Surfacing

Surfacing

PEOPLE COPING WITH DEPRESSION AND MENTAL ILLNESS

Marion Scher

4

SINDI VAN ZYL

Depression

Sindi van Zyl had everything she’d ever wanted: her dream job as a medical doctor, an adoring husband and two beautiful children. But beneath the veneer of success was a woman battling daily with her mental health, afraid to let anyone see her pain. Surprising, you would think, given that she’s a medical doctor; it shows how powerful the stigma of mental illness really is.

I first met Sindi when she was a guest speaker at one of our Responsible Reporting on Mental Health workshops for journalists in 2019. I was impressed by how open she was about her journey with mental health, particularly as a practising doctor. Being an extremely warm, outgoing person, she didn’t surprise me when she agreed to be part of this book, using her story to reach people to break the stigma – particularly as a black woman.

We meet in a leafy courtyard of a Stanley Avenue restaurant in Johannesburg and she greets me as though we’re old friends.

Instead of weighing right in about her illness, I ask her for some background about her life. Born in Harare, Zimbabwe, in 1976, she grew up as a cherished only child in what was initially a single-parent home. Her mom, originally from KwaZulu-Natal, had moved to Zimbabwe in 1974. A few years later, when her granny, aunt and cousins moved in overnight, the house, explains Sindi, ‘became full’.

‘One day I suddenly woke up and wasn’t an only child any more. This was a good thing as I’d probably have been a spoiled brat,’ she laughs. ‘I saw how my mom took on the role of nurturer for everyone, which rubbed off on me. I’m also very nurturing and caring, going beyond for people, which has proven to be at my expense.

‘Although we weren’t rich, my parents, even though divorced, made sure I went to a good private girls’ school. My mom had done a lot of work for both the ANC and PAC over the years, so when they asked how they could repay her she immediately had the answer – help towards my daughter’s education, which they did, together with my dad. I did well at school and whenever I could I always found myself helping people.

‘My first real heartache in life was the usual story. Girl meets boy. Boy breaks girl’s heart. I was only 16 and had been thrilled when he agreed to come to our school dance with me. This was it – I thought I was head over heels in love with him. Then suddenly it was over and I was left totally confused and – for the first time, now looking back on it – depressed. He’d dumped me over a school holiday and when I returned to school my best friend couldn’t wait to show me the teddy bears and flowers her new boyfriend was sending her. Of course her new boyfriend was my ex-boyfriend. She’d met up with him at a party I didn’t go to. I’d actually encouraged them to go together without ever thinking this would happen.’ She smiles now as she tells the story but you can tell there was deep hurt at the time. Most parents would put this down as a normal part of growing up – the first heartbreak. Mostly they’d be right, and their child would get over it. But sometimes it grows into a bigger wound.

‘It was three weeks into the new school term before I found out who my friend’s new boyfriend was and when I did my marks plummeted. The weird thing was none of my teachers even questioned why suddenly this really good student was getting 20 per cent for maths and science. Naturally I failed my A Levels, which just added to my growing depression at the time, especially as I’d had my heart set on studying medicine.’

Her parents were surprised and disappointed by her results and her dad said she’d just have to redo the year, which was something she couldn’t even contemplate. ‘Can you imagine – at 18 years old seeing all my friends go off to university, leaving me behind to go back to school. I said to him that as a lawyer with lots of connections, including the registrar of the University of Zimbabwe, couldn’t he still get me in? He refused point blank and so my mom pointed out to him that the only reason she was still in Zimbabwe was for me and that if this was the case she was moving back to South Africa, which she did.’

This was just the first blow that would see Sindi spiral even further downwards. She found herself having to study again for her A Levels – at night, this time, as the lecturer worked in the day. ‘This wasn’t the best scenario for me as, apart from a typing course, which ultimately really helped me, I had too much free time on my hands, so found myself drinking, smoking and doing everything I shouldn’t have been doing and then going to lectures at night. Everyone in my crowd knew I’d flunked out which made things even worse. Added to which my girlfriend and ex were still dating which was really tough for me. This was my first deep heartbreak and shaped a lot of the bad decisions I’d take going forward. My behaviour was really about numbing the pain I was feeling but I knew it was building up to be an epic disaster, making things worse.’ And still those around her didn’t see the red flags.

