therapy

Self-Diagnosis and Its Discontents

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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.

Self-Diagnosis and Its Discontents
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[blogathon] Shit People Say To Future Therapists

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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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[blogathon] Shit People Say To Future Therapists

On "Sincerely Held Religious Beliefs" and Being a Counselor

Miri, , , , , , , , , , , 18 Comments

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.

On "Sincerely Held Religious Beliefs" and Being a Counselor

The Problem With "Teen Angst" and Why You Should Take Teens' Mental Health Seriously

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[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.

The Problem With "Teen Angst" and Why You Should Take Teens' Mental Health Seriously

Dear Northwestern Administration: Wake Up

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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

Dear Northwestern Administration: Wake Up

More Than Just a Body With a Broken Brain: Why I'm Choosing Social Work

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It would be nice to be called “Doctor.”

It would be nice to be paid a very high salary and have a stable job, and to be able to produce an official piece of paper proving that I am Smart.

It would be nice to be published in prestigious journals, to receive emails from others curious about my work. It would be nice to be quoted in newspapers and magazines as an Expert.

It would be nice to be part of the elite–the less than 1% of Americans who have a doctorate.

It would be nice, but it won’t be me. At least, not for a while.

Until recently, I left unquestioned the notion that I want a PhD in clinical psychology. I just wanted it. Why? Well, it would allow me to be a therapist, which is what I want. I would get paid a lot. It would carry prestige.

But gradually my resolve started to break down and I started to wonder, Why?

I discovered that I disliked research. When I told people this, they were often shocked. But aren’t you curious? Don’t you care why people think and feel the way they do? Don’t you want to understand?

Yes, I am, and I do. I’m deeply curious. That’s why I read voraciously. And I am more than happy to read all the answers to my questions when they’re published rather than to work long days in a basement lab somewhere.

I can do research, I’m sure. But it’s not what I love, and there are others who want this much more.

The turning point came when I attended a panel of graduate students in psychology, along with an admissions person for a doctoral program in clinical psych. They all told us that when we apply for grad school, our entire resume and personal statement should discuss nothing but our research experience. Everything else I’ve done wouldn’t even matter–not the year I spent as an RA, not the three years I’ve spent as a member (and, then, a leader) in a sexual health and assault peer education group, not the summer I volunteered at a camp for at-risk kids in New York, not the initiative I started to implement a peer listening program at Northwestern, not my internship at the National Alliance on Mental Illness.

I shouldn’t even include it, they told me, because it would annoy the admissions people.

The work that I love, the lives that I hope I’ve changed–it would be an annoyance.

At first, I thought it wasn’t a big deal. Who cares what I put on my application as long as I get in?

But then I learned more. I learned that I probably wouldn’t be accepted if I admitted that my goal is to be a therapist, because they want to spend their money on someone who would bring prestige to their institution by publishing research. I realized that I would have nobody to turn to for support–no mentors–because I’d have to hide my dreams from them. I learned that clinical training in clinical psych programs is mostly lacking (ironically), so I wouldn’t be learning the practical skills that I need to help people.

And, most of all, I understood that my time in graduate school would be miserable beyond belief, because I would be living a lie, facing extreme pressure to publish or perish, and wasting at least five or six years of my life. During that time, my life would be completely on hold–I wouldn’t be able to move, work, or start a family, if the opportunity presented itself.

The future that I had once dreamed about turned into a nightmare.

It was then that I finally stopped listening to my professors–who, of course, all have PhDs–and listened instead to the friends and family I have who actually are therapists, or hoping to get there. And increasingly I understood that a masters in social work would be a better option.

MSW programs emphasize learning practical skills, and many of them have you start a clinical internship as soon as you start the program, because the best way to learn is by experience. They understand that people aren’t just isolated brains inside bodies, that circumstances affect individuals and that psychological problems aren’t always caused by faulty brain chemistry. They emphasize understanding societal inequality, working with marginalized groups, and picking up where clinical psychology leaves off.

I’ve been told that I’m “too smart” for a masters in social work, that I will be “offended” when I see how little they pay me. People who say these things must not know me very well. Although I wanted a PhD before, I’ve never really needed my career to make me feel important. I don’t need to be important. I just need to be helpful.

As for “too smart,” that’s ridiculous. The helping professions need more smart people.

The truth is that, in my hour of need, it wasn’t a man with a white lab coat and a doctorate who saved me. It was–as corny as this is going to sound–the social justice movement. That was what finally taught me that my feelings are justified, that my thoughts have merit, that my words matter.

I finally learned to see myself as more than just a body with a broken brain. I’m a whole person enmeshed in particular circumstances, and the interaction between the two has made me who I am now.

I still agree with what I’ve written before. Medication can be useful. Therapy works. Psychiatric labels are important.

But my strengths and goals require a different sort of education than what I could receive in a doctoral program, and they point me to a different sort of career than a PhD would prepare me for.

