Abstract
The following essay is the first ever in the new first-person perspectives column recently initiated by Transcultural Psychiatry. This column is intended to give voice to people of diverse ethnic, cultural, and national backgrounds with current or previous emotional distress or mental illness. This first article is written by Katrina Bartellas, a courageous young Newfoundlander who struggled with an eating disorder early in life, since making a full recovery and now herself working in the mental health field. Katrina writes poignantly about growing up in the fog-soaked intimacy of St. John’s, Newfoundland in an ambitious family of first-generation immigrant medical professionals.
The city of St John’s is situated on the easternmost extremity of the Island of Newfoundland. Newfoundland itself lies off the east coast of mainland Canada, rugged, sparsely populated, and geographically isolated from the rest of the continent. Originally settled by the Beothuk and then by British fishermen, later followed by waves of Irish immigrants, Newfoundland was a separate dominion of Great Britain until 1949 when it officially joined the Canadian federation. It remains one of the most ethnically homogenous provinces of Canada, with the overwhelming majority of its inhabitants tracing their ancestry to Britain or Ireland. Immigration rates from elsewhere have remained virtually negligible. This makes Katrina’s story all the more entrancing, given that her father emigrated to Newfoundland from Cyprus, and her mother from Ireland.
Novels such as E. Annie Proulx’s The Shipping News and Wayne Johnson’s Colony of Unrequited Dreams portray St. John’s as a mysterious yet enchanting city existing in a relentlessly harsh climate, characterized by a lively folk culture and a people whose friendliness is legendary. This legendary friendliness is evocatively recounted in this piece, where Katrina explores the supportive yet sometimes stifling small town atmosphere of St. John’s. She considers the double-edged sword of living in a town where social connections are dense and deep, discussing the role of family, friends, and teachers as it relates to her recovery from an eating disorder. She offers surprising insights into small town vices and small town virtues, sensitively exploring how the close-knit ambience of St. John’s affected her recovery.
Katrina engages in an insightful discussion of the role of psychiatric services in enhancing recovery, particularly interesting given that her parents are physicians. This is also informative inasmuch as a lot of scholarship in social and cultural psychiatry is critical of conventional mental health services. For Katrina, these services, as well as the support of family and friends, were critical to her recovery.
The journal hopes that papers such as these may be educational for all, but particularly useful in the training of clinicians and researchers. Insights expressed in these papers may also provide the transcultural psychiatry community with food for thought about received wisdom regarding recovery and healing, as well as exposing readers to the diversity of mental health experience across the world. Further submissions are welcome, and should be sent to column editor Rob Whitley at
All around the circle: From patient to provider
My name is Katrina Bartellas and I’m a mental health champion. Born to a Greek-Cypriot father and Irish mother, I grew up as a first-generation Canadian in St. John’s, Newfoundland. I was given every opportunity that my parents didn’t have. You name it, I did it: gymnastics, soccer, basketball, rugby, swimming, dance, violin, piano, guitar, saxophone, orchestra, choir, voice, acting, student council, and more. I witnessed a strong work ethic in my parents’ everyday lives as clinicians and continually pressured myself to measure up to their impressive standard of success. In between school and extracurricular activities, I returned home to a state of anxiety. I was 13 years old when I started cutting back on what I was eating. Soon enough, my daily food intake consisted of an apple. This, coupled with a substantial amount of exercise—as I was playing on my city’s top soccer team—led me to become emaciated. Within a few months, I had created several unsound habits. For instance, I ritualistically sprinted up stairwells after I ate. Sadly, exercise had developed into a compulsion. Also, my obsessive-compulsive disorder became exacerbated as I exclusively carried out tasks, such as saying my night prayers, in multiples of three. I needed professional help.
Admittedly, there are many benefits of growing up in a smaller city like St. John’s. For example, I loved that I was able to garner relationships with my school teachers. Actually, I attribute my recovery in part to my former choral director. Although others had made efforts to help me, her concrete arrangement of a doctor’s appointment, which eventually led to an evidence-based treatment plan, was vital. At the clinic, the doctor revealed my pulse to be dangerously dipping into the 30 s (beats per minute). The Heart & Stroke Foundation (“Arrhythmia,” 2014) states that an irregular heartbeat can cause fainting, fatigue, or even death. I was immediately admitted. To my dismay, mom had packed my pajamas for the night, which aggravated the situation further. I longed to flee from the hospital and strategized how to best make a dash for the exit. Yet, I was promptly put into a wheelchair and thus began my journey of healing and self-discovery in the psychiatric unit. So, I was assigned to “bed rest” for 3 weeks, which literally meant staying still for more than 20 days. Oh man, was this a challenge! No stand-up showers were allowed, so I washed myself from a basin. Walking around the ward was prohibited, so I stimulated my mind with hours on end of television. My family would visit but, sometimes, this fueled my anxiety. Both of my parents are clinicians and I came to realize a truth of small cities: surely, members of the medical community knew each other. I later found out that my mother and one of my nurses had indeed worked together in the intensive care unit for a stint. At times, I felt infuriated that my doctors and nurses, seemingly, sided with my parents, the medical specialists. “But,” I thought, “what happened to patient-centered care?”
