mental health

Don't Tell People How (Not) To Feel

Miri, , , , , , , 5 Comments

[Content note: mentions of abuse, transphobia, & racism]

The more I do this–this writing/activism/therapy thing that I do–the more I’m coming to believe that there is almost never anything to be gained by telling people how to feel, or how not to feel.

In fact, I worry that doing so is at best neutral, probably manipulative, possibly cruel, and at worst abusive.

The most obvious examples provoke little disagreement from the social circles I move in–for instance, telling a person with depression to “cheer up,” telling a person with anxiety to “calm down,” telling a person who is angry to “stop being so angry,” telling a person who has suffered trauma to “just get over it.” These are all examples of telling people how to feel, or how not to feel, that most of us would recognize as wrong.

But the message that folks seem to get when we talk about this isn’t “telling people how (not) to feel is wrong,” but rather, “don’t tell people with mental illness/trauma history to get better because they can’t just do that on the spot.”

But what if they could? What if the cause of the emotions was something other than mental illness or trauma? Then would it be acceptable to tell them how to feel?

I think some people would say yes, at least in certain situations.

Emotions and morality are all bound up in our minds. We associate certain emotions with certain moral acts and other emotions with certain immoral acts (which with which may depend on one’s social group). Although there may be a correlation, of course, it’s probably not nearly as strong as people assume. Moreover, it’s much easier, in my experience, to change your behavior than to change your emotions. Even if you are neurotypical, but especially if you are not.

So we start to point to certain emotions, which we consider “markers” of certain immoral acts, as the problem. It’s wrong to feel angry or resentful when a potential romantic partner turns you down. It’s wrong not to be angry about injustice. It’s wrong to feel happy during a time when other people are sad. It’s wrong to fail to feel sad when Objectively Sad Things (like the loss of a loved one) happen.

I would argue that none of those are actually wrong, though. It’s wrong to guilt-trip, manipulate, or punish someone who doesn’t want to date you. It’s wrong to do absolutely nothing to make the world a better place despite having the ability to do so. But you can feel resentful at someone who rejected you without ever mistreating them, and you can actively make the world a better place without ever feeling angry about injustice.

It’s ironic that we use emotions as a proxy for actions when they are so much more difficult to change. You can change them, of course, but only with time and effort, and almost never right in the moment. Happiness is pretty easy to kill, as I was reminded very directly after Obergefell v Hodges came down, but it’s rarely replaced with the feelings that were intended to replace it. When people kept suggesting that anyone who feels happy after that decision is a terrible person who doesn’t care about other issues and naively believes that The Fight Is Over, I wasn’t suddenly full of fiery anger on behalf of all the LGBTQ folks who continue to face marginalization (including, by the way, myself). I just felt sad and defeated, and very condescended to.

Nevertheless, despite my happiness at the Supreme Court’s decision, I’m not done fighting. My actions speak louder than my happiness that particular day.

More importantly, though, I worry about the ramifications of assuming that we can and should tell people how to feel. If you tell someone to calm down or cheer up or get angry and they immediately comply, I’m not sure that that’s a healthy process. I’m not sure that it’s ultimately a good thing if people are able to change their emotions (or convincingly pretend to) as soon as someone demands it. To me, that sounds more like an abusive situation than anything else.

I’m also concerned because, once you learn (as many of us do at some point or another) that others are better than us at knowing what our emotions ought to be, that process of adjusting your emotions (or emotional expressions) to their expectations becomes par for the course. Certainly someone can claim that their particular reason for telling you how to feel is Very Important and For A Good Cause, but everyone claims that, including abusive people. Many people in my life could say that it’d be For My Own Good if I could just stop feeling sad on command. Many people have a vested interest in keeping us from being angry, or expressing our anger. Once you get in the habit of “correcting” your emotions at others’ request, it’s going to be, well, a habit.

Moreover, when people believe that it’s their emotions, and not their actions, that are problematic, they often try to push away and suppress those emotions because they are Wrong. They may even succeed for a while, but ultimately, this sort of project inevitably fails. (I’ve been there.) Suppressing Wrong emotions prevents self-awareness, which is exactly what you need to make sure that you don’t hurt people because of your emotions. Telling people their emotions are Wrong is not only ineffective, but counterproductive.

You might think that if you tell someone that their emotions are Wrong, they will immediately say, “Wow, you’re right, I will call a therapist and set up an appointment right away.” Wouldn’t that be nice. But that’s not how it works. Even if there’s a strong indication that someone probably needs to go to therapy, if you stigmatize them that way, they’ll probably believe that 1) the therapist would stigmatize them that way too, and 2) they’re a terrible person who doesn’t deserve help.

Unfortunately, I notice this a lot in people who are trying to figure out how to deal with romantic rejection, especially men. They hear that people (especially men) who get upset when they’re rejected do terrible things, and they hear that feeling upset is as much a problem as the actual doing of the terrible things. And I get that the message gets diluted a lot when we’re trying to deal with horrific shit like Elliot Rodger, but thankfully, the vast majority of people are not Elliot Rodger. Feeling upset or even angry when you get rejected is normal. You can work on it with a therapist (or with some helpful online advice) if you want, but what matters is how you act. That’s what makes you who you are.

What about emotions that are Truly Awful? What if someone is disgusted by trans* people? What if someone is terrified when they see a Black man approaching on the street?

To be honest, I don’t really know what to do with these emotions (and I’m perfectly willing to admit that I don’t know). Here people can make a convincing argument that these emotions actually do lead to actual harm done to marginalized people, which is true. Here, again, the problem is the actual harm done to these people and not what goes on in someone’s head, but what goes on in someone’s head is undeniably related to the actual harm done to these people!

Then again, these emotions don’t come from nowhere. They, like many emotions, come from thoughts or ideas. Those thoughts or ideas are, “People ought to be either Men or Women” (where “Men” or “Women” means “as traditionally defined by cissexist assumptions), “Black men are dangerous,” and so on. There’s no use in telling people not to be disgusted by trans* people and not to be afraid of Black men unless we address the ideas that are prompting those feelings. As someone who has experienced lots of such shifts in feelings over time as my understanding of power, privilege, and oppression has evolved, I can attest to this.

