A Good Critique of the Medical Model is Hard to Find

I was optimistic about reading this critique of the medical model of mental illness by professor of clinical psychology Peter Kinderman, in part because it is written by someone with experience in the field and in part because it is published on Scientific American, which I trust.

However, while the article makes a number of good points that I will discuss later, it starts off immediately with such a tired and oft-debunked misconception that I almost quit reading after that:

The idea that our more distressing emotions such as grief and anger can best be understood as symptoms of physical illnesses is pervasive and seductive. But in my view it is also a myth, and a harmful one.

I’ll say it again for the folks in the back: nobody* is trying to medicalize “distressing emotions such as grief and anger.” They are medicalizing mental patterns (which can include cognitions, emotions, and behaviors) that are not only very distressing, but also interfere with the person’s daily functioning. It’s kind of like how some stomachaches are minor annoyances that you wait out (or take a Tums), and some land you in the ER with appendicitis. Therapists and psychologists are not concerned with the mental equivalent of a mild cramp.

In general, people don’t end up in my office because they get pissed off when someone cuts them off in traffic; they end up in my office because they are so angry so often that they can’t stop physically attacking people. They don’t end up seeing the psychiatrist down the hall because they get jittery and uncomfortable before a job interview; they see the psychiatrist because they feel jittery and uncomfortable all the damn time, and they can’t stop, and they can’t sleep, even though they rationally know that they are safe and everything’s okay.

I understand that it’s more difficult to grok differences in degree as opposed to differences in kind, because Where Do You Draw The Line. Yes, it would be easier if mentally ill people had completely different emotions that had completely different names and that’s how we knew that they were Really Mentally Ill, as opposed to having emotions that look like more extreme or less bearable versions of everyone else’s. (Sometimes, from the outside, they even look the same. “But sometimes I don’t want to get out of bed either!” “But sometimes I feel sad for no reason either!” Okay, well, you might be depressed too. Or you might find that those things have no significant impact on your day-to-day life, whereas for a person with depression, they do.)

But it really doesn’t help when you’ve got mental health professionals obfuscating the issue in this manner.

As I said, Kinderman does go on to make some really good arguments, such as the fact that psychiatric diagnoses have poor validity and reliability. This means that they don’t seem to correspond that well with how symptoms actually look “on the ground,” and that different diagnosticians tend to give different diagnoses to the same cases. However, these are criticisms of the DSM, not of the medical model. I’ve felt for a while that we should move away from diagnostic labels and towards identifying specific symptoms and developing treatment plans for those symptoms, not for some amorphous “disorder.”

For instance, suppose I’m seeing a client, Bob. After getting to know each other for a few weeks, Bob and I determine together that there are a few issues he’s particularly struggling with: self-hatred and feelings of worthlessness, guilt, difficulty sleeping, lack of motivation to do anything, loss of interest in things he used to enjoy, and frequent, unbearable sadness. Traditionally, I’d diagnose Bob with major depression (pending a few other considerations/differential diagnosis stuff) and move on with treatment. But without these often-invalid and unreliable diagnostic labels, I just skip that step (although I might let Bob know that “depression” might be a useful word to Google if he’s looking for support and resources). Instead, Bob and I look at his actual symptoms and decide on treatments that might be helpful for those particular symptoms. Cognitive-behavioral therapy might help with Bob’s self-hatred, feelings of worthlessness, and guilt. Behavioral activation might help with his lack of motivation and interest. Certain dialectical behavior therapy modules, such as distress tolerance, might help him cope with sadness in the meantime. Antidepressants might very well help with all of them!

Because mental healthcare doesn’t treat disorders; it treats symptoms. Whether that mental healthcare is medication, therapy, or some combination, the ultimate goal is a reduction in symptoms.

I can see how the medical model makes this seem bad when it isn’t. In traditional healthcare, treating symptoms rather than getting to the root of the problem is downright dangerous. If someone has headaches and you give them painkillers without diagnosing their brain tumor, they’re in serious trouble.

However, we haven’t yet developed great ways of figuring out what “the root of the problem” is when it comes to mental symptoms, especially since there often isn’t one. It’s almost always some complicated tangle of genetics, early childhood stressors, interpersonal patterns learned from family, sociocultural factors, and so on. All of this affects the brain in fundamental biological ways, which further drives the symptoms.

Thankfully, that’s not as much of a problem as it would be with a physical health condition. If you only focus on symptoms and don’t treat the underlying cancer or diabetes or whatever, it will slowly kill you. But if you successfully treat the symptoms of mental illness, you will make the person’s life much better no matter what originally caused the symptoms. There won’t be anything silently killing them in the background, and good therapy teaches people the skills to avoid future relapses of their symptoms.

