control, that I’ve got power over it.”

Having the invisible made visible can other benefits as well. She knows of people who’ve gotten these tattoos partially as a conversation starter, a visual way of announcing and explaining their condition or simply showing that they aren’t ashamed.

“Sometimes if I feel very overwhelmed, I think about the tattoo for my phobia underneath my chin and it makes me feel like I’m more in control.”

Fidjit’s own openness about her experiences on Instagram is one reason for her major following, which she credits to changing trends in the tattooing industry. Whether it’s the movies they love or the social movements they support, she says social media has made it easier for people to seek out artists they identify with. “I think clients are really interested in the person behind the work and their lifestyle more than their actual work sometimes,” she observes.

Her own posts about things like an abusive ex-partner and the experience of having her rapist acquitted, along with participating in fundraisers for rape crisis and domestic violence charities, has helped her attract customers with similar stories who know her studio is a safe space, even if they might not want to specifically talk about their experiences.

Fidjit’s tattoos help people struggling with mental health issues remember that they are not alone.

Fidjit says that the greatest difficulty her conditions present in terms of tattooing are often social interactions, since talking is often a major part of the job but she can find making normal conversation difficult and doesn’t always know how she’s coming across. That doesn’t stop her from offering a sympathetic ear or calling out abuses she sees in the tattooing industry.

“I’m happy to tell anybody who to avoid – I’ve had tattoos on my body from people who are abusive and it’s a horrible feeling because it’s this thing on your body from a horrible person. I hate that feeling, and I hate other people to have that feeling.”

Because while a tattoo might just be an image on skin, the story of how that image got there can mean everything.

Essays

My Long-Leggity Beastie, Anxiety

A helpful therapist and a high-school spelling bee taught me to finally confront the monster that was haunting my life.

As a junior in high school, I qualified for the regional spelling bee. The contest was going to be held at a nearby high school which I had never visited. My parents, who both had work obligations that afternoon, explained to me where the high school was located. Having only recently got my driver’s license, I assured them that I would be fine on my own.

But on the day of the contest, I was nervous. My heart was beating fast as I fired up my ancient station wagon and joined the stream of traffic heading down the parkway. Unsure of my route, my eyes darted around looking for street signs. Finally, I saw a sign that read “High School” and quickly turned down the residential street, relieved to have found my destination.

But when I inquired at the front office about the spelling bee, the secretary seemed confused. She got on the phone and made one call, then another. She shook her head. Hanging up the phone, she gave me the bad news.

I had come to the wrong school.

Heart pounding, I hopped back in my car. I drove to the correct high school in a blur, and ran into the auditorium, only to arrive as the last word was being read aloud.

I stood there, frozen, with tears streaming down my face as I realized I had missed my chance. As the audience cheered and clapped for the spellers, I broke into sobs, and hurried back to my car where I could cry in private.

I felt devastated about missing the spelling bee, although to family and friends, I laughed the whole thing off, turning it into a story about my poor sense of direction. Privately, I ruminated about how upset the whole thing had made me.

Up until then, I had been undecided about what to do after graduating high school: go to art school, to fulfill a lifelong dream of studying design? Or pursue a traditional liberal arts education, where I could indulge my love of reading and writing?

Now, I thought, I had uncovered a truth about myself that I couldn’t ignore. I concluded I was so upset because I cared about words and language so much. In my mind, this meant I needed to follow my deeper passion.

So I gave up on art school and focused on English. I looked for the words that would make this story about myself true.

But the truth I uncovered that day was actually something completely different, although I didn’t realize it at first. This was a narrative shaped, not by my passions, but by the anxiety that has been running like a dark undercurrent throughout my life.

It was not until many years later, when seated on my therapist’s couch, that I saw it for what it was, and truly understood how I had been carried along by this current of anxiety for most of my life.

The therapy session was about something completely unrelated. But in discussing how I had reacted to a certain situation, my therapist made an observation that shook me to my core.

I mentioned something about anxiety being an influence on my reaction, and she smiled, her eyes fixed to mine. “Honey,” she said with a kind smile, “anxiety has been the single most powerful driving force in your life.”

“Honey,” she said with a kind smile, “anxiety has been the single most powerful driving force in your life.”

The conversation shifted after that, and I barely remember what was said next. When our session was over, I responded mechanically to her warm and loving hug, and raced out of her office, my mind buzzing.

The single most powerful driving force in my life? What about my intellect, my curiosity, my passions? My hands were shaking as I fumbled in my bag for my car keys and made the short drive back to work. I wasn’t ready to let this information in. If I tugged on the thread my therapist had just pointed out to me, what would it unravel? So I tucked it away and tried not to think about it.

Anxiety, like other mental disorders, is an imaginative and skillful liar. One of the greatest tricks it plays is its ability to hide in plain sight, to camouflage itself as something benign. For so many years, my anxiety was the snarling wolf waiting in disguise, while all I could do was wonder: “What long teeth you have!”

As a child, my anxiety hid among an array of typical childhood fears, like the alien hiding among Gertie’s stuffed animals in the movie E.T.. Hanging on the wall in my grandmother’s sewing room was a needlepoint sampler of the old prayer, “From ghoulies and ghosties and long-leggity beasties, and things that go bump in the night, good Lord, deliver us,” complete with an image of a green, dragon-like beastie. I was terrified of that sampler; terrified of the idea of “things that go bump in the night,” terrified of E.T., or any sinister creature from any movie or TV show I ever watched. I sat in terror through the movie Gremlins as a child while my family laughed at its campy horror, then I lay awake for hours imagining that the long-limbed creatures from the film were going to crawl up from under my bed and devour me.

In high school, my anxiety was free-floating and sporadic, but it hid so well there too. My friends and I would commiserate about being “so stressed” or “totally freaking out” over endless late-night cups of coffee at Denny’s, as we attempted to juggle pre-calculus homework, play practice and debate tournaments. In college, everyone complained about having “so much work,” yet it seemed like a point of pride for each of us to be the busiest, the most burdened, the most stressed.

