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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.

Q&As

The Man Trying To Universalize Mental Healthcare

Most people in the developing world have no access to mental healthcare. By training locals to do basic interventions, Dr. Vikram Patel is making a big difference.

Mental illness, stresses Dr. Vikram Patel, an Indian psychiatrist, is by no means a phenomenon of the west. Rather, it is universal, existing across populations. When combining the most common negative mental conditions–depression, anxiety, substance abuse, schizophrenia, dementia and so on–about one and four people in the world have mental disorders, according to the World Health Organization. Yet the vast majority of people will never receive treatment. That “big scandal” is a problem that Patel, who is the Pershing Square Professor of Global Health at Harvard University, has committed his career to helping solve.

In his mission to universalize mental healthcare, Patel, who grew up in Mumbai, has focused on training local practitioners on the ground in the delivery of basic care. These “frontline workers,” while a far cry from advanced physicians, are trained in providing the basic kinds of mental healthcare which most of the world’s population would simply have no other way of receiving.  Much of what such workers do involves diagnosing conditions, such as depression or anxiety, and gauging if patients should seek more advanced care. Improving mental health literacy in communities is also a major effort. “In the same kind of way that you’d want people in a community to know how to recognize or treat a fever, you’d want people to be able to acknowledge when they have symptoms of depression or anxiety,” he says.

Physical health crises such as polio and tuberculosis have been treated successfully using frontline workers. Why not mental health ones?

Patel’s motivation for the project is simple: physical health crises such as polio and tuberculosis have been treated successfully using frontline workers. Why not mental health ones? Patel, though his Goa-based organization Sangath, has deployed the model mostly in India. But he has also worked on mental healthcare projects in several other countries, including the United States, where large proportions of people with mental illness are homeless or imprisoned. While the developed world may be ahead of the third in terms of resources poured into mental healthcare, says Patel, much of it still has a long way to go in reaching an ideal system of care. Even in the richest countries, he says, anywhere from thirty to seventy percent of people with mental health problems do not receive quality care. In more ways than one, Patel has his plates full. We reached out to hear more.

What is global mental health?

In as much as global health is a very broad umbrella, global mental health has the same sorts of complexities. Firstly, it is truly global. In many areas, global health is a euphemism for the health of the world’s poor. But global mental health really affects every country in the world. As a colleague has argued, when it comes to mental health every country is developing.

The second thing is that global mental health is concerned with disparities in the distribution of health states in the population. Mental health problems are disproportionately distributed. People who are socially disadvantaged, for example, have a much greater burden on their mental health problems and consequently those who suffer mental health problems have often got much poorer social outcomes.

How did you get into psychiatry?

I was first interested in brain disorders. But I felt a little disillusioned by neurologists who were primarily concerned with making a diagnosis. Very often there seemed to be nothing more you could do. I noticed in psychiatry that even though it seemed a much fuzzier discipline and very low on the reputation index it was an area where someone could ask questions about the person as a whole rather than just take an interest in the biomedical diagnosis. That attracted me. But it was a very unpopular decision. Every one of my mentors and family members thought it was a very poor choice. I could choose any specialty I’d wanted since I had done very well in my medical exams.

I felt a little disillusioned by neurologists who were primarily concerned with making a diagnosis. Very often there seemed to be nothing more you could do.

What was the state of mental healthcare in India around this time?

It was pretty much the dud subject of medicine in every respect. Probably ninety-five percent of India had no access to psychiatry. I would say zero percent had access to community-based services. But there’s been a sea change in attitudes towards mental health in India since I started. Part of the reasons are a concerted effort from mental health activists who have been arguing that maltreatment of mental health patients constitutes human rights abuse. People with mental health issues have demanded their sickness be treated on par with people with physical illness. Celebrities and other prominent figures who have disclosed their own experience with mental health problems has also made a difference. And in the last decade the demonstration that you could deliver mental healthcare quite effectively even in places without mental health professionals has made people feel that this isn’t just an academic issue.

What are some common mental health myths you encounter across countries?

The big one is that mental illness is not very common in the population. Many consider mental illness the medicalization of social suffering. Depression, for instance, many think is not a medical problem but a state of misery based on circumstances. A second myth is that these conditions are untreatable, except with very expensive long-term therapies. The reality is completely different. The third myth is that we really don’t have any idea about why people get mental illness, that there isn’t a scientific foundation for this field. Some countries, such as in many parts of Africa and Latin America, believe that mental illness is caused by spiritual factors. But I think that is much less common than it used to be. There is a greater acceptance of a more scientific explanation.

Can you talk a bit about your project training mental healthcare workers on the ground?

India, like many other developing countries, has been innovating with the use of community-based health workers of various types. We simply started applying the same model to mental healthcare. The real innovation was to challenge the idea that mental healthcare always required very elaborate expensive long-term care from highly trained professionals.

Even if you have loads of doctors like you do in the U.S. it doesn’t necessarily mean that people are getting the kind of coverage they need.

