“What do you have to be depressed about?”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Why You Shouldn’t Use Mental Illness As A Metaphor

And speaking of the dilution of language, I’m going to talk a little about how the language of mental illness gets co-opted regularly.

Sometimes this is done completely innocently, as metaphor. “The weather’s really bipolar today.” “I’m kinda OCD about this, sorry.” “I’m so depressed about the Blackhawks losing!”

Sometimes it’s a little less innocent, as “humor” that implicitly degrades its target: “She’s, like, totally fucking schizo.” “Clinically Depressed Rob Pattinson Cavorts With Models in New Dior Ad.” (Jezebel has historically been pretty bad about using mental illness as a punchline.)

My usual objection to using mental illness terms in this way is that mentally ill people (who comprise a fourth of American adults) are likely to find them marginalizing and hurtful. It makes us feel like the potentially-fatal conditions we struggle with are just a joke to you. It’s not a nice feeling, and if you are a person who generally cares about your friends’ feelings, you should probably be aware of this.

But the dilution of mental illness terms might have another, more insidious effect, and that is changing our mental schemas of what mental illness looks like such that it’s less and less serious, and treating it accordingly.

As an example, I was recently posting on Facebook about the infuriating phenomenon in which someone discloses a phobia or trigger that they have to warn their friends, and then their friends proceed to try to deliberately trigger them. I literally watched it happen, and then I watched the friend post a new status about how people do this, and someone tried to do it again.

So my friends and I were discussing this and one of them mentioned that a possible factor (aside from the obvious douchebaggery) is the fact that many people now use “phobia” very colloquially, as in, “thing that makes me have a sort of uncomfortable but totally harmless reaction that would probably be amusing for you to see,” as when my little brother wants me to taste something totally gross (but safe and edible) or when my mom is like “ewwww look at all this dust that’s built up on your windowsill!”

I think my friend may be right. These words are used so casually that our conception of their meaning gradually shifts without our even noticing it. It’s like a boy-who-cried-wolf type of situation in that regard. If nine different friends joke to you about how they’re “sooooo OCD” because they like all their books organized just so on their shelf (a situation familiar to just about every bibliophile, honestly), then the tenth friend who comes to you and tells you that they have OCD is probably going to evoke that mental image, rather than one of someone who actually can’t stop obsessing over particular little things and carrying out rituals that interfere with that person’s normal functioning, perhaps to the point of triggering comorbid disorders like depression. This may be a person who washes their hands until they are raw and hurting, someone who has to flick the light switch on and off seven times every time they leave a room, or someone who has recurring, uncontrollable thoughts about hurting someone they love even though they have no actual desire to do that.

Well, that sounds a little different than insisting that your books be categorized by subject and then alphabetized by author, no?

Likewise, if your friends are constantly telling you they’re “depressed” because their team lost or because they got a bad grade, only to return to their normal, cheerful selves within a few hours, the next person who tells you that they are “depressed” might elicit a reaction of, “Come on, get over it! You’ll feel better if you go out with us.”

And so the meanings of words change.

But just because the people around you use mental illness terms in that diluted way doesn’t mean you should accept it. If you want to be an ally to those who struggle with mental illness, you should treat disclosures of mental illness seriously every time unless you’re absolutely certain that that’s not what the person is telling you. Feel free to ask for clarification.

I already shared this story as a comment on another post, but I’ll share it again because it’s applicable here. I once ran into an acquaintance and we chatted for a bit. I asked him what he’d been up to, and he said, “Just, you know, getting sober. I’m an alcoholic.” And I said, “Congratulations, good for you!” And he responded, “Oh, I’m not actually an alcoholic, I just meant that I’ve been drinking less. Haha, I forgot that you’re a psych major.”

The latter comment annoyed me because of its implication that I took his seeming disclosure of alcoholism seriously because I majored in psychology. That’s not why. I took it seriously because it sounded serious, because I want to support people who struggle with mental illnesses, and because I know what a big step it would’ve been for me to tell someone I didn’t know that well that I had started treatment for depression, back when I had it.

But other than my brief chagrin, there weren’t really any drawbacks or negative consequences for me in this situation. I faced no repercussions for taking him seriously. I undoubtedly came out of the situation looking like a decent person who cares about people, and he probably felt a little silly for flinging the term “alcoholic” around, but also reassured that if he ever did get diagnosed with a mental illness, I would take him seriously.

Although it may feel that way sometimes, you do not have a limited number of Real Mental Illness Points that you need to save up for responding to people who have a Real Mental Illness, and that you shouldn’t waste on those who are just using those terms metaphorically. The worst thing that happens if someone tells you that they have a phobia and you decide to refrain from trying to trigger that phobia is…exactly nothing. The worst thing that happens if someone tells you they’ve been feeling depressed lately and you say, “I’m so sorry to hear that, is there anything I can do to help?” is that they say, “Oh, don’t worry, it’s not like, depression or anything. I’ll feel better soon.”

That’s it!

And your taking them at their word sends a message to them that you believe that these words should be reserved for describing the illnesses they indicate, rather than being used as convenient metaphors. You’re helping to set a norm about how these words should be used.

Meanwhile, if you’re someone who uses mental illness terms to describe states of mind that you do not feel are mental illnesses, I’d encourage you to take advantage of the richness of the English language (or whichever language you speak, which I’m sure is also rich) and not do that. (Russian, for example, has some beautiful words for sadness. There’s the general sadness, or grust’; there’s a stronger version, toska; there’s a type of sadness that’s accompanied by an unwillingness or inability to do anything to improve one’s state of mind, unyniye; there’s a type of sadness that isn’t really directed at anything in particular and lies somewhere between grust’ and toska in severity, pechyal’; and there’s a type of sadness that includes grief, but also sadness at the loss of a treasured possession or an important opportunity, skor’b. And that’s a few. And don’t get me started on the Portugese word saudade.)

