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.

5 Signs It Was Time For Rehab (Regardless of How Much I Was Drinking)

In seven days, I went from being sober for eight months to sitting in a chemical dependency center after a relapse, being evaluated for a potential outpatient rehab program.

I remember the bitterness and resentment that I felt as I exhaled into a breathalyzer until it clicked, sitting motionless as the nurse asked me what I meant by a glass of wine – big glasses? Small glasses?

I remember saying repeatedly – to anyone that would listen – that I couldn’t be an alcoholic because comparatively, I didn’t drink as excessively as an alcoholic should (whatever that means).

And no matter how many times I was diagnosed with a substance use disorder or gently told I needed help, I’d stamp my foot and insist that getting drunk with some regularity didn’t make it a problem.

And maybe it doesn’t. But there were a hell of a lot of other red flags that did make it a problem.

Substance abuse exists on a wide spectrum, and I’m a big believer that no two people struggling with it will look exactly alike.

But some narratives perpetuate the idea that substance abuse is simply using excessively and using often – and while these can be indicators of a problem, they are by no means the be-all and end-all of substance abuse.

I certainly got drunk and maybe more often than I should have, but that’s not why I made the decision to enter rehab. Here are five signs that helped me realize I needed support – regardless of how many drinks I had in a night.

1. My Drinking Became More Important Than The Consequences

In a single week of relapsing, I’d managed to jeopardize my employment, my relationships, my health and my sanity (including stopping my psychiatric medications because they didn’t mix well with booze).

And at the end of a night, sobering up, I was absolutely ready to do it the next day – even as I watched my job crumble, grieved as the people I loved distanced themselves from me, risked legal troubles (drinking in public, FYI, is a terrible idea), and lost my mind as my bipolar disorder started to seize hold of me again.

I had rapidly gotten to a point with my drinking where the potential consequences didn’t matter, even if it might kill me. Somehow, drinking had become more important – and I started to wonder why this substance had so much control over me.

When I talked about this with a therapist specializing in substance use, she simply looked at me and said, “I see what you’ve lost. What else are you willing to lose?”

2. I Repeatedly Compromised My Values

I’m not a liar. At least, when I’m sober I’m not a liar. When I’m not sober, I’m willing to lie straight to my partner’s face as I’m walking out of the door to the liquor store.

I try to be fair, caring, considerate. I love my friends to pieces and would never want to hurt them. But like a tornado, I willingly create chaos and fear for my loved ones when I binge. Everyone in my path has to endure a lot of pain as they try to protect me or push me away.

I put them in an impossible position again, and again, and again.

I love my job. At least, sober Sam does. But drinking Sam will miss entire days of work and blow past deadlines with complete and total numbness, leaving others to clean up the mess.

I think about who I am when I’m sober, and I think about who I am when I’m drinking, and I see all the ways my values don’t line up. The ways in which I can be selfish, hurtful, and deceptive.

And even knowing all this, I desperately still want to drink.

That sounds like a problem to me.

3. I Dehumanized Other Addicts (Because I Wasn’t ‘Like Them’)

The stigma around addiction is so real, and I found that even as someone with social justice values and ideals, I treated other addicts like shit.

I may not have the healthiest relationship with alcohol, but I’m not like them.

I don’t belong in rehab, I won’t be able to relate to these people.

This place is for addicts, not for someone like me.

I continually employed an “us versus them” mentality, othering people who struggle with substance abuse in an attempt to elevate myself as being better than, above, or more enlightened.

In my denial, I treated addicts as categorically subhuman – people I could never relate to, understand, or have empathy for. The further I distanced myself from them, the more secure I felt in my substance use.

Ever heard the phrase “thou doth protest too much”? I spent so much time and energy defending myself as a “not addict” – and no time cultivating any kind of empathy for those who were.

Why did I feel the need to do that?

4. I Wasn’t A Social Drinker – I Was An Emotional Drinker

I remember going to my first AA meeting and explaining to someone that I didn’t really think I was an alcoholic. She asked me casually, “Do you ever have just one drink?” To which I blurted out, “What’s the point of that?”

