Trump’s Mental Health Diagnosis is Irrelevant

Donald Trump’s mental health diagnosis, if he even has one, is almost entirely irrelevant to any of the questions we are trying to answer about our future and is a pointless and dangerous distraction that we cannot afford.

I regularly diagnose people with mental illnesses. I am myself diagnosed with a mental illness. As far as I can tell, these diagnoses have a few main functions:

  1. Insurance billing. Your insurance company needs to see something from the doctor justifying the money they’re spending on you.
  2. Research. Participants in studies have to be systematically categorized somehow, because a treatment for depression symptoms may not work for eating disorder symptoms and we need to know which it works for.
  3. Treatment. You and your therapist or doctor can use diagnoses to figure out a course of treatment that’s most likely to be effective, and to know what to try next if that doesn’t work. You can also use it on your own to find books and other resources that might help you or a loved one with coping skills and self-acceptance.
  4. Community. When people know what their diagnoses are, they can use those labels to find others who have very similar issues and build solidarity with them.

Notice what’s not anywhere on that list? Predicting a stranger’s future behavior.

Suppose you know that Donald Trump qualifies for the DSM criteria for narcissistic personality disorder. What exactly does this knowledge change? How does it impact your predictions of Trump’s future behavior or your decisions about your own behavior? How is a world in which Trump technically fits those criteria different than a world in which he doesn’t technically fit those criteria?

The only halfway-reasonable answer I’ve ever seen anyone give to any of these questions is that maybe if a fancy doctor examines Trump and concludes that he fits the criteria for some or other mental disorder, then people will finally realize that he’s unfit to be president.

First of all, that’s just false. Trump has been accused of sexual violence by numerous women, saluted by actual Nazis, and implicated in numerous cases of fraud. A bunch of clinical jargon isn’t going to change anyone’s opinion on anything if none of those things have. And given what I’ve gathered from Trump supporters by actually listening to them, many of them don’t recognize the validity of psychiatry, the DSM, or mental healthcare in general.

Second, Donald Trump is going to become president on January 20, 2017. Do whatever you need to do to cope with that knowledge, but it’s going to happen no matter which billing codes his doctors send to his insurance company.

Third, if–after the sexual violence and the fraud and the nepotism and the tax evasion and the naked racism and the probable interference of Russia in the election–it’s mental illness that makes people finally see Trump as unfit for office, that is horrifying.

What that says is that our unjustified, irrational fear of people with mental illnesses is more powerful than the collective evidence of someone’s past behavior.

That being a person with a mental illness is worse than being a rapist.

Worse than stealing the labor of working class people who need that income to put food on the table.

Worse than threatening to imprison and deport innocent people, and having the power to actually do it.

Worse than pandering to Nazis and dictators.

What does that say about the millions of people who share Trump’s supposed diagnosis?

And as awkward as I find it to disagree with a bunch of Harvard psychiatrists with much more experience than I have, we don’t need an expert neuropsychiatric evaluation to tell us that Trump is unfit for office. We already know because he provides evidence of this daily and has been doing so since he first emerged in the public spotlight. We elected him anyway.

And there’s both the bad news and the good news. The bad news is that you can never predict with anywhere near-certainty what someone will do in the future, especially if it’s not someone you know personally. People surprise us every day. It would be nice if we could magically divine a complete catalog of the disasters that Trump will cause while in office, but we can’t. Knowing which DSM criteria he fits will not help with that, and it may even obfuscate it even further.

The good news is that there is one fairly effective way of predicting someone’s behavior, and that is by observing their current behavior and reflecting on their past behavior. Trump has a long and clearly-evident record of dishonesty, boundary violations, fraud, discrimination, nepotism, harassment of journalists and other critics, conservative politics, and other things that most of us generally dislike. It’s a safe assumption that he will continue to do these things in the future.

Mental health diagnoses, on the other hand, are very poor predictors of behavior because the causative link between mental illness symptoms and outward behaviors is much more complicated than simple cause-and-effect. Diagnoses mostly describe internal processes, such as feeling hopeless or thinking everyone’s out to get you, and not outward behavior (although outward behavior can help identify internal processes). Someone who really wishes they were dead may or may not ever attempt suicide or even self-harm. Someone who is scared of elevators may or may not choose to use them anyway for any number of reasons. Plenty of people with depression hide it perfectly even from people who know them well. Someone experiencing hallucinations that tell them to jump out a window may or may not realize that the voices are a symptom of psychosis, and may or may not be able to ignore them and stay away from windows.

Personality disorders, which is what people typically associate Trump with, are an even more complicated thing. For starters, many professionals are skeptical of their validity as diagnoses in the first place because they’re extremely subjective and based much more on local norms of social behavior than on what is actually harmful or distressing for the patient. Regardless, we typically do not diagnose something as a personality disorder unless it’s maladaptive for the individual being diagnosed or they’re unhappy with the way they are. That others are unhappy with the person’s behavior doesn’t count. Trump does not seem to be unhappy with his behavior and you could hardly argue with a straight face that it’s been maladaptive for him.

In any case, I work with individuals with personality disorders on a regular basis and while knowing their diagnosis certainly predicts some of their symptoms–that’s literally the point of a diagnosis–it doesn’t necessarily predict their outward behavior, especially not when it comes to complex roles like running a government. That’s because, as I wrote above, diagnoses mainly describe internal processes.

Having a few random experts declare that Trump officially has a mental illness will not remove him from office or undo any of the harms he has already done or will do by that time. If it could, then we’d have to have a difficult conversation to have about just how badly we want to fuck over ordinary people with mental illnesses for the sake of removing from office someone that we elected in the first place, because that would mean that nobody with a history of mental health treatment will ever be able to hold elected office in this country again.

But it won’t, so the conversation we should be having instead is whether or not we will continue to attribute everything we don’t like in ourselves to mental illness, or whether we will stop demonizing those of us who suffer from it and instead aim our arrows at the proper targets.

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Trump’s Mental Health Diagnosis is Irrelevant

Social Media, Mental Illness, and Vulnerability

“Wow, uh…you’re very open online.” I still hear this from people every so often.

“Yup,” I say, because I don’t assume it was meant to be a compliment.

