Venting About Your Problems Is Therapy’s Failure Mode

At least, it was for me.

The more I learn about how to conduct effective, evidence-based therapy, the more I understand why none of my attempts at getting therapy helped. (It is true that my depression is “in remission” or whatever you want to call it, but I don’t credit the few total months I spent in therapy with that development.)

Many people think that therapy is about paying a person to sit there and nonjudgmentally listen to you vent about your problems. Some of this might come from the prevalence of psychoanalytic thought in our culture, including in stereotypes about therapy and mental illness. Freud and his ideas are still very dominant in the many laypeople’s opinions about psychology. Specifically, I’m thinking of free association, a technique used in traditional psychoanalysis in which the client is asked to just say whatever happens to be on their mind, however silly or irrelevant it may seem. Free association is meant to inspire the client to reveal previously-repressed thoughts or feelings that both client and therapist are then able to learn from and understand.

I suppose that sometimes this can be useful, but other times or for other people, it may not be. The problem is that therapists operating from this perspective will be biased towards finding some sort of hidden meaning in the client’s free association whether it is there or not. If you asked me to free associate, I would probably just rant incoherently about how cool the buildings downtown are or cute things the children in my family say or how frustrated I am that whenever I enter a building I am always very cold because people use excessive air conditioning in this country.

And I’m sure an unscrupulous therapist could just assume that this means that I am obsessed with phallic-shaped objects or I am desperate to have children or I find that this world is too cold and unwelcoming and I long for the safe, warm environment of my mother’s womb. Sure. My own perspective is that the things that I happen to randomly think about when I am not directing myself (or being directed by someone else) to think about something in particular are rarely relevant to the major issues I have in my life. I will survive despite the prevalence of freezing-cold rooms in my day-to-day experience.

So it is with venting about my problems, which is somewhat similar to free-association in that one is asked to simply say whatever they want to talk about or are upset about at the moment. Yes, obviously, it can sometimes be very useful. I do not deny that whatsoever. A therapist may ask, “What’s been troubling you lately?” and a client might say, “My mother is sick.” Or they might say, “My children won’t listen to me and it’s making me mad,” and then the therapist probes a little more and the client reveals that the client and their partner are constantly fighting and contradicting each other and the children don’t know who they’re supposed to be listening to anymore.

The trouble starts when venting about their problems is all the client is ever asked or allowed or encouraged to do. Then you have a therapist who’s doing nothing more than what a trusted, patient, empathic friend could do. And while, to be fair, such friends aren’t as easy to find as we may wish they were, these are not skills that you need at least six years of higher education and at least one (possibly more) professional licenses in order to administer.

And that’s about all I recall doing when I went to therapy. Of course, because I was depressed, the things I vented about frequently had to do with depression in some oblique way. But the key thing on my mind as I headed off to my weekly appointments wasn’t necessarily, “I have depression.” It was, “I just had a fight with my partner and now I’m convinced they’ll dump me and I’ll be alone forever.” Or “I’m terrifying about this exam and if I don’t do well then I am a failure.” Or “I hate myself.” Or whatever.

And my therapists, for the most part, did succeed in creating a space where I felt slightly comfortable with sharing these things, and so I shared them. They would say, “What would you like to talk about?” and I wanted to talk about my conversation with my mother or how much I miss my siblings or my fears about my partner leaving me. The therapists would attempt to understand why I felt the way I did, but they did not seem to do much to change the way I felt, even though I continued seeing the same ones for a few months at least. By then, the real work of therapy should have begun.

Whereas what I’ve now been taught to do as part of my own training in mental healthcare goes more like this: A client comes to you. You ask for some basic information from the client about their life, family, history, cultural/ethnic/religious background, reasons for coming to therapy, and so on. You ask the client what they would like to accomplish in therapy. You tell them a little bit about your own therapy practice and what they can expect from it, and see if there’s anything that makes them uncomfortable or that they feel wouldn’t work for them.

Together, you set some concrete goals for therapy that are as measurable as possible. For instance, “I would like to stop having panic attacks when I leave the house.” Or “I want to find ways to deal with feeling very upset that do not involve self-harm.” Or “I want to learn how to approach people and make friends with them.” Or “My partner and I would like to find ways to manage jealousy.” If the client suggests goals that the therapist thinks are too vague, unrealistic, or dependent on factors beyond the client’s control (“I want to find a partner”), the therapist can discuss this with the client and help them adjust the goal so that it’s more manageable (“I want to get over my anxiety about asking people out on dates” along with “I want to learn ways to deal with feeling lonely”).

Then, the therapy progresses towards these goals. Every few weeks or so, the therapist and client assess how the therapy is going so far, and the client can weigh in on whether or not they think it’s helping, what concrete progress they feel they have made, and so on. The therapist may periodically administer scales or questionnaires that help gauge improvement in a slightly more objective way. The client and the therapist together can decide to adjust or change the goals if they want to, or introduce new ones as older ones are achieved. Being able to assess and adjust therapy as it’s going on, not just when it’s about to end, is very important.

Eventually, depending on the therapist’s style and the needs of the client, they may discuss termination, which is a word I hate that refers to the process of ending one’s work with a particular client. The client may feel that they’ve accomplished the goals they had, or that they’ve gotten as far as they think they can with a therapist and will be okay on their own now, or that they need to find a different therapist who may be able to help them better. Therapy should not continue indefinitely. The therapist and the client may agree to check in again in a certain number of months to see how the client is doing and whether or not they need to return to therapy.

Of course, this is just a template; everyone does it differently and not all clients may want or need all of these steps, but this is consistent with an evidence-based approach. This process holds therapists accountable by encouraging them and their clients to evaluate the therapy.

When I look back on my time in therapy, I wonder if I could’ve done a better job of making it work for me. Maybe I should’ve offered up specific changes that I wanted to see to the therapists, such as “I want to stop crying several times a week” or “I need to learn to be okay with being single.” (Both of these things happened without the help of a therapist, by the way.) But…I didn’t really know that I needed to do that. I saw my therapists as authority figures. I assumed they knew what they were doing, and that they would ask me for specific things if they needed to. I had only the vaguest ideas of how therapy is “supposed” to work, because my psychology classes mainly focused on theories and not on practice.

