“Friendship with oneself is all important, because without it one cannot be friends with anyone else in the world.” -Eleanor Roosevelt
This past Tuesday, October 10th was World Mental Health Day, which focuses on raising awareness about mental health concerns around the world to ultimately mobilize efforts to support mental health. While I know I don’t have to state the obvious, we are nearly in 2018—a time in history where technology is at a forefront and medical procedures are becoming much more advanced. Regardless of the progression taking place in certain fields such as technology and medicine, mental illness is still a concept that remains stigmatized in many, if not most countries across the globe—including ours.
According to the National Alliance on Mental Illness, 1 in 5 adults in the U.S. (43.8 million, or 18.5%) suffer from a mental illness each year and approximately 450 million people around the world are currently suffering with a mental health issue (NIMH, 2015). Only 41 percent of adults with a mental health condition received help and just over half (50.6 percent) of children ages 8-15 received mental health services in the previous year (SAMHSA, 2014).
In 2010, the CDC reported that 57 percent of all adults believed that people are caring and sympathetic to persons with mental illness. However, only 25 percent of adults with mental health symptoms believed that people are caring and sympathetic to persons with mental illness. While efforts have been made to reduce and eliminate the stigma towards mental health, as a society, we are far from attaining this goal.
Time and time again, I have heard individuals say that people “should” be able to deal with “tough times” on their own. The response is simple. If you were to fall and sprain or break your leg, would you seek medical care or “should” you be expected to deal with this “tough time” on your own? Should you just walk it off until everything is better? That’s not a viable or realistic solution, and if we can understand and accept the significance that mental health plays in our daily lives, similarly to medical health, we can each work to break this stigma.
In life, we often find that the act of being vulnerable (to an extent) leads to the attainment or accomplishment of goals. Or at least, it puts us in the direction of doing so. For example, when searching for jobs, we find ourselves engaging in a state of vulnerability as we partake in job interviews—often a scary process for many. Asking somebody out on a date requires a level of vulnerability, as you cannot ensure the outcome you would like. Trying a new restaurant when you already have your top three go-to places also involves being vulnerable because you have no idea whether or not you’ll enjoy the food and dining experience.
So just what happens when we take this step into vulnerability? Well, for starters, you find out in the job interview if the company is the right fit for you, and vice versa. You have the opportunity to analyze the interview and note what went well and how you can improve for future job interviews. When you engage in vulnerability and ask somebody out, there’s the possibility that the person will say yes. Of course, there’s the possibility that the person will say no, but you may never know what their answer is unless you ask. And as for the restaurant, you may end up with a new favorite dish and/or dining spot, or you may realize you never want to go back there again. But we won’t be able to attain these answers and knowledge if we don’t at least try something new.
So when we look at mental health and discussing our own personal mental health, yes, this is another experience in which vulnerability may likely be required. It can be uncomfortable to openly discuss what has been going on in our lives and how that has been affecting us. It can be challenging to freely discuss how we are feeling when it seems as though preconceived notions on the part of others may constantly be present. And it can seem impossible to honestly discuss when we aren’t doing too well. But this is how we break the stigma. We have to start somewhere, and that somewhere is playing our part and finding the courage to be more open regarding our mental health.
Promoting a greater level of mental health starts by speaking up. We cannot expect to break a stigma that has been around for centuries if we don’t practice what we preach. While I can attest that at times, this is easier said than done, what is it that we have to lose? By confiding in a confidant, we allow ourselves the opportunity to be heard. We give ourselves a change to really explore how we are doing without censoring ourselves. And we let ourselves be supported—another act of vulnerability.
Can we overcome “tough times” on our own? Honestly, who cares? Strength can be found within each of us, and overcoming challenging life obstacles by oneself doesn’t define personal strength. Personal strength can often be found in reaching out for a helping and supporting hand. There is strength in numbers, and if we can create and foster a support system and find the courage to open up, we can begin to break the stigma of mental health, while working on and maintaining our own mental health as well.
