DR.SUE VARMA
THE BEAUTIFUL SIDE OF MENTAL HEALTH
PHOTOGRAPHER: EZEQUIEL DE LA ROSA STYLIST: ALEXANDER GARCIA MAKE-UP: FRANCISCO CATEDRAL TALENT: DR. SUE VARMA HAIR : JACQUELINE MORGAN FASHION ASSISTANT: VINCE MELENDEZ GOWN PROVIDED BY: MORPHEW SPECIAL THANKS TO: WATER SIDE FOR THE BEAUTIFUL LOCATION THANK YOU: KEYTT LUNDQVIST DRAMA TO THE PHOTO
2021 will mark twenty years since the September 11 (2001) attacks. As the founding medical director and attending psychiatrist to the World Trade Center mental health program at NYU Langone/Bellevue Hospital, named one of the 3 centers of excellence for treatment after 9/11, what do you foresee will by the lasting legacy of 9/11 in terms of mental health? We will have a profound understanding of the long-term consequences of trauma. There were a lot of losses, for a lot of people. These types of large-scale attacks chip away at the morale of our society- but they also show that communities have the chance to bounce back. We have learned about factors involved in resilience—with altruism and support being key—both of which were palpable after 9/11 here. In my mind, New York and much of the country will be divided into two eras—pre and post 9/11—from everything from the sense of care-free attitude we have lost to all the extra security measures we have in place to protect us as a result of these events. “If you see something, say something”- signs on subways everywhere still 18 years later; there is heightened anxiety, but understandably so. These were things that could only happen in movies, we thought. As a physician, I want to see the people whose health was impacted by 9/11—the cancers, asthma, allergies—I want to see them get the medical treatment and support they deserve. We can’t turn our backs to them. More first responders have died of illness linked to the attack than had perished in it.
For myself, I was living in New York at the time of 9/11, but was in the Netherlands on the day it happened. I moved to the Netherlands the following April, and I don’t think that is entirely coincidental. New York didn’t feel like home anymore. I have the feeling that this sense of disconnection cannot have been something that only I experienced. How did you find that New Yorkers recovered a sense of home after 9/11? A sense of home was lost. New Yorkers are some of the toughest people I’ve ever met; I’m born and raised here. They are also some of the most genuine people you will meet. People don’t necessarily realize that—we have a “rough around the edges” stereotype —but I like the “what you see is what you get” attitude. If they say they will help you they will. There were a lot of incentives for businesses and residential areas to re-invest in the downtown area, and it is thriving. More first responders have died since 9/11 due to health-related complications than in the attacks. This is a tragedy and breaks my heart. We need to support those who saved our lives.
It strikes me that we have become a more fearful society, fearful and distrustful both of our fellow citizens and of foreigners. Why do you think that is, and in the largest sense, what can we do about it? We are still a new nation, and more heterogenous. When you are contrasting the US to European nations—we don’t all speak the same language, even though we are neighbors—our food, religious practices, our street smarts and savvy all vary greatly. I think our beauty is that we are relatively new and fresh, we can invent and adopt what works and discard what doesn’t; we aren’t weighed down by tradition. But I wonder if at the same time we are also not grounded by it the way other countries may be.
Your practice seems to be a quite modern one, balanced between traditional private sessions with patients and public outreach and discussion, via television, radio and the Internet. How effective do you find the public outreach side of your practice? Does the increasing distrust many people have expressed in the media lately affect this? Is there a way to reach across this divide to foster greater public trust in this essential discussion about how to address issues of mental health? Trust is important when it comes to healthcare. We need to also feel that our doctor is invested in getting to know us, is relatable and accessible. Because of constraints and challenges with our healthcare system, financial and time pressures, not being able to practice medicine the way they want, doctors are experiencing burn-out and even higher rates of suicide than ever before. This will impact patient care and as a whole I think there are feelings of disappointment.
