The Mental Health Advocate Pedestal

[Content note: depression and eating disorders]

I recently read Olivia’s excellent blog post, “I’m Tired Of Curating.” In it she describes her experiences as a mental health advocate and a person with mental illness(es), and it resonated a lot with me:

I’m not allowed to share these thoughts because they glorify an eating disorder, because I’m not actively telling people how awful it is to be sick, because I’m remembering how intertwined I am with the disease, the way it really is part of the way my mind works rather than something that needs to be kicked out of my life.

[…] I’m sick of trying to spin these thoughts into something useful or meaningful. Since I’ve started to write openly about treatment and recovery and mental illness, I feel as if I need to be a role model or someone that others can look to to see that mental illness does not destroy your life. And yet it’s consumed all of mine and I feel as if I’ve gained nothing except 50 pounds.

I don’t want to curate my words today. I don’t want to be careful not to trigger anyone or to mistakenly portray the ways I behave in a positive light. I want to be allowed the space to honestly portray my mental illness, including the way that it looks seductive when I’m anxious and overwhelmed. Right now restriction is the only thing that makes sense to me. I hate having to hedge that with the caveat that I know it’s not healthy and no other people shouldn’t do it and yes it will fuck up my life.

[…] As someone who has a mental illness and advocates for people with mental illnesses, sometimes I feel like I’m not actually allowed to have my mental illness. Sure, I get to talk about the experience and share inspiring stories or even stories about how nastybad it is and tips and tricks that I’ve picked up, but I don’t get to publicly have the thoughts and feelings that come with a jerkbrain. I don’t get to type “I think I’m a shitstain on the world” without people disregarding everything else I say. I don’t get to type “I truly would like to skip all upcoming meals indefinitely” without being accused of promoting unhealthy behaviors. Newsflash world: I have depression and an eating disorder. These are things that I think on the regular. If it’s too ugly to see it and you have to look away when I can’t be polished, then I don’t understand the point of my activism and advocacy. I don’t understand why I write anymore.

When I read this, it suddenly put my experiences into a context that made sense. Because I’ve been there.

Not only have I felt like I couldn’t share my negative experiences with mental illness, but I was also made to feel like I couldn’t share my victories, either. I once posted on my personal Facebook that I was proud of myself for having been (safely) off of medication for a year, and someone messaged me letting me know that I shouldn’t post things like that because it’ll make people who still need to be on medication feel bad, and that this might be helpful for me to know “considering [my] future career.” Except my personal Facebook page isn’t the same as my professional counseling website, and it’s not even the same as my blog. It’s my space to share my life with my friends. The purpose of my Facebook is to connect with my friends, not to affirm other people. Of course, I like to affirm other people and often try to, but that shouldn’t be an expectation placed on me. It shouldn’t have to be the primary goal of my self-expression.

So that’s a weird, narrow line we mental health advocates have to walk. We’re criticized for being honest about the ugly sides of mental illness (either because it means we’re “glorifying” mental illness or because we’re “confirming negative stereotypes” or [insert accusation here), and we’re criticized for “making others feel bad” when we’re honest about successful recovery. (And, yes, I get to simultaneously believe that there is nothing wrong with taking psychiatric medication and to be proud of myself for getting to a place where I am able to stop taking it. You can accept medical treatment as necessary and morally acceptable and you can be glad when you don’t need medical treatment anymore!)

As a result, we end up presenting a sanitized version of our actual struggles that’s neither overly negative nor inappropriately jealousy-inducing. “Jerkbrain’s really getting me down today, please send cute animal photos.” “Today sucked so I’m going to do some much-needed self-care.” And so on and so forth. Obviously, those can be completely valid and genuine expressions, but as Olivia pointed out, sometimes it’s a lot less pretty.

A while back, I wrote about a particular strain of criticism of people (generally teenage girls) who “glorify” or “enable” mental illness symptoms by presenting them in a romantic or sexy light. The argument goes that these blogs may discourage young people from seeing their mental illnesses as treatable (or seeing them as illnesses at all) and encourage them to do harmful behaviors associated with those illnesses–self-harm, restricting, purging, etc. In that post, I concluded: “It’s easy to say, ‘Don’t romanticize depression! It encourages people to view depression as normal and healthy.’ It’s harder to say, ‘Don’t show symptoms of your depression! It encourages people to view depression as normal and healthy.'”

Unfortunately, as I’m learning, it’s not actually particularly difficult to say that at all; you just have to be a little more subtle. Certainly nobody in our communities would ever come right out and say that people with mental illnesses should hide all of their symptoms; heavens no, that would be ableist. Instead, they fill our Facebook threads with condescending reminders to “take better care of yourself” and “that’s just jerkbrain talking.” We can discuss our symptoms as long as we make it absolutely clear that we hate the symptoms and the illness and are completely dedicated to the project of making a full recovery. To admit that sometimes we don’t want to recover is to “glorify” mental illness and “enable” others. It’s to “confirm stereotypes” about people with mental illness, as if the problem is overlapping with a stereotype and not stereotyping people to begin with.

The Mental Health Advocate Pedestal is real and it’s a narrow ledge to squeeze yourself onto. Be honest, but don’t freak us out. Motivate those who are still struggling, but don’t give a rosy and unrealistic perspective. Hate your illness because it’s unhealthy and bad for you, but don’t hate your illness because that’s ableist and implies that there’s something wrong with having a mental illness. Recover, but not so much or so visibly that you make others feel bad. Accomplish because it’s inspirational for others and because people with mental illnesses can do anything neurotypical people can, but don’t accomplish too much, or else are you sure you’re really all that mentally ill? Maybe you just want attention.

I used to blame myself a lot for doing what Olivia calls “curating”–for only portraying my depression in a particular way, not too negative and not too positive. Now I’ve come to see it as a double-bind that everyone who discloses mental illness is placed in, one way or another. Why is it that we’re the ones constantly accused of “encouraging” mental illness when everything about the way our society is set up encourages it? Why is a teenage girl who posts a selfie of herself with mascara tears running down her face any more responsible for someone else’s mental illness than the neurotypical adults who tell each other to “calm down” and “just get over it,” or the boss who creates a stressful and anxiety-provoking work environment, or the primary care doctor who fails to spot the warning signs of depression and refer their patient to a therapist, or the parent who tells their teenager that they’ll “grow out of it”?

We all contribute to ableism and mental illness stigma in various ways, and those of us who actually have mental illness tend to be more aware of that than anyone.

As usual, I’ve got no solution to this except to pay attention to your automatic responses to folks with mental illnesses discussing their experiences. Watch what makes you go “Wow, that is So Real, that is So Brave of you to share” and what makes you go “Uh, are you sure you want to post that so publicly?” The answer might be instructive.

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“How can I support you?”

When people share mental health struggles online, well-meaning friends and followers often rush in to give them unsolicited advice. That’s something many of us find irritating and push back on. One of the responses we get often goes something like this: “But I give advice because I need to say something. How am I supposed to know exactly what they need?”

These days my response is usually the same: “Have you tried asking them?”

It’s both surprising and unsurprising how often the response is: “Oh. I didn’t think of that.”

It’s surprising because, rationally, that seems like the obvious thing to do when someone is struggling and you have no idea how to help them. It doesn’t make sense to waste your time and energy and risk upsetting or pissing them off by guessing what they might want and offering that. When you need information to make a good decision, and the information is readily available by asking someone who is as close as it gets to being an authority on the subject, it makes sense to just ask them.

At the same time, it’s also utterly unsurprising that people so rarely do this.

For one thing, we have all these cultural scripts about how this stuff is supposed to go, and one of them is that if you’re really a good friend/partner/family member to the person who’s struggling, you will “just know” what they need and be able to offer it without needing to be told. On the flip side, you might believe that if someone is really a good friend/partner/family member to you, they shouldn’t have to ask you what you need; they should just know. If they do ask, and you tell them, and they do that thing, then that might be nice and all, but it’s not as special as it would’ve been if they’d just known.

You’re probably familiar with these dynamics from discussions of sexual communication and the importance of asking/telling partners what they’re/you’re into, but this applies to so many other interpersonal situations.

That second part is talked about a little less often than the first, because the first seems on the surface to do more immediate harm. But they’re two sides of a coin. We need to get rid of that sort of thinking in order to be able to intentionally create strong, communicative relationships of all kinds.

In fact, I suspect that a small part* of the reason many people are vague about what they need when they let close ones know about their struggles is because they hope that those close ones will be able to help them without being explicitly told how. When you’re neck-deep in some sort of life shit, that sort of effortlessness can be so incredibly affirming. It satisfies a need many people have to feel taken care of.

(*Note I specifically said “small part”; there are many other, probably more significant reasons people do this, such as not knowing what they want, not having the emotional energy to communicate extensively/clearly, fearing criticism or pushback for stating what they really want, etc)

Besides cultural scripts about Just Knowing what someone wants, another reason people might not ask “How can I help?” is that they worry about annoying the person or putting an additional burden on them (that is, making them explain what it is they need). While that’s definitely a risk, especially with someone who expects you to Just Know, it’s significantly less annoying than shoving useless (or even harmful) advice or assistance at someone.

