If your ‘suicide prevention’ isn’t talking about the mental health system, you’re missing the point.

September 12, 2018September 12, 20188 Comments

As both a suicide attempt and loss survivor, I need to climb up onto my soapbox for a minute.

Suicide attempts, from a “preventative” standpoint, are rarely, if ever, as easily prevented as calling a hotline or a loved one. “Reaching out” — while incredibly important — is not the be-all-end-all of preventative strategies.

Especially considering the fact that many of us have a history of asking for help, and not getting the care that we needed.

I understand the impulse to ask, “Didn’t they know they could call me?” I asked myself that many times when I lost one of my best friends earlier this year. But this shows a very big misunderstanding of the emotional experience that many suicide attempt survivors have described.

Speaking from my own experience, when you are in a very acute amount of emotional distress, your thought process is not as linear or composed as you might assume.

The pain in that moment can eclipse everything else — past, present, future. It’s a sort of tunnel vision in which the pain becomes too great; in those moments, I’m cognitively incapable of stepping back to get the kind of perspective I might otherwise have.

This is why I always try to remind folks that suicide attempts don’t necessarily reflect a person’s overall state, as much as it does their level of pain in that particular moment.

To put it as a metaphor, suicide attempts remind me quite a bit of heart attacks, in the emotional sense.

After a certain point, the body’s resources can no longer fend off a very acute and painful event. It is so pronounced that your brain’s reaction is to scramble and do whatever is necessary to combat that pain, as immediately as possible.

We have some autonomy when we’re in that kind of pain. But so many of our actions are ultimately driven by the visceral agony we’re in. Our systems are flooded and overwhelmed, made worse by the adrenaline, the stress hormones, and for many of us, whatever substances we might be abusing — like alcohol — in a misguided attempt to cope.

But more often than not, unlike a heart attack, it’s also a pain that’s been building for weeks, months, or even years.

When we talk about “suicide prevention,” we focus too much on trying to understand the actual attempt, and not enough on accessibility of care.

We don’t do much to ensure that the pain doesn’t become that acute in the first place. We don’t focus enough on quality of life afterward. And most importantly, we rarely interrogate the systems in place that have failed to support them long before they reached this place.

It’s as though we’ve seen someone having a heart attack, but we start asking what they had for dinner the night before, or kicking ourselves for not offering them aspirin that morning.

When we talk about addressing heart disease, we’re not just trying to intervene in the mere moments before they happen — we know that isn’t enough, which seems like common sense in this context.

We talk about the whole person, and all of the ways in which their wellbeing needs to be prioritized well before they reach a crisis point.

But suicidality is still not viewed this way. We treat suicide attempts as very deliberate choices, rather than complex reactions that we know are better addressed sooner, not just puzzled over later.

The problem is, our mental health system isn’t set up to intervene at the moment when it’s needed.

Therapists and psychiatrists are still wildly inaccessible. And if you can find one that has availability and is covered by your insurance (assuming you have insurance), it often takes weeks, even months before you can actually see them.

If that clinician isn’t competent or a good fit? That’s additional weeks, months, and even years until you find someone who meets your needs. Which doesn’t include the months it takes for those treatments to start yielding real results.

I recently wrote a reported piece about a veteran with PTSD, for whom the nearest mental health provider that took his insurance was a staggering four hours away by car. And if he hadn’t had access to a vehicle? I’m not sure he would still be alive right now.

And all this assumes that mental health care isn’t so stigmatized in your community that you feel empowered to get help sooner rather than later, which is simply not the culture we live in.

This bureaucratic nightmare, combined with stigma, is why many people with mental health struggles often don’t seek help for nearly a decade (or more) after their symptoms set in, if they seek help at all.

And that’s why I bristle at the questions I so often hear after a suicide attempt. “Why didn’t they ask for help?” is the wrong question to ask. “What were they thinking?” is the wrong question to ask.

“What did WE do to help them, as a society?” is the question here. And more specifically, what were WE thinking, when we set up our mental health system to be so inaccessible?

I want to challenge us to think about what we’re doing to change this on a substantive, systemic level. This isn’t about reaching out. This is a call-to-action.

My own suicide note years ago simply read, “I’m sorry. I just can’t do this anymore.”

Not, “I don’t want to do this.”

Not, “I don’t have any other options.”

Not, “I don’t care about my loved ones.”

I simply said, “I just can’t.” I had reached a point at which I truly believed that I could no longer physically withstand the pain that I was in.

This led me to the emergency room and, even there, I saw people desperately trying to harm themselves by any means they could, being stopped only because they were restrained by hospital staff.

And this was not because they didn’t have “help” or “options.” It wasn’t even because they weren’t asking for support. They were in the hospital — they were surrounded by people who, in theory anyway, wanted to help them.

But their pain was that unbearable, that all-consuming.

How do you bring someone back from that? And more importantly, how do you make sure they don’t return to that place?

Beyond preventing the act of attempting suicide, I want to know how we can assure them that the life they’re returning to is one in which they are truly supported.

No one should ever get to a point of experiencing that much pain. And if they do, there should be no question of what resources are in place to guide them through recovery. But our system isn’t built to intervene sooner rather than later. Our system isn’t built to create a reliable, consistent safety net afterward.

It’s certainly not interested in establishing any real quality of life, so much as it focuses on simply preventing death.

We have a “worst case scenario” mental health system, and it’s failing. Its efficacy is a game of luck at best, a roll of the dice.

If you have insurance; access to transportation; the right combination of clinicians, inpatient or outpatient programs, and/or medications; the time to commit to recovery; the persistence to keep following up with providers; the support system around you to help you when this becomes overwhelming; and the sheer energy to navigate the system that is already overburdened — maybe, just maybe you’ll survive.

No one’s livelihood or quality of life should be left to chance.

I’m not trying to paint a bleak picture. People can and do thrive, and I’m absolutely an example of that.

But not because our system is actually successful at what it does — it’s because I am one of the lucky ones that eventually, after many years, found my way through it.

I can tell you why I attempted suicide years ago, and it’s simple: the amount of time it took to “recover” exceeded the amount of resources I had to cope.

It took eight years to get the proper diagnoses for my mental health conditions from the time I started therapy at age 17.

Which means it took eight years to find the right medications to treat my OCD, PTSD, and ADHD. And it took eight years to find a therapist that specialized in those areas — a therapist that I had to pay out-of-pocket for, because my insurance wasn’t taken by any therapists in the area who had openings for new clients.

I’m less interested in preventing the act of suicide itself, and more interested in knowing why our system is doing such a terrible job of caring for people who are struggling before, during, and after.

When we know earlier and more compassionate interventions are so critical, and when we know quality of life is exceedingly more important than simply keeping someone alive, we need to start asking why our system is set up the way it is.

We need to start demanding that something change — because our lives depend on it.

