One Year, Three Months, and Sixteen Days

Grayscale photo of waves on a beach.
Photo by Gerard Pijoan on Unsplash

One year, eight months, and twenty-eight days ago I unraveled.

Six weeks post-op from my final surgery, I found out that cancer wasn’t quite done with us yet. My mom had it too.

I lost a lot of things that spring—my words, my composure, my pride, my sanity, my optimism, quite a few friends—but thankfully not my mom. Unlike my own cancer, there were no silver linings. I lost a lot but found nothing. I learned nothing, either, least of all how to live in a world without my mom in it. That lesson, I suppose, is for another day, a day I’ll try not to think about much until it comes.

I guess I did discover something about myself, though I’m not sure if I’d call it learning. I found a part of myself that words don’t touch, that speaks no language. Even my own possible death didn’t strike this part of me. But hers did.

Continue reading “One Year, Three Months, and Sixteen Days”

One Year, Three Months, and Sixteen Days
{advertisement}

Seven Meditations for Moving Forward

A path through a forest.
Photo by Lukasz Szmigiel on Unsplash

I.

What are you feeling right now? Name it. Name them all–there are probably more than one or two.

A feeling is any word or phrase that can come after the words “I feel” without needing the words “like” or “that” to make it fit. I feel scared, I feel horrified, I feel jealous, I feel hopeful, I feel alone.

Imagine yourself sitting comfortably in a cozy room. Picture whatever makes a space feel safe and accessible to you. Maybe you’re on a beanbag chair, up against the back wall, and on the other side of the room from you is a door.

Imagine that each of the emotions you’re naming is walking through that door and sitting down in the room with you. They’re not coming to fight you, debate you, or do anything other than sit with you, but they all have something to say.

Continue reading “Seven Meditations for Moving Forward”

Seven Meditations for Moving Forward

Building Blocks of Mental Distress: A Dimensional Assessment of Mental Illness

This is a cross-post from my professional blog, where the most updated version of this will be.

The field of mental healthcare has its roots in medicine. The earliest mental health professionals were doctors—psychiatrists. Like medicine, psychiatry and clinical psychology are based on the process of assessing patients’ symptoms, performing some sort of test if needed, assigning a diagnosis, and creating a treatment plan based on that diagnosis.

This is a very sensible approach for most medical issues. If I appear at my primary care doctor’s office complaining of persistent headaches, she shouldn’t just treat the headache by prescribing a painkiller. She should refer me to someone who can figure out what’s causing the headache, and then treat that condition, whether it’s extreme stress, a head injury, a bacterial infection, a brain tumor, or some other problem.

Even though we’ve been treating mental health issues this way for at least a century, it’s not the best way to treat them. And many psychiatrists, therapists, and researchers are starting to realize that.

That’s why we’re finally starting to see approaches to assessment and treatment of mental illness that move away from the much-argued-about diagnoses in the DSM, and sometimes away from the concept of mental illness altogether. Psychologists such as David Barlow, Rochelle Frank, and Joan Davidson have been working on so-called transdiagnostic approaches[1]; the newest edition of the DSM includes a chapter about a proposed new way to diagnose personality disorders that’s based on specific personality traits rather than broad, stigmatized labels[2].

I’m looking forward to the day when the field as a whole has shifted to these types of approaches entirely. For now, I needed a tool I can use with clients to help them (and myself) understand what they’re dealing with and access helpful resources and support. So I created my own informal dimensional assessment.

Continue reading “Building Blocks of Mental Distress: A Dimensional Assessment of Mental Illness”

Building Blocks of Mental Distress: A Dimensional Assessment of Mental Illness

How Big is Your Hard Drive?

Close-up of a hard drive.
This is relevant, I swear.

This is a cross-post from my professional blog.

Some friends and I were talking recently about the concept of “emotionally unavailable” people. Most of us have had a friend—perhaps ourselves—who has tried to date someone who seemed into them, but just wasn’t quite present. Sometimes this type of partner is upfront about their ability to commit and/or be there. Sometimes, they aren’t, and their behavior seems confusing and contradictory. These pseudo-relationships can drag on for years until we are finally able to move on, understanding that however much the person enjoys our presence, they are not interested in making things more committed or structured than they currently are.

If I knew what to do in these situations I’d probably be retiring a millionaire, but I do have an analogy that might be helpful. I thought of it on the spot to give my friend some advice. (If you’ve ever been my client, you know how much I love a good geeky analogy.)

Computers come with different hard drive capacities. If yours doesn’t have enough space for you, you can maybe buy and install a new one—but for the moment, you’re stuck with the one your computer came with. Maybe you can’t afford a new one right now.

Different hard drives also have different things stored on them, and these things take up different amounts of space. I know people whose hard drives pretty much just contain the system files, maybe a few extra apps. These people use their computers mainly to get online. Maybe computers aren’t very important to them and they don’t use them much at all.

Some people have a lot to store—photos, music, videos, complex projects they’re working on. These folks are buying hard drives in capacities I didn’t even know existed. (This year, the world’s largest solid state drive hit 100 terabytes. What are they storing on that hard drive???)

Don’t think of the hard drive as your brain. Those analogies are really reductive, and usually insulting to us humans. The hard drive is a symbol, and it represents something I call your capacity as a person. That encompasses a lot of things—time, energy, physical and mental ability, willpower (which isn’t really a thing, but that’s another article; it’s useful here as a concept), tolerance for uncertainty or negative emotion, and much more. For instance, not everyone has the capacity to be a therapist. Being a therapist requires having a lot of space to hold other people’s pain. Not everyone has enough space for that. Unfortunately, some therapists end up without enough space to hold their loved ones’ pain, or even their own.

Say I have a 1 TB hard drive that’s full of music and photos. Maybe there’s 300 GB left over. Then a friend asks, “Could I put some of my videos on your hard drive? I need somewhere to store them for a while.” I say sure, but then they come over with their external drive and I see that they have an entire terabyte of videos. That’s not going to fit on my hard drive. I could probably store some of their videos, and that might still be helpful for them. But maybe they really needed to store the entire drive’s worth. I don’t have the capacity.

This kind of thing happens in friendships and relationships all the time. You might have a good amount of your own shit to deal with, but that doesn’t mean you can’t listen to your friends vent about their own problems from time to time, or give them advice about a work situation, or treat them to a nice dinner while they’re going through a breakup.

You might not be able to be a friend’s primary source of support as they navigate a serious illness, however. First of all, the time factor would be prohibitive—you may not be able to drive them to all of their medical appointments, be at their house enough to care for them when they can’t care for themselves, and so on. The stress of being a full-time caregiver would be way too much. Holding their anguish as they face the possibility of death or disability is also, well, a lot. Your friend needs more people on their team.

