You Can’t Diagnose Mental Illness from a Tweet

Today at the Daily Dot, I discussed the strange Twitter behavior of a former Paypal executive and the predictable mass rush to claim that it’s evidence of “mental illness”:

Is Rakesh Agrawal mentally ill? I have no idea, and neither do you.

There’s a long history of using mental illness as a multipurpose scapegoat when people do bizarre, harmful, or dangerous things. Mass shootings are frequently blamed on mental illness despite little evidence, as is homosexuality, kinky sex, atheism, and, apparently, weird tweets.

This accomplishes a number of things. First of all, where the behavior is harmless to others but is nevertheless not tolerated by the public–homosexuality, kinky sex, gender nonconformity–categorizing the behavior as a mental illness gives us a convenient excuse to try to change it. Second, where the behavior is harmful but we don’t want to deal with its actual, structural causes–mass shootings, sexual assault, spending too much money–categorizing the behavior as a mental illness allows us to feel like we’re doing something to prevent it without having to ask any difficult questions about how our society may be contributing to it.

Finally, when the behavior has (justifiably or otherwise) made people upset at the person, categorizing the behavior as a mental illness packs an extra punch to the insults directed at that person. That’s because mental illness is stigmatized. It shouldn’t be, but it still is. Calling someone “crazy” or telling them to “get back on their meds” or “check into the psych ward” is insulting because being the type of person who needs medication or hospitalization is presumed to be shameful.

Read the rest here.

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Confidence Is Not the Solution To Gender Inequality

My latest piece in the Daily Dot discusses research on the double bind that women have to navigate in the workplace, and why I’m so fed up with all the demands that women Just Be Confident and Ask For What You Want at work:

Women face a classic double bind: if they confirm female stereotypes of gentleness, communality, and physical attractiveness, they are liked more but presumed less competent. If they disconfirm female stereotypes and act confident and assertive, they are liked less and presumed to have poor social skills. Both being liked and being considered competent is vital for getting hired, retained, and promoted.

These effects are especially pronounced in domains that are considered traditionally “male,” which would include most of the types of fields that everyone’s always wringing their hands about female underrepresentation in: law, business, politics, science, and technology, to name a few.

Another study suggests that interviewers evaluating women who behave in a more stereotypically masculine way emphasize social skills more than competence in their hiring decisions, but when they interview men (or women who are more stereotypically feminine), their hiring decisions hinge more on competence and social skills.

Since we already know that women who are more confident and less feminine are perceived to be lower on social skills, this seems like a convenient way to penalize them in hiring decisions.

In a study published in Research and Organizational Behavior, researchers Laurie Rudman and Julie Phelan described the multiple ways in which women who act contrary to female stereotypes face backlash in the workplace.

For example, women are constantly being exhorted to self-promote so that supervisors and managers notice their skills. However, while women who self-promote may be considered more competent, they are alsoconsidered less likeable and are less likely to be hired. In another study, men who used an “assertive style” in their job application materials weremore likely to be hired than women using an identical strategy, and the actual job applications were identical except for the fictional applicant’s gender.

Once hired, women continue to face this double bind over and over again.

Read the rest here.

For the record, I did not choose the headline or the header image, and I apologize if either is offensive.

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How Young Girls Internalize Rape Culture as “Normal”

[Content note: sexual assault and harassment]

My newest post at the Daily Dot is about a study showing how normalized sexual violence is for young women:

They grab you, touch your butt and try to, like, touch you in the front, and run away, but it’s okay, I mean…I never think it’s a big thing because they do it to everyone.

This is how a 13-year-old girl described being groped by boys at school in a recently published study from Marquette University. Researcher Heather Hlavka examined recordings of interviews with girls who had experienced sexual assault and found that many of the girls consistently tried to minimize their experiences of sexual assault and harassment by claiming that it’s “just what guys do,” “just a joke,” or “no big deal.”

Sexual violence against women is so tragically normal, it seems, that girls grow up expecting it to happen or at least not being very surprised when it does.

Meanwhile, on the internet, a veteran of the comics industry who also happens to be a woman wrote a critique of a comic cover that she found objectifying and gross: specifically, it featured 16- or 17-year-old Wonder Girl with huge, clearly-fake boobs. Predictably, she received numerous death and rape threats online for daring to do this.

Dr. Nerdlove, a blogger who normally dispenses dating advice to (mostly male) geeks, wrote a blog post in response, saying:

Here’s the thing though: this isn’t about whether or not Asselin is legitimately afraid for her personal safety—while not ignoring that these are threats from people who know what she looks like, where she works and where she lives—or if these threats are at all credible. It’s about the fact that this is so common place, that women get so many threats that it stops bothering them.

I want to reiterate that so that it sinks in: women getting so many anonymous, sexually violent threats that it just becomes normal to them.

This is what we’re letting our culture turn into, people.

These two seemingly different examples have a common thread: women viewing sexual violence and threats of it as normal.

When women speak out against sexual violence and harassment, a common response from men is that other women seem fine with it. Other women take it as a compliment. Occasionally a woman or two will join the debate on their side, testifying to the fact that they don’t see anything wrong with catcalling or pressuring someone to have sex with you.

But studies like these show that even from a very young age, many women accept threatening, coercive, and even violent behavior from men because they don’t think anything else is possible. That’s “just how men are.” It’s “no big deal.”

Read the rest here.

Can You Be Happy for 100 Days in a Row?

The 100 Happy Days project.

