Episode 87: Advocating for Youth Mental Health w/ Diana Chao, Founder of Letters to Strangers

Episode 87: Advocating for Youth Mental Health w/ Diana Chao, Founder of Letters to Strangers


*TW/CW: This episode includes mention of suicidal ideation and behavior.*

Diana Chao is a 21-year-old first-generation Chinese-American immigrant from southern California. During her sophomore year of high school, bipolar disorder nearly ended her life…and inspired her to create non-profit Letters To Strangers (L2S), which uses the healing power of the written word to create awareness of mental health and illness, and spread comfort as “humanity distilled into ink”. Today, L2S is the largest global youth-for-youth mental health nonprofit, impacting over 35,000 people on six continents. For this effort, Diana has been named Oprah Magazine's 2019 Health Hero, the youngest winner of the Unilever Young Entrepreneurs Award, and the only American winner of the 2019 Global Changemakers cohort. As part of Adobe's inaugural class of global Top Talents, Diana seeks to further the intersection of creativity and social impact through conceptual photography. Her Minority Mental Health Month self-portrait series went viral with 2+ million views, and she gives workshops and speeches on youth mental health.  She’s also a 2020 recipient of the Diana Award, named for Princess Diana and honoring youth changing the world. But most of the time, she is a third-year at Princeton University trying to wake up for class on time. And, as you will soon learn: an absolute delight.



Diana Chao Letters to Strangers Uninvisible Pod Youth Mental Health

*TW/CW: This episode includes mention of suicidal ideation and behavior.*

Lauren: All right, guys. Thank you so much for joining us. I am here today with Diana Chao. Diana is a mental health advocate. She's the founder of Letters to Strangers (L2S), and she lives with bipolar disorder and she's going to talk to us about that. So Diana, thank you so much for joining us.

Diana: Thank you for having me. It's my pleasure and honor.

Lauren: Yeah, same here. very much an honor. And you're talking to us all the way from Singapore, because you're over there studying abroad. So this is quite an adventure for us. On a very cute tiny little dollhouse-sized microphone I wish everyone could see! (laughs) A Barbie-sized microphone for you, Diana! So, I figured we'd start from the top, as we always do. I would love for you to begin by sharing a bit of your story. Tell us when and how you first realized that you had something going on with your mental health, and what steps you've taken to get diagnosis and treatment since then.

Diana: For sure. I was diagnosed with bipolar disorder when I was 13 years old. And I think around that time is always a little bit difficult to navigate mental illness and mood disorders, especially because with puberty, there is an expectation that kids are going to get moody and maybe this is just all part of growing up. So that was definitely something that I internally sort of stigmatized myself with for a very long time, just trying to dismiss the severity of my symptoms. Because I didn't think it was worthy of a diagnosis, or whatever. But when I was around that age, what was happening to me was, I constantly just felt like I hated myself so much that I didn't deserve the chance to breathe. That everybody would be so much better off without me.

And I started actively engaging in suicidal behavior and thoughts.

That was a sort of turning point where no matter how much I was trying to dismiss my symptoms, you can't really argue with evidence you would heap on yourself. I was lucky and kind of unlucky that my school was having a suicide prevention assembly every year, where they brought in a psychiatrist or a psychologist. I don't necessarily think that the format in which they did that conference every year was the most effective. But that's a whole other issue. Point being, as I was able to learn a little bit of the basics of mental illness, it occurred to me that perhaps there was a deeper issue going on with me.That was the starting point in which I decided to try to seek out help and an official diagnosis. But it took me many more years after that to really wrestle with the self-stigma, the stigma within my community and my own family. It really wasn't until the past few years when I've become more open about my advocacy and my own story behind it, that I’ve committed myself more to seeking treatment, medication and things like that, and have found myself definitely taking a turn for the better.

Lauren: It’s really amazing because you really hit on all the major points here — the way in which we self-stigmatize, but also the way in which everyone lives in a family, a culture, a home, a little group of people, a town, a village — whatever your village may look like that may have a different take on mental illness. And how that's informed your own take on that as well. I wonder if you could talk to us a little bit about that … what was it that was standing in your way of seeking health? And in terms of actually getting the diagnosis at 13, do you think you were experiencing symptoms much earlier?