Some people are carrying a lot of trauma, hardship, or personal responsibilities with them already. No matter how large their hard drives happen to be, there may not be space there for you.

Not only that, but some people have pretty small hard drives to begin with. I’ve known many people who just don’t seem to have a lot of space for others in their lives. They don’t tolerate much emotional turbulence when it comes to other people. They may be interested in sex, casual friendship, or even romance, but they don’t have the capacity to build interdependent, long-lasting relationships with others—at least not until they do some work on themselves, and get some bigger hard drives. Some people want to do that work; others are perfectly content as they are.

Here’s where this analogy really breaks down—buying a new hard drive is a million times easier than increasing your capacity for holding other people. And while you can buy a larger hard drive for your friend whose computer you’re always wanting to store your videos on for some reason (this is weird), you cannot increase others’ capacity for them. They have to choose to do it for themselves, and they may not want to. Or it may take them a long time, or they may not be able to do it at all.

If you are hoping for a deeper relationship with someone whose hard drive seems to be too small—or who has way too much data on it already—you have to ask yourself whether or not it’s likely that this person is going to have more space for you anytime soon, and whether or not they want that space to be yours.


Brute Reason does not host comments–here’s why.

If you liked this post, please consider supporting me on Patreon or Ko-fi!

How Big is Your Hard Drive?

What ADHD Actually Is

ADHD (or ADD, as it used to be called) is such a misunderstood disorder, especially among adults, that I figured I’d dedicate an article to clearing up misconceptions and helping folks who suspect they have it figure out what to do next.

First, some general principles that organize my thoughts on ADHD:

  • ADHD is a developmental disability, not a mental illness. (More on this later.) This means that it begins in childhood and lasts for life. Individual symptoms might wax and wane, and your environment may be more or less conducive to the way your brain works, but ADHD doesn’t get “cured.”
  • Therefore, you do not “age out” of ADHD. If you were (accurately) diagnosed with it as a child, you still have it.
  • It’s possible for a condition to be both over- and under-diagnosed. That’s not contradictory at all. It just means that we’re looking for it in places it isn’t, and we’re not looking for it in places it is.
  • Having ADHD does not mean you have to take medication, and not being helped by ADHD medication doesn’t mean you don’t have ADHD. Those are separate questions, and there are effective strategies for ADHD besides medication.
  • ADHD has neural substrates [1] (I hate using jargon, but there’s honestly no better way to say “a specific thingie happening in your actual physical brain blorb that relates to the behaviors or subjective states you experience and others observe,” so from now on, that’s what “neural substrate means), but like all disabilities, it’s also socially constructed in many ways. That means that culture and community influence how ADHD symptoms are expressed and understood. That means that we shouldn’t be surprised when ADHD presents differently in women, people of color, etc. Rather, that’s exactly what we should expect.

So, what is ADHD exactly? Here’s the only explanation that matters:

ADHD is a disorder of executive function.

That’s it. ADHD is not about being hyperactive, forgetting things, interrupting people, losing your homework, or any other specific symptom. You can have ADHD without exhibiting any of those classic behaviors, but everyone with ADHD experiences impairment of their executive functions.

What is executive function?

Executive functions are the brain processes that help you decide what to do and when to do it. Many of these processes take place in the prefrontal cortex, a region of the brain that evolved relatively recently and helps us with higher-order cognitive tasks.

There are lots of different executive functions, especially if you get really specific with it, but here are some examples:

  • inhibiting impulses that you don’t want to act on
  • temporarily storing information that you need to use or process (a.k.a., working memory)
  • choosing what to pay attention to
  • ignoring distracting stimuli, whether internal or external
  • figuring out what steps it would take to accomplish something
  • having a sense of how long things take (for instance, when you should start getting ready in order to leave on time in order to get somewhere on time)
  • sorting relevant information from irrelevant information
  • switching smoothly between thoughts or tasks (a.k.a., cognitive flexibility)
  • adapting quickly when a plan falls through or new information becomes available
  • paying attention to and noticing your feelings and impulses

All of us, including people with executive function issues, do these mental tasks all the time. Often they happen without conscious effort. For instance, when you read a book without getting distracted every time a car drives by outside, you’re using executive function skills. When you get dressed and leave the house in the morning, you’re using executive function skills.

There are many different components to executive function and they involve different parts of the prefrontal cortex, and other brain regions too. Executive function can be impaired by many other things besides ADHD, such as autism, inebriation, sleep deprivation (or, in my case, narcolepsy), and basically any mental illness. However, when you have depression, the executive function issues resolve when the rest of the depression symptoms do. When you have ADHD and depression, the mood issues might go away but the executive dysfunction remains.

How does executive dysfunction explain ADHD symptoms?

Let’s look at some typical symptom descriptions from the DSM-V criteria for ADHD [2]. First of all, I hate these because most of them are worded in a way that’s specific to children, and most of them just sound really negative and stigmatizing. But it’s what we have for now.

For instance, the phrase “makes careless mistakes” often comes up. “Careless” implies that the person does not care enough about the task, which is why they made the mistake. But that’s not how ADHD works. A person with ADHD might make a “careless” mistake for a number of reasons:

  • They were having trouble choosing what to pay attention to, and did not notice that they were making a mistake.
  • They didn’t realize that the area in which they made the mistake was relevant. It may be obvious to you, but it wasn’t obvious to them, so they didn’t make an effort to avoid the mistake.
  • They forgot a crucial piece of information that they would’ve needed to avoid the mistake and didn’t know how to go about finding out, or didn’t notice that they’d forgotten until it was too late.
  • They couldn’t make an accurate estimate of how long the task would take, and made the mistake or allowed it to remain in their rush to get the task finished.

Here’s another example: “often interrupts.” People with ADHD might interrupt others for different reasons, too:

  • They got so excited about what they wanted to say that they were unable to inhibit the impulse to speak.
  • They know that because of their impaired short-term memory, they will forget what they want to say if they don’t say it now–and they lack the cognitive flexibility to quickly find another way to solve this problem without interrupting.
  • They find it difficult to switch smoothly between speaking and listening.
  • They failed to pay attention to the fact that the other person was still speaking.

Other criteria for ADHD are simply examples of executive dysfunctions themselves, but sometimes diagnostic criteria aren’t very useful because they tend to describe how other people experience the person with ADHD, not how that person experiences their own life and their own mind. For instance, one of the most common things I hear from people with ADHD is “I just feel constantly overwhelmed, like I can’t manage my life and keep up.” That’s nowhere in the diagnostic criteria, and if you said it to a therapist they might assume depression or anxiety. (Which many people with ADHD have, more on that later.) But that’s the feeling that results when your executive functioning doesn’t match what your lifestyle demands.

What about hyperactivity?