“Can you be happy for 100 days in a row?” the website wants to know, taunting me with its cheery font and yellow color scheme.

No, I can’t.

“You don’t have time for this, right?” the next line asks rhetorically.

I’ll answer anyway. I have time. I, despite my grad program and 3-hour commute, have plenty of time to be happy. What I lack is the capacity.

It goes on:

We live in times when super-busy schedules have become something to boast about. While the speed of life increases, there is less and less time to enjoy the moment that you are in. The ability to appreciate the moment, the environment and yourself in it, is the base for the bridge towards long term happiness of any human being.

But I do enjoy the moment I’m in. I enjoy watching the skyline from the train during my commute. I enjoyed my four-hour trek through Central Park yesterday. I enjoy the moment the shutter snaps. I enjoy the food I put into my body, especially when I’ve cooked it myself. I enjoy the feeling of my muscles straining at the gym, several times a week. I enjoy the early morning sun over the Hudson. I enjoy the relief of jumping into bed with a book or a paper after work. I enjoy the music I listen to for hours a day. I enjoy every minute I spend writing, and I spend many minutes on it every day. I’m enjoying the moment I am in right now, despite the subject that I’m about to discuss.

All of this, and yet.

I can’t be happy for 100 days in a row. I can’t be happy for ten days in a row. I can’t, except for certain very rare instances, be happy for a day.

I can be happy for an hour or a few.

And by “happy,” I don’t mean “entirely free of negative emotions.” That’s a simplistic view of happiness that few people probably subscribe to. By “happy,” I mean that the good definitely outweighs the bad. I mean feeling that your life is, basically, what it should be and that the decisions you’ve made to get to where you are have been generally pretty good. I mean feeling like you’re a good person overall, give or take a few flaws. I mean being able to wake up in the morning and feel glad that another day is starting.

I don’t know what the folks behind the 100 Happy Days project meant by “happiness” exactly, but I’m sure it’s closer to what I just described than to “entirely free of negative emotion.”

Nobody expects to be entirely free of negative emotion, so I hope that strawman is now happily burning out in the field.

I can’t be happy for 100 days in a row because my brain doesn’t work that way. The good feelings don’t “stick.” When they happen, they’re genuine and meaningful, but they wash away like words scratched into the sand. I argue against them without meaning to. That essay was shit. He doesn’t give a fuck about you. Everything about you is ugly. Your parents will die and you won’t even have the money to fly to their funerals. Your siblings barely remember what you look like because you’re never home. Your partners will leave you for real girlfriends, as opposed to the sloppy facsimile of one that you are. Everything good is temporary; everything bad is permanent.

I don’t know what the nice people who made the 100 Days website would say about this, if anything. Maybe they would say that I’m just not making enough of an effort, giving enough time, to the project of Being Happy. Or maybe they would say that they’re sorry, but this is just a fun little experiment that was never meant for People Like Me.

And there it is. It’s not that there’s anything wrong with this idea. It’s a neat idea, for certain people, for whom the biggest obstacle to being happy and satisfied with their lives is failing to stop and smell the roses.

But I can’t tell you how often I come across these things, accidentally or because a friend recommended it, and think, “Oh, right, that’s not for me.” All those self-help books, anything that addresses mood without explicitly trying it to mental health and psychology. (This one especially.) All these little projects. The mere idea of self-care.

While I know many people with mental illnesses get a lot out of self-care, and self-help, and what have you, for me personally, it’s never resonated. I’ll tell my friends that I’m sorry, I can’t go out tonight after all, because I just can’t and I’m sad and I can’t. And they’ll be supportive, they’ll say, “It’s okay, everyone needs some time to recharge and take care of themselves.” And I get frustrated and I want to tell them that NO I’m not going to “recharge” and this isn’t “taking care” of myself this is giving up and it’s NOT going to make me feel better to sit alone in my room looking out the window all night, it’s just that crying in public is inappropriate whereas crying in your room is okay, so that’s what I have to do.

For me, “self-care” and “enjoying the moment” aren’t things I do because they make me happy, since almost nothing makes me happy. They’re things I do because they help me feel like there’s a purpose to my being here. And I need to feel that way to continue to be here, because I’ve been close enough to the edge to know how slippery and ephemeral that belief can be, and what chaos breaks loose without it.

People say, “You should do what makes you happy.” They say, “I’m glad you moved to New York where you could be happier.” They say, “The most important thing is to be happy.”

Well, I have to measure my outcomes in other ways. I don’t care how much money I make (I won’t make much) or how far up on the career ladder I get (I won’t get very high) or how desirable of a person I marry (I might not marry anyone), and I can’t really be happy. What does that leave?

How many interesting and fond memories I collect. How many people I impact positively. How much and how well I write. How much I influence the causes I want to influence. Of course, it’s much harder to get a sense of these things than it is to get a sense of how happy or sad I am at any given moment.

It’s entirely possible that in a few months or years I’ll be taking this post back. Maybe happiness the way I define it is in my future, maybe one day I’ll stop bitterly regretting all the choices I’ve made and scanning communications from my friends and partners for signs of imminent departure. Maybe the view of the skyline, beautiful as it is, won’t be the best part of my day anymore, because there will be something better. Maybe the flowering trees along Broadway will be the nice little extras that push the day from good to great, as long as I remember to stop and smell them.

