’tis the season to discuss mental health

I used to refer to my therapist as my ‘paid friend,’ but let’s tell it like it really is.

For a number of people, depression and anxiety go hand in hand. For me, the height of my anxiety was during college. At the time, I couldn’t imagine attending a social function without being significantly intoxicated upon arrival. It was tradition that we’d buy a handle of vodka and rip shots before going to bars or social events, many of which I don’t remember because of the level of inebriation I reached in order to bring myself to attend. I feel a certain level of shame reflecting back, but I’ve since learned to better manage my social anxiety. It was college, and I was so caught up in having fun and fitting in that I was unable to recognize the intentions behind my actions.

I wasn’t keen to my depression until later in my twenties. I first went to therapy in 2014 following the death of my Pop-pop and the end of a year-long romantic relationship. As someone who’s always enjoyed navel-gazing & self-help books, I absolutely fell in love with therapy. I was its biggest fan and advocate, telling my friends, ‘I don’t understand how everyone doesn’t have a therapist?!’ I should have needlepointed it onto a pillow at the time.

I saw therapy as something I opted into, a self-indulgent luxury. (The real luxury was an affordable $25 copay while on my parents insurance, but upon turning 26 all good things must come to an end).** Finding a therapist with whom you vibe is more difficult than finding someone to date through the holidays. It took me a number of tries, until I found someone who I felt understood and challenged me. At the time I was both unhappy in my job and training for the NYC marathon (not mutually exclusive!) It was my first marathon, so I was adamant about sticking to my training plan especially when it came to weekend long-runs. By the end of that summer I was completing 18 mile-runs on Saturday mornings, all before noon. But come Monday, I would drag myself into the office. I’d get off the train at Canal Street and struggle to get up the stairs. I felt heavy and overwhelmed, physically drained, and out of breath climbing two flights of stairs. It didn’t makes sense. How had I run double digit miles over the weekend but two days later was fighting to muster the energy to exit the station? In time, I mentioned this to my therapist. It was after I’d completed the marathon, and I had a friend in town. I remember, because when my therapist asked if I would consider taking an anti-depressant I was outraged. I went home and both my friend and I corroborated how I was visibly absolutely not depressed.

The marathon was in November, in December I found a new job, and by January I’d broken up with my therapist. Come February I realized a new job was a very temporary bandaid to my dissatisfaction, and I was back to feeling heavy and burdened. One afternoon with the office heat on high, I could barely keep my eyes open. I took myself for a walk, but even the crisp NY air couldn’t break me free of my brain fog. When I got back to my desk, I googled ‘brain fog.’ WebMD told me to visit an ER immediately (classic), but another source named sugar as the culprit. Soon thereafter I spent a weekend with friends at Mardi Gras. I remember waiting for my flight and having the most ridiculous internal mental battle: to buy or not to buy the overpriced chocolate muffin at JFK. I called Nanni for support, resisted the muffin, and vowed that after my weekend away I would slay the sugar dragon. By the time I returned from my trip, I’d fully committed to making some changes with the hope of feeling better. I stopped drinking alcohol, started monitoring my sugar intake (literally everything has sugar — damn you, sugar dragon), started meditating, and when my phone was stolen in New Orleans I didn’t replace it for two months. (This was the start of when big cell carriers stopped selling $200 phones with a 2-year contract, and it took me a while to adjust to the idea of spending a small fortune on replacing an iPhone). Taking an active role in my health and tweaking my lifestyle worked for me at the time — I started to feel better.

Then came 2017 with my new adventure in all its glory. I was fulfilling a longterm goal of mine, joining the Peace Corps. Last night, I was searching my inbox and found an old email from 2010 when I’d first attended an information session — and there the seed was planted. I still have moments every once in a while where I stop, look around, and think to myself — ‘Oh shit, I’m in South Africa.’

I was here. I was doing the damn thing, but I wasn’t happy. I kept reflecting on the fact that I had a great supervisor, a well-functioning org, easy access to my shopping town, a comfortable living situation. I had a rooted feeling that this was where I was supposed to be. The stars seemed to align, so why didn’t I feel joy?

After a while at site, I started feeling overwhelmed. I’d wake up in the morning and could see the pile of dirty dishes from my bed. I’d lie and stare at them. ‘I should wash the dishes,’ I thought. ‘Okay, it’s time — get up and wash the dishes. Heat the water; then clean them.’ All this internal dialogue, but I hadn’t moved. It seemed easy in my head, but my body disagreed. The internal self-critic certainly didn’t help. I also began to notice unhealthy patterns in my eating and the vast range of emotion I’d vacillate between in a short period of time. It was a roller coaster. I would get up and go into town to my org. I would show up for meetings and attend community functions, but other than scheduled events I was spending a majority of my time in bed. Service is challenging, and what I was experiencing wasn’t uncommon. However, I knew deep down that there was more depth behind how I was feeling.

