7 Signs Your Psychiatrist Is a Keeper

“I’ll defer to your judgment on this one,” I said to my psychiatrist, shrugging.

“You defer to me a lot,” he pointed out, laughing. “You’re allowed to have an opinion.”

I was?

As a mentally ill person, I was so accustomed to having decisions made for me that I was baffled when my new psychiatrist was giving me the final say on my treatment – not just once but consistently.

That’s when I realized: No one ever told me what a good psychiatrist looked like, let alone the kind of treatment I deserve.

And this is nothing short of tragic because the relationship that we have with our psychiatrist can make or break us. When our mental health impacts every aspect of our lives, having a positive and trusting relationship can be the difference between surviving and thriving.

It took seven years of navigating psychiatry to finally find a clinician that I felt safe with. Seven. Years.

This is due, in large part, to the fact that I simply accepted whatever treatment I was given, rather than advocating for myself.

I didn’t know how to recognize when a clinical relationship was working for me, and when it wasn’t – and I was convinced that it didn’t matter as long as I could fill my prescriptions at the end of the day.

But it does matter. And as both a mental health advocate and a patient, I know now that a caring and competent psychiatrist can make a huge difference.

My current psychiatrist is the-bomb-dot-com. And I’ve been reflecting lately on why that’s the case: What exactly does he do differently? And what should we, as mentally ill folks, start to expect from our clinicians?

There are positive signs that I think we should all look out for in our clinical relationships – not just to help us find a good fit, but to give us the language to advocate for ourselves with every psychiatrist that we meet.

Here are seven signs to get you started.

1. They Look at You

When my psychiatrist came out from behind his desk, pulled up a chair across from me, and grabbed his laptop instead of hiding behind his desktop computer, my first thought was, “What the hell is he doing?”

He had a desk and a computer – why did he need to relocate right across from me?

But there was something about his relaxed posture, his complete attention, and most importantly, his consistent eye contact that totally disarmed me.

I immediately felt more trusting of him – something I hadn’t experienced with previous psychiatrists.

My last psychiatrist back in Michigan seldom looked at me, only to greet me and say goodbye. She stared at her computer, rapidly typing as I spoke, saying very little to acknowledge what I had said.

In hindsight, I realize this is why I always found our interactions to be cold and why I always held back on the details when speaking to her.

Something as simple as direct eye contact can change the entire temperature of a room. I went from feeling invisible to being seen.

I can’t emphasize enough what a difference this has made.

2. You Don’t Feel Rushed

In my work as an advocate, the most common complaint I come across is that folks feel their appointments are always cut short, or that they never have enough time to say what they need to.

The pace of the conversation and allotted time ultimately makes them feel like a burden, and they ask fewer questions, share less information, experience significant anxiety, and ultimately receive subpar treatment because they feel rushed.

I realize this varies widely depending on the clinic and clinicians you have access to, but I encourage folks to explore their options as much as possible.

It’s critical that you don’t feel like you’re always running out of time – this can absolutely impact your interactions and treatment.

I’m always blown away by how long my psychiatry appointments are now, and the fact that my psychiatrist always asks at the end if there’s anything else I’d like to talk about, no matter how long the appointment has already been.

We decide together when everything has been said – I’m never pushed out the door.

And if I open a (non-urgent) can of worms right at the end of an appointment, we make another appointment to discuss it, so I’m assured that it will be addressed and I know exactly when it will be.

Check in with yourself during your appointments. Do you feel rushed? Do you feel like you’re always running out of time? If you do, don’t be afraid to mention this.

3. They Respect Your Agency and Give You Choices

When I was struggling with binge drinking, my psychiatrist didn’t tell me what I should and shouldn’t do.

He made a few recommendations about resources that I could choose from, but then went on to tell me he trusted that I knew what I needed.

He believed in my self-determination, and affirmed that I was in charge. He didn’t criticize me for relapsing, or tell me that he knew what was best for me. He gave me choices.

Not once has my psychiatrist made a recommendation for me without giving me other options, and asking me how I felt about the options I was given.

My psychiatrist told me that he strongly believes in collaboration and self-education. In other words, he believes in my agency. I can’t emphasize enough how critical this is for mentally ill folks who – far too often – aren’t trusted to make competent decisions and are talked at rather than talked with.

This approach is both humanizing and, yes, anti-oppressive, as it upholds the belief that mentally ill people are truly the experts on their own lived experience. And we are.

