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 . . .


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.


*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.


If you enjoyed this post, please consider supporting me on Patreon!

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.


If you enjoyed this post, please consider supporting me on Patreon!

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.


If you enjoyed this post, please consider supporting me on Patreon!

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.


If you enjoyed this post, please consider supporting me on Patreon!

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.


If you enjoyed this post, please consider supporting me on Patreon!

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.


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.


If you enjoyed this post, please consider supporting me on Patreon!

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.


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.


If you enjoyed this post, please consider supporting me on Patreon!

Reaching Out for Support When You Have a Mental Illness

[Content note: mental illness]

After having written tons of posts about supporting people with mental illness, I realized that there was a gap–I’ve seen few articles about how to reach out for support when you’re the one with the mental illness. Specifically, how to do so in a way that’s respectful of people’s boundaries.

This is a difficult topic, for reasons that I think are obvious. I don’t want to discourage anyone from reaching out for help, ever. I also want to encourage people to be mindful of others’ needs and boundaries, even when everything hurts so much that that feels impossible to do. Especially then.

Why do these two goals feel like they stand opposed to each other? They shouldn’t. Getting affirmative consent before sharing difficult and potentially-triggering things with people isn’t just good for them, it’s also good for you. Most of us who struggle with mental illness have our moments of panic about imposing on others or being a burden on them. Making sure that we’re actually getting their consent before leaning on them for support can help us with those feelings.

I’ve been on both sides of this. I’ve been the depressed and suicidal person who had to reach out for help, sometimes in ways that didn’t really allow people to say no. I’ve also had people reach out to me in ways that made me feel trapped and coerced. So I think I have a lot of empathy for everyone in both of these situations.

This is a huge topic and this post is very long, but it still doesn’t cover all the nuances. This post is focused on the issue of consent and boundaries specifically, so please don’t be too disappointed if it doesn’t cover everything you thought it would. Suggestions for future posts are welcome as always.

Consent, Consent, Consent

The most important thing about reaching out to someone for support with a mental health issue is to explicitly ask for their consent to have this conversation. This means that, rather than sending them a sudden wall ‘o’ text on Facebook, you might first say, “Hey, can I vent to you about depression for a bit? You can respond whenever you have a moment.” Or in person, if the topic hasn’t come up organically in a way that suggests that they’re ready to hear about it, you might say, “Can we talk about some ED stuff I’m going through right now?”

If you want to talk to someone about things that are fairly likely to be triggering–examples include self-harm, suicidal ideation, eating disorders, homicidal ideation, and so on–it’s a good idea to include a content note. In a message or text, that can just look like “TW: anorexia”; in person, you might say, “Can I talk to you about some eating disorder issues I’m having. I might get into detail.” This is important because 1) the person you’re talking to might have their own issues, which you may not necessarily know about; 2) they may be in a space right now where seeing a sudden wall of text about a very serious topic might really stress them out; and 3) regardless, people can often help you better if they have some idea of what you’re going to talk to them about, especially when it’s something pretty serious like that. When I see “Hey, can I talk to you about anorexia?”, I put myself in a different headspace than when I just see “Hey, can I talk to you about some stuff?”.

When you message someone to talk to them about Heavy Stuff and do not give them a warning about the content or an opportunity to politely bow out, understand that you are making it very difficult for them to say no to you, especially if they’re not someone who feels comfortable asserting boundaries (and most people aren’t). You may not intend to make them feel this way, but that’s the effect it often has when you don’t check in to see if it’s okay first.

I’ve gotten sudden walls ‘o’ text while in class, while on dates, when I was just about to fall asleep in bed, while finishing an assignment on deadline, and all sorts of other inopportune times. It put me in a serious bind, because on the one hand I had a really serious message demanding my attention, and on the other hand, I had things that I needed to be doing. When someone suddenly sends me five paragraphs about having an eating disorder and being suicidal, it feels incredibly wrong to say, “I’m really sorry, but I’m busy right now and can’t talk.” I usually do it, but that’s only because I’ve developed very strong boundaries over the years. Most people haven’t.