One afternoon I was lying in bed thinking to myself, ‘I should go for a run. Do it. Just get up, put on your shoes, and go. Go!’ But there I was, still horizontal. I felt particularly hopeless, thinking, ‘I don’t want to feel this way anymore.’ So, I did the logical thing and once again consulted my go-to medical professional, Google. There’s a lot out there on the worldwide web (at least for now… #netneutrality), but I eventually came across this article. I recognized myself in the symptoms and behaviors outlined. The words, written so accurately, portrayed exactly how I was feeling — I cried.

Recognizing that therapy wasn’t necessarily a want but more of a need was difficult. It made me uncomfortable. For whatever reason, it changed things for me. Having considered myself an advocate for mental hygiene and the destigmatization of mental illness, I felt like a hypocrite. It was easy to advocate on others’ behalves, but when it was me I felt differently. Stigma is powerful. It’s a large barrier to why people don’t get tested for HIV and adhere to treatment here in South Africa. In deconstructing my own emotional reaction, I discovered a newfound empathy in better understanding personal challenges when it comes to health, stigma, and accepting our own truths.

As a rule, I avoid medication.

Headache? Drink water and take a nap.

Hangover? Eat pad Thai, use a nuun tablet, and take a nap.

Stomach ache? Suffer in silence and resign myself to a bathroom (or bucket).

My previous associations with antidepressants had always been negative — they were overprescribed, could turn you into a zombie, and didn’t accurately or efficiently target the necessary areas of your brain. Peace Corps’ Medical Office was patient and supportive throughout the process of my seeking care. After careful consideration, consulting with PCMO and a therapist, I learned about the metaphorical ‘brain factory’ and how anti-depressants work; that antidepressants and a holistic approach to health are not mutually exclusive; and that with modern advancements in medicine anti-depressants are now extremely targeted in their effects. I also came to terms with the fact that I needed help; that this wasn’t something I could tackle on my own. I made the decision to start anti-depressants.

I suffer from low-grade depression, also known as dysthymia. Depression can be clinical (hereditary, biological), situational, or a combination of both. Being adopted, I’m not aware of my biological family medical history. However, in my experience my depression has been triggered situationally, by my environment — my grandfather dying, my relationship ending, a significant change in environment compounded by the isolation and hardships of service. Anti-depressants worked for me and helped me through what would have been an otherwise very long and painful adjustment. I’ve been feeling better, so I recently lowered my dosage before weening myself off of medication completely for the time being. I’m not hopping out of bed at 5am and running five miles everyday, but I am able to better manage my ups and downs and the challenges that come along with service. I’ve also eliminated animal products from my diet,* spare the occasional ice cream or cheese (ugh, I miss you cheese). There’s various research on the connection between gut and mental health, and so far it’s working for me. I feel better, less sluggish, cleaner, and all around healthier.

*Habit change inspired by What the Health.

I’ve mentioned my holistic approach to health, taking action, adjusting my habits in order to change how I feel. I recognize that this is not an option for everyone. According to the World Health Organization, depression is the leading cause of disability around the world. Depression can be absolutely debilitating and is one of many mental health ailments; all of which affect different people in various ways.

I’ve wanted to share some thoughts on mental health for a while now and was recently inspired after reading posts and articles others have shared, specifically related to our mental and emotional health during the holidays. A fellow PCV wrote about the pain of feeling isolated during this time of year and how the season is filled with ‘joy and obligation’ among other various, complicated emotions. Time recently covered Katie Couric and the 19 Christmases she’s spent since her husband died. A former colleague and friend wrote a Facebook post about how as she was thinking of her grandfather, a cardinal came and landed outside her window and gave her a sense of peace. And more recently this TED article discusses how to connect with those struggling with depression during the holidays. “Depression doesn’t diminish a person’s desire to connect with other people, just their ability.”

This time of year we’re inundated with messages of joy and love and happiness; not to mention consumerism, ugly sweaters, white elephants, and the idea that an old man who sustains life on a diet of cookies and milk watches you while you sleep at night. From Thanksgiving until the New Year we’re presented with opportunities (or obligations depending on your POV) to be in the presence of family and friends; to socialize; to attend events from office parties to the holidays themselves. Brené Brown tells us that we need to dare greatly, to show up as our true authentic selves in order to find real meaningful connection — but how when our mood doesn’t match the theme of the occasion?