Hey there, friend. Before you go, I want to share some resources with you.

If you’re suicidal, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386, or reach the Crisis Text Line by texting “START” to 741741.

Don’t know what to say but want to ask for help? That’s amazing. I wrote an entire guide on how to reach out and what you could say.
You can also go to the emergency room. If you’re not sure if you should or how to prepare for something like that, I’ve got an article for that, too.
Looking for some immediate self-care resources? I’ve got some for you in this article.

This isn’t just a generic “here are some numbers” plug, I promise. This is a “I want you to stay, we need you here, please don’t go just yet” plea.

Are you a loved one that wants to reach out to someone you think is struggling? Incredible. You totally should.

I have a guide here for how you can offer support in concrete ways.

One more thing: I created this resource totally for free, but your donations help keep this labor of love going.

This blog is not sponsored by any fancy pants investors that are trying to sell you stuff.

It’s funded by readers like you via Patreon!

Every donation counts. Help keep resources like these accessible to everyone that needs them! And help buy me a cup of coffee, because I write a lot of these blogs after work, late at night, so I could definitely use the caffeine.

Some credits & gratitude go to… Photo by rawpixel on Unsplash. Artwork by Jessica Krcmarik.

If your goal in therapy is to ‘be happy,’ you might want to rethink that. Here’s why.

August 12, 2018August 12, 20186 Comments

When I first walked into a therapist’s office when I was eighteen years old, I had one goal and one goal only: “I just want to be happy,” I said.

Up until that point, I couldn’t really remember what that felt like. I didn’t know at the time that I had obsessive-compulsive disorder (as it turns out, it runs in the family), and that my near-constant state of guilt, panic, and rumination wasn’t actually the way most brains operate.

I thought happiness was the whole point of this “mental health” thing. So I became something of an emotional hypochondriac — if I wasn’t happy, something was wrong.

Suddenly my very human experiences like sadness, anger, and anxiety were all “problems” that needed to be “fixed.” I had this unreasonable expectation that, if I worked hard enough, I could minimize the presence of every other emotion to become capital-h “Happy.”

That’s not exactly the healthiest mindset, if you really think about it.

Ask anybody what they want out of life, and they’ll probably tell you the same thing I told my therapist all those years ago — it’s about being happy, isn’t it?

But happiness is just one emotion. And humans aren’t built to experience one emotion and one emotion only.

So we set ourselves up for failure. We internalize this idea that life is about sustaining something that can’t actually be sustained… but we pretend that, with the right attitude, it can be.

And then we wonder why we keep getting let down. It just doesn’t leave room for the whole spectrum of emotions every one of us is going to feel.

The thing is, if our goals for therapy (or recovery generally, or even life) are setting us up for failure, they aren’t really serving us. In fact, they’re probably going to discourage us. This becomes doubly true when we’re talking about marginalized people, where societal circumstances basically make it impossible to be happy all of or even most of the time.

And if your goal for therapy is impossible? You might give up before you ever get to the good stuff.

The really paradoxical thing about mental health recovery is that the goals that lend themselves to happiness usually aren’t about happiness at all, at least directly. A lot of people find that the less they focus on “being happy,” the more they’re able to make changes that contribute to their happiness.

Being happy with greater frequency and intensity just becomes this weird (and totally cool) side effect. At least, it was for me.

So if you’re not going to therapy or living life to become happy, what’s the point? I started asking the same thing. And what I learned along the way kind of blew my mind wide open.

If you’re wondering what might be helpful to work towards (whether it’s with a therapist, a life coach, a spiritual guide, in a support group, or even as prompts for your journal), that’s what I’m here for.

Here are five goals that I’ve found to be especially important for therapy — and why ‘being happy’ isn’t one of them.

1. I want to live a life that feels more meaningful.

Arguably every goal on this list circles back to this one. There’s an awesome TED talk by psychologist Emily Esfahani Smith unpacking this exact thing (I highly recommend it — it’s based off of a book she wrote that’s rooted in her work in positive psychology, pulling not just from research, but also from philosophical and spiritual traditions).

We can’t be happy all of the time, but if we can create a greater sense of meaning, it gives us something even better — a life that feels worthwhile. It can motivate us to invest in ourselves, our communities, and our world in a way that doesn’t depend on whether or not we’re happy in a given moment.

In other words, it’s more sustainable. Smith outlines the key pillars of a more meaningful life by breaking it down into four categories: belonging (feeling affirmed by people around you), purpose (serving others in some way that reflects our values), storytelling (which I’ll talk about a little more below), and transcendence (moments that fill us with awe or wonder).

I personally found belonging by joining groups in my local queer community and purpose by volunteering locally around causes I care about. I’ve found transcendence by going to concerts and becoming a drag performer (music and art have always made me feel like I’m a part of something bigger) and traveling a little more.

It’s worth mentioning, I was able to do this after I found the right balance of psychiatric medications to better manage my obsessive-compulsive disorder and ADHD.

So I do recognize that this requires a strong enough foundation on which to build — luckily, a shift in goals can help us determine what exactly we’re working towards which can inform what kind of support we need.

2. I want to create a better narrative for and about myself.

I’ve heard many times before that who we are is just a compilation of the stories we repeatedly tell ourselves — whether we realize that or not.

For the longest time, I’d written myself off as some neurotic, broken person that just needed to be “fixed.” And that deeply impacted how I treated myself and the choices that I made.

Working with a trusted therapist and even blogging about my experiences helped me construct an entirely different story for myself. In processing and unpacking my life experiences, I could see more clearly that I had done my best, learned from my mistakes, and emerged on the other side a stronger and more determined person.

I realized my identity was simply an interpretation of all the events I could remember. And as it turned out, there were many different ways to interpret those events that I’d never thought of.

Up until recently, I chose to interpret difficult events in my life as a reflection of my own inadequacy and failure, rather than a journey of personal growth and new insight. Practicing this reframing of my life, especially with a therapist, helped me construct a new story and a new appreciation for who I am and who I’ve become.

There’s actually plenty of research that backs this up, too; internalized narratives play a big part in our overall satisfaction with life.

The tricky thing is, we’re not always aware of the stories we’re telling ourselves (the fish in the bowl doesn’t always see the water, after all).

But when we uncover these narratives, and start to question where they came from and what we can learn from them, it can make a big difference in how we perceive ourselves (and by extension, how we feel and behave — cognitive-behavioral therapy, anyone?).

I don’t believe for a minute that we “choose” to be happy or unhappy. I do believe, however, that brains are pretty malleable things — and with practice and support, we can find a different story to tell ourselves and learn to believe in it, too.

And if our identities are really just the interpretation of a life story, those interpretations can change our whole selves.

3. I want to cultivate more intimate, fulfilling relationships.

Our relationships play a big part in our day-to-day. I’m constantly amazed, as I do more work with a therapist, at how often I’ve gravitated towards toxic relationships without fully realizing it.

