Esto lo superé: Latinx in Medicine Discuss Mental Health, Representation, and Culturally Competent Therapists
July is BIPOC¹ Mental Health Awareness month, and we at LXMED understand how being a Latinx in medicine can often lead to and/or exacerbate mental health issues. Being in medicine, a stressful and demanding field, often leads to these issues on its own. This is clear from the trend of doctors having higher rates of depression and anxiety compared with the general population and other professional groups. In addition to the stress and anxiety from school and working in medicine, Latinx often experience cultural stigma regarding seeking mental health services and a lack of cultural understanding around mental health discussions in their families. In 2018, for example, 57% of Latinx young adults (ages 18-25) and 40% of adults 26-49 with serious mental illness did not receive treatment due to these cultural barriers. In 2017, the American Psychiatric Association found that Latinx people are more frequently undertreated than white Americans with Latinx adolescents using antidepressants at half the rate of their white counterparts. Thus, being Latinx and in medicine can be a ‘double-whammy’ when it comes to mental health issues.
Dr. Laura Correa Ferrer, who just finished a dermatology fellowship, resonated with this common experience as she traversed medical school and residency as a Colombian immigrant dealing with issues in her mental health. “Mental health is pushed aside in our community,” Dr. Correa Ferrer told me. Originally from Colombia, Dr. Correa Ferrer moved to the United States when she was twelve years old. During her first year of medical school, she suffered from depression and believes she would have greatly benefitted from medication as she dealt with toxic relationships that affected her day-to-day life and caused her to have passive suicidal ideation. “I was just too stubborn to seek treatment…I didn’t want to admit failure; that’s hard as a ‘Type A’ person.”
Although she had a huge support system from her family, they didn’t know how to navigate conversations about mental health. Dr. Correa Ferrer recalls one incident while on spring break from medical school when her mental state was so poor she “felt like a zombie.” Although her family noticed a difference in her behavior, they weren’t sure what to do. Now, Dr. Correa Ferrer believes she needed an intervention, but the cultural difficulty of having a conversation about mental health in a Latinx family wouldn’t allow it.
Residency presented a new problem as Dr. Correa Ferrer dealt with anxiety as one of the only minorities in a very white geographical area and residency program. Others cast their implicit biases on Dr. Correa Ferrer for being Latina and labeled her as “too direct and abrasive.” Although she loved her patients, her co-workers' attitudes toward her created a negative environment that caused her to be angry, miserable, and “in a bad mood all the time”. “If I didn’t google ‘How to quit residency’ once a week, it was a win.” But Dr. Correa Ferrer didn’t quit residency, perhaps only because as a Colombian immigrant, she didn’t want to disappoint her family. “I didn’t want to disappoint my parents who moved to the U.S. and started completely from scratch.” In other words, Dr. Correa Ferrer’s first-generation guilt kept her afloat.
But during residency, she finally sought help. She began seeing a therapist who was Colombian like her that helped her address her guilt and trauma. During therapy, she learned how to better communicate with her parents who eventually came around to the idea of acknowledging her mental health issues. “They were more into it,” she said. When Dr. Correa Ferrer recently mentioned the incident of feeling like a zombie during medical school to her mom, her mom was much more receptive to discussing how her daughter felt and what should have been done.
When it came time to do a fellowship in a different city, Dr. Correa Ferrer immediately looked for a Latinx therapist. She finally felt like there was a “light at the end of the tunnel” because the end of her training was in sight. Having completed medical training and having this experience with mental health issues as a Latina in medicine, Dr. Correa Ferrer recommends others find mentors with similar backgrounds to help ease this experience. “Use social media to network with those on a similar path. Don’t be afraid to reach out! It takes a village to get through medicine, so find someone who can guide you.” Dr. Correa Ferrer wants to help people too and see others succeed. She knows it’s difficult but wants others to know it's doable. “There were times when I didn’t know I would get out of this.” But she did.