Note that I’m not including here folks who have diagnosed themselves with mental illnesses because they’re unable (or currently unwilling) to seek help from a professional. If you feel that you have the mental illness known as depression, then that word, I believe, is yours to use.

My point is only that sometimes misusing language has actual harms, and while language does evolve and change over time, we need words to describe mental illnesses. We can’t fight something that we can’t name, and we need to be able to fight depression and OCD without people thinking that we’re fighting feeling sorta down when your team loses or wanting to have all your books organized just so.

~~~

Related: Small Things You Can Do To Improve Mental Health In Your Community

#FtBCon Wrap-up and Thank Yous

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Hopefully you caught at least part of our first-ever FtBCon this weekend; if not, here’s a convenient playlist of all of the things. I had a blast with it despite being chained to my computer for two and a half days; I met a bunch of people, learned a lot, and got to talk about some important stuff. Not that different from a meatspace conference, actually!

The best part were all the comments I saw from people who said that they never have the option to go to meatspace cons. Many said this was their first atheist/skeptical conference. Many said that physical/mental disabilities, money, work, children, and so on kept them from traveling to cons.

Of course, FtBCon isn’t anywhere near a perfect simulation of a meatspace conference. It can’t be. Nothing can replace that feeling of walking into a huge room full of likeminded people milling about, vendors selling books and jewelry and clothing, friends you rarely get to see in person. Nothing beats taking photos with your heroes and having people recognize you from the Internet. We have to keep doing our best to make conferences accessible in every possible way.

But FtBCon came damn close. The chat room was always full of great conversation, just like the hotel lobby after the day’s talks have wrapped up. Many of the panels would keep going after they went off air, with the panelists telling each other everything they didn’t get to say during the panel and then dissolving into conversation about family or books or life. People found new bloggers and speakers to follow, people made friends, people made plans for the future.

For instance, the folks from the amazing chronic pain panel mentioned wanting to create some sort of group for skeptics with chronic pain, and my mental illness panelists and I want to do a series of private and public hangouts about mental health from a skeptical perspective. And throughout the conference, many of us were already busy thinking up ideas for the next one (in fact, there’s a lively conversation going on in the FtB backchannel about that already).

Some of the highlights for me, aside from my own panels, were listening to Shelley Segal perform a beautiful song called “My Morality,” listening to Kate (check out her brand-new FtB blog!) give a great solo talk about the DSM, giving the folks from the Pathfinders Project the chance to promote their amazing work, hearing Ashley and Kelley talk about representation in some of my favorite YA novels, and, of course, drinking with everyone at the end and dissolving into laughter every 10 seconds.

It’s hard to believe that I’ve only been a part of this community for about a year. I never could’ve guessed, a year ago, that this summer I’d be helping organize such an awesome event–and one with so much potential to be even better next time.

Here are the panels I organized, by the way. On Friday night we did Sex & Skepticism, which I’ve been hearing is many attendees’ favorite panel:

The last panel of the night was Supporting Freethinkers with Mental Illness:

And on Sunday afternoon, we did another one on mental illness: “What’s the Harm? Religion, Pseudoscience, and Mental Health”:

In conclusion, I had a fucking fantastic time. I want to thank the rest of the organizers–Jason, Ian, Stephanie, Brianne, Russell, Ed, and especially PZ, who basically put this whole thing together before we got off our asses to help. (We promise to do better next time, PZ.) I also want to thank everyone who submitted proposals for panels, including the ones we weren’t able to accommodate (sorry about that! There were only a few of us and very many of you). And I especially want to thank my panel participants–Kate, Brendan, Drama, Olivia, Ed, Greta, Benny, Sophie, Franklin, Ginny, Nicole, Courtney, Ania, Niki, and Allegra. It’s gotta take guts to go on streaming video in front of hundreds of people to talk about sex and mental illness, but you all did it and it was great.

And, of course, thanks to everyone who was so excited–everyone who shared the event on Facebook, everyone who kept the chatroom hopping with discussions, everyone who tweeted, everyone who told us that this is important and necessary.

If you attended, please fill out this survey to tell us how we did. The next FtBCon will be much better, and it may be sooner than you think…

What I’m Doing This Weekend! #ftbcon

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FtBCon is almost upon us! Here’s a handy guide to everything I’m doing this weekend, aside from ALL OF THE SOCIAL MEDIA. All times are CDT (UTC – 5). The rest of the schedule, with links to where all the sessions will be, can be found here.

I’m hosting three panels for others (not speaking, just setting up and relaying audience questions):

Promoting Social Justice in Small Atheist Groups: Friday 10pm to 10:50pm with Paul Wright, Daniel Midgley, Madge Carew-Hopkins (they’re all from Australia!)

A lot has been said about promoting social justice in large groups of atheists, like forums, blogs and conventions. It’s not always easy to keep out the trolls and harassers and to say what needs to be said, but it can be done. But what do you do in a small university atheist club, or a local skeptic meetup group? Paul Wright, Madge Carew-Hopkins and Daniel Midgley talk about atheist groups in Perth, Australia and how the arguments that rage in the wider community have parallels in local atheist groups.

Reproductive Rights: Saturday 2pm to 3pm (with Brianne Bilyeu, Greg Laden, Bree Pearsall, Fausta Luchini, Aoife O’Riordan, Robin Marty and Nicole Harris)

A panel of reproductive rights activists come together to discuss access to abortion in current events , clinic escorting and some common religious and non-religious arguments against abortion. Our panel consists of clinic escorts – including one panelist who volunteered before FACE laws went into effect (Freedom of Access to Clinic Entrances), health care professionals, an author and several bloggers who write about reproductive rights. Our panelists hail from Minnesota, Kentucky, Virginia and Ireland.

Meet the Pathfinders: Sunday 11am to 12pm (with Ben Blanchard, Conor Robinson, and Wendy Webber)

Three of the volunteers of the Pathfinders Project, a yearlong international service and research trip sponsored by Foundation Beyond Belief, will be discussing the project, themselves, why they are involved, and why humanist service is so important.

I’m also moderating three more:

Sex & Skepticism: Friday 6pm to 8pm (with Greta Christina, Ginny Brown, Franklin Veaux, Benny, and Sophie Hirschfeld)

Sexuality is an area of human experience where pseudoscience and woo frequently prevail. How can skepticism and atheism enhance sex? What are the harms of allowing quackery and unexamined biases into the bedroom? Our panelists have a wide range of experiences with sexuality and skepticism, and their views on these questions will be diverse and thought-provoking.

Supporting Freethinkers with Mental Illness: Friday 11pm to 12am (with Kate Donovan, Brendan Murphy, Olivia James, and Drama)

“Have you tried yoga?” “You just need to pray harder.” “You should try this herbal supplement.” People with mental illnesses get advice like this all the time. Although it’s not particularly helpful to anyone, with skeptics and atheists it’s especially misguided. What should we say to freethinkers dealing with mental illness? How do we support them in an evidence-based way? How can we use skepticism and critical thinking to reduce the stigma of mental illness? How can we improve access to treatment that actually works?

