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 Disability Mental Health The Good Fight Vision & Hearing Loss

The Big-Hearted Org That Brings Scuba Diving To Everyone

Disability doesn't exist underwater. Founded by Jim Elliott, Diveheart is an Illinois-based organization that wants to make sure everyone can experience what that's like.

Scuba diving is the only gravity-free activity in the world. For the physically impaired, this is an especially attractive fact. “The obstacles that individuals with disabilities face on land disappear in this forgiving gravity-free underwater world,” says Jim Elliot, the founder of Diveheart, an Illinois-based organization which submerges the disabled. The organization works both in pools and open water and now has programs from Atlanta to Asia. They are the world’s leading force in adaptive scuba diving.

The idea for Diveheart, which Elliot started in 2000, came about while instructing a group of blind people in skiing. His oldest daughter, who is blind, was involved. Elliot was struck by the enormous psychological benefits that the activity afforded the participants and wondered how it could be expanded. “I got to thinking, ‘Gosh, you can only ski at certain times and in certain places but there’s a pool in every community,’” Elliot recalls. Some years later, Elliot left his job in the media business to build Diveheart. Though founded with his own money in Illinois, the organization is now supported by individuals and foundations around the world. Diveheart has trained “well over 1,000 instructors” in the Caribbean, Malaysia, China, Australia, Israel, England, Singapore and hundreds of cities in the U.S. Recently they launched a team in Borneo.

“The obstacles that individuals with disabilities face on land disappear in the forgiving gravity-free underwater world [of scuba]…”

The organization works with all kinds of disabilities and conditions, from muscular dystrophy to blindness to those suffering with PTSD. Instructors work within a unique training program that Elliot developed, part of which involves trainers undergoing disabled “simulations”, having to do the lessons with a given disability. Diveheart also participates regularly in university research studies aimed at figuring out the various therapeutic benefits that diving affords to the mentally and physically handicapped. We reached out to Elliot to hear more.

An older man with a shaved head in scuba gear helps a disabled man in a wheelchair into the water,

Jim Elliott, founder of Dive Heart, helps a student into the water for the first time.

How did you first get involved in adaptive scuba?

I have a long history of working with people with disabilities. My dad was a disabled army vet; growing up one of my best friends had cerebral palsy and I’d walk him to school because the bullies would pick on him otherwise. I married a lady with two boys and they had their issues, healthwise, and then we had two children together. My oldest daughter was blind and my youngest ended up having scoliosis. I was a journalism major at Northern Illinois University. I started diving thinking that if I ever met Jacques Cousteau as a journalist I better know how to scuba dive. I just fell in love with it.

How did you get Diveheart off the ground?

I started diving thinking that if I ever met Jacques Cousteau as a journalist I better know how to scuba dive. I just fell in love with it.

My youngest daughter went to Shriners Hospital to have work done on her spine. I knew quite a few people with physical disabilities from there. When I first started I had this idea for the trademark, the dive heart, and I went to a trademark attorney friend of mine. I told him my crazy idea. He and his partners decided to handle all of the legal registration stuff pro-bono. They’ve been watching our back ever since and haven’t taken a dime. Could not have done it without them. We initially started with Shriners Hospital and the Rehab Institute of Chicago then started working with the VA hospitals and special rec associations. We began to expand. I started teaching instructors all over. I became the number one instructor trainer in the world for adaptive diving.

A group of dozen or so scuba divers, many of whom are disabled or in wheelchairs, posing on land in a group shot.

Diveheart is the world’s leading organization for adaptive scuba diving.

How did you learn how to train others?

Having created a training program for the blind ski group, and working with my own kids, I had a fount of knowledge that was very helpful. There were some organizations out there and I compared what training programs worked best. We worked a few for some years but I saw a lot of flaws and about five years ago we launched our own training program and certifying organization. Now we train instructors all over the world and have really become the cutting edge training program for adaptive scuba.

What is the training course like for divers?

We require the person to begin training through a standard agency, like PADI. They learn the basic science of diving (the number one PADI program in the world is in Key Largo and they do our programs every month). They go through that as far as they can then they come to Diveheart. They get a book and do online training. Then we get them in a pool. That’s maybe all they want to do. But if they want more we get them into open water. If they can’t afford to take one of our trips, then we have scholarships.

What is some of the research Diveheart has been involved in?

When autistic divers go underwater the ambient pressure is soothing, like a weighted blanket.

With Midwestern University we did the first study on autism and scuba therapy. In most cases this is a cognitive disability but sometimes there’s a physical component as well. When autistic divers go underwater the ambient pressure is soothing, like a weighted blanket. Going underwater also eliminates surface distractions, like a sensory deprivation room. That helps them focus. I remember we once took a kid who was non-verbal, who stood up at the end of a twenty minute session in four feet of water and said to the teacher, “That was amazing, I’d like to try that again.” Our mouths just fell open.

Researchers from the University of Illinois found, working with our participants around the country, that the very first pool session is the most powerful. That’s the one that creates the paradigm shift. Suddenly it’s not Johnny in a wheelchair anymore, it’s Johnny the scuba diver.
In 2011, doctors from John Hopkins found that when you get deep it creates a serotonin kick. They were working with one of the teams we had trained down in Cayman. Eighty percent of the PTSD symptoms of the veterans involved in the study were alleviated on this trip. We knew anecdotally that diving helps with pain management. We’ve had guys with chronic pain say to us on dive trips that they become pain-free for the first time. It’ll last that whole week then two additional weeks after.

A bald man helps a man with cerebral palsy into the water for a diving lesson.

Diveheart has trained “well over 1,000 instructors” to help disabled divers feel empowered underwater.

Right now we’re doing research with Northwestern and Midwestern universities on developing a ventilator system that will allow for fully paralyzed divers to get deeper. We’re working with university medical researchers in Malaysia as well. The top people in tourism there want to make Malaysia a destination for adaptive scuba, which is really exciting.

What are some ways in which you have seen scuba change lives?

We had one Marines veteran, Greg Rodriguez, who had a traumatic brain injury. He tried to commit suicide twice before he came to us. He told me, “What the doctors said I have is a traumatic brain injury but I call it my worst nightmare. But Diveheart changed everything.” Diving turned his life around. We also had a young girl who was a barefoot water-skiing champion, Amber Rangel. She caught a jump wrong at nineteen, landed on her head and is now a C5 quad. She was so depressed she wouldn’t leave her room. Her sister drug her screaming to one of our events.

