Category: Mental Health

Thoughts on My Will (With a Capital W)

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My psychodynamic therapy journey has focused a lot on my Will. Will is defined, by my therapist, as what I want, but in a way that truly benefits me. It’s not just doing whatever I feel like; it’s doing what’s best for me personally and what matches my true self.

Through a process of questioning, we came to the hard-to-hear conclusion that most of the things that I do, I do to please my abusers. Of course, I don’t do everything my parents would want, to the letter. (After all, I am transgender– my parents are definitely weird about that.)

But yes, this includes my getting better journey. I go to therapy and try my damnedest because I know my parents want me to be more functional and “normal.” (But what kind of a goal is that?)

After therapy, I was given the homework of listening to my body for when it says “yes” to something. It doesn’t happen super often, and my “no” is much louder, but it did happen a few times over the course of the week.

One of the rather strange things I discovered is that I want to do witchcraft relating to bees. I love bees, guys!

This whole thing is actually great news to me. Now that I’ve realized I do so many things in service to my parents, I can start figuring out what I truly want. I am excited to discover more about myself!

Self Care as Bowling Bumpers

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The other day in therapy I came across a metaphor.

Doing self care (like eating regularly, staying hydrated, taking your meds on time, and resting) is like having the bumpers up when you’re bowling. If you go off course and bounce a little, it’s not a big deal.

I used to wait so long to eat that I was incapable of preparing something, so I would sit on the kitchen floor and cry until someone came across me and rescued me by making me a sandwich.

Now, if I wait a little too long to eat, the rest of my self care shores me up and I am capable of making myself something (or asking for help).

Doing the absolute most to take care of yourself will pay off in the moments that you falter.

What Defines Mental Health?

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I spend a lot of time thinking and writing about mental health, so I should be an expert by now, right? Mainly I troubleshoot and problem-solve, but what am I trying to achieve? What state of mental health do I strive for? What does mental health even mean?

Let’s start with what mental health is NOT.

-Obviously, it’s unrealistic to expect to be happy and joyful all the time, even though that would be nice. Maintaining perfect happiness is impossible, and therefore not the definition of mental health.

-Even though people with mental illnesses are often considered “strange” by society, mental health certainly doesn’t mean conforming to what is expected of us— in fact, that’s a fast track to mental illness.

-We also can’t strive to be totally and 100% ourselves, as many of our baser instincts must be tempered for the good of the people around us.

The definition of mental health, to me, is emotional flexibility. It’s being happy when there’s a personal reason to be happy and being sad when there’s a personal reason to be sad, and likewise for anger. These reasons may be very unique and not sanctioned by society (many of my happy-making interests are non-standard or “weird”) but they are valid reasons nonetheless, and shaped by a person’s history and personality.

Often, my emotions aren’t flexible. I was so depressed throughout my childhood and adolescence that I first felt happiness, first felt a positive feeling at all, at age 22. That would be enough to qualify many times over for “bad mental health,” but instead of feeling hopeful about the future, the experience left me even more depressed. I was suicidal in the weeks afterwards because I couldn’t fathom that other people got to feel that way much, much more frequently. They weren’t dying inside at their own birthday parties, blowing out the candles and wishing for an end to it all. They weren’t self-harming to get through the day. They weren’t hiding their emotions until they could be alone to cry. By comparison, my first taste of positivity felt like a gift from the divine.

(Even in Bipolar Disorder, emotions aren’t flexible more than the phase that person is in. If they’re manic, they’re going to interpret every event through the lens of their mania. If they’re depressed, their outlook will be depressed too. Borderline Personality Disorder, also famous for emotional highs and lows, is not true flexibility either— many times, people with BPD experience distorted emotions that are way off base for the situation, either in scope or in type.)

Now, as I get healthier, I experience happiness more often. I’m also learning to welcome sadness and anger. I’m no longer depressed 100% of the time. I’m striving towards emotional flexibility, and I’m getting there!

There is no such thing as mutual abuse.