Diana: Yeah. I can answer that question backwards. I think it’s integrated to the whole experience itself. But definitely, I was experiencing symptoms much earlier. I think when you get to the point where you are actively engaging in suicidal behavior, that's a little bit too late, to say the least. I wish I didn't have to get to that emergency point. But that was definitely something that was affecting me in terms of my family and my background. I'm a first generation Chinese-American immigrant. And like a lot of immigrant families, we uprooted our whole lives to come to the US and the hope of a better future. And all of that. My parents didn't speak English, and I am from the poorest province in China, where we are an ethnic minority. We're not Han Chinese, which is what most Chinese people are — which means there are a lot of traditional beliefs within my family background, especially given that we come from a rural village, that is not really prominent even in other Chinese people. 

Lauren: So this is probably things that deviate from Western and Eastern medicine.

Diana: Not even deviating from Eastern medicine, but perhaps delving a bit too much into the traditional side of that. Back in China, my dad was a traditional Chinese medicine doctor. And I think there's a lot of merit to what we call TCM, traditional Chinese medicine.

But there is also the notion, because your mind and body are one, that if there's something wrong with your mind, oh, it's probably just because there's something wrong with your body.

It's supposed to be more easily dismissible that way, I suppose.

Lauren: So it doesn't really leave room for a mental illness diagnosis.

Diana: Yeah. It's also tough because I think for a lot of people — and immigrants, especially — there's this common narrative and belief that, oh, your parents or your ancestors went through so much difficulty to get to where you are today, so how could you possibly dare to feel anything other than grateful and happy. So there was just a lot of different factors happening, I think, that made me question if I even had the right to seek out help, or if maybe I was just being too much of a crybaby, or whatever else.

Lauren: So what did that look like in terms of seeking help? Was that something that you sought independently of your family because it was available to you through your school? Or did you get your family involved from an early stage as well?

Diana: This was something that I mostly sought help for independently, which was very difficult because I was 13 and the American healthcare system has a lot of challenges in and of itself. I think the one thing that is both a helpful vector in this sense, but also problematic in of itself, was that around that time was when I started having an autoimmune-related eye disease called anterior uveitis. This eye disease basically would triple or quadruple my eye pressure from that of a normal person's, to the point where it would swell my veins, and I would essentially go temporarily blind. And the temporarily part was very much questionable, because every time I got an episode, it was unclear if the medications would work or if maybe that was going to be the last time that I was able to see. That sort of physical illness, which is oftentimes a lot more acceptable for people to understand as an illness, that allowed me to go see doctors a lot more frequently than I think I would have been able to otherwise. And because my disease was so severe, I was part of a program in California that included a psychiatrist in my appointments, per se. So I think that was also helpful. Of course, it brought with it a lot of its own type of pain, but it did allow me to get to the doctor on a more frequent and reliable basis. 

Lauren: This is so interesting to me because so rarely do you hear about an autoimmune disease that comes along with its own psychological component in care. But also, that at such a young age, you were dealing with a disease that was leaving you so up in the air in terms of your abilities, and that the mental health care was provided for you there. I mean, you're really sort of stuck between these two worlds where there's provision and lack thereof. And as you say, it got to the point where you were really enacting suicidal behaviors before you were able to do something about it. And luckily, you caught yourself in time, as it were. So how did all of this relationship with the medical system which you had that was obviously quite positive in most ways, lead you to the diagnosis? Was it something that you worked through with the psychiatrist who was assigned to you? Or did you seek additional care?

Diana: I ended up having to seek additional care because in recent years, I feel like, the link between psychological distress and physical illness has been made more prominent. Or as we call it, psychosomatic symptoms — physical manifestations of that distress. A lot of research shows that this tends to happen even more so for people from cultures and backgrounds that really tend to emphasize that mind and body link, and which can perhaps, in that way, also heavily stigmatize the idea of a mental illness. Which was true for me. When I was at the doctor seeing the psychiatrist through my eye disease, the things we talked about were not framed in, like, “Oh, are you like feeling like suicide?” Or whatever. But rather, he was more like, “Oh, how are you dealing with the psychological repercussions of your eye disease and dealing with the healthcare system and all that?” So it opened the conversation for me to feel more comfortable with talking about mental health. But it didn't recognize that link between mental health and my own psychological illness.

At the same time, to be fair, I wasn't very open and upfront about my psychological symptoms, I think because I was scared of what they might think.

And at that time, I was still actively engaging in suicidal behavior and had been caught in a number of suicide attempts. I think that increasing familiarization with the idea of mental health helped me feel like I could seek out other ways of care. But it in and of itself wasn't enough of a solution.