If you find yourself doing nothing but venting about your problems in therapy–without necessarily then developing any sort of plan to help resolve or cope with the problems–that’s a red flag. Venting can be therapeutic in its own right, but you shouldn’t have to pay for the opportunity to do it. Therapists have a responsibility to provide the best treatment they can; it’s literally in our code of ethics. You deserve that from your therapist.

A Primer On Atypical Depression

At CONvergence two weeks ago, I and a few other people did a panel on myths about mental illness. It was really great, and I hope that there will be a video of it up eventually. At one point, I tangentially mentioned atypical depression, a type of depression that is sometimes contrasted with melancholic depression, or the “typical” kind.

Atypical depression is the type that I have, and that might be part of the reason it took me something like seven years to realize that I had depression at all. A few people have since told me that they didn’t even realize atypical depression was a thing. So I decided to write a brief overview of it in the hopes that more people who don’t have a name for what they’re going through might find a name for it.

There are some “classic” depression symptoms that most people think of when they think of depression: being numb or sad most of the time, being unable to take joy in things you used to like, insomnia, and loss of appetite and weight. You think of the person lying in bed unable to care about or take pleasure in anything.

Atypical depression has a rather different set of features. Instead of insomnia, you may have hypersomnia (oversleeping). People with atypical depression might regularly need to sleep 10 or 12 or even more hours. Instead of loss of appetite, you may overeat and/or gain weight. Instead of being numb or just uniformly sad, you have high mood reactivity, or mood swings. You may find that you’re able to enjoy things and feel happy when things are going very well, but as soon as things are neutral or even just a little bit bad, you feel horrible again. There are two other symptoms that are sometimes present: leaden paralysis, or the feeling that your limbs are very heavy and difficult to move, and high rejection sensitivity, which means being overly concerned about people not liking you or rejecting you, to the point that it impairs your social functioning.

Unsurprisingly, these different sets of symptoms mean that different types of antidepressants may work best for each type. I will quote Wikipedia here, since it’s sourced and there’s no good reason to rephrase it:

Medication response differs between chronic atypical depression and acute melancholic depression. Some studies[4] suggest that the older class of antidepressants, monoamine oxidase inhibitors (MAOIs), may be more effective at treating atypical depression. While the more modern SSRIs and SNRIs are usually quite effective in this illness, the tricyclic antidepressants typically are not.[1] The wakefulness-promoting agent Modafinil has shown considerable effect in combating atypical depression, maintaining this effect even after discontinuation of treatment. [5]

I don’t know how useful this information is to you if you think you may have atypical depression, but at least now you know that if your symptoms fit this pattern but your psychiatrist prescribes you a tricyclic antidepressant without further explanation, it might be worth bringing up this research. In addition, if SSRIs haven’t been working for you, you might ask your psychiatrist about trying MAOIs rather than a different SSRI or a higher dose of the same one.

In terms of therapy, I can’t seem to find any studies on the effectiveness of different types of therapy on the different types of depression (that may be because Google Scholar is actually a terrible search engine), but my educated guess would be that dialectical behavior therapy (DBT) would be extra helpful for atypical depression as opposed to melancholic depression. DBT is a type of therapy developed specifically to treat borderline personality disorder, which involves lots of mood swings, rejection sensitivity, and general troubles with managing emotions. DBT contains a lot of the same techniques as cognitive-behavioral therapy (CBT; the standard of evidence-based treatment), but it also emphasizes mindfulness and learning to cope with strong emotions. Atypical depression, with its mood swings and interpersonal issues, might be especially amenable to it.

To the extent that psychodynamic therapy is effective (actually, plenty of studies suggest that it might be), it might also be more effective on atypical depression than other approaches. Atypical depression tends to have an earlier onset, and people may experience it as an aspect of their personality that is rooted deeply in their life experiences. When practiced well, psychodynamic therapy may be useful for resolving these issues. But none of this is to say that standard CBT should not be tried.

During my senior year of college, I asked a professor who studies the neuropsychology of mood disorders whether or not he knew of any research on neurological differences between atypical and melancholic depression. After all, there’s been plenty of research on how depression affects the brain–in terms of active brain regions, neurogenesis (growth of new neurons) in various regions, and so on. Were all these studies really done using patients who might’ve had what looks like two nearly-completely different illnesses? Apparently. My professor wasn’t aware of any such studies, and I’ve only found one myself: some research that examined which hemisphere of the brain responds more to a particular face test, and in atypical depression patients, the right hemisphere was much more active than it was in melancholic depression patients and in non-depressed controls. The authors write, “This is further evidence that atypical depression is a biologically distinct subtype and underscores the importance of this diagnostic distinction for neurophysiologic studies.”

There also seems to be some evidence that atypical depression in particular is linked to thyroid dysfunction, which may explain some of the physical symptoms. However, the results seem to be rather complicated and confusing, and it’s definitely not a simple causative link.

Although the diagnostic criteria for depression contain both sets of symptom patterns and there’s even a special indicator for “atypical features,” the popular conception of depression is of the melancholic type, not the atypical type. This means that many people, believing that depression necessarily means “being completely miserable all of the time always,” may not realize that they might have depression and can benefit from treatment.

Atypical depression presents a classic boiling-frog problem. Because you are in fact capable of feeling happy for short or medium stretches of time, it can take a serious increase in symptom severity to realize that there’s anything wrong. Incidentally, as I mentioned, atypical depression also tends to have an earlier onset than melancholic depression, which means that you may spend your entire post-childhood life that way. For some people, certainly for me, it felt like it was “just my personality.” To make things even more confusing, the rejection sensitivity tends to be present even during periods of time when the rest of the symptoms are in remission. But when it comes to mental health, nothing is ever really “just your personality” if you don’t want it to be.

Hopefully, this overview will help people–at least the people who read this blog–broaden their awareness of what depression is. If there’s anything I missed in terms of research, by the way, please let me know. As I mentioned, my Google Scholar-fu is much worse than my Google-fu.

Depression Is Not Sadness (Again)

[Content note: mental illness, depression, anxiety, suicide]

When I think about the frequent charge that therapists and psychiatrists and those who work with them are trying to “medicalize” “normal” emotions like sadness and fear, I think that people don’t really understand how emotions like sadness and fear can be distinguished from mental illnesses like depression and anxiety.