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There is no such thing as mutual abuse.

Abuse is a non-consensual power imbalance. The Domestic Violence Hotline defines domestic violence thus: “a pattern of behaviors used to gain or maintain power and control.” This pattern of behaviors (which may include coercion, threats, intimidation, and isolation, among other tactics) is not exclusive to any one gender, though abusive dynamics often mirror social privilege norms (which I will address in a forthcoming post).

There is, however, DEFINITELY such a thing as mutual toxicity. Often in relationships where one person has power over the other, neither are perfect. Either person may have been or currently be toxic in their other relationships, and engage in many unhealthy behaviors.

Two people cannot abuse each other, however, because abuse is about having power over another person in a way that they did not consent to.

This may seem like a matter of semantics, but often abusers will say things like “You’re abusing me too!” after survivors push back on the control being exerted on them.

When I was first looking into the matter of abusive relationships, it was to support a close friend who had just left one. She had me read Lundy Bancroft’s Why Does He Do That? and I was rendered very uncomfortable. Many of the behaviors were things that I had done— that one time I slapped my partner when he was transphobic to me? Telling someone honestly that I thought I might kill myself if they left me?

It was only after quite a bit of introspection (and support from aforementioned friend) that I realized that I was the one being abused. Besides the individual behaviors that one or each of us engaged in, the overall dynamic of the relationship leaned heavily in his favor. He got what he wanted, and I didn’t.

Years later, I found out this was a pattern, and that he had been doing all of it on purpose. The moment of clarity was crystal clear and razor sharp– I had barely avoided serious bodily harm in the four years we were together. After that revelation, I never doubted that all along I was just an unhealthy person trying my damnedest to be heard.

If you are in an unhealthy dynamic, please remember this. No one can tell from outside a relationship who is abusive and who isn’t, but there is ALWAYS hope to leave and/or to change.

Just Show Up

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If you struggle with anxiety, overwhelm, or just plain feeling like a failure, I have a mantra for you that’s been really helping me out lately:

Just show up.

My biggest problem has always been depression. I’ve had to acknowledge that I am disabled by my mental health problems, and for an honor-roll student, that was often a struggle to accept.

In college, I used to skip class almost every day because the whole process was so overwhelming to my depressed and anxious brain: I had to get dressed in something clean (even though I never had the energy to do laundry), walk the 45 minutes to school, sit in class for up to three hours, PLUS pay attention, take notes, participate in discussion, and end up with an A at the end of the semester.

I didn’t realize that I was being a perfectionist, and life would have been a lot easier for me if I had Just Shown Up. By staying home because of my depression and anxiety, I wasn’t giving myself the chance to meet any of the expectations I had saddled myself with. I was so stressed out about being a “bad” or average student that I stopped being a student at all.

The Just Show Up philosophy isn’t the same as lowering your standards. You’re not suddenly off the hook for all your responsibilities. Instead, this is a mantra that will help you stay realistic and grounded. By Just Showing Up, you’re giving yourself the opportunity to grow and do your best without enforcing any of the guilt, overwhelm, or anxiety that comes along with expecting perfection at all times. Don’t think too far ahead. Just put on your shoes and Show Up.

The great thing about Just Show Up is that once you do, you will often find yourself doing quite well anyways– it’s something that you were capable of all along, but were too keyed up (or otherwise symptomatic) to envision. If you really can’t do a particular task, then at least you did something just by showing up. Think of all your activities like an hourly job: if you’re there, you get paid, even if you’re not always meeting your too-high expectations. People can’t be “on” all the time, and the Just Show Up philosophy recognizes that without letting bad behavior slide. In other words, nobody’s perfect.

Often, when I would apply Just Show Up and go to my college classes– sometimes in my pajamas– I would find that I was interested enough in the material to pay attention and take some notes. I was passionate enough about the topics to participate in the discussion. At the very least, I didn’t get points off my grade for another absence. Sure, I spent some time doodling due to attention span issues, but for the most part, I had succeeded just as well as the other students. I had minimized the task in my head from a mountain to a molehill. I didn’t overwhelm myself. I did exactly what I was capable of at that moment.