What’s the Harm? Religion, Pseudoscience, and Mental Health: Sunday 1pm to 2pm (with Ania Bula, Nicole Harris, Niki M., Allegra Selzer, Courtney Caldwell, and Rachel Maccabee)

Religious and pseudoscientific communities often claim to promote mental health, whether through treatment or social support. Our panelists will discuss their experiences with mental illness and how religion and pseudoscience have influenced them. They will talk about the religious and pseudoscientific treatments they have gone through and how friends and family from those communities have responded to their mental illness.

And I’m speaking in this one, moderated by Crommunist:

God is Love? Relationships in a Godless World: Saturday 4pm to 6pm (with Ania Bula, James Croft, Jamila Bey, Beth Presswood, and Anti-Intellect)

Despite the popular assertion, one does not need to believe in a god to have love in their lives; however, disbelief surely shapes the kinds of loving relationships atheists can have. What effect does lack of a god belief have on things like sexual desire, shame, and the types of relationships we feel comfortable with? A panel of people with different experiences and perspectives discusses some of the issues and takes your questions!

I hope to see lots of you online this weekend! Don’t forget that you can talk to other attendees in the Pharyngula chat room.

Small Things You Can Do To Improve Mental Health In Your Community

[Content note: suicide, mental illness]

A few weeks ago Northwestern lost yet another student to suicide. There’s been pressure building all year for improved mental health services on campus, and I think that pressure will soon culminate in real, helpful changes on campus.

At the same time, some have been saying that what we need is not better mental healthcare services, but changes in campus “culture,” such as a reduction in the stigma of accessing mental healthcare and an increase in our willingness to discuss mental health which each other.

I don’t think that these things are mutually exclusive; I think we need both. People whose troubles are relatively minor will benefit from increased openness about mental health on campus without needing any improvements in mental healthcare, but those who suffer from serious mental illnesses–the kind that can contribute to suicide–need more than just supportive friends and professors. They need treatment. Right now, it’s becoming clear that many of those people are not getting the help they need.

Echoing these debates, a blog run by Northwestern students called Sherman Ave posted a piece called “A Reflection on Death, Privilege, and The College Experience.” (Sherman Ave usually sticks to humor, but this time it poignantly diverged.) The author wrote:

In writing these words and thinking these thoughts, I do not believe that a “call to action” here ends in throwing more money toward psychological services. As much as I believe that funding of psychological services at this university should be increased, I would hesitate to claim that another few thousand dollars would have stopped Alyssa Weaver and potentially Dmitri Teplov from committing suicide. Rather, I encourage everyone reading this article to think carefully about the state of those without the privilege of stable mental health.  We should seek to sympathize with members of our community instead of ignoring them for the sake of convenience. If we have the tremendous power to come together in grievance of a lost classmate, then there’s absolutely no reason we shouldn’t be able to show the same love and solidarity for that classmate before they give up on our community.

And a commenter responded:

I agree with the need to come together to “show the same love and solidarity” to members of our community who need or want support and communication from others, but what does that practically mean? I find myself asking–how can I, as one person, contribute to a positive dialogue that moves our community towards supporting each other in the face of hardship? How do I even “identify” someone who needs my help? Or how do I make myself open to facilitating healing in my peers?

I don’t think there’s any easy answer to this. Practically speaking, changing a culture is like voting–it’s pretty rare that the actions of a single individual make an immediately noticeable difference. Westerners are used to thinking of themselves as individual agents, acting on their own and without any influence from or effect on their surrounding culture, and this is probably one of the many reasons it’s so difficult for people to even conceive of being able to make an actual impact when it comes to something like this.

You don’t have to be an activist, a therapist, or a researcher to make a difference when it comes to mental health. The following are small things almost anyone can do to help build a community where mental illness is taken seriously and where mental health is valued. Although I’m specifically thinking about college campuses here, this is applicable to anything you might call a “community”–an organization, a group of friends, a neighborhood.

1. When people ask you how you’re doing, tell them the truth.

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.

2. If you see a therapist or have in the past and are comfortable telling people, tell them.

One awesome thing many of my friends do is just casually drop in references to the fact that they see a therapist into conversation. This doesn’t have to be awkward or off-topic, but it does have to be intentional. They’ll say stuff like, “Sorry, I can’t hang out then; I have therapy” or they’ll mention something they learned or talked about in a therapy session where it’s relevant. The point of this is to normalize therapy and to treat it like any other doctor’s appointment or anything else you might do for your health, like going to the gym or buying healthy food. It also suggests to people that you are someone they can go to if they’re considering therapy and have questions about it, because you won’t stigmatize them.

3. Drop casual misuse of mental illness from your language.

Don’t say the weather is “bipolar.” Don’t refer to someone as “totally schizo.” Don’t claim to be “depressed” if you’re actually just feeling sad (unless, of course, you actually are depressed). Don’t call someone’s preference for neatness “so OCD.” These are serious illnesses and it hurts people who have them to see them referenced flippantly and incorrectly. One fourth of adults will have a mental illness at some point in their life, and you might not know if one of them is standing right next to you. Furthermore, the constant misuse of these terms makes it easier for people to dismiss those who (accurately) claim to have a mental illness. If all you know about “being totally ADHD” is when you have a bit of trouble doing the dense reading for your philosophy class, it becomes easier to dismiss someone who tells you that they actually have ADHD.

4. Know the warning signs of mental illness and suicidality, and know where to refer friends who need professional help.

You can find plenty of information about this online or in pamphlets at a local counseling center. If you’re a student, find out what mental health services your campus offers. If you’re not a student, find out about low-cost counseling in your area. If you have the time, see if you can attend a training on suicide prevention (and remember that asking someone if they’re okay or if they’ve been feeling suicidal will not make them not-okay or suicidal). Being aware and informed about mental health can make a huge difference in the life of a friend who needs help. This doesn’t mean you’re responsible for people who need help or that it’s your fault if you don’t succeed in helping them–not at all. It just gives you a toolbox that’ll help you respond if someone in your community is showing signs of mental illness.