Your private practice includes addressing work-life balance issues. What are your three top suggestions for how to achieve work-life balance? On a related note, your practice is based in New York City. I lived myself in New York for eight years, and while I loved it, I felt the demands of living in a big and expensive city could drain me of my energy. What tactics do you recommend to city dwellers for maintaining some reserve of energy in the face of the demands of working, commuting and getting things done in the big city? It’s been ingrained in many of us that US is considered the “land of opportunity” and “if you believe, you can achieve.” So most people “forget” to relax or don’t even take their complete vacations. One study shows that if they are given two weeks, they often leave a week on the table. This is in contrast to some other countries where
the month of August is frequently taken as a holiday. As for my tips, I would offer the following:
1. Make your life outside of work a priority, particularly social life, and schedule dinner w friends.
2. Have a sense of self-worth and mastery that comes from something outside of your work. A class-patients of mine love exercise-spinning, group sports, volunteering and mentoring students, and have other properties and interests from where they draw their self-esteem.
3. Schedule downtime. Cut off from work at a specific time, let people know you aren’t available, wrap up projects, or ask for coverage.
4. Plan vacations in advance.
5. Ask to work from home, have flexible work schedules where as long as work gets done that is what should count.
I wonder what role you might see for philosophy in maintaining mental health? I’m very grateful to you for bringing this up. I’ve been touched by world religions and philosophies; all of the major religions have taught me something and have been a part of my education, either formally or informally. I’ve spent most time growing up with eastern wisdom, and although was born and raised in the US, I lived in India for two years and then visited there in summers thereafter, and worked there while in medical school. Mindfulness-based stress reduction, now very much integrated into western medicine, comes from the east. I also appreciate existential, stoic philosophies, Greek thinkers and their contribution to science, etc. When I have experienced losses, the eastern tradition has been helpful, as it has been in understanding pain, sickness, tragedy, and loss as part of the cycle of life, and embracing non-attachment—seeing happiness and sorrow as the same in their transience—and that we are bigger than either. But having a faith, a philosophy, has been thought to be very protective of mental health.
How important is it to keep believing in legends, in myths, in something bigger than our everyday lives? Which legends or myths are important to your own philosophy or outlook, if any? The people who fought against all odds, in enlightening and creating mass change, and who gave their lives/well-being for it, come to mind, such as Mahatma Gandhi, Martin Luther King, and the Queen of Jhansi (Rajasthan). The Hindu godddess Durga is an amazing female role model, and the Greek gods and characters like Sisyphus never go out of style.
You have talked about the impact of losing a sense of purpose, in particular through losing a job or career, referencing the work of Victor Frankl, the Holocaust survivor, who spoke about the importance of having a sense of purpose to survive and thrive, to connect to something outside and beyond yourself..To what degree is it important to account for what has happened in order to have closure and move on? Acceptance is a necessary part of grieving, which is the hardest part. When experiencing loss, trying to understand it intellectually helps, but also having a philosophy in life is important. I like he serenity prayer, which says there are some things we need to accept and that we need courage, wisdom and serenity, to do what we can always, but let go when we can’t do any more.
In this current political and social climate, many people are looking for reasons to be optimistic. Can you name three? We need to remain optimistic because our mood predicts our success. Studies show that doctors do better when in a good mood, and students perform better when teachers have high expectations of them. They do better; it’s a self-fulfilling prophecy. Optimism is correlated with resilience after trauma. We see this after natural disasters, terrorism attacks. And is the only way to get through ups and downs of life-because there will be many. We are also making advancements in technology that are giving us access to people, conversations, opportunities in a way we haven’t seen before. This is cause for optimism.
I feel that the inclusion of mental health as part of the global dialogue is a cause for optimism. The UK has appointed a loneliness minister and a suicide prevention minister, showing at least acknowledgement of these issues. NY State is making prenatal depression screening mandatory. We still need to make care accessible to all-and we need to start early in the life cycle to prevent. But we are taking positive steps forward.