Voices of Recovery, Episode 6: Panic Attacks, Family & Organizing

Pooja Mehta has dealt with severe panic attacks and, when she was younger, voices in her head that were intensely negative. It was scary, but her parents were supportive and got her help. The reception in her cultural community was a little more complicated and difficult. She tells Dr. Ken Duckworth, NAMI’s Chief Medical Officer, about those situations, as well as her experience starting a NAMI chapter at her university, which quickly became the largest student organization on campus. Pooja also discusses the unexpected death by suicide of her brother. This conversation was part of Dr. Duckworth’s research for the book, You Are Not Alone: The NAMI Guide to Navigating Mental Health–With Advice from Experts and Wisdom from Real People and Families.

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Dr. Ken Duckworth: [0:00] A warning ‑‑ this episode contains discussion of suicide.

[0:03] [background music]

Dr. Duckworth: [0:04] Welcome to "You Are Not Alone ‑‑ Voices of Recovery." Hi, I'm Dr. Ken Duckworth. I'm a psychiatrist and the Chief Medical Officer for the National Alliance on Mental Illness, or NAMI. I'm the author of NAMI's first book, "You Are Not Alone ‑‑ The NAMI Guide to Navigating Mental Health ‑‑ With Advice from Experts and Wisdom from Real People and Families."

[0:24] I talked to over 100 people for the book. I wanted to share some of the conversations that I felt had really helpful teaching moments.

[0:32] Pooja Mehta is from North Carolina and has dealt with severe panic attacks and, when she was younger, voices in her head that were intensely negative. It was scary, but her parents were supportive and got her help. The reception in her cultural community was a little more complicated and difficult.

[0:50] When Pooja was attending a large, prestigious university, she helped create a NAMI chapter on campus, which became the largest student organization at that school. In time, Pooja learned how to better take care of herself as she helped other people do the same. It became the focus of her work after graduation, which included a Congressional Fellowship.

[1:12] Pooja lost her brother to suicide. We talk about how she has coped with that in this interview. Pooja's openness, and her determination in the face of everything she has dealt with, is a real inspiration to me and I hope to you as well.

Pooja Mehta: [1:28] I am South Asian. I grew up in the Triangle area of North Carolina which has a very large South Asian population. It was wonderful being able to grow up and experience the culture that I come from and also be able to experience American culture.

[1:53] There were definitely challenges to that in the sense of how do you navigate being a hyphenated American? I felt like, in certain circles, I was Indian. In certain circles I was American. Those two identities could never really overlap.

[2:08] When I was 14, I had my first panic attack. I remember, I'm literally sitting on my back porch and just my heart starts racing. I start hearing these voices in my head. I'm freaking out. I'm like, "Oh, my god, what is happening?"

[2:26] The only time I had ever seen this, hearing voices that aren't real, the only time that I had ever seen that was in horror movies or there is something seriously wrong with you.

Dr. Duckworth: [2:40] It's scary.

Pooja: [2:46] I didn't know what to do. I went to a park near my house and had a full‑on breakdown and then came home and pretended like nothing happened. I kept doing that for a year.

Dr. Duckworth: [3:01] So these recurred? These experiences recurred?

Pooja: [3:05] Yeah. I would have voices in my head really just reinforcing negative self‑talk, but it manifested like it was coming from an outside source. It felt like the universe or God or whatever was telling me that, "I'm worthless. I'm useless. Nobody loves me. You should hurt yourself. You should kill yourself," blah, blah, blah.

Dr. Duckworth: [3:31] So all negative.

Pooja: [3:34] Yeah.

Dr. Duckworth: [3:36] Did you recognize it as a hallucination at the time? Some people can't recognize it. Some people can recognize it.

Pooja: [3:44] I recognized that it was in my head. Like that quote from Harry Potter, of course, it's in your head, but that doesn't mean it's not real. I recognized that I was the only one hearing these voices, but I couldn't really place whether I was making it up or what was happening.

Dr. Duckworth: [4:07] What is this?

Pooja: [4:09] Exactly. Part of me was like, "Am I a prophet? What is going on?" [laughs]

Dr. Duckworth: [4:15] What's the differential here? Prophet has got to be on the list.

Pooja: [4:18] Seriously. I didn't know what to do. I had this idea in my head that I could not let anyone find out about this because I would get chained up and thrown into a padded room. That would be it. I didn't tell anyone, not even my parents.

[4:41] For me, writing has always been an outlet, so I wrote. I wrote down what these voices were telling me. I wrote down what I was thinking, what is going on, my confusion, my fear, this, that, whatever. I wrote it down in a notebook. I hid that notebook between my box spring and my mattress. Of course, my mother found it.