In sum, I don’t have all the answers on this, but I’m starting to believe that it doesn’t really do any good to police people’s feelings, even when they seem like the wrong feelings.

~~~

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Don't Tell People How (Not) To Feel
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Irrational Feelings are Still Valid, and Valid Feelings Can Be Irrational

Miri, , , , , , 2 Comments

Kate recently wrote about how sometimes, viewing your emotions as unjustified or irrational can actually prevent you from taking action to make them better. On the other hand, simply accepting all emotions as “valid” can also leave you with no way of trying to change them. To try to resolve this issue, she proposes a distinction between “local validity” and “global validity”:

Local validity is about noticing and responding to your current emotions as if they’re real emotions that are happening to you. Global validity is about reflecting about the trends and patterns of emotions and how well you think they’re grounded in a realistic view of the world.

Irrational and invalid aren’t the same thing. We can go wrong when we believe that any emotion that’s irrational must therefore be invalid, but we also go wrong when we believe that any emotion that’s valid must also be rational. (I think the latter error is made less often, but it’s true that some people feel that because emotions are “valid,” they must simply accept them as they are.)

In social circles where rationality is very highly valued, it can become difficult to tell others about how you’re feeling when you think that your feelings are irrational. Sometimes we fear judgmental responses from others (“But that makes no sense! Of course I don’t hate you! How could you possibly believe something like that?”). Other times, we may trust that people will be supportive, but we still don’t want to come across as someone who has a lot of “silly” or “irrational” feelings.

In this way, sometimes, people in social circles that have more traditional approaches to relationships and communication are at a slight advantage. For instance, suppose Sally is in a traditional monogamous relationship with Bob. Sally might feel totally comfortable telling Bob that she’s jealous when Bob spends time with his friend Susie. Sally might even feel comfortable expressing anger about this.

Of course, the resulting conversation might not necessarily be productive–Bob might just agree not to spend time with Susie anymore, or he might react angrily and tell Sally that she’s being “crazy.” But in my social circles, we often wouldn’t express feelings like Sally’s at all. We feel that being progressive/feminist/polyamorous/rational/whatever means we shouldn’t feel jealous when a partner spends time with a friend (or another partner), because that’s irrational, and therefore that feeling should be ignored rather than brought out into the open.

And so a lot of us end up trying to ignore or cope with these feelings alone. Where Bob might hug or kiss Sally and reassure her that he loves her, we get ice cream and Netflix. (Or maybe that’s just me. Seriously, I am Extremely Bad at this.)

The difference is that many people in traditional monogamous relationships treat jealousy as normal, even healthy, even a sign that you really love someone. Expressing jealousy in the context of these relationships can be a completely acceptable thing, like telling your partner that you’re annoyed that they didn’t tell you they’d be home late, or that you’re sad that they can’t spend the holidays with you and your family. I don’t want to borrow traditional monogamous folks’ ideas about jealousy necessarily, but I want to borrow their norms about expressing it and expecting your partner to hear you and respond lovingly to you even if the jealousy is “irrational.” (Yes, yes, #notallmonos.)

But as Kate’s example shows, this tendency to conflate “irrational” and “invalid” doesn’t just apply to relationships and decisions about whether or not to tell others how we’re feeling. I have a hard time engaging in self-care practices that help if I don’t feel like there’s a “rational” reason to feel the way I’m feeling.

For instance, if someone was mean to me or I had an awful day at work, I acknowledge those as “good” reasons to feel bad, and in response, I might ask friends for support or spend some money on something that brings me joy.

But if I’m feeling bad for reasons I think aren’t “good,” such as being jealous of someone or completely randomly, then I don’t feel like I have the “right” to ask for support. I don’t feel like it’d be justified to take time off of my responsibilities to do something pleasant to improve my mood. So I just sit there and suffer through it.

In a blog post, Malcolm writes about how it can be useful to “step outside” of one’s own feelings. To help someone else do that, you might ask them, “What feelings came up for you during that?” rather than “How do/did you feel?” The latter question makes people identify with a feeling in ways that the former doesn’t. To say that sad feelings came up for me feels different than saying that I am (or was) sad. He adds:

Our sociolinguistic context is full of maxims like “that’s just how I feel” or “I can’t help how I feel” or [INSERT OTHER EXAMPLES]. We don’t necessarily take them seriously, but they add to the confusion of what someone might mean when they say “I feel X”. A bunch of questions you could (mentally or verbally) ask in response:

do you endorse feeling X? do you think that feeling X makes sense?

would you like me to address (my reassurance, etc) towards the feeling, towards its causes, or towards you as the experiencer of the feeling?

is that all you’re feeling?

how do you feel about having that feeling?

do you see a way out of the feeling or does it feel all-consuming or inevitable?

Questions like these, when asked of yourself, can make it a lot easier to communicate feelings that you think are irrational. For instance: “I don’t endorse this feeling, but I’m jealous about your date with ____.” “I know this doesn’t make sense, but I’m sad about leaving for vacation tomorrow.”

And on the flip side, when people share feelings like these with us, I think it’s important not to jump too immediately to “Your feelings are valid” or “It’s okay to feel that way.” Those are very important and worthy sentiments, but for many people (such as me), they can contribute to a defeatist sort of attitude: “Well, I guess it’s ok that I’m just going to feel depressed every time a friend succeeds at something I haven’t, since that’s a valid and okay way to feel.” Often, “valid” starts to mean “unchangeable.”

Here, Malcolm’s example question, “How do you feel about having that feeling?” can be very helpful. If someone says they’re ashamed or embarrassed or having difficulty accepting that this feeling is even happening, validation can be very helpful. But if they say they’re frustrated by having to deal with the feeling, or they understand where it’s coming from but still wish it weren’t happening, then validation can unintentionally send the message that they should just accept it.

Some of this, I think, is a question of where someone is in their own process. Years ago, I was unable to fully acknowledge my depressive feelings because I didn’t understand that I had depression, and kept trying to convince myself that I “should” be happy given all the good things I had going for me. At that point, if someone had told me that sadness/depression is a valid feeling, that might’ve been a revelation.

Nowadays, I’ve basically accepted the fact that I have depression and that that brings with it depressive feelings. At this point, reminders that my feelings are “valid” are pretty much useless. I want to change them! And in order to change them, I have to understand how they’re irrational, how they’re set off, how to counter those automatic processes, and basically how to tell myself a better story about my life.

Ironically, both of these counterproductive processes can happen for the same person. Sometimes I refuse to treat my feelings as valid simply because they’re irrational. Other times, I have trouble changing irrational feelings simply because I’ve accepted that they’re valid. Depression feels so real that changing it seems impossible. But it’s not.

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Note that I intentionally avoided getting bogged down in what exactly “rational” and “irrational” and “valid” and “invalid” mean. If this post doesn’t make sense to you, we’re probably working from different definitions, and that’s okay. Another blog post, another day.

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Irrational Feelings are Still Valid, and Valid Feelings Can Be Irrational

When Someone Sets Boundaries With You and You Feel Like Crap

Miri, , , , , , 11 Comments

Reflecting on some experiences I’ve had with setting boundaries, I wrote this earlier today:

A crappy thing for which I have no solution:

Someone unintentionally makes me uncomfortable or hurts my feelings. I let them know. They apologize/etc. Then I immediately see a post from them in my feed about how they’re a terrible person because they hurt people and they were just trying to be nice/funny but they hurt someone so they’re horrible. I try to convince myself that this *isn’t* a passive-aggressive attempt to make me feel guilty, because that’s a crappy thing to assume about someone, but it itches all the same.

The thing is, one of the biggest reasons why most people have such a hard time setting boundaries is because they fear hurting people. They are desperately trying to avoid that exact “I am a terrible person” reaction. Obviously, OBVIOUSLY I would never say that you should not use your own Facebook to vent/post about your feelings, which is why I said I have no solution to this. But all the same, this is instant feedback of a sort (“Your boundary-setting makes me feel like a terrible person”) and it speaks volumes.

I was almost tempted here to ask for feedback: Do I need to be nicer when I set boundaries? Maybe I do. But I’m not asking for feedback because I know it would never end. “Yes, you need to be nicer.” “…yup, still a little nicer please!” “You know, you could really stand to be just a little bit more nice.” “Actually, what would be nicest of all is just shutting up.”

People constantly remind me that I hurt them when I set boundaries, so the only way I’ve been able to set boundaries as someone with depression and a lot of feelings and a lot of empathy is to systematically train myself to stop caring if I hurt people (in this specific circumstance). And it feels monstrous. But the alternative is much worse, and in the alternative, ALL the cost is paid by me. Every cent of it. And I have been there, and I’m never going back.

As I said, I don’t have a solution, but I do have a request: if someone setting a boundary with you causes you to immediately jump to “I am a terrible person,” please try to work on that. Probably most people with that reaction (oh hey, including myself!) are already working on it, so I don’t want to come across as condescending or patronizing. But I really feel that interpersonal things would be easier for all of us if fewer people had this automatic reaction.

I could say a lot more here about how that sort of reaction is actually self-protective and serves a purpose for the individual despite feeling like crap in the moment, but I’ll save that for some other time, because the most important thing is that other people’s boundaries are *not about you*; they are not a referendum on whether or not you are “a good person” (there is no such thing), they are not a punishment to you, they are not a weapon used to intentionally hurt you. They are about the safety and comfort of the person who sets them.

In response, someone asked me a question:

Can you give some examples of how to handle boundary-setting better? I realized halfway through reading your post that I respond similarly to “I’m a terrible person” but I have no idea where to start to fix it. How do I not feel terribly?

I responded on Tumblr, but wanted to expand on that response here.

But first I want to also expand the question. The person asked, “How do I not feel terribly?”, but I think there’s another important question to address, which is, “How do I respond properly?” I realize that’s not what they were asking and don’t mean to imply that they should’ve asked that question additionally/instead; just that it’s interesting and important to address. But more to the point, these things are related. The same things that will help you feel better in this situation will also help you respond better, but when you can’t make yourself feel better–and sometimes you can’t–responding well might be the best you can do.

So what follows are some general thoughts about what to do when someone sets a boundary with you and you feel like shit.

1. Why do you feel like shit? Being told that you’ve hurt someone or made someone uncomfortable can kick up lots of old hurts and fears, especially for those of us who have depression and anxiety. These may be particular to you and your own experience, and that’s for you to uncover on your own. But more generally, there are two broad cultural messages that many of us learn that make it very difficult not to have strong negative emotions when someone sets a boundary with us:

  • The idea that there are Good People and Bad People, and only Bad People hurt people (on purpose or by accident). This idea is wrong and harmful and needs to go away. This idea also drives us to dismiss claims that someone we consider a Good Person has hurt someone. Either they aren’t really a Good Person, or they must not have really hurt anyone. The latter is easier to accept, so that’s what we do. In this case, when faced with incontrovertible evidence that you have hurt someone’s feelings, even by mistake, you may conclude that this means you are a Bad Person. It doesn’t.
  • The idea that we must intuitively/magically divine others’ needs and boundaries, and if we can’t do this, then we are Bad At People or Bad At Life or otherwise A Failure. Guess culture contributes to this, I think. So does ableism–some people’s brains make it especially difficult to read subtle cues from others, and we tend to assume that the problem is with these people and their brains, and not with our society and our expectations. So in this situation, if someone is having to set a boundary with you, you may feel that it means you have Failed at intuiting their boundaries and therefore had to be told. In fact, verbally setting boundaries should be considered the default. It is rare to know what someone’s boundaries around everything are, even if you know them quite well.

Understanding that these cultural messages are not necessarily accurate or useful to you is a good first step in learning how to react less negatively when someone sets a boundary with you.

2. A good practice when something happens that causes strong emotions is one that applies to many interpersonal situations, whether or not they involve boundary setting: before responding in any way (to the person directly, elsewhere online, etc), take some time just for yourself to process how you’re feeling. Name the feelings to yourself. “I feel angry that they told me to stop doing this.” “I feel depressed and worthless because I did something wrong.” “I am a piece of shit because I hurt a friend.” Name the feelings even if you feel ashamed of them.

This is a little more complex than the standard “breathe in and count to ten” advice. Yes, that can help you not respond automatically in a way you’ll regret, but it doesn’t necessarily help you understand or deal with what you’re feeling.

3. Intentionally think about how these emotions may impact your response. “I’m really angry, so I might yell at them.” “I feel really upset and self-destructive, so I want them to make me feel better.” Thinking about this will help you make sure that your response is what you want it to be, not what jerkbrain is yelling at you to do. It will also help you understand why you’re feeling pulled towards a particular response (yelling, shutting down, crying, ignoring the person, etc).

4. Give yourself permission to be upset/angry, even if you wish you weren’t. Being upset/angry isn’t the problem; lashing out at people or making them responsible for your feelings is. Make a pact with yourself: “I get to feel absolutely however I feel about this as long as I make sure that I’m treating people the way they should be treated.”

5. If talking to people tends to help you feel better, consider reaching out to a friend (not a friend who’s involved directly in whatever it was that made you upset). Explain to them that you’re not asking for reassurance that you did nothing wrong; rather, you’re asking for reassurance that you’re still a good person even though you did do something wrong.

This is important because sometimes our friends care about us so much that they take “sides”: “Wow, what an asshole, what’s their problem, you didn’t do anything wrong!” This might feel good to you, but it doesn’t help you treat others well.

It might help to share with them the fact that you’re doing all this work to make sure that you still respond appropriately when called out for crossing a boundary, so that they can give you some positive reinforcement for being awesome and handling this in such a good way.