By no means is this a clinical perspective for anyone dealing with mental health concerns. This is more along the lines of what we can do to break this stigma. Should an individual find themselves in need of help, open up to a confidant and let them know what is going on. If they don’t listen, find somebody else. And if it is an emergency, do not hesitate to call 9-1-1. Know there is a plethora of mental health professionals who are here to listen. Collaborating with a mental health professional to receive treatment and accomplish any goals one sets for themselves is always going to be an option. We just have to be vulnerable by taking the first step.
There is one designated day in the calendar set aside to focus on mental health. (Granted, I missed that day, but I guess it’s better late than never). It is up to us to ensure that we focus on mental health everyday so that being vulnerable and honestly discussing how we are doing is something people can take pride in. We will be the ones who set the standards for how future generations view mental health. But in order for any change to happen, it must start with us.
Below are just a few of many available mental health resources:
On Friday morning, we hosted another workshop with a different group of Líderes Escolares. Similar to what I mentioned in yesterday’s post, today’s workshop focused on mental health, including psychoeducation regarding the difference between sadness and depression, the difference between stress and anxiety, how to spot signs of suicidality, and resources that the students can use in the case that a peer is experiencing any of the aforementioned topics.
The students who participated in today’s workshop were younger than most of the other students we worked with thus far, but their interest and participation in such serious topics was great to see. Following the workshop, one of the students stood up and thanked us for the work we have been doing in Peru, and for the information and support we have provided the Líderes Escolares with. You can never know if you are making a difference in the surrounding community, and even though we still don’t know whether or not we have been and are making a difference, it was truly rewarding to hear such young students thanking us for working with them. After working with such inspiring, young leaders, one can’t help but feel a great sense of hope for the future.
After our workshop, some of the social workers we have been working with took us out for a delicious lunch, consisting of ceviche mixto and chicharron de pescado. As soon as we finished lunch, I had to get back to Huanchaco for my last Spanish grammar class.
Once our class ended, another student and I ran over to facilitate our last group with adolescent males that I spoke about throughout the past few weeks. Today’s group focused on support systems and evaluating the different types of support we each have in our lives (including practical support, social support, emotional support, and advice-based support). This activity helps you realize the types of support you may or may not have, which is useful in thinking about who one’s main confidants may be. We then focused on TIPP, which I wrote about on Monday.
During times of crises, TIPP is a useful tool that one can utilize to take a step back from the crisis to de-escalate the situation. TIPP can be used when one is about to engage in dangerous behaviors during a crisis, when an individual needs to make an important decision, but is too overwhelmed to think/make a decision, the individual is not processing information effectively, the individual is emotionally overwhelmed, and/or the individual isn’t able to use his/her abilities. TIPP stands for Temperature, Intense Exercise, Paced Breathing, and Paired Muscle Relaxation—all of which are techniques one can utilize during a time of crisis. As we finished the session, we celebrated our time together and the group members’ participation throughout the past few weeks with a chocolate cake.
Following the group, we ran over to the beach to watch the sunset one last time, before having to leave Huanchaco later that evening. After enjoying the sunset, some of the other students and I went for dinner, and returned back to our house to pack, before leaving for the airport. Since I won’t be returning to the States until Tuesday, I took a cab to San Isidro (where I will be staying for the next few days) once I arrived in Lima at around midnight.
Today (Monday) marks our last full week here in Peru. So of course, the best way to make the most of our time here is to spend hours trekking nearly 9 miles, thousands of feet above sea level.
We were outside our hostel at 5:00 in the morning waiting for the tour bus to pick us up. Mind you, when you’re roughly 9,400 feet above sea level in the mountains during wintertime, it’s pretty cold in the morning. The bus arrived at 6:04am (not that I was staring at my watch for over an hour…), but we did stop for breakfast along the way, which definitely helped. After breakfast, we continued driving further into the Cordillera Blancas in El Parque Nacional Huascarán, where the bus would drop us off to begin our trek. As cameras and phones started snapping pictures on the bus during the drive, we stopped at Lake Chinancocha first for some pictures—every tourist’s dream.
