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.

A Primer On Atypical Depression

At CONvergence two weeks ago, I and a few other people did a panel on myths about mental illness. It was really great, and I hope that there will be a video of it up eventually. At one point, I tangentially mentioned atypical depression, a type of depression that is sometimes contrasted with melancholic depression, or the “typical” kind.

Atypical depression is the type that I have, and that might be part of the reason it took me something like seven years to realize that I had depression at all. A few people have since told me that they didn’t even realize atypical depression was a thing. So I decided to write a brief overview of it in the hopes that more people who don’t have a name for what they’re going through might find a name for it.

There are some “classic” depression symptoms that most people think of when they think of depression: being numb or sad most of the time, being unable to take joy in things you used to like, insomnia, and loss of appetite and weight. You think of the person lying in bed unable to care about or take pleasure in anything.

Atypical depression has a rather different set of features. Instead of insomnia, you may have hypersomnia (oversleeping). People with atypical depression might regularly need to sleep 10 or 12 or even more hours. Instead of loss of appetite, you may overeat and/or gain weight. Instead of being numb or just uniformly sad, you have high mood reactivity, or mood swings. You may find that you’re able to enjoy things and feel happy when things are going very well, but as soon as things are neutral or even just a little bit bad, you feel horrible again. There are two other symptoms that are sometimes present: leaden paralysis, or the feeling that your limbs are very heavy and difficult to move, and high rejection sensitivity, which means being overly concerned about people not liking you or rejecting you, to the point that it impairs your social functioning.

Unsurprisingly, these different sets of symptoms mean that different types of antidepressants may work best for each type. I will quote Wikipedia here, since it’s sourced and there’s no good reason to rephrase it:

Medication response differs between chronic atypical depression and acute melancholic depression. Some studies[4] suggest that the older class of antidepressants, monoamine oxidase inhibitors (MAOIs), may be more effective at treating atypical depression. While the more modern SSRIs and SNRIs are usually quite effective in this illness, the tricyclic antidepressants typically are not.[1] The wakefulness-promoting agent Modafinil has shown considerable effect in combating atypical depression, maintaining this effect even after discontinuation of treatment. [5]

I don’t know how useful this information is to you if you think you may have atypical depression, but at least now you know that if your symptoms fit this pattern but your psychiatrist prescribes you a tricyclic antidepressant without further explanation, it might be worth bringing up this research. In addition, if SSRIs haven’t been working for you, you might ask your psychiatrist about trying MAOIs rather than a different SSRI or a higher dose of the same one.

In terms of therapy, I can’t seem to find any studies on the effectiveness of different types of therapy on the different types of depression (that may be because Google Scholar is actually a terrible search engine), but my educated guess would be that dialectical behavior therapy (DBT) would be extra helpful for atypical depression as opposed to melancholic depression. DBT is a type of therapy developed specifically to treat borderline personality disorder, which involves lots of mood swings, rejection sensitivity, and general troubles with managing emotions. DBT contains a lot of the same techniques as cognitive-behavioral therapy (CBT; the standard of evidence-based treatment), but it also emphasizes mindfulness and learning to cope with strong emotions. Atypical depression, with its mood swings and interpersonal issues, might be especially amenable to it.

To the extent that psychodynamic therapy is effective (actually, plenty of studies suggest that it might be), it might also be more effective on atypical depression than other approaches. Atypical depression tends to have an earlier onset, and people may experience it as an aspect of their personality that is rooted deeply in their life experiences. When practiced well, psychodynamic therapy may be useful for resolving these issues. But none of this is to say that standard CBT should not be tried.

During my senior year of college, I asked a professor who studies the neuropsychology of mood disorders whether or not he knew of any research on neurological differences between atypical and melancholic depression. After all, there’s been plenty of research on how depression affects the brain–in terms of active brain regions, neurogenesis (growth of new neurons) in various regions, and so on. Were all these studies really done using patients who might’ve had what looks like two nearly-completely different illnesses? Apparently. My professor wasn’t aware of any such studies, and I’ve only found one myself: some research that examined which hemisphere of the brain responds more to a particular face test, and in atypical depression patients, the right hemisphere was much more active than it was in melancholic depression patients and in non-depressed controls. The authors write, “This is further evidence that atypical depression is a biologically distinct subtype and underscores the importance of this diagnostic distinction for neurophysiologic studies.”

