Mclean Hospital

Podcast: Lessons Learned – One Family’s Experience With Depression, a Suicide Attempt, and Recovery

December 10, 2019

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Trevor talks to Ana about how hiding her intense depression, social anxiety, and eating disorder led to fear and despair, ultimately resulting in a suicide attempt during her first semester at college.

Ana is joined by her parents Rafael and Patty, who candidly discuss the warning signs they missed, what they wish they had done differently, and how their family has used their own experience to help other families better understand adolescent mental health.

Episode Highlights

  • Rafael, Ana’s dad, talks about how mental illness is viewed in Venezuela, his native country (13:30)
  • Ana’s mother Patty explains how she missed the signs of her daughter’s illness (01:06:18)
  • Ana describes the immense pressure she was under while in high school (01:15:30)

Relevant Content

Episode Transcript

Ana: I was 19 years old—

Trevor: How old are you now?

Ana: 22.

Trevor: 22.

Ana: And I attempted suicide on October 23, 2016. I was a freshman in college. I had been struggling with depression since I want to say the beginning of my junior year. Super under the radar stuff, but I just know that I’d always been anxious ever since what happened to me in middle school with the bullying, and these two friends of mine that I’m obviously not friends with anymore. I’d always had a lot of anxiety, like social anxiety. I was worried that-

Trevor: Do you date abusive men?

Ana: I have a tendency to be attracted towards them. That’s got to change for sure. But the ex, he’s not in the picture anymore. Okay. Yeah. Sensitive topic—

Trevor: Come on. Come on, let her tell her story.

Patty: That was a good one.

Trevor: Let her tell her story.

Ana: I always worried, I was always stressed of making plans, because again, everyone grew up together. They had known each other for so long. Everyone basically already had their group, and I just remember in middle school, who am I going to hang out with? You know, it’s the last day of school, I don’t want to just go home, I want to go out, I want to hang out with my friends. Same thing happened in high school. And I made friends. I make friends. I have friends. But it was just always something where when conflict arose, I was always the one that was given the boot. Every single time. And it sounds so victim of me to say it, but to this day there are many reasons why I don’t know why I’m not friends with some people. Yes, I’m very loud, and I know that that can be a lot.—

Trevor: I know why I’m not friends with a lot of people. I’m too much to deal with. I’m not saying that’s ... I am. I’m too much to deal with. I’ve got my core set of friends who have figured out the value that they have with me, and have figured out how they have to trade that off. You know? In order to have this part of him in our lives, we got to deal with this part of him in our lives. And yeah, it’s taken a long time. But I have this core set of friends that ... And you’ll get there.

Ana: Yeah. Joined a sorority. Really thought that would help.

Trevor: No.

Ana: The thing is, I loved it when I joined, absolutely loved it. But, just going back to when it all happened, I ... There were so many people obviously from my grade that were going to Ivy’s, or if they weren’t, a lot of them went to other schools for sports. A part of me, the first school that I went to not a lot of people had heard of it, but the minute I said, oh but I’m running cross country there they would say oh okay, yeah. It almost clicked with them, where it’s like that school sounds irrelevant, oh but you’re going there for sports? Fair enough. And so also at the time, me and my ex were kind of on and off, and he was only at school like an hour away, so it just so happened ... It just so happened that it worked out, because that was a big topic of conversation between me and my parents. Of course, I was dumb—

Trevor: You guys loved this kid, didn’t you? You loved this boyfriend? He was a quality man, wasn’t he? Yeah. Rafael. Yeah. Look at that. Big fan. Big fan. Okay, please continue.

Ana: His family is very sweet. I loved his family. Don’t get me wrong—

Trevor: That doesn’t make a good boyfriend.

Ana: I mean, it helps.

Trevor: No.

Ana: Okay.

Trevor: It doesn’t.

Ana: But we had some really nice times together.—

Trevor: And that wasn’t to be ... It’s more distortions. Well, he’s got a great family. I’ve been there. Her sister is so nice to me. You know? That doesn’t make any sense.

Ana: I love his grandparents.

Trevor: Yeah. I love his grandparents. That makes no sense. I mean, I’m not going to say who, I had a mother after a breakup reach out to me.

Ana: Same—

Trevor: ... and be like, I’m so unhappy you guys didn’t work out.

Ana: Same—

Trevor: I’m like, did you tell your daughter that? What are you doing telling me this?

Ana: It’s just been ... For both of us, it was our first serious relationship. There were many things that we didn’t know how to handle. One of them being I wasn’t aware that I was struggling, and clearly, he didn’t know how to handle it. He tried sometimes. He really, really tried. But, I mean, that’s also not something that personally it’s not healthy to put all of that on someone. I’m not giving him credit either, because he really didn’t help. But at the same time, I was incredibly unwell, and I didn’t know how to communicate it, and I didn’t even know if I was being dramatic, because he would tell me at times that I was being dramatic. We broke up halfway through my senior year. I was fine after that.

Trevor: Senior year in high school?

Ana: Yes. Yeah. Because I knew it was the best decision for me. It hurt, and it wasn’t easy, because I was still codependent. I was like wait, I’m alone, wait that’s like really not okay. I mean, I was depressed. And went off to school, was sick. I made the most amazing friends that I’ve made. They were really, really good to me through everything that I had ... I’m not going to say put them through, but the amount of support that they gave me. It was their freshman year at college, they’re all 18 years old. And then for one of their friends, like yes, I don’t know if the friendship would’ve lasted if I’d stayed at that school, but for the friends that I had while I was there I’m forever grateful for everything that they did.—

Trevor: Do you still talk to them?

Ana: One of them, we did sort of reconnect. She’s kind of like the blonde version of me. I remember we had a class together and we met during orientation or something. And we had just hung out the rest of the day. And I kid you not, that night we were just meeting people, not only did people ask us if we went to the same high school together, but they asked us if we were roommates. And we had met that day. I mean, obviously I know now you don’t meet a lot of people that are like that. And for the rest of them, I did lose ... We’re not friends anymore. But it’s because I was pretty selfish after it happened. I expected their world to revolve around me. And I expected them to always be reaching out, to always be texting me and asking how I’m doing.

But then again, looking back, I didn’t even consider in the slightest bit how that affected them. A lot of them went to therapy back at school for a long time. They went to group therapy, individual therapy. That’s a lot to have dealt with that entire situation. But I mean, I believe with time, with one of my friends that I reconnected with, it’s not the same. For me, I try to be careful with it, because we both know we do want to be friends, but I’m not going to push it. It’s not like I want to reach out and tell her about other stuff that’s going on, because we just haven’t physically caught up in person yet, and that’s out of bounds.

But for the most part, a lot of the social anxiety is what still affects me. I’ve learned a lot about friendship at school, like right now and ... Right now I do have an amazing group of friends that they’re there for me, but they are also honest with me when they tell me, you know you can come to me with anything that you need, but we also want to make sure that you’re getting the sufficient amount of help that you need. There’s some things that we won’t be able to discuss with you, because we think that you know that you need to bring it to a professional, which is something that I know. And I don’t go to therapy at school, because I hate the guidance department at school. I don’t think it’s great.

Trevor: Right.

Ana: But, whatever, that’s a work in progress for them. If they tell me it’s a work progress, I’m sorry, but I’ll see it when I believe it. I have them, I have my therapist back here at home, and there are times when I’m not feeling great, and I really don’t want to tell my mom or dad, because that can raise red flags. And I don’t want my poor mother to freak out or to worry that much. But, ever since the attempt it’s—

Trevor: Wait a minute, wait a minute, wait a minute. But she’s—

Ana: Mm-hmm.

Trevor: Do you freak out, or do you act?

Patty: I act.

Trevor: Does she freak out or does she act?

Ana: You’ve gotten better. But I remember in the past, I would call her and say I haven’t been feeling too great, I don’t really get out of bed, I’ve been trying to go to class, but not really. And she’ll go, “—I will so come up to campus right now if I have to.” And I love it. That’s what every kid wants from their parent. And that sounds bad. And I love the support that I get from my parents. But that makes me nervous.

Trevor: Okay. Yeah. Okay, I see that—

Ana: Because, I want—

Trevor: Right, I see that—

Ana: I feel like it also takes a level of trust where it’s not like this is a 911 emergency type thing, this is just maybe I don’t feel too great. And it’s frustrating, because I have a therapist back here at home, but obviously I can’t pick up everything and come back to see her. And I know I haven’t seen her in a while, and one of the things that my friends tell me is that I’m a very, very self-aware person, which is ironically enough that’s something I’m aware of. I try to be very in tune with how I’m feeling, which can get tedious at times. If I wake up, and I’m going through my day, I’m like am I tired? Well, maybe it’s because I didn’t get enough sleep. Well, I did get a lot of sleep, maybe it’s because I wake up too early. But is it also because I’m stressed, or is it because something else is going on?—

Trevor: Do you think you’re too much in your head?

