This article is a co-publication of Zócalo Public Square and State of Mind, a partnership of Slate and Arizona State University focused on covering mental health.

In early 2020, weeks before Covid changed our lives, I sat uneasily with a dear medical school friend, listening to a panel of experts discuss burnout, moral injury, and wellness. The speakers focused on categorizing and describing these terms, recited research and data, and prescribed self-care strategies, including a healthy diet, exercise, yoga, and mindfulness. Many colleagues found these sessions helpful. I left feeling even more unwell.

These discussions began sprouting up at hospitals, including my own, well before the pandemic helped propel stress and burnout levels among health care workers to an all-time high. Health care worker burnout has been tied to physician and nurse suicides, depression, and medical error. It impacts cognitive function, patient safety, and quality of care.

My testy relationship with burnout and wellness presentations begins with their dominant focus on data. I don’t need research to explain what I’m feeling. Over three decades, I’ve navigated escalating obstacles to care for patients as an emergency physician in a broken health care system. The past three years, the crushing constraints eroded my integrity as a healer. I knew patients deserved better and could feel their trust slipping away.

I often feel numbed by it all. I want to feel more, care more, and recognize myself again. I want to work with the uncertainty, and understand that burnout can never be fully defined or mastered, only honored and engaged with.

Psychology researchers define burnout as experiencing depersonalization, emotional exhaustion, and a loss of accomplishment or efficacy. Wellness presentations are supposed to address such symptoms. But I’ve found that when interventions oversimplify and universalize complicated feelings under the banner of burnout, they compound my sense of losing control, depersonalizing an experience already marred by depersonalization.

The problem isn’t the message but the framing. Why do hospitals and physicians approach burnout as a problem, and not a mystery?

The French philosopher Gabriel Marcel distinguishes a problem from a mystery in a way that I find helpful. A problem, he writes, is external to us. It’s objective and universal, and its solution is available to everybody. Take a faulty electrical circuit that won’t light a bulb. We troubleshoot the power source, the wiring, even the bulb to figure out how to fix it. The repair process is rooted in a shared understanding of principles, functions, technique, and scientific knowledge.

A mystery, Marcel explains, is “a problem that encroaches on its own data.” We can’t study a mystery objectively because the problem itself is rooted in the person. We can’t lean on a generalizable technique because the individual is involved in the quest. With mysteries, we can’t substitute one person for another, one experience with another, without altering the question itself. The person asking the question matters.

Through a prism of mystery, we thwart the impulse to universalize, to define, to break a problem into its parts and analyze with detachment, which are standard techniques we bring to our study of problems in medicine. Despite the wealth of research on health care burnout, I fear it’s become shorthand for a range of complicated individual experiences that are hard to put into words, let alone define, measure, or master.

The conversation changes when the focus shifts from the occupational syndrome of burnout to the individual, from ready answers to questions about the experience itself.

What if wellness experts spared overworked physicians from their next PowerPoint presentation and instead asked them to come up with their own language to capture their experiences and feelings? Doing so would force us to drill inward, which can be difficult. But the struggle to articulate our stories is the struggle to wrestle control over our experiences.

If I had been asked, in early 2020, what nagged at me, I would have pointed to pointless medical bureaucracy and its torturer’s apprentice, the electronic health record. I would have bemoaned the way the system leans on emergency rooms to solve mental health and substance use problems that community leaders and other institutions don’t or can’t handle.

If you asked me the same question now, I’d say I was stumbling into the post-pandemic normal, concussed by all I’ve absorbed and not fully processed: needless death and suffering; patient anger, insults, and violence against ER staff; degradation of standards in respone to constraints and resource limitations; staff exoduses.

Talking about burnout is easier than talking about being burned out. Physicians and nurses fear judgment and stigma—being perceived as insufficiently smart, mentally tough, or resilient.  To admit my feelings out loud instead of hiding vulnerability—and hear in return how colleagues struggled, too—would acknowledge our range of experiences in all their messiness, and blueprint possible bridges from isolation to community.

Building a culture that supports well-being is critical, as U.S. Surgeon General Vivek Murthy has noted in his recent call to get to the roots of the health care burnout crisis. System change begins at the level of human interaction. The pressures and waves of disturbances that make a life—different personalities, relationships, previous experiences, and institutions—are complicated and individual. Fostering authentic conversation is a good place to start.