And it’s true. On my Facebook–which, by the way, is not public–I’ve posted regularly about depression, anxiety, sexuality, sexual harassment and assault, body image issues, interpersonal problems, and other various struggles, big and small, that make up life. Don’t get me wrong–I also post plenty about food, cute animals, books, and other “appropriate” topics for online discussion, although I’ve noted before that there really is no way to win at social media (including refusing to play at all).

People who don’t know me well probably assume I do it “for attention” (as if there’s anything humans don’t do for some sort of attention, one way or another), or because I’m unaware of social norms (they’re not that different where I come from, trust me), or simply because I have poor impulse control. Actually, I have excellent impulse control. I’m not sure I’ve ever acted on impulse in my entire life, with perhaps the sole exception of snapping at my family members when they get under my skin. I know plenty of people who have destroyed relationships, lost jobs, or gotten hospitalized as a result of their impulses. I get…speaking rudely to someone for badgering me about my weight.

Being open about myself and my life online (and to a certain extent in person) is something I do strategically and intentionally. I have a number of goals that I can accomplish with openness (or, as I’ll shortly reframe it, vulnerability), and so far I think it’s worked out well for me.

A lot of the good things about my life right now–and, yes, some of the bad–can be traced back to a decision I made about five and a half years ago, when I was a sophomore in college. I had recently been diagnosed with depression and started medication, which was working out great and had me feeling like myself for the first time in years. (Yeah, there were some horrible relapses up ahead, but all the same.)

I wrote a very candid note on Facebook–later a blog post–about my experience and how diagnosis and treatment had helped me. At the time, I did not know anyone else who was diagnosed with a mental illness–not because nobody was, but because nobody had told me so, let alone posted about it publicly online. While I obviously knew on some level that I wasn’t “the only one,” it felt that way. I certainly didn’t think it would be a relevant topic for my friends. Mental illness was something experienced by Other People and by weird, alien me, not by any of the happy, normal people I knew.

I couldn’t have been more wrong. In response to my post, tons of friends started coming out of the woodwork–both in private messages and in the comments of my post–and talking about their own experiences with mental illness. An ex-boyfriend texted me and apologized for dumping me years prior for what he now knew was an untreated mental illness. Acquaintances and classmates turned into close friends. Circles of support were formed. I started speaking out more and gradually became recognized as an advocate for mental health on campus, and eventually started a peer counseling service that is still active on campus today, three years after I left. These experiences pushed me away from the clinical psychology path and towards mental health services, leading me to pursue internships, my masters in social work program, and now, what looks to be a promising career as a therapist.

All because of a Facebook post that many would consider “TMI” or “oversharing.”

Well, not all because. I don’t know what path my life would’ve taken if I’d made different choices, not just with coming out as a person with depression but with all kinds of things. Maybe I’d still be here, or somewhere similar. But I can’t possibly know that–what I do know is that the decision to make that Facebook post had very far-reaching and mostly positive effects on my life.

This isn’t a “you should come out” post; I don’t do those. I’m writing about myself and why I’m so open. This experience, and others that followed, shaped my perspective about this. So, here’s why.

1. To be seen.

That’s my most basic reason and the one that comes closest to being impulsive. But basically, I don’t like being seen as someone I’m not. I don’t like it when people think my life is perfect because I only post the good things. It hurts when people assume I have privileges I don’t, and when people think I couldn’t possibly need support or sympathy because everything is fine. If I didn’t post about so-called “personal” things,  people would assume that I’m straight, neurotypical, and monogamous, and the thought of that is just painful.

2. To filter people out.

I don’t expect everyone in my life to support me through hard times or care about my problems. Some people are just here for when I’m being fun and interesting, and that’s only natural. However, posting about personal things on Facebook is a great way to filter out people who not only aren’t interested in supporting me, but who are actually uncomfortable with people being honest about themselves and their lives. Otherwise, it’s going to be really awkward when we meet in person and you ask me how I’m doing and I say, “Eh, been having a rough time lately. How about you?” Because I do say that. Not with any more detail than that if you don’t ask for it, but that’s enough to make some people very twitchy because I didn’t perform my role properly.

I don’t want anyone in my life who thinks it’s wrong, weak, or pathetic to be open about your struggles. Because of the way I use Facebook, they don’t tend to stay on my friends list for long, and that’s exactly how I want it.

3. To increase awareness of mental illness.

When I post about my experiences with depression, anxiety, and eating disorders, it’s not just because I want people to know what’s going on with me personally. I also want them to know what mental illness is. When I published that post about depression I mentioned earlier, I didn’t just get “me too” responses–I also got comments from people who said that they’d never had depression and struggled to understand what it’s like, but that my piece helped. Some people took that knowledge and applied it to their relationships with depressed friends, partners, and family members, which I think is great.

It seems weird to write this section now, because so many people in my life have themselves been diagnosed with mental illness or are very knowledgeable about it through supporting others with it. But when I first started being open online about depression, that definitely didn’t describe my social circle, and I’d like to think that my openness is at least part of the reason for the difference.

4. To reduce the stigma of mental illness.

I don’t just want to make people aware of what mental illness is like–I want them to stop thinking of it is a shameful thing that ought to be kept secret. Since I’m fortunate enough to feel safe coming out, I think that’s a powerful action I can take to reduce that stigma. The more people see my posts about depression and anxiety as normal, just like posting about having the flu or going to the doctor, the less they’ll stigmatize mental illness.

Of course, stigma–and the ableism that fuels it–is a broad and systemic problem with intersectional implications that I don’t even pretend to be able to fix with some Facebook posts. But I do what I can.

5. To reduce the stigma of vulnerability, period.

Not everything “personal” that I put online deals with mental illness specifically (although, when you have lifelong depression, everything does tend to come back to that). I write a lot about homesickness, my love for New York (and the pain of leaving it), issues with my family, relationships, daily frustrations and challenges, and so on.

Not everyone wants to share these things with their friends (online or off), but many people do–they’re just afraid that nobody cares, that they’ll be seen as weak, or that there’s no room for this kind of vulnerability within the social norms that we’ve created. That last one may be true, but there’s no reason it has to stay that way.

