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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Promoting Mental Health in the Workplace

[Content note: mental illness, including eating disorders]

This post was requested by Kate [not FtB!Kate], who donated to my conference fundraiser. She wanted to hear my opinion on mental health in the workplace and how employees and employers can foster a culture that values and promotes mental health. She had some of her own suggestions, which I’ve incorporated into this piece with her permission.

Work is often a concern for people who suffer from mental illnesses. They might worry, for instance, that their struggles will impact their work performance, that coworkers or employers will find out that they have a diagnosis and stigmatize (or even fire) them, or that offhand comments at work could trigger eating disorder symptoms.

I wrote about this topic much more generally in this piece, which was about how to prioritize and promote mental health in one’s community. Workplaces are particular types of communities, so a lot of this still applies. At the same time, workplaces present particular challenges to promoting mental health, as well as particular capabilities that might help.

Note that I’m writing this as a person with a mental illness, as a person who works, and as a person who observes human behavior. I’m not writing this as someone who’s ever been a manager or a supervisor, so while I can speak to what I would like to see from managers and supervisors, I don’t have firsthand knowledge of what it’s like to be one. If you have that experience and you’d like to weigh in in the comments, feel free to do so.

For employers/managers/supervisors

1. Ensure that the assignments you give your employees and the culture you foster in the office encourage and allow employees to take good care of themselves.

Every workplace that expects people to skip lunch or sleep less than 7 hours a night is a workplace that is detrimental not only to physical health, but mental health as well. Sleep deprivation can dangerously exacerbate many mental illnesses, and having to skip meals can cause people with eating disorders to relapse. Obviously this is unavoidable with certain jobs or when a big important project is nearing completion, but it’s avoidable with most jobs most of the time.

(At the same time, recognize that this is a problem with American culture at large, and companies feel pressure to pressure their employees in this way because if they don’t, a competitor will, and it’ll reap the profits.)

2. Make sure that new employees understand the health coverage they’re receiving under the company’s benefits plan, especially as it pertains to mental health.

Explain in as little legalese as possible what the coverage includes and doesn’t include, and where they can go to find more detailed information or look up specialists in their area. In my experience, many people are worried that if they see a mental health professional using their employer-provided insurance plan, their employer will somehow have access to their medical records. Emphasize that it’s none of your business as an employer what your employees do with their health insurance and that providers cannot disclose such information to you without a patient’s consent. For extra points, give a short overview of HIPAA.

Going over this information not only improves the odds that employees are able to get the mental healthcare they need, but it shows that you’re comfortable discussing mental health with employees and that your company thinks it’s important.

3. If you choose to have health-related contests at the office, focus them on fitness goals or healthy eating, not weight loss.

Personally, though, I’d avoid these altogether because many people consider health a personal matter and feel pretty uncomfortable about having to discuss it publicly and competitively. Even if the contest is optional, keep in mind that people will feel a strong social pressure to join in. Who wants to be the only person in the office who doesn’t seem to care about staying in shape?

In any case, framing weight loss as an intrinsically healthy and positive goal is harmful and counterproductive. You can weigh little and be very unhealthy, and if you lose weight in an unhealthy way, you’ll probably gain it back anyway. A better way to structure a health contest is by encouraging participants to achieve goals that are proven to be healthy and doable.

4. Make sure employees understand the policies and processes about taking time off for medical reasons (and remember that mental health is a medical issue).

It’s especially important to find a way to emphasize that mental health is just as important as physical health, and little gestures make a big difference. For example, you could say something like, “If you know in advance you’re going to need time off, like for a physical or a therapy appointment, you can submit the form to me at at least a week’s notice.” That provides important information while also implicitly conveying the fact that you consider therapy to be a legitimate reason to leave work an hour early.

For employees

1. Consider your own mental health when choosing responsibilities to take on at work.

It’s understandable, especially in this economy, to try to impress your boss by offering to do as much as possible and overworking yourself. However, good mental health should be seen as an investment. If you take good care of it, you’ll ultimately be more productive than if you neglect it and burn out.

This applies to all those little volunteer opportunities that aren’t directly job-related, either. If you have social anxiety, it might be a bad idea to offer to organize a social outing for the office. If you have an eating disorder that makes it really stressful to choose food to buy, it might be a bad idea to offer to bring snacks for a meeting. You know yourself best.

2. If you feel safe and comfortable, let your boss know about mental health issues that may affect your performance and how you plan to deal with them.

The “if you feel safe and comfortable” is the key part. I’m absolutely not suggesting that everyone can and should come out about their mental illness to their boss, since I know that in many cases that’s a really bad idea. (It shouldn’t be, but it is.) But personally, I know people who did this and found it really helpful because they were able to work collaboratively with their boss to make sure that they can get the time off they need and that they can fulfill their responsibilities rather than having to keep it a secret and try to solve potential problems on their own. Disclosing also makes it possible to receive any accommodations you may need, which brings me to:

3. Educate yourself about laws related to mental illness and the workplace.

The Americans with Disabilities Act (ADA) is obviously a major one, but so is HIPAA, which I mentioned earlier. The definition of “disability” in the ADA is intentionally quite general, but mental illnesses are included: depression, anxiety, PTSD, ADHD, and so on. Title I of the ADA concerns employment. There’s a lot of useful information in there; for instance, an employer cannot ask you in a job interview whether or not you’ve been treated for mental health problems, or which medications you’re taking. Keep in mind that the ADA only applies to businesses with 15 or more employees, however. Here’s another useful article about it.

For everyone

1. When someone asks you how you’re doing, be honest (within reason).

In the piece I linked to earlier, I wrote:

This is something I’ve been really making an effort to do. This doesn’t mean that every time someone asks me “What’s up?” I give them The Unabridged Chronicles of Miri’s Current Woes and Suffering. But I try not to just say “Good!” unless I mean it. Instead I’ll say, “I’ve been going through a rough patch lately, but things are looking up. How about you?” or “Pretty worried about my grad school loans, but hopefully I’ll figure it out.” The point isn’t so much that I desperately need to share these things with people; rather, I’m signaling that 1) I trust them with this information, and 2) they are welcome to open up to me, too. Ending on a positive note and/or by asking them how they are makes it clear that I’m not trying to dump all my problems on them, but I leave it up to them to decide whether or not to ask more questions and try to comfort me, or to just go ahead and tell me how they’re doing.

At work, there are obviously different standards than in other communities, or with friends and family. But even at work, there’s room for honesty and mutual support.

2. Be mindful of using language that relates to mental illness.

Casual usage of diagnostic terms (“That’s so OCD,” “You’re being delusional,” etc.) hurts people with mental illnesses by trivializing their conditions and turning them into the butt of a joke. It also makes it more difficult for people to disclose mental illnesses because it keeps people from taking them seriously. If “ADHD” is what you call it when you can’t focus on a boring project and someone tells you they have “ADHD,” you’re not going to think, “Oh, this person has a serious condition that makes it neurologically impossible for them to focus on a task unless they get treatment.” You’re going to think, “Oh, come on, they just need to close Facebook and get focused.”

3. Remember that talking about dieting and weight loss can be very triggering for people with past or current eating disorders.

Fat talk (as it’s called) is so ingrained in our culture and communication patterns that it’s hard to imagine that it could be such a serious issue for someone. But anecdotally, it seems that eating disorders in particular are very easily triggered by offhand remarks like “Ugh I need to work off this cupcake” or “My thighs are huge.” Even when not actually triggering, these comments encourage unhealthy behavior and create a social norm of dieting and preoccupation with weight loss.

I sometimes dread being around groups of women who are not my friends because more likely than not, I’m going to hear these comments. And it’s not like you can avoid your coworkers. So if you must do it, try not to do it to a captive audience.