It is a way not only of addressing the shortages of medical human resources but also as a way to improve coverage. Even if you have loads of doctors like you do in the U.S. it doesn’t necessarily mean that people are getting the kind of coverage they need. Just having more doctors in hospitals doesn’t guarantee coverage of care.

What are some of the major challenges in implementing this model?

Pushback is still coming from the psychiatric profession. Like any healthcare profession, mental healthcare professionals are quite territorial. They’re concerned about people with much less training giving mental healthcare. These fears are misplaced. We are not training psychiatrists but training people to do very specific interventions. As society becomes more professionalized, as the U.S. is, the greatest pushback is coming from the insurance industry and the professional community. Meanwhile, governments, donors, and development agencies are very excited by this stuff. They all realized that mental health problems are a very big cause of ill health but they were always reluctant to touch this area because of their fear it would open a Pandora’s box in terms of cost and intractability.

Again and again we’ve shown this works.

Are there other global healthcare interventions that have inspired your work?

My inspiration has come from within India, from the work of people such as Abhay Bang, who developed the home-based intervention for the management of newborn sepsis and pneumonia. This was pioneering stuff. Thirty years ago they were able to demonstrate that community-based workers could be trained to treat newborn sepsis and pneumonia. It led to dramatic reductions in newborn mortality. In that time there was enormous pushback from the government as well as the pediatric community at this idea. Now it is national policy. A million frontline workers have been trained to deliver this care across India. It’s become a globally accepted model.

What are you working on now?

My agenda now is scaling up, working with governments and also large organizations to scale up these psychological therapies. I’m no longer simply interested in trials but in implementation questions. Again and again we’ve shown this works.

Q&As

The Battle After The Fire

PTSD, depression, and other mental health disorders are a hidden epidemic amongst firefighters and other emergency response workers. That's an epidemic Jeff Dill wants to drag into the light.

It is a grim but telling statistic that, in America, firefighters are more likely to die by their own hand than their job. Though little talked about, firefighters and EMS personnel, the people whom society counts on to handle its crises, are among the highest at-risk groups for severe depression, a kind of personal crisis. Their rates of suicide are ten times the national average. Last year, 92 firefighters and 17 EMS workers took their own lives, compared to 93 who died in the line of duty. Despite this, less than 2% of fire and EMS stations have a truly defined behavioral health program. The job is demanding,  physically as well as emotionally and encountering death or violent injury is commonplace. Years of such work can take its toll on the psyche. But it is more than mere exposure. It is also a culture of machismo and expectations of superhuman endurance that has kept the mental health crisis among firefighters and EMS workers silently burning.

Jeff Dill of theFirefighter Behavioral Heaalth Alliance.

That’s what Jeff Dill wants to change. The former firefighter captain and licensed therapist is the founder of Firefighter Behavioral Health Alliance (FBHA), a non-profit which educates firefighters and EMS personnel on behavioral health issues. Workshops, which he gives to stations across the country, touch on topics that have long been taboo in the community: depression, PTSD, anxiety, addictions; human weakness. He shows them how to notice the warning signs, in themselves and others. Above all, he stresses the importance of asking for help. Along with such training, Dill’s group also offers support and other resources to the families of suicide victims, much of the money which comes from his workshops (in the past couple of years, they have been able to provide four educational scholarships for children of suicide victims).

A major aspect of the group’s work involves collecting data on firefighter and EMS suicides. They are currently the only organization which does so (the earliest case they’ve validated involved a fire chief in New York in 1880). Data isn’t easy to come by, and largely comes through a confidential online reporting system. A decade later, the database stands as a grim motivator for Dill. In his research, he estimates that he has spoken to over 1,100 fire and EMS workers about their general mental health, as well as 500 directly struggling with PTSD or thoughts of suicide. The knowledge collected in those interviews has shaped the seven workshops which he offers to stations.

 

A culture of machismo and expectations of superhuman endurance that has kept the mental health crisis among firefighters and EMS workers silently burning.

Lately, he says, demand is high. Stations typically come to him requesting training. This is a major change from the beginning, says Dill, when trying to get folks to talk about these issues was a challenge. Of his first-ever workshop, in Philadelphia, Dill recalls, “You’d have thought I had leprosy.” Now the group is expanding, hosting workshops abroad, bringing on new volunteers and even planning a cross-country tour in a camper. “Finally, people are talking about it and we’re seeing a lot more proactive action,” Dill says. “But we still have a long way to go.” We reached out to hear more.

How did you get started in all this?

I spent 26 years in the fire service in the northwest suburbs of Chicago. I retired as a fire captain. In 2007, when I was a battalion chief, I went back to school and got my masters, becoming a licensed counselor. Because of Hurricane Katrina, I wanted to work with fire and EMS personnel. Division One out of Chicago sent down numerous firefighters including ones from our department. When they came back they said, ‘We saw some horrific things Jeff. We were picking up bodies in the streets.’ They went to see their Employee Assistance Program. But E.A.P., though good people, didn’t have any clue as to what our culture is in the fire service. That’s when I decided to get my masters. In 2009, I founded Counseling Services for Firefighters to train counselors and chaplains. If you want to work with us you need to understand us. When I started receiving phone calls and emails from around the world asking if I knew anything about firefighter suicides, I said, ‘I didn’t know we had a problem’. I called all the major players in the fire service and no one kept any data. In 2011 I founded FBHA, and we are the only organization in the US that tracks and validates firefighter and EMS suicides.

