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Mental Health Care and the Black American Reality

By Robby Seabrook III

The following is an opinion-research piece written and conducted by the author, with his thoughts and reflections. 

Being black is difficult. From microaggressions to racist housing policies to underfunded black neighborhoods, the stress of being a black person can take its toll. Even getting assistance with mental strife is difficult for us.

As of 2007, there are 40.1 million black people in the United States. 7.5 million of them have a mental illness. Black women are more likely to be diagnosed with depression, on average, compared to black men. Roughly, one quarter of black people seek mental help.

It may be because of our past, riddled with slavery and other hardships, that we were expected to be “tough”; able to overcome any and everything thrown our way. There are also many, well-documented barriers between black people and access to psychological care, be it distance, lack of mental health professionals, lack of information, or many other reasons. Black people’s attitudes towards seeking help aren’t exactly pro-therapy, although younger African-Americans tend to be more open to that and other forms of mental health assistance. According to a University of Wisconsin-Madison study, middle-aged and older Black people are less psychologically open than their younger counterparts, which means they are less likely to share their issues and seek help. This has been the case for quite some time, but the change is happening within our youth.

For me, my suffering, and my first mental health challenge, began in 2014. I was finally working in the music/tech industry, my peers respected me, I had the attention of the women I wanted. Things weren’t half bad. Though I had some concerns as to where my career was going, and I was anxious that I might not ever be financially stable, I managed to live with those.

But in August, I arrived at work only to find out that I didn’t have a job anymoreeffective immediately. I knew that the company would eventually fold, but the company moving on without me so suddenly was jarring. I still wanted to write, but didn’t know how to make that happen. I was still dating, but once I settled down, l had more time to really think. I had no job, I was struggling to be hired anywhere else, and now I was trying to uphold a relationship with barely any money, and career goals that were just a wistful dream, in addition to feeling like a failure. In the fall and winter of 2014, I gave up on trying to hide my depression from my girlfriend, and I decided to tell her of my suffering. She rode with me.

Most of my time was spent alone in my room, sinking lower and lower by the day. I was barely going outside, wasn’t shavingit was bad. My mother, I believe,  wanted to send me to therapy, but I brushed it off. A lot of crying, a lot of outbursts, a lot of feelings of worthlessness that would not go away. I even had an anxiety attack, where the entire right side of my body went numb. I remember seeing my body convulsing in the mirror and thinking I was having a heart attack. I continued to oscillate between moments of frightening lows and rare highs. My girlfriend and I eventually broke up for reasons totally outside of my mental state; a betrayal of trust. When I decided to end it because I was so hurt over her lying to me, she told me that the real reason I was leaving her was because I couldn’t find a job and it was “messing with my head.” That hurtful comment and the listlessness of being newly single, trying to find a job while trying to find out who your friends truly are, was a lot for me. I honestly didn’t feel better until late 2015, where my picture got published in a print magazine and my writing got published online. I should have seen a mental health professional, but I didn’t. It wasn’t that I felt getting help was “weak” or anything of the sort; I was just deathly afraid of being medicated. I ended up taking online therapy in late 2016 because how anxious I was and how obsessive my thoughts were. A majority of my time in therapy circled back to one clear point: I needed to stay present and also had to set time aside for my own healing. The results lead to a much more thankful and mindful version of myself, with a clear understanding of what matters to me and what doesn’t. It was one of the best decisions I’ve ever made; it saved my life, my friendships, and my perspective.

I wasn’t totally alone, however. My friend since high school, “Carl”, (who is of Dominican descent), has had experiences with his own mental health. Diagnosed with anxiety disorder in our senior year of high school and depression, his condition spiked over time. I never knew how deep it went, but once we sat down and talked, I learned a lot more about my friend:

“I remember nights where I would stay up and think ‘I’m really not gonna play basketball,’ as crazy as that sounds. That’s what I really wanted to do with my life. So, senior year comes, I’m playing varsity basketball, I’m happy; then my body just started feeling weird. I was be gasping for air, little by little. Eventually I wake up one morning with a panic attack. So I go to the doctor, they give me a couple exams, sent me back home. When I get home my heart starts racing. I went to the doctor, and I think they said it was 170 BPM, so they thought I was on drugs. For about 3-4 days, I was like that.”

His anxiety diagnosis prevented him from participating during the rest of the basketball season. He was also diagnosed with mitral valve prolapse, a heart condition. His anxiety affected him more than his heart, yet he blamed his heart and other injuries because he didn’t want to be stigmatized:

“I never really told anybody, even to this day. When I tell people about my senior season, and they ask how it went, I always say it was an injury. I’ll blame an ankle or whatever, because unfortunately, I don’t want people to judge me in the sense of thinking of ‘Oh wow, he suffered from anxiety?’ It’s crazy, the more that I put it out there, the more I find out that so much people have suffered from it, especially minorities.”

His mental health became tougher to deal with later in life:

“In college, my worst bout with anxiety and depression happened when my cousin passed away. I was 18, he was 21, he was the first person I ever had close to me pass away. It’s like survivor’s guilt, why am I here, why didn’t I go, I’m not even happy on this earth, so it should’ve been me.”

Another friend of mine, “Pat”, detailed his mental health struggles to me:

“My father kidnapped me when I was a child. When I told him I wanted to go home, he beat me. I was always afraid of him. I always go back to that moment, that’s where that fear came from, because I was always afraid of that moment. I repressed it for so long.”


This harrowing experience from his childhood manifested into a mental health disorder, later in his life. He also recognized that another aspect of his upbringing has been affecting him:

“I think the peak of of seeing how bad mental issues could get, was when I was in college. I was nervous about this test and blacked out in class, fainted. I had to be taken to the hospital, I couldn’t take it anymore. My mother had to drive up to Richmond, from Norfolk. They diagnosed me there; I have panic disorder, and that’s when I found out about it. I do carry a lot of stuff with me, and it’s been going on since I was a kid. I used to worry about my mom, paying the bills. This is that stuff that kids aren’t supposed to worry about. I was 6 or 7 years old. I was afraid to ask my mom for stuff for Christmas, because I didn’t want us to be poor. I took her struggles, onto myself. I still do it ’til this day.”