In her article about unsolicited advice online, Katie Klabusich lays all this out in a great way:

“How can I support you?” is a question that works in almost every situation imaginable. It preempts judgement and assumptions while oozing humility. Often the person won’t have an immediate answer—likely because they aren’t used to being asked a question that’s about what they actually need as a unique human being. If they look stunned, I suggest something like: “It’s OK if you don’t have an answer or don’t need anything right now; the offer’s open for whenever. Just let me know.” And then use an emoji of some sort or make a face that conveys warmth so they know you mean it. (This could be a unicorn, the two señoritas dancing, or the smiling poo. Up to you.)

*Here’s the fine print: you have to believe their answer, whatever it is. If they tell you they don’t need anything, you don’t get to push or pressure or demand they give you something to do so you feel less helpless. Remember, this isn’t about you.

Following up a few weeks or months later (whatever equals “a while from now” with the two of you) is totally fine. Asking clarifying questions about what they need if they need something is also totally fine. Being unsure and having to ask along the way if the thing they asked for that you’re trying to provide is helping or being provided in a helpful way is also totally fine.

Telling the person you don’t know if the thing they need is something you can do is also totally fine; no one expects you to be everything they need, and we’d all rather you not promise than drop the ball. These are all honest, humble, supportive responses and, frankly, just being asked “How can I support you?” will make the person feel less alone and more cared for.

 

As Katie notes, the fact that many people won’t have an answer right away doesn’t mean that the question was wrong. It could mean that they’re surprised at actually being asked, and it could also mean that they’re not used to thinking of some of their needs as needs. For instance, we might ask someone for advice or for practical assistance, but it feels a little weirder for most people to ask someone to just listen or to tell them something affirming. Being asked “How can I support you?” can help shift them into that way of thinking about it: “Hm, what would feel supportive for me right now?”

Feeling supported is not always the same as Making The Right Decision or Growing As A Person or whatever, which is another reason people are sometimes hesitant to ask others what they need to feel supported. “But what if they’re making the wrong decision!” they might protest. “I need to tell them they’re Doing It Wrong!”

Yes, there are some cases in which it’s probably a good idea to speak up and rain on someone’s parade because you’re seriously concerned about their safety or wellbeing. But most cases are not that and most people are not the kinds of people you have that relationship with (i.e. children, little siblings, partners with whom you have that sort of understanding, etc). I have watched friends and partners make decisions that I personally thought were bad decisions, but because they were clear with me that they wanted support/affirmation and not constructive criticism, I kept my concerns to myself. For the most part, those people turned out okay, because they are adults and they have the right to make their own decisions.

I’ve written before that self-awareness is really important when you’re trying to help people, because you need to make sure you’re not just doing it to try to relieve your own feelings of helplessness. Even if you are doing it to relieve your own feelings of helplessness, you can still go ahead and try to help, as long as you acknowledge those feelings and understand that they are your responsibility and not that of the person you’re trying to help. Only then can you focus on helping them in the way they need rather than in the way you need.

Asking what they need is a big part of that. Don’t try to show off how amazing you are at magically intuiting what they need. You’re likely to mess up and cause more trouble than you solve. Just ask.

“How can I support you?” is not a magic question. It will not necessarily get you the answers you need or them the help they need. Maybe that phrasing sounds weird and stilted to you; try not to get too caught up in that and find other ways to ask the same essential thing. The point isn’t the exact words, but rather the idea that you should figure out how best to help someone before trying to help them. They might not always know, but they certainly know better than you do, even if it takes them some time to be able to access that knowledge. They are the expert on what they need, or as close to an expert as anyone is going to get.

Be prepared, too, for the answer, “Nothing.” Sometimes people share their struggles not to get help or support but to be heard and witnessed. Sometimes they don’t know why they’re sharing at all. Sometimes they will tell you that the best way you can support them is to hear what they have to say; sometimes they will tell you, “Nothing.” Thank them for their honesty and move along. “Nothing” is a difficult thing to hear, but it is also a difficult thing to say.

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How Mental Illness Labels Help

I wrote this piece for Everyday Feminism. Please note that it’s based on my own experience and I include a section about how it doesn’t apply to everyone, so please read all the way through before commenting.

When I was first diagnosed with depression as a nineteen-year-old college freshman, I felt an emotion you might not associate with getting diagnosed with a mental illness: relief.

I was relieved that it was actually a real illness and not just a personal fault. I was relieved that there was treatment available for something I thought was just my burden to carry for life. I was relieved to have the language for the background noise of hopelessness, sadness, and pessimism that I had experienced for as long as I could remember.

Not everyone agreed.

Concerned loved ones questioned my decision to accept the diagnosis and use it as a personal identifier when relevant. They worried that thinking of myself as a person who has depression would prevent me from taking responsibility for recovery, or that telling others about it would cause them to judge me and abandon me.

Many people wondered why I needed to concern myself with labels at all. Couldn’t I just go to therapy, take my medication, and leave the technical words out of it?

Actually, I don’t think I could.

Identifying with the label “depression” has helped me in a number of ways, both with recovery and with coping with the symptoms that I still have.

Here’s how.

1. Finding Helpful Information About Mental Illness

The most basic way that mental illness labels have helped me is that they’re a great way to find information about mental illness.

Sounds obvious, right?

But many people who disparage labels don’t realize that you’ll probably find a lot more useful stuff if you Google “how to cope with depression” than “how to stop feeling sad” or “what to do when you feel numb.”

When I was first learning about mental health – both in general and mine specifically – I looked up a lot of things online and read a lot of books.

My searches led me to life-changing perspectives like Andrew Solomon’s The Noonday Demon, which helped me understand different ways in which depression can manifest itself, and Peter D. Kramer’s Listening to Prozac, which helped me feel much less ashamed about needing to take medication.

These books have “depression” and “antidepressants” in their subtitles, and I wouldn’t have found them without knowing what to look for.

Many people first realize they might have a mental illness by looking at simple, nonjudgmental websites like WebMD, Mayo Clinic, or even Wikipedia.

Unlike some of the people in our lives, these websites won’t tell you that “it’s all in your head” or “other people have it worse.” They present scientific information in a way that’s easy to understand and relate to.

But in order to end up on one of these pages, you generally need to have a diagnosis in mind.

Even if you’ve already been diagnosed and started treatment, knowing your diagnosis can help you find information that’ll help your treatment.

For instance, if you’re looking up information about borderline personality disorder, you might learn that dialectical behavior therapy is one of the best treatments for it. This can help you find therapists who specialize in DBT, join groups that use it, and learn some techniques on your own.

Read the rest here.

A Good Critique of the Medical Model is Hard to Find

I was optimistic about reading this critique of the medical model of mental illness by professor of clinical psychology Peter Kinderman, in part because it is written by someone with experience in the field and in part because it is published on Scientific American, which I trust.

However, while the article makes a number of good points that I will discuss later, it starts off immediately with such a tired and oft-debunked misconception that I almost quit reading after that:

The idea that our more distressing emotions such as grief and anger can best be understood as symptoms of physical illnesses is pervasive and seductive. But in my view it is also a myth, and a harmful one.

I’ll say it again for the folks in the back: nobody* is trying to medicalize “distressing emotions such as grief and anger.” They are medicalizing mental patterns (which can include cognitions, emotions, and behaviors) that are not only very distressing, but also interfere with the person’s daily functioning. It’s kind of like how some stomachaches are minor annoyances that you wait out (or take a Tums), and some land you in the ER with appendicitis. Therapists and psychologists are not concerned with the mental equivalent of a mild cramp.

In general, people don’t end up in my office because they get pissed off when someone cuts them off in traffic; they end up in my office because they are so angry so often that they can’t stop physically attacking people. They don’t end up seeing the psychiatrist down the hall because they get jittery and uncomfortable before a job interview; they see the psychiatrist because they feel jittery and uncomfortable all the damn time, and they can’t stop, and they can’t sleep, even though they rationally know that they are safe and everything’s okay.

I understand that it’s more difficult to grok differences in degree as opposed to differences in kind, because Where Do You Draw The Line. Yes, it would be easier if mentally ill people had completely different emotions that had completely different names and that’s how we knew that they were Really Mentally Ill, as opposed to having emotions that look like more extreme or less bearable versions of everyone else’s. (Sometimes, from the outside, they even look the same. “But sometimes I don’t want to get out of bed either!” “But sometimes I feel sad for no reason either!” Okay, well, you might be depressed too. Or you might find that those things have no significant impact on your day-to-day life, whereas for a person with depression, they do.)

But it really doesn’t help when you’ve got mental health professionals obfuscating the issue in this manner.

As I said, Kinderman does go on to make some really good arguments, such as the fact that psychiatric diagnoses have poor validity and reliability. This means that they don’t seem to correspond that well with how symptoms actually look “on the ground,” and that different diagnosticians tend to give different diagnoses to the same cases. However, these are criticisms of the DSM, not of the medical model. I’ve felt for a while that we should move away from diagnostic labels and towards identifying specific symptoms and developing treatment plans for those symptoms, not for some amorphous “disorder.”

