When Ashley turned to therapy and medication for her depression she worried her Puerto Rican mom would feel guilty. And MarySue Heilemann, a nurse and researcher who studies transmedia and the mental well-being of Latinas, busts myths around mental health treatments and offers tips for getting our parents to accept our choices.
Dr. MarySue Heilemann, PhD, RN, FAAN is a professor at the UCLA School of Nursing and an Associate Director of the UCLA National Clinicial Scholars Program. Dr. Heilemann integrates issues of motivation, resilience, intergenerational cultural expectations, social justice, and gender issues in her work. Her area of expertise is three-fold: media-based interventions, methodologically-driven qualitative research, and mental health. Her focus has been on symptom management, motivation to seek help and engage in mental health care, and the enhancement of resilience among Latinas in the U.S. Dr. Heilemann has pioneered the use of transmedia in health interventions related to mental health and was a delegate to speak on the topic to the United Nations-Commission on the Status of Women in 2018. (Transmedia involves the use of storytelling over multiple digital platforms accessible on smart phones, tablets, or computers via the Internet). Her current work involves Hollywood-quality, data-informed, story-based, character-driven transmedia interventions to reduce symptoms and increase help seeking among Latinas struggling with depression and/or anxiety. She has mentored graduate students, post-doctoral scholars, and young faculty in qualitative research at UCLA and internationally and is also devoted to scholarship to improve the accuracy of portrayals of nurses in film and television. Learn more about her work and research on transmedia storytelling and mental health intervention here.
MarySue recommends this cool multilingual resource to help you and loved ones understand mental health.
If you liked this show listen to Telling Mamí She Needs Mental Health and Explaining She's Isolated, Depressed, and Caring for a Newborn.
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Hi, everybody, Ashley is with us today. She grew up in an Ecuadorian and Puerto Rican household. As an adult, she struggled with depression, and even though at first she was hesitant to get help, she eventually found a therapist and went on medication. But opening up to her mom about it made her really nervous, even when Ashley could clearly see the treatment was working. Let's get into it.
Ashley: I'm Ashley Nadine Lopez, I am an actor here in New York City. I am Puerto Rican and Cuban, but I was raised Puerto Rican and Ecuadorian. I am originally from Pennsylvania. I moved to New York City about 10 years ago for school, and then I ended up loving it and stayed here. Growing up, I called my parents, mami, papi. When I was entering college, my parents were going through a divorce. I tried therapy when I was in school and I kind of did it for two months and stopped. But once I graduated, this period of transition of leaving school and then entering adulthood and figuring out what I wanted to do next, I had a brief period of just feeling super depressed and not myself, just very out of it. I decided to look for a therapist again.
Ashley: I kind of kept it to myself. I think I was even grappling with the idea of going to therapy and figuring it out and understanding why I was even going. And I did it for a couple of months, and then I started opening up about it to my mom. And I think it was difficult for my mom to understand why I was going. She often asked me if it had to do with my childhood or if there was something that she did. And I kept trying to just talk to her about how therapy is pretty normal, and that yes, although I was dealing with my specific things around depression, I was also doing it just in general to learn more about myself and understand why I did the things I did or why things affected me the way they did, and process my relationship with my dad, who I now don't speak with anymore.
Ashley: I think there was this idea around like, there must be something wrong in order to go to therapy rather than it can just be about learning about yourself, which I struggled with too. I would go to therapy, and I'm like, "Oh, people have bigger problems than this, than a relationship issue or work issue." I'm like, "There's people that have dealt with serious trauma." And my therapist kept having to be like, "You're just as valid to come here." Eventually, I got on medication for depression, so that was like another conversation. It took me a while to look into it. It was very difficult for me because I was like, "No, I don't need it," not wanting to admit that I needed extra help.
Ashley: I guess it comes from being the oldest in my family. I was really used to being around adults. And so I think there was this sense of feeling like this person that needed to be like a role model to people and strong. And it felt like, "Oh my God! I need to be prescribed something." So I think what made me change my mind about going on antidepressants was time talking in therapy. And then I did my own research, and I was like, "Okay, I want to try it." I didn't speak to my mom beforehand, this was a decision I made on my own. I knew my mom wouldn't judge me because she's never been that way, but for some reason, I still felt nervous. I think because I didn't want her to worry about me.
Ashley: I talked to her about it and I was a little nervous, but she was like, "Oh, okay, do you feel that that's help," and ask me questions. And she was actually really open about it. But I could still sense that there was maybe some guilt on her end of feeling like, oh no, is she okay? It took a while I think for my mom to understand that it wasn't about her. I kept bringing up to her, "It's normal there's so many people doing this or there's so many people in therapy." And little by little, I think she started to realize like, oh, yeah, okay, and she understood that, and just like how I did. I kept telling her, "Hey, I think you should try it." She eventually did. She sought out therapy and she did it kind of on her own. And I was so happy and proud of her when she told me about it. It was really cool, it was kind of awesome to see the transition.
