Some Advice on Supporting Friends with Depression

This Captain Awkward post about supporting friends with depression has been bouncing around in my head ever since I read it when it was first posted last August.

Since I’ve been having my own little depressive episode since December or whenever that was, I’ve been wanting to shout this entire post from the rooftops (except, of course, I don’t have the energy). I’ll highlight this part in particular:

I think one thing you can do to help your friends who are depressed is to reach out to them not in the spirit of helping, but in the spirit of liking them and wanting their company. “I’m here to help if you ever need me” is good to know, but hard to act on, especially when you’re in a dark place. Specific, ongoing, pleasure-based invitations are much easier to absorb. “I’m here. Let’s go to the movies. Or stay in and order takeout and watch some dumb TV.” “I’m having a party, it would be really great if you could come for a little while.” Ask them for help with things you know they are good at and like doing, so there is reciprocity and a way for them to contribute. “Will you come over Sunday and help me clear my closet of unfashionable and unflattering items? I trust your eye.” “Will you read this story I wrote and help me fix the dialogue?” “Want to make dinner together? You chop, I’ll assemble.” “I am going glasses shopping and I need another set of eyes.” Remind yourself why you like this person, and in the process, remind them that they are likable and worth your time and interest.

Talk to the parts of the person that aren’t being eaten by the depression. Make it as easy as possible to make and keep plans, if you have the emotional resources to be the initiator and to meet your friends a little more than halfway. If the person turns down a bunch of invitations in a row because (presumably) they don’t have the energy to be social, respect their autonomy by giving it a month or two and then try again. Keep the invitations simple; “Any chance we could have breakfast Saturday?” > “ARE YOU AVOIDING ME BECAUSE YOU’RE DEPRESSED OR BECAUSE YOU HATE ME I AM ONLY TRYING TO HELP YOU.” “I miss you and I want to see you” > “I’m worried about you.” A depressed person is going to have a shame spiral about how their shame is making them avoid you and how that’s giving them more shame, which is making them avoid you no matter what you do. No need for you to call attention to it. Just keep asking. “I want to see you” “Let’s do this thing.” “If you are feeling low, I understand, and I don’t want to impose on you, but I miss your face. Please come have coffee with me.” “Apology accepted. ApologIES accepted. So. Gelato and Outlander?”

I think it’s a natural impulse to assume that the only way you can help someone who’s in a lot of pain is to try to address it directly, that maybe if they Vent to you and Get It Off Their Chests then they’ll feel better, and maybe sometimes they do, but I never did. I’ve written before that a lot of unnecessary pain and drama happened in my life because people thought they were willing to hear me vent and I thought it would be a good idea to take them up on the offer.

I truly believe that all of these folks mean well, but I truly believe that they don’t really understand depression, because they treat it like it’s just a LOT of sadness. Like it’s just like getting fired from five jobs at once, or being dumped by five partners at once (hey, if you’re poly, it could happen), or having a Really Bad Day where literally every single thing that could go wrong goes wrong, from getting humiliated in front of the whole office by your evil boss to losing your keys to walking into the subway station just as the express train pulls away to realizing you’re out of toilet paper right when you need the toilet paper.

Those things are not like depression. Those things are just really shitty.

One thing about depression is that it makes it really difficult to access the parts of your life that are genuinely good. For some people, this takes the form of anhedonia–losing pleasure or interest in things you used to enjoy. Not necessarily completely or all of the things, but sometimes completely and all of the things. For some people, this can mean that watching their favorite show or playing their favorite game is suddenly not fun anymore. For some, it can mean that trying to socialize with their good friends feels like reading a really boring story and not being able to actually interact with the story in any way. For others, it can mean not perceiving food as tasty anymore.

Another way this plays out is that you may still enjoy things, and know that you enjoy them, but lack the motivation to make those things happen. This seems very common. It’s a big part of depression for me. I do still enjoy spending time with my friends, but it usually doesn’t occur to me to invite them to do anything or to chat with them online, and if it does occur to me, I immediately come up with a bunch of reasons why I can’t do it and then I forget about it and end up reading for hours instead. Sometimes writing is this way for me too. But if I can just find a way to do the thing, I almost always find that it was worthwhile and wish I’d done it sooner.

So Captain Awkward’s advice about connecting with friends with depression is very on-point. If you just plop the ball down in their court, they’re probably going to look at it in confusion for a little bit and then toss it off into the bushes (possibly with a lot of shame and guilt). If you walk over, offer them the ball, and let them know how they can throw it back if they choose to, they’re much more likely to throw it back.

So here are some well-intentioned but not very helpful ways that people try to do this, and some better ways.

Less helpful: “We should hang out sometime!”*

More helpful: “I’d love to hang out if you’re up for it. Want to do that on Thursday night?” [if no] “Ok! Should I ask again next time I’m free?”

Less helpful: “Let me know if you need help with anything.”

More helpful: “Is there any way I can help?”

Even more helpful: “If it would be helpful for you, I’d love to [cook you a meal once a week/help you find a therapist/watch TV with you when you need a distraction. What do you think?”

Less helpful: You can talk to me if you need to.

More helpful: What helps you feel better when you’re feeling depressed? Is that something I can help with, and that you’d want me to help with?

Sometimes a friend with depression will say no to a lot of things and decline all or most of your invitations. This can make you feel like you’re overstepping boundaries and should immediately leave them alone until they reach out to you themselves. Pay attention to this feeling: it’s true that when people keep saying no to things you ask, it’s probably a good idea to stop asking. However, depression can also cause people to say no while wishing they could say yes.

The way to deal with this is not to assume, but to just ask directly: “You’ve said no the past few times I’ve invited you to do something. That’s okay, but I just wanted to check: would you like me to keep inviting you?” I’ve done this before with other people dealing with depression and found that they often respond that they do want me to keep asking, and they hope that one of these days they’ll be able to say yes.

For many people, depression causes a pervasive sense of disconnection from the world and from other people. When I’m having a depressive episode, I feel like I’m not part of anything, like I’m just one person and I don’t matter, like I could disappear and nothing would even change, etc. I feel like there’s a glass wall between me and everyone else. I feel like I can’t do “normal” things like laugh at a sitcom or make someone happy or fall in love. I feel like an alien sent here to try to learn how to act like a human being only I’m completely failing.

So for me, the most helpful thing that someone can do is to help bring me back into connection with others. This is why I find venting mostly useless. When I’m venting, I’m still only talking about my depression, and while the person I’m venting to may be very kind and a very good listener, this isn’t something we can connect over, you know? It’s not the same as a two-sided conversation about difficulties we’ve dealt with in our lives. It’s totally one-sided. It’s just me, talking about the exact thing I need to learn how to stop ruminating over.

Helping a depressed person feel more connected to others is a tall order even for the most empathic friend, but there are some things friends can do that might be helpful, some of which Captain Awkward mentioned.

One is to ask for their help with something they’re good at. Make it clear that you really value this person’s skill or experience with this thing. This helps them feel that they have something to offer others, which is a feeling that’s pretty thin on the ground when all you can think about is how sad you are.

Another is to talk to them about some of your own struggles. I’ve always found that hearing about other people’s problems gets me out of my head a little by activating my empathic or problem-solving sides (depending on whether they’re just sharing, or asking for advice). It’s also a reminder that everyone struggles, even if the magnitude of that struggle varies for different people at different points in time. This may be somewhat specific to me, but seriously, the kindest thing someone can do for me when I’m depressed is to talk about their problems–it means I don’t have to talk about myself (hard to do when all I can say is “yup, still sad”) and I also don’t have to pretend to be happy while they share happy things (as much as I wish I could just be happy for others when I’m depressed, that is basically impossible).

Another is to plan fun things with your circle of friends, if you share one, and include them in that. While not everyone is up for group things, especially when they’re depressed, I personally find it more helpful than hanging out with someone one-on-one. When I’m with a group of friends, there’s inside jokes and lively discussion (that I don’t have to personally initiate!) and it makes me feel like part of something again. Seriously, last month I spent a week in Minneapolis (where I have a shocking number of close friends) and my depression was basically on hiatus that whole week, because I was just always surrounded by great people that I trust and care for, and they were being interesting and/or funny all the time, and it was great.