Hyperactivity is kind of the red-headed stepchild of ADHD symptoms. Many people with the disorder don’t have it at all (though you wouldn’t know it from stereotypes and media representations), and it’s not necessary for the diagnosis. The DSM deals with this by dividing ADHD into “types”: inattentive type, hyperactive-impulsive type, and combined type. You can still have symptoms from the other category to be one of the “types,” you just have to be predominantly that “type.” It’s kind of confusing (and in my opinion, unnecessary).

Hyperactivity doesn’t initially seem to have anything to do with executive dysfunction, except perhaps in the case of impulsive behaviors. What about executive dysfunction would cause a person to need to fidget, or to talk very quickly or feel restless all the time?

I’m not convinced that ADHD as we currently think of it is all one disorder. I think it’s two that often go together: one that I’d call executive dysfunction syndrome, and another that some researchers already call reward deficiency syndrome.

(Unfortunately, one of these researchers is using the term to promote some dubious claims about genetics and substance addiction[3], but I’ll be using it more generally.)

I don’t want to get too derailed by talking about dopamine, but in a nutshell: when we do or experience things we enjoy, certain brain regions release the neurotransmitter dopamine–especially if the reward was unexpected in some way. The chemical is a sort of a signal to the body to seek out more of the thing.

We know that people vary in how much and under what circumstances their brains produce dopamine, as it’s linked to all kinds of neurological/mental conditions. But it’s possible, too, that there’s a sort of spectrum–for some people, a relatively small reward is enough to trigger a noticeable burst of dopamine, while others need much more.

Maybe people with hyperactive traits are those who need much more–so they’re always on the go, always moving, just to feel as engaged and interested as others may feel just from petting a cat or listening to the rain. And it would make sense, because dopaminergic pathways[4] are involved in executive function, too.

Anyway, that’s mostly (somewhat scientifically-based) speculation, and it doesn’t really matter. The point is, some people with ADHD struggle with hyperactivity, and some don’t. Executive dysfunction is really the core of the disorder.

And what about depression and anxiety?

If you have ADHD, you almost certainly have lots of symptoms of depression and anxiety, too. You may even qualify for the formal diagnoses of those disorders. Think about it: for your entire life, you’ve struggled to accomplish what others see as basic functions. You may have failed classes, dropped out of educational programs, gotten fired (or quit to avoid getting fired) from jobs, lost friends and partners due to executive dysfunction, and generally failed to accomplish what you want to accomplish. Worse, if you’ve been undiagnosed, you haven’t even had the language to explain to yourself (much less to others) why you failed at those things. You’ve probably internalized others’ opinions that you’re lazy, “stupid,” unmotivated, and unlikely to amount to much. Unless you come from a very privileged background, you’re probably terrified about your future and have no idea how you’re going to pay the rent given that you can’t “adult” well enough to get things together.

The thoughts that therapists consider indicative of depression and anxiety–“I’m a failure,” “Nothing’s ever going to work out,” “What if I lose this job/relationship/apartment,” “There’s no point in even trying anymore”–might actually be very “realistic” thoughts for a person with undiagnosed, untreated ADHD to have. Cognitive behavioral therapy teaches people with depression and anxiety to question their automatic thoughts and see how “irrational” those thoughts are. But what if you have very good evidence that you’re probably going to lose your job and alienate your partner, because that’s how it’s been for your whole life?

That’s why it’s very important for people who think they might have ADHD to dig beneath these thoughts and urge their mental health providers to do the same. Antidepressants, anti-anxiety meds, and therapy that’s focused on these symptoms can provide a bit of relief to someone with ADHD, but it won’t do much, and it won’t help with the ADHD symptoms. And that’ll only reinforce the belief that nothing will ever get better.

The good news is that medication, therapy, and lifestyle interventions that are targeted specifically at ADHD are very effective. Even knowing (or suspecting) that you have ADHD can immediately make things better, because it lets you stop blaming yourself and helps you access advice and support that’s helpful. So while your negative thoughts might be “accurate” in a sense–maybe you really have failed at basically everything you’ve tried, and maybe right now you’re failing too–with the correct diagnosis, all of that can change, and it can change quickly.

What should you do if you think you might have ADHD?

For starters, don’t invalidate your suspicions just because a professional hasn’t diagnosed you (yet). Most diagnoses happen because the patient noticed something first.

Unfortunately, when it comes to ADHD, a lot of medical professionals have their own biases which aren’t helpful to anyone in this situation. Be prepared to advocate for yourself a bit. The good news is that once you’re referred to the right professional, you shouldn’t have to keep advocating for yourself. They will advocate with you.

If you have a primary care doctor, tell that doctor about your concerns and ask to be referred for a neuropsychiatric evaluation.[5] These tests are performed by doctors with MDs or PhDs in clinical psychology, and they’re the primary way to diagnose ADHD. They’re also quite accurate because they measure neurological processes that can’t be faked or altered intentionally. So while some people feel nervous about not being believed when they say they have ADHD symptoms, these evaluations are a great way to put that concern to rest. You can’t fake these results just because you want stimulants.

If you don’t have a primary care doctor, but you have a therapist or psychiatrist, same thing. But if you’re not seeing any medical professionals, I’d actually suggest taking the counterintuitive route and setting up a primary care doctor first. They’re sometimes more likely to have a quick referral for a neuropsych eval available.

If you are uninsured, keep in mind that large medical systems and university hospitals often have substantial financial aid available. For instance, Ohio State’s Wexner Medical Center, where I get everything from my annual flu shot to my cancer surgery, provides assistance to anyone whose income is under 400% of the federal poverty line. Some people end up getting their care almost, or nearly, for free.

Most counties also have free or sliding-scale mental health services for uninsured residents. I’m employed by one of those. Our clients get counseling, case management, vocational assistance, psychiatry appointments, and other services mostly for free, and their medication is free, too, through a charitable pharmacy. The only issue with that is that charitable pharmacies won’t stock all psychiatric medications because some are very expensive. Stimulants tend not to be available, but that may not be true for every county.

(Also, here’s my regular reminder that until they have repealed the ACA, they have not repealed the ACA. If you can, apply for insurance this fall.)

Getting diagnosed can be helpful even if you don’t want medication. But even if you don’t get diagnosed, there are lots of ways to cope with your symptoms, whatever they’re technically called. If you have a therapist, explain to them that you’re struggling with executive function and ask them to work with you on that. If you can afford it, you can also work with an ADHD coach[6]. It’s an emerging off-shoot of life coaching that specifically focuses on the challenges faced by people with ADHD. (I actually hope to get trained as an ADHD coach someday when I can afford it.)

Besides that, two books I recommend to everyone who has or might have ADHD are:

  • More Attention, Less Deficit by Ari Tuckman [7]
  • ADD-Friendly Ways to Organize Your Life by Judith Kolberg and Kathleen Nadeau [8]

Here are some articles that people I know have found helpful:

Many people also find the ADHD subreddit helpful.