6. Practice encouraging yourself to feel gratitude towards the person who set the boundary with you. This may feel out of place right now, but I find that it helps me reframe things. “I’m glad that [person] felt comfortable enough with me to let me know I was crossing a boundary.” “[Person] helped me learn how to treat them better, that’s awesome.” If this person is doing you a kindness by setting a boundary with you, then you can’t be a terrible person, because if you were, then you wouldn’t have such great friends who help you be even better!

7. Ask yourself, what is the function of feeling like a terrible person when someone sets a boundary with you? That may sound like a weird question, but it’s one I think about a lot both as a therapist and as someone working through depression. Automatic emotional responses often have a defensive function, even if they feel very bad.

Sometimes, the automatic “I’m a terrible person” response has the function of allowing you to avoid engaging with the situation fully. If you’re a terrible person, well, obviously you’re just going to fuck up and trample all over people’s boundaries and there’s nothing to be done about it. If you’re a terrible person, then you don’t deserve this friend anyway and you might as well cut them off now that they’ve set this boundary. If you’re a terrible person, then you deserve some sympathy right now rather than having to respond to this person who’s just made you feel so bad.

Understanding this dynamic won’t necessarily make you stop feeling “I’m a terrible person” in response to things like this. We can’t always choose our feelings, though we can shape them with practice.

If you realize that your automatic responses are serving the function of allowing you to avoid difficult situations like this, you may feel even more crappy and guilty than you felt before. I’m sorry if I’ve added to that. But you can also use this knowledge to reframe future automatic responses in ways that help you move through them. “My brain is telling me that I’m a terrible person to help me avoid this challenging situation, but I want to face this situation instead and deal with it like the sort of person I want to be.” You can tell yourself that your brain’s just trying to look out for you and keep you safe, but it’s not doing so in a very helpful way right now.

In conclusion, shitty feelings happen, self-awareness helps, and your automatic emotional responses don’t have to determine the actions you ultimately choose.

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For some more general emotion management advice, Olivia has a great series on DBT (Dialectical Behavior Therapy) skills on Teen Skepchick. Although DBT was originally developed to treat Borderline Personality Disorder, it’s extremely useful for many people, including those without any diagnosable mental illness, because it teaches basic adulting skills that most of us are never taught. If you have a bit of money to invest in this effort, I recommend this workbook.

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When Someone Sets Boundaries With You and You Feel Like Crap

Setting Boundaries With Your Therapist

Miri, , , , , , , 1 Comment

It’s a rare relationship that doesn’t require any boundary setting, and the therapeutic relationship is no exception.

Setting boundaries is something many people find difficult for all sorts of reasons–fear of rejection, uncertainty over whether or not your desired boundaries are legitimate (spoiler alert: they are), a history of getting bad reactions from people when setting boundaries with them, and so on.

It’s especially difficult to set boundaries with people you perceive as having more power than you, whether they actually do or not. Therapists are often perceived as having power over their clients because of their expertise and authority, and because it can feel like your therapist is holding your mental wellbeing in their hands. Sometimes that power is more tangible–for instance, in cases where counseling is mandated or when the client needs their therapist to sign off on or approve something. And sometimes that power is compounded by structural factors, like when a client of color works with a white therapist or a queer client works with a straight therapist.

Although these power differentials are real and have consequences, it might be helpful to reframe the client-therapist relationship slightly. Namely: you, as a client, are employing your therapist. Your therapist works for you. Most likely, either you or your insurance company (or both) are paying this therapist, not the other way around. If your therapist isn’t helping you, or is doing something that you find harmful, you have a right to let them know and to expect them to fix the problem. You can fire a therapist who is failing to help you just as you can fire anyone else you hired for some task or service that wasn’t done to your satisfaction.

Some therapists may reject this framing because it feels too consumer-y, or because they worry that this will cause clients to leave them. But I would argue that we shouldn’t be using social norms to trap clients in therapeutic relationships that aren’t working for them, and also, this framing is directed more at clients than at therapists, because I think it will help them feel a greater sense of control over their therapy.

How to know when you need to set a boundary

Therapy can be uncomfortable sometimes. But it should be uncomfortable in ways that mesh with your goals. For instance, if your goal is to learn how to ride a motorcycle, but you’re scared of riding motorcycles, you’re going to be rather uncomfortable. That’s normal and okay. However, if your goal is to learn how to drive a car, and someone is pressuring you to ride a motorcycle instead, that’s not a normal and okay sort of discomfort.

If your goal is to form healthier, more stable relationships with others, you might be uncomfortable when your therapist notes that you seem to assume negative things about people without evidence. You may disagree with your therapist’s observation, at least at first. You may even be right. You may think, “How dare they tell me I assume the worst of people!” But that discomfort is part of the process. Even if your therapist’s observation turns out to be wrong, both of you have gained from this. You’ve gained greater understanding of you. But if your therapist’s observation turns out to be right, then you’ve especially gained.

On the other hand, if your goal is to form healthier, more stable relationships with others, and your therapist suggests that maybe it would help if you accepted Jesus into your life, the discomfort you may feel (at least if you don’t already believe in Jesus) is not part of the process. You and your therapist are at cross purposes. You have already decided that Jesus is not for you.

Not all examples of boundary-crossing are that obvious, however. Many people who go to therapy to deal with trauma report that therapists ask them invasive questions about the trauma, questions that they’re not ready to answer before more trust is built or before they work through things a little more. However, some therapists were trained that they should push for details about traumatic events because talking it all through in detail helps people heal. This theory has since been complicated quite a bit.

Even if sharing all the details of a traumatic event necessarily helped people heal, though, it is crucial that therapists understand that just because the therapy office should be a space where clients feel comfortable sharing anything, that doesn’t mean it automatically is. It can be triggering for survivors of trauma to reveal intimate details about what they went through to someone who is still basically a stranger to them. It’s perfectly legitimate for them to shut down certain avenues of questioning and to expect therapists to respect that boundary until they are ready to shift it.

Setting a boundary vs. firing

When do you ask a therapist to stop doing something that isn’t ok with you, and when do you simply stop seeing them? In most cases, the answer probably depends on what happens when you try to set a boundary. If your therapist refuses to respect your boundary or argues with it, it might be a good idea to find a different one.

(Note, though, that they might agree to respect your boundary but still ask you questions about the boundary itself. While this can feel uncomfortable, I think that’s usually that better kind of uncomfortable–your therapist needs to understand you and your boundaries in order to be able to help you, and it may also help you to process your reasons for needing the boundary.

For instance, when a client says that they can’t talk about something [yet], I won’t push them to talk about it. Instead, I might say, “How do you feel when you imagine telling me about this?” or “What happened last time you tried to talk about this with someone?” That yields a lot more information than “I really think you should tell me,” and is more compassionate.)

Another way to tell whether to boundary-set or leave is this: think about what it would take for this situation to be okay. For instance, suppose your therapist mentions that attending church might be a helpful way for you to cope with depression because that’s what helped the therapist. This makes you feel really uncomfortable and you don’t want to hear anything else about the supposed benefits of religious observance from your therapist. Imagine you say, “Please don’t mention religion to me anymore; I’m not religious and am absolutely not interested in attending church or hearing anything else about church.” Imagine your therapist responds, “Okay, absolutely. I won’t mention it again.” Does this feel okay to you? Are you okay continuing to open up to someone who might believe that you’d do better if you went to church (but doesn’t say so out loud), or are you still uncomfortable?

If you continue to feel uncomfortable no matter how well the therapist responds to your boundary-setting, then you might need to find a new therapist. The strength of the relationship between a client and therapist is the best predictor of the effectiveness of the therapy, so if you can’t trust or feel comfortable with your therapist, they’re unlikely to be able to help you.

Scripts for setting boundaries

In many ways, setting boundaries with a therapist doesn’t work much differently from setting boundaries with other people. Just as I might ask my friends not to talk about weight loss around me, I might ask my therapist not to mention weight loss in therapy. Just as I might ask a partner not to ask me about [topic], I might ask a therapist not to ask me about [topic].

One difference, though, is that it might be really useful in therapeutic boundary-setting to explain why you’re setting that boundary. With other people in our lives, that’s not always necessary and may be too scary/risky–I don’t want to disclose my history of disordered eating every time I ask someone not to talk about weight loss with me. Your boundaries are your boundaries whether your reason for them is one that others would consider “legitimate” or not. (All boundaries are legitimate.)

But a therapy situation, telling your therapist why you need this boundary gives them useful information that will allow them to help you better. If you say “please don’t mention weight loss because I have a history of harmful behaviors around that,” they might know what else not to mention, or what to ask for permission before mentioning. Knowing that you have a history of harmful weight loss behaviors helps them understand your psychological history and know what to look out for in the future.

Here are some specific examples of ways you can set boundaries with a therapist:

“Please do not ask me about my weight or dietary habits. It’s a trigger for me because of past issues with disordered eating.”

“Actually, I didn’t ask for advice. Please either ask me before you give advice, or wait for me to ask for it myself.”

“The issue I came here to work on was my depression, not my relationship with my parents. Let’s keep our discussion focused on my depression as it’s affecting me right now, because that’s what’s causing the most problems for me right now.”

“I’m not ready to talk about the stuff that happened with my brother when I was little. You can ask me again in a few weeks and I’ll let you know if I’m able to talk about it then.”

“My identity as an atheist is not the reason I’m struggling with depression. If you continue to suggest that my mental illness is caused by atheism, I won’t feel comfortable coming here anymore.”

“I do not believe in karma, Zodiac signs, or any other superstitions. Please stop bringing them up in our sessions and stick with what can be tested scientifically.”

“I need you to stop suggesting that it’s my fault that I’m being bullied. Even if there were some truth to that, it feels like you’re putting all the blame on me and it’s preventing me from opening up to you about things.”

It may feel somehow manipulative to tell a therapist that you won’t tell them things or come back to therapy if they don’t respect your boundaries, but it’s also true. You can’t effectively work with a therapist you can’t trust, and they need to know that.

Also, while I certainly don’t think you should be intentionally mean, don’t worry about the therapist’s feelings. It’s our job to worry about our feelings, and your job to be as direct and open with us as you can be.

When setting boundaries is a challenge

As I mentioned, most people find boundary-setting difficult, especially in situations where they feel that they have less power than the other person. If you’re finding it so difficult to set boundaries with a therapist that you’re unable to speak up about it at all, here are some suggestions:

  1. Practice first. You can practice in front of a mirror, alone in the dark, with a friend–whatever works for you. If you’re practicing with a friend, you can tell them a little about your therapist and what they’ve been doing that’s problematic so that they can roleplay as the therapist. Make sure to be clear with your friend about what you want them to do in the roleplay–for some people, roleplaying “worst case scenarios” (for instance, your therapist arguing with you and refusing to respect your boundary) can be useful because it allows them to prepare; for others, it might just be really anxiety-provoking.
  2. Write it down and bring it to session. If you don’t feel like you can come up with the right words on the spot, write them down and bring them to therapy with you so you can read them or at least refer to them. It might sound weird, but you won’t be the first person who’s done it. Many therapists actually encourage clients to do things like this, because anything that helps facilitate communication in therapy is probably a good thing.
  3. Write it down and email it. Although we often hear about the virtues of Real Face-To-Face Communication, I’d say two things here: 1) text-based communication is also a real and legitimate way to discuss difficult things, and 2) the perfect is the enemy of the good. If you are so uncomfortable bringing something up with your therapist in a session that you’re not going to bring it up at all, try doing the next best thing, which is emailing them. That way, you’ll have ample time to think about what to say and run it by trusted people if you want to. Know that your therapist may respond by asking you to bring this up with them in the next session, so you’ll probably still need to discuss it with them in person, but that initial email can help open the floodgates.
  4. Be transparent with your therapist. You can say something like, “Setting boundaries is really hard for me, so I’m having trouble finding the words for what I’m trying to say,” or “I’m really uncomfortable with something you said in the last session, but I’m scared of bringing it up.” A good therapist will know how to guide you through this and help you speak up.
  5. Don’t worry about bringing things up days or weeks after the fact. You don’t have to have a perfect, firm, concise boundary-setting comeback right away. It’s totally normal in therapy to bring up things that happened a few sessions back. It’s never too late to make sure that therapy is meeting your needs.

Conclusion

Sometimes all people need to hear to be able to set boundaries with their therapists is that they have the right to. Always remember that. Your therapist works for you. Your therapist has expertise, yes, but they are not the expert on you individually. You know way more about yourself and the boundaries you need than any therapist can ever know.

It is true that some of the boundaries you may set may delay your growth or recovery, or make it more difficult for your therapist to understand what’s going on with you. However, what delays your growth or recovery even more is feeling unable to trust your therapist or connect with them. A boundary isn’t a permanent brick wall. It’s a fence. Two people can stand and chat from opposite sides of a fence, and over time, you can choose to build a gate in the fence and open it up, or close it again.