“You tell me what the point is,” she replied. And then I realized I’d never really asked myself why I was drinking in the first place.

I drink for a lot of reasons, some of which I’m still working on understanding. I use it to cope with my mental illnesses. To self-sabotage when I can’t handle the pressures or stress of my life. To put me in another headspace when I don’t want to be in my own. To slow down time when I’m dreading something.

I drink to take the immense avalanche of emotions I deal with on any given day and subdue it so that I might survive it all.

Notice nowhere on my list does it say “to have fun with my friends” or “to get a good buzz.”

Alcoholic or not, addict or not – I don’t think these terms are necessarily useful for everyone – nothing screams red flag like “I use alcohol to deal with my emotional problems.”

5. Everyone Around Me Could See It But Me

This. Is. So. Common.

And it is no exaggeration when I say that I felt like I was losing my mind. Here I thought I didn’t have a problem, and an abundance of therapists, psychiatrists, friends, and loved ones told me numerous times that I did.

For my short time in AA, I refused to call myself an alcoholic and sat bitterly in the back row, murmuring about how none of this resonated with me because I wasn’t like them.

Instead of being open to recovery and community, I left AA, and tried to do sobriety alone, much to the dismay of everyone around me. It worked, until it didn’t work at all. And here we are.

I believe that only you can ultimately decide to take on a label like “alcoholic” or “addict,” but I also believe that when there’s writing on the wall – and on literally every inch of that wall – it might be time for a conversation.

About nine or so months ago, when people were trying to tell me I needed help, I wish I would’ve taken the initiative to find a therapist and talk through it. It didn’t mean I had to go to rehab, or AA, or commit to any kind of substance abuse support group or program.

It meant I would’ve gotten some support from a professional as I decided, for myself, what my substance use meant in the scheme of my life – and what I might want it to mean moving forward.

It can be hard to hear folks when they’re trying to impose a terrifying and life-changing label. Take it from someone who knows. The word “alcoholic” still makes me cringe (forever unpacking that stigma, even now). But these days I’m willing to accept that if everyone sees something except me, it might mean that I have something I need to work through.

***

It can be hard to see your own substance abuse when you’re in the midst of it, especially when the narratives around it can be confusing and limited.

I by no means drink heavily. And for varying reasons, I don’t drink every day. And I’m still working to admit to myself that I can be an alcoholic despite that.

When I took the time to honestly evaluate how drinking operates in my life, I finally started to see the red flags I had been missing while I was too busy counting the number of drinks I had.

It doesn’t always matter how much or how often. It never did. For me, so much of it was about the kind of person drinking made me, and the consequences waiting on the other side.

And that’s a good enough reason for rehab as any.

Mental Illness Doesn’t Care How Good You Are

It is six o’clock in the morning and I wake up suddenly. My body is trembling. My thoughts are beginning to spiral and my breath is shortening – every inhale becomes smaller, and smaller, and smaller until I fear that the oxygen in the room might run out.

I try to remember what my psychiatrist told me, about how breathing through a straw never killed anyone. I swear that this time it might.

When I fall asleep, I dream that I live in a house on the beach. I am staring out at the ocean until I see the waves grow taller, and bigger, and louder. The tide is creeping up on me now. I run inside, waiting for the first floor to flood, then the second. I keep climbing the stairs, trying to get away.

I know that I need to get to higher ground. I abandon the house and start running up a hill. No matter how high I climb, there’s always water on my heels. Sometimes it’s up to my ankles. No matter how fast I run, it’s always at my feet. All I can do is wait for the water to recede and hope that it doesn’t take me with it.

I tell myself, “No one ever drowned in an inch of water, Sam.” I swear that this time I might.

When I wake up again, my partner is next to me. I tell them about my panic attack, and about my dream. “I think I know what it means,” I explain. “That sometimes all you can do is keep searching for higher ground.”

Neither of us needs to acknowledge out loud that we’re talking about my mental illness.