If you’re having trouble getting something done, Just Show Up. You don’t have to be employee of the month. You don’t have to be valedictorian. Just Show Up.

12 Ways Technology Can Hack Your Brain

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We’ve often heard the negative ways that technology can affect our mental health. For example, studies have shown that spending too much time on Facebook and comparing your life (and body) to those of others can cause or exacerbate depression– and most of us are constantly aware how much faster (and more stressful) life has gotten with the advent of the smartphone.

However, in my experience, the internet is full of wonderful, easy-to-use tools for you to work on your recovery. Here are some resources that I’ve found that can make technology work for you and your mental health.

  1. Social media. Facebook, Twitter, and Tumblr all have amazing recovery communities full of wisdom and insight. You can start with one page or blog and, by tracing what they share, find tons of other pages/blogs to follow.
  2. You Feel Like Shit. You Feel Like Shit is a game-like self care guide that you can play through if you’re feeling bad. It asks questions and then gives recommendations based on your answers, including suggestions like playing with pets and drinking a glass of water.
  3. Psychoeducation. Just learning about your symptoms can be a huge breakthrough and there’s tons of information about every disorder on the internet. If you have a diagnosis, start by learning the basics and then look up your symptoms for more specific information.
  4. To-do apps. If you struggle with stress caused by disorganization, to-do apps can change your life. I am personally a proponent of the Bullet Journal, but I recognize that it does have its flaws. (In particular, a paper journal cannot provide reminder alarms.)
  5. Online DBT courses. Dialectical Behavior Therapy, which was designed for people with Borderline Personality Disorder, is a selection of skills usually taught in a classroom-like setting. However, not everyone has the time for three-hour classes twice a week, even if they could really benefit from the material. Instead, try DBT Peer Connections, a YouTube channel made by a peer who wanted to bring DBT to the masses.
  6. Guided meditation audio. Meditation, and the mindfulness that results, is a super important aspect of self care. With its budding popularity, there are tons of guided meditations out there for every use under the sun. You can find free meditation audio on YouTube, but if you’re into apps, Calm might be a great choice for you.
  7. Communication apps. Regularly keep in touch with friends and loved ones who can help when you’re feeling down. You can use text messenger services (like Facebook Messenger) or video chat (like Skype)– either way, having a strong support system can make a difference in your mental health.
  8. Woebot. Woebot is a robot that will help you with your woes. Using Cognitive Behavioral Therapy techniques, Woebot will respond intelligently to your messages and help you work on your mental health a day at a time. Woebot has Android and iOS apps, but you can also message it with Facebook Messenger.
  9. Food trackers. Here we have to tread carefully: apps that help you lose weight are not going to do anything for your mental health and may, in fact, harm it. However, apps that help you get enough nutrition to keep your body running at its best will help you a lot, especially if you have a history of disordered eating. Some will even help you deal with urges to engage in disordered eating behavior. Some examples include RR Eating Disorder Management and Rise Up: Eating Disorder Help.
  10. Mood trackers. Mood trackers can be particularly helpful when you’re gathering evidence so you can be diagnosed by a professional. Instead of guessing how many days a month you feel depressed, for example, you can have hard evidence.
  11. Journal apps. Some of us, for better or worse, are glued to our phones. If a paper journal isn’t for you, you can always download a good journal app to talk out your feelings and record your insights. Paper journaling has been shown to increase mindfulness, but apps are more portable, giving you the opportunity to write at any time. If you’d like to keep a digital journal, try something designed for long-form writing like the Journey app.
  12. Mental health games. Many app creators have taken the concept of gamification and applied it to mental health. Apps like SuperBetter or Habitica take your day-to-day activities and turn them into a game complete with achievements and rewards. If you’re a video game junkie, you can redirect your urge to win into meeting real-life goals.

