Mclean Hospital

Podcast: McLean, Meet Ecuador; Ecuador, Meet McLean

August 7, 2019

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On today’s episode, Trevor talks about his struggle to go with the flow.

Then Mariel Paz y Mino, PhD, (04:24), head of the Psychology Department at the Universidad de San Francisco Quito (USFQ) in Ecuador joins us. Mariel shares how she discovered her passion for mental health, public education, and improving mental health resources in Ecuador, as well as the challenges that come with this.

She touches on the lack of mental health resources and efforts to destigmatize mental health among the Ecuadorian community. Mariel also talks about the success of USFQ’s collaboration with McLean and gives a sneak peak of what’s to come in that partnership.

Episode Highlights

  • The Ecuadorian government approved mental illness coverage under health insurance a few years ago, but have yet to start enforcing it (11:00)
  • Mariel talks about learning organizational skills during her training here at McLean (24:17)
  • There are only 1.7 psychologists per 100,000 people in Ecuador (48:44)

Relevant Content

Episode Transcript

Trevor: Welcome to Mindful Things. Welcome back regular listeners, welcome new listeners. We’re going to move kind of fast, get to the interview right away, not a lot of time. On today’s episode, we are interviewing Dr. Mariel Paz y Mino. I think I rehearsed that for about five minutes and I’m not sure I even got it right that time. But Dr. Mariel Paz y Mino, she was trained here at McLean Hospital. She returned to her home in Ecuador, and is doing a lot of mental health advocacy and providing a lot of services down there. And that’s pretty much the majority of our talk, comparing mental health resources between Ecuador and here in the States.

It was a very fun talk. I really enjoyed our discussion. Really quick story, we recorded her interview on a Sunday, and as I was leaving at the end of the interview, I was driving off of campus and I see that she’s just walking. She’s here visiting from Ecuador, and she’s just walking to the exit of campus. And I pulled over and I was like, “Are you going anywhere?” And she said ... And I tell this story because I think it really illustrates the mindset of somebody who grew up in the States and somebody who didn’t. She just said, “I’m going to Boston.” That’s kind of a loaded statement. I was like, “You’re going to Boston? Where are you going?” And we’re in Belmont, so Boston, it’s close, but not really. And she said, “I’m just going.” I was like, “Do you want a ride?” “Sure,” she says, “If it’s not inconvenient.” And I said, “Not at all, I’m just going grocery shopping. I can go grocery shopping wherever.”

So I give her a ride to the Alewife T station. And she said, “Just bring me there to the Alewife T station.” Which is part of our MBTA, which is part of our subway services here in and around Boston. You can also pick up buses, you can pick up ride share cars there. I said, “Well, you’re going to Boston. Alewife is ... I mean, that’s even far outside of ... Well, not too far, but a bit far outside of Cambridge, or right on the edge of Cambridge.” And she’s like, “It’s fine.” And I’m like, “No, really. If you’re going to Boston, I’ll bring you to Boston. It’s not a big deal. It’s Sunday and I don’t have much going on.” She’s like, “No, it’s fine.” So, I dropped her off and that was that. And I was thinking as I was leaving, she just had a very wherever the wind takes me kind of approach to her day.

I’m really jealous for her that she has that. And I hate myself because I cannot do that. I just cannot. I mean, unless I’m home and swamped in my own dark thoughts and sitting there and doing nothing but thinking, yeah, maybe. But no, she chooses to not only go out and interact with life and the world outside of her, but she is kind of whimsical about it. And yeah, I don’t see that happening for me anytime soon. Yeah. I don’t know how to work on that, but I think it’s something I need to try. Okay, here we go, our interview with Dr. Mariel Paz y Mino, enjoy.

So, you’ve been interviewed live on the radio?

Mariel: I have. I have, yes.

Trevor: Yeah. Many times?

Mariel: Well, not much but perhaps three or four times while we were promoting the Mental Health Congress back in Ecuador.

Trevor: Yeah, and so it doesn’t ... Some people get intimidated.

Mariel: No. No. I think TV does it more, but radio, it’s kind of like you’re invisible—

Trevor: Oh, I like how you slid that in there. So, you’ve been interviewed on TV before?

Mariel: Well, actually, I have, but not for the Mental Health Congress—

Trevor: So you’re a superstar, that’s what you’re saying, right?

Mariel: Kind of.

Trevor: Yeah.

Mariel: No, no. I’m just joking.

Trevor: So being interviewed, it doesn’t bother you?

Mariel: No.

Trevor: Some people, it bothers them.

Mariel: Yeah, I bet some do, they don’t like it.

Trevor: Let’s kind of start from the beginning or as far back as we can go. From what I understand with some of the research that I’ve done, is that Ecuador has an issue or did have an issue struggling with mental health resources available in the country. And in a recent article I read, well, recent to me, it’s a couple years old, that there are even less mental health resources available for the indigenous population. Is this something that you were maybe aware of earlier in life and was passionately driven towards addressing it? Or was this something that you maybe discovered along the way while you were in school?

Mariel: I think it was more a thing that I discovered while I was in school. Part of our internship as undergrads were approaching underserved populations or minorities, and then you really realized they had no information whatsoever regarding mental health. It’s quite popular in Ecuador, especially for those people or indigenous cultures—

Trevor: What’s popular?

Mariel: ... It’s popular in the indigenous populations to actually find advice or information in the church, priests. So, what they usually do is if they have people who need mental health services, let’s think about depression or psychosis or something like that, they would literally go to the priest and ask for a kind of exorcism. Or they would ask for the cultural leader or the leader of the community to perform some kind of traditional or ancient ritual in order for them to get rid of whatever spirit is bothering them. They don’t have much information regarding mental health services.

Trevor: Why isn’t there a lot of information? There’s just no interest in gathering it? Or is it—

Mariel: Well, there’s—

Trevor: ... an issue that people just want to block out?

Mariel: There’s a lot of people that ... Well, there’s populations which have not had any contact with a lot of the principal or main towns in the country, and there’s another population which through their education, they’ve never been told about the benefits of mental health care, so it’s both.

Trevor: The subject is just being neglected? Or they don’t want to inform people that this is a service that’s out there that it’s ... is mental health, is it so stigmatized in Ecuador that just letting people know that there’s mental health services out there, is it just a word that’s just not getting out?