Lauren: Yeah, I think that makes a lot of sense. But it's just amazing to me that it took one disease to help you get care for the other as well. It shows the advantages and disadvantages of the healthcare system, doesn't it, as well as these pressures we place upon ourselves and upon those around us, based on the ways in which we were brought up, and the communities in which we were brought up. It all impacts that health journey. And it's important for people who are tuning in to remember that. That we all come from different places, different backgrounds, and that those backgrounds can influence how we move through the world in such very big ways. Which really happened for you, obviously. You mentioned that you were acting on suicidal behaviors, that you survived several attempts. So, as a 13-year-old girl being diagnosed with bipolar disorder, still living with anterior uveitis, what did the care plan look like for you?

Diana: Oh, gosh. You know, to be honest, I didn't really think of there being a care plan. I remember hiding in the school parking lot, trying to call people like the Suicide Prevention Hotline, or calling the psychiatrist that I had been attempting to see on the side, and as I was talking to them, feeling this need to minimize my symptoms and my feelings as much as possible. I wanted to convince them, and perhaps more importantly myself, that this was all just a phase, as some people would like to call it, and that everything was fine. Because at the end of the day, I was really terrified of what something like this could mean for me, my family. I didn't understand if that was something that would impact my worth as a human being. It just felt like I was causing more unnecessary drama and trouble for everybody in my life. So, it took a long time after that … in fact, I just decided at a certain point that I was not going to continue pursuing care because I didn't think that it was something that I deserved. I was very lucky that I had a very supportive little brother, who was the one who found me during my very last suicide attempt. And he really forced me to confront my own darkness and and choose a path that would minimize, at the very least harm to him. Much less to myself. Because at that point, I was no longer really caring about myself, and more about the people I cared about. And so because of him, I started trying to seek out other forms of self-care and self-healing; that’s part of what led to Letters to Strangers. But for the most part, I'd never really pursued a thorough care plan until I went to college and had a lot more autonomy and time to just familiarize myself with the work that I was doing, and how it relates to me on a very personal level.

Lauren: It sounds to me that aside from your younger brother, who found you, you've learned to become your own advocate on this whole journey. And I'm wondering how that's impacted your relationship with yourself. You mentioned that you started off not thinking you deserved to take up space. Obviously that's shifted, because you're now seeking treatment. So how has that shift occurred, and what happened between your brother needing you to show up for him and you realizing that you also had to show up for yourself. And gaining autonomy with your medical care as well.

Diana: Yeah, I think it really, at that time, came down to the idea of even if I don't think I am anybody of value, I have so many people who are of value to me. Okay, I don't care if I am letting myself down.

But the last thing I will let myself do, as long as I have a say in it, is to let those people I care about so much down.

And that became very much of a driving force for me. After my brother found me, I tried to find different ways of healing. And it was when I turned to writing letters to strangers, for example, that things started to feel more okay for me. That’s partly why I started Letters to Strangers as as organization, but also through those years of advocacy, with Letters to Strangers and having other people come up to talk to me, as if I was somebody who showed them the value of themselves … that was the sort of trust and vulnerability they allowed me to see that I just was fundamentally shaken by. And it made me realize that it's not even about ‘oh, if I can help somebody else.’ Because in a way, I suppose that feels a little bit too 'about me’ and what I can do for other people. It was more like that connection that I was able to build on with these people through an illness that I thought was something that made me a terrible, unlikable, disgusting person. The fact that something I hated was allowing me to connect with people on such a human and soulful level really allowed me to see that perhaps there is a lot more value and worth to me and my experiences, and what I can do in this life, than I was giving myself credit for. So that was really, I think, through advocacy and through the kindness of other people placing their trust in me, the turning point for me internally,

Lauren: I think that's so beautifully said. Why don't you tell us more about Letters to Strangers and what it is? For those who are tuning in to whom it's new, can you give them a little background on how you got started, and what the organization has grown into?

Diana: Yeah, for sure. So, Letters to Strangers started as a school student club at my high school, which I started back in October of my sophomore year of high school. And this happened after my brother had found me, so this was after I had experimented with writing letters and starting to feel like, oh, it's so strange; I’m writing letters to strangers, to people I'd never met, and I'm trying to be so kind and empathetic to them. But I was denying myself that same kind of empathy. I figured if it could help me, maybe it could help other people as well. So it started off as a school club. I had to bribe my friends with pizza at lunch to get them to come to the meetings. 