Dr. Laura Correa Ferrer
Many others in medicine have suffered from mental health issues as a result of entering school. For Javi Ochoa, however, this experience came before even officially entering medicine. Originally from El Paso, Texas, Javi started college as a pre-med student in 2011. Being away from home for the first time, stressed as a pre-med student, and no longer playing sports in college caused Javi to be hospitalized during his first year of college. However, being hospitalized and returning home improved Javi’s mental health as he began coaching his old swim team and teaching chemistry, allowing Javi to understand that coaching and teaching were his true callings and inspiring him to continue on his pre-med journey.
After graduating from undergrad, Javi worked as a scribe and made relationships with patients. He was rejected from medical school during his first application cycle so he applied for a masters. During graduate school, Javi’s mental health was tested again as his grades were not his strength. But Javi’s people skills and being involved socially as a coach, teacher, and scribe proved to help his mental health once again.
After his masters, Javi went on to medical school where he started a diabetes screening program, led different clubs as president, and conducted research. Consequently, his mental health remained stable since his social involvement was high. But with interpersonal issues sprouting, Javi was diagnosed with bipolar II disorder and went on medication. “This came at the right time though because COVID-19 started,” Javi said. “I’m social so it was really hard to not see other people.”
During his second year of medical school, imposter syndrome hit Javi hard. He questioned whether he really deserved to be in medical school. “I’d think to myself “this is real, this is definitely real’.” As Javi built more friendships in medical school, he realized everyone was going through imposter syndrome and he took comfort in not being the only one feeling this way. He thought “Maybe I am smart, and we’re all just struggling together.”
Studying for Step 1 was a different and isolating challenge for Javi as he spent his days studying all day long as most second year students do to pass the first part of their licensing exam. “School was never stressful for me. I was never depressed over school until this year,” Javi commented. That is when Javi started his social media accounts to help other students in the pre-med and medical communities. Being on social media, specifically Tiktok, gave Javi another outlet to be a coach, teach, and motivate others. “My therapist told me, ‘this is the happiest I’ve ever seen you’.”
By sharing his journey in medical school online, Javi was also able to show students a different side of being a medical student that wasn’t a romanticized or glamoured version, but was real and raw. “I was able to say ‘I’m a medical student and I have bipolar disorder.” And during his dedicated Step 1 studying, he relied on this same community, utilizing tools he’d learned in the past, and even took another week to study so as not to be stressed.
Now, Javi is going into his third year of medical school and he encourages other medical students with similar issues to establish a connection with their medical school right away. “See what resources they have available, find a therapist as soon as you move to your medical school, and start finding the help immediately.” He is also hopeful for the future as a lot of medical schools are advocating for more mental health resources for their students. He encourages students to be okay with being behind and not being ‘the best.’ “Everyone feels that way,” Javi said.
For those on the pre-med journey, Javi wants students to know they can talk about their mental health issues on their application. “You can talk about anything, it just matters how you say it. What did you take away from it? How is it going to help your patients?” Javi mentioned how he’s had patients that have the same issues he does, and it helps him to find common ground. “The more human you are, the better.” Javi also stresses the importance of using these “shortcomings” or “failures” on your application (like a lower GPA and negative mental health experience) as opportunities to show you grew back stronger. “A low GPA just shows how far you’ve come; be proud of it! Failure matters. Mental health triumphs! Be open about it and own up to it. Schools are valuing vulnerability.” It’s also important to understand that mental health shouldn’t be controversial. “Why is it okay to talk about cancer or diabetes, but not depression?” Javi asked.
Others are also connecting with their community when it comes to mental health online. Tiktok sensation and mental health advocate, Jorge Alvarez, grew up in northern New Jersey with his Cuban father and Puerto Rican mother. Having always admired the field of medicine and wanting to help others, Jorge was on the pre-med track in college. But as a first-generation college student taking difficult STEM courses, his mental health suffered. “I thought to myself, how did ‘smiling Jorge’ get to this place? How do I change this?,” he said. Thus, he began attending therapy with a therapist of color, and also began shadowing a Cuban psychiatrist his sophomore year and this experience of seeing a Latinx therapist serve a predominantly Latinx population for the first time inspired Jorge to continue on his pre-med journey.