Mariel: Well, it is pretty much stigmatized, but there’s really no information whatsoever for the people. I don’t think the government has made much, much information regarding it, and the thing is, it’s not about how much mental health services are used, it’s more about how approved and evidence-based mental health services in Ecuador are. Because I’ve known a lot of people that are psychologists, but I’m not quite sure how much they’re helping their clients or patients in the sense that I couldn’t be positive of how well trained they have been in order to positively impact the population they’re working with.

Trevor: Let’s say-—

Mariel: There’s a lack of regulations, let’s say the mental health service is this part of medicine science, which is in a gray spot, not much things have been said about how you should conduct it. We don’t have an ethic code for the psychologists there, we don’t have a law enforcing for there. So usually when you get in a situation when you have to go and ask legal advisor about something you’re going to be doing, they don’t know where to go, because you can always go to the medical or medicine protocols, but there’s not something particularly that has been said about mental health.

Trevor: So, could I start a practice in Ecuador where I say—

Mariel: I just graduated from school, I have my degree, I’ll start a practice, yes.

Trevor: My therapy sessions just means my clients come in, and we play chess for an hour, and that’s the therapy and because it’s not regulated—

Mariel: You might go with it, people might go to you, and if you’ve got something going on, that actually works them, even placebo, you might be famous.

Trevor: So right now, it’s not just a matter of trying to start maybe like a ground floor approach to mental health, but you need to get the government on board and basically, the public as well to kind of all agree that mental health services start here at this approach, this is what a real mental health service looks like, because right now it can look like anything, it could look like chess.

Mariel: Yeah, exactly. Well, we have had discussions with people from the Ministry of Health Affairs, and they have been starting to regulate, they are interested in doing it, and we’ve been part of the talks. The thing is, there’s a part of the population, which is more politically governed, so they are going to go towards a more political way of thinking and doing stuff, and there’s other people which are usually part of private identities, which are coming more evidence-based. Like, “This is something we could offer.”

Something that happened quite a few years ago, which is really great, is the fact that the government issued an act in which insurance companies should have mental health insurances, which we did not. And the cool thing, well, not cool actually, is the fact that they haven’t been able to enforce it yet, so you don’t have that. So it’s not that you can buy a mental health insurance, nobody will cover mental health.

Trevor: So there isn’t a personal health insurance policy available in Ecuador that covers mental health services?

Mariel: There is, there should be now because the government did approve that just a couple of years ago, but it hasn’t been enforced yet, so it hasn’t happened yet.

Trevor: Why do you think it hasn’t been enforced? If the government approves something years ago and it hasn’t been enforced yet, I assume, because I’m cynical, that money is somehow involved with this somewhere.

Mariel: It must be involved, but the thing is, they’re prioritized like physical health in the sense, so it’s easier for them to have a health insurance that will cover physical things and what they don’t know, and this is part of the lack of information, is the fact that mental health services have a start and an end date, those are treatments that work, they’re evidence-based, they have proof, but people usually, when you talk about psychology in Ecuador, they think, “Oh, so you’re going to psychoanalyze me?” They’re thinking about a psychoanalysis and they think that this goes on for years and years and years. So the bottom line is that most people that are not around insurance don’t have the information to know, and that’s something we want to promote now, that’s one of our main jobs in order to realize ... Listen, this is something that could be done, people could pay a certain and not much amount of money in order to have their family covered regarding any mental health issues that might arise during the year.

Trevor: How big is religion in Ecuador?

Mariel: Oh, big part.

Trevor: Okay, so is his mental health in Ecuador, that kind of thing where you’re not going to go and talk about it with your professor ... I mean, with a professional. You’re going to go and talk about it with your priest.

Mariel: They might. People might do that. And the thing is that there’s a lot of religion in Ecuador, but I’m not sure how much education there is in Ecuador. So when education lacks, usually religion takes over.

Trevor: In Ecuador, are mental health issues, are they associated with sin? It’s like, “Well, if you’re having mental health issues, you must have ...”

Mariel: Well, I don’t think they’re associated with sin. It’s mostly kind of, “Let’s pray to God, they will go away.” Especially in people that don’t have enough education regarding science and mental health facilities and information. So many small communities, which have not accessed education, they might be praying with a priest in order for demons to go away or bad thoughts to be kept away.

Trevor: So the priests, a lot of the priests in Ecuador are also therapists in a way.

Mariel: In a way, yes.

Trevor: Yeah. Are the priests in Ecuador, are they ... Could they be a research or reference tool? I mean, if they’ve been if they’ve been the therapist for hundreds of years, maybe you should talk to them about, well, what are people bringing to you?

Mariel: There’s priests that are really well educated, not all of them. But a pretty important percentage, and I’m pretty sure you just gave me an idea. That would be really interesting to see and check about how much people go for mental health care with the priests.

Trevor: I’m two for two now, because my last—

Mariel: You could be a researcher now—

Trevor: My last podcast, I suggested Sabermetrics does to the person their eyes just lit up and they wrote it down.

Mariel: I have a notepad right now, but I’m texting it to my friend.

Trevor: I’m in the money now. Here I go.

Mariel: You’ll have your part.

Trevor: Yeah, thank you.

Mariel: When the time comes.

Trevor: So again, what compelled you to go in this specific direction?

Mariel: I went to school for an undergrad major in educational psychology.—

Trevor: And where did you go to school?

Mariel: Oh, back in the University of San Francisco, in Quito, in Ecuador. And while I was doing my practicum back in the education field, I realized—

Trevor: Oh, if you don’t mind me asking, what was your practicum?

Mariel: Oh, different, different practicums. I did a lot with underserved population. ... Mm-hmm . I did, like pre-K and daycare with kids. But then I realized that as much education I could give, there was a lot of psychological care that I couldn’t because I was not well-prepared. I think that actually threw me into the psychology part.

Trevor: Was it so overwhelming? Were you like, “Well, somebody needs to do something about this.”

Mariel: Well, yeah.

Trevor: Yeah.

Mariel: Of course.

Trevor: Okay.

Mariel: There’s a lot to do there. And especially, with the small population, early prevention programs, there’s a lot you can do there.

Trevor: Mm-hmm . So, you were at school, at University of San Francisco.

Mariel: In Ecuador.