What I didn’t say to anyone at college was that when I was “so stressed” about my homework, I locked myself in my room and stayed awake for 24 hours until I had all my assignments done. I didn’t mention that when I had been “freaking out” the day before, I had been sitting under my desk crying uncontrollably for an hour, and I didn’t even really know why. These weren’t the stories I wanted to tell about myself.

Anxiety shouts, it screams, it will do anything to get your attention, and it can be hard to ignore.

Our brains love stories so much that they will make them up, stringing together unrelated events to construct a narrative where none exists. For a long time, it seemed my brain loved only the stories that flattered it; the stories that fit my idea of the person I thought I was.

And my brain is very, very good at telling stories. Stories were at once the shield for my anxiety to hide behind and also its most fearsome weapon. Anxiety has told me that something terrible is about to happen so many times that you would think I would have known it was crying wolf. Somewhere inside me, there was always a small voice saying, “This isn’t right.” But it got drowned out so easily. Anxiety shouts, it screams, it will do anything to get your attention, and it can be hard to ignore.

Accepting my therapist’s statement about the impact of anxiety on my life has meant re-writing my entire story. Looking back over my life with this newfound knowledge has been like opening up a beloved book, only to find that the characters are unfamiliar, the storyline changed, like my own private Mandela Effect.

But her statement also gave me permission to keep listening to that small voice inside me — to hear what stories it can tell. And I have learned that it is wise, and kind, and true — all the things my anxiety is not.

Anxiety pretends to be a soothsayer, reading signs and portents in everyday objects. It is why I laugh when people tell me to “trust my gut” or “use your instincts,” because anxiety rules these parts of me, and it is not to be trusted.

I laugh when people tell me to “trust my gut” or “use your instincts,” because anxiety rules these parts of me, and it is not to be trusted.

Anxiety is what tells me that someone has broken into my house and murdered my loved ones. It tells me that the shape on the side of the road is going to be a dead body. It tells me that ghoulies, and ghosties, and long-leggity beasties lurk in the shadows.

It’s so easy for everything to get drowned out by the nonstop gibbering of these fantastical yarns. But I am learning how to tune out the noise, like voices in a busy restaurant, and listen instead to what this new, small voice has to say.

It’s not always that simple or that easy. Sometimes the lies of anxiety are too cunning, sometimes its voice can’t be drowned out. Sometimes the threat of the wolf at the door feels much too real. But I am learning, after all these years, to tell the difference between fact and fiction, and to choose very carefully which stories I hear.

Essays

How Performing In ‘The Vagina Monologues’ Helped Me Confront My Depression

I may have agoraphobia, depression, and anxiety.... but thanks to my experience acting, the world is now my stage.

At 40, I found myself on a local University community theater’s makeshift stage in Birmingham, Alabama, performing on stage for the first time in my life.

The audience was only 100 people, but to me, it felt like thousands. I was on stage, making my acting debut as the ‘The Little Coochie Snorcher That Could’, a southern black lady who falls in love with a woman from a homeless shelter, in an adaptation of Eve Ensler’s The Vagina Monologues.

Salaam Green

Standing on the stage in stilettos and pink lingerie, my voice started shaking. For the first 10 seconds, the words wouldn’t come out. In panic, I looked at my stage manager, but she just nodded, as if to say: You got this.

Within seconds, I gained my footing. Once I got used to being in front of so many people in sexy clothing, playing a role totally opposite the quiet, reserved person I am in everyday life, a sense of power came over me.

For the first time, maybe in my life, I felt confident and free.

I guess I’ve always felt “crazy” or different. As a black woman, there’s a staunch stigma–more so than for Caucasians–associated with being depressed. It made me introverted and prone to panic attacks.

As a black woman, there’s a staunch stigma–more so than for Caucasians–associated with being depressed. It made me introverted and prone to panic attacks.

In elementary school, I would get so nervous before class, sometimes I couldn’t hold my bowels; I wouldn’t eat all day, just in case it happened in front of my peers. So from a young age, living with social anxiety was my normal: a normal which isolated me from other people my age, and drove me inwards.

Never eat in the cafeteria, miss the bus so you don’t have to sit next to strangers, sit in the back of class where you’ll be unnoticed. Vanish, become invisible, retreat into the abyss of depression and anxiety.

Eventually, I grew so depressed and agoraphobic that I became afraid to leave my home. I ballooned to 337 pounds, only standing up from my couch to go to work or buy fast food. When I wasn’t at work, I was on my red couch, eating fast food. Eventually, when going to see a doctor for a serious sinus infection, he told me he suspect edI had agoraphobia, an anxiety disorder characterized by a fear of open or crowded spaces.


Outside of being called “crazy,” I’d never really had a name for my condition. But now I did. As I read about the symptoms of agoraphobia at home, I realized that the diagnosis fit me like a glove. A spirit of resilience rose within me: I decided, then and there, not to let agoraphobia and depression define my life.

A spirit of resilience rose within me: I decided, then and there, not to let agoraphobia and depression define my life.

A year and 180 lost pounds later, I saw a flyer for the Vagina Monologues auditions.

I had just divorced my husband, who had told me, as he left, that I would never be anything but “crazy” and no one would ever be my friend. Like my agoraphobia diagnosis, it galvanized me. Shedding tears of resolve, I vowed I wouldn’t let him be right, and I would have friends. Chasing my childhood dream of being a writer, I joined a group in Birmingham called Women Writing for a Change. Soon, I had formed a bond with the five women in the group, who accepted me for who I was, and held me to account.It was to my writing group that I first mentioned my whim to audition for The Vagina Monologues. They were wildly encouraging.

Soon, I found myself huddled in a room at the University of Alabama with 25 other women, all auditioning for the same play. When I was first called in, I almost forgot to breathe when I read my first line: “My vagina is a shell, a tulip, and a destiny. I am arriving as I am beginning to leave. My vagina, my vagina, me”. I thought of my first love—a tall basketball player I met in high school—as I read the short piece. Afterward, the set manager thanked me, and said that my name would be posted on a Facebook account if I got the part.