Both of my friends sought outside help, with differing results. Pat told me about his experience with therapy first:

“When I first got diagnosed with panic disorder in college, I didn’t take any medicine for it. I was going through the situation in 2013. I got prescribed Paxil at that point. I am supposed to take this medicine every day. If I don’t take my pill, I’m constantly shaking, I have a problem with being in social situations where there are a lot of people. If I don’t take my medicine, it takes me a little while longer to unwind and go to sleep. It’s just something I have to take to live.”

He also expressed an honest assessment of his own self-care practices:

“My mother is telling me now that I need to see a group therapist, because there’s a lot of unresolved things that I haven’t dealt with. I think it’s more on me, it’s feeling like ‘What will people think of me, if I do this?’ It’s tough. I know I’m an ass. I need to go get myself checked, but I’m also doing a better job taking care of myself now. I wasn’t taking care of myself at all, and that’s why a lot of this happened. I don’t want to be labeled crazy, I don’t want people to see that side of me.”

Up next was “Carl,” sharing a mostly ineffective bout of therapy:

“I did go to therapy, in college, I did see a counselor for a couple days, and I just felt like the counselor couldn’t relate to what I was going through. I told him at one point, especially after my cousin had passed, he thought it was a little insane, every time i leave my house and I say bye to my mom, I know that could be the last day I come back, because of what’s happened to people around me, he thought that was a crazy way of living.”

Carl’s counselor was white, wasn’t from his neighborhood, and could not relate to his upbringing. It can be extremely difficult to open up to a mental health professional who is unlike you in nearly every way, and who doesn’t understand your day to day realities. Proper mental care hasn’t been available for blacks and people of color for that long; and less than 4 percent of members of both the American Psychiatric Association and the American Psychological Association are black. But why might that be? What really goes into that, why is this the reality of being black when seeking therapy? I asked Phil Inabinette, a mental health counselor in Norfolk, Virginia.

“When we (African-Americans) were going to school in the late 1800s, it wasn’t for STEM, it was just something we weren’t into because we weren’t really exposed to it. The first black psychiatrists and psychologists didn’t really pop up until the 50s and 60s, which isn’t that long ago. You had black theorists like Frederick Douglass, but he wasn’t a doctor, he really didn’t deal with human psychology. You didn’t really have a whole lot of people just getting into the field, and that’s become generational. That’s really never been something we’ve pushed our children into, and It’s because it’s not something that we recognize.”

Dr. Lisa Martin, a psychologist based in NYC, also lent some perspective on why the very idea of mental health hasn’t done enough for black people, and why they aren’t as involved in it.

“I think in some ways yes, the mental health industry are providing more culturally competent care and it’s focused more in our training, so even if they are going to clinicians who aren’t of color, they have someone who is more likely to be able to understand and really help. At the same time, I think that the history with the mental health industry and black people in this country is so powerful that, even generations later, people are still weary of it. And it makes a lot of sense why. “

“The accessibility of the treatment itself. How welcoming the spaces are, the times/spaces that are available, the waiting list for spaces. There are a lot of things about where mental health care is provided, that are either gonna be really gonna be welcoming or supportive to folks of color, or really not. One of the things that we look at, in this work, such as how we engage folks of color, in mental health clinics and in hospitals. There are many places along the way, stages of getting into treatment, that really can put people off. If you’re talking to someone and they are not very kind, and you’re already ambivalent about whether or not you want care, and the person isn’t very welcoming, that already is gonna make you not feel safe. Or if you go into the room with a counselor, and they feel uncomfortable with you, this is particularly a problem for men of color. There are aspects of the mental health industry, where mental health is criminalized. I think in some spaces, that can be felt, If you’re a black man and you walk into a space and feel that people are scared of you.”

Lisa also expanded on the lack of black and person-of-color (POC) mental health professionals, and why they tend to enter into social work:

“I think systemic racism in psychology is part of it. I hope to be a part of looking at what are the requirements to get into school. Right now, in order to get a PhD in Psychology, you need to have several years of research experience. And most of the research jobs don’t pay. And getting a research job often requires connections. Already, that leaves you out of the playing field. It’s already stacked against you, before even trying to think about it. So I think that’s why you see folks of color entering into social work, because they have been doing a lot of good anti-racist, culturally aware work.”

Inabinette also thinks that insufficient number of black mental health professionals has an even further effect that keeps blacks from seeking assistance:

“It’s a generational fear, that ties into the fact that there aren’t that many African-Americans in the field. there’s a fear of ridicule of labeling, of exposure.’I know something may be wrong with me, but how do I go to the person who doesn’t look like me, and may not be able to relate to me, and tell them my problems?’ So because there aren’t familiar faces in the community, or the field, it becomes much harder for African-Americans.”

There is also more to the story; it’s just not that simple to get mental health assistance as a black person. There are various roadblocks between them and mental help, be it ideological issues, difficulty of access, fear, etc. Inabinette added his perspective to this train of thought:

“It also ties into the cycle of poverty. A lot of minority communities don’t have insurance, and a lot of the ones who do don’t have good enough insurance to get mental health help. Socio-economically, in urban areas, mental illness is not funded, and that’s generally where minority populations are.”

Location also plays a part in getting mental health assistance:

“For example Brooklyn, [has] high concentrations of African-American communities, but they don’t have an equal representation/distribution of health/wellness, social services, human services, opportunities. Access becomes even more limited, when it already was due to lack of insurance and other issues. In example, if there are only 3 mental health clinics in my borough, what’s the likelihood that I’m gonna go to one of those? And they likely aren’t anywhere near your neighborhood.”

He also explained how society’s unfair and problematic views on mental illness affect those who need it most, especially in the case of black people and other minorities:

“Up until very recently, mental illness has always been a shunned type of thing, socially; that’s just throughout history. So when you apply that with race and minorities, of course it would be even more shunned because of that old adage that African-Americans have to work harder to be recognized and acknowledged, so those mental health troubles get pushed back, or argued against if you start to show some form of mental illness.”