If someone is born with a disability, it could be the first time in their life they see themselves upright. That’s the high for me

When I got her standing up underwater and she looked down and saw herself vertically, using her breath to control her buoyancy, totally independent, she said, “Oh my god, I’m standing up for the first time since my injury.” This happens a lot. If someone is born with a disability, it could be the first time in their life they see themselves upright. That’s the high for me: seeing someone get that aha moment. It just changes everything. Now they focus on what they can do, not what they can’t. That inspires people around them, too. It’s a ripple effect that really can touch society.

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.

Essays Mental Health

My Grandmother’s Murder and My Decade Of PTSD

Today, I’m still finding ways to cope, and I probably always will be. This is my reality after living with PTSD for a decade.

Two weeks after the murder, my tenth-grade biology teacher sent me an oversized greeting card in the mail. In different colors and sizes, students I knew—and some I didn’t—had filled it with condolences. I went to a small school in a small town and everyone knew what had happened. Mom’s mug shot had appeared on the local news just hours after she’d been taken to the county jail in handcuffs. WOMAN STABS MOTHER 20 TIMES had floated across a blue banner under her face.

Everyone knew I was there when my grandmother was killed, and there were no condolence cards for that kind of thing. Mr. M. had made his own by folding a large white poster board in two and stuffing it in a giant envelope. There were no instructions on what to write in a card like that either, so most students wrote I’m so sorry or time heals all wounds or she’s in a better place. Some notes were long, some short, some in ink, some in pencil, but they all shared the same sentiment: it will get better someday.

Everyone knew I was there when my grandmother was killed, and there were no condolence cards for that kind of thing.

The day before it happened, I was awkward and shy and ready for summer break to finally start in two weeks. I loved reading mystery novels and writing poems and posting funny surveys in MySpace bulletins. I hoped to become a writer one day, to write book reviews or interview interesting people about the things that mattered to them. I watched and rewatched the recordings of Pulp Fiction and Kill Bill I’d saved on the DVR so I could quote them on my personal blog of poetry and angst. Back then, I didn’t believe in the idea that life could change in an instant. But then it did: one day I was worried about the grade I’d get on my math test and the next I was hiding in my bedroom listening to my grandmother’s murder.

I’m 25 years old now and I have never forgotten the sounds she made when she died. I have never forgotten what her blood looked like when I walked into the room after it was over—how it was nothing like the kind I’d seen in movies, not even the goriest Tarantino scenes. Last month marked a decade since I received that card from Mr. M., and sometimes I wonder if what I really wanted all those little notes to say was it will go away someday.

The summer I’d been waiting for all year turned out to be the hardest time of my life. I was diagnosed with Post Traumatic Stress Disorder, or PTSD, and was told I needed to see a therapist once a week. I was told it was normal to experience night terrors for a while, but for three months, I dreaded falling asleep. I knew that when I did finally sleep, I’d hear the screams again, see the blood again, relive that night again and again and again. All summer, I slept with the lights on and the door locked and a silver flashlight next to my pillow, and I’d wake up at the same time every night with a circle of cold sweat on the back of my shirt.

On the hardest nights, I experienced sleep paralysis… It was like having an endless panic attack while being stuck flat on my back, completely frozen.

On the hardest nights, I experienced sleep paralysis, a condition that makes you feel trapped in the space between sleeping and waking in which your body cannot move at all. It was like having an endless panic attack while being stuck flat on my back, completely frozen. I confused reality with dreams, and I’d often hallucinate, seeing figures on the ceiling above my bed. In the mornings, I would imagine myself two, five, seven, ten years older and wiser and better. Healed. Fixed. Normal. But time went on and the pain was still there.

Eventually, I could sleep with the lights off or go through a whole night without waking up, but there were triggers everywhere. Anything could spark a flashback. I jumped because a baby screamed while I was waiting in line to take my driving test at the DMV or I ran out of a movie theater because there was a pool of blood on the screen. Friends and family and therapists and books said it would go away eventually. Someday I’d be able to watch a horror movie again. Someday my eyes wouldn’t well up when someone jokingly said, “I’m going to kill you!” Someday I’d wake up and my first thought would be about something other than the murder.

Kristi DiLallo was 15 when her grandmother was murdered while she was in the next room. The symptoms of that trauma still persist; they are very real, and very physical.

Now that the tenth anniversary has come and gone, and as I get further away from the event itself, I feel like the opposite is happening: triggers have gotten louder, more constant. I’ve tried so many times to turn the volume down—through talk therapy, journaling, meditation, and even hypnosis. Over the years, there have been quieter weeks and months, but I’ve still never experienced complete silence. Most of the narratives that actually name PTSD are trauma-to-recovery stories in which time really does heal all wounds and survivors are heroes. And maybe that’s true for some people, but lately, even after all these years, I feel more sensitive than ever to the sight of blood or even hearing the word “murder.”

Now that the tenth anniversary has come and gone, and as I get further away from the event itself, I feel like the opposite is happening: triggers have gotten louder, more constant.

In the beginning, my most frequent symptoms were nightmares. For the most part, they didn’t even have to be triggered by anything; I’d simply fall asleep and have a nightmare about the murder because it was so fresh in my mind. These days, I’m having nightmares again—about twice a month or more—and the triggers can be unpredictable. Of course, some are more obvious, like an unexpected violent scene in a movie, but some are hidden in small pockets of my daily life. PTSD is a difficult condition to explain, because it’s the kind of thing people have to see to believe. We live in a time when trauma is either completely misunderstood or used as the punchline of a joke—the word “triggered” itself has literally become a meme. One of the most difficult aspects of living with PTSD is that it really is invisible: nobody sees those nightmares but me.

Six years ago, I binge-watched the original two seasons of Twin Peaks in one weekend in my college dorm room. I loved the show because it was silly but not stupid, spooky but not gory. It was one of the only crime shows I could watch without covering my eyes, and it offered a meaningful, unique portrait of teenagers grappling with the trauma and grief of a murder in a small town. I recognized myself in many of the characters, even the adults, and I admired them because their grief was loud and absurd all the time: Laura’s mother screaming and crying hysterically, her father dancing with the now-iconic photo of his dead daughter, her best friend searching for the truth about the crime. When you lose someone you love, especially when the loss feels like the stuff of horror movies, you want to scream at the top of your lungs and you want to remember what it was like to look at their face instead of a photo and you want to find out why any of this ever had to happen.