But if anything, all these years of feeling like my brain is a science experiment gone awry have taught me that happiness isn’t always an accurate or precise measurement of anything. When I’m achieving everything I want to achieve and I’m surrounded by loving friends and family but I still feel miserable, the failure to be happy isn’t a “sign” of anything. For me, mood is mostly decoupled from the things that are actually supposed to create happiness, whether that’s professional success or pretty flowers or whatever.

I can’t be happy for 100 days in a row, but that means nothing other than my brain doesn’t work that way. All things considered, I think I’m doing pretty okay for myself, despite and regardless of and, most importantly, because of the challenges my mind creates for me.

Your Uninformed and Incorrect Opinions About Psychology

[Content note: PTSD, online harassment & bullying]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Stop that.

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

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

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Against Role Models

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

~~~

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

Some Evidence Against Shame and Stigma as Weight Loss Motivators

[Content note: weight/size stigma and discrimination]

It is considered self-evident by plenty of people that shaming fat people for being fat gets them to stop being fat. That’s why a common reaction to body/fat positivity campaigns is that they’re going to make people think it’s “okay” to be fat. As opposed to…not okay.

However, even if we begin with the presumption that it’s a net good for fat people to stop being fat, research evidence is rapidly piling up that suggests that shaming and stigmatizing them won’t work. In fact, it may have exactly the opposite effect.

In a paper recently accepted for publication in the Journal of Experimental Social Psychology, the authors provide this overview of research on this topic:

Media attention to obesity has increased dramatically (Saguy & Almeling, 2008), as has discrimination against overweight and obese individuals (Andreyeva, Puhl, & Brownell, 2008). Overweight individuals are often portrayed in the media as lazy, weak willed, and self-indulgent (Puhl & Heuer, 2009), and as a drain on the nation’s resources (Begley, 2012). Because stigma can be a potent source of social control (Phelan, Link, & Dovidio, 2008), some authors have suggested that stigmatizing obesity may encourage people to lose weight (Bayer, 2008, Callahan, 2013 and Heinberg et al., 2001), and policies that utilize potentially stigmatizing elements (e.g., BMI report cards) are becoming more prevalent (Vogel, 2011). Little evidence exists, however, that stigmatizing obesity promotes weight loss. In fact, among overweight individuals, experiencing weight-stigmatization is associated with greater reports of maladaptive eating behaviors (e.g., Haines et al., 2006 and Puhl and Brownell, 2006), increased motivation to avoid exercise (Vartanian & Novak, 2008; Vartanian & Shaprow, 2010), and poorer weight loss outcomes among adults in a weight-loss program (Wott & Carels, 2010; but see Latner, Wilson, Jackson, & Stunkard, 2009). Furthermore, experimentally activating weight stereotypes decreased overweight women’s self-efficacy for exercise and dietary control (Seacat & Mickelson, 2009). Collectively, these findings suggest that stigmatizing obesity has negative behavioral consequences that may increase, rather than decrease the weight of overweight individuals.

The paper also reviews research suggesting that the reason this happens is because of something called identity threat. When an individual has an identity that they know is stigmatized and something happens that triggers their awareness of that (such as a joke about the identity or a person who invokes negative stereotypes about it), the individual may experience negative effects. Some of these are physical, such as increased physiological stress response. Some are psychological, such as feelings of shame or anxiety. The person may try to act in ways that “compensate” for the flaws others may perceive in them or avoid situations in which people might think poorly of them (for an overweight person, this may include eating with people or going to the gym).

In theory, all this stress, anxiety, and effort depletes cognitive resources available for other activities that require what is known as executive function–mental tasks such as regulating emotions, setting goals, using short-term memory, and so on. Research has shown that when people of various stigmatized categories are reminded of those stigmas and stereotypes, their cognitive performance on a variety of tasks worsens.

The researchers in this study hypothesized that feeling identity threat would decrease participants’ ability to subsequently regulate their food intake. Specifically, they tested whether or not exposure to news articles about weight stigma would actually increase the amount of calories participants consumed. They believed that the participants who would be most affected would be those who believe themselves to be overweight, regardless of their actual weight, because they would be the ones who would feel identity threat when reminded that weight stigma exists.

The participants were 93 female college students (45% White, 24% Latina, 18% Asian/Pacific Islander, 3% African American, 10% other races). Prior to the study, they had filled out a survey that included a few questions about weight (the rest were just there to hide the purpose of the survey). When they arrived at the study, they were told that the purpose was “to examine correspondence among verbal, nonverbal, and physiological signals.”

They were randomly assigned to one of two conditions. In the test condition, they read an article called “Lose Weight or Lose Your Job,” which was compiled from actual news stories and described the discrimination that overweight people may face in the workplace. In the control condition, the participants read a nearly-identical article that was about smoking rather than weight.

Afterward, they were led to another room and asked to wait for the experimenter to return. The rooms had bowls of snacks that had been weighed prior to the study, and the participants had the opportunity to eat some of the snacks while they waited for 10 minutes. They were then asked to return to the previous room to complete a final questionnaire.

One of the measures on the questionnaire was called “self-efficacy for dietary control.” Self-efficacy refers to one’s sense of having the ability to do something and control one’s outcomes in that domain. This particular measure assessed the extent to which participants felt they could control their eating, avoid unhealthy foods, and so on. Various studies suggest that having a sense of self-efficacy is more important in terms of actual behavior than other factors, such as believing that the behavior is healthy or important. (For instance, here’s an example involving elderly people and exercise.)

The results were pronounced. In the weight stigma condition, women who perceived themselves to be overweight ate significantly more calories than those who did not perceive themselves as overweight. In the control condition, there was no significant difference:

The interaction between perceived weight and article type.

The interaction between perceived weight and article type.

Furthermore, women who perceived themselves as overweight had significantly lower self-efficacy for dietary control in the weight stigma condition than in the control condition, while women who did not perceive themselves as overweight actually had higher self-efficacy in the weight stigma condition than in the control condition.

This means that, within the context of this experiment, women who perceive themselves as overweight increase their food intake in response to hearing about stigma against overweight people and feel less capable of controlling their food intake. The very people being targeted by this information in ways many people think are helpful are actually being harmed by it, not only in the obvious emotional sense but even in their ability to control what they eat.

One really notable finding in this study is that actual weight did not correlate with either calories consumed or self-efficacy in either condition. Perceived weight was the relevant variable. I’ve often heard people argue against the body positivity movement because but if fat people don’t think they’re fat then how will they ever stop being fat?! Ironically, the women who did not perceive themselves as overweight had higher self-efficacy in the weight stigma condition than in the control condition.

One weakness of this study is that it is unclear whether or not the participants who increased their food intake did so consciously–or deliberately. If it was unconscious and not deliberate, then this finding may fit with previous findings about identity threat. If not, it’s still an important finding, but it’s probably easier to get people to change mental processes that are conscious and deliberate as opposed to those that are subconscious and unintentional. It’s also possible (though probably unlikely) that the women in the weight stigma condition purposefully ate more as a sort of symbolic protest. Oh, you’re going to fire me because of what I do with my own body? Well, fuck you, I’ll eat as much as I want.

Another limitation is that the type of stigmatization invoked in this experiment isn’t quite what overweight people might actually experience in their day-to-day lives. While articles like the one used in the study are common, the idea behind stigmatizing people so that they lose weight is usually more direct: for instance, telling them they need to lose weight, penalizing them for being overweight, and so on. Telling a study participant that they’re fat and ugly and need to lose weight would probably never pass an IRB review, but it would be a more naturalistic scenario, unfortunately.

While the sample used in this study is more racially diverse than many other samples in psychology studies, that really isn’t saying much. The researchers did not discuss any racial disparities in the data, but that would be an interesting direction for future studies. Also, all of the participants were young women, so it’s unclear how well this generalizes to older women and men of all ages.

With research like this, it’s important to remember that the findings should be interpreted much in the way that the statement “consent is sexy” should be interpreted. Namely, you should get consent because it’s the right thing to do, not because it’s “sexy.” Likewise, you should refrain from shaming and stigmatizing fat people because it’s the right thing to do, not because shaming and stigmatizing them doesn’t work anyway. Activists rightly criticize research like this for suggesting the implication that we should stop shaming fat people because it doesn’t get them to lose weight, rather than because it’s a shitty thing to do. That said, I don’t think that’s an implication that the researchers mean to give. We should conduct, support, and read research about how human motivation works (and how everything else works) because it’s important to know. This is just one piece of that puzzle.

It is my hope, though, that studies like this will work where “don’t be an asshole” won’t. The most important thing to me is for people to stop stigmatizing and discriminating against fat people, whatever the reason they stop doing it, because it’s harmful and needs to stop. Then maybe we can make these people understand why they were wrong to do it.

However, this research also opens up a lot of tricky questions. If shaming people who are overweight did actually help them lose weight, would more people think that this is an okay thing to do? If shaming people who do things that most of us would consider Definitely Bad, like rape or theft or even saying racist things, worked, would that be okay to do? Many would probably say yes to the latter but no to the former.

What is clear, though, is that human motivation (and reasoning in general) often works in ways that seem counterintuitive. You might think that people would respond to the stimulus of “being overweight can cost you your job” with “well I’d better stop being overweight, then!” But that’s not necessarily the case.

