Open Thread: How Do You Practice Self-Care?

A teapot and a mug that says, "Write like a motherfucker."

90 degrees outside. No fucks given.

I’m going to give open threads a try! The folks who comment here seem to have a lot of interesting things to share, so I thought it’d be cool to have some threads where you can talk about yourself as much as you want.

The topic I’m starting with is self-care. Whether or not you have what could be called Mental Health Problems, everyone needs to calm down, unwind, or get their mind off of things sometimes. Different things work for different people, and sometimes something that seems really weird or counterintuitive will help someone.

Self-care is not a replacement or substitute for treatment (if you need it). It’s a way for people to cope with stress and jerkbrain, maintain recovery from a mental illness, or help manage mental illness symptoms if you have them. So none of these things are intended to cure or treat anything, and a lot of frustration tends to arise when people offer them up as “advice” for those with mental illnesses.

We each know best what helps us best. Here’s how I like to do self-care:

  • Hot tea. (Even in the summer. Must be because I’m Russian.)
  • Writing, even if it’s about something heavy.
  • Taking a hot shower, even if it’s just to have a place to cry in private.
  • Cleaning, organizing, doing dishes. My apartment tends to get cleaner the more life problems I’m having.
  • Going for a walk and listening to music. Unfortunately, I don’t get to do this so much now that I live in the city, where it wouldn’t be relaxing or necessarily pleasant. But my high school years, back in Ohio, were full of leisurely walks around the neighborhood.
  • Playing music. Now that I finally have a keyboard piano, I’ll finally be able to do that again.
  • Reading sci-fi novels or nonfiction articles. For some reason, it has to be one or the other. Nonfiction books don’t work, and short stories or poetry don’t work.
  • Watching something that tells a good story but doesn’t require careful attention. So, Star Trek and Doctor Who are in; West Wing and Damages are out.
  • Talking to a friend about something totally unrelated.

Some things that help lots of people but not me are: YouTube videos, animal photos, talking to someone about the thing I’m upset/stressed about, eating, video games (though I like them at other times), basically anything that’s supposed to be funny/uplifting. The first two are especially frustrating, because the first thing many people will do if I say I’m feeling down is send me YouTube videos and animal photos. Then I have to either pretend that it helped, or tell them that that doesn’t help. (Except sometimes. Hard to predict.)

 

What works for you? What doesn’t?

Towards A Better Conversation About Mental Illness

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

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

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

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

1) Do your research.

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

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

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

2) Never engage in armchair diagnosis.

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

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

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

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

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

Read the rest here.

“Twitter Psychosis”? I’m Skeptical

[Content note: mental illness & delusions]

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

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

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

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

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

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

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

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

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

Read the rest here.

 

Camping Trip Mornings

My favorite moment of any camping trip is the first morning.

I wake up in my tent having finally made it through a spooky and often uncomfortable night–air mattresses and sleeping bags are not my thing–and feel relieved. I can hear dry leaves and twigs crunching beneath footsteps, the thud of hiking boots on dirt and gravel. Water pours from a spigot nearby as someone fills a kettle or washes their hands. There are sleepy conversations, debates about breakfast and pleas for the kids to brush their teeth. Having never been camping with anyone besides my family and their boisterous, colorful friends, I’ve only ever heard these discussions in Russian. Camping, like baking, knitting, and skiing, happens in my native language.

Outside the smoke curls lazily from campfires that finally collapsed shortly before dawn. Pale morning sunlight filters through the canopies of the trees, catches the drifting smoke, stumbles over the tops of the tents, and finally lands in my little sister’s hair, glowing golden, as she pulls me over for breakfast.

The picnic tables almost sag with the weight of the food and drink. Last night’s empty bottles line the tables, but so do this morning’s omelets, sausages, bread, cheese, hardboiled eggs, bagels, fruit, and tea. People shove food into my hands. Water from last night’s apparent rain runs off the blue tarp that hangs over the tables, and I find a dry spot to sit with my paper plate.

And as I look out from my perch at this small piece of the world, the things that seemed so treacherous in the dark just last night–the things you trip over, the things you step into, the things that cast creepy shadows in the firelight–now look boringly normal. The perilous trek to the campground toilets now reveals itself as a short and simple path. The black water of unfathomable depth that I saw at the edge of the flashlight’s beam is just a pond. Dragonflies flit over it, and a frog croaks at its edge.

In the morning, everything suddenly feels safe and familiar again.

