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

[Content note: suicide, mental illness]

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

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

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

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

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

And a commenter responded:

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

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

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

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

This is something I’ve been really making an effort to do. This doesn’t mean that every time someone asks me “What’s up?” I give them The Unabridged Chronicles of Miri’s Current Woes and Suffering. But I try not to just say “Good!” unless I mean it. Instead I’ll say, “I’ve been going through a rough patch lately, but things are looking up. How about you?” or “Pretty worried about my grad school loans, but hopefully I’ll figure it out.” The point isn’t so much that I desperately need to share these things with people; rather, I’m signaling that 1) I trust them with this information, and 2) they are welcome to open up to me, too. Ending on a positive note and/or by asking them how they are makes it clear that I’m not trying to dump all my problems on them, but I leave it up to them to decide whether or not to ask more questions and try to comfort me, or to just go ahead and tell me how they’re doing.

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

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

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

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

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

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

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

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

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

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

Criticizing Psychiatry Without Throwing the Baby Out with the Bathwater

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Right after that:

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

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

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

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

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

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

~~~

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

Living With Depression: Strength

[Content note: depression]

Half a year ago I started a series of posts about living with depression in order to help people understand what it’s like to have it beyond just the DSM symptoms that you always hear about. Then I moved to FtB and got super intimidated and didn’t want to write it anymore. But now I have writer’s block and I’m feeling too overwhelmed by everything going on in the world so I’m going to write about myself.

It’s not meant to reflect anyone’s experience but my own, although I’m sure plenty of people will identify with it. If things were completely different for you and you feel comfortable sharing, the comments section’s all yours.

The two previous posts, if you’re curious, were about trust and openness.

For many people, both sufferers and non-, depression is primarily a lack of strength.

Emotional strength, that is. When you hear people call depression a “weakness,” consider the fact that the opposite of “weakness” is “strength,” and you’ll see exactly what they think is lacking in those who suffer from it. Of course, enlightened as depression sufferers supposedly are about their own illness, most of us fall into the same trap at some point.

Because on the surface, depression really can look like a lack of strength. For many years, at the slightest sign of misfortune or difficulty–a bad grade, a rude remark from someone–my entire mental composure would crumple like a dry leaf you crush in your hand. Imagine going to the gym and trying to lift one of the lightest weights they have, but you drop it and collapse in a heap on the floor. That’s approximately the physical equivalent of how it feels, with all the humiliation and self-blame involved.

In reality, of course, it has nothing to do with weakness or strength. It’s an illness. It’s not your fault. (It’s not a “chemical imbalance,” by the way, as someone would usually say right about now, but it’s not a weakness either.)

But, honestly, most days I can’t internalize that knowledge, no matter how many courses I take and articles I read. I feel weak.

Anyway, my solution to this for a while was to try to present a false persona that is strong, competent, and detached. I spent a lot of time furiously pretending not to care about things, because that’s what I thought strength was. It never worked. I’m sure people saw through it, and besides, the thing with depression is that often you can’t fake your way out of it. The pain and emotions it causes are too powerful to hide. It’s like the difference between not letting it show on your face when you’ve stubbed your toe, and not letting it show on your face when you’ve fractured your leg in three places. People are gonna be able to tell. No matter what.

And that inability to hide what I felt was private, shameful, and weak was probably the worst way I’d ever felt like I failed myself. Worse than not liking college, worse than having to drop journalism, worse than not getting (or having to decline) a slew of coveted internships and other opportunities. In the endless parade of personal failures to which I am a constant, unwilling spectator, failing to be “mentally strong” is the absolute worst.

So what about physical strength, then?

It’ll probably come as no surprise (as I’m sure I’m far from the only person who does this) that I use physical strength and competence as a way to distract from and make up for the emotional strength that, despite everything I know about depression, I still feel I do not have.