This article is already getting super long, so I’ll save all my other thoughts for part 2. (A preview: why prevalence of ADHD is increasing, what connection (if any) there is between ADHD and autism, how ADHD affects relationships and emotional processing, and why people with ADHD are sometimes very good at getting certain things done!


[1] https://en.wikipedia.org/wiki/Neural_substrate

[2] https://images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_ADHD.pdf

[3] http://blogs.discovermagazine.com/neuroskeptic/2015/06/10/strange-world-reward-deficiency-syndrome-part-1/#.WrphwP0lExF

[4] https://en.wikipedia.org/wiki/Dopaminergic_pathways

[5] https://www.med.unc.edu/neurology/divisions/movement-disorders/npsycheval

[6] https://www.adhdcoaches.org

[7] https://www.amazon.com/More-Attention-Less-Deficit-Strategies/dp/1886941742

[8] https://www.amazon.com/ADD-Friendly-Ways-Organize-Your-Life/dp/1138190748/ref=dp_ob_title_bk


Brute Reason does not host comments–here’s why.

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

What ADHD Actually Is

How to Avoid Giving Your Cancerous Friend a Panic Attack: An Introduction to the Psychology of Pain

Okay, maybe this is kind of turning into a Cancer Blog.

[Content note: medical stuff]

One of the first things my oncologist said to me at the beginning of this whole wild ride was, “Don’t Google.”

Wise words. For the most part, I haven’t. I’ve used some well-vetted websites (such as the American Cancer Society) to help myself prepare for things, but I’ve never intentionally sought out other types of medical information and narratives.

However, Google being how you access legit medical websites as well as blogs, things have nevertheless found their ways onto my screen that shouldn’t have. Some of this was probably unavoidable; some of it definitely wasn’t, especially when people sent me links or I clicked on them.

There’s a lot I didn’t understand about the psychological side of medicine until recently, but once I did, things started to make sense and I started to notice things I’d never noticed before.

For instance, well-trained doctors and nurses who are not characters in TV shows or moralizing children’s books never say “THIS WILL HURT A LOT.” Actually, they don’t even say, “This will hurt.” They say, “You will feel a pinch.” They say, “There might be a burning sensation at first, but it’ll go away in a few seconds.” They say, “You’ll feel a sting when I numb the area, but after that you won’t feel anything. If you do, tell me.” They say, “Some patients find this uncomfortable. If it’s too much for you, let me know and we’ll see what we can do.”

I started to notice that as much as possible, they stay away from words like “hurt,” “pain,” and anything vague or emotionally-charged.

Then I noticed how my doctor responded when I asked about pain management post-mastectomy. He said, “We use a multi-modal pain management protocol. You get four different medications, one of which is an opioid. We find that when patients return for their one week follow-up, the majority of them voluntarily return the opioids to us, saying that they only took a few of them or never needed them at all.”

Next I asked about chemo side effects. He said, “The main side effect patients experience nowadays is fatigue. Everything else is very well-controlled with medication, so if you’re still experiencing nausea or other side effects, let us know and we’ll add medications to control it or reduce the dose of the chemo. Even with fatigue, it varies. The best way to counteract it is exercise. Try to get yourself moving at least a little bit every day. Most of my patients continue to work during chemo, if not full-time. One of them even ran the Columbus Marathon during her treatment.”

Notice what’s going on?

Whenever the question of pain, discomfort, and side effects comes up, good medical providers do several things:

1) They are honest about what most patients can expect, but
2) They don’t focus on the negative aspects or use emotionally charged language to describe it
3) When most patients can expect a positive outcome, they emphasize that
4) When discussing pain or other side effects, they quickly shift focus to what THEY plan to do to address it.

This is very important, and that’s where the psychology of pain comes in. Research shows that expectations of pain play a huge role in our subjective experience of pain—expect something to hurt a lot, and it probably will; expect it to be tolerable, and it’ll hurt less. That doesn’t mean you’re going to magically feel no pain—we have nerves, after all—but there’s a degree of subjectivity to it and we’re learning that it’s a rather large degree.

Unfortunately, once you’ve become convinced for whatever reason that something is going to be very painful, it’s very difficult to un-convince yourself of that, because at that point your brain’s fear response has sort of taken over. That’s why it’s important to manage what information you receive beforehand so you don’t end up with an expectation of intolerable pain.

And that’s why my doctor told me not to google stuff.

Doctors don’t want patients freaking themselves out with graphic descriptions of painful procedures not just because they want to help you avoid panic attacks and unnecessary stress. It’s also because expecting severe pain can lead to experiencing severe pain. More pain means more pain medications, a greater risk of complications and addiction to those pain medications, a longer recovery time, and a generally all-around shitty experience.

A wonderful book I just read, What Patients Say, What Doctors Hear by Dr. Danielle Ofri, describes this phenomenon and cites research dating back decades. From a Washington Post review of the book:

We’ve known for decades that doctors who offer empathy, build trust and set expectations help their patients fare better. As far back as 1964, a study conducted with abdominal-surgery patients illustrated what Ofri calls the “demonstrable effect of the simple act of talking.” Before surgery, half of the patients were visited by an anesthetist who said pain afterward would be normal and would last a limited amount of time, and explained how patients could relax their muscles to lessen the pain. These patients needed half the pain medication of others who didn’t receive a pain talk. If we are an overmedicated nation, better communication would seem an easy and cheap way to relieve that burden — except that listening takes time, and doctors don’t usually have that.

If doctors don’t always have the time to talk to patients about pain in this calming, practical way, we now have the internet to step in and fill the gap. Sometimes it does this well, but often it does it very poorly.

We all know cognitively that you’re likely to find a disproportionate number of negative stories online because people who have a positive or neutral experience are less likely to take the time to describe it, whether that experience is with a restaurant, lawn care service, book, or medical procedure. We know this, but when you’re scared about your upcoming surgery and you stumble upon some first-person accounts, you’re not thinking of it that way and you can’t think of it that way. The fear response takes over.

Even if the experience being described is quite typical and probably fair to expect, it still does patients like me few favors to read those descriptions. First of all, subjective experiences of pain are, well, subjective. One person’s terrible pain could be my absolutely tolerable pain, and there’s no way to know it. Pretty much everyone has pain after surgery; that’s to be expected. But reading about it can still harm me by causing me to expect more pain than I would’ve otherwise had.

Different online sources also have different motivations. I’ve read a few blogs by cancer patients and found most of the accounts there to be pretty neutral and even-handed when it comes to describing cancer treatment. Yes, it sucks, but since these bloggers were documenting their journeys overall, they also described the parts that were okay, and the parts that were just boring, and even the parts that were interesting and better than they expected.

