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

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

So let’s chat!

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

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

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

Two months ago, I was hospitalized again.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dear Teenage Sam,

I want to tell you where I was this morning.

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

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

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

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

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

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

Put another way:

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

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

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

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

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

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

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

Sam, do you understand what I mean?

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

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

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

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

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

This moment will be made possible only because you survived.

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

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

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

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

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

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

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

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

***

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

Let’s Talk About Self-Sabotage.

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

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

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

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

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

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

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

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

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

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

Sound familiar?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Got it?

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

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

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

Please Keep Inviting Me To Brunch

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

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

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

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

But I couldn’t.

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

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

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

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

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

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

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

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

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

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

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

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

But I made it.

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

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

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

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

20 Mental Health Resolutions for 2017 (Because We Sure As Hell Need Them)

This time last year I wrote out some of my mental health resolutions for 2016. And I enjoyed – so much – the process of thinking through my resolutions, reflecting on the kind of precedent I wanted to set for my sanity, and then all the conversations we had together about what kind of year we wanted 2016 to be (this is a good time to mention our online Facebook community is a stellar place for dialogue).

And then, you know, 2016 actually happened.

For those following along at home, I kicked off 2016 with a psychiatric hospitalization and wrapped up 2016 with a relapse and a field trip to rehab. As far as mental health goes, it’s not been my finest year.

This doesn’t even touch on the fact that we’ve lost numerous pop culture icons – most recently mental health and addiction advocate/badass Carrie Fisher – and we elected an orange Voldemort to the highest office of the land after a grueling and painful election season.

I’m sure we can objectively say that this is not what we had in mind for a mentally healthy year. I’m also not going to be foolish enough this time around to suggest that 2017 will be your year or my year – it’s probably no one’s year, frankly, if a nuclear arms race breaks out, although, weird, Russia seems pretty stoked.

Do I sound bitter? Maybe I’m a little bitter.

Listen, it’s been a rough year. And my resolutions from last year by no means prevented the apocalypse from happening. They did remind me to focus on what’s important (i.e. keeping it together).

I believe if we’re going to survive this next year (and, y’know, the next four… or the next – ugh, I can’t say it), renewing our commitment to our self-care and sanity is never a bad idea.

I’m a fan of going into any transition in life with a lot of intention and mindfulness, so I’m bringing some of that intention into the new year.

That’s why, despite the catastrophe that was 2016, I’m going to once again share twenty resolutions I have for 2017.

Your mental health is more important than ever, and if there were ever a time to be vigilant about keeping all your marbles in the jar, it’s when apocalyptic headlines and subsequent panic attacks are always in abundance.

If resolutions are your thing, I hope that these inspire you to come up with your own (or steal mine, it’s all good!).

Sam’s 20 Magical Resolutions For 2017 To Be A Little Less Shitty

1. I want to go to more support groups. I know that what I need right now is community support. I have a tendency to isolate myself in my apartment and watch a lot of Law & Order, and while decompressing this way can be good, it can’t be the only way I deal with my shit.

2. I’m going to try opening up to someone that I don’t usually. I’ve already started on this a little early. I tend to unload on the same three or four friends when I’m struggling. Meanwhile, there are other new friends in my life who keep telling me that I can always count on them – yet I never do. Maybe it’s time to give other people a chance to support me, too, even if being vulnerable with a new friend is scary.

3. I want to find a new hobby. Someone told me that boredom is the enemy of sobriety. I’d expand that to say it’s the enemy of mental wellness sometimes, too. I want to find a hobby that makes me happy.

4. I’ll reconnect with an old hobby, too. There are so many things that I used to do that gave me a sense of fulfillment that I’ve lost over the years. Like music. I recently bought myself a keyboard and sheet music to try relearning piano. I tend to play the same chords and sing the same songs repeatedly. I’m terrible at it but you know what? I like it anyway.

5. I want to sober up, for real. If you’re wondering about sobriety or if you might have a lousy relationship to substances, please read this thing I wrote. Alcohol and I have a rough relationship and I think it’s time to break things off. I don’t think it will be easy, but I’ll try my best.

6. I’ll try to start going new places by myself. My agoraphobia has made leaving my apartment extraordinarily difficult. But I also know that the only way I can live a functional life is if I don’t give up. I think many of us with mental illness can withdraw in unhealthy ways. It’s time to step out of our comfort zone, little by little.

7. I’m going to unplug from bad news as often as I need to. Being informed about the state of the world is valuable, but not if it comes as the expense of your sanity. I’m going to take a break when I need to. Delete the Facebook app, turn off the television, and go the fuck outside.