To see ourselves differently, we must slow down and change our angles of understanding, or “make strange,” our previous ways of knowing. This idea of defamiliarization, made famous in a 1917 essay by the Russian literary critic Viktor Shklovsky, builds on our tendency not to notice things we encounter frequently. Our perception becomes habituated. Defamiliarization disturbs all that and forces us to see experiences and objects anew.

Writing and the arts function as a medium for defamiliarization. Critics often perceive humanities and arts-based medical education—from collaborations between museums and medical schools to reflective writing courses—as soft, nice but extra, or as a pill for humanism. But the arts provide rigorous critical thinking skills—they foster perspective shifting, remind us to consider cultural, historical, and social forces, and prepare clinicians for situations that push them outside their comfort zones. In 2020, the Association of American Medical Colleges issued a landmark report recognizing the need to integrate humanities and arts into medical education through writing, visual arts, dance, improvisation, museum-based experiences, and more.

Wellness or burnout initiatives should prioritize exploration and value curiosity and uncertainty. Interventions should regard easy answers with healthy skepticism. An authentic process, even without a “cure,” is an end unto itself. In the “third space” between art and the science of medicine, we can encourage vulnerability and the emergence of different discussions and insights. I find museums, with their quiet rooms and curated art objects, provide psychologically safe spaces for nourishing destabilization. In my experience, dialogue with artists and arts experts seeds different types of questions than typical medical wellness programs. It has forced me to engage with alternative ways of looking at, and appreciating, daily experiences.

The jury is out on the role of humanities and the arts for burnout. The effects of such programs are difficult to measure. Arts-based reflection doesn’t promise answers, or lend itself to data sets. But it might allow each of us room for contemplation, a chance to recover that which is mysterious in our lives, a moment to recognize who we’ve become, what we’ve lost, and what is still within our grasp.

Let’s not forget that we’re talking about human hearts in peril, searching for that ferry from burnout to better. I can’t say what the journey looks like—only that it requires new maps.

The post Are Hospital Wellness Initiatives Making Doctor Burnout Worse? appeared first on Zócalo Public Square.

This article is a co-publication of Zócalo Public Square and State of Mind, a partnership of Slate and Arizona State University focused on covering mental health.

It was 2:30 a.m., and I was lying in bed with my phone in my hand and my TikTok “For You” page fired up.

I knew I shouldn’t be awake. A month into my junior year of high school, my workload was already piling up. If I didn’t get at least a few hours of sleep before my alarm went off, I would pay for it in class the next day.

Close out of the app, I told myself. But my thumbs didn’t stop. I kept swiping, paging through one video after another, like a person possessed.

Eventually, I ended up on a TikTok where someone played the game Subway Surfers while a voice-to-text narrator dictated an obscure Reddit post.

I snapped out of my trance. What the hell was I even watching?

It was at this moment that I knew I needed to take a break from TikTok. I owed it to myself to see how my life, and my mental health, would change without the app and the hold that its algorithm had on me.

I had been using TikTok for nearly three years at this point. I was still in middle school when I first downloaded the app as a way to view and share funny videos. Just a couple of months after I started using it, the COVID-19 lockdown happened, and all of my normal ways of interacting with the world stopped. School went virtual. I stopped playing basketball with my friends. Everything had shut down, so I started to open up TikTok more and more.

Once I began using TikTok more frequently, I found I couldn’t stop. According to my iPhone’s Screen Time reports, at one point I was logging six hours on the app a day.

When the lockdown ended and my world started to open up again, my consumption of TikTok didn’t slow down. It was when I was supposed to be doing homework or studying for a test that I found myself scrolling on the app the most. I attend Davidson Academy, one of the most academically rigorous schools in the nation. The push to excel is high, as is the feeling that you don’t want to waste your opportunity. Whenever I started to feel overwhelmed by the pressure of it all, I knew that TikTok was just a few clicks away.

Many of my peers share my experience with TikTok: A recent report by the Pew Research Center found that 67% of 13- to 17-year-olds use TikTok, and 16% said they use the app “almost constantly.” There has been a lot of talk about the negative mental health consequences of social media, and this was one of the main focuses of the recent congressional hearing on TikTok. Many teens—36%, according to Pew—recognize we spend too much time on social platforms, but sometimes it’s hard to know how to bring that time down.

