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.

~~~

Liked this post? Please consider donating so I can speak at conferences.

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. 

~~~

Liked this post? Please consider donating so I can speak at conferences.

Your Uninformed and Incorrect Opinions About Psychology

[Content note: PTSD, online harassment & bullying]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Stop that.

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

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

~~~

Liked this post? Please consider donating so I can speak at conferences.

Against Role Models

Whenever a famous person does something of which the general public disapproves, much is often made of that person’s status as a “role model” and how it influences the public’s judgment of their behavior, and whether or not it is time to revoke that status.

It seems that celebrities cannot escape being seen as “role models” no matter what made them famous. We expect an athlete or a singer or an actor to be good at not just sports or singing or acting, but at upstanding, ethical behavior, too. The assumption is that children should look up to these figures not just because they represent talent and achievement that (supposedly) comes from lots of hard work and sacrifice, but because their behavior in the rest of their lives is something to emulate, too.

This makes sense to an extent. We know that children learn by modeling the behavior of adults, and we want them to have adults whose behavior they can model. While a parent is normally the one expected to serve that function, most parents hope for their children to achieve more than they (the parents) have been able to in their own lives. Choosing and fixating upon a random successful but unknown doctor or lawyer or scientist or writer seems odd, but famous people already serve the role of entertaining the public simply by existing. So, perhaps some parents hope that celebrities can be good role models for their children and inspire them to both professional and personal success.

In fact, there is absolutely no reason why someone’s success at sports or music should be taken to mean that that person’s treatment of others is just as admirable. There’s no reason why being a great actor means you keep your promises to your partners and respect the law. There’s no reason why being in a famous band means you are very careful about your health and avoid dangerous drugs. Expecting celebrities to be able to model these types of “good behavior” makes no sense.

And even when we try to see someone as a role model in a specific domain only, it never seems to quite work. We fall victim to black-and-white thinking–people are either “good” or “bad,” and if a talented, successful athlete cheats on his wife, he goes from “good” to “bad” very quickly. Even though many people cheat, and even though occasional bad behavior doesn’t necessarily mean someone is a “bad person.”

The expectation of being a role model places undue pressures on celebrities, especially women. Tracy Moore writes:

Critiquing famous (or any) women’s behavior in terms of whether what they do is good for the girls or not is a sticky trap. It prevents them from being complicated, actual people working themselves out — you know, individuals? The thing we want women to be seen as? It keeps us in an endless loop of chasing after this One Correct Way for Women to Conduct Themselves. It’s exhausting, and I refuse to buy into it, and I don’t want to help christen it.

I also think it insults girls, who are more individual, and already far more developed as people than we give them credit for by treating them like blank slates who will copy and absorb every thing they ever see on command. That may be true for fashion, and I’m not disputing that teens copy famous people’s behavior too (and yes I’m staring down a princess phase with a toddler), but that doesn’t mean they instantly absorb the values and ideology of everyone they admire.

What I want is for women to be seen as human, which means, flawed, misguided, shitty, awesome, talented, cool, all of the above. In order to be treated like equal people, we have to have the latitude to have the same range of profound greatness and disturbing awfulness as men. We have to be ordinary, boring, fascinating, idiotic and brilliant.

Moore notes that female celebrities seem to bear a greater burden for Making Sure Our Children Turn Out Okay than male ones do, and male celebrities do seem to have an easier time recovering from Scandals with their popularity mostly intact (see: Bill Clinton, Charlie Sheen, Chris Brown, R. Kelly).

And what about non-celebrities? What happens when they’re expected to be role models?

I don’t know how this plays out in other professions or contexts, but within social work and mental healthcare, there is an immense amount of pressure put on professionals to be role models. We’ve talked about this in my social work classes.

People look to social workers and mental health professionals for more than just “help me fix my brain bugs.” They also look to them as examples of how to live well, and they often expect them to be wearing the same professional “face” even if they encounter them randomly outside of the office.

Our professors ask us what we would do if we encountered a client, say, at a bar or on public transit or even at a party. How would we manage their expectations of us with our desire to behave as we usually would at a bar or on the subway or at a party? Would it harm our relationships with our clients if they saw us acting like, well, normal people?

It’s true that if our clients think that we’re always the way we are in a session–calm, empathic, curious, mature, “wise”–it might disturb them to see us drinking at a bar or kissing a significant other in public or dancing at a party. They might wonder if we’re “faking” when we’re in a session with them. They might wonder who we “really” are.

For some professionals, this seems to be enough of a reason to significantly alter their behavior if they see a client out in public, or leave a bar or party where a client happens to be. They might even consider whether or not doing things like going to bars and parties after hours is even compatible with who they are as professionals.