PTSD is a difficult condition to explain, because it’s the kind of thing people have to see to believe.

Last year, I was excited about the long-awaited return of the show, but it gave me the worst nightmares I’ve had in years. Eventually, after watching the first six episodes with a pillow in front of my face, I stopped watching it altogether—after a particularly gruesome episode depicting a bloody car accident involving a child, as well as two stabbing deaths. Friends who knew I loved the original show would text me after new episodes, and I would feel too embarrassed to tell them I’d stopped watching it. I worried about making them feel uncomfortable with the reality of my condition: because of a single night when I was fifteen, I just couldn’t watch the same TV show as them. Recently, I started to ask myself, why am I so ashamed of something I cannot control? Surviving a violent crime is difficult for so many reasons, and the grief and guilt manifest differently almost every single day. Some days I wake up wanting to tell everyone I meet what has happened to me; other days, I want to change my name and move somewhere new and never tell anyone ever again.

Maybe my shame comes from the expectations that other (well-meaning) people have about my trauma. When I do tell people about the murder, the usual response is, “I never would have guessed” or “You look so normal.” There have also been times when I’ve told someone and it made them so uncomfortable that they changed the subject or laughed because they thought I was joking. Even though I often feel completely consumed by the murder on the inside, there will always be people who want me to either perform my pain—in ways that they can recognize from shows and movies about tragedy—or pretend it never happened at all.

“Today, I’m still finding ways to cope, and I probably always will be. This is my reality after living with PTSD for a decade.”

When I think of Mr. M’s condolence card, which I continue to be grateful for, I think of how much other people’s perceptions of my trauma affected my own understanding of it. All these years later, the time heals all wounds narrative just doesn’t make space for wounds like mine—the kind that still sting. Most of those standard clichéd condolences suggest that you won’t be in pain forever, and as a fifteen-year-old girl in the thick of my grief, I saw that as a promise and I clung to it. So what was I supposed to do when the pain didn’t go away? Pretend it wasn’t there and be ashamed that it was.

In the last ten years, I’ve hidden my PTSD from many people in my life—family, boyfriends, close friends—to the point that I hurt myself by not bringing it up. Once, I watched a Scream marathon with a group of friends because I was too embarrassed to say why I didn’t want to. This, of course, resulted in a flood of flashbacks and nightmares I dealt with on my own. In a college sociology course on family relationships, I ran out of the classroom when the professor played a 911 call of a child screaming, “Something bad is happening in my house,” because it reminded me of the night I had to make that call. Again, I felt embarrassed and hysterical and childish, but later, when I told the professor about my situation during office hours, she responded with care and concern. Her only question was, “Why didn’t you tell me sooner?”

I’ve learned that the only way I can expect others to try to understand my PTSD is to acknowledge it myself—and to cut myself some slack.

Since then, I’ve learned that the only way I can expect others to try to understand my PTSD is to acknowledge it myself—and to cut myself some slack. Last summer, after I stopped watching Twin Peaks, I made myself a promise: I challenged myself not to watch any shows or movies depicting murders, especially stabbing murders, for one month. My Netflix queue got a lot shorter, and the challenge definitely wasn’t something I planned on announcing to the world, but almost immediately, I could feel my mental health improve. I slept better. I didn’t wake up crying. I spent more time reading and writing and exercising. There were still other triggers around me, but I learned that setting my own boundaries gave me a feeling of control over a condition that has rendered me powerless so many times.

Today, I’m still finding ways to cope, and I probably always will be. This is my reality after living with PTSD for a decade: I Google movie and TV spoilers so I’ll know if I have to cover my eyes before a particular scene or if I should avoid watching it completely. I cry a lot, sometimes about the smallest things, and when I start, I don’t know how to stop. I get flashbacks on the subway or while I’m teaching a class or while I’m reading a book at home. And all of that is okay. I can allow myself to say no to a slasher movie and I can leave a room if I don’t feel comfortable and I can allow myself to enjoy the beautiful parts of my life, too. I don’t have to feel like a hero when I talk about PTSD, but I don’t have to feel weak or worthless or ashamed either. I know that although this will never completely go away, it does get better. Mine is not a story of trauma-to-recovery, but it is a story of trauma-to-hope, and I’m still learning how to tell it.

Creative Commons photo by Mark Strozier.

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.

Essays Mental Health

Respect Where You’re Broken: How I Navigated Traumatic Grief

After my brother and cousin died, I was destroyed by grief. But if you work the problem, there is light at the end of the tunnel.

My baby brother Johnny died in November 2016 from an undiagnosed cardiac arrhythmia. He was 46. His death was sudden; by the time I was called to his apartment by the police, he’d been gone a week. In the aftermath, I endured hours of grief, confusion, and anxiety, as police and medical examiners scurried back and forth around me, asking me to sign documents and bear witness to Johnny’s last days of life.

Thankfully, my cousin Debi–like Johnny, another love of my life–had planned a visit to me months earlier. Less than a week later, she drove from her home in North Chicago to Westchester to help me through my grieving process. The visit grounded me, and kept me sane. We didn’t even talk about Johnny; we just went to lunch, we walked in the park, drank beer in my kitchen, visited relatives. But always, he was in the back of our minds.

When we said goodbye, I wanted to beg her to stay, just a little longer, but I knew she had to get home to her life. Then, two months later, Debi too died. It was February: one day, we were texting each other about our taxes, and the next, she was gone.

She was 57. Grief and trauma flattened me. And trauma makes grief harder to resolve.

Grief isn’t just something that happens to you: it’s a disease. And it can kill you.

Grief isn’t just something that happens to you: it’s a disease. And it can kill you. Virginia Hughes writing for Scientific American says that “persistent, consuming grief may, in and of itself, increase the risk of other illnesses, such as heart problems, high blood pressure and cancer,” as well as feelings of worthlessness, anger, and depression.

To cure my own grief, it felt like I tried every approach; some worked, and some didn’t. But I tried everything.

In the immediate aftermath Debi’s death, I contacted a local pastor: a young woman who just graduated from Columbia University. Her website said she offered pastoral counseling, and while I’m not religious, I was flattened by grief. Counseling sounded like something I could use, and besides, it was free.