There also seems to be some evidence that atypical depression in particular is linked to thyroid dysfunction, which may explain some of the physical symptoms. However, the results seem to be rather complicated and confusing, and it’s definitely not a simple causative link.

Although the diagnostic criteria for depression contain both sets of symptom patterns and there’s even a special indicator for “atypical features,” the popular conception of depression is of the melancholic type, not the atypical type. This means that many people, believing that depression necessarily means “being completely miserable all of the time always,” may not realize that they might have depression and can benefit from treatment.

Atypical depression presents a classic boiling-frog problem. Because you are in fact capable of feeling happy for short or medium stretches of time, it can take a serious increase in symptom severity to realize that there’s anything wrong. Incidentally, as I mentioned, atypical depression also tends to have an earlier onset than melancholic depression, which means that you may spend your entire post-childhood life that way. For some people, certainly for me, it felt like it was “just my personality.” To make things even more confusing, the rejection sensitivity tends to be present even during periods of time when the rest of the symptoms are in remission. But when it comes to mental health, nothing is ever really “just your personality” if you don’t want it to be.

Hopefully, this overview will help people–at least the people who read this blog–broaden their awareness of what depression is. If there’s anything I missed in terms of research, by the way, please let me know. As I mentioned, my Google Scholar-fu is much worse than my Google-fu.

Depression Is Not Sadness (Again)

[Content note: mental illness, depression, anxiety, suicide]

When I think about the frequent charge that therapists and psychiatrists and those who work with them are trying to “medicalize” “normal” emotions like sadness and fear, I think that people don’t really understand how emotions like sadness and fear can be distinguished from mental illnesses like depression and anxiety.

I’ve tried to explain this to many people multiple times, in person and through writing, and so have many other people with mental illnesses as well as professionals in the field. Yet people continue to conflate emotions and illnesses, or rather to assume that mental healthcare advocates are conflating them. It’s often difficult to continue engaging patiently with this claim.

Even those who are knowledgeable about illness and disability make this error. In an otherwise-fantastic blog post about the medical model of disabilityValéria M. Souza uncritically cites this very inaccurate view of antidepressants:

In The End of Normal: Identity in a Biocultural Era, Lennard Davis affirms: “A drug would be a prosthesis if it restored or imitated some primary state that appears to be natural and useful” (64). Davis makes this statement in the context of his argument that SSRIs are not “chemical prostheses” for depression, since happiness is not a “primary state” of being and since there is compelling evidence to suggest that SSRIs do not actually work (Davis 55-60).

I’ll address the SSRIs-not-working thing first since I have less to say about that and it’s not as relevant to this post. The reality seems to be more that SSRIs work well for some people but not at all for many other people and we haven’t really figured out why they work for some people but not others, or more specifically, which types of people they work for and which they don’t. And on a personal note, I’m a little tired of being told that SSRIs “don’t work” when they’re part of the reason I didn’t try to off myself four years ago. There is compelling evidence to suggest they do not actually work and there is compelling evidence to suggest that they do actually work, so I’m comfortable saying that the jury’s still out on this one.

More to the point: antidepressants are not meant to cause “happiness” because depression, the illness they are meant to treat, is not defined by a lack of “happiness.” Depression involves a constellation of physical, emotional, and behavioral symptoms that make happiness very difficult or even impossible. These symptoms have a number of other deleterious effects which vary for different people. There are many ways depression can ultimately “look,” such as being unable to get out of bed, being unable to hold down a job, bursting into tears several times a day over tiny inconveniences or in response to nothing at all, losing your sex drive, being unable to sleep, having to sleep over 12 hours a day, having severe memory loss, losing the ability to enjoy any previously enjoyable activity, experiencing complete emotional numbness, obsessing over death and suicide, physically hurting yourself, or attempting suicide.

Maybe being “happy,” whatever that even means, isn’t a “primary state,” but I would argue that being able to live a relatively normal life in which you can go to school or have a job, have relationships with people, and not want to kill yourself is a “primary state.”

Being treated for (and, hopefully, recovering from) depression does not give you extra things that other people don’t have, such as constant happiness and optimism. It gives you what everyone else has had all along, which is a reasonable and age-appropriate amount of control over your emotional state and the ability to create your own happiness if you want to and make the effort.