So ask your psychiatrist what the word collaboration means to them in a clinical setting. This is far and away one of the most important signs about what kind of relationship you can expect, and what your treatment might look like.

4. Your Input Is Valued, Not Discouraged

My psychiatrist is always asking me for my opinions and for feedback, encouraging me to be an active participant in my treatment.

And I’m baffled that this isn’t the status quo.

As an advocate, I hear time and time again, “My psychiatrist was annoyed by how many questions I was asking” or “My psychiatrist was bothered by how much I was pushing back.”

Just recently, someone told me that their psychiatrist actually said to them, “You don’t get to call the shots. I do.”

This is a big, ol’ red flag, and you should head for the hills if a psychiatrist ever discourages you from being invested in your own treatment and wellbeing.

A good psychiatrist wants you to stay engaged. A lousy psychiatrist wants you to be seen, not heard, and to swallow your pills dutifully.

Don’t be afraid to seek out a different doctor if you feel that your psychiatrist isn’t listening. Newsflash: A big part of their job is listening – and if they aren’t, they’re failing you as a clinician.

5. There’s Mutual Trust Between You

During my last bout of depression, I sent an online message to my psychiatrist describing how suicidal I was and what plans I had.

I was truly at the end of my rope, and I didn’t know what else to do.

My psychiatrist didn’t call 911, though. He called me.

He calmly checked in with me, convinced me to go to the emergency room, and when I said I was on my way and that my partner was with me, he believed me. He then called the ER, filled them in on my situation, and told them to expect me.

This completely shocked me. But because I had trusted him and shared my suicidal thoughts, he trusted me to do the right thing. And you know what? I did.

admitted myself voluntarily – which anyone will tell you is preferable to being involuntarily committed and traumatized.

That kind of trust has been critical in my treatment. I feel respected and believed – and in return, I feel that I can open up and be honest about what I’m struggling with.

If you can’t trust your psychiatrist and the treatment they are recommending, how can you sustain the hope that things can and will get better? And how can you confide in them if you’re closing yourself off?

Trust is foundational in any clinical relationship. Do you trust your psychiatrist? If the answer isn’t “yes” or “we’re working on it,” then it may be time to find someone else.

6. They Acknowledge Your Identity and Trauma History

I’m transgender. And I’ve had so many psychiatrists who have pretended this isn’t the case.

Many psychiatrists have ignored the fact that my hormones do impact my mood. And almost every clinician has misgendered me, referred to me as “female,” or asked me questions that were completely inappropriate.

This is shit that I don’t put up with.

Weirdly, my current psychiatrist is the most trans competent psychiatrist I’ve ever had, despite never advertising himself as such.

I also have a significant trauma history, something that I’ve noticed many psychiatrists feel that therapists are exclusively responsible for knowing about in any detail.

But my psychiatrist has been very open to hearing about that history, and taking it into account when diagnosing and making treatment recommendations.

Which is all just to say, if your psychiatrist isn’t interested in the big picture – the aspects of your identity and history that have contributed to your mental health – they may not be a good fit.

If these things are important to you, they should be important to your psychiatrist as well, at least to some extent.

7. They Are Open to Alternative Diagnoses

When I was eighteen, I met with a psychiatrist who accused me of looking for an “easy way out,” being too young for medication, being too dramatic, and who – after all this – shrugged and said to me, “Which pills did you want?”

(I picked Prozac because I saw it on TV. She prescribed it without question or concern.)

She diagnosed me as bipolar after about ten minutes of yelling at me. And that label has followed me around since then, not being challenged or questioned by any of my clinicians until my most recent psychiatrist revisited it.

And guess what. I may not be bipolar after all. Borderline, ADHD, complex PTSD, OCD – these are labels that I only considered after my most recent psychiatrist had a real conversation with me, and these are labels we continue to revisit and explore.

Diagnoses are markers that can determine the entire course of treatment. Which therapies and medications are recommended can rely on these labels, and how we come to understand our struggles can be framed around these labels as well.

For the last seven years, it’s possible that I was receiving treatment for a disorder I might not even have. This is a huge deal.

This is why it is so incredibly important that we have psychiatrists that don’t take these diagnoses for granted. If something doesn’t feel quite right, don’t be afraid to ask for a reassessment.