When I feel scared, uncomfortable, and alone, I sometimes think about those camping trip mornings, and about how the exact same things can seem so much safer in the sunlight. This visualization that is also a memory calms me down. I think about the transformation that happens at sunrise that first day, of threatening to friendly, strange to familiar.

That transformation is mirrored in my own life to a frustrating degree. People I once held my tongue around and felt anxious with become my closest friends. Streets I explored cautiously, my eyes darting around as though searching for threats, become streets I walk down proudly, yet casually. Things that seemed burdensome and inconvenient to do become routines: ignorable at worst, comfortable at best.

It may not sound like something you’d describe as “frustrating,” but I do, because I can’t seem give myself permission to not be okay with everything immediately. Why couldn’t I have immediately recognized that person as the lovely friend that they are? Why didn’t I see these streets as my home? Why couldn’t I always do these things easily and automatically?

It’s just not how my brain works. I’d venture to guess it’s not how most people’s brains work.

I wish I were someone who craved novelty, who relished the unfamiliar, who reveled in uncertainty. Someone who could cherish their memories without feeling desperate to relive them. But I am not that person. I want it to feel like the camping trip morning all the time. I want to wake up and realize that I know exactly where I am, mentally and physically. I want to stumble outside, rubbing the dreams from my eyes, and see the people I love there waiting for me.

And most of all, I want to feel that these are acceptable things to want.

“I’m a strong woman and I don’t need help.”

A common argument against interventions that aim to decrease harassment and violence against women–conference harassment policies, stronger anti-bullying measures on social media, and so on–is made by women and goes something like this: “I’m a strong woman and I don’t need to have my hand held.” Sometimes this is served with a side of “You’re the real sexist if you think that women are weak enough to need this.”

There are a lot of false assumptions layered in these statements. Namely:

1. That not needing certain protective measures makes you “strong” relative to others.

According to the fundamental attribution error, people tend to overemphasize the role of others’ internal characteristics and underemphasize the role of the situation they are in when trying to explain others’ behavior. In this case, many people observe others asking for harassment policies, trigger warnings, and the like, and attribute this to those individuals’ supposed “weakness” rather than to situational factors.

This discourse of “strength” when it comes to harassment and bullying troubles me. What I’ve generally found is that an individual’s ability to “deal with” harassment and abuse has less to do with how “strong” they are and more to do with other factors: social support, personal history of victimization, and feeling otherwise safe in the current environment, for instance.

Further, one’s likelihood of experiencing harassment and abuse in the first place has less to do with how “strong” they actually are, and more to do with how they are perceived by others. While individual factors have some impact on that, so do social categories that people use to think about others. Women with disabilities are extremely likely to be sexually abused because others perceive them as unable to speak up or get help, and because they perceive everyone else as unwilling to believe the testimony of a woman with a disability. Sadly, the latter is often true.

Therefore, feeling able to handle contingencies like sexual assault and harassment on your own, without help, is often more an indicator of privilege than superior personal traits. It certainly is for me. Part of having privilege is having difficulty seeing how other people may not have the same opportunities or experiences as you, for reasons that are not their fault.

2. That recognizing that some people(/women) need protective measures is bigoted(/sexist).

This is the gender version of another of my favorite bad arguments, If You Notice Race Then You’re The Real Racist. No, Real Racists (insofar as there is such a thing) are people who have managed to convince themselves that they “don’t see race” while continuing to judge and discriminate on the basis of it.

In the real world, there is sexual harassment and assault. In the contexts that we’re discussing, such as conferences and college campuses, sexual harassment and assault are most commonly perpetrated by men against women. Although harassment policies, anti-bullying measures on social media, and other initiatives of that sort have the potential to help anyone regardless of gender, most people correctly note that the initiatives are being created with female victims in mind–because that’s the majority, and because the loudest voices in anti-sexual violence advocacy tend to be women.

Noticing reality is not bigoted in and of itself. (But it’s possible to discuss reality in a bigoted way, obviously. For instance: “Women are the majority of sexual assault victims because men are slavering beasts” or “There tends to be more violence in neighborhoods where the residents are predominantly Black because Black people are more violent.”) If it is true that women are the majority of sexual harassment victims–and, according to current research, it seems to be–then it makes sense to be concerned with reducing sexual harassment against women.

