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

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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.

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*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.

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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.