I met her in a coffee shop on a snowy winter day. She was pragmatic and kind. Honestly, just opening up to a compassionate stranger about what I was going through after gave me strength. She referred me to a psychoanalyst, Dr. Smith, whose practice was housed on the church’s property, and who diagnosed me with PTSD and complex grief.

As the condolence cards appeared in the mail, I pinned them to the dining room wall. It became an ad hoc memorial, almost like a mural, to Debi and Johnny, to which I added photographs, ribbons, and dry leaves. I placed a small table beneath it, and lighting a candle, spent a few quiet moments there every day, thinking about those I’d lost.

At the same time, through an excellent online resource for the grieving, I joined a private Facebook group for people who have suffered catastrophic loss. The anonymous men and women in my group knew exactly what to say to me. There, I got the practical advice I needed: don’t try to eat full meals, buy cheese, crackers, fruit, drink lots of water, go for walks, watch funny movies, create rituals, get outside, get enough sleep.

After a while, the sessions with Dr. Smith stopped working for me, so I quit. I was too angry. I outgrew The Facebook group. But I was tenacious. As spring approached, I created a “garden” of Amaryllis plants on my window ledge for Debi, two red and two pink. I loved taking care of them. The precise morning ritual of watering them kept me grounded.

Part of me said, you’ll never get better if your best relationships are with people who are dead.

Two weeks after Debi died, her sister mailed me a ring: Debi, the queen of rings, had been wearing it the day she died. It got lost in the mail, but five months after it had been postmarked, the ripped and forwarded envelope finally made its way to me. It seemed like a sign.

Around the same time, I also had a lucid dream where a basketball shot out of the clouds, and landed at my feet. A definite message from Johnny: growing up in Wisconsin, we’d always shot hoops together in the driveway.

Part of me said, they’re still looking out for me. And part of me said, you’ll never get better if your best relationships are with people who are dead.

Last September, seven months after Debi died and 9 months after I was summoned to Johnny’s apartment, I moved to a small town on the Hudson River. In my new home, my view of the water and the New Jersey Palisades was alarmingly beautiful. I should have been grateful, but I wasn’t. My new home made me senselessly angry and frustrated:  the commute was too long, the grocery store too far, where are the bagels, what am I doing? It was a litany, an endless loop. I couldn’t stop the tape. It didn’t feel like I was grieving–it just felt like everything was wrong and broken.

It didn’t feel like I was grieving–it just felt like everything was wrong and broken.

On a rainy October morning, I arrived at my office to prep for my class. I got up from my desk,  tripped on a rug, and broke my wrist. A week later after, after a sleepless night weaning myself off pain meds, I went out for coffee.

I walked north on Warburton Avenue, which is parallel to the Hudson.  The river is always in view. It was early in the morning, the sun hadn’t come up, the sky was violet. I approached a trestle bridge that connects my neighborhood with the downtown. It skirts over a deep gorge, parallel to the blue water. I had Johnny’s black winter jacket slung over my cast.

As I walked, I heard a voice: “Respect where you’re broken.” I swear it was my brother speaking to me.

I suddenly realized how fast I’d been walking. I always walked fast, too fast. I was always in a hurry. Had I been in too much of a hurry in my grieving too?

As I crossed that bridge that morning, and heard “Respect where you’re broken”, I slowed down. I took my time. After I got my cup of coffee, instead of hurrying home, I decided to explore my new neighborhood. And this is where I found a small group of people practicing tai chi, and asked if I could join.

I’m still practicing tai chi with this group. It feels fated. I love the discipline, and the teacher reminds me of Johnny. I look forward to getting out of bed in the morning so I can join them at  8:30 a.m. in the small, gated park, overlooking the river. I like being outside, in the cold. I like the crows and the geese, and the sun over my head. It is alarmingly beautiful.

I always walked fast, too fast. I was always in a hurry. Had I been in too much of a hurry in my grieving too?

According to the National Center for PTSD, one of the “problematic outcomes [of grief] is an inability to create a new identity.” Yet creating a new identity is key to moving beyond grief, because after someone you love dies, you will never be the same person again. Yes, after losing Debi and Johnny, I had moved, but I hadn’t committed to what a life after them. I had been so afraid of admitting I had been broken that I had allowed nothing new to be created in my life.

That voice in my head changed everything. It took a year, but I finally learned that if  I wanted to create a new identity, and a new life without Debi and Johnny, I had to do things differently. I had to meet new people, and go to new places. Grief and trauma are, on some level, like everything else in life: to work through them, you need to move deliberately, have hope, and work the problem. Death disrupts the very fabric of our lives, and there are no easy answers.

Having seen my way out the other end, I want to tell anyone who has been traumatized by grief: there is a way out of this hell that you feel. But it requires patience. And, as Johnny reminded me, respect.

Creative Commons Photo by Jemsweb.

Mental Health The Good Fight

How To Spot A Fake Service Dog

Service dogs helps hundreds of thousands of people live their daily lives, but counterfeits muddy the waters and create chaos. That's why Lon Hodge and his dog Gander are trying to educate people.

Sitting in a local restaurant, the man with the Great Dane laughs as his dog romps from table-to-table in hopes of getting dinner scraps. His fellow diners are not so amused. No one stops the dog because he’s wearing a service vest.

“That Great Dane is a fake,” says Lon Hodge, a Vietnam veteran with a real service dog named Gander. Lon often reads Tweets, news articles, and Facebook updates about people being denied entrance into commercial establishments because they have a service dog with them. He knows this firsthand: he and Gander are frequently turned  away from restaurants, hotels, and stores.

Lon suffers from Post Traumatic Stress Disorder (PTSD) and relies on Gander, a Labradoodle, to keep him calm. When Gander hears Lon’s voice start to rise, he licks his hand. “If I don’t respond,” he says, “he gets up and puts his front paws on my chest and looks me in the face. It’s almost as if he’s asking ‘if I’m okay?’”

A Mission Of Understanding

A black-and-white portrait of a middle-aged man sitting on a chair, rubbing noses with his shaggy service dog.

Lon Hodge and his service dog, Gander.

He and Gander are on a mission. They travel the country teaching business leaders and their employees how to spot a real service dog from a fake. Through his nonprofit, Operation Fetch, they educate veterans and businesses about people with visible and invisible disabilities, like PTSD.