Ana: Yeah. All the time. My friends, everyone tells me that—

Trevor: Yeah, me too.

Patty: Can I interrupt? Just one little comment. My mom remembers one time when she was staying over in my house, Ana, who was probably six or seven, she was little, the next day she said mommy, I couldn’t sleep last night because my head kept thinking, and thinking, and thinking. And she was six or seven. Of course, this memory, my mom told me after what happened with Ana, when you tried to look back, can you believe a child that age saying?

Trevor: Yes, I was doing the same thing. I was doing it since four.

Patty: Exactly.

Trevor: Yep. Nonstop. All day long, every day, right now.—

Patty: She would grab the monitor, the baby monitor, because we leaved it on, she was asleep, and she will go ... We were in the kitchen, and she will go like, hi, mommy, daddy, I can’t go to sleep.

Trevor: Oh my god. It’s a horror film.

Patty: A story, and we were just laughing in the kitchen—

Trevor: You’re Damien’s little sister.

Patty: She wouldn’t get out of the room.

Ana: But I would just sit there with the monitor.

Trevor: What I see here is somebody who’s traditional and very head strong. And what I see here is somebody whose kind of rebellious. So, what the hell did you expect? You know? I mean, what did you expect?

Patty: Yeah.

Ana: That sounds about right.

Rafael: And she’s still young, so imagine what is ahead—

Trevor: Yeah. Right. Right. Right.

Rafael: I used to have a lot of hair, plenty of hair—

Patty: I had nothing to do with that. Nothing to do with that—

Rafael: There’s a one-to-one correlation to that—

Patty: Nothing to do with that.

Trevor: What was ... Growing up in Venezuela, what was the topic of mental health? How was it handled? Was it spoken about? Was it talked about? Was it kept underneath? I mean, I’m asking, because I genuinely don’t know.

Patty: Basically, it’s something that you just don’t talk about.

Trevor: Why?

Patty: First of all, the treatments that you get there are pretty much probably the way it used to be here many years ago, like people are just sent to psych wards.

Trevor: Shock therapy?

Patty: Probably. I don’t even know. But the stigma is that the person just goes away and/or is hidden in the families quarters. You know? You have a gathering, the person never comes. You just never know.

Trevor: So there’s shame associated with it?

Patty: Yes. Yeah.

Trevor: Yeah, I mean that’s still the case here.

Patty: It is.

Trevor: Yeah. I read an article the other day that the headline was, “Now that the stigma of mental health is ebbing in America,” and I burst out laughing.

Rafael: Just because now you can have some likes.

Trevor: There is no ... The stigma is not ebbing. I mean, people are talking about it, but it hasn’t had the effect yet. Just because there’s ... The article was saying that well, colleges can’t keep up with the mental health resources. Well, that doesn’t mean that it’s having any effect on the stigma yet whatsoever. It’s just ... I think your generation, I think it’s really important that you guys are saying, we can’t do this on our own, we need help, which is what my generation should’ve done, and my parents’ generation. But it was something to be ashamed about. I feel like your generation gets a bad rep, but the fact of the matter is that your generation has no compunction about asking. I don’t see what’s wrong with that.

Rafael: Just quickly, so from someone how did not study the subject, as Patty did, professionally, the shame aspect being ... Living in Venezuela, and seeing, because I had relatives of mine who were suffering from the illness, they were definitely ... A family took a huge effort to move them away from the normal social living experiences as a family. And very few opportunities, they would convene, it had to be in a controlled environment—

Trevor: I don’t mean to ask a dark question, do you mean send them away, or do you mean send them away?

Rafael: Send them away in the sense that, as Patty was alluding to, you were kept in the family’s property, but you were not within the ... You were in rooms separated from where the social activity of the family was taking place. But there were a few times when they would come and engage with the rest of the family, but it had to be in a very controlled way. For me as a child, frankly speaking, at times I felt scared just to see this living being, even though it was a family member, seeing these members of the family being there. So, if no one was talking to me about what was happening to him, and explaining why he had what he had, for me it was always this enigma. And so the stigma it really took a huge toll. And it took until now, I mean now I’m more educated about the subject obviously. But the stigma it continues to be there.

Trevor: I’m not trying to walk you into anything, but deep down do you believe it’s a thing? I mean, I know you ... But do you think mental illness is really a thing, or do you think that it’s a sham that’s been brought on by commercialization, and capitalism, and ... Hey man, I suffer, and even I have my doubts—

Rafael: I’ll tell you this, it is easy to make the argument that it’s a commercial thing, very easy. And the proof of this, as an example, when I share publicly what had happened to Ana, this very, very dear friend of mine who knows Ana well, we were chatting and the very first thing that he said to me was, what’s the whole big deal? I mean, life is tough—

Trevor: And you work in finance, right?

Rafael: I work in finance, yep.

Trevor: So when life’s tough, you do cocaine, and you get through it, right?

Patty: Yeah, you self-medicate.

Rafael: Exactly. You self-medicate.

Trevor: Yeah. I mean, I actually wasn’t making a joke.

Patty: No, it’s true—

Ana: No, it is. Yeah—

Patty: It’s absolutely true—

Rafael: Oh trust me, I did deals back in the 80s, and I’ll never forget one deal. We were walking around 3:00 in the morning in New York, from one floor to the other, and when we were down from one floor to the other, we saw two of the attorney’s, the partners of the firm, doing lines on the stairs at 3:00 in the morning—

Trevor: Yeah. Yeah, that’s called Tuesday in Manhattan during the 80s.

Rafael: But, so the point to your question, yes, you can easily make the argument for justifying what’s the big deal about this. But I sincerely believe that that is in response for not actually making the case clearly to people that that is not the case. It is really an illness, and if you really want to tackle it, get the stigma out of the way. I mean, we don’t talk about diabetes anymore as a stigma illness, or headache for that matter. You have a headache, you don’t.

Ana: Or cancer.

Rafael: Or cancer. But we do with this invisible—

Trevor: I actually want to back up. You were around the finance world in the 80s, you must’ve seen people who spun out, and that is a ... I mean, it’s related to addiction, but that’s a form of mental illness. But at the time, it was just addiction. I’m guessing it was addiction and you’d watch your backbone to deal with the numbers, right?

Rafael: Totally.

Trevor: Yeah.

Rafael: Entirely.

Trevor: Yeah.

Rafael: Entirely.

Trevor: And it’s just you weren’t strong enough anymore.

Rafael: Exactly right. Exactly right. And cocaine is ... So, successful people in the industry, investment banking in particular, which is that example that I was giving you, very successful people are the ones who are able to access the most expensive drugs, cocaine being one of them—

Trevor: Right—

Rafael: I mean, marijuana, no. Just tried to get your fix very, very quickly. I saw some people really going out of the system. Maybe some of them were treated here. I don’t know. But some of them actually went out of the grid, because obviously if you’re not tackling the core of the problem, you’re self-medicating yourself, and it reaches a point where that just doesn’t work.

Trevor: I think money is an issue here, somewhere. If you’re a finance person in the 80s, and you’re doing blow, and you’re pulling in a lot of dollars, and therefore the people behind you are pulling in dollars based on what the money ... There’s no incentive to address that you have a problem if there’s that much money. Fast forward ... And I’m not saying your family, I’m talking about other families, you have an affluent family with somebody that has a mental illness, there’s no incentive to talk about it, because it takes away from the façade. You make a certain amount of money at some point, and I don’t know I could be wrong about this, it’s not just your ... It’s not just the fruits of your labor, it’s also the façade that brings in those dollars. You know what I’m talking about? It’s the image.

Rafael: Entirely.

Trevor: And if something threatens that image...

Rafael: You take care of it.

Trevor: Yeah. You take care of it.

Rafael: In whatever way to keep the façade.

Trevor: Right. And then, the flip side is that if you’re poor you just don’t have money for resources.

Rafael: Nope.

Ana: So, you’re stuck.

Trevor: So you’re stuck.

Rafael: Or you get into trouble.

Trevor: Yeah, right, you go to jail.

Rafael: Right.

Trevor: You’re looking at me, you have something to say. No? Yeah?

Ana: Say it.

Trevor: Say it.

Ana: Yes, mommy say it.

Patty: I just feel that historically I think what happened is that in our mind mental health illness looks very, very scary, like severe chronic mental illness. And it’s noticeable, and you take care of it.—

Trevor: Listen, let me interrupt you, I’m a big film fan, huge fan, love movies.

Patty: Yes. Which ones?

Trevor: Psycho is one of the best thrillers ever made. You know the damage that film has done to mental health and nobody wants to talk about it? The damage that that film has done.

Patty: Yeah, but you can also—

Trevor: His mother suffered, he suffered, and were—

Patty: Abandoned.

Trevor: What happens is that we’re taking ... And granted, this film was made in the 60s, but we’re taking mental health and we’re making an incredible piece of entertainment out of it.

Patty: Yes.

Trevor: We’re making entertainment out of mental health.

Patty: Yeah, absolutely. Yeah.