When I decided to take a break from the app, I chose to make it a month-long experiment. My hope was that this time without TikTok would help me to balance school and extracurriculars while finding a healthier way to be on my phone again.

The first week was freeing. I instantly felt more productive and I was getting more sleep. But by the second week, I felt that familiar compulsion creep back in, and craved the dopamine hit from TikTok’s tailored “For You” page.

Fortunately, it was around this time that my history teacher gave my class an assignment: Write a literature review on research in a specific field. I decided to look into the neuroscience and psychology of TikTok, in hopes of better understanding the hold it clearly still had on me.

Because TikTok is relatively new, there’s a limited amount of peer-reviewed literature around it. When I started browsing Google Scholar for answers, a lot of what I came across felt too jargony. But then a term from one paper jumped out at me: “escapist addiction.” It was used by Sebastian Scherr of Texas A&M University and Kexin Wang of Zhejiang University in a paper that argued people mainly use TikTok so they can avoid doing something else.

It was a light-bulb moment. While TikTok is designed to show you what you want to see and keep you on the app for hours, I realized I had my own reasons that were fueling this cycle of addiction. Rather than be mindful of the pressures that were weighing me down, I was using the app to avoid all of the things in my life I did not want to deal with.

I needed to face up to my own reality. I had once thought that I could do everything if only I managed my time better. But I’m not Superman; there are limits to what I can do. I wasn’t giving myself any grace and kept pushing myself beyond my limits. The more pressure I put on myself, the more I sought out TikTok to escape from it.

I never thought that my break from TikTok would turn into something more permanent, but six months have passed, and I still don’t have it on my phone. After the data and privacy concerns that have been raised about the app, I don’t have any desire to continue to use it.

From my time on TikTok, I’ve learned that the app can be a powerful tool for people my age to connect, find community, organize, and learn. But my brush with TikTok’s algorithm has also made me realize how often people don’t understand what they’re getting themselves into on social media. The more these things become embedded in our lives, the less we’re likely to question their impact on us. That’s scary. As users, we can’t always control these companies, but we can try to be mindful of what’s going on when we find ourselves unable to stop checking social media.

Deleting TikTok from my phone hasn’t totally solved my “escapist addiction.” But now, when I end up down a YouTube rabbit hole or catch myself lingering on Instagram for too long, I ask myself why I’m there, and what I want from what I’m doing. I’ve also tried to give myself outlets offline to help relieve some stress, like my school’s tennis team. Playing with my teammates, instead of just scrolling on my phone, feels good.

Occasionally, a couple of my friends will still send me TikTok videos. It’s become kind of an inside joke between us now, because they know I don’t have the app and can’t react to them. It doesn’t bother me. And rather than making me feel like I’m missing out on something, they’ve led us to some great conversations about how we can all be more mindful around our screen time.

The post What I Learned From my Breakup with TikTok appeared first on Zócalo Public Square.

This article is a co-publication of Zócalo Public Square and State of Mind, a partnership of Slate and Arizona State University focused on covering mental health.

I was 12 when I went to prison. Though Mom was the one behind bars, it felt like the system shackled me, too.

Visits to see Mom at Los Angeles County’s Century Regional Detention Facility were rare. Even when I managed to find an adult to take me, I wished I didn’t have to love her this way. Pressing the black visitation phone to my ear, only tears escaped. With a glass wall between us, we used the time to silently fall apart, together.

I am just one of millions of young people who have had an incarcerated parent. For each one of us, the consequences of America’s incarceration crisis are personal and profound; we are more likely to experience a number of physical and mental health conditions, from depression and anxiety to asthma. Today, as a student at Columbia University hoping to become a lawyer, I am ready to be our advocate. I want to inspire criminal justice reform in order to alleviate the system’s lasting impacts on families of the incarcerated.

Mom is a Mexican immigrant who arrived in Los Angeles in 1991. She brought with her an 8th grade education and pennies but also daring eyes full of dreams. America quickly humbled her. She ended up working long shifts as a cashier at a Chevron gas station.

When she got home, she’d tell me all about the customers who came in. She was yelled at for simply doing her job. “Go back to your country,” they told her. Even though America rejected her, Mom was determined for my three sisters and me to belong.

“An A, why not an A+?” she would ask me after my teacher returned a test. I didn’t understand what the big deal was.

Now, as I look back, I know Mom’s toughness was motivated by love. She taught me that I didn’t have room for error; I had to work twice as hard as my white, affluent peers to be taken seriously. It is thanks to Mom that I am still a proud academic perfectionist.