~~~

Major, B., Hunger, J.M., Bunyan, D.P., Miller, C.T. (2014). The ironic effects of weight stigma. Journal of Experimental Social Psychology, 51: 74-80.

What This Depression Survivor Hears When You Call Religion A Mental Illness

[Content note: mental illness, suicide, abuse]

Some atheists love to compare religion to mental illness, or directly call it one. I won’t link to examples; it’s pervasive and has probably happened on this network.

While there may be some useful parallels between mental illness and certain types of religious experiences, calling religion a mental illness in the general sense is a clumsy, inaccurate, alienating thing to say.

This is a list of things that go through my head, things that I hear when I hear atheists calling religion a mental illness. I’m speaking only for myself here. My experience of having depression informs some of these opinions, but so does my knowledge of psychology, my experience working with people who are struggling, and my understanding of what being religious is like and what draws some people to religion.

Some of these may seem contradictory. That’s because they are. Atheists who compare religion to mental illness may do it in various ways and with various meanings. They may do it in a “logical,” intellectualizing sort of way, or they may do it in a spontaneous, ridiculing sort of way. It can be “Religious people are victims of mental illness and need our help” or it can be “LOLOL go see a shrink for your stupid sky daddy delusions.” What I hear when I hear you calling religion a mental illness depends on the context.

“Nobody in their right mind would ever choose to observe a religion.”

Calling religious people mentally ill suggests that they do what they do because they’re “crazy.” I get that religious beliefs and rituals may seem bizarre to atheists who have never had any desire to hold those beliefs or perform those rituals. Sometimes when I’m at religious Jewish functions I sort of look around myself and feel like a bit of an alien. This is so weird, I think. Why would anyone do this?

