My Beautiful, Borderline Mind

September 6, 201710 Comments

Not too long ago, I wrote an article about the misconceptions around borderline personality disorder.

“I reject the idea that people with BPD aren’t deserving of competent care and compassion that would allow them to thrive,” I wrote, “and if we dismiss them as being irredeemable, that support becomes more difficult to access.”

Writing that piece was painful. Recalling the ways that people misconstrue my struggles was a deeply emotional process for me.

It also brought to light the very real stigma that still exists around BPD.

I started getting emails.

“My husband has borderline, but he’s horrible,” someone writes. “How can I get him to be more self-aware like you?” (This is almost, word-for-word, a message I received.)

“My partner with BPD is crazy, she’s too much,” someone explains. “What pills are you taking? Do you think that they’ll make her normal?”

This wasn’t the first time I was being held up as some kind of psychiatric achievement. Sometimes even my clinicians viewed me this way. “Most people with borderline aren’t like you,” a clinician told me recently. When I asked what that meant, he told me, “Most of them are just… flailing around, deeply unstable.”

Flailing around. That’s what most people think. Even our clinicians believe we’re chaos embodied, helpless, disturbed.

And thus I was propped up as an ideal. I was the repentant borderline, the good borderline. The more I was perceived as distancing myself from the disorder, the more people applauded me.

This is because the borderline that the world likes the most is the “reformed” borderline — the one that will apologize for being too much, will cut themselves down to be accepted, be neurotic in “acceptable” and small doses, and most of all, disavow any and all traces of the disorder.

In other words, the self-hating borderline is the one that the world loves the most.

It’s an uncomfortable truth, then, when I tell people that I don’t really hate my borderline mind. For all the hell it’s given me — and by extension, the folks who’ve supported me in my recovery — BPD has given me a beautiful intensity that I appreciate.

The world asks me to reject my borderline mind, looking for some symbolic gesture to demonstrate that I hate myself as much as they hate people like me.

In me, they see the redemption of their “crazy” spouse, their unhinged mother, their unruly child.

Every time I apologize for my existence, they are comforted knowing that they don’t have to learn to love someone with borderline — they can wait for the day when their loved one with borderline finally hates themselves enough to be someone else, or hates themselves enough to die.

But there are parts of me that I so deeply love — parts of me that wouldn’t exist if BPD weren’t a part of me, too.

And so long as we view people with borderline in such a reductive way, we fail to appreciate what’s possible for people with BPD. We demand that they erase themselves or punish themselves, rather than coming into their own, realizing themselves fully, and perhaps even learning to love themselves.

It’s devastating to think that, as we characterize people with BPD as abusers that need to repent or as irredeemably lost, we create a culture that denies people with BPD the possibility of authentic healing and self-love.

In the process of my own healing, I’ve realized that BPD is not just a source of trauma, but in some ways, it’s been a source of unique strength.

That’s the conversation that’s missing. That’s the conversation I’m longing for, waiting for.

The love that I’m capable of feeling for others, when it’s no longer fueled by fear, is a remarkable thing. My capacity for seeing the best in others, my ability to love deeply and fully, my sense of connectedness to the folks that I care about — these are things I would never change, so long as it comes from a healthy and secure place.

While I can be reactive, my sensitivity allows me to tune in deeply to the feelings of others. My firsthand experiences of pain allow me to make intense and empathic connections to others who might be suffering. And knowing what it’s like to be left behind, the loyalty that I possess makes me a reliable and caring friend.

What people with BPD need isn’t the greatest possible distance from themselves and from their disorder. What they need is security, healthy attachments, support, and genuine safety, so that they can become someone that they’re happy to be.

My borderline mind can be frightening and self-destructive. Ask anyone who was along for the ride this last year (when I was hospitalized not once but twice) and they’ll tell you as much.

But this mind also has a capacity for intense love, connection, and empathy — a potential that’s so often ignored or missed in people with BPD because of a stigma that leaves no room for us to grow.