For instance, suppose I’m seeing a client, Bob. After getting to know each other for a few weeks, Bob and I determine together that there are a few issues he’s particularly struggling with: self-hatred and feelings of worthlessness, guilt, difficulty sleeping, lack of motivation to do anything, loss of interest in things he used to enjoy, and frequent, unbearable sadness. Traditionally, I’d diagnose Bob with major depression (pending a few other considerations/differential diagnosis stuff) and move on with treatment. But without these often-invalid and unreliable diagnostic labels, I just skip that step (although I might let Bob know that “depression” might be a useful word to Google if he’s looking for support and resources). Instead, Bob and I look at his actual symptoms and decide on treatments that might be helpful for those particular symptoms. Cognitive-behavioral therapy might help with Bob’s self-hatred, feelings of worthlessness, and guilt. Behavioral activation might help with his lack of motivation and interest. Certain dialectical behavior therapy modules, such as distress tolerance, might help him cope with sadness in the meantime. Antidepressants might very well help with all of them!

Because mental healthcare doesn’t treat disorders; it treats symptoms. Whether that mental healthcare is medication, therapy, or some combination, the ultimate goal is a reduction in symptoms.

I can see how the medical model makes this seem bad when it isn’t. In traditional healthcare, treating symptoms rather than getting to the root of the problem is downright dangerous. If someone has headaches and you give them painkillers without diagnosing their brain tumor, they’re in serious trouble.

However, we haven’t yet developed great ways of figuring out what “the root of the problem” is when it comes to mental symptoms, especially since there often isn’t one. It’s almost always some complicated tangle of genetics, early childhood stressors, interpersonal patterns learned from family, sociocultural factors, and so on. All of this affects the brain in fundamental biological ways, which further drives the symptoms.

Thankfully, that’s not as much of a problem as it would be with a physical health condition. If you only focus on symptoms and don’t treat the underlying cancer or diabetes or whatever, it will slowly kill you. But if you successfully treat the symptoms of mental illness, you will make the person’s life much better no matter what originally caused the symptoms. There won’t be anything silently killing them in the background, and good therapy teaches people the skills to avoid future relapses of their symptoms.

Sometimes the root cause of mental illness is, as Kinderman points out, a social problem. Poverty, social inequality, and other issues contribute heavily to mental illness. But since you can’t solve those issues from the inside of a counseling office, all you can do is help your client as much as possible. I do this every day, and believe me, it feels weird and gross at times. But what else can I do? Until our fucked-up society decides to come in and take a seat in my office, I can only work with my clients as individuals. (Otherwise I would have a very different job and it would not be therapy.)

Kinderman argues that treating mental illnesses as diseases is wrong because of these social factors that contribute to them. I understand his concern, because he (and many other people) treat “disease” as synonymous with “thing that is entirely biologically based.” So, the medical model feels like an erasure of the complex and valid social dynamics that contribute to what we call mental illness.

But I don’t think of disease that way at all, and I’m betting most doctors don’t either. Social factors contribute heavily to physical illnesses, too. People who are living in poverty or who are marginalized by the healthcare system in other ways are much more likely to have all sorts of physical health problems, and the results tend to be more severe for them. Stress, which includes the stress of poverty, racism, and other social problems, makes everyone more vulnerable to illness. Eating well and exercising enough, two very important factors when it comes to physical (and mental) health, are not equally accessible to everyone. Heart disease and diabetes may have biological origins, but they do not happen in isolation from societal factors, either. Just like mental illness.

You might argue that physical illnesses and mental illnesses differ in that physical illnesses are more heavily caused by biological factors and mental illnesses are more heavily caused by social factors, and I might agree. But again, that’s a difference in degree, not kind. Both types of illnesses affect us physically and mentally.

Another good argument that Kinderman presents is that the medical model may not help reduce stigma, and there’s research to back this up. Kinderman writes:

Traditionally, the idea that mental health problems are illnesses like any other and that therefore people should not be blamed or held responsible for their difficulties has been seen as a powerful tool to reduce stigma and discrimination.

Unfortunately, the emphasis on biological explanations for mental health problems may not help matters because it presents problems as a fundamental, heritable and immutable part of the individual. In contrast, a more genuinely empathic approach would be to understand how we all respond emotionally to life’s challenges.

So, that’s important and deserves highlighting.

However, I think the issue of how best to reduce stigma against mental illness is slightly separate from the issue of how best to help people with mental illnesses feel better. (There’s a school of thought in the disability community that disabilities [including mental illnesses)] “hurt” only because of the stigma and prejudice against people who have them, and I’m not particularly equipped to engage with that here except to say that it makes me angry in a way I can’t possibly explain. It completely invalidates how awful and wretched I felt because my symptoms hurt unbearably and not because of anything anyone else said or did to me as a result.)

When it comes to what people with mental illnesses actually find helpful, for some it’s the medical model and for some it isn’t. In her piece on mental “sick days,” Katie Klabusich writes about how freeing it actually was to see herself as “sick” when she needed to take a day off due to her mental illness:

I’d realized that not only is it alright for me to think of the dysthymia as the illness that it is, it’s necessary. If it were a south-of-the-neck illness, I wouldn’t have had the conflict about it. Yes, I’ve worked when I had a virus and shouldn’t have. (See the stats on service industry staff who work when they’re sick; we’ve all done it.) But my thought process would have been totally different. I certainly wouldn’t have needed the Ah ha! moment to know I had the flu. So why didn’t I realize I was sick?

Our culture impresses upon us that we SUCK IT UP and GIT ER DONE when our “issue” is “just mental.” Except . . .

MY BRAIN IS PART OF MY BODY.

It turns out that what happens in my head has a real—not imagined or exaggerated—physical affect on my other bodily functions. That list of symptoms from a dysthymia flare? They’re worse than the flu. Full-blown body aches and exhaustion alone are enough to make just sitting up nearly impossible. What work Idid do last week was all done from bed. Including writing this.

Others may not find that way of thinking helpful, in which case, they should absolutely abandon it in favor of whatever does help.

I want to end on a cautionary note about this whole idea of the medical model “pathologizing” “normal” emotions, because the alternatives I sometimes see offered to the medical model seem far, far worse about this. While Kinderman seems to argue sensibly for a more “psychosocial” approach to mental healthcare and a reduction in the use of medication (which I disagree with, but at least it’s sensible), others turn entirely away from scientifically validated treatments into “holistic” or “alternative” treatment. In many of these communities, “positive thinking” is seen as the only treatment you need, and anything that strays from the “positive” (like, you know, the negative emotions that are a normal part of almost any mental illness) is actively preventing you from recovering. There’s a very victim-blamey aspect to all of this: if you’re unhappy or sick,” it’s your own fault for not thinking positively enough.

I’ve had clients from these communities in counseling, and it’s very difficult to get any work done with them because they only ever want to share “positive” thoughts and feelings with me. As it turns out, medical model or no, they have completely pathologized any sort of negative emotion–including, in fact, the totally normal negative emotions that all of us experience all the time.

Yet it’s those evil psychiatrists who don’t want anybody to be sad or angry ever. Okay.

Some critiques of the medical model are quite valid and very useful. Others seem to rest less on evidence and more on a general sense of unease about the idea of thinking of mental symptoms as, well, symptoms. Kinderman even implies that it’s unethical. But “makes me uncomfortable” isn’t the same as “unethical,” as we all know. Unless I see evidence that this conceptualization is harmful overall, I see no reason to throw it out.

That said, if you’re a mental health provider and you have clients who are clearly uncomfortable with this model, maybe don’t use it to explain their conditions to them, since it’s unlikely to be helpful. All of these labels and diagnoses and explanations should serve the client, not the other way around.

And if you’re a person who experiences some significant amount of mental distress and you can’t stand thinking of it as an illness, then don’t! You don’t have to think of it in any way you don’t like. I hope you’re getting treatment of some sort that works for you, but at the end of the day, it’s actually none of my business.

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*Yes, there are probably some bad psychiatrists out there who think that grieving at the loss of a loved one is literally a mental illness. There are also surgeons who leave crap inside of people’s bodies or amputate the wrong limb. I see these as roughly analogous.

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Brains Lie, But So Do People

[CN: mental illness, gaslighting, abuse]

For those of us with mood disorders to manage, learning and understanding the fact that brains often lie was a revelation. Suddenly we had an explanation–and not a BS, pseudoscientific explanation–for why we think and feel things that don’t make sense and that make life unbearable. We learned that feeling like everyone hates you isn’t actually a feeling; it’s a thought, and the thought isn’t based in reality. We learned that we have a much easier time remembering the bad than the good, which leaves us with the skewed impression that everything is awful and must always continue to be awful.

And so we adopted a new language. We talk about jerkbrains and depression!brains and all sorts of other brains, and we teach ourselves to constantly question and second-guess the negative things we tell ourselves.

