Limbaugh Really Should Educate Himself About Birth Control

Up until this week, those of us with a shred of optimism and/or naivete could have pretended that the difference between liberals’ and conservatives’ perspectives on birth control were due to something as benign as “differing beliefs.”

However, now that Rush Limbaugh has run his mouth on the subject, I think we can all agree that much of the conservative opposition to birth control is due not to differing beliefs that are equally legitimate and should be respected, but to simple, stupid ignorance.

The following is probably common knowledge now, but I’ll rehash it anyway:

  • Sandra Fluke, a 31-year-old Georgetown University law student, was proposed by the Democrats as a witness in the upcoming Congressional hearings on birth control. Her history of feminist activism and her previous employment with a nonprofit that advocated for victims of domestic violence made her an appropriate witness for their side.
  • Representative Darrell Issa (R-CA), the chairman of the House Committee on Oversight and Government Reform, turned her down because, he claimed, her name had been submitted too late.
  • The resulting panel of witnesses for the Congressional hearings turned out to consist of absolutely no women whatsoever, which is really funny in that not-actually-funny-way because hormonal birth control of the sort whose mandated insurance coverage was being debated is only used by women/people with female reproductive systems.
  • A week later, she testified for House Democrats, mentioning that birth control would cost her $3,000 over three years. Lest anyone misinterpret her argument as being solely about those slutty women’s desire to have tons and tons of sex, she also mentioned her friend with polycystic ovary syndrome who developed a cyst because she was denied coverage for birth control pills (which would’ve helped because they would’ve reinstated a regular menstrual cycle).

A few days later, Rush Limbaugh decided to insert his expert opinion into the discourse surrounding mandated insurance coverage of birth control. His expert opinion?

What does it say about the college coed Susan Fluke [sic], who goes before a congressional committee and essentially says that she must be paid to have sex? What does that make her? It makes her a slut, right? It makes her a prostitute. She wants to be paid to have sex.

The next day, he clarified his views:

So, Ms. Fluke and the rest of you feminazis, here’s the deal. If we are going to pay for your contraceptives, and thus pay for you to have sex, we want something for it, and I’ll tell you what it is. We want you to post the videos online so we can all watch.

And the next day (allow me to shamelessly quote Wikipedia):

The following day Limbaugh said that Fluke had boyfriends “lined up around the block.”[18] He went on to say that if his daughter had testified that “she’s having so much sex she can’t pay for it and wants a new welfare program to pay for it,” he’d be “embarrassed” and “disconnect the phone,” “go into hiding,” and “hope the media didn’t find me.”[19]

I’m not going to waste anyone’s time by explaining how misogynistic Limbaugh’s comments were, especially since plenty of excellent writers have done so already. However, it continually shocks me how he gets away with saying things that are not only offensive and inflammatory, but simply inaccurate.

First of all, a primer for anyone who’s still confused: except for barrier-based forms of birth control (i.e. condoms and diaphragms), the amount of birth control that one needs does not depend on how much sex one is having. Hormonal birth control works by preventing ovulation, and in order for it to work, it has to be taken regularly and continually. For instance, you take the Pill every day, or you apply a new patch every week, or you get a new NuvaRing each month, or you get a new Depo-Provera shot every three months. You stick to this schedule whether you’re having sex once a week or once a day or ten times a day. You stick to it if you’re having sex only with your husband, and you stick to it if you’re having sex with several fuck buddies, and you stick to it if you’re a prostitute and have sex with dozens of different people every day.

Same goes for IUDs, which last for years.

Therefore, when Limbaugh says that those who support mandated insurance coverage of birth control are “having so much sex [they] can’t pay for it,” he’s not merely being an asshole. He’s also simply wrong.

And for the record, he didn’t even get her name right. It’s Sandra, not Susan. One word of advice for you, Limbaugh: if you’re going to call someone a slut and a prostitute, at least use their correct name. But I guess we should give him credit for knowing which letter it starts with.

I don’t care what your views are on mandated insurance coverage of birth control. I don’t care what your views are on how much or what kind of sex women should be allowed to have (as much as they want and whichever kind they want, in my opinion). Because whatever your views are on these things, you have to agree that these questions should not be getting answered by people who have absolutely no understanding of how these things actually work.

For instance, Limbaugh completely ignored the part of Fluke’s testimony in which she described the problem faced by her friend with polycystic ovary syndrome. This friend’s predicament has nothing to do with sex. Absolutely nothing. For all we know, she’s a virgin.

After all, polycystic ovary syndrome isn’t caused by anything that involves sex. The current medical opinion is that it’s probably caused by genetics.

Unlike some feminists, I don’t think that men should be excluded from debates about women’s health. But men (and women) who show little or no understanding about women’s health should absolutely be excluded from these debates.