As Brené Brown notes in her book that I recently read, vulnerability isn’t the same thing as recklessly dumping your personal problems on people. I’ve also written about guidelines for appropriate sharing, and how to deal when someone’s sharing makes you uncomfortable.

The point isn’t to completely disregard all social norms; some of them are there to help interactions go smoothly and make sure people’s implicit boundaries are respected. The point is to design social norms that encourage healthier interactions, and while I’m sure there are some people who can healthily avoid divulging anything personal to their friends, I’m not one of them and my friends aren’t either. So for us, reducing the stigma of vulnerability and encouraging openness about how we feel is healthy.

6. To create the kinds of friendships I value. 

Being open online doesn’t just filter people out–it also filters people in. Folks who appreciate vulnerability read my posts, get to know me better, and share more with me in turn. I’ve developed lots of close friendships through social media, and not all of them are long-distance. In fact, a common pattern for me is that I meet someone at a local event and chat casually and then we add each other on Facebook, at which point we learn things about each other that are way more personal than we ever would’ve shared at a loud bar or party. Then the friendship can actually develop.

I’ve been very lucky to find lots of people who appreciate this type of connection. People who don’t always answer “how are you?” with “good!”, who engage with “negative” social media posts in a supportive and productive way rather than just ignoring them or peppering them with condescending advice or demands to “cheer up!” People who understand that having emotions, even about “silly” things, doesn’t make you weak or immature. People who understand that working through your negative/counterproductive emotions requires first validating and accepting them, not beating yourself up for them or ignoring them.

So, that’s why I’m so open online. If you don’t like it, you don’t have to read it. But I’m not alone in it, and it’s becoming less and less weird. It’s hard to believe that just a few years ago, I was the only person I knew with depression. Not only do I now know many, but I’m also so much more aware of all sorts of joys and sorrows I haven’t personally experienced–all thanks to my friends’ openness online. For a therapist–hell, for a human being–that’s an invaluable education.

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Social Media, Mental Illness, and Vulnerability

How to Get the Most Out of Therapy

Drawing of a therapy session in progress.
Credit: Guy Shennan

When you spend a lot of money on things, they usually come with an instruction manual to help you use them in the most effective possible way. Unfortunately, therapy doesn’t.

A common misconception about therapy held by many laypeople (and, unfortunately, some therapists) is that all you have to do as a client is show up and then…some vague hand-wavey magic stuff happens, and then the client gets better. Many people think of therapy like this:

  1. Go to therapy
  2. ???

Really, though, it’s more like this:

  1. Go to therapy
  2. Establish some rapport with the therapist before you can delve into the serious stuff
  3. Sometimes be really uncomfortable
  4. Have a lot of meta-conversations with your therapist–that is, talk to the therapist about the process of talking to the therapist
  5. Do homework (in some types of therapy)
  6. Get called on your shit by the therapist
  7. Be uncomfortable again
  8. Make changes in your life outside of therapy

As a therapist, it’s tempting to say that you should just show up and let the therapist do their job and you’ll feel better. Sometimes that’s exactly how it works. But ultimately, you can only get as much out of therapy as you put into it.

Continue reading “How to Get the Most Out of Therapy”

How to Get the Most Out of Therapy

When Including Friends with Chronic Illness Feels Like Ignoring Boundaries

Text reads, "Plans? Yeah, I know...I cancel, I postpone, I reschedule, I delay committing. Illness sometimes controls my schedule, but I am determined it won't control me! Please keep inviting me."
I’ve been seeing a bunch of memes lately to the effect of, “keep inviting your chronically ill friends to things, even if they always say no/flake out/don’t respond at all/etc.”

(Chronic illness here refers both to mental illness and to chronic physical conditions like fibromyalgia and fatigue.)

That’s a bit of advice that I’ve endorsed and given myself, especially having so often been that exact chronically ill person. I do think that those who are close to someone with a chronic illness and want to be supportive should, if they can, make that extra effort and try to get past their own feelings of rejection to try to include that person, because even if they always say no, the invitations may be a heartening reminder that they’re still wanted and missed. That’s easy to forget when you’re in the throes of a chronic illness flareup, especially if it’s depression.

Lately, though, this advice has been giving me cognitive dissonance and I think I’ve figured out why.

Continue reading “When Including Friends with Chronic Illness Feels Like Ignoring Boundaries”

When Including Friends with Chronic Illness Feels Like Ignoring Boundaries

The Mental Health Advocate Pedestal

[Content note: depression and eating disorders]

I recently read Olivia’s excellent blog post, “I’m Tired Of Curating.” In it she describes her experiences as a mental health advocate and a person with mental illness(es), and it resonated a lot with me:

I’m not allowed to share these thoughts because they glorify an eating disorder, because I’m not actively telling people how awful it is to be sick, because I’m remembering how intertwined I am with the disease, the way it really is part of the way my mind works rather than something that needs to be kicked out of my life.

[…] I’m sick of trying to spin these thoughts into something useful or meaningful. Since I’ve started to write openly about treatment and recovery and mental illness, I feel as if I need to be a role model or someone that others can look to to see that mental illness does not destroy your life. And yet it’s consumed all of mine and I feel as if I’ve gained nothing except 50 pounds.

I don’t want to curate my words today. I don’t want to be careful not to trigger anyone or to mistakenly portray the ways I behave in a positive light. I want to be allowed the space to honestly portray my mental illness, including the way that it looks seductive when I’m anxious and overwhelmed. Right now restriction is the only thing that makes sense to me. I hate having to hedge that with the caveat that I know it’s not healthy and no other people shouldn’t do it and yes it will fuck up my life.

[…] As someone who has a mental illness and advocates for people with mental illnesses, sometimes I feel like I’m not actually allowed to have my mental illness. Sure, I get to talk about the experience and share inspiring stories or even stories about how nastybad it is and tips and tricks that I’ve picked up, but I don’t get to publicly have the thoughts and feelings that come with a jerkbrain. I don’t get to type “I think I’m a shitstain on the world” without people disregarding everything else I say. I don’t get to type “I truly would like to skip all upcoming meals indefinitely” without being accused of promoting unhealthy behaviors. Newsflash world: I have depression and an eating disorder. These are things that I think on the regular. If it’s too ugly to see it and you have to look away when I can’t be polished, then I don’t understand the point of my activism and advocacy. I don’t understand why I write anymore.

