October 9, 2020
Mental Health Awareness Day
Editor's Note: This story is not so much about our project or our research, but it's about a person who makes our research possible. We are grateful that Ursula Ruiz Vera chose to share her personal experiences here so that we may consider the individuals who make up large interdisciplinary projects like RIPE. Thank you all for helping us shine a light on a topic that is too little discussed in academia.
Adrenaline rushes through your body, enveloping you in its fire and invisible smoke. Your heart pumps rapidly, further feeding into your dizziness and disorientation. Your cheeks turn red as heat fills your face and you begin to shake. Your hands start to clam up and your body feels as though it is fighting a frantic battle between hot or cold and safe or vulnerable. On a daily basis, we all deal with anxiety or worry to some extent. However, what happens if this anxiety is a frequent occurrence? What happens if it severely interferes with your life? Dealing with anxiety can be a long journey, but it doesn’t have to be a journey traveled alone.
I want to share my experience dealing with anxiety because I know that many people may struggle with this issue in silence. I hope that my story can help others realize that they are not alone, that asking for help is okay, and that they are not inferior or any less valuable because they are dealing with this problem. I will also briefly share what I have done to better manage my stress more healthily.
Part 1: Welcome to the USA
I have struggled with anxiety for a long time, but some events definitely have spiked my symptoms, one of which was the academic and social stress I experienced during graduate school. I am from Peru and despite having lived abroad for a few months in other countries, coming to live and study in the U.S. was a completely different experience. Although my English was sufficient to earn a Test of English as a Foreign Language (TOEFL) score that was necessary for graduate school, my experience in the classroom did not leave me fully prepared to live in an English, monolingual environment.
I remember telling myself during my first class, “I do not understand anything the professor is saying. How I am supposed to succeed in this class?” I ended up recording every class and listening to each class for about 6 hours while taking notes to try to get used to the rhythm of American English and recognize the words more easily. I continued taking and practicing English classes to improve my fluency, but I have to admit that having not been able to improve my English at the pace I wished made me feel disappointed and less intelligent.
Further, my social anxiety came from not being able to express myself in the way I wanted. I also dedicated most, if not all, of my time towards doing well in my courses and research. This left me with having little to no time for social interactions during the first two years of earning my Ph.D., unfortunately welcoming in isolation and loneliness. I did try to join a study group, but I quickly realized that I needed to study by myself because I could not keep up with my peers’ proficiency in English. The reality was that due to the language barrier between us, it was going to take me longer to study and I needed to accept this outcome.
I noticed I was experiencing homesickness—the stress caused by being away from home—after celebrating my first Christmas and birthday in the U.S. I was not used to celebrating these occasions by myself, and although I do not tend to give much importance to holidays, I truly missed my family during that time. Since then, I have made a commitment to spend my birthday and Christmas with friends and family, either in the U.S. or in Peru. Something that helped me feel less homesick was limiting the amount of information I was receiving from Peru and focusing on experiencing new things in the U.S. and living in the present moment.
Additionally, I had the pressure of exceeding in graduate school. I could not fail any of my courses, otherwise, I would be on academic probation or worse, I would not be able to graduate. I ended up almost failing a course during my second semester, but I was able to drop the course after receiving the grades of my first exam and realizing that I was the lowest outlier in the grade distribution presented in the classroom. I was allowed to audit what was left of the course that semester to ensure I would be more prepared for when I would later retake the course. Despite feeling embarrassed to show up to the class after such a bad grade, I persevered. It was not easy, but when I retook the course, I passed with a good grade.
I also pushed myself to perform novel and successful research. In my field of agricultural research, unexpected weather conditions that affected the plants were another variable that I could not control. At the time, this further exacerbated my feelings of anxiety and stress. The social interactions that my Ph.D. required also played a part in my stress. It was not easy to lead a project while working closely with many other colleagues who had different personalities and cultural backgrounds. I had to adapt and learn to be able to collaborate and communicate successfully to achieve our research goals.