Trevor: In Ecuador. How long is that satellite school been there?

Mariel: Oh, we’ve been there since 1988, actually. 30 years—

Trevor: That’s pretty good.

Mariel: Yeah, it’s a liberal arts school. It’s pretty much the American education. So it’s a new school.

Trevor: And so from there, I understand you came to Northeastern?

Mariel: I did.

Trevor: Okay. And so was that shortly after you wrapped up at University of San Francisco? Or did you do work in Ecuador for a while?

Mariel: Well, I knew that I had to get some more training in order to be able to see patients. So, I actually went to Spain. I went to Spain for a year, and I did work with Ecuadorian populations over there. We had a long immigration thing with Spain for a long time. So I went there, and I worked with these populations as well. I learned there a lot of CBT, there was—Institute. We also did a lot of outreach programs over there for a year.

Trevor: Right.

Mariel: And then I came back home, and I was hoping, perhaps I could start my practice now. And I was actually in the process of implementing my practice, when one day I was like, “How am I going to do it? I still don’t have much information.” And that’s how I felt mostly most of my life, in the sense that whenever I want to start doing something, I’m like, “I don’t think I have much information.” And because I’m a planner, I’ll go and find more information before doing it. So then is when I decided to come here to the United States.

Trevor: Right.

Mariel: So I enrolled. I actually did not enroll in Northeastern at first. I was trying to apply for a scholarship. So I enrolled. I came here around August, September. I remember I sold my car by in Ecuador. My dad gave me the money—

Trevor: Oh, what car did you have?

Mariel: I have a Peugeot.

Trevor: Oh, yeah, those are dope.

Mariel: My mom gave it to me when I was around 18. So, I had this really cool car. So we sold it, and I took the money and I came here. And I always knew I wanted to go to Boston, even when I was going to go to undergrad.

Trevor: To Boston? Not Los Angeles, New York City, Miami?—

Mariel: No, I always knew it.

Trevor: Boston?

Mariel: I wanted to come to Boston. I’ve always been like mesmerized by Boston. And so I told my mom, “I’m going to go Boston. I’ll find the graduate school there.” So, I came here and I remember I started working at Starbucks. So, it was pretty cool. I’m a U.S. citizen, by the way, so it was easier for me to get a job. And I thought, well, with the Starbucks work, I’ll figure the way out. So, I started working at Starbucks, and then I actually enrolled—

Trevor: which Starbucks?

Mariel: The CambridgeSide Galleria one.

Trevor: Oh, yeah.

Mariel: Inside that. So, I actually made my my first friends there, because there were a lot of young people that work around all that CambridgeSide Parkway, buildings and area. So I was the weird Ecuadorian girl that had the nice accent while preparing cappuccinos and we had our usuals. We had the people that were there every day starting 6 AM, and for me it was a different thing in Ecuador. I’ve been ... I was brought up pretty much in an accommodated situation. I never worked. I did some works, some chores inside the house, but other than that, I had never actually been working for earning stuff.

Trevor: How many shots of espresso go into a grande soy latte?

Mariel: So grande was three. Grande was two.

Trevor: Grande was two. I almost had you there.

Mariel:—Venti was three.—

Trevor: I almost had you there.

Mariel: And the tall one was one.

Trevor: Look at you!

Mariel: I had to learn a lot about Starbucks. They gave me like a big thing. Like, before you called your coffee, it wasn’t just calling it. First it was iced or no ice. Then you went the size, right? Then you went I think the non-fat, low-fat, then were like three-shot cappuccino, and you had to learn the whole deal.

Trevor: Yeah, it’s pretty out of control.

Mariel: Yeah, but it was hard. Working at Starbucks is not as easy as it sounds.

Trevor: No.

Mariel: It’s not just about putting coffee.

Trevor: My sister was an Assistant Manager there. She worked hard.

Mariel: Yeah. I actually bought an option there, now that I remember. I’m going to look that up. Yeah, perhaps I’m a millionaire now. And I haven’t known it. So, I came here, so I work at Starbucks for like ... I started working at Starbucks. I enrolled at Lesley University. So, I took a whole semester there.

Trevor: And What year is this?

Mariel: This is 2005.

Trevor: Okay.

Mariel: 2005. So, I came here. I enrolled in Lesley, I started working there. I started working at Starbucks. It was a full week schedule because I remember I woke up at 5:45. I got the CambridgeSide at 6:00, quarter to 6:00. I was actually the first ride of the T, which was weird because either you were working or you were partying. I know that’s the only two options that you could go. So I got there, I got the T, so I was an expert in public transportation, by the way. So I got there, I started working in Starbucks. My shift ended at 2:00 and then I had school from 4:00 to 10:00. That’s how I started. But it was nice. You know, I was really young and there was nothing else I had to do.

Trevor: But you had to be at work by like 4:30, right? To open the store.

Mariel: No, 5:45.

Trevor: Oh, sorry, 5:45.

Mariel: 5:45. We cleaned up until 6:00, and then at 6:00 we opened. And then I was back home at 10:00, and that was the way it went because I usually worked Saturday and Sunday. I had no friends here. So, I didn’t have a social life, so I started to build one at Starbucks, which was really cool. And then I actually applied for a scholarship at Northeastern. And then I got accepted, I got the ... it was the Atlanta scholarship, was African-American/Latin American/Native American citizen, U.S. citizen award. Yeah. So I got that, I worked as a TA, and that’s how I made my way through Northeastern and I kept working at Starbucks. It was good money. I also did some waitressing. There was this really nice Italian restaurant right next to the Starbucks. That was called Paparazzi.

Trevor: Oh, yeah.

Mariel: In the CambridgeSide Galleria. Yeah, it was nice. I made some other friends there. Good tips.

Trevor: Yeah?

Mariel: I actually went to Greece after working there.

Trevor: Oh, wow.

Mariel: I had so good tips. Yeah.

Trevor: That’s great.

Mariel: I thought it was the accent. I think the accent helped a lot. So then I started and then I got into Northeastern and then school started getting harder and harder and after that, I had to choose a place to do my practicum.

Trevor: Right.