Before beginning our journey (at around 9:15), our tour guide informed us that most people are able to make it to Laguna 69 in three hours, and some people even make it in two. The tour guide mentioned that he would walk behind the group, so as to help us keep a steady pace. He then informed us that if we were not at the Laguna by 1:00pm, we would need to turn around and return to the bus, because the bus would be leaving at 3:30pm with or without us. Considering the fact that there is nothing around the Laguna or throughout the trek, someone left behind would essentially have to wait to catch a ride back with another tour group (likely the following day). And since you’re thousands of feet above sea level in mountainous areas close to glaciers in winter-time, the weather is just as cold as you might expect.
So you know, Laguna 69 (located at the base of a glacier called Pisco Peak) is nearly 15,000 feet above sea level, which is higher than anywhere else in the continental United States. This elevation is merely 2,000 feet below Base Camp on Mount Everest (practicalwonderlust.com). Huaraz is known for its incredible hiking and trekking, and Laguna 69 doesn’t disappoint the countless amount of backpackers and tourists who stop by to give it a shot.
We began the trek through a valley (bottom right photo), which was fairly easy (aside from not being able to breathe). After making it through the valley, we came across steeper zigzags of mountainous terrain that was somewhat difficult to navigate. In realtime, I would absolutely say that it was extremely difficult to navigate. However, since it only got increasingly difficult, I have to save the use of any word synonymous with difficult, hard, impossible, scary, out of breath, can’t breathe, please save me, and/or send help.
After making it through the first half of the trek (mind you, I’m tying fast. This is now two hours later), we came across a small glacier lake (second photo on top) that was pretty stunning too. By this point, it truly was difficult to breathe (even though this kicked in minutes after beginning our trek) since the altitude was only getting higher as we progressed.
After trekking through zigzags and mountainous terrain for what seemed like forever, we finally arrived to an area of flat terrain. When you can’t breathe and everything hurts, it’s the little things in life like flat terrain that would really put a smile on your face. But again, when you can’t breathe and everything hurts, you smile internally. We walked through the flat terrain and came across another mountain that had to be climbed.
I read in a blog post that the last part of the trek involved walking over rocks that make you feel as though you’re about to twist your ankle, and constant thoughts that you’re better off quitting and not continuing. As we began walking up the pathway of rocks, I thought this was it. The thoughts of quitting were popping up (even though they were there for more than two hours now), and I had the number of a local podiatrist ready to call at any given moment. People around me were saying that this must be the last mountain before making it to the Laguna.
Excitement and anticipation were building, as was my tolerance for pain. We were so close. As we made it to the top of the mountain, I was so excited to see the beautiful Laguna that everyone had been talking about. But of course, nothing in life is that simple. As we crossed over the top of the mountain, we saw another mountain across from us, waiting to be climbed.
We made our way downhill, ready to do it all over again. The rocky path was even harder to navigate on the second mountain, and the feeling of wanting to give up was definitely real. We had to stop every few minutes due to the altitude, which had become quite the obstacle (that’s me sugarcoating it). As we continued to hike up the path, we saw people walking down telling us “Casi están allí. You’re almost there.” Those walking around us were also out of breath taking numerous breaks along the way. But we finally made it. And when we did, the view of Laguna 69 in the distance almost made me want to run towards it. Keyword: Almost.
While I wish I could say it more gracefully, the truth is, I schlepped over to the Laguna and laid down alongside the most beautiful view I had ever seen. The tranquil turquoise-blue water below the most narrow waterfall, carrying clear glacier water into the Laguna was absolutely breathtaking. It was truly a shame that the trek took my breath away first.
Seeing so many people accomplish the goal of trekking 7 kilometers (roughly 4.5 miles) towards Laguna 69, 15,000 feet above sea level was truly incredible, and it felt rewarding to be able to reap the benefit of seeing such a spectacular site. We arrived at 12:52pm, so fortunately, we got to stay a while and enjoy the Laguna, without having to turn around and return to the bus beforehand. Some people jumped into the glacial water and swam, but I was perfectly content putting my hand in and leaving it at that.
After enjoying about 30-45 minutes by the Laguna, our tour guide mentioned that it was time to return. I had completely forgotten that we had to make our way back and walk another 4.5 miles without an oxygen tank. I’ll spare you the details of our hike back, but will say that the views were incredible, and that I laid in the middle of the parking lot upon our return, thankful for the experience, and thankful for the opportunity to not have to walk anywhere else for the rest of the day.