I’ve tried to explain this to many people multiple times, in person and through writing, and so have many other people with mental illnesses as well as professionals in the field. Yet people continue to conflate emotions and illnesses, or rather to assume that mental healthcare advocates are conflating them. It’s often difficult to continue engaging patiently with this claim.

Even those who are knowledgeable about illness and disability make this error. In an otherwise-fantastic blog post about the medical model of disabilityValéria M. Souza uncritically cites this very inaccurate view of antidepressants:

In The End of Normal: Identity in a Biocultural Era, Lennard Davis affirms: “A drug would be a prosthesis if it restored or imitated some primary state that appears to be natural and useful” (64). Davis makes this statement in the context of his argument that SSRIs are not “chemical prostheses” for depression, since happiness is not a “primary state” of being and since there is compelling evidence to suggest that SSRIs do not actually work (Davis 55-60).

I’ll address the SSRIs-not-working thing first since I have less to say about that and it’s not as relevant to this post. The reality seems to be more that SSRIs work well for some people but not at all for many other people and we haven’t really figured out why they work for some people but not others, or more specifically, which types of people they work for and which they don’t. And on a personal note, I’m a little tired of being told that SSRIs “don’t work” when they’re part of the reason I didn’t try to off myself four years ago. There is compelling evidence to suggest they do not actually work and there is compelling evidence to suggest that they do actually work, so I’m comfortable saying that the jury’s still out on this one.

More to the point: antidepressants are not meant to cause “happiness” because depression, the illness they are meant to treat, is not defined by a lack of “happiness.” Depression involves a constellation of physical, emotional, and behavioral symptoms that make happiness very difficult or even impossible. These symptoms have a number of other deleterious effects which vary for different people. There are many ways depression can ultimately “look,” such as being unable to get out of bed, being unable to hold down a job, bursting into tears several times a day over tiny inconveniences or in response to nothing at all, losing your sex drive, being unable to sleep, having to sleep over 12 hours a day, having severe memory loss, losing the ability to enjoy any previously enjoyable activity, experiencing complete emotional numbness, obsessing over death and suicide, physically hurting yourself, or attempting suicide.

Maybe being “happy,” whatever that even means, isn’t a “primary state,” but I would argue that being able to live a relatively normal life in which you can go to school or have a job, have relationships with people, and not want to kill yourself is a “primary state.”

Being treated for (and, hopefully, recovering from) depression does not give you extra things that other people don’t have, such as constant happiness and optimism. It gives you what everyone else has had all along, which is a reasonable and age-appropriate amount of control over your emotional state and the ability to create your own happiness if you want to and make the effort.

By the way, you can definitely be miserable and unhappy without having a diagnosable mental illness, but it’s rare to find a person whose unhappiness is truly caused entirely by their own voluntary actions. Depression can also develop as a result of voluntary actions; for instance, if you have a number of career options available to you but you choose an extremely stressful and mind-numbing (but perhaps lucrative?) option, you might end up becoming depressed because of it. At that point, your best bet might be to find a way to make a career change, but it’s likely that you’ll also need therapy to help undo the maladaptive mental habits that the situation has created. (Medication might help too, but in a case like this I’d personally recommend therapy first.)

I think a better way to explain the difference has been that, at least in my experience of mental illness versus mental health, there are things that mentally healthy people can do to significantly increase their level of happiness, whereas people who are going through a bout of mental illness can rarely make a huge difference just by stopping and smelling the roses or making more time to play with their kids or enrolling in a cooking class or whatever. They can maybe make a small difference, but it’s unlikely to reduce the mental illness symptoms themselves. I used to get so frustrated at things like The Happiness Project and other initiatives of that sort, until I finally realized that they weren’t aimed at me because happiness would literally not even be a possibility for me until I treated my damn mental illness.

(That said, things like that can be very useful for someone whose mental illness is in remission or otherwise low-grade. Right now, I’m not fully symptomatic for depression but I’m aware that it can probably come back at any time, so I do a lot of things to keep my mental health strong to try to avoid it coming back.)

It’s difficult to tease out all the complicated interactions between mental illness, mental health, and happiness, and of course it varies for different people. In my experience–which includes my personal experience, my interactions with friends and partners, and my studies and clinical experience, here it is in a nutshell: untreated/unmanaged mental illness makes happiness virtually impossible to achieve. Treating or managing your mental illness, whether through medication, talk therapy, or personal lifehacking, helps make happiness possible to achieve. But the work of achieving it is still yours to do. No drug or therapist can just give you happiness.

And most people with mental illnesses realize this. I haven’t met anyone who was just like “I wanna go to the psychiatrist and get a pill and just be happy always forever.” Most of us just want to stop crying all the time, or stop having panic attacks whenever we need to interact with new people, or stop having intrusive and scary thoughts of killing ourselves, or stop lying awake for hours each night because we can’t stop imagining all the bad things that could happen to us.

“Happiness” is the cherry on the sundae of mental health. You need to put the ice cream and the syrup and the whipped cream in the cup first.

(I’m not sure what it says about me that in reality I actually despise maraschino cherries and always ask for them to be left off my sundae. This is an analogy that was definitely intended for the presumably more normal people who will read this.)

If you still think that what we call “depression” is just an attempt to medicalize “sadness,” then you don’t know what one or either of those things are. So I’ll illustrate with an example of an internal monologue I have had when I was sad, and one I have had when I was depressed. The subject is the same, but the emotional response isn’t. See if you can figure out which is which!

I really wish I had a partner. It’s lonely not having anyone to come home to and it feels crappy seeing all my friends with their partners even though I know I should be happy for them. Sometimes I wonder if I’m just not that attractive or likable as a person. It seems like I’m the only person not dating anyone. I hope I meet someone soon, but I don’t know when or how that will happen and I’m not that optimistic about it right now. 