By the way, you can definitely be miserable and unhappy without having a diagnosable mental illness, but it’s rare to find a person whose unhappiness is truly caused entirely by their own voluntary actions. Depression can also develop as a result of voluntary actions; for instance, if you have a number of career options available to you but you choose an extremely stressful and mind-numbing (but perhaps lucrative?) option, you might end up becoming depressed because of it. At that point, your best bet might be to find a way to make a career change, but it’s likely that you’ll also need therapy to help undo the maladaptive mental habits that the situation has created. (Medication might help too, but in a case like this I’d personally recommend therapy first.)

I think a better way to explain the difference has been that, at least in my experience of mental illness versus mental health, there are things that mentally healthy people can do to significantly increase their level of happiness, whereas people who are going through a bout of mental illness can rarely make a huge difference just by stopping and smelling the roses or making more time to play with their kids or enrolling in a cooking class or whatever. They can maybe make a small difference, but it’s unlikely to reduce the mental illness symptoms themselves. I used to get so frustrated at things like The Happiness Project and other initiatives of that sort, until I finally realized that they weren’t aimed at me because happiness would literally not even be a possibility for me until I treated my damn mental illness.

(That said, things like that can be very useful for someone whose mental illness is in remission or otherwise low-grade. Right now, I’m not fully symptomatic for depression but I’m aware that it can probably come back at any time, so I do a lot of things to keep my mental health strong to try to avoid it coming back.)

It’s difficult to tease out all the complicated interactions between mental illness, mental health, and happiness, and of course it varies for different people. In my experience–which includes my personal experience, my interactions with friends and partners, and my studies and clinical experience, here it is in a nutshell: untreated/unmanaged mental illness makes happiness virtually impossible to achieve. Treating or managing your mental illness, whether through medication, talk therapy, or personal lifehacking, helps make happiness possible to achieve. But the work of achieving it is still yours to do. No drug or therapist can just give you happiness.

And most people with mental illnesses realize this. I haven’t met anyone who was just like “I wanna go to the psychiatrist and get a pill and just be happy always forever.” Most of us just want to stop crying all the time, or stop having panic attacks whenever we need to interact with new people, or stop having intrusive and scary thoughts of killing ourselves, or stop lying awake for hours each night because we can’t stop imagining all the bad things that could happen to us.

“Happiness” is the cherry on the sundae of mental health. You need to put the ice cream and the syrup and the whipped cream in the cup first.

(I’m not sure what it says about me that in reality I actually despise maraschino cherries and always ask for them to be left off my sundae. This is an analogy that was definitely intended for the presumably more normal people who will read this.)

If you still think that what we call “depression” is just an attempt to medicalize “sadness,” then you don’t know what one or either of those things are. So I’ll illustrate with an example of an internal monologue I have had when I was sad, and one I have had when I was depressed. The subject is the same, but the emotional response isn’t. See if you can figure out which is which!

I really wish I had a partner. It’s lonely not having anyone to come home to and it feels crappy seeing all my friends with their partners even though I know I should be happy for them. Sometimes I wonder if I’m just not that attractive or likable as a person. It seems like I’m the only person not dating anyone. I hope I meet someone soon, but I don’t know when or how that will happen and I’m not that optimistic about it right now. 

I really wish I had a partner. I feel like a complete worthless failure because literally everyone else I know is seeing someone and I’m not. I’ll probably never find anyone and I’ll just be lonely for the rest of my life and there won’t be anyone to call 911 if something happens to me and they’ll find my body in my apartment days later because nobody gave enough of a fuck to check on me. Not like I blame them. I’m so ugly and stupid that I don’t know why anyone would even want to hang out with me, let alone go out with me. Everyone’s probably pitying me because I don’t have anyone and everyone can tell that it’s because I’m completely pathetic. I feel like I might as well not even exist because what’s the point of going through life alone and unloved?

One of those is a sensical reaction to lacking something in your life that’s important to you (a romantic relationship); the other is over-the-top. The emotional response in the second example is disproportionate; it doesn’t make sense to leap all the way from “I’m sad because I wish I had a partner” to “I’m a worthless failure and will die alone.”

That second monologue contains a number of characteristic cognitive distortions associated with depression, such as all-or-nothing thinking (I have to have a partner or there’s no point in even living), disqualifying the positive (the good aspects of my life are irrelevant; it’s all bad because I’m single), mind-reading (everyone must be pitying me), fortune telling (because I don’t have a partner now, I will never have one), catastrophizing (something bad will happen to me and I’ll die alone in my home because nobody will help), personalization (it’s completely my fault that I don’t have a partner; none of it comes down to chance or being in the wrong environment or anything else), and emotional reasoning (I feel like a failure because I’m single; therefore I definitely am a failure).