I’ve been doing that for as long as I can remember. I used ballet that way when I used to dance, from when I was 6 years old until I was 15. Then I switched to marching band, which you may think isn’t hard until you’ve done it. During the off-season I’d bike or walk pretty long distances or go to the gym or exercise at home. Of course, all that was irrevocably tainted by the fact that I had massive body image issues and eating habits that at times were very unhealthy, but I do remember the difference between wanting to lose weight and wanting to be strong. I haven’t always wanted to lose weight, but I’ve always, always wanted to be strong.

(Of course, physical strength is a gendered trait, and the gender that we usually associate it with is male. That means that we think of physical strength as being able to lift a whole lot of pounds–with your arms, that is–and it means that my male friends scoff at how pathetically I compare to them in that department. Of course, I just smile and roll my eyes, because I’d love to see them sit calmly in the splits for 15 minutes while reading a book, or twirl on the toes of one foot. Whatever.)

Partially, I like being strong for the same reasons anyone else does–it feels good, it’s useful, it keeps you healthier. But also, it allows me to shape my body in the way I’ve never managed to shape my mind. Getting physically strong requires a lot of effort, sure, but everyone knows exactly how it’s done. I don’t know how to stop being so emotionally nonresilient. I only know that sometimes I go months without any problems, and then suddenly, for no reason, I start crumpling again.

Muscles don’t work that way. You work them out, and they get stronger. You don’t work them out, and they eventually get weaker. You know which exercises work out which muscles. You know that if muscles are sore, you gave them a good workout. (I say this as I can barely walk for the third day in a row because of this thing I did with my calves, so there ya go).

If I were able to afford a therapist who could actually help (as opposed to the ones that I’ve had, who did not), maybe I’d eventually become emotionally strong. But for now I’ve mostly given up. The only thing that works when I feel weak is simple distraction, but the more tired and overwhelmed I am and the more mental effort I’ve already exerted on other things, the harder distraction gets.

But when I feel strong physically, it makes up for not feeling strong emotionally. Just a little bit.

Lessons I Learned From Depression

[Content note: depression]

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

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

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

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

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

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

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

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

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

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

Lesson 2: Your feelings are valid.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It's okay not to be okay.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A few said it does:

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

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

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

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

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

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

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

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

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

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

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

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

1. Mental Illness

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

2. Proof

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

3. Closeness

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

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

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

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

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

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

Blaming Everything On Mental Illness

The Associated Press has revised their AP Stylebook, the guide that most journalists use to standardize their writing, to include an entry on mental illness. Among many other important things that the entry includes, which you should read here, it says:

Do not describe an individual as mentally ill unless it is clearly pertinent to a story and the diagnosis is properly sourced.

And:

Do not assume that mental illness is a factor in a violent crime, and verify statements to that effect. A past history of mental illness is not necessarily a reliable indicator. Studies have shown that the vast majority of people with mental illness are not violent, and experts say most people who are violent do not suffer from mental illness.

That first one is important because there is a tendency, whenever a person who has done something wrong also happens to have a mental illness, to attempt to tie those two things together.

Some things I have seen people (and, in some cases, medical authorities) try to blame on mental illness:

  • being violent
  • being religious
  • being an atheist
  • abusing children
  • spending money unwisely
  • raping people
  • stealing
  • bullying or harassing people
  • being upset by bullying and harassment
  • enjoying violent video games
  • being shy
  • being overly social
  • being too reliant on social approval
  • having casual sex
  • being into BDSM
  • not being interested in sex
  • dating multiple people
  • not wanting to date anyone
  • not wanting to have children
  • being attracted to someone of the same sex
  • being trans*
  • wanting to wear clothing that doesn’t “belong” to your gender

You’ll notice that these things run the gamut from completely okay to absolutely cruel. Some of them involve personal decisions that affect no one but the individual, while others affect others immeasurably. All of them are things that we’ve determined in our culture to be inappropriate on varying levels.