A major component of mental illness is that it is maladaptive. People with OCD sometimes can’t function because they can’t stop performing their rituals or thinking about their obsessions. People with depression sometimes can’t get out of bed, shower, talk to people, go to work for weeks or months at a time. People with schizophrenia sometimes lose all sense of the distinction between reality and fantasy.

Religion can be maladaptive when taken to extremes, but that’s a problem with the manifestation, not with the core component: believing in a god. In and of itself, believing in a god can actually be very adaptive. When people feel like they have no control over the universe, when they lose someone they love, when a grave injustice happens, it can be comforting to believe that there’s someone up there pulling the strings. It’s not comforting to me, personally, but to many people it is. That doesn’t make their beliefs accurate, but it does make them understandable. You don’t have to be “crazy” to want to believe in a religion.

“Your religious friends may seem happy and well-adjusted, but they’re actually sick just like you are.”

We often hear about people who are restricted, cut off, or even abused by their religion. These cases are tragic and deserve every bit of the attention that they get. But what about all the people living happily with religion?

Atheists who claim that religion is a mental illness seem to be saying that these people are just kidding themselves. Sure, they’re happy, but that happiness can’t be real because it’s the product of a mental illness. Or they think they’re happy, but they’re really not.

If this is what you believe about religious people, ask yourself why you think you know more about their mental state than they themselves do.

“I consider myself qualified to diagnose millions of people I’ve never met with a mental illness.”

Armchair diagnosis is a bad idea. It promotes the idea that mental illness is whatever we feel on a whim that it is, and that random internet commenters are qualified to determine whether or not someone has a mental illness despite never having even spoken to them, let alone spent time with them in person as a diagnosing psychologist would.

“Whether or not I think someone is mentally ill is more important than whether or not they think they’re mentally ill.”

And in addition to that, the fact that probably zero religious believers think that their religion qualifies as a mental illness is a good indication that you should stop saying that it is. Of course, you can and should disagree with them on other things, external things, like whether or not god exists or whether or not religion is a net good in society or whether or not people can be ethical without religion. But what goes on in their own minds is something they know much more about than you ever will.

“People who say their faith helped them deal with their mental illness are just kidding themselves.”

Can’t fix a mental illness with another mental illness, right?

This is a tricky area because I do think it’s very fair to question the presumption that religion helps people with mental illness in general. First of all, people (religious and not) with mental illnesses are often told that they need to pray or “have faith” or repent or whatever, because some religious people believe that mental illness is a sign of insufficient faith or a punishment from god or both. Second, some religious people find that religion actually makes their illness harder to cope with, whether because of these responses or other factors. Some people may even become more vulnerable to mental illness as a result of something their religion taught them, such as shame or a preoccupation with doing things a certain way.

However, there are also many people who say that religion helped them cope with their mental illness, whether it was the faith itself, a supportive religious community, or both. I do not feel comfortable claiming that these people are lying to themselves or to us.

I wish that people didn’t need faith to cope. I wish we had foolproof treatments for mental illness. I wish everyone had access to those treatments. I wish we never had to send patients home saying that we don’t know what else to do for them. I wish we knew exactly what–which genes, which environments, which neurotransmitter deficiencies–caused mental illness, so that nobody ever had to feel like it was either a random accident of chance (terrifying) or an act of god (slightly less terrifying, for some people).

But right now, we don’t have any of that. So it makes sense that some people would cope by telling themselves that it’s part of god’s plan and that they can’t possibly comprehend that plan.

I want people to be happy and alive. That’s my first priority. Once they’re happy and alive, I can think about trying to get them to think more rationally and scientifically. If thinking irrationally and nonscientifically is what keeps someone from suicide (or from a miserable life), I accept that.

And as far as the community aspect goes, having a strong support system can be both a protective factor against mental illness and also a mechanism that helps people cope or recover. Building humanist communities is extremely important for all kinds of reasons and this is one of them. We’re making progress, but humanist communities still don’t have the scope or resources of religious ones. There are also still plenty of atheists publicly decrying these projects and boasting about how they don’t need them and such things are useless and pseudo-religious and for the weak-minded. That’s harmful. If a religious person feels that their church or synagogue is the only source of support they have for their mental illness, they might not necessarily be wrong.

“Religious beliefs are inherently bad and harmful to the individual, just like the distorted thoughts associated with mental illness.”

Some people, such as Greta Christina, have made powerful, compassionate arguments for the idea that religious belief is universally, intrinsically harmful to society, separate from the harmful effects that organized religion can have. I’m not sure yet how I feel about these ideas, but I’m still much more comfortable with the opinion that religious belief does harm to other people and to society as a whole than that necessarily does harm to the individual who holds it.

Most religious people would probably say that their religion helps them be happy, charitable, kind, and strong. I may feel skeptical about this, but they know better than me.

On the contrary, the symptoms of mental illness are very, very clearly harmful in a way that is undeniable. While people with mental illnesses may sometimes deny that there is anything wrong, they are often clearly unhappy, and their denial is often caused by fear of the stigma of mental illness. (All the same, though, if someone tells me they are not mentally ill, I would never argue with them.)

“All mental illness means is having irrational thoughts or believing something without evidence, and it is possible to completely stop having irrational thoughts.”

I hate to break it to you, but irrationality is probably part of the human condition. Everyone is, to some extent, subject to cognitive biases. Almost everyone at one point or another engages in superstitious, fantastical thinking. Clearing your mind of irrational beliefs that aren’t based on evidence is something that can only be accomplished intentionally, with effort. Even then, you will never be perfect. There’s a reason the popular rationality site Less Wrong is called Less Wrong, not Perfectly Right or Not At All Wrong.

