The challenges of a voice condition, anxiety and working as a waitress – interview from Japan

A young woman living in Kanagawa Prefecture in central Japan, the country of her birth, having grown up in Malaysia and studied in Australia, shared her experiences of her life with her partner in Japan, including her experiences of her voice condition of spasmodic dysphonia and the effect of this on her social anxiety symptoms. She also shares her personal history of returning to Japan as a non-native speaker, having had to abandon her hopes of pursuing a life in Australia and the effect on her emotional well-being. She currently works as a waitress in a busy restaurant, a job role she has gained experience in, including, in different countries. Please note, this account contains references to suicide.

I see working as a waitress as my first step in building my social/people skills and self-confidence. I’ve taken on the same role in other countries, but there is no restaurant that operates the exact same way as another. The general flow of work (escort, take order, serve order, clean up tables, cashier, etc.) remains similar, but some require more communication skills than the others. Moving countries has made it hard for me to step up in my career and I find myself having to always re-adjust to my environment and start from zero. Due to reasons related to relocation and toxic managers, there is no restaurant where I worked for over a year at one go.

Regardless, waitressing gives me comfort as it’s what I have built the most experience in so far, and there’s a lot of flexibility to it – having more control over my shifts, less burden of responsibility and being able to quit at any time when I feel ready or whenever necessary (i.e. with a 2 weeks notice). If I accumulate my work experience from all of my workplaces, I’d have almost 3 years worth of experience as a waitress.

If I am still new and have many things to learn and get used to, it can be hard to relax at home after a training/working day. In this situation, I spend most of my free time at home learning whatever I can to perform better at work. For example, studying the menu, preparing questions to ask the next working day, organizing and re-reading notes written down during training, etc. Only after working a certain amount of time and when I feel like I have adapted well to the workplace and coworkers, I can easily forget about work and relax at home. Though from time to time, if I experience communication problems at work (stuttering, for instance), I go over what I wanted to say and practice at home. Interpersonal problems, such as rude or angry customers, micromanagement at work, other staff who slack and lack cooperative skills, etc. tend to stick with me longer and it can feel stressful even after coming home.

Relaxing at home, to me, is just doing whatever I feel like doing at the moment – napping, watching entertainment, cooking, cleaning, etc.

In my past workplaces in Malaysia and Australia, English was the main language used and there was more cultural diversity. That made the work environment comfortable for me as it was easier to fit in, and I was frequently in a position where I had to assist staff with low English proficiency. This helper role came to me very naturally and it was satisfying for me. In Japan, work is more formal and I feel like the odd one out. In particular, communication problems that arise from language barrier is a challenge that I feel is a high hurdle to overcome as well as problems related to my anxiety. At my previous workplace in Japan, I had to give an explanation of the menu to customers after escorting them to their seats. That made me feel nervous and uncomfortable as it felt like a mini-presentation with all eyes and ears on me. The challenge at my current workplace is having to talk into a microphone when calling the next customer in line after a table is open.

All of the workplaces I’ve worked at are very busy businesses, especially during peak hours. Although I get overwhelmed, I manage well during these periods as I get very focused on my work and act according to the priorities I set. There can be many things that need to be done at one time but I do one thing after the next quickly in the appropriate order. Also, busy hours are the only time when I can tweak my work a bit so that I work swiftly. For example, in the previous workplace where I had to explain the menu to customers, I would put the menu on the table and let the customers know to call any staff if they have any questions and move on to my next task.

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He [my father] supports me with taxes and health insurance but there is definitely pressure coming from him. While he knew I developed and struggled with my voice condition, he says comments like I am still a kindergartener and questions me if I know how much money it costs to pay for taxes and health insurance. It feels demeaning and it makes me think that he is only supporting me out of obligation without any genuine worry or compassion. Because of this pressure and also my own will to be independent, I manage my money well enough where I have never needed to ask him for extra money.

From all my previous workplaces, I never earned a lot of money but also never earned too little (as there is flexibility and control over my working shift) to not be able to pay for my expenses (rent, utility bills, phone bill, food, etc.). Rent and utility bills are fixed to a certain amount, and I budget my expenses for food to a specific amount each month. This allowed me to spare a good amount of money which I usually keep for savings or spend on eating out or on gifts for birthdays. This has been the situation up until my most recent work.

