My parents are staunchly against the idea of their firstborn being prescribed psychiatric medicine. I know how that must have sounded to the primary physician handling my case. It must have sounded ridiculous, right? What kind of parents don't want their daughter to have the best chance at getting mentally better? In my parents' defense, though, psychiatric drugs could and would alter a person's brain chemistry. Taking such a huge risk is not unlike gambling. 

I do not bother telling my physician why my parents are how they are. I do not want her to know about the one night I have kept replaying and the real reasons I haven't stopped replaying it. 

The threads of events that led to that unfortunate night began sometime around September 2014. I was in my first-year political science seminar. The seminar was a 12-week-long group discussion called The History of Insurgencies and Separatism in South Asia. Just like the name implied, my classmates and I were learning the basics about terrorism, state-sponsored violence, inter-ethnic conflicts, and secessions in India, Pakistan, Bangladesh, and neighboring countries. For the most part, I did fine comprehending the weekly readings my instructor had assigned. I got perfect marks for the follow-up assessments in which I had to summarize the readings using my own words. My problem wasn't with the readings themselves but with writing papers in which I had to argue whether the authors of the specific readings would agree with the hypothetical scenarios my instructor came up with. For instance, would the social scientists and theorists Hans Morgenthau and Hannah Arendt think Kashmir should be an independent nation-state whose administration is separate from both Pakistan and India?

I had no issue coming up with arguments, but I had a lot of issues presenting my train of thought in front of other students--especially since one of them, Yunus Khan, was super critical and would debate me. I understood that he believed he was offering constructive criticism and adding something valuable by actively participating, but I didn't like how he made me feel I was cornered. Yunus was no doubt intelligent and that was exactly what was wrong--his superior intelligence meant I often had no comebacks to counter whatever he said was illogical about the way I answered my instructor's questions. 

 Yunus making me feel incompetent and dim-witted led me to these desperate measures:

1) I whined to my mom on the phone. Bad approach. My mom told me I needed to grow a backbone and accept that some people are unbearably blunt. I was so upset I hung up on her and did not reply to her WhatsApp messages for weeks on end. 

2) I went to my instructor's office hour and begged him to give me an exception so that I did not have to participate when my peers reviewed each other's not-yet-graded paper of the week. Alas, my instructor denied my request because "peer review is an important skill to learn because that's how you grow as a scholar." Yeah. Fuck my life. 

With my mom and my instructor not being on my side, I did what (at that time) seemed to be the next best course of action: skipping the regularly scheduled peer review days. Unluckily for me, my instructor caught on to what I was trying to do and asked point-blank one afternoon after class--when everyone already left the classroom--if I was planning to fail The History of Insurgencies. I was too embarrassed to admit I was avoiding Yunus, so I told him a half-truth: I found it hard to wake up on time to go to the lecture hall and I had been struggling to stay focused because my mind was foggy. 

"Rinjani, you're not the first student and certainly wouldn't be the last to have challenges with speaking up in my seminar," my instructor replied calmly. "However, since you said your mind is foggy, I wonder if a part of your struggle is mainly psychological. Would you consider going to the Health Center? You can get screened for depression and if that's indeed what's going on then the counselors would be able to help you move to a better place, figuratively speaking. I could send an email to the director of the Health Center and you would have an appointment made." 

I wanted to snap at him. I wanted to say to his face that I found it absurd he cared enough whether I was depressed but did not care enough to exempt me from the mandatory peer review process so that I could bypass the excruciating hours of debating with Yunus over the complicated politics of Indian subcontinent. The only thing that kept me from snapping was my fear that he would think I was being immature for blaming my unhappiness on Yunus. 

Fast forward to my appointment with the Health Center. 

Dr. Kyle Fisthammer, who was the director but also a psychiatrist, sat me down with long and extremely detailed questionnaires on which there were statements to mark yes or no. One of the many statements was "In the past two weeks, have you ever wished you could sleep and never wake up and/or have you believed that you were a disappointment to your family and friends?"

Once I handed back the questionnaires to Dr. Fisthammer, he tallied my overall score and explained what the score meant. 

"Rin, your symptoms point to the possibility that you're suffering from acute anxiety disorder. I think you're not only anxious about your political science course in particular but also your studies in general," he began. "And it's a normal thing international students go through. In fact, international students are more prone to anxiety than domestic and local students because they usually feel isolated and have no reliable support system. But I need you to remember that I am here for you. You can rely on me. Whatever you confide in me would stay between us." 

"I think I am intellectually inferior compared to other international students in my cohort and thus sooner or later I would be kicked out from this college," I blurted out. "I wish I had half the sharp mind of that boy from UAE. If I were him, I would be happier. If I were him, I could be the one doing the criticizing instead of the one being criticized." 

"So what you're saying," Dr. Fisthammer intertwined his fingers together while I tried hard not to cry, "is that you are dealing with impostor syndrome. You've met a person you admire for his intellect and it feels threatening because he awakens your own inner critic." 

By then my lips were quivering uncontrollably, so I just nodded quietly. The psychiatrist scribbled on his notepad and then asked if I were insured under the college's health plan like any other international student. 

"I am. When I got my acceptance letter I was also required to enroll in Blue Shield Blue Cross."

"Good, because then you won't have to worry about paying out-of-pocket for what I'm about to prescribe," he unclipped a yellow page from his notepad and handed me the prescription. "Take this to the reception desk. They would be in touch with your insurance and if you're approved for zero copays then you should be able to pick up your pills next Monday." 

The only word I could make up in his chicken scratch was "Sertraline". 