Throughout the trek, I was fortunate to walk alongside one of the students from our program who continuously pushed us to keep going. Just like anything in life, having a support system—whether it be friends, family, or even an internal support system—is truly important, because at our seemingly lowest moments when we want to give up, oftentimes we need a push to get back up and continue where we left off. Fortunately for me, I had that on this trek, and was able to enjoy incredibly beautiful sites along the way. Find and/or create your own support system, and don’t be afraid to utilize it. It will come in good use when you least expect it.
This morning (Monday), we had our class on DBT (Terapia Conductual Dialéctica), which focused on chain analysis—an integral part of this type of therapy. Chain analysis looks at the ineffective behavior an individual has conducted, in addition to the precipitating event that led to the behavior. From there, vulnerabilities surrounding the behavior and event are explored, as well as consequences stemming from the behavior, and links in between (such as actions, bodily sensations, cognitions, events, and feelings). While it’s definitely not easy being cognizant of each link when analyzing a behavior or triggering event, practicing this type of thinking and analysis regarding our actions truly helps us be more mindful of our behaviors and ways in which we can improve and react to situations differently in the future.
We also learned about validation, and the importance behind this seemingly simply concept. More often than not, we tend to respond to dilemas that others are facing by trying to fix their problems or simplify the situation. Has anyone ever told you that what you’re experiencing isn’t really all that difficult, or that you’ve overcome similar (or harder) situations before, so you’ll figure out a way to do the same once again? While the latter statement may in fact be true, it’s not exactly the response we’re always looking for. In fact, for some, this type of “validation” may lead to experiencing self-doubt in how the individual reacts to and handles trying situations.
So how do we validate what an individual is going through? Instead of trying to solve or minimize their problem, we just need to be attentive and truly listen to what they are saying. While it’s much easier to jump in and interrupt with our perceived “wisdom,” active listening will go even further and make an even greater impact.
We were left with a quote in our class that truly resonated. It translates to something along the lines of: “Sometimes we simply need someone to be with us, not to solve our problems or anything in particular—just to make us feel that we have their support and that we are important to them.” That right there is the simplest form of validation. More often than not, all we really need is somebody to listen to us. And in that moment alone, when we have that person’s undivided attention and support, we can feel validated and supported in whatever it is that we may be experiencing.
On Thursday (of last week), we returned to three different schools to observe whether or not any changes had been made in the classroom following the workshops we provided throughout the past few weeks. While some classrooms continued to have difficulties gaining the attention of students, other classrooms were thriving with participation, motivation, and passion on behalf of the teachers. It’s truly incredible to see such a small difference taking place, and we can only hope that these students will feel a greater level of support in the classroom setting, since so many of them lack the support they need and deserve in their households.
On Friday, we had our Spanish Grammar course, followed by a new experience that myself and one of the other students are just beginning. Today, we began a group for adolescent males at a site that provides meals to children of women (many of whom experienced domestic violence), as well as a safe space where they can play, do homework, do crafts, or just have socialize with friends and community members. Since there are no male workers or volunteers on site, myself and another male from our program began a group for adolescent males, which will focus on providing psychoeducation regarding healthy interpersonal relationships, feelings of anger, aggression, and how to manage them in a healthy manner, as well as effective communication skills.
While there is a great need to focus on possible trauma and situations that these children and adolescents have experienced, unfortunately, due to timing, it wouldn’t be fair to begin therapy and return to the States shortly after. Therefore, we can only hope that these groups will provide these teenagers with a greater level of support, as well as beneficial information about the aforementioned topics.
This morning (Tuesday), we began the day with our Spanish for Mental Health class. Shortly after class, we traveled to El Porvenir to host another workshop for teachers and school administrators at one of the city’s local public schools.
We start each workshop with the same question: What made you decide to become a teacher? Often times, (if you haven’t already realized) when you work in a field with little recognition when so many societal barriers are stacked against you, it’s easy to forget what motivated you to get into that particular field. It’s interesting to hear how each individual found their way to become a teacher- whether it was by choice or because everyone in their family before them was a teacher too. Regardless of how they ended up in this profession, each individual described the same goal, and that is wanting to make a difference in the lives of their students.