Rafael: And—it.

Trevor: Yeah, right. And I don’t see that changing. I’m sorry, go on.

Patty: Well no, it’s just the thing is that the percentage of people who suffer that severe mental illness is very ... Compared to the everyday mental health issue, like the functional depression people, those are the ones who are speaking out now, those are the ones who are everyday next to us and nobody knows. Maybe you don’t even know. That’s the biggest difference now. Mental health is a gradient, it comes from zero to 100. So, what is noticeable has been taken care of for ... In the history of mental illness, because they really could not function, or they were a danger to themselves, or to others. But the other part is the everyday people, and then we are not informed. We do not grow up understanding our emotions.

Trevor: And ignorance is just as dangerous as an untreated person.

Patty: Exactly. So, the problem is that when you don’t know what’s going on, you start self-medicating without knowing that that’s what you’re doing.

Trevor: Sure.

Patty: And that is when addiction comes in. So, in my point of view, it’s also the underlying issue, it’s a mental health problem. And then the alcohol, the drugs, and any other thing that comes after that is just a coping mechanism that is not healthy. But that’s a lot of us doing that.

Trevor: Yeah. Sure. No, absolutely. How long have you been practicing?

Patty: I graduated back in Venezuela as a licensed psychologist in 1990, since you asked. And then we moved here to the states, and I couldn’t practice, because of licensure requirement. So, I worked for a little while in daycare centers, and then I end up working in the Framingham Area for it was called Metro West Mental Health Association. It was a mental health agency working with Framingham Union Hospital, but we were allowed to work there because there was a woman,—, who run a Latino component at the clinic. And she was able to get us visas, and also allowed us to work in the agency under the supervision of clinicians, senior clinicians there. That was back in the 90s. And then I worked there for three or four years, and then I had my son, Carlos, and then I had Ana, and then I stopped, basically became a home stay mom. And then we travel, because of Rafael’s work, we moved around. I don’t know, fast forward—

Trevor: When did you start moving around?

Patty: Oh god.

Ana: Right after I was born—

Patty: This is a good question. Since I got married, we’ve been married 29 years, and I have moved 17 times.

Trevor: So wait, Ana, you just said right after you were born? Right?

Ana: I mean, for me I’m speaking for myself.

Trevor: Right.

Ana: And my siblings.

Trevor: So, how long ... You moved around a lot?

Ana: Yes.

Trevor: Yeah. So, what is it? You don’t feel like you have any roots?

Ana: A part of me. Yeah. That’s definitely been a big discussion in our family. Obviously, there’s pros and cons to where I’ve been. Obviously, the fact that we lived in Spain for five years, that’s something that not a lot of people can say, and I’m very grateful for it. But there was a part when we moved back to the states I was in fifth grade, and it was intimidating seeing a lot of the kids that they’d known each other since basically they were within the womb, popped out, and they’d all been friends since they were all very young. That’s something that I feel like I’ve always missed out on and I guess it affected me in the sense where I felt like I wasn’t making a lot of meaningful connections, obviously not in a bad way. That’s a cognitive distortion for me, spotted right away. Yeah, no, me and my mom talk about those a lot.

Trevor: I don’t know about that one. I’m going to give you a break on that one. As someone who has a lot of cognitive distortions myself, I’m going to give you a break on that one—

Ana: I try to justify them a lot—

Rafael: So, this is where I come very, very aggressively into an angle. Your home—

Ana: Is where your family is.

Rafael: ... is where your family is, whatever the physical aspect has no bearing.

Trevor: Yeah.

Rafael: Okay? And so ...

Trevor: I’m going to cut you off, Rafael. How much time did you spend at work versus how much time did you spend at home?

Rafael: Because of my job—

Trevor: Listen, I am not accusing you of anything, because my—

Patty: I want to hear this answer—

Ana: Yeah, I do want to hear this too—

Trevor: My father worked, and worked, and worked, and he wasn’t a present guy. That said, I’m in my 40s now, and I see it a little ... Not a little clearer. I see it a lot clearer. I do understand why he wasn’t there.

Rafael: Yeah.

Trevor: I get it. It doesn’t make the situation any better, but I get it. And now that I’m older, I’m not like you know, that’s fine, I forgive you dad. But I see it now.

Rafael: Yeah, you see it now. In my case, I’ve always understood the role of being the one that is actually taking care of the family.

Trevor: Right.

Rafael: In our case, it’s me.

Patty: But it’s a cultural thing, very strong.

Rafael: Well, just—

Trevor: I agree with them, but I see where you’re coming from.

Rafael: Yeah. You can put whatever label, layer you want to put in. The point is, whoever happens to be the one providing is already making a tradeoff. In reality—

Trevor: Hold on. Ladies, you need to understand something, where he’s coming from, that was beaten into his head.

Patty: Yes, absolutely.

Trevor: And when something is beaten into your head, how do you let that go? I have really strange distortions in my head, but they were beaten in my head. You should’ve watched this meeting between Lauren and I yesterday. I was a psychopath. Okay? I feel like I’m in the right here, but how I express it was I’m a psychopath.

Patty: But, not only did he thought that, I also was on board with that—

Trevor: Well, that was—

Patty: Like, go, go, go, go, go—

Trevor: But that was beaten into your head.

Patty: Yes. But the thing is that the way we thought of it, this is how we’re going to do it. You—

Trevor: I’m with you. I’m with you—

Rafael: Well, I haven’t finished—

Trevor: Yeah, I’m with you. But, let her get in, and then we’ll get back to you—

Patty: Yeah. Let me just finish this idea. You do what you do—

Trevor: We’re at four hours with the interview—

Patty: Okay. You do what you have to do, and don’t worry that whatever is happening at home, I’ll take care of it, so you don’t have to worry about that, because I’m committed full-time mom. I mean, what any other thing ... Go, travel, Monday through Friday, money through Friday, and I was with the three babies, and self-sufficient, like you have no idea.—

Ana: No idea.

Trevor: And this isn’t an insult, but that is not smart. I mean, it’s not. It’s not. But, that’s not your fault. It was hammered into you.

Ana: But at the same time, they both did a hell of a good job.

Trevor: I don’t know about that. I don’t know—

Ana: 100%—

Trevor: I don’t know—

Ana: I mean, I was a fetus, so I mean I can’t account for it.

Trevor: I don’t know. Jury’s still out.

Patty: Oh yeah, the jury is still out. Yeah.

Ana: Well, I mean, like my dad was exhausted from traveling, but he would still come back and it would be like he’d never left.

Trevor: Yeah, sure.

Ana: And yeah, my mom was tired, but—

Patty: I guess the thing that I regret, but it’s nothing to ... It’s just the way—

Ana: That’s the way it is—

Patty: We decided to move out of Venezuela. That was a we decision, because our first son was born with a disability. Carlos was born without legs back in Venezuela. And we already lived here three, four years before that. And I worked in Framingham, and I worked for early intervention, and I remember saying we have to go back. I knew exactly all the services that Carlos could have. We made the decision to leave everything behind again. The first time around was for study. But this time was to provide for Carlos. The minute we made that contract between him ... It was whatever it takes.

Trevor: Right. And that is a powerful basis for love. You two got together, and you said we’re not just going to go to America, we’re going to do better than the best we can.

Rafael: Yep.

Trevor: And, my guess is in the back of your head, you kind of knew the realization that you’d be away a lot, but one day they would understand the sacrifices that I made.

Rafael: Yep.

Patty: Oh yeah, absolutely.

Trevor: But it doesn’t work like that.

Rafael: Well, exactly right—

Trevor: We can get back to what you were saying.

Rafael: Yeah. So, life isn’t perfect.

Trevor: Yeah.

Rafael: Right?

Ana: Well, clearly.

Trevor: I mean, unless you’re like me, and I strive for perfection, and then I keep banging my head against a wall.

Rafael: Precisely. But the point that I was making was knowing that someone has to provide, you’re always making a trade off, and there are degrees of the tradeoff. In my case, given the demands of my job, I actually had to be away far more than what ordinarily someone else would. But I consciously made, as part of our agreement, the effort to make sure that whenever I was home, I would be making the effort so that they would feel, and my wife would feel, that I’m somehow compensated for my absence. So, the challenge for whoever is providing, whether it is her or myself, in this case myself, was making sure that I was getting as close as possible to that. Always chasing ... Mentally, you’re chasing this. But, it’s a challenge. And so, I knew that it would be a task, a very tall order to get there. But what I also did realize was I was going to be making the best effort to make sure that these kids knew what was important in life. It had nothing to do with how many gifts, or the material crap.

Trevor: That helps though. That helps though.

Rafael: It’s more about the value system. Yeah, exactly. As we know, it helps, especially in this country where 73% of ... For every dollar that is generated, economically speaking in this country, 73 cents is consumption.

Trevor: I mean, I just recently asked my dad at lunch how much I’m going to get when he croaks. That is not a joke. Shows how strong our relationship is. Go on.