That last one, I believe, explains why these things (and many others) are so often attributed to mental illness. It is comforting to believe that people who flout social norms, whether they’re as minor as wearing the wrong clothing or as severe as abusing and killing others, do so for individual reasons or personal failings of some sort. It’s comforting because it means that such transgressions are the acts of “abnormal” people, people we could never be. It means that there are no structural factors we might want to examine and try to change because they contribute to things like this, and it means that we don’t have to reconsider our condemnation of those behaviors.

It’s easier to say that people who won’t obediently fit into one gender or the other are “sick” than to wonder if we’re wrong to prescribe such strict gender roles.

It’s easier to say that a mass shooter is “sick” than to wonder if we’ve made it too easy to access the sort of weapons that nobody would ever need for “self-defense.”

It’s easier to say that a rapist is “sick” than to wonder if something in our culture suggests to people over and over that rape isn’t really rape, and that doing it is okay.

It’s easier to say that a bully is “sick” than to wonder why we seem to be failing to teach children not to torment each other.

It’s easier to say that a compulsive shopper is “sick” than to wonder why consuming stuff is deemed so important to begin with.

Individual factors do exist, obviously, and they are important too. Ultimately people have choices to make, and sometimes they make choices that we can universally condemn (although usually things aren’t so black and white). Some things are mental illnesses, but even mental illnesses do not exist in some special biological/individual vacuum outside of the influence of society. In fact, in one of the most well-known books on sociology ever published, Émile Durkheim presents evidence that even suicide rates are influenced by cultural context.

In any case, it’s an understandable, completely human impulse to dismiss all deviant behaviors as the province of “mentally ill” people, but that doesn’t make it right.

It’s wrong for many reasons. It dilutes the concept of “mental illness” until it is almost meaningless, leading people to proclaim things like “Well everyone seems to have a mental illness these days” and dismiss the need for more funding, research, and treatment. It leads to increased stigma for mental illness when people inaccurately attribute behaviors that are universally accepted as awful, like mass shootings, to it. It causes those who have nothing “wrong” with them, such as asexual, kinky, and LGBTQ people, to keep trying to “fix” themselves rather than realizing that it’s our culture that’s the problem. It prevents us from working to change the factors that are actually contributing to these problems, such as rape culture, lack of gun control, and consumerism, because it keeps these factors invisible from us.

People disagree a lot regarding the role of the media in society. Should it merely report the facts as accurately as possible, or does it have a responsibility to educate people and promote change? Regardless of your stance on that, though, I think most people would agree that the media should at the very least do no harm. Blaming everything from murder to shyness on mental illness absolutely does harm, which is why I’m happy to see the Associated Press take a stand against it.

That said, it’s not enough for journalists to stop attributing everything to mental illness. The rest of us have to stop doing it too.

[guest post] We Need To Talk About Incest Survival

[Content note: incest, sexual assault, self-harm, eating disorders]

Someone I know and respect asked me to publish this anonymous guest post. -M

Mia Fontaine wrote an article in The Atlantic recently about the incest problem in America. Although we talk about sex scandals, stranger danger, and the abuses of the Catholic Church, as a society, we don’t really address the adult on child abuse that takes place primarily inside children’s homes.

Given the prevalence of incest, and that the family is the basic unit upon which society rests, imagine what would happen if every kid currently being abused—and every adult who was abused but stayed silent—came out of the woodwork, insisted on justice, and saw that justice meted out.

I have felt compelled to write about what happened to me, but I am too terrified of the consequences to post under my own name. Still, perhaps my story might give someone else the courage to do more than post anonymously to the internet. Perhaps someone will read it and realize how important this issue is. Or perhaps I’ll just feel better having written it. All worthy goals.

I was 18 the last time it happened, it was Christmas break my Freshman year in college. I ran and hid in my room and wondered how I’d let it happen again, it hadn’t happened in so long, I was in college now, surely I should have been safe. I didn’t cry, I just shook. In the decade since that night, I’m not sure I’ve ever managed to unpack everything going on inside me at that moment. Fear, anger, confusion, hurt, desperation for love and approval.

I’m not sure when it started. Maybe I was 11 or 12? It started gradually. Inappropriate hugs, hands lingering where they weren’t supposed to be, hands being held where they didn’t want to be. It escalated over the years to being given alcohol, oral sex, and being told that “if your mother ever found out, she would kill me.”

It was never vaginal intercourse and so, until the recent change in definition, it didn’t seem like I could call it rape. And, even though he lived with me, he was a step-relation, so I wasn’t sure whether it could be properly defined as incest. And I loved him, he was family, so I didn’t want anything bad to happen to him. And it didn’t always feel bad, some of the things felt good. And when so much of life was filled with hate, criticism, and being ignored, it was really something for someone to show affection at all. At the time, I felt it was my fault and, without any labels that seemed right, couldn’t think of what it was that was being done wrong exactly, just that it made me nauseous to think about. With the massive age difference, I knew it was statutory something. I don’t know, I tried very hard not to think about it.

But then a strange thing happened. My body forced me to think about it. I stopped having my period. I knew, physiologically, that it was impossible for me to be pregnant, but I was terrified just the same. A home pregnancy test confirmed my understanding of anatomy.