True, I’ll earn less money. There will be hard times. There will, I’m sure, be bureaucracy, budget cuts, and crappy bosses.  There will be days when I don’t love it.

But there will not be days when I’m living a lie. There will not be days when I’m sitting in an expensive lab at a prestigious university, doing work that may be meaningful, that may get published, that may be improved upon, that may someday, maybe, help someone. Maybe.

And I have nothing but respect for people who want to do that. I admire that, and maybe someday I’ll return to school for a PhD. But at this stage in my life, it’s just not for me. After all, I can always get a PhD; what I can’t do is unget one and unwaste all that time.

I don’t expect every single day to be productive, every session to help every client. But I do expect that at the end of my life I will be able to look back and know beyond a doubt that, in my own way, I changed things for the better.

That’s why I’m choosing social work.

P.S. A little disclaimer–I’m not looking for any comments on how I’m wrong about the doctoral route or why I should reconsider my decision. There’s a lot more than went into it than I could even discuss here, and there are enough Older and Wiser People trying to tell me how to live as is. Thanks. 🙂

More Than Just a Body With a Broken Brain: Why I'm Choosing Social Work

Everyone Should Go to Therapy

Miri, , , , , , 10 Comments

Recently I wrote a post about why some people might choose psychiatric medication over seeing a therapist. (Fine, so it wasn’t that recent. >.<) I promised a followup post about a belief that I hold concurrently–everyone should see a therapist.

Now, before everyone freaks out, let it be known that I say “everyone” only in the most theoretical of ways. Meaning that, I recognize that as things are today, what I’m proposing isn’t really possible. But in the Happy Fun Miriam Land of the future, where stigma against mental healthcare is gone, insurance coverage is reasonable and available to the majority of people, and research has identified effective therapeutic interventions for most mental problems, everyone should and would be able to go to therapy.

For now, I’ll qualify what I’m saying with this: if you are able to see a therapist, you should, and if you are able to take your children to see a therapist, you should.

Why?

Well, why do we have regular dental and physical checkups? Why do children receive vaccines? Why do we make an appointment with a doctor when we think we’re coming down with something serious?

Hopefully the answers to those questions are self-evident.

Clearly, it is acceptable–and even expected–that people seek two types of healthcare throughout their lives: preventative and palliative. We should see a doctor regularly to make sure that nothing’s going seriously wrong with our bodies, and we should see a doctor when we suspect that something IS going seriously wrong with our bodies.

This much isn’t in dispute. But what about our minds?

For the most part, people wait until things are really, REALLY wrong with their mental state before they go see a psychologist. (And some don’t go even then, but that’s a different story.) For instance, I didn’t see a psychiatrist for my depression until I wanted to kill myself. People with eating disorders typically don’t receive care until they’re dying, or close to it. People with anxiety issues don’t get help until their anxiety is preventing them from having any semblance of a normal life.

Like most physical maladies, mental illnesses don’t just come out of nowhere. They usually develop from years and years of poor coping strategies and maladaptive beliefs. For instance, I remember being as young as 6 and constantly thinking that everyone secretly hates me, nobody wants to be my friend, and everyone’s talking behind my back. Guess what? When I was 18, I still basically believed that. Except by then, my beliefs had become self-fulfilling prophesies, and they had reinforced themselves until it became nearly impossible to get rid of them. Wouldn’t it have been so much easier if a child psychologist had helped me get over them 15 years ago?

My little brother, age 10, thinks he’s ugly. He has adorable curly hair, itty-bitty freckles on his face, and beautiful blue eyes. He’s thin and athletic, but thinks his stomach is fat and sometimes does crunches in his room. He hasn’t really learned how to make friends yet, and he has nobody to teach him. As a result, he thinks nobody will ever want to be his friend, and he chooses to brag and show off for attention rather than try to make other kids want to be his friends.

My brother does not have depression, an eating disorder, or even–believe it or not–a serious case of narcissism. What he also doesn’t have, however, are effective mental tools for interpreting the world and for being happy. And he’s not going to find these tools on his own.

What if, in addition to physical checkups to make sure that kids’ bodies are developing correctly, that they’re learning good hygiene, and that they’re eating well and exercising, we also had regular mental checkups to make sure they’re developing good mental habits?

Clearly, not everybody is going to need constant mental healthcare like I do, and like everyone else with a serious mental illness does. Most people would be totally fine checking in with a trusted family therapist every once in a while. But others, like my brother, would seriously benefit from catching the problem before it mushrooms into the sort of thing that I went through.

Even if people never do develop diagnosable mental illnesses, unhappy children often grow into unhappy adults. Ever had a boss who made your life miserable by demanding constant ass-kissing to protect her fragile ego? Ever dated a guy whose fear of commitment destroyed the relationship? Ever had a bully in high school whose inability to relate to others in a positive way greatly affected your own life?