The teachers discussed the hardships of maintaining their students’ attention in the classroom, mainly due to the fact that so many of them have to work night shifts in order to help bring in some extra money for their families. It’s difficult to know that majority of these students face a variety of obstacles outside of the classroom- most of which are outside of our control. However, what helps offer the slightest sliver of peace is the fact that there are so many selfless teachers willing and able to support these children in any way possible. It is our hope that these workshops will help those in the educational field better understand some of the difficulties that their students are facing so that an even greater amount of support can be fostered between the students and teachers.
This morning (Friday—yes, we’re still playing catch-up), we traveled to El Porvenir to present our first workshop to teachers in one of the local national (public) schools. For the past two-and-a-half weeks, another student and I have been conducting observations in 12 national schools throughout El Porvenir and Trujillo Alto. The purpose of these observations was to note how students behave in the classroom setting, how teachers respond to student behaviors, and overall student/student and student/teacher interactions. Seeing as the specific program the other student and I are working with is geared towards preventing students from getting involved in the legal system, the overall goal is to help the teachers develop and foster a more supportive learning environment for these students.
Keeping in mind that many of these students do not have strong familial support, have limited resources at home, have parents who have to work around the clock to provide for the family (and are therefore left with limited parental supervision), have parents who want them to start working after primary school because an immediate income is more important than continued education, have parents who are involved in gangs/in jail, and/or are involved in gangs themselves, there are many outside factors that come into play that prove difficult for teachers to make an overall difference in the lives of these students.
As we interacted with the teachers throughout the workshop, we discussed various individual, social, familial, school-wide, and communal risk factors that many of these students face including teenage pregnancy, alcohol and drug abuse, joining gangs, and dropping out of school. Seeing as these were primary concerns addressed during the observations we conducted, we were then able to hear about the experiences these teachers have had with their students in each of the aforementioned categories. We discussed supportive factors too though, because as difficult as it may be to navigate around so many risk factors, there are always supportive factors that can counteract any and all risk factors. For many of these students, these teachers are exactly that.
When you spend years working in a profession where more often than not you feel exhausted, pushed to the limit, under-appreciated, and feel like the odds of success for your students are stacked against them due to so many outside influences, it gets difficult (to say the least) to persevere and keep trying to impact the lives of our future generation. The teachers we met with continue to do this, and as they described their motivation to join the field of education and their desire to continue working in this field, it truly sparked a beacon of light and hope in what has seemingly felt like a dark tunnel—especially when looking at the overall resources provided to these schools for educational purposes and the countless barriers that so many of these children continuously face on a daily basis.
After the workshop, we returned back to Huanchaco for our Global Mental Health class, which I’ll discuss in a later post. The rest of the day was spent getting a head-start on homework, and of course eating pollo saltado before traveling to Cajamarca, Peru for the weekend.
This morning (Monday—yes, still behind), I completed my final observation at another school in El Porvenir. It was definitely an interesting experience because the school I observed is a Catholic school (considered more private than the others), as opposed to a national school (or public school, which is what every other school I’ve observed so far is considered). Since students from the secondary school were on a field trip to local historic sites for the day, I was only able to observe students in primary school.
Upon speaking with a local social worker, I was informed that there is a lot of crime among the students, including extortion and theft. When I spoke to the director of the school, she mentioned that a lot of the children have difficulties at home that influence their behaviors, including lack of parental support and/or parents having to work long hours, leaving their children unsupervised upon returning from school. This recurring theme seemingly continues to make its way into every school that I observe. There are so many challenges that these children face both inside and outside of school, but especially once they leave school grounds each day. The risk factors are substantial, and we have to focus on fostering more protective factors in order to provide these children with substantial support so they can have the futures they deserve.
In the afternoon, we had our weekly meeting with a group of local women and family members in El Porvenir that I briefly discussed last week. Each week, two students from the program are responsible for teaching the group members relaxation and emotional regulation techniques for them to utilize at any given moment and teach others in their community. This week, one of the other students and I were in charge of working with the group members’ children—some of whom have physical disabilities and/or difficulties with motor skills and/or verbal communication deficits. We had each child write their names and draw something that corresponds with each letter of their name. The creativity and abilities in these children are truly incredible.
