It’s hard to see something like this happen to someone like Robin Williams, much like Stephen Fry’s revelation of attempted suicide last year. It reminds me that if I make it to 63 I will still be someone who struggles with depression and who could fail in that struggle at any time. It reminds me that it will never go away. And it reminds me that it doesn’t matter how much I accomplish, accomplishments will never be bulwark enough against the thing.
Living with chronic conditions, including depression and I imagine addiction, is remarkably difficult, even when those conditions are “under control,” because you’re just a bad day or a single wrong step away from them being massively out of control. And the daily grind of dealing with them, all the energy and money poured into treatment and counsel and behavior and environment can build up without warning and pull you down.
I am lucky that all my conditions are treatable to some extent. I’ve been on medication non-stop for 22 years and I will have to take medicine every day until I die. It is remarkable, really, that I’m alive, and I am grateful for it and the science that’s made it possible. But some days are a punch to the gut. And some days I am physically unwell. And some days I am sad. And some days they all happen at the same time. And some weeks are just collections of those kind of days. And some months are collections of those weeks.
I’m having that sort of a month, but I am OK. Because there are a lot of people in the world who love me and who I love and I know that, and many of you are here on Facbeook. Depression lies, but I don’t think it could ever convince me I didn’t love you all. And that is enough for today. And tomorrow I’ll figure out tomorrow.
I should start this probably by saying that I am a big supporter of free speech (the Constitutional concept) and also a fan of the trigger warning, when used by people who are trying to create a safe space. Trigger Warnings are actually a great way to enhance free speech and allow yourself space not to self-censor certain topics, while also making it easy for those who are bothered by the subject to avoid it. That said, that doesn’t mean that every space gets absolute free speech nor does it mean that every trigger gets a warning.
I am, personally, not a big user of the Trigger Warning in my own work. Not because I think people shouldn’t use it if they’d like, but because I rarely talk about subjects that traditionally require them, I find them bulkier than tags, and don’t really think they work for Facebook/Twitter, which is where I do most of my textual interaction. They are, to my mind, most useful when linking to something else that someone might not want to click on because it is graphic, like a NSFW warning. I generally don’t have a problem with the idea that people are, at times, disturbed by my content. Many are disturbed by my atheist content, some by my language, I don’t feel the need to warn people that I am going to talk about religion disparagingly and with bad words.
This post was inspired by two separate events that happened in the last couple weeks on Facebook. The first was a post that someone made in response to MRAs trying to hurt rape victims in which the poster said in anger that they wanted to hurt the MRAs for doing that and, in the comments below, said that some people need killin’. Some people then got angry at him for talking about violence in hyperbolic fashion about people he doesn’t know without self-censoring, because any reference to death made people “uncomfortable” and suicidal people could be triggered by it and immoderate words could lead to immoderate actions. (It was unclear if anyone was being triggered themselves, or just concerned that it was possible; since distancing language is common when trauma is involved, I don’t make any conclusions.) The argument escalated to basically an insistence that, to be a good person, one should be willing to self-censor anything that might be triggering. Not to simply warn that there was content, but to completely bar yourself from speaking on the topic in shared spaces, like Facebook.
Now, to me, my Facebook page is not a safe space for other people; it’s a space where I talk without self-censorship to my friends and followers and they can tune in or shut me off, either is fine with me. No one is obligated to listen. It is my space to rant and complain and cope with horrible things and share exciting things and get angry at things that are terrible and happy about things that are adorable. That doesn’t mean that what I say there is beyond criticism in comments, but I am not going to NOT talk about something because someone finds it triggering, in the same way that I don’t always avoid spoilers. Facebook is therapeutic for me; it is how I process anxieties and questions and my own struggles with mental illness and trauma of many kinds. There are some things that are for my gratification, and it took me a very long time to understand that that’s OK, I get to do things for myself sometimes. I balk at the idea that who I am, the experiences of being me, require a content warning every time I open my mouth to talk about surviving them.