Do you know of any other ways technology can help mental health? Share with us in the comments below!

Self-Love for Dissociation

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I realized recently that for me the answer to my chronic dissociation is NOT traditional grounding activities, but rather working on maintaining an attitude of self-love– and it has been really successful!

(While some may criticize my thought process as being overly medical, I conceptualize my new realization as Unconditional Positive Regard For The Self. Unconditional Positive Regard (UPR) is a therapy concept pioneered by humanist psychologist Carl Rogers in the middle of the twentieth century. It basically means having an attitude of acceptance and caring towards your therapy clients no matter what. This does NOT mean approving of all their actions, but rather holding them in high esteem regardless of what they’re going through. I find this conceptualization to be more specific and actionable, but you can just call it self-love if you want!)

For some background, I have dissociated severely, 99% of the time, since a depersonalization-based mental breakdown at age 14. Part of the reason for this is that existing in my body feels bad. It’s hard to describe, but it’s like a visceral sense of sickness, including achiness and fatigue. (I have wavered back and forth on whether this is a chronic physical illness or more psychological in nature, but it’s such a vague complaint that I never know how to describe it to a doctor. Plus, the fact that I’ve found a psychological approach to be helpful means that it’s probably my brain!)

Grounding exercises don’t work for me because they end up just shocking my system into further dissociation. This has always been true and it made me feel hopeless about my symptoms because 5-4-3-2-1 and holding ice cubes (etc) are regarded as the ONLY solution for dissociation.

Instead, maintaining a loving attitude towards myself during daily life (independent of any particular self-care activities) is really helping! It’s hard to describe what this means exactly— I just kind of maintain an attitude of pleasant openness to myself. Even though self-caring actions and thoughts almost always come as a result, the basic concept doesn’t involve anything besides the attitude.

This approach of maintaining self-love makes it way more pleasant to be in my body, so I don’t dissociate nearly as much! Try it if you like!

How to Help Someone With Self Harm

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The common mental health problem of self-harm is often dramatized and sensationalized to the point where people aren’t sure what to even think about it. Therefore, many people deal with the self-harm of others in a way that’s not constructive for anyone involved.

If someone has come to you about their self-harm, the following is a guide on how to handle it as a friend or family member. You can do more than you may think!

First, some points:

  • If someone talks to you about their self-harm, or shows you the results, try not to express disgust. It may be a natural response, especially if you’re squeamish about gore, but many people who self-harm already feel awful about their bodies and/or their self-harm problem. Don’t give them another reason to feel ashamed. If you’re truly freaked out by what you’re seeing, excuse yourself, shake it off as best you can, and then come back and deal with the situation.
  • Related: don’t guilt trip. Making someone feel even worse about something they did is not a sure-fire way to prevent it in the future, especially when it comes to a distress-related behavior like self-harm.
  • Self-harm is actually not closely linked to suicide. This means that self-harm, no matter how severe, is usually distinct from a suicide attempt. Don’t panic, and don’t automatically assume that the other person is suicidal.
  • Self-harm is a sign of ineffective coping strategies, but it’s actually not really a problem in itself. It’s a self-regulatory symptom of a larger problem. To put it another way, no one self harms without a pressing reason. Most people react to self-harm by trying to police the behavior and/or telling someone why they shouldn’t self-harm. Instead, it’s more effective to deal with the reasons that someone self-harms. It will go away on its own with proper mental health treatment/recovery.