Rafael: No, no, no. That was the point. But it’s very tough. It’s a struggle.

Trevor: What I think the question that nobody’s asking is that the family dynamic, at least in this country, doesn’t cut it anymore. Now, when I was young, you could be lower to middle class and have one person working, and one person at home. I’m not saying which gender, I’m just saying one working and one home, and still have—

Patty: One income was enough.

Trevor: Right. And that’s not the case anymore. Also, I want to say in her defense, and I’m sure that you guys have taken this into consideration, with what’s going on today with media, all of it, her brain is being assaulted every second of every day.

Ana: All the time.

Trevor: And no offense, there’s nothing you guys can do to beat that.

Ana: No, not at all.

Patty: No. No, we didn’t grow up like that. We just didn’t.

Rafael: Two things to what you’re saying. One is I agree with you.

Trevor: You can cut her off from that media, but we’ve built this country around this media, and she’s not going to be able to make it.

Rafael: Yep.

Trevor: I mean, I went out for jobs when I was living in California and they wanted access to my social media accounts. I’m like, what is this? You don’t need access to my social ... What is this? So not only is it the way we communicate, but now it’s the way we get jobs. I’m sorry, go ahead.

Rafael: First of all, the first one, I agree with you. Societally speaking, we are at a very, very interesting inflection point, especially here in this country where. To your point, families both working, it doesn’t matter where are you in the scale, it is hard to make ends meet. And I will say this, for those who believe that is a scapegoat it’s China taking these jobs away, wake up and smell the coffee. It is the result of advancements in technology, specifically robotization that has taken a lot of things from ... So there’s a break out. And so, socially speaking, that tension I’m afraid is going to increase. The second one, social media is here and again technology moves very fast. Societally speaking, we didn’t even have a chance to train the biggest consumption group, in this case Ana’s generation, to be ready for it. And so now you’re applying for a job and yes, they’re going to check your Facebook account, because they want to know—

Patty: They want to see your pictures.

Rafael: ... what type of person you are. And by the way—

Trevor: It’s not Facebook anymore, old man, it’s Instagram. Haven’t they told you?—

Patty: Facebook is for old people.

Trevor: Yeah. Yeah. I use Facebook, my god, it’s the worst.

Rafael: Yeah. And by the way—

Trevor: And I was kidding with the old man thing. We’re the same age.

Rafael: But now, there’s artificial intelligence.

Trevor: Don’t even get me started. Don’t even get me started.

Rafael: So, it is a challenge. You want to bully someone very quickly?

Trevor: Well, now they can be bullied ... I’ve said this 90000 times on this podcast. I was bullied a lot as a kid, but it was only for six hours a day.

Rafael: Exactly.

Trevor: Well, and then I got shit from my parents when I got home. This is 24 hours a day, and you can’t sleep because there’s so much anxiety about whose bullying you at 1 AM on the Gram. I called it the Gram. So, I’m kind of—

Ana: You’re hip.

Trevor: Yeah. I’m going back to college. I may be 43, but these looks say 30, okay? I don’t want to blame social media, but I do think it’s just a piece of the larger—

Patty: Of many—

Trevor: ... puzzle.

Ana: Yeah.

Trevor: And I don’t know, I just ... The sad thing is, Ana, when I hear somebody your age suffer from major depression, body politics issues ...

Ana: Anxiety.

Trevor: Anxiety.

Ana: Whole lot of that—

Trevor: I’m almost like, well yeah.

Ana: That’s a given.

Trevor: Yeah. Of course. That’s what this system is set up to do.

Ana: Because, social media, yes, it’s the downfall, but also as my dad was speaking, it’s also up and coming with getting a job. And so, it’s sort of like a pressure with yes, it sucks, because you’re comparing yourself to everyone, but also you want to market yourself, because you know that jobs are going to be looking at that. Personally for me, I know that it’s not that ... There are some people that they like to have a theme with their Instagram. They want to do it all white, like white background, and so it has to be a nice aesthetic.

Trevor: Yeah, well everybody is now a brand. They’re not a person. You’re a brand—

Ana: It’s a brand. And so, with mine mostly it’s just being sure to post anything that I’ve been involved with, because as you said, companies are going to want to check your social media. And for me, yes, I try to monitor as much as I can of what I’m posting, but at the same time, I am a college student. But again, if guys saw what other people have been posting—

Patty: I’ve been checking. I know. I check. I follow. I check.

Ana: Yeah, no. She checks. Yeah.

Rafael: So, what I’m involved professionally for the last seven years has to do with technology. And I think—

Trevor: So, you’re the enemy.

Rafael: I’m afraid I am part of that problem. So, my commentary around it is we have to embrace—

Trevor: China.

Rafael: But we have to, and I’m going to ... On the back of the podcast I’m going to suggest something that you should watch, which I think you would like. But the point that I was going to make is this digitally enabled society that we are already in the second inning of ... It’s the second inning. This is going to be how we’re going to be operating. I don’t mean exclusively in this conversation we just had. I’m just saying, digitally enabled societal environment. We have to embrace the technology. What we have to do most importantly is making sure that we’re providing the tools to society to be able to embrace it. I think we have failed miserably.

Trevor: I 100% agree. I 100% ... The revolution in Egypt, that couldn’t have happened without social media.

Patty: Exactly. Mm-hmm.

Trevor: The successful protests in Hong Kong could not have happened without social media and certain apps. The thing is, it’s great, but there’s always going to be people that are going to find a way to make it hell for people—

Ana: It’s a double edged sword—

Trevor: And then profit off of it.

Rafael: Yes. So, if you are suffering from mental illness, and someone is going to be bullying you, now you’re going to feel the—

Patty: It’s relentless.

Rafael: ... unbelievable pressure from these platforms.

Trevor: Right. Somebody takes ... You’re not looking, and you might be making a weird face, and somebody takes a photo of it, and they meme it on Instagram, and write all over it, and stuff like that. You know what? Instagram doesn’t give a shit about it. All they give a shit about is the little advertisement that pops up on the bottom, or comes across that photo that goes and insults you. That’s the business model.

Ana: Yeah. I have—

Trevor: Well, okay, that’s not the business model, but it’s kind of the business model.

Ana: Instagram offers a business type profile where you can publicize your email, contact information, and on your posts it has an insights section, and it shows not only how many people liked or commented, but how many people might’ve saved your post, or sent it. And there have been times where I check some of my posts, especially this year I checked ... I post on the anniversary every year for the attempt, and there’s a part of me where it’s like is that me just posting because I want people’s attention to comment, so happy you’re still here. This might sound selfish of me, but this actually goes through my head, because it’s social media, there’s some things that people will argue, like oh there’s some things that people don’t have to see, or some things that are better kept to yourself. And obviously it’s all personal choice, do whatever you want. But am I doing it ... I wonder to myself if I’m doing it for myself, or if I’m doing it because I actually want the outreach. And that sounds very selfish of me, because is it weird—

Trevor: You’re talking to a narcissist my friend. It sounds all right. I’m much worse.

Ana: I checked the insights for that post, and there were ... I don’t remember now, but I know that there were maybe like four people that saved it, or between 10 and 15 that sent the post. For all I know, some people that don’t like me might be sending it, talking complete smack, but then I have to always tell myself, but you don’t know if it’s for a positive reason that people are sending it. But obviously, I’m always worst case scenario person. I used to think that I was—

Trevor: Yeah. Here we go. Yeah. Me too—

Ana: I used to think that I was a lovely ray of sunshine.

Trevor: Me too—

Ana: I walk around the sun, a smile on my face—

Trevor: No, everybody hates me. My cat hates me. Everybody hates me.

Patty: No, but Ana brings up a good point. I remember right after Ana—

Trevor: Write this down, your mom just said you brought up a good point. Write it down. Write it down.

Patty: No, but it reminds me when—

Ana: The first time I posted?

Patty: ... right after Ana’s attempt three years ago.

Ana: Oh yeah, a month after.

Patty: I remember—

Trevor: Were you ashamed by that? Were either of you ashamed by her attempt?

Patty: I’m sorry?

Trevor: Initially?

Rafael: No.

Trevor: Shame?

Rafael: No shame. No shame.

Trevor: No shame? Okay.

Patty: Oh, no. No. Shame, no. I was so scared is the word.

Trevor: You weren’t ashamed about the word getting out? I’m not accusing—

Ana: Oh wait, that’s—

Rafael: Well now, that’s different.

Ana: We’ll touch on that too—

Patty: That’s exactly what I was going to point out—

Trevor: Where you’re going too? Okay—

Patty: Yes. Because, in the hat of the mother and the hat of the clinician, when you’re training and you’re studying to be a therapist, and when it comes to depression and suicidal ideation, and attempts, that kind of thing it almost seems that the less you talk about it, the less you trigger people around you. All right? And so, it’s better. You talk this with your therapist, and maybe you go to a support group, but it’s a tricky conversation, because what you want to do is contain the problem and no copycat.