Mariel: And that’s when actually McLean was on the list. I didn’t even know what McLean was at the time. And this is something I was telling yesterday to a friend. I looked at the list and I had a good friend with mind, She had a car. She’s still my friend. She lives here in Boston. And she says, “Listen, what are you choosing?” I’m like, “I don’t know. I guess McLean’s out of my list because I don’t have a car.” She says, “Oh, I’m thinking McLean.” And I told her, “Could I get a ride?” We used to live really close by, and she said, “Sure.” Oh, so I decided to McLean. And I started coming here and the first day I came here, we were assigned to the OCD unit.

Trevor: Right.

Mariel: Me and my friend, and our supervisor was Jeff Szymanski. So that’s how I met him ... I’m talking 12 years ago or something. And I did my whole practicum here and then I got to love McLean, and then I finished my master’s degree. And then I went back to Ecuador.

Trevor: Well, wait a minute, wait a minute. Wait a minute. There’s a lot more to—

Mariel: Yeah—

Trevor: But was the plan to always go back to Ecuador with what you learned and to help out?

Mariel: Well, not actually, I did think about staying here at first, but at the time, I think I was homesick for for a while. I’ve been out of touch with my family. Well, not out of touch, but I was away from them for a long time, and they just thought it was time to go back. If I could do it over, I think I would have stayed a little bit longer.

I see opportunities here you don’t see back in Ecuador. But at the time, that was the right decision, and I just ... I think I’m sticking with it until today. Like things have come out the way they should have.

Trevor: Yeah.

Mariel: Yeah. So I went back and then I went into university. I enrolled as a professor back then, and then well, I started my PhD and I started work at the university. And then, I finally had my private practice and I started working with kids and adolescents with anxiety disorders. So I’ve been working for that for a long time.

Trevor: What tools did McLean give you that you think you couldn’t have gotten anywhere else?

Mariel: Well, it was a lot of organizational skills, protocols. There were things that were planned in a certain way—

Trevor: And are you trying to implement these protocols back in Ecuador?

Mariel: Yes, I have. In my practice, I have. I have worked with a lot of that and all of the experience that I got there. It was actually not only about learning what to do inside therapy, but also conceptualizing mental health. I think that coming here gave me a broader idea of what I think about mental health. Like what my philosophy is about it, and I think that has helped through my entire career to understand how I see it, how I see psychopathology, how I teach, how I treat my patients. And I think that was mainly what I got from here.

Trevor: If you’re implementing things from here back in Ecuador, were patients struggling to adjust to the ... All of the sudden, there’s a very organized approach to mental health instead of kind of the free-for-all approach that you described earlier.

Mariel: Well, there’s still free-for-all, you know what I mean—

Trevor: Right. And that’s what I’m saying—

Mariel: You can still find—

Trevor: ... Does it make them feel uncomfortable, or are the methods so reassuring that they fall into it right away? Do you understand what I’m saying?

Mariel: Well, I think that when you show parents, this is what has worked. There’s a lot of evidence here, you can read about it. share a lot of the biography with them, like we’re going to talk about thoughts. How bad thoughts might affect your kids. I’ll share with you a book that helped me a lot understand what’s going on inside their mind. So, I think that’s ... The thing that makes the different in Ecuador, it’s psychoeducation. Because once you tell the parents what really is going on, things actually have a different perspective. They become smaller and they realize they can target it, it’s treatable. Because when there’s no information, whatsoever, they’re so frightened and they’re so afraid of being stigmatized that they don’t ask for help.

Trevor: I have an article here from ... I think it’s from three years ago, so I want to check to see if what they mentioned in here is still correct, but they say that depression is the most common mental illness in Ecuador followed by anxiety, stress, and poly-substance misuse. Is that still the case?

Mariel: Yeah, that’s kind of correct. The last study back in 2000, what you’ve got? 2017?

Trevor: Yes.

Mariel: Yeah, so that one, that’s correct—

Trevor: Dr. Lucien Aguirre?

Mariel: Yeah, yeah, it’s a study that was conducted in Ecuador. So yeah, actually the World Mental Health Organization talks about anxiety being the first one, but the thing is that it’s also confused with somatization disorders and drug abuse as well because sometimes clients come with anxiety disorders, which is a byproduct or somatization or a drug abuse, so they get mixed up. But yeah, those are right, the numbers.

Trevor: There’s a couple sentences here, if you don’t mind me reading. And excuse me, I’m probably not going to pronounce it correctly, but nervios, meaning nerves in Spanish, is a powerful word of distress used by Hispanics/Latinos from a variety of Caribbean Central and South American countries to express concerns about physical distress, turbulent emotional states, and adverse life changes. Nervios is not necessarily pathological, but is seen as a natural consequence of the human condition.

Mariel: Well, you’re doing your job.

Trevor: I try. Is this something that ... This word, this is common?

Mariel: Nervioso, nervioso or nervios. That means being nervous. Yes, I would say that of nervioso, or I’m stressed out, you know?

Trevor: That’s the thing you hear the most?

Mariel: Yeah, I’m stressed out, I’m—

Trevor: Stressed out about what exactly, is it usually? And excuse me, is it usually ... What this article says is that a lot of it has to do with socioeconomic issues.

Mariel: Well, it might be one of the causes of course, but then you have peer pressure, you’ve got like fitting in, in a group, then you have kids and I would say, school anxiety a lot. But in kids, it translates to, “My tummy hurts. My head hurts, stomach hurts.”

Trevor: They talk about that. They talk about how they ... Instead of talking about feelings, they talk about physical manifestations of it.

Mariel: Yeah. Yeah. And that’s something we teach a lot in psycho ed, is actually naming physical manifestation so they can actually locate and understand those are emotions. And all, sometimes their emotions are in their body.

Trevor: Right.

Mariel: And a lot of work with small kids is actually helping them figure that language.

Trevor: So to explain to them what emotions really are, you first, the first step is to talk about the physical manifestations of them and then explain, “This doesn’t mean that you have a brain tumor or cancer or anything. What it means is that there’s something emotional in you that’s so strong, that is so present that it’s manifesting this way, in physical ways.” And yeah, and I can imagine for a kid that would be mind blowing.

Mariel: It’s normalizing, it’s the fact that and this is my philosophy, it’s the fact that there’s just a such a small thin line between psychopathology and not psychopathology. It’s so small, so small that something that’s ... It’s not that when you have a mental health disease, you have something you’ve never experienced. Not at all. It’s just that the manifestations you have or you have had, sometimes keep appearing a lot and they’re interfering with your daily functioning.