The resiliency asked of and required from black people also plays into how we manage our health. Some may feel that seeking help is a sign of weakness and it shows:

“African-American families didn’t have access in the 30s-70s to healthcare, and when they did, it was limited to self treating/diagnosing. Those things changed in the 80s-2000s, so we are still easing into taking care of ourselves physically, and being aware of health issues. Mental health is a health issue, and a lot of those have to be medically treated, by a doctor, by a psychiatrist or a psych, and psychiatrists can write prescriptions, they are medical doctors on some levels.”

He also draws a historical connection between getting help as a black person now, and America’s treatment of black people:

“Historically, we’ll come out of slavery, directly into segregation/Jim Crow, mental health treatment doesn’t become a thing until the 1900s. African-Americans weren’t getting this treatment in the late 1800s, early 1900s, unless they were test subjects. because they didn’t have access to anything. What happens over generations, those things become suppressed. How we as a culture, suppress things is by telling you that you have to “fight through”. That ties into not having access, not having funds, trying to answer our own problems.” The answer becomes, you’re strong enough to get through this. So if you constantly get told this, you hold tight to it, across generations.”

As we all know, the experience of being a minority includes a lot of varied difficulties. It’s also clear that most don’t understand our hesitance to take that step, how difficult it can be to get help, or the inherent biases that affect us. The issues are generational, they are fueled by institutional racism; it’s tough. Regardless, more care should be taken towards the issues black people face with mental health assistance.

 

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11/21/2017: Brain Health News Roundup

Agency Confirms That Improper Wait Lists Were Used For Veterans’ Mental Health Care

Associated Press/Washington Post

Investigators with the VA Office of Inspector General confirmed a whistleblower’s claim that staff kept unauthorized lists instead of using the department’s official wait list system. That made it impossible to know if veterans who needed referrals for group therapy and other mental health care were getting timely assistance, according to the report.”

Push for Statewide Mental Health Screenings Gains Momentum

New Jersey Spotlight

A legislative proposal to effectively double the reach of New Jersey’s county-based mental-health screening system is one step closer to reality, an advance advocates hailed as necessary to help the state better address — and possibly reduce — a growing behavioral health crisis.

But the Democratic-sponsored measure, which would cost more than $10 million annually, still faces two significant hurdles: a final vote in the state Senate, which is scheduled to meet only a handful of times before the end of the legislative session, and the signature of Gov. Chris Christie, a Republican whose second term ends in mid-January.”

 

Universal Health Plans Big Psych Expansion in New Jersey

Philadelphia Inquirer

Universal Health Services Inc. was the big winner in New Jersey’s largest expansion of its inpatient psychiatric capacity in 20 years, securing the right to add 336 beds, 41 percent of the 811 approved by the state’s Department of Health. The King of Prussia company, which is the largest U.S. operator of behavioral health facilities and which has long been dogged by federal investigations of potential billing fraud, told the state it planned to open two new 120-bed facilities, in Passaic and Monmouth Counties. It also said it would expand hospitals in Burlington and Union Counties by 48 beds each.”

Allegheny County grapples with parents on opioids

Pittsburgh Post Gazette

When opioids hijack a parent, there’s no proven playbook for getting the family back on course. Caseworkers have to decide whether to take the kids away, and policymakers are now trying to provide other options, including novel ones like whole-family rehab.”

 

It’s Time We Talk About Police Suicide

The Marshall Project (from two weeks ago)

More officers die of suicide than die of shootings and traffic accidents combined. It’s a problem that cries out for answers and remedies, but too many departments are reluctant to admit it exists, much less implement programs to address it.

While a few of the known deaths are publicly attributed to depression or PTSD, the overwhelming majority are listed as having “unknown causes.” Stigma — the fear that it will reflect negatively on a department or result in liability claims by the family — appears to be a motivating factor behind such vague information.”

Untitled

BY ETHAR ELTIGANI HAMID

Before My Diagnosis

The last time I took a psychological assessment, I was thirteen. Now, ten years later, I’m completing another psychological test. Some of the examinations I’ve undergone so far in this process are a long questionnaire (“Do you feel that your self-esteem is high?” “Do you ever feel more talkative than usual?” are some of the questions I’ve been asked), an inkblot test, and a ‘make up a story by looking at these pictures’ exercise. The inkblot test was pretty fun (I saw some cool-looking sea creatures on one card, a dark ghost-like figure on another, and what appeared to be a water-color painted garden, or something, on another). I think it is the hype around inkblots that made the experience of taking an inkblot test enjoyable, for me. The exercise in which I had to make up stories by looking at a series of picture cards was kind of uncomfortable, though. It felt sorta like kindergarten, except a grown-up kind of kindergarten; one in which the answers you give during the play-time exercise will determine whether your mind is either sick, or very sick. So; a dark and twisted kindergarten, really.

Between my first psychological assessment (all those years ago) and today, I’ve dealt with a variety of symptoms: psychosis, mania, suicidal thoughts, anxiety, and depression. Bipolar type I and psychotic depression were my two major diagnoses, during this stretch of time. (The diagnoses were given at separate times, by two different psychiatrists.) And I’ve missed a total of about nine months of school, as a result of my mental illness symptoms.

From doing my own studies and research (online) into my past symptoms, I’ve concluded that this latest psychological evaluation that I’m undergoing will reveal a diagnosis of schizoaffective disorder. Or schizophrenia. Or something similar to either of those. To be honest, part of me wishes that schizoaffective disorder is the “worst” it will be.

Thanks to the current societal consensus (and my own self-esteem), I hope my diagnosis is not “schizophrenia.” “Schizoaffective disorder” has some cutesiness to it. It’s the “affective” part–the mood disorder part–that softens and glamorizes the disorder, to a certain small extent. I’m quite sure of this phenomenon. After all, everyone can relate to mood disruptions, hence the softer reception upon hearing ‘schizoaffective disorder’. And having a disruption or disorder with one’s mood draws up a certain, albeit irrational, admiration; S/he feels things deeply; she’s such a tortured soul, and etc. All in all, it is thanks to schizoaffective disorder being in large part a mood condition that pacifies and excites people, to a certain extent.

