In April, the National Alliance on Mental Illness (NAMI) chapter at the Renaissance School of Medicine hosted “You’re Not Alone,” an evening dedicated to highlighting the impact of mental illness in our community. NAMI students read aloud stories anonymously submitted by fellow medical students, hospital staff, and faculty. A number of students shared their own mental health stories, including executive committee members Kathryn Hill (MSTP GS1) as well as Dr. Raja Pillai, PhD (MSTP MS4), who spoke candidly about his struggles with depression and balancing the many pressures of medical school. Shortly after the event, Raja sat down to chat with Nuri Kim (GS3) about his involvement in NAMI and his motivation in organizing “You’re Not Alone.”

What is NAMI? Why did you get involved?

The National Alliance on Mental Illness chapter at Stony Brook is part of a larger nationwide organization. Our mission reflects that of the larger organization: increasing awareness of mental health and illness, advocacy, and education among student and faculty in the medical profession. We try to do that through things like “You’re Not Alone.” We are also planning some fundraising walks in the future and events for increasing access for students to have better healthcare.

I’m interested in mental health in general. I feel it’s an important thing to address and destigmatize. I’ve had my own mental health struggles. It’s unfortunate how little it’s talked about or addressed in general.

When I was a first year clinical student, one of the things I was involved in was peer counseling. In second and third year, I ended up taking over peer counseling with a classmate of mine who has since graduated. Peer counseling died off while I was in medical school, and I think that was because a lot of people were not comfortable going to classmates about really personal issues. I saw NAMI as another way to [work with] mental health in a different way from peer counseling.

What is “You’re not alone”?

One of the first year medical students, Zoe Lazarus, suggested this event that happens at other colleges called “It Happens Here,” where people anonymously submit stories about their experiences with sexual assault and other people read them. She suggested doing something like that at Stony Book – and that was perfect.

I’d wanted to put something similar on for a while, where people share about their own experiences. But I was struggling because I couldn’t think of a good way to ask people, “Hey, can you share your deepest, darkest secrets? Thanks!” Zoe’s idea brought in the missing piece: anonymous stories read by other people.

What were you hoping to achieve by hosting this event?

I just want people to talk about this subject. Mental health is usually brought up through: (a) mandatory wellness “things that look good to the public,” or (b) in the news when someone has done something horrible to themselves or to others because of mental illness.

As far as I know there has been a significant increase in lip-service, but not many other types of services, and I just feel like if we want to have any hope of destigmatizing mental illness, we have to talk about it. A lot of people who talk about destigmatization, but when they actually have to talk about their feelings, they’re very reticent. Which is understandable, but progress can’t be made otherwise.

Was there anything about the actual day of “You’re Not Alone” that surprised you?

Oh, yeah. I had read all these stories submitted by both students and faculty beforehand, but there’s something about having someone read them that adds this whole other layer of emotion. I really did not have any expectation of how the emotions of the night would be. I think it ended up being a lot heavier than I had thought. There were tears from speakers and by the audience. I, myself, felt very emotional as I was sharing my own story toward the end, and I hadn’t expected to.

I was very inspired by what other people were willing to share because a lot of people shared really traumatic things, It takes an incredible amount of courage, and it meant a lot that people would share their own stories or that people would volunteer to read really heavy things for other people including stories about suicide and abuse.

And I was also happy to see that there were a good amount of students that showed up to listen. Another thing I had no expectations on was [turn out]. We got about sixty percent full, which is pretty good. It makes me feel good that we can try to do this again next year, and there may be sustained interest.

As an audience member, I agree that it was an astonishingly brave thing for members of NAMI and the community go up and share their own stories, yourself included. I think it takes not just a lot of courage, but a lot of self-knowledge and faith in mankind to do that.

I sort of thought my own story was pretty tame compared to a lot of others that were shared.

Nevertheless. When it’s yours, no matter the content, there must be some element of fear because it’s yours.

That’s probably true.

Like you’re literally exposing your insides.

Yeah! Psychiatry and surgery are both invasive.

