3 Transition Obstacles I Never Expected as Mentally Ill and Transgender

Originally published at Everyday Feminism.

“I think we need to hold off on this,” the therapist tells me, “until you’re doing a little better.”

My heart dropped. I was stunned, sitting in total silence.

This was the third time I’d been given a red light and told not to proceed with top surgery – a surgery I desperately needed, but struggled to access because of my mental illness.

This was a struggle I knew all too well as both mentally ill and trans – a struggle many of my other transgender friends had never even heard of.

Intersectional feminism tells us that the various aspects of our identity will impact our lived experiences – especially as it relates to power and privilege.

This is true for me as a transgender person who is also white, and thus does not experience racism and benefits from white privilege. I think it’s really important to be mindful of the ways that this impacts how I move through the world – and how I can be a better ally to trans people of color.

I wanted to write this article because, as a trans person with mental illness, I encounter obstacles that trans people without mental illness seldom, if ever, need to worry about.

Issues of access and competence because of my illnesses are a daily struggle – and these are issues that many neurotypical trans people take for granted.

If we’re going to uplift all transgender people, and not just a select few, we need to be mindful of the complex lives we lead – which necessitates an intersectional approach.

And for mentally ill trans people, you’d be surprised by the complexity of our struggles.

Here are three obstacles I never expected, and the real consequences that I’ve had to deal with as a result.

1. My Clinicians Have Interfered with My Access to Hormones

The first time I was hospitalized for mental illness, the psychiatrist said to me, “Have you ever considered stopping the testosterone?”

I was in total shock.

My hormones were suddenly being considered optional, rather than a necessary part of my care as a transgender person. No one seemed to believe me when I said testosterone was not optional, and that not having it would make things worse – not better.

Later that day, when I went to the nurse’s station to receive my medications, my testosterone was nowhere to be found.

“Do you need that?” the nurse asked me. “I don’t think we have that.”

Furious, I had to advocate for myself – demanding that I receive my testosterone and even threatening legal action. My partner then contacted the prescribing physician, who said, defeated, “If they won’t give Sam his hormones, I’m not sure if there’s anything I can do.”

Eventually, I did get my testosterone the following day, despite being discouraged by doctors and nurses alike from taking it. The prospect of being hospitalized under an involuntary hold, with my hormones being left to the whims of a trans-incompetent staff, terrified me.

I’ve never felt so powerless in my entire life.

I wondered how many other mentally ill trans people had this exact experience, and when I started writing publicly about it, I quickly learned that I wasn’t the only one.

A psychiatric hospitalization is meant to stabilize you with competent and compassionate care. But as a transgender person, my experiences taught me that even a so-called “safe space” can re-traumatize us in ways we didn’t think were possible.

While access to hormones can be a struggle for many transgender people, mentally ill trans people are especially vulnerable because we’re assumed to be untrustworthy and unable to determine our own needs.

This is unacceptable. Yet, it happens to mentally ill trans people far too often.

2. I Keep Being Denied Surgery

It’s not a secret that medical transition can be necessary for some transgender people – trans people like me – and that our mental health outcomes are often better when we access the care that we need.

And even though this tends to be the prevailing attitude amongst the majority of clinicians, I still struggle to access surgery because of my psychiatric health.

It becomes a catch-22 for mentally ill trans people: Clinicians want us to be reasonably stable before we access surgery. Yet, many of us can’t be stable until we access those same surgeries.

The fear is that if our mental health is too poor, we will be unable to care for ourselves after surgery, or the stress of a major surgery will trigger a worse episode and fling us into crisis.

While these can be valid concerns, overly cautious clinicians have used these concerns to deny mentally ill trans people their agency and bodily autonomy, resulting in an unbearable limbo in which we spend months, and even years, unable to access surgeries that are necessary for us to be mentally well.

A friend of mine who struggles with schizophrenia and gender dysphoria told me that they fear they may never be able to access surgery, after continually being denied because their clinicians don’t trust them to know what they need and what they can handle.

Accessing surgery can be a tremendous challenge for any transgender person – but mentally ill trans people are at a significant disadvantage, because we’re not believed to be “objective” enough to assess our own needs and priorities.

And the worst part?

This leads trans people to lie to our clinicians about our mental health, or not seek out mental health treatment at all because we fear it will interfere with our transitions.

For example, recently, a blog reader reached out to me to say they desperately need anti-depressants but are fearful of taking them because they’re scared they won’t be able to access surgery if they do.

This is outright dangerous. We’re taking huge gambles with our mental health – and it’s antithetical to why we transition in the first place.

3. My Clinicians Don’t Have the Research They Need to Help Me – Because It Doesn’t Exist

When testosterone led me to start losing my hair at a significant rate, I was prescribed Finasteride (also known as Proscar/Propecia) to help me.

Not much later, I experienced a deep depression that led to suicidal thoughts – and my first psychiatric hospitalization.

I stopped taking Finasteride while in the hospital because the nurses didn’t give it to me. Interestingly, I completely recovered from my depression not long after stopping.

I figured the new psychiatric medications must’ve worked.

Fast forward many months later, when the hair loss started to accelerate. I gave Finasteride another try.

