If there were one person in a wheelchair and another person standing, whom would you choose as having a disability? When one thinks about a disability, the first assumption is commonly related to a physical impairment, one easily seen and tangible. According to the Americans with Disabilities Act (ADA), they define ‘a person with a disability as a person who has a physical or mental impairment that substantially limits one or more major life activity. This includes people who have a record of such an impairment, even if they do not currently have a disability…and individuals who do not have a disability but are regarded as having a disability.’ Commonly, this would include people with a physical impairment and missing limb(s). However, there are many disabilities that people have that cannot be visualized. It includes those with post-traumatic stress disorder (PTSD), attention-deficit disorder (ADD), and generalized anxiety disorder (GAD). Someone could look completely “normal” at first sight from their exterior but may be managing a mental disability. Mental health is a complex facet of medicine that has only recently been getting more public attention over the past thirty years. It is still a taboo subject of conversation in many ethnic groups, including the Asian-Pacific Island Americans (APIA), which I belong to. Amongst the medical community, mental health issues and disabilities are apparent in patients we treat, but what about amongst our peers and colleagues? We can easily disguise our own mental disability by staying busy, putting a smile on, and consuming ourselves in our work and treating patients, but there comes a point when we have to address it and admit that we may need help doing so. This has been my reality.
Mental health was never a subject discussed in neither my family nor much throughout my education growing up. The only time it was ever brought up in conversation was around death, suicide, and the passing of young people in my community, such as my friends when I was in high school. I had always considered myself physically and mentally healthy, keeping busy with school and multiple clubs and sports. I had moments of stress balancing all my activities and schoolwork, sometimes having some “breakdowns” or talking back to my parents when I was sleep-deprived. It was not until I entered medical school and had to deal with very difficult situations and the stresses of a medical education that my mental health was finally categorized as something. Like most students driven for a challenging but rewarding medical career, I was always pushed to do my best and be the best. Sometimes I succeeded, and other times I did not. Getting into medical school is a challenge feat, with taking the MCAT, applying to programs, going on interviews, and trying to figure out how to pay for a graduate education. Once in medical school, it is an entirely different beast. During my interview process, I was told that medical school is like drinking from a fire hydrant through a straw. This barely scrapes the surface. Although I cannot pinpoint the exact moment when I learned that my mental health was something much bigger than just stress, I eventually broke.
Test averages, assignments, reading material, volunteering, etc. all seemed to pile up. When I thought I had swam past a large swell, another one was bashing me down into the riptide. Looking at and speaking with my peers, I tried to keep this façade up, that things were hard but that I was able to handle it. I never complained. I moved forward. But test after test, numbers, averages, and discussions about STEP1 all smacked me in the face, and I crashed. I had short 5-minute freak-outs to full, fledged panic attacks, sometimes lasting over 30 minutes. I worried about school, making sure to spend time with my family, not missing hanging out with friends, my body weight, etc. I thought I was weak and could not bear admitting this to my peers, let alone my family. It got overwhelmed trying to juggle multiple issues, and I eventually admitted what was happening with me to my family and academic advisors, seeking help from my school counselors. There were multiple meetings over the course of my first two years where we talked about how I was feeling, what I was doing, medications that had been prescribed and whether or not they were helping. Adjustments were made, behavioral techniques were attempted, some working while others did not. Yet, throughout my entire ordeal, no one except my family and close friends knew what I was dealing with. I kept pretending that everything was fine on the surface, keeping a calm presence above water while my legs were hectically treading to keep me afloat.
Over the coarse of this time, I was diagnosed with generalized anxiety disorder, a disability that affects my day-to-day. It is a disability I have only recently accepted and am managing. Some days are good, while others are not, but I try to manage it one day at a time. Exercise has helped me release some of the tension and stress I experience. The natural endorphins I get help clear my mind and allow me to focus on my breath and be in the moment. Yoga and meditation at the end of the day helps center myself, reminding me of how strong and capable I am. Self-care is an important aspect of daily living that everyone, no matter if they have GAD or not, should always try to incorporate in their lives. This could include painting, meditation, yoga, and even getting a massage. Unlike those with physical impairments, my disability is something that I can cover, hiding it from the public, helping me weave in and out of life without people staring or making pre-conceived assumptions. Yet, it is an obstacle I must face, like any other disability out there.
Disabilities do not and should not define those who must bear its weight. I learned to share my story with others and help those who might be struggling with similar problems. I sought out mentorship and advice from people in the medical field who have faced similar challenges. I learned that admitting defeat and asking for help is not a sign of weakness, but rather a sign of courage and strength. Seeking out programs, accommodations and a community available to those with disabilities have been vital to how I am overcoming and managing my GAD. I have incorporated these and other tools to better understand the signals and physical signs of when I may need to take a step back or ask for help. It is important that we work together to make safe environments where people without disabilities can learn from and engage with those who do, slowing chipping away the stigma. When we make these strides, we can change the dialect from that of shame and fear to one of acceptance and understanding.