4. Respect others’ privacy when it comes to mental health issues.

Just as you should never out an LGBT person without their permission, you shouldn’t discuss someone’s mental health with others at the office. Although I generally encourage people to be open about mental illness if they feel they can be, that has to be on their terms, not someone else’s. If you’re concerned that someone’s mental health problems are causing them to be unable to do their work, do the same thing you’d (probably) do anytime a coworker isn’t pulling their weight: talk to them about it in a kind and considerate way rather than going straight to the boss.

(An exception to this is if you’re worried that someone may harm themselves or someone else. In that case, please call 911. )

When it comes to structural issues like ableism and stigma, no community can be an island, unfortunately. There will not be stigma-free workplaces until there is a stigma-free society. But the more power you have in a workplace, the more influence yo have over its culture.

Thank you to Kate for her donation and for this prompt. 

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Can You Be Happy for 100 Days in a Row?

The 100 Happy Days project.

“Can you be happy for 100 days in a row?” the website wants to know, taunting me with its cheery font and yellow color scheme.

No, I can’t.

“You don’t have time for this, right?” the next line asks rhetorically.

I’ll answer anyway. I have time. I, despite my grad program and 3-hour commute, have plenty of time to be happy. What I lack is the capacity.

It goes on:

We live in times when super-busy schedules have become something to boast about. While the speed of life increases, there is less and less time to enjoy the moment that you are in. The ability to appreciate the moment, the environment and yourself in it, is the base for the bridge towards long term happiness of any human being.

But I do enjoy the moment I’m in. I enjoy watching the skyline from the train during my commute. I enjoyed my four-hour trek through Central Park yesterday. I enjoy the moment the shutter snaps. I enjoy the food I put into my body, especially when I’ve cooked it myself. I enjoy the feeling of my muscles straining at the gym, several times a week. I enjoy the early morning sun over the Hudson. I enjoy the relief of jumping into bed with a book or a paper after work. I enjoy the music I listen to for hours a day. I enjoy every minute I spend writing, and I spend many minutes on it every day. I’m enjoying the moment I am in right now, despite the subject that I’m about to discuss.

All of this, and yet.

I can’t be happy for 100 days in a row. I can’t be happy for ten days in a row. I can’t, except for certain very rare instances, be happy for a day.

I can be happy for an hour or a few.

And by “happy,” I don’t mean “entirely free of negative emotions.” That’s a simplistic view of happiness that few people probably subscribe to. By “happy,” I mean that the good definitely outweighs the bad. I mean feeling that your life is, basically, what it should be and that the decisions you’ve made to get to where you are have been generally pretty good. I mean feeling like you’re a good person overall, give or take a few flaws. I mean being able to wake up in the morning and feel glad that another day is starting.

I don’t know what the folks behind the 100 Happy Days project meant by “happiness” exactly, but I’m sure it’s closer to what I just described than to “entirely free of negative emotion.”

Nobody expects to be entirely free of negative emotion, so I hope that strawman is now happily burning out in the field.

I can’t be happy for 100 days in a row because my brain doesn’t work that way. The good feelings don’t “stick.” When they happen, they’re genuine and meaningful, but they wash away like words scratched into the sand. I argue against them without meaning to. That essay was shit. He doesn’t give a fuck about you. Everything about you is ugly. Your parents will die and you won’t even have the money to fly to their funerals. Your siblings barely remember what you look like because you’re never home. Your partners will leave you for real girlfriends, as opposed to the sloppy facsimile of one that you are. Everything good is temporary; everything bad is permanent.

I don’t know what the nice people who made the 100 Days website would say about this, if anything. Maybe they would say that I’m just not making enough of an effort, giving enough time, to the project of Being Happy. Or maybe they would say that they’re sorry, but this is just a fun little experiment that was never meant for People Like Me.

And there it is. It’s not that there’s anything wrong with this idea. It’s a neat idea, for certain people, for whom the biggest obstacle to being happy and satisfied with their lives is failing to stop and smell the roses.

But I can’t tell you how often I come across these things, accidentally or because a friend recommended it, and think, “Oh, right, that’s not for me.” All those self-help books, anything that addresses mood without explicitly trying it to mental health and psychology. (This one especially.) All these little projects. The mere idea of self-care.

While I know many people with mental illnesses get a lot out of self-care, and self-help, and what have you, for me personally, it’s never resonated. I’ll tell my friends that I’m sorry, I can’t go out tonight after all, because I just can’t and I’m sad and I can’t. And they’ll be supportive, they’ll say, “It’s okay, everyone needs some time to recharge and take care of themselves.” And I get frustrated and I want to tell them that NO I’m not going to “recharge” and this isn’t “taking care” of myself this is giving up and it’s NOT going to make me feel better to sit alone in my room looking out the window all night, it’s just that crying in public is inappropriate whereas crying in your room is okay, so that’s what I have to do.

For me, “self-care” and “enjoying the moment” aren’t things I do because they make me happy, since almost nothing makes me happy. They’re things I do because they help me feel like there’s a purpose to my being here. And I need to feel that way to continue to be here, because I’ve been close enough to the edge to know how slippery and ephemeral that belief can be, and what chaos breaks loose without it.

People say, “You should do what makes you happy.” They say, “I’m glad you moved to New York where you could be happier.” They say, “The most important thing is to be happy.”

Well, I have to measure my outcomes in other ways. I don’t care how much money I make (I won’t make much) or how far up on the career ladder I get (I won’t get very high) or how desirable of a person I marry (I might not marry anyone), and I can’t really be happy. What does that leave?

How many interesting and fond memories I collect. How many people I impact positively. How much and how well I write. How much I influence the causes I want to influence. Of course, it’s much harder to get a sense of these things than it is to get a sense of how happy or sad I am at any given moment.

It’s entirely possible that in a few months or years I’ll be taking this post back. Maybe happiness the way I define it is in my future, maybe one day I’ll stop bitterly regretting all the choices I’ve made and scanning communications from my friends and partners for signs of imminent departure. Maybe the view of the skyline, beautiful as it is, won’t be the best part of my day anymore, because there will be something better. Maybe the flowering trees along Broadway will be the nice little extras that push the day from good to great, as long as I remember to stop and smell them.

But if anything, all these years of feeling like my brain is a science experiment gone awry have taught me that happiness isn’t always an accurate or precise measurement of anything. When I’m achieving everything I want to achieve and I’m surrounded by loving friends and family but I still feel miserable, the failure to be happy isn’t a “sign” of anything. For me, mood is mostly decoupled from the things that are actually supposed to create happiness, whether that’s professional success or pretty flowers or whatever.

I can’t be happy for 100 days in a row, but that means nothing other than my brain doesn’t work that way. All things considered, I think I’m doing pretty okay for myself, despite and regardless of and, most importantly, because of the challenges my mind creates for me.

Online Bullying and Trauma: What’s At Stake?

[Content note: online bullying/harassment]

Since I wrote my last blog post, I’ve been treated to a number of enlightening debates about the issue of online bullying and PTSD. And by “enlightening,” I don’t mean that I changed my mind about anything or learned very much about online bullying or PTSD. Rather, I gained an understanding of just how desperately people will cling to the claim that online bullying cannot cause trauma (and therefore PTSD or other mental illnesses), or that even if it is in some way actually seriously damaging, we need to have some sort of different name for it to differentiate it from, you know, “real” trauma and psychological suffering.

This doesn’t seem to be that polarizing an issue, but it clearly has been (to wit: someone managed to compare me to a Fox News anchor and a fundamentalist Christian in the same paragraph because I claimed that both combat and online bullying can cause PTSD). Whenever people defend a view on an issue that does not impact them personally in any way with such gusto (and such incredible derision, contempt, and hatred), I get the sense that there’s more at stake here than the mere question of whether or not online bullying can cause trauma. Suppose it can, and does. What do we lose? How must we change the way we go about our lives online and off? What is so goddamn inconvenient about this idea that it must be defended so vigorously and, at times, so cruelly?

I can think of a few reasons why.