But as soon as you get into first-person narratives being published on websites like Buzzfeed and Slate and whatever, you’re going to see a much more skewed version of things because, as I’m furiously finding out, people love a graphic, miserable cancer narrative. People eat that shit up. Painful medical procedures, disgusting post-op symptoms, bizarre side effects, the works. It gets clicks. It infuriates me.

Even if those experiences are very much real, it doesn’t do someone like me any good to read it. Some patients justify it by claiming that it helps us be better “prepared”—I used to do this too—the fact is that it doesn’t make is better prepared. It makes us less prepared, because it makes us expect the worst and therefore ultimately have a worse experience.

So, when you come across these “raw” and “honest” cancer narratives and you feel the urge to send them to your friend with cancer to help “prepare” them or because you think they might find it validating, take a pause and ask yourself 1) who this is primarily being written for and 2) how exactly this will prepare your friend for what they’re about to face. Put yourself in their shoes. Imagine you’re going through treatment for a deadly illness, and you don’t know if the treatment will even work or how much damage it’ll do to you in the process. Would reading this material help you? If not, it won’t help me either.

What I do find helpful is neutral, matter-of-fact explanations of what I can expect. The best of these have come from my hospital itself, which makes tons of handouts available to patients. Here are some pages from the one they gave me about mastectomy and reconstruction surgery:

This slideshow requires JavaScript.

Websites like the American Cancer Society, the National Breast Cancer Foundation, and BreastCancer.org also do this well. When I do google, these are the websites I usually click on.

And in terms of speaking to people, two conversations have made a big difference in calming me down and setting more positive expectations for surgery. One was the appointment in which my doctor told me about how most of the opioid medications get returned within a week. The other was when my mom, who had a c-section twice, told me that post-surgery pain just felt like a very strong muscle ache, as if you’d worked out super hard the day before. That was very reassuring. I am no stranger to strong muscle aches.

In my social circles, we generally value sharing and listening to people’s personal experiences, and we emphasize that everyone’s experience is valid and important and so on. I agree with this, generally. But right now, as I’m going through cancer treatment, everyone’s personal experience is not important to me, and I shouldn’t read and give credence to something just because it’s someone’s personal experience. Doing so can not only give me panic attacks, but literally cause me to feel more pain.

So for the time being, I’m trying to stay away from negative and emotionally-charged accounts of cancer treatments, and my friends can help by not encouraging me to read them. If necessary, I’ll “prepare” myself by talking to my doctors. They have yet to make me regret it.


Brute Reason does not host comments–here’s why.

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

How to Avoid Giving Your Cancerous Friend a Panic Attack: An Introduction to the Psychology of Pain

Yes, We Did Fail to Empathize with Conservatives

Just not in the way you think.

One of the worst developments of this election season–after, that is, the fact that we’ve elected a proto-fascist sexual predator with the temper of a three-year-old denied candy–is that the Left appears to have collectively decided that the reason this happened is that we failed to empathize with conservatives and that we have been too concerned with making sure that trans people can use the right bathrooms.

I agree with part of this. No, not the bathroom part. We did fail to empathize with conservatives. But I mean that in a very different way than the thinkpiece du jour does.

Empathy means understanding what someone thinks and feels from their perspective. It doesn’t mean feeling bad for them–it’s not the same thing as sympathy. It doesn’t mean patiently debating life-or-death issues with them. It doesn’t mean coddling them or doing what they want you to. It doesn’t even mean accepting their distortions of sociopolitical reality as fact.

It just means understanding what they think and feel, from their perspective.

Overwhelmingly, white Americans–at least the ones who voted for Trump–think that people of color are the cause of their economic problems, and they feel afraid of them. They think that LGBTQ people are sinful and a threat to the proper order of things, and they feel disgusted by them. They think that women are asking for more than they deserve and that women are inherently deceitful and untrustworthy, and they feel threatened by them.

I know this because I listen to right-wingers and read what they write.

And because I have a relatively high empathic ability, which I train for hours each day in the course of my job, I can actually put myself right into a hypothetical conservative’s shoes and see why they’d feel what they feel given the beliefs that they have. If I had those beliefs, I would also feel (and vote) the way they do.

And when I put myself in the headspace of a white conservative, and run a simulation in my mind of their beliefs and values, their support for Trump and other Republicans makes complete sense to me. There is nothing hypocritical about it at all. There’s little evidence that they voted “against their interests,” because as much of a failure as Trump will be at improving their economic circumstances, that wasn’t the only interest they had. They were also very interested in reducing the number of people of color (especially Muslims) in the United States, maintaining Christianity as the dominant American value system, making sure that women don’t take what isn’t theirs, and preventing LGBTQ people from further corrupting American culture. They accomplished all of this and more by electing Trump.

Sure, many of them shot themselves in the foot economically in order to do that. But there’s nothing surprising about it. Psychological research (which I unfortunately can’t find right now, so feel free to take this with a grain of salt) suggests that people may willingly lose money in order to harm someone that they want to harm.

And sure, there are a lot more factors in this election outcome than just the specific beliefs I listed as examples. Those are some major ones, but there are others, such as “government-run programs are wasteful and harmful in general and should be reduced or eliminated” and “climate change is a hoax” and “I admire Donald Trump’s business successes and would want someone with those skills as president.” Yes, you can be a Trump supporter without being primarily concerned with, say, reducing the number and influence of people of color in America. But as others have pointed out, every Trump supporter has heard his rhetoric about people of color and women and decided that that is acceptable on some level. So yes, you’re all racist and sexist. Every last one of you.

The reason I think that lack of empathy–when “empathy” is properly defined–contributed to the Democrats’ loss is because they failed to understand what they were up against. Many liberals demonstrated a disturbing lack of critical reading skills when they insisted on taking statements like “I just want our jobs back” literally rather than interpreting and contextualizing them properly. When taken literally, this statement suggests that if Democrats want to capture more of the white vote, they need to address these voters’ presumably lost jobs. (Never mind that many of them are making six figures.)

But Clinton had a comprehensive jobs platform, and Obama is finishing his presidency with a strong record on jobs. While Clinton may have failed to adequately communicate her platform and the media certainly failed to adequately explain it to the public, I don’t think that the vast majority of these voters would ever have voted for her no matter how well she communicated. There are two reasons for that. One is that she’s a woman, and the majority of these voters do not believe that a woman can or should be president. The other is that they don’t simply want “their” jobs back; they believe that their jobs have been taken by immigrants and people of color. This belief is extremely strong, cemented by a cohesive in-group identity, and resistant to things like calm and reasoned presentation of facts to the contrary. Clinton supports immigrants and people of color, so she’s not going to have their vote. Neither is any other Democrat.