If there’s a label that might fit better, don’t be afraid to introduce it to the conversation (because yes, there’s a place for self-diagnosis in psychiatry).

A good psychiatrist is open to new possibilities, and those possibilities can ultimately impact your mental health in big ways.

I don’t know at what point I started accepting whatever treatment I got. But I can tell you that now that I’ve had positive psychiatric experiences, I’m unwilling to go back to the days where I was a passive and jaded patient.

I can see the difference a good psychiatrist can make.

The sense of agency, trust, and validation I feel is absolutely priceless – and with each new success, I’m grateful for the amazing clinicians out there who make it a point to respect and uplift us, not perpetuating the harm and abuse that psychiatry can so often enact on mentally ill people.

I expect and demand much more now. And I believe we all should.

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This piece that I wrote originally appeared at Everyday Feminism.

I’m Not Settling For ‘Good Enough,’ And Your Psychiatrist Shouldn’t Either

Crazy Talk is a mental health advice column, getting real about life with a mental illness. While I’m not a medical doctor, I’m living the good life with depression, OCD, and complex trauma, unapologetically owning my “crazy.” We’re talking all things mental health — trauma, happy pills, mood episodes, and whatever else you tweet me about! Check out last week’s column here.

Recently, I wrote a Twitter thread about what it’s been like to finally find the right medications. “Finally getting the right psychiatric medications,” I wrote, “was like realizing I’d been playing my life on ‘expert’ mode with a broken controller.” 

The response? Overwhelming. And one question that popped up a lot in that thread and in my inbox was something to the effect of, “Is ‘good enough’ with my mental health a good place to settle? Or should I not be settling at all?”

To answer this question, we have to dive into my history a little bit.

In 2016, I was in and out of psychiatric hospitals and outpatient programs. For years, I was misdiagnosed as having bipolar disorder, which meant I was put on countless medications that weren’t very effective for what I was actually dealing with. Back then, my philosophy had always been, “If I’m not suicidal, I’m fine.”

This resulted in a pretty well-established pattern. I’d struggle for a while, I’d coast. My medications sedated me, but a lot of my symptoms were always beneath the surface. I wasn’t totally miserable, but I was never truly happy.

Then something would trigger me — next thing I knew, I’d be flung into a complete crisis.

After one too many breakdowns, I found my current psychiatrist. He took one look at the seven or eight medications I was on and said to me, “Something isn’t right.” I explained to him that despite all the pills, I was never really more than just okay. And he was the first doctor I’d ever met that told me that “just okay” isn’t actually okay.

Let me repeat that: “Just okay” isn’t actually okay, especially if it doesn’t last.

Thus began the long process of reassessing all of my diagnoses and completely transforming my medication regimen. The process was so involved, I had to be hospitalized so I could be closely monitored while coming off of four medications quickly and simultaneously. And while it wasn’t exactly fun, it was the beginning of getting my life back.

Because with a real advocate in my corner, the goal was no longer survival. The goal was recovery. The goal was becoming my best self. The goal was finally living.

Here’s the thing: If you’ve been depressed and anxious for your whole life like me, you may not actually know what it feels like to be mentally healthy. This makes it easy to settle. This makes it easy to say, “If I don’t want to kill myself every second of every day, this is probably fine.”

The bar is set so low, we accept a quality of life that doesn’t have a whole lot of “quality” to it at all.

And our clinicians don’t always help in this regard. If we’re willing to settle, sometimes they are, too. I once saw a psychiatrist who said to me, “If your grades in school are fine, I don’t know what you need from me.” (Spoiler alert: I needed antidepressants, Doc.)

Sometimes when we aspire to be “okay” or “functional” — get decent grades, hold down a job, be able to shower and comb our hair — we forget that there’s more to life than just being okay.

There’s being able to appreciate a piping hot cup of coffee in the morning. There’s doing work or finding a hobby that’s meaningful to us. There’s enjoying the company of our friends. There’s having passion, ambition, and investment in something more, something bigger. It’s a good thing to be able to survive, and it’s important, too. But I’d like to believe we all deserve more than that.

Do you remember the last time you laughed deeply, maybe even until you cried? Do you remember the last time something good happened, and you couldn’t wait to call your friend and blather on about it? Do you remember the last time you actually gave a fuck about your life? Felt excited? Felt interested? Felt curious?