When I read this, it suddenly put my experiences into a context that made sense. Because I’ve been there.

Not only have I felt like I couldn’t share my negative experiences with mental illness, but I was also made to feel like I couldn’t share my victories, either. I once posted on my personal Facebook that I was proud of myself for having been (safely) off of medication for a year, and someone messaged me letting me know that I shouldn’t post things like that because it’ll make people who still need to be on medication feel bad, and that this might be helpful for me to know “considering [my] future career.” Except my personal Facebook page isn’t the same as my professional counseling website, and it’s not even the same as my blog. It’s my space to share my life with my friends. The purpose of my Facebook is to connect with my friends, not to affirm other people. Of course, I like to affirm other people and often try to, but that shouldn’t be an expectation placed on me. It shouldn’t have to be the primary goal of my self-expression.

So that’s a weird, narrow line we mental health advocates have to walk. We’re criticized for being honest about the ugly sides of mental illness (either because it means we’re “glorifying” mental illness or because we’re “confirming negative stereotypes” or [insert accusation here), and we’re criticized for “making others feel bad” when we’re honest about successful recovery. (And, yes, I get to simultaneously believe that there is nothing wrong with taking psychiatric medication and to be proud of myself for getting to a place where I am able to stop taking it. You can accept medical treatment as necessary and morally acceptable and you can be glad when you don’t need medical treatment anymore!)

As a result, we end up presenting a sanitized version of our actual struggles that’s neither overly negative nor inappropriately jealousy-inducing. “Jerkbrain’s really getting me down today, please send cute animal photos.” “Today sucked so I’m going to do some much-needed self-care.” And so on and so forth. Obviously, those can be completely valid and genuine expressions, but as Olivia pointed out, sometimes it’s a lot less pretty.

A while back, I wrote about a particular strain of criticism of people (generally teenage girls) who “glorify” or “enable” mental illness symptoms by presenting them in a romantic or sexy light. The argument goes that these blogs may discourage young people from seeing their mental illnesses as treatable (or seeing them as illnesses at all) and encourage them to do harmful behaviors associated with those illnesses–self-harm, restricting, purging, etc. In that post, I concluded: “It’s easy to say, ‘Don’t romanticize depression! It encourages people to view depression as normal and healthy.’ It’s harder to say, ‘Don’t show symptoms of your depression! It encourages people to view depression as normal and healthy.'”

Unfortunately, as I’m learning, it’s not actually particularly difficult to say that at all; you just have to be a little more subtle. Certainly nobody in our communities would ever come right out and say that people with mental illnesses should hide all of their symptoms; heavens no, that would be ableist. Instead, they fill our Facebook threads with condescending reminders to “take better care of yourself” and “that’s just jerkbrain talking.” We can discuss our symptoms as long as we make it absolutely clear that we hate the symptoms and the illness and are completely dedicated to the project of making a full recovery. To admit that sometimes we don’t want to recover is to “glorify” mental illness and “enable” others. It’s to “confirm stereotypes” about people with mental illness, as if the problem is overlapping with a stereotype and not stereotyping people to begin with.

The Mental Health Advocate Pedestal is real and it’s a narrow ledge to squeeze yourself onto. Be honest, but don’t freak us out. Motivate those who are still struggling, but don’t give a rosy and unrealistic perspective. Hate your illness because it’s unhealthy and bad for you, but don’t hate your illness because that’s ableist and implies that there’s something wrong with having a mental illness. Recover, but not so much or so visibly that you make others feel bad. Accomplish because it’s inspirational for others and because people with mental illnesses can do anything neurotypical people can, but don’t accomplish too much, or else are you sure you’re really all that mentally ill? Maybe you just want attention.

I used to blame myself a lot for doing what Olivia calls “curating”–for only portraying my depression in a particular way, not too negative and not too positive. Now I’ve come to see it as a double-bind that everyone who discloses mental illness is placed in, one way or another. Why is it that we’re the ones constantly accused of “encouraging” mental illness when everything about the way our society is set up encourages it? Why is a teenage girl who posts a selfie of herself with mascara tears running down her face any more responsible for someone else’s mental illness than the neurotypical adults who tell each other to “calm down” and “just get over it,” or the boss who creates a stressful and anxiety-provoking work environment, or the primary care doctor who fails to spot the warning signs of depression and refer their patient to a therapist, or the parent who tells their teenager that they’ll “grow out of it”?

We all contribute to ableism and mental illness stigma in various ways, and those of us who actually have mental illness tend to be more aware of that than anyone.

As usual, I’ve got no solution to this except to pay attention to your automatic responses to folks with mental illnesses discussing their experiences. Watch what makes you go “Wow, that is So Real, that is So Brave of you to share” and what makes you go “Uh, are you sure you want to post that so publicly?” The answer might be instructive.


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The Mental Health Advocate Pedestal

"How can I support you?"

When people share mental health struggles online, well-meaning friends and followers often rush in to give them unsolicited advice. That’s something many of us find irritating and push back on. One of the responses we get often goes something like this: “But I give advice because I need to say something. How am I supposed to know exactly what they need?”

These days my response is usually the same: “Have you tried asking them?”

It’s both surprising and unsurprising how often the response is: “Oh. I didn’t think of that.”

It’s surprising because, rationally, that seems like the obvious thing to do when someone is struggling and you have no idea how to help them. It doesn’t make sense to waste your time and energy and risk upsetting or pissing them off by guessing what they might want and offering that. When you need information to make a good decision, and the information is readily available by asking someone who is as close as it gets to being an authority on the subject, it makes sense to just ask them.

At the same time, it’s also utterly unsurprising that people so rarely do this.

For one thing, we have all these cultural scripts about how this stuff is supposed to go, and one of them is that if you’re really a good friend/partner/family member to the person who’s struggling, you will “just know” what they need and be able to offer it without needing to be told. On the flip side, you might believe that if someone is really a good friend/partner/family member to you, they shouldn’t have to ask you what you need; they should just know. If they do ask, and you tell them, and they do that thing, then that might be nice and all, but it’s not as special as it would’ve been if they’d just known.