While these experiences and obstacles may be standard among newcomers to a different country, everyone has their own coping mechanisms that are unique to them. At first, I did not have the necessary tools to deal with these experiences, and I did not feel as though I had a supportive environment, in part, because I focused my time on studying and working. I had almost no sufficient time to confront and regulate my anxieties and stressors. Unsurprisingly, my stress levels increased so high that it started to spill over, and it was not until I started to experience panic attacks that I realized that I needed to change my behavior.
Part 2: Hit the panic button
Panic attacks and anxiety attacks share many common traits, such as increased heart rate and shortness of breath. Panic attacks can happen suddenly and without a clear reason or trigger, whereas anxiety attacks occur in reaction to external stimuli and will go away when the external stimuli are gone. An example of an anxiety attack can be illustrated as follows. When you are traveling on a turbulent plane, you can get scared and have some of the following symptoms: sweaty hands, increased heart rate, and changes in body temperature or difficulty in breathing. As soon as the turbulence stops, these symptoms disappear and you feel better (more information here). Symptoms that are more characteristic of panic attacks are shaking or trembling—seemingly for no clear reason—along with the sensation of feeling disconnected from oneself and their surroundings. Personally, that disconnection is perhaps the most painful part of experiencing a panic attack.
I remember the vivid details of how I felt when I experienced my first panic attack. I was sitting in class listening to a research seminar and my heart rate suddenly started to build up to the point where I felt hot flashes and had to leave the room. My “fight or flight response”—a physiological response typical of dangerous or life-threatening situations—was triggered, even though nothing was actively threatening my life at that moment.
During a panic attack, the sympathetic nervous system is stimulated, causing the release of stress hormones like epinephrine or adrenaline, norepinephrine, and cortisol. In my situation, I felt dizzy, my vision was blurry, I could not stop shaking, and I felt disconnected from myself. I do not remember what I did exactly to calm myself down because, at the time, I was more focused on what I was feeling than what I was doing. I probably called my sister because that is what I would usually do when I experience a panic attack. I am lucky that I can reach out to my family so easily, despite the physical distance between us.
Since that day, I have learned that talking with someone and focusing on more positive thoughts or doing something that engages my attention—like seeing pictures of my nephews—helps me relax. After recovering a bit that day, I cried because I knew that I needed professional help. I cried because I felt I was not strong enough to deal with this situation on my own. I thought that something was wrong with me and that I had failed to take care of myself. These feelings may be common among many other people as well, due to the social stigma—which has since improved—surrounding mental health. However, reaching out for help does not mean that something is wrong with a person or that they have failed to do something. Reaching out and asking for help takes strength and courage.
Part 3: Reach for a helping hand
I went to see a counselor at the university clinic, and I had two sessions in one week. During my second session, I told my counselor that I wanted to consult a psychiatrist to see if any medications could help ease and improve my panic attacks. I was not familiar with the medical system in the U.S. at the time, but I knew that psychiatrists are doctors who prescribe medication that can help in these situations and I just wanted to feel better.
After that experience, I noticed that people in the U.S. seem to be more open-minded about mental health than in Peru, where it is more common not to seek professional help and to instead hide these mental health problems. Luckily, my family has always been open to seeking professional help when needed, which allowed me to be able to identify that I needed to reach out and ask for help. I started my medical treatment at the end of my second year in graduate school, and I continued following this regimen until I graduated.
When I finished my graduate studies, I felt confident enough to stop my treatment. I started to ease myself off my medication until I stopped completely within two months with medical supervision. However, I realized that I have only treated the symptoms of my anxiety and have not confronted the root cause of the problem.
Moreover, I had an idealistic idea that looking for jobs after finishing my Ph.D. would be simpler. The truth of the matter was that I underestimated how stressful it was to look for jobs. Furthermore, I did not know if I wanted to continue in academia or choose a different path. International students are granted only a specific period of time to get a job in their degree field. In my case, I had a mere three months to do so or I would need to return to Peru. The uncertainty of the future weighed heavily on my shoulders.
On the other hand, the idea of going back to Peru did not sound too bad to me because I missed my country. But realistically, I did not know whether or not I even had a chance of getting a job there either. My family wanted me to stay in the U.S., where my two sisters were already established, and I listened to their recommendation. Meanwhile, I was going through a breakup and I was seeing my friends graduate and leave town, which all contributed to my emotional instability.