Lantigua: As I listened to Ashley's story, I wanted to cheer for her. Not only did she get her mom to understand her decision to get treatment, she did it in such a way that she allowed her mom to see that maybe she could also benefit from therapy. Yes, Ashley, that's a win. Ashley's story also made me curious about our own hesitation around seeking mental help. How could understanding our doubts as first-gens and especially as Latinas help us better address our parents' concerns? To help us figure out, you can guess what I did. I called in an expert.
My name is MarySue Heilemann, and I'm a professor at the UCLA School of Nursing. And I'm also a researcher, I research mental health. But first and foremost, I am a nurse, and my entire career has really focused on serving Latina women here in the United States. And I went on for a doctorate so that I could do research to find out more and help Latina women with their emotional health and wellbeing.
Lantigua: As you listened to Ashley's story, what did you hear?
Heilemann: Oh, I heard a lot of great stuff. Her story is really emblematic of many of my patients, as well as my participants in my research. In fact, I was so inspired by my own patients and my own participants that I tried out this idea with them about creating a transmedia web app. And so they worked together with me to create this web app, and they said a lot of the similar things that Ashley did, that "she was not feeling herself." And that's one of the most common things that people feel. It's this fuzzy feeling of, wow, I don't feel like me and I feel kind of down, but she did what everybody should do and that is she acted on it. She went ahead and found a therapist, and then she started to open up with her mom about it. And I think Ashley just dealt with that so beautifully.
Lantigua: What makes the way she dealt about it beautiful?
Heilemann: Well, first of all, she gave her mom time, and she also took a lot of risks. And the risks were to just be vulnerable and be herself and say, mom, this is actually pretty normal. Lots of people in the world today talk with a therapist and I'm no different than other people. And then she also taught her mom some things. She helped her mom understand that it wasn't just about dealing with her feelings of sadness and stuff, but it was also a chance for her to learn more about herself as she was growing up. And I think what Ashley did is, she offered her mom an opportunity to relate to her because her mom would know, yeah, there's some things in my past that I did, that I don't understand why I did it. And so Ashley sharing and being transparent with her mom allowed her mom to feel her own feelings and relate even to the point where Ashley was able to encourage her mom, "I think therapy could work for you too."
Lantigua: That is a very atypical story for our show. And I'm wondering if it is atypical for you in your work, or if you see stories about this sort of intergenerational growth among Latinas.
Heilemann: Well, I certainly see intergenerational growth, that's for sure, but it isn't easy. It doesn't always come without bumps in the road. What I'd say the most common thing that Latinas tell me about their decision to get into therapy and their fears is that their parents and their family are going to think they're... And I'm going to put air quotes here, "think they're crazy." And we know from other research that women also become afraid because of stories they were told, that if you go seek help, you're going to get committed to an institution. But that myth takes time to break.
Lantigua: So this transmedia work that you've been doing, I really want to hear about it, and I want to hear what the findings are, particularly about Latinas.
Heilemann: The whole reason I got inspired to create a transmedia storytelling web app was because I learned about the work by first Miguel Sabido and his work in Mexico inserting messages into telenovelas, but then Henry Jenkins and his work on transmedia. And also another theorist, Albert Bandura, who talked about the fact that if someone is watching a media production, whether it's a play or a radio show or a television show or a film, they're going to be more impacted by the media if they could really relate to the main character.
Heilemann: So what I thought would be wise would be to draw on past research that I've done. I do a lot of qualitative research and I've done some intervention studies as well, testing out different ways of doing therapy to see what is most desirable for Latina women. So I pulled on that data and the character we developed was based on the stories of dozens of Latina women. And what happens to her in the story... The events aren't so important, but it's how she experienced them and how she thought about them.
Heilemann: And our intervention is called, Catalina: Confronting My Emotions. And so the women relate to Catalina because as they see and hear and feel her going through her emotions and realizing, you know what? I'm struggling a lot with feeling overwhelmed and sad and worried all at the same time. They're saying, you know what? I feel that way too. And then, in the story, Catalina decides to get help. And she goes to therapy with a nurse therapist who is a Latina woman, and we named her Veronica. And when Catalina goes to this therapist in the videos, she talks about what it was like to be in therapy. The viewer gets to understand from this character's point of view, what it was like. Our research tells us that they're also constantly checking in with their own self about their own life trajectories.
Heilemann: Relatability is really high. And yes, Catalina does express that she's afraid her friends are going to think she's crazy. And she tells her best friend, "Don't tell anybody." And in our production, the nurse therapist, Veronica listens non-judgmentally, and she also conveys how common it is for women to struggle with feelings of sadness at the same time they're feeling worried and anxious because the two go together. When this happens, many women and including Latinas, they don't realize this is something that could actually change. They think, well, that's just the way life is. But what Veronica points out in the bonus video is that it doesn't have to be this way.
Lantigua: This is really fascinating to me because the whole purpose of starting the company initially was to refresh and update the story of Latinos in the United States. And I am fascinated by your findings because they really do parallel sort of the ethos of storytelling that we want to have here with Latina to Latina, with How to Talk to Mami & Papi, and with other things that we do. So it's very affirming.