When I started receiving phone calls and emails from around the world asking if I knew anything about firefighter suicides, I said, ‘I didn’t know we had a problem’.

Why is this such a prevalent issue?

We have validated 1,060 fire and EMS suicides. I travel about 130,000 air miles every year across US and Canada. I’ve spoken to well over 15,000 firefighters. With those suicides which we have validated, the number one known reason was marital and family relationships. That’s followed by depression, then medical conditions. Number four was addictions and five was diagnosed with PTSD. Are these all interactive? Absolutely.

Why are family relationships number one? Is it difficult for firefighters to sustain relationships?

It’s difficult in that we don’t tell people what we see and do. That burden is in your mind. It starts changing you. Any firefighter that says they haven’t changed because of the job is not telling you the whole truth. Because it does change you. How can it not? It is not only the things that we see and do but all that’s expected out of us, from the community, our brothers and sisters, and even history dictates how we’re supposed to act. You live it 24/7, so all the sudden, now you’re isolating at home, you bring a lot of anger home, you’re not as communicative as you should be. All of these are very detrimental to relationships.

You’ve talked before about “cultural brainwashing.” What is that?

Any firefighter that says they haven’t changed because of the job is not telling you the whole truth.

I don’t use it as a bad term. It’s just that we have always been taught to handle all of our issues on our own. ‘Don’t bother anyone else and don’t be the weak link of the company.’ When you’re battling issues, personally or professionally, and you’re not supposed to turn to anyone and handle them yourself, well, the easiest thing to do is go down to the liquor store and pick up a six-pack. Maybe you’re having night terrors and not sleeping well. Before you know it, you’re hooked. It doesn’t make us bad people. We were always just told to handle things on your own.

How dangerous is the job?

In reality, the traumatic calls are very minimal compared to the average calls: the car accidents where there’s really not a serious injury and the medical calls. In most departments, 70% are medical runs. When you start talking about tragic calls, it also depends upon the volume of calls. In some cities they run a lot of calls and they see a lot of things. But each place is different. Maybe one station has expressways going through their district and they’re seeing a lot of serious crashes. It really depends.

Looking back on your own career, what were some personal difficulties you encountered?

In 2011, my granddaughter, at 22 months, lost her right eye to cancer. I was in fire service at this time. It was a struggle and I didn’t realize it. I began to isolate. It’s amazing how it affects you and you don’t even realize it. My crew knew what had happened but I didn’t tell them how much it affected me. We had a video of her playing in the nursing station before the surgery. I would go home on my off days and watch that video on my computer, sitting in tears every night. Looking back I can’t believe, that wow, why didn’t I reach out for help? I was a battalion chief, so you’re supposed to have your men and women look up to you. Now I think it would have been a lot easier if I had just said, ‘Hey man, I’m struggling with this.’ If I am, and I’m in this business, then guess what, someone else might be too.

It’s amazing how [depression] affects you and you don’t even realize it. Looking back I can’t believe, that wow, why didn’t I reach out for help?

What are some tips for dealing with stuff?

We have our top five warning signs. Recklessness and impulsiveness. Anger’s a big one–you’ll see a lot of fire and EMS struggle with anger. Isolation is one as well. Loss of confidence in their skills and abilities, because their head’s just not in the game. And of course the last one is sleep deprivation. That’s a real huge one. The schedule, even for volunteers, is rough. You’re woken up in the middle of the night. One warning sign we’re really seeing grow among retirees is that they’ve lost their sense of humor. Humor for us in the fire service is our coping mechanism. For those retirees, that’s a big one. We tell families to watch out for that.

Have you found any regional differences in your work?

Our whole job is predicated on helping those who call for help, so where did it go wrong so that we can’t ask for help?

Absolutely. Ninety percent of our workshops are from Pennsylvania south and to the west. The northeast is a very difficult nut to crack. They’re very tight. The history of the fire service is deep. I have some great friends in New York and Boston who talk about their great-great-great-grandfather being a firefighter, their uncle, brother, etc. It’s an eye opener but we’re starting to see some movement up there as well. Because I have data on some our brothers and sisters who have taken their lives there. Other states are more open to changes. And they are making them.

What kinds of reactions have you received?

Early on no one wanted to hear about what we did. When you start talking about that people start looking at themselves; they don’t want to admit that maybe they’ve been struggling. That’s always perplexed me, though, because our whole job is predicated on helping those who call for help, so where did it go wrong so that we can’t ask for help? But it’s changing. We now have bookings through 2019 for our workshops. So you see, it’s changing.