About how, for the last eight months since I was hospitalized, I have watched the waves come in and out, chasing me uphill and luring me back down. I have known the kind of grief of being small in the face of something that could eclipse you, could make you disappear effortlessly.

When I see my psychiatrist later that week, I tell him that I have something to say, and that it isn’t nice. He tells me that I don’t have to be nice, that I should say how I feel. I tell him that I feel broken. I tell him that I feel irredeemable. I tell him that I am ashamed. I tell him that I am tired. I tell him that six medications is too much and too little. I want to know –

“Why you are the way you are,” he says quietly. This is a tender wound that I try to avoid. 

I nod, choking back words – words like, this isn’t fair, I don’t deserve this, I only ever tried to be good, I only ever tried to be kind, I shouldn’t be here, I should never have been here, fuck this and fuck you.

I know that maybe he has asked himself this before, about me, about the others. Because when I look at him, I don’t see pity – I see pain.

The unspoken truth: There is a particular kind of agony that comes with the realization that you could be good in every way, and mental illness will still chew you up and spit you back out.

You can do everything right – take all of your pills, go to all of your therapy appointments, read every bit of literature, do all your self-care – and still be trapped between the incisors, gnawed to pieces in the aftermath of another episode.

Some days, I can be standing on the platform waiting for a train, or cleaning up my apartment, or having lunch with a friend – and like a sudden, unexpected punch in the gut, I want to weep because I know I’ve been good, I want to weep because I know I’ve tried, and here we are.

I’ve tried so hard.

When I tell a friend about my dream, I quietly comment, “The ocean doesn’t care about how good you are.”

They tell me, “I know.”

I keep looking for someplace safe, somewhere high enough, somewhere untouched. And when I think I’ve found it, all I can do is wait. All I can do is wait, overcome with bitterness, overcome with rage, weeping with the force of a hurricane, breathing through a straw.

How Many Mental Disorders Is Too Many?

How many is too many? This is what I asked myself when a psychiatrist – who I was seeing temporarily while my usual was on paternity leave – looked up from a stack of books and a database on his computer and said to me, “This is really complicated.”

When I asked him what he meant, he seemed a little worried when he said, “Your diagnoses and your medications are very… complex.”

I knew that. Every clinician that opened up my file knew that. Every pharmacist that ever filled my prescriptions. Every friend that finally realized how much energy goes into being a mostly-assembled Sam Dylan Finch.

With my bipolar diagnosis reinstated after a hypomanic episode triggered by Zoloft, it could now rejoin my growing list of neuroses: borderline personality disorder, obsessive compulsive disorder, agoraphobia, substance use disorder, and generalized anxiety and/or ADHD depending on which clinician you ask.

This doesn’t even capture the psychotic and dissociative features of a few of the illnesses I deal with.

Some people would call these “co-occurring diagnoses” on a good day but I would actually just call these a straight up clusterfuck.

People like to tell me that “it’s all just labels” and that the words are ultimately unimportant. But they weren’t there ten years ago,  when I was a teenager that fantasized about ending my life, tormented by obsessive thoughts and deep depression. Back then, the only thing I wanted was to understand what was wrong.

My psychiatric diagnoses have given me that understanding, and affirmed that it wasn’t just in my head, that it wasn’t made up, that I wasn’t alone.

People can tell me that my diagnoses are just words at the end of the day, but those words are important to me, and that’s what makes them important. And the impact of these disorders is something that I have to live with every minute of every day – so why wouldn’t it be critical to name something that’s so pervasive in my life?

(Honestly, when people tell me it’s just words, I laugh. If you woke up to the sound of a chainsaw every morning with no explanation, would you ignore it altogether in favor of just saying, “Well, it’s just noise”?)

But I would be lying if I said my psychiatric diagnoses always make me feel empowered. The truth is that while I am glad to have a name for a once invisible battle, I’m also afraid.

I’m very afraid. I’m afraid because, like many clinicians have told me, this is complicated. Complicated to understand. Complicated to treat. Complicated to manage. I’m afraid that maybe there’s such a thing as “too mentally ill” or “too many mental disorders,” and that there will never be a “normal” for me – that I’ll always be swimming upstream.