I was discharged a week after Christmas, which allowed me to appreciate the big ribbons and pine trees that occupied the previously boring hallways. More importantly, I bore witness to another truth of my hometown. Although health caregivers are universally mandated to be empathetic, I felt fortunate to have received treatment in Newfoundland, a place where helping your neighbor is second nature to most. Markedly, many local celebrity athletes and musicians took time out of their busy schedules to visit Janeway patients during the holiday season. Moreover, a nurse brought in her manicure kit one December night so that I could feel like a princess! Such random acts of kindness are typical of Newfoundlanders, who are renowned for their generosity.
Nonetheless, something was bothering me: I was deeply concerned about going back to school as one of my friends informed me that “everyone knew.” Despite the anticipated awkwardness of my return, when I approached my homeroom, my classmates ran over to hug me, which brought me to tears. Undeniably, this was the moment when I realized that my recovery was in reach. Of course, there were additional stressors at school yet the encouragement from my classmates and teachers made reintegration easier. I rationalize their support as a function of my personal social ties and involvement at school, as well as the dominant values that govern Newfoundlanders. This sense of friendliness contributes to Newfoundlanders’ sense of identity and is evident in our customs. Take the Newfoundland Christmas-time tradition of mummering, for instance, that can be traced back to the 18th century (“Performing arts,” 1999). Typically, a group of people in disguise would be welcomed into a person’s home and offered food and drink by the host in return for a good tune or joke. Remarkably, the province has been internationally recognized for its kindness and openness. In 2002, Gander, a town in Newfoundland, received an international resiliency award from Washington, DC after its 10,000 residents opened their homes to 6,700 airline passengers and crew members after flights were grounded in the aftermath of 9/11 (“Gander honoured by U.S.,” 2011). I consider myself lucky to have grown up as a Newfoundlander both to regularly witness and partake in this sentiment of lending a hand to a friend, family, or stranger in need.
In line with this attitude of resiliency and in spite of the monster that had consumed my life and wreaked havoc for my family, I continually exposed myself to trying situations. I practiced perseverance. As a result, I became the strong woman that I am today. My hospitalization taught me certain realities. Namely, I learned that physicians can form powerful connections with patients. At the time of my hospitalization, my relationship with my parents was nonexistent and I put great trust in my physicians. As a result of their compassionate care, I felt confident in my treatment plan and reassured, despite my foreign—and sometimes scary—surroundings.
That year, I also learned the importance of multidisciplinary teams. My physician picked up on my creative personality and incorporated regular sessions with the art therapist into my treatment plan. I cannot overstate the extent to which art served as a major outlet for me in my path to wellness. In fact, the very inclusion of art therapy as a viable stress management tool marks the progress and evolution of the medical field toward a biopsychosocial framework. By this, I mean that, more often than not, a holistic approach, which considers the psychological, social, as well as biological influences upon a patient’s functioning, is not only taken but also favored.
After many years, I regained control of my life and rebuilt strong relationships with my loving parents. Today, I honor my good health by mirroring the same personal qualities I see in my parents; I work hard to help others and have pride in the work that I do. This attitude inspired me to cofound the McGill Student Chapter of Jack.org (a national network of young mental health leaders) to change the perception of good mental health on campus. This mentality also empowered me to work on a toolkit under Dr. Heather Stuart, the Bell Mental Health and Anti-Stigma Research Chair, to significantly decrease stigmatized attitudes of Canadian youth toward people with mental health problems. Most recently, it led me to become a content provider for the first mental health policy and 5-year plan of the McGill student body.
I believe good mental health to be pivotal in building healthy relationships, reaching one’s individual potential, managing life’s difficulties, and enjoying life’s beauty. My personal experience empowered me to understand proper diagnosis and support for patients. Currently, I am pursuing psychiatric research at the Douglas Institute (a teaching psychiatric hospital affiliated with McGill University and located in Montreal). Furthermore, I have been blessed with the transformative opportunity of working as a physician assistant at Tiny Tots Medical Centre (the largest privately held pediatric ambulatory care facility in Canada). Additionally, if proven successful at my medical school interview at Memorial University (Newfoundland’s premier university situated in St. John’s), I will have come full circle: from patient to provider. Students sometimes ask me, “How do you stay motivated?” Plainly, I am driven by insightful, memorable quotes. For instance, Dory, the beloved fish in the blockbuster film Finding Nemo, sings, “Just keep swimming,” which divulges a simple but clear message from my personal story. Notably, given the level of local support, familial love, and good quality medical treatment at my disposal, it was important for me to persevere and this alone built momentum until I, once again, felt truly unstoppable.