Q&As

This ‘Bipolar Babe’ Stomps Out Stigma With Storytelling

The deaths of Anthony Bourdain and Kate Spade prove that anyone can be isolated by the stigma around depression, says Andrea Paquette of the Stigma-Free Society.

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A bright pink t-shirt with the words “Bipolar Babe” on the front has led to a movement to stomp out stigmas that allow negative attitudes and perceptions of people with differences to persist.

Andrea Paquette, 41, of Vancouver, British Columbia, Canada made the t-shirt nearly a decade ago to overcome feelings of shame related to her diagnosis of bipolar disorder. The move was part of an empowerment strategy she devised after recovering from a suicide attempt. More than helping herself, the t-shirt became the impetus to start the Stigma-Free Society, a not-for-profit charitable organization (the equivalent of a 501(c)(3) organization in the United States) dedicated to spreading acceptance, understanding and empathy and stomping out the stigmas related to mental illness, physical and developmental disabilities, race, sexual orientation, gender identity and expression, and religion.

Andrea’s mission has taken off. Since launching the charity with the help of dedicated partners, she has told her story to more than 18,000 youth in high schools in British Columbia. She contributed a chapter to the book Hidden Lives: Coming Out on Mental Illness (2012), and is working on a book about people who have overcome immense challenges to live extraordinary lives.

Folks caught up with Andrea to find out why her story is so powerful and share her stigma-stomping message with our readers.

Andrea Paquette, founder of the Stigma-Free Society.

Why are personal stories a good way to stomp out stigma about mental health?

My passion was to share my story so others don’t have to suffer in silence like I did. People connect with personal stories; it’s what moves them in their hearts. Hearing about a person facing extraordinary things helps others relate to the issue. It makes us feel more human to be with another human being who has suffered or is dealing with some kind of challenge.

People connect with personal stories; it’s what moves them in their hearts.

Tell us about the first time you told your story?

I was asked to speak in front of 500 people. I was scared and shaking and red-faced, and I looked around at all these people, and I said, “Hi everybody, my name is Andrea, and I have bipolar disorder, but I’m not bipolar disorder. I’ve learned I have a mental illness, but I am not defined by that illness, and I can live an amazing life.” I knew in that moment the stigma had shattered. It was time to come out, I guess you can say, and just be okay with having bipolar disorder.

How did you react to your diagnosis?

I had a major psychotic episode when I was 25, which led to my hospitalization. I got diagnosed quickly, and I’ve been asked if that was a relief, but, to be honest, it really devastated me.

Growing up, I had a mother who had bipolar disorder, but it was always swept under the rug, and it was never discussed as a family. Mom would just disappear for weeks on end, and we were never given an explanation other than “she has nerves.” You would think I’d be aware or look for signs of mental illness in myself, but I never did. The diagnosis was quite a shock.

Describe some of the challenges you faced after your first episode.

I hit my deepest, darkest depression of my entire life. I couldn’t grocery shop for myself because it felt too overwhelming to even step into the store. Even cooking something easy felt like building a house. I couldn’t even shower; it felt like climbing Mount Everest. It was horrible.

I’m very candid about what happened. I medicated myself with sleep for two weeks, day and night, because I didn’t want to see the sun. And then I attempted suicide, which landed me in the intensive care unit for three days. I luckily survived.

What I always say following up with that, because it can be traumatic to hear about my attempt, I say we need to talk about suicide because we don’t talk about it enough. It’s quite taboo still in this society. I didn’t reach out for help; I didn’t talk to my family; I didn’t reach out to my friends, my doctor, any community resources. I wasn’t alone but I felt very alone. We need to remember there is always help and there is always hope.

We need to remember there is always help and there is always hope.

What’s in your tool kit to help you through a bad day?

Near the beginning, I thought that that dark place was where I was going to be for the rest of my life. But the truth is, it passes. We’re not always going to be in this really bad, dark place.

Nowadays, I know I have access to my psychiatrist, who is a partner in my mental health journey. I’ve sought out counseling — cognitive behavioral therapy and dialectical behavior therapy, which is about mindfulness and learning those types of strategies. I also have an app called Simple Habit. It helps me go to sleep with five, ten, twenty minute guided meditations.

If I feel really off, I can take an extra dose of my medication, doctor directed. Self-care is huge. It’s not just about bubble baths, but it does include bubble baths, too. Surrounding myself with positive people. If I’m not feeling well enough to go out, I’ll get on the phone and talk to my best friend for hours. I’m lucky I have people in my life who are there to support me and love me no matter what.

And my work. What’s kept me going is to make a difference in the lives of other people and to let people know that there is always hope.

Paquette speaking at a school assembly about mental illness and suicide prevention.

What are some things people misunderstand about mental illness?

When you’re in a mental health crisis, people often have this stereotype that you’re scary, violent or dangerous, the scary guy in an asylum in a straight jacket. For myself, I was more kind and empathetic and loving than I’d ever been in my entire life. That’s how it showed up for me. One of the stories I always tell in presentations is the day I saw a man with no legs in a wheelchair. I felt so much empathy, I was crying. I gave him my gold diamond ring that was given to me by my deceased grandmother. I said you need this more than me.

