dead leaves on a lace placemat

Note: After the results of the CT scans came back, it has come to my attention that I do not have cancer. Thank you so much, from the pit of my pulpy heart, for your well-wishes & prayers. 

Listen to me read this piece here:

Dear Esmé,

I recently worked in a very high-stress field site on the Omani-Yemeni border alone. I didn’t tell any of my coworkers about my history with mental illness. Luckily, I didn’t experience anything out of the ordinary, but if something did, I often wonder what would happen. Would I risk being fired? How would I be judged by future employers and denied to work in this field? The stresses of isolation, demanding work load without 24/7 Western amenities, [and] absence of professional mental health care from my home culture in the region, and working with people who flat out oppose your presence is enough to make anyone snap. I’m very young in my career, but it’s shocking to me that even basic mental health care is not available within a well-known government agency. No wonder so few people even build a career in international development even within their home cultures and working directly with issues that impact them, whether it’s mental illness or gender rights.

How have you discussed your challenges and accomplishments with mental illness to graduate school, jobs, or fellowships like the one you were awarded? This has been especially important, as I have two medical leaves from college. Also, have you discussed points in your life in your professional career when you took time off? Do you know any women who have worked in high-stake environments with mental illnesses or intense challenges? When I worked in Oman, I was the first woman to manage a U.S. government program on the Yemeni border region. I worked entirely alone 1,000 km from the nearest Westerner, better yet work office. I did very well and loved my job, but often felt isolated. I didn’t feel comfortable telling my all male coworkers in fear that I wouldn’t be taken seriously professionally. I’m especially interested to hear about different ways women work in challenging environments, make room to take care of themselves in tough circumstances, and ask for help.



Dear H,

Before I say anything else, I must say this: you’ve been doing — and will continue to do — tremendously important work. Whether or not you live with mental illness can’t take that away from you. If I could sit myself down — the myself from the last few months — I would have said the same thing.

I would have said to her, You’re growing thinner, but you’re not disappearing.

I would have wrapped my arms around her and said, The story isn’t over yet, chickadee.

But most of all, I would have said, You do good work in the world. This is your legacy. Even if you do undergo electroconvulsive therapy — even if the other problems turn out to be cancer — even if you never write another word again, love, you will be a writer. And you will be someone who helps people.

I don’t know why basic mental health care isn’t available within well-known government agencies. It’s one injustice among many in the field of mental health advocacy. In the last year, I’ve bumped up against so many that I’m often overwhelmed by the thicket, and need to take a breath.

Remember to breathe. To really breathe. I often find myself holding my breath; it’s no wonder that I’ve been fainting.


I can’t find it now, but the letter that I wrote to Yale — the letter that they requested I write, for re-entry after my initial medical leave — wasn’t the one I’d write now. The trouble is that I didn’t really know certain things until now, in my thirties, when they were asking me to explain myself at nineteen. The letter I wrote, instead of being contrite — instead of apologizing for the inconvenience of my illness — was still angry at having been told to leave in the first place. It blamed the Mental Hygiene department at the university for mishandling my care.

When I watch dramas about prisoners advocating for release, that letter is what I think of.

You must say things like the following:

I won’t do it again.

I’ll be good.

I’m sorry for what I’ve done.

I understand that I was wrong.

I’m a different person now.

All of the right things to say.

The trouble with writing applications, H, and dealing with bureaucracy, is that we don’t know who’s on the other side.

I wish that I could say, Be honest. Be true. To be honest and true is how we’ll make it out alive. And I wish that I would say, They’ll respect your honesty.

They might not respect your honesty.

They may be afraid.

They may believe that you’re unfit for a high-stakes position because you’ve got brambles in the head. Discrimination exists; I’ve been on the receiving end of it. I know that you know this, or you wouldn’t have written to me. You wouldn’t have stayed quiet with your male coworkers if you didn’t live with that anxiety lurking.

I actually have to fill out an application of sorts right now. It’s sitting on the bed behind me, but I’ve held off on answering its questions. As I write this to you, I’m preparing myself to formulate my own replies with regard to the status of my health. (Sample question: What is your general state of health?)

Dearest H, I have learned in these situations that you are your own primary interest. Which means that you will need to tell them whatever information they need in order for you to be safe in any circumstance. And you will need to be honest with yourself in choosing what to disclose.

For example, you may need to be able to contact a capable psychiatrist wherever you go. You may need to have access to a pharmacy in medical emergencies.

Outside of that? Your intuition will have to be your guide. At times, intuition can be muffled. It can be hard to hear. But in silence, it can often give gentle nudges toward yes or no. Yes, mention mental health challenges, especially when framed in the recovery model, and when addressed as a catalyst for wishing to change policies that affect those with psychiatric illness. Or perhaps not. Perhaps mental health challenges are best framed as “health challenges,” or “medical issues.”

I say this realizing that I believe in radical sincerity; but part of radical sincerity is also assessing how to protect oneself. And how to make one’s way in the world when situations are vulnerable — when you, yourself, are vulnerable, both from your illness and from the stigma of others.


There was another question, I know, that had to do with how to be a woman living with mental illness in a high-stakes job. I can’t answer that from experience, but I know it’s possible. Elyn Saks, who wrote brilliantly about living with schizophrenia, and is a law professor and think-tank leader, is one; this article in The New York Times is another one that I turn to when I need to feel less alone. I left my full-time job because the freedom of entrepreneurship, which could accommodate for my medical conditions and rhythms, was more right for me than the imposed pressures of cubicle life.

As I imagine your life, I see you navigating through a breathtaking, albeit potentially frightening, wood.

There is no map. And the destination is unknown.

But know this: you are brave. You are strong. You will get where you are going, and you are changing the world. Of this, I am certain.

I’m so proud of you.


With love,