Sometimes the root cause of mental illness is, as Kinderman points out, a social problem. Poverty, social inequality, and other issues contribute heavily to mental illness. But since you can’t solve those issues from the inside of a counseling office, all you can do is help your client as much as possible. I do this every day, and believe me, it feels weird and gross at times. But what else can I do? Until our fucked-up society decides to come in and take a seat in my office, I can only work with my clients as individuals. (Otherwise I would have a very different job and it would not be therapy.)

Kinderman argues that treating mental illnesses as diseases is wrong because of these social factors that contribute to them. I understand his concern, because he (and many other people) treat “disease” as synonymous with “thing that is entirely biologically based.” So, the medical model feels like an erasure of the complex and valid social dynamics that contribute to what we call mental illness.

But I don’t think of disease that way at all, and I’m betting most doctors don’t either. Social factors contribute heavily to physical illnesses, too. People who are living in poverty or who are marginalized by the healthcare system in other ways are much more likely to have all sorts of physical health problems, and the results tend to be more severe for them. Stress, which includes the stress of poverty, racism, and other social problems, makes everyone more vulnerable to illness. Eating well and exercising enough, two very important factors when it comes to physical (and mental) health, are not equally accessible to everyone. Heart disease and diabetes may have biological origins, but they do not happen in isolation from societal factors, either. Just like mental illness.

You might argue that physical illnesses and mental illnesses differ in that physical illnesses are more heavily caused by biological factors and mental illnesses are more heavily caused by social factors, and I might agree. But again, that’s a difference in degree, not kind. Both types of illnesses affect us physically and mentally.

Another good argument that Kinderman presents is that the medical model may not help reduce stigma, and there’s research to back this up. Kinderman writes:

Traditionally, the idea that mental health problems are illnesses like any other and that therefore people should not be blamed or held responsible for their difficulties has been seen as a powerful tool to reduce stigma and discrimination.

Unfortunately, the emphasis on biological explanations for mental health problems may not help matters because it presents problems as a fundamental, heritable and immutable part of the individual. In contrast, a more genuinely empathic approach would be to understand how we all respond emotionally to life’s challenges.

So, that’s important and deserves highlighting.

However, I think the issue of how best to reduce stigma against mental illness is slightly separate from the issue of how best to help people with mental illnesses feel better. (There’s a school of thought in the disability community that disabilities [including mental illnesses)] “hurt” only because of the stigma and prejudice against people who have them, and I’m not particularly equipped to engage with that here except to say that it makes me angry in a way I can’t possibly explain. It completely invalidates how awful and wretched I felt because my symptoms hurt unbearably and not because of anything anyone else said or did to me as a result.)

When it comes to what people with mental illnesses actually find helpful, for some it’s the medical model and for some it isn’t. In her piece on mental “sick days,” Katie Klabusich writes about how freeing it actually was to see herself as “sick” when she needed to take a day off due to her mental illness:

I’d realized that not only is it alright for me to think of the dysthymia as the illness that it is, it’s necessary. If it were a south-of-the-neck illness, I wouldn’t have had the conflict about it. Yes, I’ve worked when I had a virus and shouldn’t have. (See the stats on service industry staff who work when they’re sick; we’ve all done it.) But my thought process would have been totally different. I certainly wouldn’t have needed the Ah ha! moment to know I had the flu. So why didn’t I realize I was sick?

Our culture impresses upon us that we SUCK IT UP and GIT ER DONE when our “issue” is “just mental.” Except . . .


It turns out that what happens in my head has a real—not imagined or exaggerated—physical affect on my other bodily functions. That list of symptoms from a dysthymia flare? They’re worse than the flu. Full-blown body aches and exhaustion alone are enough to make just sitting up nearly impossible. What work Idid do last week was all done from bed. Including writing this.

Others may not find that way of thinking helpful, in which case, they should absolutely abandon it in favor of whatever does help.

I want to end on a cautionary note about this whole idea of the medical model “pathologizing” “normal” emotions, because the alternatives I sometimes see offered to the medical model seem far, far worse about this. While Kinderman seems to argue sensibly for a more “psychosocial” approach to mental healthcare and a reduction in the use of medication (which I disagree with, but at least it’s sensible), others turn entirely away from scientifically validated treatments into “holistic” or “alternative” treatment. In many of these communities, “positive thinking” is seen as the only treatment you need, and anything that strays from the “positive” (like, you know, the negative emotions that are a normal part of almost any mental illness) is actively preventing you from recovering. There’s a very victim-blamey aspect to all of this: if you’re unhappy or sick,” it’s your own fault for not thinking positively enough.

I’ve had clients from these communities in counseling, and it’s very difficult to get any work done with them because they only ever want to share “positive” thoughts and feelings with me. As it turns out, medical model or no, they have completely pathologized any sort of negative emotion–including, in fact, the totally normal negative emotions that all of us experience all the time.

Yet it’s those evil psychiatrists who don’t want anybody to be sad or angry ever. Okay.