After a few months of searching, I was able to get a wonderful job at the same University, but I knew my mental health was not at its best because I was dealing with some symptoms of depression, together with anxiety. I noticed that when my shaking symptoms came back, I found it hard to get out of bed and go to work.
Again, I reached out for help, but I could not see my previous doctor because I was no longer a University student. To start the whole process again could be a little frustrating, but I just had to take action to take care of myself. I was lucky enough to find a doctor who was able to see me quickly after I called many others who were not receiving new patients or had any earlier appointments available. Despite this, I was able to find a doctor, but the reality is that in the U.S.—maybe in the entire world—the number of doctors working in the mental health field is disproportionate to the number of people who need and seek mental health treatment. This issue is covered in more detail in this article from the Association of American Medical Colleges.
I ended up dissatisfied with my experience with my new doctor because she told me that I should never quit my medication again, without giving me any other treatment alternatives or options. I view medication as an important part of treating both short-term and long-term conditions. I am hoping that I learn how to better manage my anxiety in other ways and eventually quit using medication. I want to emphasize that I am not suggesting that people should try quitting medication if they are in treatment due to mental health issues. Depending on one’s diagnosis, they can evaluate their options with the supervision of their doctor; however, it may also be prudent to seek multiple opinions.
I decided to find a different doctor with whom I was more comfortable, one who would listen to my specific wants and needs as a patient. It took me two years to find my new doctor, and since then, I have been working on trying to become more emotionally stable and putting myself in a position where I can better succeed the next time that I try to ween off my medication.
Part 4: Identify your recipe for success
I am a fan of programs and books that tackle the topic of self-motivation, self-help, and personal and professional growth, which encourage people to become and grow to be the best version of themselves. A couple of the books I have read are the best-sellers written by Marie Forleo and David Goggins, and one of my favorite YouTube programs is “Impact Theory” by Tom Bilyeu.
Therapies like “cognitive behavioral therapy” (a practical approach to changing behavior) and “metacognitive therapy” (a recognition of thinking patterns that perpetuate certain behavior) are very common ways to help manage one’s anxiety. I try to apply some of these tools in my life. With the help of these sources, I have learned how to identify situations that can trigger my stressors. I have learned more about my fears and why I react the way I do in certain situations. I have also learned to stop negative thought spirals and nonsense that I would tell myself, which has been eye-opening for me.
I also prioritize physical activity because it helps me to relieve stress, and I have noticed how much happier I feel after I exercise. I do meditation and use breathing techniques for at least 10 minutes every day. I try to eat healthy foods and I use supplements known to be good for my brain like Omega-3 fatty acids. I am no longer the hermit that I was when I first started my Ph.D. One day, this last April, I woke up and I had the realization that I was happy and at peace with myself. Except for the added stress from COVID-19, other things in my life have, thankfully, not changed. I still have the same work, the same house, the same friends, and the same coworkers. I feel joy and I am grateful for what life has given me, including the obstacles I have faced because they have shaped me to become the person I am today.
I have to recognize that throughout my journey dealing with anxiety, I was fortunate to have health insurance and to be able to receive professional help. I cannot imagine how I would have handled my panic attacks without this help and one thing that I know for sure is that I could not have finished my Ph.D. without reaching out to others. Due to COVID-19, many people have lost their jobs and are experiencing many financial struggles. Also more than likely, people do not have medical insurance and are experiencing even more difficulty obtaining it because they may need to prioritize paying rent and food.
Is there something we can do to help people close to us to better handle their stress? How can we create a supportive environment for people struggling with anxiety? Especially during this time where anxiety is prevalent, the power of an act of kindness can go a long way. It would be ideal to create environments where people do not feel afraid to share their experiences with mental health issues. It took me around 9 years to feel that I can share my story and that I can handle people’s reactions. I hope my story helps at least one person to not feel so different or bad about themselves.
Stressful situations will come unexpectedly in life because life is unpredictable. Although we cannot control the situation, we can control how we react to it. Do not overlook your mental health; it is essential and possible to achieve your dreams in the future. You do not need to go through this by yourself. It is okay to ask for help and it is easier if you are not going through this alone.
By: Ursula Ruiz Vera || RIPE Postdoctoral Researcher