After our group, we went back to Trujillo for our Psicología en Peru course. Tonight, we focused on statistics within the country, all of Latin America, as well as throughout the world. When we look at a global scale, depression happens to be the most common mental illness. However, in Latin America, only five percent of the adult population reportedly suffer from Depression. According to the NIH, “In 2015, an estimated 16.1 million adults aged 18 or older in the United States had at least one major depressive episode in the past year.” If so many people in the United States alone have experienced depression, why is the percentage so low in Latin America? It’s because so many people do not seek or receive mental health services. This number is merely what is reported.
Among so many other challenges, stigma is the biggest problem pertaining to bringing attention to mental illness in Latin America, and especially Peru due to discrimination against mental health. If you seek any type of help or treatment, you’re considered “weak” or “crazy.” You’ll likely be asked, “Are you weak? You’re not strong enough to deal with this?” Alongside stigma, shame and misconceptions about having a mental illness come into play as well.
Even if we were to put stigma aside, psychoeducation is another challenge. If someone does in fact have a mental illness, many times, they’ll go to the local clinic with the belief that it’s a physical illness as opposed to a mental illness. In a perfect world, hypothetically speaking, of course, let’s say that someone does in fact go to the hospital for an issue pertaining to their mental health. As I mentioned the other week, you would have to wait days in the hospital before getting an appointment, and when you finally do get one, your appointment would only last a few minutes, and would consist of being asked a few “yes” or “no” questions to determine if you have depression.
There isn’t enough time to converse with the patient, so the odds of someone actually getting the help he or she needs and deserves are slim to none. But first, you’d have to overcome the stigma and shame in order to even make it to this point. And you’d have to hope that your family wouldn’t abandon you due to shame as well. Now if you want to talk about services, there is about 1 psychiatrist per every 300,000 people in Peru. If we were to look at another country, let’s say Colombia for example, there, you would find 2.1 psychiatrists per ever 10,000 people. Pretty significant difference, right?
The following statistics have been taken from Según el Instituto Nacional de Salud Mental (INSM) (2014): Nearly 5 million people (11.8%) in Peru suffer from some type of mental illness. 700,000 out of 1 million Peruvians suffer from depression, while 200,000 out of 1 million Peruvians suffer from some type of anxiety disorder. Less than 4 percent of these individuals receive services in specialized centers. Why, you may still ask? Fifty percent of such individuals believe they can overcome their mental illness on their own. Thirty percent don’t believe in treatment, and thirty percent don’t know where to go to receive services. (Yes, the percentages overlap.)
This is why education is so important. We must spread the word about mental health because until we can do so, millions of people will not receive the necessary services they require.
Last night, we went salsa dancing at a local club, which didn’t start until midnight. Given the fact that most reasons to stay up later in the States (i.e. Blacklist, Scandal, How To Get Away With Murder, etc.) are over by 10:00pm., it’s safe to say that this was way past my usual bedtime. We were out until 3:00am before I remembered I had to be at my internship site nearly two hours away at 8:00am.
Today’s observation was pretty interesting, since I was able to observe an art class, during which the students were learning Marinera—the coastal dance of Peru. I was then able to observe another class where the students were asked to draw a tree in which each part of the tree represents an important aspect of their lives—including values, support systems, and goals for the future. Last week, one of the principals informed me that vocational considerations aren’t usually discussed with the children, so it was great for so many children to have the opportunity to think about their interests, plans, and goals. It was also refreshing to see a professor teach with such passion because doing so allowed her to maintain the class’ attention, which appears to be a big problem in many of the public schools here. But it just goes to show, if you are truly passionate about what you do, you can absolutely make a lasting difference in the lives of so many others.
Upon returning from the school, I had class on global mental health, which I’ll discuss later on. For dinner, we went out for local street food, and of course, we had more papas rellenas, a baked potato dough usually filled with beef, onions, hard-boiled eggs, cumin and other spices. Once prepared, this incredible healthy (just kidding) blob of goodness is deep-fried. Because what isn’t ten times better deep-fried?