These people have psychological issues. I’m not saying that in a degrading way at all; many people have issues. But because most people don’t think that they should see a therapist unless they want to off themselves, people like these usually don’t get help.

Although I strongly despise the mindset that people with mental problems should be treated as personal inconveniences, the fact is that people do affect each other emotionally. Imagine if every time someone got a contagious illness, all they could do was just continue going about their daily lives until it passed, infecting everyone they came into close contact with. Luckily, that’s not how it works; most people go see a doctor when they realize they’ve come down with something. What if people did the same for mental problems?

I think that’d be a much more pleasant world to live in.

And I promise I’m not just saying that because I’m going to be a therapist and want money.

Everyone Should Go to Therapy

Antidepressants and Strength of Character

Miri, , , , , , , 8 Comments
You're not a bad person if you take any of these roads. I promise.

Spoiler alert: They have nothing whatsoever to do with each other.

There are different levels of stigma surrounding mental illness. There’s the stigma of having a disorder in itself, the stigma of being in treatment for a disorder, and, perhaps most of all, the stigma of that treatment being pharmacological.

People love to hate psychopharmacology, especially antidepressants, the efficacy of which is constantly being questioned (often for good reason). However, I’ve noticed that drugs like antidepressants receive a special type of scorn, one that cannot be based solely on the efficacy mystery.

I’ve found that where mental treatment is concerned, therapy holds some sort of moral superiority over drugs in many people’s eyes. I think many people still feel that mental disorders are spiritual illnesses, not medical ones, and that treating them with a pill is some sort of cop-out. (Imagine the public furor if researchers came up with a pill to, say, erase the feeling of guilt.)

This would explain why, though therapy is still stigmatized–after all, the Ideal Person works out these issues on his or her own–it is considerably less looked down upon than psychotropic medication. Our culture values struggle and hard work so much that even recovering from an illness should be mentally effortful.

What people don’t realize is that there are plenty of perfectly legitimate reasons why someone might choose medication over therapy, at least in the short term. Consider, for instance, the situation I found myself in a month before I began my sophomore year of college. Having spent my entire freshman year growing progressively more depressed, I’d thought that coming home for the summer would magically fix everything. It didn’t. With a month to go, I realized that I felt like I’d rather die than go back to school.

That was when I was first diagnosed with depression, and I think my psychiatrist realized, as did I, that I just didn’t have time to muck around with my feelings–I had to get better quickly, or else going back to school would be more upsetting and stressful than I could handle. So I started taking antidepressants and quickly improved enough to feel like I could deal with being in school. The mucking around with my feelings came later.

Aside from that, I can think of many other reasons medication can at times make more sense than therapy. For example:

  • Financial concerns. Antidepressants cost me $30 a month, while therapy costs $80 for four weekly sessions. That’s a pretty big difference for many people.
  • Time. Some people are at a point in their lives where they literally can’t spare an hour or more a week for therapy. That might sound ludicrous to you, but if you’re a college student, a new parent, or a low-income worker, it probably doesn’t.
  • Availability. Unfortunately, not everyone lives in an area where good therapists are available and accessible (and bad therapists will do more harm than good). This is especially true for members of marginalized communities, who may have a hard time finding therapists who are sensitive to their issues. Not all therapists are as open and accepting as they should be.
  • Insurance. I’m lucky to have a fantastic insurance policy that covers basically everything I’ve ever needed. However, many policies are very picky with regards to therapy (as opposed to medication, which does require a prescription from a person with an MD). For instance, some policies refuse to cover therapy unless there’s an official diagnosis, and you don’t necessarily need to have a diagnosable mental disorder in order to need help. Besides, you can’t be diagnosed without going to a specialist to begin with.
  • Nature of the disorder. Although most mental illnesses obviously involve a psychological component, some do not. For example, many people in temperate climates get Seasonal Affective Disorder (SAD) during the winter months, which is characterized by a low-grade depression as well as various physical symptoms. It’s usually treated with antidepressants or light therapy, which actually has people sit in front of full-spectrum light.
  • Language. Therapy requires people to talk pretty extensively about themselves and their lives, something that would be very difficult for, say, a new immigrant who’s just learning English. Unless such people are able to find a therapist who speaks their native language, it would be pretty hard for them to get anything out of therapy.
  • Comfort. As a future therapist, I obviously wish that everyone were comfortable with the idea of therapy. But not everyone is. That could be because of cultural factors, family attitudes, personality, or negative experiences with therapy in the past. I think that using medication to improve your quality of life while working up the courage to see a therapist is perfectly okay.

I hope that this list shows that making decisions about mental health isn’t that different from making decisions about physical health–it has more to do with personal preferences and practical concerns than with the strength (or lack thereof) of one’s character.

Of course, I do believe that therapy is really important and generally awesome, which is why one of my upcoming posts will be about why I think that everyone (or almost everyone) should see a therapist. Stay tuned.

Antidepressants and Strength of Character