Another way that you may unintentionally make it difficult for people to set boundaries is by getting their consent for a certain type of conversation (“Hey, got a minute to chat?”) and then, once they agree, making it clearly way more than a minute and more than just a “chat” (“So I’m really really depressed and I think I’m about to lose my job and I just don’t know what to do, I’m almost out of savings and–“). Phrases like “got a minute to chat” and “hey what’s up” are vague, sometimes intentionally so. Once someone gets into a conversation with you, it’s almost impossible to then be like, “Um, actually, I thought this would just be a casual chat; I’m not really available for a conversation like this right now.”

If someone tells you that no, they cannot talk/listen right now, respect that answer, even if it feels unfair or unreasonable. They may in fact be lazy. They may in fact be selfish and callous. They may in fact completely not understand what you’re going through and if they did then they’d listen. They may in fact just be shallow people who want everything to be sunshine and daisies all the time. They may be all of those things, but they still deserve to have their boundaries respected.

The Importance of Being Specific

Consent is one reason why, when you’re reaching out to someone for support, it can be helpful to be as specific and clear as possible about what you need from them. (I say “as possible” because that can be really difficult when you’re in a moment of crisis.) If they know what they’re being asked to do, then they can actually consent to it. But taking a moment to think about what you need from others right now will help you, too–it’s easier to get what you need if you know what that is and ask for it:

“Hey, I need to just vent at someone about some depression stuff. Would you be able to listen for a bit?”

“I’m feeling down and it would be helpful to distract myself. Could you come over and play video games with me?”

“I’m feeling unsafe tonight. Is it ok if I spend the night at your place and just do my own thing with someone else in the room?”

You may, like me, be concerned that if you let people know you’re having a hard time, they’ll try to offer you types of help that you don’t need. In that case, it can be a good idea to be clear about what you’re not looking for, too:

“I’m going through a really rough time. I don’t really want to talk about it, but could we just chat for a while about something else?”

“I’m having a really bad day. I’m not really up for talking to anyone, but could you send me some cute animal videos?”

What if you want support but have no idea what would help? In that case, being specific is clearly impossible. I think it’s better to be transparent and say something like, “I’m feeling really bad and to be honest I don’t know what would help right now. I just wanted to reach out to someone.” Hopefully, your support person might have some ideas about how to help or what to say.

The reason this sort of transparency is helpful is because otherwise, the person might assume that you do need something specific and you know what that is, but that they need to somehow intuit it. Or they may ask you what they should do, which can be stressful for you to have to respond to.

As a more long-term strategy, though, it might be helpful to try to figure out what other people can do that would help you feel better, so that you know what specifically to ask for from them. If you have a therapist, they can help with that project. If not, you can ask others who struggle with similar issues (maybe on a support forum if you don’t know anyone personally) what works for them. Just because you have similar issues doesn’t necessarily mean the same things will work for you, but there’s a good chance you’ll find something.

Why This Can Be So Hard

Back to the issue of boundaries. For many of us, the pain of mental illness is so strong that it’s hard to empathize with someone who says it’s too much for them to hear about. Resentment can build. You think: “They can walk away from this conversation, but I have to live with this my whole life.” When someone is unable to listen to us talk about how awful we’re feeling, that can kick up those feelings of resentment.

But just as we ask our friends, partners, and family members not to take it personally that we have a mental illness, we should try not to take it personally when they have their own feelings and limits. There’s a reason psychologists have a concept called “vicarious traumatization,” and a reason why therapists and social workers have such high burn-out rates. Of course, you may not be asking them to do anything close to what a therapist does, and they may not experience it as “traumatization,” but the point is that being very close to someone’s pain can have an impact. In addition, your support people may be dealing with their own mental health issues, which you may or may not know about. They may want to listen to you, but may be unable to because of what it brings up for them.

One last thing I want to say about this is that for me personally, depression made it really difficult to see how my own pain was hurting others. I don’t mean in that awful way that we talk about, where people take our pain as a personal insult or expect us to be happy all the time. I mean that seeing someone you love in pain hurts. Legitimately. But when I’m depressed, I think I’m so awful that I don’t understand how anyone could possibly care that I’m hurting–even though I reach out to them with the hope that they’ll listen. (Mental illness causes many such contradictions.) And when they say that they care so much that it’s really difficult for them to hear about it, it sounds like they’re insulting and patronizing me, presumably to “get out” of having to listen to me. That this perception is often wrong is something that I had to recover from the worst of it before I could understand.