Learning about mental illness is also extremely important because it helps you decolonize your mind from the stigma you’ve probably learned. Even those who really want to be supportive and helpful to people with mental illnesses have occasionally had fleeting thoughts of “Why can’t they just try harder” and “Maybe they’re just making this up for attention.” That’s stigma talking. Even if you didn’t learn this from your family, you learned it from the surrounding culture. Studying mental illness helps shut that voice up for good.

5. Understand how social structures–culture, laws, business, politics, the media, etc.–influence mental health.

If you learned what you know about mental  health through psychology classes, your understanding of it is probably very individualistic: poor mental health is caused by a malfunctioning brain, or at most by a difficult childhood or poor coping skills. However, the larger society we live in affects who has mental health problems, who gets treatment, what kind of treatment they get, and how they are treated by others. Learn about the barriers certain groups–the poor, people of color, etc.–face in getting treatment. Learn about how certain groups–women, queer people, etc.–have been mistreated by the mental healthcare system. Find out what laws are being passed concerning mental healthcare, both in your state and in the federal government. Learn how insurance companies influence what kind of treatment people are able to get (medication vs. talk therapy, for instance) and what sorts of problems you must typically have in order for insurance to cover your treatment (diagnosable DSM disorders, usually). Pay attention to how mental illness is portrayed in the media–which problems are considered legitimate, which are made fun of, which get no mention at all.

It’s tempting to view mental health as an individual trait, and mental illness as an individual problem. But in order to help build a community in which mental health matters, you have to learn to think about it structurally. That’s the only way to really understand why things are the way they are and how to make them change.

Self-Diagnosis and Its Discontents

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

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

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

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

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

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

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

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

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

1. It gets people into treatment.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[blogathon] Shit People Say To Future Therapists

Today’s my blogathon for the Secular Student Alliance! I’ll be posting every hour starting now until 6 PM central. Don’t forget to donate! To start, you get a rant!

Sometimes I wish I’d kept my career plans a big secret. Maybe if I had, I wouldn’t constantly be having conversations that go like this:

Me: “Wow, I just don’t understand this person.”

Them: “You don’t understand a person?! But you’re going to be a therapist! How can you be a therapist if you don’t understand people?!”

Me: “Sometimes I just don’t have the energy to listen to someone talking about their problems.”

Them: “But you’re going to be a therapist! How could you run out of energy to listen to people talking about their problems?”

Me: “Huh, I really don’t know what you should do in this situation.”

Them: “But you’re going to be a therapist! How could you not be able to give me advice?!”

I understand why people sometimes feel compelled to say these things. I think they stem largely from a misunderstanding of what therapists do and also from what therapists are like as people.

Firstly and most glaringly, these comments are amiss because, clearly, I am not yet a therapist. I have many years of training to go. So the fact that I have not yet developed certain skills that I will need is not, in and of itself, cause for alarm. Either I will develop them over the course of my training, or I will fail to develop them and I will realize that I need to pursue a different career (I have a few backups). But I doubt that that’s the case.

For now, I am trained in just a few specific things: active listening, conflict resolution, sexual health, referring callers to mental health resources, and a suicide prevention protocol known as QPR. That’s it.

I don’t think people realize that while there probably is a certain “type” (or more) of person who becomes a therapist, we’re not born being able to do these skills. We develop them through training and experience. Nobody would ever demand that an undergraduate in a premed track be able to diagnose them with diabetes or cancer. Why should I be able to fix someone else’s emotional troubles?

Second, I think people have this view of therapists as calm, self-assured, eternally tolerant saints who always understand everyone and never feel frustrated with anyone and never tire of listening to painful and difficult things. The reason people have this view is probably 1) this is how good therapists typically behave in therapy sessions, and 2) this is how therapists are typically portrayed in the media, even though there are many styles of therapy that don’t look like this at all. Some are even confrontational!

But that’s not really how it is. Therapists get bored. Therapists get annoyed. Therapists get frustrated. They get overwhelmed and exhausted from listening to people. If they are good at what they do, they don’t show this in therapy–like a good dancer doesn’t show the pain they feel, or a good salesperson keeps smiling and being enthusiastic. Sometimes people doing their jobs have to act in ways other than how they feel. This is normal.

But for therapists, it’s especially important to be mindful of these feelings in oneself rather than trying to tamp them down, because otherwise they can affect how the therapist treats their client. In traditional psychoanalysis, this is called “countertransference,” and while psychoanalysis is quite outdated, the term is still used by respected therapists like Irvin Yalom.

So, personally, if a therapist told me that they neeever get bored or frustrated or annoyed with their clients, that would be a red flag. Nobody that I’ve ever met is such a saint. I would probably conclude that this person is either trying to make themselves look good, or–worse–that they’re not very aware of the negative emotions they sometimes experience during their work.

Of course, I might be wrong. Maybe some people really are like that.

Another misconception is that therapists “just get” people or “just know” the solutions to their problems. This is also false. While therapists are probably more perceptive than the general population, that only really helps when it comes to understanding how a person is feeling, not why they feel that way or what might be the best way for them to change how they feel, as there’s no one-size-fits-all approach to this.

That understanding, if it ever happens, happens after a period of time during which the therapist has gotten to know their client, learned a lot about their background, and started to discern their patterns of thinking. That thing you see in the movies where a therapist “just knows” what’s wrong with you after ten minutes? Nope.

It’s also worth pointing out–as callous as it may seem–that once I become a therapist I will be doing this for money. I will expect to be paid for doing it. When I’m not at work, doing work for free will seem like…not the best use of my time. While I’m sure that I’ll always enjoy listening to my friends talk things out and try to help them feel better, being expected to do so just because I happen to be a therapist is unfair.

I will not be the same person with my friends and family as I am with my clients. This is normal and okay, and it’s the case for basically anyone who has a job that involves working with people. If you want to avoid needlessly annoying and frustrating your friends in the helping professions, try not to expect them to essentially work for free and to act saintly and perfect while doing it.