“Schizophrenia,” on the other hand, is such a damper. It’s such a full-blown monster of a disease, in many people’s eyes. As a result, no one really wants to hear it–no matter how much you’re hurting…no matter how much you want to be open about it.

Obviously, I don’t condone the fact that aspects of society have designated some disorders as acceptable—almost “cool”, and others as repugnant. (Like, with the mood disorder thing, again. I mean, bipolar these days is considered almost “in,” in certain scenarios. And depression, though painful and ugly in most respects, is sometimes portrayed as a cool character quirk, rather than a serious illness.) And I don’t condone the fact that some mental disorders are much more stigmatized than others. Yet, I fall for such dangerous beliefs and social constructs.
~
I am eager to find out what exactly has been plaguing me for the past 10 years, since my past diagnoses were apparently wrong, or faulty. So in that regard, I can’t wait for my diagnosis.

At the same time, I am kind of worried. What if it’s schizophrenia? What the heck will I say to people? What can I say? I don’t think we, as a species, have come up with a reasonable answer to that, yet.

~

After My Diagnosis

Last week, I received a new mental health diagnosis. My diagnosis used to be bipolar, and then, some years later, psychotic depression. Now, after having completed a lengthy psychological evaluation, I was told (and I read in my report) that “schizoaffective disorder, depressive type” is “most appropriate, at this time” (“this time” being February, 2017—eleven years into my mental health issues).

I’m satisfied with this diagnosis. I feel that it suits me much better than the former two. To be honest, I was expecting a diagnosis of “schizophrenia, paranoid type,” to a large degree. But hearing the words “schizoaffective disorder” creates a “this is just right” feeling, in me. And a significantly relief, as well.

Schizoaffective disorder is a mental disorder characterized by both schizophrenia symptoms and mood disorder symptoms. And from what I read online (through mayoclinic.org, nami.org, and other sites), the diagnosis is made when a patient shows symptoms of both conditions, but does not strictly meet the criteria for either one, alone. In my case, the “schizophrenia symptoms” are mainly paranoid delusions, and the “mood disorder symptom” is depression. (Others might have hallucinations and/or delusions as their “schizophrenia symptoms,” mixed with “bipolar mood symptoms,” in which case they might receive a diagnosis of “schizoaffective disorder, bipolar type.”)

I will be cautious with disclosing my new diagnosis to others. This is a choice I am consciously making. While I was under a bipolar diagnosis, I only told my closest friends (well, friend) about my condition. Even then, I only mentioned it twice, I think, for fear of alienating myself from her. While I was under a “psychotic depression” diagnosis, I didn’t really tell anyone. It was the “psychotic” part that I knew was really stigmatized in our societies. Sometime, I would even lie (half lie?) and say that I had depression—leaving out the “psychotic” part, because I knew it would change the way people look at me.

With this new diagnosis, I don’t think I will tell anyone. I know it’s much better-received than its sister condition, schizophrenia. But we’re a long way before the phrase “schizo-anything” is acceptable, or even tolerated.

Ethar E. Hamid is an aspiring writer and artist from Khartoum, Sudan, currently living in northern Virginia. She hopes to contribute to the worldwide discussions about mental health, black/POC experiences, Muslim experiences, and the experiences of other marginalized people, through her work.

 

a tuesday fifteen years ago

BY SAMANTHA PAIGE ROSEN

samantha

Seven months after the attacks, I found myself nauseated in the third row of our minivan, about to pass Ground Zero. Dad’s own obsession led us there, while in the city for Easter weekend.

“Don’t worry, it’ll just be dirt and trash and rubble,” he assured me and my two younger sisters.

Tall buildings surrounded an enormous hole filled with piles of dirt, concrete, and scraps of metal, sectioned off by plastic orange construction gates.

Then, much quieter, Dad said, “It’s like it was never even there.”

It was just rubble, but it terrified me. I was only 11, but I knew underneath were the obliterated bodies of those who jumped or fell from 1,100 feet above ground at 125 miles per hour, the scorched skin and exposed bone of those who burned, the bloodshot eyes of those who asphyxiated. I felt like I would get pulled into the heap if I got too close.

We lingered for a minute until Mom said, “Stu, that’s enough.”

On the way to our midtown hotel, the Omni Berkshire Place, Dad took a long route so we could see the streets of New York City. It was crowded compared to my hometown of Philadelphia, but less so than usual since the attacks—that’s how we could afford to stay at a hotel like the Omni Berkshire Place. People were afraid to visit. New York wasn’t safe anymore.

Looking out my window I said, “This is dirty.”

The steam rising from the manholes and the scattered trash on the sidewalks reminded me of the smoke and debris I had seen on TV and at Ground Zero a few minutes before.

My only other memory of New York City before this visit was a weekend my family spent in 1998, going to the Museum of Natural History, listening to a man play Don McLean’s “American Pie” by the swan boats in Central Park, and being dragged to Ellis Island to see how my great-grandmother came to America. That and the footage from September 11th.

 

***

 

Math has always been my least favorite subject. I never understood it. I asked my teachers why one step in an equation preceded or followed another. Why was it parentheses, exponent, multiplication, division, addition, subtraction (something I only still know because of the acronym: “Please Excuse My Dear Aunt Sally” and I actually have an Aunt Sally)?

“It just is,” they sighed. But I couldn’t memorize the steps if I didn’t understand them, and I couldn’t understand them until I knew why we were supposed to do them. I couldn’t understand anything—not fully—unless I figured out the why I believed should follow the how. I still can’t.

Perhaps my need to know why stems from my anxiety, which I’ve had for as long as I can remember. We live in a world in which a horrific tragedy can occur at any moment, without warning or reason. It is this constant uncertainty that feeds anxiety. Death, even from old age, has always disturbed me.

When I was four, my grandfather died.