Reading this, you may realize that you have overstepped boundaries in the past. (Or maybe you already knew this.) Mental illness can make people feel like they’re horrible and deserve to die, and realizing that you have overstepped boundaries may exacerbate this.

Try to be gentle with yourself. Mental illness can provoke boundary-crossing behavior, and while it’s important not to use this as an excuse not to work on it, it also means that you’re not a terrible person, and you can get better–both in terms of boundaries and in terms of your symptoms themselves.

Talking about this issues presents what The Unit of Caring refers to as a competing access needs problem. Some people will really benefit from this advice. Some people may already be so terrified of violating boundaries that they almost never ask for the help they need. (This may be surprising given that I wrote this post, but I’m squarely in the latter group.) Mental illness also complicates matters in that people may simultaneously be excessively terrified of crossing boundaries, while also sometimes crossing boundaries!

If you feel that implementing this advice will do harm to you, then don’t implement it. However, I would posit that it would actually be helpful for most people, because my core message here isn’t “You should be Very Very Careful about not violating anyone’s boundaries,” but rather “Hey, here’s how to reach out for help in a way that respects people’s boundaries.”

Supportive People Who Aren’t Really

One reason you may be terrified of crossing boundaries is because you may have done your due diligence and followed all this advice and then still had people tell you that you’ve overwhelmed and burdened them and they never wanted to help you this much but felt obligated to. There’s a lot going on here, such as:

  • Poor boundaries on the part of those people
  • People being used to passive communication and reading unspoken messages into your words that you never put there (such as, “If you don’t help me I will hate you/hurt myself/etc”)
  • A duty-centered view of relationships (believing that being your friend/partner/family member obligates them to help you whether or not they want to or can safely do so)
  • Simple ableism: believing, however implicitly, that your mental illness makes you so weak and helpless that they are ethically obligated to help you, no matter at what cost to them

The plentiful existence of people who act in these ways makes it difficult to talk about boundaries and mental illness. If we’re constantly accused of being burdensome and asking for too much no matter how careful we are, that can easily obscure the fact that sometimes we really do reach out to people in ways that make them feel like they can’t say no. But remember: both of these things can be true, and are true. They sound contradictory but are not.

There’s no simple way to fix this problem. If you’re not sure whether or not you’re being mindful of boundaries, it might be worthwhile to consult a friend that you trust to be honest and ask them for feedback. And if you notice that there are people in your life who keep telling you that it’s okay to vent about your feelings or to ask them to take you out for ice cream but then it turns out that they never wanted to help you and only did it out of a sense of obligation, it might be time to downgrade these people from “friend that I ask for mental health support” to “acquaintance that I talk about Marvel films with.”

Whatever their reasoning for not being honest (or not being aware enough of their own needs to be able to be honest), it’s not a healthy dynamic. It’s the sort of dynamic that leads many of us to feel like such awful burdens all the time. It’s the sort of dynamic that can make it really difficult to take this blog post seriously, because if people are constantly calling you a burden when you’re not, you may not be able to recognize the ways in which you might actually be crossing boundaries.

Of course, supportive people are difficult to come by and it can feel counterintuitive to stop going to these people for support when they seem to be acquiescing. (And if you ever feel like it’s a matter of life or death, please, do whatever you need to do to keep yourself safe.) But they’re not, in fact, supportive people. If they were, they would properly set boundaries with you in a way that’s compassionate but still assertive. Pretending to consent and then blaming you for believing them is an unkind and unsupportive thing to do.


If you are in crisis and do not feel safe, and none of your support people are available to talk to, please call 911, go to the ER, or call one of these hotlines if you don’t feel safe doing the first two things:

  • National Suicide Prevention Lifeline
  • The Trevor Project (for LGBTQ youth)
  • Trans Lifeline

Some Advice on Supporting Friends with Depression

This Captain Awkward post about supporting friends with depression has been bouncing around in my head ever since I read it when it was first posted last August.

