Ask Ada: Help Me Deal With My Panic Attacks!

Plus: Ada reminds us all that grief takes many forms, and it's okay for anger to be one of them.

Welcome to Ask Ada, Folks’ bi-weekly advice column for people impacted by health issues or disability. Want Ada to help you with a problem? Email Ada at or tag @folksstories on Twitter with the #askada hashtag.

Why Isn’t My Friend Sadder Over His Wife’s Suicide?

Dear Ada,

A friend of mine recently killed herself. She was in her thirties, free-spirited and full of life. Just a week or so before she took her life, she and her husband (who I was friends with first) were talking to my wife and I about their plans to soon start trying for a family. And then just as suddenly she wasn’t here any longer.

I miss her, and I don’t know how to support my friend, her husband. He doesn’t seem to be processing her death at all. If anything, he’s very angry with her and has nothing nice to say about her whenever we talk. He says he hasn’t cried about it since the week it first happened. I don’t get it. They seemed like they had a healthy relationship, and I feel like I’m grieving her more than he is. I want to be a good friend to him, but I really don’t know how. How can I get past my loss, and how can I help him through his?

A Grieving Friend

Dear Grieving Friend,

A few years ago I was in a similar situation. The husband of one of my closest friends killed himself. We all attended college together, and I had to grieve the loss of him while also learning how to be there for her.

What I learned from this situation is that grief takes all forms and does not follow any predictable patterns. There is no correct way to feel, no path through healing, and no easy way to forgive the individual for leaving you too soon.

It is also impossible for you to understand your friend’s grief. The loss of a spouse, especially from suicide, is not something someone who hasn’t experienced this can fathom. The first thing you can do to help you both is to acknowledge this as a fact.

The way I see it, your friend is consumed with anger at his wife for stripping him of the future they planned together. He’s angry about her lies of omission— that she hid her pain and sorrow so deeply that even he didn’t recognize the signs. He’s angry that she made a permanent, life-altering decision that would rock every facet of his entire world. He’s angry that he has to wake up every moment for the rest of his life without her beside him.

Grief is not always what we expect. Anger is a normal part of the process.

The anger startles you, because it feels inappropriate. If anything, you expect sorrow. But, as I mentioned earlier, grief is not always what we expect. Anger is a normal part of the process. David Kesson, co-author of two books with Elisabeth Kübler-Ross, who defined what we know of as the five stages of grief, says, “Anger is strength and it can be an anchor, giving temporary structure to the nothingness of loss.”

And while we’re discussing the stages of grief, know that your friend may cycle through denial, anger, bargaining, depression, and acceptance in a nonscripted manner. Kesson explains, “People often think of the stages as lasting weeks or months. They forget that the stages are responses to feelings that can last for minutes or hours as we flip in and out of one and then another. We do not enter and leave each individual stage in a linear fashion. We may feel one, then another and back again to the first one.”

The best way you can support your friend is to be a constant in his life. If he wants to talk, listen to him. He doesn’t need your advice or reasoning with. He just needs someone to hear him. If he wants company, but doesn’t want the conversation to revolve around his wife, then just show up. Watch a movie together. Just be. He may want to do things to get out of his house and out of his head. Try new experiences with him. Build more memories. Be there as he takes on each new day.

Whatever you do, don’t avoid him because you don’t know what to do or what to say. No one ever knows what to say. Just showing up consistently — in person, on the phone, through texts or emails — however you can make yourself available, will help.

We like to think that we have the power to help people heal, but your friend is on a very long path that only he can navigate.

And finally, it’s important to take care of yourself, too. You too just lost a person you cared about, and while the pain may not be as severe, you have every right to feel your feelings. Grieve your loss. Talk with your wife and friends when you’re feeling low. Act as each other’s support systems. Swap stories of the good times. Remember the happy moments you all shared each other. Don’t let your memory of her fade, and do what you need to stay healthy while grieving.

If you or someone you know needs support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255.

How Do I Keep Calm When I Have A Panic Attack?