Two days later, I got word I’d gotten the part. 16 women out of 25 made it. Apparently, I nailed the audition.

The night of the performance, I found myself huddling again in a crowded public restroom with these same 15 women. As I nervously prepared myself, I wondered if even a single one of my-costars could have guessed that a year earlier, I’d weighed nearly twice as much, and had been so anxious, I couldn’t even leave my house.

I wondered if even a single one of my-costars could have guessed that a year earlier, I’d weighed nearly twice as much, and had been so anxious, I couldn’t even leave my house.

Like I nailed the audition, I nailed the performance, drawing gasps from the audience as I went off-script with sexy moves and overtures. The part I’d been given—Playing a confident, body positive, queer black woman—was the polar opposite of the part I played in life, and how most of my friends and even family saw me. But I drew strength from it. I realized that if a role like this—in which a black woman goes on stage and proudly owns her sexuality–could become mainstream enough to be in a well-known play like The Vagina Monologues, then maybe, too, the stigma around mental illness could be lifted in the African-American community, and people like me could be more accepted.

Post-Monologues, I still suffer daily from the symptoms of depression and agoraphobia. There are days when I sit for thirty minutes in my car, sweating anxiously, afraid to go to work to face my day. But having proven that I can go on stage has served as a hopeful beacon to me. There remains a stigma of being an African American southern woman who suffers from depression and a fear of going outside, but reclaiming my voice and expressing myself, through acting and writing, has put me on a healing.

I may be recovering from agoraphobia, but the world is now my stage.

Profiles

The Adopted Artist With Her Head In The Clouds

Anxiety, depression, and the nature of memory intertwine in Andrea Joyce Heimer's unforgettable paintings.

Like many young artists, Andrea Joyce Heimer spent her early twenties stuck in an office job that she didn’t like while she tried to find her creative voice. Unable to afford art school, she was determined to teach herself to paint in a photorealistic manner — the only style she thought could convey the adolescent memories she wanted to depict. But no matter how many instructional books she bought or how hard she tried, she couldn’t master perspective. Eventually, she quit out of frustration.

Andrea Heimer.

Around the same time, Heimer, who had been struggling with anxiety and depression since high school, fell into one of her deepest depressions. She couldn’t get herself out of the house for weeks. “It was like I just hit a wall,” she says. “I thought, ‘I’m going to off myself unless I figure out something to keep me busy.’”

Still surrounded by art supplies, Heimer decided pick up a brush again. This time, however, she wasn’t going to worry about what the painting looked like. She told herself, “I’m just going to do it how it comes out. I’m going to return to childhood where I just draw for the fun of it.”

She ended up painting four pieces. The paintings were all flat, with no shading and the perspective was skewed. But there was something appealing about them. With encouragement from her husband, she reached out to some folk art galleries and received a positive response from the first place she contacted. She was still stuck in a depressive loop, but that positive reply gave her just enough of “a little oomph” to make another painting and then another. Slowly but surely, that momentum built on itself, eventually pulling her out of her dark hole.

Having dispensed with spatial perspective, her paintings are filled with layers of detail, all floating on the same plane

Today, Heimer is a full-time artist, splitting her time between an MFA program in New Hampshire and her home in Washington. Having dispensed with spatial perspective, her paintings are filled with layers of detail, all floating on the same plane. Objects and characters that might otherwise be hidden are brought into view, unveiling the mystery and violence hidden just below the surface of suburban neighborhoods. The effect is akin to Grandma Moses meets David Lynch. In her acrylic world, ordinary rites of passage collide with mystical rituals: cult members argue over wallpaper choices, giant wolves suckle teenage boys, and a devoted husband drinks his wife’s bathwater. At the same time, kids get bowl cuts in the living room, bad boys hang out at the baseball diamond “being dangerous and irresistible,” and girls cultivate crushes that are mythical in scope.

Often only 16 inches by 20 inches, or smaller, her paintings reward viewers who pause for a closer look. Minute patterns on wallpaper and clothing reveal themselves to be cowboys and Indians, thunderstorms and rainbows, or a starry cosmos of planets and comets. These repeated patterns are therapeutic for Heimer. Even when the painting doesn’t aesthetically need the patterning, Heimer needs it. “For someone who has tendencies to overthink things, it’s such a relief to go do something repetitive,” she says. “It’s that meditative process of drawing the same tiny design over and over and over again–you can lose yourself completely for two hours just doing that.” To paint these details, she leans close to the canvas, keeping her face only an inch away from the surface. “I’m sure that’s terrible for my spine,” she says. “But it’s that intimate time spent with that object that breathes more life into it. I miss that when it’s not there.”

It’s that intimate time spent with that object that breathes more life into it.

Heimer began developing a keen eye for detail early on. When she was in third grade, her parents pulled her aside after dinner and told her that she was adopted. Visibly uncomfortable, they kept the conversation short, and didn’t discuss it again. Determined to never be surprised like that again, she became a studious observer of life in her hometown of Great Falls, Montana.

“You’re going along, you have this normal life … and then all of a sudden you find out that your parents aren’t who you think they are,” explains Heimer. “Then that opens a door. You’re like, ‘Okay, well what else isn’t what it seems?’’’

Great Falls sits on the northern Great Plains, surrounded by vast stretches of open prairie. “You can literally find the edge of town and go stand there. There’s nothing beyond it, which is an unnerving thing,” says Heimer. The neighborhood she grew up in, however, felt like a typical suburb. She lived a couple blocks away from her elementary school. There was a park across the street from their house and beyond that a golf course.

Heimer would spend hours riding her bike past the houses, coming up with narratives about the lives inside. “I don’t know if there’s some underlying perversion in me, or something. Maybe it’s a normal tendency. You ride the same route and you start noticing the same people and you wonder, ‘Are their lives like my life?’”

Heimer at work in her studio.

As a goth teenager, she’d go to music shows and sit in the parking lot because she was more interested in listening to people’s conversations than the bands inside. “I would sit in my car a lot with the window down pretending to read a book or something, but really I was listening to the people who were standing next to my car talking,” she says. “Saying it now, I’m like, ‘God, what a weirdo. Just go talk to somebody like a normal person.’”