On top of that, I’m not going to try to stay on top of every possible thing that could trigger someone that follows me, because it’s just not possible. I do not advertise any of the spaces in which I write to be universal safe spaces, because they aren’t. Which leads me to the second incident.
I am a member of a Facebook group that claims to be a “Safe Space” and has a very long list of Content Warnings that anything to do with the subjects in question has to be hidden behind many returns so that people can avoid the content if they’d like. One of the things on that list is the word “trigger,” which is apparently a trigger for people; hence, CW rather than TW. Another thing on that list is People in Drag — there are to be no pictures of people in drag in this forum.
This made me very angry. I expressed this anger in a constructive form, simply saying that I thought it was inappropriate for drag to be on the list, because it was creating an unsafe space for other individuals for whom drag was a part of their identity. Would it be OK to put “black people” or “women” in your list of content warnings? “Sorry, any pictures of someone who is not a white heterosexual male must go behind a cut.”
The person who’d asked for the warning to be added responded, saying that they were traumatized by the sight of people in drag and the moderators defended it saying that there doesn’t have to be a reason for a trigger, it just is one. Except this person wasn’t *triggered* into having PTSD symptoms and flashbacks, they were just grossed out by it.
The result is that, in this community, because the list of triggers is so long, everyone just hides every post and tries to come up with a CW for them, often in vague useless ways or ways that are far more disturbing than the sentence long update.
This is, of course, this particular group’s right, and they can create a safe space for whomever they want, whether it includes me or not. And it is my right to feel mildly horrified that people are equating seeing a picture of a drag queen and being grossed out with people seeing graphic depictions of rape and having flashbacks to their own trauma.
I want to be very clear here, being upset at something is not the same as being triggered by it. I am deeply upset by many gruesome images and I dislike seeing them, but they don’t trigger me. Almost all of my triggers are really mundane, and they happen inconsistently and without warning — I can’t ask the number 864 to suddenly stop existing, right? I don’t have an expectation that people generally avoid anything that might trigger me, I just have strategies with coping with what it’s like to have a brain that isn’t always my friend.
In much the same way that you don’t have a right not to be offended, you don’t have a right not to be triggered. You have a right to feel your feelings and express those feelings. You even have a right to ask for certain spaces to be different. But I also think it is unfair to expect friends to self-censor every public thought for your benefit and that it is insulting to equate being grossed out or upset by something to being triggered by it. I get to ask for consideration of my needs, but I also have to accept that other people have needs as well and, sometimes, they are in conflict — and while my need to not have flashbacks does seem, on the face of it, like a greater need than someone else’s need to vent, it’s not really my place to decide that for them. I get to decide what spaces I expose myself to and how to respond if someone else can’t make a safe space for me, but someone needing to talk about things that might trigger someone else doesn’t make them a bad person.
While it is true that in most adults language is localized in the left hemisphere of the brain, (but not for 40% of left handed people! About 20% have right-side localization and another 20% have bilateral language) and it appears that the right side of the brain handles processing new situations….that’s a far cry from being “left-brained” or “right-brained”. Wanna learn actual really cool stuff about brain hemispheres? Go look at the case of split-brain patients.
2. Your brain is not mostly made up of neurons.
Neurons are really neat, and they obviously have an impact on your thoughts. But have you heard of neuroglia? They outnumber neurons 10 to 1. That’s right, for every neuron, you have ten glia. Their functions aren’t quite so earth shaking, but they’re the streetsweepers and maids and mechanics, keeping the whole system running smoothly. Wikipedia does a nice summary.
3. Hot water, cold water? Your brain is not so good at this.
Sometimes when you run your hand under very hot water, it seems almost cold for a split second. If you’re like me, you shiver when you step into a hot bath or jacuzzi. When researchers had two unlabeled pipes, one with hot water and one with cold water running through them, patients who briefly held one couldn’t say which it was. Why?