~~~

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Setting Boundaries With Your Therapist

A List of Ways I Have Used Trigger Warnings

Miri, , , , , 10 Comments

[Content note: mentions of sexual assault]

These are some ways I have mentally responded to encountering a trigger warning/content note on the internet:

  1. [ignores, continues reading]
  2. “Oh, yikes, this is going to be pretty serious. Ok, I’m ready. Let’s do it.”
  3. “I think I need to take a few minutes to mentally prepare myself before reading this.”
  4. “Welp, that’s just too much right now. I’m going to wait a few hours or days until I’m in a better brainspace and then engage with this.”
  5. “Ok, this is totally fine for me, but it’s nice to know what I’m getting into.”
  6. “I can do this. But I’m going to message a friend and talk to them while I read it, or maybe pet the purring kitty.”
  7. “I’m going to read this, but I already know I’m going to be a wreck afterwards, so I’m going to set up some hot tea/some time with a friend/Chinese food/a fun TV show to help me afterwards.”
  8. “You know what? I don’t need to read this. I’ve lived this. I know this. There’s no reason to make myself think about it again.”

I’ve been hearing a lot about how trigger warnings are nothing but a way for trauma survivors to “avoid challenging material.” I present this list in order to show some more typical ways that people use trigger warnings, such as mentally preparing themselves for the material, choosing the best time to engage with it, and setting up self-care practices that will help.

As you see from #8, yes, sometimes people choose not to engage with triggering material at all. In that latter (and not extremely common) case, it’s useful to remember that people who are triggered by something are usually triggered by it because they have lived it. I’ve sat through many classroom discussions about sexual assault, suicide, eating disorders, sexism, and other things that I have lived through, and while I occasionally did learn from these discussions, more often I learned little or nothing, because I have lived through it. And yes, everyone’s experiences are different, which is why it can be useful for survivors of trauma to share their experiences with fellow survivors and learn from each other. But that’s usually not what the classroom space is.

I’m also a bit fed up, to be honest, with this deceptive word “challenging.” What is a challenge? Here are some things that I find challenging:

  • applied math problems
  • recipes that involve very precise timing
  • coping with depression
  • keeping my apartment clean when I’m very fatigued all the time
  • wrapping my head around dense and difficult literature or philosophy
  • persuading myself to make the effort to go out and see friends even when I’m wiped out from work, because I know that it’ll be good for me
  • sitting through a very boring class or meeting
  • saying goodbye to people I love after a visit
  • shooting in low-light conditions without a tripod
  • telling someone that I love them
  • addressing situations where I feel like someone is communicating passive-aggressively and we need to get things out into the open and talk about them
  • dentist appointments
  • arguing with someone who thinks that rape victims ever deserve what happened to them
  • economics
  • climbing up four sets of stairs while carrying several bags of groceries
  • figuring out how to properly manage my enormous student debt
  • relationships where I feel like I’m more invested in the person than they are in me

You might notice that many of the things on this list seem to have absolutely nothing to do with each other because “challenging” is a very ambiguous word!

There are intellectual challenges, like solving a difficult math problem or understanding a difficult text. There are interpersonal challenges, like figuring out the right way to address a conflict with a partner. There are physical challenges, like climbing a lot of stairs while carrying a heavy load. There are emotional challenges, like coping with depression or with dentist appointments. Some challenges involve combinations of these things. For instance, shooting in low-light conditions without a tripod involves an intellectual challenge (knowing what all those manual settings on the DSLR mean and how to set them) and a physical challenge (holding the camera as still as possible). Telling someone that they have hurt my feelings involves an interpersonal challenge (figuring out the right way to say what I need to say in a way that’ll be effective) and an emotional challenge (dealing with my hurt feelings as I do this).

When people condescendingly claim that college students who ask for trigger warnings are trying to “avoid challenging material,” they are–perhaps intentionally–conflating two meanings of the word “challenging.” Triggering material is emotionally challenging. The challenge is that you feel like you’re about to start screaming and crying in front of your classmates and professor. The challenge is that suddenly you’re back in that bar or that dorm room or wherever it happened, and you’re trying to get away but you can’t get away and you’re trying to scream but nothing comes out. The challenge is that suddenly you’re floating somewhere high above the classroom looking down at yourself sitting there unable to move. The challenge is that you forget who or where you are. The challenge is that your brain starts to empty out like a glass with a crack in it, and no matter what you do you just can’t fill it up again and they’re all looking at you because the professor asked you a question and you have no idea what any of those words meant or how to even make words.

Do we really go to college to encounter this type of “challenge”? No, college coursework is intellectually challenging. The challenge is understanding the nuances of complicated arguments or literary devices. The challenge is connecting ideas together in a way that flows and makes sense, finding patterns in the texts, defending your opinions using evidence from the book. The challenge is being willing to entertain an argument that you personally disagree with, to examine it from all sides. Sometimes, the challenge is memorizing facts, though that’s not so common in college. Sometimes the challenge is writing code that works, or designing a study that effectively examines a particular research question.

You know who would be pretty bad at those types of challenges? Someone who, in their mind, is currently stuck reliving the worst thing that ever happened to them.