What’s becoming more apparent today is the amount of stress matric learners – and, in Sindi’s case, A Level students – are under to get the grades they need to get into university. This is an area that both schools and parents need to pay attention to. At that age, kids seem self-assured, but often they’re far from it.

Fortunately, a fresh start was on Sindi’s horizon. ‘Once I’d redone my A Levels – which I managed to pass, although not with the results I’d wanted – I joined my mother in South Africa. My mom was living in Pretoria at the time, in a little apartment in Schoeman Street, downtown Pretoria. I’d applied to the University of Cape Town, which had accepted me for medicine but sadly we couldn’t afford it, so there I was sitting at home, listening to the radio and thinking about my life. One day, looking out the window of the flat I saw these young people selling university rag magazines. I wasn’t sure what this was as we didn’t have rag week in Zimbabwe and I had no idea there was a university on my doorstep. It wasn’t until the beginning of March that our landlord Charl told my mom about “the varsity up the road”, suggesting we should go there to try and get me in.

‘We literally walked up the road and there was the University of Pretoria. We went to the main building and asked where we could apply for me to do medicine. They said I was too late for that but maybe to apply for the BSc at another UP campus down the road. When we got there the dean’s secretary said, barely looking up, that applications were closed. She didn’t reckon on dealing with my mom, who told her we weren’t going to leave until we saw the dean. So we sat and sat and sat, until eventually two hours later she said he’d see us. Unfortunately he had no idea about O Levels or A Level exams, so he gave us the standard “we’re full” answer. My mom then turned to me and said in Zulu, “Sindi – I’m not the one who wants to become a medical doctor, you are. I’ve done my bit. I got you here, now talk to this man and tell him.”’

When Sindi tells this story you can hear her mother’s voice coming through and I begin to realise where a lot of Sindi’s strength and personality come from. She explained to the dean that A Levels were equivalent to first-year university in South Africa and assured him that if he let her in she’d catch up. Her argument was persuasive and he agreed.

‘The following week, now 20 years old, I waltzed into this class, where no one had ever seen me before, and I even got a room in the famous Huis Erika residence. I’d told them I wanted to become a doctor and they suggested I apply to every intake for medicine and not give up. They also suggested I change my subjects to BSc physiology and psychology in case I don’t become a doctor, which I did in my second year.

‘A slight hindrance was my complete lack of Afrikaans but luckily the head of physiology, Professor Viljoen, was our lecturer and she was fascinated by this black Zimbabwean girl, so each day when I got to class she’d say, “Goeie môre,” and give me an Afrikaans lesson. This was how I learnt Afrikaans, and as my main subject was in this language, this was essential. At first I paid people to translate my text books, then after a while I got an Afrikaans/English dictionary which really helped.’ Given Sindi’s determination to succeed, it’s not surprising that she’d add learning a language to her already-full academic schedule.

‘One day I saw a notice about auditioning for Radio Tuks, the university’s radio station, so I went along and applied to be a newsreader. I went back the following day and looked at the list pinned to the noticeboard with the names of the successful applicants. I was devastated when I didn’t see my name there, until someone said, “Your name is on the DJ list,” and suddenly there I was – DJ Sindz, the first black female radio disc jockey in the university’s history. I did this for the next five years and loved it,’ she says, laughing and giving me an arm-wave demonstration of her DJ look.

Each year she’d apply for medicine, but it was only in her fourth and final year of her BSc that she got accepted. ‘I did this without getting any credits for my BSc, meaning I had to start from scratch, but I thought, My dream has to come true. The only downside was once again I found myself coming out of a very messy relationship just as I was going into medical studies which didn’t help ease me into my first year. Once again my bad behaviour, drinking, smoking and too much partying that goes with hard student life, came into play. It was my way of dealing, once again, with my depression. When you’re depressed you find things to fill that hole. And of course I wasn’t acknowledging this as depression.’

This is common behaviour, particularly for someone like Sindi who would be classed as high-functioning. She wants to be open as she can about it, despite her high profile in her field, sparing nothing in her quest to help others.

‘Luckily in my second year of medicine I joined a church, was born again and found Jesus, which literally saved me. The news spread like wildfire – “You know Sindi, the wild one, she’s now born again” – everyone was shocked. It was a complete transformation. The other good thing that happened that year was meeting my wonderful husband Marinus van Zyl, who volunteered to transport people to and from the church I attended. 2001 – what a year; I went from a wild child to a born-again Christian, and met my white Afrikaans husband,’ she laughs.