Some critiques of the medical model are quite valid and very useful. Others seem to rest less on evidence and more on a general sense of unease about the idea of thinking of mental symptoms as, well, symptoms. Kinderman even implies that it’s unethical. But “makes me uncomfortable” isn’t the same as “unethical,” as we all know. Unless I see evidence that this conceptualization is harmful overall, I see no reason to throw it out.

That said, if you’re a mental health provider and you have clients who are clearly uncomfortable with this model, maybe don’t use it to explain their conditions to them, since it’s unlikely to be helpful. All of these labels and diagnoses and explanations should serve the client, not the other way around.

And if you’re a person who experiences some significant amount of mental distress and you can’t stand thinking of it as an illness, then don’t! You don’t have to think of it in any way you don’t like. I hope you’re getting treatment of some sort that works for you, but at the end of the day, it’s actually none of my business.


*Yes, there are probably some bad psychiatrists out there who think that grieving at the loss of a loved one is literally a mental illness. There are also surgeons who leave crap inside of people’s bodies or amputate the wrong limb. I see these as roughly analogous.


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

A Good Critique of the Medical Model is Hard to Find

"But that applies to EVERYONE"

Every so often when I’m talking about some niche issue, such as how to consensually have sex with an asexual person or how straight women can be better to their queer women friends, someone who is not a member of the marginalized group under discussion chimes in with, “But everyone should do that” or “But you shouldn’t do that to anyone.” No joke, once on Twitter I saw some trans people talking about how you shouldn’t ask them about their genitals, and someone was like “And you shouldn’t ask cis people about their genitals either.”

Okay, I mean, yes. I’m happy to grant that many of these suggestions about how to treat people with particular identities should and do apply to pretty much all human interaction. Don’t touch white people’s hair without their permission either. Don’t ask cis people about their genitals either. Sure.

But the reason this type of comment always comes off as very All-Lives-Matter-ish is because there is a reason the original author has chosen to focus their remarks on a particular type of situation or person. What might that reason be? Some ideas:

  1. The issue is much more likely to affect the group under discussion.
  2. Cis people, how often has a stranger asked you which genitals you have? How often has a potential partner asked you which genitals you have?

    The world is an infinitely varied and complicated place, so I’m sure there exists a cis person somewhere who has had someone ask them, “So do you have a dick or a vagina?” I’m sure there are cis people who have, upon introducing themselves to someone, had that person suddenly ask if they have had surgery on their genitals. (How sure am I? Not actually that sure.)

    But if you ask trans people, they are much, much more likely to have had this experience, often multiple times. In fact, I suspect that any cis person who has had this experience, only had it because they were “read” as trans for whatever reason, and that plays into the exact same harmful ideas that impact trans people every day. There would be no such thing as reading a cis person as trans without the gender-essentialism that gives rise to anti-trans prejudice and discrimination. Just like a straight boy being bullied because he’s assumed to be gay, this can certainly hurt the cis person in question, and their feelings about that experience are valid. But when we’re talking about understanding and preventing the issue, we need to understand why it actually happened. More on that later.

  3. The issue is more harmful to the group under discussion.
  4. So, yes, it is pretty rude and inappropriate to touch people’s hair without their permission, because hair often feels like a part of one’s body and having it groped by random strangers can be rather violating. (Also, some people put a lot of work into getting their hair to look the way it does, so don’t put your greasy hands on it!) Some white people, especially those with curly or otherwise unusual/interesting hair, may indeed have had lots of negative experiences with strangers grabbing it.

    But not only are we much less likely to experience this sort of incident–which in itself means that it’s overall less harmful to us–but it would have an entirely different meaning to us, and that minimizes the harm, too. Touching Black women’s hair is an echo of the many other ways in which white people have historically treated their bodies and their selves as objects for their consumption. They also don’t have the same freedom white people do to set boundaries and ask the person to stop touching their hair, lest they activate the Angry Black Woman stereotype. Doing so can have dangers beyond social rejection.

  5. The dynamics of the issue are different for different groups.
  6. The principle of consensual sex is pretty much the same no matter who’s having sex with who. Sex almost always involves power dynamics (even when both/all people involved have the same gender, power imbalances may arise from other identities), and this can complicate consent when the person with more power is unaware that the person with less power is only saying “yes” because they feel on some level that they have to.

    Asexuality introduces another potential power imbalance into the mix, and brings along with it unique dynamics. For example, many people consider asexuality an “illness” that can be “cured” through good sex. Many people consider it “unethical” for an asexual person to date an allosexual person unless they agree to “give” them as much sex as they want. Different asexual people have different levels of interest in sex, different motivations for consenting to sex, different emotional responses to sex, etc.

    That makes articles like “How to Have Sex With an Asexual Person” absolutely crucial, because they dissect the dynamics that are unique to this situation (an asexual person and an allosexual person having sex) rather than broadly applicable across all sexual situations. Yes, at first glance it all sounds the same–get consent, check in during, etc–and so I can see why it’s tempting for people to brush it off with “Well everyone should do that.” But then you’d miss the nuances.