Heilemann: Oh, wonderful.
Lantigua: So I thank you for that. So Ashley is exemplary basically in how she handled this. And I also commend her tremendously because it takes a lot of self-knowledge and strength and compassion to come at it the way that she did. On the other side, how can parents who might be listening, be more receptive, prepare themselves, just maintain a general openness about the conversation around therapy for their first-generation, second-generation children?
Heilemann: I think the first thing that would be really helpful is if parents remember they instilled in their children, principles and knowledge and skills for taking care of themselves. And when a son or daughter comes to a parent and says, I think I need to talk with a therapist, or I've been talking with a therapist. If their first reaction can be, wait, stop, let me just remember. I spent a lot of years helping my child know how to take care of themselves, and they have determined in this fast-paced, chaotic, exciting, and terrifying world that they could benefit from talking with someone in therapy. Let me just take a breath and trust for a minute that they really know something about themselves that maybe I don't know. And that maybe I can just take a step back and listen to understand.
Heilemann: The other thing would be if parents could do some self-talk, which is like, I may jump to conclusions. We say it's sort of all or nothing thinking or catastrophing, oh no, they're in therapy. It must mean this. It must mean that. It must be... And they're going down that rabbit hole. If they can stop themselves and say, wait, I'm going to just pause here and understand. It's not all or nothing. It's not all bad or all good. It's usually in the gray. And so if a parent can take that into account, I think that would help a great deal.
Lantigua: I want to talk about the medication part of this because I feel like that's a secondary step to overcome in many instances with intergenerational conversations about therapy. So first, there's the mom, I feel like I need to go to therapy, but then there's, hey mom, I'm in therapy, but also I'm about to start on this medication, or I've started on this medication. How can a first-gen prepare to have that conversation with their parents so that their parent doesn't immediately go, oh my God! Something's really, really wrong with my kid.
Heilemann: Sure. Well, first, the most common way Americans get treatment for sadness or depression, or feelings of worry, which we call anxiety, is to go to their primary care doctor, nurse practitioner, physician's assistant, or MD and get a prescription for antidepressants. It is by far the most common way that people in America get treatment, and they don't necessarily go to talk therapy.
Lantigua: Okay. So can we just stop right there? Because that's a major myth that you just busted.
Heilemann: Right. And so what that means is that a lot more people are on antidepressants than any of us realize. It's very, very common, and it's very effective. The difference is that antidepressants don't talk back, right? They don't have a conversation with us.
Lantigua: They don't remember what you said last week and connect the dots.
Heilemann: Exactly. And just like Ashley pointed out, which is what in our research many women have said was the most powerful thing is, "Looking back on my life and realizing why I did some of the things I did." Learning about that takes talking. We all start somewhere, and baby steps are important. So sometimes people start with their hairdresser or their priest or pastor or their neighbor or their best friend, and that's fine. But our participants tell us that it feels really different to talk with a professional than it does to talk with a friend or a mother or a co-worker. And I think it's because it's this one-hour period or this 50-minute period where it's all about you, and it's very focused. You don't have to do small talk and chit-chat, you get right to the issues.
Heilemann: But it is just like you said, Juleyka, well, last week we left off on this place. What have you been thinking about since last week on that topic? And then it's guided by the person in... the person who's getting therapy. So for example, one of the lines in our Catalina Production that Catalina says, because it was so important to the women in our studies was that Catalina says to her best friend, "I thought it was going to be me talking the whole time, but I realized, you know what? It wasn't just me, we both talk. It's more like a conversation." And so going back to your question about what can help people accept other people being in therapy, is realizing that it's a conversation. That's what it is, it's a conversation about you with the purpose of helping you grow and heal. So that was another myth that got busted.
Lantigua: MarySue, what a pleasure to talk to you. Thank you so much.
Heilemann: Oh, well, thank you.
Lantigua: Okay. Here's what we learned from MarySue today.
Get them to relate. When speaking with our parents about seeking treatment, getting vulnerable and opening up about your experience is the best way to get them to relate to you. It also helps them feel compelled to see your point of view.
Bust the myths. Share the knowledge you've gathered about what talk therapy is and what it isn't. Talk frankly about how medication is managed, and provide information that might help dispel the myths around mental health treatments.
And remember, remind them to trust. Reassure your parents that they raised you to take care of yourself and that the values and lessons they instilled are actually helping you make these decisions.
Lantigua: Thank you for listening, as always. How To Talk To [Mamí and Papí] about Anything, is an original production of LWC Studios. Virginia Lora is the show's producer. Kojin Tashiro is our mixer. Manuela Bedoya is our marketing lead. I'm the creator, Juleyka Lantigua. On Twitter and Instagram, we're @talktomamipapi. Bye, everybody. Same place next week.
Lantigua, Juleyka, host. “Convincing Mamí My Depression Is Not About Her.”
How to Talk to [Mamí & Papí] about Anything,
LWC Studios., June 20, 2022. TalkToMamiPapi.com.