Assorted Thoughts on Self-Care

I have a bunch of complicated feelings on the topic of self-care, but none of them seemed quite sufficient for its own tidy blog post. So I’ll discuss them here and maybe expand on some of them later. Some of them are mostly political, some are mostly personal, and most are a mix of the two.

I. Self-care versus communal care.

Lately I’ve been noticing how often self-care becomes a replacement for care that really ought to be provided by the community: by employers, by mental health professionals, by friends and families, by (dare I say it) taxpayers.

Self-care cannot replace being paid a living wage that allows you to get through the day without breaking down because you’re so stressed about money. Self-care cannot replace effective, accessible therapy and psychiatric medication for those who need it. Self-care cannot replace having love and support from close people in your life. Self-care cannot replace adequate parental leave, sick leave, childcare, elder care, healthcare, and other basic necessities. Self-care will not help when the only way to have a job that pays enough to cover the things that self-care does not magically provide is to put yourself so far in debt for your college education that you spend the rest of your life worrying about money anyway.

Self-care has very important limits, and I think most of us activisty types are aware of that. But it’s jarring to see self-care touted as a solution by institutions that are creating (or neglecting their responsibility to solve) the very same problems they are touting self-care as a solution to. Self-care doesn’t pay my rent, much less my student loan debt. Self-care doesn’t help when an employer won’t give me enough time off to do any damn self-care.

II. Self-care is a harm reduction measure.

Having said all that about the limits of self-care and the responsibilities of people/institutions to step up at times and care for each other, I think there’s another way to think about this that might be helpful: self-care as a harm reduction measure. Harm reduction, as the words imply, suggests that at times when immediately taking all the harm away is impossible, reducing the harm may still be possible (and worthwhile). In its prototypical usage in alcohol/drug treatment, it might refer to giving intravenous drug users free clean needles because, while we can’t magically make them stop being addicted right now, but we can reduce the harm of their drug use by greatly reducing their likelihood of contracting infections by using dirty needles.

Harm reduction in the self-care context can mean that, since we can’t magically create a just society today, we can help people cope with the way things are for now. If you have a mental illness but no therapist or psychiatrist, there are things you can do to help yourself get by in the meantime. If you don’t get paid enough and are constantly stressed about money, there are things you can do to forget your worries for a few hours and give yourself some small things to look forward to. If you are taking care of your aging parent while working full-time because there is no other care available/affordable, there are things you can do for yourself to ease the burden you’re carrying. (The wording here is not to imply that a person who needs care is themselves a burden or that it is wrong to need that care; we all carry burdens of various weights and sometimes that includes caring for someone we love who can’t care for themselves. It should be okay to be honest about the difficulty of that, even if it is a labor of love.)

Of course, one potential concern about harm reduction in any context is that people will get complacent and stop working on the broader, systemic changes that would reduce the harm the rest of the way. For instance, same-sex marriage can be seen as a harm reduction measure against homophobia–it won’t solve the problem, but it will help reduce some of its harms for the time being. (Some people don’t realize that there even is homophobia beyond the marriage issue, but they are wrong.) But some radical LGBTQ activists worry that, having achieved same-sex marriage throughout the U.S., we’ll collectively sigh in relief and say, “Well, that’s good enough, I guess.” And, meanwhile, trans people of color will still be subject to disproportionate violence and discrimination, folks will still be losing jobs, housing, and families because of their sexuality or their gender, trans people will won’t be able to access appropriate healthcare, and so on.

The same thing could happen on a smaller scale with self-care. We might develop our own effective individual self-care practices and decide that, really, it’s okay, we can live with juggling two or three jobs while caring for children and aging parents.

At least, that’s the argument against harm reduction. (The left-wing argument, that is.) But in my experience, when people give up on fighting for systemic change, it’s less complacency and more burn-out or straight-up not having enough time. Burn-out, at least, is the exact thing that good self-care is supposed to prevent. Besides, the argument that harm reduction is actually harmful because it prevents people from staying motivated to pursue more complete solutions sort of implies that people should be expected to suffer even more in the meantime so that they can be better agents of social change, and that’s downright creepy.