  7. The person leading the discussion is a member of the group in question and that’s the experience they can speak to.
  8. I don’t know what it’s like to be proselytized to as a religious person, to date as a straight person, to have sex as a cis man. So if I’m talking about various adverse experiences I’ve had with those things and how they might have been better, I can only speak to my experience as a Jewish atheist, as a queer person, as a woman. If religious people, straight people, and cis men can learn something from that and apply it to their own lives–if they feel validated by what I’ve said–that’s great, but that’s not who I’m writing for.

    So when I write about some negative experiences I’ve had with straight women as a queer woman and folks immediately rush to be like “well nobody should ever do that to anyone regardless of identity,” it feels very dismissive. Of course nobody should ever do that to anyone. But I’m not anyone, I’m me, and I’m situated at one particular intersection of identities. That location in part determines which sorts of experiences I have, and I don’t want that to be erased. I want you to see where on the map I am.

“But that applies to everyone” can obviously be a true statement. It’s pretty rare that we would want to treat people differently depending on their social identity. But the fact is, whether we mean to or not, we do treat them differently. That’s been scientifically proven over and over. Likewise, all lives should matter, but they demonstrably don’t, so activists focus on those that we do not treat as though they matter.

Many, many excellent ideas and practices emerge from communities of queer and trans people, people of color, people with disabilities, and other marginalized groups. Many of these ideas and practices would be very useful for dominant groups to adopt. Why don’t cis hetero couples ask each other which words they prefer to use for their genitals and other body parts? Why don’t neurotypical people use color-coded communication badges to make socializing at conferences easier? (I encourage them to, provided they don’t act like they came up with those awesome ideas on their own.)

But that doesn’t mean that marginalized people don’t get to talk about their own experiences and issues as they apply to them specifically, rather than to everyone universally. If you liked something one of us wrote about a niche issue and feel that it’s applicable more broadly, why don’t you write your own article rather than complaining that our writing wasn’t broad enough? Maybe it wasn’t for you.


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

"But that applies to EVERYONE"

Assorted Thoughts on Self-Care

I have a bunch of complicated feelings on the topic of self-care, but none of them seemed quite sufficient for its own tidy blog post. So I’ll discuss them here and maybe expand on some of them later. Some of them are mostly political, some are mostly personal, and most are a mix of the two.

I. Self-care versus communal care.

Lately I’ve been noticing how often self-care becomes a replacement for care that really ought to be provided by the community: by employers, by mental health professionals, by friends and families, by (dare I say it) taxpayers.

Self-care cannot replace being paid a living wage that allows you to get through the day without breaking down because you’re so stressed about money. Self-care cannot replace effective, accessible therapy and psychiatric medication for those who need it. Self-care cannot replace having love and support from close people in your life. Self-care cannot replace adequate parental leave, sick leave, childcare, elder care, healthcare, and other basic necessities. Self-care will not help when the only way to have a job that pays enough to cover the things that self-care does not magically provide is to put yourself so far in debt for your college education that you spend the rest of your life worrying about money anyway.

Self-care has very important limits, and I think most of us activisty types are aware of that. But it’s jarring to see self-care touted as a solution by institutions that are creating (or neglecting their responsibility to solve) the very same problems they are touting self-care as a solution to. Self-care doesn’t pay my rent, much less my student loan debt. Self-care doesn’t help when an employer won’t give me enough time off to do any damn self-care.

II. Self-care is a harm reduction measure.

Having said all that about the limits of self-care and the responsibilities of people/institutions to step up at times and care for each other, I think there’s another way to think about this that might be helpful: self-care as a harm reduction measure. Harm reduction, as the words imply, suggests that at times when immediately taking all the harm away is impossible, reducing the harm may still be possible (and worthwhile). In its prototypical usage in alcohol/drug treatment, it might refer to giving intravenous drug users free clean needles because, while we can’t magically make them stop being addicted right now, but we can reduce the harm of their drug use by greatly reducing their likelihood of contracting infections by using dirty needles.

Harm reduction in the self-care context can mean that, since we can’t magically create a just society today, we can help people cope with the way things are for now. If you have a mental illness but no therapist or psychiatrist, there are things you can do to help yourself get by in the meantime. If you don’t get paid enough and are constantly stressed about money, there are things you can do to forget your worries for a few hours and give yourself some small things to look forward to. If you are taking care of your aging parent while working full-time because there is no other care available/affordable, there are things you can do for yourself to ease the burden you’re carrying. (The wording here is not to imply that a person who needs care is themselves a burden or that it is wrong to need that care; we all carry burdens of various weights and sometimes that includes caring for someone we love who can’t care for themselves. It should be okay to be honest about the difficulty of that, even if it is a labor of love.)