[5:04] She calls me to the same back porch one day. She and my dad are sitting there. My mom is holding the notebook. I'm so scared. I'm so mentally preparing myself to be told that, "You need to be put somewhere and kept there. You're dangerous," this, that, whatever. That did not happen.

[5:28] My parents sat me down and they explained to me that this is a chemical imbalance. Both my parents are pharmacists. My dad was anti‑depressants are the number one selling drug on the market. They really just normalized it for me. They really made me feel like this is now how it's supposed to be, but we're going to figure out how to get you to the point where you're OK.

Dr. Duckworth: [6:00] What a wonderful reception.

Pooja: [6:02] I cannot tell you how blessed I am to have my parents. One thing that they did say was, "Don't tell anybody about this." I know why they said that, because most people in my community would not and still do not have that kind of response. They don't understand it. They don't acknowledge it.

[6:26] This isn't real. This is attention seeking. This is a flaw. They knew that I would be the recipient of very harmful things if I did make this something that people knew about.

Dr. Duckworth: [6:44] You mean in the South Asian community or do you mean in the so‑called American culture?

Pooja: [6:50] Specifically in the South Asian community. That's the context that they meant it in.

[6:54] For me, hearing that when I was 15, made me think that this is something that I should be ashamed of. I started self‑stigmatizing heavily. My mom would take me to therapy and I would not engage with my therapist. I would forget to take my medication all the time. My mom would literally be on me. "Have you taken your pills today?"

[7:23] It was a struggle because I was very much in this phase of denialism where, "I don't have a problem. I don't need help," because I had this idea that needing help was bad. That was my entire high school experience, from ages 15, 16, 17. I almost overcorrected so that people wouldn't think to pull the curtain back and see if anything was wrong.

[7:56] In high school, I was straight As, 4., all the AP classes, popular, involved in all of these clubs. This image of "perfection" so that nobody would think that there was anything that was happening here.

[8:18] I continued that into college. I continued that. I was very insecure in myself, very much like I have to act a certain way that people will want me to act so that they don't think to look further into what's going on with me.

[8:34] One day, towards to the end of my freshman year, I had a panic attack in my dorm. I couldn't get hold of my parents. I called someone who, at the time, I considered my best friend on campus. She lived in my dorm. We went out together. We did everything together.

[8:54] The next day, I get an email from the administration saying that I have been asked to leave campus because I am "a danger to myself and others".

[9:09] The first time I told my story completely to someone that I didn't know intimately was to a bunch of suits fighting for my ability to stay on campus and continue my education. I'm having to defend myself and defend my right to an education.

Dr. Duckworth: [9:33] Right. Instead of saying, "We have a counseling center. Feel free to come by. We have a 3:00 appointment today." That still would feel intrusive, I imagine, because your friend would have told the administration, but at least it would have been non‑hostile.

Pooja: [9:53] That's when I realized, that this is so misunderstood. You have some of the "brightest and most prestigious minds" and this is their reaction. Something's wrong here.

[10:10] I started telling my story on my own terms, and I braced myself for the impact. I braced myself for people lashing out at me, telling me that this was bad or whatever. The first time I told my story openly was an anonymous article in the school newspaper, that I still have the clipping of. [laughs]

Dr. Duckworth: [10:29] Again, freshman year, or is this later on?

Pooja: [10:34] This was sophomore year.

Dr. Duckworth: [10:36] Sophomore year, OK.

Pooja: [10:37] Freshman year, I was just focused on let's get through the year. Let's get…

Dr. Duckworth: [10:40] Get through it, yeah.

Pooja: [10:43] Sophomore year, I published an article anonymously in the school newspaper, and just waited to see what the response to that was, and it was pretty positive like, "I'm so glad somebody's actually talking about this now."

Dr. Duckworth: [10:58] That's what people said in the comment section, but they didn't know it was you.

Pooja: [11:02] They didn't know it was me.

Dr. Duckworth: [11:03] You could see from the students that there was a need here.

Pooja: [11:06] Yeah. I started putting pieces of my story out there with my name on it.

[11:16] More people responded and more people reached out to me publicly or privately to be like, "I thought I was the only one," or like, "I didn't know that this was something that someone could be struggling with." Just all of these revelations coming out. That inspired me, with a group of other students, to found the NAMI on campus.

Dr. Duckworth: [11:41] Fantastic.

Pooja: [11:42] Which, to this day, is the largest student organization on campus.