Shortly after, just exactly like before, I experienced a deep depression that led to suicidal thoughts – and was hospitalized for a second time. I was given Finasteride in the hospital this time, and when I was released, I was still hopelessly depressed.

That’s when I started to wonder: With Finasteride messing with my hormonal balance, was it possible that this was the culprit? So I stopped taking it on my own. And to the surprise of my clinicians, the depression and suicidality almost completely subsided within a few days.

My psychiatrists were shocked by how rapidly I recovered when I stopped taking it.

And my prescribing physician admitted that because this is usually prescribed to cisgender men, we don’t have enough research to know for certain what Finasteride might bring up for trans folks – and especially for those with a history of mental illness.

While this side effect was one she hadn’t heard of, she conceded that it was totally possible that Finasteride and I weren’t a good match. “I believe you,” she said.

And she had good reason to. I later found out that we actually have research that links suicidality and depression to Finasteride users, and we have users and loved ones alike who are demanding answers, including a lawsuit alleging that the drug company failed to disclose this as a potential side effect.

But – no surprise – that research still focuses on cisgender men.

We really have no concept of how risky Finasteride could be for trans people, especially mentally ill trans people who could very well be more susceptible.

My clinicians never once considered that the way that Finasteride affected my hormones may, in fact, be affecting my mental health. And because there’s no research or precedent on how to treat patients like me, I have hospital bills and trauma from two hospitalizations that may have been totally preventable.

My clinicians have unanimously urged me to never take Finasteride again.

This is all well and good, but what about the countless other transgender people who are still being prescribed this – especially those with a history of mental illness?

Without proper research, we will never be able to definitively say what the risks are – and trans people, especially those most at risk for mental health struggles, will continue to take drugs like Finasteride without properly knowing what those risks might be.

Hormones and psychiatric medications are so complex, and we have little to no research that tells us how to treat mentally ill trans people.

As such, we receive disjointed care – care that doesn’t take into account the complex interactions between hormones and mental illness.

I’m no doctor, but it terrifies me to know that without setting a precedent for how to holistically care for mentally ill trans people, we may very well be receiving subpar treatment – treatment that could endanger our lives.

***

Every day, I receive e-mails and blog comments from all over the world, with mentally ill trans people asking me what they’ll be up against if they begin their medical transitions.

I can’t say for certain.

For one, we’re all so vastly different, responding to hormones and medications in unique ways. Access and clinical competence also varies widely by geographic location. And, frankly, what little research exists doesn’t help us much.

Here’s what I know for sure: We do face potential challenges and risks that are understudied, and we’re a community that is astonishingly underserved.

I can only speak from personal experience when I say that the terrifying and unjust reality is that our clinicians often don’t know what we’re up against. We’re left to be our own advocates, a position that is both difficult and scary.

And as a feminist, I know, unequivocally, that we deserve better than that.

If we want to be supportive of the transgender community, it’s high time that we take an intersectional approach and start advocating for those most vulnerable among us – mentally ill trans people included.

***

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As a Suicide Attempt Survivor, I’m Still Waiting For Stories of Resilience On TV

Approximately 92-95% of suicide attempts end in survival.

I didn’t know this, though, when I tried to end my life almost eight years ago. I’d only ever heard of stories that ended in death or in hospital beds. I’d only ever seen them as a plot twist on a television program or tragedy porn in the news. To me, people who attempted suicide overwhelmingly ended up in the ground, or on occasion in psych wards, but there was never any life to be lived afterward.

There was never a single story that said to me, “You can survive. And then you can truly live.”

Imagine my surprise, then, when I woke up alone, head pounding, room spinning. There was no point of reference. What do you do when you survive? Where do you go? Later that night, I googled “suicide survivor,” but back then everything I found was for people who’d lost someone – never for someone who’d nearly lost themselves.

I went to bed. I got up the next morning, went to class. When I saw my therapist a few days later, I mentioned it in passing, ashamed of my failure, trying to remain casual and unaffected and distant. She asked me how I felt now and I said I felt nothing. 92-95% failure rate – I know that years later – but in that moment I thought I must be the only one who could fuck up something that should be so straightforward.

Stop your own heart. There must be a thousand different ways to do it. I’ve seen this on television a million times, I told my therapist, teenagers like me who dramatically and precisely erase themselves. She asked me how I did it, and I told her just like a teenager I saw on Dateline. It was supposed to be quick. It was supposed to be simple.

“I don’t know how I messed this up.” My hands curled into two perfect fists.

She asked me if I was going to try again and I told her, “What’s the use?” I was embarrassed. And you can’t 5150 someone who’s too embarrassed to try, who’s treating the whole ordeal like nothing more than a terrible faux pas, something to be forgotten. Someone who isn’t dangerous anymore, just humiliated.

Television, with its drama and sensationalism, didn’t prepare me to live. It didn’t prepare me for the next morning, when my life was still the same as I’d left it.

Television only prepared me for trying. It allowed me to imagine the vindication and justice of succeeding – portraying suicide as triumph, suicide as revenge, suicide as release, suicide as justified, suicide as beautiful tragedy, suicide as an art form, even, as the answer – but it never prepared me to survive, for everything after.