Currently, I am living with my partner (and is the first time living together with someone) and this new lifestyle has lifted a lot of financial burden off me. I no longer pay for rent and utility bills and, fortunately, this happened when my voice quality began to deteriorate to its worst state. After relocating and moving in with my partner, I was unemployed for several months and used this open time to find a diagnosis for my voice condition. I relied on my savings when I needed money during this period and after getting a formal diagnosis, I gathered my courage to look for a temporary job that required minimal communication while I thought over the treatment options. Financial stress is a big focus in my life now due to this voice condition in addition to anxiety and low self-confidence. Being financially independent is an immediate goal for me and I wish to achieve it as soon as I possibly can.

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Before this voice condition [spasmodic dysphonia] occurred, I did not have any major issue in socialising and as my anxiety was at a bearable level, it was still possible for me to challenge things that were out of my comfort zone. I think the best way to describe it is that I had high-functioning anxiety – where on the inside, I’m constantly nervous and tremble from fear but I put on an act to perform well and behave appropriately. There were a few times, however, when I physically struggled and my nervousness was clearly visible to the people around me. I never intentionally ran away or avoided social situations nor did I make a conscious effort to put myself in them.

Around the time when my symptoms deteriorated and my voice quality changed drastically, I withdrew from talking as much as I possibly could. While my family could hear the change in my voice and when I expressed to them that it was difficult to talk, they continued to push me to go for job interviews (for professional work positions/full-time jobs) and dismissed my concerns. I became so quiet to the point it seemed like I underwent a personality change and there was a lot of frustration towards my family who pressed on their judgements and lacked understanding. I lived with my eldest sister during this time and worked at a restaurant. I pushed myself hard to pull through every working day and the action of talking itself became very fearful and tiring at both work and home. Every shift, customers would ask me, “What is wrong with your voice?”, “Is that your normal voice?”, “Is your voice alright?” etc.

Suicidal thoughts were on my mind very frequently as I felt extremely isolated, scared and hopeless. While living with my sister, I could not do what I needed to do for myself – taking a break from everything and to look for a diagnosis. I applied to jobs just to show them that I was trying real hard as they would constantly ask questions if I’ve applied to any and to how many. But with this voice where I cannot speak clearly and can be easily mistaken for sounding very nervous or appearing unconfident, failure was only met with failure. There was only one interview I passed, where the interviewer asked if I was sick and wished me to get better. I got a job offer from that teaching company and while I know my family would have wanted me to accept it, I declined it because I could not see myself working comfortably and felt that my spasmodic voice would cause many issues at work. 

Spasmodic dysphonia robbed me from expressing and presenting myself the way I want to. I do not sound professional at all and trying to make a good impression, especially in interviews, is extremely difficult. Even basic, day-to-day tasks like grocery shopping, ordering food at restaurants, etc. are much harder than usual and I feel dread when a staff asks me questions to which I have to reply with more than three words.

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I chose to further my studies in Australia because I wanted to immerse myself in white culture and saw it as a way to gain experience in doing things on my own. Distance-wise, it was not too far from Japan or Malaysia for visits. Adapting to Australia and familiarizing myself with it’s systems (transport, health insurance, accomodation, etc.) was, thankfully, easy for me as I had a mutual connection – my father’s coworker’s son studied in the same city. Although I had never met him before I moved to Australia, he was very friendly and was there to guide me and answer any questions or doubts I had.

I studied my Bachelor’s in Health Sciences (Public Health major). I actually wanted to study Physiotherapy or Veterinary, but due to my insufficient grades in high school/pre-university, my options were limited.

In general, my life in Australia was sometimes lonely, but peaceful and steady. I was very focused on my studies as I knew that if I failed even one subject, I would not be able to retake any without going through a miserable, intense talk with my father. When I was outside of the classroom, I was alone most of the time and I made only 2 good friends from university. Many things I did in Australia was for a specific goal – to land a full-time job and get citizenship. However, it was a little far too late when I realized it was an unattainable goal due to the unrealistic nature of the criteria to be fulfilled in order to be eligible to apply for citizenship.

There were a lot of oral presentations I did in university – usually in small classrooms and once in a big lecture theatre. Often, I hear people say that in the beginning they feel nervous but after speaking for awhile, they feel more relaxed and used to it. Strangely, for me, I get more and more nervous the longer I have to stand and speak in front of a crowd. The presentation I gave in the big lecture theatre was extremely stressful. I accidentally read the same line twice and I went into full panic mode. My chest was pounding, my legs were trembling and I was trying hard to control my head tremor. My vision started to get blurry and the last thing I wanted was to faint in front of everyone, so I stopped talking and squatted. This was my first time experiencing a panic attack and I was unable to continue my presentation due to the fear of having another attack and also because of embarrassment. The impact of the experience sticks with me until today, and I avoid job applications where presentations are involved in the interview process.

