Understanding mental health disorders in order to empathize with patients
I am a student pharmacist, like you, and I have struggled with mental health for most of my life. I suffered from depression during high school and have had generalized anxiety disorder (GAD) for as long as I can remember. I used to be ashamed that I had these conditions. I now see that my shame was because of society’s perception and the stigma around mental health disorders.
When I learned that GAD is an actual disorder and that my constant, overwhelming anxiety was not my fault, it felt like a huge weight lifted off me. I also realized that I did not have to battle depression alone as a teenager and that seeking treatment would have saved me from the gut-wrenching emotional and physical pain I endured for years in silence. No one should have to suffer mental health disorders in silence or feel that they are alone. I promised years ago that I would be more active in helping others with similar mental health conditions.
When I was presented with the opportunity to write this article, I was initially hesitant to rip open old wounds. But then I remembered APhA–ASP President Michael Murphy’s theme “Begin Your Legacy” and Alex Sheen’s 2017 APhA Annual Meeting & Exposition keynote speech, “Because I said I would.” I realized I need to be more proactive if I want to leave my legacy as a humanitarian who helped others with similar mental health conditions as mine, and that means stepping out of my comfort zone. I am beginning my legacy here, by sharing my story to help student pharmacists understand how depression and anxiety affects a person, and so that they can better empathize with the people who suffer from these disorders.
Stigma often arises out of naivety. People tend to reject what they do not understand and cannot see. Educating others on these disorders can help break those negative perceptions. I also want to let those who are living with depression and anxiety know that they are not alone and that there is hope. Over the years, I formed bonds with people who also have anxiety over a mutual understanding of what the other person is battling. They have become my support system on the hard days, when my anxiety is too heavy to carry alone. My hope is that I can help at least one other person find their support system and encourage them to open up.
The dark years
As a teenager, I seemed “normal” on the outside. Inside, I battled depression. I could not understand why I was depressed because I felt I did not have a legitimate reason. I had a family who loved me unconditionally and provided me with a comfortable life and had a fantastic group of friends. However, I could not escape this constant overwhelming emotional pain. I felt immense guilt that I was fortunate to have the life I had, yet I was depressed. In my mind, feeling depressed meant that I was not appreciative of what I had. The guilt would worsen my depression and I would feel helpless because I could not control either emotion.
During the day, I would put on a “happy” face and push through, but when I was alone, the tears would flow. I can recall countless times that the emotional pain was so painful I could barely breathe. I just felt pain and darkness. I needed an outlet for this pain, which I regrettably found through cutting myself. Many people think self-harm is a way of getting attention; the reality is that the physical pain is a distraction from the emotional pain. I could deal with physical pain, but I could not handle the emotional pain. I knew that there were treatment options, but society had created a culture that suggested you were crazy or an attention seeker if you saw a “shrink” or resorted to “popping pills.” As a result, I never considered therapy.
Living day after day, pretending to be happy while I was drowning in depression, was physically and emotionally exhausting. There were days when I just felt like living was becoming too hard. I was broken and did not have an ounce of energy left in me to even get out of bed. People often say suicide is selfish and that statement really stings. Contrary to some beliefs, suicide is the last resort in that person’s mind, not the first. Living has become impossible and they feel that they do not have any other option. But they have to know that there is hope. I survived, but how many people did not?
Coping with anxiety
Everyone experiences anxiety as part of normal physiology. Anxiety is a natural response to a stressor and is intended to encourage the person to resolve the stressor. Anxiety over an upcoming exam motivates students to focus on studying harder. Thus, a healthy level of anxiety can be beneficial. In contrast, clinical anxiety is an exaggerated response to a stressor or is present when there is no stressor. Imagine experiencing the anxiety you feel before final exams every day. That is what I experienced on a day-to-day basis, and even more severely around exam times.
On a typical day, I would dissect every interaction I had and find mistakes in everything I did. I would replay and fixate on my mistakes over and over for hours. I was constantly anxious over worst-case scenarios no matter how much I told myself there was little to no chance that those things would happen. I dredged up embarrassing or bad memories and became obsessed with rehashing all the details and emotions, thinking of all the ways I could have avoided those moments. Any emotional response is amplified a hundred-fold in people with anxiety. The heartbreak from hearing tragic stories could send me into a dark place. I have had sleeping issues for as long as I can remember because I cannot shut my mind off. Falling asleep, and staying asleep, were a challenge. I woke up throughout the night unable to fall back asleep because my mind was constantly running.
Over the years, my anxiety worsened to the point that it physically hurt and caused heart palpitations. Countless hours in the day were wasted because my mind could not stop fixating on every problem. Every minute is precious when you are in pharmacy school, so it was severely affecting my school work. Anxiety attacks increased from a couple times a year to several times a month. During an anxiety attack, it feels like I cannot catch my breath, causing me to hyperventilate, and it eventually progresses to a mental breakdown. Anxiety attacks are analogous to an electricity surge that overwhelms the circuit, causing the panel to explode, except the electricity is anxiety and the exploding panel is my mind.
On my better days, I couldn’t even enjoy the feeling of calmness, because I feared the anxiety would come back. I began to consider pharmacotherapy, but was still hesitant. Anxiety is all I have ever known in my life; I never knew a day without anxiety. Was I ready to know what healthy felt like and then have that taken away from me when I needed to discontinue drug therapy if I became pregnant? I know, I was worrying about something that wouldn’t happen for years. It sounds ridiculous, right? That is the crux of anxiety; obsessing and worrying over every negative possibility as if it were happening in the moment, no matter how remote the situation (or how unlikely it would happen).
I finally sought help from my physician. I broke down in her office and said, “I cannot take it anymore. I am suffocating.” I was started on an SNRI agent since my demanding schedule did not allow for cognitive behavioral therapy. There is a reason SSRIs and SNRIs are titrated from a low dose. The first 2 weeks of initiating therapy were plain hell. I felt awful, so much so that I began battling whether I could tolerate it another day. However, I could not bear the anxiety any longer, so I had to push through those 2 weeks until the agent became therapeutic and the adverse effects subsided. Nowadays, I still have anxiety that negatively effects my quality of life but it is tolerable and manageable, thanks to therapy.
How you can make a difference
As a friend, the first step in helping those with mental health disorders is to listen, be empathetic, and simply be there for them. Avoid diminishing their worries by telling them to relax or that it is not a big deal. As a pharmacist, you can help patients understand their condition and how to seek help. Most importantly, educate others about mental health disorders as an effort to dispel false notions.
In order to help patients and educate the public about mental health disorders, you need to learn the pathophysiology, signs, and symptoms of these disorders. If you are unsure where to find reliable medical information on mental health, do not be afraid to ask a professor or mentor.
Mental health disorders have claimed and affected enough lives. It is likely that you or one of your peers struggles with mental health. It is time to break the silence and change the way society views mental health. As a
future health professional and pharmacist, you owe it to your patients.
As civic leader George Bell once said, “You can pretend to care, but you can’t pretend to show up.” It is time to show up.
By Anonymous