Remember that no matter how patient you are, and how much your friend may want to be able to spend time with you, sometimes it’s just going to be impossible. Some people disappear for weeks or months at a time when struggling with depression. It’s legitimate to feel sad that you’re not getting to see your friend, but please don’t take it out on them or make them feel guilty. Believe me, they already feel like human garbage, because that’s how depression tends to make people feel. Remember the ring theory and find someone else to talk to about your legitimate feelings about not getting to see your friend who has depression. If not being able to see them for a long time causes you to no longer feel close enough to them to consider them a friend, that’s also legitimate. Accept that nobody’s at fault and move on. They didn’t get depression as a personal slight against you.

The most important thing about supporting someone with depression is to be really self-aware. Make sure that you’re really doing it because you care about them and want them to feel better, not because you need the validation of Fixing Someone’s Problems. Depression isn’t going to be fixed by someone’s friends, no matter how kind and patient they are. You may invite them to a thing and they may appear and seem totally happy and then later that night they post another Facebook status about how awful they feel, and you may feel like you Failed and you might as well not have bothered, but trust me–it’s more than just in-the-moment feelings. I may feel like shit, but I’ll remember somewhere in the back of my mind that I have friends who love me and who make an effort to get me out of my room, and that matters.

Besides that, stuff like friendship bonds can be a protective factor against future depressive episodes. Your friend will eventually recover from their current episode, and now that they feel better, they may be able to fully internalize how much people care about them and how connected they are to others. That can help prevent a future relapse. That matters.

So don’t do it because you’re hoping to see obvious and immediate results. Don’t make a person with depression carry that burden for you.

~~~

Now that I’ve reached the end of what I have to say, I just want to note that it’s almost impossible to even write about this (especially given that I am currently depressed) because the response is always immediately “Yeah well you don’t speak for all depressed people, my partner/best friend/I are totally different!”

Yes, I don’t speak for all depressed people, but I speak for more depressed people than just myself. If you already know for a fact that this doesn’t apply to the person you’re thinking of, just ignore it. (Or write your own article that describes your own experience.) But you probably don’t know that, and you can open up a conversation about it by showing them this article and asking if they feel that it applies to them.

~~~

*I just want to state for the record that, depression or no, I have no idea what to do with “We should hang out sometime!” Are you merely expressing a preference for the sake of expressing it? Are you asking me if I also want to hang out? Are you asking me to plan/initiate the actual hanging out? In practice, I just respond, “Yeah, totally!” and then nothing ever happens.

A Case for Strengths-Based Diagnosis

[Obligatory disclaimer that I am not (yet) a licensed therapist and that the following is my personal opinion, informed by practice and academic study.]

Recently in a class on adult psychopathology, my professor was discussing the strengths and weaknesses of the DSM (Diagnostic and Statistical Manual of Mental Disorders), the text used to diagnose mental illnesses and categorize them for the purposes such as research, insurance billing, and sharing information among professionals.

One of the weaknesses he mentioned was one I’d actually never heard before: that the way the DSM diagnosis is written and shared does not include any space for also “diagnosing” the client’s strengths.

At first, this seemed irrelevant to me, not in the sense that thinking about your client’s strengths is not important, but in the sense that I didn’t see how it matters for a diagnosis. It almost seemed a little patronizing: “Yes, you have major depressive disorder and social phobia, but hey, at least you seem like you’re pretty resourceful and good at expressing yourself!”

But then I rethought that.

Here’s an example of a DSM-V diagnosis:

296.35 (F33.41) Major depressive disorder, early onset, recurrent episode, in partial remission, with atypical features

300.4 (F34.1) Persistent depressive disorder, early onset, with atypical features, with intermittent major depressive episodes, without current episode, moderate

V62.89 (Z60.0) Phase of life problem

It’s honestly difficult for me to imagine looking at this information with anything other than relief. For me, diagnosis has always meant one thing first and foremost: You’re not a terrible person; you just have an illness.

But to other people, seeing something like this can communicate a whole lot else. You’re sick. You’re fucked up. There is nothing redeeming about you. You can’t do something as simple as not being so sad. This is especially true when someone is already predisposed to interpret information about themselves in a negative light, because, well, that’s what mental illness always does.

In that moment, it can be really helpful to have confirmation–not just from a friend or loved one, but from a professional whose job it is to assess you–that you do have strengths and positive qualities.

So, here are some reasons incorporating strengths into diagnoses might be a really good thing.

  1. Giving hope and affirmation to the client.

Just like it can be nice to go get a dental checkup and hear, “You’ve been doing a great job at preventing cavities, but you need to floss more consistently in order to keep your gums from getting irritated,” it can be nice to hear, “Based on what you’ve told me, I believe that you’ve had a major depressive episode for the past few months. However, you’ve clearly been very good at reaching out to friends and family for support, and it sounds like you have a lot of people rooting for you to get better.”

Therapists and psychiatrists say “nice” things like this all the time, but writing it down as part of a diagnosis might be symbolically meaningful. To the client, that communicates the fact that their strengths are just as important as their diagnosis–important enough to be written on the form or in the chart. It shows that their mental healthcare provider, whom they might feel shy around or even judged by, does see them as a whole human being with strengths as well as a diagnosable illness.

  1. Providing possible avenues for treatment.

A psychiatrist may diagnose a client and then refer them to a therapist (therapy combined with medication tends to be more effective than either in isolation). Now what? The therapist can look at the diagnosis, or ask the client what it is, and proceed from there.

What if the diagnosis included something like, “Client reports that volunteer work helps them distract themselves from symptoms, and that writing in a journal has occasionally been helpful”? The therapist now has some potential ways to help the client. Or the diagnosis might include, “Despite severe symptoms, client shows a high level of insight about the possible origins of their depression.” The therapist now knows that lack of self-awareness isn’t the problem–symptom management might be.

I continue to be amazed that none of my therapists ever asked me if there’s any way I could incorporate writing into my depression recovery, or if there are any ways I’ve been incorporating it already. Writing is my life. Usually I’ve either said as much in therapy, or I haven’t because nobody ever asked me what I like to do or what makes me feel good. Why not?

  1. Reducing negative bias from providers.

I can’t make definitive statements without more research, but based on what I understand about bias, I can imagine that consistently viewing a client as “major depressive disorder with atypical features and moderate persistent depressive disorder” does things to one’s perception of that person. Not positive things.

It is difficult (if not impossible) to effectively help someone you view as deficient or weak. First of all, your likely pessimism about the person’s recovery will almost certainly be perceived (and possibly internalized) by them. Second, any roadblocks that come up in treatment will likely be interpreted as “resistance” or “not really wanting to get better” or “not being ready to do the work of therapy.” In fact, maybe it’s that your approach isn’t actually helpful to them. Third, without a conscious awareness of the person’s strengths and assets, what exactly are you using to help them recover? Therapy isn’t about “healing” people so much as helping them discover their own resources and help themselves. If you don’t even know what those might be, how could you possibly help the client see them?

Many therapists try to think of their clients’ positive traits in addition to their “negative” ones. However, formalizing and structuring this process as part of a diagnosis might make it sink in better, and become more embedded in one’s general impression of a person. The questions we generally have to ask while diagnosing someone are fairly negatively oriented–”Do you ever have trouble falling asleep? How often? To what extent does this impact your daily life?”. What if we also asked, “What helps you sleep better? How do you cope with being tired after a night of insomnia?” Maybe that can help shift a therapist’s perspective of this person from “insomniac” to “person with difficulty sleeping, who has reached out to friends for help with daily tasks.”

  1. Preventing provider burnout.

I dislike talking about my work because people are consistently amazed at it in a way that annoys me. “How could you deal with hearing these awful things?” they ask. “Isn’t it really depressing to work with all these people?” It isn’t, because thanks to my training, I’ve internalized a strengths-based perspective. When I think about the people I’ve worked with, I don’t see poor suffering depressives and trauma victims. I see resilient, determined individuals who are working to overcome their challenges in the best ways they can.

I think that some people in this field burn out because they can only see the suffering and the oppression and the unfairness of it. I also see those things, obviously, because they’re sort of a big deal. But if that’s all you see when you sit with a client, not only will that be reflected in your treatment of them, but it’ll also impact your own ability to persevere.