8. No more counterproductive arguments. Period. If I’m arguing online when I know it’s accomplishing nothing, I’m going to hand my phone to my partner and go take a shower. It’s one thing to educate, engage, or intervene as a marginalized person or ally. But I need to try harder to see the difference between a teachable moment and a troll.

9. I’m going to (consensually) hug, kiss, and cuddle my friends more. Lord knows we need more of that in the apocalypse.

10. I’m working on accepting my limitations in 2017. I recently had to step down from my full-time job for my recovery, and I’ll be returning in a smaller capacity more akin to what I can handle right now. 2017 is going to be the year where I’m realistic about what I can do, and I’m not going to beat myself up because it’s not where I would like to be.

11. I’ll demand better of my clinicians, always. If I don’t feel like I’m getting the care I deserve, I’ll say so. If I don’t like the solutions I’m being given, I’ll ask for better ones. If I don’t like my clinician, I’ll get a new clinician. Therapists, psychiatrists, case workers beware.

12. I’ll stop using my friends to avoid being proactive. Sometimes I rely on other people to catch me when I fall, instead of making sure I don’t fall in the first place. If they’re going to do their part as friends, I need to do my part and take care of myself. Am I using all the resources at my disposal? Keeping in touch with my clinicians? Taking all my medications? My friends are responsible to me, but they aren’t responsible for me.

13. I’ll go to the hospital or rehab when I need to – even if I don’t want to. Sometimes a crisis calls for a response I may not like or enjoy. No one likes hospitals and no one likes rehab. But it may also be exactly what I need to get better.

14. I’ll be more communicative when I’m struggling. I tend to only convey how bad things are when it’s already blown up in my face. I did this at my job, I do this with my loved ones. But so much could’ve been avoided if I had been honest about where I was at, and done so sooner. There’s nothing wrong with being honest.

15. I’m going to start dealing with my actual feelings, rather than how I think I “should” feel. My boss (who is brilliant) emphasizes this often. An example of this in my life was when I felt like I should be happy because I had everything I thought I wanted, without acknowledging that, even so, I was falling apart. Sometimes we miss the red flags with our mental health because we’re not giving ourselves permission to feel how we really feel. For me, this begins with understanding that you don’t need permission or justification to feel depression.

16. I’ll treat my relationship with myself as a priority. Do you ever go through a period of really low self-esteem, and you kind of let it fade to the background because it doesn’t seem important? I do that all the time. And yet in real life, if I had a rough patch with my partner or friend, fixing it would be my priority. If I don’t feel good about myself, I’ll commit to self-care and support until I can start to feel more positively about myself again. Because caring about myself IS urgent.

17. I’ll practice healthy boundaries. This means inviting my friends to support me rather than imposing my crisis on them. This means asking for what I need rather than expecting it. And above all, this means checking in and making sure my needs aren’t exceeding someone’s emotional capacity. Not because I’m a burden, but because we’re only human, and I would want someone to do the same for me!

18. I’m going to be proud each day that I survive. Being mentally ill is difficult as fuck. Any day that I manage to hang in there is a terrific accomplishment, and in 2017, I want to make sure I keep that in mind.

19. Self-care. More self-care. And even more self-care. Never apologizing for taking care of myself – lighting new candles, taking long showers, writing to my heart’s content, and getting cozy with a heating pad and a good book. These things will always be necessary, especially in the coming year.

20. I will stop basing my value off of what I do instead of who I am. So much of what I thought made me valuable had to do with my job at Everyday Feminism, the success of my blog, the lectures I’ve given, and what I had managed to accomplish. In 2017, I want to look in the mirror and say, “You are valuable because of your empathy, your humor, your tenderness, your strength, and your determination.” Who I am. Not what I do. And I think all of us could afford to take a minute or two to reflect on the difference.

These are my mental health resolutions for the year. A lot of hopes, a lot of feelings. But that’s what this holiday is for, right?

I sincerely hope that in taking some time to reflect on what’s important to you and what you need this coming year, you’ll be as ready as you can be to take on all the challenges ahead, even the ones you don’t expect – because if 2016 is any indication, 2017 will probably have a lot of those.

Mental Illness Doesn’t Care How Good You Are

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I’ve tried so hard.

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

They tell me, “I know.”

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

How Many Mental Disorders Is Too Many?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Being complicated sucks. Being complicated hurts.

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

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

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

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

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

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

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

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

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

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

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