When we discussed this in class, I was glad that most of my classmates reacted with minor indignation. Why should we be expected to be professional 24/7? Why does everyone else get to take off their work persona when they leave the office, but we don’t? Why is it our fault if our clients judge us as immature or irresponsible just because we go to bars on the weekends?

I think there are two reasons why expecting therapists to act like therapists 24/7 is harmful. One is that, on the individual level, it’s stressful and takes a toll on one’s mental health and freedom to live life the way they want to. Deciding to be a therapist should not be a life sentence to never behave like a normal person outside of work again. That’s too much of a burden for someone whose work is already very stressful and difficult.

Second, part of our role as mental health professionals is encouraging clients to think rationally, accurately, and adaptively about other people and their relationships with them. “This person is drinking at a bar therefore they are immature and I can’t trust them as my therapist” is not a rational, accurate, or adaptive thought. (Well, it could be accurate, but you’d need more evidence to come to that conclusion.) Neither is, “This person is behaving differently after hours than they are at work, and therefore the way they behave at work is totally fake and they’re just lying to me.”

But speaking as someone who’s been on both sides of that relationship, I have to say that we are really, really patronizing our clients if we think that they are incapable of realizing that we have selves outside of the office. We are treating them like children if we presume that they need to be carefully prevented from seeing any part of our non-therapist persona, including kissing a partner in public or getting tipsy at a bar.

But it’s possible that some clients might be confused or bothered by seeing a therapist acting non-therapisty out in public. I think that the best course of action then is to discuss that in therapy, not laboriously alter one’s public behavior so that such an issue never comes up to begin with.

Because our classes are mostly discussion-based and there’s little in the social work code of ethics about situations like this (dual relationships, though, are a different matter), my professor never gave a definitive answer on whether or not we should endeavor to be role models to our clients no matter where we encounter them. His intent, I think, was mostly to spark discussion and let us know that this is something to consider.

The examples of celebrities and mental health professionals are two very different examples, but my conclusion is largely the same for each: being expected to be a “role model” in every context, at work and outside of it, in one’s chosen domain (be it sports or entertaining or counseling) and in every other domain in which it’s possible to judge a person’s behavior, is too much.

A final reason holding people up as “role models” is harmful: the criteria by which we judge them are largely based on social norms, which can be a very poor barometer for determining how ethical an action is. That’s why, when Miley Cyrus was vilified for her performance at the VMAs and reprimanded by many commentators for not being a good enough “role model,” the focus of most of the criticism was not the racism inherent in her performance, but the fact that she dressed revealingly and shook her ass. And she shook it…at a married man! How dare she. The married man, by the way, made a clear show of enjoying it, and he’s the one who’s married. And the one who sings a song about “blurred lines.”

It’s also why, when Kristen Stewart cheated on Robert Pattinson (to whom she was not married) with Rupert Sanders (who is married), it was Stewart on whom the majority of the public opprobrium fell, and who was finally compelled to publicly apologize. (A hopefully unnecessary disclaimer: I think breaking a promise to a partner is wrong, but I also wish people didn’t make promises they couldn’t keep in the first place, and I don’t think cheating is the worst thing a person could do and I don’t think a person who cheats owes an apology to anyone but the person they cheated on.)

And women of color in particular are held to impossibly high standards as “role models,” as public reactions to Beyonce and Rihanna attest.

Sometimes the intersections between the expectation of role model behavior and various types of prejudice affect people’s livelihoods in really crappy ways. To return to the example of therapists, I’ve been reading this blog by a woman who is studying to be a therapist and also works as a stripper. The faculty of her program are pressuring her to either quit sex work or leave the program, because doing both is necessarily an ethical violation. They also told her that being a stripper “contributes to further injustice in the world,”  and is therefore incompatible with her other role as a therapist.

That’s a slightly different type of role model that she’s being expected to perform, but that demand that therapists be perfect in every aspect of their lives is still there. The role of therapist is supposed to take precedence over everything else she may want to do in her life, including making enough money to get by and finish her education. And in this case, these expectations are intersecting with stigma and prejudice against sex workers.

So, whether you’re a celebrity or just a regular person trying to make the world better, it’s rarely a neutral expectation that one be a “role model.” Like all social expectations do, it comes along with lots of baggage. And it’s incredible how often, for women, being a “role model” means having no sexuality.

Children may need adults to look up to and clients may need therapists to learn from, but that’s not a good enough reason, in my opinion, to expect or demand perfection from people.

I think a more realistic view is that almost everyone can teach us something, and almost everyone has done things we probably shouldn’t emulate*.