If every time a therapist made a diagnosis, they had to intentionally remind themselves of the client’s strengths, that might go a far way in helping them remember that there is hope and everything is not absolutely bad.

As I’ve mentioned, plenty of mental health professionals already incorporate a strengths-based perspective into their work. But this is more common in areas like social work, where diagnosis is rarely used and actually often criticized, anyway. I certainly don’t remember any of my psychiatrists or PhD-level therapists spending any time asking me about my strengths or coping strategies. They gave me my diagnosis, and that was mainly it as far as assessment goes.

One might argue that strengths assessment has no place in the DSM because it needs to be standardized and reliable. However, reliability may be a problem for the DSM regardless, meaning that different professionals assessing the same client may disagree in their DSM-based diagnosis.

One might also argue that the DSM is “about” mental disorders, not “about” a client’s overall set of traits or strengths. I’ll grant that. Regardless, I think that formally incorporating individual strengths into clinical assessments in therapy and psychiatry may be helpful. May be.

Feminist Bloggers Cannot Be Your Therapists

[Content note: mentions of sexual assault and suicide]

I’ve been thinking more about Scott Aaronson. Specifically, I’ve been thinking about what he struggled with during adolescence, and about the (in my opinion, misguided) notion that feminism could have possibly been of any help to him.

The battle cry I’ve heard from men since Aaronson’s now-infamous Comment 171 was published is that feminist writers and activists need to be more mindful of situations like Aaronson’s when we choose our language and strategies. There seems to be a collective yearning for acknowledgement that the usual feminist rhetoric is not only unhelpful for people in the teenage Aaronson’s frame of mind, but actively harmful to them. There is one piece of this that I fully agree with, that I will get to later. But for the most part, I continue to feel a sort of frustration and exhaustion, and I think I’ve finally figured out why.

I wrote in my previous post on the subject that I feel that we (women) are being given all these male traumas and struggles and feelings to soothe and fix, as we always are. But now I understand why exactly I feel like we’re such an inadequate receptacle for these things.

Let’s look at some of the most salient parts of Comment 171:

I spent my formative years—basically, from the age of 12 until my mid-20s—feeling not “entitled,” not “privileged,” but terrified. I was terrified that one of my female classmates would somehow find out that I sexually desired her, and that the instant she did, I would be scorned, laughed at, called a creep and a weirdo, maybe even expelled from school or sent to prison. And furthermore, that the people who did these things to me would somehow be morally right to do them—even if I couldn’t understand how.

You can call that my personal psychological problem if you want, but it was strongly reinforced by everything I picked up from my environment: to take one example, the sexual-assault prevention workshops we had to attend regularly as undergrads, with their endless lists of all the forms of human interaction that “might be” sexual harassment or assault, and their refusal, ever, to specify anything that definitely wouldn’t be sexual harassment or assault. I left each of those workshops with enough fresh paranoia and self-hatred to last me through another year.

[…] Of course, I was smart enough to realize that maybe this was silly, maybe I was overanalyzing things. So I scoured the feminist literature for any statement to the effect that my fearswere as silly as I hoped they were. But I didn’t find any. On the contrary: I found reams of text about how even the most ordinary male/female interactions are filled with “microaggressions,” and how even the most “enlightened” males—especially the most “enlightened” males, in fact—are filled with hidden entitlement and privilege and a propensity to sexual violence that could burst forth at any moment.

Because of my fears—my fears of being “outed” as a nerdy heterosexual male, and therefore as a potential creep or sex criminal—I had constant suicidal thoughts. As Bertrand Russell wrote of his own adolescence: “I was put off from suicide only by the desire to learn more mathematics.”

At one point, I actually begged a psychiatrist to prescribe drugs that would chemically castrate me (I had researched which ones), because a life of mathematical asceticism was the only future that I could imagine for myself. The psychiatrist refused to prescribe them, but he also couldn’t suggest any alternative: my case genuinely stumped him. As well it might—for in some sense, there was nothing “wrong” with me.

[…]And no, I’m not even suggesting to equate the ~15 years of crippling, life-destroying anxiety I went through with the trauma of a sexual assault victim. The two are incomparable; they’re horrible in different ways. But let me draw your attention to one difference: the number of academics who study problems like the one I had is approximately zero. There are no task forces devoted to it, no campus rallies in support of the sufferers, no therapists or activists to tell you that you’re not alone or it isn’t your fault. There are only therapists and activists to deliver the opposite message: that you are alone and it is your privileged, entitled, male fault.

It’s worth reading the entire thing, and reading it carefully. (Aaronson’s defenders are correct that some people have been making accusations of Aaronson that are directly refuted by things that he said in the very same comment. Let’s not do that.)

Here’s what I thought. If someone came to me and said that he earnestly believes that he will be “expelled from school or sent to prison” if a woman finds out that he finds her attractive, and that he has “constant suicidal thoughts,” and that his daily existence is characterized by “crippling, life-destroying anxiety,” I would not recommend that he read Andrea Dworkin or attend a sexual assault prevention workshop. I would recommend, gently and tactfully, that he go see a therapist.

I would do that because these are very serious issues. They are serious enough that, when a client tells me that they have “constant suicidal thoughts,” there is an entire protocol I’m required to follow in order to ensure that they are safe and receive appropriate care if they accept it.

I will not speculate about what mental illness Aaronson could have theoretically been diagnosed with in his adolescence; I oppose such speculation and it’s actually irrelevant. I don’t need to diagnose him to say that he had serious issues and could have really benefited from treatment. (However, I may reference some diagnoses in what follows, not to suggest that Aaronson had them but to show how mental illness can interact with other life circumstances.)

Maybe Aaronson didn’t think to seek therapy as an adolescent, because therapy and mental illness are still quite stigmatized and would have been even more so when he was younger. Maybe nobody close to him noticed or cared what was going on, and therefore did not encourage him to seek therapy. Maybe the psychiatrist he asked to prescribe castration drugs did not pause to consider that a teenager seeking castration is a red flag, and that maybe he should refer him to a colleague who practices therapy. Maybe, maybe, maybe.

But why aren’t we talking about it now? Why are people blaming feminism–the feminism of the 1970s or 80s, no less–for failing to cure what appeared to be a serious psychological issue? Why are people claiming that the solution now is simply for feminist writers and activists to be more compassionate and considerate towards male nerds like Aaronson, as though any compassion or consideration could have magically fixed such a deeply layered set of deeply irrational beliefs?

This troubles me. If I ever start claiming that, for instance, I’m a terrible person and deserve to literally die because I’m queer, or that I cannot be in the same room with a man without literally having a panic attack, I sincerely hope that people advise me to seek mental healthcare, not to read feminist literature.

Lots of helpful things can harm a small subset of people because of that subset’s individual traits. For instance, there are a lot of PSAs about washing your hands to prevent the spread of disease and things like that. But some people have OCD and wash their hands compulsively, to the point that they’re hurting themselves physically and having trouble accomplishing daily life tasks because they have to wash their hands so much. I can imagine these PSAs being extraordinarily unhelpful to them.

We also often hear about the importance of donating to charity. Most people could probably donate more to charity if they wanted to. However, some people compulsively donate so much to charity that they harm themselves or their families. I can imagine this being exacerbated by someone telling them how important it is to donate to charity. Perhaps they feel they are never good enough.

I can see how feminist literature might have functioned in a similar way for Aaronson. The truth is that most men are about as far away from his mindset as you can get. Some are even the opposite extreme. Most men spend very little time thinking about how their behavior impacts women. Most men need to spend more time thinking about it. But how could he have known that these feminist books were not for him? If they were to put on the cover, “If you’re a great guy who does not hurt women, you don’t need to read this,” well, no man would ever read it. They all think they’re great guys who do not hurt women, even though some of them rape women.

Neurodiversity is an axis of privilege/oppression. People who suffer from mental illness or whose brains are set up differently from what is considered the “norm” (such as people with autism) lack privilege along this axis. They have difficulties because our society is not made to accommodate them. However, if these people are white, or male, or straight, or cisgender, or so on, they still benefit from the privileges afforded to people in those categories.

For instance, despite all his other fears and anxieties, Aaronson did not have to live in constant fear of being sexually assaulted, because he is male. He did not have to live with a significant risk of being harassed or brutalized by the police, because he is white. He did not have to deal with having people constantly refuse to identify him as the gender he identifies as, because he is cisgender. He did not have to struggle to physically access places he needs or wants to go, because he is able-bodied. Of course, he still faces some risk (in some cases fairly negligible) of all of these things, because having privilege doesn’t shield you from everything.