Dear Ada,

Life is stressful! I’m currently juggling ongoing physical symptoms from multiple autoimmune diseases including rheumatoid arthritis, celiac disease and eczema. On top of physical health issues, I’m deep in the grieving process over the loss of a family member and a beloved pet. I’m discovering (with the help of a therapist) that the unpredictable nature of my physical health conditions and coping with loss, triggers tension in my body, resulting in feelings of overwhelm, panic attacks and anxiety. How do you suggest calming down quickly, in the moment, when these feelings unexpectedly pop up in public, at work or while visiting others?

Thank you,

Feeling Frazzled

There’s nothing worse than panicking in public. Not only is your body and brain reacting to whatever stimuli that is causing you severe anxiety, but you’re doing it in front of other people, which just adds embarrassment to the heightened emotional and physical response you’re already feeling.

The first step to calming down during a panic attack is to recognize that you’re having one. During one, a person may feel as if they’re having a heart attack, or worse — dying. Recognizing that this is temporary experience takes the power away from those fears. Here are a few tips to bring you back to reality when you are spinning out of control.

If there’s too much happening around you, it may help to close your eyes for a few moments or minutes as you center yourself. If that doesn’t work, identify an object you can focus on instead. Does it have a unique size, texture, color, pattern, or smell? Touch the object if possible to ground yourself in the moment and describe it to yourself. If focusing on an object is helpful in these moments, it may help to carry a few on you — keychains, for example — that you can use during any future panic or anxiety attacks.

Know your triggers, and don’t make light of the experience. Panic and anxiety attacks can feel terrifying when you are experiencing one.

Next, try repeating a mantra and deep breathing. It can be difficult to think clearly when you’re in the midst of a panic attack, and repetition and speaking calmly will help you work through it. Keep your mantra short. Tell yourself something like: “I am safe and this will pass.”  Then, take one long breath in. Hold it in for a few seconds, and slowly release it. Deep, controlled breathing is what teaches the brain that the body is actually not in danger. Then, repeat the process of mantra, breathing, mantra, breathing, until you move through the anxiety and begin to feel calmer.

Finally, know your triggers, and don’t make light of the experience. Panic and anxiety attacks can feel terrifying when you are experiencing one. If you can identify your triggers, you can put the work in to avoid them when possible. With your current situation, that might mean additional therapy appointments, making more space in your schedule for rest and recuperation, or even massages to reduce the tension in your body.

And remember, as life-altering as these events may feel in the moment, know that they are only temporary, and you will get through them.

Are you facing a problem that is being complicated by a health condition or disability? Folks’ advice columnist Erin Ollila wants to help. Email and tell us your problem.

Mental Health

How ‘Russian Doll’ Unpacks The Daily Pains Of An Anxiety Disorder

Netflix's latest smash has smart things to say about mental health.

In the Netflix Original Russian Doll, a 36-year-old woman (Nadia, played by co-writer Natasha Lyonne) is trapped in a time loop set around her birthday. Within her strange predicament, Nadia endures a multitudes of random and violent deaths: she’s hit by cars, falls down stairs, is blown up, and has heart attacks. Every time she dies the time loop resets to the same time and place, with Nadia staring herself down in the mirror of her friend’s bathroom. On the surface, it’s a familiar time loop narrative centered around the same central trope as Groundhog Day. But as the title suggests, Russian Doll has layers upon layers to unpack. And, for me at least, one of the most glaring ideas nestled within this Matryoshka of a show is it’s exploration of anxiety disorders.

As someone who has struggled with General Anxiety Disorder, Obsessive Compulsive Disorder, and Panic Disorder since I was a child (with a few years worth of PTSDand Social Anxiety in my twenties, for good measure), I saw the familiar traits of the five main anxiety disorders at the core of the show. Chronic anxiety and panic have driven me to to live in a constant state of dread– as though death is as omnipresent and looming as it is in Russian Doll—and given me the sort of heart palpitations and shortness of breath that actually kill Nadia in the seventh episode.