Of course, you could argue that if even a few people had responded positively to Clinton’s attempts to bring them into the fold, that might’ve tipped the election to her favor and she would’ve won. That’s a valid argument and I don’t disagree, but even in that case you’d be left with millions and millions of voters that Democrats have misunderstood and underestimated. Still a problem, especially given the long-term trajectory of right-wing populist movements. If Trump had lost this year, that would’ve prevented things from getting as bad as they’re going to get in the immediate future, but it wouldn’t have solved the problem.

So how do we stop misunderstanding and underestimating right-wingers? How do we have actual empathy towards them?

1. We take them seriously.

When someone tells you who they are, believe them. Trump has been telling us who he is for decades and people still won’t believe him. “Oh, he didn’t really mean that about grabbing those women.” “He didn’t literally mean that Mexican immigrants are rapists, just that there are probably some rapists among them, like any other group.” “He’ll probably surround himself with good people once he gets to the White House.” We’re now seeing how that’s turning out.

Same with Trump’s supporters. When they say that their jobs have been taken by immigrants, they mean that that’s what they believe. You are not going to win them over unless you either manage to convince them that this deeply-held, socioculturally-reinforced belief is false (good luck with that), or you tell them that you’re going to kick all the immigrants out so they can have their jobs back.

Many–not all–Trump voters have real economic concerns. But they have chosen a fundamentally racist way of explaining the origins of those problems, and they will not accept a solution that doesn’t get at what they see as the problem.

2. We learn to read and listen critically.

On the other hand, we can’t take people’s statements so literally and interpret them so shallowly that we fail to understand what they actually mean. When Trump supporters said that they want to get rid of all the elites in the federal government, they didn’t mean that they wanted the next president to be someone who grew up in a Rust Belt town with ordinary non-politician parents, built their own small business from the ground up, and knows what it’s like to struggle financially. When right-wingers use words like “elites,” what they typically mean is urban liberals and/or Jews. So nobody should be surprised that most Trump voters seem totally okay with his own elite status and that of the people he’s filling his administration with.

LIkewise, the language of racism is typically full of codewords and euphemisms that allow people to dodge away from the implications of what they’re saying. When white people say that they’re worried about the changing demographics of this country, they mean that their majority is on its way out. The only reason for a white person to be concerned about being the minority is that they hate or fear people of color.

Taking people’s words literally might seem like a necessary part of taking them seriously, but that’s only if you refuse to acknowledge that most people communicate indirectly. That’s especially the case when we have heavily stigmatized certain forms of direct communication. For instance, in most circles, people will make you feel very uncomfortable if you say something like, “Black people are lazy and I don’t like them.” (Yes, even if those other people believe that on some level themselves.) So instead, you learn to say things like, “I just think that a lot of these welfare programs are encouraging dependency and preventing people from getting out there and getting an actual job.”

Well-meaning liberals may respond to this person by pointing out that while fraudulent applications for food stamps do happen, most are genuine. They may point out that some of this person’s (white) relatives have been on government assistance. They might say that, actually, there are work requirements involved with food stamps and you can’t just take them and do nothing.

They won’t get anywhere because the person hasn’t said exactly what they mean.

3. We understand the powerful role of tribalism and identity.

Identity politics did cost Clinton this election. Specifically, identity politics won the election for Trump. This election was won by conservative white identity politics.

For white conservatives, things like opposing immigration (of non-white people), fearing Muslims, distrusting women, being disgusted by homosexuality, and believing that government programs and other institutions unfairly favor people of color aren’t just isolated opinions, like preferring summer to winter or liking a particular brand of frozen pizza.

Rather, those are strong markers of group identity. Even when presented with strong contrary evidence, you can’t just abandon them because then you’d be like Them, not like Us. And being like Them is unspeakably awful.

I’m not saying liberals don’t have their own versions of this, by the way. They sure do. But the point is that they underestimate the role this plays in our current political situation at their peril.

If you really want to convince someone that the pizza they like is shitty or that winter is obviously the superior season, you might succeed by presenting them with well-reasoned arguments and responding effectively to their rebuttals. (You probably won’t–they have those opinions for a reason–but you could.) That’s because they probably don’t really, really need to believe that their pizza is better or that summer is the best season.

When it’s a matter of group identity, that changes. Conservatives don’t simply believe that climate change is a hoax; they really, really need to believe that climate change is a hoax. If they stop believing that climate change is a hoax, they will lose part of their sense of who they are, not to mention cause conflict with their friends and family and also start fearing that we’re all literally going to die. That’s some powerful motivation to keep believing that climate change is a hoax. Avoiding cognitive dissonance is a much stronger drive than your calm and reasoned arguments can possibly provide.

So now that we know how to truly understand Trump supporters, what do we do with that?

Here’s where I’m not really a helpful source of advice, because I don’t actually think there’s anything to be done. I don’t think that being nice to them or debating calmly with them will change their minds. I don’t think creating progressive policy that addresses their economic concerns will help, for the reasons I’ve laid out. The way to get right-wingers to vote for you is to support the policies that they support, and you can’t do that as a Democrat or any other kind of liberal or progressive.

I think we can do two things:

1. Galvanize the left-wing base so that they turn the fuck up at the polls next time.

Stop with the “voting doesn’t really matter” fucking bullshit. We’re about to find out exactly how much it mattered. This is my main aim when I write and share things about Trump, about racism, about fascism, and so on. I’m not trying to convince conservatives. I’m trying to get progressives who can vote to get the fuck out there and vote. I fucking promise you there are progressives in Ohio, Michigan, Pennsylvania, and literally every other red and swing state who could have voted in this election and chose not to.

Because I don’t believe that we can convince conservatives to stop supporting Trump (or other relatively less awful but still awful politicians), I believe that our best option is to strengthen our own base so that it can defeat conservatives in elections. And not just elections, of course. I’ve just started hosting monthly letter-writing parties to get my friends and myself to write letters to our representatives and senators. Progressives need to start doing all of this kind of shit in much greater numbers and defeat conservatives with brute strength, not, ironically, brute reason.

I don’t like this. I wish we could all just rationally debate each other until the best ideas won, but that’s very clearly not how the world works. Progressives need to get more comfortable with relying on things like numbers and politics rather than on simply Being Right and feeling good about it.

2. Do our best to educate young people.

Of course, brute strength isn’t a perfect or sustainable solution. As I said, we could’ve avoided a Trump presidency and prevented a lot of harm that way, but the shitty ideas would still be out there, ready to strike at any time. Kinda like Obama being president didn’t end racism.

We need to keep trying to reach young people before they develop a strong tribal conservative identity. That’s very hard to do, because these identities can form early. My 14-year-old brother is a passionate Trump supporter and there’s nothing any of us can do to talk him out of it now. Maybe there could’ve been years ago. Maybe I should’ve tried. But I had no idea this was coming. Now I know exactly what can happen, and how quickly.

(Yeah, yeah, he might “grow out of it” or whatever. But that’s not going to happen through arguments with me. I already tried that.)