But as I mentioned, such protective measures are useful to anyone who experiences harassment or assault, regardless of gender. When you say that such measures are by default sexist against women, you are assuming that all potential victims are female, and ignoring all the ones who are not. Although I do so hate to play “You’re The Real _____,” it is actually quite sexist to assume that men cannot be victims of sexual harassment or assault, and quite cissexist to assume that non-female, non-male people don’t even exist, as victims or otherwise.

3. That “strength,” whatever that is, is a quality that everyone ought to have, regardless of personal circumstance, and having it makes you clearly superior to those who don’t.

This is probably the main reason this response arises. A lot of people feel good about themselves when they position themselves as strong and independent and maybe a little bit better than those who can’t “take care of themselves.” In this way, the “I’m a strong woman” narrative is actually sort of a reasonable response to sexism. When you’ve been told implicitly and explicitly your entire life that you’re weak because of your gender, why not reimagine yourself as strong? Stronger, perhaps, than other women?

But when you say, “I’m a strong woman and I don’t need this,” what does that say about the women who are not “strong,” who do not consider themselves “strong,” who cannot be “strong” in the ways that you are referring to?

I was originally inspired to write this post after a discussion on my Facebook about an article that I posted about interaction badges. This is a measure implemented at some conferences for Autistic people to help them set boundaries around social interaction. Red badges mean, “Do not initiate interaction with me”; yellow badges mean, “Only initiate interaction with me if we know each other”; and green badges mean, “I would like to talk but have trouble initiating; please initiate with me.” The badges are very useful for people who sometimes have trouble reading subtle social cues from others or sending such cues themselves, which describes many people on the autism spectrum.

I posted about this idea and said that it would be a cool thing to implement at the conferences I go to–not just because plenty of ASD folks attend these conferences too, but because it would be helpful for lots of people neurotypical and otherwise. Predictably, someone said that they’re a “strong woman” and they don’t need this and so on. A friend of mine responded that, well, some of us aren’t strong, and some can’t set boundaries, and why do these people deserve to feel uncomfortable or even unsafe just because they don’t have the capability to be “strong” in this way? How is that fair at all?

There are plenty of legitimate reasons someone might temporarily or permanently lack the ability to assertively set boundaries. People with autism sometimes experience selective mutism, which means they cannot speak. People with social anxiety or similar conditions might panic and be unable to relax and find the words they need. In more extreme situations, sexual assault victims often experience a sort of paralysis that prevents them from being able to speak up and say “no.” This is a documented effect.

Setting boundaries is often exhausting, and different people have different amounts of energy (or spoons, if you prefer that metaphor) to do it. If colored badges make a space more accessible, why not? If you personally don’t need it, who cares?

4. That these protective measures are being implemented with the assumption that everyone needs them.

Actually, most people do not get harassed and assaulted at conferences or elsewhere. Some of the people who do get harassed and assaulted at conferences or elsewhere will have ways to cope and deal with that on their own, without using the resources made available to them by that space. When I was assaulted in college, I decided not to report it or utilize any campus resources for survivors because I didn’t feel that I needed them. When I was harassed at conferences, I decided not to let the organizers know, because I preferred to deal with it in other ways. To the best of my recollection, I have never used any formal procedure for dealing with harassment or assault, for my own personal reasons.

So, for various reasons, you may not need to use a protective measure in a given space. That’s great! Nobody implied that you, personally, need this measure. If you don’t end up experiencing harassment or assault, that’s obviously good. If you do, but you’re comfortable handling harassment or assault on your own, then you don’t need to avail yourself of the measures in place to help survivors. But not everyone is, for more reasons than I’m able to list.

This is why “I’m a strong woman and I don’t need this” ultimately falls so flat for me as an argument for or against anything. Claiming that harassment policies are useless because you don’t personally need them is no more sensible than claiming that a restaurant should not have vegan options because you’re not personally a vegan. And claiming that harassment policies somehow imply that all women (yourself included) are weak and need protecting is no more sensible than claiming that the mere presence of an elevator is accusing you of laziness.

There are people who sometimes need harassment policies and there are people who sometimes (or always) need elevators. If you don’t, ignore it and go about your business.

