De-stigmatizing Mental Illness

I don't mind a good bout of crying every now and then. Crying releases the build-up of negative emotions like sadness and anger in a much less destructive way than lashing out verbally or physically. This is one of the reasons why I often run late during my office appointments. I can never walk out on a patient crying, I allow people time to release their pent-up frustrations and fear, stress and anxiety, anger and depression.

But crying on the 2nd day of the Lunar New Year was not an auspicious sign.

Vietnamese lore says what you do the first 3 days of the new year reflects what you do the rest of the year. Traditionally, we don't work on the 3 days of Tet, we don't cook, we don't slave over a hot stove. We spend time with family, eating pre-cooked banh Tet or banh Chung, sticky rice wrapped around mung bean and pork belly, steamed in banana leaves. We dress in red, the color of happiness, and wish each other joy, health, and prosperity, and give the younger generations little red envelopes full of brand-new lucky dollar bills.

So crying for no obvious reason during those 3 days was just...bad timing. I didn't know why I needed to cry, I just did. At least, I was able to do it after work while driving home.

The next day, I figured out the reason for my tears. It took an empathetic Mexican patient who came in with sky-high blood pressure, which she attributed to the New Year's Eve shooting in Monterey Park, the neighborhood where she used to live.

There was the aha! moment when I realized that my heart was reacting to an emotional trauma that my mind had not acknowledged. The hate, anger, and violence that disrupted the Asian community and caused the cancelation of Lunar New Year celebrations and festivities in Los Angeles affected me more than I thought.

This has occurred recurrently in my life. When I got the news of my grandfather's death, I was in my 3rd year of medical school. He was the first person I knew in my life to have died, but I had not seen him since I was 10 years old and he lived and died 8 thousand miles away. I didn't think much about it. For the next week, though, I walked around like a zombie and failed to follow up on questions, problems, and assignments. Until a friend asked what was going on with me, I had not connected the 2 events, that I was grieving in some way, even though my consciousness did not see the need for it.

In August of 2021, when I started having chest pain and difficulty swallowing, I did the usual workup to check my heart and lungs with EKG and chest imaging before admitting that it was probably watching all the footage of the fall of Kabul that triggered my emotional memory of the fall of Saigon decades earlier. Then in June of last year, when I couldn't breathe for a week, I was able to make the connection with the overturning of Roe v. Wade fairly quickly.

As scientists, we're trained all our lives to be logical and clinical, to think through everything. In order to solve problems, diagnose illnesses, and treat disorders, we learned to constantly see the world as a series of problems that need answers and solutions. It's the mind that processes all our data input and consciousness, the emotions don't get much say or attention.

As doctors, it is imperative that we separate the heart from the mind. We hear and see things all day long that can blow our minds and break our hearts. But as long as the mind can function, we can still do our job and help our patients. The heart is not a requirement for the job, is not part of the professional picture, and will just have to sort itself out later. It's just not acceptable and actually dangerous to freeze in the middle of an emergency. It's just not professional and somewhat pathetic to cry in the middle of a code. So we learn to suppress the emotional response to human tragedies, allowing us to stay detached and functional at all times.

I don't know if medical school nowadays teaches the importance of mental health maintenance for physicians, or do they still just teaches us how to treat patients with mental illnesses without regard to what it does to our own psyche. I remember looking around at my class of residents and marveling at how we each handled the intense stress and pressure in our own way. Some of us do it better than others. Cindy had a major breakdown during the ICU rotation. We had to take turns calling her and driving over to pound on her door until she could drag herself out of bed and call someone back. Marc had a close call with mixed drug and alcohol overdose. Vince died of suicide a few years after starting work somewhere in Kern county.

After a week of proctoring students recently, a colleague of mine was venting about how fragile the current medical students are "What do you mean they're stressed and anxious because they have to watch a patient die? We're doctors, that's what we do. If you can't take the heat, get out of the kitchen." And I had to point out that maybe it's better that they acknowledge those emotions and learn how to deal with them before they bubble up and catch them unaware.

When these emotions are suppressed or repressed for a long time, they can manifest as physical symptoms like headache, eye twitching, trouble swallowing, ears ache, jaw clenching, ear ache from TMJ, neck pain, chest pain, shortness of breath, nausea, vomiting, constipation, diarrhea, dizziness, skin rash, muscle spasm, etc..... They can also come bursting through in some unobtrusive or spectacularly violent way, like my silent tears or the mass shootings that we get every day now.

If it seems like there are more people having anxiety and depression than ever, it's because the stigma is slowly coming off these mental illnesses, and people can actually talk about it, especially the younger generations who don't have the same "keep calm and carry on" or "grin and bear it " attitudes of the older generations. For them, having anxiety or depression is no more shameful than having high blood pressure. And so it should be, because really, isn't it much more healthy to deal with it than denying it publically, then going home and drinking yourself to death?

For me, mental illnesses fall into 2 general categories. There are schizophrenia, paranoia, delusions, major depressive, or bipolar disorders where the chemical defects in the brain require medications to correct, and no amount of lifestyle changes or therapy will do the trick. Then there are anxiety and depression, which can be affected by life stressors and can be treated with psychotherapy in the early and milder stages.

We all have varying capacities to handle the stress that life throws at us. And unfortunately, some of us have more stressful lives than others. The sooner you recognize, acknowledge, and address your anxiety and mood disorder, the faster you can get back your equilibrium and resume a normal life. Sometimes just letting off steam may do the trick, but sometimes you need more help. If you do choose to try therapy, just remember, psychotherapists are just like doctors or dentists or plumbers or electricians, some may work with you better than others. It is up to you to decide whether a treatment is working for you or not.

Medicine is still working its way out of the dark ages. We're doing pretty well with infectious diseases and cardiovascular diseases. We're coming along with cancer treatments and autoimmune diseases. But mental illnesses and women's health are barely getting started and still carry so much stigma in so many vast halls of medicine. At least there are lights shining now in some of these corners of darkness.