The surface area problem: hot and cold nerve receptors are located in too close proximity, and will sometimes fire incorrectly if overstimulated. Known as paradoxical cold (when a cold receptor fires at high heat) and paradoxical warmth (when a warm receptor fires at cold temperatures), your brain can override with other knowledge. For instance, I am quite sure that my bath is steaming and the rest of my body is perceiving the heat rising off of it. So, I scrap the notion that I could be stepping into an icebath and feel warmth. Here’s a good summary at Mental Floss.
4. Neurons migrate.
After they’re created, neurons have to move in the right direction and make the right connections. It’s possible that they make the journey by following radial glia (Oh, the undervalued glial cells). When incorrect migration occurs, you get all sorts of severe disorders.
I wrote this piece a few months ago, the week I terminated therapy. I didn’t really expect to keep writing full posts about the experience of mental illness. And it’s true. I’ve been managing my eating well. I haven’t been panicky at the prospect of getting dressed in the morning. Grocery aisles aren’t overwhelming. It’s summer, and I’ve worn shorts.
And then there was the other shoe.
The other shoe dropped a few weeks ago…in which I developed an entirely new set of symptoms and related behaviors, which very nearly prevented me from doing important things like working and getting out of bed. I briefly reconnected with my old therapist to attempt to get a handle, or at least someone to tell me I wasn’t as crazy as my brain said. She’s recommended I see a specialist over the next school year, a decision I’ll be following. The university, quite luckily, happens to have several. I’ve no doubt I’ll be comparing the relative coziness of their couches.
It’s entirely possible that the whole of May was an isolated occurrence. I’d like it to be.
It also might be that what happened was indicative of a larger problem underlying the patterns of eating disordered behavior I’ve had. Or those two might coexist in the three pounds of brain matter I run around with. Mostly, I can find out more by waiting to see what happens next. Which means I don’t have answers. You may have noticed that I like having answers about mental illness.
You’ll noticed too that I haven’t explained what my brain is doing… And I don’t know that I will be any time soon.
And this, right here, is the rant, and the part that’s far more important.
I wrote about anorexia under my online identity quite easily. It isn’t my real name, sure, but it’s the name you’ll find on my Twitter, my Facebook, a name my employer could probably turn up with little digging. And I don’t mind that, because talking about an eating disorder isn’t all that risky, as a college-aged woman wanting to go into social work. We’ve got, in our society, this list of mental illnesses that are considered more acceptable. Safer.
And I used to fall neatly into one of those safer disorders.
But tell somebody you have schizophrenia, a personality disorder, substance abuse issues….and suddenly people respond differently. There’s this setting apart you can almost see, like people who occasionally handle weird brain shit cannot also enjoy things like pizza and small talk.
And that makes me angry.
It’s not okay that some disorders sounds like an answer and some sound like a life sentence. That parents avoid seeking assessment for their children because they worry the damage a label could do–that an accurate, descriptive word could be more dangerous than targeted help for the future of their child. It makes me angry that the decision comes down to whether my resume could outweigh the results of a quick google. And it infuriates me that this is a question that people face over and over and over again.
So let’s fix that, shall we?
Edit: Ashley rightly pointed out that risk is verrrry relative. It’s fine and good for me to think that I take little to no career risk when contemplating social work as someone with an ED. Were I contemplating politics, the stakes would be different. The first iteration of this post was unnecessarily missing nuance.
I swear to god, you’d think daring to have an eating disorder while not being rail skinny was the equivalent of wandering around yelling “I WAS MURDERED” while still breathing. No. Staaaahp.
2. But if you don’t think you’re thin enough, what does that make me?!
Bad at understanding mental illness? Lucky to not have an eating disorder?
When someone reveals their mental illness to you, this is not the time to excise your demons.
3. No wonder you’re so tiny!
I wasn’t on the receiving end of this one, but I heard it happen and fled the conversation. Just no. If you do this, you are BAD and you should feel BAD.