Yes, those who insist that trigger warnings are no substitute for professional mental healthcare and that it’s not a professor’s job to heal their student’s personal trauma are absolutely correct. Trigger warnings will not heal trauma. However, they will also not “prevent people from healing” or whatever’s getting thrown out as the latest justification for not using them. What they do is allow people to engage with triggering content in a way that works for them. Only sometimes will they cause people to choose not to engage at all, and remember, the absence of the trigger warning wouldn’t have made them engage with it anyway. It would’ve made them try, get triggered, and fail to engage. It’s such a creepy “Gotcha!” sort of thing to insist on tricking people into trying to engage with triggering content by not including a trigger warning when they asked for one.

In my experience, most survivors of serious trauma–the ones that get triggered by things–are either already accessing mental healthcare, are unable to access mental healthcare, or have tried it and found it unhelpful. Please stop with the condescending advice to students to seek mental healthcare “instead” of asking for trigger warnings. Engaging with triggering content in a thoughtful, intentional, and controlled way is often part of someone’s healing process and has been recommended by plenty of mental healthcare professionals.

Trauma survivors know best what they need. They don’t know perfectly, but they know better than someone with no experience or knowledge of that trauma. If you don’t want to use trigger warnings, then don’t, and say so. But don’t cloak that unwillingness in a patronizing concern for the survivor’s well-being. We see past that stuff. You’re not the ultimate authority on what we need and what’s best for us. Just say it’s too much of an inconvenience for you and you won’t do it.

A List of Ways I Have Used Trigger Warnings

Reaching Out for Support When You Have a Mental Illness

Miri, , , , , , , , , , , 3 Comments

[Content note: mental illness]

After having written tons of posts about supporting people with mental illness, I realized that there was a gap–I’ve seen few articles about how to reach out for support when you’re the one with the mental illness. Specifically, how to do so in a way that’s respectful of people’s boundaries.

This is a difficult topic, for reasons that I think are obvious. I don’t want to discourage anyone from reaching out for help, ever. I also want to encourage people to be mindful of others’ needs and boundaries, even when everything hurts so much that that feels impossible to do. Especially then.

Why do these two goals feel like they stand opposed to each other? They shouldn’t. Getting affirmative consent before sharing difficult and potentially-triggering things with people isn’t just good for them, it’s also good for you. Most of us who struggle with mental illness have our moments of panic about imposing on others or being a burden on them. Making sure that we’re actually getting their consent before leaning on them for support can help us with those feelings.

I’ve been on both sides of this. I’ve been the depressed and suicidal person who had to reach out for help, sometimes in ways that didn’t really allow people to say no. I’ve also had people reach out to me in ways that made me feel trapped and coerced. So I think I have a lot of empathy for everyone in both of these situations.

This is a huge topic and this post is very long, but it still doesn’t cover all the nuances. This post is focused on the issue of consent and boundaries specifically, so please don’t be too disappointed if it doesn’t cover everything you thought it would. Suggestions for future posts are welcome as always.

Consent, Consent, Consent

The most important thing about reaching out to someone for support with a mental health issue is to explicitly ask for their consent to have this conversation. This means that, rather than sending them a sudden wall ‘o’ text on Facebook, you might first say, “Hey, can I vent to you about depression for a bit? You can respond whenever you have a moment.” Or in person, if the topic hasn’t come up organically in a way that suggests that they’re ready to hear about it, you might say, “Can we talk about some ED stuff I’m going through right now?”

If you want to talk to someone about things that are fairly likely to be triggering–examples include self-harm, suicidal ideation, eating disorders, homicidal ideation, and so on–it’s a good idea to include a content note. In a message or text, that can just look like “TW: anorexia”; in person, you might say, “Can I talk to you about some eating disorder issues I’m having. I might get into detail.” This is important because 1) the person you’re talking to might have their own issues, which you may not necessarily know about; 2) they may be in a space right now where seeing a sudden wall of text about a very serious topic might really stress them out; and 3) regardless, people can often help you better if they have some idea of what you’re going to talk to them about, especially when it’s something pretty serious like that. When I see “Hey, can I talk to you about anorexia?”, I put myself in a different headspace than when I just see “Hey, can I talk to you about some stuff?”.

When you message someone to talk to them about Heavy Stuff and do not give them a warning about the content or an opportunity to politely bow out, understand that you are making it very difficult for them to say no to you, especially if they’re not someone who feels comfortable asserting boundaries (and most people aren’t). You may not intend to make them feel this way, but that’s the effect it often has when you don’t check in to see if it’s okay first.

I’ve gotten sudden walls ‘o’ text while in class, while on dates, when I was just about to fall asleep in bed, while finishing an assignment on deadline, and all sorts of other inopportune times. It put me in a serious bind, because on the one hand I had a really serious message demanding my attention, and on the other hand, I had things that I needed to be doing. When someone suddenly sends me five paragraphs about having an eating disorder and being suicidal, it feels incredibly wrong to say, “I’m really sorry, but I’m busy right now and can’t talk.” I usually do it, but that’s only because I’ve developed very strong boundaries over the years. Most people haven’t.

Another way that you may unintentionally make it difficult for people to set boundaries is by getting their consent for a certain type of conversation (“Hey, got a minute to chat?”) and then, once they agree, making it clearly way more than a minute and more than just a “chat” (“So I’m really really depressed and I think I’m about to lose my job and I just don’t know what to do, I’m almost out of savings and–“). Phrases like “got a minute to chat” and “hey what’s up” are vague, sometimes intentionally so. Once someone gets into a conversation with you, it’s almost impossible to then be like, “Um, actually, I thought this would just be a casual chat; I’m not really available for a conversation like this right now.”

If someone tells you that no, they cannot talk/listen right now, respect that answer, even if it feels unfair or unreasonable. They may in fact be lazy. They may in fact be selfish and callous. They may in fact completely not understand what you’re going through and if they did then they’d listen. They may in fact just be shallow people who want everything to be sunshine and daisies all the time. They may be all of those things, but they still deserve to have their boundaries respected.

The Importance of Being Specific

Consent is one reason why, when you’re reaching out to someone for support, it can be helpful to be as specific and clear as possible about what you need from them. (I say “as possible” because that can be really difficult when you’re in a moment of crisis.) If they know what they’re being asked to do, then they can actually consent to it. But taking a moment to think about what you need from others right now will help you, too–it’s easier to get what you need if you know what that is and ask for it:

“Hey, I need to just vent at someone about some depression stuff. Would you be able to listen for a bit?”

“I’m feeling down and it would be helpful to distract myself. Could you come over and play video games with me?”

“I’m feeling unsafe tonight. Is it ok if I spend the night at your place and just do my own thing with someone else in the room?”

You may, like me, be concerned that if you let people know you’re having a hard time, they’ll try to offer you types of help that you don’t need. In that case, it can be a good idea to be clear about what you’re not looking for, too:

“I’m going through a really rough time. I don’t really want to talk about it, but could we just chat for a while about something else?”

“I’m having a really bad day. I’m not really up for talking to anyone, but could you send me some cute animal videos?”

What if you want support but have no idea what would help? In that case, being specific is clearly impossible. I think it’s better to be transparent and say something like, “I’m feeling really bad and to be honest I don’t know what would help right now. I just wanted to reach out to someone.” Hopefully, your support person might have some ideas about how to help or what to say.

The reason this sort of transparency is helpful is because otherwise, the person might assume that you do need something specific and you know what that is, but that they need to somehow intuit it. Or they may ask you what they should do, which can be stressful for you to have to respond to.

As a more long-term strategy, though, it might be helpful to try to figure out what other people can do that would help you feel better, so that you know what specifically to ask for from them. If you have a therapist, they can help with that project. If not, you can ask others who struggle with similar issues (maybe on a support forum if you don’t know anyone personally) what works for them. Just because you have similar issues doesn’t necessarily mean the same things will work for you, but there’s a good chance you’ll find something.

Why This Can Be So Hard

Back to the issue of boundaries. For many of us, the pain of mental illness is so strong that it’s hard to empathize with someone who says it’s too much for them to hear about. Resentment can build. You think: “They can walk away from this conversation, but I have to live with this my whole life.” When someone is unable to listen to us talk about how awful we’re feeling, that can kick up those feelings of resentment.

But just as we ask our friends, partners, and family members not to take it personally that we have a mental illness, we should try not to take it personally when they have their own feelings and limits. There’s a reason psychologists have a concept called “vicarious traumatization,” and a reason why therapists and social workers have such high burn-out rates. Of course, you may not be asking them to do anything close to what a therapist does, and they may not experience it as “traumatization,” but the point is that being very close to someone’s pain can have an impact. In addition, your support people may be dealing with their own mental health issues, which you may or may not know about. They may want to listen to you, but may be unable to because of what it brings up for them.

One last thing I want to say about this is that for me personally, depression made it really difficult to see how my own pain was hurting others. I don’t mean in that awful way that we talk about, where people take our pain as a personal insult or expect us to be happy all the time. I mean that seeing someone you love in pain hurts. Legitimately. But when I’m depressed, I think I’m so awful that I don’t understand how anyone could possibly care that I’m hurting–even though I reach out to them with the hope that they’ll listen. (Mental illness causes many such contradictions.) And when they say that they care so much that it’s really difficult for them to hear about it, it sounds like they’re insulting and patronizing me, presumably to “get out” of having to listen to me. That this perception is often wrong is something that I had to recover from the worst of it before I could understand.