‘I was very happy and there was also a lot of forgiveness in my life and repairing of relationships. Three years later Marinus and I got married and when I graduated the following year I decided I wanted to do my internship in Soweto and give my heart and passion to working with black people. So I applied to Baragwanath Hospital [now the Chris Hani Baragwanath Hospital]. I speak Zulu and Shona, as well as Tswana, which I learnt while living in Pretoria. Not many interns volunteered to go to Bara so I was pleased to get in but had no idea what I was in for. There was nothing on earth that could possibly have prepared me for the death and despair that HIV was causing then, in 2005.’

Hospitals were neither prepared for nor trained to deal with the number of HIV/Aids cases and the deaths this virus brought with it. For Sindi and many other young doctors at the time, this was particularly challenging – and beyond stressful, the reality of HIV pushing her further down into the depths of depression.

‘When today you see graphs showing the peak of the deaths caused by HIV, it was around 2006/7 – while I was at Bara. When I first arrived I started off in paediatrics. Babies were dying like flies and I wasn’t coping. My second rotation was internal medicine and as it was winter we knew that for people with HIV and weak chests this would be particularly hard. When I try to explain to people this situation words are never enough. I soon started smoking again, in a constant state of worry about my patients. I was so determined to save lives. I was one of those doctors who, when I arrived at work to find a patient had died, I’d start sobbing. I’d go to bed at night thinking when I get there tomorrow we’ll do bloods but when I arrived and asked where that patient was, the nurses would flippantly say, “Oh, she’s gone.” It broke my heart.’ She still chokes up at the memory.

‘There would be five of us on call, four on the ward admitting patients and one who was on ward call. This is the person who gets called when a patient, for instance, is having a fit or if a patient passes away. So on any given night during ward call I was certifying about 25 bodies a night. We would take turns doing the different duties between casualty admitting and being on call in the ward. When a patient died the nurses would wrap the body and get a death certificate ready, put it in a file which they’d put to one side. They’d call me whatever time of night it was to certify the deaths before calling the mortuary to fetch all the bodies.

‘Sometimes I’d arrive on the ward to find they’d wrapped ten bodies before I’d had a chance to even certify them as dead. I’d make the nurses unwrap each body to confirm they were dead which the nurses hated me for. They’d say, “Oh, it’s Van Zyl and you know what she’ll make us do.” I’d only sign the death certificate when I’d confirmed the death. I understood they were overwhelmed but somehow they became callous with it. I felt you can’t let your integrity and your standards drop. Maybe I did also in some areas of my life but not when it came to my patients and people’s lives. You can falter in your own life but not when it comes to other people.

‘I seemed to be constantly in tears. I was putting my all into my work which is where my later passion for working with HIV cases came from. It wasn’t a conscious decision at the time. I just think seeing all those babies dying in paediatrics and the adults in medicine broke me. But the worst was still to come.’

The waiter arrives with our breakfast. His timing is perfect; it gives Sindi a moment to take a breath before carrying on with the story.

‘Next I moved to surgery and here I worked with a doctor from Eastern Europe. He’d been at Bara for a long time but had kept failing his exams. He had a principle that he wouldn’t operate on a patient until he had their HIV test results, which back then took five hours. I was totally against this practice but I was just an intern and had no say. One day, a lady in her 50s came in with an acute abdomen problem so we rushed her to theatre. But this doctor said no, he wouldn’t touch her until he had her HIV test results. I went home and the next morning on ward rounds when we reached her bed I asked where she was. This was in front of professors, senior registrars, everyone. The nurse calmly replied, “She died.” Right there and then I lost it – in front of everyone. I told the doctor he had killed that patient with his HIV test rules, and then, crying, I fled the ward.

‘My experiences at Bara formed me. Something happened there that shifted the core of who I was and would become. Although my husband has always been a good listener, it was easier to come home and drink than talk, so I was always drinking. I felt that everyone’s going through this – I’m not special, so I don’t need to see a therapist. Bara is tough but I must get through it. Obviously, looking back, I should have gone to see someone. Even today the hospitals need to change the way they work, particularly with interns. It’s not okay to work 36 hours straight.’