I really wish I had a partner. I feel like a complete worthless failure because literally everyone else I know is seeing someone and I’m not. I’ll probably never find anyone and I’ll just be lonely for the rest of my life and there won’t be anyone to call 911 if something happens to me and they’ll find my body in my apartment days later because nobody gave enough of a fuck to check on me. Not like I blame them. I’m so ugly and stupid that I don’t know why anyone would even want to hang out with me, let alone go out with me. Everyone’s probably pitying me because I don’t have anyone and everyone can tell that it’s because I’m completely pathetic. I feel like I might as well not even exist because what’s the point of going through life alone and unloved?

One of those is a sensical reaction to lacking something in your life that’s important to you (a romantic relationship); the other is over-the-top. The emotional response in the second example is disproportionate; it doesn’t make sense to leap all the way from “I’m sad because I wish I had a partner” to “I’m a worthless failure and will die alone.”

That second monologue contains a number of characteristic cognitive distortions associated with depression, such as all-or-nothing thinking (I have to have a partner or there’s no point in even living), disqualifying the positive (the good aspects of my life are irrelevant; it’s all bad because I’m single), mind-reading (everyone must be pitying me), fortune telling (because I don’t have a partner now, I will never have one), catastrophizing (something bad will happen to me and I’ll die alone in my home because nobody will help), personalization (it’s completely my fault that I don’t have a partner; none of it comes down to chance or being in the wrong environment or anything else), and emotional reasoning (I feel like a failure because I’m single; therefore I definitely am a failure).

While mentally healthy people do make cognitive distortions too, mental health is a spectrum: the more you’re able to refrain from thinking in these harmful ways, the more mentally healthy you’ll (generally) be. If you look at the first monologue, you’ll see some slight distortions, like the fear that you’re unlikeable or unattractive just because you happen to be single, or the perception that you’re the only person not dating when that’s obviously not true. But only in the second example do these irrational thoughts become all-encompassing. And, importantly, only the second example involves thoughts of death and suicidal ideation.

Note also that in the first example, being single is causing sad feelings, whereas in the second example, the emotional responses are not primarily caused by the singleness. Perhaps being single is the immediate trigger of the extreme sadness and negativity, but what’s really causing it is depression. A depressed person who is miserable about being single will not stop being miserable if they stop being single; they will usually be miserable about other things. That’s exactly what happened to me back when I was having that monologue. I’d inevitably get into a relationship and then be miserable because I didn’t think my partner liked me enough, or because I was worried about school, or because I felt like all my friends hated me, or because I hated myself, or just because.

Depression can trick you into thinking that you’re depressed “about” something. You’re probably not. You’re depressed because you have depression, and luckily, you can treat it.

Sadness, on the other hand, is about things. You can be sad because you’re single or because you got a bad grade or because you hate your job. Sadness is a normal, healthy reaction to experiencing things that you don’t like. It’s a useful and important emotion because it tips us off to situations that we should try to change if we can. Sadness can prompt us to take a step back and think about things and how we would like them to be better.

Medicalizing sadness and medicating it away would probably harm individuals and also our society as a whole. It would make things pretty boring. Isn’t it great that antidepressants and therapy are not actually trying to do that? Isn’t it great that we can help people avoid catastrophic, paralyzing, life-ruining sadness and fear like the ones associated with mental illnesses, while helping them get in touch with healthy and situationally appropriate sadness and fear? That we can help them understand their emotions and use them to change themselves, their lives, or the world, without having their lives completely governed by them?