All those years of listening have turned into a wealth of stories to draw upon — and led to conversations that Heimer could never have predicted as a teen. “The paintings are almost like — this is going to sound so stupid — but I feel like each one has its own personality or its own magnetic force,” she says. “I feel like they’re little people trying to help me along.”

I feel like each [painting] has its own personality or its own magnetic force… like they’re little people trying to help me along.

The lively, diary-like revelations in her paintings seems to help others open up as well. “I don’t know if it’s because a lot of them are very embarrassing, but you would not believe the things that people tell me at openings,” she says. “After a two-minute conversation, they’ll confess something really deep or embarrassing or touching. I wasn’t expecting those interactions, and they make me feel good in a way that nothing else does.”

Heimer has found that these moments of connection give her a sense of buoyancy that helps counteract the weight depression. She is pursuing her MFA in part so that she can teach part-time and make interacting with others a more regular occurrence. “I realized that I was spending eight hours a day alone in the studio painting. That’s not healthy either,” she says. “I totally love being around art students. It’s another magical thing, being around other people who are making things and learning.”

“I don’t want to be super dramatic and be like, ‘It’s given me something to live for,’” says Heimer of her art. “The pace and the momentum of it, I think, help. I still have medication. I do all the stuff that I’m supposed to. But there’s something about that forward momentum. It doesn’t have to come from a painting career. It can be anything that you care about that propels you forward.”

The Good Fight

Ghana’s Purple People

In Ghana, where mental health issues are widely misunderstood, a homespun support group helps people suffering from anxiety and depression.

Ceiling fans, planes flying above her hostel and anxiety over school work used to send Sandister Tei into a state of panic and shakiness.

When she went to a local doctor in her home country Ghana to try find out why she was having strange thoughts and these physical reactions to them, she was told she had malaria–a common disease caused by mosquito bites in this West African country.

At 19, she knew this diagnosis was wrong. She knew what malaria felt like, but didn’t see the connection to her current state.

Sandister Tei was 19 when she started suffering from anxiety attacks. She was diagnosed with malaria instead.

“Being nervous and panicking about things, I didn’t think malaria could do that to me.”

So, she did her own research on Google and happened upon the word “serotonin,” telling her that what was going on was more likely to do with a chemical imbalance.

It got her thinking about how she was as a child, she often suffered  fatigue and would worry a lot. People would accuse her of being lazy, or that she kept to herself too much. Her school work suffered as did her self-esteem. Thanks to Google, she had some light thrown on her situation.

“I did more and more reading and realized this thing is not as exclusive: there are others out there,” Tei, now 30, and an online journalist for one of Ghana’s top media houses, recalls.

Journalism Leads To A Proper Diagnosis

She found ways to try and cope and deal with her mental health problems, but it affected her university life. She was studying geography at the University of Ghana when she started working towards a career in journalism, kicking it off with the student rags and local newspapers.

She then started blogging, and posting on Facebook, which lead her to wanting to work in online journalism.

“Being nervous and panicking about things, I didn’t think malaria could do that to me.”

Tei sought out opportunities to learn more about online journalism, with her eyes set on studying outside Ghana, as she did not see any courses within the country that had this focus.

In 2013, Tei landed a scholarship to do her masters in journalism at Cardiff University in Wales.

It was in Wales that she went to another doctor and was properly diagnosed with depression.

That diagnosis and the treatment turned her life around, her grades improved as did her energy levels. It got her thinking about the years she suffered in Ghana, because no one was able to tell her what was going on with her health.

“If I had someone to tell me to go to the hospital to get this drug, maybe I would not have suffered this much needlessly for like ten years. So that is when I thought I should be able to tell people about this, to help somebody. I am not going to administer drugs, but tell them you might want to go to hospital because there is medicine for your problems.”

When she came back to Ghana in 2015, she felt it was only people who knew about mental illness that would speak about it.

There wasn’t too much education available on mental health. “It wasn’t a national conversation,” she found.

This is something the experts echo. In 2016, Executive Director of the Mental Health Authority, Dr. Akwasi Osei, told local media mental health care in Ghana needed critical attention. He said  Ghana’s doctor-patient ratio in the mental health sector stands at 1:1.7 million as compared to 1:1 million in Nigeria and 1:50,000 in Kenya. He quoted a report that suggested  41 percent of the population, predominantly women, suffered from mental distress and depression.

41 percent of Ghana’s population, predominantly women, suffer from mental distress and depression.

In late 2016,  nurses from the Accra Psychiatric Hospital went on strike to highlight how dangerously underfunded the facility was. It is often in the news for not having the means to feed and medicate its patients. In the capital Accra, it is hard not to notice the number of mentally unstable people left to fend for themselves on the streets.

With this context, Tei decided to start a mental health support group in Accra.

Ghana’s Purple People

A friend organized a free space for her to hold the meetings, and she named the group Purple People – an affirmative name for an affirmative group.

“When you are depressed, anxious or when you are in a very bad mood, people say you are feeling blue. Purple has some blue in it, and the color purple is linked to royalty, well-being, affluence, goodwill. A lot of positive things. I think that even though we are ‘blue people’ we have the potential to crossover to the purple space.”

There are about a dozen members, they can meet each week, whoever feels like meeting, can do so.

Tei Sandister founded Purple People as a way to help raise awareness of mental health in Ghana.

Tei keeps contact with the members in a private Facebook group, and then has a public page to post articles on mental health and to advertise the group meetings if people want to join.

Purple People seek to listen to each other on common experiences, share and shed light on coping strategies to help each other while also encouraging members to seek professional help.

Since she advertises the group through social media and a blogger email list, she has found most of the members are professionals in Ghana, aged 27 to about 36. There are health care workers, an entrepreneur, software engineer, an environmentalist and Tei is a journalist.

While the group members are well-educated, living in Accra, eventually Tei wants to be able to target those in this country who might not have the same access to information.

“With Purple People, all of us can speak English and all of that but at a certain time I will focus more on people who can not speak English or even access Google, or don’t have the internet.”