~~~

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Criticizing Psychiatry Without Throwing the Baby Out with the Bathwater

So, I read this article in The Atlantic called “The Real Problems with Psychiatry” and…I’m torn. The article is an interview with this guy Gary Greenberg, a therapist who has previously written a book called Manufacturing Depression: The Secret History of a Modern Disease and has now followed that up with The Book of Woe: The Making of the DSM-5 and the Unmaking of Psychiatry.

Now, to be clear, I haven’t read either of these books. I might, just to see the full depth of his arguments. But I decided to read the interview anyway and assume that he accurately represented his own claims in it.

Parts of the interview, I think, are really on point. Greenberg discusses the history of the DSM (the manual used to diagnose mental disorders) as a way for psychiatry as a discipline to establish credibility alongside other types of medicine. He criticizes the DSM on the grounds that the mental diagnoses that we currently have may not necessary be the best way to conceptualize mental illness, and he thinks that once we gain a better understanding of the brain we will find that they have little to do with the physical reality of mental illness:

Research on the brain is still in its infancy. Do you think we will ever know enough about the brain to prove that certain psychiatric diagnoses have a direct biological cause?

I’d be willing to bet everything that whenever it happens, whatever we find out about the brain and mental suffering is not going to map, at all, onto the DSM categories. Let’s say we can elucidate the entire structure of a given kind of mental suffering. We’re not going to be able to say, “here’s Major Depressive Disorder, and here’s what it looks like in the brain.” If there’s any success, it will involve a whole remapping of the terrain of mental disorders. And psychiatry may very likely take very small findings and trump them up into something they aren’t. But the most honest outcome would be to go back to the old days and just look at symptoms. They might get good at elucidating the circuitry of fear or anxiety or these kinds of things.

I don’t know if he’s right. But I suspect that he might be.

He also makes a great point about the fact that we often assume that anyone who acts against social norms, for instance by committing a terrible crime, must necessarily be mentally ill:

It’s our characteristic way of chalking up what we think is “evil” to what we think of as mental disease. Our gut reaction is always “that was really sick. Those guys in Boston — they were really sick.” But how do we know? Unless you decide in advance that anybody who does anything heinous is sick. This society is very wary of using the term “evil.” But I firmly believe there is such a thing as evil. It’s circular — thinking that anybody who commits suicide is depressed; anybody who goes into a school with a loaded gun and shoots people must have a mental illness.

Greenberg also discusses how mental diagnoses have historically been used to perpetuate injustice, such as the infamous “disorder” of “drapetomania,” which was thought to cause slaves to try to escape their masters, and the fact that homosexuality was once considered a mental illness (and other types of sexual/gender variance still are).

He also talks a lot about how the DSM and its categories are tied in with all sorts of things: scientific research and mental healthcare coverage, for instance:

To get an indication from the FDA, a drug company has to tie its drug to a DSM disorder. You can’t just develop a drug for anxiety. You have to develop the drug for Generalized Anxiety Disorder or Major Depressive Disorder. You can’t just ask for special services for a student who is awkward. You have to get special services for a student with autism. In court, mental illnesses come from the DSM. If you want insurance to pay for your therapy, you have to be diagnosed with a mental illness.

The point about needing a DSM diagnosis in order to receive insurance coverage is really important and cannot be overstated (in fact, I wish he’d given it more than a sentence, but again, he did write books). As someone who plans to eventually practice therapy without necessarily having to formerly diagnose all of my clients, this matters to me a lot, because it may mean that I might have to choose between diagnosing and working only with clients who can afford therapy without insurance coverage (which, at at least $100 per weekly session, would really not be many).

But sometimes Greenberg makes a good point while also making a terrible point:

One of the overlooked ways is that diagnoses can change people’s lives for the better. Asperger’s Syndrome is probably the most successful psychiatric disorder ever in this respect. It created a community. It gave people whose primary symptom was isolation a way to belong and provided resources to those who were diagnosed. It can also have bad effects. A depression diagnosis gives people an identity formed around having a disease that we know doesn’t exist, and how that can divert resources from where they might be needed.

First of all, we don’t “know” that depression “doesn’t exist.” We know–or, more accurately, some of us suspect–that the diagnosis we call “major depression” might not map on very accurately to what’s actually going on in the brains of people who are diagnosed with it. What we call “major depression” is a large cluster of possible symptoms, and since you only have to have some of them in order to be diagnosed, two people with the exact same diagnosis could have almost completely different symptomology. Further, because depression can vary like a spectrum in its severity, the cut-off point for what’s clinical depression and what’s not can be rather arbitrary. It’s not like with other types of illnesses, where either you have a tumor or you don’t, either you have a pathogen in your bloodstream or you don’t.