Many of us have patterns in how we engage, the kinds of people we seek out, and in what ways we invest in others (or don’t). Just a few weeks ago, I wrote about one of my worst patterns as a people-pleaser. I suspect we’d be a lot more satisfied in life if we were more aware of these things, but that awareness takes work.

Being more aware of our relational patterns is an awesome goal, and it can wind up making us happier in the long run. It benefits ourselves, the people we care about, and the communities in which we live.

If you’re not sure where to start, there are some questions worth considering:

Who are the people I spend my time with? How do I feel before I spend time with them and how do I feel after? I wasn’t able to answer the second question at first, so I had to start being more mindful when I hung out with people. And let me tell you… it was mind-blowing to see how some of the people I invested in most made me feel worse.
How do the people closest to me express their care, investment, and affection for me? How do I reciprocate and how often? This helped me to become more grateful for the generosity that I wasn’t always the best at noticing, and also made me aware of the relationships in which I was giving a lot more than I was receiving. (Relationships are rarely an equal transaction, but being mindful can help us make better decisions around where we want to invest our energy.)
Who are the people, if any, that hype me up? And how can I find them or connect with them more regularly? I sat down and thought of three people that consistently make me feel good about myself. And no joke, I threw them in a group chat on Facebook and now we get brunch together most weekends. I even have a spreadsheet where I keep track of the relationships I’m nurturing. I can honestly say that my life improved instantly when I did this.

If you don’t have close friends or loved ones that hype you up or make you feel good, that’s also important to know. It might be time to start expanding your social circle, whether that’s online or off!

4. I want to develop resilience and healthy self-reliance.

I’m by no means saying that pursuing happiness is totally futile! It’s important to do things that you love and bring happiness into your life.

But I also think, along with seeking out joy, it’s a good idea to couple it with learning how to cope with the difficult stuff, too.

Being happy is awesome, but being able to roll with the punches becomes really important at those times in which happiness isn’t feasible or possible (because your boss is the worst, or the president tweets again, or life just happens to suck for a while — it happens!).

When there’s a setback, how quickly do you bounce back? Are there ways you’d like to be able to take care of yourself, but find are difficult to do? In other words, how often do you feel helpless or stuck, and are there opportunities to change that?

Rather than becoming unhappy and looking to “fix” it, berating myself for feeling negatively, or getting flustered as I tried to figure out how I got there, I started accepting how I felt in the moment. After all, thoughts and feelings come and go, because that’s kind of how brains work (they are super imperfect meat machines, basically).

So while waiting for the clouds to pass, I started grounding myself in the moment and asking, “What can I do, right now, to make this moment a little better?”

Therapy, for me, has been the best route in learning new coping skills (along with antidepressants, because sometimes our brains need an assist). But I realize not everyone can access super great therapy (a rant for another day).

That’s why I’ve written about mental health apps that can teach you some new skills, shared many of my favorite self-care resources for those that might need it, and am a strong advocate for self-help books, online communities, and support groups. The internet can open up access to a lot of these things. Go forth and educate thyself!

Resilience is an important goal (or process really). It allows us to live in a world that’s constantly changing, and gives our brains permission to be the finicky and unpredictable things that they sometimes are.

5. I want to uncover where I’m making life more difficult for myself.

Everyone on the planet has self-defeating patterns. I mean, I don’t necessarily have any research to back this up, but I have yet to meet someone that doesn’t shoot themselves in the foot with some regularity.

Some people with depression make themselves sad on purpose because it feels “safe,” as an example (I explain more about why in this post).

More often than not, the coping skills we developed when we were younger aren’t so great for the adult world. The rules and environment are completely different (and also, we likely just weren’t as skilled in general at taking care of ourselves — wisdom and experience and all that).

Recently I noticed just how much avoidance makes me miserable. I’d avoid things that stressed me out (like going to the dentist or answering important emails), without fully acknowledging that I was only prolonging my pain.

But here’s a fun discovery: The momentary discomfort of facing what stressed me out was a lot easier than the lengthy, drawn-out anxiety attack that occurred while I put things off.

The more I plugged my nose and walked through the stuff that I hated but needed to face, the easier and easier it became to tackle my stress. Don’t get me wrong — I hated every freaking minute of it with a fiery, burning passion… but that misery was temporary. Never addressing the problem, however, was permanent.

This might seem obvious to you (like, hello Sam, you’re how old and just now getting this?), but when we’re in the midst of it, we don’t always connect the dots.

We might also assume that we’re helpless or powerless despite the circumstances of our lives being very different (read about “learned helplessness theory” at some point, it can be really helpful to know about).

And oftentimes, to notice and break these patterns, we need help — because this stuff is ingrained and most likely exists for a very good reason.

In the past, these patterns might’ve made sense to minimize your immediate stress as much as possible. But I think most of us reach a point when those old tricks start to interfere with the longer term stability we’re trying to achieve.

Learning more about these patterns, then, is what can help us start to unlearn them. And honestly? Every single person on the planet could benefit from working on that.

Yes, this is all easier said than done. But that’s why it’s a process!

Remember, the stuff on this list is meant to give you a sense of direction as you work towards mental wellness. They aren’t destinations or achievements — they’re simply part of a larger process that some of us call “personal growth” and others simply call “life.”

It’s ongoing, but in therapy especially, it’s always good to set up some goalposts where you can.

My goalpost of “be happy” wasn’t working for me. But the moment I stopped expecting myself to be happy all the time, my life got a whole lot better (and calmer, really) in ways I didn’t expect. Things like purpose, growth, intimacy, and resilience made a bigger impact than “happiness” ever could.

We live in a world in which happiness is fleeting. It comes and goes. But the good news is, we can have meaningful lives — lives in which we grow and connect with others in meaningful ways — without being constantly happy.

Besides… no one needs that kind of pressure!

When we start thinking about happiness as the awesome byproduct of personal growth, rather than making happiness itself the goal that we chase, we wind up with a much stronger foundation for mental health.

And weirdly enough, when we’re not obsessed with happiness and so terrified of losing it, it becomes a lot easier to be happy — and appreciate it, too — than it ever was before.

This blog is not sponsored by any fancy investors or companies that are trying to sell you stuff.

It’s funded by readers like you via Patreon!

Every donation counts. Seriously. Throw a dollar my way, and help keep resources like these accessible to everyone that needs them.

Photo by Eunice Lituañas on Unsplash.

Yes, I have a ‘mental disorder.’ But it’s not being transgender.

July 20, 20187 Comments

It seems like every other week, some conservative with a podcast and an ax to grind announces that being transgender is a mental disorder — despite having no credentials that would actually, I don’t know, make them qualified to diagnose someone.

And I’ll be honest — it’s frustrating to still hear this.