Lauren: Amazing. I remember having to do that for some clubs, too. (laughs)

Diana: Right? It's impossible to get a bunch of high schoolers to do anything,

Lauren: Unless there's free food!

Diana: Exactly, exactly! But yeah, I started off very much like, I’ll just see what happens. And then, as I was talking to more people about it and my friends from other schools, people started to show a lot of interest in it, which blew my mind. And through that, it slowly grew and grew into a bigger and bigger organization, with people starting chapters in their own schools, in their own communities.

And now today, we are the world's largest youth-for-youth mental health organization with over 35,000 people impacted on six continents.

We try really hard to not just make it about de-stigmatizing mental illness … through awareness and youth for youth, but also medically and professionally reviewed education, and also very much tackling the access side of health care by advocating for grassroots-based policy changes which are run by a lot of our youth chapters, and also really pushing for the integration of mental health education into school curriculums around the world as well.

Lauren: It is unbelievable that you were able to … this is what I think is so inspiring to people who are tuning into the show … that you were able to get a diagnosis, know that something's up, and even by accident, create a community, expand that community, and begin to get well through that community. It really goes to show the power … of that community, that the minute you sort of look beyond yourself, no matter what you're dealing with, you can begin to heal. It’s incredible what you've managed to achieve, and at such a young age. And also living with various conditions and navigating those in the US healthcare system … we’re gonna get into that. But I'm wondering what a typical day is like for you as you're managing symptoms? Are you still also living with anterior uveitis and having to prevent episodes with that? Are you finding balance in your life, between work and life, as you're managing symptom management in your day-to-day?

Diana: Thank you for that question. I really wish somebody had told me about the idea of psychosomatic symptoms earlier. Because as I've been healing mentally over the past few years, so has the severity and frequency of my uveitis. I spent about half of high school, just in and out of hospitals, in and out of clinics. I had to miss Letters to Strangers club meetings because I was at a doctor’s, because I was having yet another episode. And yet I've remained now episode-free for the past two years. Which is something that is inconceivable to high school me. I really believe that that is largely due to me getting better mentally. I definitely still struggle with a lot of mental health episodes these days. Because I've been seeking more consistent treatment, both from therapy and also from medication. And also because I've really internalized now that idea of self-worth, and truly believe that even if I don't feel, at certain times, like I am someone worthy of this air that I'm breathing, I will make myself that someone who is worthy. And I'm going to commit to those ideals by really pushing through to see what I can do, for not just myself but my community as well. So that's the sort of mentality I've been very lucky, in many senses, to be able to now embrace. But for sure, like there's still a lot of times when I am experiencing a hypomanic episode and I am being extremely productive and taking way too many risks. And then I get hit with a depressive crunch, and I end up just crying by myself for weeks. So it's definitely still something that impacts me, but I think I've just become a lot more accepting of it being sometimes a part of who I am. And that doesn't detract from the value of me as a human being, and every little victory counts.

Lauren: I think that's really beautifully said. And the fact that you've been free of episodes with the uveitis for two years. It's interesting because that mind/body connection has been part of this conversation from the very beginning. It’s so important that there's a mental health aspect to any kind of care for chronic illness. When the mental illness itself is a chronic illness, there are those layers, that's for sure. But it sounds like you've really managed to, as you say, accept that some of these ups and downs are part of who you are, and that you may have hypomanic and hyper-depressive episodes, but that's part and parcel of who you are, and that that's to be expected. It's almost that knowing it could be coming gives you more freedom, doesn't it, instead of not knowing how to cope.

Diana: Exactly.

Lauren: So, it sounds like you were taken care of, obviously, from quite a young age and taken seriously by your medical professionals and your family. But I'm wondering if you were ever in situations where you were confronted and forced to validate the existence of either your mental or physical illness to other people, and what those situations might have looked like.

Diana: Well, actually, for a very long time, my family was very much in denial of anything being “wrong” with me. That was a big sticking point in my life growing up, I think, because that was a big reason why I didn't feel like I deserved to seek care. And, frankly, I was in a very toxic home environment that contributed to a lot of those stressors and triggers for my mental illness. And I think that was partly also why, once I left home to go to college — I took a gap year before I went to college — but once I left home for my gap year and all that, that correlated with a turn of my mental illness for the better. So I think definitely that contributed, too, environmental factors.

But also I think, as I was wrestling with a sort of self-denial, I tried really hard to throw myself into other things to validate my existence.

