Mental Health in the Peace Corps
As you can tell by the title of this blog, today I want to chat about mental health. Specifically, mental health as a Peace Corps Volunteer.
Statistically speaking, mental health disorders affect a shit ton of people each year (give or take a shit ton) and some of those people are Peace Corps Volunteers (yep, those are real stats).
I’ve wanted to talk about this issue for some time now, but until I’d been in Peace Corps over a year, I didn’t feel 'experienced' enough to address this topic. Now that I have lived the ins and outs of mental health in the Peace Corps, I feel able to talk about this issue with more authority (for lack of a better word).
WHAT IS MENTAL HEALTH?
According to MentalHealth.gov, “Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices.” The Mayo Clinic says that mental health illnesses include depression, anxiety, schizophrenia, eating disorders and addictive behaviors (to name a few). However, psychiatric disorders are not the same as medical diseases. Some doctors argue that the term mental illness may be misleading because mental disorders are simply descriptions of observations as opposed to physical illnesses. Anxiety doesn’t show up on a blood test. An x-ray of someone with depression looks the same as the x-ray of someone without. There is no urine test that can diagnose anorexia, and someone with alcoholism doesn’t have a brain tumor to explain his or her addiction. Mental health rarely leaves physical signs, but that is why it is so dangerous.
MY HISTORY WITH MENTAL HEALTH PROBLEMS
I struggle with anxiety, but I am happy to say that my anxiety is manageable. I wouldn’t be in South Africa if it weren’t. I never (rarely – at least not in the recent past) let my anxiety control my life. Just like I jump off bridges to face my fears, I never avoid facing my anxiety (which is my biggest fear). I don’t think anyone who interacts with me would ever assume I have bad anxiety; in fact, most people are surprised when I tell them. I suppose my gregarious, loquacious, friendly, adventurous exterior disguises my anxious, terrified, nervous, reticent interior. (Can you tell I’ve been studying for the GRE?)
My close friends and family know about my personal struggle with anxiety and panic disorder because I have learned that the best way for me to cope is through open and honest communication. Hiding my anxiety, lying to friends, and burying my condition only led to more severe panic attacks and inability to function normally. Although I don’t want to go into immense detail here on the inter-webs about my mental health history, I will give you the cliff-notes version so you can understand where I am coming from when I write about mental health in PC.
According to my mother, I started displaying signs of anxiety as early as 6 years old. I vaguely remember my first panic attack around that time, but I’m pretty sure I’ve blocked out most of the memory. Until I was in my teens, I called my anxiety ‘the weird feeling’ simply because I didn’t understand or know how to express what was happening in my mind. At 16 I was officially diagnosed with anxiety and panic disorder. Over the years my struggles have ebbed and flowed. I go through good periods and bad. I have been medicated and not (currently, I am taking anti-anxiety medication and have been for about three years). It wasn’t until my anxiety got really bad in college that I finally opened up to friends about my mental health issues. Living with 3 other girls in a small apartment didn’t leave room for many secrets. Anyway, by the time I decided to apply to PC, I was well versed in all things metal health. I knew my anxiety like the back of my hand - where it stems from, what happens in my brain when I have a panic attack, positive coping mechanisms, etc.
PEACE CORPS' APPROACH TO MENTAL HEALTH
Mental Health is something that PCVs become very aware of during their service. If not because of PC staff constantly reminding us, then because we deal with struggles in-country that we never faced in the States. Living in isolation from friends and family, in a village without electricity, running water, indoor plumbing, and Internet, where you most likely don’t speak the language of those around you, and witnessing racism, poverty, and abuse (and sometimes being subject to those things), can all take a toll on the psyche. Without proper coping mechanisms, PCVs can develop anxiety, depression and other mental health issues. Some volunteers even develop addictions to cigarettes or alcohol as a way to cope with these newfound struggles.
Apparently, Peace Corps’ approach to mental health as changed a lot in the 21st century. PC staff is now very hands on in ensuring that every volunteer is mentally healthy and stable. During PST, PC medical staff holds sessions to teach PCVs warning signs of mental health problems and healthy coping mechanisms. In fact, medical comes to every training, even one year into service, to reiterate these lessons. Peace Corps has a psychiatrist on staff who meets with volunteers who are struggling at site. She also works with PCVs who have experienced assault and/or trauma. The PC psychiatrist serves all Southern African countries (she counsels PCVs over the phone or Skype if they are too far away to meet in person) but luckily for PCSA, she is based out of the Pretoria office. Another way that PCSA helps with the struggles of service is through the Peer Support Network, a committee made up of two currently serving PCVs from each cohort who are available for additional support (much like an RA in college). They are given extra money each month to buy airtime to call other PCVs, and they also help medical staff at our trainings. They also work with diversity in PC, specifically how diversity affects the PC experience (i.e. race, gender, age, sexual orientation, religious beliefs, etc.) During PST, each trainee is assigned a PSA member as his or her “mentor” of sorts, to help with the transition to village life.
When applying to Peace Corps, PC Medical in Washington goes through your personal medical history with a fine-toothed comb. In addition to a myriad of doctor’s appointments, PC also wants a record of every medicine you’ve ever been prescribed. If you report any history of mental health issues (which you must if you want to continue on medication) they require even more information. My therapist and psychiatrist in Miami had to fill out forms and write letters to PC explaining that I was mentally fit to serve, and I had to write a personal statement about how I would cope with my anxiety abroad. Despite PC’s hesitation to accept volunteers with mental health problems, I think having experience with anxiety has only helped me in Peace Corps. The coping mechanisms I developed over the years are easily transferred to coping with my new living and working situation. I cannot tell you how many PCVs have developed anxiety in-country and have been put on anti-anxiety medication by medical staff. Not only are they trying to adjust to life in a rural village, they now have to learn to live with a giant cloud of anxiety over their head. I remember being diagnosed with anxiety and panic disorder at 16 and feeling terrified of my own brain. I was adapting to life on anti-anxiety medications and learning how to live with this fog in my mind. Now I try to imagine going through all that while also living in a rural village in South Africa away from my loved ones and I can’t imagine what these PCVs go through. Sometimes I believe my experience with anxiety has been as asset to my service, as opposed to a disadvantage.