These are my two best ideas, but honestly, I’m feeling pretty depressed and cynical about the whole changing-minds project right now so I welcome disagreement on that.

What I’m much more certain of is that however we proceed, we need to do so with as accurate an understanding of conservatives’ perspectives as possible. That means acknowledging their opinions about women, people of color, immigrants, Muslims, LGBTQ people, and people with disabilities.

Pretending that these opinions do not exist and are not a major driver of conservatives’ political behavior isn’t going to do any good. It won’t convince conservatives that they should agree with us because we’re nice to them and don’t make them uncomfortable. It won’t make them vote for someone who wants to do things that they don’t want to happen, like protect abortion access and ensure equal pay for women.

Too much of the commentary about this election has been focused on whether or not Trump supporters are _____-ist, or whether or not you can support Trump without being _____-ist, or how it makes Trump supporters feel to be called _____-ist. For the purposes of this discussion, it doesn’t matter what you call them. They have made their opinions very clear. Are we going to listen?


Brute Reason does not host comments–here’s why.

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

Yes, We Did Fail to Empathize with Conservatives

Deconstructing Jealousy

Note: This is written from my perspective as someone who practices polyamory from a non-hierarchical perspective, so my personal examples are grounded in that experience. You can mentally edit them to apply them to just about any type of relationship, monogamous or poly, romantic or platonic.

I don’t think that “jealousy” is a useful concept. It’s used as an umbrella term for a variety of negative interpersonally-triggered feelings that are actually quite different from each other. Unfortunately, people don’t always realize this and may communicate about “jealousy” without noticing that they’re talking about different things.

Even worse, some of these things are very stigmatized (some deservedly and some less so), which means that labeling anything “jealousy” gives the whole conversation a negative tone. I could imagine telling a partner that I feel upset or angry, but I would never say, “I feel jealous.” Unless my partner is very aware of the concepts I’m about to discuss in this post, telling them this would shut down the conversation and keep it from going anywhere productive. Where it goes from there depends entirely on whether or not my partner says, “Okay, but what does that mean?”

This semantic ambiguity keeps us in a state of confusion about what “jealousy” actually means for us, what is causing it, and how it can be resolved. Every time we feel negatively about someone else having an experience we aren’t sharing, this gets labeled “jealousy”–sometimes when we don’t even want that experience for ourselves!

I’ve identified six different feelings that are often called “jealousy.” There are probably more than that, but I think that most of the time when it feels much more complicated, that’s because you’re feeling more than one of these at once and that can get confusing. I’ve also given the feelings names to make them easier to write about, but I totally admit that most of the names are pretty clunky and imprecise and honestly I don’t know what to do about that other than try to invent new words, which I’m horrible at. If someone wants to take on that project, have at it.

  1. Possessiveness: “I want you all to myself.” / “I should have this, not you.”

Thanks to the way our culture teaches all of us to think about romantic relationships, I spent my adolescence convinced that if someone really loves me, they won’t need anyone else. Sometimes I got irrationally jealous if my boyfriends had close female friends, because I thought I ought to be “enough.” The idea of polyamory would’ve been appalling to me at the time because, honestly, I just didn’t want to share. I didn’t think that anyone else should “get” what I’m “getting.”

This is probably the most toxic form that jealousy takes. Unlike the other five feelings that I’ll discuss, this one places the blame on the other person for “making” you feel jealous by taking more than they “ought” to take, or by having something that you “ought” to have instead.

This is also what many people think of when they think of the word “jealousy,” which causes them to attach a strong negative stigma to a feeling that may or may not originate from possessiveness.

Possible cause: Feeling entitled to all of someone’s romantic/sexual attention, believing yourself more “worthy” of certain things than others, generally having unrealistic ideas about how relationships ought to work

Possible solution: You’ll probably want a therapist for this one, because you’ll need to work on some really deeply-seeded beliefs about people and relationships. In order to stop feeling possessive, you have to really internalize the idea that you are not entitled to anything from anyone, and that just because you’re not the only/central person in someone’s life doesn’t mean the relationship is worthless or they don’t care about you. You deserve good things, but so do other people.

  1. Envy: “I want to have this too.”

I always envy my male partners their relationships with women. While I’m sure it feels anything but easy for them, they aren’t carrying the weight of institutional and internalized homophobia and biphobia and a lifetime of invisibility, of feeling like what you want isn’t even real, valid, or possible. Men have scripts for meeting women and forming relationships with them; women don’t, not really. That’s starting to change, but it didn’t start to change fast enough for me.

So, I will probably never have uncomplicated feelings when the men I’m dating date women. It’s not because I don’t think they should get to do that if I can’t, or even because I’m interested in those specific women. It’s because I wish I could’ve grown up feeling like asking out and being in a relationship with a woman is a normal, totally achievable thing that’s completely valid for me to want. I wish I could’ve grown up with older girls giving me advice on how to ask girls out to prom. I wish that when I met a woman I liked, there was a statistically significant chance that she’s even attracted to people of my gender.

While I’m sometimes envious of female or nonbinary partners dating other women, it’s not quite the same because I know that they’ve had to overcome exactly what I do, or even more. I’m envious but it’s more an envy of awe than of sadness and regret. I envy men in a different way because it’s just so much easier for them, and often they don’t even know it.

Possible cause: Having unmet needs or unfulfilled desires in your own life, especially if you feel like there’s no way for you to meet/fulfill them.

Possible solution: Rather than focusing on the people who have what you want and don’t have, figure out if there are ways to make those things more likely to happen for you too. Reach out to others for advice and support. Learn new skills. Although getting what we want often feels impossible, especially for those of us who struggle with depression, it often isn’t. When it is, a therapist can help you find ways to cope with that grief–and grief is often what it feels like.

  1. Insecurity: “I feel bad about myself, and this reminds me of that.”

Reading or hearing about people’s very serious, very committed relationships frequently triggers my insecurity in a way that others would probably label “jealousy.” But that doesn’t make much sense to me–I don’t really want a relationship like that, at least not at this stage in my life. The problem, though, is that I ultimately believe that I am Bad At Relationships and that I’ll never be able to commit to someone in such a serious and meaningful way, and that I just don’t have the capacity to love someone that way. I also kinda hate myself for how badly I need space and independence, and how much I therefore avoid any enmeshment in my relationships. Seeing evidence that others can do it just reminds me of all my relational failures and makes me feel really, really shitty and down on myself.

Is it jealousy if I don’t even want it, but maybe want to want it, but I’m not even sure if I’d even enjoy it? I dunno. I do know that it’s not as simple as looking at what someone else has and wishing I had it too (or instead). I just want to be “normal.” It has very little to do with those people’s actual relationships and everything to do with my own insecurities that have been around since long before that couple started posting sappy stuff on Facebook.