Self-Forgiveness

Reading this, you may realize that you have overstepped boundaries in the past. (Or maybe you already knew this.) Mental illness can make people feel like they’re horrible and deserve to die, and realizing that you have overstepped boundaries may exacerbate this.

Try to be gentle with yourself. Mental illness can provoke boundary-crossing behavior, and while it’s important not to use this as an excuse not to work on it, it also means that you’re not a terrible person, and you can get better–both in terms of boundaries and in terms of your symptoms themselves.

Talking about this issues presents what The Unit of Caring refers to as a competing access needs problem. Some people will really benefit from this advice. Some people may already be so terrified of violating boundaries that they almost never ask for the help they need. (This may be surprising given that I wrote this post, but I’m squarely in the latter group.) Mental illness also complicates matters in that people may simultaneously be excessively terrified of crossing boundaries, while also sometimes crossing boundaries!

If you feel that implementing this advice will do harm to you, then don’t implement it. However, I would posit that it would actually be helpful for most people, because my core message here isn’t “You should be Very Very Careful about not violating anyone’s boundaries,” but rather “Hey, here’s how to reach out for help in a way that respects people’s boundaries.”

Supportive People Who Aren’t Really

One reason you may be terrified of crossing boundaries is because you may have done your due diligence and followed all this advice and then still had people tell you that you’ve overwhelmed and burdened them and they never wanted to help you this much but felt obligated to. There’s a lot going on here, such as:

  • Poor boundaries on the part of those people
  • People being used to passive communication and reading unspoken messages into your words that you never put there (such as, “If you don’t help me I will hate you/hurt myself/etc”)
  • A duty-centered view of relationships (believing that being your friend/partner/family member obligates them to help you whether or not they want to or can safely do so)
  • Simple ableism: believing, however implicitly, that your mental illness makes you so weak and helpless that they are ethically obligated to help you, no matter at what cost to them

The plentiful existence of people who act in these ways makes it difficult to talk about boundaries and mental illness. If we’re constantly accused of being burdensome and asking for too much no matter how careful we are, that can easily obscure the fact that sometimes we really do reach out to people in ways that make them feel like they can’t say no. But remember: both of these things can be true, and are true. They sound contradictory but are not.

There’s no simple way to fix this problem. If you’re not sure whether or not you’re being mindful of boundaries, it might be worthwhile to consult a friend that you trust to be honest and ask them for feedback. And if you notice that there are people in your life who keep telling you that it’s okay to vent about your feelings or to ask them to take you out for ice cream but then it turns out that they never wanted to help you and only did it out of a sense of obligation, it might be time to downgrade these people from “friend that I ask for mental health support” to “acquaintance that I talk about Marvel films with.”

Whatever their reasoning for not being honest (or not being aware enough of their own needs to be able to be honest), it’s not a healthy dynamic. It’s the sort of dynamic that leads many of us to feel like such awful burdens all the time. It’s the sort of dynamic that can make it really difficult to take this blog post seriously, because if people are constantly calling you a burden when you’re not, you may not be able to recognize the ways in which you might actually be crossing boundaries.