I spent most of my life going through the motions. I may not have always felt empty, but it took a long time to ever feel full. And while surviving is your top priority, I don’t want to live in a world where mentally ill people give up on thriving, with clinicians that enable us to.

Sometimes we do need to coast. Pace is everything, and this mental illness thing is a long freakin’ haul. But coasting should be a pit stop, not a final destination. This is especially important to remember, because too often while we’re coasting, we miss some of the warning signs (like boredom, for example) that can evolve into full-blown depression.

While it’s not reasonable to expect a dramatic shift overnight, it’s not unreasonable to say, “Actually, I want to be more than just okay. I want to be well.”

You deserve to be well. And you deserve a clinician who believes that you can be.

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Crazy Talk: Why Do I Keep Making Myself Sad On Purpose?

Crazy Talk is an advice column powered by your donations on Patreon, written by Sam Dylan Finch (that’s me!), and hosted by your fave queer blog, Let’s Queer Things Up! While I’m not medical doctor, I am a card-carrying member of Club Crazy, living the good life with a mood disorder, anxiety, and complex PTSD (gotta catch ’em all!). We’re talking all things mental health — trauma, happy pills, mood episodes, and whatever else you tweet me about. I’m kicking the stigma where it hurts, one question at a time. Check out last week’s column here.

Hi Sam, 

I struggle with anxiety and depression and I have for years. I’ve noticed that sometimes, when I’m at a low point, I’ll get sucked into listening to sad music, revisiting sad memories, watching sad movies, and basically making myself worse. I know that it doesn’t help, but it’s almost like a compulsion. What’s wrong with me?

Let’s start with what I think is a pretty important disclaimer: Not knowing your particular history, I can’t say with any certainty what drives you to make particular choices. I’m crazy… but I’m not a mind reader! I can, however, remark on my own experiences and observations. Hopefully that will give you some food for thought. Bonus points if those thoughts are then shared with a therapist!

I want to validate this for you upfront: Emotional self-harm? It’s a thing.

I find this question to be really relevant, as I used to do this a lot myself. At my worst, you could find me listening to angsty music; reading old, despairing blog entries; or camped out on my couch watching really triggering shows on an endless loop. No matter how many times my friends told me to give it a rest, it kept pulling me back in.

But as you’ve noticed, it never helps. It only sustained the depression that I was already feeling, often making it worse than when I started. So why did I do it? I have some theories:

Depression is predictable. While depression isn’t an ideal state to be in, it’s not necessarily full of surprises, either. I had a therapist once tell me that people who are dealing with depression can sometimes feel drawn to it, even unconsciously, because its familiarity and predictability feels safe. It makes sense, then, that we might engage in activities that sustain our sadness or keep us numb; we might feel afraid of the unpredictability that comes with doing something differently (I touch on this in my article about self-sabotage as well!).

I had unresolved trauma. Sometimes we force ourselves to relive the pain we’ve experienced because it’s unresolved. For me, I found myself purposefully triggering myself because I hadn’t yet found a way to accept and release the trauma I’d been through. This is what eventually led to my diagnosis of complex PTSD (which I wrote about here and here).

We might make ourselves feel pain because we’re hoping that, by re-experiencing it, there might be a different outcome. We’re usually looking for some kind of epiphany or realization to help things feel more conclusive, but we’re seldom able to do this effectively without guidance. Our brains are saying, “Hey! We have unfinished business here!” And in a way, they’re pushing us to relive something, hoping we’ll actually resolve it this time — but we aren’t always equipped to do so.

If your strolls down memory lane have become compulsive, triggering, and intrusive, it might be best to seek out a therapist that can help you process your pain in a more productive way.

I needed to feel understood/seen. Everyone wants their pain to be recognized and affirmed. We might seek this out by looking for representation in music, television shows, movies. I used to watch every TV show that featured a PTSD survivor, because I wanted to know I wasn’t alone; I especially wanted to see someone “overcome” that struggle so I could live vicariously through them.

I mean, you’re reading this article now. And you might have had a moment already of, “Wow, this is so me.” It’s a validating feeling, right? It makes a lot of sense, then, that we might subject ourselves to content that’s triggering with the hopes that it’ll make us feel validated, even if that validation is accompanied by pain.

I didn’t have the tools that I needed. When we gravitate towards unhealthy coping mechanisms, we’re often doing this because we don’t have healthy alternatives in place. I was most likely to seek out my triggers when I was already vulnerable — when I didn’t have a team of clinicians in place, when I was isolated from my support systems, when my meds were out of whack, and when I didn’t have a real treatment plan in place.