I’m afraid of being hospitalized again. I’m afraid of being hospitalized again and again, because statistically this is likely. I’m afraid of attempting suicide again. I’m afraid of attempting again and again, because this, too, is possible and maybe even likely.

People often tell me that I’m not a statistic. I know this is true. But we can’t also pretend that statistics have no bearing on what my future might look like. I can’t ignore the fact that I am vulnerable. And I go to bed every night knowing this – knowing that I have a lot of good reasons to feel unsafe, even on my best day.

The more diagnoses I’m given, the more overwhelmed I feel.

I am mistrustful and fearful of my own mind – how it seems to always be working against me, how even my best efforts are sometimes not enough to stay in control. I never seem to know what’s real and what’s part of an illness.

I don’t know where each illness stops and I begin. I’ve spent a lot of the last two months confused, feeling claustrophobic in my own head, like I need to get out of here because there’s no room for me, like the wind is constantly being knocked out of me.

In conversations about mental health, we often talk about people who have one or two disorders. And I’m usually somewhere on the sidelines, wishing people like me were more visible – people who have so many diagnoses, they sometimes lose track of themselves, sometimes lose themselves to the fear of what they’ve become and could become.

I am an optimistic and determined person on the whole, and I still lose myself to that fear from time to time. When my psychiatrist quietly acknowledged the complexity of my trauma, I wondered if it’s possible to be so mentally ill that you become impossible to care for, impossible to help, impossible to love.

I spend a lot of time worrying that I can’t be loved.

In a society that tells us we’re broken if we have one mental illness, what happens when you have six?

Can you ever really be honest about who you are and what you’re going through without seeming too crazy? Too hopeless? Too much? This is the perpetual question for me, as someone who is both a person offline (go figure) but also an activist and writer online, who wants to create the space for people to be authentically themselves, but has to navigate the same stigma, too.

I think with all of the fear that I’m experiencing lately, I’ve finally gotten to a point where I’m tired of being isolated like this. I want to create a space for all of us to own how terrifying it is to be told we’re “complicated.”

Being complicated sucks. Being complicated hurts.

I remember that when I was initially diagnosed with just depression as a teenager, I was told by clinicians that my depression was very treatable, always emphasizing a positive prognosis and long term goals.

At this point in my life, when I meet clinicians, we only ever talk about today – we never talk about the future in any capacity. I think because neither of us knows what to say.

And that’s what my psychiatric journey has looked like: a lot of subtle ways in which it was communicated to me, with each new doctor and each new name, that being “complex” means difficulty – difficulty treating, much less supporting or affirming.

But I’m tired of apologizing to clinicians, to friends, and even to readers for being messy. For having more issues than National Geographic. For giving “certifiably insane” a whole new spokesperson. And I know so many mentally ill people with countless diagnoses who are equally exhausted, trying to package things in a more presentable way so people will accept them.

Sometimes people have three, four, five, six, seven, eight, you-name-it diagnoses and if we aren’t making room for those people to show up authentically, we are failing the mental health community as a whole.

This work isn’t about making spaces for some of us. It’s about making room for all of us.

Having co-occurring diagnoses is a scary place to be. Sometimes it’s a hopeless place to be, especially when your clinicians seem a little defeated themselves and the people in your life don’t know how to help you.

Sometimes (often) people don’t even believe me. Sometimes they see it as a chance to write me off as beyond repair. Sometimes my mental illnesses go from being a concern to being a joke. Sometimes I’m dehumanized and pathologized to the point where I’m seen exclusively as a case study. In my life, I’m consistently reminded of how people have no idea how to treat other people with co-occurring diagnoses, especially as they increase in number.

If we can’t create support for folks like me, where else are they going to go? When else can they be themselves?

Psychiatric labels can be important to us, scary to us, even empowering to us – for me, it’s been all three. But one thing they’ll never be is the sole determiner of our worth. We are whole people with value, no matter how few or how many diagnoses we have.

That’s the truth. And it’s a truth we need to make sure everyone – especially mentally ill folks – know.