You wouldn’t let a doctor who believes that babies come from storks deliver your baby. You wouldn’t let a mechanic who doesn’t know how an engine works work on your car. And you shouldn’t let politicians and commentators who think that you need more birth control if you have more sex decide whether or not birth control will be covered by your insurance.

And, for the record, I also don’t think that Congressional hearings on birth control should look like this:

"If You're Fat, Then What Am I?"

There are a lot of misconceptions out there about body image and eating disorders. I can’t even begin to address all of them here. But there’s one I’ve been thinking about lately–that problems with body image are caused solely by comparing yourself to unrealistic standards, and can be solved by simply comparing yourself to the “real” bodies around you instead.

First, a disclaimer–I’ve never had anorexia or bulimia. However, I’m not entirely out of my depth here. Had I gone to see a psychiatrist at some point prior to this year, he or she would probably have taken note of my obsessive calorie-counting, severe dietary restrictions, compulsive weight-checking and fat-pinching, and general conviction that I was “fat,” and diagnosed me with something called “eating disorder not otherwise specified,” or “EDNOS.” This means that one doesn’t meet the diagnostic criteria for any of the eating disorders, but is definitely disordered nonetheless.

(For the record, I’m much better now.)

Anyway, one thing I remember very vividly from my years of thinking I’m fat was one particular response that I often encountered. Some people (mostly other girls), upon learning how I felt, would respond with this: “If you’re fat, then what am I?”

Now, I understand exactly where this comes from. Many of my peers were probably insecure, too, and it makes sense that they would be reminded of their own insecurity once I mentioned mine. Since I was indeed thinner than many other people, that response makes sense on some level. If I’m fat, they must be obese!

But it doesn’t really work that way. It would certainly be convenient if people’s self-concepts were always rational and based on reality. But the very definition of mental problems is that they’re distortions of reality–they’re unrealistic. That’s why grief after the death of a loved one isn’t considered a mental disorder, but depression is.

And that’s exactly why “If you’re fat then what am I” is not an effective response. At the time, I didn’t give two shits what other people were. It didn’t enter my thought process. In my case, my conviction that I was fat was mostly caused by cultural factors; namely, the fact that Russians are fucking preoccupied with beauty and weight. Absolutely preoccupied. It was also caused by years of ballet lessons, my depressive personality (which magnifies personal flaws), the belief that I could lose 10-20 pounds and still be healthy, fear that guys wouldn’t find me attractive if I had folds on my stomach, and many other causes.

For other people with body image and eating issues, the causes may be different. Some people develop the feeling that they’re unable to control their environment, so they control the only thing they can–their body. Others may start out actually overweight, start to diet and lose weight, and find that they’re addicted to the feeling of getting thinner. Others develop an overwhelming guilt whenever they eat, especially when they eat unhealthily, and they start to purge after eating. Some may have friends who constantly talk about their bodies’ flaws (remember Mean Girls?) and start to think the same way.

Whatever the causes are, these issues are much too complicated to be defeated by a simple glance at someone who weighs more than you.

Of course, “If you’re fat then what am I” also fails one of the most basic requirements of being a good listener–don’t change the subject to yourself. If your friend feels crappy and needs to talk to you, don’t make it about you. If your own issues are making it difficult for you to listen, tell your friend that. Sure, they might be disappointed that you can’t listen to them, but that’s much better than how they’re going to feel when you take their pain and turn it into a conversation about you and your weight.

It’s easy to resent people who, according to you, “should” be perfectly happy with their weight but are not. I can’t say I don’t get a twinge of annoyance whenever I witness a girl much smaller than me freaking out about her weight. But then I remind myself that she’s not me. Poor body image seems almost like a cliche among young women these days, but it’s so much more complex than you might think.

Everyone Should Go to Therapy

Recently I wrote a post about why some people might choose psychiatric medication over seeing a therapist. (Fine, so it wasn’t that recent. >.<) I promised a followup post about a belief that I hold concurrently–everyone should see a therapist.

Now, before everyone freaks out, let it be known that I say “everyone” only in the most theoretical of ways. Meaning that, I recognize that as things are today, what I’m proposing isn’t really possible. But in the Happy Fun Miriam Land of the future, where stigma against mental healthcare is gone, insurance coverage is reasonable and available to the majority of people, and research has identified effective therapeutic interventions for most mental problems, everyone should and would be able to go to therapy.

For now, I’ll qualify what I’m saying with this: if you are able to see a therapist, you should, and if you are able to take your children to see a therapist, you should.

Why?

Well, why do we have regular dental and physical checkups? Why do children receive vaccines? Why do we make an appointment with a doctor when we think we’re coming down with something serious?

Hopefully the answers to those questions are self-evident.