What do you want people to remember when they’re having a dark day?

Peer support is one of the best avenues when you’re having a dark day. With mental health, it’s about connection. People are feeling disconnected, they need to create some connections. A medical model is great; seeing a doctor is needed. But you need community. You need people who understand you. Support groups, especially for youth, who often feel like they’re the only ones dealing with a mental health issue, will get people that social interaction.

When you’re in a mental health crisis, people often have this stereotype that you’re scary… For myself, I was more kind and empathetic and loving than I’d ever been in my entire life.

What has surprised you about your mental illness?

When I woke up from my attempt, I was devastated to be alive. My psychiatrist is the one who brought the sunshine back in my life. He made me realize mental health is manageable. I didn’t think it was; I thought my life was over; I thought who I had been was gone. I ended up becoming a better person for it. My biggest curse became my biggest gift.

I look at my life now, and I’m very happy. I have a very blessed life, pets and family, people who love me, job and opportunities, travel. I never thought having a mental illness I’d be able to have all this. People often think that when you have a mental illness you’re stuck at home cause you’re a lost cause, but you can lead a very, very full life. I never let bi-polar disorder stop me.

Some people take the point of view that we shouldn’t speak openly about suicide because drawing attention to it can cause others to follow suit. What do you think?

I am an advocate for presenting about suicide in an appropriate way. I never think we should be sugar coating our conversations to make people feel comfortable. It’s an uncomfortable topic, and it needs to be talked about.

The suicides of Kate Spade and Anthony Bourdain made international headlines. What kinds of conversations took place around their deaths?

When celebrities like Kate Spade and Anthony Bourdain commit suicide and are revealed to have mental illnesses, it’s a real testament that anybody can be affected by hardship, by losing hope in life. It’s just really sad. Their deaths are a horrible tragedy, but I’m just grateful these incidents are opening up an even deeper conversation. Celebrities are talking about mental illness and suicide on stage; the media is talking about it. I pray we can learn something from their loss.

When celebrities like Kate Spade and Anthony Bourdain commit suicide, it’s a real testament that anybody can be affected by hardship, by losing hope in life…

Do you discover more about your story, gain more insight into yourself, the more times you tell it?

I feel like every time I tell my story I get a little piece of my heart back. It’s always healing. During this interview, I’ve had tears in my eyes talking about my story. There’s always room for further insight, healing, discussion. I just pray that telling my story brings benefit to people. Maybe someone out there will hear the message that there’s hope and there’s help.

Any parting words for our Folks readers?

I close all my presentations with these words: No matter what our challenges, we can all live extraordinary lives. We can go through challenges; we can go through hardships; we can go through hell. But you know what? We can make it extraordinary.

Folks Video Stories Instagram Profiles

Folks Video Story: An Orchestra For Everyone

In our first Video Story, we visit the world's only classical music ensemble for the mentally ill to see how Bach and Beethoven can help keep depression in check.

Prizewinning conductor Ronald Braunstein had a much-heralded early career in the classical music scene. After graduating from Juilliard, he won the first prize in the Berlin Philharmonic conducting competition—the conductor’s equivalent of winning a Gold Medal at the Olympics. From there, he conducted all over the world, from the Berlin Philharmonic to the Swiss Radio Orchestra.

Eventually, Ronald’s career unraveled due to his bipolar depression. Stigmatized for his mental health issues, he was eventually fired from a high-profile conducting job. But that isn’t the end of Ronald’s story. Embracing his diagnosis, Ronald recentered himself and founded the Me2/Orchestra, the world’s first classical music ensemble for the mentally ill.

In this, our first video Story, Ronald Braunstein let Folks film behind closed doors of a Me2/ rehearsal, while telling us about how he turned his life around after being fired for having bipolar disorder, how music helps him balance his depression, and the ways in which the Me2/ Orchestra has helped him and others realize that having mental health issues is nothing to be ashamed about.

If you like this Folks Video Story and would like to see more, please share it on Twitter or Facebook, and like it on YouTube. And if you’d like to learn more about Ronald Braunstein and the Me2/ Orchestra, you can do so by clicking here.

Essays

Depression Doesn’t Happen After Pregnancy Only

I wanted to have a big family, but my struggle with antepartum depression ultimately led to me reconsider how many children I wanted to have.

For the first time in months, I summoned the strength to go food shopping. As I waddled from the parking lot through the sliding supermarket doors, I felt as if I had anvils on my shoulder and cement soles on my sandals. I grabbed a shopping cart and glanced at the shopping list I’d brought with me. We needed all the basics for breakfast, lunch and dinner, yet I couldn’t care less about feeding my family. All I wanted to do was drive home, draw the shades in my bedroom and crawl into bed. I was pregnant and I was depressed.

