I welcomed 2016 with a nervous breakdown.
The household was quiet on the third day of 2016, as it should be at four in the morning. My parents found me on my bedroom floor, crying, clutching a pair of shears. I was cutting random locks of my hair which, at the time, reached just to my waist. Snipping and clipping, I didn’t really know what I was doing; I just wanted to deface myself in some way to express on the outside how much I hated myself on the inside. I didn’t realize that was an act of self-harm. The night before my impromptu haircut, I had a sketchy hook-up with a random guy whose face and name I can’t even bring to mind right now. I felt neither satisfaction nor shame after the deed – just self-loathing and that ever-present gnawing feeling of hollowness. I didn’t realize that an unsafe one-night stand was self-harm either.
I was officially diagnosed at nineteen with major depressive disorder and generalized anxiety disorder. But I knew since I was younger that there was something wrong with the way I felt genuinely empty inside. It has always been difficult to explain what depression felt like. Some days it was a vapor cloud that choked out the motivation and energy within me. At times, it was a slight breeze, blowing just enough that I feel truly happy at that instance, but also enough to remind me of its waiting presence. Depression wasn’t always ugly crying in my experience. Usually, it meant lying in bed and drawing a blank as to why life was still worth living and wondering how much effort and resources could be saved if maybe, just maybe, I could disappear and stop existing for a while (or forever).
Anxiety was much easier to notice. I had always been self-conscious and overly critical of myself, but I thought the ever-present noisy torrent of irrational thoughts in my head was normal. I remember my first panic attack was at twelve years old, but I don’t remember what triggered it, and that’s the point, I think – that a person with generalized anxiety would panic at usually insignificant things. Throughout teenhood, my parents got me tested for cardiac arrhythmias, hormonal imbalances, respiratory issues, and so on, because “panic attack” seemed such a foreign term back then.
The panic is real, though: the nausea, difficulty in breathing, numbness, tunnel vision; feeling faint and tense at the same time; the sudden rush of adrenaline. “Fight or flight” kicks in, but it has a third option: “freeze” – and that’s usually what happens. A panic attack feels like being asphyxiated by my brain but my body just can’t do anything about it. Then as quickly as its onset, it’s gone. but of course, I’m going to be extra wary of when the next one will be.
Life went on, as it does, until my senior year of undergrad and suddenly the pressure and work was too much. Insomnia kept me up at night and I was too fatigued and apathetic to go to class the next day. Every exam was greeted with a panic attack. I reached my breaking point so I just went and set an appointment with a psychiatrist. I didn’t want to think about it anymore, I just wanted to be functional again. The relief I felt at that first consultation was overwhelming. At the time, discussing treatment options with my psychiatrist – whom I now refer to as my mentor-tita while she accompanies me throughout my recovery and med school journey – was something I had never thought I could actually do, three or five years ago. The thought of taking medications (antidepressants and anti-anxiety meds) for my conditions daunted me, but I knew that that solution was better than my current state. I was so nervous to tell my parents that I had seen a shrink behind their back – that there was something wrong with me – but they were so accepting and supportive that I just cried. (Until today, they try to understand me even at my lowest lows, and for that, I love them so much.) I attended monthly psychotherapy sessions with my psychiatrist. I took my meds every day. I dealt with the exams, I co-defended my thesis, and I tried to have the best senior year with my close friends. I graduated! I still had really awful depressive episodes though and while medical school was the next big step for me, I knew I wasn’t quite stable enough for it yet. My parents allowed me to take a year off before applying for med school to be mentally healthy, and again, I’m so grateful to them for that.
Unfortunately, while on the road to recovery, it’s dreadfully easy to fall back on old toxic habits and relapse. Especially, I guess, in a toxic and stressful environment such as med school. During my first semester, I stopped seeing my psychiatrist, convincing myself that there was just “no time”. There were weeks when I felt energetic, hyperactive, and even confident. (I don’t feel this often, so the rush is always thrilling). I didn’t feel the need to sleep because I felt like I could start accomplishing things on my to-do list instead. Then came the crash. I felt irritable, unmotivated to go to class, and generally indifferent. I had panic attacks most days as well. I would get out of class to hyperventilate, sometimes to vomit. I binged on alcohol to drown the depression. The suicidal ideation crept back and the thought of overdosing on prescription meds felt so within reach. I didn’t know which emotional state was “normal” anymore.
I finally, finally, finally stopped avoiding my psychiatrist, and she was concerned that I was rapidly cycling through episodes of depression and hypomania. She was concerned that my antidepressants were treating the depressive episodes but worsening the hypomanic ones. Apparently, it was quite common to misdiagnose Bipolar II disorder as solely major depression, because the hypomanic episodes could easily manifest as productivity and energy. Only after years would patients be diagnosed as Bipolar II, just as in my case. (Hypomania is great because it makes you feel invincible for a while. But mixed episodes of hypomania and depression were scary: zero sense of self-preservation plus one-hundred percent energy to do irrational and risky things, like chain smoke, or binge drink, or run around in the middle of the night waiting for a car to run into you.)
I’ve never been the healthiest person–physically, mentally, or emotionally. How ironic that I’m studying to treat and care for sick patients while I could barely care about my own well-being. Most days, I’m still not sure until when I’ll be around in the near future. But when I do find myself in those days, I remember my list: my parents, who are always so loving and supportive despite how I difficult I can be; my siblings, whom I will try my best to protect always; my friends, who are the pillars propping me up. I think of how much I’ve dreamt of having those two letters – M.D. – after my name since I was little. I think of the times when I am most myself (i.e., loud and awkward, but easily amused by the most random of things (food, cats, memes, cute boys, etc.) and not defined by and at the mercy of my mental illnesses. I think of sunflowers and how the lovely yellow blooms naturally turn to greet the warm light of the sun. But mostly, I think of the times when I was at my worst – not simply looking down towards the bottom of a dark pit, but feeling like I was stuck way down there. I think of getting panic attacks and harming myself (not with scars on my arms, but with scars on my lungs and liver and heart). And then I remember that I’m still here and my heart still beats within my chest, quiet but steady and defiant.
Sometimes, that’s all you can achieve in a day: To survive, to live another one, to carry on despite having a harder time with your mind than most people do. There are good days and there are bad days, but what matters is that you are still here. Always remember that self-care is important. Surround yourself with a solid support system, loved ones who are open-minded, caring, but firm with you as well. Remind yourself that you are not alone, no matter what your mental illness tells you. Circumstances change and things get better, although they take time, effort, and patience. Please take care and I wish you the best.
-Sara Eleazar, medical student
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