Clearly, it is acceptable–and even expected–that people seek two types of healthcare throughout their lives: preventative and palliative. We should see a doctor regularly to make sure that nothing’s going seriously wrong with our bodies, and we should see a doctor when we suspect that something IS going seriously wrong with our bodies.

This much isn’t in dispute. But what about our minds?

For the most part, people wait until things are really, REALLY wrong with their mental state before they go see a psychologist. (And some don’t go even then, but that’s a different story.) For instance, I didn’t see a psychiatrist for my depression until I wanted to kill myself. People with eating disorders typically don’t receive care until they’re dying, or close to it. People with anxiety issues don’t get help until their anxiety is preventing them from having any semblance of a normal life.

Like most physical maladies, mental illnesses don’t just come out of nowhere. They usually develop from years and years of poor coping strategies and maladaptive beliefs. For instance, I remember being as young as 6 and constantly thinking that everyone secretly hates me, nobody wants to be my friend, and everyone’s talking behind my back. Guess what? When I was 18, I still basically believed that. Except by then, my beliefs had become self-fulfilling prophesies, and they had reinforced themselves until it became nearly impossible to get rid of them. Wouldn’t it have been so much easier if a child psychologist had helped me get over them 15 years ago?

My little brother, age 10, thinks he’s ugly. He has adorable curly hair, itty-bitty freckles on his face, and beautiful blue eyes. He’s thin and athletic, but thinks his stomach is fat and sometimes does crunches in his room. He hasn’t really learned how to make friends yet, and he has nobody to teach him. As a result, he thinks nobody will ever want to be his friend, and he chooses to brag and show off for attention rather than try to make other kids want to be his friends.

My brother does not have depression, an eating disorder, or even–believe it or not–a serious case of narcissism. What he also doesn’t have, however, are effective mental tools for interpreting the world and for being happy. And he’s not going to find these tools on his own.

What if, in addition to physical checkups to make sure that kids’ bodies are developing correctly, that they’re learning good hygiene, and that they’re eating well and exercising, we also had regular mental checkups to make sure they’re developing good mental habits?

Clearly, not everybody is going to need constant mental healthcare like I do, and like everyone else with a serious mental illness does. Most people would be totally fine checking in with a trusted family therapist every once in a while. But others, like my brother, would seriously benefit from catching the problem before it mushrooms into the sort of thing that I went through.

Even if people never do develop diagnosable mental illnesses, unhappy children often grow into unhappy adults. Ever had a boss who made your life miserable by demanding constant ass-kissing to protect her fragile ego? Ever dated a guy whose fear of commitment destroyed the relationship? Ever had a bully in high school whose inability to relate to others in a positive way greatly affected your own life?

These people have psychological issues. I’m not saying that in a degrading way at all; many people have issues. But because most people don’t think that they should see a therapist unless they want to off themselves, people like these usually don’t get help.

Although I strongly despise the mindset that people with mental problems should be treated as personal inconveniences, the fact is that people do affect each other emotionally. Imagine if every time someone got a contagious illness, all they could do was just continue going about their daily lives until it passed, infecting everyone they came into close contact with. Luckily, that’s not how it works; most people go see a doctor when they realize they’ve come down with something. What if people did the same for mental problems?

I think that’d be a much more pleasant world to live in.

And I promise I’m not just saying that because I’m going to be a therapist and want money.

The Complete Idiot's Guide to Breast Cancer Awareness

If you have ever seen a bunch of women posting Facebook statuses with a random color, or a location where they “like it,” and felt a mix of confusion and frustration, you are not alone.

These memes are part of an effort for breast cancer “awareness,” a word that I use cynically here and only in quotation marks. The color meme referred to women’s bra color, and the location one referred to where they like to put their purses. Of course, they made it sound sexual to attract more attention: “X likes it by the bed”, “Y likes it in the closet,” etc.

Now, an acquiantance of mine (who also happens to be the Director of Health Promotion and Wellness at Northwestern University, and therefore isn’t entirely ignorant about these things) has reported that this stupid trend still has not died.

Perhaps even less sensically, the latest iteration of this meme is people posting stuff like “is going to New York for five months” or “is going to Las Vegas for twelve months,” and this, too, is supposed to elicit friends’ queries and be met with the response that it’s for breast cancer “awareness.”

As anyone with even a modicum of critical thinking skills can tell you, such a status, when finally deciphered, tells you exactly one thing: “There is a thing called breast cancer and you should know about it.”

Yes, yes there is. But could we finally get beyond that?

For instance, here are some actual facts about breast cancer:

If you’d like to do some actual good, why not spread this information around?