Most women are familiar with the concept–if not the experience–of postpartum depression or baby blues, since it affects 85 percent of females who’ve given birth. Most men have probably heard of it as well. However, few people are aware of a related syndrome called antepartum or prenatal depression–also known as depression during pregnancy–which is a very real disorder. According to a University of Michigan study, only one-third of pregnant women with depression receive treatment. That’s because antepartum depression is severely under-reported–and therefore unrecognized and untreated.

Why? Antepartum depression’s symptoms (exhaustion and mood swings, for example) mimic those of pregnancy.

Leah Ingram, her husband, and daughters, circa 2002.

Though my first pregnancy was uneventful, during the second trimester of my second pregnancy, I felt like a dark cloud had descended over me. No matter what I did or how much my husband, Bill, tried to cheer me up, I couldn’t make this cloud go away.

Antepartum depression’s symptoms (exhaustion and mood swings, for example) mimic those of pregnancy.

In a matter of days, I went from “chatty Cathy” to a veritable mute. I was too tired to get out of bed or get dressed yet I couldn’t sleep at night. I didn’t want to eat either. I pretty much “checked out” as a wife and mother for nearly four months. I didn’t clean or cook nor did I care. Bill became my then one-year-old daughter Jane’s primary caretaker, and had she not already been in a daycare situation while my husband was working (and so was I, ostensibly, from home), I don’t know who would have looked after her. I surely was in no shape to do so.

I was lucky, though. My antepartum depression didn’t go unrecognized or untreated. When I talked about my everlasting ennui to the certified nurse midwife who was my primary care practitioner during my pregnancy, she didn’t just brush me off as hysterical. She suspected that something was amiss and referred me to a clinical social worker, who immediately diagnosed me with antepartum depression.

Because I hadn’t previously been treated with medication for depression–heck, I’d never actually been diagnosed–starting me on antidepressants was off the table. However, that’s not always true for women who have already been diagnosed. According to the Centers for Disease Control, nearly half of all women taking antidepressant medication continue to take them throughout their pregnancy. The Mayo Clinic says that taking these medicines during pregnancy do come with some risk to the baby, but not taking them bring risks for the mother, especially if she has severe depression or a bipolar disorder that requires constant treatment.

For me talk therapy would have to do. During my weekly sessions I talked with my clinical social worker and learned to be patient with my prognosis–and ask that my family be the same. We had to weather and wait out the storm.

Thankfully, a few weeks before my due date, my outlook began to improve. I started getting out of my pajamas before noon, I managed a few trips to the supermarket, and my appetite returned. By the time my daughter Annie was born–full term, nearly eight pounds and completely healthy–I was almost all the way back to my old self.

When Bill and I got married, we wanted to have a big family–four children, maybe more. That never happened, because I never wanted to risk becoming that depressed again.

This may sound like a fairy tale ending to my story, but it’s not. When Bill and I got married, we wanted to have a big family–four children, maybe more. That never happened, because I never wanted to risk becoming that depressed again.

When Annie was in elementary and middle school, she often asked why she couldn’t be a big sister. Even getting her a dog didn’t ebb the flow of those big sister questions. So our go-to response had to do with affording college and how that’s easier with two kids only. But the truth is way darker.

Leah and Annie today.

Annie turns 21 later this month, and I still mourn the children I never had after Annie. Sometimes I’ll stop and wonder what life would have been like with four children, each spaced two years apart. That was the original plan. However, we had to alter that plan after Annie’s birth. Neither one of us wanted the risk of me having antepartum depression again.

I think that was the right choice. Still, I’m sad that Annie never got to be someone’s big sister.

Creative Commons photo by Mohd Fazlin Mohd Effendy Ooi.

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

How Crohn’s and Depression Pushed This Man Into Law School

After chronic illness caused him to spiral into depression, JD Ward is studying to help people like him from falling between the system's cracks.

Before being diagnosed with Crohn’s Disease at the age of 18, and subsequently suffering a blood infection that almost claimed his life, JD Ward had never experienced anxiety or depression. But he says that physical and mental health are inextricably linked. And he wants to use his experiences to help others with mental illness.

In the years before his diagnosis, JD was part of more than one band, routinely traveling and playing in front of crowds. Having been given a guitar at the age of 12, he found in music an emotional outlet as well as a part-time job. Even though he describes himself as an antisocial introvert, being on stage never bothered him.

J.D. Ward.

When he began to get symptoms of a mysterious illness at 17, JD left the music circuit and returned to his family home. He was soon diagnosed with Crohn’s Disease, and put on medication to help manage the illness.

But all would not be well. In 2012, the medicine reacted with a virus and caused the life-threatening blood disease Hemophagocytic Lymphohistiocytosis.

“For all intents and purposes, HLH is like cancer,” says JD, who, near death, spent time in intensive care receiving multiple surgeries and cancer treatments. “It is in remission now, but it could come back.”

While being treated, JD had to give up his job and was given a colostomy bag for eight months. He struggled to adapt to his new life, and eventually made the decision to go back to school.

Initially, he signed up for pre-med. He says the idea behind studying medicine was that he wanted to be the one in the doctor’s chair, rather than the patient.