In the past two years, they partnered with Amazing Pet Expos to talk to people in the pet industry about service dogs. Everything from how to get a service dog to training them to caring for them and, of course, detecting fakes are covered.  (Plans are in the works for another expo to be held next May. Details will be posted on their Facebook page.)

Lon works with businesses to educate them and the public about just what a problem fake service dogs are. He’s given talks at the corporate offices of Starbucks, McDonald’s, Walmart, and Vantage Hotels. “These corporations want you to shop in their stores,” he says. But when businesses turn people with real service dogs away because of negative experiences with counterfeits, they often hurt their own business, and the lives of their customers.

What Makes A Service Dog ‘Real’?

“Service dogs help people live their lives more independently,” says Brianne Corbett, vice president of client services and dog operations at Freedom Service Dogs of America. “The handler and service dog are in tune with each other. And while most of us have a special bond with our pets, service dogs are more than pets.”

The Americans with Disabilities Act (ADA) defines service animals as dogs individually trained to do work or perform tasks for a person with a disability. Service dogs provide a range of duties–from turning lights on and off, retrieving keys, keeping veterans with PTSD free from stress, and a host of other tasks. The ADA doesn’t call them pets.

“With PTSD, it’s hard to lift your head above your anxiety,” says Lon. “Gander keeps me calm. Like a person in a wheelchair, that person needs his chair to move about. I need Gander for the same reasons. He’s not my pet; he’s my service dog.”

“Like a person in a wheelchair, that person needs his chair to move about. I need Gander for the same reasons. He’s not my pet; he’s my service dog.”

While most pet owners have a tight bond with their pets, it’s different with service dogs. Carol Bryant, a dog blogger and publicist, travels everywhere with her dog Dexter. He doesn’t wear a service vest and she won’t go into places that don’t allow dogs. Plain and simple, she respects the rules and would never take Dexter where he isn’t welcome. That means dining in hotel rooms when she’s on the road in order to spend more time with her dog. If she goes to a meeting and can’t bring her dog, her partner willingly steps in to watch him.

The head of a shaggy service dog with white hair.

The sign of a true service dog like Gander, Hodge says, is he’s practically invisible.

Dogs With A Job To Do

People with service dogs don’t have that option. They need to be with their service dog all the time, and that’s the true sign of a real service dog. “It’s not a real service dog if you check into a hotel and leave the dog in the hotel room when you have dinner or go out somewhere,” Lon says.

When Lon brings Gander into a restaurant, most people have no idea he’s present. “He’s quiet and usually lies under the table,” he says. “He’s never approached anyone. That’s a sign of a service dog. Still, I can understand why some people don’t know the difference. It’s confusing.”

Shutting Down The Counterfeits

So, how can this be resolved? According to Lon, there’s a movement circulating to shut down phony registries. Anyone with an active credit card can go online and purchase bogus vests and ID cards stating you have a real service dog. Lon’s not in favor of shutting down these operations because, “where there’s an illegal will,” he says, “there’s a way; people will circumvent the law in an absence of true standards.”

Instead, Lon wants to see a national conference on standards, training, and registry that brings together hotels, restaurants, law enforcement, the ADA, dog trainers, service dog agencies, and people like him with a vested interest in a peaceful coexistence and accommodation.

“Our goal is to try and fix this with the least possible stress for everyone,” he says. “People just aren’t informed. When they listen to me and when they meet Gander, they get it.”

The number of service dogs is not accurately known, since there’s no real registry. Congress did a study in 1990 and found there were 43 million Americans with disabilities and approximately 387,000 service dogs across the U.S.

A service dog wearing a collar with a red bone around it, standing on a speckled carpet in front of a screen with the Walmart logo.

Lon and Gander speak to companies to educate them about why service dogs are important, and how to spot the fakes.

Roughly 20 veterans commit suicide each day nationally according to a report from the Department of Veterans Affairs. “Life profoundly changes for the better when veterans with PTSD and brain trauma injuries are paired with a service dog,” says Corbett.

Changing The System, One Dog At A Time

Gander continues to improve Lon’s life. He’s a rescue from a Colorado kill animal shelter who took part in a prison dog training program and received additional training from Freedom Service Dogs in Englewood, CO. He’s been with Lon since 2012. Home is in Chicago; yet, they spend more than 50 percent of their time on the road addressing corporations, businesses, Rotary Clubs, veterinary colleges, universities, and bar associations about service dogs.

After listening to Lon and meeting Gander, Starbucks, McDonald’s, Walmart, and Vantage Hotels now welcome service dogs. Unfortunately, not all companies are receptive. After three separate incidences with American Airlines, Lon is now in a court battle with them. “Google American Airlines and veterans with service dogs and a few lawsuits pop up,” he says. “We call ahead and are told everything will be fine,” he says. “And then at check-in, they give us a hard time, asking for certification that doesn’t exist and threatening that Gander can’t fly with me. It triggers my anxiety. Even the Service Dog of the Year was banned from an American Airlines flight. ”

Lon wants people to think of him and Gander as a team. “People need to understand that Gander’s an extension of me,” he says. “I owe him an incredible debt of gratitude.”

“My wife, who’s a Chinese historian, says Gander was a ‘bodhisattva,’ which in Buddhist lore is a character that has reached enlightenment, but has decided to stay on earth to teach compassion and love. My wife says if I get reincarnated, I’ll come back as Gander’s servant because he does so much more for me than I think I can ever do for him.”

Mental Health Profiles

After Deadly Earthquake, Living With PTSD In Mexico City

On September 19th, a deadly 7.1 magnitude earthquake shook Mexico City, killing hundreds. Those who survived still live with the trauma.

“I remember everything around cracked,” says Mich Mariaud, 29-year-old language instructor and Mexico City native. On September 19, 2017, a 7.1 magnitude earthquake shook Mexico City to its core, damaging thousands of buildings and resulting in 228 deaths.

Weeks later, Mich reflects on the moment she felt the earthquake as she was exiting a mall in Roma Norte, a neighborhood in the heart of Mexico City that was hit the hardest. “The pavement cracked, the building cracked, everything cracked, and it was a horrible sound. It sounded like someone crumpling paper.”

With eerie coincidence, this earthquake occurred on the 32nd anniversary of the 1985 Mexico City earthquake that killed upwards of 10,000 people. 32 years ago, the damage was so severe that concrete figures on those who died still aren’t known.

Mich Mariaud has experienced symptoms of PTSD ever since the deadly September 19th earthquake in Mexico Citry.