After three months with no period, I made an appointment with a psychiatrist at school, but, when I refused to take antidepressants because I was terrified my parents would find out, they refused to see me. Then I decided I had to make an appointment with a gynecologist. My mother was annoyed by my urgency at needing to go. It took two months to get into see someone — a very religious, old Southern man with a private practice.

He didn’t believe me when I said I’d never had sex and forced me to take a pregnancy test–I explained that after six months amenorrheic I’d be showing if I was lying, but that didn’t help. They never asked me if I’d been sexually abused, but who knows what I would have said. They never asked what I thought had precipitated the loss of periods. I guess I wasn’t thin enough to be anorexic, so it didn’t matter, even though it was a clear sign of depression. The fifth or sixth time he asked me if I was really a virgin, I started to cry, I never felt so judged. Not that being a virgin was important to me, but being honest absolutely was.

He wrote me a prescription for some hormone that induced a period and for a year’s supply of birth control. Somehow, the massive cramping didn’t make me feel any better.

I had to go to a family event that fall where He was present. And He had started dating someone I knew, someone I respected and liked a lot. I didn’t know what to do. At the same time, my family was harshly criticizing me for being fat (size 12) and not caring about my appearances. Presumably they thought my unhappiness was from being “too fat to be loved” rather than some negative experience of mine.

I began self-harming–cutting and starving myself. I visited pro-ana websites “out of curiosity”. I would eat a Milky Way bar and nothing else. I would eat with other people so they wouldn’t know anything was out of place and go home and throw it up. I made a friend take all my knives and scissors. I fantasized about driving through stop signs and red lights through traffic and getting into horrible accidents. I drove through the city late at night trying to get lost.

I’m not sure what broke, but finally I went to see another school therapist and agreed to take antidepressants.

It was too late, I felt, to try to tell my parents, and my therapist agreed, but only because she thought my parents were horrible. She felt like I should just try to get them to treat me like an adult and stop complaining about my weight all the time. The incest and rape thing just wasn’t that important because it wasn’t going to happen again, but unless I stopped them, my parents would continue to be awful.

It got better. I stopped seeing the therapist six weeks later, and was much better than I had been. I still occasionally had nightmares, but managed OK. A year after this, I tried to talk to my mother about what had happened. I woke up in the night after a nightmare and was shaking, and my mother heard me walking around. She took me to an all night diner and we talked. I told her what had happened and she told me I had misinterpreted events. I insisted I had not. She didn’t remember the conversation the next day. Her therapist later told me that she wouldn’t survive being told, the guilt would kill her, so she must have blocked it. He told me I couldn’t ever tell her.

I am happy now, I love myself, I love others and others love me. I am doing what I want to do, I am an activist in causes I care about, and I am fighting fights I want to fight. And I can’t find it in myself to fight this fight out loud.

I feel like an enabler, writing this anonymously. Never having confronted him. Never having told the family. What good would it do now, to open all of that up? It wouldn’t help anyone, just open wounds. Just make people hate me or hate him…but probably me. Who wants to do that? To destroy a family? I like a lot of the people who would get hurt.

And so I stay silent. Along with thousands and thousands like me. Justice is not being stopped by a powerful organization like Penn State or the Catholic Church, but by the reality that the victims would be hated just as much as, if not more than, the perpetrators. We’ve broken down some of the barriers to reporting stranger assaults on children, but we haven’t solved the larger problem of helping those living with their abusers. Society isn’t built to fix this problem or help people like me, but it doesn’t always have to be like this. Go read that article in The Atlantic, share it, write about this issue, support RAINN, and be willing to hear the truth, even when it is unpleasant.

LGBT Celebrities Do Not Owe Coming Out To Anyone

Everyone’s got an opinion on Jodie Foster’s speech at the Golden Globes last night. If you haven’t seen it, here’s a video with a transcript.

In the speech, Foster spoke affectionately of her ex-partner, with whom she raised children, and explained that she “already did [her] coming out about a thousand years ago back in the Stone Age” but values her privacy too much to make it a big spectacle.

That’s not a good enough excuse for one writer, though (watch out, it’s apparently Low-Hanging Fruit Day over here at Brute Reason):

I mean, is it 1996? Jodie’s defensive speech, in which she seemed to blame Honey Boo Boo and reality TV for supposedly creating a climate that forced her out of the closet, harkened back to a time when it was a big deal to proclaim your sexual orientation. Hello, it’s 2013! People are getting “gay married” and homos can be out in the military and stuff!

[…]Why am I so angry? Because I’m roughly the same age as Jodie, and yet I had the courage to come out exactly 20 years ago.

I honestly don’t see what is “defensive” about Foster’s speech and where exactly she “blames” current pop culture for “forcing” her out of the closet. She does joke about how celebrities are expected to live very publicly and have their own reality shows and fragrances and whatnot, but the part where she blames this for making her come out seems to be entirely in Baer’s imagination.

Baer goes on and calls Foster’s need for privacy “an excuse” and then offers this bizarre caveat:

A lot of people will criticize this piece and write angry, hateful comments saying that it was up to her when and where to come out, and they’re absolutely right, but that still doesn’t mean she wasn’t a coward, and it doesn’t change the fact that she could have helped millions of people by coming out years ago.

A bunch of things jump out at me:

1. This article seems to be more about the author than about Jodie Foster.

As in, it’s all about Baer and how courageous she was for having come out a long time ago. Even though she doesn’t dedicate that much of the article to talking about her own courage, that’s clearly the main theme–she was courageous and Foster was not.

Baer undoubtedly deserves respect for coming out so early (well, for coming out at all), but that doesn’t mean Foster is a “coward” for not being so public about her sexual orientation. As she explains in her speech, everyone that she wanted to know, knew. That may not be “out enough” for Baer, but it’s still out.

Whenever someone’s done something awesome–come out, for example, or recovered from a mental illness–there’s a certain tension in figuring out how to talk about the people who haven’t succeeded in doing that thing yet without being a total asshole about it. My reasoning is that you don’t know why they haven’t and it’s best not to assume. I suppose Foster could really be a coward, but personally I doubt it. It’s more likely that she had other reasons for not coming out publicly (assuming that the ways in which she has already come out don’t matter, which is what Baer seems to be assuming).

2. Considering Foster’s history, Baer is incredibly dismissive of her stated need for privacy.

Many celebrities guard their privacy carefully, and not all of them have any desire to be in tabloids all the time. But Foster has a unique story in that regard. In the 1980s, a fan of hers named John Hinckley, Jr. became obsessive and started sending her love letters. He then attempted to assassinate then-President Reagan, stating that he was trying to impress Foster. The resulting intrusion of her privacy by the media is something that she’s known to have had a lot of discomfort with.

Given this, one would think that Foster could get away with needing privacy a bit more than the average celebrity, but in rushing to condemn her, Baer misses these nuances.

As Foster said in the speech:

But seriously, if you had been a public figure from the time that you were a toddler, if you’d had to fight for a life that felt real and honest and normal against all odds, then maybe you too might value privacy above all else. Privacy.

3. It’s not Foster’s job to “help millions of people” by coming out.

It’s not anyone’s job, actually. Foster’s job is to make movies. Baer’s job is to write articles about the entertainment industry. All of us should probably try to be decent people and to help others when they need it, but not at the cost of our own well-being. Chastising someone for failing to “help millions of people” just seems odd to me because it presumes that Foster is somehow failing live up to her responsibilities as a person.

It’s undoubtedly true that many people would’ve been happy had Foster come out (or, again, come out more publicly in the way that Baer apparently wanted her to). Perhaps she would’ve been an inspiration for a lot of LGBT kids. But that doesn’t make coming out an imperative. I would probably inspire lots of people if I won a marathon or donated all of my worldly possessions to charity, but that doesn’t make it a moral imperative for me to do so.

4. Baer’s reaction shows an incredible amount of entitlement.

We consider ourselves entitled to a lot from celebrities. They must be Good Role Models. They must always be grateful for their fame, even if they never asked for it and even if it often causes them enormous personal difficulties. (Consider the never-ending excoriation of Kristen Stewart for failing to appear cheerful and grateful enough.) If they’re queer, they must always come out and be willing to serve as advocates for LGBT causes.

You could argue that it’s not healthy or “right” for any queer person to live in the closet (though in my opinion you’d still be wrong). But that’s not what Foster was doing. Given that she had already come out to everyone who matters to her and has lived her life as a gay woman–for instance, by dating another woman and raising children with her–Baer’s presumption that Foster owes us anything more than that is predicated on the fact that she’s a celebrity.

Like many others, Baer assumes that celebrities’ lives exist for her consumption and that celebrities who happen to be queer exist solely to validate her and other LGBT folks. But Foster is a human being. She is a human being who happens to be a famous actress and who also happens to be gay.

5. Baer is shockingly dismissive of the negative consequences that coming out can have for celebrities.

She writes:

Nobody was asking Jodie to be president of the gays. Ellen [Degeneres] is a great example of someone who came out, had no interest in being the poster child and is just living her life honestly and openly. Though she occasionally fights publicly for LGBT causes, being a lesbian doesn’t define her. But here’s the amazing thing that happened to Ellen. At first her big announcement seemed to derail her career. She disappeared for a while and almost gave up on show business because she was “mired in depression.” After some dark days, which a lot of newly out people experience, Ellen ultimately was rewarded for being her true self. Today, because of her talk show, she’s arguably one of the most beloved stars on the planet, adored by millions, gay and straight alike (except for a handful of moms who now refuse to shop at JCPenney, but c’mon, they’re dumb).

First of all, I’m not sure why Baer thinks that Ellen isn’t a “poster child” when such a great deal of media coverage about her has to do with the fact that she’s a lesbian. But second, notice how Baer just skims right over the part where Ellen suffered from depression and nearly quit her career as a result of coming out. As though that doesn’t even matter because she gets to be “her true self” now. As though the bullying from One Million Moms is just a crappy little side effect.

What if that sort of public opprobrium and the depression that can result from it wasn’t something Foster felt capable of dealing with?

Nobody should have to suffer through bullying, depression, and possible career loss for coming out as gay or trans*. I think we can all agree on that here, and many of us advocate in various ways to make coming out easier and safer. But blaming an individual for not being willing to put themselves through this is unconscionable.

