For The Mentally Ill Folks Who Didn’t Think They’d Make It This Year

The year had only just begun when I heard my psychiatrist, his voice quiet on the other end of the phone, telling me to go to the emergency room. “Will you go?” he asked me.

And I remember in that moment feeling like my cells were crawling and clawing in my body. The mere state of “being” was painful. I wanted to ask that doctor if he knew what he was asking me to do. How could he ask me to stay when everything hurt this much?

Last January, I couldn’t think of one good reason not to jump in front of the next train.

It’s December.

There were a million reasons not to.

Here’s what I would have missed: Trying my first veggie burger at Burger King. Learning I had obsessive-compulsive disorder. Eating sushi for the first time. Getting the first job that I’ve ever loved. Finding the best therapist I’ve ever had. Adopting a cat named Pancake that makes my heart so much fuller. Discovering how much I love yoga and learning more about astrology.

Buying the best pair of boots I’ve ever owned. Listening to Lorde’s best album and witnessing Kesha’s… everything.

Holding a dear friend’s hand while they waited for an ambulance. Crying with my partner when their father died. Learning a best friend’s new name. Trying out the word “no” for the first time. Looking in the mirror at my body and feeling gender euphoria for the first time. Figuring out (finally) that I actually am an introvert. Remembering what it feels like to believe in magic (and making a little magic of my own).

All the times I picked up the phone when someone needed me. All the times I said the right thing to someone that needed to hear it. All the times my being here made someone else feel like they should stay. All the times I said “I love you” and had the honor of hearing back, “I love you, too.”

All of the many, many moments this year when I woke up and thought, “I’m so glad I’m still here.”

It wasn’t easy. I relapsed spectacularly. I had to leave (what I thought was) my dream job. I almost lost my apartment along with it, and came within inch of losing everything else. I had to watch Trump celebrate his inauguration on a flickering screen in a psych ward, next to a poster from 1995 with “stress-busting” tips like, “Stop worrying so much.”

I was in that hospital for a week. In the last two days, it rained so hard that my ceiling leaked, drenching my group therapy handouts on the shelf below. You know, the handouts that were supposed to teach me how to be well again. And for a moment, I remember being flustered, thinking that maybe I should just throw them away.

I laid them out carefully to dry.

When I was discharged, I brought them home with me. And I started to rebuild, day by day.

If you’re reading this, it’s probably safe to say it wasn’t easy for you this year, either. I won’t presume to know why and I won’t tell you how to feel. But from one survivor to another, there were a couple things I wanted to shout out into the big internet void, hoping maybe the right person will read them.

Because you and I? We got through it. And the mere act of being here is a tremendous thing.

1. You are remarkably strong.

How do I know that? I guess I don’t exactly. But I have a hunch. Because it takes real strength to keep yourself alive, especially when your brain isn’t cooperating. You’ve had years now to throw in the towel, and yet, here we both are.

And yes, I suspect there were setbacks and close calls and tantrums, even, and all of that is valid. There was rage and grief, because if life is anything, it’s definitely not fair. I don’t doubt that it took everything in you, maybe even things you aren’t proud of, to keep going. And looking at where you are now, you may feel scared that you don’t have what it takes to rebuild.

But you’re here. Holy shit. You’re still here. And of all the jobs you have, staying alive is the most important one. You had the guts and resilience it took to survive this year. That was you.

Sometimes it was recklessly running into battle because, fuck it, what do I have to lose? Sometimes it was having an impulse, and choosing the less destructive one instead. And sometimes it was swallowing the pills you didn’t want to take, dragging yourself out of the bed you didn’t want to leave, or slowly sipping that nutritional shake to make sure your body had something, anything to sustain itself.

Whatever you had to do, you did it. And you should be so, so proud of that.

2. You belong here.

There have been more moments than I can count when I wondered if I ever should’ve been born. If there was really a place for me in this world. If someone like me could exist someplace like this.