Like Nadia’s fellow time loop victim Alan (Charlie Barnett), I’ve also been ruled by routine and compulsions, becoming so preoccupied with germs and contamination that I’ve spent hours cleaning and “correcting” the same spots. And I’ve spent days, if not entire years of my life, attempting to party my way out of PTSD and social anxiety symptoms just as Nadia does in episode two – only to discover imbibing a cocktail of temporarily feel-good substances serves only to exacerbate symptoms in the long term.

At their most chronic, an anxiety disorder can make you feel trapped within a pattern of feelings and behaviors as persistent, endless, and isolating as a time loop.

At their most chronic an anxiety disorder can make you feel trapped within a pattern of feelings and behaviors as persistent, endless, and isolating as a time loop. I don’t need to be dying over and over and reliving the same day to understand exactly what Nadia means when she tells her ex-boyfriend, “I don’t know how to convey … to anyone who really cares about me that I’m experiencing something truly terrifying. That I am f*cking scared, that I’m questioning my own sanity,” because in the penetrating fog of my worst anxiety, I’ve lived this. Anxiety disorders amplify your fears, dread, and traumas. They magnify the worst and most terrifying parts of your mind and can leave you barely capable of functioning. You’re trapped in a loop of negative thought patterns and behaviors and as a result, you relive the same struggle time and again, desperate to take back control of your life.

When we meet fellow time-looper Alan in episode three, it’s never outright stated that he has an anxiety disorder but all the clues are there that he’s struggling with mental health issues and a chronic case of Obsessive Compulsive Disorder. Throughout his narrative arc, it’s clear that Alan has an obsessive desire for perfection and exactness. He even asks his cheating girlfriend, Beatrice: “Do you think it’s possible to correct your life?”—as though his misery and missteps are as easily fixable as the furniture he repeatedly adjusts in his home. But moving a cushion an inch to the left does about as little to give him control over his life as maintaining the same routine does.

Despite being stuck in a time-loop and repeating the same day over and over, he (at least initially) changes little about how he lives it. Instead, time and again, his day maintains the same order. He packs his bags for a romantic vacation he knows he won’t take, he goes to his girlfriend’s apartment despite knowing she’s about to break up with him, and he repeats the same affirmations to himself, stating “I am beautiful. I am loved and deserve love. I am in control.” Except, Alan is definitely not in control and no affirmation or obsessively implemented routine can change that.

At the peak of my own anxiety disorders I found myself repeating affirmations and maintaining rituals in a bid to prevent intrusive thoughts and the dread and panic of potentially not surviving the day. I had my routine perfected to the point that stepping out of those self–made rituals spelled certain doom and frantic panic for me. Maintaining the same habitual behaviors made me feel momentarily in control of my mind and life – but any deviation from them would push me closer towards chaos and what I believed was certain death. It’s like Alan tells Beatrice: “Routine is an incredible thing … We become what we repeatedly do.” If the definition of insanity is doing the same thing over and over again, but expecting different results, then Alan is slowly driving himself insane in the show. During the years I was ruled by my OCD, so was I.

Russian Doll is a show about breaking patterns – of time loops, destructive behaviors, addiction, and inherited trauma. But so are anxiety disorders.

At its core, Russian Doll is a show about breaking patterns – of time loops, destructive behaviors, addiction, and inherited trauma. But so are anxiety disorders. I found the only way out of my own heinous predicament was in actively breaking the patterns I found myself repeating on a daily basis and to accept help and intervention, just as Nadia and Alan do. Through Cognitive behavioral Therapy, I’ve learned to limit and control the distorted patterns of thinking that have ruled every anxiety disorder symptom I’ve ever suffered through.

