Accepting the Risk of Being Just as I Am

16 June 2023:

A common fear in the military revolves around the impact seeking medical mental health care could have on a service members career. Unbeknownst to me, I recently was in a position where I got to test this theory, along with several others. Here's the story:

At the end of my Intensive Outpatient Therapy (IOP) last September I was TERRIFIED to return to work. I was pretty convinced that the Air Force as an institution was a large source of my depression, negligence to my self-care, and the toxic environment created from distrust among fellow Airmen, competition, performance pressure, gaps in mentorship, among other things was beyond repair. All of this made me distrust the entire organization but most of all, I distrusted myself in being able to stand firm in who I am without shrinking within it. As an officer, Black person, and woman I felt TREMENDOUS pressure to be a high performer. I was chained by perfectionism and I was immobile without considering every possible perception others could make of me and the implication of an action I rendered. My way of thinking and operating in the Air Force led me to a promotion to Major in 8.5 years (which is uncommonly fast) and to develop a reputation in my careerfield as a "High Performing Officer." While desiring to give my best is a feature of my character and personality, living with this pressure and the reality that I am a human who is not perfect, makes mistakes daily, and carrying the shame and fear of this; was killing me. By early October 2022 as I looked in the mirror petrified to return to work and trying to think of what I could do instead of continuing my military career, it dawned on me: what if I just showed up to work just as I am? The true me. The me that is imperfect, very wounded, has weekly medical therapy appointments to heal those wounds, is unsure of herself and the organization she serves in, but has a newfound desire to live and get better. This is the me without a mask. This is the me who refuses to "fake it." This is the me who will do her job as it is defined, but enforce personal and professional boundaries in order to preserve self-care. Could this me be accepted? I decided to take the risk to find out. In my mind, I had proven enough of my value and worth to the Air Force to try to 'earn' their acceptance of me. It was time for the Air Force to prove to me if they were worth my acceptance of it.

As I returned to work I had the mentality that I was getting out. I told my Commander (CC) and my new civilian leadership of the new team that I was on that my service committment is up in 2024 so I'll just do what I need to do until then. My new CC relocated me to a new job at a new base, with a totally different team in order to have as close to a fresh start as possible. I quickly learned that after experiencing something traumatic, returning to the environment that hurt you, will not help you heal. So I was thankful for this move.

As each day passed, I confronted a new layer of hurt, distrust, caution and old scars. But with pacing myself in my work and not putting the pressure on myself to be this hard charging officer who takes on alot, I felt a little more safe in my job each day. When I first arrived to the new position, one thing that helped with the initial feeling of safety was the diversity of my team and their willingness to be vulnerable. One LTC was Puerto Rican and diabetic, one of the senior ranking civilians was Black and operating as a single parent due to his wife's job keeping her stateside, the Senior Enlisted Leader was a woman Master Chief in the Navy and our supervisor was a retired AF veteran, White man from the midwest. Each of them was mature and not afraid to talk about diversity or other topics that could be viewed as uncomfortable conversations. My supervisor was also very clear in communicating the expectations for my job and gave me a lot autonomy to perform in it. He put a significant emphasis on self-care saying, "you take care of yourself" when it came to me having to be out of the office two to three hours each week for my weekly medical appointments. The job could be as demanding as I wanted it to be, and my team members made it very clear that they were supportive of me and my work.

As the weeks turned into months, I received thoughtful feedback from my team on things I did well and things I could improve upon. I also was given TDY opportunities to go back stateside and to Hawaii; these were opportunities I had never been given before and were amazing. I confided to my friend how all I was doing was just my job, nothing extra but my team and leadership seemed to be really happy with that. I was confused. My friend, who also is a black female USAF officer in a different careerfield, then said to me, "Imagine if we JUST did our jobs..... we are so used to killing it by doing so much more, that just doing our jobs feels like something is wrong." She was right. I was so used to operating in the mindset that I had "something to prove" to justify my presence in the spaces I was in or to try to "catch up" in what I didn't know, that this new mentality of acceptance with myself in the state I am in now, and harmony with both work and my personal life was new to me. Could it be possible that I am already enough, just as I am?