While mentally healthy people do make cognitive distortions too, mental health is a spectrum: the more you’re able to refrain from thinking in these harmful ways, the more mentally healthy you’ll (generally) be. If you look at the first monologue, you’ll see some slight distortions, like the fear that you’re unlikeable or unattractive just because you happen to be single, or the perception that you’re the only person not dating when that’s obviously not true. But only in the second example do these irrational thoughts become all-encompassing. And, importantly, only the second example involves thoughts of death and suicidal ideation.

Note also that in the first example, being single is causing sad feelings, whereas in the second example, the emotional responses are not primarily caused by the singleness. Perhaps being single is the immediate trigger of the extreme sadness and negativity, but what’s really causing it is depression. A depressed person who is miserable about being single will not stop being miserable if they stop being single; they will usually be miserable about other things. That’s exactly what happened to me back when I was having that monologue. I’d inevitably get into a relationship and then be miserable because I didn’t think my partner liked me enough, or because I was worried about school, or because I felt like all my friends hated me, or because I hated myself, or just because.

Depression can trick you into thinking that you’re depressed “about” something. You’re probably not. You’re depressed because you have depression, and luckily, you can treat it.

Sadness, on the other hand, is about things. You can be sad because you’re single or because you got a bad grade or because you hate your job. Sadness is a normal, healthy reaction to experiencing things that you don’t like. It’s a useful and important emotion because it tips us off to situations that we should try to change if we can. Sadness can prompt us to take a step back and think about things and how we would like them to be better.

Medicalizing sadness and medicating it away would probably harm individuals and also our society as a whole. It would make things pretty boring. Isn’t it great that antidepressants and therapy are not actually trying to do that? Isn’t it great that we can help people avoid catastrophic, paralyzing, life-ruining sadness and fear like the ones associated with mental illnesses, while helping them get in touch with healthy and situationally appropriate sadness and fear? That we can help them understand their emotions and use them to change themselves, their lives, or the world, without having their lives completely governed by them?