You’re probably familiar with these dynamics from discussions of sexual communication and the importance of asking/telling partners what they’re/you’re into, but this applies to so many other interpersonal situations.

That second part is talked about a little less often than the first, because the first seems on the surface to do more immediate harm. But they’re two sides of a coin. We need to get rid of that sort of thinking in order to be able to intentionally create strong, communicative relationships of all kinds.

In fact, I suspect that a small part* of the reason many people are vague about what they need when they let close ones know about their struggles is because they hope that those close ones will be able to help them without being explicitly told how. When you’re neck-deep in some sort of life shit, that sort of effortlessness can be so incredibly affirming. It satisfies a need many people have to feel taken care of.

(*Note I specifically said “small part”; there are many other, probably more significant reasons people do this, such as not knowing what they want, not having the emotional energy to communicate extensively/clearly, fearing criticism or pushback for stating what they really want, etc)

Besides cultural scripts about Just Knowing what someone wants, another reason people might not ask “How can I help?” is that they worry about annoying the person or putting an additional burden on them (that is, making them explain what it is they need). While that’s definitely a risk, especially with someone who expects you to Just Know, it’s significantly less annoying than shoving useless (or even harmful) advice or assistance at someone.

In her article about unsolicited advice online, Katie Klabusich lays all this out in a great way:

“How can I support you?” is a question that works in almost every situation imaginable. It preempts judgement and assumptions while oozing humility. Often the person won’t have an immediate answer—likely because they aren’t used to being asked a question that’s about what they actually need as a unique human being. If they look stunned, I suggest something like: “It’s OK if you don’t have an answer or don’t need anything right now; the offer’s open for whenever. Just let me know.” And then use an emoji of some sort or make a face that conveys warmth so they know you mean it. (This could be a unicorn, the two señoritas dancing, or the smiling poo. Up to you.)

*Here’s the fine print: you have to believe their answer, whatever it is. If they tell you they don’t need anything, you don’t get to push or pressure or demand they give you something to do so you feel less helpless. Remember, this isn’t about you.

Following up a few weeks or months later (whatever equals “a while from now” with the two of you) is totally fine. Asking clarifying questions about what they need if they need something is also totally fine. Being unsure and having to ask along the way if the thing they asked for that you’re trying to provide is helping or being provided in a helpful way is also totally fine.

Telling the person you don’t know if the thing they need is something you can do is also totally fine; no one expects you to be everything they need, and we’d all rather you not promise than drop the ball. These are all honest, humble, supportive responses and, frankly, just being asked “How can I support you?” will make the person feel less alone and more cared for.


As Katie notes, the fact that many people won’t have an answer right away doesn’t mean that the question was wrong. It could mean that they’re surprised at actually being asked, and it could also mean that they’re not used to thinking of some of their needs as needs. For instance, we might ask someone for advice or for practical assistance, but it feels a little weirder for most people to ask someone to just listen or to tell them something affirming. Being asked “How can I support you?” can help shift them into that way of thinking about it: “Hm, what would feel supportive for me right now?”

Feeling supported is not always the same as Making The Right Decision or Growing As A Person or whatever, which is another reason people are sometimes hesitant to ask others what they need to feel supported. “But what if they’re making the wrong decision!” they might protest. “I need to tell them they’re Doing It Wrong!”

Yes, there are some cases in which it’s probably a good idea to speak up and rain on someone’s parade because you’re seriously concerned about their safety or wellbeing. But most cases are not that and most people are not the kinds of people you have that relationship with (i.e. children, little siblings, partners with whom you have that sort of understanding, etc). I have watched friends and partners make decisions that I personally thought were bad decisions, but because they were clear with me that they wanted support/affirmation and not constructive criticism, I kept my concerns to myself. For the most part, those people turned out okay, because they are adults and they have the right to make their own decisions.

I’ve written before that self-awareness is really important when you’re trying to help people, because you need to make sure you’re not just doing it to try to relieve your own feelings of helplessness. Even if you are doing it to relieve your own feelings of helplessness, you can still go ahead and try to help, as long as you acknowledge those feelings and understand that they are your responsibility and not that of the person you’re trying to help. Only then can you focus on helping them in the way they need rather than in the way you need.

Asking what they need is a big part of that. Don’t try to show off how amazing you are at magically intuiting what they need. You’re likely to mess up and cause more trouble than you solve. Just ask.

“How can I support you?” is not a magic question. It will not necessarily get you the answers you need or them the help they need. Maybe that phrasing sounds weird and stilted to you; try not to get too caught up in that and find other ways to ask the same essential thing. The point isn’t the exact words, but rather the idea that you should figure out how best to help someone before trying to help them. They might not always know, but they certainly know better than you do, even if it takes them some time to be able to access that knowledge. They are the expert on what they need, or as close to an expert as anyone is going to get.

Be prepared, too, for the answer, “Nothing.” Sometimes people share their struggles not to get help or support but to be heard and witnessed. Sometimes they don’t know why they’re sharing at all. Sometimes they will tell you that the best way you can support them is to hear what they have to say; sometimes they will tell you, “Nothing.” Thank them for their honesty and move along. “Nothing” is a difficult thing to hear, but it is also a difficult thing to say.


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"How can I support you?"

How Mental Illness Labels Help

I wrote this piece for Everyday Feminism. Please note that it’s based on my own experience and I include a section about how it doesn’t apply to everyone, so please read all the way through before commenting.

When I was first diagnosed with depression as a nineteen-year-old college freshman, I felt an emotion you might not associate with getting diagnosed with a mental illness: relief.

I was relieved that it was actually a real illness and not just a personal fault. I was relieved that there was treatment available for something I thought was just my burden to carry for life. I was relieved to have the language for the background noise of hopelessness, sadness, and pessimism that I had experienced for as long as I could remember.

Not everyone agreed.

Concerned loved ones questioned my decision to accept the diagnosis and use it as a personal identifier when relevant. They worried that thinking of myself as a person who has depression would prevent me from taking responsibility for recovery, or that telling others about it would cause them to judge me and abandon me.