*****

October 2014

Roughly a month into taking sertraline, nothing changed except I was haunted by recurring nightmares of fighting with my mom. The details of the fight would vary from one nightmare to the next, but a common occurrence that connected all the nightmares was that I always ended up physically attacking my mom: kicking her in the abdomen, punching her in the jaw, or grabbing a knife from the kitchen and not feeling any remorse as the knife sank into her chest. 

I brought up my discomfort to Dr. Fisthammer and mentioned that I would like to stop the sertraline, but he responded that quitting sertraline cold turkey would lead to nasty withdrawal effects. What he could do, instead, was to lower my dose. 

"I need to let you know something else that might happen, Rin. A lowered dose by no means reduces the potency of the drug--it only reduces how much your body has to absorb at once. I hope you haven't forgotten that sertraline comes with an FDA black box warning?" 

"Yes, sir. You've warned me that adolescents who take sertraline are more susceptible to suicidal ideation and therefore if I start having those kinds of thoughts, no matter if they are passive or active, I should come to you straight away."

"Exactly. Now, Rin, could you sign a document for me? It's a pact of sorts."

1) I promise to call the Health Center if I ever have thoughts about suicide

2) I promise to do the same if I feel the urge to self-harm, which includes but is not limited to excessive drinking, self-mutilation, and using weapons to cause injury to self

3) I promise to let the Health Center refer me to law enforcement and/or nearby hospitals if necessary, i.e. when psychotherapy alone is not working

Early November 2014

Yunus Khan was not just my classmate in the political science seminar. He minored in Creative Writing, so we shared another class too--Introduction to Sylvia Plath and Major Modernist Poets.

I ignored Yunus' presence most days because our funny and charming creative writing professor, Dr. Audricka Kirkland, thankfully did not employ the damned mandatory peer reviews for our essays and journals. Dr. Kirkland did want her students to read their essays and journal entries aloud, but she didn't ask the class to provide commentaries so no one ever said things like "your essay did not make sense" or "your journal is so weird" or "your writing style is unsophisticated and your poem is not representative of how Sylvia Plath would utilize poetic language."

My luck ran out, however, when Dr. Kirkland announced she was dividing the class into pairs to do research in the library about Plath's contemporaries and how their poems contrasted with Plath's more feminism-flavored ones. 

"Rinjani Pratiwi is paired with... let's see... Yunus Khan." 

"Nice!" Yunus was about to high-five me but I gathered my textbooks, slung my purse across my shoulder hurriedly, and dashed out of there. I could hear everyone murmuring confusedly and Dr. Audricka yelling that there were twenty more minutes to go before class would be dismissed, but I was so preoccupied with the desire to kill myself that I paid no attention to the commotion.

"Rin! Rin, where are you going?" Yunus was already behind me and pulled on my sweater's sleeve. "Listen, we can talk about it. If you don't want to be partnered with me--"

"Go to hell!" I barked and unsuccessfully tried to shove him to the ground but he grabbed my wrist. His hold was strong and I couldn't break free. 

"I'm not going anywhere until you tell me what the matter is."

"You're playing dumb!" I screamed. "You're killing me and you have the gall to ask me what the matter is?" I slapped him with my free hand. "I hate you! Leave me alone." 

Yunus stood motionless with an expression somewhere between disbelief and hurt but he eventually said "okay" and walked away. A rational part of me regretted slapping him, but a pettier part of me felt a messed up sense of satisfaction from hurting him. Strangely, the sense of satisfaction was short-lived and the desire to kill myself did not vanish. 

I ran the rest of the way to the Health Center. Panting and sweating a bucketload, I barely had the strength to push to the door to the (eerily empty) waiting area open. The lady at the reception desk seemed alarmed at my sudden entrance and rushed to help me to a seat. 

"You're Rinjani, right?" she studied my face. "Here to see Dr. Fisthammer?" 

"Y-Yes." I managed to reply while catching my breath. "I-I w-want to die." 

"Is that just a thought or are you actively planning to die?" she looked me in the eyes but her voice remained steady. "Do you have the means to carry out your plan?"

The document I signed forbade me from lying to medical staff, so I showed her the bottle of sertraline I had in my bag and confessed to her that I was going to swallow the entire content of that bottle in one go. 

"It's a bad idea," she said while snatching the sertraline and pocketing it. "I'm taking you to Dr. Fisthammer's office but if you don't calm down we need to follow the safety protocol." 

"What safety protocol?" I asked but then recalled vaguely a sentence in my agreement with Dr. Fisthammer that stated the Health Center had the right to get law enforcement involved. "With all due respect, how is a police officer going to be helpful to a suicidal girl?" 

"They're trained to de-escalate potentially violent individuals who would be a danger to themselves or those around them," the reception desk worker replied, still with a steady tone of voice that started to irk me. "They are also authorized to call an ambulance for emergencies." 

"This is an emergency!" I said in the hope of getting a reaction out of her--I hated how she was able to keep an emotionless voice when I was this close to ending my life. "And I could become a danger not to myself but to you as well. I'm not kidding you. I could slap you just like I did with a boy who annoyed me. Go on and call the cops." 

I was obviously only taunting her out of spite and stupid impulse, but she took my words seriously. Ten minutes or so later, a man in a blue uniform arrived at the Health Center.  

"We can do this the hard way or the easy way, your choice, you hear me?" the uniformed man knelt down beside me. "The hard way would be I handcuffed you like a criminal. The easy way would be if you ask me to voluntarily take you to the ER so you could get a referral to the psychiatric ward where you would be closely monitored for at least 72 hours." 

"Admit me to the ER, please." I said in defeat. "After all, it would only be temporary, right? Three days at most? Three days is nothing. I could take a break from studying and doing homework." 

It did not register in my mind yet that I was saying farewell to my student visa and thus jeopardizing my $25,000/semester scholarship.