Of course, one potential concern about harm reduction in any context is that people will get complacent and stop working on the broader, systemic changes that would reduce the harm the rest of the way. For instance, same-sex marriage can be seen as a harm reduction measure against homophobia–it won’t solve the problem, but it will help reduce some of its harms for the time being. (Some people don’t realize that there even is homophobia beyond the marriage issue, but they are wrong.) But some radical LGBTQ activists worry that, having achieved same-sex marriage throughout the U.S., we’ll collectively sigh in relief and say, “Well, that’s good enough, I guess.” And, meanwhile, trans people of color will still be subject to disproportionate violence and discrimination, folks will still be losing jobs, housing, and families because of their sexuality or their gender, trans people will won’t be able to access appropriate healthcare, and so on.

The same thing could happen on a smaller scale with self-care. We might develop our own effective individual self-care practices and decide that, really, it’s okay, we can live with juggling two or three jobs while caring for children and aging parents.

At least, that’s the argument against harm reduction. (The left-wing argument, that is.) But in my experience, when people give up on fighting for systemic change, it’s less complacency and more burn-out or straight-up not having enough time. Burn-out, at least, is the exact thing that good self-care is supposed to prevent. Besides, the argument that harm reduction is actually harmful because it prevents people from staying motivated to pursue more complete solutions sort of implies that people should be expected to suffer even more in the meantime so that they can be better agents of social change, and that’s downright creepy.

III. Everyone’s self-care looks different.

This is an oft-repeated fact, but sometimes it’s still hard to internalize this. I used to get so frustrated with the idea of self-care because all the examples I saw online were like…take a bath! Watch a crappy TV show! Spend all day in your pajamas eating ice cream out of the carton! These are all perfectly valid things to do, but these types of activities make me feel worse rather than better. Taking a bath is nice, I guess, but it’s hard to keep my mind engaged on anything when most of the things that I could engage it on cannot be safely taken into a bathtub. Watching crappy TV and spending all day doing nothing makes me feel like a useless waste of space, so I try to avoid it. (Again, it doesn’t mean you’re a useless waste of space if you enjoy those things. It means I don’t like them.)

So for a while I was all like “what is self-care even” because all the examples I saw failed to resonate with me and seemed more like self-neglect than self-care. As it turns out, for me, self-care usually involves doing the sorts of things that other people need to avoid for self-care: reading articles online, spending time in big groups of people, writing (for public consumption, not in my journal), being with my family, listening to someone else’s problems. Self-care for me looks nothing like sitting around on the couch looking like crap and eating crap.

This is why when people ask me for suggestions on how to do self-care, I don’t really know what to say. I only know what works for me, and I’m starting to pick up on the fact that I’m a little unusual in this way. (For instance, people keep asking me how I manage to write so much despite my depression and despite how hard writing online can be. I find this question confusing. I have depression, so how can I possibly not write? Being online can be shitty, so how can I not use writing to cope with it?)

IV. Self-care versus self-preservation.

I find it useful to distinguish between the self-care we do to replenish and sustain ourselves, and the self-care we do to prevent ourselves from falling to pieces completely. This distinction would help clarify my earlier thoughts on self-care as a form of harm reduction, and it would help explain why some forms of self-care actually seem somewhat harmful, at least in the long term.

Consider these two different situations. One: You’ve had a long, crappy day at work and you’re feeling demoralized about your work and about your value as a person. You’ve spent all day around people who don’t care about you and treat you like shit, and at times like this it’s hard to remember that you do really matter and you’re important to people. You’d planned on going home after work tonight and doing adult things like laundry and making lunch to take to work the next day, but you realize that what you really need right now is to recover from your day. So you message some friends and ask them to meet up with you at a bar, where you drink and laugh and talk about anything other than work.

Two: You’ve had a long, crappy day at work. Things just keep piling up and by the end of the day, you’re an inch away from ending up in the bathroom sobbing. You can’t stand the thought of talking to even one more person today. Although you had plans to go out with your friends after work–something you normally love to do, something that normally helps you recharge from days like today–this time you just can’t bring yourself to go. You message them to let them know you can’t make it this time and head home, where you lie on the couch, pet your cat, and watch Gossip Girl because you have no energy left for anything else. It’s not like you even enjoy it, really, and you wish you could’ve gone out with your friends, but at this point you just can’t.

I’ve been in both of these situations, and for me, the difference is agency. In the first situation, I have chosen to do something that will restore a sense of worth and joy to me, and that is self-care. In the second situation, I have “chosen” to cancel my plans in order to do something that I need to do (that is, nothing much at all), but it doesn’t feel like a choice. Yet this second scenario often gets labeled as “self-care.” “It’s ok,” my friends will say when I cancel. “You need to take care of yourself.”

But that doesn’t feel like caring for myself. That’s just preserving myself so that I don’t burst out crying at the bar with my friends or sit there staring catatonically into space. I didn’t go out because I couldn’t, even though I wished very much that I could’ve because that would’ve made me actually feel better.