1. If online bullying can cause trauma, we must acknowledge that the internet is “real life.”

And there goes all the condescension about “surfing the web instead of going out into the ‘real world,'” all the snarking about people who meet their partners online (and perhaps don’t immediately follow that up by meeting in person), all the unsolicited advice about “don’t let it get to you, it’s just the internet,” all the ridicule of people whose primary social ties are through the internet, and all that.

2. If online bullying can cause trauma, we may have to be as careful with criticism and argument online as most of us are offline.

This is a lesson some writers learn the hard way. I remember the first time some public figure I criticized in a blog post actually read and responded to the thing, and I realized that I’m not just shouting into the void anymore. The person I criticized said that the criticism stung but that they learned a lot from it and that I was right. All the same, would I have written it differently if I’d expected them to read it? Absolutely. And these days I do.

I was a little bit horrified and dismayed to see how much power my words had, despite the fact that I had not been cruel or hateful at all. Criticism hurts, even when it’s justified and necessary, and even when the target of the criticism is ultimately glad to have received it. Offline we learn all sorts of techniques for criticizing someone effectively and fairly, like sandwiching the critique between two compliments. Online it’s easy to forget why we’re given that advice. It’s also easy to forget, especially when you’re not exactly internet famous, that the person you’re calling out might actually read it.

To be clear, I’m not saying that all online criticism (or even most of it) qualifies as “bullying.” Negative comments towards other people exist on a continuum. But if online bullying can be traumatic, then online criticism can be needlessly hurtful if not done carefully. Note that I said “needlessly”: sometimes hurting people is unavoidable because, as I said, criticism hurts. But I consider it an ethical responsibility to try to minimize needless hurt.

3. If online bullying can cause trauma, we have to take it seriously.

No more “don’t feed the trolls” or “it’s just some asshole in his parents’ basement” or “don’t let it get to you” or “it’s not like they can do anything to you anyway.” Even if they can’t physically find you and hurt you, they have already “done something” to you: they bullied you.

Of course, even offline bullying isn’t taken as seriously as it should be; things like that are said to victims of offline bullying too. But it’s not dismissed quite as much. There’s an understanding among most people that if you’re taunted and teased and harassed all day long at school, then it’s going to seriously harm you and your experience at school, especially if physical violence is involved. With the internet, it’s usually “just stop going on Twitter,” ignoring the fact that for many people, being on Twitter or other parts of the internet is pretty much as necessary as it is for children to attend school.

But we don’t want to take online bullying seriously because we don’t want to take the internet seriously, and because it’s easier to just dismiss it and put the onus on victims to avoid it rather than on social sites to develop better safeguards against it and on bullies to stop fucking bullying. We’ve chosen to treat bullying much as we’ve chosen to treat rape: as some sort of amorphous force of nature that we can never stop, only try to avoid.

4. If online bullying can cause trauma, we must expand our understanding of mental illness beyond what we see in the media.

Seeing a friend blown up by an IED can cause trauma. Receiving a constant stream of slurs and graphic threats of violence, dozens a day for several years, can also cause trauma. The former is much easier to portray in film and literature, and it’s what people are familiar with. You can’t shoot an interesting scene in which someone’s terrified to leave the house because some creep on Twitter said he knows where they live and plans to come rape them.

And that scene isn’t the type of scene that persuades people to donate thousands to PTSD therapy research. It doesn’t inspire a lot of sympathy. But it should, because as I wrote in the last post, sympathy is not a zero-sum game.

People keep insisting that if we claim that both combat and online bullying can cause trauma/PTSD, we’re somehow saying that combat and online bullying are “the same.” They’re not. Nobody claimed this, ever, at any point. If you hypothetically asked a large sample of people if they’d rather go to war for six months or be bullied online for six months, the majority may well pick the latter. Who knows? Who cares?

A multiplicity of different stimuli and experiences may lead to the same symptoms. Those symptoms may vary in severity based on the original stimulus, or they may not. I’m sure there are people who had much more difficult lives than I have whose depression is much less severe, or who don’t have depression or any mental illness at all. So what?

5. If online bullying can cause trauma, we have to accept the ways in which people avoid it.

As I’ve said, it’s not the victim’s job to prevent their own victimization. Nevertheless, the same technology that makes bullying so easy also makes avoiding it easier at times.

And yet. The same people who declaim that anyone traumatized by the internet must remove themselves from it forthwith (which, as I’ve noted, is not realistic, fair, or ultimately helpful) are also usually the people who ridicule anyone who takes steps to limit their exposure to nastiness online. These are the people who whine about their free speech whenever their comments are deleted from a blog. Who complain when a blogger has no comments section at all, as though having one were mandated by some Internet Rule. Who consider the existence of the Block Bot to be some enormous personal slight. They think that either you must be willing to engage with any and every person who decides to show the fuck up in your Twitter mentions or your comments section, or you must shut down your Twitter account and your blog.

Look, if you believe that it’s the responsibility of someone who’s getting bullied to avoid the bullying, you cannot then condemn them for avoiding it by any means other than never going on the internet again. This all-or-nothing crap is silly.

In conclusion: accepting the claim that online bullying can be traumatic may involve a shift in how we think about internet interaction. Generally, this shift entails taking more responsibility for the way we treat people online, taking online communication more seriously, and letting go of some stereotypes and misconceptions about the internet and mental illness. That sounds like hard work. I’m not surprised people find it so inconvenient.

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Your Uninformed and Incorrect Opinions About Psychology

[Content note: PTSD, online harassment & bullying]

This is going to be a little different from most of my posts because I’m angry about a number of things, most of which boil down in one way or another to this: I am tired of people with no experience or education (whether through formal schooling or one’s own research) presuming to condescendingly (and, at times, abusively and violently) talk down to those who do have that experience and education. I am tired of being presumed incompetent by default unless I laboriously prove my qualifications, knowledge, and skills, while older men get to prattle on about fields they have no apparent experience with without ever needing to qualify their unasked-for lectures with proof of their competence. That’s all for that.

Now. Apparently a bunch of Skeptics™ don’t know what posttraumatic stress disorder is, but insist on lecturing those diagnosed with it (or those who have studied it) without ever bothering to educate themselves about the disorder, its symptoms, and its etiology. Because nothing says skepticism quite like blathering on about what you have no evidence for!

This is nothing new, of course. Some other entirely unsupported claims related to psychology that I have heard from Skeptics™:

  • Religious belief qualifies as a delusion.
  • Having a delusion qualifies as a mental illness.
  • Religion is a mental illness.
  • Cognitive dissonance is a mental illness.
  • You can instantly stop yourself from feeling upset or angry about something “irrational.”
  • It is “irrational” to feel pride about one’s minority identity because you didn’t “do anything” to have that identity.
  • Sticks and stones may break my bones but words will never hurt me.
  • It is “irrational” to fear strange men coming at you in the dark because most men are not violent.
  • It is “irrational” not to want to get the police involved after a sexual assault for fear of retraumatization.
  • If you feel traumatized by online harassment, then you are “weak.”
  • And, apparently, only war and similar experiences can cause PTSD.

Look, I could present you with shelves full of books and articles that refute all of these points. I could. Or, you could actually consider doing some research before you opine on subjects you’ve never studied and issues you’ve never personally faced. You could.

I understand that psychology is a unique discipline in a few ways. Unlike with other sciences, everyone has experience forming hypotheses about psychology, observing psychological phenomena, and analyzing those phenomena. We all do it every day whenever we try to figure out if someone is lying, whether or not a crush likes us back, how to help a friend who’s feeling really sad, how to appeal to an interviewer, what caused our parents to act the way they do, and so on.

There’s nothing really like that with, say, physics. The most interaction most people have with physics on a daily basis is just understanding that you probably shouldn’t leap off a building to try to fly. The most interaction most people have with chemistry on a daily basis is bemoaning the fact that some item that got left outside in the rain has gone all rusty. The most interaction we have with biology on a daily basis is remembering that our bodies need food in order to continue functioning, and that’s mostly automatic anyway thanks to our sense of hunger. The most interaction we have with computer science on a daily basis is maybe formatting an HTML tag on Tumblr.