4. All you have to do is eat healthily!
In other news, depression can be cured by changing your brain chemistry, and calculus can be understood by using numbers.
It’s a nice effort, but at best you’ve said a word somewhat related to the consumption of food: “healthy” and decided that it’s as simple as just doing that!
5. Here, eat this!
Weird, but common. People will often immediately hand me food. It feels very uncomfortable to turn them down, but a lot of the time, I’m just not hungry right then either. Please don’t use me to assuage your feelings about my disorder.
Treat your jerkbrain like a puppy. Do you scream when your fuzzy pup pees a little on the carpet?
You just patiently take it back outside.
And it doesn’t work the first time–the damage is done, of course, and you might have to clean the carpet. But if every time he seems to be even remotely interested in the outdoors, every time he’s eaten, every time it seems he might be searching for a choice squatting spot on the shag rug, you take him outside, soon that puppy is going to be housetrained.
And that’s nice analogy for what I’d like more people to do with their uncooperative brains–treat them like puppies. Tug them back in the right direction when they loop into how everything is TERRIBLE and EVERYONE HATES YOU and ALL OF THE STRESS. (My brain at least, is an ALL CAPS WARRIOR when it comes to telling me bad things). Smile ruefully when they’re uncooperative and nudge them in the right direction over and over again.
It’s not foolproof, and it’s not easy, of course. Scare a well-trained puppy enough, and he’ll pee on the carpet, no matter how many hours of training he has.
But getting angry at yourself is self-defeating and exhausting and overwhelming. In short, everything that lowers your defenses for the next episode of Brains Being Sucky…and that’s no fun.
[As a side note, I’d like to thank The Atlantic for putting a link to the original research in their footnotes. Nice touch, actually including the science you’re talking about. Everyone else, take heed.]
While I wasn’t particularly impressed with the article in the Atlantic, there were some good things to be said about the original research (found here if you have access. At the very least you should see the abstract and summary).
First, a word of caution. This is a prospective study. In other words, a study that followed people over time, in real time. That means that there’s a small sample size (159 participants), because it’s hard to find funding for an following a huge group of people. Retrospective studies can offer the ability to have a large group of participants, but also mean that you can quite easily miss important variables. As a result, prospective studies are considered to yield data a cut above that of retrospective. The tradeoff is, the smaller sample size can cause the occasional news site to get super excited about what are pretty conditional results.
What did they do?
Okay, so what actually happened? Researches went to McLean Hospital (an excellent place to get psychiatric care, I hear), and talked to patients in their day program. These are clients who aren’t living in the hospital, but are coming to receive services all day and returning to their homes at night. (This sort of thing is also called partial hospitalization).
All participants were given a battery of statistically sound tests to measure congregational support, religious affiliation, depression, self-harm, and belief in God, as well as psychological well-being.
Of Note: No God was specified, the participants were simply asked “Do you believe in God?” and told to circle a number from 1 to 5, where 1 is defined as “not at all” and 5 is defined as “a strong sense of belief”.
No part of treatment was changed–the researchers were just interested in who seemed to respond best to treatment.
Who did they look at?
The methods section is a little fuzzy on whether they approached 159 patients and two refused from that point, or whether 159 was the total number of participants. Regardless, the sample size wasn’t terrible large.
On one hand, this is a group of people in a very well controlled environment–a hospital–one of the few ways you can have control over environmental factors during the study. On the other, anywhere between many and most–those are the scientific terms–of people with depression and anxiety won’t be hospitalized. So you’ve got a slice of the population with very serious manifestations of these disorders, possibly with presentations that aren’t responsive to traditional coping mechanisms or therapy. [Keep that last part in mind, it comes up again.]
On the other, you have a very particular subset of people with these disorders. Partial hospitalization programs take your entire day–that means you’r either taking time off from your job or not working. While insurance usually covers partial hospitalization, you have to actually have insurance. That means that what we’re looking at here is a subset of people with access to this kind of care.
And what does the methods section say about the demographics?