Mich is one of the millions of Mexico City residents suffering from post-traumatic stress following the earthquake. PTSD can manifest itself in people who have experienced a shocking or dangerous event. The disorder can result in disturbing thoughts, night terrors, event, personality change, and an increase in the fight-or-flight response, causing those who suffer from PTSD to sometimes find themselves living in a perpetual state of anxiety and terror.

Natural disasters, such as the earthquake in Mexico City, often cause PTSD for the people that experience them. “These types of experiences are particularly insidious because they tend to traumatize large populations of people at once, and can result in epidemics of Survivor Guilt and other PTSD symptoms,” according to Psychology Today.

A survey from the John Hopkins Bloomberg School of Public Health shows that after the 1985 earthquake in Mexico City, there was a 32% prevalence of PTSD within 10 weeks after the earthquake. 

Mich remembers that less than an hour before the earthquake she was in a student’s 8th-floor apartment in the Condesa neighborhood of Mexico City. Later, this student told her that the apartment shook so violently that many things inside violently fell and smashed.

After hearing this, even months later, Mich had a hard time bringing herself to take the elevator to her student’s 8th-floor apartment in the heart of Mexico City, “even though I knew her apartment was fine, thinking about going up to the 8th-floor made me panic,” she remembers. This is an example of an “avoidance symptom”, a common trait of PTSD, whether it’s acute or chronic.

Months after the earthquake, destruction is still visible everywhere in Roma Norte. This building fell with victims inside.

The quake struck at 1:14 p.m., merely two hours after a practice alarm sounded. This alarm goes off every year on September 19th to remind residents of evacuation procedures put in place after the 1985 earthquake that killed about 10,000 people.

Ironically, for the actual quake, the alarm didn’t sound. But with the violent movement, millions of residents took to the streets in panic. Some ran from falling buildings covered in dust, others held onto each other while the ground shook beneath them. Mich was taking her lunch break in Roma Norte, one of the neighborhoods that was hit the hardest.

After barely staying on her feet, Mich ran to find her mother to on Avenida Reforma. Reforma, a major thoroughfare that runs diagonally across the heart of the city, was full of people. “The worst part was the smell of gas,” Mich remembers. The smell filled the street and caused panic, pockets of people began to run through the street yelling about gas leaks.

When she found her mom, they returned to their home in Ecatepec, about 16 miles away from the most affected areas. On the way home, seeing terrifying destruction along the way, they were terrified that their neighborhood may have also suffered intense damage. Had their home fallen? Were their neighbors safe? Luckily, the cracks in their building were superficial.

Despite this reassurance, the fear did not pass. Mich spent that night awake, fully clothed with her shoes on, waiting for aftershocks. “All that night I did not sleep. I wanted to sleep, but I couldn’t. I was terrified. I didn’t close the door and I kept everything clear in case.”

The next day, Mich did not want to leave her home. She sat watching the news, too afraid to go back into the city. She, as did many other people, listened to the radio where officials asked residents not to get in the way of professional rescuers trying to save people possibly alive under the rubble of collapsed buildings.

Flowers decorate the fence surrounding one of the fallen buildings in Roma Norte, in memoriam of the people who died inside.

“It was tough for everyone to process the situation. I know that we can die at any time, but that experience made me realize that it is true.”

Information came in about the death toll. Talk of the bodies found in the rubble really shook Mich. “This new information made me feel a different kind of fear. The day of the earthquake I felt the fear of the experience, but the following days I felt the fear of seeing how it happened, of seeing how many people had lost everything.”

In the days after the earthquake, the city came to life with emergency response from professionals and citizens alike. Community parks around the neighborhoods of Roma and Condesa, where the brunt of the destruction occurred, were filled with medical professionals, including free therapy made available to local residents who were suffering from similar symptoms as Mich.

“The constant anxiety stayed with me for three weeks,” Mich remembers. Having flashbacks of the moment the quake happened, the avoidance of certain areas of the city, and the fear of recurrence are all common symptoms of PTSD, and all things Mich experienced in the weeks and months after September 19.

To fight anxiety she continually faced, she started to embroider. “Doing something with my hands helps my anxiety,” she says. “My anxiety has dropped. It has not disappeared, but I can handle it.”

Though she is feeling a bit better, there are still moments of worry: checking for cracks in the buildings she enters, walking on the other side of the street when she sees an abandoned building, being alert at any siren she might hear.

Many others are still suffering post-earthquake stress and anxiety attacks. It is still the first thing that you hear people asking each other at the supermarket, “where were you during the earthquake?” or, “is your family and home ok?” For many, they are not. With up to 4,000 buildings damaged, many families have been displaced and the city will be dealing with structurally damaged buildings for months to come.

A popular clothing store in Roma Norte that was destroyed during the earthquake.

Almost as an afterthought, Mich reflects on her work and how she was personally affected by the destruction.

Typically, she does one-on-one tutoring lessons in the homes of her students. Trying to grow her blossoming business, she decided earlier this year to start a language school with one of her colleagues in order to reach more people and provide group lessons. Prior to the earthquake, she found a co-working space to open her language school. However, “The earthquake happened in the middle of our school’s opening. Before the earthquake, more foreigners were looking for activities, but after, the numbers reduced because people felt not very sure that buildings were safe.”

The school is in one of the neighborhoods that was most affected by the quake. And even though their building was unharmed, confirmed by officials checking building security post-earthquake, many are still deterred from being active in these neighborhoods and the local economy is slow to rebuild.

And while Mich’s post-traumatic anxiety is easing, she understands that time and focused mental remedies haven’t been as helpful for some of her fellow “chilangos” (slang for Mexico City residents). She says to move forward, the people of Mexico City need to “continue with the normality of your life and not let fear dominate what you do.”

The era of constant news and information creates difficulties in moving forward. And research shows us that survivors of natural disasters are much more likely to be affected by lifetime anxiety disorders.

As Mich mentioned, hearing the news changed the type of fear she experienced. “There came a time when I had to disconnect. I wanted to keep listening to the news and I keep seeing what was happening, but I realized that it made me feel damaged.” Self-care for her, in a way, was formed through turning off the TV, the radio, and walking through her work neighborhoods, confronting the destruction by continuing her life and her work.

Mental Health Q&As

The Neurologist Poet Who Helps Heal Combat Vets

"Physical and emotional pain defy language, defeat it," says Dawn McGuire. Her work helps vets suffering from brain injury and PTSD fight back.