There’s no reason for people to assume they are qualified to lecture others on physics, chemistry, biology, or computer science. There are many reasons for people to assume they are qualified to lecture others on psychology.

And to a certain extent, our individual experiences with human psychology are valid and real in a way that our opinions on other scientific topics might not be. We rightfully mock Jenny McCarthy for claiming that vaccines cause autism and creationists who claim that the earth is 5,000 years old because that is demonstrably false. But when someone writes one of those useless books on How To Get All The Women To Have Sex With You, we think, Well hmm, if it worked for him… When someone says that antidepressants are unnecessary because doing yoga made their depression better, well, maybe yoga really did make their depression better.

Think of the platitudes that are often proclaimed regarding human psychology. “Opposites attract.” “Relationships are ultimately about a struggle for power.” (Note: do not date anyone who says this.) “You can’t truly be happy unless you have children.” “Homophobes are just secretly gay and acting homophobic so that nobody guesses.” (Fuck that Freudian bullshit.) All of these statements have a little bit of evidence supporting them but a lot of easily-findable counterexamples, and yet people repeat them because they feel true to their experience and their understanding of the world. These opinions come from real experiences that really happened and can be interpreted in a multitude of ways. But that doesn’t mean that they are supported by research.

So, onto our Skeptics who think themselves qualified to determine who has PTSD and who doesn’t based on their own random little criteria. First of all, if someone has the symptoms of PTSD, then they have the symptoms of PTSD. You can’t Logic! and Reason! your way out of this.

But second, to anyone who claims that only things like combat, assault, or natural disasters can cause PTSD, maybe you should see what actual researchers in psychology have to say about that. Namely:

Research on online bullying and harassment is, unfortunately, still sparse. But given the dismaying way in which interactions online can incite the same strong emotions that interactions in person can, I fully expect this area of research to fill up quickly. We’ve already seen in several high-profile cases that technology-based bullying and harassment can provoke someone all the way to suicide. That they might also experience PTSD is not a huge logical leap at all.

As far as the official diagnostic criteria for PTSD go, here we have a further gap. There are several sections and subsections of the criteria, which I will attempt to summarize:

  1. Exposure to actual or threatened death, serious injury, or sexual assault. This can be your own or someone else’s, and it can include exposure to traumatic details (like you might experience as a police officer or doctor).
  2. At least one “intrusion symptom,” which includes symptoms like flashbacks, nightmares, intrusive memories, and strong unpleasant physiological reactions to stimuli that remind you of the event.
  3. Persistent avoidance of things that remind you of the event. This can mean trying to avoid memories, people who were there, and so on.
  4. Negative effects on mood and cognition, such as forgetting important parts of the event, distorted and negative thinking (such as blaming yourself for what happened), persistent negative moods like sadness or anger, and feeling detached from other people.
  5. Negative changes in arousal and reactivity, such as recklessness, angry outbursts, trouble concentrating, insomnia, and so on.
  6. The usual DSM-type caveats: it has to be longer than a month (these time frames vary for different mental illnesses, by the way); it has to cause “clinically significant distress or impairment in social, occupational, or other important areas of functioning”; and it cannot be attributable to the effects of a substance like alcohol or medication, or to another medical condition.

So. You can see that where we run into trouble is with that first criterion, which attempts to define the types of events that may cause PTSD. This is unusual. Diagnostic criteria for other mental illnesses rarely include etiology as part of the diagnosis, because it’s understood that various types of life stressors, environmental factors, and genetic/biological predispositions can combine to cause problems like depression, anxiety, substance abuse, ADHD, and even schizophrenia.

Notably, the International Statistical Classification of Diseases and Related Health Problems, which is the diagnostic manual used by the World Health Organization, does not attempt to stipulate which types of trauma cause PTSD. It just states that the first criterion is “exposure to a stressful event or situation (either short or long lasting) of exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone.”

I can easily see bullying and harassment falling under that category, as the only people I have ever seen claim that bullying and harassment are not traumatic are people who have not personally experienced it.

The key is this: it’s called posttraumatic. Stress. Disorder. If trauma has occurred, and is now causing all of these symptoms, then it makes sense to refer to the illness as PTSD. I’ve written before that I think it’s harmful to refer to clearly non-clinical problems with mental illness terms, because that really does dilute the meaning of words like “depression” and “OCD.” However, if your psychological experience literally looks like the psychological experience of someone who served in combat and now has the same symptoms as you, I’m absolutely comfortable with calling that PTSD whether or not the DSM strictly agrees or not. Then it’s less appropriation and more self-diagnosis, which is often the only option for some people. The DSM is constantly evolving, and I predict that as more and more research is published that examines PTSD symptoms in victims of sexual harassment, bullying, and online abuse of various kinds, the DSM criteria will accommodate this evidence. Which, as I said, is already appearing, just not in huge numbers yet.

Now. I want to validate the discomfort or anger people may feel when they see that a diagnosis they have because of a horrifically violent experience, like military combat, is suddenly being used by people who receive abusive tweets online. It’s okay to be upset because you feel like your experiences are being minimized. However, it’s also important to try to look at it skeptically. Your military-caused PTSD is no less difficult and painful and legitimate just because someone who got bullied in school also has the same diagnosis, just like the fact that someone as privileged as I am still has depression does not minimize the fact that some people have depression because they grew up abused and in poverty. This is not a zero-sum game. It is not any type of game. There is not a limited number of diagnoses that can be meted out, such that if too many victims of online harassment get diagnosed with PTSD, some of your fellow vets will get a shrug and a “Sorry man, we’re all out.”

And those of us who care for and about people with mental illnesses do not have a limited and quantifiable amount of empathy to give out. I feel empathy for my clients who lost their entire families to the Holocaust, and I feel empathy for my clients who are upset because their children live far away and never visit. I feel empathy for my friends who are worried about getting a job after graduation, and I feel empathy for my friends who are worried about making it out of an abusive relationship. I don’t need to try to rank their problems from least to most severe. That is not what mental healthcare is about.

But now I’m angry again, because you don’t get to tell people what mental illness(es) they do and do not have. You especially (and yes, I’m back to all you Skeptics™ now) don’t get to speak authoritatively on topics you have no authority to speak on. I don’t subscribe to the elitist notion that a PhD is the only way to make your opinions matter, but I do subscribe to the notion that you should learn about the things you want to talk about before you talk about them.

Psychology may be something we all have experiences with and opinions about, but it is still a science. It’s a science with thousands of research journals and departments. It’s a science with good methods and not-so-good methods. You have libraries and Google Scholar available to you. If you’re confused about something, you can avail yourself of the opinions of people who study, research, and practice psychology.

I’m tired of hearing complete and utter bullshit from Skeptics™ about psychology, spoken without even a hint of caution, with nary a “I think that” or “Isn’t it the case that” or “I might be wrong, but.” Instead I hear, “Cognitive dissonance is a mental illness.” I hear “You can’t possibly have PTSD from that.”

Stop that.

Yes, I’m talking to you, dude who memorized a list of cognitive biases and thinks that counts as knowledge of psychology. And yes, you too, dude who memorized a list of logical fallacies and thinks that counts as an understanding of good argumentation. And you as well, dude who read some crap blog post about Top Ten Ways Religion Is Like A Mental Illness and thinks that counts as a clinical license to diagnose people.