Ana: The domino effect.

Patty: If you hear that in the next town a kid commits suicide, or attempts, the biggest fear for the next town around, or the next high school, it’s that something is going to happen in your high school too just by knowing that something happened, because it can trigger people. I am coming from there. And then Ana, her ... This is interesting, because she attempted, she goes to inpatient, she comes back home, she does a partial ... But what Ana felt was more like a relief, like yes, I have a problem, all these years I’ve been struggling with something and I didn’t know.

So, it’s more like for her was like there is more people out there like me, and for Ana was so important to allow some kind of room, or venue, or a way for people to talk about it, like the other way around. I remember when she was going to post this, and the semicolon tattoo. We were like ... I felt that we were being pulled by Ana, like hold Ana, hold on, hold on, and Ana was like no, I want to talk about this, because this has been a problem for so long. And I know I can get something out of this other than the support.

Trevor: Yeah. Okay.

Patty: So, I remember being torn by this, like no, but this is not what we’re supposed to do. That’s not what’s supposed to happen.

Trevor: What do you mean that’s not what you’re supposed to do?

Patty: Because, in the community, it was more ... And that was pretty much the feedback that she got from her school and everything. No, no, no, Ana—

Trevor: What community? Framingham?

Patty: No.

Rafael: Concord.

Ana: Concord, Mass.

Trevor: Oh, Concord, Mass. Okay. Yeah. Okay.

Rafael: We’re weird.

Trevor: Okay.

Ana: Yep.

Trevor: Okay. I thought it was still Framingham

Ana: No, that’s where I work.

Trevor: I was like they going to charge you 10% extra at Jordan’s, because you have a mentally ill kid?

Patty: No, it was just more like that conversation needs to be taking place in a safe place by professionals, not by you Ana, because you don’t have the skills, you don’t have the training, and you could trigger people. That’s the sentence. You can trigger people. Don’t allow kids to watch 13 Reasons Why, because you’re going to trigger people. There’s the fear. And this generation, they talk about everything—

Ana: Everything.

Patty: ... on social media.

Trevor: They do.

Patty: Everything. So, what are you talking about here if they’re self-disclosing every single little detail, private detail, of their life on a platform?

Ana: They can find it anywhere. They can Google, they can use Instagram.

Patty: And so, I kind of understood what she was saying. When Ana got involved with the Deconstruction Stigma campaign here, and Rafael he kind of put an email for all our relatives and friends to explain what happened, with a link for the Deconstruction Stigma link and all of that. And the amount of email reply’s that Rafael got back about people saying, in my family too, my best friend, my wife, my daughter, family, family, and we didn’t know. Me and your cousin, or siblings, that they have it, they attempted to, but they each other don’t know, but now we know, because they reach out separately. For me, it was really an eye opener. Like, we’re not talking about this. I remember doing, Ana, the intake in the inpatient facility, and they ask us about family history.

Ana: Family history.

Patty: And then I go like okay, so yes, my aunt had major depression, and my mom, although she doesn’t want to admit it. And then Ana goes like, when were you going to tell me that? I don’t know. Now? It’s happening now. So, years ago, when I was little, every time I heard, I don’t know why, that someone has asthma, people go like oh, she’s going to die. You know, back in the day it’s kind of ... And cancer, nobody would talk about that, nobody will share that, because that was not something you would share with anybody, because it was painful, it was sad, the person is going to die. Now, you see people with cancer all over the place talking about their recovery, sharing. So I think now the mental health issue here is coming more and more like yes, I have it, you have it. That’s what I was trying to tell you at the beginning. You don’t share necessarily you have an uncle, or a long history of people with schizophrenia, because it really isn’t that common compared to what I call functional depression that is more shared.

Rafael: I’m going to jump a little bit, as Patty described, when Ana came to us with the idea of very, very determined to share this, the pragmatic me ... I remember talking to her, and saying, well you want to make sure that you’re making the right decision for your future well-being. And I was thinking more about the employer. So, the moment I began to explain, and we went back and forth. I mean, I later understood, and supported her entirely, all the way. But I realize how dumb I was, and how ignorant I was in actually alluding do that. What do you mean the employer? I mean, I was actually stigmatizing herself with the idea.

Ana: And I know that.

Rafael: When Patty mentioned about the replies that I got back, I’m going to mention one example, obviously no details.

Trevor: Let me defend your father for a second. Regardless of background, or what country there came from, there is millions and millions who think just like that. And when you have that many that think like that, it’s hard to not take it personal. Yes, it’s hard, but it’s an epidemic and it’s not their fault. How they act on it is their fault.

Ana: Yeah. That’s what I advocate for too.

Trevor: But it’s not ...

Ana: I’ve had friends that obviously aren’t in my life anymore that I tell them, they see it, but they just don’t get it. I’ve had a friend at UNH say that when she met me, I was the first person that she had ever really had a conversation with about mental health, wasn’t really exposed to it. And I was in a relationship with someone that didn’t get it either. And I know that—

Trevor: Yeah, get used to that one.

Ana: Oh yeah, it’s lovely. Well, I mean now, if I meet anyone it’s all over my social media. So, you either take it or leave it.

Trevor: Yeah. Yeah, right.

Ana: And that’s a them problem. And that’s something that it took me a while to understand, clearly. But, as my mom was saying, it was a relief when I was diagnosed, because I had a feeling that something was going on, but any time that I maybe felt like opening up about it, especially in my relationship, he would say you’re being dramatic, I don’t believe in mental illness. I mean, that obviously doesn’t help.

Trevor: And I’m not suggesting my father or you don’t have the ability to think for yourself. But, there’s something to be said for conditioning. It goes back to the tuning fork. And these men were conditioned at all costs to raise you the right way. And when you don’t come out the right way, deep down inside, even though he might not ever admit this, or tell me I’m wrong, but he sees it as a failure on his part.

Ana: Yeah.

Trevor: And failure for these men is not an option. You guys need to learn that it’s an option. That’s your fault.

Rafael: Yeah. Yeah.

Trevor: But you also need to know that they were raised that it wasn’t an option.

Ana: Exactly.

Rafael: I will basically say—

Trevor: Sorry if I spoke for you.

Rafael: No, no, no. Well, I will correct what you said. I think there is—

Trevor: Good.

Rafael: The stigma started with me in my own case, but I didn’t know that I had it until we began to actually talk about what had happened with Ana. And here is this girl who you would’ve had no idea that she was struggling with mental illness. Maybe Patty had some insights—

Trevor: Yeah, we’re going to talk about that later.

Rafael: But I’m going to connect this to the conversation that we were just having. When I told her about the employer, this to me was a wild moment for me to actually say, you have stigma. You’re stigmatizing the illness. So, coming back to exactly this question that we just had. I can quickly correct being who I am.

Trevor: Good—

Rafael: How I—

Trevor: And you’re not a bad person.

Rafael: No, no, no.

Patty: No, but he can correct past, which is—

Rafael: I understand what you’re saying. I correct very quickly, but in my mind, and especially how I was trained as a parent with my eldest son, he’s wheelchair bound, he has ... He’s different than many people. So what? Right? So what?

Patty: That’s absolutely true. Rafael and I have been challenged as parents, because you said something very important. As parents, you have this expectation with the baby when you have it in front of you. And you commit—

Trevor: And that’s your fault, no offense. That’s your fault.

Patty: Exactly. But, you kind of commit yourself to do everything in your power for that baby to have this perfect life, unlike you that didn’t have it, or you try to correct your issues, or whatever happened to you, and make it not happen to the baby.

Ana: Well, that shot to hell.

Patty: Oh my god, it’s impossible. But that’s something that you do. You think you can really do that. And Rafael, we were challenged from the beginning as parents when we were told, and I was still pregnant, that the baby was coming with no legs. The level of acceptance, if you have a kid and you’re not sure if your kid has some issues, but then all of a sudden, the kid is doing fine, you go I know he’s fine. The thing with somebody who doesn’t have legs is that there’s no room for denial. Every time we were changing that diaper, you will see the reality. So, immediately, Rafael and I were just, okay, so this is what unconditional love means, from the beginning. The acceptance of whatever he can possibly do in his life is going to be wonderful. You know?

Rafael: So, when Ana—

Patty: But then when Ana was coming—

Rafael: That’s right.

Patty: ... the first thing we say is, am I going to have another ... We cleared that out. You’re not going to have another baby with the same condition. And the first time, they treat us here so nicely here in Brigham and Women’s they actually allowed us to see ... To have more ultrasounds that you can have just for me to see her legs. Right?

Trevor: That’s nice. That’s nice.

Patty: And even though two weeks later, I will be driving in the car, and I will go like, what if those were not the legs? Right? Because that’s how your mind goes.

Trevor: That’s how your mind goes.