Mom is, and has always been, my beloved. As she began to struggle with addiction, when I was just 12, I made sure Mom was fed and cared for. But I knew what she really needed was something I couldn’t give her: rehabilitation.

I was hopeful when Child Protective Services eventually got involved, but they only made a bad situation worse. A social worker simply showed up at my middle school one day and told me I wouldn’t be going home, because I was entering foster care. A police escort took me to my younger sisters’ schools to break the news to them gently. After all, the social worker told me, it was my “responsibility,” since I was the oldest.

The most painful part of this traumatic experience was that I didn’t get the chance to tell Mom bye. With me gone, who would make sure she was okay?

All I could do was focus on my little sisters. My twin, Ariel, and I became their maternal figures. We cooked food for them, stayed up late when they were sick, told them “I love you.” We were simply there.

As my sisters and I moved from foster home to foster home, Mom lived with my grandpa, where her addiction intensified—and made her the perfect “criminal,” as far as police were concerned. They stopped Mom one day, searched her, found a screwdriver in her purse, assumed it was a weapon, and whisked her off to jail.

Many incarcerated moms look like mine. The Sentencing Project, a Washington, D.C.-based nonprofit, reports that Latinx women are 1.3 times more likely to be incarcerated than white women. With a Spanish accent and an inadequate lawyer, Mom had the odds stacked against her. As I had been busy serving my sentence in foster care, she started serving hers in prison.

After several years, when Mom eventually got out and regained custody, life didn’t get much better for us. Twenty-seven percent of formerly incarcerated people, according to data published in 2018, are unemployed—and she was one of them. A box on a job application signalled an automatic rejection: “Have you ever been convicted of a crime?”

She eventually got a job as a babysitter, making around $250 a week. The gig helped put food on the table and pay the rent, but I envied the child she babysat. Why did she get to be held in Mom’s arms?

To help make ends meet, I juggled a few jobs in high school. I volunteered with various foster care, feminist, and racial justice nonprofits, which I began to call my family. They empowered me to tell my story. I made speeches to California legislators and helped pass a juvenile justice reform bill. I participated in research that helped expand higher education for foster youth.

I am the safety net for my family. I want more for us than sharing a one-bedroom apartment forever. So, hammer in hand, I shattered the walls. Statistics suggest I should have been held back, or dropped out of high school altogether. I’m lucky to be among the 2% of children with incarcerated moms who will graduate from college. Even when you are wealthy and white, it’s rare to get into Columbia, with its 3.73% acceptance rate. As admissions decisions are released this spring, I’m not expecting many kids like me to receive acceptances here, if they even applied.

Being complacent about these inequities is the real crime. Since 1991, the number of children with incarcerated mothers has increased by 131%. Throwing more moms in jail is not the solution to underlying problems, like addiction and mental illness, that require rehabilitation and treatment. My mom was still an addict post release, just an addict with a felony. Given that kids in foster care are more likely to end up in prison themselves, I easily could have joined her.

Mom tells me to move on. She often comforts me with words like, “We’re together now Angel, let it go.” But when she hugs me tight, I can feel she’s afraid to lose me again. In a way she already has: I’m on the other side of the country. Most kids look forward to college as a time of independence, but I’ve already been on my own for far too long. Mom didn’t regain parental rights until I was almost 18 years old. At least my younger sisters get to grow up with her.

My emotional pain will never truly heal. I still flinch when someone knocks too loud at the door, because that’s how the police and social workers always arrived. I know someday when I am a lawyer, tears will cascade down my cheeks as I walk through the courtroom doors. It was in court that my lawyers gave me a teddy bear, every six months, after denying me parental reunification.

All of my experiences ensure that I will fight harder for my future marginalized clients. I know what it means to be seen as a criminal because you’re Black, a woman, a foster child, and the daughter of an incarcerated mom.

I was 12 when I went to prison. I wonder when I’ll be free.

The post My Mom Is Out of Prison, But I’m Still Not Free appeared first on Zócalo Public Square.

This article is a co-publication of Zócalo Public Square and State of Mind, a partnership of Slate and Arizona State University focused on covering mental health.