Since I’ve been having my own little depressive episode since December or whenever that was, I’ve been wanting to shout this entire post from the rooftops (except, of course, I don’t have the energy). I’ll highlight this part in particular:

I think one thing you can do to help your friends who are depressed is to reach out to them not in the spirit of helping, but in the spirit of liking them and wanting their company. “I’m here to help if you ever need me” is good to know, but hard to act on, especially when you’re in a dark place. Specific, ongoing, pleasure-based invitations are much easier to absorb. “I’m here. Let’s go to the movies. Or stay in and order takeout and watch some dumb TV.” “I’m having a party, it would be really great if you could come for a little while.” Ask them for help with things you know they are good at and like doing, so there is reciprocity and a way for them to contribute. “Will you come over Sunday and help me clear my closet of unfashionable and unflattering items? I trust your eye.” “Will you read this story I wrote and help me fix the dialogue?” “Want to make dinner together? You chop, I’ll assemble.” “I am going glasses shopping and I need another set of eyes.” Remind yourself why you like this person, and in the process, remind them that they are likable and worth your time and interest.

Talk to the parts of the person that aren’t being eaten by the depression. Make it as easy as possible to make and keep plans, if you have the emotional resources to be the initiator and to meet your friends a little more than halfway. If the person turns down a bunch of invitations in a row because (presumably) they don’t have the energy to be social, respect their autonomy by giving it a month or two and then try again. Keep the invitations simple; “Any chance we could have breakfast Saturday?” > “ARE YOU AVOIDING ME BECAUSE YOU’RE DEPRESSED OR BECAUSE YOU HATE ME I AM ONLY TRYING TO HELP YOU.” “I miss you and I want to see you” > “I’m worried about you.” A depressed person is going to have a shame spiral about how their shame is making them avoid you and how that’s giving them more shame, which is making them avoid you no matter what you do. No need for you to call attention to it. Just keep asking. “I want to see you” “Let’s do this thing.” “If you are feeling low, I understand, and I don’t want to impose on you, but I miss your face. Please come have coffee with me.” “Apology accepted. ApologIES accepted. So. Gelato and Outlander?”

I think it’s a natural impulse to assume that the only way you can help someone who’s in a lot of pain is to try to address it directly, that maybe if they Vent to you and Get It Off Their Chests then they’ll feel better, and maybe sometimes they do, but I never did. I’ve written before that a lot of unnecessary pain and drama happened in my life because people thought they were willing to hear me vent and I thought it would be a good idea to take them up on the offer.

I truly believe that all of these folks mean well, but I truly believe that they don’t really understand depression, because they treat it like it’s just a LOT of sadness. Like it’s just like getting fired from five jobs at once, or being dumped by five partners at once (hey, if you’re poly, it could happen), or having a Really Bad Day where literally every single thing that could go wrong goes wrong, from getting humiliated in front of the whole office by your evil boss to losing your keys to walking into the subway station just as the express train pulls away to realizing you’re out of toilet paper right when you need the toilet paper.

Those things are not like depression. Those things are just really shitty.

One thing about depression is that it makes it really difficult to access the parts of your life that are genuinely good. For some people, this takes the form of anhedonia–losing pleasure or interest in things you used to enjoy. Not necessarily completely or all of the things, but sometimes completely and all of the things. For some people, this can mean that watching their favorite show or playing their favorite game is suddenly not fun anymore. For some, it can mean that trying to socialize with their good friends feels like reading a really boring story and not being able to actually interact with the story in any way. For others, it can mean not perceiving food as tasty anymore.

Another way this plays out is that you may still enjoy things, and know that you enjoy them, but lack the motivation to make those things happen. This seems very common. It’s a big part of depression for me. I do still enjoy spending time with my friends, but it usually doesn’t occur to me to invite them to do anything or to chat with them online, and if it does occur to me, I immediately come up with a bunch of reasons why I can’t do it and then I forget about it and end up reading for hours instead. Sometimes writing is this way for me too. But if I can just find a way to do the thing, I almost always find that it was worthwhile and wish I’d done it sooner.

So Captain Awkward’s advice about connecting with friends with depression is very on-point. If you just plop the ball down in their court, they’re probably going to look at it in confusion for a little bit and then toss it off into the bushes (possibly with a lot of shame and guilt). If you walk over, offer them the ball, and let them know how they can throw it back if they choose to, they’re much more likely to throw it back.

So here are some well-intentioned but not very helpful ways that people try to do this, and some better ways.