And so for me, that thing was most obviously academics and paper achievement. I did really, really well in school and I got a lot of awards for various things that were academic. But I remember I had a conversation with a psychology teacher I had in high school, after I graduated — because I didn't come out publicly with my full mental illness story until after I left home. And she was telling me about how she was so surprised that I already had a mental illness back in high school, because she thought I was happy-go-lucky, but also just always stressed-out kid about academics. And I was, like, “Yeah, you saw that because that's what I wanted you to see.” I was trying so hard to convince people that I was this really hard-working kid who was going to put my all into academics. And I think because, also as an Asian kid, that worked very well with stereotypes. So no one really ever questioned it, and it allowed me to hide a lot of the things that I was going through. I could always just dismiss it as, like, “Oh, I'm just stressed about this test." Things like that.

Lauren: It’s really interesting because you also mentioned early on in this conversation, this experience of being a child of immigrants, and that your family was in denial and that the approach to medical care may have been a little differently informed than your “typical” experience, right … aka the white person experience in America. I'm wondering if you could highlight for us some of those experiences, either of prejudice or privilege, within the healthcare system here in the US. Particularly in regard to the way that that you present yourself, as a Chinese-American woman, as a woman of color. Can you see your circumstances maybe being different if you were white, if you had grown up in a non-immigrant household, or maybe if you didn't even have the physical symptoms that correlated with your mental health issues.

Diana: I think the statistic is, over 80% of mental health practitioners, mental health professionals in the US, identify as white. So, there's definitely been a cultural discrepancy to say the least, between the sort of care I think I would have most benefited from — versus the care that I received when I did receive it.  I think there's sometimes this sentiment, especially among communities of color, that mental illness is a white person thing. 

Lauren: I want to just say right now … everyone has mental health issues. Mental health does not discriminate. For those who are tuning in right now, mental health has no race and ethnicity; it literally can affect anyone.

Diana: Exactly. I think that was a sentiment that I was also personally thinking about. It affected how open I was willing to be about things when I was talking with professionals, because I didn’t want to say this because I don't know what's gonna happen to me. And I don't want them to think that I'm this dramatic kid who's overreacting just to get a response from people. Which is what I thought of mental illness at the time. And also, I think there are just certain value differences. I think in Western society, there's a lot of focus on your individual feelings. Especially when you go to a more common type of therapist. With cognitive behavioral therapy, they tend to ask you questions … “So, what's been bothering you? Tell me more about this …”

Lauren: And this is presuming that you even think you have the right to be bothered. White people already usually have a certain privilege that allows them to think they have the right to be bothered, where a lot of people of color don’t. This is part of the immigrant experience, isn't it.

Diana: Yeah, because they were asking me these questions and I'm just, like, I don't know if answering this is going to reflect poorly on my family. And I don't want to explain the values that we have in my family, in my culture, that I think justify certain behaviors, but which might sound really crazy to a person who is not of my background. It made me self-censor a lot, and made me really wary of what I felt like I could talk to them about.

And also, I was afraid that they would misinterpret some of the things I might say.

Like if I said, “Oh, my family's giving me a lot of pressures," I think the stereotypical response when they see my face was, like, “Oh, do you have Tiger parents who are pressuring you too much about school?” And I'm like, I wish that was the situation! There are just so many nuances to my cultural experience, and I didn't have the energy; I didn't have maybe even self-confidence to feel like I should delve into that. And so I just chose to act like they didn't exist.

Lauren: So does that mean that if you’re, especially a young person who's still coming into their own with regard to mental health … does it mean that in many ways, there needs to be more access to mental health care for people of color by people of color? It sounds like you were talking to white therapists, and maybe if you'd been speaking to someone who was from the same area as your family in China, then that might have brought a certain level of understanding. It would have leveled the playing field a little bit, right?

Diana: Yeah, absolutely. In my past few years of advocacy … so it has been over five years now since I really started doing this work … one thing that has come up over and over again is the Chinese community and the larger Asian communities’ outpouring of support for me whenever they hear about what I do. Because for a lot of these parents and families, they know that there's an issue, but they don't really know how to talk about it or go about seeking care for it, especially in a very white-centered system. In fact, the diagnostic manual, the DSM that's used to diagnose mental illnesses by mental health professionals, for the most part, culture-bound syndromes are included only in the appendix.

Lauren: Oh, my goodness. Okay, that’s interesting.