Besides that, here are some other ways you can help:

  • Volunteer to provide support for people battling breast cancer. (This is even easier if you know of such a person. You can help by driving them to doctor’s appointments, making them meals if they’re too tired, babysitting their kids, or just being there to listen.)
  • Donate to charities that provide such support, or to organizations that fund research on breast cancer. Here are some to get your started: Susan G. Komen for the Cure, the National Breast Cancer Foundation, and the National Breast Cancer Coalition. With a quick Google search, you could find local charities, charities that cater towards a particular demographic that you belong to, and so on.
  • If you want to go beyond simply giving money, participate in charities’ fundraising events, such as Susan G. Komen’s Race for the Cure. That way you get to raise money while meeting other people who care and physically showing your support for survivors and people battling breast cancer.
  • If you’re politically liberal, be an activist for government initiatives that fund cancer research, education initiatives, support for cancer patients, expanded insurance coverage, etc. One good place to start: ask your representative to support H.R. 3067, the Accelerating the End of Breast Cancer Act of 2011, which proposes an initiative to end breast cancer by 2020.
  • If you’re studying medicine or biomedical engineering, consider making cancer research your focus. Or work as a research assistant in a lab that studies cancer.
  • Buy products from companies that donate to breast cancer research (but beware of pinkwashing).
  • Similarly, if you happen to own a business or want to start one (and I know many of you Northwestern students do), consider donating a percentage of your profits to breast cancer research.
  • If you’re going into journalism and you’re interested in health, consider writing about breast cancer. Not everyone has enough knowledge to decipher academic articles; you can be the one who makes that information accessible to those who need it.

As you can see, some of these require your time and money. Others do not. The few seconds that it takes you to type your stupid status could be better spent posting a link to an important recent article about breast cancer.

And now, I get it. Cancer is a terrifying thing. The amount of information available about it could fill books upon books, and some of it is constantly going obsolete or being revised. Even I felt a bit overwhelmed just looking at the few websites I looked at to research this article.
I also get that when your friends are posting oh-so-funny things on Facebook, you want to join in the fun. Trust me, I was in middle school once, I know.

But I have some unfortunate news for some of you: neither I, nor breast cancer survivors, nor families of breast cancer victims give a flying fuck what color your bra is or where you like to put your purse, cutesy sexual innuendo notwithstanding.

If you’re old enough to make sexual innuendo, you’re old enough to educate yourself and others about breast cancer (and, for that matter, anything else you think people should be educated about). Let’s stop selling ourselves short here.

*edit* Another reason I just thought of to hate these memes–they are generally restricted to women only, and women aren’t “supposed” to tell men what they mean, thus constructing breast cancer as a “girl thing.” Not only do men witness their friends, girlfriends, wives, mothers, daughters, sisters, etc. fighting breast cancer, but some men actually get breast cancer, so it’s not only a women’s problem.

Anyway, there is enough of a stigma placed on men who get breast cancer without its promotion through this meme.

Update (2/2/2012): In case anyone’s going through my archives and reading old posts, let it be known that I officially withdraw my support for the Susan G. Komen Foundation in light of its defunding of Planned Parenthood.

Yes, We Need Psychiatric Labels

Recently I stumbled upon a Huffington Post article by one Dr. Peter Breggin, who lists himself on HuffPo as a “reformed psychiatrist.”

This should’ve told me everything I needed to know, but I read on.

The article is titled “Our Psychiatric Civilization” and tries to make the tired point that in this day and age, we are defining ourselves by our psychiatric diagnoses and not by anything else. It’s difficult to fully dissemble this argument because Breggin unceremoniously shoves so many unrelated arguments into the same sad little article, but his main points seem to be:

  • Psychotropic medication is overprescribed.
  • Psychiatric diagnoses (i.e. major depression, bipolar disorder, ADHD, etc.) oversimplify the human condition.
  • Back in the good ol’ days, people apparently did a lot of spiritual soul-searching rather than resorting to all those damn pills.
  • The way people connect in our culture is through their psychiatric diagnoses.

I honestly don’t know which planet Breggin is living on, but it’s certainly not mine. I’ve addressed the overprescription crap elsewhere so I won’t talk about that now.

As for the second point, this is, to a certain extent, true. Psychiatric diagnoses DO oversimplify one’s psychological state, but that’s because you have to have a starting point. If you’re diagnosed with ADHD, you know that, some way–whether it’s through medication, therapy, or some combination of the two–you need to learn how to focus your attention better. If you’re diagnosed with major depression, you know that you need to somehow learn how to fix your cognitive distortions and become more active. If you’re diagnosed with seasonal affective disorder, you know that you need to do things that counteract the shortening of the days–use a full-spectrum lamp, take vitamin D supplements, etc.

Just as knowing that I have, say, asthma or the flu doesn’t describe the full state of my entire body, a psychiatric diagnosis isn’t meant to describe my entire psychological condition. Breggin seems to think that we live in a world where all we know about each other is what pills we’re popping, and nothing else. This is ludicrous. In fact, that’s something we don’t often know, given the stigma that still exists regarding mental illness.