You don’t have to look very far to get the general medical consensus. The World Health Organization and American Psychiatric Association have both affirmed that being transgender is not, in fact, a mental illness.

And while “gender dysphoria” can be medically diagnosed, this is specifically done to access gender-affirming care — not because being transgender is in itself a disorder.

It’s true that some people really and truly don’t get it. There are some folks that use this kind of language because they don’t know how else to talk about the trans experience.

They don’t know exactly what a “mental disorder” is or what it’s like to be transgender. And they see that we’re suffering and dysphoric — so they don’t know how else to talk about it.

As someone who lives with obsessive-compulsive disorder (OCD) and also happens to be transgender, I can tell you upfront that there’s just no comparison.

Being transgender and having a psychiatric illness aren’t at all the same. Comparing them isn’t just an “apples to oranges” situation — metaphorically speaking, we’re not even in the same food group here.

And why is that? To start, let’s talk about what mental illness is.

The American Psychiatric Association defines mental illness as a health condition that impacts thinking, emotion, and/or behavior in a way that creates distress. More often than not, this leads to difficulty functioning in social, work, and/or family activities.

For people who aren’t transgender, they might look at this definition and come to the conclusion that trans people are mentally ill, because many of us do experience distress, and being transgender absolutely does impact how we think about ourselves and how we behave.

The problem is, it’s not being transgender that, in and of itself, creates distress and dysfunction. It’s the difficulty in trying to be who you are when the society around you is deeply hostile towards you.

It’s not my gender identity that’s caused me distress. It’s moving through the world as a trans person.

If anything, identifying this way has brought me enormous relief and made me a happier person overall.

I started to experience distress because of how others treated me. I was distressed when I experienced invalidation, harassment, and rejection. I was distressed when I was closeted, trying to be something that I wasn’t.

And my functioning was impacted when I couldn’t access care, like hormones and surgery.

When I wasn’t able to be who I was, and when I encountered violence and opposition because of it, that’s when I was distressed.

When someone is suffering as a result of how the outside world treats them, especially when they are part of a group that has historically been marginalized, that’s not a mental disorder.

The word you’re looking for there is “discrimination.”

The more “insane” thing to do would’ve been to keep pretending to be someone I wasn’t, which was a much more agonizing experience for me.

Figuring out my gender wasn’t a problem. In fact, it was a huge relief and it improved my life, so long as society did not interfere with my ability to transition. I’m far more mentally healthy now than I ever was prior to transition… by a long shot.

And that’s why I consider my experiences with obsessive-compulsive disorder and my transgender identity to be — categorically — two very different things.

It’s true that how society treats me because of my OCD, and a lack of accessibility to the therapies and medications I needed to thrive, were both contributing to my distress. Discrimination happens to people with mental illness, too, and it can have a profound impact on our lives.

But there’s a component to my distress that originates outside of that mistreatment.

OCD — and the neurobiology behind it — creates patterns of thought, emotions, and behaviors that are in themselves distressing, even under the very best circumstances.

Labeling those patterns as a disorder is the quickest way to say, “There are aspects of my biology and brain chemistry — mixed in with my environment and genetics and everything that makes me a human — that create specific and unpleasant mental/emotional experiences for me.”

Those patterns have been studied over the years, and they’ve been observed in many people who all respond similarly to particular solutions. The label exists to guide people like myself to the resources and solutions that will help reduce our suffering.

Many of these mental and emotional patterns associated with OCD feel at odds with who I am, and when I don’t work to mitigate their impact, my mental health worsens.

Being transgender, though, feels in alignment with who I am, and when I am able to freely explore and express this part of myself, my mental health improves.

The unpleasant experiences that stem from OCD aren’t reflective of who I understand myself to be; I feel more “myself” in the absence of those experiences.

As a transgender person, though, I feel more “myself” when I am able to embrace my gender identity. The more present I am in that experience, and the safer I feel in expressing that, the more whole I feel.

To call my transgender identity “disordered” implies that I need to minimize this part of my experience, but to be the very best (and healthiest) version of myself? I need the exact opposite.

The key differences here, then, are where that distress is coming from, and under what circumstances it improves.

Those two factors are where being transgender and being mentally ill diverge completely.

I don’t experience distress when I think about being a gender other than what I was assigned at birth, and I don’t experience distress from behaving accordingly. In fact, the more freely I am able to live my life in ways that align with my identity, the healthier I am.

But I do experience distress when I think, behave, and feel things as a result of the neurobiology we call “obsessive-compulsive disorder.” And the more I’m able to minimize and manage the impact of those thoughts, behaviors, and emotions, the healthier I become.

In that way, these are totally opposite scenarios.

When we diagnose someone, we’re essentially saying, “This pattern is present, but if it were less so, this person’s mental health would improve.”

So when you say that being transgender is a mental illness, you’re saying that suppressing or minimizing that identity would then lead to mental health.

But this simply isn’t the case. When trans people are able to be themselves and access gender-affirming care, their mental health outcomes are often better. This is especially true in situations where discrimination or violence is less likely, or in the case of youth, when they are supported by their families.

So by its very nature, being trans cannot be a mental illness — because invalidating and minimizing a trans person’s identity has not been proven to positively affect their wellbeing.

It’s the complete opposite.

If you were to classify being transgender as a mental illness, then, you would be making a recommendation to a clinician to treat us in a way that would not improve our health, which completely defeats the point of making any diagnosis in the first place.

But there are plenty of trans people who continually emphasize how much these attitudes harm us.

We don’t need transgender people to stop being trans, nor do we need to further stigmatize our identities and experiences. Gender diversity is not an illness — a society that is hostile towards it, though, is far more distressing.

If diagnoses are meant to help improve a person’s health, I’m still waiting to see any proof that labelling us mentally ill is actually improving our lives.

The sad reality is, many of the people who still insist that being transgender is a “disorder” don’t actually care about our mental health.

Because let’s be honest, if they did? They’d stop talking and do a much better job of listening.

People who are determined to label transgender people “mentally ill” — those who do so to rile people up on Twitter, not just because they haven’t thought about this much — do so because it’s a way of dehumanizing us.

It’s a way of suggesting that we are delusional and that we aren’t who we say we are. It implies that trans people need to be “cured” or “fixed,” and that we shouldn’t exist. To them, we’re mistakes that never should have happened.

That mentality is used to justify a lot of the emotional and physical violence that wounds and even kills us, and it perpetuates the hostility and self-hatred that drives so many of us to suicide.

But I want to be crystal clear about something: my being transgender was never a mistake.

My path hasn’t been an easy one in a lot of respects. But the strength and determination that I carry in my heart is part of a legacy — it comes from generations of transgender and gender nonconforming people, those who were willing to risk everything for a future they knew they might never see.