Second, Greenberg doesn’t seem to extend his analysis of the effects of the Asperger’s diagnosis onto other disorders. There is absolutely a community of people who have (had) depression, eating disorders, anxiety, and so on. Those communities are absolutely valuable. My life would be demonstrably worse without these communities. They haven’t “diverted resources” from anything other than me wallowing in self-pity because I feel like I’m the only person going through these things–which is how I used to feel.

Right after that:

What are the dangers of over-diagnosing a population? Are false positives worse than false negatives?

I believe that false positives, people who are diagnosed because there’s a diagnosis for them and they show up in a doctor’s office, is a much bigger problem. It changes people’s identities, it encourages the use of drugs whose side effects and long-term effects are unknown, and main effects are poorly understood.

Greenberg is correct that false positives are a problem and that diagnosing someone with a mental illness that they do not have can be very harmful. However, his dismissiveness of the problem of false negatives–people who do have mental illnesses but never get diagnosis or treatment–is stunning coming from someone who is a practicing therapist. Untreated mental illnesses are nothing to mess around with. They can lead to death, by suicide or (in the case of eating disorders) otherwise. Even if things never get to that point, they can ruin friendships, relationships, marriages, careers, lives. While I get that Greenberg has an agenda to push here, some acknowledgment of that fact would’ve been very much warranted.

In short, Greenberg seems to make the logical leap that many critics of psychiatry and the DSM do; that is, because there is much to criticize about them and because it’s unclear how valid the DSM diagnoses are, therefore depression is “a disease that we know doesn’t exist” and antidepressants are harmful (that’s a whole other topic, though).

Antidepressants may very well be harmful. Diagnostic labels may also very well be harmful, for some people. But I think the stronger evidence is that untreated mental suffering is harmful, and sometimes therapy just isn’t enough and cannot work quickly enough–for instance, for someone who is severely depressed to the point that they can’t possibly use any of the insights they may gain in therapy, or to the point that they are about to commit suicide.