No one told me how to rebuild my life. No one told me how to take the fragmented pieces of myself and thread them back together. I was only taught how to die, and never how to live.

Find me a story of a survivor who’s glad to be one. Give me a survivor who gets their own damn show, where suicide isn’t just a plot twist for shock value but the genuine truth of their struggle.

Give me the 13 Reasons Why of the 92-95% of people who wake up and have to face a world they weren’t expecting to see again, see a reflection they’d already parted ways with.

Give me the stories of teenagers like me whose lives aren’t sensational because of how they died, but instead tremendous because of how they survived, how they lived. Give me more than trauma porn. Give me more than triggers that exploit their traumas – more than the blood in the bathtub, the wailing of the ambulance, the walls of the psych ward.

Give me their full humanity. Give me recovery, give me relapse, give me resilience.

Give me back my humanity. 

There are youth like me who wake up to a spinning room, posed with the question of how they will rebuild. They’re looking for stories like theirs to help them engage with trauma and reimagine their lives – and they’re only finding this in the form of tragedy, revenge, descent.

If the overwhelming majority of us will survive, why do our only representations confine us to madness or death?

Every single day, people like me survive. People like me live, and along the way, discover something worth living for. We grow up, we get older. We find ways to become whole. We’re so much more than our proximity to death and the pain that we’ve held in our bones. And our singular trauma doesn’t exist for the sole purpose of entertaining you, nor is it designed for your consumption.

We’re more than this. We’re larger than this.

When will I get to see a story like mine on the screen? Show me someone who lives. Show me someone who survives and goes on to truly live.

We’re still here. We’re still waiting.

Help me keep Let’s Queer Things Up! radical, accessible, and free. Please consider donating as little as $1 per month to our Patreon Campaign.

We need you. You need you. If you ever need support, please consider the following crisis resources:

The National Suicide Prevention Helpline: 1-800-273-8255
The Trevor Lifeline for LGBTQIA+ youth: 1-866-488-7386
Trans Lifeline: 1-877-565-8860

Or check out my favorite mental health apps at this resource list.

Who is Sam Dylan Finch?

(GUEST POST) This piece is brought to you by the lovely guest author and writing/publishing/feminist extraordinaire, Alaina Leary, who interviewed me for this piece. If you’ve ever wondered who the heck I am or where I came from, these (super thoughtful!) questions are a great introduction. I cried a lot while answering. Which will surprise absolutely no one.

Screen Shot 2017-03-19 at 9.06.01 PMAs a disabled and transgender writer, Sam Dylan Finch is passionate about amplifying the voices of marginalized people, as well as drawing from his lived experience to educate and empower.

Currently, Sam is an editor at RESIST and Social Justice U, and the founder of Let’s Queer Things Up!, a blog exploring the intersections of queerness, feminism, and mental illness. His work has appeared in the New York Times, Huffington Post, Everyday Feminism, The Establishment, Rewire, and many more.

I’ve been following Sam’s work since around 2015, and have watched him talk about mental illness, trauma, recovery, transitioning, gender identity, and feminism on multiple public platforms. I’ve been fortunate to work with Sam in a few professional capacities and have had the pleasure of getting to him know on a personal level, which is an absolute joy, because he radiates the same love and light in his everyday life that he does in his work.

I had a chance to ask Sam some questions about writing, activism, and being radically vulnerable in his work.

AL: How did you get your start in writing and activist work?

SDF: I’ve always been writing, but I actually have been blogging since I was 13 years old! Back in the day, we had Freewebs and shitty graphics and used the font “terminal” a little too much.

I’ve loved blogging for all these years. As a mentally ill and queer youth, being “seen” was extremely powerful, and was critical in my survival. It was the ultimate way to take up space in a society that didn’t otherwise offer me that visibility or validation.

As for my activism, it really began when I was participating in a walk to raise awareness about mental health with NAMI (National Alliance on Mental Illness). I think I was 18 years old at that point?

I was so excited to be visible as a mentally ill person for the first time. But I quickly noticed that the stigma persisted, even there. People signed into the walk with fake names. When cameras flashed, they ducked out of the way or hid behind posters. When the news crews came, many people scattered or ran away.

It was my first real political action of any kind. These were my people, my community. And even in that space, people were afraid. Terrified. Afraid of losing their jobs, afraid of being recognized by family and friends and colleagues, afraid of being seen. And I thought, “This isn’t right. This isn’t the kind of world that I want for mentally ill people.”

Not everyone can be visible. But whatever the personal cost, I promised myself that day that I would be. I haven’t looked back.

AL: A lot of your work has followed your journey—transitioning, being diagnosed with mental illnesses, dealing with your recovery. What has it been like to share yourself so vulnerably and honestly in your writing?

SDF: Recently someone messaged me and told me that, because I’d written so openly about my psychiatric hospitalizations, they had found the courage to admit themselves and get help.

So whenever the trolls try to tell me that no one cares about what I have to say, I remember how it felt to get that message – to know that this person was safe that night and that I played a part in that. Even if this one person was the only one that cared about my words, their survival is worth it to me. Their life is worth that much.

Being so honest in your writing can be scary. It opens you up to criticism and hostility that can wound the most tender parts of you. But it’s also an incredible process, because I get to remind folks that they aren’t alone in their struggles, and in return they remind me that I’m not alone, either. We build community. We build connection. We build strength. We build safety.