Breggin goes on to claim in a condescending way that there’s no reason for people to connect with each other based on psychiatric diagnoses at all:

Patients ask me, “Should I join a bipolar support group?” If I were flippant, which I never am with patients, I could respond, “Only if you want support in believing you’re bipolar and need to take psychiatric drugs.”

My first thought upon reading this drivel was, Thank G-d he doesn’t say this to patients. My second was more like, What the fuck?

The idea that seeking support from others who face similar issues as you is somehow disempowering and promotes seeing oneself as a victim is quite possibly the most batshit stupid thing I’ve ever heard from someone whose profession is helping the mentally disordered. Shockingly enough, people like to feel like they’re not the only ones with problems. Perhaps this has truly never occurred to Dr. Breggin.

Quite the contrary, I have benefited immensely from connecting to other people who have depression and other mental disorders. Many of my friends have one, and together we’ve formed a sort of support network. All of us can always count on having someone to talk to, and those of us who aren’t as far along in the process of recovery as others can ask friends for advice. I don’t know where I’d be right now without that.

(Maybe in a perfect world, we could just have support groups called “Fucked-up People Support Group,” but somehow this seems counterintuitive.)

Anyway, psychiatric diagnoses can also be immensely helpful in explaining to healthy friends and family what the deal is. While Breggin seems to think that “depressed” is some sort of insulting, disempowering label I ought to reject, let me tell you some of the labels that my close friends and family described me with before they knew I had depression:

  • overdramatic
  • overemotional
  • bitchy
  • attention whore
  • immature
  • insensitive
  • selfish
  • crazy
  • weird
  • fucked up

Yeah um, I’d take “depressed” over that any day.

Not surprisingly, you don’t make a particularly strong case for yourself when you try to insist to people that, no, it’s not that you’re really overdramatic, it’s just that you have this problem with, well, being overdramatic, and you’re trying to work on it, you promise!

Trust me, that doesn’t work. What does work is saying, “I have a disorder called depression that distorts my thinking and sometimes makes me act in a way that seems overdramatic. With therapy and medication, it’ll improve.”

Apparently, though, Dr. Breggin is much too intent on destroying his own profession to allow those with mental illnesses even that small comfort. After all, he makes it pretty obvious that the reason he hates psychiatric labels so much is because they make it possible to prescribe medication, and that, of course, is a big no-no.

If I got a dollar every time some well-meaning fool tried to inform me that the medication that saved my life is unnecessary, I would have enough money to actually afford a therapist.

Obama the Patriarch

I usually stay away from commenting on Obama’s presidency because, to be honest, I was just a kid during all the previous presidencies I’ve lived through and really have no comparison to make.

However, a recent statement by Obama has caused me to come out of my apolitical cave and rage. After the FDA made a recommendation that Plan B One-Step, a form of emergency birth control that is available over the counter to anyone over 17, be available to girls under 17 without a prescription as well, Kathleen Sebelius, Obama’s secretary of health and human services, overruled the FDA’s recommendation. This is disappointing enough as is, but then Obama came out in support of her and said the following:

“I will say this, as the father of two daughters: I think it is important for us to make sure that we apply some common sense to various rules when it comes to over-the-counter medicine….And as I understand it, the reason Kathleen made this decision was she could not be confident that a 10-year-old or an 11-year-old going into a drugstore should be able — alongside bubble gum or batteries — be able to buy a medication that potentially, if not used properly, could end up having an adverse effect.  And I think most parents would probably feel the same way.”

As usual when I write about women’s issues, I literally don’t even know where to start with this. First, and perhaps most obviously, I don’t understand why we’re having all this conversation about 10- and 11-year-olds. The change would have applied to all girls under 17, and the majority of teenage girls who might need to buy Plan B are not 10 and 11. Try 15 and 16. If Obama and Sebelius are that concerned about 10- and 11-year-olds specifically, they could’ve asked the FDA to recommend allowing only girls 12 and over to get Plan B without a prescription.

Second, and also very tellingly, if the FDA has deemed Plan B safe for over-the-counter use, who are Sebelius and Obama to assume they know better? Sebelius has a BA in political science and an master’s in public administration; Obama has a BA in political science and a law degree. Unlike many cynics, I don’t necessarily doubt that these two have the knowledge and ability to perform their respective jobs, but I would not trust them over the doctors and researchers who staff the FDA when it comes to medical issues.

Third, Obama immediately reveals what this is really about when he says, “as the father of two daughters…” Understandably, Obama would be worried for his two daughters if they were ever in a position to need Plan B. However, for all of the battling that Obama has had to do with the Far Right of this country, he clearly doesn’t seem to realize that many girls don’t have daddies like Obama who would care for them, be able to afford doctors’ appointments, support their right to get an abortion, and guide them through a decision. For many girls, it would be a choice between obtaining Plan B on their own or being shamed, abused, disowned, and/or forced to carry a baby to term.