Indeed. Depression is not sadness. Anxiety is not fear. Nobody is actually trying to eradicate sadness and fear.

~~~

At Skepchick, Olivia has a great take on this, concluding that:

I do think that it’s important to address our societal phobia of sadness, grief, and pain. But the way to do that is not to throw the mentally ill under the bus by implying they are running from their negative emotions when they seek out treatment. It also doesn’t mean casting shade on the few tools for treatment of mental illness that we actually have evidence are effective. A diagnosis of depression does not say “this person is too sad”. It says “this person can’t function the way they would like to because their emotions are consistently out of control”. There is a world of difference between those two statements.

Are Celebrities Responsible for Modeling Good Mental Health?

[Content note: depression, mental illness, suicide]

My newest piece at the Daily Dot is about Lana Del Rey, mental illness, and what we expect from artists and celebrities.

Singer Lana Del Rey has recently reignited an age-old discussion about the glamorization of depression and suicide among (and in) young musicians. In a Guardian interview she has since tried to distance herself from, Del Rey focused on death:

‘I wish I was dead already,’ Lana Del Rey says, catching me off guard. She has been talking about the heroes she and her boyfriend share—Amy Winehouse and Kurt Cobain among them—when I point out that what links them is death and ask if she sees an early death as glamorous. ‘I don’t know. Ummm, yeah.’

[...] It’s unlikely that statements like Del Rey’s actually make anyone go, “Huh, maybe I should try killing myself.” However, they can be harmful because they perpetuate norms that discourage seeking help and prioritizing mental health. Del Rey certainly isn’t single-handedly responsible for this, by the way—mental illness has long been associated with artistic brilliance, glamour, and even sometimes sexual desirability. Some believe that you can’t really be a great artist unless there’s something very wrong with your brain, but I think that’s largely confirmation bias. If you think that artists must be crazy, you’ll pay extra attention to the ones that are and little attention to the ones that aren’t.

We tend to expect that when artists go through difficult times, their way of coping is to make art about it. (Neil Gaiman gave a beautiful speech about this.) Making art can indeed help people deal with all sorts of adverse circumstances, including mental illness, but sometimes it’s not enough. Luckily, some artists, musicians included, have spoken out about seeing therapy and medication when they needed it—not an easy thing to do in a society where mental illness is still stigmatized and being a celebrity means having your private life constantly scrutinized and sold as entertainment.

On the other hand, I’m also leery when celebrities are expected to be “role models” and to demonstrate positive, healthy behavior to the children and teens who look up to them. It would certainly be nice if, when interviewed about her moods, Del Rey said something like, “I’ve been going through a hard time and dealing with lots of sadness, but I’m seeing a great therapist and taking good care of myself.”

But holding her responsible for the mental health of hundreds of thousands of young people is unfair and hypocritical. Del Rey’s young fans would benefit a lot more from seeing their own parents model good self-care, but we don’t encourage that in parents any more than we do in glamorous singers. Instead, we shame people who take poor care of themselves, and we shame people who are open about seeking therapy.

Read the rest here.

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.

Self-Diagnosis and Its Discontents

There’s a certain scorn reserved for people who diagnose themselves with mental illnesses–people who, based on their own research or prior knowledge, decide that there’s a decent chance they have a diagnosable disorder, even if they haven’t (yet) seen a professional about it.

I understand why psychologists and psychiatrists might find them troublesome. Nobody likes the idea of someone getting worked up over the possibility that they have a mental illness when they really don’t. Professional mental healthcare workers feel that they know more about mental illness than the general population (and, with some exceptions, they do) and that it’s their “job” to serve as gatekeepers of mental healthcare. This includes deciding who is mentally ill and who is not.

Self-diagnosis also gets a bad rap from people who have been professionally diagnosed with a mental illness. They feel that people who self-diagnose are doing it for attention or because they think that diagnosis is trendy.

This actually bothers me much more than the arguments against self-diagnosis coming from professionals. Why?

Because the claim that people who self-diagnose are just “doing it for attention” or because they think it’s “cool” is the exact same claim frequently made about people who get diagnosed professionally.

To be clear, I’m not saying that people never label themselves as mentally ill for attention. Maybe some do. Maybe a significant proportion of people who self-diagnose don’t really have a mental illness at all. I’d have to see research to know, and from my searches so far I haven’t really found much research on the phenomenon of self-diagnosis. (But I’m taking note of this for my master’s thesis someday.)

However, there’s a difference between someone who’s feeling sad for a few days and refer to themselves as “depressed,” and someone who’s been struggling for weeks, months, or years, and who has read books and articles on the subject and studied the DSM definition of the illness. The former may not even count as “self-diagnosis,” but rather as using a clinical term colloquially–just like everyone who says “oh god this is so OCD of me” or “she’s totally schizo.” (This, by the way, is wrong; please don’t do it.)

(It’s also likely the case that some people self-diagnose because they have hypochondria. However, the problem is not that they are self-diagnosing. The problem is that they have untreated hypochondria. Maybe diagnosing themselves with something else will get them into treatment, where a perceptive psychologist will diagnose them with hypochondria and treat them for it.)

Even if some people who self-diagnose are wrong, I still think that we should refrain from judging people who self-diagnose and take their claims seriously. Here’s why.

1. It gets people into treatment.

I wish we had a system of mental healthcare–and a system of social norms–in which everyone got mental health checkups just as they get physical health checkups. For that, two main things would have to change–mental healthcare would have to become affordable and accessible for everyone, and the stigma of seeing mental health professionals (whether or not one has a mental illness) would have to disappear. (There are other necessary conditions for that, too–the distrust that many marginalized people understandably have for mental healthcare would have to be alleviated, and so on.)

For now, going to see a therapist or psychiatrist is difficult. It requires financial resources, lots of time and determination, and a certain amount of risk–what if your employer finds out? What if your friends and family find out (unless they know and support you)? What will people think?

Because the barriers to seeing a professional are often high, many people need a strong push to go see one. Having a strong suspicion that you have a diagnosable mental illness can provide that push for many people, because nobody wants to go through the hassle of finding a therapist that their insurance covers (or finding a sliding-scale one if they don’t have insurance), coming up with the money to pay the deductible, taking time off work to go to the appointment, dealing with the fear of talking to a total stranger about their feelings, and actually going through with the appointment, only to be told that there’s “nothing wrong” with them.

As much as I wish things were different, the reality right now is that relatively few people go to therapists or psychiatrists unless they believe that they have a mental illness. If self-diagnosing first gets them into treatment, then I don’t want to stigmatize self-diagnosis.

2. It helps them find resources whether or not they see a professional.

In the previous point, I explained that for many people, self-diagnosing can be a necessary first step to getting treatment from a professional. In addition, once people have diagnosed themselves, they are able to seek out their own resources–books, support groups, online forums, etc.–to help them manage their symptoms. This can be extremely helpful whether or not they’re planning on getting treatment professionally.

While psychiatric labels like “depression,” “generalized anxiety,” and “ADHD” have their drawbacks, they are often necessary for finding resources that help people understand what they’re going through and help themselves feel better. If I’m at a library looking for books that might help me, asking the librarian for “books about depression” or “books about ADHD” will be much more useful than asking them for “books about feeling like shit all the time and not wanting to do anything with friends” or “books about getting distracted whenever you start work and not really having the motivation to finish any of it and it has nothing to do with laziness by the way.” Same goes for a Google search.

It’s certainly fair to be worried that people looking on their own will find resources that are unhelpful or even dangerous. But I think this is less of a problem with self-diagnosis per se, and more of a problem with the lack of scientific literacy in our society, and the lack of emphasis on skepticism when evaluating therapeutic claims. For what it’s worth, going to see a mental health professional will not necessarily prevent you from encountering quackery and bullshit of all kinds. And in any case, the blame does not lie with the people who self-diagnose and then fall for pseudoscientific scams, but with the people who perpetrate the scams in the first place.

This point is especially important given that many people will not be able to access professional mental healthcare services for various reasons. Maybe they can’t afford it; maybe they work three jobs and don’t have time; maybe they can’t find a therapist who is willing to accept the fact that they are trans*, kinky, poly, etc. Maybe they are minors whose parents are unwilling to get them into treatment. Maybe they were abused by medical professionals and cannot go back into treatment without worsening their mental health.

There are all kinds of reasons people may be unable to go and get their diagnosis verified by a professional, and most of these are tied up in issues of privilege. If you have never had to worry that a doctor or psychologist will be prejudiced against you, then you have privilege.

3. It can help with symptom management whether you have the “real” disorder or not.

At one point when my depression was particularly bad I noticed that I had some symptoms that were very typical of borderline personality disorder. For instance, I had a huge fear that people would abandon me and I would bounce back and forth between glorifying and demonizing certain people. If someone made the slightest criticism of me or wasn’t available enough for me, I would decide that they hate me and don’t care if I live or die. I had wild mood swings. That sort of thing. It’s not that I thought I actually had BPD; rather, I noticed that I had some of its symptoms and wondered if perhaps certain techniques that help people with BPD might also help me.

Luckily, at this time I was still seeing a therapist. So in my next session, I decided to mention this observation that I had made, and the conversation went like this:

Me: I’ve noticed that I have some BPD-like symptoms.
Her: Oh, you don’t have BPD.
Me: Right, but I seem to have some of its symptoms–
Her: No, trust me, I’ve worked with people with BPD and you do NOT have BPD.

I suppose I could’ve persevered with this line of thinking, but instead I felt shut down and put in my place. I dropped the subject.

So determined was this therapist to make sure that I know which mental illness(es) I do and do not have that she missed out on what could’ve been a really useful discussion. What she could’ve done instead was ask, “What makes you say that?” and allow me to discuss the symptoms I’d noticed, whether or not they are indicative of BPD or anything else other than I am having severe problems relating to people and dealing with normal life circumstances.

The point is that sometimes it’s useful to talk about mental illness not in terms of diagnoses but in terms of symptoms. What triggers these symptoms? Which techniques help alleviate them?

So if a person looks up a mental disorder online and thinks, “Huh, this sounds a lot like me,” that realization can help them find ways to manage their symptoms whether or not those symptoms actually qualify as that mental disorder.

This is especially true because the diagnostic cut-offs for many mental illnesses are rather random. For instance, in order to have clinical depression, you must have been experiencing your symptoms for at least two weeks. What if it’s been a week and a half? In order to have anorexia nervosa, you must be at 85% or less of your expected body weight*. What if you haven’t reached that point yet? What if you don’t have the mood symptoms of depression, but you exhibit the cognitive distortions associated with it? Acknowledging that you may have one of these disorders, even if you don’t (yet) fit the full criteria, can help you find out how to manage the symptoms that you do have.

4. It helps them find solidarity with others who suffer from that mental illness.

I understand why some people with diagnosed mental illnesses feel contempt toward those who self-diagnose. But I don’t believe that sympathy and solidarity are finite resources. If someone is struggling enough that they’re looking up diagnostic criteria, they deserve support from others who have been down that path, even if their problems might not be “as bad” as the ones other people have and/or have not yet been validated by a professional.

Acknowledging that you may have depression (or any other mental illness) can help you find others who have experienced various shades of the same thing and feel like you’re not alone.

My take on self-diagnosis comes from a perspective of harm reduction. The idea is that strategies that help people feel better and prevent themselves from getting worse are something we should support, even if these strategies are not “correct” or “legitimate” and do not take place within the context of established, professional mental healthcare.

We should work to improve professional mental healthcare and increase access to it, especially for people in marginalized communities and populations. However, we should also acknowledge that sometimes people may need to help themselves outside of that framework. These people should not be getting the sort of condescension and eye-rolling they often get.