That’s been an open wound from the moment I realized I wasn’t like most people (though, to be truthful, I have to wonder if there was ever a time I didn’t feel that way). I was queer, I was transgender, I was traumatized, I was sensitive, and by most accounts, I was crazy.

I certainly wasn’t the kid my parents were expecting. And I was never going to be the kind of person this world was built for.

I was lucky to find people, though, who taught me that while this world wasn’t built for us, it doesn’t mean there isn’t a place for us here.

And we might be a little rough around the edges. We might be a little wild, a little unsteady, and a little weird. But we find ways to grow no matter where we’re planted. Some of us make art, create zines, speak in poems. Some of us throw our bodies on the line for shit that matters. We speak truth to power, we stare down our fears and our demons, we exist despite everything that tells us we should not.

We show up for one another. We take up space. And we keep trying, knowing that there are kids like us growing up in the world that are going to need us to look up to.

We keep trying for them, the way we wished someone had been there for us.

…one of them was probably born, just now. (Let’s hope they find themselves a little faster than it took for us to find ourselves.)

This is the legacy we’re here to build, the legacy we’ll someday hand down to them.

3. Please be gentle with yourself.

Be gentle. Be soft.

There is an inner child within all of us, I think. Someone who’s doing their best in a scary world they were never prepared to enter. Someone who, every day, is hanging on tight as life does what it does best — changes.

And just when we think it’s settled, it changes some more. Sometimes for the best, but often for the hell of it, and almost never in the ways that we expect.

You are allowed to make mistakes. You are allowed to be messy, emotional, unsure. You are allowed to be afraid (in fact, I’d be surprised if you weren’t). And being human in all of these ways? That doesn’t make you “too much,” no matter what anyone else says.

You deserve compassion. You deserve patience, understanding. You deserve all the space and support you require to grow.

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It’s easy to ruminate on what you wish you’d done, or the ways in which you disappointed yourself or someone else. That’s a feeling I know all too well; I think everyone, especially folks with mental health struggles, knows how that feels (which isn’t exactly comforting, but hey, at least you’re in good company).

I hope that when you find yourself going there, you remember what I’m telling you now: You are worthy of kindness and care. And whenever you can, I hope you’ll give yourself permission to receive it.

4. You aren’t alone.

I don’t say this to you as an empty platitude or promise. I say this because it’s the truth.

Mental illness and trauma can so easily cut us off from our connection to the outside world, making everything and everyone feel like it’s a million miles away.

But feeling lonely is not the same as being alone. And I can almost guarantee you that someone out there has walked in those same shoes before — or at least wears the same size.

This year, I was finally diagnosed with “pure obsessional,” a very difficult form of obsessive-compulsive disorder. I spent a lot of years with painful and confusing obsessions that I couldn’t control — and it convinced me that I was some kind of monster, the sort of monster that no one could ever understand.

When I got my diagnosis, a whole new world slowly opened up to me. I started to learn just how many people in the world were a lot like me, even people that I knew and talked to every day.

Shame and stigma are like a fog sometimes. We can see ourselves and our struggles so clearly, but it’s difficult to see anybody else. But that doesn’t mean other folks aren’t out there.

And if you keep searching, keep reaching out, the figures in the distance will become clearer. There is someone that’s been waiting for your story.

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I know it’s terrifying to venture out into that fog, not knowing who’s out there. I know it’s scary to be vulnerable, to ask for help, or to share a piece of yourself with someone else. More than once, I’ve wished I could gather up the words I just said and shove them all back into my mouth.

But then someone says those words — “I thought I was the only one,” “You feel that way, too?” or my personal favorite, “YES!” with a bunch of frantic hand motions or snapping — and it suddenly feels worth it. Or at the very least, it gives us just enough courage to keep venturing out.

So here’s to this year and everything it took for us to survive it.

And the next one, too, whatever it may bring. Here’s to another year of stumbling through the fog. Here’s to all the people who waved their flashlights, giving us something to follow; here’s to all the shoulders we cried on, and the right words that came at the right time.