She plans to try spread the message of her group in one of Ghana’s local dialects–Akan, through local radio stations in the future.

With the current formation of Purple People, she says, people don’t just connect in the weekly meetings. 

“There have been times people will write there [in the Facebook group] they are feeling really bad and need help – can someone get to them. I don’t want to call it a hot line, but eventually it became something like that.”

When this happens, members will rally and get the person the help they need.

Despite starting the group, Tei also uses it to learn more about her own issues.

Last year, amid work-related problems, she started developing intense anxiety.

She turned to the group for some pointers on what was going on and how she can help manage it.

“I set up a group but ended up going back to the group and asking ‘I know some of you have panic attacks already how is this thing like’?”

In Ghana, if a person seeks treatment for depression, they are likely to be taken to a hospital or a church group.

Another member of the group held a session for those who wanted to learn more about anxiety and shared coping mechanisms.

However, Tei is quick to point out that the group does not try, or seek to treat people, but instead helps them finds ways to get treatment, or deal with issues.

They support each other to go to the hospital to get professional help.

Tei explains that in Ghana, if a person seeks treatment, or someone seeks it on their behalf they are likely to be taken to a hospital, or a church group. Ghana does not have the General Practitioner (GP) system many western countries have.

In cases where someone might be aggressive, Tei notes they might be checked into a psychiatric  hospital, though depending on who is trying to help them, they might end up at a church, under the belief that prayers will fix them.

It was Google that helped her realize her racing head wasn’t malaria, and it was through the internet she brought Purple People together. And with her whole work being about being online, this extends to the little free time she has as well. Tei is involved with the Wikipedia community, where she edits Wikipedia Ghana. She is a co-founder of the Wikipedia Ghana community, and one of its representatives.

A Changing Direction

While she had to search hard to identify what was going on with her 11 years ago, Tei says there is a lot more mental health awareness and advocacy in Ghana now. Those who feel like they are lost in the dark luckily have more avenues to turn to.

Those who feel like they are lost in the dark luckily have more avenues to turn to.

“I have turned on the radio a few times and heard people talking about mental heath, and I have read a few articles here and there of people talking about depression.

“I have sat in meetings where people have come out and said ‘Hey I am depressed, have anxiety or am panicking’,” Tei says.

“I get the impression people are becoming more aware and speaking up.”

 

Profiles

Princess Leia’s Patronus

Therapy animals like Carrie Fisher's bulldog, Gary, are more than just pets. They're soothers of the soul.

She may have been best known as a princess, but Star Wars’ Carrie Fisher, who died at the end of 2016, was much more than an actress. She was a fearful wit, a raw and clever writer, and a tireless mental health advocate, having suffered with Bipolar Disorder throughout her life.

Carrie Fisher also had a companion animal: a goofy French Bulldog with a personality as large as his constantly protruding tongue. His name is Gary Fisher, and he accompanied Carrie everywhere, from the red carpet to the White House. He has over ten thousand followers on both Twitter and Instagram.

Din/date night with mom 🐶❤️️#garyinitaly2016 #garytravelstheworld #garyloveshismom

A post shared by Gary Fisher (@garyfisher) on

 

He was by her side during many interviews, and she spoke about how his presence helped her deal with her mental illness illness.

“I have a chemical imbalance that, in its most extreme state, will lead me to a mental hospital,” she told ABC News in 2000. “I have two moods. One is Roy, rollicking Roy, the wild ride of a mood. And Pam, sediment Pam, who stands on the shore and sobs … Sometimes the tide is in, sometimes it’s out.”

Bipolar Disorder is characterized by these unpredictable changes. Manic episodes can bring excessive energy, decreased need for sleep, exaggerated self-confidence, and reckless behavior, while  depressive episodes induce severe low moods, inability to concentrate, and lethargy. The condition can be managed with medications and psychotherapy, but for Carrie and many others, there’s a cuddlier way to treat their condition: therapy animals, like Gary Fisher, who exist to reduce the anxiety and loneliness that can come from being chronically ill.

Fisher is not the only celebrity to have a therapy animal.

Musician Aesop Rock, the New York American hip-hop artist known for his famously verbose rhymes, suffers from depression, anxiety and agoraphobia. But recently, he’s had a bit of a breakthrough, something he talks about in Kirby, a track about his cat from this year’s Impossible Kid. The final lines, “Fifteen years taking prescriptions / Now a shrink like, I’onno, maybe get a kitten,” suggest that animals have an important role to play in mental health treatment.

Portland musician Aesop Rock credits his cat, Kirby, with helping relieve his chronic depression.

Rolling Stone magazine asked the rapper if a therapist did actually make the recommendation. “Yeah, pretty much,” he said. “I don’t know if it was brought up by them or brought up by me, but it was definitely confirmed as a good idea. Just how animals can give us, you know, a feeling of a purpose, to some degree, and just taking care of something can be a positive thing.”

The science is all there. A South African study showed that interaction with dogs can double a person’s blood oxytocin–a hormone and neurotransmitter that controls fear and anxiety–as well as increasing beta endorphins (natural painkillers), and dopamine.

Researchers at the University of Missouri also found that petting dogs causes spikes in serotonin, the neurotransmitter that many antidepressants attempt to elevate.

“By showing how interacting with pets actually works,” says the study’s lead author, Dr. Rebecca Johnson, “we can help animal-assisted therapy become a medically accepted intervention— one that could be prescribed like medicine and reimbursed by insurance.”

An examination of studies on the role of oxytocin release in human-animal interaction ring up an impressive list of benefits. The presence of a companion animal has measurable anti-stress effects, reducing fear and anxiety and promoting calmness. Having an animal at home can also lead to better physical health – one study showed that pet owners had 15 per cent fewer doctor visits than non-owners. Plus, oxytocin–often called the “love hormone”–helps increase empathy, memory, trust, positive self-view, and social skills.

The author’s cat, Carina, barely sits still long enough for a selfie.