Dr. Duckworth: [11:47] Wow, that's really impressive, and you created it just from this experience, and the courage you had to pursue sharing your experience in how many other students.

Pooja: [12:00] Because I saw the need. I realized that there's a lot of us, and you're not alone. There's a lot of people in this struggle and it's unique, but it's universal at the same time. I also found that it helped me become more accepting of my personal diagnoses and my personal struggles.

[12:23] I started engaging in therapy. I started taking my medication willingly. I started doing things to help and support myself, and I started being better. I started being able to function in a way I wanted to. I started transforming into this person who I liked, so I kept doing it. I kept doing it.

[12:51] After graduation, I moved to Madison, Wisconsin for a job, and I worked with 30 mental health services there. I helped design their 75th‑anniversary campaign with anniversary billboards across the city of people putting their name and their diagnosis on a billboard.

Dr. Duckworth: [13:12] Wow.

Pooja: [13:15] I had a billboard in 2018 that said, "I'm an honors graduate with anxiety," and I had my face on it. I remember seeing that and thinking back to 2010 when I got my diagnosis and like, "How did we get here?"

Dr. Duckworth: [13:31] How did we get here? It's a great question, but it's happened.

Pooja: [13:34] It's happened. Even today, the fact that I'm talking to you about this, the fact that I'm doing a Congressional Fellowship. The fact that I have and live with mental illnesses and it was part of my application, I think back to that 15 or that 14‑and‑a‑half year old, who would take three or four showers a day, so that the water would mask her crying, so no one would know that was happening to her, and here we are.

Dr. Duckworth: [14:06] Let me ask you a couple of NAMI questions. How did you found NAMI on campus? Did you connect with a local NAMI and say, "I want to do it." How did that happen?

Pooja: [14:18] I can't take credit for being the one to discover this. There was another student who reached out to me. I don't know how he found out about NAMI. He reached out and was like, "I want to do something for students." That was right around the time that NAMI on‑campus model had been launched. He reached out to me. He reached out to a couple of other people and we made it happen.

[14:46] We started this club, and we had almost 500 people join. We thought it was like, "OK, people are just joining or whatever." Not all 500 people were active, but I would say a good 200 were, which is a lot of people.

Dr. Duckworth: [15:05] That's a lot of people when you think about where attitudes were 5, 10 years ago. Has the university changed?

Pooja: [15:15] Yes.

Dr. Duckworth: [15:16] Let's talk about that a little bit because the book is a message of hope that you can actually change stuff in part. The university wouldn't have done what they did to you.

Pooja: [15:27] No. Let's call a spade a spade. The university's interest is in protecting the university. If they do see a threat in a student, no university wants to have a student die by suicide on their campus. The recognition of when extreme intervention versus therapeutic intervention is needed, the understanding of that has gotten a lot better.

[15:58] Then just the conversations around this stuff, so that students aren't getting to a point of crisis, where they do need that level of extreme intervention. Just like having available resources. We have a student wellness center now. Counseling and psychiatric services has open office hours where you can just drop in and talk to someone. You don't have to make an appointment.

Dr. Duckworth: [16:23] That's a big change.

Pooja: [16:26] There are a lot of things that are happening in the name of mental health and wellness to really make students aware of the fact that these resources are available to them, but also encourage conversations within themselves.

[16:43] Like stopping someone in the hallway and say, "Hey, how are you actually doing," or being able to like, "Hey, I'm struggling. Can you come help me," without feeling afraid that that person is going to then report you to the administration. [laughs]

[17:02] There's been a big cultural paradigm shift in how mental health is talked about and thought about on campus. Again, like everything else, we have a ways to go, but we've also come a long way.

Dr. Duckworth: [17:20] How about progress in the South Asian community?

Pooja: [17:24] Same sort of thing. Over the years, when I started speaking out, as far as I knew, I was literally the only South Asian speaking about this. As awareness increased and also as the world became more connected, I have found other people in my cultural community, both around the country who are speaking about this, and then later on, in India, who are speaking about this.

[17:52] The same South Asian community that my parents cautioned me against, told me to be discreet about this around them, in 2019, I had the opportunity to stand on the stage in my community center and speak about my journey to that same community.

[18:19] There were people who came up to me afterwards and said something along the lines of this isn't real or this, that or you should try yoga or you just need to go to the temple more and pray more, whatever. There were people who said that, but one, it wasn't in a dismissive way, it was in a, "Let me help you way," even though their way of helping was completely off.

[18:45] [crosstalk]

Dr. Duckworth: [18:46] Trying to be constructive.