Patty: Exactly. And then, it was only a matter of just to see her. So, the expectation ... Imagine. The expectation. And I remember Rafael and I, when we’re in the car, and we saw Ana’s legs, and we’re happy, and we’re silent in the car. Not a word. And I said to Rafael, what are you thinking? He started giggling and laughing. He said, I’m happy, I’m happy the baby has legs. But then, he said it so beautiful, but I feel I’m betraying Carlos. Speaking of pain. I know, we have to love them both.

Rafael: The conversation around this new challenge, and me realizing quickly in the process that I was actually stigmatizing the very, very thing that almost took her life away. Having had the opportunity to be the father of someone like Carlos, it allowed me to correct very quickly. But at the same time, going back to what you were sharing with us with your own experience, I quickly realize having talked to many of my friends who were parents that not only they had no clue, and there were stigmatizing this thing, but at the same time they were all making the same mistake that Patty was alluding to, which is I’m trying to create the perfection in my children. And not to really go to the extreme, we have seen even extreme cases where publicly now we know people who have actually gone out of the way to write checks—

Patty: For their perfect kids.

Rafael: ... for their perfect child. We have seen ... When we moved back to Concord from Europe, how much madness parents in our town, what they do—

Ana: To get their kid ahead.

Rafael: ... to get their perfection of the child. Obviously, when it comes to mental illness, you’re weak.

Ana: You can’t talk about that.

Rafael: You’re weak.

Trevor: Yeah, I think legacy is a mental illness myself, I think most people wouldn’t. But the chase for legacy, the keep the perfection going, is a dead end.

Ana: And obviously I’m not undermining the accomplishments of—

Trevor: You can undermine people here on this show, it’s okay.

Ana: Well, I mean if they hear this, I definitely don’t want kids back in my town to—

Trevor: Oh, nobody will hear this.

Rafael: I will certainly share this in all seriousness, because for the reasons that we’re talking about, but there is a case to be made around the embedded pressure that we find ourselves today as a society. And it’s the baby boomer generation, interestingly enough, who definitely did far better than their parents, the largest amount of—

Trevor: I would argue that. But that’s another podcast all on its own.

Rafael: Yes. So, I’m grouping all of that into that.

Trevor: Yes. Yes. I understand.

Rafael: Right?

Trevor: Yes.

Rafael: So, it’s like that is an entitlement that this generation has, which funny enough is putting all this unnecessary pressure into this generation, i.e. Ana’s, and when you overlay this with something that is stigmatized as the invisible illness, i.e. mental health, you’re on your own.

Trevor: Yeah. Okay. I need you two to make me a promise. Okay? No matter how frustrated or angry my line of questioning is going to make you, you guys need to remain calm. Okay?

Ana: Okay.

Trevor: Okay. You.

Patty: What?

Trevor: I have a bone to pick with you.

Patty: Okay.

Trevor: I don’t understand how a professional in your field did not see this coming. Could you explain it to me?

Patty: Yeah.

Trevor: Okay.

Patty: I think she started with ... It was mostly anxiety around junior year. That’s how she presented. Anxiety. She was in therapy before, and I said to her—

Trevor: What did you specialize in, by the way, with your practice?

Patty: Adults.

Trevor: Adults?

Patty: And young adults.

Trevor: Young adults.

Patty: College students.

Trevor: College.

Patty: Yeah.

Trevor: Okay.

Patty: You can see the signs now.

Trevor: Okay.

Patty: So, we were never shy about telling our kids ever to go and see a therapist.

Trevor: There’s nothing shy about you two. I put that out there right now.

Patty: We were very keen. And I guess it’s again because we had Carlos, and we knew that at some point a person with no legs, it was just going to do a number on all of us. I went to therapy when I was young. And Carlos, I don’t know how often we offered, he kept saying no, no I’m fine. And when Ana needed it, it’s okay Ana, let’s just do this. She had a little incident in middle school. Well, not a little incident. But it was some kind of a bullying?

Ana: Yes, it was. It was bullying.

Trevor: Hold on, hold on, hold on.

Patty: Really not well handled by the school, if you ask me, but something that it could have been taken care of. It just blew out of proportion, and then Ana found herself saying to a friend—

Trevor: Were you bullied?

Patty: Yes.

Trevor: Okay.

Patty: Yeah. Yeah. And then Ana ... I’m calling the school. What’s going on? But then Ana made a comment saying to a friend, well, if they’re not going to be my friends I might as well kill myself. So, the minute a kid says that in a school setting, that triggers a whole protocol of things that have to be done, because the child is suicidal. And I’m like, what? She’s just mad, it’s an expression. That was my first ... You know. You have to take her here, and to the ER, and I’m like whoa, she has a therapist. Oh, we didn’t know she has a therapist. And I’m like, I didn’t know you needed to know that, but yes, she has a therapist, she’s been in therapy, so I took her to her therapist just to help her out what happened. In any case, that year was really tough for Ana. Ana did an amazing job with the help of her therapist, and she finished the school year, in all fairness, strong. But that was the first bump in the road. But she was in therapy. Then the second year, I don’t know when you stopped, because Ana at one point said I think I want to stop seeing—

Ana:

Patty: Yeah. She liked her too, and then she ... The therapy said I don’t need her anymore. And then she started high school and high school was fine freshman year.

Trevor: Let me clarify, at this point you didn’t suspect the magnitude at this point?

Patty: No. For me, it was anxiety and so far manageable, because she’s very open with me, will tell me all the time what’s going on, and we will make a plan of what to do, and she had her therapist. And Ana has the thing always that she will get into her mood, but then she will bounce back. And she’ll even report to you, momma, you know what, I’m feeling much better, I really think that I’m fine now. You really think so? Yes. And for me that was the most confusing part of all of this, because I don’t think she was really faking that. She was really feeling better. And then it got worse in junior year.

So, in junior year in high school, I think Ana had a lot on her plate. All of that came together and also one difference for her was that she had her first boyfriend, serious boyfriend. For me, the fight with the boyfriend or the argument with the boyfriend was triggering her all the time. Then she decided to go back to therapy. And I said yes, let’s just look for someone else, and then she started seeing this other one. So, she was in therapy, having her ups and downs, and when I say downs there were noticeable, and the ups there were also like, oh my god she’s feeling much better.

Trevor: Better or manic?

Patty: That’s where I’m going. Okay? Because that’s precisely what finally at the end of this, I said oh my god, it was not depression, she had a mood disorder. So, every time she ... Except that her highs are not the highs of a manic that are really noticeable, like wait what’s this? It’s more normal.

Trevor: Listen, I’m going to ask a difficult question. You’re still not telling me how you didn’t see it. Could you not see the mood disorder, or did you not want to see the mood disorder?

Patty: I honestly couldn’t see it.

Trevor: Okay. I believe you.

Patty: I only saw the anxiety very high, and when she was depressed, down, so that’s depression. The one thing I regret big time, and I can tell you take full responsibility for that, is that I had an issue with medication.

Trevor: Okay. Yeah, that ... My parents had an issue with medication. A lot of parents with my contemporaries had issues with medication.

Patty: I was very afraid.

Trevor: There’s not just a stigma against mental illness. I’ve always said, there’s a stigma against medication.

Patty: Yeah. So, for me, every time I almost felt like this is it, I think Ana needs something, and then all of a sudden, she’s bounced back. How can somebody whose ... When you’re depressed, you’re depressed, and nobody can take you out of bed, but then all of a sudden, she would go ... Three, four days later she’d clean her room, she organized, and then started doing exercise again. And we’re like wow, how resilient. Honestly, that’s how I felt. She pushed for the idea a lot of time, and I kept saying to her, I don’t know if you’re a candidate for medication because you seem to be able—

Trevor: Do you prescribe medication?

Patty: No.

Trevor: Okay.

Patty: No. No, I don’t prescribe medication because I can’t.

Trevor: You can’t. Right.

Patty: Yeah. But I have another take on medication.

Trevor: A psychologist prescribes medication. Wait, no. A psychiatrist. I’ve been in therapy for 20 years, I still don’t know.

Patty: Anyway, I remember thinking ... And then she’d have ups and downs, and ups and downs, but it never ... The part that I missed with that is mood swing. I missed it. I could not believe I did.

Trevor: Can you look at her the same way you can look at a patient? Or is it because it’s your daughter?

Patty: Oh, that’s a good question. Yeah. It’s my daughter, she’s not my patient.

Trevor: Yeah, so it’s different. And I think some people would assume well, because it’s your daughter you should see it, but maybe because it’s your daughter you couldn’t see it.

Patty: It’s difficult to have those two hats.

Trevor: And maybe that’s the issue with the person I have an issue with. I still beyond me cannot understand how you can look the other way. But maybe. Maybe because it’s your child, you can’t see it, because it’s a completely different set of parameters.

Patty: And also will take you to a different track.

Trevor: Right.

Patty: And she was supposed to get ready to go to college. And that’s also something that as in the middle of all of this. At one point, I remember saying to Ana in May of her senior year, I said Ana, you don’t need to go to college, just take a gap year. I mean, that was the only time that I felt afraid—

Trevor: You don’t understand. A gap year can burn you. It really can.