Diana: People don't really think of the mental healthcare system as something that is available for conversations within communities of color. This one time, when I was giving a talk in all Chinese to an all Chinese parents sort of audience, it just blew my mind. Because I think for a long time, I thought that my Asian heritage and background was part of why I didn’t want to seek mental health care. I mean, that is so true to an extent. But it made me realize after talking with them that it's not like they didn't care. And it's not like they didn't have an understanding. But it was more that they had no way of how to navigate it.

Lauren: When they also maybe didn't have specifically the language for it either. It’s not something that's part of the heritage.

Diana: Exactly. And so when I was able to talk to them about it, with language that they understood, as somebody who they felt like they could relate to, suddenly the empathy and the care that was shown by these parents and by these families, it just blew me away. And I wish that was the greater dialogue about it, rather than, “Oh, you know, Asian parents, immigrant parents, are super strict …” or whatever else.

Lauren: Absolutely. And it sounds like part of the outreach, not just to people who were living with mental illness, but also to young people who are looking forward to careers, perhaps in medicine, the message here is: Hey, we need more mental health professionals who come from all different backgrounds. So if it's something that interests you, pursue it.

Diana: Yeah, I had this one girl come up to me — because a lot of kids, especially kids of color, they relate to me a lot as well, because I think oftentimes on panels, I am the only person of color, I'm the only young person, etc. And I've often had kids come up to me and they’re, like, “You know, I told my parents I want to be a doctor, and I want to get a doctorate, and they were super excited. And I told them I wanted a doctorate in psychiatry, and then they were so disappointed immediately.”

Lauren: Wow, it's so outside the understanding and experience.

Diana: Yeah, I really wish there was more emphasis on getting people of diverse backgrounds into the provider side of things. Actually that's one thing that we've been trying to do at Letters to Strangers. We just wrapped up our second annual round of scholarships. But we've been working on providing scholarships that emphasize mental health as a possible career path for people of color, for people of underprivileged backgrounds, etc.

Lauren: Well, another amazing thing that you are doing! So why don't we dig into our healthcare system a little bit here, too, because your experience has been wide and varied. Can you talk to us about ways in which you've seen the healthcare system in the US work for patients, and ways in which it's really not? We were already talking about a lot of this inherent privilege and prejudice that exists, particularly in the divide between white and ethnic and racial minorities, if you will. I’m wondering, how does that change your experience of the healthcare system?

Diana: I think I was quite lucky to be in California. My family was living below the poverty line; we were really just using government-subsidized and supported healthcare programs. There was a special one called CHIP, Children's Health Insurance Program. I was really lucky to be able to be a beneficiary of that, because I highly doubt I would have been able to access healthcare otherwise, or even in other states, with the sort of family monetary background that we had.

The thing that I wish people were more aware of is the time commitment of caring for someone with chronic illness.

At the time, because I was under 18, I always had to have a parent or guardian with me whenever I went to the doctor. And because I was seeing eye doctors half the time, that required a lot of time for my parents to be at the doctor's with me. I was really lucky that my parents and my family, we were engaged in a small business of our own. So at the very least, we could do work on the go. But I can certainly imagine that without that sort of flexibility in their work schedules, this would not have been possible. And in fact, one of the reasons why I didn't want to seek mental healthcare was also because I couldn't bear the thought of adding even more pressure onto them to have to go to even more things with me.

Lauren: Which is another note on why, when it comes to healthcare that people are paying for, and when people are on government-subsidized programs, mental healthcare needs to be a priority as much as a physical condition is within these systems, doesn't it. We're certainly seeing that gap in the system right now with COVID, aren't we. The gaps of people who are being left behind, and this separation with the 99% and the 1%, it becomes ever more clear. I'm wondering also, as a side note, how the COVID experience is impacting your mental health and your coping techniques. Right now, you've been abroad for most of this experience, in a place that experienced COVID well before the US did. I want to know what you've seen in your community, in terms of coping strategies, and how people who are living with mental illness and mental health issues are finding this self-isolation to be.