For me personally, living with borderline has been retraining my brain to recognize when I am safe, after having lived for many years without protection in the face of complex trauma and PTSD. It’s been a process, too, to create the safety that I lacked for so long, and to trust in it when I have it.

It’s also been important to understand that safety doesn’t have to come in the form of support from others — it’s safety I can create for myself.

But that’s a realization I never would’ve come to if I’d listened to the stigma that told me that having BPD meant I was inherently bad, spiteful, or dangerous, teaching me to fear myself rather than be kind to myself.

Nothing about this process has been “flailing around,” as a clinician once said — it’s been a desperate search to regain the safety I’d been denied. And nothing about that process has been “manipulative,” either. Any misdirection to meet my needs, especially during a struggle I wasn’t prepared for and never asked for, was an act of survival, however flawed or unskillful.

My borderline mind has embedded in it a propensity for chaos that I won’t deny, but just the same, it gives me an incomparable ability to love and be loved. I have a sensitivity that keeps me deeply engaged with my world, a vulnerability that gives me immense integrity and strength, and an intensity that makes me creative and dynamic and alive.

And with the right support, I’ve been able to nurture that empathy and depth in incredible, unexpected ways.

I don’t believe that a diagnosis of borderline personality disorder is a statement of finality, of futility, of hopelessness, and I resent any suggestion that it is. I think for many, it can be an opportunity — a chance to grow, and to take everything we were taught to fear, and find the strengths hiding just underneath.

I wouldn’t be who I am without BPD. And I’m tired of the world demanding that I be anybody else.

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

September 1, 20177 Comments

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

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

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

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

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

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

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

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

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

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

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

1. (Nothing)

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

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

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

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

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

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

“How can I help support you?”

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

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

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

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

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

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

2. ‘I’m Glad You’re Better Now’

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This kind of attitude is ingrained in our everyday lives.

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

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

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

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

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

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

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

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

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

4. ‘Please Don’t Tell Anyone’

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

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

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

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

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

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

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

5. ‘What Was It Like?’

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

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

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

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

It started to feel dehumanizing.

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

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

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

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

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

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

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

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

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

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

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

7. ‘Try Not to Dwell on It Too Much’

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

That you’re still breakable?

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

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

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

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

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

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

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

This piece that I wrote originally appeared at Everyday Feminism.

Your Bias Against People With Borderline is Still Ableist

August 15, 2017August 15, 20175 Comments

256.

That’s how many different ways borderline personality disorder can present itself, just looking at the diagnostic criteria alone. Factor in co-existing disorders, trauma history, and all of the biological, sociological, and psychological influences that make us individuals? You’ll find that “borderline personality disorder” loosely describes a very diverse group of people.

It’s also been used to describe me. More specifically, as a survivor, it’s been used to describe the sort of “emotional PTSD” I developed overtime as a response to very traumatic life circumstances.

But no one ever wants to talk about borderline as a product of abuse. I continue to encounter people who only view borderline as a propensity for abuse — as irredeemably horrible people to be avoided at all costs.

And painting people with borderline with one uncomplicated, overgeneralized brushstroke? Treating us like a plague, as inherently immoral, as dangerous? That’s still ableist.

We need to start calling abusers what they are: Abusers.

And we need to start calling people who unilaterally demonize people with any mental illness what they actually are: Ableist.

Because here’s the thing: So long as we keep treating borderline as synonymous with abuse, we take a very painful and difficult disorder and deeply stigmatize it. BPD is not a disorder that causes abuse — more appropriately named, it’s a disorder of emotion dysregulation. Abusers themselves, regardless of their mental health status, are solely responsible for their actions.

I’m not denying that there are people with borderline personality disorder that are abusive. But I reject the idea that all people with BPD are abusive, or should be assumed to be abusive. And further, I reject the idea that people with BPD aren’t deserving of competent care and compassion that would allow them to thrive — and if we dismiss them as being irredeemable, that support becomes more difficult to access.