Financially, my father covered all of my university fees and my living expenses. I would receive a sum of money that was meant to be used for a whole year at one go, and so I built a habit of keeping receipts then noting down the prices for the necessities (toilet paper, shampoo, toothpaste, etc.). Eventually, I made a weekly budget for food and a total monthly budget, and stuck with this routine the entire time in Australia. This financial management, as well as small income from my part-time job, enabled me to save up a fairly good amount of money which I prepared in the case of being unemployed for some time after graduation.

Post-graduation period was stressful and there were some dark moments here and there. A lot of my worries were around getting a full-time job and the reality of moving back to Japan as the only appropriate solution was hitting me harder at a gradual pace. This was at my conscious level, but at my subconscious level, I was emotionally struggling from the impact left from a physical fight I had with my father when I visited Japan for a while for my coming of age ceremony. I found myself in unbearable loneliness and misery at times in Australia, and I made a suicide attempt. The sort of thoughts that ran through my head right before the suicide attempt was, “I am completely alone and I want to escape from everything”, “I don’t want to see another day”, “My death might bring new meaning and inspire my father to change”, “My death might inspire people to be kinder and bring more awareness and openness towards mental health”, etc.

The decision I made to return to Japan was based on logical reasoning. Instead of focusing on my feelings (how much I did not want to go back due to my fears), my focus strongly pointed towards an objective perspective (what I should do, what I will be left with if I continued to stay in Australia and what other opportunities I would be missing out on). Only after making the decision, the fear of the unknown reality that was waiting for me slowly started creeping in. I kept myself busy from negative emotions as much as possible with my part-time work, self-study in Japanese and packing. Regardless of the fear, once I made the decision, it was 100% set and it never swayed. I recall breaking down and crying on my final day of work.

*Note: the decision itself did not contribute to my suicide attempt. The anxiety around the awareness that things were not going well for me (the job hunt) and how moving back to Japan was becoming a more and more realistic option contributed to it.

When I left Australia, I made a visit to Malaysia where my mother was, before returning to Japan. Being in Malaysia again felt very nostalgic and made me think of the carefree days of my youth. It was nice to catch up with my mother again, and I got to meet with a childhood friend after many years. On the day of departure, I had lunch at the airport with my mother and I remember feeling like it was my “last moment” before going face-to-face with whatever was in store for me. I broke down crying and I couldn’t help but feel mentally and emotionally unprepared for it all. My mother was on alert with the time but I insisted on heading to the departure gate near the time it closed. When I felt it was time to make a move, I said my goodbye to my mother in front of the departure hall. While I was walking towards the departure gate, I looked at the list of the flight information and found out the gate had already closed. I panicked knowing I missed my flight – but at the same time there was big relief. And so, I got to stay in Malaysia for a while longer until I was at the airport again – but this time, I felt more prepared to leave.

I think my past suicide attempts has made me more susceptible to suicidal thoughts. To this day, I still struggle to make full sense and accept/embrace various things, such as my identity or my father’s behavior. There is a constant lack of peace within myself and an inherent dissatisfaction about life due to believing that life is hard and tragic. The feeling and thought of “wanting to get away from everything” is still there, but the awareness that taking my own life will indefinitely hurt other people keeps me away from doing it. 

This is all I can write although there are more things I wish I can write. It feels very suffocating and painful trying to process everything into proper words and sentences. Thank you for letting me write up to what is comfortable for me 🙂

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In general, making friends or close bonds is hard for me due to several reasons. I don’t necessarily go out of my way to approach and talk to people with the purpose of building personal connections (i.e. friendship). I tend not to take initiative as the process is tiring and I rather leave it to happen naturally. I find it uncommon to “click” with people beyond surface-level, and so, for these reasons my social circle has always been very small. When I do initiate conversations, it’s usually for the purpose of building surface-level, positive relationships in order to get along with classmates at school or coworkers at work. Outside my social circle, I appear to be very rigid, agreeable and polite/nice to a fault. I smile as much as possible and it feels very unnatural. I hold myself back from saying things that are actually on my mind, and because I try to please people (even in subtle ways, like making firm eye contact when people talk to me to show them that they have my full attention), social interaction is exhausting and draining. I fear of being disliked by people and want people to have a good image of me. 

My social life, right now, is still very small. My partner is the only one whom I happily interact with everyday, and his family a few times a month. Especially with my voice condition now and the burden of future expenses, I’d rather avoid expanding my social circle at least until my voice has made a recovery.