Or, better yet, understand that others may need help that you do not, and support them in their effort to get it.

~~~

I’ve previously written some other stuff related to this argument:

Also of relevance is the fact that the “strong woman” narrative has particular meaning and significance for women of color.

A Primer On Atypical Depression

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Are Celebrities Responsible for Modeling Good Mental Health?

[Content note: depression, mental illness, suicide]

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

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

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

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

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

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

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

Read the rest here.

“When one is in the penalty box, tears are permitted.”

I recently discovered Star Trek. Don’t laugh! I have foreign parents who were unable to expose me to such things in a timely manner.

In episode 9 of the first season of Star Trek: The Next Generation, Captain Picard and his crew are confronted for the second time by the mysterious “Q,” a member of an apparently omnipotent species that can teleport and manipulate matter and energy in ways that humans cannot. This time, as last time, Q decides to test the crew of the Enterprise, toying with them like playthings. After transporting everyone but the Captain to the surface of an unknown planet, he challenges them to a game. Lieutenant Tasha Yar boldly confronts Q, and he punishes her by suddenly making her disappear. He explains to the others that Yar is in a “penalty box” where she is safe for the time being, but the penalty box only has one spot. So if anyone else messes up, they’ll get sent to the penalty box, and Yar will be gone forever.

Captain Picard comforts Lieutenant Yar in her penalty box.

Captain Picard comforts Lieutenant Yar in her penalty box.

As it turns out, the penalty box seems to be located on the bridge of the Enterprise. Seeing Yar, Picard asks what happened.

Yar: It sounds strange…but I’m in a penalty box.

Picard: A penalty box?

Yar: Q’s penalty box. It sounds strange but it definitely isn’t. I know that one more penalty–by anyone–and I’m gone.

Picard: Gone?

Yar [agitated, starting to cry]: Yes, I am gone! It is so frustrating to be controlled like this!

Picard: Lieutenant…Tasha. It’s all right.

Yar: What in the hell am I doing? Crying?

Picard: Don’t worry. There is a new ship’s standing order on the bridge. When one is in the penalty box, tears are permitted.

Now allow me to make a corny analogy.

A lot of situations we end up in are like Lieutenant Yar’s penalty box. They suck. They’re terrifying. They’re unfair. Maybe, like the penalty box, they’re precipitous; one more misstep, and we’re done: not literally disappeared from the entire universe, perhaps, but fired from a job, flunked out of school, broke, alone. Sometimes we ended up there through no fault of our own, or even–as Yar was doing–while trying to make things better for ourselves or for others. But, stuck in the penalty box, we can’t fully acknowledge that the situation is crappy, and we don’t give ourselves permission to feel crappy about it.

My memory works in a very cyclical way: as time goes on, I think about things that happened during the same season but during a previous year. So now it’s mid-May and I’m remembering finishing college, graduating, packing, and that long, horrible move to the city I (nevertheless) loved then and still do. I have another move ahead of me this summer, so I’m especially thinking about it. Though, this time it’s within the same city and it’s to live with my best friends.

I think about how harsh I was on myself during that whole process, how worked up I’d get, crying about leaving and then crying about crying and probably at some point crying about crying about crying. Crying became such a routine for me last summer that I could’ve kept track of time that way.

For whatever combination of psychological and environmental factors, it seemed like that move was my penalty box. I felt on the edge of something horrible and I couldn’t even imagine what. I felt completely out of control, even though I had, after all, chosen the move. The move was my penalty box and on some fundamental level I didn’t really believe that tears were permitted. I knew that they were, but I couldn’t believe it.

Everyone I know who thinks about this stuff has their ways of trying to explain it. One good friend says, “No feelings about feelings.” Not as a rule, but as an ideal to aspire to: we get to feel sad or angry or afraid or embarrassed or ashamed or jealous, but we should try not to have feelings about the fact that we feel those things. Others just say, “Feel your feelings.” Mental health professionals practicing dialectical behavior therapy try to teach their clients a skill called “radical acceptance”: the ability to recognize that you’re feeling a certain horrible way and to accept it, not as something that’s good or preferable, but as something that, at least for now, just is.

The acceptance of feelings seems to be harder for many people than the acceptance of situations. I’ve adapted quickly to situations I’d previously thought would be intolerable, but I do not adapt quickly to my own emotions. It’s not just the emotions that feel bad; it’s the meta-emotions that do the most damage. Feelings about feelings.

There is no easy way out of this. There’s no convenient self-help trick that’ll stop the feelings about feelings. There is no Stop Hating Yourself For Being Sad In Five Easy Steps!. I wish there were.

But sometimes there are skills or coping mechanisms or even phrases from television shows that help.

When one is in the penalty box, tears are permitted.

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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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