However, as a person who was (apparently) neuroatypical, Aaronson did have to live with “crippling, life-destroying anxiety.” He did not appear to have access (even if it’s just because he didn’t know to ask for it) to mental healthcare that could have helped him. He was forced to spend years feeling horrible. If he told people how they felt, they may have blamed him for it, because victim-blaming is a key component of our society’s oppression of neuroatypical people. Had he lacked some of the other privileges that he had, such as race and class, he may not have been able to access the apparently-useless psychiatrist that he did access.

Aaronson claims that he did not have “male privilege” because he did not feel that he had it. I’ve addressed arguments like these before. He presumably did not feel privileged because on one very salient and relevant axis, he certainly was not.

But otherwise, having or not having privilege isn’t actually dependent at all on how you feel. You have it or not. Men on the street hurl sexual obscenities at you or they do not. Cops stop you and slam you to the ground for no reason or they do not. You are allowed to marry someone of the gender(s) you’re attracted to or you are not.

Aaronson might be interested (or not) to know that many feminists are busy fighting to ensure access to mental healthcare for everyone, and an end to the stigma that prevents people from seeking help. But maybe that’s irrelevant now.

As I mentioned earlier, I am taking one piece of Aaronson’s (and the many others who have echoed him) criticism to heart. Namely, feminist materials need to be better at specifying what to do rather than just what not to do. Now is a good time for a reminder that I offer a workshop on this exactly, with a light-hearted tone and lots of audience participation and definitely no yelling at men that they are horrible awful creeps no matter what they do. I am far from the only person who offers such materials, but it would be cool if there were more. That said, anyone claiming that feminism does not offer this at all has quite clearly not done their research. Andrea Dworkin and some random shitty college sexual harassment training are not the only resources feminism has to offer.

(Some things that I have read along these lines [“these lines” meaning, roughly, “affirmative resources that help men and others conduct their sexual/romantic lives ethically without shaming them]: Charlie Glickman, Doctor Nerdlove, Yes Means Yes (the book and the associated blog by Thomas Macaulay Millar), Pervocracy, Franklin Veaux. If you don’t like any of these, create your own!)

But even then, your average casual feminist blogger or columnist cannot take responsibility for fixing the problems of someone who apparently sincerely believes that speaking to a woman will get him sent to prison. Or someone who is literally unable to talk to a woman because they have so much social anxiety. These are issues for professionals to deal with. Professionals can affirm. They are there to hold your feelings and make you feel comfortable and supported. They can teach social skills. They can help you examine maladaptive and irrational thoughts. They can help you learn how to cope with anxiety. That is what therapists are for. They are imperfect, but they are trained for this. I worry about placing this responsibility on every feminist with a blog.

Aaronson claims in his comment that “there are only therapists and activists to deliver the opposite message: that you are alone and it is your privileged, entitled, male fault.” I’m not sure if this comes from experience or is purely the creation of his mind with the biases that it had at the time. If Aaronson went to see a therapist and that therapist shamed him, then that therapist is wrong and does not deserve the title. (I’m not trying to do a No True Therapist fallacy here; I’m just pointing out that shaming people is against our ethics and if you cannot not shame people then you should not be a therapist.)

If Aaronson did not see a therapist, perhaps because he was afraid that they would shame him, then that’s unfortunate. And I don’t blame him. But I still think that we should be encouraging people with such pronounced irrational beliefs to seek therapy, not feminist literature.