Of course, supportive people are difficult to come by and it can feel counterintuitive to stop going to these people for support when they seem to be acquiescing. (And if you ever feel like it’s a matter of life or death, please, do whatever you need to do to keep yourself safe.) But they’re not, in fact, supportive people. If they were, they would properly set boundaries with you in a way that’s compassionate but still assertive. Pretending to consent and then blaming you for believing them is an unkind and unsupportive thing to do.

~~~

If you are in crisis and do not feel safe, and none of your support people are available to talk to, please call 911, go to the ER, or call one of these hotlines if you don’t feel safe doing the first two things:

  • National Suicide Prevention Lifeline
  • The Trevor Project (for LGBTQ youth)
  • Trans Lifeline
Reaching Out for Support When You Have a Mental Illness

A Case for Strengths-Based Diagnosis

Miri, , , , , , 13 Comments

[Obligatory disclaimer that I am not (yet) a licensed therapist and that the following is my personal opinion, informed by practice and academic study.]

Recently in a class on adult psychopathology, my professor was discussing the strengths and weaknesses of the DSM (Diagnostic and Statistical Manual of Mental Disorders), the text used to diagnose mental illnesses and categorize them for the purposes such as research, insurance billing, and sharing information among professionals.

One of the weaknesses he mentioned was one I’d actually never heard before: that the way the DSM diagnosis is written and shared does not include any space for also “diagnosing” the client’s strengths.

At first, this seemed irrelevant to me, not in the sense that thinking about your client’s strengths is not important, but in the sense that I didn’t see how it matters for a diagnosis. It almost seemed a little patronizing: “Yes, you have major depressive disorder and social phobia, but hey, at least you seem like you’re pretty resourceful and good at expressing yourself!”

But then I rethought that.

Here’s an example of a DSM-V diagnosis:

296.35 (F33.41) Major depressive disorder, early onset, recurrent episode, in partial remission, with atypical features

300.4 (F34.1) Persistent depressive disorder, early onset, with atypical features, with intermittent major depressive episodes, without current episode, moderate

V62.89 (Z60.0) Phase of life problem

It’s honestly difficult for me to imagine looking at this information with anything other than relief. For me, diagnosis has always meant one thing first and foremost: You’re not a terrible person; you just have an illness.

But to other people, seeing something like this can communicate a whole lot else. You’re sick. You’re fucked up. There is nothing redeeming about you. You can’t do something as simple as not being so sad. This is especially true when someone is already predisposed to interpret information about themselves in a negative light, because, well, that’s what mental illness always does.

In that moment, it can be really helpful to have confirmation–not just from a friend or loved one, but from a professional whose job it is to assess you–that you do have strengths and positive qualities.

So, here are some reasons incorporating strengths into diagnoses might be a really good thing.

  1. Giving hope and affirmation to the client.

Just like it can be nice to go get a dental checkup and hear, “You’ve been doing a great job at preventing cavities, but you need to floss more consistently in order to keep your gums from getting irritated,” it can be nice to hear, “Based on what you’ve told me, I believe that you’ve had a major depressive episode for the past few months. However, you’ve clearly been very good at reaching out to friends and family for support, and it sounds like you have a lot of people rooting for you to get better.”

Therapists and psychiatrists say “nice” things like this all the time, but writing it down as part of a diagnosis might be symbolically meaningful. To the client, that communicates the fact that their strengths are just as important as their diagnosis–important enough to be written on the form or in the chart. It shows that their mental healthcare provider, whom they might feel shy around or even judged by, does see them as a whole human being with strengths as well as a diagnosable illness.

  1. Providing possible avenues for treatment.

A psychiatrist may diagnose a client and then refer them to a therapist (therapy combined with medication tends to be more effective than either in isolation). Now what? The therapist can look at the diagnosis, or ask the client what it is, and proceed from there.

What if the diagnosis included something like, “Client reports that volunteer work helps them distract themselves from symptoms, and that writing in a journal has occasionally been helpful”? The therapist now has some potential ways to help the client. Or the diagnosis might include, “Despite severe symptoms, client shows a high level of insight about the possible origins of their depression.” The therapist now knows that lack of self-awareness isn’t the problem–symptom management might be.

I continue to be amazed that none of my therapists ever asked me if there’s any way I could incorporate writing into my depression recovery, or if there are any ways I’ve been incorporating it already. Writing is my life. Usually I’ve either said as much in therapy, or I haven’t because nobody ever asked me what I like to do or what makes me feel good. Why not?

  1. Reducing negative bias from providers.

I can’t make definitive statements without more research, but based on what I understand about bias, I can imagine that consistently viewing a client as “major depressive disorder with atypical features and moderate persistent depressive disorder” does things to one’s perception of that person. Not positive things.

It is difficult (if not impossible) to effectively help someone you view as deficient or weak. First of all, your likely pessimism about the person’s recovery will almost certainly be perceived (and possibly internalized) by them. Second, any roadblocks that come up in treatment will likely be interpreted as “resistance” or “not really wanting to get better” or “not being ready to do the work of therapy.” In fact, maybe it’s that your approach isn’t actually helpful to them. Third, without a conscious awareness of the person’s strengths and assets, what exactly are you using to help them recover? Therapy isn’t about “healing” people so much as helping them discover their own resources and help themselves. If you don’t even know what those might be, how could you possibly help the client see them?

Many therapists try to think of their clients’ positive traits in addition to their “negative” ones. However, formalizing and structuring this process as part of a diagnosis might make it sink in better, and become more embedded in one’s general impression of a person. The questions we generally have to ask while diagnosing someone are fairly negatively oriented–”Do you ever have trouble falling asleep? How often? To what extent does this impact your daily life?”. What if we also asked, “What helps you sleep better? How do you cope with being tired after a night of insomnia?” Maybe that can help shift a therapist’s perspective of this person from “insomniac” to “person with difficulty sleeping, who has reached out to friends for help with daily tasks.”

  1. Preventing provider burnout.

I dislike talking about my work because people are consistently amazed at it in a way that annoys me. “How could you deal with hearing these awful things?” they ask. “Isn’t it really depressing to work with all these people?” It isn’t, because thanks to my training, I’ve internalized a strengths-based perspective. When I think about the people I’ve worked with, I don’t see poor suffering depressives and trauma victims. I see resilient, determined individuals who are working to overcome their challenges in the best ways they can.

I think that some people in this field burn out because they can only see the suffering and the oppression and the unfairness of it. I also see those things, obviously, because they’re sort of a big deal. But if that’s all you see when you sit with a client, not only will that be reflected in your treatment of them, but it’ll also impact your own ability to persevere.

If every time a therapist made a diagnosis, they had to intentionally remind themselves of the client’s strengths, that might go a far way in helping them remember that there is hope and everything is not absolutely bad.

As I’ve mentioned, plenty of mental health professionals already incorporate a strengths-based perspective into their work. But this is more common in areas like social work, where diagnosis is rarely used and actually often criticized, anyway. I certainly don’t remember any of my psychiatrists or PhD-level therapists spending any time asking me about my strengths or coping strategies. They gave me my diagnosis, and that was mainly it as far as assessment goes.

One might argue that strengths assessment has no place in the DSM because it needs to be standardized and reliable. However, reliability may be a problem for the DSM regardless, meaning that different professionals assessing the same client may disagree in their DSM-based diagnosis.

One might also argue that the DSM is “about” mental disorders, not “about” a client’s overall set of traits or strengths. I’ll grant that. Regardless, I think that formally incorporating individual strengths into clinical assessments in therapy and psychiatry may be helpful. May be.

A Case for Strengths-Based Diagnosis

Facebook Needs a "Sympathy" Button

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My latest piece for the Daily Dot is about the challenges of expressing sadness and loss on Facebook as it’s currently set up.

If you’ve ever posted some sad news on Facebook, you might’ve watched as the status received a few likes followed immediately by comments such as, “Liked for sympathy” or “I’m only liking this out of support.”

It’s not surprising that a gesture meant to stand on its own needs a little explanation when the post in question is negative rather than positive or neutral. “Like” is an odd verb to use when someone’s talking about their recently deceased pet or a crappy day at work, but a thread full of identical comments reading “Sorry to hear that” seems almost as awkward.

Many people still think of social networks like Facebook as places where people primarily share things like news about job offers and impending moves, BuzzFeed articles, and photos of food, babies, and animals. However, that view is out of date. Depending on your social circle, Facebook may also be a place to vent about health troubles, share articles about crappy things going on in the world, and seek condolences when loved ones pass away.

Commenting and “liking” may no longer seem sufficient as responses. Mashable writer Amy-Mae Elliot suggests a “sympathy” button as an addition to Facebook:

‘Sympathy’ is the perfect sentiment to cover what Facebook lacks. It can mean a feeling of pity or sorrow for someone else’s misfortune, and also an understanding between people—a common feeling. It would be appropriate for nearly every Facebook post that gears toward the negative, from sending ‘Sympathy’ if someone loses a loved one to saying ‘I sympathize’ if someone’s in bed with the flu.

Clicking the ‘Sympathy’ button would let your Facebook friend know you’ve seen his post and that he’s in your thoughts. And unlike the fabled ‘Dislike’ option, it would be difficult to hijack or abuse the notion of sympathy.

It’s not as snappy as a “like” button, and it doesn’t have an easily-recognizable symbol that can go along with it, but it would make it easier for Facebook users to engage with negative posts.

The “like” button isn’t the only way that Facebook’s design subtly encourages positive posts and discourages negative ones.

Read the rest here.

Facebook Needs a "Sympathy" Button

Feminist Bloggers Cannot Be Your Therapists

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[Content note: mentions of sexual assault and suicide]

I’ve been thinking more about Scott Aaronson. Specifically, I’ve been thinking about what he struggled with during adolescence, and about the (in my opinion, misguided) notion that feminism could have possibly been of any help to him.

The battle cry I’ve heard from men since Aaronson’s now-infamous Comment 171 was published is that feminist writers and activists need to be more mindful of situations like Aaronson’s when we choose our language and strategies. There seems to be a collective yearning for acknowledgement that the usual feminist rhetoric is not only unhelpful for people in the teenage Aaronson’s frame of mind, but actively harmful to them. There is one piece of this that I fully agree with, that I will get to later. But for the most part, I continue to feel a sort of frustration and exhaustion, and I think I’ve finally figured out why.

I wrote in my previous post on the subject that I feel that we (women) are being given all these male traumas and struggles and feelings to soothe and fix, as we always are. But now I understand why exactly I feel like we’re such an inadequate receptacle for these things.

Let’s look at some of the most salient parts of Comment 171:

I spent my formative years—basically, from the age of 12 until my mid-20s—feeling not “entitled,” not “privileged,” but terrified. I was terrified that one of my female classmates would somehow find out that I sexually desired her, and that the instant she did, I would be scorned, laughed at, called a creep and a weirdo, maybe even expelled from school or sent to prison. And furthermore, that the people who did these things to me would somehow be morally right to do them—even if I couldn’t understand how.

You can call that my personal psychological problem if you want, but it was strongly reinforced by everything I picked up from my environment: to take one example, the sexual-assault prevention workshops we had to attend regularly as undergrads, with their endless lists of all the forms of human interaction that “might be” sexual harassment or assault, and their refusal, ever, to specify anything that definitely wouldn’t be sexual harassment or assault. I left each of those workshops with enough fresh paranoia and self-hatred to last me through another year.

[…] Of course, I was smart enough to realize that maybe this was silly, maybe I was overanalyzing things. So I scoured the feminist literature for any statement to the effect that my fearswere as silly as I hoped they were. But I didn’t find any. On the contrary: I found reams of text about how even the most ordinary male/female interactions are filled with “microaggressions,” and how even the most “enlightened” males—especially the most “enlightened” males, in fact—are filled with hidden entitlement and privilege and a propensity to sexual violence that could burst forth at any moment.

Because of my fears—my fears of being “outed” as a nerdy heterosexual male, and therefore as a potential creep or sex criminal—I had constant suicidal thoughts. As Bertrand Russell wrote of his own adolescence: “I was put off from suicide only by the desire to learn more mathematics.”

At one point, I actually begged a psychiatrist to prescribe drugs that would chemically castrate me (I had researched which ones), because a life of mathematical asceticism was the only future that I could imagine for myself. The psychiatrist refused to prescribe them, but he also couldn’t suggest any alternative: my case genuinely stumped him. As well it might—for in some sense, there was nothing “wrong” with me.

[…]And no, I’m not even suggesting to equate the ~15 years of crippling, life-destroying anxiety I went through with the trauma of a sexual assault victim. The two are incomparable; they’re horrible in different ways. But let me draw your attention to one difference: the number of academics who study problems like the one I had is approximately zero. There are no task forces devoted to it, no campus rallies in support of the sufferers, no therapists or activists to tell you that you’re not alone or it isn’t your fault. There are only therapists and activists to deliver the opposite message: that you are alone and it is your privileged, entitled, male fault.

It’s worth reading the entire thing, and reading it carefully. (Aaronson’s defenders are correct that some people have been making accusations of Aaronson that are directly refuted by things that he said in the very same comment. Let’s not do that.)

Here’s what I thought. If someone came to me and said that he earnestly believes that he will be “expelled from school or sent to prison” if a woman finds out that he finds her attractive, and that he has “constant suicidal thoughts,” and that his daily existence is characterized by “crippling, life-destroying anxiety,” I would not recommend that he read Andrea Dworkin or attend a sexual assault prevention workshop. I would recommend, gently and tactfully, that he go see a therapist.

I would do that because these are very serious issues. They are serious enough that, when a client tells me that they have “constant suicidal thoughts,” there is an entire protocol I’m required to follow in order to ensure that they are safe and receive appropriate care if they accept it.

I will not speculate about what mental illness Aaronson could have theoretically been diagnosed with in his adolescence; I oppose such speculation and it’s actually irrelevant. I don’t need to diagnose him to say that he had serious issues and could have really benefited from treatment. (However, I may reference some diagnoses in what follows, not to suggest that Aaronson had them but to show how mental illness can interact with other life circumstances.)

Maybe Aaronson didn’t think to seek therapy as an adolescent, because therapy and mental illness are still quite stigmatized and would have been even more so when he was younger. Maybe nobody close to him noticed or cared what was going on, and therefore did not encourage him to seek therapy. Maybe the psychiatrist he asked to prescribe castration drugs did not pause to consider that a teenager seeking castration is a red flag, and that maybe he should refer him to a colleague who practices therapy. Maybe, maybe, maybe.

But why aren’t we talking about it now? Why are people blaming feminism–the feminism of the 1970s or 80s, no less–for failing to cure what appeared to be a serious psychological issue? Why are people claiming that the solution now is simply for feminist writers and activists to be more compassionate and considerate towards male nerds like Aaronson, as though any compassion or consideration could have magically fixed such a deeply layered set of deeply irrational beliefs?

This troubles me. If I ever start claiming that, for instance, I’m a terrible person and deserve to literally die because I’m queer, or that I cannot be in the same room with a man without literally having a panic attack, I sincerely hope that people advise me to seek mental healthcare, not to read feminist literature.

Lots of helpful things can harm a small subset of people because of that subset’s individual traits. For instance, there are a lot of PSAs about washing your hands to prevent the spread of disease and things like that. But some people have OCD and wash their hands compulsively, to the point that they’re hurting themselves physically and having trouble accomplishing daily life tasks because they have to wash their hands so much. I can imagine these PSAs being extraordinarily unhelpful to them.

We also often hear about the importance of donating to charity. Most people could probably donate more to charity if they wanted to. However, some people compulsively donate so much to charity that they harm themselves or their families. I can imagine this being exacerbated by someone telling them how important it is to donate to charity. Perhaps they feel they are never good enough.

I can see how feminist literature might have functioned in a similar way for Aaronson. The truth is that most men are about as far away from his mindset as you can get. Some are even the opposite extreme. Most men spend very little time thinking about how their behavior impacts women. Most men need to spend more time thinking about it. But how could he have known that these feminist books were not for him? If they were to put on the cover, “If you’re a great guy who does not hurt women, you don’t need to read this,” well, no man would ever read it. They all think they’re great guys who do not hurt women, even though some of them rape women.

Neurodiversity is an axis of privilege/oppression. People who suffer from mental illness or whose brains are set up differently from what is considered the “norm” (such as people with autism) lack privilege along this axis. They have difficulties because our society is not made to accommodate them. However, if these people are white, or male, or straight, or cisgender, or so on, they still benefit from the privileges afforded to people in those categories.

For instance, despite all his other fears and anxieties, Aaronson did not have to live in constant fear of being sexually assaulted, because he is male. He did not have to live with a significant risk of being harassed or brutalized by the police, because he is white. He did not have to deal with having people constantly refuse to identify him as the gender he identifies as, because he is cisgender. He did not have to struggle to physically access places he needs or wants to go, because he is able-bodied. Of course, he still faces some risk (in some cases fairly negligible) of all of these things, because having privilege doesn’t shield you from everything.

However, as a person who was (apparently) neuroatypical, Aaronson did have to live with “crippling, life-destroying anxiety.” He did not appear to have access (even if it’s just because he didn’t know to ask for it) to mental healthcare that could have helped him. He was forced to spend years feeling horrible. If he told people how they felt, they may have blamed him for it, because victim-blaming is a key component of our society’s oppression of neuroatypical people. Had he lacked some of the other privileges that he had, such as race and class, he may not have been able to access the apparently-useless psychiatrist that he did access.

Aaronson claims that he did not have “male privilege” because he did not feel that he had it. I’ve addressed arguments like these before. He presumably did not feel privileged because on one very salient and relevant axis, he certainly was not.

But otherwise, having or not having privilege isn’t actually dependent at all on how you feel. You have it or not. Men on the street hurl sexual obscenities at you or they do not. Cops stop you and slam you to the ground for no reason or they do not. You are allowed to marry someone of the gender(s) you’re attracted to or you are not.

Aaronson might be interested (or not) to know that many feminists are busy fighting to ensure access to mental healthcare for everyone, and an end to the stigma that prevents people from seeking help. But maybe that’s irrelevant now.

As I mentioned earlier, I am taking one piece of Aaronson’s (and the many others who have echoed him) criticism to heart. Namely, feminist materials need to be better at specifying what to do rather than just what not to do. Now is a good time for a reminder that I offer a workshop on this exactly, with a light-hearted tone and lots of audience participation and definitely no yelling at men that they are horrible awful creeps no matter what they do. I am far from the only person who offers such materials, but it would be cool if there were more. That said, anyone claiming that feminism does not offer this at all has quite clearly not done their research. Andrea Dworkin and some random shitty college sexual harassment training are not the only resources feminism has to offer.

(Some things that I have read along these lines [“these lines” meaning, roughly, “affirmative resources that help men and others conduct their sexual/romantic lives ethically without shaming them]: Charlie Glickman, Doctor Nerdlove, Yes Means Yes (the book and the associated blog by Thomas Macaulay Millar), Pervocracy, Franklin Veaux. If you don’t like any of these, create your own!)

But even then, your average casual feminist blogger or columnist cannot take responsibility for fixing the problems of someone who apparently sincerely believes that speaking to a woman will get him sent to prison. Or someone who is literally unable to talk to a woman because they have so much social anxiety. These are issues for professionals to deal with. Professionals can affirm. They are there to hold your feelings and make you feel comfortable and supported. They can teach social skills. They can help you examine maladaptive and irrational thoughts. They can help you learn how to cope with anxiety. That is what therapists are for. They are imperfect, but they are trained for this. I worry about placing this responsibility on every feminist with a blog.

Aaronson claims in his comment that “there are only therapists and activists to deliver the opposite message: that you are alone and it is your privileged, entitled, male fault.” I’m not sure if this comes from experience or is purely the creation of his mind with the biases that it had at the time. If Aaronson went to see a therapist and that therapist shamed him, then that therapist is wrong and does not deserve the title. (I’m not trying to do a No True Therapist fallacy here; I’m just pointing out that shaming people is against our ethics and if you cannot not shame people then you should not be a therapist.)

If Aaronson did not see a therapist, perhaps because he was afraid that they would shame him, then that’s unfortunate. And I don’t blame him. But I still think that we should be encouraging people with such pronounced irrational beliefs to seek therapy, not feminist literature.

No wonder I was so frustrated when I wrote that earlier post. I felt like feminist writers are being asked to do the job of a mental healthcare professional.

