Transcript of What Happens When “Fine” Becomes a Mask? High-Functioning Depression, Immigrant Identity, Motherhood & Survival Roles with Dr. Nneka Oluoha

Welcome to Notes from the Edge, where we have the conversations we should have been having all along. We talk about the things that we're not talking about. I'm your host, Lisa Lacey, writer, trauma educator, executive advisor, and author of the upcoming memoir Notes from a Certified Madwoman. Welcome to The Edge. Hey, my friends, welcome back to another episode of Notes from the Edge. I am your host, Lisa Lacey, and this is the place we have the conversations we should have been having all along. Guess what? You ain't talking about it, but today we're gonna. And our special guest today is Dr. Neka Aloha. who is a Nigerian American physician, novelist, speaker, and storyteller whose work explores the intersection of all the things we love to talk about in here: mental health, culture, family, immigration, faith, identity, and resilience. Born and educated in Nigeria before immigrating to the United States and then continuing her medical career in California, she brings both a physician's perspective And a storyteller's understanding to conversations about the emotional struggles that can exist beneath outward success. You guys, her forthcoming literary novel Live for Me, Nakeem examines depression, marriage, motherhood, family relationships, cultural expectations, and the immigrant experience through the life of a Nigerian woman who appears highly capable while privately struggling.

And I know we're talking directly to some of you today. So through medicine and fiction, Dr. Aloha explores the truths people often have difficulty saying directly and uses storytelling to reduce stigma, create empathy, and make hidden suffering visible. Dr. Neco, welcome in. How are you today? Welcome to Notes from the Edge.

Thank you so much, Lisa. I'm so glad to be here with you today.

Yeah, I'm glad to have you. The minute I saw you as a potential guest, I was like, yes, these are all the things we absolutely love to talk about in here. And because it's Notes from the Edge, we're gonna go ahead and dig right in. All right.

All right.

All right, well, let's talk about your book first. Because your character, the character you've created in your fiction novel, performs competence and gratitude and motherhood and outwardly professional success and emotional stability and, and I'm assuming fine, right?

Yeah.

But at what point do you feel, especially living your lived experience and writing this novel, what point do you think that something that helped us survive eventually becomes a prison that we're living inside of?

I think for most people, that includes me as well, is being able to create that distinction. Sometimes what has helped us to survive was and is very necessary. Things like competence, showing up, giving your 100%, being dependable, being reliable, being that child you need to be, being the mother you need to be, being the neighbor, you know, the friend, everything that you should be is, is what has helped you make it this far. But sometimes you need to know when to take a break for yourself, or when to rest, or when to ask for help. If you keep performing all the time and being that person you think you should be, then it becomes a prison.

Yeah.

Because you're so deep in that role that you don't realize that this is now a role. This is no longer you. It's now a role that you're performing, and you need to put it down for a few minutes or even for a few hours or even days or however long you might need. If we keep carrying these expectations with us, if we keep being what people want us to be and not being who we should be even for a few minutes, then at that point, it's a prison to us. sometimes we don't even see it, you know. We're so deep in that role, in that, um, living that life that we shouldn't be living all the time, and we don't even see what's going on. Sometimes it's the people close to us that see it, or sometimes people don't see us at all and we're just there, you know.

I love that. Sometimes people don't see us at all because the mask and the performance is so good.

Yeah.

What I love about you brought— that you brought up Um, is the idea of just dropping the role for— to practice for a day, maybe half a day. So for you, when did you realize, wow, I'm really successful, but I'm kind of struggling behind the scenes? What, what was that moment or collision of moments that made you realize, you know, I'm performing now and it's no longer serving me?

I think for me, when I came to that realization was right before I wrote my first book, this book we're talking about, Leave for Minkem. That's when I came to that realization because all my life I've always seen myself as a writer. I was a writer first before I became a physician. So the words on books have always called to me. I'm the little girl who read Shakespeare. So at a point, I kind of saw myself and I was like, I've actually not published anything yet, but I'm living this life. You know, I go to work on my schedule. I show up, I take care of people. I come back, I take care of my family. I'm the daughter that is expected. I'm the wife I'm supposed to be. I'm all these things, but I haven't done anything with my writing and that's my passion. And that's when I— and that's when I, I, I had to reevaluate my life and kind of look at it and say, okay, I keep telling myself I'm, I'm very busy, which I am, you know.