So what do you think were the main strengths of the event this year?

I think the main strength was that for a period of time—about an hour and a half—everyone was on the same level. A group of people showed their vulnerabilities—just laid it out there. And the people listening were taking part in it. Everyone was participating in his or her own way. I think for a moment, I felt more connected with a lot of people than I normally do.

How would you say your experience at the bench informs the way you see or articulate issues in mental health or in other aspects of your life?

This part of my life [involving mental health] helps inform my research, and I think this is true for all MD/PhD students. If you experience an illness and then you later research that same illness, you realize how easy it is to turn a complex condition into a mouse model in your mind. When you’re writing papers on major depressive disorder, you will write the same few sentences: “Major depressive disorder is the second greatest cause of global burden and is predicted to be the biggest by 2030. It is characterized by — and so on and so forth.” You think of it so coldly. But having experienced it myself and having seen the clinical side of it, I’ve seen that major depressive disorder is such a complex entity.

And then the other way around: Just the science—more than anything else—has humbled me. It’s very tempting to say that we know that major depression is a disorder of the brain and neurotransmitters, chiefly serotonin…. We don’t even know what major depression is, really. We don’t even know if it’s one disorder or multiple disorders, and once you start to do the science, you really see that.

At the same time, it’s really exciting to see that maybe with these scientific methods we can separate: “Maybe you have this type of depression that will respond to serotonin, or maybe you have this type with will respond to norepinephrine, maybe you have this type in which actually your brain is fine you just need a lot of cognitive behavioral therapy.” Although of course we know that CBT alters the structure of the brain, and it’s fascinating…

But it’s important not to separate the fascinating intellectual journey from the real grounded emotional one.

Something that the event highlighted for me was just how common a lot of these things are. There were so many motifs that recurred throughout multiple stories—and specifically in the context of healthcare and people in academia… Given that sense of how common mental illness is in health sciences generally, do you see any common pitfalls among those in the MSTP community?

I think medical students — and graduate students, to a lesser degree – wear hardship with pride. People sort of on some level want to be in the worst circumstance may be to prove that they can get through it. As soon as I started medical school, people were talking about how they were studying, how little time they had for anything else—but with a certain measure of pride, like I said before. And I think that feeds into this larger attitude in medicine that we give ourselves completely because we are great people, and we are great people because give of ourselves completely. That’s an unsustainable cycle. At some point, you have to take care of yourself or you will become jaded. You’ll stop caring about your patients. You’ll become bitter and angry and resentful.

I think self-care really needs to be a common theme both in graduate school and in medical school. With medical school there’s this generational thing: “I had to go through this so I have to go through this,” and then on our end “Wow, these people went through this. How can I not go through this? Am I weaker?”

And in graduate school, there’s this idea that, “Well, you’re the workhorse. You’re there to spend sleepless nights and get the data out. Once you’re the PI, you can tell everyone else what to do.” (For the record: My PI was not like this!)

That attitude can serve you in the short term, but it will not work in the long term. And if it does “work,” you may be successful, but you’re not going to be happy or content. Maybe there are exceptions, but that’s my point of view on it.

What is self-care? Could you give us a short list of things that either you do for your own self-care or that exemplify self-care more generally?

For myself, I need a creative outlet. If I have to do that same thing day in and day out, I tend to fall into negative cycles of thinking, particularly comparing myself to other people unfavorably and worrying what other people think about me. So what I need to do is to make sure that other sides of myself that I know. I develop other sides of myself like writing plays, creating adventures for Dungeons and Dragons. Even simple things like going to the gym and making my own food that tastes good. Just sort of reminding myself that I am a complete, multidimensional individual who is not just a student.

I also sometimes do mindfulness meditation in the morning. During the wintertime I will have my breakfast, I will take my cup of tea upstairs. I will sit with my bright light and just focus on my breathing for about ten minutes. And then do a short body-scan, where I one by one, check in with how each part of my body is doing. That’s something I learned to do over months of practice because at first it’s really hard to do that.

Thank you, Raja, for your time.