~~~
*The diagnostic criteria for eating disorders are expected to improve with the release of the new DSM-V, but I’m not sure yet whether or not the 85% body weight requirement will still be there. In any case, this is how it’s been so far.

[blogathon] Shit People Say To Future Therapists

Today’s my blogathon for the Secular Student Alliance! I’ll be posting every hour starting now until 6 PM central. Don’t forget to donate! To start, you get a rant!

Sometimes I wish I’d kept my career plans a big secret. Maybe if I had, I wouldn’t constantly be having conversations that go like this:

Me: “Wow, I just don’t understand this person.”

Them: “You don’t understand a person?! But you’re going to be a therapist! How can you be a therapist if you don’t understand people?!”

Me: “Sometimes I just don’t have the energy to listen to someone talking about their problems.”

Them: “But you’re going to be a therapist! How could you run out of energy to listen to people talking about their problems?”

Me: “Huh, I really don’t know what you should do in this situation.”

Them: “But you’re going to be a therapist! How could you not be able to give me advice?!”

I understand why people sometimes feel compelled to say these things. I think they stem largely from a misunderstanding of what therapists do and also from what therapists are like as people.

Firstly and most glaringly, these comments are amiss because, clearly, I am not yet a therapist. I have many years of training to go. So the fact that I have not yet developed certain skills that I will need is not, in and of itself, cause for alarm. Either I will develop them over the course of my training, or I will fail to develop them and I will realize that I need to pursue a different career (I have a few backups). But I doubt that that’s the case.

For now, I am trained in just a few specific things: active listening, conflict resolution, sexual health, referring callers to mental health resources, and a suicide prevention protocol known as QPR. That’s it.

I don’t think people realize that while there probably is a certain “type” (or more) of person who becomes a therapist, we’re not born being able to do these skills. We develop them through training and experience. Nobody would ever demand that an undergraduate in a premed track be able to diagnose them with diabetes or cancer. Why should I be able to fix someone else’s emotional troubles?

Second, I think people have this view of therapists as calm, self-assured, eternally tolerant saints who always understand everyone and never feel frustrated with anyone and never tire of listening to painful and difficult things. The reason people have this view is probably 1) this is how good therapists typically behave in therapy sessions, and 2) this is how therapists are typically portrayed in the media, even though there are many styles of therapy that don’t look like this at all. Some are even confrontational!

But that’s not really how it is. Therapists get bored. Therapists get annoyed. Therapists get frustrated. They get overwhelmed and exhausted from listening to people. If they are good at what they do, they don’t show this in therapy–like a good dancer doesn’t show the pain they feel, or a good salesperson keeps smiling and being enthusiastic. Sometimes people doing their jobs have to act in ways other than how they feel. This is normal.

But for therapists, it’s especially important to be mindful of these feelings in oneself rather than trying to tamp them down, because otherwise they can affect how the therapist treats their client. In traditional psychoanalysis, this is called “countertransference,” and while psychoanalysis is quite outdated, the term is still used by respected therapists like Irvin Yalom.

So, personally, if a therapist told me that they neeever get bored or frustrated or annoyed with their clients, that would be a red flag. Nobody that I’ve ever met is such a saint. I would probably conclude that this person is either trying to make themselves look good, or–worse–that they’re not very aware of the negative emotions they sometimes experience during their work.

Of course, I might be wrong. Maybe some people really are like that.

Another misconception is that therapists “just get” people or “just know” the solutions to their problems. This is also false. While therapists are probably more perceptive than the general population, that only really helps when it comes to understanding how a person is feeling, not why they feel that way or what might be the best way for them to change how they feel, as there’s no one-size-fits-all approach to this.