No wonder I was so frustrated when I wrote that earlier post. I felt like feminist writers are being asked to do the job of a mental healthcare professional.

~~~

A few relevant points that I did not have time to expand on here, but may in the future:

  • Part of the reason that a lot of what Aaronson read/watched was so shaming towards men was probably because it was shaming towards sex and sexuality in general. Especially those college sexual harassment trainings, some of which are woefully retrograde. It’s important to remember that stigma/shaming around sex is something that is so entrenched in our culture that it’s bound to show up all over the place, even, yes, in feminist literature.
  • Aaronson claims that all the feminist literature he read confirmed his belief that straight men are awful and violent. While this may be so–I haven’t read Dworkin and don’t intend to–I have also personally watched men respond to materials that were not at all whatsoever shaming of men by claiming that they were being shamed by those materials. This seems to be a very common bias. They expect to be shamed by feminist materials, so they feel shamed by them.
  • I have seen dreadfully few discussions about how everyone–especially non-/anti-feminist men and women–perpetuate toxic ideals about masculinity. It’s usually not feminist teenage girls slamming shy nerdy boys into lockers and publicly humiliating them, is it? We should talk more about that. Unfortunately, most men dislike talking about toxic masculinity, because they think that “masculinity” is synonymous with “men,” and perhaps also because they have bought extensively into this ideal and appreciate the privileges it affords them.
  • There needs to be a space where we can say, “Wow, that is really awful, I’m sorry you felt that way and had to live with that, but I need to point out that your interpretation of things was inaccurate.” Because right now, it’s looking to me like anyone who includes the latter part of that sentence is accused of hating men or lacking compassion. If I read a Richard Dawkins book, came away with the idea that Dawkins believes that all religious people should be put to death, and therefore started to fear for the lives of my religious relatives, I would want someone to try to explain to me that I had misinterpreted the book. It would not be compassionate at all to allow me to continue believing that Dawkins was calling for my relatives’ deaths. It is not compassionate to allow Aaronson to believe that feminists want him to never, ever so much as kiss a girl. (A moot point now, but it wouldn’t have been earlier.)
  • It is also entirely possible that all the feminist literature that Aaronson read was woefully inadequate. (I disagree, and wish he had picked up bell hooks, but let’s grant it.) Feminism is, like every other field of study, constantly advancing and finding new ways to analyze and advocate. The feminist literature of the past decade or so focuses a lot more on helping men than the feminist literature of the 1970s and 80s. But feminist activism still consists mostly of women, and when men join in, they often try to speak to us about our own issues than to other men about men’s issues. And women, naturally, will focus first on issues we primarily face, some of which are life-threatening. Men, please, don’t stand around and lament the fact that feminists are not addressing your problems. Familiarize yourself with feminist principles and join in.

Opening Up, Closing Down

[Content note: depression, suicide, self-harm]

The truth about mental illnesses that many of us have learned is that they change you for good. Even after the symptoms are gone, the medication gradually reduced to nothing or stabilized at a dose that works, something remains. (And for many of us the symptoms are never entirely gone.)

Depression left my scaffolds–indeed, my very foundation–cracked. I’m okay, even joyful, much of the time. But it feels a little flimsy.

One of the ways this plays out in my daily life is that I have problems with intimacy. I don’t mean the sexual euphemism, but rather the ability to be vulnerable, to let people in, to be seen as you are, to be comfortable with closeness.

I am intensely uncomfortable with all of this.

I hate talking about myself, whether it’s positive or negative. I hate feeling like I need someone’s help to deal with emotions. I hate wanting someone’s help to deal with emotions even when I know I don’t need it. I hate the first time I tell someone I love them and I hate many of the subsequent times too. I hate it when people know that I miss them. I hate being visibly upset around someone, which means that if it’s at all possible to leave, I leave. I hate expressing any emotion besides joy and anger (which I rarely feel) to anyone. I hate it when someone says things to me in an attempt to build intimacy but I don’t know what to do so I say nothing. I hate when people notice emotions I didn’t intend to share. I hate when they tell me this as though it’s going to somehow endear them to me. I hate that there’s nowhere I can cry without being seen or heard by someone.

So relationships, whether platonic or romantic or sexual or some combination, are difficult.

Some people have difficulties like these for their whole lives, but for me, it happened as a result of depression. And, ironically, depression is also the thing that’s hardest for me to share with people.

During my nine years of depression–in fact, probably my whole life up to and including that–I was very different. My experience of mental illness was that it triggered a sort of leaking of thoughts and emotions. I literally lacked the ability to hold them in. They spilled out of my hands, like when I try to move a big pile of laundry from the washing machine to the dryer and little bits and pieces–a sock here, a tank top there–keep falling on the floor. I remember crying apropos of nothing on the band bus in 10th grade and telling my boyfriend that there’s no way to be happy when you hate yourself. Fifteen is old enough to know that this is not an appropriate thing to say. It didn’t matter. It just came out.

It’s not like I didn’t try to plug the leaks. In 6th or 7th grade, I decided to keep a record in my journal of “things left unsaid.” Each day I intentionally tried to shut myself up at some crucial juncture, and rewarded myself for it by writing it down in the notebook later–the thing left unsaid, the person I didn’t say it to, and the reason I didn’t say it.

Years later, what I learned about psychology and behavior change suggested that this could be quite an effective strategy for some people. But it didn’t help me much, because my problem wasn’t purely behavioral. When I looked at those entries later, I noticed how many of them had to do with hurt feelings. “Thing left unsaid: that I was upset about what _____ said about my outfit. Reason: because it wouldn’t make a difference.”

I tried so very hard, but everything hurt. If they couldn’t read it explicitly in my words, they read it implicitly in my face, my body, my tone. I couldn’t hide it. I gave up writing the entries within weeks because it was already too late, everything was leaking out and I couldn’t patch the holes fast enough. In college the dam broke completely, and everything from those little hurts all the way up to wanting to kill myself became common knowledge for those who interacted with me a lot.

For a while it was okay. I thought that being so open was keeping me going–and, as I’ll get to in a moment, it was important in some ways–but what it ultimately did was it completely broke me. It destroyed any sense of self-respect, independence, and competence that I had. When I confided my depressive feelings to someone, usually a partner, I felt like garbage. I felt so much more shame about the act of confiding than I ever did about the feelings I confided themselves.

If you’ve ever had to call the last person you want to speak to right now because they’re the only one available to talk you out of slashing your own wrists, then maybe you know what I’m talking about.

You have to reveal. You have to open up, in order to live. You have to tell it to the therapist and the psychiatrist and your parents and your partner and anyone else who is in any way responsible for your well-being.

You tell people the darkest most horrible things not because you trust them and want to let them see this part of you, but because you have no fucking choice.

And so the concept of “opening up” has been totally ruined for me, because I didn’t get to save it for those special, bonding late-night conversations with someone I feel ready to show myself to.

I had to do it.

Now I don’t.

And not having to feels like freedom. It feels like victory. It feels like independence, finally. It feels like adulthood, although it shouldn’t. It feels like maturity, although it shouldn’t. It feels like wholeness. It feels like safety.

It feels like recovery.

So now I sit at the computer with words typed into the chat box–“I feel sad,” “I can’t stop crying,” “I miss you so much”–and I can’t send them. I want to send them and I don’t want to send them. Not wanting to send them almost always wins out.

In a way, intimacy was easy when I was depressed. I wore it on the outside and it created a sense of intimacy with many people almost instantly. New partners saw my neat little red scars so early on, too early on. “We’ll work on that,” said one, an aspiring psychologist. “I wish you wouldn’t do that,” said another.

Now nobody has to see, and it’s almost impossible to want it any other way. Intimacy has gotten much harder. Perhaps mirroring my own style, new partners disclose little and so I lose interest in them quickly, convinced we have nothing in common besides politics.

Instead I write. The stress of work, the rush of falling in love, the little depressions that come and go, the grief of losing my old lives, the fear of the future–they sink into paper and that’s where they stay.

It’s lonely and isolating as hell, but it beats feeling opened up and exposed.

And now, although I’m known as someone who talks about depression a lot, I don’t really talk about it. I speak obliquely of it, the way someone might mention the passing of a loved one without ever speaking openly of their grief.

I can say that there is fatigue. I can say that it feels sad and numb and dark and hopeless. I can say that I wanted to die. I can say that my head was–still is, much to my constant disappointment–fuzzy and slow, memory useless, words perpetually at the tip of my tongue but left unspoken. I can write this blog post about how depression has affected my ability to desire, build, and feel intimacy.

But I do not ever, not anymore, tell you how it really feels. I will not make you listen to me tell you I hate myself I hate myself like I’ve never hated anything before and I wish I could rip my body and my mind to shreds–

No, I stay on a meta level. I’m comfortable talking about it conceptually.

But the feeling of depression itself? That is a dark room into which I want to go alone. I don’t want anyone knocking on the door trying to get me to let them in. I don’t want to have to hold their hand and guide them around the sharp corners they can’t see, because when I’m in that room, I need to be caring for myself. Not for anyone else.

Of course, it always starts out with them hoping to care for me, but that’s never how it ends up. People end up needing my support to navigate the nightmares in my own head.

Well, I’m sorry, but I just don’t have the mental fortitude for that. Caring for one person–me–is enough.

Presumably, I don’t have to be stuck this way for my whole life just because I have/had depression. I’m hoping to start therapy again soon, for this and for other reasons. But for now, as I reflect on myself and my life at this very special (for me) time of year, it’s hard not to feel hopeless about all the little things I can no longer do, at least not without lots of anxiety and fear. Like tell someone how the stress actually feels. Or talk to someone about how powerless I feel in my work. Or ask someone if they can talk to me for a while to help me get my mind off of things.

In this way, and in many other ways, mental illnesses may never end, or may take much longer to end than we expect, and there is no hopeful cheery note for me to end this on.

Before You Speculate About Amanda Bynes’ Mental State

[Content note: mental illness, ableism]

I wrote a piece for the Daily Dot about the gleeful speculations about Amanda Bynes’ supposed mental illness.

Former child star Amanda Bynes hasn’t been having a good month. After being arrested for DUI in California, Bynes left her family and made her way to New York City, where she’s attempted to shoplift clothing twice, which she claims was a “misunderstanding.”

Bynes also gave an interview to In Touch magazine in which she apparently said that she believes there’s a microchip implanted in her brain that allows people to read her thoughts. She later made a series of tweets claiming that the interview was fake and that she will sue the magazine for calling her “insane.” Celebrity gossip websites have, of course, taken this story and run with it, speculating about Bynes’ mental health and diagnoses and treating the situation like a spectator sport.

Even if Bynes really did tell In Touch that she believes she has a microchip implanted in her brain that allows people to read her thoughts, that doesn’t mean it’s okay to call her “insane” or “crazy,” and I’m not surprised she’s angry about it. Words like that don’t just mean “displaying symptoms of a mental illness.” They connote ridicule, ignorance, and sometimes even hate.

They also place people with mental illnesses in a category apart from the rest of us, the ones who aren’t “crazy.” In fact, mental illnesses exist on a spectrum. Some people have a a few hallucinations or delusions during a time of extreme stress (or perhaps sleep deprivation). For others, psychotic symptoms are a struggle they must manage for their entire lives.

Are all of these people “crazy?” Is everyone who has ever had a random and totally irrational thought “crazy?” Is everyone who takes medication for anxiety, depression, or bipolar disorder “crazy?” Words like “crazy” and “insane” do not refer to any specific set or level of symptoms. They refer to someone we wish to hurt, ostracize, or laugh at.

How do you report a story like Bynes’ without perpetuating the stigma that people with mental illnesses face?

For starters, recognize that some things are newsworthy whether the person who did them is a celebrity or not; others are newsworthy only when they’re done by someone we’re already paying attention to—or used to pay attention to. People get DUIs and shoplift all the time, but when a famous person does it, that suddenly becomes a reason to write an entire news story. Someone having delusions is also not in and of itself interesting to the public—although, in a way, I wish it were, because maybe then people would know more about it and stigmatize those who struggle with it less.

Obviously, journalists have to make money. Sometimes that means writing stuff that sells, whether or not you personally think that this information is important to collect and provide to the public. However, oftentimes journalists—especially those who cover celeb news—shrug off all responsibility for choosing their subject matter by claiming that it’s “just what sells” or “what the people want.”

Read the rest here.

A Flare-up of a Chronic Illness

[Content note: depression]

This is a personal post, not an advice post or a big societal problems post. But past experience has shown that some people appreciate and benefit from it when I describe how I try to think about things.

“Reframing” is a term we sometimes use in mental healthcare (and elsewhere) to basically refer to changing the way you think about something. While therapists sometimes suggest ways to reframe things to clients, it’s ultimately up to the individual to decide whether or not they want to reframe, and if so, how.

For some people this concept can hit a nerve because it can sound a lot like the well-meaning but ultimately useless (and even hurtful) advice we get to “look on the bright side” and “think about the positives.” But that’s not what reframing means to me. Here’s an example.

In one of my classes, we are required to meet in pairs for ten weeks to administer and receive counseling. Not as a roleplay exercise, but as an actual attempt to disclose one’s struggles or work with someone else on those struggles. Many students in the class expressed strong discomfort with being one of the “clients” in this exercise, but I’m already accustomed to sharing very personal and intimate details with thousands of strangers online, so I had no qualms about signing up to be counseled.

During our first session, my student-counselor asked me a question: “What, to you, would be an ideal or perfect day?”

It didn’t take me long to think about my answer, which turned out to be sort of a non-answer.

“There isn’t one,” I said. I explained that after eleven years of depression, there is no longer such a thing as an ideal or perfect day and it feels like there never was. That sort of thing is so far out of the realm of possibility for me that, in my view, there’s no point in sitting around hypothesizing about it*.

The reason is that hypothesizing won’t bring me any closer to experiencing it. The things that stop me from being able to have perfect days, those days you spend the rest of your life wishing you could relive, are not surmountable things.

As an example, I told them about the previous weekend, when my roommate and I had gone to visit friends in the suburbs of Philly and then went to a steampunk-themed dance in the city proper. I’d been looking forward to it for a while. It was supposed to be one of those awesome nights. We got all dressed up, and I was wearing my friend’s spectacular dress that I felt amazing and sexy in, and I was with my friends, and it was going to be awesome.

Until, of course, it wasn’t. Not long after we got there, I experienced one of the things I refer to as a depressive trigger, for lack of a better term. It’s whatever the depression version of getting triggered is–specifically, it brings on acute depression symptoms–and it happens to me periodically. I heard it and I felt every metaphorical gear that keeps my brain working properly grind to a halt. It was like driving down a beautiful country road in the sunshine and suddenly finding yourself in a thunderstorm.

After that I couldn’t make myself function. I felt an uncomfortable combination of numb and sad in a very “deep” sort of way. I was constantly on the verge of crying, and knew I would if I let myself think about the thing that had triggered me. I couldn’t talk to anyone, at least not in any socially appropriate way, and I couldn’t dance or pretend to be happy or do much of anything else.

So I left my friends, sat in a corner, and spent most of the rest of the night writing in my notebook (good thing I carry it everywhere) and messaging with one of my partners on my phone. (Situations like this, by the way, are one of the reasons I’m so adamant that it should be socially acceptable to be on your phone at social events. Because my options at this point were: cry in front of my friends, be on my phone, or leave and somehow find my own ride back from Philadelphia to New York at 10 PM on a Saturday night.) I was eventually more or less okay, but it took a long time, and I spent most of the night on the effort to make myself feel more or less okay.

This is not atypical for me; it’s been happening for almost as long as I can remember, and while the triggers have changed a little over the years–as has my ability to manage them–the fact that they happen in the first place has not.

I used to hate myself for it. I’d berate myself endlessly for “ruining” everything or “wasting” good times away, especially since the triggers were as predictable as they were unavoidable. Surely I could learn to stop doing this? (But I see nothing about “acute depression triggers” in any of the scholarly material I read and I don’t even know if this is a typical aspect of the experience of depression or if anyone has ever reported it at all. I just know that that’s how depression works for me.)

Now, I told my student-counselor, I think about it differently. Of this specific incident, I think: I had a flare-up of a chronic illness, but I was able to manage it.

And because I’ve learned to think about it that way, a lot of other things start standing out–the things that went right. I had a great, relaxing day with my friends before it happened. I got dressed up and felt good about how I looked. At the event itself, during the times when I was feeling more or less okay, I met some interesting new people and took some great photos that I’ll have to look at and reminisce. While I was feeling triggery, my friends noticed and checked in on me in ways that demonstrated their concern and care but did not step over any of my emotional or physical boundaries. (Most significantly, I don’t like to talk about the things that cause me to feel bad, and nobody asked or expected me to.) While I was feeling triggery, I managed to disclose a little bit of it to my partner online–not something I am often able to do–and my partner was supportive. I was able to stop it from getting any worse.

Reframing is not the same as its distant cousins, “looking on the bright side” and “finding the silver lining.” I didn’t choose to look on the bright side or find the silver lining. The silver lining found me, after I had reframed the situation in a way that didn’t make me look like a horrible wretched failure of a person. And when I reframe, I don’t attempt to dilute or ignore the reality of the situation. It is not preferable that things like this happen when I’m trying to have a good time with my friends. There is no “silver lining” to getting triggered. I’m not going to wax poetic about what this teaches me about myself or about the human condition. I’m not going to gush about how situations like this really bring out the wonderfulness of my friends and partners, because my friends and partners are wonderful a lot of the time, whether or not I’m currently feeling like crap.

When I think back to that night now, I don’t feel sad, because I’m remembering the good things along with the bad. Previously, the distortion that my brain engages in would’ve made that impossible. I’ve tried to somehow force myself to think about the good things before and failed. It could only happen once I found a way to look at the situation realistically.

I didn’t fail. I didn’t ruin anything. I didn’t choose for this to happen. I had a flare-up of a chronic illness, but I was able to manage it–with the help of some of my friends, but also by drawing on my own strengths and resources.