A massive problem for many young doctors is the long hours and pressures of working in underfunded, poorly resourced hospitals. For Sindi, with her undiagnosed and untreated depression, and as in many similar cases, alcohol was the easy answer.

‘When I got home I’d go straight for my coping mechanism – a few bottles of Hunter’s Dry. I still managed to go to church – my love of God didn’t change and I tried, given the circumstances, my best to be a good wife. We were also trying to have a baby but I don’t think the drinking helped.’

Today, doctors and nurses are still crying out to be heard, particularly student doctors. What is noticeable, though, is the increase in the number of suicides in this particular group. Something desperately needs to change. Sindi is insistent about one thing: these young doctors mustn’t be afraid to get help. They are not expected to be perfect.

After her internship, Sindi went to Coronation Hospital, part of the Helen Joseph complex, which she found less frantic and better than Bara. Once again she found herself in the paediatric ward, as well as in orthopaedics.

‘I also worked at community clinics, which is where I fell back in love with medicine. By the end of 2007 I decided to work at Meadowlands Clinic in Soweto where I stayed for a year, doing my overtime at Lilian Ngoyi Community Clinic and in Lenasia South. My work was now so much more satisfying.

‘In February 2008 I finally fell pregnant and my daughter Nandi was born in October.’ We pause the interview while the proud mom shows me some photos of her children.

‘I stayed home on maternity leave for a while and then returned to Meadowlands. At the same time an NGO based in Soweto working in the HIV/Aids field heard about me and my work ethic, and offered me a job, which I took. This was very fulfilling as I finally felt I was really doing something towards making sure no one would die the way they had in 2006. By then medication was more readily available but the issue now was coping with the growing waiting lists.’

Sindi’s new job was an exercise in changing hearts and minds. ‘Our job was to train nurses in dealing with HIV/Aids and patient care. They were scared, with some not even wanting to do it. Our job was to explain HIV in simple terms to get the nurses to understand and be able to give the treatment, especially for pregnant women. This was extremely important as there were still a lot of babies being born with HIV, which we desperately wanted to change. The prevention of mother-to-baby transmission was our priority. I used to say to the nurses: “The adults can take care of themselves but an HIV baby is fully reliant on another adult to make sure their medication is taken – they can’t take it themselves. They must still grow up to go to crèche, primary school, high school – all while living with HIV.”

‘Winning them over wasn’t easy. They felt they were already burdened with a lot of work and we found the way to get through to them was storytelling. I’d tell them stories about Bara and the number of babies who had died. I’d say some of you are already grannies and if you don’t implement this programme for these pregnant mothers, they’re going to give birth to HIV-positive babies who will grow up and fall in love with your grandchildren. They don’t know if they’re HIV positive because no one will check. So how will you feel if your grandchild one day becomes HIV positive because you refused to treat a lady to save her baby from being infected? I even appealed to their blackness and their spirit of Ubuntu to make them do the right thing.

‘Some clinics would have 40 women arrive who would be told that only 20 of them could be seen. The rest must go home. For each day they didn’t know their status it was an extra day not knowing whether their babies were infected. It was so hard and I couldn’t understand why they couldn’t see it.’

Sindi was dealing with all the stresses of her job, much of which she would take home with her. Having a young child didn’t make life easier. She was on the edge, and she didn’t know it. Help was so near but she still wasn’t ready to go there.

‘In 2011 I joined Twitter and it saved my life,’ explains Sindi in a voice that tells me how excited she was to find social media. ‘At first I’d complain about my work and all the challenges. One day someone said, “Sindi, it can’t be that you’re always complaining about your work, why don’t you rather use this platform to educate us so we can share the information and help people understand what needs to be done.” That was a real lightbulb moment for me. Then I started writing a blog on another guy’s site, which had a big following. On Twitter I’d give nuggets of information and advice – #HIV, #thisisforever, and so on. I’d tell them what to do and people started sharing this information.

‘When people asked me about this I’d say if the health system can’t do the right things, let the patient force the right thing out of the health system. When a patient comes in and looks like they know their rights, they get treated very differently from a patient who doesn’t. White patients fell into that category whereas black patients simply wouldn’t complain. My tweets and blogging I called active citizenship. Empowering people to force their healthcare workers to do the right thing ultimately saved my life. A lot of the pain and pressure I’d been feeling over the years lifted once I joined Twitter and realised that through this powerful platform I could save lives. That really changed my life and still does to this day.’