Your opinion does not deserve respect if you haven’t bothered to do even the most basic research to support it. Take a fucking seat. Preferably in a Psych 101 lecture.

~~~

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Disrupting Depression’s Negative Feedback Loop

[Content note: depression]

Recently I went through a spot of depression. I’m not sure if I’d call it “An Episode Of Clinical Depression” or not; when you have a personality that already meets several of the diagnostic criteria for depression and you’ve had it since your earliest memories, it can be hard to tell what is or isn’t “An Episode Of Clinical Depression.” So, I don’t really care what I call it.

The whole thing seemed to draw on a few of the recurring themes in my life: I Cannot Date Like A Normal Person; Everything Good In My Life Is Over; I Will Never Have A Real Career Or Any Money; and, my personal favorite, There Is Nothing Redeeming About Me Except My Writing Ability. (Make a note of these; they’ll be on the exam.)

Of course, objectively, everything was going pretty well for me this winter. I have great friends in NYC that I see once a week or more. School stuff was going fine. I love New York. I have a no-longer-very-new partner that I like very much and whose only significant drawback is having the misfortune of not living in New York. (Alas, not everyone can be so lucky as me.) The fact that I managed, in light of all this, to be entirely convinced of my own failure in every conceivable department (while I remained confident of my writing skills, I berated myself endlessly for underutilizing them) was the first sign to me that something was once again significantly off in my brain.

Depression is really nothing but a huge negative feedback loop. The worse I felt, the more I became convinced that I have nothing of value to offer other people as a friend, partner, or anything else. I found that I could barely stand messaging with friends online (something that’s normally my lifeline) because I felt like I had nothing to say. People would ask how my life is or what’s up or how I’m doing or whatever and I had no way to answer that question. My life is bad. Nothing is up. I’m doing shitty. And you?

My various attempts to talk about the depression itself (only when people asked, of course) generally got nowhere. Either they would be like “That really sucks, I’m sorry :(” and the conversation would end there (as it should–I don’t want to force anyone to listen to this) or they would attempt to fix me and that would fail and there would be frustration all around. A few people would listen patiently and then say very little and I had the distinct sense of over-stepping, and so I tried not to ever do it again.

To make matters even worse, I couldn’t stand hearing about their lives, either. Hearing about someone going on a date or otherwise doing romance-/sex-related things became a literal depressive trigger. One time I ended up going back and forth between crying and just being miserable for the rest of the day because someone told me that someone else we know went on a date. Not because I begrudged them their happiness at all, but just because I was entirely convinced that I would never go on a date again because for whatever reason I can’t handle going on dates. (Long story. In sum: introversion.) I also hated hearing about job-related success because I was (and remain) convinced that I will never in my entire life have a job I like OR a job that gives me enough money. I’m not even talking both, mind. Either/or. But that’s also a long story.

So, since I couldn’t talk about my own life and I could only listen to other people talk about their lives as long as they weren’t happier with those lives than me, that left me with…not a lot of conversation topics. (My other mode is RAGE ABOUT SOCIAL JUSTICE!, but I’m only okay with doing that when someone specifically starts a conversation with RAGE ABOUT SOCIAL JUSTICE! Otherwise I assume nobody gives a fuck.) And thus I ended up largely avoiding conversations. And that only made me more and more convinced that I’m broken and wrong and cannot interact with other people like a normal fucking human being, which only exacerbated the depression, which only made me more and more convinced–and so on. There was even a point when I hit rock-bottom and made a list of ways in which I’m a total worthless failure compared to one of my friends and I came up with 21 reasons. That is a lot of ways to fail. And I could’ve probably kept going.

Sometimes there is no rhyme and reason to any of this. I remain hopeful that someday researchers will understand exactly how and why it happens and how to stop it, but for now, the depressive feedback loop continues ad nauseum–until it’s suddenly interrupted. What it takes to interrupt it is something that varies from person to person. For some it’s drugs or therapy (drugs worked that way for me once a long time ago), for some it’s getting out of a situation that’s become intolerable, for some it’s finding a way to make a situation tolerable, for others it’s totally random.

For me, it was reconnection. Everything suddenly flipped around on a random day when a friend saw a sad tweet of mine and offered to listen if I wanted to talk. Knowing this friend is struggling with depression too, I told them a little bit about it and they responded kindly and helpfully, neither trying to fix me nor leaving it at “sorry, that sucks.” We didn’t talk for long, but it was enough to disrupt the depressive feedback loop. (It was also enough to make me realize that one of my major mistakes this entire winter has been attempting to discuss depression with people who do not have it. Of course that’s not going to go anywhere. They can’t possibly have any idea what the fuck I’m prattling on about.)

That day I started talking to more people. People I hadn’t talked to much for a few weeks or months, or that I’d been talking to a little bit not very authentically. I let myself believe that I am the sort of person who actually talks to people long enough to become that person again. And the more I felt like a competent and sociable person who has positive traits, the less I got insecure and anxious when people talked about their own accomplishments, and the more I was able to show genuine happiness for them, and the more I felt like a competent and sociable person who has positive traits.

And that evening, I found out that two of my closest friends are moving to New York this summer. These are the kind of friends that I feel comfortable asking to hang out when I’m feeling down, the kind of friends I’d invite to my shitty little apartment, the kind of friends I don’t need a “reason” to go see. The kind of friends that my other local friends will eventually become, but not yet.

Already the huge city felt less lonely.

Later that night I took a hot shower because why not. I could hear my phone pinging with messages from my friends. The bathroom window was open because the city was finally unfurling from its long frozen sleep, and the steam from the shower was billowing out the window into the darkening sky. I’ve often felt a strange nostalgia and comfort standing at this spot, and that night I finally realized why: my grandma’s apartment in Israel is the only other one I’ve spent lots of time in that has a bathroom window, and for a moment I felt like I could almost be back in my first home again.

The second I realized that, I suddenly knew that everything would be okay again.

To be sure, I knew that there would still be awful nights after this one and that it would probably take a long time to be as happy and hopeful as I was during my senior year of college. But every time in the past that I’ve gotten that unmistakeable “it’ll be okay” feeling, it was the beginning of a long but steady trek up and out of the ditch I’d found myself in.

I recently saw the movie Frozen (yes, just recently). A lot of things resonated with me in that movie, but in particular I liked the theme of connection. In the movie, Elsa tries to hide her magical talent (and, by extension, her entire self) from everyone around her, even the little sister she loves, in order to keep them safe from the magic and to keep it a secret. That to me sounded a lot like a metaphor for depression, whether or not it was intended to be one. I also go to certain lengths to keep people from seeing how miserable I sometimes am*, and I also do this in order to “protect” them from worrying about me, from the frustration of being unable to help, and from whatever mild or severe drop in mood they may experience upon exposure to me. Like Elsa, I ultimately fail at this.

Elsa discovers in the end (spoiler alert) that the only way to prevent her gift from consuming her and everyone around her is through connection with others, through being close to people she loves and experiencing the positive emotions that brings. Likewise for me, there is no relief from depression without connection. Locking myself away in a tower makes for a good fairytale, but not so much for a recovery.

But that’s where my story diverts from the Frozen metaphor. There is no turning my depression into a wonderful force for good that makes a big happy ice skating rink for all the villagers and a cute snowman who talks and a beautiful ice palace. I have always resisted the societal imperative to turn all adversity into a “blessing in disguise.” While I certainly learned useful things from the experience of being depressed, that doesn’t mean that depression itself has positives, at least not for me. If you’d like to view yours that way, you are of course welcome to.

For all the fuss I make about how I can’t do this or that or I totally fail at this or that (I have basically decided that I am never going on a “date” again and I have also given up on trying to find a summer internship because they’re all unpaid and I’m fucking tired of paying for public transit and for lunch every day without being paid for my goddamn work), I’m actually improving in all sorts of ways. My writing’s never been better. I’ve started writing for the Daily Dot, which demands a level of confidence I did not previously have. I’ve been starting more conversations with people online, which I don’t usually do (especially not while depressed).

And, for the first time ever, I’ve written a blog post that’s purely about myself and my life and I don’t even have the slightest urge to put a big disclaimer at the top about how this is a personal post and you probably shouldn’t read it.

That’s right, I actually don’t give a fuck if you read this post and think it’s a waste of your time. Too bad, I guess. :)

Now that I’ve gone all meta, I’ll just say this: this is not an advice post. Please don’t leave me angry comments about how suggesting that you talk to your friends more isn’t going to help. If you’re going through something that may or may not be “An Episode Of Clinical Depression,” please do whatever makes the most sense to you or seek advice from a qualified professional. But what I do think that anyone can glean from this story is that sometimes you have to find a way to disrupt the negative feedback loop somehow. The challenge is figuring out what will disrupt it for you specifically.

What I went through this winter was pretty mild compared to other depressive things I’ve gone through, so it makes sense that the solution to it was also pretty easy and simple. Letting my friends back in felt like opening the curtains and letting the sunlight back into my room after a long, dark winter.