I don’t know what private struggles Foster has gone through with regard to her sexuality, and neither does Baer. It’s none of our business. That’s why calling her a coward for not doing what others have done is wrong.

A Handy List of Everything Wrong with Creating a Database of People with Mental Illnesses

It’s not like anyone expected the NRA to say anything intelligent during its long-awaited press conference on Friday, so I’m not exactly disappointed by what they said. I am, however, completely appalled at the NRA’s ignorance of mental illness and insensitivity to those affected by it.

Along with a few other laughable suggestions, like putting armed security guards in elementary schools, Wayne LaPierre, the NRA’s Executive Vice President, said this:

“How many more copycats are waiting in the wings for their moment of fame from a national media machine that rewards them with wall-to-wall attention and a sense of identity that they crave, while provoking others to try to make their mark.

A dozen more killers, a hundred more? How can we possibly even guess how many, given our nation’s refusal to create an active national database of the mentally ill?”

Now, I’m not sure to what extent LaPierre actually believes that this is a realistic and ethical goal as opposed to a throwaway remark intended to deflect responsibility from his organization and the products it defends. It’s also unclear how much the NRA’s leadership has discussed and promoted this idea.

However, I think it’s still worth using this example to show how ignorant these people are about mental illness, because I’m quite certain that they are not alone.

So, here’s everything I can think of that’s wrong with the idea of creating a national database of people with mental illnesses.

1. It’s redundant.

As Kate explains on Ashley Miller’s blog, mental health professionals are already required to break confidentiality and report when patients pose a clear threat to themselves or others. Rather than putting this in some sort of “database,” they report it to the people who know best how to use this information–the police. I’m not sure if LaPierre is suggesting that we create a public database of people with mental illnesses so that armed vigilantes can take matters into their own hands or what, but I think most reasonable people agree that dealing with people who have expressed the intent to harm others is best left to the police.

Furthermore, as Sarah Kliff writes in the Washington Post, 38 states already require or allow the use of mental health records in background checks for people trying to purchase guns, and the Gun Control Act of 1969 bans the sale of guns to people who have been committed to a mental institution in the past. However, that act is difficult to enforce because state reporting laws vary so much, and unfortunately for LaPierre, it is unconstitutional for the federal government to require states to report mental health records for a national database.

2. It violates existing laws.

As Kate also mentions, HIPAA (the Health Insurance Portability and Accountability Act) requires that people’s medical records be kept private. (So strict are medical confidentiality rules that when I saw a psychiatrist as a 19-year-old dependent on my parents’ medical insurance, the psychiatrist had to ask for my consent before she explained to my mom why she thought I needed antidepressants.) Creating a national database of people with mental illnesses would mean repealing or amending this law. Can the NRA summon up enough support in Congress for that?

If LaPierre intends to use this database to restrict the ability of people with mental illnesses to access to resources they need, such as jobs and schools, that would also violate the ADA (Americans with Disabilities Act), which bans discrimination on the bases of mental and physical disability. And, regardless, as mentioned in #1, creating a national database would probably not be constitutional because the federal government would have to force states to report mental health data.

3. It’s probably impossible to determine which diagnoses should be included.

Repealing or amending HIPAA would also mean deciding which diagnoses would suddenly not be subject to confidentiality. People like LaPierre seem to think that schizophrenia and bipolar disorder are the most “dangerous,” but what about substance addiction, which is highly correlated with violence? Would every alcoholic have to be registered? What about autism, which many people falsely associate with violence? And, if yes, then what about Asperger’s Syndrome, now considered a “mild” version of autism that’s on the low end of the spectrum? What about depression, which can sometimes involve psychosis?

Or, since LaPierre simply called it a “national database of the mentally ill,” should we include everybody with mild depression, social anxiety, a phobia of elevators, an eating disorder? Should we include people whose mental symptoms are caused entirely by another, purely medical illness? Should we include people who develop depression as a result of, say, cancer?

4. The list of ethical ways to use this database is very short.

Seriously, what would you do with it? Deny these people access to employment, education, and housing? Then you’d have to repeal the ADA. Surveil them? That’s a violation of civil liberties (not that our government’s great about that). Bar them from purchasing guns? As mentioned above, that’s already going on in the majority of states, and it’s one of the reasons “liberals” are trying to pass stricter gun regulations. But this is where the common argument against such regulations–that criminals will find a way to get guns anyway–can be turned right back on those who tend to spew it. It’s worth noting that Adam Lanza did not purchase his guns; he got them from his mother, who bought them legally and is not reported to have had any mental illness.

5. Most people with mental illnesses do not get treatment.

And you can’t register them in a database unless they do, obviously. One study suggests that over 60 percent of people with serious mental illnesses, such as schizophrenia or bipolar disorder, do not receive consistent treatment. This means that a majority of the people who should be in the database wouldn’t be in it, anyway.