My only issue with PCSA’s approach to supporting mental health is the limit on therapy sessions. Med staff only approves 3-6 visits to the PC psychiatrist before they reevaluate your mental health and have to decide if you are mentally fit to serve. In their opinion, if you are still struggling at site after 6 sessions, more sessions aren’t going to help. In my opinion, ongoing therapy sessions aren’t a sign of weakness, but rather, strength. I believe I could see the PC therapist once a month and still be a successful volunteer. I understand their concern that therapy sessions take the volunteer away from their work at site, but I don’t think one meeting a month would be detrimental to success. Personally, I like to keep a close eye on my anxiety and monitor it regularly. Basically, if I notice my anxiety getting a ‘bit much’ I like to nip that in the bud before it gets even worse. I’ve seen the PC psychiatrist twice and those sessions were helpful in reiterating my thoughts and feelings and even learning some new tips and tricks. At the moment I don’t feel like I need more sessions, but if a problem arises, I’d like to know the option is available without the concern that I will "max out" my therapy card. [Edit: I've recently learned that PCSA no longer has a defined limit on therapy visits because they approach each situation on a case-by-case basis]
There are almost 150 PCVs in Peace Corps South Africa and not everyone loves PC's approach to mental health, but that's why I want to start the conversation. Nothing can improve without dialogue.
MENTAL HEALTH IN SOUTH AFRICA
Over the last few years mental health has became a topic of conversation in the States and more and more people are opening up about their struggles. Kristen Bell recently gave an interview to Off Camera about her history with depression and anxiety and the stigma around those things (watch it here). Hayden Panettiere openly discusses her experience with postpartum depression (read about it here) and I recently read an article about mental health and stigma in Hollywood, which I'll link here. Many insurance companies now cover mental health treatments, and increasingly more people take advantage of therapy and anti-anxiety medication. Although mental health is becoming less stigmatized in the West, we still have a long way to go. Until mental health is treated as seriously as a broken bone or tumor, people will continue to suffer in silence.
Unfortunately, mental health is not a subject that is widely spoken about in the villages of South Africa (if at all). I’m struggling to find a way to address mental health in a culture that believes witchcraft is responsible for alcoholism and that uses the term “crazy” to describe anyone who has a mental disability. In fact, I’m not sure if mental health is an issue I will be able to address at all during my service, but I believe defeating the stigma starts with open and honest dialogue, which is partly why I'm writing this.
If there is a book titled, Teaching Mental Health Awareness in Rural Villages, send it my way, please ;)
ARE YOU COPING CORRECTLY?
Is alcohol a positive coping mechanism until used in excess? A night out with friends is sometimes exactly what someone needs to deal with life at site.
Running/Exercise is usually considered a positive coping mechanism, but what if the PCV runs until he or she loses too much weight or gets injured?
Med staff says reading or watching a movie can be a good coping mechanism, but what if you read so much you never leave home and isolate yourself from your community?
What about sex? Sex is scientifically proven to release endorphins and other “feel-good” hormones that can reduce anxiety. But what if the PCV has unsafe sex or ultimately gains a reputation in the village and ruins local relationships?
My point is: there is no “right” way to cope with anxiety. Sometimes it takes a lot of trial and error to figure out what works for you, and there’s a line that each PCV needs to be careful not to cross no matter what he or she choses as a coping mechanism. I love running, but I have definitely lost a lot of weight because of it (luckily, I am still in the healthy zone) and I am currently nursing a fractured ankle, which is killing my psyche since I rely on running as my main stress-reliever. I decided early on in my service not to drink alcohol at site because I don’t want to start using alcohol to avoid my feelings, and drinking alone is a slippery slope to alcoholism. I love to read and watch TV shows, but I don’t bring books or my hard drive to my org so I am not tempted to zone out and avoid work. I live close to Pretoria so I could easily go to town each weekend and avoid village life, but my boss and I limit my visits to one weekend per month. I make it a point to play with the neighbor kids on weekends that I am at site so I don’t shut myself away in my house, and as a “reward” for hand-washing laundry for one year; I sometimes take my laundry to the Laundromat in my shopping town. I buy chocolate anytime I see it (chocolate isn’t available in my village) but I also force myself to cook a “real” mean at least once a week (because I could easily eat chips and candy for every meal). I am in no way a paragon of how to cope with mental health struggles in the Peace Corps, but I think I’ve learned a lot over the years and have some useful advice.
Don’t be scared to join Peace Corps because you have struggled with your mental health, and don’t be scared to join because you think you may develop problems. Peace Corps is still the best decision I’ve made, even with the struggles I’ve faced, and overall, I do feel supported by PC staff and my fellow volunteers. High School Musical said it best: we’re all in this together.
Anywho, I could talk about anxiety and mental health till the cows come home, so I’m gonna finish off here before I ramble even more. Let me know if you have any advice/questions/support/contentions etc. because I’d love to hear them!
I’m actually on the hunt for some alternative/holistic approaches to treating my anxiety so I don’t have to be medicated forever. If you know of any, please send them my way!