Society wants marginalized people to believe that sharing their stories is playing a card, playing the victim, or telling lies. But I believe that being visible as mentally ill and transgender has helped illuminate some important truths. And I hope that it’s made folks in my community feel held and affirmed along the way. I honestly can’t think of anything I’d rather be doing.

AL: What has your journey with intersectional feminism been like? Tell me a little about how you came to find feminism and embrace it.

imageSDF: I found feminism in college. Cue all the groaning about those damn “liberal arts” schools. I double-majored in Anthropology and Women’s & Gender Studies, and that radicalized me. When I realized that my personal struggles were deeply political ones, I started to connect the dots. A lot of folks resent “identity politics” (boohoo for them), but understanding that our lived experiences are shaped by a larger system was mind-blowing and important to me.

My studies taught me the ways in which identity, power, and privilege affect us personally, systematically, culturally. I never looked at anything the same way after that – I never looked at myself the same way again.

In particular – and it’s really important for me to mention her – I wouldn’t be the writer or activist that I am today without Dr. Suzanne Bergeron, who taught my first gender studies course in undergrad and was there every step of the way as I navigated university. As mentally ill and queer, academia was not always a safe place for me, and having a fierce mentor like her is why I was able to succeed despite so many obstacles.

Institutions like universities are not always built with marginalized folks in mind. In fact, when I was a student, we didn’t even have an LGBTQIA+ center on our campus. That’s why mentors are so critically important for the survival of marginalized folks in spaces like universities. I can’t tell you how many times I wanted to drop out, or how many times I showed up for Dr. B’s office hours and had to be talked down. She was so patient.

And that’s what feminism has come to mean for me. It’s not just a philosophical worldview that remains abstract, but a daily practice and a commitment we make to one another. It’s a commitment that we make so that we can resist these systems together and allow marginalized folks to come into their own and truly thrive, especially when these systems aren’t by and for us.

I learned that from her. And I’ve tried to be that person now, like, showing up for folks in my life but also through the public work that I do. I’m trying to carve out space where people like me can show up as themselves, like my mentors did for me.

AL: Has anyone ever reached out to you to tell you how your work has impacted them? What does that feel like?

SDF: Every day. I cry about it. It’s especially intense when it comes from a queer and/or mentally ill youth, because that’s such a difficult and powerless place to be. You know, I was there.

And back in my day… I know, I sound old when I say that, but the world has changed a lot in the last decade. I was never able to find people like me with stories like mine. I genuinely believed that I would never see 18, because I’d never seen an adult like me surviving.

When I started writing publicly in these spaces, the most important thing to me was making sure that young folks who weren’t sure if they could make it would see what might be possible for them. That they could reclaim their power. That they could get older. That there was a future with them in it, maybe even a bright future at that. That you could grow up – like me, severely mentally ill and transgender and traumatized – but still be soft, be brilliant, be alive.

I want that for everyone. That when you reach the end of your rope, you can see other possibilities. You can see them, because you’ve seen someone living them. Someone like you, someone who knows how you feel. I didn’t see those possibilities once upon a time, because I couldn’t find them, and I almost ended my life because of that. So I’m trying to create a world where those possibilities are known, never out of reach, never hard to find.

So when someone tells me that I’ve done that, there’s no way to describe how it feels. There just aren’t words… I’ll never have words to explain what that means to me.

AL: How do you come up with topics for your blog posts and writing you pitch? Where do you draw that inspiration, especially for deeply personal writing?

SDF: My writing just comes from my very messy life! When I started my blog, I wasn’t sure if I’d have a lot to say or how long I could keep it up. But that was a few years ago now, and I haven’t run out of ideas yet.

Being mentally ill, gay, non-binary, and transgender – considering where we are situated historically and culturally, you know, the “transgender tipping point” and the new administration and all that – means that there’s an important place for marginalized communities in the narrative we’re writing about this moment.

And with online media at the center of it all, marginalized folks like me have more power than ever to write that story instead of allowing others to write it for them. That’s the inspiration: making history through our words, to ensure that our lives and our struggles aren’t erased.

AL: What’s the hardest piece you’ve ever written?

Screen Shot 2016-03-05 at 9.51.16 PMSDF: Anything that I’ve written about suicide, to be honest, is the most difficult for me. It’s the most difficult because I know suicidal folks are going to find it, read it, and weigh their options. That feels like an enormous and important responsibility, and I take it very seriously.

Suicide as a topic makes me deeply emotional. I mean, I look at everything I’ve been able to do – and I imagine the other scenario where I never lived to see 18, and everything that might be different otherwise. “Sam Dylan Finch” as a person would’ve never existed. That’s not even a name I had claimed until, I don’t know, four years ago.

My whole body of work, and all the good that it did… you know, there’s an alternative timeline where none of that happened. I can’t even wrap my mind around what that timeline looks like, how many people are affected.

Honestly, I didn’t know I had any potential. Most of my life, I haven’t even had very great self-esteem, because depression can rob you of that. And how many people out there are like me, not even aware of what they’re capable of? So I imagine the collective potential of ALL survivors – everything we could do together, the ways we could shape the world – and the weight of that feels so heavy.