Most participants were Caucasian (83.6%) and single (61.4%), and there were a high number of college graduates (45.3%). Impairment in the sample was high in that 56% of participants were unemployed, and all patients presented with global assessment of functioning (GAF) scores of <45, representing serious symptoms/impairment.
…Sounds a lot like what we’d expect.
What was found?
Even after controlling for age and gender (Women and those who are older are more likely to believe in God), belief in god was related to having better outcomes in the program. Not related to outcome: religious affiliation. You didn’t have to believe a certain kind of God, you just had to believe there was a god out there.
Belief in God was also related to having greater support from the religious community, (I’m shocked, I tell you, SHOCKED), but not related to having a greater ability to regulate emotions.
So should you convert to vaguely-unspecific-god-belief? Probably not. Researchers actually concluded something entirely different than the title of the article would lead you to believe. It appears that there was an important mediating variable: belief in the success of the treatment process. People who believed in God were significantly more likely to place their trust in the ability of the program to help them.
And that, not belief in God, strikes me as the more important link. People who believe in the the ability of a type of therapy to help them are far more likely to see results of the therapy than those who are skeptical. And it appears that those who have faith in a deity are also more likely to believe in the authority of their psychologists and psychiatrists–perhaps an expected result?
Some words on race as it influences this research:
Black and hispanic rates of admission to inpatient hospitalization care are, as a result, much higher. Without the ability to trust in or access preventative health care, many more are going to need emergency services, including involuntary commitment, which can be an unpleasant process; first responders are often untrained in compassionate care of psychiatric patients. And so the cycle of distrust repeats. Which means fewer minority participants in studies like these, which means care tailored to non-minority clients.
This is…an interesting study.
It’s not badly done by any means. But it is a small sample size, and not very generalize-able to the population of people with depression. I’d like to see more research that examines a cross-section of people in inpatient, outpatient, and therapeutic settings, with a careful eye to the influence of trust in psychiatry. Until then, I’m willing to reach a cautionary conclusion that for white participants who can and need access outpatient programs, belief in god is linked to belief in the promised results of treatment, which leads to better outcomes, with the caveat that the populations of People Who Can Access Outpatient Care and People Who Trust Outpatient Care In The First Place overlap heavily.
* I know I’m actually just talking about two specific minorities in this section. Unfortunately, there’s basically no other research available. If someone say, had extra money to throw at research into other minorities and psychiatric care, they should do that posthaste.
We were juniors, boyfriend and girlfriend, officially. Up late and texting, doing that flirting thing where you demand each others deepest secrets and pretend you’re giving yours away.
Except I did give mine away.
“I had an eating disorder.”
I was lying, of course. It wasn’t the past tense–it was the second year of an eating disorder, one that would get worse, more disorganized, and wreak much more havoc on my sanity in the coming four years.
But it was the first step.
And he had guessed–known, really, for months. He’s my best friend now, far and away in Texas. In this month, marking six years since I developed what would reach clinical-level anorexia, I asked him about it. He doesn’t remember when he figured it out, really. It was, according to him, always part of how he knew me.
And I don’t think he’s wrong. It’s been six years ago, as of this month, since the behavioral side of anorexia started. Every time I’ve looked back and tried to think “back when I was stable/normal/didn’t have an eating disorder”…I realize I’m looking back at times when I was actually worse, when I wasn’t eating, when I couldn’t go ten minutes without invasive, obsessive thoughts about food.
Six years. More than a quarter of my life.
There’s this thing they talk about in therapy some times: grieving for the normal self. Because even were your disorder to remit entirely…you wouldn’t go back to being Old You. Your brain learns things. You grow and bend and shape yourself around coping mechanisms and triggers and ways of responding to the world. Old You is just gone. And Old You was a whole person, with plans and potential and places to go and things to do and ways of looking at the world. Maybe a little more optimistic, a little shinier and fresh-faced. You get to have all those things again, those plans and that potential, it’s true. But sometimes they’re a little dusty, a chipped, in pieces.