So if being irrational is a sign of mental illness, then we are all mentally ill, atheists included. But more likely, (extreme) irrationality is only one component of mental illness. Others might include engaging in behaviors that are harmful to oneself, behaving in ways that are not considered normative in that particular cultural context (a problematic criterion, but a useful one when used in conjunction with others), being unhappy with one’s mental state, and not being able to function properly in one’s daily life.

“My desire to make a point is more important than what the psychological evidence says about religion and mental illness.”

To put it simply, the processes that lead people to be religious are not the same ones that lead them to be mentally ill. As I mentioned above, religious belief is a subset of the sort of irrational thinking to which all humans are prone. Humans look for patterns in the world and easily form superstitions on the basis of those patterns. Humans also generally enjoy the feeling of being part of a group or having a community, and religion is an easy way for a lot of people to experience that feeling. Many people who are religious were born into religious families and were taught that god exists and [insert religious tenets here] from birth, so it sticks.

On the more abusive end of things, people may stay in harmful religious sects or communities for similar reasons as they stay in abusive relationships. They are made to feel by their abusers that they will never be complete without the faith. They are taught that they will go to hell forever if they leave. They are made to feel worthless and powerless. They are told that people outside of the religious communities are bad people.

Being affected by abuse does not mean you’re mentally ill. It means that someone who knows how to take advantage of people took advantage of you. Furthermore, religion is but one of many props people can use to abuse and control each other.

On the contrary, mental illnesses have substantial genetic and biological components to them. Studies on identical twins, including ones reared apart, have demonstrated fairly high concordance rates for some disorders. While the chemical-imbalances-cause-depression theory has now been shown to be drastically oversimplified, mental illnesses clearly do have some sort of neural causes, triggers, and effects. Mental illnesses are often (but not always) triggered by major stressful life events; they can occur when an individual goes through hardship with which they are not psychologically equipped to cope.

Unlike religion, mental illnesses are not taught to people by other people; they tend to occur when genetic/biological susceptibility lines up with stressful environments or adverse life circumstances. Unlike religion, people do not try to remain mentally ill so that they do not lose their support systems or because they are afraid of what would happen if they stopped being mentally ill. They remain mentally ill until they receive proper treatment, or until the illness remits on its own. Unlike (non-abusive) religion, people do not have a choice whether to stay or leave. Those who suffer from eating disorders, substance abuse, or OCD may claim or genuinely feel that they have a choice, but they actually don’t, and that becomes evident as soon as they try to stop. Yet countless people voluntarily leave religion every day. That doesn’t sound like a mental illness to me.

“You chose to have your mental illness, just like people choose to be religious.” 

Some atheists who make this comparison believe that having religious beliefs is a choice (and abandoning them would also be a choice). If having the symptoms of a mental illness is a choice, what does this say about the rest of us?

“Mental illnesses (like religion) can be cured by making fun of people’s irrational beliefs and shaming them on the internet.”

Normally recovering from a mental illness requires therapy, medication, a strong social support system, or some combination of those. I rarely see atheists agitating for better mental healthcare services for religious people to help them deconvert. In fact, providing people with the resources they would actually need to leave religion (as opposed to simply telling them they’re wrong over and over again) is not a major focus of very many atheists. Of course, I would be remiss not to mention the work done by groups like Recovering From Religion and the Clergy Project. But I also haven’t personally witnessed anyone associated with these groups claiming that religion is a mental illness.

“Religious people can’t be held responsible for their beliefs; they’re just victims of an illness.”

If you do agree that mental illness is not a choice, however, that implies that being religious is not a choice either. That implies that religious people do not have agency over any part of their religious belief or observance. Not only is this offensive to religious people, but it actually suggests that we shouldn’t hold them responsible for their beliefs. You wouldn’t blame a person with anxiety for feeling anxious, would you?

“I don’t care about mental illness unless it’s religion.”

Relatedly, better mental healthcare is not a major concern of many atheists (the ones who don’t have mental illnesses, that is). It really should be. Mental healthcare is stymied by both religion and pseudoscience, and advocating for more research, funding, and concern in this area is a project that I think would be of great relevance to the secular movement. But the only time I see most atheists bringing it up is when the “illness” is religion. What about the 25% of American adults who will suffer from an actual mental illness (or more than one) at some point in their lives?

“Mental illness is bad and shameful; that’s why I’m using it to disparage religion.”

Sometimes when I see the religion-mental illness comparison being made, it’s being done in a way that is clearly meant to ridicule and put down. Atheists frequently employ language that stigmatizes mental illness to refer to religious people, such as “crazy,” “insane,” “nutcase,” and so on. Even when you’re not using such clearly hurtful language, though, you can still be perpetuating stigma by saying that such-and-such Islamist “belongs in a mental institution” or that such-and-such fundamentalist Christian “needs to see a shrink.”

If you think religion is horrible and then you compare it to the condition I have, how am I meant to think you see me?

“You are a rhetorical prop for me to use to disparage religion.”