Pooja: [18:48] Yeah. The intent wasn't malicious. Two, there were a lot more people who were ready to acknowledge that like wait…Because the way I ended it is a warning that this could be your child because I was, I am.

Dr. Duckworth: [19:08] Yes.

Pooja: [19:10] There were a lot of parents who came up to me that were like, "How can I talk to my child about this? How can I recognize if they need help? How can they feel comfortable coming to me?"

[19:25] I think that is incredible progress because, growing up, I knew so many people, and even now I know so many people, who struggle with this idea of, "I'm really struggling with my mental health. A lot of it is rooted in my family dynamics, and I do not feel comfortable going to my family to ask for help."

[19:51] Just the fact that, in general, we're trending towards a desire to have these conversations, to acknowledge that this is happening within our community, and to try at least to do something about it, is very promising to me.

Dr. Duckworth: [20:09] Do you want to pursue your experience of having lost a brother? Is that something you are OK with? Do you want to set that aside?

Pooja: [20:19] I have no problem talking about loss. I have no problem talking about my brother. I have no problem sharing my experiences in my grief journey. Like I think I told you on our informal call, I'm actually writing a book about it. That being said, I actually looked at the date.

[20:36] On February 17th, 2020, I took a mental health first aid class to get recertified. I got a refresher on the signs and symptoms of suicide, suicidal ideation, how to intervene, this and that, and whatever. Then six weeks later, I woke up to a world where my brother was dead. Before my brother died, I very much associated suicide and mental illness, almost to a one‑to‑one.

[21:12] I knew that not everyone with a mental illness dies by suicide, but I did have this idea in my head that everyone who dies by suicide has a either diagnosed or undiagnosed mental illness. It's preventable and "predictable" if you know what to look for. My brother didn't show any of those signs. Not a single one.

[21:37] The last engagement he had with another person was talking to a classmate about how to divide homework problems, and I found him 20 minutes later.

Dr. Duckworth: [21:47] Oh, my.

[21:48] [crosstalk]

Pooja: [21:50] If you're struggling with suicidal ideation, you're not talking about homework problems. You know? Losing my brother, and losing him in the context that I did, he never had any mental health issues, he never struggled with anything like that. I know there are a lot of people who would say that I'm in denial about that, but really I'm not.

[22:16] In my family, we talk about this extremely openly. I asked him point blank at least once every two weeks, "How are you actually doing?" Sometimes he'd be doing fine, and sometimes he'd be struggling and we would talk about it.

Dr. Duckworth: [22:30] No, this is really a thing. There is not a one‑to‑one correlation, and we don't understand it very well. It's a point that hasn't really been made yet.

Pooja: [22:39] Yeah. I know this is a book about hope and stuff like that, and I know that suicide is preventable, these are the signs to look out for, whatever, it empowers people, it gives them a sense of hope and a sense of, "I can save my loved one," but maybe not. I'm sorry…

Dr. Duckworth: [23:02] Maybe not. Well, the book is also trying to be honest, and so we're interviewing people who've been through this. Some have major mental health issues. That's common, but I know it's not universal. I know that from my practice. The thrust of what you're saying is not all suicide can be identified and prevented.

Pooja: [23:27] At this point, no.

Dr. Duckworth: [23:29] That's true. That happens to be true.

Pooja: [23:33] At this point, we do not know enough about why people die by suicide to be able to identify it. Not even all the time, most of the time.

Dr. Duckworth: [23:46] I think what's helpful about that is it helps with people who blame themselves for not identifying the signs.

Pooja: [23:57] I struggled with that a lot. I struggled because in my advocacy journey I had heard this saying that suicide is preventable. On World Suicide Prevention Day, I really struggled with that because a suicide loss survivor, suicide is preventable. Some people put that implied all suicide is preventable.

[24:24] The question for this club that no one wants to be a part of is, "Why didn't you prevent it?"

Dr. Duckworth: [24:28] I'd never say that. Whenever anybody at NAMI writes something, I always correct that because that's not true. It's not all preventable. You can't leave people with that. In developing this idea, we would develop the idea that sometimes it cannot be prevented.

Pooja: [24:51] One thing that my therapist helped me realize is it's not that I missed the signs. It's that the signs were not there. I relive that day over and over. Even if I had done this, even if I hadn't done that, even if I had got up earlier or later or whatever, there was nothing that I could have done. There was nothing that he let me do, if that makes sense.

Dr. Duckworth: [25:19] Yes, it does make sense. This squares with my experience as a practitioner. In my community mental health center, we took care of 1,500 patients. We'd identified 150 of them as the highest risk people.