They stared down all of the dangers that came with that, showing up for each other and for a better world, so that one day, trans people like me could truly live. It’s a legacy that I now have the privilege of inheriting, and it’s one that I don’t take for granted.

For me, being transgender is an honor — and every single day, I step into my life knowing that from the moment I was born, I arrived with a purpose.

I want a future where every trans person can become who they are with every ounce of safety, love, and affirmation they deserve. And if that’s your definition of “crazy,” it sounds like I have my work cut out for me.

Challenge accepted.

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Transgender people shouldn’t have to lie about their mental health. But many do.

June 23, 20186 Comments

Until this last year, accessing top surgery was a losing battle for me. But it’s not because of where I live, my health insurance, or any of the other typical barriers you might imagine when trans people are looking for care.

It’s because I’m mentally ill.

I live with obsessive-compulsive disorder (OCD) and complex trauma; I’m also transgender. And I’ve found that, at this particular intersection, accessing the health care I need has been an uphill battle.

I’ve been denied care numerous times over the years, under the premise that I was too mentally ill to undergo a major surgery — ignoring that gender dysphoria, an acutely painful experience for many trans people, was contributing to my poor mental health.

It took two years to be placed on a waitlist for surgery, when a therapist finally decided that I was “stable” enough (without any explanation of what that actually means).

And it wasn’t just surgery that was made difficult. Psychiatrists in the past have encouraged me to stop taking testosterone, convinced it was making me “worse.” While hospitalized for depression, I had nurses trying to withhold my hormones because they didn’t feel it was “necessary.”

This last January, I finally got top surgery and I now have consistent access to hormone replacement therapy. But I still live in fear that, should my mental health decline again, I won’t have access to the gender-affirming care that has vastly improved my life and wellbeing.

Frustrated by my own experiences, I started reaching out to other trans people with mental illness to see if they’d encountered similar challenges — and I was horrified by what I found.

“A lot of doctors I saw questioned my ability to handle hormones as someone with a history of depression and self-harm,” Luke, a non-binary trans man in Ontario shared with me.

Could that history really justify someone being denied hormones altogether? I was wondering that, too. So I did a little research on the literature we have. And… it’s not exactly helpful, to say the least.

The World Professional Association for Transgender Health (WPATH) created their Standards of Care. The SOC are, more or less, the most recognized clinical guidelines for treating transgender patients. They advocate for an “informed consent” model: allowing for trans people, once fully informed of the risks and benefits of treatment, to choose for themselves the right path forward.

The standards also advocate for competent treatment of co-existing mental health conditions with the use of therapy and medications, where appropriate.

But if you look closer, you’ll find that they are limited in how they discuss treatment of mentally ill trans people. “Clients should be assessed for their ability to provide educated and informed consent for medical treatments,” it reads, without actually offering adequate guidelines for what this looks like in practice.

It also states that, before surgery is considered for someone with severe psychiatric disorders and impaired reality testing (so delusions or hallucinations, really), “an effort must be made to improve these conditions with psychotropic medications and/or psychotherapy before surgery is contemplated.”

This raises a really important question: How, exactly, do we measure “improvement” in mentally ill trans people?

And if there isn’t significant enough improvement, is a trans person simply in limbo, unable to access transition-related care?

Mentally ill trans people, then, are ultimately left to the whims of whatever mental health clinician they happen to be seeing — with very little recourse if they disagree with that clinician’s assessment of their readiness for care.

The SOC directly list conditions like psychosis, bipolar disorder, dissociative identity disorder, and borderline personality disorder as mental illnesses that could impact “readiness for surgery.”

But in a document of 120 pages, the SOC actually say very little on how, exactly, to assess at what point a mentally ill trans person might be “ready” to access surgery. Until this is made clearer, transgender people are put in an impossible position of deciding whether or not it’s safe to disclose their mental health status.

Interestingly, WPATH — and the overwhelming majority of care providers who work with transgender people — agrees that gender-affirming care is medically necessary. What’s puzzling is that, in almost any other context, mental health status would not preclude someone from medically-necessary care for any other condition.

Gender-affirming care somehow seems to be an exception, reinforcing the notion that trans-related care is “optional.”

The most direct mention of denying access to surgery in the Standards of Care reads, “No surgery should be performed while a patient is actively psychotic.”

This seems to be the only statement that a trans person can point to when they encounter obstacles, but given the other mentions of “readiness” and “improvement,” there are still too many ambiguities— and too many clinicians who aren’t at all familiar with the SOC to begin with.

Not to mention, none of this helps trans people with more severe mental health challenges who still need to access care.

It’s worth noting, too, that disorders like borderline personality disorder — which is flagged as a potential issue in the SOC — include an “unstable sense of self” as a diagnostic criteria, as well as difficulty trusting others and recurrent suicidality.

Coincidentally, these sound an awful lot like issues any trans person could struggle with simply because they are transgender.

In other words? Any trans person could be denied care if a clinician who’s unfamiliar with this population misdiagnoses them. In fact, at the time at which I was denied surgery, I myself was misdiagnosed as borderline. When that diagnosis no longer applied, I finally found myself on the waitlist.

While some boundaries surely need to exist, the utter lack of clarity in these guidelines means that trans people with any mental health struggle are at risk.

I spoke to Traci Lowenthal, a licensed psychologist that has worked closely with the transgender community. Most of the time, she shared, “mental illness should not be a barrier to getting necessary trans health care.”

The keyword here being, of course, “should.”

When assessing the readiness of a mentally ill trans person to pursue surgery, the most important factors, she says, are safety and the ability to consent.

So long as they can provide informed consent and keep themselves safe (the example she gives is proper hygiene and medication compliance post-surgery), there should be no barrier in accessing gender-affirming care.

“If a person has delusions,” she continued, “it would be ideal if their mental health provider could help them prepare for how those delusions may impact them while they receive medical care and during recovery.”

Compare this to my two-year battle to access surgery. It wasn’t because I was delusional — I was told, in essence, that I was too depressed to undergo surgery. There was no effort made to determine if surgery might improve that depression, and if there could be ways to better prepare for surgery in that state of mind.

The end result? Transgender people are scared to be honest about their mental health. And this has serious consequences.

I spoke with Ghost (a pseudonym), a trans person in Detroit, Michigan, who experiences schizoaffective disorder, delusions, and anxiety. For them, this has meant a constant fear of interference and mistrust in clinicians. “I am absolutely terrified that my mental health status will be used against me [in transitioning],” they explained.

“I’ve already experienced ‘the look’ from a medical professional,” they went on. “The one they use when you tell them [your mental health status], and they’re suddenly very skeptical of you.”

And with disorders like schizophrenia and borderline disorder especially, all of the trans folks I spoke to said they encountered disbelief when disclosing they were transgender, simply because they had one of these illnesses.