Finally, I’m disturbed by the ageist and patriarchal notion that young women are somehow incapable of making their own decisions about sexual health. Yes, children need and should have access to guidance from adults. In a perfect world, every girl would be able to go to her parents for help with something like this. But that’s not the world we live in, and we must make do accordingly. Not only has the FDA already determined that Plan B is safe, but, unlike many medications that are available over the counter to children, you can’t overdose on it or otherwise fuck it up–when you buy it, you only get one.

Furthermore, there are other ways to make sure young teens know what they’re doing when it comes to emergency birth control. For instance, mandate pharmacists to provide an option for girls to privately ask them questions about how to use Plan B. Pharmacists know a lot. Why not use them as a resource?

Much has been made of Obama’s failure (or lack thereof) to support women’s rights, and it’s a debate I don’t normally follow because one can really spin it either way. On this issue, however, I would argue that Obama has definitively failed to support women and girls. Instead, he has promoted the antiquated notion that beliefs trump science when it comes to reproductive rights.

Antidepressants and Strength of Character

You're not a bad person if you take any of these roads. I promise.

Spoiler alert: They have nothing whatsoever to do with each other.

There are different levels of stigma surrounding mental illness. There’s the stigma of having a disorder in itself, the stigma of being in treatment for a disorder, and, perhaps most of all, the stigma of that treatment being pharmacological.

People love to hate psychopharmacology, especially antidepressants, the efficacy of which is constantly being questioned (often for good reason). However, I’ve noticed that drugs like antidepressants receive a special type of scorn, one that cannot be based solely on the efficacy mystery.

I’ve found that where mental treatment is concerned, therapy holds some sort of moral superiority over drugs in many people’s eyes. I think many people still feel that mental disorders are spiritual illnesses, not medical ones, and that treating them with a pill is some sort of cop-out. (Imagine the public furor if researchers came up with a pill to, say, erase the feeling of guilt.)

This would explain why, though therapy is still stigmatized–after all, the Ideal Person works out these issues on his or her own–it is considerably less looked down upon than psychotropic medication. Our culture values struggle and hard work so much that even recovering from an illness should be mentally effortful.

What people don’t realize is that there are plenty of perfectly legitimate reasons why someone might choose medication over therapy, at least in the short term. Consider, for instance, the situation I found myself in a month before I began my sophomore year of college. Having spent my entire freshman year growing progressively more depressed, I’d thought that coming home for the summer would magically fix everything. It didn’t. With a month to go, I realized that I felt like I’d rather die than go back to school.

That was when I was first diagnosed with depression, and I think my psychiatrist realized, as did I, that I just didn’t have time to muck around with my feelings–I had to get better quickly, or else going back to school would be more upsetting and stressful than I could handle. So I started taking antidepressants and quickly improved enough to feel like I could deal with being in school. The mucking around with my feelings came later.

Aside from that, I can think of many other reasons medication can at times make more sense than therapy. For example:

  • Financial concerns. Antidepressants cost me $30 a month, while therapy costs $80 for four weekly sessions. That’s a pretty big difference for many people.
  • Time. Some people are at a point in their lives where they literally can’t spare an hour or more a week for therapy. That might sound ludicrous to you, but if you’re a college student, a new parent, or a low-income worker, it probably doesn’t.
  • Availability. Unfortunately, not everyone lives in an area where good therapists are available and accessible (and bad therapists will do more harm than good). This is especially true for members of marginalized communities, who may have a hard time finding therapists who are sensitive to their issues. Not all therapists are as open and accepting as they should be.
  • Insurance. I’m lucky to have a fantastic insurance policy that covers basically everything I’ve ever needed. However, many policies are very picky with regards to therapy (as opposed to medication, which does require a prescription from a person with an MD). For instance, some policies refuse to cover therapy unless there’s an official diagnosis, and you don’t necessarily need to have a diagnosable mental disorder in order to need help. Besides, you can’t be diagnosed without going to a specialist to begin with.
  • Nature of the disorder. Although most mental illnesses obviously involve a psychological component, some do not. For example, many people in temperate climates get Seasonal Affective Disorder (SAD) during the winter months, which is characterized by a low-grade depression as well as various physical symptoms. It’s usually treated with antidepressants or light therapy, which actually has people sit in front of full-spectrum light.
  • Language. Therapy requires people to talk pretty extensively about themselves and their lives, something that would be very difficult for, say, a new immigrant who’s just learning English. Unless such people are able to find a therapist who speaks their native language, it would be pretty hard for them to get anything out of therapy.
  • Comfort. As a future therapist, I obviously wish that everyone were comfortable with the idea of therapy. But not everyone is. That could be because of cultural factors, family attitudes, personality, or negative experiences with therapy in the past. I think that using medication to improve your quality of life while working up the courage to see a therapist is perfectly okay.