For the most part, this is how mood disorder recovery happens. Once you develop the awareness that many of your depressive or anxious thoughts are not based in reality, you are able to develop coping skills to stop these thoughts or minimize their impact. This is CBT, in a nutshell. CBT is not a panacea–some people, especially those whose disorders started early in their life (or seem like they’ve been going on forever) don’t find this sufficient to actually stop the thoughts. But recovery can’t happen until you internalize the fact that brains lie.

Here’s where I worry, though. When I start hearing this:

“My friends are always making jokes at my expense and it makes me feel hurt. But that’s just my depression, I know they don’t really mean it.”

“I know I should be ok with my partner wanting us to be poly. It’s just my anxiety, it’s not a rational thing.”

“It’s not that I don’t want to have sex with him, it’s just that I don’t really have a sex drive because of my medication. So I do it anyway because I mean, I don’t mind.”

Sometimes we overcompensate. We get so used to these tropes–depression makes you feel like people hate you, anxiety makes you freak out that your partner’s going to leave you when there’s no evidence, medication makes you lose your sex drive–that we assume those causations. If you’re diagnosed with depression and your friends are making mean jokes and you feel hurt, it’s because of your depression. If you’re taking medication and you don’t want to have sex, of course it’s the medication.

Obviously these things are all true in many cases. It could very well be that all evidence suggests your friends love you and assume you’re be okay with some good-natured teasing. It could very well be that all the evidence suggests that your partner is committed to you, poly or not, and that your anxiety contradicts your other beliefs about the relationship and your preferences. (For instance, polyamory often makes me very anxious, but I’ve decided that it’s nevertheless what’s best for me and so that’s what I’m doing.)

But sometimes, your “friends” are being callous assholes and don’t care that their jokes hurt you. Sometimes, your partner is pressuring you to try polyamory even though it just doesn’t work for you, and everything about this is (rightfully) freaking you out. Sometimes, meds or no, you’re just not attracted to someone and haven’t internalized the fact that you don’t owe them sex. Sometimes the reason you don’t want to have sex with someone is because they’re giving off a ton of red flags and you should pay attention to them.

This gets even worse when close people, well-meaning or not, start pulling out these sorts of phrases in order to “help” you: “Oh, that’s just Depressed Miri talking.” “That’s your jerkbrain.” “This isn’t who you really are, it’s just your illness.” “Did you take your meds today?”

The message? “That’s not based in reality.”

Don’t get me wrong. When used by a kind, perceptive, absolutely not abusive person, these responses can be incredibly powerful and helpful. Sometimes we really do need that reality check: a partner who helps you draw the connection between skipping meds and feeling bad; a friend who patiently reminds you that sometimes depression feeds you lies.

When used by someone who wants to control you, though, they become very dangerous.

Upset that your partner keeps canceling your plans to see their other partner? That’s your depression, of course they still love you, it’s only natural that they’d want to see their new partner a lot. Scared to have sex without a condom? That’s just your anxiety, they already told you they’ve been tested, so what’s the problem? Annoyed that your friend keeps cutting you off in conversation? You know that irritation is a depression symptom.

I’ve written before that attempting to treat your depression or anxiety by invalidating your feelings can lead to a sort of self-gaslighting; even more harmful, I think, is when others do it to you. I have to admit that I start to get a queasy feeling when I see someone trying to manage their partner’s mental illness for/with them. As I said, sometimes this can be a great and healthy situation, but never forget that in a relationship between a person with a mental illness and a neurotypical person, the latter holds privilege. With privilege comes power, and with power comes responsibility.

The problem here, obviously, is not with CBT or the term “jerkbrain” or even the idea that thoughts/feelings can be irrational; the problem is abusive people learning this terminology and taking advantage of it. To a lesser extent, too, the problem is with ourselves over-applying these concepts to situations that are legitimately unhealthy, unsafe, or just straight-up unpleasant.

I don’t have a solution to this, but I do have some suggestions if you worry that you might be in this situation:

1. If you have a therapist, ask them to work with you on (re)learning how to trust your gut when appropriate. Most of us have a spidey sense when it comes to abusive people and dangerous situations; the problem is that our culture often trains us to ignore that sense. “But he’s such a nice guy, give him a chance!” “But it’s not your friends’ job to make sure none of their jokes ever offend you!” and so on. For many people, especially marginalized people, a crucial task is to remember what that sense feels like and to feel comfortable using it.

2. When an interpersonal situation is making you depressed or anxious, ask for a reality check from more than one person, and make sure that none of those people is directly involved in the situation. If you’re sad because your partner hasn’t been spending as much time with you as you’d like, that’s obviously an important conversation to have with your partner at some point, but the reality check part has to come from someone else, because your partner probably has a vested interest in keeping things as they are. (Not necessarily a bad thing! Maybe your partner has already patiently explained to you many times that they love you and wish they could see you more, but this year they need to focus on completing and defending their dissertation. Or maybe your partner is neglectful and stringing you along in this relationship that they’re only in for the sex and not being clear with you about what they actually want.)

It helps to find people that you can trust to be kind and honest. In many social circles I’ve been in in the past, there was a tendency to support your friend no matter what, and “support” meant agreeing with them about all interpersonal matters. If I’m upset at my partner, my friend agrees with me that they’re a jerk who doesn’t deserve me. If another friend is angry at me for missing their birthday party, my friend agrees with me that they’re obviously overreacting and being so immature. That’s not helpful for these purposes. You need someone who will say, “That sounds really rough for you and I’m sorry, but the fact that your partner has been busy lately doesn’t mean they hate you and don’t care if you live or die.”

3. Remember that feelings don’t have to be rational to be acted on. While it’s good to treat feelings with some amount of skepticism when you have a mental illness, that doesn’t mean you have to just ignore those feelings unless you can prove to yourself that they’re rational. There are many interpersonal situations that trigger my depression or anxiety for reasons I’ve determined aren’t rational, but I still avoid those situations because, honestly, life’s too damn short to feel like crap all the time, and I can’t will myself out of my depression and anxiety.

For example, here’s a meme I come across often:

Yes, rationally I know that sarcasm doesn’t mean you hate me, that that’s a perfectly valid way of expressing yourself and interacting with people, that for many people that’s part of their family culture/subculture, etc. etc.

But this interpersonal style interacts really badly with my depression. It makes me feel insecure and small. It is disempowering. It makes my brain go in circles about What Does This Person Really Think Of Me Do They Hate Me Or Not Did I Do Something Wrong.

(A part of me wonders if the reason people do this isn’t so much because they enjoy feeling relaxed enough to just be their snarky, sarcastic selves, but because they enjoy making people feel the way I just described. I’m not sure.)

So I decided at some point that I just wasn’t going to put up with it. When someone treats me this way, I remove them from my mental list of people I trust or want to get closer to. I minimize my interactions with that person. I prepare myself to set specific boundaries with them if that becomes necessary, but it usually doesn’t because distance does the trick.

At no point do I have to convince myself that, yes, all the available evidence suggests that this person hates me or is a cruel, bad person. I’m sure they don’t hate me. I’m sure they are a decent human being. For my purposes, though, it doesn’t really matter.