III. Everyone’s self-care looks different.

This is an oft-repeated fact, but sometimes it’s still hard to internalize this. I used to get so frustrated with the idea of self-care because all the examples I saw online were like…take a bath! Watch a crappy TV show! Spend all day in your pajamas eating ice cream out of the carton! These are all perfectly valid things to do, but these types of activities make me feel worse rather than better. Taking a bath is nice, I guess, but it’s hard to keep my mind engaged on anything when most of the things that I could engage it on cannot be safely taken into a bathtub. Watching crappy TV and spending all day doing nothing makes me feel like a useless waste of space, so I try to avoid it. (Again, it doesn’t mean you’re a useless waste of space if you enjoy those things. It means I don’t like them.)

So for a while I was all like “what is self-care even” because all the examples I saw failed to resonate with me and seemed more like self-neglect than self-care. As it turns out, for me, self-care usually involves doing the sorts of things that other people need to avoid for self-care: reading articles online, spending time in big groups of people, writing (for public consumption, not in my journal), being with my family, listening to someone else’s problems. Self-care for me looks nothing like sitting around on the couch looking like crap and eating crap.

This is why when people ask me for suggestions on how to do self-care, I don’t really know what to say. I only know what works for me, and I’m starting to pick up on the fact that I’m a little unusual in this way. (For instance, people keep asking me how I manage to write so much despite my depression and despite how hard writing online can be. I find this question confusing. I have depression, so how can I possibly not write? Being online can be shitty, so how can I not use writing to cope with it?)

IV. Self-care versus self-preservation.

I find it useful to distinguish between the self-care we do to replenish and sustain ourselves, and the self-care we do to prevent ourselves from falling to pieces completely. This distinction would help clarify my earlier thoughts on self-care as a form of harm reduction, and it would help explain why some forms of self-care actually seem somewhat harmful, at least in the long term.

Consider these two different situations. One: You’ve had a long, crappy day at work and you’re feeling demoralized about your work and about your value as a person. You’ve spent all day around people who don’t care about you and treat you like shit, and at times like this it’s hard to remember that you do really matter and you’re important to people. You’d planned on going home after work tonight and doing adult things like laundry and making lunch to take to work the next day, but you realize that what you really need right now is to recover from your day. So you message some friends and ask them to meet up with you at a bar, where you drink and laugh and talk about anything other than work.

Two: You’ve had a long, crappy day at work. Things just keep piling up and by the end of the day, you’re an inch away from ending up in the bathroom sobbing. You can’t stand the thought of talking to even one more person today. Although you had plans to go out with your friends after work–something you normally love to do, something that normally helps you recharge from days like today–this time you just can’t bring yourself to go. You message them to let them know you can’t make it this time and head home, where you lie on the couch, pet your cat, and watch Gossip Girl because you have no energy left for anything else. It’s not like you even enjoy it, really, and you wish you could’ve gone out with your friends, but at this point you just can’t.

I’ve been in both of these situations, and for me, the difference is agency. In the first situation, I have chosen to do something that will restore a sense of worth and joy to me, and that is self-care. In the second situation, I have “chosen” to cancel my plans in order to do something that I need to do (that is, nothing much at all), but it doesn’t feel like a choice. Yet this second scenario often gets labeled as “self-care.” “It’s ok,” my friends will say when I cancel. “You need to take care of yourself.”

But that doesn’t feel like caring for myself. That’s just preserving myself so that I don’t burst out crying at the bar with my friends or sit there staring catatonically into space. I didn’t go out because I couldn’t, even though I wished very much that I could’ve because that would’ve made me actually feel better.

At the same time, though, it’s still self-care of a sort. Given that I already felt so awful, choosing to stay in rather than try to force myself to go out undoubtedly makes my life easier in some ways. It prevents me from burning out further. It prevents potential damage to my relationships with others. It prevents me from embarrassment if I don’t feel comfortable being my burned-out self in front of my friends (and, although this is a hypothetical, I actually don’t).