I also think that, too often, we erase survivors who have developed the disorder as a valid response to trauma. We selectively look at abusers who have borderline, while ignoring the high prevalence of trauma in borderline folks. Many of the symptoms associated with BPD, like dissociation and interpersonal instability, are incredibly common in folks who have been abused. In fact, if we took into account trauma history, many (but not all) people with borderline could easily be diagnosed as having complex PTSD.

With all the same symptoms and simply a different framework, we go from being assumed to be abusers to being honored as survivors — that’s the power of stigma.

As a survivor that has been diagnosed with both complex PTSD and borderline, I find myself stuck between a rock and a hard place. To access spaces where I can connect with other survivors, I find myself withholding my borderline diagnosis, so I’m not considered “suspect.”

But as someone who believes that borderline shouldn’t be stigmatized, rejecting BPD as a diagnosis feels like betraying other people with the disorder who are battling everyday against painful assumptions.

I personally find “borderline” to be a difficult word to reclaim, because it’s so entrenched in negative assumptions that it fails to be a useful word when I’m trying to access spaces that help me and mental healthcare that supports me. If I enter into a space as a person with borderline, I am feared and ostracized. If I enter into a space as a person with complex PTSD, I am cared for and affirmed.

Ask anyone if they want to see people with borderline to be well and to thrive, and they won’t necessarily disagree. But ask them to be careful about the language that they use — so that thriving is a real possibility that isn’t impeded by stigma — and you’ll get pushback that these conversations stigmatizing borderline are actually helping survivors.

I’m wondering which survivors are being helped by these conversations, though. Because survivors with borderline don’t seem to count — they’re apparently just a necessary casualty here, as if their trauma doesn’t matter the moment they become too emotionally unstable, too much.

As a trauma survivor, I deeply empathize with folks who have been abused by someone with BPD, and have found community and support by connecting with other people who have been similarly abused. But I believe that we can have conversations about patterns of abuse without ableism — and decoupling “abuse” and “borderline,” recognizing that there are many ways that BPD manifests, is an important first step.

The reality is, we relinquish abusers of their responsibility if we attribute their abuse to mental illness, rather than demanding that they take ownership of the harm that they’ve caused. And when we equate a particular mental illness with abuse, we draw false equivalences that actually harm survivors and psychiatrically disabled folks alike.

The reality is, most people with BPD are far more likely to hurt themselves than someone else (notably, this is true of mental illness generally). And much of the research shows that mental health outcomes improve drastically overtime for folks with borderline (90% will be more or less “recovered” by age 50), especially when they have access to competent care.

But the more that we interfere with folks seeking out that care, the longer it takes for folks with BPD to access it — which, no doubt, contributes to the 1 in 10 people with BPD that complete suicide (a number that, frankly, should be unacceptable to us all and cause for alarm).

Survivors, then, don’t need to be unilaterally protected from all people with BPD — survivors need to be protected from people who exhibit abusive behaviors, regardless of their mental health status. Behaviors like poor boundaries, manipulation, impulsivity, aggression, and verbal abuse are not unique to BPD and never have been; the sooner we recognize that, the better we can support all survivors and not just those we deem “worthy” of that care.

Abusers have never been taken to task by pushing responsibility off of them and onto an inherent “disorder,” and survivors have never been helped by demonizing and pathologizing their trauma.

This false dichotomy — that it’s survivors versus “borderlines,” that we are always at odds — has created the very harmful idea that abuse is a disorder, and that survivors with maladaptive coping strategies are inherently dangerous or untrustworthy. The reality is much more complicated than this, which is that abusers are not a monolith and neither are survivors.

Mentally ill folks are falsely and repeatedly depicted as violent, dangerous, and dishonest. And it’s ableist, regardless of the disorder, to make those generalizations.

