The Foreign Service Journal, January-February 2016

THE FOREIGN SERVICE JOURNAL | JANUARY-FEBRUARY 2016 49 The nurse practitioner helped me with a low dose of Lexapro that was life-changing. I knew the benefit of cognitive behav- ioral therapy (CBT) for GAD, but while overseas was unable to access it; local health care was poor, and there was no private space in the embassy for a video connection with a therapist in the United States. When I finally came back to the United States I began CBT with a therapist and a psychiatrist who continued my prescription. My GAD improved dramatically, and I learned useful skills for managing stress. Unfortunately, when I moved back overseas, the GAD returned. The techniques I learned to manage it are not very useful in an organization that pays lip-service to work-life bal- ance, but in reality demands extreme working hours even when unnecessary (in places that are not war zones). Work demands make it difficult to find time to exercise, and bosses hesitate to allow annual leave because there might not be enough people around if there’s an emergency. Having GAD does not make me bad at my job. I can put in long hours and work in stressful situations. But working long hours every single day just to push out another perfect memo or not scheduling annual leave because you have to be prepared for every possible contingency at all times is not healthy. a Mental Health and Toxic Workplaces I t’s great that the State Department is attempting pro-active measures and screening programs focused on officers in priority staffing posts (PSPs), but I do not think there is enough emphasis on good mental health care for all officers and their family members regardless of where they serve. I went through the required screenings and classes for fin- ishing service at a PSP and experienced neither difficulty with mental health during the tour nor delayed effects afterward. So it took me by surprise when, just a few months into a new assignment in a fairly nice city, I developed depression and anxiety while working with a difficult supervisor at a post that I would characterize as having toxic leadership issues (which made it difficult to find higher-ups to assist with my supervisor issue). It took me a while to realize that it was not just temporary stress and difficulty learning a new job; an unhealthy work environment pushed me into a full-blown depression. I finally sought treatment when physical symptoms that had no underlying physical cause doctors could identify began making my life difficult. I appreciated the fact that my post had a regional psychia- trist, because that made it easier to discreetly and quickly seek help. I was referred to a locally-based American citizen psychologist and pursued several months of therapy. Between that and the fact that a few key people at post who were sources of toxicity finally left, I improved my life and work level. Once I felt safe enough to talk with colleagues about what I’d gone through, several told me they had experienced the same dif- ficulties with the same people. This begs the question: What prevents us from speaking up? Part of the answer is that we are in a work culture where there is little incentive to rock the boat. Also, there is an element of “stiff upper lip” expected. I felt like there was something wrong with me for not “managing up” correctly. I realize now that it wasn’t a problem with me, and I have learned certain things I would do differently if I were to again find myself in such a situation. Though my therapy was successful, I was disappointed that the RMO/P had initially suggested prescription medication. I think in U.S. culture and in the liability-driven work culture of government, we over-emphasize quick solutions and pop-a- pill-and-make-it-go-away attitudes too often. We need to bring a level of holistic analysis to any problem, whether it is mental health treatment or developing foreign policy. In the absence of a supportive and empathetic response to people dealing with mental health issues, privacy is of the utmost importance for creating a sense of safety, which sup- ports the treatment process. I remember how important it was to me to see lots of mes- saging from the State Department and the Secretary (e.g., department notices, management announcements) making it clear: getting treated for a mental health issue is a sign of strength and responsibility, not weakness. The intent for the mental health screening programs for people returning from high-threat assignments is correct, but the execution still feels very pro forma. In the check-out process from my PSP post, a big group of us were seated in an auditorium and asked to go through a checklist of “Do I have this symptom [insert an extreme symptom example]?” Is that environment and process conducive to sharing or reflecting on an issue they may be having? Instead, we need to emphasize colleagues and family mem- bers watching out for each other; they are truly the first people who are going to notice if someone is acting differently and experiencing difficulty. n