Lying in my parents’ bed in the days following his death, watching the credits to The Wizard of Oz roll I asked my mom, “Why do people have to die?”

“Your body is a machine,” she explained for the first of many times. “Eventually the machine gets tired and doesn’t work well anymore. When your time is up, the machine turns off and you go to sleep. That’s all.”

She intended this response to be comforting, but it never was. I couldn’t accept this as a legitimate why. Death still seemed senseless.

On a Tuesday in September 2001, Mom kept me company while I got dressed for my afternoon dance class. Usually she was downstairs making dinner or cleaning up after my sisters, but today she spent time with me. Through the mirror, I watched her watch me put long, thick bobby pins in my hair. I asked her why people would hijack planes and fly them into buildings.

“The people who did this want us to be afraid,” she said. “But we have to keep on living, or else they control us and they win. We can’t let them win. We can’t live in fear.”

I couldn’t accept this either. I was already afraid.

 

***

 

As we pulled up to our hotel, my sister Liz saw someone check for explosives under our car with a metal detector before parking it in the hotel’s underground lot. I was too busy sobbing and hyperventilating to notice. I knew the city and the crowds were making me cry, we shouldn’t have driven by Ground Zero, and I was scared. But that was the extent of my analysis. I trailed my parents closely in the lobby, stifling my tears long enough to reach our suite. I kept my eyes on the floor. I didn’t want to see anyone, and I didn’t want anyone to look at me. Alone in our unit of five, I started crying again, clinging to my mom, and repeating how uncomfortable I was. Mom suggested I go watch TV. 4:30—wasn’t 7th Heaven on right about now? I turned the TV to The WB channel, but I couldn’t focus. I couldn’t relax.

An hour later, when my parents mentioned going out for dinner, I burst into hysterics and refused.

I paced around the room, shaking my head, repeating, “I can’t go, I just can’t. I’m too scared.”

I knew I was ruining our trip, but I couldn’t help it. I had to stay put. I didn’t feel safe on the streets of New York.

“What do you mean you can’t go?” Dad shouted. “It’s just dinner! We’re in New York for Christ’s sakes!”

Mom was concerned. She placed an emergency call to my psychiatrist, Dr. Reber, whom I had seen for anxiety and depression in elementary school and returned to around November. Dr. Reber told my parents to give in and stay at the hotel for the night. We ordered a pizza and I curled into a ball on my parents’ bed, while my sisters watched the Disney Channel in the adjoining room. I took a shower, but emerged the same girl I was before; I couldn’t wash off the fear. I was surprised by how fragile I was capable of feeling, and disturbed I couldn’t be comforted by my parents’ presence.

The next day, my family coaxed me out into the city. I don’t remember how. Perhaps a good night’s sleep had calmed me a little. Still, I felt disembodied as I walked into FAO Schwarz. Why was everything so oversized? A giant bear at the entrance, a giant piano, a giant moon face clock. Everything in New York was overwhelming. The buildings were too tall, the streets were too busy, the subways too claustrophobic. For the rest of the trip, I physically moved through the city, but my head was so clouded with fear I can’t remember anything we did. I didn’t feel safe again until I had been home for a few days. And this feeling didn’t last long.

 

***

 

My family seldom talked news or politics at the dinner table, a practice both of my parents learned from their parents. I knew we went to war in the Middle East, for example, but I didn’t know where or why or how until my senior year of high school, when I decided to teach myself about recent history and politics. But their decision not to discuss 9/11, I know, was a conscious one. This was an opportunity to protect what remained of our innocence. I’m still not sure whether knowing the details would have made me more or less afraid.

My dad watched the footage of the attacks over and over on TV. My mom says he had a sick interest in it. But he never let on to us kids. I don’t remember speaking at all with Dad about 9/11.

In a way, I had a sick interest in it, too. I already knew things that shouldn’t happen—horrible things—do happen. Like the plane that crashed into my local elementary school, killing two children and five pilots, including Senator John Heinz. I was only a year old at the time, but I read about the crash when I was eight, in a magazine retrospective that gave me nightmares for a month. 9/11 was this crash, heightened by thousands more deaths and malicious intentions. While it didn’t cause my anxiety, it expanded my growing list of reasons to be afraid of the world, further confirmed my right to have anxiety, and awakened my dormant fears. Now death and terror had a setting and a number—2,996 people—I couldn’t have imagined before 9/11.

In the months following the attacks, I became afraid of the dark again. I stopped singing in the shower. I looked over my shoulder whenever I walked home from school. I wouldn’t use an elevator, convinced I would get squished to death between the doors. Nor would I answer the phone or make a call. What if a terrorist posing as a pizza delivery guy was on the other end? What if a terrorist was tracing my phone? By the summer I was afraid of choking, and stopped eating most foods except cereal and peanut butter and jelly. I considered these safe foods.

Depending on the day, I might have been afraid to go outside. I imagined being hit by a car or getting kidnapped or struck by lightning. I convinced myself it was too dangerous to leave the house. Mom tried to explain that anything could happen at any time, even at home, so I shouldn’t be afraid of the outside world. She told me a story about a boy who was killed by a falling tree while playing in his backyard. Instead of taking her point—that it’s impossible to try to outsmart death—I stopped going in my backyard.

Shortly after 9/11, I saw a news story about an NYPD officer named John Perry. On the morning of the attacks, he was on his way out of his precinct after filing his retirement papers. He planned to start a new career as a medical malpractice lawyer, but ran to the scene when he heard about the first tower. Before entering the building, he helped a woman who fainted. The south tower collapsed with him in it.

For years, I ruminated over this story. How close this man came to making it through the physical danger he faced daily in his career. How close he was to enjoying retirement after years of hard work (at the time, I didn’t know he was moving on to a career in law). And he just died. The same day he retired. I understood his impulse to run to the scene to help, but I was—and remain—baffled by how cruel fate could be.