While folks with borderline may exhibit behaviors or coping strategies that can be leveraged in abusive ways, it’s ableist to assume that all of them will present that way. Some abusers have BPD, but not all people with BPD will go on to be abusers — similarly, some abusers are survivors of abuse themselves, but not all survivors will go on to abuse, either.

There are many risk factors that correlate with abuse. But those correlations do not cause abuse.

I am close to many people who have borderline, and many of those relationships are beautiful in their own way. I’ve found that, for folks with BPD who have a solid support system, some of the best qualities can emerge out of those struggles. I’ve known folks with borderline to be incredibly loyal friends.

They care deeply. They feel intensely. And that kind of depth, when harnessed, leads people with borderline to be some of the most passionate and empathic people that I know.

I’m not asking anyone to maintain a relationship with an abusive person. I’m also not asking survivors to ignore their gut feeling when a person seems like they could be harmful, or stay in a relationship that seems like it’s heading into dangerous territory.

I’m just asking folks to self-reflect on their biases, and in particular, acknowledge the ways in which those biases can be harmful.

Especially when considering the long history of borderline as a diagnosis being leveraged to dismiss “difficult” patients (especially women) and linked to oppressive ideas about marginalized people, we should all be wary of the conclusions we draw based on a framework that is already, in many ways, flawed.

As a survivor of trauma, there is no deeper betrayal (in my mind) than other survivors ostracizing me because of a mental health diagnosis — especially one that is a direct result of a kind of suffering we both share. Our coping strategies may be different (and the intensity with which we feel this anguish may differ, too), but our pain is very much the same.

If we’re invested in a world in which those struggling with mental illness can access the support, care, and compassion that they need to live well, we need to push back on this idea that disorders like borderline are inherently abusive, and that those suffering from them are disposable.

Dehumanizing people, regardless of their diagnosis or history, is in itself a very toxic behavior. And I believe that people with borderline and survivors alike deserve a hell of a lot better.

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

August 12, 2017August 13, 20174 Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

5 Ways Your Critiques of Psychiatry Might Be Ableist

August 5, 2017August 8, 20174 Comments

I won’t beat around the bush: Mental illness has pushed me to the edge many, many times.

There were times when I was so detached from reality, it necessitated urgent and even drastic interventions to bring me back. There were times when the pain was so unbearable, I lost my will to live.

In the last year alone, I’ve been institutionalized twice. I’ve been on more psychotropic medications than I could possibly count. I’ve been diagnosed with at least half the disorders in the DSM at some point or another. I’ve had some of the best clinicians, and also some of the absolute worst.

While psychiatry has certainly done its fair share to traumatize me, I also wouldn’t be here without it. And this is why, when some naive neurotypical person tweets me to ask me if I’ve tried meditation or yoga, telling me that the pills are “toxic” and “unnecessary,” it leaves me shaking with rage.

Psychiatry has deep and undeniable flaws; it has, historically speaking, been an oppressive force in the lives of mentally ill people, at times pathologizing us and diminishing our humanity. I’m not here to sugarcoat that reality. But just the same, so many mentally ill people need this level of care to make our lives bearable—and with persistence and committed clinicians, it can become an important catalyst in our recovery.

That’s why I take serious issue with folks, particularly those who are not mentally ill themselves, unilaterally deciding that psychiatry is irredeemable, throwing the proverbial baby out with the bathwater—ignoring the agency, safety, and needs of mentally ill people.

It’s one thing to push for more competent and compassionate care for mentally ill folks, expanding our choices and respecting our self-determination (which I have fiercely advocated for throughout my career and continue to do so). It’s another matter entirely to presume to know what we need, writing off psychotropic medications as a personal failure to cope or, as one commenter on my blog once told me, “the easy way out.”

There is nothing easy about navigating psychiatry. There is nothing easy about finding the right medications, the right clinicians, the right combination of self-care and clinical interventions to be well again. There’s nothing easy about accessing psychiatric care in the first place. It requires tremendous strength, patience, and courage—full stop.