For what it’s worth — and I really hope it’s worth something — some very tender boy in California (hello, that’s me!) sends his love. You survived. And I, for one, am so glad that you did.

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7 Things I Wish People Hadn’t Said After My Psychiatric Hospitalization

It took four weeks for my breakdown to happen – like a slow spiral, my sanity slipped out from underneath me. But in my memory, it doesn’t feel like such a long time. It’s as if I blinked, and suddenly I was in the emergency room with an IV in my arm and a security guard watching me sleep.

From there, I was committed, and driven an hour and a half by ambulance to a hospital in some city I’d never heard of before.

It took seven days before I was deemed fit to return to the “real world” – a world I was not prepared for, a world that I did not assimilate back into so easily.

Everything was the same as when I left it – yet none of it felt familiar. My bed felt too soft, like it could swallow me whole; my apartment felt like I was visiting someone else’s place; and my friends felt distant, like I hadn’t seen them in years. I could never seem to relax, waking up five, six times a night and greeting the morning exhausted, as if I hadn’t slept.

For a long time after, there was almost constant anxiety when I was with the people that I loved. Spending time with friends was unnerving; knowing that they’d seen me at rock bottom made me feel exposed, like there was nowhere to hide, nowhere to go.

I couldn’t be myself or let my guard down. I used to feel at ease socially, but for a while, I felt safer when I was alone.

There are reminders of my pain, even now. Every so often, there are flashbacks of the breakdown that sent me to the ER. The voices, the suicide note, the delusions, the alcohol, the intervention, the doctor’s disappointment (“I’d hoped this wouldn’t be necessary”), and the IV stuck in my arm – a blurry haze of shame and despair and fear.

To say that being hospitalized changed things for me doesn’t even begin to scratch the surface – I spent half a year after as a visitor to my own life.

Going back home after my psychiatric hospitalization was one of the most alienating experiences I’ve ever had, and like many people who have been hospitalized, finding the support I needed to feel secure during that transition was difficult.

There’s a lot to be desired when it comes to supporting folks who were recently hospitalized, especially when that hospitalization, like mine, is traumatic for them. And that support begins with how we talk about the experience.

To start, here are seven things that were said to me after my hospitalization that didn’t feel so supportive – and why you really shouldn’t say them.

1. (Nothing)

A lot of people didn’t know what to say, so they didn’t say anything at all. To be honest, I didn’t know how to ask for their support, so I didn’t say anything, either.

In our own ways, we were both just scared. We didn’t know how to process or where to begin. We didn’t know how to be vulnerable around each other. There was no cultural script for how to have these conversations. And for many people, I think they were afraid that if they said the wrong thing, I might fracture and break.

And yet, even though I understood this, I think the silence is still what hurt me the most.

Everyone is different in how they deal with emotional pain. Some people will explicitly ask their loved ones not to ask or talk about the experience. That’s a very valid reaction to trauma. But for others, saying nothing can suggest that you don’t care, that you’re pretending it didn’t happen, or that their hospitalization has scared you off – any of which can be very painful.

I think it’s important to ask your loved one what they need, so you can act accordingly.

If you want to say something but you don’t know how to approach it, here are some suggestions that might be helpful:

“How can I help support you?”

“Would it help if you talked and I just listened?”

“It sounds like you’re going through a lot, let me know if you need a friend.”

“Do you want me to bring some food over?”

“Can I send you a care package in the mail?”

It’s also true that after supporting someone through a mental health crisis, you may need to take some time apart. I was just as appreciative of the friends who stepped back, but still took the time to say, “I need some space to take care of my own mental health, but I want you to know that I’m proud of you for committing to your recovery.”

Your response doesn’t need to be perfect. All we need is some indication that you care.

2. ‘I’m Glad You’re Better Now’

One of the most common things people said to me when I left the hospital was telling me how relieved they were that I was “better.” Never mind that I’d never said things were better; never mind that I’d never said that I was recovered.