Some trans people have resorted to hiding their mental health history, or outright lying about their mental health status to providers. Others postponed psychiatric treatment altogether to ensure they could first transition without interference, which included forgoing psychotropic medications they desperately needed.

The unfortunate reality is, clinicians can’t adequately prepare someone for the specific challenges of medical transition if they don’t know about their client’s mental health status. And of course, when trans people have greater reluctance to seek out psychiatric care during their transition, they’re unlikely to get the support they need for the best possible outcome.

The fact that trans people should have to choose between gender-affirming care OR mental health care is unjust. Access to both is critical, especially for such a vulnerable population.

Trans people face an extraordinary risk for suicide — but if they fear disclosing their mental health struggles, they are likely to suffer in silence. This puts their lives in danger.

And when a trans person with mental illness is, indeed, denied access to care, the path forward is equally unclear.

Florence Ashley, transfeminine activist and LL.M. candidate at McGill University — with a special focus on bioethics and transgender health care policy — highlights just how much of a grey area this is.

Pointing again to the WPATH Standards of Care, she notes, “The only case that WPATH describes as precluding surgery is while the patient is ‘actively psychotic.’”

The rest, she agrees, is murky at best. “As with many issues faced by trans people, the best we can do is extrapolate from sources of law that have yet to be applied to the specific issue,” Ashley said, noting that a case might be made on the grounds of medical liability and professional ethics.

However, there appears to be no legal precedent for trans people specifically to look to when making such a case.

“This really ties back to a core problem in trans law,” she continues. “At some point, policymaking bodies will have to take up responsibility and pass enforceable policies and laws on trans-specific problems in collaboration with trans communities. Otherwise, we’re always going to be left behind.”

It’s evident, then, that more research and attention is needed to properly support trans people with mental health struggles. We need clearer guidelines, direct policies, and competent clinicians who are prepared to work with trans people regardless of mental health status.

For the transgender people who fear that they will not be able to access gender-affirming care, however, this offers very little comfort.

“I’m constantly worrying that someone will look more deeply into my history and see attempts, hospitalizations, a history of self-harm, and take it all away,” Tamsin, trans woman in Vancouver confessed.

While she finally has access to hormones, she fears it isn’t guaranteed. “[It will] cause me at least some anxiety for life.”

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10 Ways to ‘Reach Out’ When You’re Struggling With Your Mental Health

March 3, 2018March 3, 201844 Comments

I’m a mental health writer and advocate, and a suicide attempt survivor. I’ve told people on this blog many times, “Keep reaching out.” I’ve written multiple articles preaching the importance of vulnerability, defying stigma, and owning your struggles.

This is my whole thing, okay? This is what I do.

So when one of my closest friends died by suicide a few weeks ago, I wasn’t just shocked — I was completely gutted.

I thought there was never a question of whether or not my loved ones could reach out to me. But the very person who I’d talked to so often about mental health… didn’t call me.

Not even to say goodbye.

The last night I spent with them.

In the weeks following their suicide, my grief took me to dark places. I soon began having my own suicidal thoughts. And even then, when it was my turn to “reach out”? Even after losing my friend? I began to withdraw, too.

I watched, with painful awareness, as I did much of what my friend seemed to do leading up to their suicide. I wrote myself off as a burden. I isolated myself. I got lost in my own head. And despite knowing the danger of where I found myself, I said nothing.

After an especially scary night, I realized something: No one ever explained to me how to ask for help. No one told me what “reaching out” even meant.

As my grief began to snowball, I hesitated to tell anyone I was struggling, largely because I didn’t know how. I didn’t know what to ask for, and without knowing what to ask for, it felt too complicated and futile to ask.

“Why didn’t they tell me?” is such a common refrain when we talk about suicide or mental health challenges in general. It’s easy to make this remark, because “tell someone” seems like a simple request. But in truth, it’s vague at best.

“Reaching out” is this skill we’re somehow expected to know, yet it’s never taught and rarely modeled for us.

It’s this vague, hopeful sentiment that people throw around, without ever really defining it. What are we asking people to do or say? It’s not exactly clear.

So I want to get more specific. We need to be more specific.

I don’t know if an article like this could’ve saved my friend. But what I do know is that we need to normalize asking for help and talk about what that might look like, rather than pretending it’s a simple and intuitive thing to do.

Maybe then, we can reach people sooner. We can meet them more compassionately. And we can find better ways to support them.

So if you’re struggling but you don’t know what to say? I get it.

Let’s talk about it.

1. “I’m (depressed/anxious/suicidal). I’m not sure what to ask for, but I don’t want to be alone right now.”

Sometimes we don’t know exactly what we need, or we’re unsure of what someone can offer. That’s okay; that shouldn’t discourage us from reaching out. It’s perfectly fine if you have no idea what you need or want — especially when all you can think about is how much you’re hurting.

Let someone know how you’re feeling. You might be surprised by the ways they offer to support you. And if they aren’t helpful? Keep asking until you find someone who is, or seek out a hotline (I know it can be weird to talk to a stranger, but there are some awesome hotlines out there).

2. “I’m struggling with my mental health and what I’ve been trying isn’t working. Can we (meet up/Skype/etc) on (date) and come up with a better plan?”

Feeling helpless or exhausted is part and parcel for dealing with a broken mental health system. But a team approach can make it a little more manageable. Sometimes we need a cheerleader/researcher that helps us explore our options, especially when we’re having trouble believing that we have any.

One thing you’ll also notice is that, for almost everything on this list, I suggest setting a time.

This is important for a couple reasons. The first being that it helps the person you’re talking to understand the urgency behind your ask. It can also be helpful to know that there’s an event in the near future when you can expect to receive some support. This can help us hang in there when things get bleak.

3. “I don’t feel safe by myself right now. Can you stay on the phone with me/come over until I calm down?”

I know this is a hard one to say. Because we often fear telling someone just how much we’re struggling, and admitting that we don’t feel safe? That’s a biggie. Obviously you can replace the word “safe” if it’s not working for you, but I always encourage people to be direct, because it’s the surest route to getting exactly what we need.

Asking someone to be present might feel especially vulnerable. It might not even feel like, in the moment, it’ll make that much of a difference. But you’re more likely to feel better with support than without any.

And remember, from everything we know about mental illness, depression is more likely to be a liar than a truth-teller (I talk about that a bunch in this blog post).

4. “I’m in a bad place, but I’m not ready to talk about it. Can you help me distract myself?”

You do not have to talk about what’s bothering you if you’re not ready.

Opening up a whole can of worms might not be the safest or best thing for you in that particular moment. And guess what? You can still reach out for help.

Sometimes we just need someone to shoot the shit with, so we aren’t stuck in our heads, making ourselves a little crazy. This is a valid and healthy thing to ask for! And it’s a subtle way of making folks aware that you’re having a rough time, without needing to go into detail.

The sooner the folks around you are aware that you’re having a hard time, the quicker they can show up to help you through it.