And that’s why I feel like people with mental illnesses are being used as convenient stand-ins when someone wants to diss religion. I feel like our suffering is just a tool for you to pull out of the antitheist toolbox when you need it. “Look how stupid religion is! It’s just like a mental illness!” you say. My depression is not at all like a religion. Unlike a religion, I didn’t choose it. Unlike a religion, it has never provided me with rituals and communities. Unlike a religion, it was not something taught to me by people, not something I could’ve avoided. Unlike a religion, it can’t go away no matter how many times you tell me I’m wrong. Unlike a religion, it has no positive effects, ever. Unlike a religion, my depression didn’t just make me empirically wrong about certain things; it broke my entire life into pieces and took away my ability to enjoy anything. Please stop using that awful legacy to score cheap points against religious believers.

“Attacking religion is more important to me than being inclusive and supportive of atheists with mental illness.”

I tell other atheists over and over again that this is hurtful, inaccurate, and completely pointless. And over and over again, despite the massive support I get in these comment threads from other atheists with mental illnesses, they insist on using this stigmatizing, alienating language. They ignore our knowledge of psychology and mental illness and continue to claim, against the evidence, that religion can be categorized as a form of mental illness. Rather than diving in and learning more about how mental illnesses are defined and which mental processes contribute to religiosity, they refuse to let go of this rhetorical tool.

I don’t think that’s a coincidence. I think that deep down many people think so poorly of people with mental illnesses that they know how effective it can be to compare anything you think is bad to a mental illness. It happens all the time.

But considering how many people I know in this community who are diagnosed with a mental illness, I would cautiously say that maybe you shouldn’t keep alienating us. I’m just one person, but I have serious qualms about working with an atheist leader or organization that holds the view that religion is a mental illness. I doubt I’m the only one.