I’ll be honest: I don’t want to lose anyone else to suicide. I understand better than anyone why people end their own lives, but that doesn’t make it any easier to let folks go. Because that’s not just an individual loss, but a collective loss for us all. We’ll never know what you had to offer. We’ll never know what you could’ve done, the life you could’ve led. And whether it was just for you or for all of us, you deserve to know what you were capable of in this life. That matters to me. Survivors matter to me.

When I write about suicide, it’s the hardest thing of all, because I just want to reach through the screen and say, “We need you. You need you.” It’s gut-wrenching. It’s life and death, for real. It will never get easier to write those words, but I also know they’re the most important words that I write.

AL: What do you like about being on the editorial side of the writer/editor relationship, in your past work at Everyday Feminism and your current role at Resist? Is it more satisfying to you to be an editor or a writer?

SDF: I’m always asking myself, “What needs to be said?” And of course, “Do I need to be the one to say it?” If not (as is often the case, because I have my own privileges), I’m doing everything I can to support the folks who are saying it.

That’s why I pursued editing in addition to being a writer – my voice isn’t the only voice that matters, and I want to do everything I can to get diverse voices out into the world. I learn so much through the process. I don’t think I could ever just write or just edit. I see both as critically important work to be doing.

AL: What are some of the things you’d like to accomplish in the next ten years? How do you want to make your mark?

SDF: This interview is making me super emotional. So many feelings.

Because I’m imagining that like, I’ll be 35 in ten years. That sounds young to a lot of people, but when you aren’t used to imagining yourself getting older, it feels immense. I never thought about getting there. And more queer, trans, and mentally ill kiddos are coming up in the world, and they’re going to need folks to show them that they can make it, too. Now more than ever.

This might sound a little dramatic, but in those moments when I can’t live for myself, I live for them. Every time my heart beats, it’s like a signal – it’s like morse code or something – just making sure they know they aren’t the only ones out there.

That’s how I want to make my mark. I want to survive, for all of us. In ten years, twenty years, fifty years. With every beat, telling them: “I’m here, I’m here, I’m here.”

If you want to let Sam know how his work has made a positive impact on you, he’s just relaunched his Patreon campaign, which allows readers to personally connect with him while supporting the very important work that he does!

We need you. You need you. If you ever need support, please consider the following crisis resources:

The National Suicide Prevention Helpline: 1-800-273-8255
The Trevor Lifeline for LGBTQIA+ youth: 1-866-488-7386
Trans Lifeline: 1-877-565-8860

Or check out Sam’s favorite mental health apps at this resource list.

Alaina Leary is an intersectional feminist activist, editor, and publishing professional based in Boston, MA. She is currently a social media assistant for We Need Diverse Books, and is completing her MA in Publishing at Emerson College. Her career focus is on how to increase inclusive, authentic, intersectional representation in the publishing industry. She also edits for several online magazines, including Her Campus, Luna Luna Magazine, Germ Magazine, and Doll Hospital Journal. When she isn’t busy reading, you can find her at the beach or curled up with her girlfriend and their two adopted literary cats. Read her articles here.

Wellbutrin Is My True Love, Top Surgery Is On The Horizon, & Other Life Updates

Screen Shot 2017-03-07 at 5.50.00 PMIt’s been a while since I posted a more “old school” blog post about how things are going! My life has changed so drastically in the last month that it finally feels necessary to share.

So let’s chat!

The photo on the left is a photo of me, one year and three months on testosterone. I was on such a low dose in the beginning that I haven’t made as much progress as I’d like. But so far, I’ve really enjoyed the changes – minus the ridiculous acne and hair loss, which are a little annoying to say the least.

Once upon a time, I wrote about being denied top surgery due to my mental health status. I finally feel safe enough to announce that I’m breezing through the clinical interviews and don’t anticipate being denied again. It’s hard to say when the actual surgery would happen, but I feel hopeful that it’s going to be sooner rather than later.

Speaking of mental health status, things could not be more different than they were before. If my last blog was any indication, you can probably guess that I’m doing really well. But I want to flesh out exactly what’s changed – and what this means for my writing moving forward.

Two months ago, I was hospitalized again.

I was struggling with a depressive episode that I genuinely believed I wouldn’t recover from. I can’t tell you how despondent I was, especially since my previous hospitalization was under a year ago. It was difficult to accept that after everything I went through the first time, I still had not recovered.

This hospitalization was a wakeup call – what I was doing wasn’t working. I had to step away from my editorial role at Everyday Feminism, which was a painful decision for me (and still is). I put my writing on hold, cancelled my speaking gigs, passed up a book deal, and made the decision to commit to my recovery full-time, even if it meant sacrificing my dream job and a lot of the opportunities I worked so hard for.

After the hospitalization, I entered an intensive recovery program, and am now in the process of transitioning into a DBT program. I built a clinical team of therapists and a totally bomb psychiatrist that helped me reassess my diagnoses and treatments.

All of my original diagnoses – bipolar disorder, generalized anxiety disorder, and OCPD – were completely scrapped and replaced with new labels and new treatments. 