I hope that this list shows that making decisions about mental health isn’t that different from making decisions about physical health–it has more to do with personal preferences and practical concerns than with the strength (or lack thereof) of one’s character.

Of course, I do believe that therapy is really important and generally awesome, which is why one of my upcoming posts will be about why I think that everyone (or almost everyone) should see a therapist. Stay tuned.

Sleep: Forgotten Martyr of College Life

See? It's even on a shirt.

Academicssocial life, and sleeppick two.” -popular advice given to college freshmen

I’m sure you’ve heard that one before. Most college students, it seems, pick the first two.

What surprises me isn’t so much the fact that they do, but the fact that sleep deprivation is considered such a routine part of college life. Nobody seems to see anything wrong with this idea that getting through college necessitates depriving oneself of sleep.

I have a different way of looking at things because I have a different body. More specifically, living with depression means that sleep takes on a central significance in my daily life. Get too little, even by an hour, and I’m facing the sort of fatigue most people experience only after an all-nighter. Get too little too often, and I’m significantly increasing my chances of relapsing.

Most people don’t have depression (though many do, especially in college), but everyone knows, in the backs of their minds, that sleep is really, really important. Lack of sleep is implicated in all sorts of health problems, from susceptibility to stuff like colds and flu, to obesity, diabetes, attention and memory problems, and, of course, depression. Fatigue also makes the other two items on that list, academics and social life, nearly impossible to handle.

What’s strange is that sleep is probably unique in its complete invisibility as a college health issue. Dining halls increasingly provide healthy options, including full salad bars at each of Northwestern’s. Campus medical centers provide free condoms and cheap STI testing. Campus gyms are open from 6 AM to 11 PM each day and provide plenty of free (or cheap) classes, intramural sports teams, and what have you. Counseling centers provide free counseling and stress management workshops (though of course there’s much to be desired in that department). Anti-binge drinking initiatives abound.

But sleep is that subject that nobody ever seems to touch. After all, exercise makes you look good and can be fun, grabbing a free condom is easy, and getting a salad instead of a pizza is no big deal. Getting enough sleep, meanwhile, requires actual lifestyle changes–and, sometimes, actual sacrifices.

Ultimately, though, I think that the whole “pick two” joke is a false dichotomy (trichotomy??). I know that having all three is possible, because I have all three. I have great grades, I have great friends, and I sleep a solid 8-9 hours a night.

(A few weeks ago, frustrated by the fact that I’m usually exhausted by the time I come home from classes at 6 or 7 PM, I called my mom to complain. She said, “Of course you’re tired. It’s normal to be tired after a long day of classes.” Until she told me this, I’d never realized that. Because the campus culture I’m steeped in tells me that I should come home in the evening, go to meetings and do homework until midnight, and then engage in a social life until 2 or 3 or later–or, if I’ve been procrastinating with my homework, I should just stay up all night.)

What worries me most is that people wear their sleepless nights like badges of pride. You never hear anyone say, “Dude, I’ve legit been eating three slices of pizza EVERY DAY this week,” or “Man, guess how long I’ve managed to go without working out!” or “Guess what, guess what? I totally didn’t use a condom last night!”

But they make those comments about their lack of sleep. The only comparison is the way people talk about binge drinking.

Why is sleep deprivation cool? Probably for similar reasons as binge drinking is. It’s a mark of physical endurance, in a way, and it’s a way of displaying that you have the “right” priorities–socializing, usually–and not the “lame” ones.

Yet colleges actively try to combat the culture of binge drinking, but they ignore the problem of sleep deprivation. Why?

Fatism and Going to Extremes

Discrimination against fat people is a problem. People who are overweight are often judged to be less competent, less intelligent, and more lazy–not to mention less attractive–than people who are of a “normal” weight. They face discrimination in the workplace, and there are some jobs for which they are unlikely to ever be hired at all.

It’s only natural, then, that a movement has sprung up to combat “fatism”–and that’s awesome. What bothers me, however, is the tendency of anti-fatism activists to deny the fact that being severely overweight has negative effects on one’s health. I hear a lot of “weight has nothing to do with health” arguments these days, and this sort of denialism is simply dangerous. Obesity is a problem in America, and it does put you at increased risk for a lot of health problems, such as:

  • high blood pressure
  • heart disease
  • stroke
  • type 2 diabetes
  • sleep apnea
  • breast and colon cancer
  • osteoarthritis
Given that heart disease is the leading cause of death in the United States, I feel like its prevention is something that should be taken seriously.