Officer Perry’s story gave me an idea for a kind of preventative game. At least once a day I asked myself, if our house went up in flames, who would I try to save first? I didn’t simply wonder; I put myself in the middle of the scene, imagining every detail. I would save Liz, the youngest and most helpless. I would run to wherever she was, tell her to grab onto my neck like a monkey and not let go, and we would jump out of the second-floor window together.

But how could I abandon Mom, Dad, and Jen left inside? How could I reach the fire department outside, without a phone? What if I had to raise Liz on my own after the rest of my family perished in the fire? What if it was winter and we had to wait outside for too long and froze to death? Would I rather freeze to death waiting outside or burn to death inside? Burn or freeze? Burn or freeze? I chose burn every time because I hate being cold. Now I know to choose freeze. At least I would die numb.

I became paralyzed even considering entering into a situation where I couldn’t control my own safety in the event of an emergency. Since there’s always a chance something could go wrong in any situation—a plane can come from anywhere and crash into anywhere, for example—I felt perpetually trapped and incapacitated. Every experience seemed to have a dark underbelly.

Dr. Reber and I spent sessions riding the elevator together up and down, out through the doors and back in again. We made phone calls to Dakota Pizza, Delancey Street Bagels, and our local Borders bookstore. It’s not that I thought anything specifically bad would result from calling people on the phone, but my anxiety was so out of hand that one fear spiraled into another. Fear of terrorists became fear of strangers became fear of answering the phone when a stranger called became fear of answering the phone when anyone called became fear of calling anyone on the phone. In the brain of someone with Generalized Anxiety Disorder, it all connects.

He also challenged me to reintroduce the foods I had deemed unsafe, since the antidote to anxiety is evidence. I began to see after several months I could ride the elevator, make a phone call, answer the phone, or eat a slice of pizza without a disastrous result. There’s always a 1 percent chance something catastrophic could happen, but most of the time, it doesn’t. It’s possible but not probable, as my third-grade teacher Mrs. van Hollander used to say. That was an equation I could understand. I gradually learned to dial the possibility down to background noise. Now I had choice phrases, relaxation techniques, and safe experiences to draw on when my what if voice grew too loud.

 

***

 

While I have never again experienced such a prolonged period of debilitating anxiety, my anxiety will never go away. At 26, I still work with a therapist on things I can say to remind myself to see reason in anxious moments. My mantras include (but are in no way limited to), “Don’t think so much,” “Don’t torture yourself,” “Don’t imagine the worst case scenario,” “Don’t try to protect yourself by worrying about things you can’t control,” “Don’t let emotions get in the way of priorities,” “One day at a time,” “Whatever is thrown your way, you can handle,” “You are resilient,” “Tolerate uncertainty until things become more certain,” “Thoughts aren’t facts. Observe them and let them go before having an emotional reaction,” “Accept the randomness of the world instead of trying to predict and control it,” and “You might be in a great place that’s also terrifying, and that’s okay.”

I’m still working on not looking over my shoulder at all times. I’m a young woman who is mostly alone and constantly on guard. I move places by myself—Pittsburgh, Washington, D.C., Los Angeles, New York (state, not city). The alone part isn’t necessarily by choice; it just seems to happen that way. No one waits up to make sure I get home safely. Each night, upon locking myself into my apartment, I’m in slight disbelief I actually did it. I actually kept myself out of harm’s way.

I can’t tell you how many times I’ve thought a swollen lymph node was a tumor. I read about someone with an illness, and I immediately see myself afflicted, no matter how rare. An exhaustive list of my phobias to date is as follows. Some I’ve gotten over, and some I never will: Dying; family dying; pets dying; any animals ever dying; movies where animals die and/or face obstacles and/or look like my cats; Alzheimer’s; cancer; aging; guns; any weapons; kidnapping; sexual assault; any kind of assault; house fires; stove burners; choking; eating (greater possibility for choking); elevators; telephones; trees; lightning; flying/airplanes; driving/cars/highways; public transportation, especially subway tracks (don’t you envision someone falling in front of a speeding train every time you wait for the subway?); vomiting; illness; reptiles; men; cities; high-rises; crowds; nightmares; scary movies; darkness; loud noises; walking alone; banks (greater potential for robbery, thus gun violence, thus death); extreme cold; mountaineering; germs; dogs (see: loud noises); cruise ships; the ocean.

A few of these fears continue to infiltrate my brain, although I’m better at recognizing and subduing them before they cycle into a tornado. Last night I was driving on the highway around midnight when a familiar thought plagued me. What if my car drifts into the guardrail or into another lane while a car is passing? What if another car drifts and hits me? In a few seconds, I could kill myself by making one tiny mistake. I could do it on purpose right now. I could do it by accident. For a second, I wondered how it would feel. I have a morbid curiosity, my sister says. Like my dad. And that’s where I stop the thoughts. Now I can stop the thoughts.

Occasionally I will hear someone say, looking in my direction, “…for those of us who are old enough to remember 9/11…”

The problem with this remark is I was old enough to see and remember the attacks and the aftermath. As a child watching what truly did seem like the end of the world, fear became built into my consciousness. Being so young meant I internalized the fear of a nation when my own identity was still forming. All the children who were around my age did. In this sense, we are our own generation, defined by fear.

I will never forget asking my mom, as I watched her watch me on the afternoon of the attacks, whether we were going to have World War III.

“I don’t know,” she replied. “I don’t think anyone knows.”

With this response, I understood I was growing up in a fundamentally unsafe world. We couldn’t play in our front yard unsupervised. For a while, we couldn’t open the mail. Unlike the adults of 2001, my country’s fear developed with me, in me. No matter where I go, no matter the context, there’s always a possibility for terror, in my mind. I saw it that day with my own 11-year-old eyes.

This piece has been updated. Here is a note from the author: 

I initially wrote “A Tuesday Fifteen Years Ago” during my first year of graduate school. The following year, when preparing to incorporate the piece into my thesis, I was counseled by an adviser to give the story a structure that supported what it was truly about: an inherently anxious child processing a catastrophic event, rather than a catastrophic event igniting a child’s anxiety. Now the essay is even more appropriate for BMM, with additional scenes to illustrate such an anxious mind. This essay has been– and perhaps always will be– a work in progress, much like myself. I knew BMM would appreciate this, and I’m grateful they allowed me to publish my revision.    