~~~

*That said, the question the student-counselor asked is typically a pretty good one to ask, as it helps the therapist understand what their client hopes to change about their life. But I already know that I want something impossible. I want to be cured. I won’t be, and that’s okay.

The Sad Girls of Tumblr

[Content note: mental illness, depression, self-harm, suicide]

I’ve written before about the potential dangers of presenting depression and other mental illnesses as somehow attractive or appealing or more “real.” In a blog post dealing with the same issue, Spencer writes:

We love to romanticize depression. On Tumblr, browse the “#soft grunge” tag and you’ll find artfully edited photos of scars and Instagram-filtered pictures of cigarette cartons with phrases like “You’re going to die anyway” superimposed. “Soft grunge” treats depression and suicide like beautiful black roses–twisted, painful romantic ideals. We do it off of Tumblr too, like when we associate our favorite comedians’ or authors’ mental illnesses with their genius. Half the time, it seems, “tortured soul” is uttered in awestruck, not empathetic tones.

That post also links to another post, called “On Tumblr’s Romanticization of Depression,” by a blogger named Sarah:

Every time you reblog pictures of a computer screen that says “stupid sad girl” or Marlboro cigarettes with sticky notes pasted on them saying “because you broke my heart,” every time you contribute to a culture that makes depression seem like a quirky thing to add to your “about” section instead of a serious disorder with one of the highest death rates of any illness, you are actively making it okay for people to ignore their health problems and just be sad. That’s enablement.

People need to stop posting pictures of pills and tagging them #death, #suicide, #self hate, #soft grunge, and #pale. Trust me on this one, overdosing on pills: not really a good time. It’s nothing like the pictures of parties that are scattered all over your dashboard. A pretty blue-eyed boy will not come up to you when you’ve been lying in an ER bed for four hours because you can’t walk and tell you how beautiful you and your sadness are. Maybe that’s because you won’t be wearing pants at the time (I wasn’t), or maybe that’s because you’ll barely be able to speak because your mind is so distorted by the drugs. He won’t kiss your fucking scars. In fact it’s likely that nobody ever will, because seeing the mutilated flesh of someone you love is terrifying.

In a general sense, I agree. Spencer and Sarah make the point that seeing depression presented as sexy and alluring may discourage people from viewing it as an issue to work on, and while it should always be an individual’s choice whether or not to consider themselves “mentally ill” or to seek treatment for a mental illness, normalizing such pain and suffering probably doesn’t help.

But then I started thinking–how many of the people posting these things are depressed themselves, and how much moral responsibility should we assign to a person in the depths of mental illness to avoid presenting their own condition in a way that may encourage others to follow suit?

Sarah allows for this possibility, including a caveat:

Which isn’t to say that no girl with a soft grunge blog is actually diagnosed with depression (or any other mental illness), because I’m sure many are. And I think I can kind of understand the appeal. Feeling like you’re a part of something can be comforting, and so can seeing that other people feel the same way you do. When you’re in the healing stages of a mental illness, having support isn’t just important, it’s a necessity. But the soft grunge subculture doesn’t support the “Sad Girls” it idolizes, it enables them.