In the same year as Sindi started tweeting, she fell pregnant again and had her son Marinus, named after his father, in the December. What she didn’t know during her pregnancy was that she had preeclampsia, a complication characterised by high blood pressure with a possibility of damage to the liver and kidneys.

‘By around eight months I knew I was putting on quite a bit of weight but thought it was the pregnancy. One day a nurse I was training looked at me and said, “Doctor, you’re not looking good, you’re very puffy.” I explained I was pregnant but she insisted on testing my urine and blood pressure, which was through the roof. My husband rushed to the clinic and took me straight to hospital.

‘The timing couldn’t have been worse because as I got to the hospital my friends were gathered at a Milpark restaurant for my baby shower – without me. I wasn’t able to contact everyone so I was getting messages asking where I was. I was angry at myself – a doctor – for having this diagnosis and not knowing I was sick.

‘Marinus was born with the cord around his neck and was rushed straight to ICU. This also made me angry. I was angry at everything. I went on maternity leave and stayed home for a while but by then all the things that went wrong around his birth pushed me towards my final breakdown. I also had postpartum depression, which no one picked up. Again I questioned myself – how could I be depressed? I had a boy – what our whole family had dreamed about, especially with eight granddaughters. But I just wasn’t truly happy.’

It would be expected that husbands and family may not identify postpartum depression – but even though Sindi is a doctor herself, neither she nor the medical professionals around her noticed anything. This is an extremely common condition, which often goes undiagnosed and can grow into a serious mental health condition.

Sindi’s voice joins the voices in almost every interview in this book when she tells me, ‘I didn’t think this could be depression with everything I had to be thankful for.’ Generally, when women are pregnant they hear all about what to do with their baby – from changing nappies to breastfeeding to nutrition – but rarely does anyone mention postpartum depression.

‘The months went by and I returned to work and by the following June I started changing. Formerly a social butterfly, now I wasn’t even eating. I was weepy and I was sinking. I didn’t want to see anyone.’ This is hard to imagine of the larger-than-life, supremely confident woman sitting opposite me.

‘One day in 2013 I suddenly woke up and said to my friends, “I think I’m depressed.” Their reaction was to tell me to stop being so dramatic. My husband knew something was wrong but didn’t know what to do either. In February they fired my boss and made me a manager. The worst thing you can do to a person like me is take me away from my patients and give me time sheets, budgets and admin work.

‘To compound the depression I went to work one morning only to come back that night and find our apartment empty. My husband had decided it was time for us to move but hadn’t told me. During the day he’d got his friends to come and they moved our entire home. This plus my change at work was just too much for me. I even missed my best friend’s wedding. I got up that day, dressed for the wedding and then, not being able to face it, went straight back to bed. I’d really deteriorated. Suddenly every single noise would put my nerves on edge, which I didn’t know then was something called hyperacusis. Our bedroom was very close to the main road so I moved to the guest room, put earplugs in my ears but could still acutely hear noise.

‘Each night at around 4am my baby son would wake for a nappy change. One night, with my husband fast asleep next to me, I heard my son rattling his cot. I knew what was wrong and that I needed to change his nappy but I couldn’t move. I just lay there and cried and cried. The next morning I called a doctor friend of mine who had told me her story of depression the previous year. I told her what was happening and she said I needed to call my doctor and tell him what was going on. He arrived at the house, asked me a few questions and said, “You’ve got clinical depression and you need to get help now.” I’d known this in my heart for a long time but no one would believe me, particularly because I’m really good at running on autopilot. My doctor arranged for me to be admitted to hospital straight away and the one thing I asked was that no one told my mother until everything was arranged.’

There’s suddenly a word here that wasn’t in Sindi’s story before – ‘clinical’ depression, meaning that this is a clinical illness that affects the brain, just as having a heart condition affects the heart or diabetes affects glucose levels. This was a word Sindi knew only too well and what finally convinced her that she needed to do what the mental health professionals were telling her to do.

‘When my mom and aunt did come to the hospital I could see my mom wasn’t happy. I told them everything and being religious Christians they laid hands on me and did what they thought would help, which is great because God does heal, but I needed to be in hospital. My mom didn’t understand and asked me why was I in this place with all these people – in a mental health hospital. By then I was on medication and I looked at her and said, “I’m not well so I have to be here.”