At the same time, though, it’s still self-care of a sort. Given that I already felt so awful, choosing to stay in rather than try to force myself to go out undoubtedly makes my life easier in some ways. It prevents me from burning out further. It prevents potential damage to my relationships with others. It prevents me from embarrassment if I don’t feel comfortable being my burned-out self in front of my friends (and, although this is a hypothetical, I actually don’t).

That is a harm-reduction sort of self-care, whereas my first example was a more positive form of self-care. It wasn’t about preventing things from getting even worse so much as it was about making things get better. Both of these forms of self-care have their place, as painful as it is when one gets confused for the other.

V. Self-care should fit the situation.

Just as different people find different forms of self-care helpful, different situations might call for different forms of self-care. I touched on that in the previous section, but it goes further than that. At the Secular Women Work conference this summer, Hiba Krisht did a workshop about burn-out and self-care in which she made the point that effective self-care needs to restore whatever it is you’re lacking in that moment. If you’re lacking energy, self-care should restore energy (or at least conserve it, when restoring it is impossible). If you’re lacking connection, self-care should restore it. If you’re lacking peace and quiet…you get the idea.

While that sounds totally obvious in retrospect, I never thought of it that way before, and that was why, as I mentioned above, most suggestions for self-care techniques fell flat for me. Lounging around in a bubble bath is great for when you need calm and solitude, but that’s not what I usually need. I need intellectual stimulation and connection with people.

Unfortunately, that makes self-care even more difficult than it already is for most people, since feeling intellectually understimulated and disconnected from people also usually goes along with lots of sadness, fatigue, and other shit that makes it really difficult to achieve intellectual stimulation and connection with people. What then complicates matters further is that most people, including most of the friends I’d theoretically be connecting with, conceptualize self-care more as sitting in a bubble bath or watching Gossip Girl than being out at a loud bar with friends yelling about recent psychology research. So when I tell my friends I’m feeling shitty, they’re much more likely to say, “Aww, it’s okay if you need to just lay around on the couch and watch TV” than “Oh, sounds like you need to head out to a crowded noisy bar with a bunch of us to yell about research.” And when I’m in an especially shitty state, I can’t always access my memories of things that have helped in the past, so I’m unlikely to draw the “feeling shitty? go hang with friends!” connection on my own. Plus, I feel awkward asking people to hang out with me when I’m feeling shitty, because they might not realize that I’ll probably stop feeling shitty as soon as we start hanging out (but also, I can’t necessarily promise that’ll happen 100% of the time, you know?).

And sometimes it admittedly feels really weird how fast my friends jump to saying “it’s okay to just cancel our plans and be alone!” when I mention I’m having a hard time. At that point, the crappy part of my brain is thinking…do they want me to just cancel and be alone? Would they rather not deal with me when I’m down? Is it bad to want to be cheered up by people when I’m sad?

Ultimately I try not to ascribe such negative motives to my friends and try to trust them to just set their own boundaries. But regardless, it would be so helpful if people would more often ask, “What do you think would be helpful for you right now?” rather than reminding me (with the best of intentions) that I have the option of doing something that would make me feel much, much worse.

Self-care, both as a concept and as a practice, is not a panacea. We shouldn’t try to make it do more work than it’s capable of. But I’m definitely not ready to throw it out, either.

Assorted Thoughts on Self-Care

On "Obvious" Research Results

There is a tendency in my social circles sometimes to dismiss social science results that seem “obvious” and aligned with our views with, “Well, duh, why didn’t they just ask a [person who experiences that type of marginalization/trauma/adverse situation].”

I’ve seen it happen with studies that show that fat-shaming is counterproductive, and studies that show that sucking up to abusers doesn’t stop abuse, and probably every other study I’ve ever written about here or posted on Facebook.

To be honest, I’m often having to suppress that initial response myself. It is infuriating when we’ve been saying something for years and now Science Proves It. (Of course, science doesn’t really “prove” anything.) It’s especially annoying when some of the some of the same people who deny my experiences when I share them are now posting links to articles about research that says that exact thing, without any apology for disbelieving me.

At the same time, though, I try to separate my frustration from my evaluation of the research. In reality, the fact that a result seems “obvious” or “common sense” doesn’t mean that the study shouldn’t have been conducted; for every result that aligns with common sense, there’s probably at least one that completely goes against it. Considering the fact that negative results have such a hard time getting published in psychology, there are probably a ton of studies sitting around in file drawers showing no correlations between things we assume are correlated.

Moreover, research is important because it helps us understand how prevalent or representative certain experiences are, and listening to individuals share their stories isn’t going to give you that perspective unless you somehow manage to listen to hundreds or thousands of people. (Even then, there will probably be more selection bias than there will be in a typical study, in which the subject pool at least isn’t limited to the researcher’s friends.) I will always believe someone who is telling me about their own experience, but that doesn’t mean that I will assume that everyone who shares a relevant identity with that person has had an identical experience. That would be stereotyping.