I still occasionally find myself staring down the barrel of my own mortality – intrusively envisioning death in benign everyday objects like a staircase, a meal, or a bar cellar hatch wide open in the middle of the street  – but I’ve also rewired my brain into rejecting the fear and dread that looped through it for so long. Truthfully, none of us are in control of our lives – that’s a message Russian Doll makes clear. But we can, at least, take some control of our minds and the way in which we engage with the world around us. Life may not be possible to correct, but it’s definitely possible that anxiety disorders can be.

Chronic Illness

Raising Your Kids With A Giving Heart, Despite Chronic Illness

After struggling through her son Ashton's kidney disease and her own health challenges, it's more important than ever for Amanda Zari to raise her kids with a giving heart.

When Ashton Zari was only four, he started asking for his birthday to be turned into a fundraiser, now called Ashton’s Birthday Wish, for the Ronald McDonald House of Central Ohio. In the last four years, Ashthon has raised over $40,000 in donations, organized face painting parties for the other kids at the home, volunteered his family to make dinner for the other residents, started a bathing suit closet for kids who didn’t know to pack one for the splash pad, met the President, and has written and illustrated a children’s book called How I Became a Superhero.

Ashton’s passion for helping families and other children at the Ronald McDonald House is inspired by his own experiences. Ashton was born with Bilateral Urinary Reflux, which means urine flows backwards from the bladder into the kidneys causing urinary tract infections and, when left untreated, kidney damage. Because Ashton was almost three years old before doctors realized what was going on, he now has Chronic Kidney Disease and Idiopathic Constipation. In the last 5 years, he and his family have spent close to 300 nights at the Ronald McDonald House of Central Ohio while receiving treatment at Nationwide Children’s Hospital.

Friends and family often joke that keeping up with Ashton’s fundraisers and service project ideas can be a full-time job for his mother, Amanda Zari. But Amanda, who also has two younger children, insists she is always willing to support Ashton’s wild ideas because she knows helping others is how he stays motivated. She explains that Ashton, a child with chronic pain and illness, needs those moments as often as possible.

Ashton Zari, and his mom, Amanda.

Amanda will be the first to tell you, though, that she hasn’t always been so willing. While today she considers it part of her life’s purpose to help other families on similar journeys, her motivation is fueled by memories of how dark her life was when their family first got the news of his illness.

Folks recently chatted with Amanda Zari about how her family navigates this difficult path and what inspired them to focus their energy on helping others. Our conversation has been edited for clarity and brevity.

You didn’t find out Ashton was in kidney failure until he was almost three, but there were signs all along that something was wrong. What led up to his diagnosis?

As a baby and toddler, Ashton cried all the time. He would get these random fevers and my husband, Anthony, and I would take him to the doctor, but they kept telling us he just had an ear infection or probably just a virus.

When I was 16 weeks pregnant with Addison, our second child, Ashton had been sick for almost three weeks. I took him to the pediatrician three times, and each time I was told it was just a virus. Eventually the fever spiked to 104.9, and I decided to take him to Urgent Care.

The doctor came in the room and I just started sobbing. “I’m not going to lie to you,” I said. “I’ve had him at the doctor’s three times in three weeks. This little boy is sick and no one is listening to me.”

“I’m not going to lie to you,” I said. “I’ve had him at the doctor’s three times in three weeks. This little boy is sick and no one is listening to me.”

They had him pee in a cup, they ran labs, they did x-rays of his urinary tract, and they did a renal ultrasound. Finally the doctor came back in and told me, “Amanda, your little boy is very sick. He is in kidney failure.”

Within two weeks, we were meeting with doctors at Nationwide Children’s Hospital in Ohio. His first surgery was when I was 36 weeks pregnant. No one wanted me to travel because they were afraid I would go into labor, but I had to be there. A week after we got home, I had Addison.

But then you had your own health scare which led you into a pretty dark place. What happened?

I did not take care of myself during my pregnancy. I pretty much sat around and cried, feeling bad for myself because my little boy was sick and might die. I wasn’t exercising, and I wasn’t sleeping. I was going to work and crushing it, but when I came home there was nothing left.