Mental illness haunts me in two different ways. The first surrounds me, living and working in Los Angeles, California, daily. When I see people half naked, lying on the hot sidewalk on the way to the trendy new coffee house. When I meet parents searching for their missing adult children and being turned away by agencies who can help—but will not—because it would be a “privacy violation.”  When I hear of people with untreated mental illness finding themselves locked in claustrophobic jail cells and chained to furniture for the few hours a day that they are allowed out to ensure they do not harm themselves or someone else.

The other haunting also takes place here in Los Angeles, but is a product of my travel to Trieste, Italy, “the city that cares.” In Trieste, none of these tragedies exist—and that fact haunts me, in a good way. Recognized by the World Health Organization (WHO) as demonstrating a global best practice in community-based mental health care, grounded in accoglienza (the Italian word for hospitality), Trieste is a north star for the world.

Ever since I first witnessed the human-centered system in Trieste in 2017—and I have visited five times now, first on a fellowship and later as an observer for an entire month—I am more convinced than ever that my own city, Los Angeles, is capable of moving toward a true community-based system of care. That is, if we have the political will.

The current American mental health care system dates back to the 1960s, when the vision to close the mental institutions in the U.S. and build out a community system of care was gaining traction. From L.A. County, we can see clearly the through-line of the abandonment of this vision. After President John F. Kennedy called for a community-based system of care in the U.S. in his last major policy address in 1963, a gradual devolution of authority from the federal government to the state and now to the 58 counties followed, culminating in the 2011 elimination of the California State Department of Mental Health. This moment served as a capstone to the withdrawal of direct responsibility, or accountability for, mental health care from the state.

California is not alone in this downward slide. Today, America’s mental health system is fragmented, built upon clinical interventions, and tied to a reimbursement system that pays for some useful things but ignores all the life needs of a person in crisis.

In Italy, I discovered, this same story played out differently. Like the U.S., Italy was involved in the mid-20th-century movement to bring an end to the horrible conditions in asylums and institutions. But unlike the U.S., Italy had a visionary psychiatrist who started a revolution in his country around mental healthcare that persists to this day.

As a young psychiatrist, Dr. Franco Basaglia railed against institutional life, influenced by his World War II imprisonment as a member of the anti-fascist resistance. When he was assigned to head an asylum in the town of Gorizia (in the same province as Trieste) in 1961, he was horrified by the conditions he witnessed. As documented in the excellent book The Man Who Closed the Asylums, Basaglia initiated radical changes that flew in the face of conventional “treatment.”

Here are just a few measures he put in place: outlawing restraints, unlocking the wards, instituting meetings between patients and staff, and requiring that the doctors shun their white coats.

By the time Basaglia moved to Trieste’s asylum in 1971, his “democratic psychiatry” movement was gathering momentum. Basaglia and his supporters promised recovery for mental patients and pushed for measures to reintegrate people back into the community, where they could connect with family and friends and find meaning through work.

But he didn’t stop there. In 1977, Basaglia moved to close the asylum in Trieste, and the following year the Italian Parliament passed Law 180, known as Basaglia Law, which formally led to the dismantling of the asylum system throughout the country.

Italy’s community system of care—and the local mental health centers that anchor it—continues to focus upon treatment, recovery, and prevention today. But what struck me most about what I observed in Trieste was a culture that allows people to be treated with human kindness. I was particularly taken by the city’s emphasis on supporting a person’s life aspirations. Trieste’s community mental health program does not define people by their mental illness; they understand that a diagnosis is just one piece of information. Housing is integrated into the program, ranging from independent living to supportive family-style arrangements with 24/7 staff support. In a crisis response situation, community mental health center staff steer people away from the trauma of hospitalization, or worse, incarceration, through short-term housing in a home-like setting managed entirely by peers. Peers play a significant role in the entire system, offering support and the wisdom that can only come from lived experience. The community mental health team also connects people to clubs, associations, and social cooperatives that help them find employment appropriate to their skills and capabilities.

The current situation in California couldn’t provide a starker contrast.

I have yet to meet a person or a family member who can describe a successful story of moving from the onset of mental illness symptoms to treatment to diagnosis to sustained support to recovery. Instead, they find themselves stuck in a system (or rather, a non-system) built upon clinical interventions, tied to a financial model that emphasizes symptom management but ignores the longer-term life needs of a person in crisis.