Many people wondered why I needed to concern myself with labels at all. Couldn’t I just go to therapy, take my medication, and leave the technical words out of it?

Actually, I don’t think I could.

Identifying with the label “depression” has helped me in a number of ways, both with recovery and with coping with the symptoms that I still have.

Here’s how.

1. Finding Helpful Information About Mental Illness

The most basic way that mental illness labels have helped me is that they’re a great way to find information about mental illness.

Sounds obvious, right?

But many people who disparage labels don’t realize that you’ll probably find a lot more useful stuff if you Google “how to cope with depression” than “how to stop feeling sad” or “what to do when you feel numb.”

When I was first learning about mental health – both in general and mine specifically – I looked up a lot of things online and read a lot of books.

My searches led me to life-changing perspectives like Andrew Solomon’s The Noonday Demon, which helped me understand different ways in which depression can manifest itself, and Peter D. Kramer’s Listening to Prozac, which helped me feel much less ashamed about needing to take medication.

These books have “depression” and “antidepressants” in their subtitles, and I wouldn’t have found them without knowing what to look for.

Many people first realize they might have a mental illness by looking at simple, nonjudgmental websites like WebMD, Mayo Clinic, or even Wikipedia.

Unlike some of the people in our lives, these websites won’t tell you that “it’s all in your head” or “other people have it worse.” They present scientific information in a way that’s easy to understand and relate to.

But in order to end up on one of these pages, you generally need to have a diagnosis in mind.

Even if you’ve already been diagnosed and started treatment, knowing your diagnosis can help you find information that’ll help your treatment.

For instance, if you’re looking up information about borderline personality disorder, you might learn that dialectical behavior therapy is one of the best treatments for it. This can help you find therapists who specialize in DBT, join groups that use it, and learn some techniques on your own.

Read the rest here.

How Mental Illness Labels Help

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.


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A Good Critique of the Medical Model is Hard to Find

Brains Lie, But So Do People

[CN: mental illness, gaslighting, abuse]

For those of us with mood disorders to manage, learning and understanding the fact that brains often lie was a revelation. Suddenly we had an explanation–and not a BS, pseudoscientific explanation–for why we think and feel things that don’t make sense and that make life unbearable. We learned that feeling like everyone hates you isn’t actually a feeling; it’s a thought, and the thought isn’t based in reality. We learned that we have a much easier time remembering the bad than the good, which leaves us with the skewed impression that everything is awful and must always continue to be awful.

And so we adopted a new language. We talk about jerkbrains and depression!brains and all sorts of other brains, and we teach ourselves to constantly question and second-guess the negative things we tell ourselves.

For the most part, this is how mood disorder recovery happens. Once you develop the awareness that many of your depressive or anxious thoughts are not based in reality, you are able to develop coping skills to stop these thoughts or minimize their impact. This is CBT, in a nutshell. CBT is not a panacea–some people, especially those whose disorders started early in their life (or seem like they’ve been going on forever) don’t find this sufficient to actually stop the thoughts. But recovery can’t happen until you internalize the fact that brains lie.

Here’s where I worry, though. When I start hearing this:

“My friends are always making jokes at my expense and it makes me feel hurt. But that’s just my depression, I know they don’t really mean it.”

“I know I should be ok with my partner wanting us to be poly. It’s just my anxiety, it’s not a rational thing.”

“It’s not that I don’t want to have sex with him, it’s just that I don’t really have a sex drive because of my medication. So I do it anyway because I mean, I don’t mind.”

Sometimes we overcompensate. We get so used to these tropes–depression makes you feel like people hate you, anxiety makes you freak out that your partner’s going to leave you when there’s no evidence, medication makes you lose your sex drive–that we assume those causations. If you’re diagnosed with depression and your friends are making mean jokes and you feel hurt, it’s because of your depression. If you’re taking medication and you don’t want to have sex, of course it’s the medication.

Obviously these things are all true in many cases. It could very well be that all evidence suggests your friends love you and assume you’re be okay with some good-natured teasing. It could very well be that all the evidence suggests that your partner is committed to you, poly or not, and that your anxiety contradicts your other beliefs about the relationship and your preferences. (For instance, polyamory often makes me very anxious, but I’ve decided that it’s nevertheless what’s best for me and so that’s what I’m doing.)

But sometimes, your “friends” are being callous assholes and don’t care that their jokes hurt you. Sometimes, your partner is pressuring you to try polyamory even though it just doesn’t work for you, and everything about this is (rightfully) freaking you out. Sometimes, meds or no, you’re just not attracted to someone and haven’t internalized the fact that you don’t owe them sex. Sometimes the reason you don’t want to have sex with someone is because they’re giving off a ton of red flags and you should pay attention to them.

This gets even worse when close people, well-meaning or not, start pulling out these sorts of phrases in order to “help” you: “Oh, that’s just Depressed Miri talking.” “That’s your jerkbrain.” “This isn’t who you really are, it’s just your illness.” “Did you take your meds today?”

The message? “That’s not based in reality.”

Don’t get me wrong. When used by a kind, perceptive, absolutely not abusive person, these responses can be incredibly powerful and helpful. Sometimes we really do need that reality check: a partner who helps you draw the connection between skipping meds and feeling bad; a friend who patiently reminds you that sometimes depression feeds you lies.

When used by someone who wants to control you, though, they become very dangerous.

Upset that your partner keeps canceling your plans to see their other partner? That’s your depression, of course they still love you, it’s only natural that they’d want to see their new partner a lot. Scared to have sex without a condom? That’s just your anxiety, they already told you they’ve been tested, so what’s the problem? Annoyed that your friend keeps cutting you off in conversation? You know that irritation is a depression symptom.

I’ve written before that attempting to treat your depression or anxiety by invalidating your feelings can lead to a sort of self-gaslighting; even more harmful, I think, is when others do it to you. I have to admit that I start to get a queasy feeling when I see someone trying to manage their partner’s mental illness for/with them. As I said, sometimes this can be a great and healthy situation, but never forget that in a relationship between a person with a mental illness and a neurotypical person, the latter holds privilege. With privilege comes power, and with power comes responsibility.