So for I kid, for example, right? If he’s having anxiety, you might want to start by working out with him. Like, “Let’s go for a run, let’s run around the block. Let’s jump up and down until we’re so tired,” and once we’re tired, I can actually ask him, “So let me know how your heart pounds.” And he’ll be like, “Oh my god, it wants to come out. Can you feel it?” Yeah. So, “Put your hand on your chest. Let’s feel it. So what are you doing in order to control that?” “Well, I’m breathing, because if I don’t breathe, I think I’m going to faint, because I’m so tired.” “Oh, yeah.” And you go with it, until there’s a time when you tell him, “Now, could you tell me what you feel when you’re anxious? How’s your body manifesting?” And they actually do the match and they realize, it’s not that their body has never felt anxious before. It’s just that they are afraid about the fact that they’re anxious or the word anxiety, or I’m getting nervous or I might have an anxiety disorder, but it has nothing to do with the fact that their body hasn’t felt that.

They have, and they know how to calm it, and they know how to go back to a homeostatic—

Trevor: Right

Mariel: ... stage. So, part of the work we do is actually help them have the information in order for them to recall how it feels.

Trevor: Right.

Mariel: Now that they can identify it, and they can name it, they can actually work through it.

Trevor: Right. So in 2016, that’s when you founded the clinic.

Mariel: Yeah. In 2016, I was named the head of the psychology department in the university. Previous directions have had a not-so-formal, let’s say, way of a mental health clinic that was functioning. So it was functioning inside the university, there were certain classrooms in which students picked up clients on work. But since I moved in, I decided that it was time to formalize this.

So, I have a close friend, his name is—. He’s the director of the medical systems, the health medical systems in the University. He has a clinic. And I actually asked them, “What would you think about bringing the mental health clinic into your clinic, in order to have a more professional, formal way of treating our patients?” And he said, “Well, that sounds amazing.” So, in 2016, we moved the, let’s say, informal way that we had been and the interior former director had been managing into a more formal, so now students had to where they’re more ... How would you call that? I’m missing that word. The ...

Trevor: Blazer?

Mariel: That’s not the blazer, it’s the white tunic doctors wear?

Trevor: A lab coat?

Mariel: Yeah, like a lab coat so they were more formal. They couldn’t wear like broken jeans into consultation. So we need like a more formal way to treat our clients. We started using the call center from the clinic in order to formalize more the information. We started using the computers in order to get all the information there. However, what was done before and we kept on doing was serving populations that were underserved, and that did not have money to get consultations. So we financed those. So I’m telling that our consultations for the people that couldn’t pay were $3, ​$1, $5. And that’s the way we’ve kept coming so far.

Trevor: And what funding sources do you get for the clinic? Or ...

Mariel: We don’t get funding sources.

Trevor: Nothing?

Mariel: No.

Trevor: Nothing.

Mariel: We get funding sources from my friend the director from the clinic, because he has been nice enough to offered us rooms in which we can do our practice. So I would say that’s the funding we get.

Trevor: That’s nice.

Mariel: Yeah, yeah, he’s really nice. And he’s into mental health as well. He understands the need and the impact of mental health and physical health as well. So yes, that’s the help we’ve gotten. And then we’ve got like a lot of our students, the last year clinical students go there and have their supervision there. And then from the money that we have raised, because we have the students that under supervision give services to these underserved population, but we also have professionals such as professors, or other professionals that we have hired in order to give mental health to people that are able to pay for the consult. Which is like around $39. So, from that money, some of it, we have reinverted ... We have reinvested in order to buy the cameras we’ve needed for the supervision and small things, tests, psychological test for evaluations.

But it’s kind of ... auto, the money we get is the money we invest. And that’s the way we’ve been working.

Trevor: So, it sounds like it’s been a ... overall, a pretty big success?

Mariel: Yeah, in two years, we have had over 10,000 sessions. So we’ve helped around 6000 people.

Trevor: I mean, that’s incredible. But what roadblocks or obstacles have you encountered so far in the two years? What setbacks, if any?

Mariel: Well, first of all, there’s always the financial part. Like we could do more if we would have more space, sometimes we need more room. Protocols, there’s lots of psychologist we have hired but we haven’t been sure of the way they practice. So that has been a big thing because we can’t just hire whoever wants to practice, we’ve got to make sure they’re providing the right service.

Trevor: Right.

Mariel: Stigma. Stigma has been a big part of it as well.

Trevor: So how bad is the stigma down here? I mean, we kind of talked about it earlier. I mean, stigma.

Mariel: You don’t want to talk about somebody having the mental health.

Trevor: Right. But I mean, a lot of people don’t want to talk about it here either. Is it worse in Ecuador than it is here?

Mariel: I don’t think it’s worse. It’s just that we’re a smaller population. And let’s say that in Ecuador, we don’t have our ... Let’s say—

Trevor: Would people not associate, if you came out and said that you had a mental illness, is it so bad in Ecuador, that people would just stop associating with you? Is it that bad of a stigma?

Mariel: It could, yeah.

Trevor: Yeah?

Mariel: You could ... Well, you couldn’t get fired because that’s not, there’s a law also, you can’t hire. That’s discrimination. But pretty much if you know somebody has had a mental condition, you look them differently. People look at them differently for sure.

Trevor: I can’t remember in America but I remember in other countries in the 50s and 60s, certain things that we now know or if you were a sensible person have always known weren’t a mental illness, are there things like homosexuality or anything like that, that is viewed as a mental illness?

Mariel: Well, it’s incredible that you mentioned that now. We’re having a whole debate, not about it being a mental health illness, but the ... we just signed, the Congress just approved ... It wasn’t the Congress. I think it was the law ... something, I’m sorry, I’m lost in the English words here.

Trevor: It happens to me all the time—

Mariel: But they just legalized the same sex marriage.

Trevor: Okay.

Mariel: In Ecuador, they just did it and it was a whole commotion, especially for the church.

Trevor: Really?

Mariel: Yeah, yeah, like always it is. So we have a stand, in the sense that there’s people to say, “Listen, you can marry whoever you love.”

Trevor: Right.

Mariel: “That’s up to you.” And there’s other people that have started talking about, “What’s going to happen with adoption? And what’s going to happen with the heart of the family? We should keep it this way, and the core values of the church.” So it’s a big thing. And ...