I was diagnosed with borderline personality disorder (which explains the misdiagnosis of bipolar, and it’s something I hope to write about soon), a mood disorder of some sort (I’m going to hazard a guess and say it’s just depression), ADHD (which, when finally treated, completely changed my life), and obsessive traits of some kind (potentially OCD, the jury is still out on that one).

We’re also exploring C-PTSD and my therapy has shifted to become more trauma-informed – a trauma history I’ve actually written very little about, because it’s been hard for me to come to terms with it. Incorporating a trauma lens has helped to create a clearer picture of what I’m up against.

It’s a lot, I know. But it also feels a lot more true than what I started with.

I’ve tried to distance myself from being overly-invested in these labels, and refer to the ones that are most useful when I need them. As is often the case with psychiatry, the labels we acquire at the beginning of our journey are not always the ones that stick around – and clinicians can disagree amongst themselves, which has happened to me quite a bit.

But the language actually matters very much from a treatment perspective – the medications I’m being prescribed are radically different from the ones I used to be on for bipolar disorder.

When they stopped treating me for what I don’t have, and started treating me for what I do have, the transformation was like night and day.

We’re no longer sedating the hell out of me. For the first time, I’m being given meds that are also activating – which means my issues with things like depression and ADHD are finally being addressed with amazing results.

For the first time in my life, being cheerful and calm is my default. I’m relentlessly optimistic. I can focus on my work and get things done without the constant hyperactivity and distraction. Obsessions don’t consume 95% of my thoughts.

Agoraphobia no longer confines me to my apartment (I leave every day, sometimes multiple times a day – whereas before I might leave once every two weeks if I was lucky). I’m not suicidal or despairing. I bounce back from stressful situations with ease.

People in my life have remarked on how I seem exactly like myself, and yet totally different in every way.

I even keep a gratitude journal now and I meditate every day – it feels a little gross, to be honest.

I don’t think I realized, when mental illness had a complete hold over my life, how hard I was working to just survive. I didn’t realize how low my quality of life really was. I wasn’t fully conscious of how weighed down I was.

The biggest shock to my system came when we added Wellbutrin to my medication regimen. Suddenly, I could get out of bed. I could go outside. I could get my work done. And I could actually feel excitement, joy, and enthusiasm.

Wellbutrin made me feel fully and totally alive for the first time. I didn’t move through the world with a death wish, passively hoping some freak accident would end it all. I now carried with me a boundless hope and a deep appreciation for myself and my life.

Death used to cross my mind every day. Now, if it ever appears, it’s always an oddity and a visitor, not a permanent fixture.

Before the new diagnoses and medications, I considered myself a shadowy figure trying to nurture a tiny flame. I felt that the gloom and doom was who I was, and that little light within me was my survival instinct, always on the brink of being extinguished.

And then suddenly, I woke up and my world was inverted, flipped inside-out. I was a bright and impossible light. And carefully nestled within me, I was protecting what little darkness was left – holding it carefully, like a small keepsake, to remind me that the darkness will always be a part of me.

Never in my entire life have I felt this way before. I didn’t even know it was possible.

And knowing now that it is, I’m more determined than ever to do this work. I’m committed to mental health advocacy and writing, sharing my story with more urgency than ever, with the hope that my light might make the path a little clearer and the possibilities a little brighter.

And maybe together, we can build a world for mentally ill people that is so bright, we can always find our way back from the darkness.

So now, I rebuild my life into something better, something more sustainable. Hopefully a new job will present itself, the timing being right this time (need to hire a writer or editor? I know a kid, wink wink).

In the meantime, I’ve been writing some of my best work and publishing in new places (I’ll post on Facebook and Twitter as these articles go live!).

I’m making new connections, taking risks, going on adventures, writing my heart out, and most importantly, holding myself in compassion as I discover what it means to be truly living.

I don’t know what’s next. But for the first time, I’m so excited to find out – and whatever it is, good or bad, I know I can handle it. I always knew that I was strong, but this time around, I can actually feel it.

An Open Letter To My Teenage Self (Before You Try To End Your Life)

Dear Teenage Sam,

I want to tell you where I was this morning.

I woke up with the California sunshine peaking through the blinds, falling on my face, colliding with my eyes. You wouldn’t believe how beautiful it is, waking up like that. It’s my favorite way to wake up, and we get to wake up this way every day now.

While I was drinking my coffee, I was curled up on the couch crying. You and I don’t do much crying these days, because you fell in love, moved across the country, and found an antidepressant that helped you to understand what happiness actually feels like.

(We used to cry a lot. You never understood why – but I promise, you will one day.)

I have a brilliant friend who says that recovering from depression is kind of similar to wearing high heels for a long time – that moment when your feet touch the ground, and you remember what walking is supposed to feel like.

When you wiggle your toes, stretch your feet, and remember what solid ground is like underneath you.

This morning I was crying because I finally understood what that really meant.

Put another way:

Yesterday, I lit a lighter by myself for the first time.

We were always afraid of fire, you know, afraid of something catching fire or getting burned. 25 years old, and I’d never made a fire until last night.

(And I think this can account for, at least in part, why you’ve never taken up smoking cigarettes.)

When I held it in my hand, I knew at last what it was like to hold fire. What it was like to glow brightly without getting burned.