Regardless, denying these health problems does not help anyone, and admitting that being obese is unhealthy is not tantamount to justifying discrimination against obese individuals. After all, one’s health is one’s own business, and not taking care of your body shouldn’t result in being discriminated against.

It worries me when social movements respond to a problem in society (such as fatism) by taking the extreme opposite view. This happens a lot with progressives. For instance, noticing that our society has pervasive and restrictive gender roles, some claim that gender is entirely socially constructed and has no basis in biology whatsoever. (Apparently these people never noticed that men and women do actually have at least one very noticeable biological difference.) Some note that homophobia is rampant in society, so they insist that heterosexuality is actually constructed and unnatural, and that same-sex relations are the only “genuine” ones. Similarly, some people think that because discrimination against fat people exists and discrimination is wrong, therefore, there is nothing whatsoever bad or unhealthy or in any way undesirable about being overweight.

But being fat isn’t the same as being part of other marginalized groups, such as being a woman, being gay, being transgender, or being Black. No reputable scientific study has ever found that being gay or transgender is in any way unhealthy or abnormal (except, of course, in the statistical sense). No reputable scientific study has ever found that women or African Americans are inferior in any way to men or Caucasians. But our entire body of medical evidence shows that being severely overweight comes with significant hazards to your health. This is something that is simply true. Regardless of whether you think BMI is a good measure of obesity, and regardless of how easy or difficult it is for you to lose weight, being obese is unhealthy. Does this mean that discrimination against fat people is okay? Hell no. But it does mean that obesity is something that should be discouraged.

Incidentally, some of the things that anti-fatism activists consider discrimination simply aren’t. For instance, when airlines ask obese people to buy two seats, guess what–it’s not because they just don’t like obese people. It’s because if your body requires more than one seat, then you should have more than one seat–in which case, it follows that you should pay for more than one seat, because it wouldn’t be fair to give some people a second seat for free. Furthermore, it would be unfair for a person who paid for a seat to effectively receive only half a seat because the person sitting next to them clearly requires part of theirs. Does it suck to have to pay more to fly if you’re fat? Yes. But in that case, lobby for airlines to make seats bigger, not to give you permission to use half of another customer’s seat.

Also, companies that provide incentives for their employees to exercise/get down to a healthy weight/whatever are not being fatist. They’re doing two things: 1) encouraging their employees to be healthier, and 2) saving themselves money by reducing lost productivity due to medical problems and by reducing the amount they have to pay as insurance. Fact: being healthier and not obese reduces medical expenditures. Similarly, doctors who recommend that their obese patients lose weight are not being fatist. They are being doctors. I am terrified of the day when doctors are prevented from dispensing sound, evidence-based medical advice for fear of offending someone.

Regardless, it is, in fact, quite possible to discourage obesity without promoting eating disorders, obsessive dieting and exercising, and holding oneself to an impossible standard of beauty, as the mass media does. Conflating  efforts to discourage obesity with efforts to promote unhealthy behaviors or stigmatize fat people is intellectually lazy. There is, for every issue, a solution that is healthy, reasonable, and benefits the greatest possible number of people. Just because that solution is extremely hard to find doesn’t mean it doesn’t exist. It’s there, and I can guarantee that it is almost never at one extreme or the other. It’s usually somewhere in the middle.

Kids These Days

I am going to do something I rarely do–label something with an “ism.”

A post on CNN’s health blog, The Chart, points out that oral sex can increase cancer risk–valuable information, to be sure. But for some unknown reason, the blog frames the information like this:

Here’s a crucial message for teens: Oral sex carries many of the same risks as vaginal sex, including human papilloma virus, or HPV. And HPV may now be overtaking tobacco as the leading cause of oral cancers in America in people under age 50.

“Adolescents don’t think oral sex is something to worry about,” said Bonnie Halpern-Felsher professor of pediatrics at the University of California, San Francisco. “They view it as a way to have intimacy without having ‘sex.'”

Actually, the author of this blog and the professor quoted in it might be surprised to know that adults also occasionally engage in oral sex, so this might be a “crucial message” for them as well as for teens. In fact, sometimes these adults even view it as a way to have intimacy without having ‘sex’!

But of course, there’s no need to miss another valuable opportunity to insert a “kids these days” reference into a completely unrelated topic. Which is, yes, ageism.

On another note, since when does a random doctor or professor get to unilaterally define “sex”? Just because oral sex undoubtedly carries risks doesn’t make it equivalent to, say, vaginal or anal sex. Different people ascribe different significance (or lack thereof) to different sexual behaviors. To many people, oral sex is not as “serious” or meaningful as penetrative sex. This doesn’t mean they shouldn’t be aware of its risks, but it does mean that no higher authority can or should try to define “sex” for everybody.