So where do you start? I have a list of free mental health apps that have personally helped me pivot away from emotional self-harming, and it can offer pretty immediate relief. If you don’t have a clinical team already (a therapist or psychiatrist), consider looking for those as well.

Remember: Be gentle with yourself. In all likelihood, you’re not engaging in these behaviors because you enjoy being depressed (I have yet to meet someone who does). This behavior is indicative of a lack of effective coping skills and unresolved pain. Rather than treating it as something that’s “wrong” with you personally, look at it as a red flag. This is your brain’s weird way of letting you know that you need additional support.

I know it’s easy to slip into the whole, “What the hell is wrong with me?” mentality. But what I’ve found to be true is that there’s always some form of method to our madness — or in this case, sadness.

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Crazy Talk: Is Your Boredom Just Depression In Disguise?

Crazy Talk is an advice column powered by your donations on Patreon, written by Sam Dylan Finch (that’s me!), and hosted by your fave queer blog, Let’s Queer Things Up! While I’m not medical doctor, I am a card-carrying member of Club Crazy, living the good life with a mood disorder, anxiety, and complex PTSD (gotta catch ’em all!). Talking all things mental health — trauma, happy pills, mood episodes, and whatever else you tweet me about. I’m kicking the stigma where it hurts, one question at a time.

Hey Sam. I mentioned to my new therapist that I’ve been bored to the point of making myself miserable. I thought that maybe I just needed to get a hobby (I don’t do much these days besides watch TV, probably doesn’t help) but she thinks I might be clinically depressed. How do you know this difference between “normal” boredom and actual depression? -Bored & Blue

Hi there Bored & Blue,

To start off, can I say how happy I am that you’re seeing a therapist? That, in and of itself, is a big step and will go a long way towards getting to the root of your boredom.

This is a really important question, one that I wish I’d paid more attention to back in the day. I never realized that boredom could be a symptom of depression, which would’ve helped me recognize it sooner rather than later. But like you, I just figured my boredom was the result of my own inaction — not a symptom of a bigger issue.

But your therapist is right in that boredom can be a red flag for folks that deal with depression! I think one way to parse out the difference is figuring out whether or not your boredom is responsive. In other words: Are you able to participate in activities that help alleviate it? Or does it linger no matter what?

I remember boredom being a really big feature of my last major depressive episode. I desperately wanted to find something to do to make it better, but I lacked the energy to get out of bed, and didn’t seem to enjoy the things that used to make me happy. You can imagine, then, the predicament I was in: Even if I did get a hobby, I wouldn’t have had the ability to participate or enjoy it — thus the boredom and subsequent misery was almost constant.

Boredom can be one of those early warning signs that can tip you off to an incoming depressive spell. Not all boredom coincides with depression (sometimes you really do just need a change of pace!), but persistent boredom almost always co-occurs with some kind of mental health issue.

Depression can sap the life out of you. Depression can take the things you used to be interested in or passionate about and make them feel dull as dirt. Depression can make you forget what it ever felt like to be happy or excited, replacing it with self-loathing and emptiness. Sound boring? It definitely can be. So it doesn’t really surprise me that many depressed people complain about being bored in the midst of an episode.

You described this situation as making you miserable. Yikes. Anytime you are describing your mood as “miserable,” some alarm bells should be going off. If this has been going on for longer than two weeks, almost every single day, there’s a very good chance that you’re dealing with some form of depression, especially if it accompanies these other symptoms.

No matter where this boredom is coming from, boredom signals that we might need to consider some life changes. Every one of us deserves a sense of fulfillment and variety, and without it, our mood can really suffer. A therapist can help you navigate how you can make some positive changes in your lifestyle to address this.

You talked about finding a hobby, and there’s no harm in that! But remember that there are other options, too. For me, in addition to finding a therapist, one way I found relief from my persistent boredom and sadness was starting an antidepressant. It made a huge difference! Once I had my energy and interest back, I was then able to pursue new activities and get out more.

A little homework: There’s a great video here covering ten different symptoms of depression in greater detail; I’d also recommend watching this video by my fave YouTuber, Marina Watanabe of marinashutup, about the sneaky nature of depression.