Early interventions are so critical for our mental health. In other words: Don’t wait for your whole basement to flood before you fix a leaky pipe — fix the pipe when you notice the problem has started.

5. “Can you check in with me (on date/every day), just to make sure I’m alright?”

I cannot say it enough — do not underestimate the value of asking for a check-in. I am such a huge fan of this as a coping skill, especially because it can be super helpful for everyone involved.

If you take nothing else away from this article, it should be this: Please ask people to check in with you. It’s such a small thing to ask for in the age of texting, but it can help us stay connected, which is freaking critical for our mental health.

(If you’ve played The Sims before, remember the social bar? That’s you. You need to fill it. Humans need to connect with other humans. It’s not just about wanting to, it’s that we actually require it to survive.)

And this can happen in so many smart ways. A few of my favorites:

“I haven’t been doing well. Can you text me every morning to make sure I’m okay? It would really help me.”
“Hey friend. I’ve been kind of sad lately — do you maybe want to Snapchat/send selfies to each other before bed every night, just to check in? It’d be nice to see your face.”
“I’m in a funk right now. Do you want to be self-care buddies? Like text each other once a day something that we did to care for ourselves?”
“I’ve been isolating myself a little lately. Can you check in with me every so often, just to make sure I didn’t fall off the face of the earth?”

Add emojis wherever fitting if you want it to feel more casual (but really, you don’t need to, there’s nothing wrong with asking for what you need!).

Asking for people to check in with you when you’re struggling is just like buckling your seatbelt when you get in a car. It’s just one extra safety measure in case things get rough.

Both can actually save lives, too. Consider this a PSA.

6. “I’m having a hard time taking care of myself. I need extra support right now around (task). Can you help?”

Maybe you need help getting to an appointment or the grocery store. Maybe you need a cheerleader to make sure you took your meds, or someone to send a selfie to to prove you got out of bed that morning. Are your dishes piling up in the sink? Do you need a study buddy? It doesn’t hurt to ask for support around tasks like these.

Sometimes these things add up when we’re struggling with our mental health. But we forget that it’s okay to ask for a hand, especially at those times when it could really make a difference.

Being an adult is already challenging. If you’re going through a rough time? It’s even harder. We all hit a point when we need some extra support. Don’t be afraid to let folks know directly how they could support you.

7. “I’ve been feeling so low. Can you remind me about what I mean to you or share a favorite memory? It would really help me.”

I used to think that asking for something like this meant I was “fishing for compliments.” And what a lousy way of looking at it…

Sometimes we need reminders that we matter! Sometimes we can’t recall the good times, and need someone to help us remember them. This is true of every single human being on the planet.

It’s such a simple request, too. If you’re the kind of person that feels nervous about making a big ask (again, I’d encourage you to challenge that assumption — it’s okay to ask for help!), this can be a small step in the right direction.

8. “I’m struggling right now and I’m afraid I’m reaching my limit. Can I give you a call tonight?”

To be honest, it wasn’t until my friend died that I finally found these words in particular.

Up until that point, I’d never been sure exactly how to raise the alarm. You know, that moment when you’re not at the end of your rope, but you’re getting there? It’s a crucial moment.

Yes, you can and you absolutely should reach out then, even if you aren’t sure if it might make a difference (spoiler alert, people might actually surprise you). I think about how much pain I could’ve avoided if I’d saw that moment for the opportunity it really was.

Listen to that little voice in the back of your mind, the one that’s trying to tell you that you’re a little too close to the edge for comfort. Listen to that nagging feeling that tells you you’re in over your head. That’s your survival instinct — and it’s an instinct you should trust.

9. “I know we don’t talk much, but I’m going through a tough time and I feel like you’re someone I can trust. Are you free to talk (day/time)?”

I wanted to include this because I realize that not all of us have people we’re close to that we confide in.

When I was a teenager, everything changed for me when I reached out to a teacher at my high school that I barely knew. She had always been incredibly kind to me, and I had a gut feeling that she would “get it.” And she did!

To this day, I still believe that she saved my life at a time when I had no one else to turn to. She connected me with a social worker, who was then able to help me access the resources I needed to recover.

While it’s important to be respectful of people’s capacities and boundaries (and be prepared, of course, if someone can’t be there for you or isn’t helpful — it’s not personal!), you might be surprised by the responses that you get.

10. “I’m suicidal. I need help right now.”

Raise the alarm.

Raise the damn alarm, friends, and be as direct as you need to be. An emergency is an emergency, whether it’s a heart attack or a self-harm risk. Harm to you in any form is reason enough to ask for help.

I promise you, there’s someone in this world — an old friend or a future one, a family member, a therapist, even a volunteer on a hotline — who wants you to stay.

Find that person (or people), even if it takes time. Even if you have to keep asking.

Give people the chance to help you. It’s a chance that my friend deserved, and it’s a chance that you deserve.

(And if all else fails, I have this resource about going to the emergency room when you’re suicidal. I’ve personally been hospitalized twice, and while it’s not a ritzy vacation, it’s the reason I’m here today.)

Pick something from this list. Write it down, even if it’s on your hand or a sticky note. Reach out — because now you know how.

Hell, bookmark this article while you’re at it. I know I’m going to, because there are times when I need this advice, too.

If you’re struggling with your mental health, let me remind you that it’s never too soon or too late to let someone know.

And it’s never, ever too heavy, too messy, or too much to ask — even if you asked fifty times the day before.

I’d have rather had my friend “bother me” every day for the rest of my life than have to lose them forever. Their life was that precious.

And yes, so is yours.

Hey there, friend. Before you go, I want to share some resources with you.

If you’re suicidal, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386, or reach the Crisis Text Line by texting “START” to 741741.

You can also go to the emergency room. If you’re not sure if you should or how to prepare for something like that, I’ve got an article for that, too.

This isn’t just a generic “here are some numbers” plug, this is a “I want you to stay, we need you here, please don’t go just yet” plea.

And lastly…

There’s a memorial fundraiser in honor of my dear friend, Cris Alvaro. The funds raised will go to organizations that support trans mental health and racial justice.

This article is, of course, dedicated to them.

Topher, you’re still the brightest star in my galaxy. We couldn’t keep you safe. But I will never stop fighting for a world that could have.

Feature photo by Matthew Henry on Unsplash.

15 Mental Health Resolutions For The New Year

December 29, 2017December 29, 20176 Comments

2017 was pretty momentous, as far as mental health and recovery goes.

I was finally diagnosed with obsessive-compulsive disorder (OCD), which was one of the most important realizations I’ve ever had. It’s also the year I finally said goodbye to alcohol and hello to online therapy (both A+ decisions). As far as personal growth goes, it was kind of a banner year for me.