I can testify. I have my own oxytocin-inducing fur friend, a rescue cat I adopted five years ago from a shelter where I was volunteering. I had no intention of getting a pet, but Carina–who made a name for herself as a revolutionary by learning how to open cages and letting herself and other cats out– stole my heart. I’ve never looked back.

Therapy animals don’t always reduce anxiety, of course. Take it from me. A few mornings ago, I  walked into my bedroom after taking a shower – only to hear the telltale noise of a cat about to be sick.  “Oh no!” I thought. “Where is she?” I looked around wildly then dropped to my knees and peered under the bed.

And there she was… right next to my pile of carefully wrapped and hidden Christmas presents. I dove, not thinking anything beyond ensuring that my family wasn’t going to get a box of cat barf for Christmas. I got there in the nick of time. The second I scooped her up, she let rip. All. Over. Me.

Yes. Half naked, clawed, covered in cat sick. What a way to start the day.

But I quickly forgave her, because Carina is my rock. When my chronic pain, fatigue, and depression hit, she’s there. Unlike humans, there’s never any judgement when I can’t meet the day. In fact, she’s not only not judgemental: she’s thrilled that I’m spending the day in bed with her. She’s the warm furry “little spoon” that makes the situation bearable.

Anthea Whittle, who spoke with Folks last year about her rare neurological disorder, says the same about her cat Hollyberry.

“I first met Holly when she was living with a friend, being around three other cats was making her stressed and anxious. I took her on and was really pleased that her condition instantly improved It wasn’t long before she became my best friend. She never criticizes me or cares if I sleep all day – in fact she usually joins in. Her genuine affection for me is clear, I am her person now, the one she trusts, and that feels really great. She has an amusing personality and is such an adorable companion constantly, whether I’m feeling well or unwell.”

“It just feels good to be able to provide a happy life for her and have her unquestioning affection in return.”

 

Carrie Fisher was a force to be reckoned with. She spoke openly about living with mental illness, her past taking illegal drugs to deal with her disorder, and the pressure of being a woman in the film industry. And, of course, she talked about Gary and what he meant to her.

“He’s very soothing to have around,” she told NPR’s Terry Gross in November.

“Is he officially a therapy dog?” asked Gross. “You get to take him everywhere… Did you have him certified as a therapy dog so you could take him onto planes and things like that?”

“Yes, yes,” responded Carrie. “… he’s just very nice to have around. So he sits with me on the plane. Frequently, he sits in the chair and I sit on the ground.”

When I awoke to the news of Carrie’s death, like so many others I was terribly sad–and one of my immediate thoughts was: how will Gary cope?

The dog’s social media accounts remain active, and Carrie’s daughter Billie Lourd has taken Gary in. Most of the posts are sad, first-person anthropomorphizations about how much Gary misses Carrie.

That’s what makes Gary Fisher amazing. Even now, he’s providing therapy to people.  His owner might be dead, but as the world mourns Carrie Fisher, they externalize their grief upon this timelessly goofy dog, filling the comments on his social media posts with outpourings of love, affection, and support…. all writing straight to him, like Gary can read the comments.

Even after her death, Carrie remains a light for many people with mental illness: how to cope, how to keep going, and how to face stigma head on. “I outlasted my problems,” she said in that famous ABC interview. “I am mentally ill. I can say that. I am not ashamed of that.”

Meanwhile, Gary Fisher, and other therapy animals, provide a different kind of light: that even in the midst of chronic illness, or darkest depression, every human is worthy of acceptance. Every human is worthy of being loved.

Profiles

Beating Anxiety With Drumsticks

For Patti Niemi, becoming a professional symphony percussionist meant first coming to terms with her anxiety.

When percussionist Patti Niemi plays, you hear it. Down in the pit, among the San Francisco Opera Orchestra’s other musicians, there is no hiding the sound of her hitting the snare drum, bass drum, glockenspiel, marimbas, bells, or chimes… let alone the calculated crash of her favorite instrument, the cymbals.

She’s loud, a fact she revels in. “There’s just nothing like playing with 75 other instrumentalists, a whole host of singers, and still being the loudest one in the group,” says Niemi. But it has its drawbacks.  “One of the hard things about being the loudest, however, is that once I play a crash there are a couple of seconds when I can’t hear much of anything else. So if I have to play a number of loud crashes in a row, the sound gets pretty overwhelming.”

Patricia Niemi’s anxiety almost cost her a career as a symphony percussionist.

Loud crashing noises make most people anxious, but not Niemi. Banging stuff is more than her passion: it’s her life. But for a person who suffered crippling anxiety all her life, the auditioning process to become a professional percussionist almost ended her career before it started. It was only by accepting her condition that she was able to finally achieve her dreams.

Petite and dressed in beige slacks and a basic black top, Niemi strikes a much subtle note when she’s not performing. On first impression, it’d be easy to mistake her for a librarian or some type of research scientist. But for decades, Niemi has commanded audiences’ attention by engaging in “sanctioned banging.” The notes she plays range from thunderous to the faintest tremble, and they always require the sort of precision that would make most mortals drip with sweat.

The cover of Sticking It Out.

In her 2016 memoir Sticking it Out: From Juilliard to the Orchestra Pit, Niemi describes one particularly tricky xylophone solo as “five minutes of running my arms up and down the xylophone as fast as I could and hitting little wooden bars that were only an inch and a half wide. It was a high-wire act that demanded to be executed perfectly … any wrong note would linger like a fart in church.”

This does not seem like an obvious fit for someone who was so anxious as a child that she lined up all the kitty statues in her pink bedroom at right angles, folded her garbage before setting it in the trash, and, in third grade, feigned illness three Mondays in a row to avoid playing a simple alphabet game in music class.

“Mr. Vaglio would go around the circle and if your letter was A, you’d have to say ‘accordion’ or anything music related,” Niemi tells me in a café near the War Memorial Opera House, where she regularly performs. “I was like, no way. I’m going to fail at this. I didn’t go in but he waited until I got back. He knew I loved music. I lost on the first round and I was just devastated.” (She failed to think of a word for “g,” glockenspiel not yet a part of her daily vocabulary.)