And I really liked Old Kate.
Therapy was a eulogy, stories of when I could look in mirrors, and dancing and days when I could just throw on clothes in the morning.
And now, finally, I think I’ve laid that Kate to rest.
I have this weird alternate life where I write things on the internet and people read them. On weekends I go to conferences and go by a different name, and on Monday the coach turns into the best pumpkin ever and I work at Fabulous Unspecified Internship.
I’ve gone skinny-dipping. I’ve gone skinny-dipping in Lake Michigan in the middle of winter. (Note: REALLY cold.)
I am emotionally able to care for another animal and I know this because I’m doing it right now.
I live in a city that I love. I’m in love.
I don’t dance anymore, and it hurts. But sometimes I actually see New Kate in the mirror, and that makes me think that someday I’ll go back into a studio.
I’ve learned some of two different languages, and I get to take classes about bioethics and astronomy and artificial intelligence and and and…and each day ends with just wanting more more more. More books, more research, more people who want to know anything about everything and everything about anything.
There’s something they don’t tell you about eating disorders. About how much you want more than anything to wake up and be in a different skin, how much you don’t want to feel your own body, to notice what space you take up.
I’m trying to force myself to be more engaged with the world, which can be difficult to do when you’ve got the imaginary pressure of “must write something brilliant” when really you just aren’t feeling brilliant at all. Instead, see all of these other brilliant things.
17) Avoid fictional drama and tragedy like the plague. No Grey’s Anatomy, no to The Notebook, or anything that won a Pulitzer prize. You’ve got enough going on In Real Life. Comedy only. Or trashy stuff. Old episodes of WonderWoman? I’ve got the box set. Mindless drivel, like the latest CGI blockbuster. Or clever, funny books. David Sedaris. Jenny Lawson. Fiction exists to elicit emotion, and the emotion you need to express most right now is laughter.
When I was a boy and I would see scary things in the news, my mother would say to me, “Look for the helpers. You will always find people who are helping.” — Fred Rogers
So when you spot violence, or bigotry, or intolerance or fear or just garden-variety misogyny, hatred or ignorance, just look it in the eye and think, “The good outnumber you, and we always will.” — Patton Oswald
I have been really struggling this last month or so with anxiety and depression — they tend to come together, in deeply fatiguing, self-reinforcing cycles of emotional exhaustion. The pressure of the end of my coursework for my PhD, impending comprehensive exams, being disowned, recurrent illness, having to move suddenly, death and rape threats, and coping with break-ins and stuff being stolen has all been just a lot for me to deal with. And while I have more or less coped, sometimes I’ve been a lot closer to less than to more.
It used to be that things like what just happened in Boston would make it worse. It would set off my anxiety about being in public spaces, irrational fear about things truly unlikely to happen to me, and the fact that humanity was capable of such things would depress me. It’s called terrorism for a reason, and being prone to feeling terror at minor things like telephones ringing, it makes sense that I’d get it from major things like people being attacked.
I felt a little sad today, as I read about what happened, but I mostly felt a rush of love for Bostonians and those at the marathon who immediately set about trying to help those who had been hurt, tell others what was going on, and figure out what had happened. This is probably partly detachment, but it is also that I see the events much more differently than I used to. The truly amazing thing about when things go wrong isn’t that things could or did go wrong, but that so many people risk their own safety and lives, often instinctively, to help strangers.
And actually, as difficult as my last few months have been and as much as I haven’t gotten my depression and anxiety fully under control, other people have repeatedly shown their fundamental decency and desire to be the person who makes things even just a little bit better for me. People can be terrible, but most of us are just waiting for a chance to be wonderful to one another, it just sometimes gets lost in our own daily struggles. But not always.
See people run towards the explosion, see the message from the Red Cross that they had enough donated blood only hours after the explosions, see strangers opening their homes to out-of-towners evacuated from their hotels. Know hope.