I could tell that the people in my life were relieved to see me, and glad that I seemed steadier than before. So they expressed it the only way they knew how – with gratitude.

I completely understand the impulse. Because I was glad to see them, too.

But it still doesn’t feel good to have everyone around you assume that you’re okay, especially after something that might have been traumatic. I found myself swallowing my grief, feeling like there wasn’t any space to not be okay – and when post-hospital life became more and more difficult, I didn’t feel like I could talk about it.

Many people assume that being out of the hospital means that we’re cured. But in reality, hospitalizations are often just the beginning of our healing, and much of the work we do to regain mental wellness happens outside of the hospital.

Recovery is not simple or linear, and mine certainly wasn’t. It took so much emotional strength to cope with the nightmares, flashbacks, panic attacks, and not to mention, the intensive therapy program that I attended three days a week when I returned home.

I don’t think anyone knew the burden I was shouldering, and just how brave I was to face it all.

So the idea that I should be “back to normal” – without understanding how hard I was working to stay afloat – only made me feel more distanced from my loved ones. I felt like there was an unspoken expectation that I would be stable and untroubled from here on out, which was impossible with all that I was still dealing with.

I felt like I had no permission to express what I was actually feeling – because there was now an assumption about how I should be feeling.

Everyone deserves the chance to recover on their own terms; try not to assume that someone is “back to normal” if they haven’t told you so.

3. ‘This Could’ve Been Avoided If You Had Just…’

It’s understandable that our loved ones, who presumably care very much about us, find themselves wishing that the hospitalization hadn’t happened, or feeling scared about what we went through.

It’s also understandable if there’s anger about the hospitalization, because sometimes it’s traumatic for more than just the folks who end up hospitalized.

So trust me when I say that I get it – fear, anger, and sadness were just a small slice of the spectrum of emotions my loved ones were feeling, too.

In the bigger picture, we are a part of a culture that so often blames victims for their own suffering – that tragedy or violence could be prevented if we had only made different choices. We blame rape survivors for having drunk too much, we blame poor folks for not spending wisely, we blame victims of police brutality for not “following orders.”

This kind of attitude is ingrained in our everyday lives.

With all of the emotions that you might be feeling, and the cultural script of blaming the victim, you may find yourself wanting to tell someone how their hospitalization and subsequent trauma is their fault, a result of poor choices that they made.

And I know that that assertion might feel very true, very real, and very justified.

But the truth is that it’s too late. What’s happened is done. When people pointed out that it was my choices that led to my hospitalization, they resurrected the pain, the memories, and the self-blame that had already been tormenting me.

My wounds were still fresh – and prodding at them only made things worse.

It made me feel like I deserved to go through the traumatic experience – like I should be punished for having a mental illness.

I had already spent every night in the hospital, thinking about what I should’ve, could’ve, or would’ve done. I already knew what choices were the wrong choices, because I’d replayed them in my mind a hundred thousand times. And I was not in the emotional state, when I left the hospital, to hash it out all over again.

No matter what the circumstances are, it’s triggering to blame someone for their own trauma, effectively forcing them to relive it.

It’s important to remember that mental health is far more complex than just individual choices. There are so many factors – psychological, biochemical, and even political – that can steer someone’s mental health in one direction or another.

Maybe there’s a conversation in the future which can involve prevention strategies and reconciliation. But for now, a person recovering after a hospital stay has one priority and one priority only: themselves.

4. ‘Please Don’t Tell Anyone’

A number of people discouraged me from writing about my hospitalization. Friends told me to reconsider how openly I’d posted on social media about it. Family members told me not to tell other family members. The underlying message, while not explicit, was that I should be ashamed of what happened to me, and that I should keep it a secret.

I chose to write about it on the internet instead. Because frankly, as a queer person and as a mentally ill person, I’ve spent most of my life in the closet and I’m not about to go back in.

The reality is, it’s up to the person who was hospitalized to disclose or not disclose. It’s up to them to decide what they feel comfortable sharing and what they don’t. And it’s up to them to tell this story on their terms – because what happened belongs to them, and not to anyone else.