Presuming that this process is for the weak—for people who are simply unevolved in their attitudes about mental health, people who need to just pull themselves up by their bootstraps instead of “relying on pills”—is a blatantly ableist attitude that needs to be examined.

In this article, I’m going to unpack exactly what I mean by that.

Before you dissuade a mentally ill person from seeking out psychiatric care, look for these five signs that your argument may actually lack the compassion and nuance it needs.

1. If You Deny the Agency of Mentally Ill People

One of the biggest issues I find with critiques of psychiatry is that it utterly denies the agency of mentally ill people. Namely, rather than respecting our choices and believing that we know what is best for us, the assumption is that we can’t be trusted to make decisions about our bodies and our mental health.

This plays directly into the prevalent attitude that mentally ill people shouldn’t be believed or trusted, and that we lack the self-insight to determine what our needs are. This is utterly disempowering; it strips us of our autonomy, and places the power back into the hands of neurotypical people rather than encouraging us to make our own choices.

And it’s this same attitude that actually perpetuates one of psychiatry’s greatest flaws that still operates in clinical settings today: the insistence that mentally ill people should have no voice in their own recovery and in the decisions that impact their lives.

Any critique of psychiatry that oppresses mentally ill people—upholding the harm that we experience at the hands of this institution—is ultimately not radical, nor is it socially just.

2. If You Impose One Narrative on Every Mentally Ill Person

Any critique of psychiatry that treats mentally ill people as a monolith—that our needs, experiences, and lives are more or less identical—is steeped in the ableist attitude that we are not diverse or complex individuals.

This couldn’t be further from the truth. Some mentally ill folks will benefit immensely from meditation and a good dose of Vitamin D from the occasional hike in the woods. Some will find that a spiritual practice aids in their healing. Others find that therapy is the key to their stability, while folks like myself find that medication is a critical component of their care. And you know what? Some folks rely on all of the above. I certainly do.

Making a sweeping generalization that all mentally ill people require the same type of care is harmful, because it dismisses the unique ways our trauma and pain presents, and it advocates for restricting our choices rather than expanding them.

When you push for a singular solution to complex and individual struggles, it puts every mentally ill person at a disadvantage. It encourages us to try one inflexible approach that may not work for us, instead of advocating for a recovery that is tailored to our particular needs that can evolve with us as we gain more insight about ourselves.

This, to me, is the epitome of privilege—if you insist that your own journey should dictate the standard for everyone else, you are centering your own lived experience while willfully ignoring that those experiences are not universal, especially when taking into account those at the margins who exist at very distinct axes of oppression you may not share.

And considering the ways in which psychiatry, past and present, has not always been culturally competent and aware of the needs of marginalized communities, this ultimately feeds into the violence that these communities experience at the hands of their clinicians.

3. If Your Critique Impacts Access to Care

Your critiques of psychiatry do not exist in a bubble. Which is to say, we must consider not just the intention of our critiques, but the impact of them as well. If you depict psychiatry as being irredeemable, and those who seek out psychiatric care as weak and misguided, you feed into a stigma that says there is something shameful or wrong about reaching out for help.

This directly affects the gap in mental health care, in which mentally ill folks are already underserved and struggle to access care. This is not something to be taken lightly.

For example, I took four years from the onset of my symptoms to actually seek out proper care. This is because I was consistently told that I was too young to need mental health care, and that I was being dramatic and not trying hard enough to be well. I was too young to need a psychiatrist, apparently, but I was not too young to attempt suicide at age seventeen. I was not too young to believe that psychiatric hospitals weren’t for “people like me,” and didn’t get help after my attempt.

I had absorbed these messages from the people around me, who believed that psychiatry was a shameful last resort for people who weren’t trying hard enough. Like many folks who are struggling and could benefit from it, I didn’t want to associate myself with it. A completely preventable tragedy—one that nearly took my life as a teenager—was a direct result of critiques from neurotypical people who lacked nuance and perspective on what psychiatric care can actually offer.