Here’s a concrete guide on how to deal with someone else’s self-harm: 

  1. Your first step should be assessing the need for medical attention. If they haven’t already shown you, ask to see what they did so you can try to tell what they need physically. You may need to take them to the emergency room, or you may just need some Neosporin. 
  2. Then, try to deal with the reason(s) they self-harmed. People self-harm for many reasons, but it’s generally a way of calming down in the face of extreme stress. Maybe they do it to punish themselves or to feel less numb, but it has actual chemical benefits. Self-harm calms the nervous system by releasing feel-good endorphins. It’s not just senseless self-violence, as much as it may seem that way to someone who hasn’t personally experienced the problem. So see what you can do for them. Shift the attention from the self-harm behavior and discuss what made them do it in the first place. Maybe they got a bad grade on a test and need a tutor to get back on track. Maybe they need to express themselves about being sexually assaulted. If they’ve come to you with their self-harm, they trust you, so see what practical steps you can take to help them.
  3. If you feel it is necessary, see what you can do to help them with their self-harm problem in general. This is a good opportunity to see if they need any concrete help in their recovery. For example, they may need rides to therapy appointments or they may want you to take their self-harm tools away from them.
  4. If someone comes to you for help avoiding imminent self-harm, congratulate them (because it’s hard to reach out for help with a behavior that is often shamed!) and then provide some constructive distractions. Remember that everyone has a fundamental need for connection in the face of negative emotions, and do something WITH them. Go get ice cream, watch a movie together, or even just stay on the phone with them. (Distraction is a good fallback strategy, but don’t forget that if they would rather talk about what’s on their mind, you should let them. Engage with them about their feelings in an empowering way and you can do a lot of good!)

The above would be the ideal situation, in which everything went smoothly and in the best interests of the person who self-harmed. However, if you’re reading this, it’s very likely that you already had your initial reaction and something different happened. What do you do next?

If you handled someone’s admission of self-harm badly, go back to them and apologize. We can’t deal openly with mental health problems and their stigma by avoiding the topic.

Once you’ve apologized, then go back and use the guide above for taking next steps.

On Distraction and Ableism

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There’s an attitude– and it’s a subtle one– that mentally ill people are doing something wrong. Even among otherwise understanding professionals and loved ones, there’s an idea that if mentally ill people would just learn to think correctly, like everyone else, they wouldn’t be mentally ill anymore.

This idea has its basis in the benefits of skills training. Of course, practicing self-care skills, good habits, and programs like DBT can lead to more resilience. I’m not arguing that there’s nothing that mentally ill people can do to improve. The issue is that people who aren’t mentally ill think that the same things will work for everyone.

The example I’ve encountered recently is the matter of distraction. Neurotypical professionals recommend this highly as a temporary strategy for halting a spiral, not understanding that sometimes it’s impossible. For mentally ill people, our feelings don’t necessarily have anything to do with our external circumstances– for neurotypicals, they usually do. Therefore, a spiral can continue even if our external circumstances are removed from the original trigger. When you’re mentally ill, your feelings are deeper and last much longer.

I know this because I am now (more or less) properly medicated. Things work now that didn’t before, because my chemicals are on a more even keel. I was amazed to find that now, I don’t have crises that last for weeks because of a thought that I had. Instead, my feelings are reactions to my environment and nothing more. While sometimes a bad mood can last a few hours or something can make me deeply uncomfortable, it lifts within a day or two. This was not true, and not possible, before my brain was more straightened out.

My emetophobia was triggered twice in one day recently, and because of all the work I’ve done managing my brain and stabilizing my chemicals, distraction finally worked for the first time. I gently redirected my focus and felt much calmer. I was amazed at how easy it was. Of course, it wasn’t that I had never tried distraction before, or had been doing it ineffectively– the difference was that my brain chemicals were much more cooperative than they had been.

I find this is often the case with breathing techniques and meditation as well. Obviously they work for some mentally ill people, but if they don’t, it’s not because someone is doing something wrong or not trying. It’s just not the right technique, or it’s not effective enough. I want every other mentally ill person to know that if your brain isn’t working like you want it to, it isn’t your fault. It isn’t a personal failing. While there are actions you can take to heal yourself, it’s not a matter of willing yourself into health.

Review: The PTSD Workbook by Mary Beth Williams

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The PTSD Workbook by Mary Beth Williams (second edition) is an interactive journey through trauma recovery backed up by science and personal wisdom. It largely conforms to other works about trauma I have read, especially Judith Herman’s ideas about the three phases of trauma recovery.