During a time of year that’s focused on community and gathering, it can be tempting to isolate when we aren’t in the holiday spirit, lest we risk feeling alone in a room full of people. In her latest book, Brown warns against isolation, “unchecked loneliness fuels continued loneliness by keeping us afraid to reach out.” Our brain works against us, tricking us into maintaining isolation when that’s the opposite of what we need. Instead, Brown argues that community and connection are anecdotes for loneliness, even when we feel we’re not well-suited for company. Whether coping with grief or mental health, it’s best not to go it alone.

In South Africa, funerals are true communal affairs. Everyone attends regardless of how well you knew (or didn’t know) the deceased. Since our communities are disproportionately affected by the HIV epidemic, funerals are all too common. Just today, the Gogo next door told me she attended a funeral; one PCV voice noted me on her way back from a funeral this morning; and another went to sit with a woman this afternoon who just lost her daughter. Brown writes, “Funerals matter. Showing up to them matters. And funerals matter not just to the people grieving, but to everyone who is there. The collective pain (and sometimes joy) we experience when gathering in any way to celebrate the end of a life is perhaps one of the most powerful experiences of inextricable connection. Death, loss, and grief are the great equalizers.” There’s a definite ‘collective pain’ that expresses itself through mourning in South Africa. The friend and fellow PCV who visited the mother mourning the loss of her child mentioned how she was direct in discussing the events that led to her daughter’s death and explicit in expressing her grief. She commented how this was in direct opposition to how we dance around death in the States. This got me thinking — how do we as Americans mourn and grieve? After the formality of a funeral, often times — in private, alone, or sometimes not at all.

Collectively, 2017 was a difficult year; the social political state of our nation is divisive to say the least. Have you grieved? Have you mourned your own loss and the loss of others with whom you empathize? Loss caused by natural disaster in Puerto Rico, Texas, Florida, California; death and suffering caused by the shooting in Vegas and the blatant display of hate and racism in Charlottesville; the pain of the women who have come forward with courage and vulnerability to say #metoo; marginalized communities that have been disproportionately affected by the uncertainty and changes brought on by a new administration; your own personal failures and losses; and the list goes on. Did you even realize how much there is to mourn, no matter where you fall on the political spectrum? Maybe not — we like to distract ourselves, because grieving is painful.

I grew up in a family where crying was frowned upon. I remember being upset, crying, getting scolded for crying (which caused an opposite reaction than the one intended), and then crying some more. When I first got to South Africa my emotions were stifled, but I think all those years of fighting back tears have caught up with me. I recently welled up at a tweet about a cat being rescued from the California fires, and I’m not even a cat person. I met a woman traveling once who told me that with each tear we’re releasing pain and emotion. Honestly, I love crying; almost as much as I love therapy. Both are extremely cathartic. On occasion if I tell someone I cried, they tend to reflexively say ‘sorry.’ I do the same, but in reality — crying is good. If you’re struggling in that department, these may help:

The holidays are a time of joy, but we have to open ourselves up to grief and sadness in order to embrace and experience the full spectrum of emotion. We can’t have one without the other, and when we try and suppress our sadness it simultaneously prevents us from feeling joy.

Nanni always says it’s the calm after the storm that’s the hardest: the month following a loved one’s death when the funeral planning and commotion have stilled, and you’re left to sit alone in your grief. For some, the period after the holidays is the challenge, not the holidays themselves. Having been surrounded by company since November, only to return to isolation in the new year can be jarring. OptionB is a great resource if you yourself or a loved one is struggling this holiday season. During the next few weeks, I am reminding myself that for some it’s not the most wonderful time of the year, reaching out to those who I know are struggling, and offering grace and understanding to myself and others.

I’ll leave you with the poem Masks by Shel Silverstein. It’s one of my favorites and a reminder to be ourselves. When I was teaching in Thailand, I had my students recite it to me as a graded assignment — music to my ears:

**An added note on therapy: The perceived financial cost of therapy can be a deterrent for those seeking professional help; however, mental health care providers will often have payment options on a sliding scale making care more affordable. Remote therapy is another option to consider that provides added flexibility. If you are a university student, there are often free or low-cost services at your university’s health center.

I am NOT a trained medical or mental health professional. If you are struggling with your mental health, please seek professional care.

The content of this post is mine alone and does not necessarily reflect the views of the U.S. Government, the Peace Corps, or the South African Government.