You are allowed to act in ways that minimize negative emotions even if those emotions are mostly being caused by mental illness.

~~~

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On Conflicting Emotional Needs in Relationships

[Content note: personal discussion of emotional imbalances in relationships. If you’re struggling with feeling like a burden to your partner(s), you might want to skip my perspective on this. Or maybe not.]

On the one hand: you deserve to be able to express your feelings in a relationship, and if your partner refuses to hear and affirm your feelings, that’s probably not a healthy situation.

On the other hand: you deserve to be able to set your boundaries. If someone you’re close with is having a lot of strong feelings that they want to express repeatedly–especially if the feelings are about you or the relationship–that can be very difficult to reconcile with your own mental health needs.

I don’t really know what to do in these situations except end the relationship or transition it to a more casual one. (That’s my own approach, not my advice to others.)

I used to believe, back when I was more often in the first situation, that the right thing to do when you care about someone is to just make yourself listen to them even if you don’t really feel like it. Relationships Are About Compromise, after all.

I didn’t realize at the time how easily this attitude can lead to becoming your partner’s untrained, unpaid therapist, or having your own issues exacerbated or triggered. It’s nobody’s fault; it’s just an occupational hazard of being a human in relationship with other humans.

But the other thing I learned is that it also isn’t healthy for me to frequently feel like I’m reluctantly doing my partner a favor just because it’s The Right Thing To Do.

Of course not all favors that we do are reluctant. If a friend needs help moving, I usually help out if I can, even though I would never choose to move furniture just for fun. But I didn’t do it because it’s The Right Thing To Do; I do it because it’s ultimately rewarding and because I get to spend time with friends in the process.

Likewise, I’m (usually) happy to listen to my friends’ and partners’ feelings, even when they’re strong and negative and expressed “uncharitably.” I’m used to hearing lots of sad things; it’s sad to hear them but it usually doesn’t harm me in any noticeable way. Although I can’t solve my friends’ problems for them–and wouldn’t want to–these conversations can be very rewarding for both of us.

But by the point in a relationship where we’re having the tenth conversation about “I just feel like you don’t really love me that much,” there’s generally nothing rewarding in it. (Truthfully, I’m not sure it’s rewarding for the person sharing it, either.) At that point, I’m listening because I feel like that’s what I should do, not because I want to.

For a while this seemed like an okay thing to do. It even seemed like the ethically correct thing to do, until I thought about how it would feel if I know that someone was only doing things for me out of a sense of obligation or commitment, and not because it’s actually pleasurable, meaningful, or rewarding for them.

(Note that difficult conversations can be meaningful and rewarding, if not pleasurable. Difficult conversations can bring a conflict towards resolution, build emotional intimacy, and develop more understanding of each other, to give just three examples. But I’m not talking about those.)

In fact, when I realized that this was going on and that people in my life were listening to me basically just to avoid feeling like Bad People, it totally messed up my ability to open up about my feelings. I stopped trusting people to set boundaries with me, because I’d seen proof that they don’t–ostensibly to avoid the possibility of hurting me, but also to avoid their own guilt.

In fact, it probably would’ve been hurtful to hear, “Sorry, babe, we’ve already talked through this a lot and I don’t have the bandwidth to talk through it again. Is there another way I can support you?” But hurtful doesn’t always mean wrong. What’s ultimately more hurtful, the sting of having a boundary set with me, or the steady, years-long erosion of trust in everyone that happens when enough people I care about act dishonestly with me?

And maybe, in a perfect world in which everyone is honest and direct, some of my partners would have said that they weren’t able to listen to me talk about certain things. Maybe that would’ve been a dealbreaker and I would’ve found partners who do not have those particular boundaries, and I would’ve trusted them to let me know if that changed.

But there are no easy answers for people who can’t find anyone willing to support them at the level that they need (and who cannot access therapy, presumably). Quite a few of us with a mental illness history can probably even say that someone’s failure to set their boundaries ended up saving our lives.

I don’t know.

But thankfully, most situations are not life-threatening. It should be ok if your partner has already processed your fears of rejection with you and isn’t able to do it anymore. It doesn’t mean they don’t love you or aren’t committed to you, it just means their needs are conflicting with yours. And it shouldn’t be the case that the needs of the partner who needs more support automatically override the needs of their partner.

I think part of the problem is our cultural conception of romantic partners as The One and My Other Hand and such. Many people believe that you should be able to tell your partner everything and have all your emotional (and sexual) needs met by them. If you need some sort of support–for instance, someone to listen to you regularly talk about your fears of being dumped–your partner should be available for that, and if they’re not, there’s something wrong with the relationship (or with your partner as a person).

(While this sounds like it’s only applicable to monogamy, plenty of poly couples actually work under the assumptions. Their “primary” partner is supposed to be able to fulfill all of their emotional needs, and their “secondaries” are for a bit of fun on the side. Aside from the sexual component, the “primary” partner still has to be able to do all the emotional support stuff.)

This is the point where someone is tempted to protest But It Works For Us, but okay–if it works, it works. But for many people it doesn’t. Worse, they think that the problem is with them, and not with our collective assumptions. If you and your partner are being honest, open, self-aware, and respectful of boundaries, but you still can’t fully meet each other’s needs, maybe it’s time to explore other options–not necessarily breaking up, but adjusting your expectations about how much of the support you need should come from one person.

(By the way, that doesn’t even imply that you should try polyamory. There’s no reason why certain emotional support needs can only be met by partners and not by friends.)

My concern about these conversations is that we’re always auditing people’s boundaries and shaming them for not being available enough to their partners. (Even when we’re not those people’s partners, perhaps especially then. I get so many comments from people I literally don’t even know about how I must be a terrible selfish partner. Suppose I am. What’s it to you?) I could already hear the responses to this post as I was writing it–“So what, you’re saying it’s ok to refuse to listen to your partner’s feelings?” “So it’s ok for someone to just shut down all their partner’s concerns?”

It’s notable how words like “all,” “always,” and “never” end up creeping into these conversations when they were never originally there.

Well, first of all, there’s setting boundaries and there’s abuse. Setting boundaries is, “I’m sorry, I don’t feel like I can handle this discussion. What else can we do?” Abuse is, “Come on, you’re acting crazy. This isn’t a big deal. You should be grateful I’m still with you at all.”

Second–and this is basically the whole point of this post–expectations about what’s reasonable to ask of a partner vary wildly from person to person. For me, listening for hours per week to someone venting about work or school or people they know is totally reasonable, but having more than a few “I just feel like you don’t love me as much as I love you” conversations per relationship completely destroys my ability to stay in that relationship. For whatever reason, I just can’t with that conversation. I hate feeling like I have to prove my love, I hate feeling like we have to quantify the amount of love we feel and compare it, I hate feeling like I owe my partner stronger feelings just because they have stronger feelings for me, I hate being pressured to show my love in ways that I’m not comfortable with. I just hate all of it. But that’s me. And some of the things that I am happy to do for partners, others probably aren’t.

Finally, I’m not sure that “is that ok?” is even the right question to be asking in these situations. Is it ok for you? If not, then don’t date that person. Otherwise, it’s not really relevant. Relationships with zero or minimal emotional support do exist; they’re casual hookup situations and they work great for some people.

As always with needs and boundaries, the more extensive yours are, the pickier you’ll have to be about your partners. If you need a partner who is able to support you through your mental illness at a very high emotional level, many people will not be a good fit for you, and it’s not because they’re selfish and emotionally withholding. It’s because your needs are in conflict.

Likewise, if you need a relationship in which Serious Conversations About Feelings and Relationship Talks are minimal, many people will not be a good fit for you, and it’s not because they’re clingy and suffocating. It’s because your needs are in conflict.

Of course, everyone always tells me that it’s not as simple as “just don’t date the person who isn’t a good fit for you,” because you have strong feelings for them and you can’t just get over them. This is true, and being unable to date someone you really want to date is never a good feeling no matter what the reason. But I’m not sure that being in a relationship with strongly conflicting needs is any better, unless you’ve made a plan with yourself/your partner about how those needs are going to be met (outside the relationship).

Instead, people tend to assume that being single (for now) is necessarily worse than being in a very emotionally mismatched relationship, and then end up blaming and resenting their partner for not meeting their needs or for having needs that the relationship cannot accommodate. The belief that romantic relationships should provide for all of one’s needs makes it both impossible to accept the relationship as it is, and impossible to leave it.

Gently guiding that belief to the grave where it belongs is a topic for another post, but understanding the fact that many couples have conflicting emotional needs and that this doesn’t make anyone wrong or bad is a crucial first step.

~~~

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What We Can Learn From a Reformed Troll

[Content note: online harassment & threats]

Many of us who have dealt with trolls online have spent a lot of time–to much, probably–wondering what motivated them, how they would justify their actions (or not), whether they would ever regret it or apologize.

Writer Lindy West actually got to find this out. After she publicly called out a troll who’d made a Twitter account impersonating her late father and used it to harass her (yes, that happened), he emailed her and apologized. He even donated money in her name to the Seattle Cancer Care Alliance, which had treated her father before he died. On an episode of This American Life, West called him and talked to him more about why he did what he did.

The conversation was both amazingly honest and also painfully unsurprising, at least to those of us who have dealt with this sort of behavior. The ex-troll admitted that he’d been in a really bad mental place when he’d made multiple accounts just to harass West. In the email he’d originally sent to apologize, he wrote, “I don’t know why or even when I started trolling you. I think my anger from you stems from your happiness with your own being. It served to highlight my unhappiness with myself.” In the TAL episode, he explained that he was overweight and unhappy with his body, and West’s public satisfaction with (and celebration of) her own weight made him resentful. Gender played a role, too:

Women are being more forthright in their writing. There isn’t a sense of timidity to when they speak or when they write. They’re saying it loud. And I think that– and I think, for me, as well, it’s threatening at first. …I work with women all day, and I don’t have an issue with anyone. I could’ve told you back then if someone had said to me, oh, you’re a misogynist. You hate women. And I could say, nuh-uh, I love my mom. I love my sisters. I’ve loved my– the girlfriends that I’ve had in my life. But you can’t claim to be OK with women and then go online and insult them– seek them out to harm them emotionally.

West added:

In my experience, if you call a troll a misogynist, he’ll almost invariably say, oh, I don’t hate women. I just hate what you’re saying and what that other woman is saying and that woman and that one for totally unrelated reasons. So it was satisfying at least to hear him admit that, yeah, he hated women.

Indeed, that level of self-awareness is pretty rare in anyone, let alone in men who harass and threaten women.

Although none of my really-awful trolls have ever apologized, one who used to mildly troll my comments section did, and confessed that it had to do with his own mental health issues that he was taking out on me and my blog. I became his outlet, the lightning rod for all his grievances with himself and the world. From talking to other women with a presence on the internet, I know my experience (and West’s) is not unique.

There is a lot to learn from the TAL episode. Although trolls/online harassers probably have a variety of motivations, there clearly is a subset of them that troll because they can’t or won’t deal with their own personal issues. I want to be very careful here and not do the whole blaming mental illness thing, but I also want to trust people who have mental illnesses when they say that their mental illness is what prompted them to do something shitty. That’s part of humanizing mental illness, too–acknowledging that sometimes, especially when untreated/unmanaged, it can cause people to act in ways that aren’t really in accordance with who they actually want to be.