~~~

*And to be clear, wearing revealing clothing and/or being a sex worker are not the sorts of things I’m particularly desperate to discourage.

In Defense of Conferences #sk6

This morning as I was sitting in my horrifically delayed plane to Missouri for Skepticon, I had this exchange on Twitter.

I don’t mean to pick on Ali at all; he stated his argument well (even though I think I’m right and he’s wrong!) and was really great about listening to my take on it and walking back his statements once he realized where he’d been missing information. (Thanks for being such a great argument buddy, Ali!) However, Twitter being what it is, I don’t think I was really able to adequately explain my view on this and why conferences are so important to me. So I’m going to do it here, not as a jab at Ali or anyone else specific, but just as a response to a claim I encounter fairly frequently.

I guess I take this a bit personally because of the nature of my involvement in social justice, progressivism, and activism (it’s literally going to be my entire career, as well as what I do during a significant portion of my free time) as well as my own history in this community (going to these conferences and meeting these people is probably the reason I don’t have clinical depression anymore). It also stung to read these comments as I was en route to a con where I’d be giving a workshop that’s aimed at preventing sexual harassment and assault. Like, you’re going to claim I’m not doing anything worthwhile? Really?

But I know everyone isn’t me, so I tried to set that aside and examine the claims more objectively (not that objectivity is ever actually achievable). I still don’t think they have much merit.

First of all, basically every professional field and every hobby or interest has conferences. I’ve never heard of one that doesn’t. Researchers have conferences to share their research, tech developers have conferences to show off new products, mental health professionals and educators have conferences to discuss best practices and learn from each others’ experiences, and so on. Writers both amateur and professional have conferences to learn new skills, hear other writers’ work, and network with agents and publishers. When I was a sexual health peer educator in college, we even went to conferences just for health peer education to present our workshops to other peer educators who might provide valuable feedback and adopt some of our methods for themselves.

Nobody, I hope, would argue that a therapist is engaging in a “circlejerk” by spending a weekend sharing their experiences with other therapists as opposed to treating clients. Or that a research scientist is engaging in a “circlejerk” by spending a weekend listening to presentations on other people’s research rather than working on their own project in the lab. Or that a writer is engaging in a “circlejerk” by spending a weekend networking with potential publishers rather than being holed up in the coffee shop with their manuscript.

But activists, for some reason, are expected to always, always be “on.” If we’re not out there protesting or fundraising or educating or arguing or volunteering or otherwise Creating Change, we’re “circlejerking.”

Does this seem convoluted to you? It does to me.

People who criticize conferences on these grounds seem to be making a very similar strawman as people who criticize so-called “slacktivism” (in fact, I’m sure there is significant overlap between those two groups). Does anyone actually believe that changing their profile picture on Facebook is an act of Serious World-Changing Activism? I doubt it. Does anyone actually believe that attending Skepticon or a similar conference is an act of Serious World-Changing Activism? I doubt that too.

From what I gather, people who attend secular/skeptical/otherwise progressive conferences do so for a number of reasons:

  • To learn new things
  • To make new friends
  • To see old friends
  • To network and find new opportunities for jobs or volunteering or other activisty things
  • To feel a sense of belonging and acceptance
  • To feel a sense of hope
  • To have fun

I believe that all of these goals are important. I think they can be as important as Changing The World. And while people might not go to conferences with the explicit goal of Changing The World while they are there, the things they learn and experience at conferences might help them to eventually do so.

And I have to say, Changing The World is very hard when you feel alone, unsupported, and unaware of what else is out there.

Personally, I can speak to most of the reasons on that list. I learn new things at conferences all the time. One of the talks that stuck most with me from last year’s Skepticon, for instance, was Jennifer Oulette’s talk on drugs, their potential health benefits, and the difficulties of researching them since they’re illegal. That was an issue I’d never really thought about! Now I feel much more prepared to seek out even more (scientifically accurate) information on that subject, advocate for more sensible drug policy, and correct misconceptions that people may have about drugs. I might never have run across this information otherwise, because it’s not my field and I can’t read every damn article on the internet.