I hope that one day we’ll have all the answers we need to minimize both false negatives and false positives. But for now, we don’t, and I worry that attitudes like Greenberg’s may prevent people from getting the help they urgently need, as much as they may simultaneously promote vital criticism and analysis of psychiatry and the DSM.

~~~

Note: I didn’t fact-check everything Greenberg said in the interview because I’m hoping that The Atlantic employs fact-checkers. But if you have counter-evidence for anything in that article, even parts I didn’t quote here, please let me know.

Lessons I Learned From Depression

[Content note: depression]

People struggling with mental illness (or any sort of illness, or anything crappy, really) are constantly exhorted by well-meaning people to find the “silver lining” in their experience. This often takes the form of tropes about “learning who your real friends are” or “learning how to fully appreciate life” or “understanding what’s really important in life” and on and on.

For a long time I resisted the entire notion of finding “lessons” or “learning opportunities” in my decade-long struggle with depression. (Yes, decade-long. Yes, I’m 22.) Part of this was because the people who demanded that I do so were just so damn annoying, frankly. No, I will not spin you a convenient story about What Depression Has Taught Me to make you feel better when you see my tears or my scars.

But mostly I resisted because I felt that admitting that I’ve learned things from this experience requires intentionally forgetting the fact that most of it had no meaning. There is no meaning to losing half of your life to something you can’t even see or prove to people or sometimes even describe in words. There is no meaning to having most of the memories of your life discolored, blurred, and tainted by a misery and terror that had no name. This is not the stuff of inspirational memoirs or films. While some people suffer for political causes or for their children or in order to produce a great work of art, I suffered for absolutely no reason at all.

But, of course, I did learn some things. Maybe I would’ve learned them even if I’d had a more normative emotional experience, but right now it really seems like I learned them as a result of being so miserable a lot of the time. And while I reserve a very special fury for those who implore us to create meaning out of meaningless suffering and produce “lessons” and “silver linings” and “bright sides” carefully repackaged for their consumption, I think these are lessons that are worthwhile to share.

I am not my GPA, weight, debt, scars.Lesson 1: Not everything your brain tells you is accurate.

Most people, I think, go through life without giving much thought to whether or not their perceptions are providing them with the most accurate possible picture of reality. But sometimes our brains are pretty crappy at this. Of course, I would’ve learned that without the help of depression, because I study psychology. So I’ve known for a while about stuff like the fundamental attribution error, the halo effect, anchoring, confirmation bias, the Dunning-Kruger effect, the false-consensus effect, the just-world hypothesis, in-group favoritism, the hot-hand fallacy, the Lake Wobegon effect, status quo bias, and all sorts of other biases, fallacies, and errors.

But what really brought it home was depression. While the cognitive errors I’ve listed are generally adaptive and keep people happier, depression was the opposite. Instead of telling me that people like me despite evidence to the contrary, my cognitive distortions told me that everyone hates me despite evidence to the contrary. Rather than telling me that I’m above-average in most things, they told me that I’m below-average in most things. On any given day I would invariably feel like the stupidest, ugliest, least likable, most worthless person alive. True story.

At some point it occurred to me that I would never recover if I didn’t learn how to treat what my brain said with a healthy amount of skepticism. So I started to. (Perhaps not coincidentally, this was the time in my life when my political views evolved the most, because I also started challenging my knee-jerk reactions to various issues in our society.) Of course, this is a lesson that is not limited to folks with mental illnesses, because everyone’s brain does this to them at some point. For many people, including some of those who proudly label themselves “skeptics,” thinking critically about what happens inside one’s brain does not come nearly as easily as thinking critically about what happens out there in the world.

So, for me, this meant a lot of time spent repeating to myself, “Yes, I feel like Best Friend hates my guts, but that’s just a feeling and it’s not necessarily true” and “Yes, not getting that internship makes me feel like I’m a complete failure who will never amount to anything in her chosen field, but that’s just my brain lying to me again” and “Yes, Partner wants to see their friends rather than me tonight, but this doesn’t mean that Partner doesn’t care about me and doesn’t want to keep seeing me anymore.”

Pause, rewind, repeat, and there you have my recovery.

Lesson 2: Your feelings are valid.

Does this seem like a contradiction to the previous lesson? It’s not. Unfortunately, when confronted with the apparently irrational emotions of others, many people immediately jump to the conclusion that those emotions are WRONG. (These people should never try to be therapists.)

However, just because someone’s emotions do not seem like a “rational” response to what they’re going through, that doesn’t mean there’s no reason for them. That reason can be whichever complicated and still-misunderstood brain processes cause depression. It can be that those are the emotions they saw expressed in their families growing up, and learned to mimic at an early age. It can be that last time this sort of thing happened, it ended terribly and now they’re freaking out over this seemingly minor thing because it could end that badly again. It can be that what’s currently happening to them is reminding them of something else entirely.

Or it could be for any number of other reasons that you do not know, and that the person having the “irrational” feelings might not know either. So why assume?

It’s important to remember, too, that there tends to be a pattern to the emotions we decide are “irrational” and “inappropriate” in others. Anger from a woman or a person of color is perceived differently than anger from a white man. Sadness from a woman is perceived differently than sadness from a man. Archetypes like the Angry Black Man and the Hysterical Woman are sometimes so deeply ingrained that we don’t even notice ourselves applying them.

But all emotions are valid. Some are less adaptive than others, some we want to change, some can contribute to unacceptable behavior if we don’t address them, yes. But they’re all valid, and telling others (or ourselves) that some emotions are not okay to have doesn’t help in changing them.

Lesson 3: Sometimes you have to keep your mental health in mind when making decisions.

This is the one I’ve resisted the most. I had to quit studying journalism because it was giving me panic attacks, and I chose not to pursue a PhD in part because I didn’t think I could handle it emotionally (well, and because the thought of it just bored me). When it comes to my personal life, my mental health is a big part of the reason I gave up monogamy, although I’m now glad I did for many other reasons. It’s also part of the reason I never studied abroad, gave up many other opportunities, and chose to move to NYC.

When I first started to realize that mental health is a factor that I need to consider when making decisions about my academic, professional, and personal life, I felt abandoned and betrayed by my own brain. I understood intuitively that sometimes you can’t do things because they require physical traits or abilities that you lack or because you don’t have the cognitive skills or because you just lack access to those opportunities. But to have all those things and still give something up just because my brain doesn’t like it? That seemed ridiculous.

In fact, that way of thinking is just an extension of the stigma of mental illness. Just as we think that mental illness isn’t really “real,” we think that mental health isn’t really important. It’s reasonable, we think, to choose not to live in Florida because you can’t deal with the weather or to choose not to go running because it’s too hard on your knees or to choose not to be a physicist because you can’t do math worth a shit, but not getting a PhD because grad school would make your depression relapse? Not being a journalist because interviewing people gives you panic attacks? Not studying abroad because being away from people you love makes you suicidal? What the hell is up with that. Just deal with it.

So for a long time I did stuff that made me miserable because I was fighting so hard against the notion that mental health is something you need to take care of and cultivate, just as you would with your physical health. But one of the most important things I’ve learned how to do in college is knowing when to say “no” to things that sound fantastic but might break down the levees I’ve built up to keep the depression from flooding in.

Of course, sometimes it still makes me furious. I recently gave up a great opportunity for that reason; I badly wanted to do it but every time I thought about actually doing it, and the sacrifices it would entail, I broke down, sobbing, paralyzed, unable to say yes or no to it. Eventually I finally turned it down, full of resentment at myself and my useless brain, but trying to understand that my reason was a good one and that I deserve permission to make this choice.

Now, naturally, there are those who would tell me to Just Do It! and Get Out Of Your Comfort Zone! and blabbityblahblah, but those people will just have to trust me when I say that I know the potential dangers much better than they do. Mental illness is a whole ‘nother ballgame. When I want to Get Out Of My Comfort Zone! I try getting to know someone new or reading something I disagree with that makes me a bit uncomfortable. When I move to NYC, I can Get Out Of My Comfort Zone! by joining new groups or going to events where I don’t know people and seeing what happens.