Indeed. Depression is not sadness. Anxiety is not fear. Nobody is actually trying to eradicate sadness and fear.

~~~

At Skepchick, Olivia has a great take on this, concluding that:

I do think that it’s important to address our societal phobia of sadness, grief, and pain. But the way to do that is not to throw the mentally ill under the bus by implying they are running from their negative emotions when they seek out treatment. It also doesn’t mean casting shade on the few tools for treatment of mental illness that we actually have evidence are effective. A diagnosis of depression does not say “this person is too sad”. It says “this person can’t function the way they would like to because their emotions are consistently out of control”. There is a world of difference between those two statements.

Are Celebrities Responsible for Modeling Good Mental Health?

[Content note: depression, mental illness, suicide]

My newest piece at the Daily Dot is about Lana Del Rey, mental illness, and what we expect from artists and celebrities.

Singer Lana Del Rey has recently reignited an age-old discussion about the glamorization of depression and suicide among (and in) young musicians. In a Guardian interview she has since tried to distance herself from, Del Rey focused on death:

‘I wish I was dead already,’ Lana Del Rey says, catching me off guard. She has been talking about the heroes she and her boyfriend share—Amy Winehouse and Kurt Cobain among them—when I point out that what links them is death and ask if she sees an early death as glamorous. ‘I don’t know. Ummm, yeah.’

[...] It’s unlikely that statements like Del Rey’s actually make anyone go, “Huh, maybe I should try killing myself.” However, they can be harmful because they perpetuate norms that discourage seeking help and prioritizing mental health. Del Rey certainly isn’t single-handedly responsible for this, by the way—mental illness has long been associated with artistic brilliance, glamour, and even sometimes sexual desirability. Some believe that you can’t really be a great artist unless there’s something very wrong with your brain, but I think that’s largely confirmation bias. If you think that artists must be crazy, you’ll pay extra attention to the ones that are and little attention to the ones that aren’t.

We tend to expect that when artists go through difficult times, their way of coping is to make art about it. (Neil Gaiman gave a beautiful speech about this.) Making art can indeed help people deal with all sorts of adverse circumstances, including mental illness, but sometimes it’s not enough. Luckily, some artists, musicians included, have spoken out about seeing therapy and medication when they needed it—not an easy thing to do in a society where mental illness is still stigmatized and being a celebrity means having your private life constantly scrutinized and sold as entertainment.

On the other hand, I’m also leery when celebrities are expected to be “role models” and to demonstrate positive, healthy behavior to the children and teens who look up to them. It would certainly be nice if, when interviewed about her moods, Del Rey said something like, “I’ve been going through a hard time and dealing with lots of sadness, but I’m seeing a great therapist and taking good care of myself.”

But holding her responsible for the mental health of hundreds of thousands of young people is unfair and hypocritical. Del Rey’s young fans would benefit a lot more from seeing their own parents model good self-care, but we don’t encourage that in parents any more than we do in glamorous singers. Instead, we shame people who take poor care of themselves, and we shame people who are open about seeking therapy.

Read the rest here.

Trigger Warnings Are Not “Censorship”

In unrelated news, I have a post up at the Daily Dot today about trigger warnings. Excerpt:

Students at various universities have been trying to take trigger warnings offline by requesting them in certain educational materials. Predictably, even professional and reasonable writers and journalists have responded to this by unleashing a hysteria about “censorship,” “dumbing down,” “suppression of discourse,” “hand-holding,” and other terrible things that will happen if we choose to warn students about potentially triggering material before they read it.

First, a clarification: nobody, to my knowledge, has asked that students be exempted from reading material that they find emotionally difficult. If a professor assigns reading and a student chooses not to do it, that student’s grades will probably suffer. Even if they don’t, though, universities function on the presumption that students are adults who must be allowed to make their own decisions about things like time management, amount of effort put into schoolwork, and so on. Trigger warnings on syllabi do not change any of this.

Much of the panic about trigger warnings in classrooms also focuses on the fear that privileged students will avoid material that makes them uncomfortable. So if you put “TW: misogyny, sexual violence” on a syllabus next to an assignment, male students might think, “Ugh, I don’t want to read about that” and avoid it.

But privileged students already avoid material that makes them uncomfortable; that may be one reason you see way too few white students in courses on African-American literature. Trigger warnings might make this slightly easier, but it doesn’t fix the larger, systemic problem of people choosing not to engage with material that challenges their worldview.

Further, avoiding trigger warnings for the sake of tricking privileged students into reading material on racism, sexism, and other unpleasant topics means potentially triggering underprivileged students by refusing to warn them that the upcoming reading assignment concerns traumatic things they may have experienced. People who lack privilege relative to others are constantly being asked to sacrifice their mental health and safety for the sake of educating those others, and this is just a continuation of that unjust pattern.

Read the rest here.

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Masculinity, Violence, and Bandaid Solutions

[Content note: violence, guns, mass shootings, misogyny]