Find a better argument. Find one that is accurate, first of all, and that stomps on as few already-marginalized people as possible.

~~~

Moderation note: I have finals this week and am unlikely to be around to answer every single question and argument I get. I will moderate strictly for comments that stigmatize mental illness, though. If this piece sets off lots of debates in the comment section, hopefully they can flow smoothly and somewhat productively without much input from me.

“What do you have to be depressed about?”

If you have experienced depression while living what appears to be a fairly nice life, you’ve probably had someone ask you, “What do you have to be depressed about?”

Sometimes people who ask this question are genuinely curious because they think that depression is necessarily “about” something and they just don’t understand what, in your case, it could be “about.” Sometimes, though, people who perceive your life to be better than theirs feel resentful and jealous and, upon hearing that you are suffering from depression, demand to know what could possibly be wrong with your life that could cause a mental illness.

The origins of depression are complicated and still not very well-understood. One model that’s gained ground lately is called the diathesis-stress model. The term “diathesis” refers to a vulnerability, which could be genetic, biological, environmental, or psychological. “Stress” refers to a catalyzing event, a life stressor that can increase one’s chances of developing a disorder (the diathesis-stress model has been used to describe more than just depression).

One specific type of diathesis that has been researched concerns a specific gene, known as the serotonin transporter gene or 5-HTTLPR. Some studies suggest that people with a particular variant of the gene are more likely to develop depression, but only if they have a significant life stressor. If not, then there’s no difference between people with the different variations of the gene.

The results are mixed so far, but this is just one example of a way in which having “something to be depressed about” can indeed provoke depression. But it’s not the whole story. People without significant life stressors can still get depression, and people who do have life stressors are still much more likely to get depression if they have that genetic predisposition–the diathesis.

Diathesis can come in all sorts of forms. Having learned poor cognitive coping skills as a child could be a diathesis. Having abnormalities in the brain’s neurochemistry could also be a diathesis, although the “chemical imbalance” theory of depression as we’re used to seeing it is more or less bullshit.

Some types of diathesis might be considered to count as “something to be depressed about,” such as living in poverty, having a chronic health condition, or having an unstable or abusive family life. Others, such as having genetic predispositions or brain abnormalities, would not count as such for most people. Asking someone what they have to be depressed about is therefore not very useful.

But moving away from the science of depression’s origins, I’ll state the obvious: no matter how well you know someone, you never know everything that’s going on in their life. Not even if it’s your kid. The person may have a significant life stressor that’s triggering their depression that they just haven’t told you about, and they probably won’t if you sarcastically ask them what they have to be depressed about. If you’re genuinely curious, a better way to phrase that question is, “I’m sorry to hear you have depression. Is there anything that’s triggering it for you?”

The important thing with that is to never ask questions like you already know the answers. The question, “What do you have to be depressed about?” comes along with the implied answer, “Nothing.” Even if you don’t think it does. That’s how many people are going to hear it. So don’t get too caught up on the literal meaning of the words you are saying, and think about how they’re going to be interpreted.

The hypocrisy of the “What do you have to be depressed about?” question becomes blatant when you consider our typical response to those who do, by all accounts, have something to be depressed “about.” What tends to happen is that when we feel that depression is to be expected in a given situation, we also frame it as “okay.” Normal. Natural. It’ll pass on its own and we shouldn’t interfere.

This might explain the controversy over the decision to remove the bereavement exception from the newest edition of the DSM. Previously, people who were grieving had a two-month “window” during which they could not be diagnosed with depression, which often looks very similar to bereavement. With the publication of the DSM-5, this exception was removed. Lots of people were Very Concerned that this means that we’re “medicalizing” a “normal” process such as grieving.

I know I probably over-rely on comparisons to physical health, but that’s because they can be very illuminating. If you’re subjected to a some loud noise and you get a headache, or you work out strenuously and get extremely sore muscles, few people would suggest that you shouldn’t take medication to ease those pains just because they happened “naturally” (whatever that means). Being extremely sad, even “depressed,” as a response to a loved one dying is definitely “natural,” but that doesn’t mean it can’t interfere with your functioning as a person, and that you don’t deserve help dealing with it.

I’m not necessarily saying that high levels of grief should be diagnosed as depression, though. I’m just pointing out the hypocrisy of expecting people to produce compelling “reasons” for being depressed, but then refusing to consider people who do have compelling reasons to be depressed, even if they show all the symptoms.

My final gripe with the “What do you have to be depressed about?” question is that it’s often a way of trying to rank human suffering. What do you have to be depressed about? Some people are abused by their parents. What do you have to be depressed about? Some people are starving. What do you have to be depressed about? Some people have cancer.

Well, if you, personally, were abused by your parents, are starving, or have cancer, I wouldn’t fault you for feeling that the concerns of people with depression aren’t as serious as yours. That’s your right. But there are no measurements with which we can assess how bad someone has it. There is no Standard Life-Shittiness Unit. We need to stop looking for one, and treat every individual’s pain as legitimate.

Of Pranks and Playboy: The Pros and Cons of Online Hoaxes

Header for Playboy's fake party guide.

If you were online at all last week, you probably came across a Playboy article called “Top Ten Party Commandments.” The article was in Playboy’s usual style, but rather than emphasizing your typical dudebro disregard for women’s feelings, opinions, and preferences, it’s all about how you can’t truly have a good time without consent and it discusses the cool initiatives different campuses around the country are doing to promote consent.

So, obviously, the article wasn’t really written by Playboy. It was a prank by a group called FORCE: Upsetting Rape Culture, which was also responsible for a similar hoax involving Victoria’s Secret last winter.

I really like hacktivism like this, but it does have some negative externalities. I’ll talk about some of the pros and then some of the cons.

First of all, it gets attention. Someone who might not click on a link to an article called “Why Consent is Important” might click on a link to an article called “Playboy’s Top Ten Party Commandments.” That person would then be exposed to information and opinions they might have never considered before.

Second, a hoax like this answers the question every activist is tired of hearing: “Yeah, well, if the way things are right now is so bad, what’s your idea, huh?” Although I reject the idea that in order for criticism to be legitimate, one must have a ready-made solution at their disposal, the fake party guide does a great job of giving an example of the type of content a consent-positive magazine might publish. It shows that, in a world free of rape culture, lingerie brands might replace phrases like “Sure Thing” with “Ask First,” and college party guides might rank campuses based on which are the best at promoting safe and healthy sex, not which have the drunkest women.

Third, these pranks provoke a strong positive reaction that sends a powerful message to the companies they mimic. That message is, you don’t have to promote rape culture to sell products. We’re often told that this is “just what sells.” Maybe it does, but consent can sell, too. After the Victoria’s Secret prank, social media filled up with people praising Victoria’s Secret and announcing that they plan to go out and buy the new (fake) products. Likewise, before people figured out it was fake, they congratulated Playboy on taking this new direction.

Part of the fake playboy party guide.A smart business will gauge the public responses to these hoaxes and act accordingly. Victoria’s Secret apparently said that they would “look into” creating a consent-positive lingerie line, although I haven’t heard anything else about that since December. Playboy, on the other hand, publicly stated that they had nothing to do with this hoax, and asked that it be taken down. Bad move.

The drawback of these pranks, though, is that many people will inevitably not hear the part about how it’s a prank; they’ll only hear the part about how X Company That Wasn’t That Good About This Stuff totally switched tacks and created some cool new product that doesn’t suck. I was still bursting people’s bubbles about the Victoria’s Secret months after it happened. Corrections aren’t as sticky as the original news story they’re correcting.

Furthermore, plenty of research confirms that it is really difficult to correct misinformation once it has been spread. From a guide in the Columbia Journalism Review:

Unfortunately, available research in this area paints a pessimistic picture: the most salient misperceptions are typically difficult to correct. This is because, in part, people’s evaluations of new information are shaped by their beliefs. When we encounter news that challenges our views, our brains may produce a variety of responses to compensate for this unwelcome information. As a result, corrections are sometimes ineffective andcan even backfire (PDF).

And even if people are not actively engaged in resisting unwelcome facts, the limitations of human cognition can hinder the correction of misperceptions. For example, once a piece of information is encoded in memory, it can be very difficult to undo its effects on subsequent attitudes and beliefs. Trying to correct a false claim with a negation (e.g., “John is not a criminal”) can also lead people to more easily remember the claim you are trying to negate (“John is a criminal”). Finally, people may use the familiarity of a claim as a heuristic for its accuracy. If corrections make a claim seem more familiar, we may be more likely to see the underlying—and incorrect—claim as true.

What this means is that, even if a media outlet prints a correction (which some had to do after misreporting the Playbox hoax as genuine) and even if people actually see it (which they’re probably not very likely to, since it won’t spread virally like the original news did), the correction is not very likely to “stick.” And, even more worryingly, reporting the Playbox hoax accurately the first time might still lead people to misremember it later as being not a hoax.

But so what if people keep thinking that Victoria’s Secret and Playboy really created these products? Well, it’s always unpleasant when someone gets credit that they don’t deserve. But also, it skews people’s perceptions of how far we’ve come and what is left to be done. Major corporations like these still don’t really take public stands for consent; rather, they create products that negate its importance or actively promote rapey stuff. If people develop the impression that this is changing when it really isn’t, they might be more skeptical of efforts to make it change.

Although it bothers me that these pranks likely end up spreading misinformation, I still think that the pros outweigh the cons. But you may disagree.