In October of last year, I was confronted with making a decision on my next assignment. As a Major, I am eligible for leadership jobs that are considered key milestones in one's career. Completing these milestones are favorable for a track for Command, which as an officer, is what many of us are taught to desire and train for. We are Commaders-in-training and will one day be leaders of the force. My experience and skills that I've developed over the span of my career, make me a very attractive candidate for these milestone jobs. But the truth was, I wanted a job that allowed me to walk in allignment with MY values and not the values of someone else. My values in this moment are trust, connection, self-care, authenticity, and freedom. I spent my entire USAF career taking care of others and while I've loved it and am proud of what I was able to do for others, I have neglected my own needs and silenced my own desires in this process. I've been working at least one job since I was 13 years old and doing everything I could to catch up accademically, culturally, as well as prepare for my future by checking the skill and education boxes the USAF values. My fears of "not being enough" because to someone, I am not enough, have kept me trapped. The truth is, while I have manifested so many of the good things in my life, I have experienced a lot of hurt along the way, and I want more time to heal myself. I want to learn who I am. I want to learn what I like and desire for my life and not give power to other peoples opinions of me. I want to strengthen my marriage, and be present in new experiences with my husband; a husband I've prayed for since I was 12 years old. The fatigue I feel from serving others is largely due to the years of not allowing myself to accept rest without guilt; believing that I was unworthy of rest unless I earned it; or take pleasure in doing things that are just for me while I know others on my team are struggling. I want to learn how to do this while balancing work and other life responsibilities at the same time.

When the Vulnerable Mover List (VML) came out, I found and was later hired for, a job in the top location I desired to go to. Unfortunately, because it was another overseas assignment, I would have to get an approved medical waiver in order to go. My Psychiatrist shared with me how because I was hospitalized for a suicidal event within a two year period of when I would need to report to the new duty station, the chances of my waiver getting approved were very low (30%). But my Psychiatrist developed a game plan. With an endorsement from himself, my current Commander and future Commander at the new assignment, he believed that this could increase the odds to a 90% chance of my waiver getting approved. We had this conversation in February 2023 and by the end of May 2023 we got the results.

My waiver was approved. I was cleared to go to my next overseas assignment. My top choice, as supported by the medical team.

I was relieved, shocked, excited all at the same time. When Michael and I received the news we just hugged each other. "This is really happening," I thought. Everything we went through these past two years has led us here.

The week after I received the results I met with the Psychiatrist. He showed me the medical waiver and explained the process to me. There were a list of 14 mental health issues that could lead a service member needing a medical waiver for an assignment and the items in bold could be disqualifying conditions for some Combatant Commands. Two of the boxes were checked for me, along with two disqualifying conditions:

"Suicidal Ideation, Suicide Attempt, or self-mutilation within the past 24 months."

The second condition I had was box 3:

"Behavioral health-related hospitalization within the past 24 months."

I then looked further at the comments in the narrative and recommendation section. I saw that my current CC described me as a "legitimately phenomal worker" and "outstanding officer." My gaining CC (a man I had never met) said, "he is willing to accept the risk and recommends approval to the waiver." As I read this in the Psychiatrist's office, a feeling of warmth traveled through my entire body from my head, into my hands and all the way down to my feet. I thought to myself, "They accepted me just as I am. Baggage and all. How is that possible?"

I met with my current CC that same week and showed her the waiver. I then reflected on the presentation I gave to the Squadron back in February, on my journey and asked her how was she able to trust me to speak to all 240 of the Airmen about the causes of my stressors and mental health issues. I asked her, "Why didn't you screen my presentation to see what I was going to talk about? How were you able to trust me?" She told me that she trusted me because I came to her and offered to share my story, that it wasn't prompted by anyone else. And that I chose to get help for myself rather than wait for help to be directed to me. She then explained how she doesn't screen a lot of things but she knew that she didn't want to provide input on my message because it would change it. It would have become more of her message rather than my own.