The problem here, obviously, is not with CBT or the term “jerkbrain” or even the idea that thoughts/feelings can be irrational; the problem is abusive people learning this terminology and taking advantage of it. To a lesser extent, too, the problem is with ourselves over-applying these concepts to situations that are legitimately unhealthy, unsafe, or just straight-up unpleasant.

I don’t have a solution to this, but I do have some suggestions if you worry that you might be in this situation:

1. If you have a therapist, ask them to work with you on (re)learning how to trust your gut when appropriate. Most of us have a spidey sense when it comes to abusive people and dangerous situations; the problem is that our culture often trains us to ignore that sense. “But he’s such a nice guy, give him a chance!” “But it’s not your friends’ job to make sure none of their jokes ever offend you!” and so on. For many people, especially marginalized people, a crucial task is to remember what that sense feels like and to feel comfortable using it.

2. When an interpersonal situation is making you depressed or anxious, ask for a reality check from more than one person, and make sure that none of those people is directly involved in the situation. If you’re sad because your partner hasn’t been spending as much time with you as you’d like, that’s obviously an important conversation to have with your partner at some point, but the reality check part has to come from someone else, because your partner probably has a vested interest in keeping things as they are. (Not necessarily a bad thing! Maybe your partner has already patiently explained to you many times that they love you and wish they could see you more, but this year they need to focus on completing and defending their dissertation. Or maybe your partner is neglectful and stringing you along in this relationship that they’re only in for the sex and not being clear with you about what they actually want.)

It helps to find people that you can trust to be kind and honest. In many social circles I’ve been in in the past, there was a tendency to support your friend no matter what, and “support” meant agreeing with them about all interpersonal matters. If I’m upset at my partner, my friend agrees with me that they’re a jerk who doesn’t deserve me. If another friend is angry at me for missing their birthday party, my friend agrees with me that they’re obviously overreacting and being so immature. That’s not helpful for these purposes. You need someone who will say, “That sounds really rough for you and I’m sorry, but the fact that your partner has been busy lately doesn’t mean they hate you and don’t care if you live or die.”

3. Remember that feelings don’t have to be rational to be acted on. While it’s good to treat feelings with some amount of skepticism when you have a mental illness, that doesn’t mean you have to just ignore those feelings unless you can prove to yourself that they’re rational. There are many interpersonal situations that trigger my depression or anxiety for reasons I’ve determined aren’t rational, but I still avoid those situations because, honestly, life’s too damn short to feel like crap all the time, and I can’t will myself out of my depression and anxiety.

For example, here’s a meme I come across often:


Yes, rationally I know that sarcasm doesn’t mean you hate me, that that’s a perfectly valid way of expressing yourself and interacting with people, that for many people that’s part of their family culture/subculture, etc. etc.

But this interpersonal style interacts really badly with my depression. It makes me feel insecure and small. It is disempowering. It makes my brain go in circles about What Does This Person Really Think Of Me Do They Hate Me Or Not Did I Do Something Wrong.

(A part of me wonders if the reason people do this isn’t so much because they enjoy feeling relaxed enough to just be their snarky, sarcastic selves, but because they enjoy making people feel the way I just described. I’m not sure.)

So I decided at some point that I just wasn’t going to put up with it. When someone treats me this way, I remove them from my mental list of people I trust or want to get closer to. I minimize my interactions with that person. I prepare myself to set specific boundaries with them if that becomes necessary, but it usually doesn’t because distance does the trick.

At no point do I have to convince myself that, yes, all the available evidence suggests that this person hates me or is a cruel, bad person. I’m sure they don’t hate me. I’m sure they are a decent human being. For my purposes, though, it doesn’t really matter.

You are allowed to act in ways that minimize negative emotions even if those emotions are mostly being caused by mental illness.


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Brains Lie, But So Do People

On Conflicting Emotional Needs in Relationships

[Content note: personal discussion of emotional imbalances in relationships. If you’re struggling with feeling like a burden to your partner(s), you might want to skip my perspective on this. Or maybe not.]

On the one hand: you deserve to be able to express your feelings in a relationship, and if your partner refuses to hear and affirm your feelings, that’s probably not a healthy situation.

On the other hand: you deserve to be able to set your boundaries. If someone you’re close with is having a lot of strong feelings that they want to express repeatedly–especially if the feelings are about you or the relationship–that can be very difficult to reconcile with your own mental health needs.

I don’t really know what to do in these situations except end the relationship or transition it to a more casual one. (That’s my own approach, not my advice to others.)

I used to believe, back when I was more often in the first situation, that the right thing to do when you care about someone is to just make yourself listen to them even if you don’t really feel like it. Relationships Are About Compromise, after all.

I didn’t realize at the time how easily this attitude can lead to becoming your partner’s untrained, unpaid therapist, or having your own issues exacerbated or triggered. It’s nobody’s fault; it’s just an occupational hazard of being a human in relationship with other humans.

But the other thing I learned is that it also isn’t healthy for me to frequently feel like I’m reluctantly doing my partner a favor just because it’s The Right Thing To Do.

Of course not all favors that we do are reluctant. If a friend needs help moving, I usually help out if I can, even though I would never choose to move furniture just for fun. But I didn’t do it because it’s The Right Thing To Do; I do it because it’s ultimately rewarding and because I get to spend time with friends in the process.

Likewise, I’m (usually) happy to listen to my friends’ and partners’ feelings, even when they’re strong and negative and expressed “uncharitably.” I’m used to hearing lots of sad things; it’s sad to hear them but it usually doesn’t harm me in any noticeable way. Although I can’t solve my friends’ problems for them–and wouldn’t want to–these conversations can be very rewarding for both of us.

But by the point in a relationship where we’re having the tenth conversation about “I just feel like you don’t really love me that much,” there’s generally nothing rewarding in it. (Truthfully, I’m not sure it’s rewarding for the person sharing it, either.) At that point, I’m listening because I feel like that’s what I should do, not because I want to.

For a while this seemed like an okay thing to do. It even seemed like the ethically correct thing to do, until I thought about how it would feel if I know that someone was only doing things for me out of a sense of obligation or commitment, and not because it’s actually pleasurable, meaningful, or rewarding for them.