Addison was born, and she was perfect, but everything in my life was so out of control that I became determined I was going to breastfeed her —because this was something I could control. I already hadn’t been sleeping, but now I was setting my alarm for every two hours to nurse her. When she was just four weeks old, I found out I had to return to work or we would lose our family’s health insurance – it wasn’t a choice.

The doctors discovered I have a disorder called Addison’s Disease, just weeks after my daughter Addison was born.

I was only back at school teaching for a week when I started having seizures that led to me spending eight days in a medically induced coma. The doctors discovered I have a disorder called Addison’s Disease, and I am telling you that God is up there laughing because I’m diagnosed with Addison’s Disease just weeks after Addison was born. Essentially, what it means is that my body doesn’t produce enough cortisol. So when I was putting my body under all that stress, it didn’t have what it needed to deal with it, so it shut down.

When I woke up, I didn’t recognize my husband or know who my children were. I didn’t even know I lived in West Virginia. All of my muscles had atrophied, and I had to relearn everything – how to walk, tie my shoes, and feed myself.

It took about six weeks for my memory to come back, and I had to move back in with my mom because I needed full time care. It was demoralizing. She was having to take care of both me and my children, and that’s not at all who I am. I was angry, and no fun to be around. I wasn’t the person I am today or the person I was in college. I was a bitter, sour version of myself.

A woman holds her newborn baby while crying immediately after birth.

Amanda with her daughter, Addison, after her birth.

How did you get through that time?

On January 1st, 2015, about nine months after my seizures, my very sweet friend came to me and said, “I’m tired of you sitting here… You are not showing up for your family. This is not you.”

She started dragging me, three times a week, to the gym. I went begrudgingly, at first, but eventually that is where I began to find myself again.

I’ve learned that when you hit hard times, rock bottom, you’re going to come out a giver or you’re going to come out a taker.

In the beginning, I felt like I was going to stay at the bottom of that ditch forever, but I found a community of people who loved me when I was unlovable and they helped me see things could get better. After a year, I stopped focusing on being sour and decided to focus on positivity so that when we got devastating news again, instead of going back into the ditch, we could acknowledge it sucks and start asking what we can do for other people.

I’ve learned that when you hit hard times, rock bottom, you’re going to come out a giver or you’re going to come out a taker. There’s not a whole lot of in between. You’re either going to be the person that sits on the bottom or you’re going to be the person who comes out fighting, even if it’s begrudgingly, so you can help other people fight it out too.

Amanda credits her work in the gym as giving her the strength to get through her own health and mental health challenges.

In what ways are you and Ashton using your unique situation to encourage others?

Inspired by everyone who had helped me at the gym, I decided to use all of that time sitting in the hospital with Ashton to get my personal training certification. I started making training plans for the other moms  that can be done from the hospital bedside, and leading exercise classes and healthy lifestyle challenges.

Ashton and I sort of fed off of each other because we were both going through a really hard time, and we will often joke that the Phoenix is our spirit animal because we sort of came out of the ashes at the same time, asking, “What can we do?”

“How can we serve the families that are going through the same things we are?”

I was making Facebook videos about body image and self love. Ashton began to take notice of this and realized, “If you can encourage people, so can I.” So he started making his own “How To Be Happy” videos.

Ashton’s Birthday Wish was eventually born out of that idea. We started it, with his fourth birthday, as a way to give back financially to the Ronald McDonald House, but it has made an evolution over the last four years. We’ve become very service based and we’re constantly asking, “How can we serve the families that are going through the same things we are?”

Amanda and her kids.

Ashton has done some pretty amazing things, but I am sure a lot of the work of implementing his ideas falls onto your shoulders. Do you ever say no to his ideas?

No, I don’t. There is no way to describe his life other than it is hell, but his cup is filled by serving people at the Ronald McDonald House — whether it is through raising money, putting out an inspirational video, writing cards to other kids, or writing a book.

My son inspires me all the time because he dreams big, and he very rarely falls short.