Mm-hmm.

I wouldn't discredit that. So I, I'm, I'm busy, there's no time to write, it takes a lot of work, which is all true. But I realized that maybe if I can put aside or just write down one word at a time, or even if it's a few words a day that would get me on the way, you know, to doing what I, I would love to do. So I did just that, and obviously it was not easy, but here I am today.

Well, congratulations, my friend. That is huge. And I love that you did this excavation and evaluated your life and said, I'm a writer, I'm not writing, and I'm gonna write. And friends out there that have a book in you, she started with a few words a day. It can be done because you're right, you're right, Doctor. We do tell ourselves, I'm too busy, I don't have time, I've got to do this, or I've got to do this, or I've got to do this. And there's all kinds of stuff that gets in the way. So I love that you, um, you know, dropped the role mask and performance by writing your novel, which I'm assuming was very cathartic for you. Was it a healing process for you going through writing it?

It was. It was an incredible journey, you know, because my, uh, my book Live for Me, Nkem was written through multiple points of views. So I have, um, Nkem's perspective, I have her husband's perspective, and that of her children, and she has 4 children. So I feel like I lived all those roles while writing my book. So the moment I was in Nkem, I was going through her depression with her, I was going through her journey with her. I was finding the answers alongside her. Then I was her husband too. I was frustrated with her, trying to get her to seek for help, trying to understand why she wouldn't or what was going on, and trying to understand how to help, how to be there for her. Then I was her kids too. I was frustrated with her. I loved her. I lived all those roles with Nkem. And I asked myself at some point, why did I make her have 4 kids?

Just to make it a little more challenging. A little more challenging.

Like, it seems like you hate yourself. Why do you make her have 4 kids? At a point I said, okay, maybe I should make her have 3 kids instead. But I felt like all of those kids, because I already had them down on paper, they all brought different things to the story. So at that point, it felt like I couldn't get any of them out of the story.

Once they're in there, they're in there. And Marion, you— and it sounds like you really embodied this work, and I love that. I do talk to a lot of authors on the podcast, and I've never heard one talk so, so definitively about embodying the character. So that's such beautiful, beautiful work. Now, there is an assumption that if somebody is working, parenting, doing all the things that you do, doing all the things that Ncam did in the book, showing up laughing, that they've got to be okay and nobody worries about them, right? So why can the highest functioning person in the room sometimes be the one who's suffering, one, sometimes the most, And 2, what are we missing?

I think what we're missing might be the real conversations. Because there's this culture of, how was your day? Oh, it was great. That's what you're expected to say. Or how are you doing? Oh, I'm fine. I'm doing great. That's what you are expected to say. If you say anything beyond that, you see the people's faces start to change. If you say, oh, I think I might be struggling a little bit, and then you see the person you're speaking to, they almost close off. There's a closed-off expression. They might take a step back and they might be like, oh no, I'm not ready for this. You may not say it out loud, but you can read it very clearly. So because of that, many people have learned to hide what they really feel. They go with the, oh, I'm great. Oh, I'm fine, because that's what they're expected to say. That's what they're expected to to respond with. So in the midst of this, how they really feel is being buried. And sometimes, unfortunately, this is not only limited to strangers. It could be with family too, as well. Because if a stranger doesn't want to know how you're doing, I mean, that might be okay.

But when the people close to you also do not really want to know, that's where the problems start from. Maybe it might be a mother asks her son, how are you doing today? And he says, oh, I'm not doing so well, and she's like, oh no, you know. And maybe she might not want to hear that because maybe her own expectations, maybe from culture, is that this is a son, he should be strong. Because we get that too sometimes. They tell, um, boys, you know, why are you crying? Are you a girl? You know.

Mm-hmm.

Or, or you have a girl being told, oh, why are you crying? You're the eldest child, you should be the responsible one, the strong one. Sometimes they grow up carrying these things and they put these pressures on themselves too, as well, apart from the pressures from family or anything else. That pressure is there to be successful, to look like you're successful, and embody these expectations. Sometimes it comes from the job too. Maybe you're the head of the company or you're a very strong presence in the company or wherever it is that you do work, and you have that pressure to always show up. Always give 110%, and you expect that of yourself. So if you find that you might be struggling, you might feel like, I'm not the one to mention this. It's not me. It maybe is the janitor who should struggle, not the head of the company, or it's this other person that should struggle, not me. So people don't speak up or ask for help. They expect that of themselves, and it becomes a mask that they wear. And they carry with them until they no longer can.