As veterans have returned from two major post-9/11 conflicts in Iraq and Afghanistan, neurologist and researcher Dr. Dawn McGuire has cared for them. She has also long studied the types of traumatic injuries, including brain trauma, most commonly associated with combat veterans, and the impact of those chronic conditions on their acclimation back into everyday life.

Dawn McGuire.

In addition to her work as a researcher and physician, McGuire is also an award-winning poet who draws inspiration from her clinical studies and her patients. Her work emerges from a rich if relatively recent tradition of narrative medicine, in which physicians and caretakers learn and practice the inextricable links between caring for the sick or injured, and telling stories about health, illness, and wellness.

In her latest collection, American Dream with Exit Wound, published in early 2017 by independent publisher IF SF in San Francisco, she explores themes of hazardous materials and bodies as battlegrounds for soldiers returning home, and how, for returning vets, every day can continue to be war. “I use my poems as an act of imagination, to help myself cross the gap into their lives, to be of real use,” McGuire says of how she uses writing to further access the emotions necessary to her work as a clinician.

Her previous collection, The Aphasia Café, which was also published by IF SF and won the 2013 Next Generation Indie Book Award for poetry, similarly explored issues of self-identity, shame and redemption. Celebrated for her work rendering post-combat healing as poetic verse, McGuire will be reading from American Dream with Exit Wound at the 2017 Los Angeles Times Festival of Books in April.

She shared more about her work—her caregiving, as well as her writing—with Folks.

How did you come to work with veterans returning from Iraq and Afghanistan?

I’m a neurologist and researcher. I first started to see vets in my early training at the University of California, San Francisco, at the San Francisco Veterans Administration hospital. After 9/11, I became involved in traumatic brain injury (TBI) research and began to see vets who were referred to my free clinic for complex neurological problems—typically brain injury with post traumatic stress disorder (PTSD) and often addiction. They needed more attention than was possible in the medicine-as-business model. I support myself with research, so I have the blessing of being able to practice medicine without insurer [and other related] constraints.

What do you think those who don’t know veterans personally or aren’t personally impacted by these wars misunderstand about the servicemen and –women returning from battles overseas?

It’s easy to misunderstand silent suffering. Who really lives in their world once they return? Their squads are scattered, and they are expected to assimilate immediately back into a culture for which they have sacrificed more than their bodies.

It’s easy to misunderstand silent suffering. Who really lives in their world once they return?

They also sacrificed, in many instances, the core values and principles they were raised with. They may have committed acts that would be moral atrocities in a civilian context. There is little or no appreciation of the psychic splits that occur because of this, the disintegration of the sense of self. There needs to be, as a given, counseling, training, and ritual—as there was in boot camp to create the warrior mentality. There needs to be a boot camp for their restoration and re-creation, run by healers.  

There’s such a rich tradition of medical professionals and healthcare workers—everyone from Walt Whitman to Atul Gawande—writing about their work, their patients, and their perspectives on health, healing, and wellness. Who has inspired your work, and in what ways?

The cover to McGuire’s latest poetry collection, American Dream With Exit Wound.

I went to medical school at Columbia University, the birthplace of narrative medicine (albeit a decade after I graduated). But of course, the atmosphere that enabled Dr. Rita Charon to found the first program in narrative medicine was already in place when I was there. Personal involvement, and striving to empower compassionate care, were rewarded.

The program at Columbia, founded in 2000, states: “The care of the sick unfolds in stories. The effective practice of healthcare requires the ability to recognize, absorb, interpret, and act on the stories and plights of others.”  

The other visionary of narrative medicine is Dr. Rachel Remen, at UCSF, where I trained in neurology after Columbia. So it has been the validation of my practice, against the grain of medicine-as-business, that has inspired and empowered me.

Is there a specific poem in American Dream with Exit Wound that has an especially evocative backstory?

About a third of the collection has to do with vets, addiction, or both. I don’t have any identifying details in my poems to protect patients whose backstories may have gotten me writing. The most powerful, to me, is the title poem, in which the iconic ancient warrior Achilles is a junkie. His hyper vigilant lover is looking for signs that he is using, as any addict’s loved ones tend, painfully, to do.

In your last poetry collection, The Aphasia Café, you wrote about a different sort of symptom set and how that condition manifests in the mind and body. How did writing about war wounds and PTSD differ, but also, how do you see the two as similar?

The Aphasia Café had many poems concerned with the breakdown of language as a symbol system, after stroke, for example. American Dream with Exit Wound deals with another kind of language disruption. Physical and emotional pain defy language, defeat it. The vets I see speak in monotones and monosyllables. Besides medical treatment for their neurological problems, I try to make a space in which their stories, in their multiple dimensions, can be conveyed and, in the best outcome, their sense of agency restored.  It takes time and trust.

It’s in the literature of vets themselves, their own stories, that I believe there is the greatest hope.

What gives you hope when caring for this generation of veterans? In the same vein, how do you view the role of literature in providing hope?

It’s in the literature of vets themselves, their own stories, that I believe there is the greatest hope. Narrative is strong medicine for these complex and marginalized soldiers. It can break into silence, [what I call] their solitary confinement. It can make real connection imaginable again.

Buy a copy of  American Dream With Exit Wound here.

Mental Health Q&As

Madness, Medication, And Music

Abused as a child, acclaimed concert pianist James Rhodes combats PTSD with Mozart and Bach.

When he was seven years old, James Rhodes heard classical music for the first time: A live recording of Johann Sebastian Bach’s Chaconne for solo violin in D minor, playing from a beat-up Sony cassette machine in his London home. Rhodes, now an acclaimed concert pianist, believes he would’ve met an early death by suicide or drugs had he not heard that funereal Chaconne as a boy. His first encounter with Bach “felt like being freezing cold and climbing into an ultra-warm and hypnotically comfortable duvet with one of those £3,000 NASA-designed mattresses underneath me,” Rhodes writes in Instrumental: A Memoir of Madness, Medication, and Music. “I had never, ever experienced anything like it before…. Music has, quite literally, saved my life.”

Rhodes’ autobiography frankly discusses the years of trauma that followed his childhood abuse.