It’s true that there’s a very real stigma around psychiatric hospitalizations. And when my loved ones asked me not to share, I know they only wanted to protect me.

But frankly, I never asked to be protected – and their attempts at shielding me only revealed their discomfort with my hospitalization, not mine.

There are always potential consequences when talking about mental health struggles. But it’s up to the person who was hospitalized to weigh those risks, and decide what makes sense for them.

Instead of telling people how to navigate their disclosure, it’s more important to support people in whatever choices they make – because it’s about their safety, their comfort, and their needs… not yours.

5. ‘What Was It Like?’

I think that the people who have asked me this wanted to be supportive and give me a space to process the experience, but they failed to acknowledge that I might not be ready to share.

(For the record, this goes for “what got you hospitalized?” and “did you hurt yourself?” inquiries, too. Ugh.)

Many people felt entitled to details about what happened to me in the hospital – entitled because they were family, or because we were close, or because they were curious. They seemed to suggest that what happened wasn’t mine, to process on my own time. That, instead, it belonged to everyone else but me.

And as people pushed and pried for details, I felt violated – I felt like they were exploiting my suffering because they had a morbid curiosity about being institutionalized, not about my healing or well-being.

It started to feel dehumanizing.

The reality is that many of us leaving psychiatric facilities may not feel safe sharing, aren’t in a place to relive what happened, or just don’t want to talk about it. And that should be respected – we should never be putting anyone on the spot, as if their hospitalization is just an entertaining story instead of a very personal experience.

6. ‘When Are You Going Back to Work/School?’

Being asked when I was going back to work was by far the most stressful question I was asked.

I promise, every single one of us wants to go back when we’re ready, so this is a question you don’t even need to ask. And if we need to go back sooner, it’s a decision that’s ours to make.

What many people don’t understand is that hospitalization is often the beginning, not the end, of recovery.

It will take its own course, on its own time – there’s no absolute formula for knowing when a person will start to return to their baseline mood and functioning.

If you want to support someone’s recovery, it’s far more important to be patient and understanding than to push someone to do something they may not be ready for.

And it’s critical to understand that going back to school or work when we’re still trying to recover may make things worse, not better.

I’ve known people to end up right back in the hospital because they returned to a toxic work situation or stressful semester at school before they were truly equipped to handle it.

The question shouldn’t be “when are you going back?” The right question is, “How are you feeling? How can I be supportive?”

Because if you’re really that interested in their return to work or school, you should be focused on how you can support them in getting better – valuing their humanity and wellness first and foremost, instead of their productivity. Pressuring them won’t get them back to “normal life” any faster.

7. ‘Try Not to Dwell on It Too Much’

A lot of well-intentioned people told me that instead of ruminating about what happened, I should “try not to dwell on it,” stay busy, go out, and keep it off my mind. But it felt like such a careless thing to say – that if I ignored what happened, it would just disappear.

I knew that their mindset was something like, “I can see that you’re in pain when you think about this, so maybe you should find a way not to think about it.” Logically, I can see why it would feel like this is sensible advice.

But the reality is that for many of us, we couldn’t ignore it even if we tried. Sometimes we’re dwelling on it even if we desperately don’t want to be. And being told not to think about it sounds a lot like saying, “Why can’t you just move on?” or “Why are you making such a big deal out of this?”

I developed some post-traumatic stress after my hospitalization – and the sheer tension that my body carried at every moment made my trauma not just an emotional experience, but a physical one, too. This wasn’t just a train of thought I needed to redirect. It was anguish and fear that I held in every cell of my body.

I wish people would’ve just asked, “How can I be helpful right now?” rather than instructing me on how best to deal with post-hospital life, especially when that advice didn’t resonate with me.

It’s better to never assume that you know what’s best for someone – especially if you haven’t experienced hospitalization firsthand.