That is a harm-reduction sort of self-care, whereas my first example was a more positive form of self-care. It wasn’t about preventing things from getting even worse so much as it was about making things get better. Both of these forms of self-care have their place, as painful as it is when one gets confused for the other.

V. Self-care should fit the situation.

Just as different people find different forms of self-care helpful, different situations might call for different forms of self-care. I touched on that in the previous section, but it goes further than that. At the Secular Women Work conference this summer, Hiba Krisht did a workshop about burn-out and self-care in which she made the point that effective self-care needs to restore whatever it is you’re lacking in that moment. If you’re lacking energy, self-care should restore energy (or at least conserve it, when restoring it is impossible). If you’re lacking connection, self-care should restore it. If you’re lacking peace and quiet…you get the idea.

While that sounds totally obvious in retrospect, I never thought of it that way before, and that was why, as I mentioned above, most suggestions for self-care techniques fell flat for me. Lounging around in a bubble bath is great for when you need calm and solitude, but that’s not what I usually need. I need intellectual stimulation and connection with people.

Unfortunately, that makes self-care even more difficult than it already is for most people, since feeling intellectually understimulated and disconnected from people also usually goes along with lots of sadness, fatigue, and other shit that makes it really difficult to achieve intellectual stimulation and connection with people. What then complicates matters further is that most people, including most of the friends I’d theoretically be connecting with, conceptualize self-care more as sitting in a bubble bath or watching Gossip Girl than being out at a loud bar with friends yelling about recent psychology research. So when I tell my friends I’m feeling shitty, they’re much more likely to say, “Aww, it’s okay if you need to just lay around on the couch and watch TV” than “Oh, sounds like you need to head out to a crowded noisy bar with a bunch of us to yell about research.” And when I’m in an especially shitty state, I can’t always access my memories of things that have helped in the past, so I’m unlikely to draw the “feeling shitty? go hang with friends!” connection on my own. Plus, I feel awkward asking people to hang out with me when I’m feeling shitty, because they might not realize that I’ll probably stop feeling shitty as soon as we start hanging out (but also, I can’t necessarily promise that’ll happen 100% of the time, you know?).

And sometimes it admittedly feels really weird how fast my friends jump to saying “it’s okay to just cancel our plans and be alone!” when I mention I’m having a hard time. At that point, the crappy part of my brain is thinking…do they want me to just cancel and be alone? Would they rather not deal with me when I’m down? Is it bad to want to be cheered up by people when I’m sad?

Ultimately I try not to ascribe such negative motives to my friends and try to trust them to just set their own boundaries. But regardless, it would be so helpful if people would more often ask, “What do you think would be helpful for you right now?” rather than reminding me (with the best of intentions) that I have the option of doing something that would make me feel much, much worse.

Self-care, both as a concept and as a practice, is not a panacea. We shouldn’t try to make it do more work than it’s capable of. But I’m definitely not ready to throw it out, either.

Self-Diagnosis and Its Discontents

There’s a certain scorn reserved for people who diagnose themselves with mental illnesses–people who, based on their own research or prior knowledge, decide that there’s a decent chance they have a diagnosable disorder, even if they haven’t (yet) seen a professional about it.

I understand why psychologists and psychiatrists might find them troublesome. Nobody likes the idea of someone getting worked up over the possibility that they have a mental illness when they really don’t. Professional mental healthcare workers feel that they know more about mental illness than the general population (and, with some exceptions, they do) and that it’s their “job” to serve as gatekeepers of mental healthcare. This includes deciding who is mentally ill and who is not.

Self-diagnosis also gets a bad rap from people who have been professionally diagnosed with a mental illness. They feel that people who self-diagnose are doing it for attention or because they think that diagnosis is trendy.

This actually bothers me much more than the arguments against self-diagnosis coming from professionals. Why?

Because the claim that people who self-diagnose are just “doing it for attention” or because they think it’s “cool” is the exact same claim frequently made about people who get diagnosed professionally.