~~~

*By the way, the fact that I write publicly about depression is not at all incompatible with the fact that I hide the worst of it. I do pretty much everything described in this perfect article about how to be a “good depressive citizen.” In fact, I’ve probably done it in this post. But I tried to circumvent that a little by letting you see a little bit if how I actually felt.

Edit: So I got curious and read the Wikipedia entry about “The Snow Queen,” the fairytale that Frozen is loosely based on. It sounds like an even better metaphor for depression than the movie:

An evil troll (“called the devil“)[2] makes a magic mirror that distorts the appearance of everything it reflects. It fails to reflect the good and beautiful aspects of people and things, while magnifying their bad and ugly aspects. The devil teaches a “devil school.” He and his pupils take the mirror throughout the world and delight in distorting everyone and everything; the mirror makes the loveliest landscapes look like “boiled spinach.” They try to carry the mirror into Heaven with the idea of making fools of the angels and God, but the higher they lift it, the more the mirror grins and shakes with delight, and it slips from their grasp and falls back to earth, shattering into millions of pieces. These splinters — some no larger than a grain of sand — are blown around and get into people’s hearts and eyes, freezing their hearts like blocks of ice and making their eyes like the troll-mirror itself, seeing only the bad and ugly in people and things.

Religion vs. Mental Illness, A Bit More Concisely This Time

Chris Stedman, author of Faitheist and blogger at the Religion News Service, asked me to comment on why atheists should stop calling religion a mental illness for a piece he published today. I ended up giving him a way longer comment than he necessarily wanted or needed (#bloggerproblems), so I thought I’d publish the full thing I sent him since it’s nevertheless a way more concise explanation of my views than my huge post on this was.

Equating religion with mental illness is harmful for a number of reasons. First of all, when done to make fun of or put down religion, it also puts down by association people struggling with problems like depression, anxiety, eating disorders, or schizophrenia. People with these serious mental illnesses already face plenty of stigma and discrimination, so derogatory remarks about how religious people are “all crazy” or “belong in a mental institution” are harmful.

Second, this comparison ignores the fact that religion and mental illness are different psychological processes. Religion largely stems from cognitive processes that are essentially adaptive, such as looking for patterns, believing in things that are comforting, and getting joy out of connecting with others and feeling like a part of something larger than oneself. Mental illnesses, by contrast, are fundamentallymaladaptive. People who cannot leave the house without having a panic attack, who feel a compulsion to wash their hands hundreds of times a day, or who are convinced that everyone hates them and they are better off dead, are experiencing symptoms that interfere with their ability to go about their lives. Except in extreme cases, religion does not operate this way. It is important to point out when religious beliefs and observances reach a level at which people cannot function normally, but we do the secular movement no favors by focusing on these instances to the exclusion of the vast majority of religious people who are healthy, happy, productive members of our society.

Third, calling religion a mental illness keeps us from asking serious questions about what actually does attract people to religion. Often, it’s the sense of community, the support available to people who are struggling financially or emotionally, the quick way to make friends, and the opportunity to mark important life occasions such as births, marriages, and deaths using traditions that feel meaningful. Although some of us are trying, atheists are still not that great at providing these types of communities. Many refuse to even acknowledge that most people value–even need–such communities. Calling religion a mental illness is a convenient way to avoid thinking about what we could actually be doing to make the secular community more welcoming and inclusive, and what sorts of resources we are lacking that people can find in religious communities.

Finally, claiming that religion is a mental illness obscures the fact that we all–yes, atheists too–regularly engage in irrational thinking. Religion is a type of irrational thinking, but it is not the only type; introductory psychology textbooks catalog dozens of biases, fallacies, and other ways in which our minds trick us. While it’s impossible to become entirely free of cognitive bias, we can become more free of it by learning to notice it. If thinking irrationally is a mental illness, then we are all mentally ill, and the term loses its meaning. As a survivor of mental illness myself and as someone who plans to work as a therapist, I think we should save that term for situations in which people are truly suffering and having trouble going about their lives.

Don’t forget to go read Chris’s piece!

And incidentally, I’ve been quoted by journalists a bunch of times and it has almost always come out sounding weird and out of context and not like what I meant at all. Chris avoided this issue entirely and even let me see a draft of the piece to make sure he wasn’t misrepresenting what I said or getting anything wrong. If he ever asks you for a quote, say yes!

What This Depression Survivor Hears When You Call Religion A Mental Illness

[Content note: mental illness, suicide, abuse]

Some atheists love to compare religion to mental illness, or directly call it one. I won’t link to examples; it’s pervasive and has probably happened on this network.

While there may be some useful parallels between mental illness and certain types of religious experiences, calling religion a mental illness in the general sense is a clumsy, inaccurate, alienating thing to say.

This is a list of things that go through my head, things that I hear when I hear atheists calling religion a mental illness. I’m speaking only for myself here. My experience of having depression informs some of these opinions, but so does my knowledge of psychology, my experience working with people who are struggling, and my understanding of what being religious is like and what draws some people to religion.

Some of these may seem contradictory. That’s because they are. Atheists who compare religion to mental illness may do it in various ways and with various meanings. They may do it in a “logical,” intellectualizing sort of way, or they may do it in a spontaneous, ridiculing sort of way. It can be “Religious people are victims of mental illness and need our help” or it can be “LOLOL go see a shrink for your stupid sky daddy delusions.” What I hear when I hear you calling religion a mental illness depends on the context.

“Nobody in their right mind would ever choose to observe a religion.”

Calling religious people mentally ill suggests that they do what they do because they’re “crazy.” I get that religious beliefs and rituals may seem bizarre to atheists who have never had any desire to hold those beliefs or perform those rituals. Sometimes when I’m at religious Jewish functions I sort of look around myself and feel like a bit of an alien. This is so weird, I think. Why would anyone do this?

A major component of mental illness is that it is maladaptive. People with OCD sometimes can’t function because they can’t stop performing their rituals or thinking about their obsessions. People with depression sometimes can’t get out of bed, shower, talk to people, go to work for weeks or months at a time. People with schizophrenia sometimes lose all sense of the distinction between reality and fantasy.

Religion can be maladaptive when taken to extremes, but that’s a problem with the manifestation, not with the core component: believing in a god. In and of itself, believing in a god can actually be very adaptive. When people feel like they have no control over the universe, when they lose someone they love, when a grave injustice happens, it can be comforting to believe that there’s someone up there pulling the strings. It’s not comforting to me, personally, but to many people it is. That doesn’t make their beliefs accurate, but it does make them understandable. You don’t have to be “crazy” to want to believe in a religion.

“Your religious friends may seem happy and well-adjusted, but they’re actually sick just like you are.”

We often hear about people who are restricted, cut off, or even abused by their religion. These cases are tragic and deserve every bit of the attention that they get. But what about all the people living happily with religion?

Atheists who claim that religion is a mental illness seem to be saying that these people are just kidding themselves. Sure, they’re happy, but that happiness can’t be real because it’s the product of a mental illness. Or they think they’re happy, but they’re really not.

If this is what you believe about religious people, ask yourself why you think you know more about their mental state than they themselves do.

“I consider myself qualified to diagnose millions of people I’ve never met with a mental illness.”