I told her that during that time, I saw myself as a sick person. "The things I was saying...what I was doing to myself.... I know I had to have not looked credible... I felt crazy and saw myself as a sick person," I said to her. I shared how I didn't understand the trust she had for me. But her trust in me helped me be open to trusting again. To someday trust others and learn to trust myself hopefully without second guessing myself. She then said to me, "I never saw you as a sick person. I just saw you as a person who was going through a really difficult time."

During my final meeting with the Psychiatrist I asked him about my diagnosis. I hadn't had a suicidal ideation in nine months, had been off antidepressants since the end of January, and was no longer in therapy. "I've been diagnosed with Major Depressive Disorder. Will I have this my entire life?" "No." He said. He then said that it will remain in my medical record for the rest of my career so I can claim it to the VA when it comes time to retire or seperate from the military (which will be to my benefit), it will only be visible for assignment purposes for two years and after that it will not be visible to anyone in my career unless I choose to share it. He then explained how depression is a part of the human experience. 99% of humans experience a depressive episode at least once in their lifetime. Medication can be an option to help stabilize the mood, while therapy can help a person reframe their mind in order to build new strategies to cope with the stressors they experience in life. He then went on to explain how different doctors have different outlooks on medication. Some would rather keep a patient on antidepressants their entire life just to be safe. Others (like himself) follow statistics and prefer to keep the depressed patient on the medication for 6 months then begin a discontinuation process. "You are no longer depressed," he told me.

When I walked out of that office I felt a steady surge of freedom. All of the things I had been carrying; my hurts, my fears, my uncertainty and insecurities, suppression of my desires and feelings, I layed it all out, outside of myself and the unimaginable happened. I was set free. While it took longer than desired, I got the level of care that I really needed just by telling the truth of what was happening in my mind. I began to reconnect with myself and other people. I learned that I CAN be accepted, be wanted and be chosen JUST.AS.I.AM. No faking. All me. I can take a knee and the world will keep spinning. I can help myself and opportunities, community, good things will still find me. And while this external acceptance is comforting, true liberation is accepting myself. JUST.AS.I.AM.

The best thing about these discoveries is that I am not "special" or "unique." What I've experienced does not have to be exclusive to just me, others can get help and be free too.

Years a go in undergrad I took a social work class on veterans and mental health. During the course we read a book called, "The Cost of Courage: Combat Stress, Warriors, and Family Survival," by Josephine Pryce, Colonel (Ret.) David Pryce, and Kimberly Shackelford. I recently revisited the book and while it was published in 2012, I would argue that many of the findings are still true today. J. Pryce, D. Pryce and Shackelford reference the work of suicide theorist, E.S. Schneidman who described how suicide comes from psychological and emotional pain called "psychache" that follows an individuals psychological needs being distorted or denied (2012). The pain becomes so overwhelming that the person with psychache learns to not fear lethal self harm as it becomes what they believe is, "the only solution to their psychache". Schneidman argues that to prevent suicide "We have to reduce psychache." (2012)

Reading this was eerily relatable. As I reflected on trying to take my life, I remember thinking that people who care for me may feel sad or blame themself even though none of them were to blame. In the next thought it was very clear to me that this was my only solution because I could no longer deal with this pain. Nothing I did was making it better and the world around me that was hurting me was beyond my ability to change. I felt doomed. "I don't belong here... I am unlovable... I am a slave... I am the problem. Die. DIE NOW!" My mind kept telling me. I also felt like my mind was not my own anymore. Like the pain or psychache had taken over and it was done with seeking alternative methods to release itself and suicide was the only option. In a subtle, whisper of a thought, I remember thinking that my loved ones may blame themselves for my choice. And while I knew it was not their fault for me dying and not fair but deeply hurtful to them, I could not conceptualize or convert the idea of their pain into motivation for me to continue living, and persevere through my own pain. In my mind, I just had to stop this pain.

As I read further I came across a section that described some of the stigma and barriers to seeking help. Beliefs that military members had regarding seeking medical help for mental health made them "weak", fear of being treated differently by their leadership, difficulty getting time off work to go, too embarrassed, among other reasons. But a leading barrier to getting help was the fear that it would negatively impact or cause them to lose their career.