Truthfully, as much as we don’t want to dwell on it, so many of us who were hospitalized are not “over it.” But it’s okay not to be over it – and letting people know that can be a powerful way to support them, affirming their right to take this recovery at their own pace.

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Most days that I was in the hospital, I had spaghetti and veggie meatballs with green beans for dinner. It was one of the more edible of the few vegetarian options, I was told, and with experience I quickly realized they were right.

Every so often, it comes back to me. I can be with a friend or sitting at home and suddenly taste it. Unexpectedly, its texture and smell and stale flavors will overtake me without warning.

It takes me back to the meals I stared down, remembering the way the nurses would inquire about how much I ate and write it down, clipboard in hand, like I was a specimen under observation. I’ll recall the faces of the other patients, waking me up with a jolt when they threw their bodies against the doors in the middle of the night, screaming LET ME OUT, desperate to escape.

And if I close my eyes, I’m being escorted to a room, I’m throwing punches, I’m being handed a cup of pills that I can’t name, I’m disappearing involuntarily into a wave of dreamless sleep.

So how do you explain that the panic all over your face came from phantom spaghetti?

How do you explain you can’t see an ambulance without flashing back to your body in restraints? That you have nightmares about the night you spent alone in the emergency room, in a drug-induced haze, bombarded with questions you can’t answer by people in white coats, tormented by voices only you can hear?

How do you tell someone that most days you still don’t feel real? That you feel robbed of something that you can’t define? That something – your identity, your safety, your connection to the world – was taken away and you’re afraid you’ll never get it back?

How do you explain to someone that realizing you weren’t invincible made you lose any trust in yourself you ever had?

That every moment inside your mind is like walking through a cluttered room where everything is breakable?

That you’re still breakable?

I’m not over this. But sometimes, the things that people have said about my psychiatric hospitalization made me feel like I was supposed to be.

It felt like there wasn’t any room for my pain when I emerged on the other side. It felt like I wasn’t allowed to be shaken, to be lost, to be shattered. I don’t think they realized the impact their words had on me – in fact, I think most people had the best of intentions when they said what they did – but I walked away feeling like I had to carry this burden alone.

That’s why I wrote this. Because if our loved ones really do care, they can and should do better.

There’s something to be said for holding the space for someone’s struggles, giving us permission to feel whatever it is we’re feeling. In a world that wants us to be silent about what happened to us, acknowledging that we’re hurting and bearing witness to it is an incredible gift.

I wish I had a triumphant conclusion for this article – about how, against all odds and with the loving support of my community, I have healed.

In some ways, I have. But there are days when I still hurt, still remember.

But each time someone reaches out to me – saying something caring, something sensitive, something thoughtful – it feels like there’s a stitch that wasn’t there before, helping to hold me together.

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This piece that I wrote originally appeared at Everyday Feminism.

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 That Crazy Friend 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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What Being Institutionalized As A Trans Person Made Me Realize

Back in the days just before I started testosterone, I used to say, “If HRT were to start causing problems with my bipolar disorder, there’s no question – I’d stop the hormones.”

I swore, over and over again, that I would never sacrifice my sanity for my transition. But this is not what I said in the psych ward, when the psychiatrist asked me, “Would you be willing to stop testosterone?”

Repeatedly, day after day, doctors would ask me about stopping HRT and my answer was the same every time.

“That’s not an option.”

My self of six months ago would have been aghast if he knew I was refusing to stop HRT despite being institutionalized.

But it wasn’t six months before. It was present day.

Present day, under a 5150 – wishing I weren’t alive, hearing voices that told me I was better off dead, and drinking more than my fair share to cope with both – the Sam that had hair on the back of his hands where there wasn’t any before, the Sam that was losing his curvy shape by the day, the Sam that looked in the mirror and felt whole for the first time, went against medical advice and insisted that they find another way to help him.

And I think that if you aren’t trans – and maybe even if you are – you might think that’s absolutely crazy.

But in my mind, I would’ve rather struggled to find medications that allowed my transness and bipolar to coexist than give up on my transition for the indefinite future, losing any hope of being in a body and inhabiting a self that felt right.