To be clear, I’m not saying that people never label themselves as mentally ill for attention. Maybe some do. Maybe a significant proportion of people who self-diagnose don’t really have a mental illness at all. I’d have to see research to know, and from my searches so far I haven’t really found much research on the phenomenon of self-diagnosis. (But I’m taking note of this for my master’s thesis someday.)

However, there’s a difference between someone who’s feeling sad for a few days and refer to themselves as “depressed,” and someone who’s been struggling for weeks, months, or years, and who has read books and articles on the subject and studied the DSM definition of the illness. The former may not even count as “self-diagnosis,” but rather as using a clinical term colloquially–just like everyone who says “oh god this is so OCD of me” or “she’s totally schizo.” (This, by the way, is wrong; please don’t do it.)

(It’s also likely the case that some people self-diagnose because they have hypochondria. However, the problem is not that they are self-diagnosing. The problem is that they have untreated hypochondria. Maybe diagnosing themselves with something else will get them into treatment, where a perceptive psychologist will diagnose them with hypochondria and treat them for it.)

Even if some people who self-diagnose are wrong, I still think that we should refrain from judging people who self-diagnose and take their claims seriously. Here’s why.

1. It gets people into treatment.

I wish we had a system of mental healthcare–and a system of social norms–in which everyone got mental health checkups just as they get physical health checkups. For that, two main things would have to change–mental healthcare would have to become affordable and accessible for everyone, and the stigma of seeing mental health professionals (whether or not one has a mental illness) would have to disappear. (There are other necessary conditions for that, too–the distrust that many marginalized people understandably have for mental healthcare would have to be alleviated, and so on.)

For now, going to see a therapist or psychiatrist is difficult. It requires financial resources, lots of time and determination, and a certain amount of risk–what if your employer finds out? What if your friends and family find out (unless they know and support you)? What will people think?

Because the barriers to seeing a professional are often high, many people need a strong push to go see one. Having a strong suspicion that you have a diagnosable mental illness can provide that push for many people, because nobody wants to go through the hassle of finding a therapist that their insurance covers (or finding a sliding-scale one if they don’t have insurance), coming up with the money to pay the deductible, taking time off work to go to the appointment, dealing with the fear of talking to a total stranger about their feelings, and actually going through with the appointment, only to be told that there’s “nothing wrong” with them.

As much as I wish things were different, the reality right now is that relatively few people go to therapists or psychiatrists unless they believe that they have a mental illness. If self-diagnosing first gets them into treatment, then I don’t want to stigmatize self-diagnosis.

2. It helps them find resources whether or not they see a professional.

In the previous point, I explained that for many people, self-diagnosing can be a necessary first step to getting treatment from a professional. In addition, once people have diagnosed themselves, they are able to seek out their own resources–books, support groups, online forums, etc.–to help them manage their symptoms. This can be extremely helpful whether or not they’re planning on getting treatment professionally.

While psychiatric labels like “depression,” “generalized anxiety,” and “ADHD” have their drawbacks, they are often necessary for finding resources that help people understand what they’re going through and help themselves feel better. If I’m at a library looking for books that might help me, asking the librarian for “books about depression” or “books about ADHD” will be much more useful than asking them for “books about feeling like shit all the time and not wanting to do anything with friends” or “books about getting distracted whenever you start work and not really having the motivation to finish any of it and it has nothing to do with laziness by the way.” Same goes for a Google search.

It’s certainly fair to be worried that people looking on their own will find resources that are unhelpful or even dangerous. But I think this is less of a problem with self-diagnosis per se, and more of a problem with the lack of scientific literacy in our society, and the lack of emphasis on skepticism when evaluating therapeutic claims. For what it’s worth, going to see a mental health professional will not necessarily prevent you from encountering quackery and bullshit of all kinds. And in any case, the blame does not lie with the people who self-diagnose and then fall for pseudoscientific scams, but with the people who perpetrate the scams in the first place.