We’re all familiar with the pattern now: a solitary young white man goes on a shooting rampage. People die. The media describes him as “crazy,” “disturbed,” “troubled,” “insane.” Everyone collectively bemoans the failings of our mental healthcare system, presuming that its failure is relevant here. People with mental illnesses cringe at the reminder of what our society thinks of them. A few people advocate stricter restrictions on guns. The victims are buried and memorialized, the killer’s parents shunned or comforted, and the killer gradually forgotten.

And it happens over. And over. And over. Again.

Whatever depth there is in this analysis is limited to the parts of the internet where I live. You won’t see the anchors and talk show hosts on CNN or MSNBC or, obviously, Fox News, wondering what it is about white men that produces so relatively many mass shooters–relative to other gender/racial groups and relative to other countries. They will talk about one of two things, mostly depending on their party affiliation: gun control or mental healthcare.

And it’s so difficult to ask them to talk about something else because we should be talking about gun control and mental healthcare. More and better gun control and more and better mental healthcare would vastly improve quality of life in the United States, and maybe in the right combination, could even prevent many of these shootings.

But wouldn’t it be better to fight the ideas and beliefs that lead to violence?

There’s plenty of evidence that Elliot Rodger, the 22-year-old white man who murdered six people and injured seven more in Santa Barbara yesterday, felt entitled to sex with women and hated them for denying it to him. In a YouTube video uploaded just a day before the mass shooting, Rodger said:

You girls have never been attracted to me. I don’t know why you girls aren’t attracted to me but I will punish you all for it. It’s an injustice, a crime because I don’t know what you don’t see in me, I’m the perfect guy and yet you throw yourselves at all these obnoxious men instead of me, the supreme gentleman. I will punish all of you for it. [laughs]

On the day of retribution, I am going to enter the hottest sorority house at UCSB and I will slaughter every single spoiled, stuck-up, blond slut I see inside there. All those girls I’ve desired so much. They have all rejected me and looked down on me as an inferior man if I ever made a sexual advance toward them, while they throw themselves at these obnoxious brutes.

I take great pleasure in slaughtering all of you. You will finally see that I am, in truth, the superior one, the true alpha male. [laughs]

If this weren’t terrifying enough, OllieGarkey at Daily Kos points out that the YouTube channels to which Rodger has been subscribed included well-known men’s rights activists. According to David Futrelle, he was also a commenter at PUAHate, a misogynistic forum that has been down since the shooting. On one forum post, Rodger wrote:

Women have control over which men get sex and which men don’t, thus having control over which men breed and which men don’t. Feminism gave women the power over the future of the human species. Feminism is evil.

Rodger’s various online postings have all the language of sexual entitlement and misogyny: “get sex,” “breed,” “alpha male,” “slut,” “not fair.” I’ve heard this from many men who have assaulted or abused me or others. It is not uncommon.

I’m going to say something that should be obvious: a minority of men think about women in quite this violent and hateful a way. An even smaller minority act on that violence so brazenly. But many men violate women’s boundaries and autonomy constantly, and all men are socialized to think about themselves, about sex, and about women in similar ways.

In the coming days you will hear all about mental illness. (This is because most people only talk about mental illness when they get to blame an act of violence on it, and not when millions of people are merely suffering in silence.) You will hear about how the mental healthcare system failed Rodger, how mental healthcare is too expensive, how there aren’t enough mental healthcare professionals, how insurance coverage is fucked up, how medication doesn’t work or doesn’t work well enough or works too well, how irresponsible parents don’t get their children mental healthcare quickly enough.

You will not hear that, while 2 percent of violent acts can be attributed to people with mental illnesses, people with mental illnesses are four times more likely to be the victims of violent crime than people without mental illnesses. You will not hear about the ways in which people with mental illnesses are discriminated against for many reasons, one of which is that they’re believed to be inherently violent, partially because of how the media focuses on mental illness in the wake of every single mass shooting. You will not hear that Black people who commit violent acts are never presumed to be mentally ill; they’re just presumed to be Black. You will not hear about how it’s only “terrorism” if a brown person does it; the fact that it’s politically motivated and intended to terrorize a particular group of people is not, apparently, enough. You will hear a lot about “not all men,” but you will not hear that misandry irritates and misogyny kills.

You will not hear that boys and men are taught to believe that they are entitled to women’s bodies in uncountable ways, every day, in every setting, by their parents and by the media and by everyone else. You will not hear again about the boy who stabbed a girl to death for refusing to go to prom with him, or about this entire list of women being hurt or killed for ignoring or rebuffing men’s sexual interests, or the constant daily acts of violence to which women are subjected for exercising their right to autonomy.

And before you call Rodger “crazy”: it is not actually “crazy” to believe stuff that’s been shoved down your throat from birth.

I wish it were. It’d be nice if humans reasoned rationally by default, that if you grow up with people telling you things that don’t make sense, like religion or that sex is dirty or that women owe you anything at all, you’d just go, “Well, that makes no sense!” and refuse to ever believe it.