Sometimes I learn things that are less immediately practical, but still extremely important. Another talk at last year’s Skepticon was Greta Christina’s on grief, secularism, and her own personal experiences with that intersection. I have not experienced a loss like Greta’s before. I do wonder what will happen when I inevitably experience such a loss, and how I will process it without faith. As a future mental health professional considering working with people who are leaving religion (or have recently left religion), helping people deal with grief without faith is extremely important to me. Her evocative talk was valuable both on a personal level (I care about Greta and want to know about her life) and on a professional level (I want to learn how people process grief and how I might be able to help them).

I could go on and on. This Skepticon is my 8th secular conference, and so many brilliant talk and speakers stand out to me from the past year and a half of my involvement in this community. I’ve learned so much. Reading articles on the internet just isn’t the same.

I think people–especially people who consider cons to be “circlejerks”–diminish or misunderstand the significance of learning at cons. Yes, we drink. Yes, we play Cards Against Humanity. Yes, we dress up in costumes or fancy clothes or whatever. Yes, we shoot the shit with friends. Yes, we hook up until ridiculous hours of the night/morning. But you’ll notice that the talks at conferences? They have audience members. Many of those audience members are so invested and interested in what’s being discussed that they laboriously live-tweet/-blog everything so that others can learn too. After the con, people write about their impressions of various talks and what they learned, or they repost videos of talks or even transcribe them so that they’re more accessible.

I don’t think I need to provide any more evidence that people learn at conferences and they value that learning.

But moving on to the less practical stuff. For instance, my incredible friends and colleagues, whom I’ve either met directly at conferences or through the people I’ve met at conferences, or whom I’ve really gotten to know at conferences. These people are 200% there all the time. The people I’ve met at conferences advocated for me when Facebook wouldn’t take my stupid death threat page down. They’ve gotten me speaking gigs and other opportunities. They help me with my writing, which is significant since I had very few writer friends until I got involved in all this. They post “<3″ or “*hug*” on my Facebook statuses when I’m struggling with depression or anxiety. They give me things to think about and they teach me every day. They are my lovers and partners. They are the people I’d call if I got mugged or lost a loved one or got a job or got an offer to have a book published. They are my chosen family.

It’s a common practice, especially among self-identified skeptics, to discount the importance of community, acceptance, belongingness, and mutual respect–all that touchy-feely shit many of us would rather ignore or pretend we don’t need. But we do.

Virtually everyone needs these things. But activists especially need them. Activism can be very alienating. Our efforts fail. People belittle or even threaten us. Apathy is pervasive. Nothing seems to change. Burnout is always on the horizon.

But then you show up in a huge building full of people who care about the things you care about*. Who want you to feel like you’re having an impact. Who want you to keep doing what you’re doing. Who come up to you just to tell you that your writing changed their life. Who will laugh at the trolls with you and shake with fury at the people who threaten you with death and cheer for you when you’re speaking and signal-boost for you when you’ve done something cool or you’re in a tight spot and need help. Who don’t make you explain over and over why we still need feminism or what’s so wrong with school prayer. Who don’t say “nerd” like it’s a bad thing.

This is what they call a “circlejerk.”