Armchair diagnosis is a bad idea. It promotes the idea that mental illness is whatever we feel on a whim that it is, and that random internet commenters are qualified to determine whether or not someone has a mental illness despite never having even spoken to them, let alone spent time with them in person as a diagnosing psychologist would.

“Whether or not I think someone is mentally ill is more important than whether or not they think they’re mentally ill.”

And in addition to that, the fact that probably zero religious believers think that their religion qualifies as a mental illness is a good indication that you should stop saying that it is. Of course, you can and should disagree with them on other things, external things, like whether or not god exists or whether or not religion is a net good in society or whether or not people can be ethical without religion. But what goes on in their own minds is something they know much more about than you ever will.

“People who say their faith helped them deal with their mental illness are just kidding themselves.”

Can’t fix a mental illness with another mental illness, right?

This is a tricky area because I do think it’s very fair to question the presumption that religion helps people with mental illness in general. First of all, people (religious and not) with mental illnesses are often told that they need to pray or “have faith” or repent or whatever, because some religious people believe that mental illness is a sign of insufficient faith or a punishment from god or both. Second, some religious people find that religion actually makes their illness harder to cope with, whether because of these responses or other factors. Some people may even become more vulnerable to mental illness as a result of something their religion taught them, such as shame or a preoccupation with doing things a certain way.

However, there are also many people who say that religion helped them cope with their mental illness, whether it was the faith itself, a supportive religious community, or both. I do not feel comfortable claiming that these people are lying to themselves or to us.

I wish that people didn’t need faith to cope. I wish we had foolproof treatments for mental illness. I wish everyone had access to those treatments. I wish we never had to send patients home saying that we don’t know what else to do for them. I wish we knew exactly what–which genes, which environments, which neurotransmitter deficiencies–caused mental illness, so that nobody ever had to feel like it was either a random accident of chance (terrifying) or an act of god (slightly less terrifying, for some people).

But right now, we don’t have any of that. So it makes sense that some people would cope by telling themselves that it’s part of god’s plan and that they can’t possibly comprehend that plan.

I want people to be happy and alive. That’s my first priority. Once they’re happy and alive, I can think about trying to get them to think more rationally and scientifically. If thinking irrationally and nonscientifically is what keeps someone from suicide (or from a miserable life), I accept that.

And as far as the community aspect goes, having a strong support system can be both a protective factor against mental illness and also a mechanism that helps people cope or recover. Building humanist communities is extremely important for all kinds of reasons and this is one of them. We’re making progress, but humanist communities still don’t have the scope or resources of religious ones. There are also still plenty of atheists publicly decrying these projects and boasting about how they don’t need them and such things are useless and pseudo-religious and for the weak-minded. That’s harmful. If a religious person feels that their church or synagogue is the only source of support they have for their mental illness, they might not necessarily be wrong.

“Religious beliefs are inherently bad and harmful to the individual, just like the distorted thoughts associated with mental illness.”

Some people, such as Greta Christina, have made powerful, compassionate arguments for the idea that religious belief is universally, intrinsically harmful to society, separate from the harmful effects that organized religion can have. I’m not sure yet how I feel about these ideas, but I’m still much more comfortable with the opinion that religious belief does harm to other people and to society as a whole than that necessarily does harm to the individual who holds it.

Most religious people would probably say that their religion helps them be happy, charitable, kind, and strong. I may feel skeptical about this, but they know better than me.

On the contrary, the symptoms of mental illness are very, very clearly harmful in a way that is undeniable. While people with mental illnesses may sometimes deny that there is anything wrong, they are often clearly unhappy, and their denial is often caused by fear of the stigma of mental illness. (All the same, though, if someone tells me they are not mentally ill, I would never argue with them.)

“All mental illness means is having irrational thoughts or believing something without evidence, and it is possible to completely stop having irrational thoughts.”

I hate to break it to you, but irrationality is probably part of the human condition. Everyone is, to some extent, subject to cognitive biases. Almost everyone at one point or another engages in superstitious, fantastical thinking. Clearing your mind of irrational beliefs that aren’t based on evidence is something that can only be accomplished intentionally, with effort. Even then, you will never be perfect. There’s a reason the popular rationality site Less Wrong is called Less Wrong, not Perfectly Right or Not At All Wrong.

So if being irrational is a sign of mental illness, then we are all mentally ill, atheists included. But more likely, (extreme) irrationality is only one component of mental illness. Others might include engaging in behaviors that are harmful to oneself, behaving in ways that are not considered normative in that particular cultural context (a problematic criterion, but a useful one when used in conjunction with others), being unhappy with one’s mental state, and not being able to function properly in one’s daily life.

“My desire to make a point is more important than what the psychological evidence says about religion and mental illness.”

To put it simply, the processes that lead people to be religious are not the same ones that lead them to be mentally ill. As I mentioned above, religious belief is a subset of the sort of irrational thinking to which all humans are prone. Humans look for patterns in the world and easily form superstitions on the basis of those patterns. Humans also generally enjoy the feeling of being part of a group or having a community, and religion is an easy way for a lot of people to experience that feeling. Many people who are religious were born into religious families and were taught that god exists and [insert religious tenets here] from birth, so it sticks.

On the more abusive end of things, people may stay in harmful religious sects or communities for similar reasons as they stay in abusive relationships. They are made to feel by their abusers that they will never be complete without the faith. They are taught that they will go to hell forever if they leave. They are made to feel worthless and powerless. They are told that people outside of the religious communities are bad people.

Being affected by abuse does not mean you’re mentally ill. It means that someone who knows how to take advantage of people took advantage of you. Furthermore, religion is but one of many props people can use to abuse and control each other.

On the contrary, mental illnesses have substantial genetic and biological components to them. Studies on identical twins, including ones reared apart, have demonstrated fairly high concordance rates for some disorders. While the chemical-imbalances-cause-depression theory has now been shown to be drastically oversimplified, mental illnesses clearly do have some sort of neural causes, triggers, and effects. Mental illnesses are often (but not always) triggered by major stressful life events; they can occur when an individual goes through hardship with which they are not psychologically equipped to cope.

Unlike religion, mental illnesses are not taught to people by other people; they tend to occur when genetic/biological susceptibility lines up with stressful environments or adverse life circumstances. Unlike religion, people do not try to remain mentally ill so that they do not lose their support systems or because they are afraid of what would happen if they stopped being mentally ill. They remain mentally ill until they receive proper treatment, or until the illness remits on its own. Unlike (non-abusive) religion, people do not have a choice whether to stay or leave. Those who suffer from eating disorders, substance abuse, or OCD may claim or genuinely feel that they have a choice, but they actually don’t, and that becomes evident as soon as they try to stop. Yet countless people voluntarily leave religion every day. That doesn’t sound like a mental illness to me.

“You chose to have your mental illness, just like people choose to be religious.” 

Some atheists who make this comparison believe that having religious beliefs is a choice (and abandoning them would also be a choice). If having the symptoms of a mental illness is a choice, what does this say about the rest of us?

“Mental illnesses (like religion) can be cured by making fun of people’s irrational beliefs and shaming them on the internet.”

Normally recovering from a mental illness requires therapy, medication, a strong social support system, or some combination of those. I rarely see atheists agitating for better mental healthcare services for religious people to help them deconvert. In fact, providing people with the resources they would actually need to leave religion (as opposed to simply telling them they’re wrong over and over again) is not a major focus of very many atheists. Of course, I would be remiss not to mention the work done by groups like Recovering From Religion and the Clergy Project. But I also haven’t personally witnessed anyone associated with these groups claiming that religion is a mental illness.

“Religious people can’t be held responsible for their beliefs; they’re just victims of an illness.”

If you do agree that mental illness is not a choice, however, that implies that being religious is not a choice either. That implies that religious people do not have agency over any part of their religious belief or observance. Not only is this offensive to religious people, but it actually suggests that we shouldn’t hold them responsible for their beliefs. You wouldn’t blame a person with anxiety for feeling anxious, would you?