Other solutions are available to us. In a podcast interview I conducted with Guyton Colantuono, executive director of Project Return Peer Support Network, we discussed the peer respite center, a cost-effective, trauma-informed alternative to hospitalization or jail. He explained that it costs $840,000 per year to run a 12-bed facility—which averages out to $295 to $368 per client, per day. By contrast, it costs $2,200 to spend a night in the emergency room of a typical hospital. Yet there are only two peer respite centers in all of L.A. County.

The guiding principles that are so evident in Trieste don’t require a secret handshake to unlock here. It will take the unwavering focus on the needs of the whole person—not just clinical interventions. A commitment to hold systems accountable to people and outcomes—instead of protecting the institutions. A culture shift to practice radical hospitality—as opposed to adhering to positional authority and power dynamics. A belief in every person’s ability to recover and the right to pursue a purposeful life—as opposed to writing off the hopes and dreams of a person with a mental health diagnosis. And a community ethos to foster social inclusion, and eschew marginalization and isolation.

This movement for change will require involvement at all levels of government—local, state, and federal. Some might say that is impossible to enact Trieste’s ethos of care here. But I would counter that it is immoral not to try.

The post What the World Can Learn From Trieste’s Mental Health Model appeared first on Zócalo Public Square.

This article is a co-publication of Zócalo Public Square and State of Mind, a partnership of Slate and Arizona State University focused on covering mental health.

I’ve had OCD for as long as I can remember. My parents just didn’t know what to call it. I seemed like your average worrywart. No go-karts for me at birthday parties and no rides at Disney, outside of “it’s a small world” (which now seems scarier than any roller coaster because of the singing animatronics). I refused to learn how to ride a bike. I got my driver’s license but haven’t driven a car since my 18th birthday. There are few things more humbling than having to ask your mom to take you into town for a bagel when you’re in your late 20s.

A frantic narrator was ruling my internal monologue and I had, until recently, resigned to letting her hog the microphone. But then, a year ago, I decided to try something I’d never even considered previously: medication.

I’d done years of cognitive behavioral therapy, but it got me only so far. I felt like Sisyphus, only the boulder was my mental illness and the top of the hill was the fully realized version of myself that made stew for her friends without worrying about accidentally poisoning them. Now, on medication, I feel like I’m finally getting to know myself for the first time. My head is clear. I never thought I needed an SSRI (selective serotonin reuptake inhibitors), but now that I’m on one I can’t believe I suffered so much before. And I can’t believe how much stew my friends were missing out on.

The compulsions arrived while I was in college. I became obsessed with my health, specifically getting infections and diseases through open wounds. I would wipe my body with alcohol pads every day, even when I didn’t have cuts, just in case I couldn’t see them. My skin probably had more contact with alcohol than my tongue. Sure, I went to parties, but would have sustained panic attacks if someone so much as brushed past me with their elbow.

And then in 2015, home on Long Island for spring break (I was very cool), I was presented with my biggest fear: a real medical emergency. An ache in my lower stomach that I assumed was gas—my mom tried to burp me thinking it was trapped—turned out to be appendicitis. An exploding appendix is not really something you can avoid, so I had my first taste of exposure therapy that day. And did I mention that the day was March 15? Yes, the Ides of March. The universe majored in English, I see.

My body, my safety, my health—these things I obsessed over—were out of my control and in the hands of the hospital. OCD deludes you into thinking that you can protect yourself with an ironclad grip over your reality, but that’s impossible. You can’t control everything. Kind of like how in New York City you can play with your radiator all you want, but at the end of the day, your building is controlling the heat. So there I was, being rolled into the operating room with no choice but to let go. The anesthesia helped, too.

When I woke up in the recovery room I was greeted with apple juice and a realization: I was fine. I would be constipated for the following seven days, prompting my aunt to light a candle in a church for me, but I was fine! Well, fine in the immediate sense. I would soon go through a few months of intense cognitive behavioral therapy—walking through the streets of Manhattan touching doorknobs and trash under the supervision of a medical professional. Then I had a few good years where the OCD was in check: I started dating the man who is now my husband, I graduated college, I went to Guy Fieri’s Mt. Pocono Kitchen. I was on top of the world.