But we didn’t evolve that way, at least not yet. Unless we work very hard at it, we’ll inevitably believe what we’re taught so incessantly, as sexism is taught to all of us. Yet we are all capable of rational thought if we work at it, which is why I hold Rodger and all other men who believe in their conditioning and subject women to violence fully accountable for their actions.

A very good therapist could have helped Rodger with this process. Maybe. But when mass shootings happen and everyone bemoans the fact that the shooter didn’t go to (or wasn’t helped by) therapy, they never seem to ask themselves what this therapy would entail. You don’t go to therapy or go on medication and suddenly become happy. What you have to do is unlearn the maladaptive and harmful ways in which you’ve learned (or been taught to) think. For someone like me, this means learning not to be so afraid and not to treat every minor setback as the end of the world. In Rodger’s case, this might’ve meant learning how to be okay with not having sex with women for a while, learning the social skills to eventually find and keep a partner, and, most importantly, learning that women do not owe him a single damn thing. With that realization might’ve come freedom.

In other words, the way to help Rodger would have been to help him unlearn what he never should have learned in the first place. And there’s no guarantee that even the best of therapists could succeed at this; everyone in the field knows that sometimes clients are just beyond help (at least by a given therapist) and that it’s tragic and sad and don’t we wish we could’ve caught them earlier?

What if our culture had never taught Rodger these horrible beliefs?

What if our culture didn’t still treat women as possessions?

What if our culture didn’t emphasize hypermasculinity and getting laid at all costs?

What if, what if, what if.

So everyone’s going to blame our faulty mental healthcare system now. But let’s do a thought experiment.

A child is born in an area with terrible preventative healthcare. They don’t receive a single vaccine, and they are never taught about healthy eating, hygiene, and exercise. Nobody models good health for them, nobody teaches them in early childhood about the importance of washing your hands. Getting medical check-ups and physicals isn’t even an option. They have no idea what a healthy blood pressure or heart rate might look like. As far as this child knows, a doctor is where you go when you’re so sick you’re dying.

At 22 years of age, this person is now so sick that they’re dying. They have had a horrible diet for their entire life, and they have never treated their body well. They have suffered from increasingly worsening symptoms for weeks, but didn’t realize that they needed to see a doctor. The disease they have is one that they never received the vaccine for. Finally, at 22 years of age, this person goes to the hospital, and the doctors do their best but are unable to save them. The person dies.

Do you blame the doctors who tried but failed to keep this person alive? Or do you blame the entire system, the fact that there was never any preventative healthcare, the fact that they were not given a vaccine and they were not taught the skills to make contracting diseases less likely?

The type of masculinity that young boys are taught is not compatible with mental health and with ethical behavior. Full stop. We’re fortunate that so relatively few will take it to the lengths that Rodger did, but I don’t know a single man who doesn’t suffer as a direct consequence of it. I know few who have never made others suffer as a direct consequence of it. We need to inoculate boys against this harmful and maladaptive thinking rather than teach it to them.

Improving and reforming and revolutionizing mental healthcare is important, but it’s too important to discuss only in the few days after a mass shooting has happened. If this is something you care about, join me in discussing it all the damn time.

Remember this: by the time someone is in their early twenties and spewing hatred and bitterness, it may very well be too late. It’s never too late, however, to work harder at unlearning the lies we are taught about gender.

On Hating Yourself, And All Of Your Selves

[Content note: depression]

The self, as everyone learns in an introductory psychology class, is not a stable or definable entity. “Self” is not a biography or a fashion style or a set of identity labels–it is something more contextual, more situational, more fluid than that. Selves shift depending on who we’re with and what we’re doing and how our bodies feel at the moment and too many other variables to list, and anyone who decries the supposed “fakeness” of being a different person in different situations or with different people fails to realize that we’re all made up of multiple selves, and it’s not always obvious which (if any) are more “authentic.”

What, then, does it mean to hate yourself? If your self is multifaceted and constantly shifting, hating it is like trying to hold water in your hands.

Yet many people with depression or other mental illnesses will tell you authoritatively that they “hate themselves,” and, at least for me, that expression stems from a deep-seeded emotion that I can’t identify in any other way. It’s not a basic emotion like sadness or anger, but neither is it a concrete, System 2-type of thought, such as, “I am dissatisfied with my current approach to dating and relationships.”

All I know is that I feel the thing and I think that I hate myself, all of myself, the parts that come alive when I’m out in the city alone and the parts that only a few of my partners see and the parts that manage to think my way out of this and the parts that were brave enough to leave everything I knew to move here and the parts that make it possible for me to sit and listen to someone for an hour and the parts that are writing this now.

It doesn’t make sense to hate even the selves that I’m most proud of, but I do it anyway. At that moment I don’t want to pick and choose. At that moment I would happily surrender my entire self in order to receive a new one from some cosmic lottery. At that moment I’m convinced that if that lottery created a new me at random, reset all the sliders and let the chips fall where they may, that would still lead to a more optimal result than the one I’m stuck with now.