Samantha is a New York-based writer behind Samantha Paige Rosen Writing & Research. She contributes to The Washington Post, The Philadelphia Inquirer, The Week, and other publications. Samantha is earning her MFA from Sarah Lawrence College’s Creative Writing, Nonfiction program, where she wrote this essay. Follow her on Twitter: @samanthaprosen

a slave to my mind

Editors’ note: The following poem details graphic imagery of bulimia, and may be upsetting.

My name is Rhea Mathews, currently residing in India. My psychology teacher once told our class that if we were faced with stress, that we should channel that chaos into writing. I remember exactly when I started penning down thoughts. My first love had just broken up with me. I didn’t know what I was feeling and how to deal with the heartbreak so I cried and I wrote and I cried some more. It was relieving, even empowering, it provided me clarity and perspective. Slowly after this I began writing poetry. My poetry is very personal to me, I haven’t shared it with anyone. The piece I submitted was about being bulimic, I had put off writing this for a long time because I didn’t know if I was ready to face the truth.

Staring into the pot of my filth that had been forcefully purged left me feeling empty and deeply flawed. Bulimia haunted me for three years of my life. It gave me a warped self-image, and every day was spent on overcoming the self-defeating of guilt, anxiety and depression associated with the disease. It took me time to realize the harm I was inflicting on my mind and body and to change the negative perceptions of what I conceived to be attractive and desirable. The social stigmatization of this mental illness dissuaded me from ever opening up about it. People suffering from disorders are often unwilling speak about their tribulations or even worse unable to accept the reality of the situation. Mental disorders transcend boundaries created by caste, creed, religion, and state, and therefore it makes it all the more crucial for society to understand the complexity and severity of mental diseases to be empathetic and provide support to those whom need it.

I submitted this piece because although it may not be an extraordinary piece of work, it is honest. It’s what people need to hear, especially those suffering from any mental illness because if even one person can feel that they are not alone in this journey, then it’s worth it. If one person can relate and understand, it can empower them. If one person’s negative preconceived notions, of what it’s like to have a mental illness, changes, then society is already a little bit better.


I wrapped away this problem,

Buried it at the back of my head,

Kept it so deeply hidden,

So not a tear would be shed.

But it didn’t disappear,

It didn’t go away,

It continued to haunt to me,

Each and every single day.

A lingering shadow,

A demon in my mind,

A toothbrush in my toilet,

That I wished not to find.

It didn’t have a face,

I did not speak its name,

That would make it real,

Did that make me insane?

To deny, suppress and ignore,

For three exhausting years,

All the misery, guilt, and pain,

Bundled with all my fears.

Low self-esteem.

Low self-worth.

Lack of self-respect.

Dirt. Dirt. Dirt.

Illusory standards of beauty,

Is what I decided to chase,

Because I didn’t accept,

My body, my mind or my face.

It began with two fingers,

Dug deep down my throat,

Faced the mirror after,

I looked repulsively bloat.

I had successfully purged,

Everything I had eaten,

Teary eyes, runny nose,

I had just been beaten.

By a version of me,

That I truly despised,

Being your own enemy,

Something I can’t describe.

I tried to just,

Reduce my appetite,

But the pangs of hunger,

Were what I couldn’t fight.

The body needed,

More than I was giving it,

So then I ate excessively,

And felt absolutely shit.

I was overwhelmed,

By these negative thoughts,

My only relief was purging,

Believe it or not.

It gave me a feeling,

Of self-satisfaction,

A sense of control

Fueled by this action.

I lost twelve kgs,

In less than a year,

It made me quite happy,

That’s what I feared.

I didn’t care about,

The damage I was inflicting,

I told myself I want this,

On days, even insisting.

It was an unnatural,

Obsession with food,

Unhealthy and damaging,

That dictated my mood.

Every plate served,

Every bite I had to swallow,

Ultimately left me broken,

Weak, empty and hollow.

I experienced days staring,

Into the pot of my filth,

Tears streaming down,

And intense feelings of guilt.

Why am I doing this to my body?

Will people love more?

Will I be happy if I lose weight?

What am I doing this for?

Day after day,

It got easier to do,

A mild irritation now,

And only a tear or two.

Food was constantly,

Dispelled from my body,

I got used to this habit,

And I loved it, oddly.

To eat all you want,

Not put on a single calorie,

The best of both worlds,

This was my mentality.

I treated it casually,

It became a way of life,

A self-defeating cycle,

Of sadness and strife.

Eating in secret,

Over-exercising,

Hiding it from everyone,

And constantly lying.

It gave me happiness,

That was temporary,

After a while,

Relief came rarely.

My teeth become yellow,

I became disgustingly thin,

I stopped loving myself,

For what was within.

Misguided thoughts,

Is what I was left with,

Beauty by being slim,

It was all just a myth.

I was envious of all types of women,

Those who were slimmer,

Those who didn’t give a fuck,

And were much plumper.

They had this aura,

No one could bring them down,

No amount of body-shaming,

Would ever make them frown.

They loved their bodies.

They loved their extra skin,

They loved their curves,

They loved everything within.

I have to teach my children better,

Not pass on this false perception,

Of beauty and attaining love,

It’s all a horrid misconception.

Don’t be fooled by the models in the magazines,

The advertisements and the billboards,

That objectify people and their bodies.

The posts that highlight your insecurity,

The instagram pictures that distort reality,

And provide a negative notion of,

What’s considered desirable and attractive.

The articles on losing weight,

The diets to follow,

And your calorie intake,

Throw it all away.

Throw it all away.

It’s not important,

Society does not have to determine,

How you look or behave.

I’ve begun my journey to alter,

My warped self-image,

Learning to love myself,

For me, that’s a privilege.

It took me two years,

To finally accept and admit,

That I was bulimic because of,

The social stigma associated to it.

Don’t trivialize your suffering,

Don’t be afraid to speak about the tribulations.