Less helpful: “We should hang out sometime!”*

More helpful: “I’d love to hang out if you’re up for it. Want to do that on Thursday night?” [if no] “Ok! Should I ask again next time I’m free?”

Less helpful: “Let me know if you need help with anything.”

More helpful: “Is there any way I can help?”

Even more helpful: “If it would be helpful for you, I’d love to [cook you a meal once a week/help you find a therapist/watch TV with you when you need a distraction. What do you think?”

Less helpful: You can talk to me if you need to.

More helpful: What helps you feel better when you’re feeling depressed? Is that something I can help with, and that you’d want me to help with?

Sometimes a friend with depression will say no to a lot of things and decline all or most of your invitations. This can make you feel like you’re overstepping boundaries and should immediately leave them alone until they reach out to you themselves. Pay attention to this feeling: it’s true that when people keep saying no to things you ask, it’s probably a good idea to stop asking. However, depression can also cause people to say no while wishing they could say yes.

The way to deal with this is not to assume, but to just ask directly: “You’ve said no the past few times I’ve invited you to do something. That’s okay, but I just wanted to check: would you like me to keep inviting you?” I’ve done this before with other people dealing with depression and found that they often respond that they do want me to keep asking, and they hope that one of these days they’ll be able to say yes.

For many people, depression causes a pervasive sense of disconnection from the world and from other people. When I’m having a depressive episode, I feel like I’m not part of anything, like I’m just one person and I don’t matter, like I could disappear and nothing would even change, etc. I feel like there’s a glass wall between me and everyone else. I feel like I can’t do “normal” things like laugh at a sitcom or make someone happy or fall in love. I feel like an alien sent here to try to learn how to act like a human being only I’m completely failing.

So for me, the most helpful thing that someone can do is to help bring me back into connection with others. This is why I find venting mostly useless. When I’m venting, I’m still only talking about my depression, and while the person I’m venting to may be very kind and a very good listener, this isn’t something we can connect over, you know? It’s not the same as a two-sided conversation about difficulties we’ve dealt with in our lives. It’s totally one-sided. It’s just me, talking about the exact thing I need to learn how to stop ruminating over.

Helping a depressed person feel more connected to others is a tall order even for the most empathic friend, but there are some things friends can do that might be helpful, some of which Captain Awkward mentioned.

One is to ask for their help with something they’re good at. Make it clear that you really value this person’s skill or experience with this thing. This helps them feel that they have something to offer others, which is a feeling that’s pretty thin on the ground when all you can think about is how sad you are.

Another is to talk to them about some of your own struggles. I’ve always found that hearing about other people’s problems gets me out of my head a little by activating my empathic or problem-solving sides (depending on whether they’re just sharing, or asking for advice). It’s also a reminder that everyone struggles, even if the magnitude of that struggle varies for different people at different points in time. This may be somewhat specific to me, but seriously, the kindest thing someone can do for me when I’m depressed is to talk about their problems–it means I don’t have to talk about myself (hard to do when all I can say is “yup, still sad”) and I also don’t have to pretend to be happy while they share happy things (as much as I wish I could just be happy for others when I’m depressed, that is basically impossible).

Another is to plan fun things with your circle of friends, if you share one, and include them in that. While not everyone is up for group things, especially when they’re depressed, I personally find it more helpful than hanging out with someone one-on-one. When I’m with a group of friends, there’s inside jokes and lively discussion (that I don’t have to personally initiate!) and it makes me feel like part of something again. Seriously, last month I spent a week in Minneapolis (where I have a shocking number of close friends) and my depression was basically on hiatus that whole week, because I was just always surrounded by great people that I trust and care for, and they were being interesting and/or funny all the time, and it was great.

Remember that no matter how patient you are, and how much your friend may want to be able to spend time with you, sometimes it’s just going to be impossible. Some people disappear for weeks or months at a time when struggling with depression. It’s legitimate to feel sad that you’re not getting to see your friend, but please don’t take it out on them or make them feel guilty. Believe me, they already feel like human garbage, because that’s how depression tends to make people feel. Remember the ring theory and find someone else to talk to about your legitimate feelings about not getting to see your friend who has depression. If not being able to see them for a long time causes you to no longer feel close enough to them to consider them a friend, that’s also legitimate. Accept that nobody’s at fault and move on. They didn’t get depression as a personal slight against you.