Until the OCD came sneaking back. Gradually, trying to get rid of fruit flies in my apartment turned into hours cleaning and inspecting for bugs. Then we had a global pandemic, people started Cloroxing their groceries, and I became even more obsessed with disinfecting. I’d wash my hands 30 times in a row after touching an “outside world” jacket just in case I didn’t wash them the right way the 28th and 29th time. When we found out COVID was spread primarily through airborne droplets, it was too late for me. Handwashing had extended into compulsions that didn’t have anything to do with the virus. Every drawer needed to be closed. I had to check my carbon monoxide alarm dozens of times before going to sleep. The studio apartment where I was 24/7 with my husband became a soundstage for my OCD. A petri dish for my behaviors.

I could feel my brain short-circuiting when I tried to complete even simple tasks like getting dressed—I definitely washed these pants, right? Maybe I didn’t actually do laundry yesterday and I imagined it. Best to put them in the dirty hamper. Every moment of my day I was beholden to my compulsions. So I finally agreed to start taking medication after some long conversations with my mom, my sister, and my best friend—all of whom intervened independently of one another, which is when you know the situation is very dire.

I was afraid of taking medication. I didn’t want to introduce another variable into my life. It just seemed like the OCD was a part of me. I felt like I had to ride it out. I’ll be my normal self soon, I just kept saying. I believed in medication for other people, but I convinced myself that my OCD “wasn’t bad enough” to warrant it. I’ve always had a hard time admitting when I needed help. But I had to let go, just like I did the day I said goodbye to my appendix.

When you have OCD, it’s like everything sets off a fire alarm. The people you love can tell you there’s no fire all they want, but when the alarm is still going off in your head, all you can focus on is escaping that burning building.

Now that I’m on medication, the fire alarm is quieter. My SSRI—which psychiatrists often prescribe for OCD—allows me to sit with the discomfort of not fulfilling a compulsion. It makes the obsessive thoughts less sticky. I can finally go about my day and worry about normal things now, like: Do I look weird in this hat?

After a year on medication, I’d be lying if I said I still didn’t check the stove or the front door lock, but it doesn’t control my life anymore. Now I can actually enjoy a restaurant with my husband without some pestering thought about a crumb on the seat from the guest before. And I’m so grateful to my husband, my parents, my sisters, and friends for being so involved in my life and noticing when something was wrong. Now, I’ve gotten to know the Katherine who was buried underneath her buzzing thoughts for so long. The Katherine who loves to travel, who loves to cook, to explore, to see, to touch, to experience life and who, maybe—after a few Bell Auto School lessons—will love to drive.

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My depression was triggered by The Lion King. Watching Scar throw Simba’s father to his death, I started crying and couldn’t stop. I was 11, terrified something would happen to my mom—my lifeline, and the parent who had removed us from an abusive situation six years earlier. That night, it felt like a dark room opened inside my chest, filled with feelings I couldn’t name.

The room stayed with me—sometimes growing larger, containing hopelessness and instances of self-harm, and sometimes emptying, only to fill up again with a new sense of despair. Ashamed of this endless loop, I struggled with how to integrate mental illness into my personal narrative.

Those feelings were the catalyst for my new children’s novel, Zia Erases the World, the story of an 11-year-old girl facing her first depression. Zia doesn’t know how to talk about her room of shadows, which she calls the Shadoom, and keeps her secret locked inside her. Upon discovering a magical dictionary that can erase whole concepts from existence, Zia erases fear, pain, and sadness. After the world unravels as a result, she has to make it right.

When I speak at schools around the country, I share two stories: Zia’s, and my own. I acknowledge that today’s students face realities I never imagined, from accelerating climate change to active shooter drills. In 2019 more than 1 in 3 high school students experienced persistent feelings of sadness or hopelessness, a 40 percent increase since 2009. That same year, 21 percent of American children reported having had a major depressive episode at some point.

In December 2021, US Surgeon General Vivek Murthy released a landmark advisory on the youth mental health crisis—which he called “alarming” before the pandemic and “devastating” after a year and a half of quarantines and isolation.

But if tweens and teens were given the chance to shape their own narratives, what would they say?

I decided to find out by speaking with them directly. Most of the young people I interviewed were strangers to me. But after more than a dozen interviews, I got to know Diemond, Camryn, Iona, Jaime, Wyatt, and Rayan, all of whom asked me to use their first names for this piece. “Depression feels like a bad dream,” said Diemond, a 19-year-old from New York. “The same dream over and over, and you can’t wake up.”

Camryn, an 18-year-old from Illinois, described depression as “a lot more than just feeling sad. It’s those ups and downs. Feeling empty and not having motivation to get out of bed, brush my hair, brush my teeth.”