‘Over the next three weeks she only saw me twice as it was hard for her to see me there. For her, mental health carried a stigma, which it does for so many people. She was so worried what people would think, she swore me to secrecy so no one would know where I was. When I came home I could see she was ashamed. She had a whole load of reasons I shouldn’t be depressed. After all, I was married to a great husband, had two beautiful children and was a doctor. What hadn’t she done for me? She’d dedicated her life for me. She saw my breakdown and depression as her failure. How could I be depressed when I had so much?’

Families often ask themselves, when a family member develops mental health issues, what they could have done differently. Ultimately, only the person living with the illness themselves can start the process of getting better, particularly in the case of clinical depression.

‘Being in hospital was like heaven for me. I was the patient being looked after and I could just let go. I loved the art sessions and the knitting. I loved everything about the experience, particularly having no responsibilities. I could just be me and it was the most healing thing. Of course, by then I was also on antidepressants and having therapy. I found it fascinating that by sitting and telling my story, I saw this amazing psychologist take the threads and weave them into ropes, piecing everything together.’

You would imagine that, as a doctor herself, Sindi would understand the value of psychology – but if you ask a medical doctor how much they learnt about therapy in medical school, you’ll find it’s a minimal amount.

I can hear the relief in Sindi’s voice as she continues her story. ‘During therapy I was able to talk about all the things that had happened during my internship and community service. One of the things my psychologist said was that I had to forgive myself, which really helped me. Once I came out of hospital I was given some time off and I could feel I was getting better and working on myself also.’

But Sindi was soon to face her worst nightmare. ‘Just seven weeks after my hospital admission, on the 22nd of May, my mom died. I was shattered – my mom meant the whole world to me. Even my psychiatrist was lost for words, as these two traumatic events in my life had happened so close together. I knew my breakdown had been really difficult for my mom, added to which she was a diabetic. It all happened so fast: she became sick on a Thursday and died the following Wednesday, in ICU on a ventilator.

‘My psychiatrist decided to add to my medication because my depression went from being about me and my healing to being about my mom’s death. Grief and depression are two different things. I was battling to understand why my mom had gone and it was hell. Thank goodness I was on medication when she died because I’m not sure what I would have done otherwise. I believe God prepares us for these things and my being on medication did just that.

‘After the cremation I kept my mom’s ashes in a box in my wardrobe as I wasn’t ready for her to be interred. I also told God I wanted her to come back. It says in the Bible, Ezekiel 37: “You are able to raise the bones and put them together with the flesh and skin.” Every morning I’d wake up and say to God, I’m still waiting for you to bring my mom back. But He didn’t and that was hard.

‘I eventually stopped working at the NGO in July 2014 and took the rest of the year off, before going back in March 2015. I was tired and even felt I didn’t want to be a doctor any more, which wasn’t a practical thing financially. I felt like saying I’m done and hanging up my stethoscope. But instead for the next two years I worked at a clinic in downtown Johannesburg, which I did enjoy, before moving to where I am now, in private practice.’ It was a new start for Sindi.

‘It was only at the end of 2016 that I felt ready to let go of my mom’s ashes.’ Tears form in her eyes. ‘I woke up one day, sat in front of my wardrobe and told God to bring her back. My husband came to sit next to me and said, “Honey, you need to give the ashes to your family because you know she’s not coming back.” I cried, but understood, and gave them over to the family, and we interred them. This was really hard but I was still on medication, which kept me hanging in there. I was also still going to therapy – just not as often as before and, importantly, I was getting better.

‘One of the biggest changes I had to make was learning to have boundaries, accepting that I can’t save the world. This was hard for me to accept – that I must deal with one person at a time and couldn’t help everyone at the same time. The cognitive behavioural therapy I did with my psychologist really helped, teaching me how to react in situations: to look at a situation, assess its severity and, on a scale from one to ten, judge how bad it is and how I should react. I had to learn all these things as I wasn’t naturally like that.’

Cognitive behavioural therapy (CBT) is a highly effective and popular talking therapy that manages people’s problems by changing the way they think and behave.

‘Navigating the grief was the hardest thing for me and I was now a completely different person to the one I’d been before. Suddenly I wasn’t afraid of anything. Suddenly getting through the day became much easier. I wasn’t waking up feeling tired and not coping. This whole experience also completely changed my attitude towards mental illness.