The most important thing about supporting someone with depression is to be really self-aware. Make sure that you’re really doing it because you care about them and want them to feel better, not because you need the validation of Fixing Someone’s Problems. Depression isn’t going to be fixed by someone’s friends, no matter how kind and patient they are. You may invite them to a thing and they may appear and seem totally happy and then later that night they post another Facebook status about how awful they feel, and you may feel like you Failed and you might as well not have bothered, but trust me–it’s more than just in-the-moment feelings. I may feel like shit, but I’ll remember somewhere in the back of my mind that I have friends who love me and who make an effort to get me out of my room, and that matters.

Besides that, stuff like friendship bonds can be a protective factor against future depressive episodes. Your friend will eventually recover from their current episode, and now that they feel better, they may be able to fully internalize how much people care about them and how connected they are to others. That can help prevent a future relapse. That matters.

So don’t do it because you’re hoping to see obvious and immediate results. Don’t make a person with depression carry that burden for you.


Now that I’ve reached the end of what I have to say, I just want to note that it’s almost impossible to even write about this (especially given that I am currently depressed) because the response is always immediately “Yeah well you don’t speak for all depressed people, my partner/best friend/I are totally different!”

Yes, I don’t speak for all depressed people, but I speak for more depressed people than just myself. If you already know for a fact that this doesn’t apply to the person you’re thinking of, just ignore it. (Or write your own article that describes your own experience.) But you probably don’t know that, and you can open up a conversation about it by showing them this article and asking if they feel that it applies to them.


*I just want to state for the record that, depression or no, I have no idea what to do with “We should hang out sometime!” Are you merely expressing a preference for the sake of expressing it? Are you asking me if I also want to hang out? Are you asking me to plan/initiate the actual hanging out? In practice, I just respond, “Yeah, totally!” and then nothing ever happens.

“That totally happened to me, too!”: The Urge to Relate

A lot of what happens in therapy should only happen in therapy. (I’m looking at you, folks who oppose trigger warnings because “exposure is very important for overcoming trauma.”) But a lot of other things that happen in therapy are very applicable to the rest of our relationships and interactions. One of those is the tension between normalizing someone’s experience and validating it.

Normalizing someone’s experience essentially means helping them feel that their experience is normal. Short of memorizing statistics, the easiest way to do that is to relate what they’re telling you to something that’s happened in your own life. This is a very common conversational move. Someone tells you about a bad breakup and you say, “Oh, I totally went through something similar recently. It can be really hard.” Someone tells you their NYC subway horror story and you respond with one of your own. (We all have an arsenal of those.)

Validating someone’s experience is a more complex conversational move. To validate means “to demonstrate or support the truth or value of.” In the context of therapy or supportive conversations between friends, validating someone’s experience means letting them know not only that you believe them when they say that it happened–which can be particularly important when someone discloses, say, sexual violence or mental illness–but also that you affirm this as an “okay” thing to talk about or think about. The opposite of validating is to say “That’s not that big of a deal.”

Obviously, you can both validate and normalize someone’s experience in the same conversation. Therapists frequently do both.

However, the way of normalizing that we most frequently use in casual settings–relating someone’s experience to our own lives and selves–can get in the way of that.

For instance, someone says, “I’m having such an awful time getting out of the house this winter.” If you immediately jump in to say, “Oh, me too, it’s so awful, I couldn’t even make myself go to my friend’s birthday party because it was so cold out,” you may succeed in helping them feel like it’s okay to be having this difficulty, but you may also miss an opportunity to affirm the fact that their own unique experience is legitimate and difficult for them.

I get this often with fatigue. I try not to talk about being tired very much because I don’t like “complaining,” but sometimes I do mention it, and people usually jump in immediately to talk about how tired they are and how they only slept four hours last night and so on. But the thing is…my tiredness is a little different. I sleep at least 8 hours almost every single night, and have been for years. If I let myself, I would sleep 10 or 11 or more hours. I don’t know what it means not to want to sleep. Every day I daydream about coming home and going to sleep.