But with the COVID-19 pandemic hitting during Jorge’s junior year of college, he was no longer struggling on campus, but was struggling at home and reflecting a lot in isolation. He began conducting research at Columbia University that made him ponder what healing actually meant, and as a hospital sitter, his eyes were opened to the reality of the American hospital system. These experiences caused Jorge to begin making Tiktoks and sharing his experience of being a Latino first-gen student struggling being pre-med. “No one like me was talking about mental health,” Jorge said. Consequently, people resonated with his content, and his video on collectivism² in Latinx families was his first Tiktok to hit a million views.
Posting on Tiktok about mental health in the Latinx community and his own experience gave Jorge a large platform to reach others and start conversations that caused people to reflect. “I’d get DMs from people telling me to keep talking about this or saying ‘I started therapy because of you’.” As Jorge continued posting about burnout, hustle culture, being an immigrant, and other prevalent issues in the Latinx community, and getting more and more followers, he began seeing that he can help and impact his community on a macro-level. “Latina mothers would reach out and say they appreciated my posts because they realized they were doing things I was discussing.” Now, he has almost 140,000 followers and works on social campaigns with Latinx businesses and organizations.
In May, Jorge attended MTV’s Mental Health Youth Action Forum, hosted with the White House, where he got to work with First Lady Dr. Jill Biden and Selena Gomez, and pitch his very own mental health campaign to companies like Pinterest and Snapchat. Attending this event allowed Jorge not only to share his story and have a platform to help others, but realize that working on mental health advocacy on a grand-scale instead of as a healthcare provider is his true calling. “I want to be the representation that I didn’t have - a Latino man talking about mental health. I got home from the forum and told my mom, ‘Mami, I don’t want to be a doctor anymore, this is what I need to be doing’.”
Realizing he is called to be a ‘connector’ and not a physician was difficult for Jorge to accept feeling so much cultural and academic pressure to finish his pre-med journey. “We change and grow. We unlearn and realize the path we’re supposed to be on. It’s not all about pursuing a title.” Jorge now realizes he personally thrives when he is strategizing with community partners and medical experts to help his community discuss mental health. He recently received a grant to work on a mental health campaign for BIPOC as an executive co-producer with his partner, and is optimistic about the future for Latinx mental health. “Since the pandemic, mental health is being discussed more, and more people are feeling comfortable acknowledging that this is how we feel.”
While Jorge realized medicine was not his calling to impact change in mental health, other Latinx are becoming therapists to help others in their community. Jackie Garcia is a licensed clinical social worker (LCSW), meaning she is a mental health provider licensed to work in her own community. She does so by helping her patients explore their options to best deal with challenges and relationships in their lives, and as Jackie put it, “Everyone has different needs.” She is also the content creator behind the Instagram account “TherapyLux,” where Jackie works to break cycles and heal, often posting about the stigma around Latinx mental health and the benefits of therapy. “I have a lot of faith and hope in the power of a therapeutic space that can be healing when I’m able to connect with my patients.”
Perhaps Jackie has so much faith in the power of therapeutic spaces because she herself benefitted from attending therapy. Jackie was born in the United States but grew up in Tijuana, a border city in Baja California, Mexico. After moving three different times, and multiple different schools, Jackie and her family moved to the United States in search of a better future when she was eleven years old. This final move during her formative years to a new country was different from her previous moves. Unlike before, Jackie experienced culture shock as there was a new language, new people, and even, new clothes. “It was difficult to adapt,” Jackie commented, and understandably so.
During middle school, Jackie was often bullied for being different, not knowing the language, and being labeled as “la niña nueva.” She began navigating her identity and hanging out with people who were a negative influence. During this time of rebellion, resentment, and confusion, Jackie’s father placed her in therapy. He knew things needed to be different, and luckily they were. “My therapist helped me see that what I was feeling was not abnormal given the situation,” Jackie told me. Her therapist was also a Latina and would conduct their sessions in Spanish. “After this experience, I knew I wanted to work in a field with people with similar stories and having a difficult time adjusting given their background.”