If you have a mental illness,

Seek support and help to change your situation.

I urge both men and women,

To speak up and fight,

For those who suffer,

Do what is right.

so, what if monster was human?

BY TUBA S.

Tuba S piece

If my panic disorder were a person, he would never leave my side. He would be the pathetic reason as to why I would run from corridor to corridor and like a shadow, he would retrace each supposedly cautious step of mine. He would come after me till I would fall weak to his desires. Vulnerability was my best look, he’d say,  before taking over my chaotic mind.

If my panic disorder were a person, he would laugh at my attempts to understand him. Ruthlessly, he would kick me in the stomach till I’d become short of breath. Gripping me by my bony shoulders, he’d shake me to the point of dizziness and when at last I were to succumb to his purpose he would scream in my face, “Stop trying to understand a monster!” Although, I would never stop, because understanding him had evolved from an action into a compulsion.

Continue reading so, what if monster was human?

i thought it was over

BY ANONYMOUS

it's not over

I thought it was over.

I had escaped high school, and I was going to leave my depression and anxiety behind me. By the summer after graduation, I was already feeling so much better. The next year of college had its fair share of stressors, but I was able to handle them all in a relatively normal way. Every time I dealt with a situation, I looked back on how I would have handled it four years ago, and I was so, so proud of my progress.

Then it happened again.

Continue reading i thought it was over

the things i’ve never said

BY MALLORY GOTHELF

So where does my journey begin? Where does anyone’s journey really begin? Does it begin the day we are born? Are we somehow born with an innate understanding, that in the very moment we grace the world with our presence, we have suddenly entered a place full of trial and tribulations? Is that why a baby screams and cries? Or maybe our journey begins when we start interacting with the world around us. We then learn that some people don’t have our best interests at heart and monsters are just the demons in our minds, rather than under our beds. That is all just speculation though. I’m much more interested in the journey itself than the starting place.

Continue reading the things i’ve never said

police militarization, Charles Kinsey, and mental health

BY REBECCA HEILWEIL AND CLARE CONNAUGHTON

The militarization of the police, mental health and systemic racism all affect each other.

This month, after a long-string of police shootings, the intersection of these issues became clear in the shooting of Charles Kinsey, an African-American mental health and behavioral therapist and resident of Florida.

On July 18, a 23 year-old man with autism left MACTown Panther Group Homes, short for the Miami Achievement Center for the Developmentally Disabled. The letter from the President available on their website states that the center’s mission “is to create hope and opportunity for People with Developmental and Intellectual Disabilities. We believe that all people, at all ages, and all levels of ability, have the potential to learn and grow. We also believe that all individuals are entitled to the same dignity and respect that each of us expects in our lives.” It also specifies that “The people we serve do not fail-but we fail them due to our human and systemic weaknesses.”

The police department stated they were responding to a man threatening to commit suicide with a gun.

Despite lying on the ground with hands up, and specifying that he was a behavioral therapist and that his patient had a toy truck, not a gun, he was still shot by SWAT team member Jonathan Aledda. Aledda allegedly fired three times, and one of the bullets hit Kinsey in his leg. Kinsey is also shown on videos asking his patient to lay down on his stomach.

After the shooting, the head of the local police union, John River, said that the officer was aiming for Kinsey’s patient. He added that Kinsey “did everything right.”

Though severely injured, Kinsey is expected to make a full recovery. The family of the man with autism has said that he is still suffering trauma from the incident.

This cannot be the way we deal with mental health, mental illness and development disabilities in this country. Mental illness and development disorders have historically been addressed through institutionalization, penalization, and other forms of social control. This incident reminds us that we are far from treating mental illness and development disorders as they should be treated. While these are separate and distinct categories, the stigma towards them creates a world where violence, apathy, and militarized police constitute our first response, rather than compassion. 

Too often, police responding to calls for mental illness intervention are neither qualified nor trained to deal with them. Too often, we rely on the criminalization of mental illness in order to treat it.

Worst of all, the effects of these programs fall disproportionately on the poor and racial minorities. Charles Kinsey’s shooting exemplifies that the criminalization of being African-American in this country and the stigma of mental illness and developmental disorders both reinforce violence from those who are supposed to protect us.

For further resources regarding the issue of policing and mental illness, Harold Pollock’s  “Better Police Training” provides a good introduction. Many police departments have fantastically implemented better training to deal with mental illness and policing. As Pollock highlights, “A disturbing number of violent policing incidents involve individuals living with intellectual and developmental disabilities (IDD). Baltimore’s Freddie Gray, for example, appears to have been cognitively harmed by lead paint exposure, and Chicago’s Laquan McDonald experienced a complicated mix of mental health challenges and learning disabilities.”

Paul S. Appelbaum’s piece, “Mental Health Courts” also provides important background for potential solution to the increasing imprisonment of those with mental illness, often a result of true mental health care falling too financially out of reach for many Americans.

To support efforts fighting police brutality, consider donating to Campaign Zero, the Southern Poverty Law Center, the American Civil Liberties Union, Mothers Against Police Brutality, and countless other regional and national efforts.

For those who are able and comfortable, attending rallies and protests  is another way to spark action. Starting conversations in your local communities or the spaces you frequent, even among your friends and families, is another way to promote change. Also consider contacting your local representatives and express your support for fighting police brutality and mental health awareness. Find your local representative in Congress here.

 

depression in metaphors

BY PAUL BARACH

paul piece

At age 11, gravity suddenly became extra strong, pressing my back against the carpet of my parent’s bedroom. The ceiling was my field of vision. Off-white with bucket lights that needed dusting. Ceilings would become a familiar sight. I didn’t want to leave the house, or the room, or the floor.

I didn’t want anything. It would all feel the same.

My older brother came into the room. “C’mon Paul. Let’s go play in the yard.”

It was a sunny day in the Pacific Northwest. The kind of day you have to make the most of before the Sun announces its retirement in October yet again.

“I can’t.” I replied.

“Why not?”

I didn’t have words for it then. Continue reading depression in metaphors