Between the ages of five and ten, Rhodes was repeatedly raped by a gym teacher named Peter Lee at his posh London prep school. Bullied into silence by his rapist, Rhodes was thirty when he first spoke of this brutal ongoing trauma—which, by that point, had led to “multiple surgeries, scars (inside and out), tics, OCD, depression, suicidal ideation, vigorous self-harm, alcoholism, drug addiction, the most fucked-up of sexual hang-ups, sexuality confusion, paranoia, compulsive lying, eating disorders, PTSD, [Dissociative Identity Disorder], and on and on,” Rhodes writes. “Child rape is the Everest of trauma.” Polite euphemisms like “abuse” and “molestation” don’t cut it, he says: “Let’s call this what it is.” After Rhodes went public with his story, police tracked down Lee, who was working in Britain a boxing coach for boys; Lee died of a heart attack before he could stand trial.

Far more than psychiatric medications and stints in mental hospitals, classical music sustained Rhodes through his darkest hours. After transferring to a new school at age ten, he began obsessively studying piano, worshipping composers like Prokofiev, Rachmaninov, Schubert, and Ravel. In 2009, he released his first live album, Razor Blades, Little Pills and Big Pianos. Defying the stuffy conventions of classical music culture—he proudly wears his tattoos and Chuck Taylors on stage—the largely self-taught pianist has helped make the compositions of dead men in powdered wigs accessible to contemporary audiences.  

Told in frankprose, Instrumental is a harrowing testament to the resilience of the human spirit and the redemptive powers of art. It’s also a call to end the culture of silence surrounding sexual abuse. The suppression of Rhodes’ story continued when his ex-wife took him to court in attempt to prevent the publication of Instrumental, arguing that its discussion of rape and mental illness would psychologically damage their son. In 2015, the U.K.’s Supreme Court overturned the ban on the publication of Rhodes’ memoir; a judge argued, in part, that the book could help survivors of sexual abuse.

We spoke to Rhodes about how to listen to survivors of sexual abuse; how mentally ill artists create in spite of, not because of, their mental illness; and which classical compositions might provide momentary relief from today’s politically-induced anxieties.


Your book is about music as salvation. How did music keep you alive?

It showed me that there was something beautiful in the world that, at the time, seemed only hostile and ugly. It provided, continues to provide, proof of something good.

In Instrumental, you write that “Shame is the legacy of all abuse…. I am many things. I am a musician, a man, a father, an asshole, a liar and a fraud. But yes, most of all I am ashamed. And perhaps there is a chance that I am those negative things as a result of being ashamed. That if I can accept, befriend, diffuse that feeling of blame, fault, badness, evil that is inside me, the defects and beliefs that seem to keep the world operating against me will fall away.” How has publicly discussing your abuse shifted your experience of shame, if at all? Has it helped you “accept, befriend, diffuse” feelings of shame?

No. If anything it has increased the feelings of shame because it’s all out there and exposed. But I don’t think that’s a reason to not talk about these things. The more people talk about difficult subjects, the easier it will become for others to talk and the less stigma will be associated with those topics.

[Music] showed me that there was something beautiful in the world that, at the time, seemed only hostile and ugly.

“Composers and mental illness go hand in hand like Catholics and guilt, or America and obesity,” you write; your book offers many examples of genius composers who suffered from various mental illnesses. The contested correlation between creativity and mental illness has long been the subject of much romanticization, research, and debate. In your experience, how has mental illness impacted your creative process (and vice versa)? Do you think you’re an excellent pianist in spite of or, in part, because of your mental illness?

I don’t think I’m an excellent pianist period! But thank you. And I also think we are all quite mad, to a greater or lesser extent. People who create do so despite any mental illness not because of it. They (we) do it because at 4 in the morning when you want to throw yourself out of the window because you’ve had too much to think, you can sit at a piano or a computer or a canvas and find a way through, a distraction, a way to disappear safely.

Your experience at a psychiatric hospital in Britain—which involved being force-fed medications—was like something out of One Flew Over the Cuckoo’s Nest. The laundry list of diagnoses you received within days included “bipolar disorder, acute PTSD, autism, Tourette’s, clinical depression, suicidal ideation, anorexia, DID, borderline personality disorder.” Did any of these diagnoses help you better understand and manage your suffering at the time, and do you find any of these diagnoses helpful now?

No. You can see 10 different psychiatrists and get 10 different diagnoses and multiple different meds. It’s such an inexact science. And we understand so little about the mind. I just accept that I’m not quite ‘right’ in the head and get on with it.

Through his life, James Rhodes has turned to music to help cope with the haunting repercussions of childhood trauma.

The first family friend you told about your abuse responded by saying “Well, James, you were the most beautiful child”—probably one of the least helpful things you could say in that situation. Others have callously suggested that you are “only talking about the abuse that happened as a means of selling albums or getting sympathy.” What are other common wrong ways to respond to stories of sexual abuse? What are some things people have said or done that you have found particularly helpful and healing?

The most helpful things in my experience are belief, empathy, compassion and, most of all, having someone listen. I think perhaps we’ve forgotten how to listen, how to shut up. So often we are speaking to someone and just know they are reloading as we are talking, waiting to spew words at you. Listen, be still and don’t shy away from uncomfortable subjects.

The most helpful things in my experience are belief, empathy, compassion and, most of all, having someone listen.

When a judge ruled to allow you to publish your memoir and communicate publicly about your traumas, he argued that the book could help other victims of abuse. How have rape survivors responded to Instrumental? What are some examples of people who’ve been helped by reading your story?

There’s been an overwhelmingly positive response. Thousands of messages from people who have gone through similar things or those who have loved ones (nieces, nephews, children, exes, etc.) who they now understand a little better. It’s been an astonishing, humbling, amazing response. And reinforces why it’s so important to speak out and also why the UK’s Supreme Court made the right decision in overturning the ban.

What composers are you listening to most so far in 2017?

I’ve listened to a metric ton of Mozart recently. Teodor Currentzis conducting Don Giovanni and Figaro mainly. He’s one of the greatest living musicians in my opinion.

What pieces of music would you prescribe for momentary relief from today’s rampant politically-induced anxiety?

Music isn’t going to fix the Trump disaster, any more than it’ll fix Brexit or mental illness. But it does make things a little bit shinier and it does provide solace and a sense that there is something better in this world than the insanity on display right now. Bach’s keyboard concertos played by Glenn Gould, Rachmaninov’s 2nd piano concerto or any of the pieces on the Instrumental Spotify playlist can only help.