His cup is filled by that. So my job, as a parent, is to help him. I am so proud of him but I can’t take any credit for any of his ideas. He inspires me all the time because he dreams big, and he very rarely falls short. I have never met a child with his work ethic.

How have you reconciled the dreams you had for your family with the life you have been given?

This is a daily battle for me. I always knew I wanted to have kids, and I always knew I wanted to teach. Everything in my life was building up to that. I was going to get married, teach, and have children. I had my whole life planned out. When we found out Ashton was sick, and how sick he really was, that was one of the most soul crushing times for me because I realized my life was not going to look like what I had always imagined.

I wouldn’t know this joy, and I wouldn’t appreciate the moments where we belly laugh until we cry if I didn’t know how hard life can be.

There are still days that I look on social media and see my friends’ kids playing tee ball or going to school events. The jealousy still flares every once in a while, but what I have found is that there is so much beauty in day to day life. Sometimes it takes another second for us to sit down and look for it, but I can tell you that I appreciate the little special moments so much more than I would if I had the dream life that I expected. I wouldn’t know this joy, and I wouldn’t appreciate the moments where we belly laugh until we cry if I didn’t know how hard life can be.

The Zaris at Ronald McDonald House at Halloween.

When all of this is said and done, what lessons or memories do you hope your children come away from this with?

I hope that they come out of this with a sense of resiliency. We do our best to have a routine and plan. Sometimes, though, we just have to roll with the punches and make the best of it. But we do that by having dance parties while we cook pancakes, singing really loud in the van when we’re driving, and cherishing every moment we get at home because we’re on the road so much.

I also hope they always keep the servant heart they grew up with, seeing us giving when we have so little. I hope they continue to constantly try to bless other people because anything that we’ve done for other people, God has blessed us back with five or six times. I hope they come out with just a sense of no matter how hard your life is, there are things you can do for other people.

To learn more about Ashton’s Birthday Wish, visit

Essays Mental Health

What My Students Don’t Know About My Mental Health

Being a high school teacher is challenging enough before you add anxiety, depression, and ADD into the mix.

By 8 a.m., sweat has soaked through my shirt. I am overweight, so most people assume the sweat is because I am out of shape. The secondary students in my English Language Arts classes are particularly rude about it, pointing out the dark stains on my chest and underarms.

“Mr. Sweeney, why you sweatin’?” a student says in the underdeveloped vernacular of the poverty-stricken area our school serves in Richmond, Virginia. “You ain’t doin’ nothin’.”

A ruder student grins and shouts, “Mr. Sweeney, you sweat ‘cause you fat.”

Then they laugh. Always, they laugh.

The students’ assumptions about my sweat are only partly true–I am out of shape, after all–but there’s more to the sweat that I am afraid to tell them.

“I get hot when I’m working hard,” I reply. On rare occasions, when I’m feeling especially chipper, I may say something more combative, like: “Mature people sweat; you’ll find out one day.” This usually gets a laugh out of one or two students.

I forgive them. They’re just kids, after all. Most of them don’t see me as a person: they see me as their teacher.

Still, the remarks sting. Because I am a person: in particular, a person struggling with mental health issues, including anxiety, depression, and mild ADD. And while my sweating may draw attention to my weight issues, it’s not caused by it.

I sweat because it’s a side effect of Effexor, the go-to medication to treat anxiety. Ironic, really. It forms a perfect loop: the kids notice me sweating, they make comments about it, which makes me more depressed and anxious, which makes me need Effexor.

But, of course, I can’t tell anyone this.

The education industry values mental acuity and communication over all other skills. What this means is that I’m afraid to tell people about my mental health issues, especially my superiors

The education industry values mental acuity and communication over all other skills. What this means is that I’m afraid to tell people about my mental health issues, especially my superiors, lest they think that my mental acuity has been somehow compromised. It hasn’t, but the stigma around mental health in education runs deep.