‘I realised that, throughout all my studies at medical school, mental health was barely touched on. We’re not sensitised enough, which is why medical students and doctors would rather keep it all to themselves than share when they have a problem. You hear someone is depressed, someone has taken their own life, but what does this mean? There were two members of my family who died by suicide and you understand, but don’t really understand. You think there should have been a better solution for this person. Maybe they could have done this or that or maybe they still would have done what they did. Until you’ve walked in those shoes and heard those voices telling you you’d be better off dead, you can’t understand.’ I can hear the passion in her voice and, at the same time, the frustration that more people don’t know this.

‘When Robin Williams, one of my favourite actors, died by suicide in August 2014 I decided it was time for me to speak out. I thought if I could tell my story and tell one person to not die by suicide, I’m going to. I called my dad, as he was coming to South Africa the following week, and said, “I need to talk to you. I need to tell you a story because I’m going to do something but I wouldn’t want you to find out in the newspapers.” Because my mom didn’t want me to tell anyone, he didn’t know about my breakdown the previous year, so I explained what had happened to me and that I wanted to speak out. I wanted to help save lives, not with medicine this time but by talking about my experience. I said that as a doctor with an established following on social media around HIV/Aids, I thought I was in a good position to do this. Added to which being a Christian was important, because Christianity didn’t always accommodate mental illness. I told him I felt I had work to do and he said, “Fine, go ahead.” So that was it – I wrote a blog on my experiences and have been tweeting ever since. SADAG saw what I was doing, reached out to me and I’ve been one of their advocates ever since.’

When people like Sindi speak out, it makes the world of difference in breaking down the stigma of mental health, particularly in the black community.

At last, Sindi started to feel the lightness of life. ‘These days I’m a busy, although probably a little unconventional, working mom, with a 12-year-old daughter and 9-year-old son. Both kids are very close to their dad, particularly because during their early years when I was absent from their lives with my depression, retreating to my bed so much, they came to rely on him.

‘What really brought me back to life was a dream trip to New York. In September 2017 I was invited by the Gates Foundation as part of a group to attend an event there. It was a fully paid trip and my long-cherished dream of visiting the Big Apple came true. When things weren’t going well for me I always thought, it doesn’t matter, one day I’ll get to go to New York. Then my mom died and I thought, My worst nightmare has happened, now nothing else is going to go right, so I just gave up on the New York dream. ‘Being there was unbelievable. I remember standing in Times Square at midnight with all those lights surrounding me, thinking if New York could happen in a way I didn’t expect, then it means I need to continue with my life. When I return home I’m going to carry on with everything I’ve put on hold. All the dreams I had need to be reignited.

‘Today I’m able to be a better mother to Nandi and Marni and wife to my wonderful husband Marinus and every year now I go back to New York …’

TOOLBOX TIPS

Family support

• Family members struggling with guilt, anger or worry about why their loved one is ill should seek their own support.

• It’s not helpful to focus on the past and how things should have been done differently.

• Get support and educate yourself, so that you can be there for the family member who needs you.

Seek professional care

• Being admitted to a psychiatric facility comes with a lot of stigma. What many don’t realise is how helpful it can be.

• Just as you would go to hospital to treat a physical illness, you should go to a psychiatric facility if you’re not coping with your mental health.

• In hospital, you’re treated by a multidisciplinary team of professionals, all there to help you gain skills to cope.

Compassion for yourself

• People focus a lot of attention on past decisions, mistakes or regrets, berating themselves for things they cannot change. This isn’t helpful.

• What is helpful is to be patient, kind and compassionate with yourself. Forgive yourself as you would others, and bring your attention to the present moment.

One step at a time

• It’s easy to become overwhelmed when expecting too much from yourself. Be realistic. Set reachable goals. Set boundaries for yourself and others. Do one thing at a time.

• Focus on what you’re doing, in the moment, instead of focusing on all the things that need to be done.

Create space in your life for yourself

• People mistakenly think they’ll take a break when everything that needs to be done is done. But to-do lists are never-ending, leaving many exhausted and overwhelmed.

• Taking breaks, mentally and physically, where you feel fulfilled is important. The more replenished you feel, the easier life becomes.

• Identify activities you enjoy and carve out time for them – even if it’s just a dedicated 10 to 15 minutes a day that’s purely for you.

 

 

 

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