So, sure, to me it might be totally obvious that people who make creepy rape jokes are much more likely to actually violate boundaries–because I’ve experienced it enough times–but my experience may not have been representative. It is very much still my experience, and it is very much still valid and I have the right to avoid people who make creepy rape jokes since they make me uncomfortable, but it isn’t necessarily indicative of a broader trend. (Of course, now I know that it probably is, because multiple studies have strongly suggested it.)

The weirdest thing by far about the “Why didn’t they just ask a [person who experiences that type of marginalization/trauma/adverse situation]” response is that, well, they did. That’s literally what they’re doing when they conduct research on that topic. Sure, research is a more formal and systematic way of asking people about their experiences, but it’s still a way.

And while researchers do tend to have all kinds of privilege relative to the people who participate in their studies, many researchers are also pushed to study certain kinds of oppression and marginalization because they’ve experienced it themselves. While I never did end up applying to a doctoral program, I did have a whole list of topics I wanted to study if I ever got there and many of them were informed directly by my own life. The reason researchers study “obvious” questions like “does fat-shaming hurt people” isn’t necessarily because they truly don’t know, but because 1) their personal anecdotal opinion isn’t exactly going to sway the scientific establishment and 2) establishing these basic facts in research allows them to build a foundation for future work and receive grant funding for that work. In my experience, researchers often strongly suspect that their hypothesis is true before they even begin conducting the study; if they didn’t, they might not even conduct it.

That’s why studies that investigate “obvious” social science questions are a good sign, not a bad one. They’re not a sign that clueless researchers have no idea about these basic things and can’t be bothered to ask a Real Marginalized Person; they’re a sign that researchers strongly suspect that these effects are happening but want to be able to make an even stronger case by including as many Real Marginalized People in the study as financially/logistically possible.

As I said, I do completely empathize with the frustration of feeling like nobody takes our experiences seriously until they are officially Proven By Science. I also wish that people didn’t need research citations before they are willing to accommodate an individual’s preferences for the sake of inclusivity or just not being an asshole. (For instance, if I ask you to stop shaming me for my weight, you should stop doing it whether or not you have seen Scientific Proof that fat-shaming is harmful, because I have set a boundary with you.)

However, if we take individual experiences as necessarily indicative of broader trends, we would be forced to conclude that, for instance, there is an epidemic of false rape accusations or that Christian children are overwhelmingly bullied in the United States for their religious beliefs. Certainly both things happen. Certainly both things happen very visibly sometimes. Both are awful things that should never happen, but it is, in fact, important to keep in perspective what’s a tragic fluke and what’s a tragic pattern, because flukes and patterns require different prevention strategies.

I’ll admit that a part of my discomfort with “well duh that’s obvious why’d they even study that” is because I don’t want the causes I care about to become publicly aligned with ignoring, ridiculing, or minimizing science. We should study “obvious” things. We should study non-“obvious” things. We should study basically everything as long as we do it ethically. We should do it while preparing ourselves for the possibility that studies will not confirm what we believe to be true, in which case we dig deeper and design better studies and/or develop better opinions. I find Eliezer Yudkowsky’s Litany of Tarski to be helpful here:

If the box contains a diamond,
I desire to believe that the box contains a diamond;
If the box does not contain a diamond,
I desire to believe that the box does not contain a diamond;
Let me not become attached to beliefs I may not want.

Even if your experiences turn out to be statistically atypical, they are still valid. Even if it turns out that fat-shaming is an effective way to get people to lose weight, guess what! We still get to argue that it’s hurtful and wrong, and that it’s none of our business how much other people weigh. Knowing what the science actually says at this point is the first step to an effective argument. Knowing what the possibly-faulty science is currently saying is the first step to making better science.

On "Obvious" Research Results

Being Extra Nice To Abusers Doesn't Stop Abuse

[CN: abuse]

So I’m reading this Washington Post article about some recent research on abusive bosses and come across this perplexing bit:

But the researchers also found something they didn’t expect. They predicted that acts of compassion and empathy—employees who assist bad bosses by going above and beyond, helping bosses with heavy workloads even when they’re not asked—would be negatively linked with abusive behavior. In other words, such acts of kindness might help lessen future rude or abusive behavior.

The study, however, found that wasn’t true. “Abusive supervisors didn’t respond to followers being positive and compassionate, and doing things to be supportive and helpful,” said Charlice Hurst, an assistant professor at Notre Dame’s Mendoza College of Business who was a co-author on the paper. Their findings, she said, seem to “clash with common sense.”

To put it mildly, these findings only clash with common sense if you’ve never been abused or bullied. If you have, then you know that abuse is not about persuading people to do nice things for you. It’s about controlling them: their feelings, their thoughts, their self-esteem, their experiences, their behavior, even the course of their lives. It is also about asserting power publicly to control bystanders as well.