Remember that this process can take some time, so be sure to be patient and compassionate with yourself. This is the kind of elephant you’ll have to eat one bite at a time, or so to speak. I hope that you’ll keep going to therapy, keep an open mind, and keep advocating for your health and happiness — these are all excellent choices that will be beneficial to you whether you are clinically depressed or not.

All the best,

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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:

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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.

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6 Things People With Mental Illness Might Be Scared To Admit

You know, it’s possible that everything on this list is just me. But working in mental health advocacy for some time now, I’ve learned that it’s never really “just me” or “just you” – if we’re struggling, it’s almost guaranteed that someone out there knows that struggle.

Confession: I was hospitalized four months ago and I’ve been afraid – afraid of myself, afraid of my friends, afraid for my life – almost every minute since then.

Of course, I was scared to open up about it until I realized that it’s the fear that holds us back. If we never admit that we’re hurting, we can never find the support and reassurance that we need to pull through.

It’s true that I don’t know your story or your struggle. But I hope that, by knowing mine, you’ll feel less alone.

Because it’s okay to be scared – and you’d be surprised at just how many of us are putting on a brave face, hoping that no one sees just how afraid we really are.

Since I got out of the hospital, I’ve been faking it with the hopes that no one sees how much pain I’m in. But today, I’m letting my guard down – I’m hurting and I’m afraid, but I know I’m not alone.

1. I’m afraid that I don’t deserve to be happy.

I recently posted on the LQTU Facebook page about how many people with mental illness tend towards self-sabotage when they’re happy.

And, no surprise, many people responded with comments and messages about how they’ve sabotaged their own recovery – and at the root of it, it seems, is a conviction that they didn’t deserve their recovery to begin with.

Been there, still there. What I’m scared to admit sometimes is that I don’t feel like I deserve to be happy – so I push my happiness away.

Happiness scares me because I feel like I’m going to let everyone down. There’s so much pressure to be “recovered,” so much pressure to be “better,” so much pressure to have your shit together.

Sometimes I try to dismantle my own happiness because I don’t feel worthy or good enough – like I can’t live up to the expectations of being healthy – and it feels easier to relapse and let things fall apart with no room to disappoint myself or anyone else.

For me, alcohol is the quickest way to sabotage myself – and damn, I am a skilled self-saboteur when I’ve got a glass or a bottle in my hand. But before I pick up the drink, I try to remind myself that instead of fearing happiness, I should give myself permission to feel it.

Happiness is not a prize that you win or a reward reserved for the best or sanest people – it’s just a feeling to be enjoyed and a feeling that everyone is entitled to.

You don’t have to be “good enough.” You just have to let it in.

2. I’m afraid that if people see my illness, they’ll think less of me.

When I had my breakdown, I was lucky enough to have friends supporting me – in ways that were often to their own detriment. Much of it is gone from my memory, but I have flashbacks, and when I do I’m always gripped with one thought: they will never see me the same way again.

I’ve always been afraid that if people saw me during a breakdown, they would realize that I’m not perfect.

I don’t have it all figured out, I don’t always have it under control, I can hurt people, I can be selfish, I can be psychotic – and everything that I was up until that point is replaced with the memory of me at my worst.

I’ve believed that if I didn’t control my mental illness and package it in a way that was acceptable or inspiring, my value to other people would be diminished. And these days, I’m constantly afraid that I’m not worth enough – even if nothing anyone has said or done indicates otherwise.

I try to remind myself that my worth can’t depend on how others perceive me or my illness. When I’m obsessing over how others see me, I ask myself, “Well, how do I see myself?”

And if how I see myself is particularly negative, or I am noticing things about myself that are harmful or not good, I know that I have some self-work to do – and that’s not the responsibility of my friends or loved ones. That’s work only I can do.

3. I’m afraid that I’ll lose control.

Happiness is not a guarantee for anyone, but when you have a mental illness, you can sometimes become hypervigilant, convinced that at any moment an episode will grab you by the ankle and pull you down.

I’m tapering off of my anti-psychotic medication right now, and it’s felt like walking on eggshells, tracking my mood every day and searching for signs that something might be wrong.

Every time I see something out of the corner of my eye, I worry I might be seeing things again; every time I’m sad, I panic that it could be the beginning of a depressive episode.

It can feel like any particular thought or feeling is a sign of impending doom if you scrutinize it too much – and it starts to feel like you can’t trust yourself or your perception of reality.