After a year, he decided to change direction and chose a double major in law and psychology. He hopes to use the combination to help people with mental illness, especially those within the legal system.

“It can be hard to find people who can empathize with physical and mental illness, when most people haven’t experienced it. So they don’t know how to respond.”

It took several years for JD to get his own diagnosis of anxiety and depression. Even though his father works as forensic mental health nurse, he felt unable to talk about what he was experiencing.

“I knew if I went and talked to Dad, he’d know what to do, but I still couldn’t do it. But it was him that helped me get diagnosed with depression, when I was in the hospital recently.”

“Once I’d accepted that I had a mental illness and I needed to get help, it was a lot easier to keep the conversation going.”

“Once I’d accepted that I had a mental illness and I needed to get help, it was a lot easier to keep the conversation going,:

Living at home while he’s studying means JD can have these conversations whenever he needs to. His father and his brother both work in the same criminal mental health unit, so JD’s interest in the intersection of law and psychology seems to run in the family. He says it felt like a natural pathway.

“I’m not sure exactly what job I’m going to have, but I want to help ensure people with mental illness retain their human rights within the legal system. People with mental health difficulties are often underrepresented and can slip through the cracks.

For example, if you’ve been contained under [New Zealand’s] Mental Health Act you lose your autonomy because of the risk to yourself or others, but it’s so important we make sure people are not devalued, that their rights are still upheld when that happens.”

JD has three years left before he will graduate with a Bachelor’s Degree in Law and a Bachelor’s Degree in Science and Psychology.

His Crohn’s Disease, while controlled more than ever before with the chemotherapy medications Remicade and Methotrexate, is an “ongoing battle.” As well as having low energy and appetite, he is on the waiting list for surgery on a fistula: a tract in his gut that leaks and never heals.

A typical day for JD means getting to the gym, getting to class, and getting home to rest. Those things will all be impacted by how many bathroom trips he might need, how much food he can eat during that day – and whether or not his mental health is playing ball. If it’s a bad day, he may not be able to do any of those things.

He also still plays guitar, and says it’s an essential hobby that helps keep him grounded, as well as an emotional outlet.

Now at law school, JD wants to practice law to defend the rights of those with mental health issues.

“I get pretty angry sometimes, music helps with that. I’ve come to terms with my illness, but sometimes a doctor might say certain things, and it gets to me.

“It’s unhealthy to deny yourself that right to be angry. I spent a long time not accepting the full extent of what I’d been going through, it became really hard to reconcile everything. Once you do accept it and you get angry and upset – then you can let that go and move forward.”

It’s unhealthy to deny yourself that right to be angry… Once you do accept it and you get angry and upset – then you can let that go and move forward.”

The music is another thing he shares with his father, who has been playing since before he was born. JD has put some of his own recordings online, but says that can make him feel pretty anxious.

“It’s quite a vulnerable thing to do, and you have the anxiety about criticism or judgment over what you’re sharing.

“You have to write crap before you get to the gold. And you don’t want to, of course, you’ve got the anxiety of how people might react to that.”

When he thinks about his life in ten years, JD says he hopes he’s in a position where he’s helping make people’s lives better.

“In this day and age, mental health is still in the background, so we need more people bringing it to the forefront, and protecting the rights of people while we do it.”

Essays

What Depression Means When You’re An Immigrant’s Kid

If you're a first-generation American, how do you tell your family about your depression when they believe that the answer to everything is to lift yourself up by your bootstraps?

In my sophomore year of high school, I started having bouts of suicidal ideation. I would think about how best to kill myself, painlessly, without putting any of my loved ones through a gruesome scene. By then, though, I had learned that these were not issues I could discuss with my family.

Mental health was not discussed in our home.  The reasons were cultural. As a family of first-generation Latino immigrants, my parents believed that even the strong only had a slight chance of making it. As for the weak? They didn’t survive.

My parents came to this country not just in search of a better life, but to escape dangerous situations back home. Their lives were full of anecdotes of surviving situations that we, their children growing up in the United States, could only imagine. For my parents, depression and anxiety were luxuries only the wealthy could afford. We didn’t avoid talking about mental health, so much as we lacked the very language necessary to discuss it.

For my parents, depression and anxiety were luxuries only the wealthy could afford.

Immigrants learn to live with sadness. The background noise of their lives is the impossible to fulfill yearning for family, friends, sights, and smells of a home left forever behind. Emotional pain is the price that immigrants pay in the hopes of a better future.

We, their children, benefit from this sacrifice. Our lives are filled with tremendous privilege. But for our parents… well, when you’re busy working several jobs to make ends meet, there is little time to stop and reflect if you’re happy.

My father grew up in rural Mexico. As the oldest of seven, he was forced to leave school after 6th grade to work in the fields so that he could help support his family.  At 17, he emigrated to the United States and worked two jobs to send money back home. A dutiful son, he never stopped providing support, even after I was born.