~~~

A few relevant points that I did not have time to expand on here, but may in the future:

  • Part of the reason that a lot of what Aaronson read/watched was so shaming towards men was probably because it was shaming towards sex and sexuality in general. Especially those college sexual harassment trainings, some of which are woefully retrograde. It’s important to remember that stigma/shaming around sex is something that is so entrenched in our culture that it’s bound to show up all over the place, even, yes, in feminist literature.
  • Aaronson claims that all the feminist literature he read confirmed his belief that straight men are awful and violent. While this may be so–I haven’t read Dworkin and don’t intend to–I have also personally watched men respond to materials that were not at all whatsoever shaming of men by claiming that they were being shamed by those materials. This seems to be a very common bias. They expect to be shamed by feminist materials, so they feel shamed by them.
  • I have seen dreadfully few discussions about how everyone–especially non-/anti-feminist men and women–perpetuate toxic ideals about masculinity. It’s usually not feminist teenage girls slamming shy nerdy boys into lockers and publicly humiliating them, is it? We should talk more about that. Unfortunately, most men dislike talking about toxic masculinity, because they think that “masculinity” is synonymous with “men,” and perhaps also because they have bought extensively into this ideal and appreciate the privileges it affords them.
  • There needs to be a space where we can say, “Wow, that is really awful, I’m sorry you felt that way and had to live with that, but I need to point out that your interpretation of things was inaccurate.” Because right now, it’s looking to me like anyone who includes the latter part of that sentence is accused of hating men or lacking compassion. If I read a Richard Dawkins book, came away with the idea that Dawkins believes that all religious people should be put to death, and therefore started to fear for the lives of my religious relatives, I would want someone to try to explain to me that I had misinterpreted the book. It would not be compassionate at all to allow me to continue believing that Dawkins was calling for my relatives’ deaths. It is not compassionate to allow Aaronson to believe that feminists want him to never, ever so much as kiss a girl. (A moot point now, but it wouldn’t have been earlier.)
  • It is also entirely possible that all the feminist literature that Aaronson read was woefully inadequate. (I disagree, and wish he had picked up bell hooks, but let’s grant it.) Feminism is, like every other field of study, constantly advancing and finding new ways to analyze and advocate. The feminist literature of the past decade or so focuses a lot more on helping men than the feminist literature of the 1970s and 80s. But feminist activism still consists mostly of women, and when men join in, they often try to speak to us about our own issues than to other men about men’s issues. And women, naturally, will focus first on issues we primarily face, some of which are life-threatening. Men, please, don’t stand around and lament the fact that feminists are not addressing your problems. Familiarize yourself with feminist principles and join in.
Feminist Bloggers Cannot Be Your Therapists

Why We Should Ban Conversion Therapy

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[Content note: suicide, transphobia, abuse]

I wrote this article for the Daily Dot about conversion therapy. Please note that I did not write and do not endorse its headline as it appears at the Daily Dot.

At the close of a year that saw both incredible gains for transgender people and a number of tragic acts of transphobic violence, 17-year-old Leelah Alcorn, a trans teen from Ohio,committed suicide on Sunday. In a note that she had preemptively scheduled to post on her Tumblr, she described the bigotry she had faced from her parents, who tried to isolate her from her friends and the Internet as punishment. They also sent her to Christian therapists who shamed her for her gender identity.

In response, the Transgender Human Rights Institute created a Change.org petition on December 31. The petition asksPresident Obama, Senator Harry Reid, and Representative Nancy Pelosi to enact Leelah’s Law to ban transgender conversion therapy. Less than two days later, the petition has already gained 160,000 signatures and made the rounds online. It may be the most attention that conversion therapy has gotten outside of activist circles for some time.

Aside from LGBTQ activists, secular activists, and mental healthcare professionals seeking to promote evidence-based practice, not many people seem to speak up about conversion therapy, or understand much about it. Most discussions of it that I come across deal with therapies that attempt to “reverse” sexual orientation from gay to straight or to eradicate same-sex attraction. However, conversion therapy also includes practices aimed at transgender people with the goal of forcing them to identify as the gender they were assigned at birth.

In her suicide note, Alcorn wrote, “My mom started taking me to a therapist, but would only take me to Christian therapists (who were all very biased), so I never actually got the therapy I needed to cure me of my depression. I only got more Christians telling me that I was selfish and wrong and that I should look to God for help.” Although she did not elaborate further about her experience in therapy, it’s clear that the treatment goal was not to help Alcorn reduce her risk of suicide, accept herself, recover from depression, or develop healthy coping skills that would help her stay safe in such an oppressive environment. The treatment goal was to force Leelah Alcorn to identify as a boy and to fulfill her parents’ and therapists’ ideas about what being a Christian means.

This is not mental healthcare. This is abuse.

Read the rest here.

Why We Should Ban Conversion Therapy