That understanding, if it ever happens, happens after a period of time during which the therapist has gotten to know their client, learned a lot about their background, and started to discern their patterns of thinking. That thing you see in the movies where a therapist “just knows” what’s wrong with you after ten minutes? Nope.

It’s also worth pointing out–as callous as it may seem–that once I become a therapist I will be doing this for money. I will expect to be paid for doing it. When I’m not at work, doing work for free will seem like…not the best use of my time. While I’m sure that I’ll always enjoy listening to my friends talk things out and try to help them feel better, being expected to do so just because I happen to be a therapist is unfair.

I will not be the same person with my friends and family as I am with my clients. This is normal and okay, and it’s the case for basically anyone who has a job that involves working with people. If you want to avoid needlessly annoying and frustrating your friends in the helping professions, try not to expect them to essentially work for free and to act saintly and perfect while doing it.

~~~

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On “Sincerely Held Religious Beliefs” and Being a Counselor

Via JT, here’s a new bill that recently passed in the Tennessee State Senate Education Committee by a 7-2 vote:

Republican state Sen. Joey Hensley encouraged fellow senators to pass SB 514 to “prevent an institution of high education from discriminating against a student in the counseling, social worker, psychology programs because of their religious beliefs.”

Hensley’s bill would protect any student who “refuses to counsel or serve a client as to goals, outcomes, or behaviors that conflict with a sincerely held religious belief.”

Here’s another relevant quote:

Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof…

I don’t have to cite this one, right?

Forcing public universities to allow their graduate students to use their religion to avoid doing what they’re supposed to do is absolutely “respecting an establishment of religion.” And, contrary to the apparent opinions of the seven senators who voted yes, allowing public universities to require their graduate students to do what they’re supposed to do does not constitute “prohibiting the free exercise” of religion unless you view your counseling work as a form of religious worship. Hopefully, nobody does.

All of this relates to the larger problem of people believing that the First Amendment gives them the right to do a crappy job at work without being fired. When you’re choosing a career path, you should consider, among other things, whether or not you are willing to do the things that your chosen job requires. For instance, I started out college planning to be a journalist, but I realized that pestering people (especially survivors of traumatic newsworthy events) for interviews went against my personal ethical code. Rather than expecting the profession of journalism to adjust itself to my ethical code, I found a different field.

If you are unwilling to help people simply because of who they love, don’t become a counselor.

If you are unwilling to drive a bus simply because it has an ad about atheism, don’t become a bus driver.

If you are unwilling to give someone their prescribed medication simply because it will prevent them from getting pregnant, don’t become a pharmacist.

If you are unwilling to perform an elective surgery on someone simply because it will change their assigned sex, don’t become a plastic surgeon.

If you are unwilling to teach actual science simply because it includes evolution, don’t become a science teacher.

When I was applying to my social work program, I read through the list of requirements for acceptance. I needed a B.A. from an accredited college/university, at least 60 credits in the liberal arts, a decent GPA, and so on. There was also a list of attributes that social work students should have: empathy, interpersonal skills, and a bunch of others. On the list was also this:

The social work student must appreciate the value of human diversity. He/she must serve in an appropriate manner all persons in need of assistance, regardless of the person’s age, class, race, ethnicity, religious affiliation (or lack thereof), gender, ability, sexual orientation and value system.

There you have it. It’s a requirement. If I’m unwilling to do it, I shouldn’t go into the field.

Of course, with counseling things can get a bit tricky. If a counselor realizes that their personal bias may prevent them from working appropriately with a given client, it is their responsibility to refer the client to another counselor. Not to just say, “Sorry, can’t help you,” but to try to ensure that they get the help they need somewhere else.

Furthermore, counselors should not attempt to practice outside of their expertise, so if a client shows up with problems that you have no idea how to work with, you should also refer them to someone else. That doesn’t necessarily mean that you should refer out every LGBT client who comes your way, of course, but if they’re struggling with issues like coming out, dealing with homophobia, or trying to have children, and you have no experience counseling LGBT individuals facing such issues, this is probably not the client for you and you are probably not the counselor for this client.

But there’s a fine line between being unable and being unwilling to do something. There’s a difference between lacking the training or experience you’d need to work with someone and simply not wanting to work with them because you disapprove of their “lifestyle.” There are plenty of “lifestyles” of which I suppose I “disapprove,” but all that really means is that I wouldn’t want to do the same thing and don’t necessarily understand why someone would. That doesn’t mean I can’t still affirm that person as a human being worthy of sympathy and help.

I don’t know how it is everywhere else, but in the programs I’ve looked at, graduate psychology students who are interning tend to work with clients on a sliding scale, which means that these interns are often the only type of counselor that some people can afford. The silver lining of a bill like this is that these clients, who may already be disadvantaged, will be spared from homophobic counselors.

However, the bill’s language does not suggest that it was written to protect LGBT clients, but rather homophobic counselors. And crucially, the bill contradicted advice from psychologists, social workers, and those who oversee graduate psychology programs. They noted that programs could lose accreditation, that part of the job of a counselor is to put their “sincerely held religious beliefs” aside when they do their work. But no, the Religious Right won out again.

Quotes from some Tennessee senators are very telling:

Sen. Stacey Campfield, R-Knoxville, couldn’t understand why psychology departments aren’t teaching their students how to pray away the gay with homosexual clients.

“So if someone were to, say, come in and—I’m just going to throw an example out there—say they were a homosexual and a person did not believe that was a natural act and they suggested, say, change therapy?” Campfield asked. “Would that be something you could allow a student to do?”

Sen. Rusty Crowe, R-Johnson City, said, “I would think that you should be up front and truthful and tell them if they are doing wrong and try to counsel them to do what’s right. That really disturbs me.”

I have sympathy for people whose sincerely held beliefs, religious or otherwise, make it difficult for them to do what they need to do. As I said, I’ve been in that boat. And a certain amount of accommodations for religious people at work and school is, I believe, reasonable. It’s not a huge deal for professors and employers to allow people to occasionally miss a day for a religious holiday or to wear religious garments. It is a big deal for them to exempt students and employees from a crucial part of their training or job.