“I don’t care about mental illness unless it’s religion.”

Relatedly, better mental healthcare is not a major concern of many atheists (the ones who don’t have mental illnesses, that is). It really should be. Mental healthcare is stymied by both religion and pseudoscience, and advocating for more research, funding, and concern in this area is a project that I think would be of great relevance to the secular movement. But the only time I see most atheists bringing it up is when the “illness” is religion. What about the 25% of American adults who will suffer from an actual mental illness (or more than one) at some point in their lives?

“Mental illness is bad and shameful; that’s why I’m using it to disparage religion.”

Sometimes when I see the religion-mental illness comparison being made, it’s being done in a way that is clearly meant to ridicule and put down. Atheists frequently employ language that stigmatizes mental illness to refer to religious people, such as “crazy,” “insane,” “nutcase,” and so on. Even when you’re not using such clearly hurtful language, though, you can still be perpetuating stigma by saying that such-and-such Islamist “belongs in a mental institution” or that such-and-such fundamentalist Christian “needs to see a shrink.”

If you think religion is horrible and then you compare it to the condition I have, how am I meant to think you see me?

“You are a rhetorical prop for me to use to disparage religion.”

And that’s why I feel like people with mental illnesses are being used as convenient stand-ins when someone wants to diss religion. I feel like our suffering is just a tool for you to pull out of the antitheist toolbox when you need it. “Look how stupid religion is! It’s just like a mental illness!” you say. My depression is not at all like a religion. Unlike a religion, I didn’t choose it. Unlike a religion, it has never provided me with rituals and communities. Unlike a religion, it was not something taught to me by people, not something I could’ve avoided. Unlike a religion, it can’t go away no matter how many times you tell me I’m wrong. Unlike a religion, it has no positive effects, ever. Unlike a religion, my depression didn’t just make me empirically wrong about certain things; it broke my entire life into pieces and took away my ability to enjoy anything. Please stop using that awful legacy to score cheap points against religious believers.

“Attacking religion is more important to me than being inclusive and supportive of atheists with mental illness.”

I tell other atheists over and over again that this is hurtful, inaccurate, and completely pointless. And over and over again, despite the massive support I get in these comment threads from other atheists with mental illnesses, they insist on using this stigmatizing, alienating language. They ignore our knowledge of psychology and mental illness and continue to claim, against the evidence, that religion can be categorized as a form of mental illness. Rather than diving in and learning more about how mental illnesses are defined and which mental processes contribute to religiosity, they refuse to let go of this rhetorical tool.

I don’t think that’s a coincidence. I think that deep down many people think so poorly of people with mental illnesses that they know how effective it can be to compare anything you think is bad to a mental illness. It happens all the time.

But considering how many people I know in this community who are diagnosed with a mental illness, I would cautiously say that maybe you shouldn’t keep alienating us. I’m just one person, but I have serious qualms about working with an atheist leader or organization that holds the view that religion is a mental illness. I doubt I’m the only one.

Find a better argument. Find one that is accurate, first of all, and that stomps on as few already-marginalized people as possible.

~~~

Moderation note: I have finals this week and am unlikely to be around to answer every single question and argument I get. I will moderate strictly for comments that stigmatize mental illness, though. If this piece sets off lots of debates in the comment section, hopefully they can flow smoothly and somewhat productively without much input from me.

“What do you have to be depressed about?”

If you have experienced depression while living what appears to be a fairly nice life, you’ve probably had someone ask you, “What do you have to be depressed about?”

Sometimes people who ask this question are genuinely curious because they think that depression is necessarily “about” something and they just don’t understand what, in your case, it could be “about.” Sometimes, though, people who perceive your life to be better than theirs feel resentful and jealous and, upon hearing that you are suffering from depression, demand to know what could possibly be wrong with your life that could cause a mental illness.

The origins of depression are complicated and still not very well-understood. One model that’s gained ground lately is called the diathesis-stress model. The term “diathesis” refers to a vulnerability, which could be genetic, biological, environmental, or psychological. “Stress” refers to a catalyzing event, a life stressor that can increase one’s chances of developing a disorder (the diathesis-stress model has been used to describe more than just depression).

One specific type of diathesis that has been researched concerns a specific gene, known as the serotonin transporter gene or 5-HTTLPR. Some studies suggest that people with a particular variant of the gene are more likely to develop depression, but only if they have a significant life stressor. If not, then there’s no difference between people with the different variations of the gene.

The results are mixed so far, but this is just one example of a way in which having “something to be depressed about” can indeed provoke depression. But it’s not the whole story. People without significant life stressors can still get depression, and people who do have life stressors are still much more likely to get depression if they have that genetic predisposition–the diathesis.

Diathesis can come in all sorts of forms. Having learned poor cognitive coping skills as a child could be a diathesis. Having abnormalities in the brain’s neurochemistry could also be a diathesis, although the “chemical imbalance” theory of depression as we’re used to seeing it is more or less bullshit.

Some types of diathesis might be considered to count as “something to be depressed about,” such as living in poverty, having a chronic health condition, or having an unstable or abusive family life. Others, such as having genetic predispositions or brain abnormalities, would not count as such for most people. Asking someone what they have to be depressed about is therefore not very useful.

But moving away from the science of depression’s origins, I’ll state the obvious: no matter how well you know someone, you never know everything that’s going on in their life. Not even if it’s your kid. The person may have a significant life stressor that’s triggering their depression that they just haven’t told you about, and they probably won’t if you sarcastically ask them what they have to be depressed about. If you’re genuinely curious, a better way to phrase that question is, “I’m sorry to hear you have depression. Is there anything that’s triggering it for you?”

The important thing with that is to never ask questions like you already know the answers. The question, “What do you have to be depressed about?” comes along with the implied answer, “Nothing.” Even if you don’t think it does. That’s how many people are going to hear it. So don’t get too caught up on the literal meaning of the words you are saying, and think about how they’re going to be interpreted.

The hypocrisy of the “What do you have to be depressed about?” question becomes blatant when you consider our typical response to those who do, by all accounts, have something to be depressed “about.” What tends to happen is that when we feel that depression is to be expected in a given situation, we also frame it as “okay.” Normal. Natural. It’ll pass on its own and we shouldn’t interfere.

This might explain the controversy over the decision to remove the bereavement exception from the newest edition of the DSM. Previously, people who were grieving had a two-month “window” during which they could not be diagnosed with depression, which often looks very similar to bereavement. With the publication of the DSM-5, this exception was removed. Lots of people were Very Concerned that this means that we’re “medicalizing” a “normal” process such as grieving.

I know I probably over-rely on comparisons to physical health, but that’s because they can be very illuminating. If you’re subjected to a some loud noise and you get a headache, or you work out strenuously and get extremely sore muscles, few people would suggest that you shouldn’t take medication to ease those pains just because they happened “naturally” (whatever that means). Being extremely sad, even “depressed,” as a response to a loved one dying is definitely “natural,” but that doesn’t mean it can’t interfere with your functioning as a person, and that you don’t deserve help dealing with it.

I’m not necessarily saying that high levels of grief should be diagnosed as depression, though. I’m just pointing out the hypocrisy of expecting people to produce compelling “reasons” for being depressed, but then refusing to consider people who do have compelling reasons to be depressed, even if they show all the symptoms.

My final gripe with the “What do you have to be depressed about?” question is that it’s often a way of trying to rank human suffering. What do you have to be depressed about? Some people are abused by their parents. What do you have to be depressed about? Some people are starving. What do you have to be depressed about? Some people have cancer.

Well, if you, personally, were abused by your parents, are starving, or have cancer, I wouldn’t fault you for feeling that the concerns of people with depression aren’t as serious as yours. That’s your right. But there are no measurements with which we can assess how bad someone has it. There is no Standard Life-Shittiness Unit. We need to stop looking for one, and treat every individual’s pain as legitimate.