(Note that difficult conversations can be meaningful and rewarding, if not pleasurable. Difficult conversations can bring a conflict towards resolution, build emotional intimacy, and develop more understanding of each other, to give just three examples. But I’m not talking about those.)

In fact, when I realized that this was going on and that people in my life were listening to me basically just to avoid feeling like Bad People, it totally messed up my ability to open up about my feelings. I stopped trusting people to set boundaries with me, because I’d seen proof that they don’t–ostensibly to avoid the possibility of hurting me, but also to avoid their own guilt.

In fact, it probably would’ve been hurtful to hear, “Sorry, babe, we’ve already talked through this a lot and I don’t have the bandwidth to talk through it again. Is there another way I can support you?” But hurtful doesn’t always mean wrong. What’s ultimately more hurtful, the sting of having a boundary set with me, or the steady, years-long erosion of trust in everyone that happens when enough people I care about act dishonestly with me?

And maybe, in a perfect world in which everyone is honest and direct, some of my partners would have said that they weren’t able to listen to me talk about certain things. Maybe that would’ve been a dealbreaker and I would’ve found partners who do not have those particular boundaries, and I would’ve trusted them to let me know if that changed.

But there are no easy answers for people who can’t find anyone willing to support them at the level that they need (and who cannot access therapy, presumably). Quite a few of us with a mental illness history can probably even say that someone’s failure to set their boundaries ended up saving our lives.

I don’t know.

But thankfully, most situations are not life-threatening. It should be ok if your partner has already processed your fears of rejection with you and isn’t able to do it anymore. It doesn’t mean they don’t love you or aren’t committed to you, it just means their needs are conflicting with yours. And it shouldn’t be the case that the needs of the partner who needs more support automatically override the needs of their partner.

I think part of the problem is our cultural conception of romantic partners as The One and My Other Hand and such. Many people believe that you should be able to tell your partner everything and have all your emotional (and sexual) needs met by them. If you need some sort of support–for instance, someone to listen to you regularly talk about your fears of being dumped–your partner should be available for that, and if they’re not, there’s something wrong with the relationship (or with your partner as a person).

(While this sounds like it’s only applicable to monogamy, plenty of poly couples actually work under the assumptions. Their “primary” partner is supposed to be able to fulfill all of their emotional needs, and their “secondaries” are for a bit of fun on the side. Aside from the sexual component, the “primary” partner still has to be able to do all the emotional support stuff.)

This is the point where someone is tempted to protest But It Works For Us, but okay–if it works, it works. But for many people it doesn’t. Worse, they think that the problem is with them, and not with our collective assumptions. If you and your partner are being honest, open, self-aware, and respectful of boundaries, but you still can’t fully meet each other’s needs, maybe it’s time to explore other options–not necessarily breaking up, but adjusting your expectations about how much of the support you need should come from one person.

(By the way, that doesn’t even imply that you should try polyamory. There’s no reason why certain emotional support needs can only be met by partners and not by friends.)

My concern about these conversations is that we’re always auditing people’s boundaries and shaming them for not being available enough to their partners. (Even when we’re not those people’s partners, perhaps especially then. I get so many comments from people I literally don’t even know about how I must be a terrible selfish partner. Suppose I am. What’s it to you?) I could already hear the responses to this post as I was writing it–“So what, you’re saying it’s ok to refuse to listen to your partner’s feelings?” “So it’s ok for someone to just shut down all their partner’s concerns?”

It’s notable how words like “all,” “always,” and “never” end up creeping into these conversations when they were never originally there.

Well, first of all, there’s setting boundaries and there’s abuse. Setting boundaries is, “I’m sorry, I don’t feel like I can handle this discussion. What else can we do?” Abuse is, “Come on, you’re acting crazy. This isn’t a big deal. You should be grateful I’m still with you at all.”

Second–and this is basically the whole point of this post–expectations about what’s reasonable to ask of a partner vary wildly from person to person. For me, listening for hours per week to someone venting about work or school or people they know is totally reasonable, but having more than a few “I just feel like you don’t love me as much as I love you” conversations per relationship completely destroys my ability to stay in that relationship. For whatever reason, I just can’t with that conversation. I hate feeling like I have to prove my love, I hate feeling like we have to quantify the amount of love we feel and compare it, I hate feeling like I owe my partner stronger feelings just because they have stronger feelings for me, I hate being pressured to show my love in ways that I’m not comfortable with. I just hate all of it. But that’s me. And some of the things that I am happy to do for partners, others probably aren’t.

Finally, I’m not sure that “is that ok?” is even the right question to be asking in these situations. Is it ok for you? If not, then don’t date that person. Otherwise, it’s not really relevant. Relationships with zero or minimal emotional support do exist; they’re casual hookup situations and they work great for some people.

As always with needs and boundaries, the more extensive yours are, the pickier you’ll have to be about your partners. If you need a partner who is able to support you through your mental illness at a very high emotional level, many people will not be a good fit for you, and it’s not because they’re selfish and emotionally withholding. It’s because your needs are in conflict.

Likewise, if you need a relationship in which Serious Conversations About Feelings and Relationship Talks are minimal, many people will not be a good fit for you, and it’s not because they’re clingy and suffocating. It’s because your needs are in conflict.

Of course, everyone always tells me that it’s not as simple as “just don’t date the person who isn’t a good fit for you,” because you have strong feelings for them and you can’t just get over them. This is true, and being unable to date someone you really want to date is never a good feeling no matter what the reason. But I’m not sure that being in a relationship with strongly conflicting needs is any better, unless you’ve made a plan with yourself/your partner about how those needs are going to be met (outside the relationship).

Instead, people tend to assume that being single (for now) is necessarily worse than being in a very emotionally mismatched relationship, and then end up blaming and resenting their partner for not meeting their needs or for having needs that the relationship cannot accommodate. The belief that romantic relationships should provide for all of one’s needs makes it both impossible to accept the relationship as it is, and impossible to leave it.

Gently guiding that belief to the grave where it belongs is a topic for another post, but understanding the fact that many couples have conflicting emotional needs and that this doesn’t make anyone wrong or bad is a crucial first step.


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On Conflicting Emotional Needs in Relationships