Although the association between mental illness and violence is tiny, people with untreated mental illnesses are more likely to be violent than those whose illnesses are being treated properly (although the link between mental illness and violence is still very small). This means that the people who would be on this database are the ones who are least likely to cause anyone any harm.

In any case, the percentage of people who don’t get the treatment they need would probably go up, because:

6. It would discourage people from seeking treatment.

The stigma of mental illness and treatment already keeps many people from reaching out for help. If you know that going to see a therapist or psychiatrist could put your name on a national registry of people to be feared, stigmatized, and discriminated against, why would you do it?

Even if most of what I’ve said above about misuses of this database turns out to be a huge strawman–which I don’t know, because LaPierre hasn’t specified how he wants this database to be used and it’s important to consider the potentially dangerous ramifications–people will still worry. Even if the only purpose of the database is to prevent people with mental illnesses from purchasing guns, people will still be worried about that information falling into the wrong hands.

This, of course, is the final nail in the coffin of LaPierre’s idea. Even if nothing else that I’ve said about it were true, this point would be reason enough not to do it. Anything that prevents people from getting treatment is, by default, the wrong solution.

I already know many people who refuse to seek treatment for a mental illness because they are worried about being discriminated against if the wrong person finds out. Although the ADA supposedly protects them, it is difficult if not impossible to prove that discrimination has occurred. Those fears could grow much more urgent if simply going to a doctor and receiving a diagnosis puts your name and medical information into a national database accessible to god-knows-who.

This is what tells me that not only is LaPierre scapegoating people with mental illnesses to divert opprobrium from his own organization, but he also completely misses the point and fails to understand the first thing about mental health and treatment.

He gives away his views on people with mental illnesses when he says this: “The truth is, that our society is populated by an unknown number of genuine monsters. People that are so deranged, so evil, so possessed by voices and driven by demons, that no sane person can every possibly comprehend them.”

We are “genuine monsters” to him.

He’s wrong, of course. There are plenty of “sane” people who comprehend those with mental illnesses–researchers, therapists, psychiatrists, social workers, friends and family of those affected, and people who have recovered from those illnesses. That LaPierre personally fails to understand them says more about his own lack of both empathy and research in the field than about the supposed need to stick them all in a national database for the perusal of bigots.

It is also worth noting that in this emotionally charged statement, LaPierre fails to distinguish between people who commit acts of violence because of an illness they cannot control without proper treatment–which LaPierre wants to make it even harder for them to get–and people who commit acts of violence because they have no respect for human life and are seeking to make a political point, get personal revenge, and so on. Although violence and death, especially of children, is tragic regardless of the cause, that doesn’t mean that all violence is caused by the same type of person.

If I could make a suggestion to LaPierre, I would tell him to talk less, read and listen more. There’s reasonable disagreement to be had about how to prevent further mass shootings, but his suggestion was not reasonable. It was ignorant, offensive, and probably dishonest.

How To Make Your Social Spaces More Welcoming To Shy, Socially Anxious, or Introverted People

Social interaction is hard for many people for many different reasons. Plenty has already been written on how these people can change themselves or learn how to better cope with social situations, so I have little interest in rehashing that. What I really want to discuss is how others can set up their social spaces and events in ways that make it easier for these people to participate.

A disclaimer: this post is written from my individual perspective (albeit with a few suggestions from friends). I’m just one person, one person who is an introvert and has struggled with social anxiety and shyness in the past. If you read this post and find it useful, discuss it with other people you know who might disagree with or confirm various parts of it.

It’s also important to note that shyness, introversion, and social anxiety are different things. Shyness is a personality trait that some people grow out of after childhood and others don’t. Introversion is a personality “type” that rarely changes much during a person’s lifetime and can involve a bunch of related traits. Social anxiety is a mental disorder that can be treated in various ways, but not everyone has access to treatment or is able to find one that works. The reason I’m lumping them all together in this post is only because people who have them can all benefit from similar social accommodations–not because they’re the same thing.

So, first and foremost:

1. Include them.

Sounds so obvious, doesn’t it? Unfortunately, it’s not. Social events of all kinds, whether informal ones like parties or “serious” ones like conferences, are often attended by groups of friends. But they’re also often attended by people who come hoping to make friends and meet like-minded folks. If you’d like to bring new people into the fold of your group, you have to create an environment in which new people feel welcomed and wanted, even if they’re shy, quiet, or anxious around strangers.

I can’t count the number of times I’ve walked up and introduced myself to people–or, worse, been invited somewhere with a group of established friends–who then proceeded to ignore me and keep discussing their own inside jokes and gossip. When I was younger and more socially anxious, reaching out to people was almost impossible because I was terrified of this exact possibility and the awkwardness that ensues when you’re greeted and introduced and then ignored.