Jackie is now living out that goal as a LCSW working in private practice and seeing Latinx patients in similar situations to what she experienced. Many of her patients are 25 to 35 years old and navigating all the “firsts” that come with being first-generation Americans. She sees trends in her Latinx patients of learning to heal from emotionally-unavailable parents, grieving the relationships they wish they had with their parents, learning to be in healthy relationships, and healing their inner child. They often suffer from trauma, anxiety, depression, and although it’s individual work, Jackie helps her patients grow (i.e. starting a new relationship, quitting their job, taking a chance) as a team. Being a Spanish-speaking therapist has also helped Jackie connect with her patients and their parents. “We’re both human beings,” she said. “I tell them to talk to me like they would talk to anyone.” Spanish has helped her use lingo that Latinx use to express different things in our community, and often uses Spanglish during her sessions.
She advises our community to “get your healing” since understanding yourself and others makes a huge difference and helps us no longer live in trauma responses. “We tend to subconsciously repeat these patterns, but breaking the cycle of generational trauma is doable.” For those seeking mental health resources, Jackie advises using Latinxtherapy.com, the first directory that provides Latinx therapists, professionals, speakers, and recommends “shopping around” for a therapist. “Find a therapist you relate to on a spiritual, emotional, cultural level because you’re sharing intimate details where you need to feel safe to make progress.”
Jackie Garcia, LCSW
Finding a culturally competent therapist is Izel Leon’s advice as well. As a Mexican American Operating Room Nurse, Izel was the first in her family to pursue medicine, which drastically impacted the way she viewed herself in nursing school. She was also very aware of the lack of Latinx representation in medicine, which further reinforced her imposter syndrome. “Even though I would study and prepare and ask questions, I always felt like I had this sense that I wasn't enough, I didn't know enough, I wasn't good enough.”
As a new nurse entering a speciality that was not touched upon heavily in nursing school, Izel’s mental health suffered tremendously and she had anxiety-induced insomnia. The experience was very overwhelming and filled with self-doubt for Izel despite passing her boards and doing well in nursing school, even graduating with honors. “I had this sense of having to earn my place and just this overload of information. I think the first six months I slept so poorly I would cry all the time to my roommate and I just really wondered if this was the right path for me.” Izel admits she has perfectionist tendencies that cause her to be really hard on herself. Although these mental health issues most likely began in high school, they did not come to fruition until Izel started her professional career. “Medicine constantly evolves. There’s something to learn, grow, and improve,” she said. And COVID-19 did not help this situation either. “All of a sudden my career was at the forefront and I was expected to be this ‘hero’. I was afraid to see my family because I was being exposed at the hospital.” This experience was particularly difficult for Izel as she is very family-oriented, as many Latinx are.
As mentioned before, Izel recommends Latinx in the medical community find a therapist. “I grew tremendously when I found a therapist of color who specialized in working with people in the medical field. I just felt so deeply understood.” With a therapist, Izel was able to identify where she was struggling and name emotions and physical feelings for the first time. “She helped me normalize my experience and really speak tenderness into my experiences that has allowed me to be more loving and more gracious to myself.”
She also recommends having a small support system of other Latinx in medicine since people in your own family might not be aware of all the pressure people in the medical field face. Izel listed these expectations as the pressure to perform, not make mistakes, and know everything. But having a support system of Latinx in medicine can really help. “It’s just so comforting because you feel known and seen. They understand your particular struggles, and there's just a sense of solidarity there that is really healing, affirming, motivating and grounding because tienes tu gente que te entiende.”
Izel also believes in the power of community therapy and not being afraid to share your stories. When Izel began opening up about her anxiety, panic attacks, and insomnia, she noticed that her friends were feeling the same way. “Just knowing that you're not alone in those emotions helps you remind yourself that it will pass and better times will come. Healing is so possible.” When she does struggle emotionally, she looks to the past, reflects and journals. “By chronicling your difficult moments and the moments you’ve overcome that, you’re able to remind yourself ‘this is what was going on and esto lo superé.”
¹ Black, Indigenous, and people of color
² a way of thinking that focuses on the family or the group over one person’s personal ambitions