It wasn’t easy, though. 2017 was also an important reminder that healing takes hard work. The combination of political and personal turmoil landed me in the hospital last January, and a series of unchecked compulsions finally led me to seek professional help for my OCD after it tore through my life like a relentless tornado.

That’s because, my dear internet pals, healing isn’t linear. When you think you’ve got a plan in place, the universe often laughs in response.

So why make resolutions at all? Well, I believe it’s powerful to begin a new year by saying, “I’m choosing me.”

Every year for the past few years, I’ve shared my resolutions with the internet with the hopes of inspiring folks to choose themselves, and to be thoughtful about how they’ll care for themselves in the new year.

These resolutions are affirming our right to commit to and prioritize our wholeness; they’re the map that reminds us that to give to others, we have to first nourish ourselves.

These are fifteen resolutions that I have for 2018. I hope that you’ll steal them, throw them up on your vision board, tattoo them on your body, whatever — if you feel inspired, I hope you’ll carry them with you as you navigate the new year.

1. I will stop looking for permission to be happy.

I’ve noticed that I shy away from things that make me happy in favor of the things that make… literally everyone but me happy. I’m a people-pleaser by nature, but in 2018, I want to start unapologetically seeking out things that bring me joy, even if I’m the only one enjoying it.

2. I’ll think twice before I do something out of a sense of obligation.

I have a very difficult time saying “no,” especially as someone with a strong sense of empathy and loyalty. In the new year, though, I want to reconsider just how often I’m doing things because I feel obligated to — especially from people who could be taking advantage of my generosity.

3. I’ll focus less on what my life “should” look like.

Instead of living a life that looks good on paper, 2018 is going to be the year that I focus on self-reflection and building a life that makes me happy, regardless of how it compares to anybody else. Because sure, there are people in their late twenties that are traveling the world or working themselves to the point of exhaustion. But neither of those things actually appeal to me — so why should I measure myself against them?

4. I’ll commit five minutes to doing things that make me anxious.

I’m a chronic procrastinator. One of the antidotes I’ve read about is setting aside five minutes to Do The Thing, and giving yourself permission to stop after that if you don’t want to continue. Why? Because getting started is the difficult part, and it’s easier to commit to doing something for five minutes than trying to tackle the entire task. So this coming year? I’m going to do my best to commit five minutes to the stuff I’m dreading.

5. I’ll embrace being “too much.”

I’ve worried a lot about loving too hard or having too many feelings, or otherwise being “too much” for people. But what I’m realizing is that my intensity and depth of emotion are an intrinsic part of who I am. It’s a part of me that doesn’t need to change.

6. I’ll set boundaries even if it’s difficult for me or the other person involved.

I’m a pushover. I’ll admit it. When people demand my time or energy, I often cave immediately. And when I try to set limits, the faintest sign of disappointment or resentment will send me into a tailspin. But this next year, I’m setting boundaries and sticking to them. My heart is worthy of protection.

7. I’ll savor the time I spend alone.

This past year, I talked about how difficult I found it to be alone. But more recently, I’ve started to really enjoy it. In the new year, I want to take myself on more dates, embrace long walks for daydreaming, and give myself the space and time to reflect without interruption.

8. I’ll try to ruminate less on what I could be doing and enjoy what I’m actually doing.

How often do I worry about what I could or should be doing instead of just being present? Easier said than done, but rather than feeling guilty for how many hours of Netflix I’ve watched, I want to get in the habit of simply asking myself, “Is there something wrong with what I’m doing now?” And if there isn’t, maybe I can just freaking enjoy it for once.

9. I’ll let myself tap out if I feel like I can’t support someone emotionally.

There are people I’d literally fall onto a sword for. That doesn’t mean that I should, though. And if I find myself depleted, I want to make sure I’m taking care of myself instead of burning out.

10. I’ll give myself permission to ask “ridiculous” questions.

I’m a little embarrassed to admit how often I don’t understand something or pretend to know what people are talking about, just because I’m afraid of looking uncool or clueless. But what would happen if I just asked more questions? In 2018, I guess I’m going to find out.

11. I’ll practice naming exactly what I need from the people that I love.

I’m pretty sure this has been a resolution for me three years in a row now. But that’s because it’s so, so important. I want to keep practicing being direct when I need support. It’s the best way for folks to know what to offer me when I’m struggling.

12. I’ll curate my social media more intentionally.

I’ve started spending most of my online time on Instagram now. Why? Because I (purposefully) follow accounts that are positive and affirming, so it’s basically my only safe haven at this point. I highly recommend being thoughtful about who you follow and what you expose yourself to. It’s important to be informed, but it’s also important to take care of your mental health, too. (I talk a bit more about this in this blog.) Next year, I want to continue curating all of my social media accounts to be more balanced.

13. I’ll pause sometimes and make sure I’m doing what I actually want to be doing.

How often did I go along with someone else’s plan just because they were more assertive than me? How frequently did I default just because it was easier to? While it’s totally fine to go with the flow, every so often, I want to check in with myself and make sure I’m spending my time in ways that feel fulfilling for me, too.

14. I’ll ask the folks I care about what makes them feel loved.

I want to get in the habit of asking the people that I love what makes them feel appreciated. It’s different for everyone, right? Some people want to be showered with encouraging words. Some folks want physical touch or a thoughtful gift. So why not ask the people that are meaningful to me what makes them feel cared for?

15. I’ll resist letting shame control me.

Remember when I mentioned being diagnosed with OCD earlier? It took this long because I was so ashamed of my intrusive thoughts and bizarre rituals that I kept it to myself. Not anymore, though. This next year, I’m not going to let shame discourage me from getting the support I need. Often times, the things that make us feel like monsters or weirdos are actually common and very human experiences. No more shame.

So, readers, here’s to a brand new year.

After what was a difficult year for many of us, I hope these resolutions inspire you to invest more deeply in your own mental health and happiness. A year of honesty, authenticity, and self-care — in other words, the year that each and every one of us deserves.

You’ve got this!

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Looking for some extra resources to make 2018 a better year?

I’ve got a few to recommend!

If you need to get organized: ADHD Survival Guide: How I Stopped Procrastinating and Got My Sh!t Together

If you’re thinking of getting some extra support: 7 Signs That Online Therapy Might Be Right For You

If you’re looking to incorporate more self-care into your life: 5 Awesome, Immediate Self-Care Resources For When You Feel Like Actual Garbage

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Happy New Year!

Photo by Inna Lesyk on Unsplash

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

November 30, 2017December 2, 201719 Comments

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.

Via Frizz Kid Art

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.

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.

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.

Appreciate the blog? Please consider becoming a patron! A dollar a month might seem small, but it’s helps keep this labor of love going.

Need a therapist? If you follow this nifty link, you can get $50 off your first month of therapy with Talkspace. Not a bad deal! ¯\_(ツ)_/¯ Read more about online therapy with Talkspace here.