Iona spoke to me outside their therapist’s office, two days before their 11th birthday. For them, the depression began as numbness. “When my dog got sick, I felt absolutely nothing. I couldn’t grieve or cry. That was tough. My dog passed away and I didn’t feel anything. It was just like if a snail died.”

“I got worse,” Iona went on. “I started feeling again, and I wanted to hurt myself.” These desires “weren’t scary to me at the time—I just thought they were normal and this happened to everybody. Now that I’m better and taking medication, I realize those weren’t normal thoughts.”

As I conducted more interviews, I noticed that the young people who identified as female or non-binary spoke more about depression. Those who identified as male spoke more about anxiety. My sample size was admittedly small—according to the CDC, boys and girls report similar levels of anxiety. But the statistics do point to higher rates of depression, suicidal ideation, and attempted suicide among girls.

Jaime, a fifth grader from Los Angeles, told me by phone how he tries to stave off his anxiety attacks by focusing on something else. “But sometimes it feels like you’re delaying the feeling, and then it builds up like water boiling. You get that low heat and it starts to simmer, and then you notice it and think, ‘I’ve gotta turn down the heat.’ But at some point, you’ve just gotta throw in the pasta. You gotta let it boil. And then let it pass. Just try not to burn down the house.”

Despite the subject matter, these weren’t depressing conversations. One mom shared that her son came out of his room “looking a foot taller.” He told her, “It felt so good to talk about everything.”

That was the one resounding common thread in all the interviews: Talking helps. Young people don’t want to be forced to talk, but having even one person they feel safe opening up to makes a huge difference, whether it’s a teacher, therapist, parent, or friend.

For 13-year-old Wyatt, the anxiety and depression began in third grade. “My uncle, my grandma, my cousin, and my cat all died, which was pretty hard for me,” he said. Eventually, he tried counseling. It took a couple of counselors to find the right fit, but the second one gave Wyatt tools that helped him move through the grief. “In my house we had this little corner with soft blankets and squishy things. Me and my mom set it up. It felt like you were getting hugged by a whole bunch of penguins. We called it the ‘Cozy Corner.’ I could go lie down and burrow in for a couple minutes or a couple hours, close my eyes and relax.”

Unsurprisingly, the pandemic came up often, and many acknowledged a pervasive sense of loss. “I’m 11,” Jaime said. “Covid was 25 percent of my life. When things finally started to get better, my mom took me to Trader Joe’s, and I just walked around remembering half the products in the store. ‘Look at the Fig Newtons! Look at the mango popsicles!’ I was having the time of my life. Only later did I get sad. I realized what a big part of my childhood I missed.”

Rayan, a high school senior from Syracuse, used the time to be more creative. “I created my first ever documentary during the pandemic,” she told me. “It covered my daily routine, coming to the United States, the fears of being an outsider. I have so many things people hate. I’m Black, I’m Muslim, I’m female.”

When I asked Rayan about mental health, she said she doesn’t like to talk about her emotions. But watching her quiet, haunting documentary, it’s abundantly clear she has found other means of self-expression. “When I write, it’s kind of like I’m talking to my emotions,” she said. “If nobody is listening, at least my notebook will listen to me.”

As a writer, I believe in the power of artistic expression to heal, comfort, and connect. Shaping our own narratives can help us find light amid the shadows: something the tweens and teens I spoke to did with stunning clarity and courage.

As a child, I was fortunate to have adults in my life I could open up to. After The Lion King, I told my mom what I was feeling, and she immediately found a mental health professional to offer support. Even so, it took many years before I could find the right words for my experience. But as I speak more publicly about my depression in the wake of Zia Erases the World, it has put me on a path parallel to Zia’s. Inspired by the honesty of the children and young adults I’ve met, I’m trying to embrace mental illness as a part of my narrative. And by naming my most private pain, my darkest secret, I hope to help young people feel the same way they’ve made me feel: less alone.

At my last school visit, a fifth grader asked: “When did your Shadoom go away?”

The answer, much like depression itself, is complicated. It did go away, and it didn’t.

But what I told her—what I tell everyone I speak to—is that you are always adding tools to aid in your self-care. Therapy. Medication. Friends. Art. Music. Books. If you can name your own dark room, the people in your life can rise up to meet you. Mental health struggles become a means of connection, not isolation. And instead of erasing your story, you tell it as a way to survive.

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