But also, you need not have a diagnosable mental illness to be in a bad place in your head at some point in time. You need not have a diagnosable mental illness to believe on some level that it’s okay to outsource emotional caretaking to someone else. The common thread here isn’t “mental illness” but “people avoiding dealing with their own issues and taking their pain out on others,” which, as I’ve been discussing a lot around here, is a gendered phenomenon.

In the episode, West concludes:

If what he said is true, that he just needed to find some meaning in his life, then what a heartbreaking diagnosis for all of the people who are still at it. I can’t give purpose and fulfillment to millions of anonymous strangers, but I can remember not to lose sight of their humanity the way that they lost sight of mine.

That is what horrified me most about this whole thing, aside from imagining what it must’ve been like for West pre-apology. How on earth could a random writer on the internet give these people what they need–partners, friends, self-love, satisfying jobs? It’s a frustration that I’ve felt before.

When the episode first aired, I saw a lot of people hailing it as some sort of sign that, see, trolls really are people too, and they’re redeemable, and maybe if we just remember not to lose sight of their humanity, then they’ll see the light and stop trolling! (Note that although I’m borrowing some of West’s wording here, I absolutely don’t think she’s this naive. Not after everything the internet has put her through.)

It’s a nice thought. It means that the solution to the revolting bullshit people (mostly women) deal with online is neither to “just ignore it” nor to lash back out or ridicule or petition social media platforms for better moderation. It’s just to talk to them and figure out what’s making them hurt so bad.

You can probably see why this is unacceptable as far as general advice goes. As West said, women can’t take responsibility for healing all these strangers’ hurts. People in my field get paid good money to do that, and I’m not about to do it for free for someone I’ve never met who just called me a fucking cunt.

Moreover, though, I’m not sure that most trolls are “redeemable.” Buzzfeed writer Tabatha Leggett, who got rape and death threats after writing about watching The Simpsons (yes, really), recently described her experience contacting her trolls, and seems to have had a rather different one than West did:

The first guy was a stand-up comedian from Chicago. He’d left a meme that said “kill yourself” in the comments section. He insisted that leaving a meme was different to typing out the words “kill yourself”. “Anyone who knows the meme wouldn’t take it seriously,” he told me. “I just wanted to tell you to shut the fuck up.”

I told him that his comment, underneath the hundreds of other abusive ones I’d received, came across as threatening. He told me I was an idiot for feeling that way. I asked him why he felt the need to comment at all. Why not just avoid reading my stuff in the future?

“You might have other really good stuff that you write about,” he replied. “I just didn’t want you to write about The Simpsons again. I was like, shut up.”

Another man that she spoke to did apologize, but it’s unclear which of these reactions is more typical. Point is, sometimes no amount of emotional labor will extract an apology (let alone genuine regret). And even if it did, what difference does it make? The damage has been done, and there always seem to be more trolls willing to take the place of those who realize the error of their ways.

If there’s anything to take away from Lindy West’s interview with her troll, it’s that trolling is more about the troll than the target. However, note that many people are miserable and full of self-hatred and do not make accounts impersonating a writer’s dead father that they use to harass her. The ex-troll’s misogyny and our society’s tolerance of it probably played as big a role in his behavior as did his personal problems.

