Anxiety Chronicles is a series from The Lily that examines the journeys different women have with anxiety.

This week, we hear from Gisella Tan, a San Francisco-based freelance writer from Hong Kong. At her day job as a marketer, she advises brands on their content strategy.

Interested in contributing to a future installment of Anxiety Chronicles? Fill out this form.

I began experiencing anxiety when I left Hong Kong for college in Los Angeles. Leaving home long term for the first time was exhilarating; since middle school, I had yearned for escape.

Freshman year was sadly not as rosy as I had imagined. Suddenly, I faced the struggle and stress of losing my safeguards of family, friends and familiarity.

It took time, but I eventually found comforts in new friends and extracurricular activities. My family encouraged me to stay in the U.S. post-graduation, citing Hong Kong’s bleak future. However, this required me to earn the grades and resume to deserve a visa-sponsoring job. I was overwhelmed with the pressure to meet that invisible threshold, demanding constant excellence from myself — packing my schedule with classes, student leadership meetings and internships — that led to exhaustion.

But the threat of failure was real. I had my first panic attack shortly after graduation when scrolling through the mounting pile of job rejections and contemplating my expiring student visa.

Although I’ve found temporary stability in my immigration status since then, I still feel constant anxiety from the possibility that my life here could be abruptly upended.

My hands are immediate indicators of whether I’m having a high-anxiety day. I wake up with half-moon cuts in my palms — I’ve been clenching my hands into fists while asleep, nails digging into flesh. Throughout the day, my hands and feet stay clammy no matter the temperature.

My anxiety drains me. I take an unrewarding nap after work, but I’m trembling uncontrollably. It’s almost like a soft vibration.

If I’m facing particularly stressful situations, my anxiety manifests as hyperventilations and a sprinting heart. The lack of control is terrifying; I’m worried I may have a heart attack. On occasion, I even throw up.

I am crippled by the fear of dying and preoccupied with thoughts of death. Logically, I understand why. My anxiety transpires from the dread of failure and worries of a life colored with regret.

It’s ironic. In feeling anxious about a life wasted, my decisions are fearful and overly cautious. I refuse to jaywalk. I make my loved ones message me when they leave and arrive home. I’ve never gone skiing. In avoiding danger, I avoid adventure. Happy moments are tinged with “what if” — when celebrating a birthday dinner, I’m worried about a potential mass shooter; when my boyfriend takes a moment too long to respond to a text, my default thought is that he’s dead.

Ultimately, even in relatively neutral situations, I’m unable to let my guard down and truly relax. When I catch myself momentarily undeterred, I’m racked with guilt, anxiety spiraling.

On my worst days, I am completely lethargic and useless. If it’s a work day, I’ll call in sick. If it’s a weekend, I’ll cancel all plans.

I can easily spend the whole day in bed, which I’ve deemed the safest place, alternating between unconsciousness and trepidation.

If circumstances don’t allow for staying in bed, I’ll run through the day’s routine with a hazy mind. Minor setbacks can set off uncontrollable sobbing sessions in a bathroom. Interpersonal gaffs will be magnified and ruminated on all day; to be safe, I avoid socializing. Paranoia about death engulfs me wherever I go. My sense of self-worth plummets and I can barely function. “What’s the point?” I ask.

I wanted to truly internalize the fact that death is a certainty, albeit a scary one. American culture is fairly death illiterate, so I turned to secular Buddhism for reassurance. It’s also been helpful to tune out news.

Having a dog has also been instrumental. Now, my responsibilities extend beyond taking care of myself — having to take him out on walks has broken my usual routine during high-anxiety days. I’ve learned that my anxiety is dampened when forced to get a breath of fresh air.

Anxiety is still such a taboo subject to discuss, especially in Asian cultures. I’ve witnessed my loved ones refusing to acknowledge invisible mental health disorders, putting the onus on the person suffering from depression or anxiety to “just make an effort to feel better.” I wish they understood that anxiety is a real disorder instead of berating me for moping while feeling its effects.

Anyone can have anxiety. It’s not taboo. It’s not shameful. If a friend or family member does share that they are struggling with anxiety, listen empathetically and respectfully.