Of course my friend’s experience is also legitimate, and it sucks to only get four hours of sleep and feel shitty. But for them, not feeling tired as often as simple as finding the time to sleep enough. For me, absolutely nothing I have been able to try without medical intervention has helped.

So when I mention being tired and people immediately jump in to relate, I feel like I can’t talk about how extensively awful it is for me, because everyone feels tired! Feeling tired is normal! That’s just how life is! (Deal with it!)

On the other hand, some things feel bad not just in and of themselves, but also because of the shame and isolation that surrounds them. Mental illnesses are often like this because few people know a lot of people who are open about it (though that may now be changing). When I was first diagnosed with depression, I didn’t know even one other person who was (openly) diagnosed with it. I thought everyone else had it together and I alone was a failure. I saw the statistics on how common depression is, but they did nothing for me. What helped was to start meeting other people who struggled with it. Depression still sucked, and still does, but I no longer had to carry the burden of Being The Only Person In The World Who Can’t Even Be Happy.

How can you tell what someone needs in a given moment? How do you know if it’ll be more helpful to normalize their experiences, or to validate them?

Often there isn’t really a way to tell. In sessions with clients, I rely a lot on intuition and previous experience. But there are some things that people say that can serve as hints as to what they might need from you.

For instance, when people say things like, “I can’t believe I’m having trouble with something so simple,” or “I’m such a failure; I can’t even find a job,” or “Nobody else has all these problems,” that can be a sign that normalizing might be helpful. It can reassure them to know that other people do have trouble with these supposedly simple things, or that other people do actually struggle a lot with finding a job, or that other people do have these same problems. Sometimes what the person is dealing with really is shitty, but it feels a lot shittier than it has to because they think they’re the only one who’s so pathetic and incompetent as to have that problem.

On the other hand, when people say things like, “I know it shouldn’t even be a big deal, but–” or “Everybody probably deals with this but–“, pay attention to those but‘s. The part after the but is the part they have trouble accepting as valid. Everybody deals with it! It’s not a big deal! Therefore, what right do I have to even complain about it?

When someone says things like this, sharing your own experience and relating to them might not be as helpful. What they really need to hear at that moment is that their unique version of that probably-common problem is worthy of paying attention to and talking about. They might know perfectly well that other people have similar problems, but it still feels bad and that’s the part they want to hear acknowledged. Yes, everybody hates winter, but here’s how it sucks for me. Yes, everyone is tired, but I almost passed out after climbing a few stairs. Yes, I know you probably miss your family too, but I just really really miss mine today.

“Common” problems are easy to relate to. Most of us have had bad breakups or manipulative family members or really exhausting days. But rushing to relate your own experience closes off the possibility of learning more about their life. When you feel an urge to share your own experience, instead, try asking more about theirs and seeing if your experience is still as relevant as you thought.

With certain types of issues, relating your own experiences can also easily come across as one-upping even when you don’t mean it to–although, to be real, sometimes that’s exactly how people mean it. Please don’t one-up people. There’s no need. There is not a limited quantity of sympathy in the world, so there is no need to compete for it.

You might also accidentally relate to only a very small part of what they actually said, leaving them feeling misunderstood or unheard. For instance, if I share a story about a classmate saying something very hurtful and ignorant about queer people, and you share a story about a classmate saying something very inaccurate about cell biology, you may have missed the fact that the relevant part of my story wasn’t “a classmate said something silly” but rather “a classmate made a homophobic comment in class that impacted me personally.”

The urge to relate to someone’s experiences comes from a lot of places, I think. It’s a common way of trying to show someone that you understand. Showing someone that you understand them is a common way of earning their trust, respect, and affection. It indicates that you have things in common.

In therapy, of course, things are different in that the focus should always be on the client and their needs. But therapists do sometimes share stories from their own lives, and the purpose is slightly similar to how it works in casual conversations between friends–it’s a way for therapists to signal understanding of their clients, and also to let them know that they are not alone in some of their experiences. Sharing a personal story can be more powerful than simply saying something like “You’re not alone in that,” because it gives something more than a reassurance: it gives evidence. (Anecdotal, but still.)

Yet both in therapy and in life, sharing one’s own experiences can get in the way of fostering a better, deeper understanding of another person. It can also make it difficult for them to tell you more about their experience, because you’ve now turned the conversation back to yourself. It can seem very disingenuous if it’s clear to the person that you don’t actually understand very well at all.

