My Whole Body Is a Nervous System: The Anxiety Diaries of an SPT
Estimated Reading Time: 10 minutes
Welcome to year 2, day 1, of my doctor of physical therapy program. I leave my musculoskeletal dysfunction class early so I can make my first appointment with a therapist at my school's Counseling and Psychological Services (CAPS) office.
On the fifth floor, I tell the psychologist that I had trouble sleeping during first year more often than not. I tell her my mind was racing every night during my first clinical in the summer, even without any tests looming. I tell her that I stress about being stressed. I tell her that I might have "like, a little anxiety or something."
Spoiler alert: Six months later, I can tell you that I definitely have anxiety. I should add that I am not a mental health professional or a wellness guru. And I couldn't even begin to capture the intricacies of living with mental illness beyond my recent attempts to understand what it means to deal with anxiety. Everything stated in this article is from my own experience navigating the mental health system as a physical therapist graduate student.
What is anxiety? Mine is mind-racing, heart-pounding, muscle-aching stress. It's constant fatigue and the necessity to eat snacks all. the. time due to energy depletion from lack of sleep and incessant worrying. Irritability. Restlessness. Feeling like I'm not in control of any aspect of my life. Drowning in uncertainty 24/7. Not having the motivation to pay attention in the classes required for me to complete the degree that's setting me up for my future life. I'm tired just writing that.
In isolation, these typical signs of anxiety might strike you as "normal" for a student physical therapist, especially if they occur before or during an exam. And while it is normal (and can even be good!) to have stress in life, especially in a rigorous graduate school program, it is not normal to feel as though your whole body is a nervous system.
If I look back on my life, I had probably been dealing with anxiety since adolescence, but I didn't know what to call the nebulous cluster of seemingly-unrelated symptoms until recently. Before now, I hadn't experienced them simultaneously and so intensely. I chalked them up to me being stressed because of my perfectionist tendencies, and I convinced myself I'd be able to handle it. I never felt like I had everything under control, but I repeatedly told myself, "everything's fine."
My grades were high enough for me to be accepted into an excellent DPT program. I hadn't come close to failing any classes. I had a part-time job, volunteered regularly, and became the class representative for our curriculum committee. All this is to show that I looked like someone who knew how to excel on paper. To the outside world, I looked "fine."
Inside though, I felt like that pit in my stomach, filled only with dread and apathy. My waking thoughts were of my overwhelmingly full to-do list, which allowed no time for myself or my personal interests. For weeks on end I wondered, "Who the heck has time to eat, sleep, AND exercise? I need to be studying!" But I didn't even want to do that. Every time I thought I might reach a mental breakdown, I was granted a reprieve by virtue of the break between trimesters.
At this point, you might be thinking, "I know those feelings. I'm screwed." Thankfully, I'm here to offer some good news: You can do something about it.
If you're not struggling with something in life, you're in the minority. Maybe it's a DSM-5 recognizable mental illness. Maybe it's grief from the loss of a loved one. Maybe your partner broke up with you, and it's hitting you harder than you anticipated. Maybe it's finances, or purpose, or burnout. Maybe you can't even identify a single trigger or event that may be causing your distress, but you know that you don't feel like yourself. Whatever the case, you can (and should) ask for help from a professional, because we all deserve to be well.
Why did I finally go to talk therapy? Frankly, I got tired of feeling tired all the time. I had a LOT of knowledge on how to be well, but I wasn't putting it into practice. I didn't like that I was constantly seeking reassurance from my peers and professors to tell me that I was competent and valued. (If that rings a bell, read Cruz Romero's article on imposter syndrome.) And I went to CAPS because I have big ambitions! My anxiety was firmly standing in the way of my potential as a student and future clinician. I didn't want to be the accomplice.
So, here's what you can do to help yourself. Find out whether your school has a counseling office; many do. They should have a website and a phone number. They may even have an online screening tool to see whether professional counseling is right for you. If not, you can check out this site. If you can't find any services, ask 1 of your program's administrators to direct you to them. Your faculty members are literally paid to help you succeed. Talk with someone. Make an appointment. Go!
If you're still not convinced, here are my top 8 reasons why you should talk with someone ASAP about your mental health (+ 1 reason why I'll accept that counseling might not be for you right now):
* Disclaimer: The information presented in this article is not intended as a substitute for care from a mental health care professional. The author's opinions are her own."
- Everyone else is doing it—they're just not talking about it. After I started going to therapy and sharing my experience, I was shocked at how many classmates told me they were going to or had been to counseling. We tend to keep it hush-hush because mental illness is still so stigmatized. Mental health problems can leave you feeling isolated and lonely, but by no means are you the only one with issues. I've even talked with faculty members about their feelings of anxiety.
