I’m of the generation that doesn’t believe in therapy. Not so much that we don’t believe in it … more that we are of the mindset that we should be able to manage on our own. If we did need help, we would figure it out privately. By the time I became a physician, self-reliance wasn’t just a value; it was a tried-and-true survival strategy. Years ago, during a medical malpractice deposition, the plaintiff’s attorney asked — almost disdainfully — whether I had ever been in therapy. I remember answering with pride. Nope.
I grew up during the reign of terror in the Islamic Republic of Iran — an era that inspired Margaret Atwood’s dystopian novel “The Handmaid’s Tale.” In the mid-1980s I immigrated to the U.S., a time when antipathy toward Iranians was high. I also grew up amid the normalized alcoholism of my father and extended family. Survival mode was my default state. I learned early how to shrug off whatever came my way, trusting that I would somehow manage.
When I became a parent, I was intentional about creating the family life that I’d missed out on — one filled with stability, predictability, opportunity, and warmth. My sons grew up in one home, attended the same schools year after year, and formed lasting friendships. They were surrounded by cousins, family traditions, and joyful rituals — annual ski trips, shared meals, ordinary happiness. So when, during adolescence, they would ask for “mental health days” I was bewildered. It made no sense.
The first real fracture appeared during my eldest son’s middle school years. Bright, curious, and deeply intelligent, his grades began to slip. For his father and me — both children of immigrants, both physicians — this was deeply unsettling. I practiced emergency medicine; my husband pursued an academic physician-scientist path focused on curing childhood cancers. Achievement and perseverance had been etched into us by shared life experiences of our parents’ sacrifices. When our son’s Bs became Cs, and eventually Ds, we were shocked, dismayed, and righteously angry. It was during the in-home COVID year that the pressures converging on our teenage son pushed him to a breaking point that forced us to consider therapy for him.
That decision changed him and our family far more than we expected.
As we began to understand his neurodivergence, I also began to recognize how my own survival-based stance shaped our family culture. The way I moved through the world — the very posture that had helped me endure — was eroding our family’s connections. I came to understand that what was needed wasn’t a tweak or a new parenting technique, but a fundamental shift — not just for my child, but for me as well.
It was also during this period that I personally experienced the power of therapy — not as an abstract concept, but as a lived process. Over the following years, I began to see that there is another way to move through life: one that is relationally sound, emotionally grounded, and wholehearted. These shifts have reshaped my personal life, my family life, and my professional life in ways that have remained enduring and transformative.
Therapy offered me tools and perspectives that meaningfully changed my life, and I came to believe that anyone who is willing and motivated can grow with the right guidance and support. From that place, I took another step. After 28 years as an ER physician, unwilling to remain beholden to the legal, insurance, or pharmaceutical industries, I chose work that feels meaningful and aligned with my values. In May 2025, I graduated from USC’s Marriage and Family Therapy program and began transitioning from emergency medicine to becoming a therapist.
I like to think of our mental health in the same way we view our physical health. We don’t stigmatize working with a personal trainer for physical fitness. Why should psychological health be any different? Therapy does not have to take years. Some seek short-term, solution-focused work for specific issues; others pursue deeper exploration to untangle long-standing patterns. The scope and boundaries of therapy are defined by the unique relationship between therapist and client.
I’ve completed a generational journey from “I don’t believe in therapy” to becoming a therapist myself. This doesn’t mean my problems have disappeared or that life has stopped throwing curveballs. But I find myself moving through the world with greater ease and steadiness, without scorching those closest to me, and with a sense of centeredness I once could not have imagined. Given how relatively short our lives are, why not live as fully and wholly as possible?
Shahrzad Rafiee is an emergency medicine physician practicing in Long Beach California since 2001. She is also an Associate MFT and working as a therapist.
Image by Diana Connolly/Shutterstock