Trevor: Does the church have strong government influence in Ecuador?

Mariel: Oh, of course.

Trevor: Yeah.

Mariel: Of course. And not just the government. In every family, you’ve got a grandmother, great grandmother, an aunt who would say, “Oh my God, that’s like, unbelievable.”

Trevor: Are you religious?

Mariel: I’m not. I think I’m more spiritual than religious.

Trevor: What does that mean?

Mariel: That means that I have ... I don’t get along with the church. That’s what it means. I believe in God, I believe in energy, I believe in sources. I’m beyond grateful with the life I have, but I don’t agree with the church.

Trevor: And has the church, have they been—

Mariel: Powerful. Powerful.

Trevor: Have they been critical of mental health services?

Mariel: Not about mental health services in specific, but the church tends to give advice to the people and they usually go through the church way. And there’s a study actually, that says that people with anxiety disorders and who are more reactive temperament or personality tend to be more religious, because they tend to need some guidance about what’s going to happen next, and “Where can I rely on? And it’s very difficult for me to rely on my own thoughts and things and it’s easier to have a religious or a priest or somebody that’s going to take care of the situation.” So that happens a lot in Ecuador. Yeah.

Trevor: So, you are collaborating with McLean now on Deconstructing Stigma?

Mariel: We are.

Trevor: Yeah?

Mariel: Oh, we’re just starting actually to work on that campaign.

Trevor: Can you walk me through what that’s going to be?

Mariel: Well, everything kind of started last year around March 2018. Some other professors in the department actually suggested, “I’ve been looking around and I found this really interesting campaign called Deconstructing Stigma. So should I go check what that’s about? You know, I think it would be something interesting for us.” And we all agreed it would be. So, I think ... Saul, which is a nice friend of mine and also a professor at the school contacted Adriana Bobinchock here at McLean and she said, “Listen, we’re from the University of San Francisco, we’ve been checking your campaign. We’re really interesting, is there something or some way we could collaborate or make this something in Ecuador?” And actually, Adriana and Scott, they were both pretty receptive. I was like, “Sure, where are you from?” And we also had another teacher from us that also did her practicum here. So there were special ties that were in between. And so we decided that we wanted to go into Deconstructing Stigma. But at the time I told Adriana and Scott, “Listen, I’m just feeling that there’s no information about mental health here in Ecuador,” in order for us to just throw the Deconstructing Stigma at first. So why don’t we go first into a more like informational stage? And they said, “Sure, what would you suggest?” And we were like, “Why don’t we do a Congress, in order to start talking about mental health?”

And that’s what happened last March, March 2019. Adriana and Scott actually put together a great team of professionals that came to Ecuador in order to talk about mental health. So we did a nice Congress that was named From Adolescence to Adulthood: Everything You Need to Know About Mental Health. And we ... They came back in March. We had such a great opportunity and I thought that was the beginning of a really strong relationship we’ve created and now the second part of this project will be launching Deconstructing Stigma back in Ecuador. So that’s how it has all come together.

Trevor: Now that we know how it’s going to come together, what’s the future plan? How are you going to roll it out?

Mariel: Well, actually, we’re here right now in Boston to work on that. We’re planning next year, we’re also planning about the second mental health Congress because it was a success. We actually sold out all the seats we have for the Congress. And so that’s part of why I’m here right now. And it’s going to be to discuss and see how we’re going to be creating these in Ecuador. So, bringing what you have created here, and adjusting it to our social perspective and how we’re going to launch these and we also want to do a lot of what they did in India. They have shared a lot of information about the fact that they created a museum, a brain museum, so kids were also able to go there and see what a brain looked like and what neurons look like.

And I think that could also be brought to Ecuador, because that would be a great opportunity for kids to start getting engaging mental health and how’s the brain and how it works, and why do we need to take care of it? So, I think it’s going to be an incredible opportunity for the Ecuadorian population.

Trevor: Mm-hmm . Do you have any family members or loved ones that suffer from mental health issues?

Mariel: I don’t. I don’t have loved ones, but I have close people or friends who have had. And I’ve seen how difficult it has been for them in Ecuador to have to get the right diagnosis, to get the right treatment. And that has actually pushed me towards keep working on this because there’s a lot of need.

Trevor: Do you have any mental health issues?

Mariel: I think I’m in the border, in the sense that I might or I might not, I haven’t been exactly diagnosed yet. But you never know.

Trevor: You never know.

Mariel: You never know, and that’s what I’m saying about mental health. Sometimes that you might be health one day and then you might not be the next one. It depends on so much stuff.

Trevor: Is there a gender dichotomy with mental health in Ecuador? Are you seeing more services go towards men than women or the other way around? Or is that not happening?

Mariel: I think women are more stigmatized with it, but I think that comes, something that comes everywhere.

Trevor: Yeah, that’s a universe—

Mariel: You look at anxiety and think you would say there’s more percentage of women that are diagnosed. I think there’s like—

Trevor: ... The crazy woman stigma.

Mariel: ... Exactly.

Trevor: Right, yeah—

Mariel: Or that hysteria—

Trevor: The hysterical woman stigma. Right.

Mariel: In Spanish, you’ll say,—. You’ll never say—. And that that has to do with something that has happened in history, you couldn’t say ... I would say there’s more demand in adolescents now. I would say there’s a big, big adolescent population that needs help.

Trevor: Why?

Mariel: I would say, there has been a big population as children that haven’t been properly directed into understanding their emotions. So we now have a big adolescent population that has had these anxiety problems before, which has not been managed. So they get into alcohol abuse, they get into drug abuse.

Trevor: So, it sounds like we’re not just talking about therapy, but it sounds like there are—

Mariel: Preventions.

Trevor: ... These are missing parenting skills, right? And that’s not what I mean, but you know what I mean? Like parents need to know about this stuff, so that they can address these issues—

Mariel: And that’s when I go back to psycho ed.

Trevor: Yeah.

Mariel: That’s when I go to psycho ed, because I think now parents are realizing how important it is to be present. How important it is for being mindful.

Trevor: Right.

Mariel: And so, we’re actually giving these these pep talks and we’re ... There’s a lot of parents that are engaged. But the thing is most people that want to know information are from a higher socioeconomic class. I don’t see much friends from a low socioeconomic wanting to be trained in this. So that has to change because the education has to go to everyone.