And if that’s a circlejerk, then pass me the lube.

~~~

*I am quite aware that cons do also have shitty people at them, but the point is that the ratio of awesome-to-shitty people is much better at these cons than in the world at large.

Miri’s Survival Guide to Moving Across the Country Alone in a State of Terror and Panic

I have known I was going to write this post ever since I first stood in my stifling Chicago apartment looking at a bunch of empty boxes and thinking, “Wow, moving is going to be difficult! I’d better take good care of myself and give myself time to be a little sad and process things.”

Juuuust kidding. What I actually thought was, “Fuck me I hate this why am I doing this why am I such an idiot this is what I’ve always wanted fuck these boxes I don’t want to put my shit in these boxes I’m going to get Chipotle now.” And so I did.

Unfortunately, when it comes to emotional self-care, I’m a do-as-I-say-not-as-I-do kinda gal. I’m working on it. But, to paraphrase a John Green character slightly, if you don’t say the honest thing, it never becomes true. I’m writing this as much for myself as I’m writing it for you–I’m giving myself permission to need the advice that this post provides.

I was and remain incredibly lucky. I moved not out of necessity, but out of passion. I had a loving family with the resources to help me move, and even more family who welcomed me when I got here. I moved to my favorite place ever. It continues to amaze me every day. Not everyone is so lucky when they move, but given how difficult a time I still had with it, I figured maybe someone might benefit from this advice.

To be clear, this is not a post about the logistical/practical side of moving. It’s a post about the emotional side of moving. I’m the last person who should be talking about the former, but maybe only the second- or third-to-last who should be talking about the latter. So latter it is.

Care for yourself.

I don’t just mean in the typical self-care ice cream/chocolate/funny movies/bubble baths way, although that can also help. (Good luck getting a New York bathtub to cooperate with that, though.)

What I mean is to be kind and gentle with yourself, just like you’re (hopefully) being with the fragile things you’re packing up.

Sometimes before and during and after the move, I had to talk to myself sort of like a child. “Okay, we’re going to get in the minivan and drive for a very long time. No, we’re not coming back. We’re going to a new place.” “I know this apartment feels weird and scary right now, but this is where you live now. I promise you’ll start to like it when you get used to it.” Sometimes that was the only way I could handle thinking about the immensity of the changes that were happening. Sometimes you need to let yourself be a little kid again.

But other times I was very bad at this. I berated and blamed myself endlessly, guilt-tripped myself for not being more grateful for the opportunity, played the sort of endless games of “But you TOLD me you wanted to move” and “Didn’t you SAY this was where you wanted to live” that I absolutely despise other people playing with me, and would never try to play with someone else.

Finally I had to ask myself how I would treat a friend who was moving to a place they loved but was having a lot of trouble coping nonetheless. What if it were one of my partners? What if it were Kate? What would I say to them?

I felt so ashamed when I realized that I was speaking to myself as though I resent myself. I realized that even if a random person from my friends list whom I barely know messaged me and shared concerns like the ones I had, I would still be infinitely kinder and more patient with this person to whom I have no connection and owe nothing than I was being to myself. There was no good reason for this.

Be as kind to yourself as you would to anyone you love and value.

The internet is probably your friend.

If you’re reading this, you probably use the internet at least a fair amount. Congratulations!

During this transition, just like all the previous difficult times of my life, the internet kept me sane. Not only did it help with all the logistical stuff, but it gave me something to “come home” to when home didn’t feel like home. (I mean, home still doesn’t really feel like home.) There were definitely days when I came home, threw my stuff down, closed the door to my room, went online, and talked to my friends. And the amazing thing was, the internet is the same internet no matter where you are. The same people I talked to when I was in Chicago were still there. I watched Grey’s Anatomy on Hulu in Chicago and I watched it here in New York. I read the same blogs. I listened to Citizen Radio. Finally, something in my life was stable!

It’s important not to go overboard with this, but use it if/when you need to.

But remember to go out and try to put down roots.

I am, again, incredibly privileged to live in New York. As soon as I got here I started seeing the friends and family I already had here, and quickly made a bunch of new friends. I went to lectures and films, I tentatively ventured to some Meetups (although there are still tons of interesting ones I haven’t gotten to), I went to parties I got invited to, I saw friends in neighboring cities that were once a plane flight away but now just a $30 roundtrip ticket and a 2-/3-hour bus or train ride away.

And, as always, I went out alone to explore the city. Wandering around as an inhabitant of the weird space between tourist and New Yorker is fun.

But even when you’re not sure you really want to, try to get yourself to do social things at least sometimes. In my experience, the most amazing friends/partners will appear in your life in a way that seems random, but really isn’t. Maybe you go to a party that’s totally boring except one of the people you talk to there mentions offhand a cool-sounding Meetup group and you look it up and go to it and meet a cool person who doesn’t become a super close friend but who does eventually invite you to a poetry reading where you meet someone awesome who becomes one of the people you cherish the most.