Unfortunately, we can’t magically heal everyone’s misery. We can stop blaming victims of harassment for that harassment, and we can institute some better social norms and institutional policies that help prevent harassment. People like Lindy West are part of the reason we’re finally having that conversation on any sort of scale, but it’s embarrassing how much we had to put up with before that conversation finally got started.

~~~

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Don’t Tell People How (Not) To Feel

[Content note: mentions of abuse, transphobia, & racism]

The more I do this–this writing/activism/therapy thing that I do–the more I’m coming to believe that there is almost never anything to be gained by telling people how to feel, or how not to feel.

In fact, I worry that doing so is at best neutral, probably manipulative, possibly cruel, and at worst abusive.

The most obvious examples provoke little disagreement from the social circles I move in–for instance, telling a person with depression to “cheer up,” telling a person with anxiety to “calm down,” telling a person who is angry to “stop being so angry,” telling a person who has suffered trauma to “just get over it.” These are all examples of telling people how to feel, or how not to feel, that most of us would recognize as wrong.

But the message that folks seem to get when we talk about this isn’t “telling people how (not) to feel is wrong,” but rather, “don’t tell people with mental illness/trauma history to get better because they can’t just do that on the spot.”

But what if they could? What if the cause of the emotions was something other than mental illness or trauma? Then would it be acceptable to tell them how to feel?

I think some people would say yes, at least in certain situations.

Emotions and morality are all bound up in our minds. We associate certain emotions with certain moral acts and other emotions with certain immoral acts (which with which may depend on one’s social group). Although there may be a correlation, of course, it’s probably not nearly as strong as people assume. Moreover, it’s much easier, in my experience, to change your behavior than to change your emotions. Even if you are neurotypical, but especially if you are not.

So we start to point to certain emotions, which we consider “markers” of certain immoral acts, as the problem. It’s wrong to feel angry or resentful when a potential romantic partner turns you down. It’s wrong not to be angry about injustice. It’s wrong to feel happy during a time when other people are sad. It’s wrong to fail to feel sad when Objectively Sad Things (like the loss of a loved one) happen.

I would argue that none of those are actually wrong, though. It’s wrong to guilt-trip, manipulate, or punish someone who doesn’t want to date you. It’s wrong to do absolutely nothing to make the world a better place despite having the ability to do so. But you can feel resentful at someone who rejected you without ever mistreating them, and you can actively make the world a better place without ever feeling angry about injustice.

It’s ironic that we use emotions as a proxy for actions when they are so much more difficult to change. You can change them, of course, but only with time and effort, and almost never right in the moment. Happiness is pretty easy to kill, as I was reminded very directly after Obergefell v Hodges came down, but it’s rarely replaced with the feelings that were intended to replace it. When people kept suggesting that anyone who feels happy after that decision is a terrible person who doesn’t care about other issues and naively believes that The Fight Is Over, I wasn’t suddenly full of fiery anger on behalf of all the LGBTQ folks who continue to face marginalization (including, by the way, myself). I just felt sad and defeated, and very condescended to.

Nevertheless, despite my happiness at the Supreme Court’s decision, I’m not done fighting. My actions speak louder than my happiness that particular day.

More importantly, though, I worry about the ramifications of assuming that we can and should tell people how to feel. If you tell someone to calm down or cheer up or get angry and they immediately comply, I’m not sure that that’s a healthy process. I’m not sure that it’s ultimately a good thing if people are able to change their emotions (or convincingly pretend to) as soon as someone demands it. To me, that sounds more like an abusive situation than anything else.

I’m also concerned because, once you learn (as many of us do at some point or another) that others are better than us at knowing what our emotions ought to be, that process of adjusting your emotions (or emotional expressions) to their expectations becomes par for the course. Certainly someone can claim that their particular reason for telling you how to feel is Very Important and For A Good Cause, but everyone claims that, including abusive people. Many people in my life could say that it’d be For My Own Good if I could just stop feeling sad on command. Many people have a vested interest in keeping us from being angry, or expressing our anger. Once you get in the habit of “correcting” your emotions at others’ request, it’s going to be, well, a habit.

Moreover, when people believe that it’s their emotions, and not their actions, that are problematic, they often try to push away and suppress those emotions because they are Wrong. They may even succeed for a while, but ultimately, this sort of project inevitably fails. (I’ve been there.) Suppressing Wrong emotions prevents self-awareness, which is exactly what you need to make sure that you don’t hurt people because of your emotions. Telling people their emotions are Wrong is not only ineffective, but counterproductive.

You might think that if you tell someone that their emotions are Wrong, they will immediately say, “Wow, you’re right, I will call a therapist and set up an appointment right away.” Wouldn’t that be nice. But that’s not how it works. Even if there’s a strong indication that someone probably needs to go to therapy, if you stigmatize them that way, they’ll probably believe that 1) the therapist would stigmatize them that way too, and 2) they’re a terrible person who doesn’t deserve help.

Unfortunately, I notice this a lot in people who are trying to figure out how to deal with romantic rejection, especially men. They hear that people (especially men) who get upset when they’re rejected do terrible things, and they hear that feeling upset is as much a problem as the actual doing of the terrible things. And I get that the message gets diluted a lot when we’re trying to deal with horrific shit like Elliot Rodger, but thankfully, the vast majority of people are not Elliot Rodger. Feeling upset or even angry when you get rejected is normal. You can work on it with a therapist (or with some helpful online advice) if you want, but what matters is how you act. That’s what makes you who you are.

What about emotions that are Truly Awful? What if someone is disgusted by trans* people? What if someone is terrified when they see a Black man approaching on the street?

To be honest, I don’t really know what to do with these emotions (and I’m perfectly willing to admit that I don’t know). Here people can make a convincing argument that these emotions actually do lead to actual harm done to marginalized people, which is true. Here, again, the problem is the actual harm done to these people and not what goes on in someone’s head, but what goes on in someone’s head is undeniably related to the actual harm done to these people!

Then again, these emotions don’t come from nowhere. They, like many emotions, come from thoughts or ideas. Those thoughts or ideas are, “People ought to be either Men or Women” (where “Men” or “Women” means “as traditionally defined by cissexist assumptions), “Black men are dangerous,” and so on. There’s no use in telling people not to be disgusted by trans* people and not to be afraid of Black men unless we address the ideas that are prompting those feelings. As someone who has experienced lots of such shifts in feelings over time as my understanding of power, privilege, and oppression has evolved, I can attest to this.

In sum, I don’t have all the answers on this, but I’m starting to believe that it doesn’t really do any good to police people’s feelings, even when they seem like the wrong feelings.

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Irrational Feelings are Still Valid, and Valid Feelings Can Be Irrational

Kate recently wrote about how sometimes, viewing your emotions as unjustified or irrational can actually prevent you from taking action to make them better. On the other hand, simply accepting all emotions as “valid” can also leave you with no way of trying to change them. To try to resolve this issue, she proposes a distinction between “local validity” and “global validity”:

Local validity is about noticing and responding to your current emotions as if they’re real emotions that are happening to you. Global validity is about reflecting about the trends and patterns of emotions and how well you think they’re grounded in a realistic view of the world.

Irrational and invalid aren’t the same thing. We can go wrong when we believe that any emotion that’s irrational must therefore be invalid, but we also go wrong when we believe that any emotion that’s valid must also be rational. (I think the latter error is made less often, but it’s true that some people feel that because emotions are “valid,” they must simply accept them as they are.)

In social circles where rationality is very highly valued, it can become difficult to tell others about how you’re feeling when you think that your feelings are irrational. Sometimes we fear judgmental responses from others (“But that makes no sense! Of course I don’t hate you! How could you possibly believe something like that?”). Other times, we may trust that people will be supportive, but we still don’t want to come across as someone who has a lot of “silly” or “irrational” feelings.

In this way, sometimes, people in social circles that have more traditional approaches to relationships and communication are at a slight advantage. For instance, suppose Sally is in a traditional monogamous relationship with Bob. Sally might feel totally comfortable telling Bob that she’s jealous when Bob spends time with his friend Susie. Sally might even feel comfortable expressing anger about this.

Of course, the resulting conversation might not necessarily be productive–Bob might just agree not to spend time with Susie anymore, or he might react angrily and tell Sally that she’s being “crazy.” But in my social circles, we often wouldn’t express feelings like Sally’s at all. We feel that being progressive/feminist/polyamorous/rational/whatever means we shouldn’t feel jealous when a partner spends time with a friend (or another partner), because that’s irrational, and therefore that feeling should be ignored rather than brought out into the open.

And so a lot of us end up trying to ignore or cope with these feelings alone. Where Bob might hug or kiss Sally and reassure her that he loves her, we get ice cream and Netflix. (Or maybe that’s just me. Seriously, I am Extremely Bad at this.)

The difference is that many people in traditional monogamous relationships treat jealousy as normal, even healthy, even a sign that you really love someone. Expressing jealousy in the context of these relationships can be a completely acceptable thing, like telling your partner that you’re annoyed that they didn’t tell you they’d be home late, or that you’re sad that they can’t spend the holidays with you and your family. I don’t want to borrow traditional monogamous folks’ ideas about jealousy necessarily, but I want to borrow their norms about expressing it and expecting your partner to hear you and respond lovingly to you even if the jealousy is “irrational.” (Yes, yes, #notallmonos.)

But as Kate’s example shows, this tendency to conflate “irrational” and “invalid” doesn’t just apply to relationships and decisions about whether or not to tell others how we’re feeling. I have a hard time engaging in self-care practices that help if I don’t feel like there’s a “rational” reason to feel the way I’m feeling.

For instance, if someone was mean to me or I had an awful day at work, I acknowledge those as “good” reasons to feel bad, and in response, I might ask friends for support or spend some money on something that brings me joy.

But if I’m feeling bad for reasons I think aren’t “good,” such as being jealous of someone or completely randomly, then I don’t feel like I have the “right” to ask for support. I don’t feel like it’d be justified to take time off of my responsibilities to do something pleasant to improve my mood. So I just sit there and suffer through it.

In a blog post, Malcolm writes about how it can be useful to “step outside” of one’s own feelings. To help someone else do that, you might ask them, “What feelings came up for you during that?” rather than “How do/did you feel?” The latter question makes people identify with a feeling in ways that the former doesn’t. To say that sad feelings came up for me feels different than saying that I am (or was) sad. He adds:

Our sociolinguistic context is full of maxims like “that’s just how I feel” or “I can’t help how I feel” or [INSERT OTHER EXAMPLES]. We don’t necessarily take them seriously, but they add to the confusion of what someone might mean when they say “I feel X”. A bunch of questions you could (mentally or verbally) ask in response:

do you endorse feeling X? do you think that feeling X makes sense?

would you like me to address (my reassurance, etc) towards the feeling, towards its causes, or towards you as the experiencer of the feeling?

is that all you’re feeling?

how do you feel about having that feeling?

do you see a way out of the feeling or does it feel all-consuming or inevitable?

Questions like these, when asked of yourself, can make it a lot easier to communicate feelings that you think are irrational. For instance: “I don’t endorse this feeling, but I’m jealous about your date with ____.” “I know this doesn’t make sense, but I’m sad about leaving for vacation tomorrow.”

And on the flip side, when people share feelings like these with us, I think it’s important not to jump too immediately to “Your feelings are valid” or “It’s okay to feel that way.” Those are very important and worthy sentiments, but for many people (such as me), they can contribute to a defeatist sort of attitude: “Well, I guess it’s ok that I’m just going to feel depressed every time a friend succeeds at something I haven’t, since that’s a valid and okay way to feel.” Often, “valid” starts to mean “unchangeable.”

Here, Malcolm’s example question, “How do you feel about having that feeling?” can be very helpful. If someone says they’re ashamed or embarrassed or having difficulty accepting that this feeling is even happening, validation can be very helpful. But if they say they’re frustrated by having to deal with the feeling, or they understand where it’s coming from but still wish it weren’t happening, then validation can unintentionally send the message that they should just accept it.

Some of this, I think, is a question of where someone is in their own process. Years ago, I was unable to fully acknowledge my depressive feelings because I didn’t understand that I had depression, and kept trying to convince myself that I “should” be happy given all the good things I had going for me. At that point, if someone had told me that sadness/depression is a valid feeling, that might’ve been a revelation.