Trevor: Right.

Mariel: Mm-hmm . But, I’m pretty sure that, if we’re able to target most parent population in a few years, we’ll have better results in terms of adolescents under substance abuse, consumption, and psychopathological problems, because there’s a lot of work to be done in the younger population.

Trevor: Do you find that parents are open to learning these new approaches to their kids? Are they offended? Do they think that they’re being ... that their parenting is being judged?

Mariel: I think language has changed a lot. And I think that through words that are more simple, kind of like, being present or being mindful or breathing or connecting, you are able to get parents’ attention more than talking about, “Let’s prevent anxiety.” Sometimes when you use the names that have been associated with mental health illnesses, people get scared. And they say, “Why would I go there? I’m I’m not ever going to have a child that has a mental disorder or, or a mental health issue.” But when you talk about how do you make people be more present? How do you make people be more connected? How do you engage your family in more emotional development? People tend to go there, because they do want to get informed.

Trevor: Do you know what the suicide rates are in Ecuador?

Mariel: I think I had that number. I’m not quite sure right now, but it’s high, especially in the adolescent population. Lately, we’ve had a lot of kids that have committed suicide. And the weird stuff is the people around those kids after they’ve been interviewed to see something was going on, people will say, “Well, it seems like everything was great.” It seems that there was no problem whatsoever. And that’s the thing. Kids don’t ask for help. They don’t get to get help at all. So later on, they just one day, they wake up and they can’t handle anymore and they just throw themselves.

There’s been a lot of kids that have committed suicide by throwing themselves from a bridge. Yeah. So, I actually saw some statistics yesterday, they were talking about 1.7 psychologists per 100,000 people in Ecuador. So that’s nothing. We’re talking about to psychology.

Trevor: Wait, what?

Mariel: 2 psychologists per every 10,000 people in Ecuador, and we’re about 16 million people in Ecuador.

Trevor: So, your resources are—

Mariel: Scarce.

Trevor: Yeah.

Mariel: Mm-hmm . And the thing is, that if they are, we should really get into realizing which are really worth it. Because we might be talking that those 1.7, they’re not all qualified.

Trevor: And so suicide is, is it peaking? Is it starting to lower or is it on the rise in Ecuador?

Mariel: I think it’s on the rise.

Trevor: It’s on the rise?

Mariel: Yeah. A lot of mental health illnesses are on the rise. And the fact is, that—

Trevor: And because of that, suicide is on the rise?

Mariel: ... Yeah, because the thing is that there’s a lot of mental health issues going on, but they don’t get treatment, because they don’t know where to go. They don’t know where to get help or they think it’s going to cost too much or parents are just trying to ignore or ...

Trevor: So how are you trying to do your outreach? Are you using media? Are you using Word of mouth? Are you using everything?—

Mariel: Well, we’re creating now—

Trevor: Is it social media? Where are the targets for the most amount of exposure to get the word out?

Mariel: Well, social media, that’s a lot and we use that a lot. Since we started the mental health Congress, I have had a lot of people that have come to the clinic. Even while we were there, we had these men from Guayaquil, which is another city in Ecuador, he just knew that the Congress was going on. And then we had some experts from Harvard Medical School and from McLean, he just took a flight, came in with his son’s MRI and everything and he was like, “I really need some help.” And he actually got referred and he got the the information he needed. But he was saying, “I’ve been trying to help my son for years now. And when I heard it on the radio, that you guys were here and that you had started this campaign and talking about the Congress, I really wanted to come here and see if you guys could help.” So social media is really strong, and that’s going to help us out a lot.

And what I’m trying to do is actually, some of the McLean experts that have agreed to come and help us train professionals in Ecuador. They’re coming and they’re offering also outreach programs, which we can offer schools, right? Trying to train teachers in schools to be able to spot certain anxiety characteristics in kids in order for them to start doing prevention things, and avoiding mental health issues and adolescents.

Trevor: Is violence on the rise with kids?

Mariel: Violence on the rise, explain that a little—

Trevor: Violence, like here, here we have school shootings all the time.

Mariel: Oh, we don’t get that in Ecuador that much. Well, that’s the thing. We’re a smaller population.

Trevor: Right.

Mariel: We do have violence a lot, a lot.

Trevor: Is it growing? Is there a connection between that and mental health?

Mariel: There is a connection between mental health and violence, for sure. We don’t hear about school shootings as much as you do here. But again, Ecuador is a smaller population. It’s composed differently in terms of the psycho, the socioeconomic, what I mean is we don’t have a middle class. It’s really, really small. So, you have people that can access and there’s people that actually cannot access. And it’s not that it’s not happening because you hear in the news, in the tabloids about a woman getting shot and a man getting murdered and things like that.

But it does not belong to the people you’re used to getting along with or it, or it doesn’t belong to your immediate environment. So people tend not to listen to it, something that it might not happen just because it doesn’t happen next to you.

Trevor: Right.

Mariel: But we have a lot of violence. And we have a lot of lack of education as well, and I think that comes together as well.

Trevor: Mm-hmm . I attended a conference a year or so ago. Well, I didn’t attend it, I was there working. But I remember the Boston Police Department talking about how they’re taking more of a mental health approach to a lot of issues. Have you seen local law enforcement in Ecuador being open to such a thing? Or, did I just touch on a very, very bad subject? I’m sorry.

Mariel: Could you bring those people to Ecuador? Could you? Could we train the police over there?

Trevor: So the police, they’re not open to it at all?

Mariel: No. Well, I don’t think they’re open. I just think they’ve never heard about it. I don’t think it’s in their immediate actions.

Trevor: Is it a waste of time to send somebody over and try to educate them on it—

Mariel: Nope, I don’t think it’s ever a waste of time. There’s always opportunity. And if you can make the difference with one police officer who really thinks about the importance of mental health for the population, that would be awesome. So you can bring that in as well, with your research proposal.

Trevor: Okay. I think we’re just about wrapped up except one thing I need to bring up, and we’ll relate this to mental health somehow. Is you love karaoke, apparently?

Mariel: Oh, I do love karaoke. Yeah.

Trevor: Yeah? What’s some of your favorite karaoke songs?