All of the reasons for stigma were extremely relatable. At the initial onset of my depression, I feared what would happen to my career if I saught help or how others would view me, so I often prioritized the job above taking time away from work. But I got to such a state of despair that my psychache seemed to disconnect me from every part of my life that I ultimately decided to just confront the stigma, go and be fully transparent about what I was experiencing. The disappointing thing is, that seeking help (at least at the remote base that I'm at) didn't immediately equate to receiving it. At my location, the mental health office is at 200% capacity meaning that they are only able to service active duty members and unless you are in a state where you are trying to kill yourself (the technicians will ask when screening to schedule you for an appointment), the earliest appointment you will get is likely two to three weeks out. There is much encouragement to use other resources like the Chaplain, Marriage and Family Life Counselors (MFLC), military onesource, resilience trainers, and while these resources are more accessible and can provide valuable support, when you get to a state of repeated suicidal ideation and self-mutilation like I was in, medical mental health care is needed.

There also was inconsistency in the quality of care a member receives from a given provider. Some of the feedback I shared with the Psychiatrist was how I felt a lot of pressure from two of the Psychologists I saught treatment from to medically retire and get out of the Air Force. I shared how the mental state I was in, I didn't know what I needed to do to help myself and the pressure to get out of the Air Force left me feeling like my emotions to the various stressors I was having was unhealable while serving in the military and the only solution was to get out. I shared how one of my fellow patient friends experienced the same pressure and after experiencing no reprieve from a low dosage of ProZac and no other care outside of a monthly check-in and 1-hr a week stress management class, he ultimately decided to seperate. "I didn't like how the Air Force did that." He shared with me after I caught up with him months later. "It's like, once there's any kind of problem with you they just push you out without trying to meaningfully help you get better." I shared this with the Psychiatrist and he told me that was foul. That the mental health provider is supposed to do everything they can to help you get better and return to the fight. He then explained how an issue with mental health care is that the quality of care is so dependent on the provider. The provider brings their own experience to the level of care they provide and if they are jaded (which appeared to be the case of some of my providers) that will impact the quality of therapy they provide. Patient to provider match is also critical as without trust and rapport, care will also be stunted. He shared how the hospital is rolling out a new program called "Brave" that will allow patients to meet in the hospital to meet with a provider who is stateside in order to provide care virtually. He had concerns as the person-to-person contact is the preference for quality care but is hopeful that this help give patients more options and quicker access to licensed providers.

Seeking Mental health care was scary because there were so many unknowns. I spent a total of two months away from work getting treatment followed by an additional month of leave which is something I had never done before. I had a restriction code on my SURF (a document that is a summary of ones career), that was visible to hiring authorities and while they may not have known the details of what it pertained to, it was there. Yet in spite of all of my fears and uncertainties, this experience has revealed to me that it truly is okay to NOT be okay. And when you're not okay, you can be completely honest about it and get the help that you need to get better. I held nothing back to my medical providers in what I was thinking and doing to myself. Being fully transparent ultimately helped me get the level of care that I needed. J. Pryce, D. Pryce, and K. Shackelford emphasized that "in order to reduce the stigma with seeking mental health care, it needs to be made clear to all military personnel that, just as physical injuries are expected in combat, so are mental health issues and PTSD." (2012)

Out of the 11 jobs I applied to, five of them placed bids to hire me and I was hired for my top choice; even with all of my issues. Then, when a medical waiver was needed for me to be cleared to go to my next assignment, my current leadership, medical team, and future leadership advocated for me. I chose to take the risk in being honest about who I really am and where I was at, even though the reality of this terrified me because it was so low, but living in this truth ultimately allowed me to get the help that I needed. And to my surprise, the world around me shifted to accept me, just as I am. No faking, no hiding. Just me.

I took the risk of being just as I am, and discovered that everything I've been seeking: trust, connection, care, authenticity, and freedom, was always within me. I hold the power to make the changes I wish to see in the world, and so do you.