That’s why bullies and abusers “win” almost no matter how you respond. If you lash out in anger, they get to use their higher status to get you in trouble for your anger. If you cry, they get to ridicule you. If you ignore it and walk away, they get to paint you as a coward–and, regardless, they still get to influence bystanders even if they haven’t influenced you. If you start being extra nice to them, then they reap the benefits of your niceness while reinforcing their dominance over you. The only way to “win” in an abusive situation is to find a way to get out of it entirely and never look back, and that’s exactly what abuse is designed to prevent you from doing.

And in the event that a boss is deliberately choosing to be abusive in order to elicit “supportive and helpful” behavior from you, then behaving in a supportive and helpful manner would only reinforce the abuse*. It would be like feeding scraps to a dog that begs at the table, except that dogs that beg are at worst annoying and bosses that abuse are at worst life-ruining. I am absolutely horrified at the idea that people are advising victims of workplace abuse to perform “acts of compassion and empathy” towards their abusers, because if anything, that’ll only teach the abusers that abuse is an effective method of getting people to kiss your ass.

The article continues:

In the paper, the researchers say one explanation may be that bosses just see all that extra work as part of the job, something academics refer to as “organizational citizenship,” and therefore don’t feel the need to treat their employees any better because of those efforts.

I submit that it’s not that at all, but rather that people who abuse, whether they do it in a school or their home or their office, do it because they reap some psychological reward from it. Why would they give that reward up just because you did some of their paperwork?

One might protest that this is making it seem like there’s nothing that victims of workplace abuse can do to stop the abuse. Indeed, the article notes that the researchers have so far “only discovered what not to do” to stop abuse, and nothing to do to stop it.

While that might aggravate those who believe strongly in a just world, it makes complete sense. Abusive situations are abusive precisely because they involve a significant imbalance of power. The person with less power does not have the capacity to influence the situation significantly. If they did, they probably wouldn’t have been abused in the first place. And the thing about having relatively little power is that you can’t just decide one day to have more power. That’s not how power works.

That’s why telling victims of abuse and other power-based acts of violence (such as sexual assault) to prevent that violence is not only hurtful and condescending, but also totally useless. That’s why comparing abuse and sexual assault to other situations, like stolen bikes, doesn’t work.

The researchers in this particular study seem to have wised up a lot about abusive dynamics over the course of their research. Co-author Charlice Hurst says that in order to prevent workplace abuse, “Companies have to create cultures where abusive supervisors are not acceptable, and they have to implement policies for employees to report being bullied.” In other words, the responsibility for preventing bullying rests on the shoulders of those who have more relative power within the workplace, not those who have less. The way to stop bullying is to implement reforms at the systemic level, not at the individual level.

(And no, before anyone jumps in with “but some employees are just terrible and rude and bad at their jobs, so shouldn’t they improve,” that’s completely irrelevant. The solution to a bad employee is to tell them how to improve and if they don’t, fire them. It’s not to abuse them.)

While victims of abuse do not have much control over the abuse itself (unless they manage to extricate themselves and leave), they do have some control over their emotional reaction. It is very important that I said “some.” I didn’t say “complete,” or “a lot.” And that control can include, for instance, going to therapy to learn coping skills. But the reason I bring this up is that “passive-aggressive retaliation,” one of the reactions the researchers showed to be ineffective in terms of stopping abuse, was also shown in a different study to be effective for a different purpose: helping employees cope. In sum, “Employees felt less like victims when they retaliated against their bad bosses and as a result experienced less psychological distress, more job satisfaction and more commitment to their employer.”

Of course, retaliation of any sort can be dangerous, you know your situation best, take all psychology reporting with an appropriate grain of salt, et cetera. I’m hesitant to do some sort of “coping with abuse” advicepost because I don’t want to come across like I’m condoning abuse or being fatalistic about it, but on the other hand, 1) abuse happens and 2) it’s already been demonstrated numerous times that you cannot prevent your own abuse. Using whatever coping strategies work for you seems like a good idea.

I hope that studies like this one bring more awareness to the psychology community about the dynamics of abuse. Too often, psychologists fall into the trap of focusing overly on individual factors (like what abuse victims can/should do) as opposed to structural factors (like what communities/systems can/should do). This causes them to make ridiculous assumptions like “it’s just common sense that being nice to an abuser would make them stop abusing!”

It makes sense that only someone with more power (whether individual or collective) than an abuser can make them stop abusing, although that may not always be sufficient. If an abuser holds such absolute power in your workplace that nobody and nothing can hold them accountable, you’re going to have issues with abuse no matter how nice the abuser’s victims are.


*I want to be very clear here that sometimes being extra nice to an abuser feels like the only safe thing to do, in which case you should do whatever makes you feel safe first and foremost. I will never pass judgment on the ways in which individuals choose to cope with their abuse. However, I also don’t think we should advise people to do things that seem like they’d make abuse worse, so, that’s what I’m getting at here.


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

Being Extra Nice To Abusers Doesn't Stop Abuse