I’m convinced that it’s such a terrible hand that I hold that I’d rather discard it, reshuffle the deck, and draw anew, than keep playing with the cards I was dealt.

In reality, this is not a good model for personality or self or character or whatever it is that I hate so much. Selves can be improved; that’s the entire reason we have the whole genre known as “self-improvement,” as useless as many of these offerings are. And my selves were not the product of an unlucky draw, either. They are quite predictable results of my genetics, upbringing, environment(s), experiences, and so on. I’m sure that only a small portion of it is really random. While that doesn’t necessarily make me like the results any more, it does mean that they aren’t meaningless.

And on good days I have plenty of evidence that this self-hatred isn’t rational–that is, it doesn’t follow from the premises. One example is the way that I’ve managed to keep steadily hating myself even as I’ve changed dramatically over the last few years. Self-hatred, along with a few other things like love of writing, has remained a constant in my life when little else has. I remember bursting into tears on the band bus my sophomore year of high school and trying to explain to my first boyfriend that I couldn’t be happy when I hated myself so much. And now, eight years later, I have (for whatever reason) this blog and these readers and all these friends who are listening to me repeat the same tired fucking bullshit that I’ve been telling anyone who would listen since before any of these people even knew who I was. I am, more often than I care to admit, still the broken girl trying to communicate the uncommunicable to someone who had no idea what on earth I was on about.

I used to hate myself for being romantic and preoccupied with relationships. Now I hate myself for being cynical (on a good day I call it “realistic”) and apathetic about the whole thing while everyone around me starts serious relationships and moves in with partners and gets engaged.

I used to hate myself for depending on people just to get through the day without breakdowns. Now I hate myself for being unwilling to ask for the smallest bit of help from anyone outside my immediate family.

I used to hate myself for being weird and nerdy and obsessed with science and technology. Now I hate myself for being not weird enough and not nerdy enough and obsessed with the social sciences, except not in the right “scientific” way like all my friends are where you post articles about statistics and meta analyses and replication. (I’m interested in these things too, yes, but I hate myself for not being interested enough in them.)

I used to hate myself for being passive and never speaking up when people hurt me. Now I hate myself for the meticulous boundary-setting I do on an almost-daily basis.

I used to hate myself for caring so much about things like grades and achievement and being the best. Now I hate myself because I can’t be arsed to care.

I used to hate myself for being so pathetically and childishly insistent on telling my parents everything. Now I hate myself for the way I can’t bring myself to even tell them that I’m getting paid to write now, or that I spoke at a conference, or that I’m dating someone new.

Unless I’m just programmed to hate everything, this doesn’t make sense. Rather, it seems that I hate everything that I label as “myself,” no matter what values that self actually takes on.

And maybe everything I just wrote is wrong because I’ve never really hated myself “for” things; I just hated (and still hate) myself indiscriminately. I could accomplish all of my goals tomorrow and I would still hate myself. I could resolve all the unresolved conflicts in my life and I’d still hate myself. I could conquer all the demons and banish all the ghosts and open all the doors and insert more cliches here and I’d still hate myself, because it has nothing to do with who I actually am or what I actually do.

Maybe that sounds depressing and pessimistic, but to a depressed person–or this depressed person, at least–it’s actually incredibly freeing. There is no reason for the self-hatred, or whatever the proper term for that darkness is. I didn’t do anything to deserve it. It is, for whatever genetic or circumstantial reason, just my darkness to live in. For now.

You Can’t Diagnose Mental Illness from a Tweet

Today at the Daily Dot, I discussed the strange Twitter behavior of a former Paypal executive and the predictable mass rush to claim that it’s evidence of “mental illness”:

Is Rakesh Agrawal mentally ill? I have no idea, and neither do you.

There’s a long history of using mental illness as a multipurpose scapegoat when people do bizarre, harmful, or dangerous things. Mass shootings are frequently blamed on mental illness despite little evidence, as is homosexuality, kinky sex, atheism, and, apparently, weird tweets.

This accomplishes a number of things. First of all, where the behavior is harmless to others but is nevertheless not tolerated by the public–homosexuality, kinky sex, gender nonconformity–categorizing the behavior as a mental illness gives us a convenient excuse to try to change it. Second, where the behavior is harmful but we don’t want to deal with its actual, structural causes–mass shootings, sexual assault, spending too much money–categorizing the behavior as a mental illness allows us to feel like we’re doing something to prevent it without having to ask any difficult questions about how our society may be contributing to it.

Finally, when the behavior has (justifiably or otherwise) made people upset at the person, categorizing the behavior as a mental illness packs an extra punch to the insults directed at that person. That’s because mental illness is stigmatized. It shouldn’t be, but it still is. Calling someone “crazy” or telling them to “get back on their meds” or “check into the psych ward” is insulting because being the type of person who needs medication or hospitalization is presumed to be shameful.

Read the rest here.

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