Mariel: Oh, I love the ones ... I’m sure you never heard them. That’s the bummer.

Trevor: Oh, that’s—

Mariel: Have you ever heard of Luis Miguel?

Trevor: Oh, gosh, yes.

Mariel: Selena—

Trevor: Selena? Selena, it was so it was worldwide news when she was killed.

Mariel: I know.

Trevor: Yeah.

Mariel: Actually, they remade a movie recently.

Trevor: Well, they—

Mariel: They remade the movie 19 ... 2018.

Trevor: Right. But the original was with J. Lo, and that’s what made her famous. Right?

Mariel: No, actually, there’s another movie which is now with J. Lo.

Trevor: Right, but the original film on the 90s was the one with J. Lo, and that’s how she broke out. Right?

Mariel: Yeah. And I love Selena, I love Luis Miguel. I don’t know if you’ve heard about him.

Trevor: So, you like doing karaoke—

Mariel: Oh, I love ABBA. ABBA songs.

Trevor: ABBA?

Mariel: Yeah, love ABBA.

Trevor: Like the Swedish ...

Mariel: Yeah, yeah, A-B-B-A.

Trevor: Yeah, mm-hmm . Mm-hmm .

Mariel: Yeah, my mom used to hear that when I was little.

Trevor: Which ABBA song? Let me guess. Fernanda?

Mariel: No, Dancing Queen.

Trevor: Oh, Dancing Queen?

Mariel: I love Dancing Queen. Yeah, Dancing Queen, well, all of them. I love ABBA songs, all of them.

Trevor: Do you know in the early 2000s, I think it was 2002-2003, they were offered, the four of them, to get back together. Somebody did the math, and with concert tickets and sales from merchandise, they would have grossed, not netted, they would have grossed each of them $1 billion.

Mariel: Why didn’t they—

Trevor: And they still turned it down, because that’s how much they hate each other.

Mariel: ... Oh my god. That’s amazing.

Trevor: Yeah, they still turned it down. Now, the announcement came that they are getting back together, two years ago, but nothing’s happened.

Mariel: Have you been to the Broadway show?

Trevor: Mm-mm.

Mariel: Mamma Mia?

Trevor: Mm-mm.

Mariel: Oh, it’s amazing. You should get—

Trevor: Yeah, no. If they get back together, I’m definitely going to go because this, even more than Fleetwood Mac, there’s no music group I think, English speaking group in history that’s hated each other as much as ABBA—

Mariel: ... I didn’t know that. That’s news for me.

Trevor: Hate each other. All of them hate each other. I think the two women get along okay, but ...

Mariel: Which is weird.

Trevor: Yeah, they all hate each other. They want nothing to do with each other.

Mariel: Oh, that’s so bad—

Trevor: They were offered $1 billion apiece and they still turned it down.

Mariel: I love all of them.

Trevor: Yeah.

Mariel: Like Take a Chance On Me, and Chicquitita. All of them, I love ABBA. I love the 80s music as well.

Trevor: Like what? Madonna?

Mariel: I like Madonna. I could sing Madonna.

Trevor: Wait, did you like when she went into Latin and Spanish songs, or did people ... Were people offended by those?

Mariel: I don’t think she’s a Latin singer.

Trevor: She tried.

Mariel: Yeah, but no. I like Madonna. I like her songs. I’m ... Well, I’m thinking more karaoke stuff.

Trevor: Yeah. Like what—

Mariel: I’m definitely going for ABBA. I think that’s one of my best songs to sing.

Trevor: ... Do you use karaoke in your mental health?

Mariel: I haven’t yet, and you come with really nice treatment strategies. We could do karaoke as well.

Trevor: I found not karaoke but music rhythm games, I found playing those have been a big help for me.

Mariel: Mm-hmm . Music helps a lot.

Trevor: Mm-hmm .

Mariel: Yep.

Trevor: So, is there anything else we should add before we wrap up? Is there anything you want to say?

Mariel: No, I’m just so happy. I just wanted to thank for you, thank you for having me today. I just think this is a great opportunity for me to share about some of the mental health things that are going on in Ecuador. And I’m just hoping that we can keep on collaborating with McLean and all their stuff—

Trevor: How much of a rock star and inspiration are you? Are there students coming up to and saying, “I heard what you did, and I see what you’re doing and I want to do what you’re doing.” I mean, clearly there’s students, didn’t we just talk about that? There’s a student from Ecuador here right now training? No?

Mariel: No, there’s professors.

Trevor: Professors, right—

Mariel: There’s professors that are part of the faculty that were trained here as well. Yes. But no, no, I think that, like the mental health Congress was great for inspiring most of our students to see that there’s so much we can still do.

Trevor: Okay.

Mariel: And that investment in mental health actually would make us get rid of all the other investments we usually do in physical health.

Trevor: Right.

Mariel: So, I think that’s really important and it has helped me that way. It has helped me as a mom as well. You know, I think my instruction has helped me understand my upbringing and realize all the things and changes I need to do in my kids’ upbringing in order for making them healthier.

Trevor: Right.

Mariel: Mental health, yeah. Healthier mental health for them.

Trevor: Mm-hmm .

Mariel: Mm-hmm .

Trevor: Is there anything you want to add before we wrap up?

Mariel: No, I think that’s it, thank you.

Trevor: Thank you very much.

Mariel: Thank you, Trevor.

Trevor: So what did you think of that? Fun interview. I wish her the best of luck. Because it sounds like there are a lot of obstacles in the way for mental health services and the stigma around mental health in Ecuador, and I think it’s great that she is collaborating with our Deconstructing Stigma initiative. We need more people like Dr. Mariel Paz y Mino in the world.

Quick note, that story about ABBA that I talked about in the interview, that is true. Can you imagine hating someone so much that you would turn down a billion dollars? Can you imagine that? Because here’s something crazy, I can. I can imagine that and that’s messed up. Another thing I need work on. Okay, two weeks, two weeks, two weeks, two weeks. Not only do I already have the next episode ready, or already recorded, I think we have another two or three already recorded. So we have plans, we have plans here. And I’m working with a new producer, I’m just going to call her my producer, co-producer, Lauren, and she’s been really great. So I think a lot of good things are coming your way, so stay tuned.

And thank you for listening. I really appreciate it. Okay, two weeks. 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.

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