However, I’m not sure that really answers my question.

First of all, I take issue with the term “enablement” as used here. Professionals and others usually use this term to mean doing things that encourage someone else to behave self-destructively. For instance, someone may “enable” a friend’s problem drinking by constantly offering them alcohol or inviting them out to bars; a parent may “enable” a child’s preoccupation with getting high grades by grilling them about their grades and expressing disappointment at anything less than an “A.”

But I’m not sure what exactly Sarah thinks is being “enabled” here. If it’s depression itself, then that doesn’t make sense, because depression is not a risky or maladaptive behavior that can be enabled. It’s a mental illness. It could also be not getting treatment for depression, but I’m not sure that makes sense as a behavior that can be “enabled,” either. Not getting treatment for depression is, sadly, the default. True, if people’s Tumblr feeds were filled with age-appropriate, compassionate advice about seeking help for emotional distress, they might be more likely to do so. But in that case, the entire way the dominant culture approaches mental illness qualifies as “enablement.” In that case, every time a friend told me to “just cheer up!” or “just come hang out with us!” when I was feeling sad, they were “enabling” my behavior of not seeking treatment, because they were suggesting that depression is something that can be fixed by choosing to “just cheer up” or go to a party.

More to the point, I think that this view somewhat discounts the very realistic possibility that the people posting these “soft grunge” images are themselves depressed, and what this means about “enablement.” Who are they enabling? Themselves? Each other? Others who are more or less depressed than they are? Younger Tumblr users?

It’s complicated to me because I view this type of self-expression–the romanticization, the preoccupation with death, the attention-seeking (which I do not mean pejoratively)–as part of the mental illness itself. As a symptom, even. I haven’t seen any studies about this and have no idea which Google Scholar keywords could possibly help, but anecdotally, my experience with people who suffer from mood disorders is that some of them cope with the illness by viewing themselves and the illness in this way. Not all, obviously, but almost no mental illness symptom is shared by everyone who has that diagnosis, so to call something a symptom is not to imply that it’s a universal symptom.

It is sometimes comforting, especially when you’re scared and don’t know what’s happening to you and lack the knowledge to label it “depression,” to think of it as something special and even positive. This is especially the case when you’ve been steeped in a culture that glorifies a certain type of disaffected sadness, and ties it causally to greatness in art, music, and literature. So, even if the girls of the soft grunge subculture are enabling others, that’s only because they were first enabled themselves.

Some of it is a sort of sour grapes thing, too. You try to be happy, you can’t, everything hurts, and you think, fuck it, who wants that boring shit, anyway?

When I was in high school, I didn’t have a Tumblr (I don’t think it existed yet), but I definitely found these types of images appealing in some way. Maybe if something like Tumblr existed I would’ve even shared them. The reason they appealed to me was because they made me feel like the way I felt was a way of being more alive, not a way of missing things that other people got to have–joy, security, optimism, hope, self-esteem. And even if I didn’t meet the diagnostic criteria for depression at the time, I certainly did just a couple years later when I was diagnosed with it.

I don’t think that any of this necessarily makes promoting such memes and images ethically okay. Most of us have no problem condemning pro-ana/-mia blogs and forums, for instance, and this is really the depression/bipolar disorder version of that. (I suppose, though, you could argue that pro-ana/-mia materials are more dangerous than “pro-depression” materials, if you could even call these Tumblrs that.)

But it does mean that it’s not as simple as telling people to stop doing it.

I think the first step would be to start taking adolescent mental health seriously. It’s a serious issue. Most people know this, I think, on some level. But we still don’t take a preventative approach.

It’s expected that parents start taking their children in for dental checkups as soon as they have teeth. It’s expected to start seeing an ob/gyn for checkups as soon as you become sexually active. Why not taking that sort of proactive approach to mental health in adolescence–or even in childhood?

(Of course, all of that is bound up in issues of privilege and access, but even teenagers whose parents can easily afford and access mental healthcare often fail to receive it until things become very bad.)

So, yeah, in short, I don’t disagree with either of the perspectives I linked to. I just think it’s a little more complicated than I ever realized before. It’s easy to say, “Don’t romanticize depression! It encourages people to view depression as normal and healthy.” It’s harder to say, “Don’t show symptoms of your depression! It encourages people to view depression as normal and healthy.”

Towards A Better Conversation About Mental Illness

This is my latest for the Daily Dot, about how we can discuss mental illness more accurately, productively, and compassionately, particularly in the wake of tragedies like Robin Williams’ suicide.

After comedian Robin Williams committed suicide two weeks ago, fans took to the Internet to express their grief, as well as their admiration for his work. Whenever a beloved celebrity passes away, regardless of the cause, social media temporarily becomes a sort of memorial to that person, a chronicle of the ways in which they changed lives.

However, when the cause is suicide, a celebrity’s death also brings out lots of dismissive, inaccurate, or even hateful statements about people with mental illnesses. According to some, Williams was “cowardly” and “selfish” for committing suicide. Last week, Musician Henry Rollins wrote an op-ed for L.A. Weekly (for which he apologized over the weekend) in which he said that he views people who commit suicide with “disdain,” claiming that Williams traumatized his children. There was plenty of rhetoric about suicide being a “choice,” the implication being that it’s the wrong choice.

Comments like these not only misinform people about the nature of mental illness, but they are also extremely hurtful to those who struggle with it. As the Internet continues to respond to Robin Williams’ death, here are some suggestions for a better conversation about mental illness and suicide.

1) Do your research.

We all have a “folk” understanding of psychology, which means that we experience our own thoughts and feelings, interact with other people, and thus form our opinions on psychology. Obviously, noticing things about ourselves and the people around us can be an important source of knowledge about how humans work.

But it’s not enough. If you haven’t had a mental illness, you can’t really understand what it’s like to have one—unless you do your research. Depression isn’t like feeling really sad. Anxiety isn’t like feeling worried. Eating disorders aren’t like being concerned about how many calories you consume. Your own experiences may not be enough.

Before you form strong opinions about mental illness and suicide, you need to know what mental illnesses are actually like, what their symptoms are, what treatment is like, what sorts of difficulties people may have in accessing treatment or making it work for them. If you can make tweets and Facebook statuses about a celebrity’s suicide, you can also do a Google search. Wikipedia, for all its drawbacks, is a great place to start. So are books like The Noonday Demon and Listening to Prozac.

2) Never engage in armchair diagnosis.

Now that you have a good idea of what different mental illnesses look like, you should try to figure out who has which ones, right?

No, please don’t. Armchair diagnosis, which is when people who are not trained to administer psychiatric diagnoses try to do so anyway, is harmful for all sorts of reasons that Daily Dot contributor s.e. smith describes in a piece for smith’s personal blog:

The thing about armchair diagnosis is that it mutates. First it’s a ‘friend’ deciding that someone must have bipolar disorder because of some event or another. Over time, that’s mutated into an ‘actual’ diagnosis, repeated as fact and accepted. Everyone tiptoes around or gives someone sidelong glances and makes sure to tell other people. Meanwhile, someone is completely puzzled that other people are treating her like she’s, well. Crazy.

Whether the person you’re talking about is a celebrity or not, it is up to them whether or not to make public any information about their health. Mental health is part of health. While having a mental illness should never be stigmatized, unfortunately, it still is. People deserve to decide for themselves whether or not they are willing to disclose any mental illnesses they may have.

Even if someone commits suicide, that doesn’t mean we can come to any conclusions on which mental illness they had or didn’t have. First of all, not everyone who commits suicide could have been diagnosed with any mental illness just prior to it. Second, various mental illnesses may lead to suicide. Many online commentators, including journalists, simply assumed that Williams had depression. However, he may have also had bipolar disorder, in which depressive episodes are interspersed with manic ones. Williams himself never stated which diagnoses he had, so it’s best not to assume. Whatever he had or didn’t have, it is clear that he was suffering.

Read the rest here.