Support groups for returnees are most likely non-existent here in Japan. I’ve heard of schools for returnees to catch up or brush up on their Japanese skills, but I have never physically seen local support groups or institutions that offer social support. Maybe, they exist online, which is where I, fortunately, found a support group for my voice condition. Most of the members there have been diagnosed with the same condition and other members are friends or family members who have joined to be more involved and learn more about the condition. The group is very active and people post questions or share their experiences to spread knowledge, uplift others or to simply vent.

Anxiety, however, does impact how I utilize social media to make or maintain social connections online. I have a weak presence on social media due to my fear of people making judgements on what I put up. I feel afraid to share my feelings, thoughts and life experiences to people I don’t know well. I am particularly sensitive to photos and can become flustered if I find out other people have put up photos of me. My quietness has resulted in losing good connections I once had and overtime, it has enhanced the fear of posting things online.

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Preparing the next steps for my voice condition required an in-depth research in understanding the condition and the options available. As the voice condition has no cure, it does make the pathway to a smooth road more complicated than it seems to be. Even though there are plans in place, there is still uncertainty if it will be successful or if it will fall right into place. 

Currently, I am taking botulinum toxin A (i.e. botox) injections which helps to relax the muscles of my vocal cords, thus, reducing the spasms. The effect of this treatment is only temporary, and so, multiple visits to the ENT is needed when the effect has worn off. Due to the inconvenience of multiple trips and side effects that initially occur, and the high-cost in the long run, my next step is to attempt surgery. The surgery does not restore the voice completely, but improves the voice drastically in comparison to the symptomatic voice for over a course of years. Whether the improvement will last for a lifetime is unknown, but the level of satisfaction from patients who have undergone the surgery is relatively high.

Given that the surgery is successful and my voice becomes free of spasms, I will start looking for full-time jobs. The area of interest will be teaching English to children and if there is low recruitment, I plan to utilize an employment service center to look for other jobs that are suitable for me. If the surgery is unsuccessful and my voice remains spasmodic, I will make use of the employment service center to look for full-time jobs where speaking is involved little to none. Job interviews always make me very nervous and tense, but as I push myself little by little, I can give myself a pat on the back after every effort. 

Knowing that there is no quick fix for anxiety, I am aware that it will be a long process to get better and requires patience. I have reflected enough to come to an understanding that to fully overcome it, I need help from a counsellor/psychologist. Seeking help from a counsellor/psychologist has been in my mind for years, but as it is expensive, I plan to approach one some time after getting a full-time job. Currently, I don’t really know if I can say I truly have social anxiety or if I simply have had many experiences of the symptoms. That is the main reason why I feel the need to see a psychologist. I think seeing one can help me clarify many things, especially my mental state. It feels like it’s been many years that I’ve wondered and asked myself, “What is wrong with me?”. There are times when I have thought my anxiety is more linked to cPTSD as I’m certain my anxiety was triggered from past negative family events and harsh upbringing.

Apart from time commitment and high cost, I have delayed seeing a psychologist due to moving around as it seemed to be such a hassle to talk about myself from zero every time I saw a new one. When I was in my teens, asking my parents for permission to send me to a psychologist was absolutely out of the question. Because of this, I approached my school counsellor when I noticed my anxiety impacted my studies. The only place and time I could study with good focus was when I was at home or alone if I was outside. Learning at school (focusing on my teacher in class, class presentations, random questions being thrown at me during class, exam revision with the class, etc.) was difficult for me. For exams, when my seat was in the middle of the room or when the exam invigilator walked by me, I got too anxious to be focused on my paper and blanked out. As a result, my grades suffered. The conversation I had with my school counsellor pretty much sparked my awareness about the core problem of my anxiety. 

During the time when I moved into my partner’s home and was unemployed for a while, I tried online counselling, in hopes there would be high engagement and progress regardless of the cost and time. However, the counsellor appeared uninterested and the interaction was not engaging. It also felt too overwhelming because there was too much that has happened and too much to explain. After a few trial sessions, I cancelled my registration and withdrew from the program. 

At this point, I am unsure if I will overcome everything but I am taking things step by step without complicating things too much. Resolving my own problems (voice condition and employment/financial issues) and expanding my social support (making friends and getting to know people with similar life experiences) will hopefully decrease my stress and increase my overall happiness and wellbeing. Only then, facing and addressing my family problems (which I believe is the core issue) will come so that I am already on my two feet and less prone to being emotionally fragile.

I think I have noticed something interesting – how some people can remember a lot of things (in great detail too) while others, block it out and can’t recall much. Hm, I wonder why that is so and how different the journey to healing would be between the two groups.

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Author: Workers' Archive

Covering sensitivity at work and beyond on my website: https://samuelaliblog.wordpress.com/

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