Despite this early case of stage fright, by age 10, Niemi was determined to play drums. Initially drawn to them as a surefire way to stand out, she later discovered that she intuited the instrument that best suited her natural skills. A music aptitude test that year placed her in the top one percent for rhythm and the lowest percentile for melody.

From then on music and anxiety were constants in her life. But, as Niemi writes, “at that point, music didn’t cause me any more anxiety than simply waking up in the morning and being a person. I was always anxious.” These two threads would continue to run through her life, sometimes parallel, and at more painful points, fully entangled.

Throughout elementary school and on into high school, she loved practicing and the challenge of making her brain think in a completely different way. To her, the hours spent playing never felt like a sacrifice: it felt like an addition. Music was her passion and soon the pursuit of her end goal–joining a professional orchestra–became as much of the fun as the music itself.

Niemi plays with the San Francisco Opera Orchestra.

“For years, the first thing on my mind when I woke up was, ‘how can I move closer to my goal of winning an audition?’” says Niemi. “It was gratifying to know that I had all the pieces of the puzzle, and I just had to figure out how to put them together.”

One of the puzzle pieces was getting into a music conservatory. After high school, Niemi entered Julliard, one of the world’s most prestigious programs. It was during her second year there that she experienced her first full-blown bout of performance anxiety. She had gotten a gig with a local freelance orchestra to gain experience. At her first rehearsal, she begged to play a famously difficult snare drum part in Capriccio Espagnol, an orchestral suite based on Spanish folk melodies, composed by Nikolai Rimsky-Korsakov in 1887.

In the piece, the other instruments fall silent as the snare drum goes from a loud roll to a very, very soft one. A teacher had described this moment to her as feeling like “you’re standing there with your pants down.” At that totally exposed spot, her hands betrayed her. “They shook so wildly, jerked so unpredictably, that I had to lift my sticks above the drumhead to keep them from making random swipes at it,” writes Niemi in her memoir. Everyone, including the string players who twisted completely around in their chairs, turned and stared at her, wondering why she wasn’t playing. The conductor snarled, “Play, Play.”

It was mortifying. I was so embarrassed,” Niemi tells me, hugging her knees to her chest. “The worst part for me was I didn’t get a warning. All the way through high school and my first year at Julliard, I didn’t have nerves. I mean, I had anxiety my whole life, but as far as performing, performing was fun. I don’t know how that switched so badly.”

The next day, she went to the doctor and got a prescription for Inderal, a beta-blocker that curbs the physical signs of performance anxiety. Now she could swallow two 20-milligram tablets and her hands wouldn’t shake and her heart wouldn’t pound. Far from turning her into a Zen master, Niemi writes “the effect was to pull me off the ceiling and prop me onstage with a heightened yet tolerable awareness of the performance I was about to play.”

Known today as a common prescription for musicians and other performers, Niemi took the drug in secret, ashamed to rely on any medication. At the time, she felt like taking a pill was cheating on a level akin to professional baseball players taking steroids. The outward attitude among her fellow students was that musicians should muscle through any performance anxiety, that learning to slay those fears was part of the job. “You’re supposed to be brave and be able to say, ‘Sure, I can do this,’” says Niemi. “But I couldn’t.”

You’re supposed to be brave and be able to say, ‘Sure, I can do this.’ But I couldn’t.

She had found a way to steady her hands but her mind still rattled and hummed with worry. As she saw it, her situation came down to a stressful math equation: the number of orchestras divided by the number of percussionists. There are around 50 orchestras in the U.S. that pay a living wage, three or four percussionists per orchestra, and around 75 competitors per audition for one opening. “There’s just no guarantee,” says Niemi. “If you work really hard in medical school, you’re going to become a doctor; you’re going to get a job. If you work that hard to win an audition, you still might not.”

In the weeks leading up to an audition, Niemi would sit alone in a room and practice eight to 10 hours a day. This was one of the gifts of anxiety, she says. Where others may have struggled to maintain that level of self-discipline, her worries propelled her to practice all the time. At Julliard, after hours of practicing and very little sleep, she once hallucinated flies hovering and landing on her drum pad. When she realized that they weren’t real, she was thrilled. She took the hallucination to be clear evidence of her diligence.

Niemi banging away some anxiety, xylophonically.

Her anxiety reached its apex in 1996, four years after landing her spot in the San Francisco Opera Orchestra. That year, Niemi had a chance to audition for the more prestigious Metropolitan Opera Orchestra. In the weeks leading up to the audition she felt like her body was constantly vibrating. She wanted to cry all the time. She couldn’t sleep or eat. In the end, she didn’t take the audition.

“I would have liked to keep taking auditions and seen how far I could get,” says Niemi. “But auditions are the worst of it, so I just stopped. I didn’t take anymore. … It was really hard at first, because all I had ever wanted to do was be a musician. To get to the point where I said I can’t go further because of my nerves… that was painful.”

Niemi started taking Prozac during that period and continues to take it today. She says the drug was “a real lifesaver,” but she still struggles with anxiety. “I’d love to not be an anxious person, but it teaches you compassion for other people… We don’t always behave well, but there’s usually a reason — a lot of it is anxiety. But maybe that’s just my lens,” she laughs.

I’d love to not be an anxious person, but it teaches you compassion for other people.

Niemi hopes that talking about her experiences will help others feel less alone and spare younger musicians some of the guilt and embarrassment that she felt. “I think it’s a gift to younger students for me to say this is what I had to do. That would be great if you don’t have to go down that path, but don’t feel bad about it.”

After devoting more than four decades to perfecting the art of banging on things, Niemi’s performance anxiety has not diminished much. And yet, as a professional musician, she puts herself in the position to be judged over and over again: something that triggers the flight response in most of us. Even with all that stress, Niemi considers it a great privilege to be part of such a beautiful collaborative effort.

“The sound that a full symphony orchestra makes is the most thrilling sound I’ve ever heard,” she says. “Standing in the middle of all those musicians and adding to that sound is truly a joy.”

Histories

Survival Of The Fittest

Charles Darwin's own illnesses may have influenced evolutionary theory. Here's how.