Now, as an adult who’s much more likely to be the one with the established friend group than the newbie, I sometimes catching myself doing the same thing and I try to make an effort to include the new person in the conversation instead.

Excluding people from conversation is rude at best and anxiety-provoking at worst, and it’s easy to avoid. If you’d like new people to come to your events and feel welcome there, you have to actually include them.

And on another level, it’s important to actually invite people to your event even if they seem shy or not very social. Give them a lot of information about the event–what will happen there, how many people there will be, who else they know is coming, and so on. As long as your invitation isn’t coercive (see below), they can decide for themselves whether they’re comfortable attending or not.

2. On the other hand, don’t try to force them into social interaction.

Social coercion bothers me, both in my personal life and on a philosophical level. If someone’s perfectly happy sitting off to the side on their own, there’s no reason for you to try to force them to mingle just for the sake of feeling like a successful host. Even if you think it’s “for their own good.”

If you see a person at your event who seems shy or anxious, you could come up to them alone and ask if they’d like to be introduced to others or to participate in whatever’s going on. (For large events like conferences, it can be helpful to have a person whose job it is to do this.) If they say no, that’s it. Say, “Okay, please let me know if you change your mind!” and leave them alone.

Note that some people with social anxiety wouldn’t agree with me on this, because they wouldn’t want to be approached at all. This is one great reason why you should seek other opinions, not just mine!

3. Physically organize your space in a way that allows shy or anxious people to have time alone.

We’re used to having to sneak outside and stand in the cold. We’re used to hiding away in the bathroom as people knock on the door and ask if we’re “okay in there.” (No, but not in the way you mean.)

Why not make that unnecessary?

An event should have quiet areas or rooms where people can go just to be alone and recharge. If that’s not an option, consider having things they can look at or fiddle with when they don’t feel like talking–coffee table books, those little mechanical puzzles, and so on. Introverts, shy people, and people with social anxiety often find that they need to get away from people for a bit after socializing for a while. Unless the venue allows that, this often means that they have to just call it a night and go home.

4. Try to avoid overcrowding as much as possible.

I know that sometimes having a crowded event or party is unavoidable, especially for those of us who are still young and living in tiny cheap apartments. If you can, though, make sure there’s plenty of space for the number of people you’re inviting. Ensure that people can easily get through aisles or to their seats, and that there’s enough seating. An overcrowded event is annoying for everyone, but for people with social anxiety it can be unbearable.

5. Provide activities for people to do instead of just talking.

This kind of goes along with not forcing people into social interaction (see #2 above). See if it’s possible to provide board games or other things that people can do with each other that saves them from the burden of having to come up with conversation topics, which can be really hard to do when you’re shy or anxious, especially if you don’t have any close friends at the event.

Another thing you can do is create opportunities for people to help out that don’t involve a ton of socializing. Ask for volunteers to record talks on video, serve food, etc. Some people who otherwise have trouble being social find it easier when they have something else to do too.

6. Pay attention to the way you have conversations.

Aside from actually including people in the conversation (see #1), there are various things you can do while talking to shy, anxious, or introverted people that will make it easier for them to participate.

First of all, decreasing the emphasis on small talk or avoiding it entirely can really help people who have trouble with conversations. It may seem counterintuitive, since small talk is often what we do when we don’t know what else to say. However, it’s also the type of conversation that many introverts and shy people have the most difficulty with, because you have to follow preestablished social “rules” and find a way to somehow make it interesting that you’re majoring in biology or spent the holidays in Chicago or have a daughter studying at Ohio State.

Instead, ask them something more interesting. Don’t be afraid to venture into “taboo” subjects like politics and religion. Many shy and quiet people will suddenly open up when asked about something they’re passionate about.

When you’re having conversations with people, allow for comfortable silences. Silence is a healthy, normal part of interacting with others. Sometimes people–especially shy or socially anxious people–need time to process what’s been said or to form a cogent response. I once went on a first date and the conversation had gotten pretty deep and interesting, so I paused for a few moments to collect my thoughts. My date immediately went, “Well, that’s an awkward silence!” No, the silence wasn’t awkward. That comment was awkward.

Trying to fill up every single silence makes us feel like we’re inadequate at conversation and makes the anxiety worse.

One last very important thing: please avoid loudly calling attention to people’s verbal slip-ups, mispronunciations, and so on. If you must correct someone, do it quietly and politely. “Oh, I think you might’ve meant genotype, not phenotype,” not “Um, what are you talking about? It’s definitely genotype, duh.” Or “Just FYI, it’s pronounced ‘salmon’!”, not “HAHA did you just call it SAL-mon? What’s wrong with you?” (You may think I’m exaggerating, but as a foreigner who got most of her English vocabulary from reading, my frequent mispronunciations have garnered some incredibly rude responses from friends.)

Changing the way you plan events and interact with people in order to include those who find socializing difficult may seem like a lot of work, but it’s worth it. Some of the most interesting people you’ll meet are very withdrawn at first, but welcome them and they may amaze you.