Well, and that's just it. And, you know, I was a— I was in high-performing survival for 20 years, and the end result was total mental collapse. We can only carry so much. What I loved about what you said is, you know, the executive who's running the business is judging themselves for struggling, right? We shame ourselves. I should be I could be. Um, so I love that you're bringing attention to that, that no matter what your position is— that's a role, right? So no matter what your position is, you're human underneath all of that. So yeah, and finding the right people to tell the truth to is important, right?

Correct.

Yes, yes, because if they're the ones that are taking the step back maybe they're the ones that don't really want to hear about your day. So finding those safe people, my friends out there, if you are struggling, is pretty key. Because if you find somebody who isn't supportive, it may shut you down and you may not open up again. So, um, yeah. So let's get to how you ended up here. So you grew up in Nigeria and then built a medical career in the United States, in California. So talk to me about what happens psychologically when you're trying to balance 2 cultures while carrying everything you carry, taking care of everything, taking care of the family, taking care of your practice? Um, how in the world did you do all of that?

Yeah, that's an interesting question. So, um, obviously the cultures— the culture between Nigeria and the United States is very different. So, um, after I immigrated, there was a phase of the culture shock. Nigerians in general, we tend to be more chatty. We tend to talk. We tend to be the loudest voice in the room, the most visible presence in the room. And while here, people are a bit more quiet. Not everybody, obviously, that's an overgeneralization, but in a nutshell, people are a bit more quiet. So there was that of, oh my goodness, I'm in the flat and I don't even know who my neighbor is. I don't hear any noise from that part.

Yeah, we stay very isolated, don't we? We kind of isolate ourselves. We're like, it's me over here and I'm hiding.

I'm hiding in the house. Yeah, so that was the first surprise to me of not knowing who lived right next door to me, and that general quietness was— at the point, I've always been an introverted person. I've always valued quiet, but that felt a bit too quiet. That was so strange. Then, um, then also like trying to, um, acclimatize to having different types of food available and then trying to, um, then writing exams. Of course, that was tough to make it into the medical, um, field here. And then being a mother as well. So sometimes I feel like I'm being several people at the same time. The person I am with my, with my kids Um, because they are growing up here, their culture seems to be entirely different in this generation now. So the person I am with them is different from the person I am with my parents or even with my husband. And when I go to work as well, I'm, I'm somebody different because I know I need to relate to my patients and my, and this, and my co-workers and, and the staff around me. I need to relate with them not as as the Nigerian knacker, but someone that is somewhere in between, you know.

So there's, there's all of that too. And also comes out in the little things, like for instance, a coworker inviting you out to eat, then you think, oh, what kind of place is it? Can I even eat the food that is there?

Yeah.

So, and then deciding that, okay, I, I will show up not because of the food, but because I want to be with these people they're my co-workers and I enjoy their company, so I'm going to go there for that reason. And also finding out how to say no to some foods without coming off like you're being offensive. So there's all of that juggling involved too as well. And, um, that's, um, something that, um, Nkem also embodies in, in my book, uh, Life of Nkem, because she's also an immigrant, she's a wife, she's a mother, and she's also battling with her mental health concerns. So she also feels that pressure to be several different people at the same time. Only difference is that she might not have done the best job of hers in the beginning, but along with her journey to learn how she goes and what she carries with her.

Oh, I love that. And as we read it, we can learn with her. So You're a physician who chose fiction, and you've already said, hey, I was a writer first, but you chose fiction to talk about depression.

Mm-hmm.

What do you feel like we can learn from a story, from Nikkim's journey, that we wouldn't learn if you were seeing us as a physician or just talking to each other? Why is— and you're a storyteller. And I'm a trained storyteller too, so I believe in the power of stories. So for you, what can we learn and why can we learn so much better with stories, especially when it comes to something that needs to be talked about more, mental health and depression specifically?

I think the role, you know, where fiction plays a good role is that in real life, let's say you go to see your therapist, maybe it's an hour session, or you go see a psychiatrist or even another medical provider. And, you know, you hear the statistics, you know, you hear about postpartum depression, you hear about depression, you hear about PTSD. It's just something that you heard. Sometimes, you know, by the time you're in the parking lot, it's kind of gone already.