Diana: It's definitely been very tough. I was talking to some of my friends about it, and how I was put in a government-guarded quarantine facility for two weeks because I was away in Myanmar when a new law passed in Singapore that required stay-home notices for anyone returning from Southeast Asian countries. Then the university decided to up that a level for me by putting me in that quarantine facility. And so I was locked in this 100-square-foot room by myself for 14 days, and I didn't see another human being. I even tried to open the door right at mealtime so that when the people who deliver the food came, I could see their faces. But they often would just leave the food on the door handle and then run away. So I couldn’t see other faces, I didn’t have that sort of human-like interaction. And I just spiraled. I had not felt that degree of depression that I did during quarantine. I hadn't felt that way for a very long time. And it just really brought back a lot of negative memories for me. I don't blame anybody for that. I think it's very important that they do this for public health. And so I completely understand the situation that they had to put me in. But it also makes me empathize a lot more with people who are in self-isolation, whether that be self-implemented or government-facilitated during this time. Because it's very, very difficult to be trapped in your own head when your head is your own worst enemy. So, that's something that I've been thinking about a lot. I've been doing some webinars and things like that about mental health during COVID-19.

And certainly everybody's been affected mentally, to some extent; regardless of a mental illness or not, it's very hard to be living through this time.

But also, it just emphasizes as well, for me, when I see things that are, like, “Oh, just make sure that you self-care.” And I’m, like, great, but … you know …

Lauren: It's a very privileged point-of-view, the self-care thing!, I struggle with the self-care thing, because it’s so riddled with problems. And the idea that a lot of people have about self-care is very limiting for people who are limited by geography or income or, you know, a million factors. So it's very interesting you bring that up. I'm glad you do.

Diana: Thank you. For sure. I mean, we use self-care in a lot in our dialogue and education. Last November, Letters to Strangers published the world's first youth-for-youth mental health guidebook. It's this behemoth of a book. It's fully illustrated, 80,000 words, A to Z of mental health, written entirely by 14- to 21-year-olds, but reviewed by medical and industry professionals. I bring this up because we have a section in there called “Protective Factors and Self-Care’. And what we really tried to do in that section is dispel a lot of the myths around self-care and really illuminate more about what it's supposed to be. Because one thing that I have struggled with for a long time was this idea of self-care being something that felt a little bit narcissistic to me, especially coming from a background where community values are so much more important than individual, temporary self-satisfaction or whatever.

Lauren: Which COVID’s reminding us of, that the community is more important than the individual, too. In case we were wondering! (laughs)

Diana: Yeah, I think that's something that I've been thinking about a lot, especially with COVID.

Lauren: I think that's really well said, and we'll certainly link to the book on the website page for this episode as well, so that everyone can access it. We're getting to the end. I mean, I feel like this is so rich; there's so much more we can dive into, and I want to talk to you for a million hours. But in order to keep this within podcasting time limits, I wanted to head into our Top Three Lists. I like to wrap up with a couple of top three lists. And the first one is … I’m wondering what your top three tips might be for someone who, maybe they suspect something's a little off with them. Or maybe they have a diagnosis. Maybe they are a young person like you were, navigating the system. What tips would you give for others who are living with invisible conditions?

Diana: I think, firstly, embracing that you are someone who is deserving of care. And if there is something that is hurting you, then that doesn't reflect your self-worth, but rather just highlights the importance of you taking care of yourself so that you can provide better for yourself and for the people around you that you care about. That being said, gosh … how do I say this concisely?

Lauren: You don't need to be concise. You can speak as long as you wish!

Diana: Thank you! Well, I think, with social media and with a lot of the way that the media portrays and perhaps even, you can say, romanticizes mental illness...

I’ve been seeing a sort of alarming trend where people not only self-diagnose, but over-pathologize mental illness. Like, equating being sad with being depressed, equating being moody with being bipolar.

And it leads to some dangerous consequences because it sort of simplifies and dismisses some of the more severe nuances of these illnesses. The most disturbing thing I heard … I talk to a lot to high schoolers and people of that age with my work. This kid came up to me … she just dropped this casually in the middle of the conversation … she said, “Oh, you know, yeah, like depression isn't cool anymore because anybody can say they have it, so bipolar disorder is the new thing.” And I was like …

Lauren: What?! What are the kids up to these days, geez?!

Diana: Well, you know, it's like this need for …

Lauren: For oneupmanship?!