My mental health challenges can often make my job more stressful. My principal wants me to appear organized and clean, but my ADD often leads to clutter. When I grade students’ essays, parents me to challenge them to succeed to greater heights, but my depression sometimes affects my mood while grading, making such efforts difficult. Students look to me for answers, but my anxiety causes me to sometimes make mistakes, like muddling my words or misspelling something on the blackboard.

“How you gonna teach us to write and you can’t spell?” a student says. In response, I tell the student that writing isn’t as much about spelling as it is about putting ideas across.

Mental acuity, communication: these are the most prized skills in education. Anxiety and depression may occasionally effect little things like spelling, but they do not impact my ability to communicate ideas or think critically.

As I’ve learned in therapy, life is a series of coping skills. My mental conditions are nothing to be ashamed about.

The truth is, I can be a stellar teacher in spite of mental illness.

The truth is, I can be a stellar teacher in spite of mental illness. What one may call clutter, I like to call systemized chaos.  When students want advice, I can empathize to the best of my ability and be honest.

A plump young girl in glasses taps my shoulder.

“Mr. Sweeney, doesn’t it hurt your feelings when these other students call you fat?”

“It does hurt,” I admit.

“How do you deal with that?”

I have rehearsed the answer many times in my head. I’m almost excited that she asked.

“I remind myself that I have ideas and abilities that make me unique. And I work in a profession where I get to show off my intelligence and pass these valuable things on to others. That feels better than the hurt.”

She adjusts her glasses, and makes my day.

“Mr. Sweeney, it doesn’t matter if you sweat,” she says. “I like your class.”

Disability Mental Health Roundups

5 TV Shows That Get Disability Right

From Stranger Things to Keeping Up With The Kardashians, here's five shows that refuse to look at chronic illness and disability through an able-bodied lens.

When it comes to representations of disability and chronic illness in popular culture, it’s easy to be frustrated. Anyone that knows me will attest that I often lament the lack of realistic depictions of disability on TV, which is all too glaringly obvious when you spend the majority of your life propped up in bed with your laptop, like me. (I could probably get up: I just choose Netflix).

Any disabled or sick person will tell you that seeing an inaccurate depiction of the condition they’re toxically glued to for the rest of their life hurts. For instance, I found ballet show Flesh & Bone gripping until one of the dancers discovered she had MS, and her diagnosis was as hamfisted as a Joss Whedon rewrite.

But all is not lost. There are shows that are getting accurate representation right. These television shows refused to be lazy, and instead dared to get disability right… in some cases, even daring to cast disabled actors in disabled roles (Eddie Redmayne, take a seat).

If you want to support the change you’d like to see in television, here are five television shows that get disability right.

Breaking Bad

A man with cerebral palsy talks to a bald man in glasses in a living room with plaid curtains in the background.

RJ Mitte as Walt Junior in Breaking Bad.

RJ Mitte’s depiction of drug lord Walter White’s son remains one of the strongest examples of a disabled actor being cast in a role which doesn’t focus on his disability. That’s important, because the part could’ve so easily gone to an able-bodied, Mickey Mouse Club reject. Living with cerebral palsy in real life, Mitte’s character had the condition, but it didn’t have him. Walter White Jr. was never defined by his disability, and is basic proof that just as Shonda Rhimes employs colorblind casting on all of her shows, an actor’s physical or mental impairments shouldn’t limit their chance to audition for any part. Plus, Walter’s dad, as a person with cancer who’s undergoing aggressive therapies, is a literal disabled badass, and I invite you to fight me.

American Horror Story

Jamie Brewer, who has Down Syndrome, is one of the core cast members of American Horror Story.

Actor Sarah Paulson recently said of American Horror Story co-creator Ryan Murphy (via Variety): “His unfaltering commitment to telling the stories of women is noteworthy. This is a man who wants to tell the stories of women over 40.” And the same is true when it comes to casting disabled actors in unexpected roles. One such disabled actor is Jamie Brewer, a woman with Down Syndrome who’s played clairvoyant witches, cult members, and creepy dolls, and continues to recur on the series even now. Plus, Inside Edition recently called Brewer the “First Woman With Down Syndrome to Star in Off-Broadway Play,” and if that’s true, it’s no mean feat that the prolific performer is blazing a trail and hopefully, instigating a major change.