Patty: Well, the thing is, the way I was looking at her at that moment, I felt that she was not going to be able to cope with the demands of a new environment, and a new everything.

Trevor: Because let me guess, if you didn’t go to college right away you would be looked at as a loser among your contemporaries, right?

Ana: My graduating class, seven went to Cornell, two went to Harvard, one went to Yale, three or four went to Stanford—

Trevor: Right. Right. Right. That’s a lot of pressure.

Ana: It was insane.

Trevor: That’s a lot of pressure.

Ana: And I just didn’t ... Because I’m pretty sure a lot of the people in my graduating class, a lot of them didn’t take gap years, so I was worried. I was like okay, well I can’t be left behind. I don’t want to waste a year. What am I going to do at home? I was recruited for cross country to the first school that I went to. I was like no, no, no, I can’t miss out. I was like I’m on track, I know what I’m doing. I just told myself I don’t care what’s going on, I’m going to go.—

Patty: And your therapist told you right that summer, she told you that maybe you should take medication. Remember?

Ana: I had to force it. Not force it out of her, but I remember sitting there. It was one of the last sessions before I went to school. I sat there and I said, I think I might be depressed. And she sat there, and she said, you might be. That was just ... I’m sitting there. I’m like okay, that’s not ... I don’t know what to do with that. I’m trying to think in my head, how do you respond to that? At that point, I just felt like I was trying to get something out of her, like I felt like I was being dramatic and trying to make ... Maybe make a bigger deal out of something that is usually normal. I started pinpointing it as oh, well maybe I’m just not really doing well right now, because I’m going off to college, I’m going to be six hours away, it’s a big transition. And I was like okay, maybe it’s just because of that. But I got mono halfway through July, so I couldn’t run cross country. It overlapped when—

Trevor: Cross country probably helps with the depression.

Ana: Running does. But at the same time, I was running a lot because first semester senior year I stopped eating. I was really anxious.

Trevor: So, it’s the body politics issues.

Ana: Yeah. My boyfriend wasn’t ... He had graduated, so he was already at college at that point, and that anxiety was eating me alive, that I didn’t know what he was doing. There was an issue—

Trevor: Got to learn trust, kid. It sucks, but you got to learn it.

Ana: Well, it goes both ways.

Trevor: Yeah. No, I know it does. You’re right. It does.

Ana: Especially when ... There was an issue when he was at school, and I feel like I should’ve been strong enough to end it, but I didn’t, because I was so codependent on him. And to a level, I think he was codependent. It was so unhealthy. I loved him a lot. I still care for him as a friend. But obviously, looking back now, there were so many things wrong with it. I used to blame him for so long for what had happened. But as you said way earlier, there’s just some people that I used to label as ignorant, which yes there are also people that are legitimately ignorant, like when my boyfriend at the time said I don’t believe in mental illness, that is ignorant. But, it’s all about perspective, education, awareness.

Trevor: Yeah. That ignorance is rooted in something.

Ana: Yeah, and so obviously that didn’t help. At the time I was in such a negative mindset. And running obviously more than like 30 miles a week, and I started noticing my weight loss. And during my junior year I was on birth control that had made me gain like eight pounds. I had been the heaviest that I had been at that point.

Trevor: That’s rough.

Ana: I was in a relationship, and I started getting nervous that other girls were prettier than me. And obviously, it doesn’t help having a girlfriend that’s like, well she’s prettier than me, are you going to do something? That gets frustrating too. But at the same time, with him, that could literally be a whole other podcast.

Trevor: Let’s do it. Why not? Let’s just stay here through Thanksgiving. Let’s cook the food right here.

Ana: But I loved the weight that I was losing, and I was losing it rapidly. I think within September I had lost like five pounds. And on one race day I skipped eating, and I ran the best time that I ever had. So, runners had weird rituals where they’re like okay, well if I did this that one race, then that means it’s going to work for the rest of them. So, I started skipping meals, and skipping eating on race days. From the moment I got to school, which was what? Like 7-something, until after my race, I would get home at 6 PM, didn’t eat.

Trevor: Jesus. That’s crazy. Not crazy. That’s intense.

Ana: It is, because I thought ... Because I was also getting comments from my high school where a good amount of girls also had eating disorders. So, you have people left and right saying you look so good, you look so skinny, and I also liked how I looked. So, I was like wait, you’re right, I do look really good, but it was in such an unhealthy way. There were some days where I binged, but I knew I was running, so I was fine. I wouldn’t gain any weight from it. Me and my boyfriend broke up, I lost five more pounds.

Trevor: Yeah, breakup diets are the best.

Ana: Then the binging started.

Trevor: I’ve had one of those.

Patty: And the binging came back.

Ana: The binging started, and that set off a whole new ... I mean, I’m taking medication for it right now. I love food, but at the same time I’m sitting there. I’m like, I am literally on medication because I could eat all day, it was anxiety. I’m nervous because of this, I’m going to eat. Oh wait, I’m anxious because I just ate, I’m going to eat more. Okay, well I’m really full, I’m gaining weight, okay I’m depressed because I gained weight, but I’m anxious because I’m depressed, but am I depressed? I don’t know if I am. The cycle just kept going and going. Told me I couldn’t run cross country. I had mono overlapped with bronchitis. Had bronchitis overlapped with walking pneumonia. And that was between mid-July ’til when I came home in October.

Trevor: Mom, was a lot of that stuff, no offense, was it psychosomatic?

Patty: Good question. I thought of that many times. But, the whole ritual ... You see, you don’t know all that. You just go, come home, and everybody comes home in the afternoon—

Trevor: I’ve been calling you mom for a while, I’m sorry. Is that okay?

Patty: It’s okay. Oh, I love that. I’m her mom.

Trevor: Okay. Okay. Sorry.

Patty: But, going back, I can’t really wear both hats. I just really can’t. The way I sit down with a client, and when they describe how they’re feeling is completely different when you ask your kids. It really is. It’s really different. I’m more fine-tuned. Actually, after all this experience, because what I have learned, obviously because of what happened, Ana started taking anti-depression medication.

Trevor: Oh, what do you take?

Ana: I take Lamictal

Trevor: Oh. Me too.

Ana: Love her. Love her. She works wonders.

Patty: So, that was the thing, but listen, she was prescribed Celexa because now of course I know about medication more than ever.

Ana: Yeah. I started with Celexa—

Patty: But then, Celexa made her worse.

Trevor: Oh, yeah.

Patty: So, that’s the first thing—

Trevor: Wellbutrin made me worse.

Patty: But then, that’s the first thing that you find in the books—

Trevor: Nothing against Wellbutrin or Celexa. Medication works differently for everyone.

Patty: We came back from the holiday break in December, this is after her attempt, and the medication, and we sat down a psychiatrist. One day with a therapist one day, Ana was in a chair, like how can I ... Not talking. The very next day, with a psychiatrist, and she was like this. You know? That’s when I said no, no, no, no. This is a mood disorder, completely different. And then trying to explain to Rafael.

Trevor: So, the mania that we talked about. Yeah. Yeah.

Patty: My take on this is if we have a baseline, and then you have the mood swings, so bipolar one, bipolar two, well bipolar two actually is really you see the down ... They’re clearly and distinct. And then people go like, there she goes again, or there he goes again, it’s distinct. But what I noticed with her is that her highs look more like baseline and then down.

Trevor: Yeah.

Patty: So, what happened a lot—

Trevor: That’s me. That’s me.

Patty: What happened a lot with these type of clients is that they seek help when they’re depressed. So, what do they explain to the psychiatrist? I can’t get out of bed, I can’t move. But the part when you’re high, that is not really that high, it goes undetected. And then you’re prescribed an anti-depressant medication instead of a mood stabilizer. And it makes a whole difference. It’s huge. So now, when I’m sitting with my clients, the way I ask questions is completely different, because I first want to see if there are any days in the week that you did not feel down, and why. And I ask questions about normal stuff. Do you empty your dishwasher every day normally, but when you’re not feeling well when do you do it? And often did you do it this week? I really go into the sleeping patterns, everything, because that’s something that if you don’t ask the right questions, you’re not going to get the full picture.

Trevor: Go ahead.

Rafael: I’m going to jump very quickly, this is what I would call the educated conversation. Right?

Trevor: That’s right here?

Rafael: No, the one that Patty just described. And obviously, Ana is the patient, so she can—

Ana: The patient?

Rafael: You know, the patient—

Ana: The patient?

Rafael: ... in the conversation.

Trevor: Hey. Hey, it’s okay.

Ana: I’m very picky about words.

Trevor: I know. I know.

Rafael: To me, who I am not versed, educated, into the subject. It is ... I mean, you can just imagine. I remember this meeting that Patty is describing with a psychiatrist. I let her speak. We were talking about the different prescriptions, and I immediately had to tell her, I said listen, I’m going to tell you simply from where I’m coming from.