And I learned that it wasn’t fire that we were so afraid of – it was the belief that we could never be trusted with something like that. That, given the chance, we would always destroy something good. That we could come so close, and draw so near, but we could never control the fire.

(And I think this can account for, at least in part, why bonfires and fireplaces always frightened you a little.)

But last night, I held the light between my fingers. I watched the flame flickering and dancing in the dark, and I finally understood that I could trust myself again.

Sam, do you understand what I mean?

I mean that, one morning, you will wake up and know what it’s like to move through the world without aching feet, the ground reliable and solid and soft underneath you. And you’ll know joy not just as the absence of pain, but the PRESENCE of something.

Something ecstatic and whole and hopeful that you didn’t know you could feel.

I mean that, one night, you will know what it feels like to be bright and unstoppable and in motion, without fearing what might happen if you get carried away – if you love too hard, if you feel too much, if you trust yourself too deeply. You will love, you will feel, and you will trust with beautiful abandon.

You will know what it’s like to be in awe of yourself, startled but not afraid.

I promise, there will come a morning – tears sliding down like beautiful gems scattered across your cheeks – and you will say underneath your breath, “This is the way I was supposed to feel.”

This moment will be made possible only because you survived.

I can’t stop you from trying. I know that. I know this because I spent many years looking for you behind closed doors, flashbacks deceiving me, trying to spare you before you stopped breathing.

I know this because I remember how desperate you were to end your pain. There wasn’t a single force in the universe that could’ve intervened.

(When you’re older, you’ll become acquainted with emergency rooms, and meet the doctors that will ultimately diagnose and save you.)

I forgave you a long time ago – for this, and all the trauma to follow – from the moment you woke up, as the room spun and closed in all around you and I knew you needed someone to care for you.

You need to be brave. And you were brave, Sam, you have always been brave.

This is a remarkable thing you’ll learn about yourself soon – that you might always struggle with the impulse to hurt yourself, but you will never lose the instinct to care for yourself, stitching up your own wounds.

Surviving is what you do. You will survive this, too.

I know this now, having courageously and stubbornly picked myself up so many times, a lesson I learned from watching you.

***

If you or someone you know are thinking about suicide, you can always call:

Let’s Talk About Self-Sabotage.

Confession: When I’m happy, I freak out.

A blog-reader-turned-bestie (yes, sometimes I befriend y’all in real life because you are lovely human beings) and I were recently talking about this over milkshakes. Being happy is terrifying when you aren’t quite used to it.

You know, that dreaded sense that the other shoe will fall? Yeah. That. It’s the worst.

The pressure of trying to sustain something that we’re not used to can create a lot of stress for us. And we might feel the impulse to self-sabotage, especially when we don’t have the support we need to cope.

Sometimes I even have suicidal thoughts when I’m happy. Do you?

The idea that I’ve peaked, and that I might as well die now while things are still good. It seems like the perfect time. Then I fall down the rabbit hole of, “Am I actually happy if I’m having thoughts like these?” (Save yourself the time: Yes. Suicidal thoughts aren’t exclusively the domain of depression.)

And of course, I don’t know how to explain this to the folks I love – that joy is triggering, because I am so used to that joy being taken away from me.

Mental illness has taught me that happiness is inherently unstable and temporary, that I shouldn’t trust it. That mistrust is the product of repeated trauma. It can make me impulsive, hypersensitive, and fearful. It makes it difficult to be grounded.

And worst of all? It becomes a self-fulfilling prophecy. I start to act out because of that fear, which reinforces the fear itself.

I thought it was just me, until I started talking about it. I actually found that lots of people with mental illness or experiences of trauma have this same mistrust of joy. It can lead us to making some lousy choices – in an attempt to regain control and cope with the fear, we make some misguided decisions and push away the very happiness we’ve so desperately wanted for ourselves.

Sound familiar?

Being happy makes me a little crazy. And if you’ve ever thought you were the only one, I assure you – it’s actually a really common thing.

When you’ve spent years associating happiness with the calm before the storm, it’s no surprise that you might associate joy with a lack of safety. In fact, maybe you find depression or anxiety to be a little safer – because it’s more predictable, something more known to you.

I’m here to tell you, friend, that this is totally understandable. Brains are very malleable things – and trauma can lead us to develop some pretty maladaptive impulses, including the impulse to self-sabotage.

I am the Prince of Self-Sabotage. Happiness absolutely terrifies me. It terrifies me because  it feels like it’s only ever betrayed me. Just when I think that I’ve gotten into a good rhythm, life throws me a curveball and I’m not only depressed again, but also grieving the loss of the stability I thought I’d finally had.

Has happiness betrayed you? If so, it’s no surprise that your first instinct is to push it away.

Recently, I’ve gotten to a good place again. Courtesy of Wellbutrin (quickly becoming a favorite of mine), the most sarcastic/excellent psychiatrist on the planet, the love and support of community, new job prospects that leave me totally ecstatic about what’s to come, and personal growth that surprises and delights me every day.

And of course, cue the terrible thoughts like, “Okay, what gives? When does the other shoe drop?” and even, “I kind of feel like taking a chainsaw and splitting myself in half” (to which my psychiatrist asks me, “Um, do you have access to a chainsaw?” Fear not, Doc. No, I do not).