Yeah.

So it's just something that was just thrown at you and you're like, okay, depression, these are the symptoms, these are the signs, blah blah blah, and then it's gone. And, um, Live for Me in Chem is not, it's not the textbook on depression. It's by— is in no means— it's, it's not, um, a guide on how to manage depression. It's not a medical textbook in any way. I'm not a psychiatrist. But, um, that being said, it does invite the reader to sit in Kem's experience for a few hours, for, you know, some 100 pages. So by the time you get through sitting in her experience, seeing what she sees, feeling what she feels, and not just her too, you get to see it from the perspectives of her children too, because you learn how depression affects the entire family.

Yes.

Most times we think of it as, oh, this person suffers from depression, but no, it's almost like the whole family is suffering right alongside with her. So by the time you sit with her and experience all of this, you come away with a deeper understanding of how depression affects not only one person but entire family. So, and I think that's something that fiction does, um, really well, you know, it kind of holds on to your hands and it pulls you in into this story, into this experience. And while you're in there, you experience all of that, and that knowledge is almost like something that you've lived. So—

Mm-hmm.

So you— it's no longer something that you heard. It's not like you actually had that experience. And I think after having that kind of experience, we become more empathetic. We understand more. We might be willing to give a little bit more of ourselves to someone else that is in need.

Yeah.

Because sometimes the key to, um, helping someone who is struggling is actually being able to listen. And sometimes if you don't know what you're listening to, you may not even hear it. You know, so if you, if you open yourself up and you have an idea, um, what the lived experience might be, then you're a better support person for someone who might be struggling, or it might even help you understand yourself even better.

Yeah, because you're living it with her, right? Yeah. Yes, I love that, that you embody the experience like you embodied her experience while you were writing it. So we go on a journey Journeys are actually where we learn the most. So I love that. Yeah, I love that. So let's talk to the people that might be struggling. So we opened up with that question, hey, how are you? And the accepted answer is great, good, fine. I'm fine. We perform fine. So what should we be doing instead? What would you like to see happen if you come to me and you go, hey Lisa, how's your day? My day's a little off, right? Maybe I just got in an argument with my husband or found out some news from the corporate side of my life. How should we approach each other differently?

I think for the person who is asking the question, maybe be a bit more open to hearing beyond the words, because most times there's some kind of clue or a hint. I know we are all great performers. We wear this mask very well, but sometimes there's always a hint, maybe an unfinished answer, like, oh, it was great. Well, it's great. And we would love to be, oh yeah, sure, sure. Oh, that's good to hear. So that we just cut it off and move on. Maybe we need to be at work on time, or there's something that we need to do, or we just feel like we're not ready to listen. And we're like, okay, that's good that you're doing okay. It was good to see you. All right, catch up next time. And we move on. So maybe just take a minute to say, are you sure? it sounds like there was something you were going to say. And even if the answer ends up being, oh no, I'm sure I'm okay. And then you may say, if you do have something to talk about, um, I'm here to listen. Sometimes just offering that ear might be enough, you know.

It really is sometimes, isn't it?

It is.

I mean, sometimes you just have to externally process it. And so my, my friends and I have a thing where We go, you know, do you, do you want advice today or do you want me to just listen? And sometimes my best friend will be like, do you want to be right today? And I'll go, yes, I want to be right today. And then the next thing she's like, you were the asshole in that situation.

So, oh my goodness. Yes.

But we do, we, we have that agreement that we ask each other, hey, you know, what are your needs right now? Do you need me to just be here and listen? And sit with you in this tough moment, or are you open to some suggestions or advice around it? And it really helps because sometimes just having another person— or you know what, Doctor, sometimes just sitting with somebody, even if it's in silence.

Oh yes, I think that actually— yeah, I actually have that in my book too, and that's That's actually part of the dedication in front for those who sit in the dark and for those who have learned to sit beside them. So that's actually the dedication to Live for Me Nkem. And I think Nkem's husband does that. That's one of the things he does well. He's just learned to just sit quietly beside her in her dark space.

Yeah.

Yeah.

Yeah, which is— I, I think it's hard for people to do because we want to fix it, we want to judge it, or we're so uncomfortable with our own emotions maybe around it that it creates challenges. So I love the opening in your book because it is a reminder to us That just sitting next to somebody in silence is sometimes enough. Yes. Yeah, right. Yeah, yeah, yeah.