You’re the Worst

Gretchen Cutler of You’re The Worst struggled with depression.

Gretchen Cutler could’ve been a cookie cutter anti-rom-com heroine, breezing through her character arc on too much booze, sex, and witty repartee. Instead, when You’re the Worst returned for a second season, Gretchen revealed herself to have the sort of show-stopping depression that ends lives, and destroys relationships. For anyone familiar with clinical depression, breakout sitcom You’re the Worst became agonizing to watch because its representation was so damn close. When viewed next to fellow character Edgar Quintero’s PTSD, You’re the Worst significantly defined itself as the sitcom that wouldn’t sugarcoat mental health even for a second.

Keeping Up With the Kardashians

Kim Kardashian struggled with anxiety on Keeping Up With The Kardashians after being robbed at gun point.

Love them or hate them, the Kardashians are honest when it comes to the truly negative and difficult-to-handle aspects of life. And when Kim Kardashian West was robbed at gunpoint in Paris in 2016, she developed a serious case of anxiety as a result, and viewers were given glimpses of her agonizing reality with the disabling condition. And despite mainly being off-camera these days, Rob Kardashian’s diagnosis with diabetes punctuated his own reality series, Rob & Chyna. Whether or not you agree with the Kardashian brother’s approach to handling his chronic condition, his denial and refusal to face up to the realities of the illness were endlessly relatable for any of us who have ever struggled to come to terms with our own diagnoses.

Stranger Things

Gaten Matarazzo of the Netflix phenomenon Stranger Things.

Gaten Matarazzo finally got his big break when the creators of Stranger Things decided to write the actor’s disability—cleidocranial dysplasia, a condition which affects the development of a person’s bones and teethinto the script. In a recent interview, Matarazzo revealed that he’d lost out on several auditions in the past, “Because they couldn’t write in a disability into the show because they had already written the script” (via HuffPost). However, as the casting process for Stranger Things proves, there’s literally zero reason that any role should be defined as able-bodied in the character description. It just shouldn’t, and doesn’t need to, happen anymore.

What These Shows All Get Right

These shows might all be majorly different in content and tone, but they’re linked by the fact that they’re not framed through an able-bodied lens. Instead, each depiction, regardless of genre, explores the highs, lows, and mundane details of disability, chronic illness, or mental health. Even more important is the fact that actual, real life, bonafide disabled people were cast in roles that were rewritten completely or simply created for them. Rather than farming out these roles to able-bodied actors, casting directors, creators, and show-runners took the time to consider disability. And in the cases of Matarazzo, Brewer, and Mitte, character arcs were altered for the better thanks to the actors portraying them.

These shows might all be majorly different in content and tone, but they’re linked by the fact that they’re not framed through an able-bodied lens.

Whether there’s strictly a “right” way to handle disability in the arts is questionable, but thanks to the growing number of crucially truthful roles for disabled and sick performers, the television landscape is getting more and more relatable. For instance, the first show by and starring Maysoon Zayid, co-founder of New York’s Arab-American Comedy Festival, is called Can-Can and is currently being developed at ABC. The autobiographical sitcom will (per Variety) follow a “Muslim woman who has Cerebral Palsy (Zayid), as she struggles to find love, the right career, and discover who she is separate of her opinionated Muslim parents,” which sounds super promising, and a little overdue.

It’s time that the stories of chronically ill and disabled human beings weren’t erased, glossed over, or summarized in a “case of the week” episode on a generic medical show. Sick people are tired as it is without having to fend off another inaccurate, depressing, or infuriating depiction of their well-worn diagnosis. And thanks to the television shows above, that’s slowly starting to change.

Advice Explainers Mental Health

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.”

Mental Health 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.

Mental Health 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.

Mental Health 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.

Mental Health 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.