“Twitter Psychosis”? I’m Skeptical

[Content note: mental illness & delusions]

Over at the Daily Dot, I did some mythbusting about this alleged “Twitter Psychosis.” For whatever reason, it’s hard for me to pick out an excerpt, so I’ll just go with what I think is the most relevant part of this story, but you should go read the full thing to get the background:

Unlike most other published psychological research, the study about Mrs. C and “Twitter psychosis” is a case study— a type of research in which researchers study one particular person, or case. Something you should know about case studies is that they’re the least scientifically rigorous experimental design possible. There’s obviously only one subject or participant, and a particular person’s psychology is so idiosyncratic and impacted by so many factors that we may or may not even notice that it’s difficult to draw any firm conclusions. Unlike other studies, that compare some group to some other group, case studies don’t allow us to see what happens if certain conditions are different.

This study was further an observational case study, not an experimental one. In experiments, researchers change something or do something to the participants and see what happens. In observational studies, they can only observe what’s already going on. This means that it’s impossible to tell what causes the observed phenomena to occur.

That said, case studies are useful sometimes. When researchers are first discovering a new phenomenon, or when people with a particular condition are very rare, there might be no choice but to study a single individual. Observational studies in particular are useful when it’s unethical or impossible to tweak some variables to see what happens. Twitter psychosis, if it’s a real thing, is probably quite rare. We would have to study thousands of participants to find cases of it. And if Twitter really can cause psychosis in certain people, it’s clearly unethical to purposefully expose them to it to see what happens. So, case studies, including observational ones, are often the first step of studying something new.

My main concern with this type of research—and with other recent warnings by mental health professionals that the Internet (and social media in particular) can cause or aggravate mental illnesses—is that people dealing with mental health problems may be pressured by friends, family, or doctors to stay offline. Of course, sometimes staying off the Internet (or off social media specifically) can be a wise choice for someone for any number of reasons. However, the general trend of anti-tech alarmism makes it likely that “stay off the internet” will be a piece of advice too often and too easily given.

People with mental illnesses can be vulnerable to persuasion and even coercion by those with authority over them, including therapists and psychiatrists. If a person with a Ph.D. says, “I think you need to stay off Twitter,” they may take their advice without any grains of salt.

You might ask why this matters. It matters because the Internet can also be an incredible source of support and information for people with mental illnesses. Tumblr, in particular, is known for its supportive community, but it’s not the only one. Reddit has subreddits dedicated to every major mental illness where users can post stories, ask for advice, and support each other. Twitter’s hashtags make it easy to find tweets about your illness, and mental health organizations and professionals are very active there, posting supportive messages, advice, and news about clinical research.

And Facebook is where many people “come out” about their mental illnesses for the first time, finding it easier to share with many people at once rather than with individuals—but without having to show it to the whole world. (Incidentally, Facebook is also where I run a support group for atheists dealing with mental health problems, which many of the participants have told me has been really helpful.)

It’s possible that Twitter can trigger psychosis in some people with other risk factors, and researchers should conduct more studies to find how whether, how, and why this happens, and how it can be prevented. But we should be careful not to cut suffering people off from a potentially vital source of support.

Read the rest here.

 

Depression and Self-Gaslighting

Gaslighting is a term you probably know, but if you don’t, it refers to the act of telling and convincing someone that their feelings or perceptions are not really true. In the context of interpersonal relationships, gaslighting is considered to be an abusive behavior, as it can render people incapable of trusting themselves and their own judgment, instead placing an undeserved trust in the gaslighter.

Cognitive distortion is also a term you probably know. It refers to a set of maladaptive mental habits that people with mental illnesses tend to have. (The Wikipedia list is useful, and I discussed some specific examples in this post.)

A cognitive-behavioral approach to mood disorders involves teaching the client the difference between thoughts and feelings. A lot of people will say things like, “I feel like a failure.” The therapist’s role is to remind them that “I feel like a failure” isn’t actually a feeling, but a thought. “I feel like a failure” is really “I think that I’m a failure.” The therapist may ask, “How do you feel when you have the thought that you are a failure?” The client may say, “I feel hopeless,” or “I feel miserable.” Hopefully, the therapist can help the client see that a lot of their thoughts are actually cognitive distortions, and that there are more helpful and realistic ways to think about the same things.

That’s the standard CBT frame that’s used in all the training videos I watch in school. But the reality, at least for me, is a little less tidy. Sometimes feelings come seemingly out of nowhere, and while I know there is a reason for them (and I usually know what the reason is), there was no proximal cause for the feeling. There was no maladaptive thought.

Sometimes I see a partner with someone else and I just feel awful. I don’t think, “I bet they’re going to leave me now,” or “That person is way cooler than me,” and then feel awful. I just feel awful. Is it because I trained myself to feel awful on cue, as a conditioned response? Maybe. Others would argue that feeling awful is a “natural” response to seeing a partner with someone else, though I disagree. Regardless, the feeling comes immediately and without any stimulus other than seeing the thing.

Sometimes I have to leave my family after a visit and I become extremely depressed. (I will have to do this in a few days. I’ve already had a few breakdowns about it.) I don’t think, “I WILL NEVER SEE MY FAMILY AGAIN” or, slightly more realistically, “It is Terrible and Bad that I have to leave my family.” I just think about the mere concept of leaving and instantly collapse in tears. (To wit: there is nothing less undignified than collapsing in tears while sitting on the toilet, but that just happened to be when I remembered about my flight home. It happens.)

Last year I wrote about some things I had learned from depression, including two slightly/seemingly contradictory maxims: “Not everything your brain tells you is accurate,” and “Your feelings are valid.” You can read that post to see what I meant by these things, but the jist of it is that depression can teach you to be more skeptical about some of the stuff going on in your brain, but also that you get to feel how you feel without passing judgment–or having others pass judgment–on it. Some would say that feelings can’t be “wrong.” They can be crappy, or not useful, or distracting, or whatever, but they cannot be empirically inaccurate or morally wrong.

However, this is where reality gets murkier than these convenient teachings. Feelings aren’t wrong, per se, but they can be premised on exaggerated or inaccurate fears or worries. I feel bad when my partners like people who I think are Better than me. But what is “better”? Can I really accurately say that someone is “better” than me, rather than maybe better at certain things and worse at others? And isn’t the whole point of polyamory that nobody has to leave anyone just because they’ve found someone “better”?

I feel depressed when I have to leave my family and go home to New York. But I know I will be just fine and quite happy when I get there. I know this because I’ve gone through it many, many times now. There is no reason to feel so depressed I can’t get out of bed for two days. Yes, it’s sad to say goodbye to your family. To me, personally, it is slightly tragic, even, that I can’t live close to them the way people usually do in our culture. But it is not that sad. It is not weeping-on-the-toilet-bowl sad. Few things in my life are objectively that sad.

These are far from the only situations like this that I experience; it happens all the time, every day. I get very frustrated. “No feelings about feelings,” a friend of mine says, not as a rule, but as an aspiration. I can’t make it work.

So I start gaslighting myself. “That’s not true.” “That perception is just wrong.” “That’s false and you know it.” “There is no reason to be upset right now.” “Your hypothesis that that person is somehow objectively better than you is premised on nothing but a pile of turds.” “THAT FEELING IS WRONG AND YOU SHOULD IGNORE IT FOREVER.”

Cutesy slang about jerkbrains and badfeels aside, what I’m now doing is very serious. Now I have abandoned a defensive stance and taken up an offensive one, with which I will battle the Wrong Feelings and vanquish them in a burst of light. Gaslight.

What happens when you teach yourself not to trust your own perception? How many toxic people become “just difficult for me to deal with because I’m so insecure and oversensitive”? How many untenable situations become marginally acceptable because “I’m only miserable about it because my brain lies to me”? How many injustices become annoyances to shrug at because “I’m just pessimistic about everything and don’t realize how good life is”?

People tell me that I’m so good at setting boundaries, but sometimes I wonder how much shit I have patiently accepted because I thought my brain was lying to me. In any case, I’m very glad I discovered feminism at the same time I discovered that I have depression.

Somewhere between “Your feelings are bad and you should feel bad” and “Your feelings are an accurate barometer of external reality” lies a vast unexplored land of feelings that are excessive but useful, of feelings that don’t make any sense but that alert you to an issue that needs to be explored, of feelings that can be discussed with a partner to build trust and intimacy, of feelings that have been spot-on many times before but have simply outlived their usefulness in this new and happier life you have built.

I wish I could really believe that feeling things is okay.