I think sometimes the silence can be challenging because just like you said, we want to fix it. We have our opinions and thoughts about it, but sometimes depression, there are some parts of it that the person who is going through it has to do by themselves. And there's only so much you can do. And sometimes the most you can do is to sit beside them while they do the rest. And when it comes to that, if all they need is silence, we should be willing to and able to give it to them and just sit quietly beside them. But that's not always easy to do. But sometimes that's what we We need to do.

Yeah, it's, it's not always easy, but again, it can be absolutely so beneficial. And I love your point that the— this work is sometimes a very solo journey. It's our internal work to do and work through, and it's our dark night to go through, and we will always come out on the other side eventually, um, if we can find the right support. support underneath us, uh, while we go through it. And that includes supporting ourselves, um, through it. So yeah, I, I do think you're right. It's because we, we feel like we have to do more.

Yes, yes.

And we don't. And we don't. Yeah, I love that. Well, Dr. Nneka, where can people find this beautiful book of yours?

So Live from Income is available on Amazon. It's currently up on pre-order right now as we speak. Yeah, Barnes& Noble, books.com, and, you know, many major retailers. It goes live on September 9th. So September 9th, that's when the actual physical copy will be in our hands. But, you know, right now we can preorder Live from Income.

Wonderful, guys. Please go there. There's going to be a clickable link. You don't have to write any of that down. There will be a clickable link, uh, right underneath this in the show notes where you can go. Please go pick up the book in presale, preferably, so she can come out as the number one bestseller before it even launches. That would be Fantastic. All right, my friend, we ask our guests a couple of questions before we let them go. Are you ready?

Yes.

Okay, the first question is, in your own life, what have you performed in order to survive, and what did dropping that role, mask, or performance do for your life?

I think the major one I would say would be with competence, and that's also integrated with strength. So, you know, being here, being a physician, and being a mother as well, you're expected to have, you know, all the answers. You're expected to show up, do what you need to do. And, you know, I think for me, the most part, I thought that with my children. I felt like I always had to have the answers. I always had to do what they needed. And sometimes, well, not sometimes, all the time, being a mother is not a job you can put down. You can't really take a break. You can barely get a restroom break. So I feel like I had to learn to say, this is mommy's time. you know, go spend some time with your dad. Or I even had to learn to accept help from other relatives, you know, and say, oh, can you watch them for a few hours while I, you know, do this or do that? Because there was some sort of guilt because whenever I go to work, and come back, I feel like this is my time with them.

There was the guilt of if I have someone else watch them, then I'm not being the mother I should be. I'm not being who I should be with them. But then I realized that if I spend all this time at work and spend all this time with them, then there's no time for me. I had to learn that, you know, Setting aside, even if it's an hour a week for myself, didn't make me, um, a bad mother or a terrible mother. It just meant that I had more to give to them when I'm with them. So I had to learn to put that aside.

100%. You do end up having more if you give yourself the time. But mom guilt is sneaky guilt, so I get it, I get it. All right, the last question is What do you want us to be having more conversations about? What do you want us to be talking about that you're not hearing us talk about?

I think maybe what— how we really feel. And that's one of the cultural things I felt when I first came here. I feel like in Nigeria, when you ask someone, how are you, you've opened up a whole trapdoor. and everything comes spilling out. So if you do not wish to hear it, maybe do not ask. But here it's a bit different. There's a script for it. There's an answer. Oh, how are you today? Oh, I'm great. And I found that very— that was one of the culture changes I felt when I first came here. Oh, someone asked me how I am and they actually do not want to know. That's very strange.

Don't ask if you don't want to know. Yes, I like that stance. I love that stance. I'm gonna borrow that. Don't ask if you don't want to know. Absolutely. Well, we are going to send so many people your way to help you in pre-sale. Congratulations on the book, and congratulations on being willing to jump out of your comfort zone, carve out the time for yourself, and take this journey with the characters in your book. Um, so exciting. Friends out there, I'm gonna ask you the same question. What are you performing in order to survive? And what might setting that role, mask, or performance down do to just lighten your load a little bit? I am your host, Lisa Lacey, here with our guest, Dr. Nneka Aluha. And when you find the answer to that, we will both see you at the edge. Thank you so much, doctor.

Thank you so much, Lisa.