Charles Darwin, whose theory of natural selection inspired the phrase “survival of the fittest,” was, for much of his life, rather unfit. A mighty array of illnesses plagued Darwin for decades, including insomnia, eczema, and heart palpitations, but his most constant companions seem to have been anxiety and terrible gastric distress. During his lifetime, the origin of Darwin’s illnesses confounded twenty doctors, including his own father, a well-regarded physician.

In 1841, a 32-year-old Darwin wrote, “My father scarcely seems to expect that I shall become strong for some years; it has been a bitter mortification for me to digest the conclusion that the ‘race is for the strong’ and that I shall probably do little more but be content to admire the strides others made in science.”

It’s an understatement to say that his dark prediction was far from accurate. Darwin was much more than his maladies, but given all his ailments, it’s easy to see why he assumed he’d be relegated to the sidelines of science.

Even before boarding the H.M.S. Beagle for the around-the-world voyage that would inform of his theory of evolution, the 22-year-old naturalist showed signs of the ills that would ebb and flow throughout the rest of his life. In his autobiography, he recalls that the two months he spent waiting for the weather to clear before setting sail from Plymouth, England, in December 1831, “were the most miserable which I ever spent.”

“I was out of spirits at the thought of leaving all my family and friends for so long a time, and the weather seemed to me inexpressibly gloomy,” writes Darwin. “I was also troubled with palpitations and pain about the heart, and like many a young ignorant man, especially one with a smattering of medical knowledge, was convinced that I had heart-disease.”

Despite his belief in the survival of the fittest, Charles Darwin's health issues have never been widely reported.

Despite his belief in the survival of the fittest, Charles Darwin’s health issues have never been widely reported.

Despite what some doctors now see as evidence of a panic disorder, he was determined to get on that ship. “I did not consult any doctor, as I fully expected to hear the verdict that I was not fit for the voyage, and I was resolved to go at all hazards,” he writes.

Other than some bouts with seasickness, he was mostly healthy during his nearly five-year voyage around the world. Unfortunately, upon his return to England, his health began to fail.

Ever the scientist, Darwin turned a keen eye to his own body’s behaviors. He chronicled these observations in letters to friends and family and in his “Diary of Health,” which he maintained from July 1, 1849, to January 16, 1855. In his book My Age of Anxiety, Scott Stossel notes that the diary “eventually ran to dozens of pages and listed such complaints as chronic fatigue, severe stomach pain and flatulence, frequent vomiting, dizziness (‘swimming head,’ as Darwin described it), trembling, insomnia, rashes, eczema, boils, heart palpitations and pain, and melancholy.”

When Darwin was 56, he reached out to Dr. John Chapman, a prominent specialist in “psychological medicine” for help. Stossel writes that at this point “Darwin had spent most of the past three decades—during which time he’d struggled heroically to write On the Origin of Species—housebound by general invalidism. Based on his diaries and letters, it’s fair to say he spent a full third of his daytime hours since the age of 28 either vomiting or lying in bed.”

In one particularly revealing letter to Chapman, Darwin gave a harrowing list of his symptoms:

“For 25 years extreme spasmodic daily & nightly flatulence: occasional vomiting, on two occasions prolonged during months. Vomiting preceded by shivering, hysterical crying[,] dying sensations or half-faint. & copious very pallid urine. Now vomiting & every passage of flatulence preceded by ringing of ears, treading on air & vision. … Nervousness when E [Emma, his wife] leaves me.”

Darwin’s illnesses stumped physicians then and they continue to perplex doctors now. Collectively, medical professionals have created a long list of diagnoses that includes “smouldering hepatitis,” malaria, duodenal ulcer, peptic ulcer, gout, “suppressed gout,” Chagas’ disease (a parasitic infection possibly contracted from a bug bite in Argentina), Crohn’s disease, arsenic poisoning, lupus, lactose intolerance, and an allergy to the pigeons he used in his research.

Stossel points out that although Darwin’s stomach issues were clearly debilitating, there may have been some benefit to his accompanying anxiety, citing research that shows that anxious people with high IQs tend to be better workers.

“From the high-strung can also come, at least some of the time, great science,” writes Stossel. “Dean Simonton, a psychologist at the University of California Davis, who has spent decades studying the psychology of genius, estimates that a third of all eminent scientists suffer from anxiety or depression or both. He surmises that the same cognitive or neurobiological mechanisms that predispose certain people to developing anxiety disorders also enhance the sort of creative thinking that produces conceptual breakthroughs in science.”

Charles Darwin as a young man.

Charles Darwin as a young man.

Despite being regularly laid low by his troublesome bowels, Darwin was a tenacious thinker. Even on days when he was too sick to sit at his desk for more than an hour or two, he still worked. Along with frequent references to his poor health, his letters also often celebrate his devotion to his scientific research.

Biographer John Bowlby observed that “work was constantly used by Darwin as a means of diverting his attention from his bodily discomforts and … from thoughts about whatever was causing him anxiety or depression.” In his mid-fifties, Darwin wrote to his cousin that work “is the only thing which makes life endurable to me,” and to another friend, “I have my hopes of again some day resuming scientific work, which is my sole enjoyment in life.”

His family recognized the upside of Darwin’s studies, too. When he was 51, his wife Emma wrote to a friend, “Charles is too much given to anxiety, as you know, and his various experiments this summer have been a great blessing to him.” And his son Leonard recalled that his father once said, “he was never quite comfortable except when utterly absorbed in his writing.”

“Even ill health, though it has annihilated several years of my life, has saved me from the distraction of society and its amusements,” wrote Darwin. As anxious as his illness left him, it kept him at home working, and may have actually helped Darwin become the father of modern biology and develop the revolutionary theory of evolution—no small strides by any measure.

As his son, Francis, wrote in The Life and Letters of Charles Darwin, “These two conditions—permanent ill-health and a passionate love of scientific work for its own sake—determined thus early in his career, the character of his whole future life. They impelled him to lead a retired life of constant labour, carried on to the utmost limits of his physical power, a life which signally falsified his melancholy prophecy.”