What’s a kid to do? Well, in my opinion, it starts with just acknowledging that happiness is scary, and that’s 100% okay.

Sounds deceptively simple. But you and I both know this is easier said than done. I have to remind myself of this fifty times a day – that there isn’t a disaster waiting for me around every corner. I have to remind myself that I’ve been conditioned overtime to believe that happiness isn’t safe, but that doesn’t make it true.

It’s also good to check in with myself about how I’m dealing with that stress. Am I reaching out for support from a therapist and/or friend? Am I talking about my fears or ignoring them? Am I staying busy? Am I taking care of myself?

I’m a big fan lately of guided meditation when I’m not feeling so grounded. More specifically, there’s this app that I can’t shut up about called Stop, Breathe & Think, which recommends a few meditations (and even yoga videos!) based on your emotions (imagine, like, a self-care mood ring).

You tell it how you’re feeling, and it makes custom recommendations for you. When I find myself freaking out – like my skin is crawling or I’m claustrophobic in my own body – it’s the perfect thing. (Nope, they didn’t ask for the plug – I just love and appreciate them that much.)

A lot of people believe that self-care is only crucial when you’re in a bad place. But I’ve found that self-care is absolutely critical when I’m happy – because the moment I’ve stopped prioritizing my mental health is when I’m actually most vulnerable.

Let me repeat that, because it’s super important: The moment I’ve stopped prioritizing my mental health is when I’m most vulnerable.

Got it?

I know it might seem counterintuitive to reach out for help when you’re happy, of all things, but it can be very necessary if your happiness is a stressor.

And this is a process, of course, one that I know will be ongoing throughout my life. But it helps to know that I’m not alone. And I hope that this reminder can be helpful to you, too.

When we start seeing happiness as a completely understandable trigger and learn to be gentle with ourselves, instead of letting trauma dictate how we should respond, we can start to do the really important work of recovery and healing – which is absolutely something each and every one of us deserves. Yourself included.

Please Keep Inviting Me To Brunch

I don’t know, in actuality, what it’s like to be set on fire.

The closest thing I have – which I am convinced must be similar to burning alive – is my most recent bout of depression, in which I was in such agonizing and relentless pain that I became the emotional equivalent of a rotisserie chicken.

I felt certain that this would be the episode that pushed me to end my life. And then before I knew it, I was in the emergency room (again).

I had spent the weeks leading up to my hospitalization confined to my bed, promising my friends that tomorrow would be the day I found the strength to stand up – responding to Facebook invitations with a “maybe” and the determination that, yes, I would be at that brunch, I would bring orange juice, I would get better.

But I couldn’t.

Movie nights and picnics and parties flew by without me, the photos popping up on my news feed as a reminder that being mentally ill sometimes meant being trapped, no matter how desperately I wanted to see people, to make connections. Each passing day became a struggle to remember what it felt like to have fun, much less to be seen.

I sent the same message in various permutations: “I’m sorry I can’t make it – I’m just too depressed.” “I’m sorry to bail at the last second, I just don’t have it in me.” “I’m sorry I’m such a flake, my anxiety is just bananas right now.”

I always hoped they could read between the lines, knowing that what I was really saying was, “Please don’t give up on me.”

Every invitation I rejected came with a silent, desperate plea of, “Please don’t let this be the last time you invite me.”

Because the truth is, even though I’d missed ten brunches and six birthday parties and countless invitations for drinks, I didn’t want them to stop inviting me. Their invitation meant that they knew I was still alive, that they still cared about me, that they wanted me to be there, that they were thinking of me.

And what depressed person – or any person, really – doesn’t want to be thought of? Especially in their darkest, most frightening place.

“Maybe” to some is an annoyance or a cop-out when you don’t want to say “no,” but for me, when I RSVP’d with “maybe,” it was my way of saying, “I still have hope that things could get better.”

On the other side of all this, I needed to know there was a life filled with friends and laughter and waffles, and that everyone was just waiting for me, for whenever I was finally ready.

When I left the hospital, those invites were the only thing that reminded me that I could have a “normal” life again.

Those invites said to me that my mental illness didn’t make me less valuable as a friend, less wanted as a companion, and less worthy of support, love, and delicious breakfast foods. I was wanted – not in spite of my illnesses, but exactly as I was. No matter what my struggles looked like, I was still wanted.

I wasn’t damaged goods. I was still… me.

This past Sunday, I got out of bed, took a shower, got on the bus, and finally showed up for brunch. It took countless doctors, a complete overhaul of medication and hormones, and of course, the sweet encouragement of good friends (new and old) to get me there.

But I made it.

It was my first taste of the outside world in a long, long time – and I didn’t realize how much I needed it. The donuts, the video games, the orange juice, and the fluttery feeling in my heart when someone would say that they were glad that I was there, and I could feel how much they meant it.

Because while it’s true that psychiatric interventions have, more or less, put out the fire and tamed my depression, it was being surrounded by good friends that made me finally believe that I could heal.

And with every new invitation, I’m reminded that there are things (and people) worth showing up for.

As it turns out, there’s been no better combination for me than Zoloft and brunch.