Nowadays, I’ve basically accepted the fact that I have depression and that that brings with it depressive feelings. At this point, reminders that my feelings are “valid” are pretty much useless. I want to change them! And in order to change them, I have to understand how they’re irrational, how they’re set off, how to counter those automatic processes, and basically how to tell myself a better story about my life.

Ironically, both of these counterproductive processes can happen for the same person. Sometimes I refuse to treat my feelings as valid simply because they’re irrational. Other times, I have trouble changing irrational feelings simply because I’ve accepted that they’re valid. Depression feels so real that changing it seems impossible. But it’s not.

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Note that I intentionally avoided getting bogged down in what exactly “rational” and “irrational” and “valid” and “invalid” mean. If this post doesn’t make sense to you, we’re probably working from different definitions, and that’s okay. Another blog post, another day.

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Setting Boundaries With Your Therapist

It’s a rare relationship that doesn’t require any boundary setting, and the therapeutic relationship is no exception.

Setting boundaries is something many people find difficult for all sorts of reasons–fear of rejection, uncertainty over whether or not your desired boundaries are legitimate (spoiler alert: they are), a history of getting bad reactions from people when setting boundaries with them, and so on.

It’s especially difficult to set boundaries with people you perceive as having more power than you, whether they actually do or not. Therapists are often perceived as having power over their clients because of their expertise and authority, and because it can feel like your therapist is holding your mental wellbeing in their hands. Sometimes that power is more tangible–for instance, in cases where counseling is mandated or when the client needs their therapist to sign off on or approve something. And sometimes that power is compounded by structural factors, like when a client of color works with a white therapist or a queer client works with a straight therapist.

Although these power differentials are real and have consequences, it might be helpful to reframe the client-therapist relationship slightly. Namely: you, as a client, are employing your therapist. Your therapist works for you. Most likely, either you or your insurance company (or both) are paying this therapist, not the other way around. If your therapist isn’t helping you, or is doing something that you find harmful, you have a right to let them know and to expect them to fix the problem. You can fire a therapist who is failing to help you just as you can fire anyone else you hired for some task or service that wasn’t done to your satisfaction.

Some therapists may reject this framing because it feels too consumer-y, or because they worry that this will cause clients to leave them. But I would argue that we shouldn’t be using social norms to trap clients in therapeutic relationships that aren’t working for them, and also, this framing is directed more at clients than at therapists, because I think it will help them feel a greater sense of control over their therapy.

How to know when you need to set a boundary

Therapy can be uncomfortable sometimes. But it should be uncomfortable in ways that mesh with your goals. For instance, if your goal is to learn how to ride a motorcycle, but you’re scared of riding motorcycles, you’re going to be rather uncomfortable. That’s normal and okay. However, if your goal is to learn how to drive a car, and someone is pressuring you to ride a motorcycle instead, that’s not a normal and okay sort of discomfort.

If your goal is to form healthier, more stable relationships with others, you might be uncomfortable when your therapist notes that you seem to assume negative things about people without evidence. You may disagree with your therapist’s observation, at least at first. You may even be right. You may think, “How dare they tell me I assume the worst of people!” But that discomfort is part of the process. Even if your therapist’s observation turns out to be wrong, both of you have gained from this. You’ve gained greater understanding of you. But if your therapist’s observation turns out to be right, then you’ve especially gained.

On the other hand, if your goal is to form healthier, more stable relationships with others, and your therapist suggests that maybe it would help if you accepted Jesus into your life, the discomfort you may feel (at least if you don’t already believe in Jesus) is not part of the process. You and your therapist are at cross purposes. You have already decided that Jesus is not for you.

Not all examples of boundary-crossing are that obvious, however. Many people who go to therapy to deal with trauma report that therapists ask them invasive questions about the trauma, questions that they’re not ready to answer before more trust is built or before they work through things a little more. However, some therapists were trained that they should push for details about traumatic events because talking it all through in detail helps people heal. This theory has since been complicated quite a bit.

Even if sharing all the details of a traumatic event necessarily helped people heal, though, it is crucial that therapists understand that just because the therapy office should be a space where clients feel comfortable sharing anything, that doesn’t mean it automatically is. It can be triggering for survivors of trauma to reveal intimate details about what they went through to someone who is still basically a stranger to them. It’s perfectly legitimate for them to shut down certain avenues of questioning and to expect therapists to respect that boundary until they are ready to shift it.

Setting a boundary vs. firing

When do you ask a therapist to stop doing something that isn’t ok with you, and when do you simply stop seeing them? In most cases, the answer probably depends on what happens when you try to set a boundary. If your therapist refuses to respect your boundary or argues with it, it might be a good idea to find a different one.

(Note, though, that they might agree to respect your boundary but still ask you questions about the boundary itself. While this can feel uncomfortable, I think that’s usually that better kind of uncomfortable–your therapist needs to understand you and your boundaries in order to be able to help you, and it may also help you to process your reasons for needing the boundary.

For instance, when a client says that they can’t talk about something [yet], I won’t push them to talk about it. Instead, I might say, “How do you feel when you imagine telling me about this?” or “What happened last time you tried to talk about this with someone?” That yields a lot more information than “I really think you should tell me,” and is more compassionate.)

Another way to tell whether to boundary-set or leave is this: think about what it would take for this situation to be okay. For instance, suppose your therapist mentions that attending church might be a helpful way for you to cope with depression because that’s what helped the therapist. This makes you feel really uncomfortable and you don’t want to hear anything else about the supposed benefits of religious observance from your therapist. Imagine you say, “Please don’t mention religion to me anymore; I’m not religious and am absolutely not interested in attending church or hearing anything else about church.” Imagine your therapist responds, “Okay, absolutely. I won’t mention it again.” Does this feel okay to you? Are you okay continuing to open up to someone who might believe that you’d do better if you went to church (but doesn’t say so out loud), or are you still uncomfortable?

If you continue to feel uncomfortable no matter how well the therapist responds to your boundary-setting, then you might need to find a new therapist. The strength of the relationship between a client and therapist is the best predictor of the effectiveness of the therapy, so if you can’t trust or feel comfortable with your therapist, they’re unlikely to be able to help you.

Scripts for setting boundaries

In many ways, setting boundaries with a therapist doesn’t work much differently from setting boundaries with other people. Just as I might ask my friends not to talk about weight loss around me, I might ask my therapist not to mention weight loss in therapy. Just as I might ask a partner not to ask me about [topic], I might ask a therapist not to ask me about [topic].

One difference, though, is that it might be really useful in therapeutic boundary-setting to explain why you’re setting that boundary. With other people in our lives, that’s not always necessary and may be too scary/risky–I don’t want to disclose my history of disordered eating every time I ask someone not to talk about weight loss with me. Your boundaries are your boundaries whether your reason for them is one that others would consider “legitimate” or not. (All boundaries are legitimate.)

But a therapy situation, telling your therapist why you need this boundary gives them useful information that will allow them to help you better. If you say “please don’t mention weight loss because I have a history of harmful behaviors around that,” they might know what else not to mention, or what to ask for permission before mentioning. Knowing that you have a history of harmful weight loss behaviors helps them understand your psychological history and know what to look out for in the future.

Here are some specific examples of ways you can set boundaries with a therapist:

“Please do not ask me about my weight or dietary habits. It’s a trigger for me because of past issues with disordered eating.”

“Actually, I didn’t ask for advice. Please either ask me before you give advice, or wait for me to ask for it myself.”

“The issue I came here to work on was my depression, not my relationship with my parents. Let’s keep our discussion focused on my depression as it’s affecting me right now, because that’s what’s causing the most problems for me right now.”

“I’m not ready to talk about the stuff that happened with my brother when I was little. You can ask me again in a few weeks and I’ll let you know if I’m able to talk about it then.”

“My identity as an atheist is not the reason I’m struggling with depression. If you continue to suggest that my mental illness is caused by atheism, I won’t feel comfortable coming here anymore.”

“I do not believe in karma, Zodiac signs, or any other superstitions. Please stop bringing them up in our sessions and stick with what can be tested scientifically.”

“I need you to stop suggesting that it’s my fault that I’m being bullied. Even if there were some truth to that, it feels like you’re putting all the blame on me and it’s preventing me from opening up to you about things.”

It may feel somehow manipulative to tell a therapist that you won’t tell them things or come back to therapy if they don’t respect your boundaries, but it’s also true. You can’t effectively work with a therapist you can’t trust, and they need to know that.

Also, while I certainly don’t think you should be intentionally mean, don’t worry about the therapist’s feelings. It’s our job to worry about our feelings, and your job to be as direct and open with us as you can be.

When setting boundaries is a challenge

As I mentioned, most people find boundary-setting difficult, especially in situations where they feel that they have less power than the other person. If you’re finding it so difficult to set boundaries with a therapist that you’re unable to speak up about it at all, here are some suggestions:

  1. Practice first. You can practice in front of a mirror, alone in the dark, with a friend–whatever works for you. If you’re practicing with a friend, you can tell them a little about your therapist and what they’ve been doing that’s problematic so that they can roleplay as the therapist. Make sure to be clear with your friend about what you want them to do in the roleplay–for some people, roleplaying “worst case scenarios” (for instance, your therapist arguing with you and refusing to respect your boundary) can be useful because it allows them to prepare; for others, it might just be really anxiety-provoking.
  2. Write it down and bring it to session. If you don’t feel like you can come up with the right words on the spot, write them down and bring them to therapy with you so you can read them or at least refer to them. It might sound weird, but you won’t be the first person who’s done it. Many therapists actually encourage clients to do things like this, because anything that helps facilitate communication in therapy is probably a good thing.
  3. Write it down and email it. Although we often hear about the virtues of Real Face-To-Face Communication, I’d say two things here: 1) text-based communication is also a real and legitimate way to discuss difficult things, and 2) the perfect is the enemy of the good. If you are so uncomfortable bringing something up with your therapist in a session that you’re not going to bring it up at all, try doing the next best thing, which is emailing them. That way, you’ll have ample time to think about what to say and run it by trusted people if you want to. Know that your therapist may respond by asking you to bring this up with them in the next session, so you’ll probably still need to discuss it with them in person, but that initial email can help open the floodgates.
  4. Be transparent with your therapist. You can say something like, “Setting boundaries is really hard for me, so I’m having trouble finding the words for what I’m trying to say,” or “I’m really uncomfortable with something you said in the last session, but I’m scared of bringing it up.” A good therapist will know how to guide you through this and help you speak up.
  5. Don’t worry about bringing things up days or weeks after the fact. You don’t have to have a perfect, firm, concise boundary-setting comeback right away. It’s totally normal in therapy to bring up things that happened a few sessions back. It’s never too late to make sure that therapy is meeting your needs.

Conclusion

Sometimes all people need to hear to be able to set boundaries with their therapists is that they have the right to. Always remember that. Your therapist works for you. Your therapist has expertise, yes, but they are not the expert on you individually. You know way more about yourself and the boundaries you need than any therapist can ever know.

It is true that some of the boundaries you may set may delay your growth or recovery, or make it more difficult for your therapist to understand what’s going on with you. However, what delays your growth or recovery even more is feeling unable to trust your therapist or connect with them. A boundary isn’t a permanent brick wall. It’s a fence. Two people can stand and chat from opposite sides of a fence, and over time, you can choose to build a gate in the fence and open it up, or close it again.

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