When I started imagining killing myself, my parents were divorcing, but in truth, they’d always led different lives. The majority of my life, they’d barely been in a room together, working opposite shifts so I could always have a parent at home with me. When they split, it was hard for me to shake the feeling that the divorce wasn’t, in part, my fault.

So I kept my suicidal thoughts to myself. I felt that whatever suffering I was going through simply couldn’t compare to the hardship they endured in their lives. After all, when your parents came to America escaping poverty and–in my mother’s case–a civil war, it’s hard to make a case that anything in your cushy American life is hard.

When your parents came to America escaping poverty and a civil war, it’s hard to make a case that anything in your cushy American life is hard.

Until my first year of college.

One day, I was in the middle of a lecture when my foot started shaking, and my heart felt fit to burst. I left class and attempted to drive home but was forced to pull over. I felt as if all the oxygen had suddenly been sucked from the car; an intense fear washed over my body.

Over the next few days, the symptoms worsened. I called my primary care doctor. Nothing was physically wrong with me, but she was Latina, and she suggested that maybe my heart palpitations and tremors were due to panic attacks.

When I told my mother that my doctor thought I might have an anxiety disorder, she reminded me why I hadn’t brought up my suicidal ideation years before. She said: “If you cannot handle life at 19, what will you do when you have real problems?”  It was insensitive, but she meant no harm. She was trying to protect me.

My whole life, my mother told me that I needed to be strong, because life was tough for people like us. When she was in high school back in Guatemala, her grandfather and other relatives had been slaughtered by guerillas. She and her six brothers and sisters were sent away into hiding; they were never able to return. It had an indelible effect on her world view: in her mind, loss and tragedy were always just around the corner. She wanted me to be prepared.

The fear that your accomplishments will never make up for the sacrifices your parents made for you is a pressure that many children of immigrants born in the United States have. For some of us, it drives us to succeed, surmounting cultural barriers to be the first in our families to, say, attend college, or become a doctor.

There is a burden to the “pull yourself up by the bootstrap” mentality that can further isolate children of immigrants

But that pressure can also take its toll on our psyches. There is a burden to the “pull yourself up by the bootstrap” mentality that can further isolate children of immigrants, even within their own families. It makes us feel like we shouldn’t ask questions, that we should have everything all figured out. We are outsiders at school, where we lack the social capital and financial resources of our peers; at home, we’re outsiders from families who view us as pampered and “too American.”

So between our feelings of inadequacy and the lack of awareness of mental health, no wonder Latinx-es like me can succumb to depression. In fact, a study published in 2014 found: “First-and second-generation Hispanics/Latinos were significantly more likely to have symptoms of depression than those born outside the U.S. mainland.” The Center for Disease Control also reported that Latinx students actually had a higher rate of suicide attempts than white and African-American kids.

Luckily for me, once I was diagnosed, I was fortunate enough to have both health insurance and a doctor who understood the stigma of mental health issues in my community. She urged me to seek counseling, and told me that if I found my home life stressful, I should consider living alone. She reassured me that the transition to college was difficult for everyone and that my feelings were absolutely normal.

To many, those small words of comfort and understanding might seem trite. But for me, they were life changing. For the first time, I knew I wasn’t alone. I also understood that it was acceptable to set boundaries with my family. That prioritizing myself was an act of survival that was just as important as the ones my mother had tried to teach me. In a culture that so often values community above the self, and that sanctifies women for dedicating themselves to the service of their families it can be difficult to say, I choose to take care of myself.

It would be a few more years before I actually sought counseling. Simply put, I had to overcome the ingrained stigma towards being labeled “crazy.” What finally pushed me into it was a Latina boss who shared she, too, had sought therapy in her life. Treatment helped me gain a better understanding of the issues that led me to be depressed and anxious in the first place. I realized self-care wasn’t a luxury, like my parents had taught me, but an act of survival.

I realized self-care wasn’t a luxury, like my parents had taught me, but an act of survival.

In my late 20s, I suffered a debilitating depressive episode. This time I used a combination of treatments to power through it, including medication, therapy, yoga, and life coaching. If I stepped outside myself it still felt indulgent to dedicate so much money and effort to my “frail” psyche, but I had started to see my mental health as a chronic condition that needed to be managed. And I didn’t feel guilty about it: I knew that I had privileges, information and resources my parents never had access to.

Today, I’m quite open about my mental health. I talk to my family about my depression and anxiety, and the more I am comfortable talking about it, the more others open up to me about their own struggles. I am frank and open with my parents about my troubles: for example, when I was on antidepressants, I made sure both of them knew I was having a hard time.

In turn, I think this openness has helped them live more emotionally healthy lives. A few years ago, my father had a mental health evaluation. During that session he was told that he too suffers from depression, and afterwards, we had a good conversation about how he thought this related to his difficult childhood, and addictive behaviors. As for my mother, while she is not yet open to seeing a therapist herself, her awareness of mental health issues has increased.

What goes around comes around. It turns out, my parents were on the right track: you need to give your children the tools to handle the ups and downs of life. But sometimes, children can give their parents those tools too.