It would’ve been trading one kind of anguish for another. Which, to me, didn’t feel like a real solution at all.

For the cisgender medical providers around me though, they couldn’t wrap their heads around why I would refuse to stop HRT.

They couldn’t comprehend why I was willing to sit in an institution for however long it took to find a medication regimen that stabilized my bipolar disorder without denying me my transition.

And I say this not because I’m taking pride in being stubborn, but because cisgender people in general don’t know or understand the lengths trans people go to – the sacrifices we make, the trauma we endure – just to be who we are.

Cisgender people don’t understand that even in spaces that are supposed to be “safe,” trans people are subjected to harm that cis people will never endure.

I didn’t expect my hospitalization to be one in which my transness was understood, but I was blown away by just how little support there really was available to me.

If we aren’t suffering at the hands of someone else, we’re suffering the emotional trauma of being trans in a system that does not yet know how to affirm us, help us, or treat us.

In my case, there wasn’t a single doctor that could tell me if I would be allowed to continue on testosterone – because there’s simply not enough research around treating mentally ill trans people.

I had to sit in a psych ward, my mind eating itself alive, waiting helplessly to see if it was lithium that would win this fight or if I would be denied hormones because it was considered too risky to continue.

I had to wait, day after day, knowing that the hospital could take my hormones away at any time.

Thankfully, it was lithium that won out, this time.

But I quickly learned that even the best psychiatrists struggle to know what to do with transgender patients.

And when you’re locked in the psych ward, being treated like a medical mystery is not reassuring when your life and your transition are on the line.

This doesn’t even begin to capture the utter incompetence I experienced in the hospital, from staff members who did not know how to talk about trans people to the rampant misgendering despite my files clearly being marked “FEMALE TO MALE.”

I went there to heal but instead, panicked doctors and nurses encouraged me to stop HRT, they unapologetically misgendered me despite being repeatedly called on to do better, and a facility that assured me it was trans-competent turned out to be more invalidating of my gender than any mental health facility I’d ever been in before.

I was supposed to be a patient. But I was forced into the role of advocate and educator, at a time when I barely had the energy to care for myself, let alone teach an entire (rotating) staff how to treat transgender people.

In the San Francisco Bay Area, of all places, in a psych ward where suicide attempt survivors and suicidal trans people – of which there are many – will be going to receive care and begin their healing.

In a hotbed of insensitivity, cluelessness, and even violence.

It begs the question: For a community that is in dire need of mental health support, where do we go when we’re in crisis?

For me, I had no choice but to go to the ER when my breakdown happened. And I fear for other trans people who are similarly left without viable options, and are subjected to transphobia that wears them down during a time when they should be healing.

And I fear for the number of mentally ill trans folks that were denied hormones before they were ever given a chance to find an alternative.

I was released from the hospital yesterday, now very stable on both lithium and testosterone.

But I’m alarmed by the number of professionals that told me stopping HRT was my only solution, the amount of transphobic microaggressions I experienced in a hospital of all places, the number of battles I had to fight in a place I should’ve been cared for.

I’m outraged for my community, and the trauma they’ll endure in psychiatric facilities that are supposed to be for healing – not for harm.

There’s a glaring deficit in research, treatment, and care of transgender people, especially those with mental illness.

Until we acknowledge this, transgender people will continue to be failed by the mental health system – and will continue to end their lives instead of getting help. And facilities like the one where I stayed aren’t just responsible for doing better. They’re complicit in this epidemic of lost trans lives.

“Don’t transition” is not a solution. “Don’t be in crisis” is not a solution.

Transgender people with mental illness need and deserve better.

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A note on labels: Like many people with mental health struggles, I’ve experienced my fair share of misdiagnoses. Since writing this piece, I’ve finally been correctly diagnosed with obsessive-compulsive disorder and complex PTSD, which have been life-changing realizations for me. That said, I hope that the resources I created in the past can still be helpful. (Jan 2019)

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