That’s getting out of my comfort zone. Ignoring the fact that I have important needs when it comes to my mental health, though, is not “brave” or “spontaneous” or “gutsy.” It’s just irresponsible, just as it would be irresponsible go ride a motorcycle without a helmet or to not wash my hands during flu season.

So give yourself permission to treat your mental health with the care and concern it deserves. Of course, you might be aware that doing something could make your mental health worse and choose to do it anyway for any number of reasons, and that’s completely fine, too.

But so many of us struggle merely to accept the idea that it’s okay not to do things for the sole reason that they might worsen our mental health, and that’s something we have to overcome.

It's okay not to be okay.

Does Telling People to “Think Positive” Actually Help? An Informal Survey and Some Protips

Positive thinking is the bane of my existence. Not because I can’t do it, but because I’ve so often been exhorted to do it in the most unhelpful of ways. I’m someone who prefers to talk mostly about the neutral or negative aspects of my life to friends and family because I don’t want to seem like I’m bragging, which probably leads people to assume that I have difficulty “thinking positively” (and I wouldn’t blame them). Of course, during periods of depression, positive thinking is mostly impossible, but when I’m feeling relatively healthy I’m actually quite optimistic.

Point is, I’ve gotten a lot of unsolicited advice to “think positive!” and “look on the bright side!” and “just try to find the silver lining!” Chances are, I’ve either done that already, or I’m not going to be able to do it no matter how many times one tells me to.

So despite the fact that I’m actually quite adept at finding reasons to be hopeful and getting good things even out of bad situations, being told to do so, even though it’s almost always well-meaning, usually rubs me the wrong way. Like, what, you don’t think that “thinking positively” occurred to me? And for that matter, when you tell people to “think positively,” does anyone ever go, “Oh wow, I didn’t even realize I could do that! Thanks so much!”?

And yet thinking positively helps me, and it must help many other people or else people would quit telling each other to do it. I wanted to find out more about the contexts in which people find it helpful to be reminded to “think positive” versus the ones in which they don’t, so I did an extremely informal survey of my online friends and followers. I basically asked (I’m paraphrasing here), “Does it ever help you to be told to ‘think positive’?”

Disclaimer: This is not “research,” this is just me asking people I know about their opinions. Maybe if I’d gone for that PhD after all, you’d be reading about this in Science someday, but that’s not going to happen.

Some people said that it doesn’t help at all:

Nope. I find it helpful when people genuinely ask thoughtful questions and then actively listen. Pat answers are a brush off, nothing more.

No. Usually it just makes me feel like I have to shut up now because the person is done listening.

I think just saying “think positive” is a limiting concept since it doesn’t teach anyone how to change negative self talk to positive.

“Think positive” as a general suggestion can actually be harmful – it doesn’t enable its recipient to solve a problem any more than they were before, and can easily lead to an affected individual thinking they’re at fault for being unable to fix something simply by failing to think positively.

“Just think positive” almost always comes couched with The Secret or other metaphysics bullshit in my life. Sooooo I cringe whenever I hear it.

I also don’t think it helps, but for me it’s because it feels like an invalidating thing to say. I’d rather my feelings be acknowledged for their authenticity than be dismissed for not being all sunshine and rainbows like they “should” be.

Telling myself to think positively also occasionally helps, but not always. Other people telling me that does not generally help, particularly since if someone is telling me “just think positive” it’s usually in the context of, I’ve told them some specific problem I’m worrying about and they’ve given me “think positive” as a non-answer.

not when by someone who lacks knowledge of my life and circumstances. Not when I’m clinically depressed, at all.

I’ve never found it helpful, and now I understand that the reason I’ve always found it so upsetting is that the statement comes from a place of neurotypical privilege. My visceral response is almost always “Don’t you think I’ve TRIED THAT ALREADY. Seriously, if it were that simple I would FEEL BETTER.”

I think the logic behind “think positive” and “look on the bright side” are, er, “positive” alternatives to “you like being sad.” They all stem from this idea that is it the person’s own doing, that it is something the individual can control but isn’t trying hard enough, etc. But real depression and anxiety are caused by something beyond the individual’s ability to control.

There aren’t enough characters here for all the four-letter words.

A few said it does:

Certainly. I usually have negative expectations, and have to be reminded to consider positive outcomes. Otherwise, I’d never try anything.

In a really weird way it can me. Like it pisses me off, but it’s a good reminder at the same time.

The majority, however, gave an answer that was basically either “Yes, but” or “No, unless.” And these people generally hit on the same basic point:

It has, if people point out *actual* positive things about the situation.

Yes, but not if they are being dismissive. If they are like, “what about x, and y” then yes. But dismissive, NO.

It can sometimes be helpful to be reminded OF something good, but it doesn’t really help just to be told “look on the bright side.”

It depends entirely on who’s saying it to me. Like if my bestie tells me to chin up it’s entirely different then some random ass fuck

Not as a general statement, no. What has occasionally helped is if someone breaks down a situation and specifically outlines possible positive outcomes – but you can’t just think your way to them.

Although I have found it helpful to try to find the positive aspect in a bad situation, and if I find one I will point it out (especially if the “bright side” is actually black humor), telling people to just generally look on the bright side of life is horse hockey.

Only if they’ve got evidence that says I should. Saying that emptily just sounds like “smile, emo kid!” #ThingsThatDrainMyPacifism

Sometimes, especially if it’s offered along with an example of a silver lining I may have overlooked.

These aren’t nearly all of the responses, but looking through these and the others I got, I hit upon a few major themes that may help you discern whether or not telling someone to “think positive” is worthwhile:

1. Mental Illness

One of the worst things about disorders like depression and anxiety is that they rob you of your ability to be hopeful and think positively. It’s not that you’re not trying, it’s that you can’tSo, when someone’s dealing with sadness, stress, pessimism, etc. that’s brought on by a mental illness as opposed to just “faulty” thinking, telling them to “fix” their thinking isn’t going to be helpful.

2. Proof

Many people said that being advised to think positively helps when they’re actually given “proof” that there’s something to think positively about. Otherwise it just sounds like an empty platitude; if the person who’s telling you to “think positive” can’t even come up with a reason why, that’s not reassuring.

3. Closeness

It feels different to be told to “think positive” by someone who actually knows you very well than, as one person said, by “some random ass fuck.” Although nobody elaborated on why, I can think of several reasons. It’s easier to trust that someone who knows you well generally wants to help you rather than to just get you to stop talking about sad stuff. Someone who knows you well is also more likely to know what helps you. They’re also more likely to actually understand your situation, making advice to “think positive” sound much less flippant than it would otherwise.

In general, telling people to “just think positive” has the same problems as, for instance, telling people to just stop being hurt by bigoted comments or to just learn to keep saying no to persistent unwanted sexual advances: it doesn’t actually help them to do these things. Changing the way you think and feel isn’t like flipping a switch. It requires hard work and practice, just like learning a language or a musical instrument.

Generally that’s a job for a therapist or perhaps a really good self-help book, but if you’d like to help facilitate that process for someone, here are some scripts to help them learn to think more positively without doing the annoying and dismissive “Just look on the bright side!” thing:

  • “That sounds like a tough situation to be in. Is there anything you could do that would make it easier right now?”
  • “Do you think anything good can come of this?”
  • “I’m sorry, that really sucks, but just know that I/your friends/your family will be here to support you.”
  • “Would it help if we went out and did something fun to help you get your mind off of it?”
  • “I know it seems pretty awful right now, but I think you will come out a stronger person because of this.”

Note that these don’t work for everyone and are very dependent on the situation, so use your best judgment. But these are all things that have really helped me to hear at one point or another. And notice that a lot of them involve asking, not telling. Don’t tell people to think positively or do something to get their mind off of it; ask them if they’re able or willing to.

And as with all things emotional, affirming whatever the person is feeling right now is the most important thing. Even if it’s negative! Their emotions are valid even if you don’t understand them or think that they’re productive.