Diana: I guess. You want to have empathy and attention from people. And with social media being something that attracts attention constantly, you have to resort to new ways to get that level of attention. There was even an article in The Economist a while ago that was talking about the rise in digital self-harm — where people would make fake accounts to bully themselves, to see if they could draw support from people who they think might or might not be their friends, where they want to test the loyalty. The difficulty with this is … on the one hand, it's very easy to be, like, oh my gosh, what's wrong with these people? Why are they being like this? But on the other hand, it highlights that there's a deeper societal level of insecurity that we need to address, and that it's very tempting to be fully judgmental with this. I think I've also had to wrestle with my own internal judgments to really try to tackle this from an empathetic point-of-view. So that's something that I think is important, especially for young people today, when they think they might have a mental health condition — to fully educate themselves on what mental illness means. And to know that you don't have to have a full-blown diagnosis to be deserving of seeking help. There's very much value to being preventive about your mental health care. And however much we may be hurting; if we're hurting, that's enough reason to care. I hope we can extend that care regardless of the level of diagnosis that someone may have, so that we can normalize the idea of seeking health care for your mental health without having to amplify or overblow it.

Lauren: Yeah, or even to validate it. Just knowing that if something's a little funky, it's time to get it checked out. 

Diana: Yeah, exactly. 

Lauren: So that's like tips one and two! What else would you offer as advice?

Diana: I think also just remember that people don't really care that much. If there's something that you're really embarrassed about, or that you'd like to check your own thoughts about, ricocheting inside your head … people are so busy with their own lives, that if you mess up, it's okay.

Honestly, no one's gonna remember this. So don't beat yourself up over it. 

Lauren: I think that's a great reminder, especially for young people who are dealing with that kind of peer pressure, and things like that in school. So what about this one: Top Three Things that give you unbridled joy. This is a good one. It's juicy. So, despite any kinds of changes you've had to make in your life to manage symptoms of your mental illness or of your physical condition. This could be guilty pleasures, secret indulgences, comfort activities — if you're having a flare-up, things like that, what are three things that are super, super joyful that you turn to when you need a little boost?

Diana: I love this question! So the first answer obviously has to be writing. It means a lot to me. I think also food, obviously.

Lauren: Well, you’re in Singapore right now, so I imagine you're getting some amazing food over there! 

Diana: Oh, yeah. That’s one of the top reasons why I don't want to go back to the States. Can’t leave all this behind! (laughs)

Lauren: Fair enough! 

Diana: And then thirdly, I think the vastness of things. What I mean by that is, whenever I feel trapped, it blows my mind when I think about just how vast everything is. How many new experiences there are to be had, how many new places there are to visit, how many new people there are to meet.

The vastness of things defies logic in a way, and it forces me to confront the idea that no matter how trapped or isolated or whatever else I might be feeling, there is so much more to be explored out there.

And that makes life itself worthy of a chance.

Lauren: That’s really, really gorgeous and very deep. For me that's like living in LA and going to the ocean. There's no better reminder of how much bigger the universe is than you when you're stuck in your head like that, and looking at the ocean. For me, at least. I think that's a great tip for anyone who’s, like, how do I get out of my head? Go look at something bigger, right? Is there anything else you'd like to share with us? Absolutely, please share where the listeners for this episode can find Letters to Strangers, and can find the work you're doing.

Diana: Thank you for the opportunity. If people are interested, they can learn about how to get involved with us, or get things like the guidebook on our website at LetterstoStrangers.org. And we offer the black-and-white PDF of the guidebook for free to download. So we are trying to make it as accessible as possible.

Lauren: That’s as accessible as it gets! And of course, you appreciate donations.

Diana: Yes. And we have physical copies and full-color copies for purchase that I think bring it to a whole new level as we have so many illustrations in the book as well. On social media, we are available at @L2SMentalHealth. I would be very happy to talk to people about their thoughts on mental health and what they would like to get involved in. It's a constantly evolving field, and I just am really grateful to be seeing this increasing attention in care, and education surrounding it, especially within communities of color or otherwise marginalized backgrounds.

Lauren: Well, there's no better place to wrap it up than that. Diana, it has been such an honor and a pleasure speaking to you today. And I look forward to seeing how Letters To Strangers continues to grow. And guys, if you're tuning in and you’re, like, I'm a teacher, I need to have Diana come speak at my school … go check out the website, go find out about what Letters to Strangers is up to, and see if you can get someone to come and talk to your kids. Because they are the future. And this can all be done virtually as well while we're in the midst of the COVID thing. There are plenty of resources there as well. So, Diana, thank you so much, and we wish you well in your future endeavors, and hopefully we'll be able to have you back sometime soon.

Diana: Thank you so much, and I am super grateful for your thoughtfulness and empathy in conducting this conversation. So you guys, if you need support … !

Lauren: If you need support, here it is. All right guys, thank you so much.


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