I was super excited to dive in and do all of the activities. However, the workbook quickly lost my trust, though I continued to read through it in the hopes of gleaning some sort of wisdom. This is a very good workbook that I believe could help many people– with one small revision.

On page 25, there is an exercise about “My Trauma-Related Beliefs.” Readers are invited to think and write about the subconscious beliefs that trauma has given them and explore how true they are. The first example is “I believe I am a victim and that my troubles are the fault of others.” Readers are invited to think about whether that belief has determined their course of action in the past, with the assumption that they will work on revising it once they have had it pointed out. In this example, it’s a failure of personal responsibility to say that all of your troubles are someone else’s fault, even if people never deserve to be traumatized.

The second example is where I have an issue. The belief reads: “I believe that I can’t do things– that I am physically or emotionally incapable of doing them.” To give Williams the benefit of the doubt, I can see how learned helplessness could be a real problem that some people have and need to learn how to deal with. However, it continues in parentheses: “By the way, be aware that ‘I can’t’ generally means ‘I won’t’ or ‘I don’t want to.’ ‘I can’t‘ is really a statement of refusal.”

What?!

Psychological disabilities are real, just like physical ones. If someone can’t walk, they can’t walk. If someone can’t grocery shop, for example, they can’t grocery shop.

Let’s take the grocery shopping example further. Obviously, the person in question with a psychological disability (like PTSD) COULD go through the physical motions of going to the grocery store. Some people in wheelchairs CAN walk. However, the health consequences associated with completing that action will often make it not worth it. A wheelchair user, who can walk under very specific circumstances and/or for short times, would still suffer if you took their wheelchair away. They may be in severe pain or fall and injure themselves. Likewise, someone who “can’t” go to the grocery store may know that they will have a panic attack or exhaust themselves if they do, which are both examples of significant suffering that makes the activity not worthwhile. Just because they are technically capable of doing something that someone without a disability could do, it doesn’t mean that it would be good or healthy for them to do it.

You may have heard of “spoons,” or “spoon theory.” It’s not a metaphor that I love, since I prefer more common-sense units like “batteries,” but it’s worth mentioning since it’s spawned an entire subculture. “Spoons” are the measurement of energy or ability a physically or psychologically disabled person has. While they’re not usually easily measurable in exact numbers, a “spoonie” who uses the spoon theory to talk about their illness may start out the day with a finite number of “spoons.” Each activity, depending on how challenging it is to complete, depletes (or sometimes replenishes) spoons. For example, taking a shower might be lots of spoons for someone, while a healthy person would barely notice the amount of energy it takes. A spoonie who is completely exhausted and needs to rest is said to be “out of spoons.” Pushing past this limit, while sometimes possible, tends to result in longer recovery times and lots of suffering.

Part of the implication in the workbook was that people often decide they “can’t” do things just because they don’t want to do them. I can understand why people feel this to be true. There are a few reasons for this.

One, people with disabilities often have to choose carefully what activities have room in their lives due to limited ability or spoons. They may prioritize beloved hobbies or time with family and friends over, for example, doing the dishes, because they can’t do both. This can look like they’re making excuses because they don’t want to do something. In reality, they are trying to take care of themselves by making sure their lives include meaningful activities.

Secondly, unpleasant activities often take more spoons just BECAUSE they are unpleasant. It’s like feeling sleepy during and/or after a boring meeting– the properties of the event or activity make it harder to deal with. It’s not laziness or oppositionality or babying ourselves– it’s a genuine result of symptoms that everyone with a disability understands, but those who don’t have one might not.

When dealing with disabled people (either others or yourself) please understand that disability really does mean that there are some things a person can’t do.

Note: there is a lot of ableism surrounding physical disabilities as well as psychological ones. It just isn’t true that physical disabilities are as widely understood as many psychological disability activists believe. I don’t mean to imply that anything else is the case through my comparisons, but I do feel that often physical disabilities are easier for people to imagine and empathize with than psychological ones.