Allowing people to freely observe their religion does not necessitate bending over backwards to allow them to keep doing jobs with which their religion clashes. Sometimes you just gotta get another job.

Besides, such counselors are free to go practice at any of the many religiously-affiliated counseling centers that exist in this country, which is a topic for another post.

The Problem With “Teen Angst” and Why You Should Take Teens’ Mental Health Seriously

[Content note: depression and suicide]

There’s a disturbing and pervasive idea out there that the psychological troubles of teenagers are inconsequential and unworthy of attention because they’re just a part of “teen angst” or “growing up” or whatever.

I’m thinking about this now because last night I ran across this Facebook page. It’s called “No Respect For Suicidal Teens,” and please don’t click on it unless you’re prepared for the hateful victim-blaming that it promotes. (If you can, though, you should go and report it.)

First of all, it’s completely false that teens can’t “really” be depressed and suicidal. Although the age of onset for depression and bipolar disorder is most commonly in the late teens and 20s, many people report that their chronic mood disorder began when they were teens. (Count me among them.) Left untreated, mood disorders often get progressively worse, or they remit on their own but then keep recurring.

Painting all teenage mood problems in a single shade of “teen angst” can prevent teens with diagnosable mood disorders from seeking help, because they either second-guess themselves and conclude that what they’re experiencing is “normal” (read: healthy) or they try to get help but are rebuffed by well-meaning adults who tell them that this is just what adolescence is and that they’ll grow out of it.

And then, of course, they find that it doesn’t get better after adolescence, and sometimes they tragically conclude that they must simply not have “grown up” yet. (Again, count me among them.)

Second, mental issues do not need to have reached clinical levels to be unpleasant, troubling, and inconvenient. Any time you’re unhappy with some aspect of your emotions, moods, thoughts, or behaviors, that’s a good enough reason to seek help from a therapist. Seriously. Either the therapist will help you accept aspects of yourself that you’d been bothered by, or they will help you change those aspects. Whether or not those aspects have a fancy name in the DSM isn’t really relevant.

So a teenager whose emotional experience is characterized by “angst” can benefit from seeking help even if they don’t have a “Real Problem.” All problems are real; the fact that they can vary dramatically in scope and magnitude doesn’t make them any more or less so.

And what if every teenager needs help managing their mental health during adolescence? Doesn’t that mean we’re making mountains out of molehills and inventing problems where none exist?

Nope. Nobody thinks it’s weird that virtually every teenager (who can afford it) goes to a dentist and has their wisdom teeth checked and probably removed. Nobody thinks it’s weird that virtually every female-bodied teenager (who can afford it) starts seeing a gynecologist when they become sexually active. Nobody thinks it’s weird that people of all ages regularly get physicals and get their eyesight and hearing checked.

It is expected that everyone will need (and, hopefully, receive) treatment for some sort of physical ailment over the course of their lives. Yet the idea that even a sizable minority of people will need treatment for a mental problem still gets many people ranting about how we ought to just “snap out of it.”

Are some teenagers actually “over-dramatic” (whatever that even means)? Probably. But it’s hard to tell who’s being over-dramatic and who isn’t, which is why that’s a decision best left to a professional. I was constantly accused of being “over-dramatic” when I was a teenager. Not to put too fine a point on it, but everyone changed their minds very quickly once I became so depressed I could barely function and thought about suicide constantly. Perhaps that could’ve been prevented had I gotten help earlier rather than taking everyone’s analysis of my “over-dramatic” personality to heart.

If a teenager mentions or threatens suicide, take them seriously and help them get treatment. If they turn out to have been “over-dramatic,” a therapist can help them figure out why they threaten suicide hyperbolically and find a way to stop. That’s a therapist’s job, not a friend’s, teacher’s, or parent’s.

The belief that the thoughts and feelings of children and teenagers are not to be taken seriously is widespread and dangerous, and goes far beyond just mental health. It is far better to take someone seriously and get them help when they didn’t really need it than to ignore someone’s call for help and attention when they do need it.

Dear Northwestern Administration: Wake Up

I have a letter to the editor of the Daily Northwestern today. If I seem kind of angry, that’s because I am. 

Dear Editor,

Today I learned that Alyssa Weaver, the Weinberg junior who passed away last week, took her own life.

I didn’t know Alyssa. I could’ve, though, because she was going to move into my apartment when she returned from studying abroad. We’d chatted on Facebook a few times. I had no idea how much we had in common.

Because, here’s the thing. Her tragic story was very close to being mine, as well.

I’ve had clinical depression since I was 12 years old. I didn’t know it until the end of my freshman year at Northwestern, by which point it had become so serious that I became reclusive, miserable, exhausted, and preoccupied with the thought of taking my own life.

I went to CAPS. I got my twelve free sessions. My therapist was kind and supportive but never screened me for depression or any other mental illness. After the sessions were over, I was no better, had no idea what to do next, and deteriorated even more.

The only reason I’m here now is because, thankfully, the school year ended right then. I went home to my family, and I am privileged enough to have a loving, supportive family with good insurance that covers mental health. I saw a psychiatrist and started taking antidepressants. I recovered, for the most part, although even now I live in the shadow of the knowledge that depression as chronic as mine usually comes back.

I’ll be blunt. The state of mental health services on this campus is absolutely unacceptable. We have too few staff members at CAPS. We have no orientation program on mental health. There are still faculty members at this school–I will not name names–who refuse to accept mental health-related accommodations provided by Services for Students with Disabilities. Unlike virtually every other top-tier school and even many high schools, we have no peer counseling service, although I have been trying to start one for a year and a half. There just aren’t enough resources.

The only reason we have campus events about mental health at all is because of NU Active Minds, an amazing student group that’s still fairly new. But they should not be doing this work on their own, and there’s only so much they can do.

Dear Northwestern administration: Wake up. Stop building $220 million athletic complexes. Start spending just a bit more of that money on the mental health services your students desperately need.

I have fought tooth and nail to beat my depression and to find a supportive community here at NU. It breaks my heart that some of my fellow students have been unable to win that battle.

How many more Wildcats will we have to lose before the administration starts taking mental health more seriously?

Sincerely,
Miriam Mogilevsky
Weinberg senior
Director of NU Listens