[25:38] When you looked at a decade of who died by suicide, half of them were in that group and half were not. It just spoke to the limitations of our ability to identify risk. It was only a handful of people, but they were not all in the group that we had said, "Let's review extra carefully their treatment plan. Let's turbo check them out and follow up with them."

[26:05] It was the ordinary population of people who came in off the street. He wasn't even in that population. He wasn't even in a community mental health center.

Pooja: [26:15] For me, I have taken to this idea that we are with suicide the way we were with heart attacks 200, 300 years ago. 300 years ago, someone would be walking on the street and they would just drop dead and no one had any idea why.

[26:33] Then, over time, we realized it was something we started calling a heart attack. Then, we learned why it happens. Then, we learned, what can we do to prevent it from happening? Now, we're at a point where we can kind of identify when someone is at risk and kind of help people live a lifestyle that will put them at less risk, but there's still a good number of folks out there where it comes just out of the blue.

Dr. Duckworth: [26:58] That's correct. It's absolutely true. I think it would be a point that would comfort a few people because the relentless message that is is preventable is unfortunate because I don't think…It doesn't square with my experience as a doctor.

Pooja: [27:13] I realize that that's a message of hope for a lot of people.

Dr. Duckworth: [27:16] It is a message of hope, ultimately.

Pooja: [27:19] But it's a message of pain for anyone who is living with that kind of loss.

Dr. Duckworth: [27:28] It's a lot.

Pooja: [27:29] Some suicide is preventable. Some people do follow those signs. Those signs and symptoms are established for a reason. Some people do follow that. Some people can be intervened. Some people can be saved. We should do everything we can to make that happen.

[27:48] We need to recognize that there is a lot more we need to learn before we can start saying the implied all suicide is preventable.

Dr. Duckworth: [27:58] I happen to agree with you 100 percent on that. Really, I do. I'm…

Pooja: [36:01] I appreciate that. It's very validating to hear that this is a mindset that the chief medical officer of NAMI agrees with.

Dr. Duckworth: [28:10] Absolutely. 100 percent. I'm so sorry you and your family went through that.

Pooja: [28:18] Thank you. I'm so sorry that more people join this club every day.

Dr. Duckworth: [28:23] I know.

Pooja: [28:26] Knock on wood, this is the hardest thing I will ever live through. Please, God, let it be the hardest thing I could ever live through.

Dr. Duckworth: [28:36] I'm fairly confident, but I can't predict the future anymore than you can.

Pooja: [28:40] God, I cannot imagine going through something worse. It's horrible.

Dr. Duckworth: [28:45] There's a chapter I have on loss, which we could make sure we illustrate the idea that what you saw was not an ill person and that people shouldn't blame themselves.

Pooja: [28:56] No. My brother ordered a computer screen the day he died, and it arrived the day of his funeral. People who are contemplating suicide don't do that. People who are contemplating suicide as we know it don't do that.

Dr. Duckworth: [29:13] As we know it. That's well‑said. There's another chapter that I have. You could include this story in. It's called the Hardest Family Questions. One of the questions that you're facing is, "What did I miss? Did I miss anything?" Or, are you facing it? I'm here to tell you, you didn't miss anything.

Pooja: [29:35] I was facing it. Every once in a while, I find myself asking that question, and I have to stop myself and remind myself that, "No, you had nothing to do with this. You did absolutely everything you were able to do."

Dr. Duckworth: [29:52] Yes, absolutely true. I have a chapter called The Hardest Family Questions, people and families have to deal with really hard questions in the mental illness space. This sounds like…

Pooja: [30:08] One thing that my parents have struggled with is they have one daughter who openly talks about having a mental illness, and they have a son who died by suicide.

[30:20] You put two and two together, and there are ignorant people in my community who think that they have somehow failed as parents, that they have somehow not done the right things, and this is how their kids turned out, where it's like, "Sir." [laughs]

Dr. Duckworth: [30:37] Right. It's a lot more complex than that. Their response to you was so loving when you were 14. That's an unusual family response. I'm going to say, having interviewed 110 people, not everybody gets the important…

[30:56] [crosstalk]

Pooja: [30:56] It is. I recognize that that is a privilege. [laughs]

Dr. Duckworth: [30:57] Yes, but it says so much about them.

Pooja: [31:03] It devastates me when I hear secondhand, or sometimes firsthand, I have straight up yelled at people because they're talking about my parents in front of me in a language they think I don't understand, but I do.

Dr. Duckworth: [31:14] Is there an example of that?

Pooja: [31:18] I was at my temple helping out at an event, and there were two people talking, and one person asked, &q…