This process can be extremely frustrating. But, given enough chances, it will work.

BUT try not to fall victim to FOMO.

I got FOMO bad. Real bad. I have, in the short time I’ve been living here, somehow managed to convince myself that if I don’t do every single thing to which I am invited and/or hear about then 1) I am a Failure and 2) I will never make good friends and find my people.

Something that helped was hearing my friends talk about when they moved to new places. Some of them didn’t do social things for weeks or months, either because they couldn’t handle it emotionally or were too busy with whatever they moved there for or just couldn’t find anything to do. And yet, somehow it ended up working out. Now they have friends and partners and communities and activities. You don’t have to Create Your Entire Life all at once.

So there were also nights when I made myself stay in because I was exhausted and I needed it. I fidgeted at my desk or in my bed and told myself that I have a very long time to do All Of The Things, and that doing All Of The Things at once is not worth it if I’m exhausted and miserable. 

If you need to, get some perspective.

I’m lucky to have a family of immigrants whose stories are horrific and hilarious and inspiring enough to have kept me going at times. My aunt told me about how she moved to New York from Russia years ago and spoke no English and had no money, and ended up doing the same long walk from Battery Park to Central Park that I once took in the summer heat with no cash to spare for a bottle of water or for the bus. She worked cleaning houses before she was able to pass her medical licensing exam and become a successful physician. My mom told me about moving to Israel from Russia right before I was born and living in one of the worst neighborhoods in Haifa, while pregnant with me, taking care of my then-8-year-old brother, and trying to find work. And, of course, not speaking any Hebrew.

Their stories of awful landlords and crumbling apartments and culture shocks and exploitative jobs makes me grateful, despite all the difficulties, to have been able to move here relatively easily.

Your mileage may vary with this strategy, because hearing other people’s tales of woe may not necessarily make you feel better about yours. For me, it often doesn’t. But the way my family members tell these stories and the fact that I can see how far they’ve come since then gives me a good dose of perspective.

One thing that I’m really sensitive to, personally, is condescension. I had more than my fair share of Adults being really (unintentionally, but still really) condescending and giving me patronizing advice that I didn’t ask for and telling me that I was Doing It All Wrong. So go to people you trust for things like this. My family was great about it. Random people on my Facebook, not always.

Speaking of which, now is a great time to enforce your boundaries.

While enforcing boundaries is always important, it becomes especially important when moving, when so many other things are out of your control. It’s not too much to ask of your friends and acquaintances not to do things that really bother you, whether it’s bombarding you with patronizing unsolicited advice or constantly asking for updates on how packing’s going or (if they live in the place you’re moving) pressuring you to make plans to see them when you’re not ready to yet.

My own personal issue was that, as soon as I started making plans to move, and especially as those plans drew nearer and nearer and especially after they happened, a large portion of my Facebook friends list decided that I would be their Official Repository for “Humor” Articles About How Much New York Sucks. How expensive it is. How shitty the apartments are. How hard it is to find them. How annoying the subway is. (It’s not even that annoying.) How rude New Yorkers are. (They’re not even.) I try to think that people thought I’d find this funny because I can relate rather than doing it to piss me off. Unfortunately, though, it turned out to be a huge anxiety trigger. Because guess what! I do have doubts about moving here. It is hard sometimes. The housing situation really is a little dismal. Shit really is expensive. Do I really need to be reminded of this? No.

The entire genre of LOLOL WOW LOOK AT THIS CRAZY STUPID NEW YORK SHIT LOL NEW YORKERS ARE SO WEIRD LOL articles really needs to die out, in my opinion. But until it does, I didn’t want any more of them posted on my wall. So I told people that and explained why, and enforced that boundary whenever people broke it afterward. It made my life just a little bit happier, at no cost to me or anyone else.

If you’re someone who likes routines (and most people do), create some as soon as possible.

When you move to a new place it might be tempting to Try All Of The Different Things to try to get yourself to feel more comfortable and at home. Sometimes this can be really helpful and fun, but sometimes what you need to feel at home is routine.

That’s why I quickly established My Gym and My Deli and My Work!LunchPlace and My School!LunchPlace and My Cafe. My School!LunchPlace is Chipotle, which people make fun of me for because why would you move to New York and just eat at Chipotle. Cause it makes me feel comfy, okay? I will probably eventually get tired of my love affair with Chipotle, or its CEO will say something really bigoted, and I will stop going there and start enjoying food from Every Country In The World. (For real, right next to the building where I have class is a Mediterranean place, an Ethiopian place, an Italian place, an Indian place, a Chinese place, and a Japanese place. And that’s without walking a few blocks to where Harlem begins.)