Possible cause: Having some unresolved negative feelings towards yourself that get kicked up when good things happen to someone else.

Possible solution: Work through those feelings on your own, with a therapist, or with a friend who agrees to be a source of support. Learn how to better align your perception of yourself with reality–there’s a good chance you’re not nearly as bad at Thing as you think. (Yes, this applies to me too.) Do things that make you feel good about yourself, which may or may not have anything to do with the thing you feel bad about. (For instance, I feel good about myself when I write, take long bike rides, cook, and hang out with friends.)

  1. Lacking: “I’m realizing I want/need more time/attention/etc from a particular person.”

Recently I found myself feeling “jealous” of a friend who’d been talking to me about their partner a lot. Specifically, I was “jealous” about the fact that their partner often plans and initiates interesting new activities for them to do together. I quickly realized that the “jealousy” wasn’t because I wanted to be with my friend’s partner, or with my friend, or because I begrudged them those fun things they did together, or because I felt bad about myself, or even because I was missing any particular thing from my life that my friend has. I do fun things too.

But it made me realize that I would really love it if my own partners made more effort to plan interesting new things to do together rather than letting me make the plans, or falling into whatever our default for that particular relationship is. I feel really cared about when someone thinks of a cool thing for us to do and suggests it and, if I agree, makes it happen. And although it does happen for me sometimes, it doesn’t really happen as much as I would like, and it took listening to my friend to realize that.

(Have I communicated that to anyone? Noooo. But at least I know now.)

While for me the feeling was triggered by a friend, the way this often happens is that your partner starts seeing someone new and does more/different things with that new partner, and you realize that you actually haven’t been getting quite what you wanted from this relationship. It may look from the outside like you’re “just jealous” about their new relationship, but it’s not that simple. You’re realizing what your own needs are, and what you’re currently lacking.

What I’ve called lacking is pretty similar to what I’ve called envy, but the difference is that lacking is attached to a specific person/relationship. For instance, I might feel envious because I wish I had a good job like my friend does, but I might feel that my relationship is lacking because I’m not seeing my partner as often as I’d like.

Possible cause: Having some unmet needs in your relationship(s).

Possible solution: Identify what it is that you need and let that person know. If they’re unable to meet that need, decide if you need to end the relationship, work on changing your expectations, or (if appropriate) try to find ways to meet that need in some other way.

  1. Hurt: “I’m not okay with the way this happened.”

Some of my most painful and confusing experiences with “jealousy” were when a partner did something that hurt me, and it happened to involve another partner. For instance, I once had a partner for whom I was their only partner at the time. I mentioned that I had been in a poly discussion group where we talked about such relationships–one of us is seeing multiple people, but the other is seeing only one–and they surprised me with: “Well, actually…I do have another partner.” Record-scratch. That’s how I found out that they’d had another partner for…weeks? Months? And never told me because…reasons? It wasn’t “cheating,” since we didn’t have “rules,” but I was shocked and hurt that given the overall seriousness and commitment of our relationship, they wouldn’t think that that’s an important thing to at least mention.

Honestly, I never felt okay about that other partner after that and I never wanted to hear anything about them. The relationship started to unravel soon after that. It’s not that I didn’t want them to date anyone else–I’d actually spent the whole relationship hoping that they would, so that it’d feel more equal and they’d be able to reach out to someone besides me with those types of relationshippy needs. But I just wasn’t okay with the way it happened. I felt hurt, ignored, overlooked. I kept thinking, “If I’m not someone they’d even talk to about something so awesome that’s happening to them, what sort of relationship even is this?” No longer a very close or healthy one, as it turned out.

This is a huge pitfall for many couples and friends because it’s so easy for the non-”jealous” person to dismiss it as jealousy and have a convenient excuse to ignore the hurt they caused. And it’s not just romantic poly contexts in which it happens! For instance, if a friend cheated on an exam and got a better grade than I got after studying really hard and taking the exam honestly, I’d be pretty upset–not because I’m “jealous” of their higher grade, but because I’m not okay with the way this happened. If a friend started dating someone new and blowing me off to hang out with them instead, I’d be pretty upset–not because I’m “jealous” of their new relationship, but because I’m not okay with the way it’s happening.

Possible cause: Feeling disrespected, ignored, insulted, or otherwise hurt by someone’s actions.

Possible solution: Let the person know how you feel, and/or end the relationship if you feel hurt enough that you no longer want to continue it. Let the person know if there’s anything they can do to repair the hurt.

  1. Disconnection: “I want to reconnect after feeling separated.”

For many poly couples, disconnection and reconnection are part of a normal and healthy cycle. A partner goes on a date with someone new, or flings themselves headfirst into an exciting new relationship, and we feel an ache of (hopefully-temporary) separation. It doesn’t exactly feel good–it may actually feel really sad sometimes–but ideally, it feels okay. This type of “jealousy” is how I might feel waiting for a partner to let me know how a first date went, or accepting that we’re going to see less of each other for a while because they’re getting really invested in someone new and spending lots of time with them.

After feeling that way, it’s normal to want to reconnect with a partner in some way that’s meaningful for both of you. Some people like to see a partner after they get home from a date with someone else (assuming it doesn’t last the whole night, obviously). Sometimes I just need a hug or some reassurance that I still matter. You could write this off as clinginess or insecurity if you want, but I don’t think it is. It’s normal to want to connect with people you love after having been separated or disconnected in some way, even if that separation or disconnection was totally voluntary for both of you.

Possible cause: Feeling separated from your partner because they’ve been doing something else that doesn’t involve you.

Possible solution: Figure out what would be a meaningful way for you to reconnect with them, and ask them to do that. If you want, you could even instate it as a ritual for the two of you.


Obviously this is all very much a work-in-progress, and not all of the feelings I described or the language I used to describe them might resonate with your own experience. In that case, I encourage you to deconstruct “jealousy” for yourself and figure out what it actually means for you so that you can communicate more effectively.

I could probably expand all of those little “solution” bits into full articles, so use those as jumping-off points, not as Complete Certified Therapist Advice.

Also, do not do a Google Image search for “jealousy.” It will be upsetting.


Brute Reason does not host comments–here’s why.

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

Deconstructing Jealousy

How Mental Illness Labels Help

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

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

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

Not everyone agreed.

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

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

Actually, I don’t think I could.

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

Here’s how.

1. Finding Helpful Information About Mental Illness

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

Sounds obvious, right?

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

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

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

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

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

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

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

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

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

Read the rest here.

How Mental Illness Labels Help

A Good Critique of the Medical Model is Hard to Find

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

So, that’s important and deserves highlighting.

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

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

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

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

MY BRAIN IS PART OF MY BODY.

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

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

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

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

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

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

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

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

~~~

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

~~~

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

A Good Critique of the Medical Model is Hard to Find