Rather than acknowledging the importance of this (flawed but still critical) resource for many people, the stigma interfered with my ability to access care. Without the necessary nuance, critiques of psychiatry can often harm the very people we’re trying to protect.

If you’re going to critique psychiatry (and yes, psychiatry should never be above reproach), it’s important to consider the impact of your words. Does this critique empower mentally ill people? Or could it harm us in the process?

4. If You Presume to Know the Struggles of Mentally Ill People

If you aren’t mentally ill, you can’t know what this struggle is like. And if you can’t truly understand our struggles, you aren’t in a position to introduce a bias that presumes to know what we need in the first place.

One of my favorite phrases with regards to disability is “nothing about us without us.” Which is to say, a critique about psychiatry—an institution that directly impacts our lives—that doesn’t consider the perspectives and voices of mentally ill people is deeply problematic. In fact, I’m of the belief that the only people who should be critiquing psychiatry are neurodiverse people themselves, including those who identify as mentally ill and those who have disavowed the label but are affected by it nonetheless.

We should be elevating their voices rather than talking over them. It’s ethically questionable to pretend that you can understand a struggle that isn’t yours to claim in the first place.

It’s oppressive to introduce an uninformed critique that has no real impact on your life, rather than letting those who are most affected by these issues speak truth to power. If you’re committed to an anti-oppressive framework, you must commit yourself to centering the voices of those on the margins – which means knowing when to stay in your lane.

5. If You Prioritize Your Criticisms Over Our Survival and Safety

There has been significant pushback against memes like this one, where actual antidepressant medications are labeled “shit,” while the great outdoors are the only acceptable and real antidepressant. As if walking through a forest will somehow magically cure us… and we’re too unintelligent and “lazy” to realize it.

There’s one word that readily comes to mind when I see memes like this: Selfish. From up on their privileged and oblivious high horses, their critiques of psychiatry and psychiatric medications take precedent over the safety of mentally ill people who rely on these medications to survive.

They don’t actually care about mentally ill people. If they did, they would advocate for any and all paths in recovery that make life more livable for us. They would be glad for any and all treatments that improve our quality of life. That’s not what memes like this are about, though.

Confirming and broadcasting their narrow and uninformed “opinion” becomes more important than advocating for the wellness of mentally ill people. Sounding off on something they actually know nothing about takes priority over tuning into the communities that have a real stake in these conversations.

It’s ableism in its most unapologetic form—it’s vicious and it’s careless, because instead of centering the needs and survival of mentally ill people, those with the most privilege and nothing to lose reinforce a myth and a stigma that endangers our lives. Putting our safety and survival in jeopardy is morally repugnant. It ultimately becomes a critique of mentally ill folks themselves, rather than a valid and thoughtful critique of the institutions that affect our lives.

Critiques of psychiatry are necessary. They’re necessary to strengthen the quality and competence of the care mentally ill folks receive. They’re necessary to impact positive change, and to ensure that mentally ill folks can reclaim their power and their lives as they navigate these systems that are flawed but sometimes necessary.

Critiques of psychiatry that don’t take on an anti-oppressive framework, however, can operate in sinister ways, doing harm rather than good. It’s important that we remain vigilant and learn to recognize the ableism that is often embedded in many of the popular criticisms we come across.

It’s then—and only then—that we can start to do the necessary and important work of building systems that truly empower mentally ill people, placing them at the center of this work, rather than obliviously pushing them further to the margins and silencing them. Because any criticism that ultimately silences the very communities most affected is not empowering, and it replicates the very oppression we’re seeking to dismantle.

This piece that I wrote originally appeared at Unapologetic Feminism.

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

July 27, 2017August 11, 20173 Comments

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

Hi Sam,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Crazy Talk: Is Your Boredom Just Depression In Disguise?

July 21, 2017August 12, 20175 Comments

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

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

Hi there Bored & Blue,

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

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

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

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

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

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

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

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

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

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

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

All the best,