Routines help me feel like a resident rather than a tourist. In a city of tourists, that feels nice. Knowing exactly where to stand on the platform so I get on the train at such a spot that when I get off the train I’ll be right by the stairwell that will take me to the next train I need is cool. So I stand on the platform in the same spot every time.

Relatedly, unpack as soon as you can. Unless it’s too stressful. Then don’t.

Typically, I find that unpacking helps me feel at home and gives me fewer things to worry about, since I can finally stop living out of boxes and start knowing where all my shit is. But this time was a bit different, because it was very difficult to fit everything into my limited storage space, and every time I tried to unpack I just got terribly anxious. If this happens to you, let go of any perfectionism you may still have after moving across the country alone in a state of terror and panic (that tends to really cut down on the perfectionism) and let things just lie in boxes or piles on the floor. There will be time enough to put all of the thingies where they need to go.

Avoid reminders of your past home when you need to.

The wisdom on this goes both ways; some people feel comforted by such reminders, while other people, such as me, break down crying in public. That happened today, which is actually what prompted me to finally write this post and stop putting it off.

It was the first actually cold day of the season, and the first snow. There’s a Target near where I work and I needed to get some stuff. Tights. A pillow. Whatever. I found the Target and walked in, and the glass door slid shut behind me, and suddenly…I was home.

I don’t mean home as in a shopper’s paradise, although that too. Home home. The Target was laid out exactly the way the one back in my hometown in Ohio was, with the women’s clothes and the accessories just to the left of the entrance. I walked over to some purses and scarves and just stared stupidly at them. I remembered doing my college shopping four years ago. I remembered buying Pokemon cards for my little brother. I remembered when my ex-boyfriend and I bought identical folding sphere chairs. I remembered clothes shopping with my mom. I felt like I could do a 180 and walk right back out and be in the sprawling wasteland of a parking lot with the mall across the street and the pool down the road. I could get in my parents’ car and drive home (driving?!) and my family would be there waiting for me.

If you’ve never walked aimlessly through a nearly-empty Target crying and not being able to breathe properly, I don’t really recommend it.

It just felt so stupid. It’s a stupid fucking generic store. They have them everywhere. I’ve even been to plenty of other Targets in plenty of other cities and states, without any bouts of Sudden Crying. But there it was.

I bought my shit and left the store without my coat on, thinking that maybe the sudden cold would make me snap out of it. It didn’t. The wind reminded me of Chicago and I just cried even harder. I put the coat on and went to the subway. I cried all the way back to Manhattan, half-napping part of the time. By the time I got to Times Square, I felt like I was back in New York again and not wallowing in some Midwestern past, and I felt a little better.

The point of that whole story is: I’m probably not going to go to Target again. At least not alone, or at least not until I’ve settled in better. It’s not worth it. I almost want to, because that stupid store is the only place in the five boroughs that has ever given me that visceral I-could-walk-right-out-into-Ohio feeling. I know I could chase that feeling if I let myself, but I won’t. I moved here for a reason. I left that place behind.

But remember where you came from.

I spent many useless years trying to shed Ohio and the Midwest from my identity like so many useless outgrown and unfashionable clothes. In college, I remember being extremely proud whenever anyone told me that I looked or sounded like I was from New York, which was often. And in my junior year when I was taking Hebrew, I was practicing with my teacher and asked her how to say, “I want to be from New York.” She said, “You mean, ‘I want to live in New York.'” I said, “No, I don’t just want to live there. I want to be from there.” (The correct translation, by the way, is Ani rotzah l’hiyot meh-New York.)

I am not from New York. I am never going to be. That ship sailed 22 years ago when I was born in Israel (not too shabby a place to be from), and sank somewhere in the deep sea when my parents bought a house in Ohio. So it was. Instead of a childhood in Central Park and the Met and Rockaway Beach, I had a childhood reading in my backyard and hiking and going to the pool and riding my bike for miles and miles. Oh, and unlike kids here, I never had to take a fucking exam just to get into middle school. Could’ve certainly done worse.

Even if your move is not quite like Miri’s Brave Quest To Finally Be In A Place She Belongs, you might still be struggling with the desire to fit into your community versus the desire to remember where you’re from and the way you lived there. As you get to know new people, tell them about your old life and what your past homes were like. Let people understand you as the product of all the experiences that led up to your move to this new place, not just the new ones you’re having with them now.

It’s tempting sometimes to see moves as opportunities for total reinvention, and I definitely had a bit of that going on. But sometimes that can feel very isolating, like there are huge pieces of you that you didn’t bring with you when you moved. So bring them.

“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

996823_476553892435099_1326891563_n

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

996823_476553892435099_1326891563_n

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.