And while we often tell ourselves that we relate to others in order to make them feel better, there sometimes is some selfishness in it. We want to prove to others that we “get it” so that we feel better about ourselves and our ability to understand and connect with people. A natural impulse, but that doesn’t make it necessarily helpful or productive all of the time.

I see this often in conversations about injustice. A marginalized person shares an experience they have had with discrimination or prejudice, and a person who is categorically unable to have the same experience nevertheless tries to relate something from their own life. Sometimes they relate an experience of being treated badly in a way that has nothing to do with their societal position, and sometimes they relate an experience that has to do with another dimension of identity.

There are definitely some important similarities in the ways in which many different marginalized groups are treated, but that doesn’t necessarily always mean that we can relate. The presumption of understanding can easily get in the way of actual understanding when a white woman assumes that her gender helps her understand someone’s experience of racism, or when a gay man assumes that his sexual identity helps him understand a trans woman’s marginalization. I mean, maybe it does, in a few limited ways. But we should always strive to learn more before assuming we “get it.”

I think a lot of people experience the urge to relate. I’ve definitely felt it. For instance, once a friend of mine who is Black was sharing some experiences of racism they had had, and I suddenly noticed a little gear turning in my brain trying to generate similar experiences from my own life that I could share. I thought, wait a minute, I never told my brain to do that! That wouldn’t be helpful right now. How could I listen fully if part of my brain was so busy trying to connect my friend’s experience to my own? How could I even come close to understanding their experience if I was already biasing that understanding by thinking of my own interpretations of my own experiences, which had nothing to do with racism?

This, I think, is what drives a lot of the confusion and miscommunication that happens around issues like race and gender. For instance, suppose a Black woman is telling me about how her coworkers and supervisors always assume she is angry and hostile when she isn’t. I start thinking about times when I have been assumed to be angry and hostile, and how that hurt, and how I dealt with them. Maybe I dealt with them by adopting a more friendly and cheery approach, and that helped. Awesome! I’m going to tell my friend about My Experiences and What Worked For Me!

Except that What Worked For Me is very unlikely to work for someone who is not white. As a white woman, I am not automatically assumed to be angry and hostile no matter what I do, generally speaking. So adjusting my demeanor, even though I felt that I was behaving appropriately before, might help change others’ perceptions of me in a substantially helpful way. A Black woman can be as painfully polite and deferential as she possibly can and yet she’s still likely to face that sort of stereotyping. Maybe if I’d listened rather than spent all that brainpower thinking about my own life experiences, I would’ve understood that.

(See also: Lean In by Sheryl Sandberg.)

Likewise, when I talk about feeling threatened by a man in public and men jump in to tell me that I should’ve Just Punched Him or Just Told Him To Fuck Off, they are thinking of their own experiences and how they might’ve reacted in that situation (for better or worse). A man who decides to Just Punch a man who is being offensive to him may end up getting hurt in a fistfight, but the consequences would be much more severe for me if I tried the same thing.

(See also: “Just call the police!”)

So, what do you do when someone shares an unpleasant experience and you have no idea whether or not relating something from your own life might be useful?

Here are some scripts:

  • “Do you think it might help to hear about something similar I’ve dealt with?”
  • “I’ve gone through something that sounds a lot like that. Feel free to ask me more about it if you want, or to just talk about your own stuff.”
  • “I know this may not necessarily fix the problem, but something that helped me with that was _____.”
  • “That sounds really hard, but you’re not alone in dealing with that.”

Alternatively, it’s almost always a good idea to ask them more questions (with the caveat that they don’t have to talk about it more if they don’t want to) so that you can understand what they’re going through better.

In social work school, we learn a lot about the importance of being very aware of what’s going on in our own heads as we’re trying to help others. That’s useful for any sort of interpersonal situation. It’s a good idea to go into these types of serious conversations with an awareness of what you’re bringing to the table, including your own needs and desires and biases. Many of us want to feel competent when it comes to understanding and helping our friends. That’s commendable, but it too easily turns into a search for affirmation from people who are busy trying to share their own troubles.

Don’t let your need to demonstrate your understanding get in the way of actually understanding.