Ana: I have no idea what’s going on.

Rafael: I just came into this very, very late in the process, so I’m just trying to get up to speed.

Trevor: I would love to have dinner with you guys. I bet it’s crazy. Please, keep going.

Ana: Yeah.

Rafael: But what I basically said to her is, look how much progress we have made from a technology perspective. And again, talking about technology, I’ve been very involved, artificial intelligence, machine learning, I mean you name it.

Trevor: Machine learning freaks me out. It terrifies me.

Rafael: But the point that I was making to her is—

Patty: Why?

Rafael: Why in the hell you’re not able to say here is the diagnosis, here’s the prescription, and it works. No.

Ana: It’s so much more.

Rafael: Here’s a guinea pig. I’m going to try. So, the cocktail changes—

Patty: And you tweak it.

Rafael: Whatever. And then, if you don’t detect that it’s a mood swing disorder, then the patient is going through these motions, and so it’s I guess apparent. I’m seeing her, I mean it is very, very daunting—

Patty: It was painful.

Rafael: And I consider myself to be a quick learner. So, the reason why I’m bringing this up is for many parents out there who are like me. It’s very, very difficult. So, we, societally speaking, we make it excruciatingly difficult to support—

Patty: If we don’t talk about it.

Rafael: ... if we don’t talk about it.

Patty: If we don’t talk about it.

Rafael: So, at the core is the stigma. If we don’t tackle the stigma, everything else ... I don’t want to say that it’s irrelevant, but it makes it even harder.

Trevor: Yeah.

Patty: I mean, how comfortable are we when we say we’re guilty of something?

Trevor: Hold on. Hold on.

Patty: Never comfortable.

Trevor: Hold on. You’re guilty of what? What are you guilty of? What are you guilty of?

Patty: Looking back, things that I would’ve done sooner. I would have pressed a little bit more about maybe Ana exploring the use of a psychotropic medication before going to college. I know you can’t time a crisis, but in hindsight every time I remember that when the conversation was brought up for her to take medication, for me it was too late because she was just going to go to college. And you need to be ... You need support, for people to give you feedback on how you’re feeling with the medication. Alone in a dorm, new freshman taking medication, how are you going to know what’s what? Is it the medication, is it side effects, is it what? That’s the part that I go like, well maybe.

Trevor: When are you going to let that go?

Ana: Let’s give it a while—

Patty: It will go ... Well, yeah. I think it’s also attached with the fact of Carlos too. I have a son with no legs, and even though I am a bright person, and I’ve been through all the doctors in Boston, that they can reassure me that that was a congenital condition, that there was nothing ... It was not genetics, because I had two healthy girls. You know? You do go as a mom, and that’s what I said about culture, at least in my country, you blame parents. Period. It doesn’t matter. It’s the parents fault.

Rafael: So, the whole guilt, yes, I went through a very short period of ... And again, pragmatic, analytical, analyzing where did we fail to preempt the attempt. For me, it was very specific. Where did we fail as parents to avoid that moment that she decided to attempt and basically get herself out of this life. And in the analysis, what I realized what there was absolutely nothing that I personally could’ve done to avoid that moment. Nothing. Absolutely nothing. Because, in my analysis, I think we have given Ana the love, unconditional love, we have provided her with the opportunities, the tools to arm her to do what she needed to do. Absent of—

Trevor: What did she need to do?

Rafael: To face life.

Patty: To have a life.

Trevor: To face and survive life.

Rafael: To face life.

Trevor: As you define it?

Rafael: No. I’m not defining. Whatever choices she has, to prepare her—

Trevor: That wasn’t accusatory. I’m just trying to get—

Rafael: No, I know. And I’m glad that you asked.

Trevor: I should not have pointed. I’m sorry.

Rafael: No, no, no, but I’m glad that you asked to clarify to the audience. There was no adjective, there was no pre conceived definition of what life for her was supposed to be. It was basically love, unconditional, that’s a huge safety net. For her to know that her parents are unconditionally loving her, that is huge. And so, in analysis, I quickly realized that. But what I also realized is that that is based on the assumption that the support system around her, this is more societal, is there. And that’s when I realized, so for example in the case of her school, her school where she attended failed miserably.

Ana: So bad.

Rafael: Miserably.

Trevor: Yeah. Well, that’s a global scale issue.

Rafael: Yes. But so that was ... and then—

Trevor: Not to—

Patty: Minimize.

Trevor: ... reduce it. Not to minimize.

Ana: No, but it is ...

Rafael: Totally. And that’s why—

Patty: No, but it’s normal every single college campus.

Rafael: But the reason why I’m bringing this point is that’s why Patty and I, in addition to being a supporter of Ana, we are strong advocates to this. We invest a great deal of time making sure that we’re fighting to really take this stupid stigma out of the conversation.

Trevor: Before we wrap up, is there anything that you guys want to say? I want to interview the youngest daughter. I bet she’s the clutch in all of this.

Patty: You have no idea—

Ana: You have this poor girl. Not poor girl. But so far, I make jokes with her all the time. I’m like, all right, we’ve got the older ones with the no legs, we’ve got this one that almost didn’t make it, what’s going to happen with you?

Trevor: Yeah. Yeah.

Ana: Oh, and our dog has social anxiety.

Patty: I get the dog, and the dog is anxious, and—

Ana: All the time.

Patty: ... this is what I get from my dog. What we’re expecting from one of your kids? I’m like, okay, so my dog he is anxious. He’s anxious. I don’t care.

Trevor: Rafael, you don’t have to answer, just wink, I’m going to ask a question, wink yes, did you ever just in the driveway just ever go, Logan’s 45 minutes away, I can head back to Venezuela, I can change my name.

Rafael: Like why do I have to go back? I’m already out. I’m already abroad. I could actually extend my stay. I already have a passport in this country, I could literally stay.

Trevor: I think that’s ... All jokes aside, I think that’s a very human thing to think about. But you showed up every time.

Rafael: Yeah. The last thing that I want to say—

Trevor: I know my father wanted to jet many times.

Rafael: I’ll tell you, the last thing I want to say is, and again I’m from the analytical, pragmatic—

Ana: Black and white.

Rafael: ... type of guy that I am.

Trevor: Yeah, you’re very binary.

Rafael: I am binary.

Trevor: But that would make sense where you come from.

Rafael: Yes. Well, how I’ve been trained, and how I have evolved.

Trevor: Yes. Yes.

Rafael: Because it has nothing to do with your upbringing necessarily, it may have an impact, but it’s not necessarily. All of this, we’re blessed because Ana is here, but there are very many millions who actually are not here. And it does not have to take a celebrity to make the case to the public that oh my god, yeah, he suffered from mental health, and he had the resources, and yet he couldn’t make it. Well, that is very pathetic as a society. Right? My plead, and that’s why we’re involved, is we need to do a better job in making the case to the public that this needs attention. And it only takes a conversation to start the process.

Trevor: Okay mom, anything to add?

Patty: No.

Trevor: No?

Patty: Other than that I guess I remember looking back when all of this happened, I remember driving six hours down to Pennsylvania to be near Ana in the ER. And I remember thinking in my head, this is it. This changes her life from before and after. And how are we going to help her for the rest of her life, this incident that happened last night, how she’s going to live with this, because it’s going to change her life forever. And for me, given that I just didn’t know, my mind kept going back to that. Oh my god, she did it, and now what? How do you survive something like this? How does it look like? And now I can tell you that it’s a long process, and you don’t ... It’s not that you’re going to reach a point, it’s just your life, and it’s okay. And that’s how it looks like.

So, the same way you probably had a car accident, and you fractured an arm, and after that your life continues. I know it’s not the same, but it’s just your life, and it shouldn’t be something that you’re always going to go back to that day. It’s chronic. And also, it transforms. Every time you get older, and you mature, you will have your same condition, but it just changes a little bit. There’s more knowledge, and you will understand more who you are. And it’s going to be fine. I guess, I have to think like that.

Ana: Well I mean, look where I am. I wouldn’t have done any of this, obviously I mean make it out on the other side, and this isn’t typical for a lot of people that may attempt, but I mean that’s all I’m going to say. I don’t know what it was in me that started all of this, but with all the opportunities that I have, it’s not that I’m thanking what happened, but ... I don’t know. I’m hoping that I’m helping at least one person.

Rafael: You are.

Patty: Mm-hmm.

Rafael: Thank you.

Trevor: You’re welcome. Thank you.

Rafael: Thank you.

Trevor: Thank you for listening to Mindful Things, the official podcast of McLean Hospital. Please subscribe to us and rate us on iTunes or wherever you listen to podcasts. If you have any suggestions for special topics or future guests, email us at mindfulthings@mclean.org. And don’t forget, mental health is everyone’s responsibility. If you or a loved one are in crisis, the Samaritans are available 24 hours a day at 877.870.4673. Again, that’s 877.870.4673.

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The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.

© 2019 McLean Hospital. All Rights Reserved.

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