- You don't need to be at a breaking point to get counseling. You can still benefit from talking to someone or seeing a mental health professional! Physical therapy is beginning to address prevention and health promotion. Think about this within the context of your brain health. Instead of training new movement patterns, you'll focus on training new thought patterns. Just like physical therapists see patients across the spectrum of physical functioning, mental health therapists can provide suggestions for you at any stage to keep your emotions and your stress at manageable levels. Be proactive.
- You have to advocate for yourself; other people don't always see your struggle. Case in point: During an oral exam, one of my favorite professors told me, "You need to be more confident!" I, in sheepish frustration, blurted out, "Well, I have a lot of anxiety." My professor responded, "Really? You don't seem like it! It's not, like, debilitating, is it?" Was that the right venue to disclose my anxiety? Probably not. The point is that faculty with whom I regularly interact had no idea I was having problems. And even if your peers notice that something is wrong, they might not know how to intervene. Streamline the process and be your own best mental health champion. I believe in your power to use your voice. I believe in you.
- Your friends, family, and support network are not substitutes for a trained therapist. Compassion fatigue is real. And it happens when a person such as friend, family member, teacher, or physical therapy practitioner accumulates feelings of stress from other peoples' experiences. I'm not saying you can't vent to any of these people—ask my roommate, she'll confirm I do this all the time—but talking about personal issues can be draining on relationships, especially if it's not reciprocal. All healthy relationships need boundaries. Do friend things with your friends! Enjoy your family time. Manage personal stresses by seeing an objective third party who can talk with you about your personal stresses at a designated time and space. Mental health professionals have the expertise to provide you with research-based, clinical tools to help you meet your needs.
- You can lead by example. Cultivate an academic culture that's focused on student learning and well-being instead of grades. Teach others that everyone deserves the right to thrive, not just survive. Part of being a professional is learning to take responsibility for yourself—and that includes your health. Asking for help doesn't mean you're broken or doomed or incompetent. If you're still questioning whether you should do this for yourself, at least do it for your patients. One of the best analogies I heard at CSM 2018 was if you're on an airplane, you need to put on your own oxygen mask before anyone else's. You can't treat patients effectively if you're not taking care of yourself. This brings me to my next point….
- You might become a better clinician. Going through counseling helped me better understand what life is like for my patients living with mental illness. Making time for appointments, putting in the work of being vulnerable, practicing skills throughout the week, calling insurance to see whether visits are covered, figuring out if you like your counselor, etc. It's a lot to handle when you're already down. What better way to understand the system than to immerse yourself within it?
- You have time for regular appointments with a therapist. You don't have time to NOT go see a therapist. I can't tell you how much time I wasted during undergrad and my first year of PT school because I didn't have my mental health under control. I wasn't optimizing my study time in order to make personal time. (FYI, staring at notes while not absorbing material and scrolling through Instagram for half an hour is not efficient or beneficial.) Maybe you think things will just get better after PT school. News flash: "Real" life can be just as demanding as school; don't you want to have some tools in your toolbox to deal with it? There will always be 24 hours in a day, and you will never have more time than you do now. It's much easier for me to justify missing part of a class for an appointment than it would be to cancel patient appointments or leave work early once I'm a practicing PT. Set yourself up for success by investing in yourself now.
- You can afford regular appointments with a therapist. At my school, all CAPS visits are free for enrolled students. A few visits may be enough to get you through your tough time or give you skills to prevent a real breakdown from happening in the future. If you need to be referred out for further counseling, it can be expensive. But, you can still shop around for someone who fits your insurance plan. Some places offer free services or reduced rates for those in need. Again, think about this as an investment in your health—current and future.
- But, you just really, really don't want to/can't go to therapy right now, even if it's logical. Sometimes there are extenuating circumstances which make any type of therapy (physical therapy, counseling, etc) out of the question for right now. Maybe you've seen this in your time working with patients. Sometimes we're stubborn or in denial about the extent of our distress. Sometimes we have external family commitments. Sometimes we just really, really can't find the time or money. If this is you, here are some very basic strategies I've found helpful to increase resiliency and boost your mood for the time being.
- Use a meditation app to take 5+ minutes for a mental reset.
- Write a gratitude letter or copy down 3 things you're grateful for every day.
- Take a walk and focus on objectively noticing your surroundings.
- Keep a journal.
Don't use these as the magic pills which preclude you from seeking counseling to discuss your issues with a trained professional, though.
IF YOU ARE IN A CRISIS OR CONSIDERING SUICIDE, GET HELP NOW and/or CALL 911.
The following resource directories are free and available 24/7:
With these tips in hand, I'll remind you that I am not a mental health professional or a wellness guru. And I couldn't even begin to capture the intricacies of living with mental illness beyond my recent attempts to understand what it means to deal with anxiety. Everything stated in this article is from my own experience navigating the mental health system as a physical therapy graduate student.
Heather Beaudoin, SPT, is a second-year DPT student at Northwestern University. You can connect with Heather via email at: firstname.lastname@example.org.