This point is especially important given that many people will not be able to access professional mental healthcare services for various reasons. Maybe they can’t afford it; maybe they work three jobs and don’t have time; maybe they can’t find a therapist who is willing to accept the fact that they are trans*, kinky, poly, etc. Maybe they are minors whose parents are unwilling to get them into treatment. Maybe they were abused by medical professionals and cannot go back into treatment without worsening their mental health.

There are all kinds of reasons people may be unable to go and get their diagnosis verified by a professional, and most of these are tied up in issues of privilege. If you have never had to worry that a doctor or psychologist will be prejudiced against you, then you have privilege.

3. It can help with symptom management whether you have the “real” disorder or not.

At one point when my depression was particularly bad I noticed that I had some symptoms that were very typical of borderline personality disorder. For instance, I had a huge fear that people would abandon me and I would bounce back and forth between glorifying and demonizing certain people. If someone made the slightest criticism of me or wasn’t available enough for me, I would decide that they hate me and don’t care if I live or die. I had wild mood swings. That sort of thing. It’s not that I thought I actually had BPD; rather, I noticed that I had some of its symptoms and wondered if perhaps certain techniques that help people with BPD might also help me.

Luckily, at this time I was still seeing a therapist. So in my next session, I decided to mention this observation that I had made, and the conversation went like this:

Me: I’ve noticed that I have some BPD-like symptoms.
Her: Oh, you don’t have BPD.
Me: Right, but I seem to have some of its symptoms–
Her: No, trust me, I’ve worked with people with BPD and you do NOT have BPD.

I suppose I could’ve persevered with this line of thinking, but instead I felt shut down and put in my place. I dropped the subject.

So determined was this therapist to make sure that I know which mental illness(es) I do and do not have that she missed out on what could’ve been a really useful discussion. What she could’ve done instead was ask, “What makes you say that?” and allow me to discuss the symptoms I’d noticed, whether or not they are indicative of BPD or anything else other than I am having severe problems relating to people and dealing with normal life circumstances.

The point is that sometimes it’s useful to talk about mental illness not in terms of diagnoses but in terms of symptoms. What triggers these symptoms? Which techniques help alleviate them?

So if a person looks up a mental disorder online and thinks, “Huh, this sounds a lot like me,” that realization can help them find ways to manage their symptoms whether or not those symptoms actually qualify as that mental disorder.

This is especially true because the diagnostic cut-offs for many mental illnesses are rather random. For instance, in order to have clinical depression, you must have been experiencing your symptoms for at least two weeks. What if it’s been a week and a half? In order to have anorexia nervosa, you must be at 85% or less of your expected body weight*. What if you haven’t reached that point yet? What if you don’t have the mood symptoms of depression, but you exhibit the cognitive distortions associated with it? Acknowledging that you may have one of these disorders, even if you don’t (yet) fit the full criteria, can help you find out how to manage the symptoms that you do have.

4. It helps them find solidarity with others who suffer from that mental illness.

I understand why some people with diagnosed mental illnesses feel contempt toward those who self-diagnose. But I don’t believe that sympathy and solidarity are finite resources. If someone is struggling enough that they’re looking up diagnostic criteria, they deserve support from others who have been down that path, even if their problems might not be “as bad” as the ones other people have and/or have not yet been validated by a professional.

Acknowledging that you may have depression (or any other mental illness) can help you find others who have experienced various shades of the same thing and feel like you’re not alone.

My take on self-diagnosis comes from a perspective of harm reduction. The idea is that strategies that help people feel better and prevent themselves from getting worse are something we should support, even if these strategies are not “correct” or “legitimate” and do not take place within the context of established, professional mental healthcare.

We should work to improve professional mental healthcare and increase access to it, especially for people in marginalized communities and populations. However, we should also acknowledge that sometimes people may need to help themselves outside of that framework. These people should not be getting the sort of condescension and eye-rolling they often get.

*The diagnostic criteria for eating disorders are expected to improve with the release of the new DSM-V, but I’m not sure yet whether or not the 85% body weight requirement will still be there. In any case, this is how it’s been so far.