Especially when you’ve just come off of a breakdown or traumatic experience, it can feel like the ground underneath you will never be solid. The instability can make you a little crazy (literally).

But it comforts me to know that as I work at my recovery, I’ll slowly get my footing again.

4. I’m afraid that my illness makes me a bad person.

It has taken a long, long time to be okay with saying, “Sometimes I act in really shitty ways when I’m struggling with my mental health.”

I’m not going to sugarcoat it: I have hurt people. Sometimes I’m a walking stereotype of borderline and it takes a lot to deal with my shit, be accountable for my mistakes, and reel it in.

What I’ve realized overtime is that being “good” or “bad” is not the point. I think it’s really a question of being responsible or irresponsible about the impact of our behaviors.

I spent a hell of a long time being more concerned with denying that I was hurting other people because I didn’t want to think of myself as being “bad.” It was about my ego; it was about preserving this image of myself as being “good.” It was irresponsible because I opted for denial instead of ownership of my behaviors.

But in recent years, I’ve worked on accepting that instead of being “good,” I should aspire to be responsible: recognizing when I’ve done harm, being accountable for it, and helping to facilitate healing between myself and my loved ones.

Whether or not you are good or bad isn’t important. But your choices will determine the kind of impact you have in the world – so commit to making the best choices that you can.

5. I’m afraid that I won’t survive it next time.

I can’t tell you how many mentally ill folks I’ve spoken to who have all said, “I won’t make it past [insert young age].” Episode after episode, it feels like we barely scrape by, and when we get to the other side we’re certain that we could never face it again.

Sometimes when I try to imagine battling another psychotic, depressive episode, I swear up and down that I could never survive it. And when I imagine trying to live with these illnesses for much longer, I despair about how it’s almost guaranteed that I won’t live a long life.

But when I’m convinced I won’t live to see 30, I remind myself that there was a time when I thought I wouldn’t live to see 20.

I also remind myself, like I explained in this article about depression (it’s one of my favorites, you should read it), that sometimes mental illness tricks us into thinking we can see the future – the simple truth, though, is that we never could and we never will.

Back when I was attending AA meetings (which was… interesting, to say the least), the thing that stuck out to me was the idea of taking it one day at a time. Sobriety, just like mental health recovery, feels huge when we look at the long term, the big picture.

But they both can feel a little more manageable when we keep our eyes on what’s in front of us, because that’s what’s within our power to control.

This seems (1) cliche and (2) laughably simple, I know. But even so, the only way we can move forward is one step at a time – so every day I remind myself that the only moment that’s relevant right now is the one I’m living in.

Believe me, I understand the fear. I don’t know how long I’ll live, and that scares me. I don’t know if I’ll be able to manage the next episode, and that terrifies me.

But what I do know is that the choices I make today – the ways I choose to take care of myself in the now and the support I put in place – can make a difference tomorrow, and even beyond that.

And really, for better or for worse, that’s the best I can do.

6. I’m afraid that this illness is all that I am.

Everyone likes to remind me that I’m more than my illnesses. But this struggle is my every day – if I’m not drowning in a depressive episode, I’m fighting hard to keep my head above water and my life intact. There isn’t a single moment that I’m not somehow impacted by these labels.

Sometimes I fear that this struggle is so central to my existence that it overshadows everything else that I am – if I am, indeed, anything else.

And sometimes I worry that it has consumed my life to the point where it’s the only thing anyone else can see.

Every day, I’m still trying to uncover who I am apart from all of this. Trying to get in touch with the joy and passion and thrill that is buried underneath all this, the part of me that lives for something and comes alive for something.

I want to know what that part of me is like, what it takes to bring it to life.

I’m never going to pretend that these illnesses aren’t ever-present in my day-to-day.  I’m never going to pretend that my choices won’t always be informed or influenced by my struggles. And I’m never going to pretend that the impact this has had on me hasn’t touched every aspect of my life.

Just looking at this list of fears, I ask myself if mental illness will always have this kind of grip on me – if I’ll spend every day of my life afraid.

But all any of us can do, really, is try to cultivate something beautiful for ourselves. Something that makes us feel whole. Something that gives us a sense of purpose. Even if the garden is barren, even if it’s covered in snow, we find a way to make something – anything – grow.

We can have something more for ourselves, something that belongs to us. That may not define us or help us put the pieces of our identity back together – but it gives us a place to start.

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