Tag: recovery

Fatphobia in eating disorder recovery exists. And now my friend might die because of it.

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This is admittedly a long blog post, and a triggering one at that. For those of you who would like to help Shira but can’t read this post, please check out the fundraiser we started for her.

When Shira and I first connected, I had a feeling in my gut that we were meant to cross paths.

She had read my article on how I used body positivity to avoid confronting my years-long battle with anorexia nervosa, and we clicked immediately.

As a fellow blogger and advocate, no one could come closer to understanding how I felt than Shira did. (Not to mention, her winning combination of New York attitude and snark, and love of all things sparkly, captured my heart immediately.)

But at that time, Shira’s world was so incredibly small. That’s because, as an eating disorder therapist, Shira had kept her eating disorder a secret from her community.

While her organs were literally shutting down, and a terrifying fall left her badly concussed and her nose broken, she existed in a private hell that few knew about. The outside world only knew Shira as the same beam of sunshine and powerful advocate for body liberation she’d always been. But in private, Shira was dying.

In those earlier days of my recovery, Shira was a lifeline to me. To be honest, she still is.

Because even in the depths of anguish, Shira has the biggest heart of anyone I know. No matter how far down she’s fallen, she is a relentless cheerleader for those that she cares about, and the thousands of followers who have been inspired by her journey.

That’s because as a therapist, as a blogger, and as a friend, her sincere belief is that no one — not one single person — gets left behind.

Shira fought tooth and nail for four months in residential treatment, making enormous strides.

And while she was there, in a moment of extraordinary courage, Shira revealed to the world her 20-year-long battle with an eating disorder — putting her reputation as a therapist and advocate on the line to tell an undeniably powerful truth about the reality of eating disorders.

She wanted to affirm that, yes, eating disorders are a mental illness that doesn’t discriminate, even among healing professionals.

And even those who know everything there is to know about an eating disorder, about body positivity, about health at every size? Can still suffer from these relentless illnesses.

Her bravery in that moment has stuck with me every day in my recovery since then.

Throughout this past year, over texts and calls and audio messages on the train, we took on our eating disorders together. I watched Shira fight her way from the brink of death in a residential facility for four months, in awe of the grit and determination she showed up with day after day.

On the days when I didn’t want to keep going, she’d somehow telepathically sense it, I swear, because it would be less than five minutes later that I’d get a text asking, “What’s for lunch?”

After she was medically stable and eating consistently, it was time to transition to a partial hospitalization program back home, which would help ease her back into her daily life. We were both hopeful that she was well on her way to the recovery she so deserved.

Miraculously, she was able to secure a full scholarship for PHP, as insurance providers seldom cover eating disorder treatment. We were elated and hopeful.

I want to be able to tell you that, once in program, the momentum continued. But this is not that story. That program nearly destroyed her.

I don’t say that as an exaggeration. I say that as someone who listened helplessly on the other end of the phone, filled with rage, shock, and horror at everything my friend had to endure.

As an advocate, I’m not unfamiliar with the mental health care system and its horrors. As a survivor, I have stories of my own. But despite that knowledge and experience, what happened to Shira shook me to my core.

From day one, the first text I got from Shira about her new treatment team told me everything I need to know about the place: “They mocked Health at Every Size and the fact that I’m a therapist.”

My blood went cold. “Wait, what?” I typed back.

“Yeah,” she replied. “My case manager said, ‘Health at Every Size therapist? How does THAT work?’ And then when I tried to explain, she said, ‘Well, you seem to have ALL the answers.’”

But a snide comment from a case manager was just the tip of the iceberg. Things were about to get much, much worse.

The day program Shira was a part of had a “three strike” rule as part of a contract they require patients to sign.

In her gut, Shira knew that a strike system would bring out perfectionistic tendencies (a fear of failure is super common in folks with eating disorders). She voiced that, in the past, this sense of shame had sabotaged her recovery efforts.

Her concerns were brushed aside. They insisted that their “three strike” rule helps them determine if someone needs a higher level of care, and that these “boundaries” were an important part of the care they provided.

This became a pattern, though: Whenever Shira tried to voice that something wasn’t working, she was told that her “malnourishment” and her eating disorder’s “tendency to manipulate” made her an unreliable advocate for herself.

This part, of course, comes as no surprise to me. Clinicians often treat people with mental illnesses as if they aren’t competent enough to vocalize their needs and expectations.

But the strike rule would become a sticking point, because within one month, Shira — despite all of her success in her four months of residential care — would accrue all three of her allotted strikes.

The first strike happened when she refused to eat ice cream. She did so not because she was unwilling to eat it, but because of the instructions her dietician gave her cohort.

“The dietician said, ‘You three get two scoops of ice cream.’ She then looked at me and said, ‘You’ll get a kiddie scoop.’”

Some of you won’t understand the gravity of that comment. To be clear, a dietician told a patient with anorexia nervosa to eat less food than her peers, because she is a patient in a larger body.

The message here being, of course, that Shira needed to eat a child-sized portion of ice cream, because she wasn’t thin enough to “safely” consume more than that.

This plays directly into the eating disorder’s conviction that she needed to tightly control her food intake and her body. Her peers could eat a “normal” amount of ice cream. But she couldn’t and was singled out, because something was “wrong” with her body.

“This was the message I received my entire damn life,” Shira told me. “That I couldn’t eat like everyone else.”

This dietician perpetuated a fear of food and implicitly encouraged restriction, all of which are absolutely inappropriate to suggest to someone with anorexia nervosa, regardless of size.

Restriction is never an appropriate recommendation for someone with an eating disorder.

And yet that’s what she was told… in a prestigious treatment center.

Shira refused to eat the ice cream, grappling with an immense amount of shame, self-loathing, and fear. And by refusing to eat the ice cream, Shira earned her first strike.

This became an ongoing problem in treatment, in which she was told, for example, to eat 70% of her sandwich (yes, seriously). It left her feeling guilty about eating, and when she was still hungry afterward, she wondered if something was wrong with her.

Even after the center agreed to stop controlling her food intake with numbers, the damage had already been done — she knew she only “needed” to eat a percentage of what she was given, both from what she was told and what she overheard when other patients were given their food.

She began to backslide in her recovery.

Prescribing restriction for larger patients, though, wasn’t the worst part. It was the silencing of Shira’s voice, particularly around size inclusion.

Whenever Shira tried to address the complexities of recovering in a larger body, she was shut down by clinicians and peers alike.

She was discouraged from discussing her fears around returning to a bigger body, as someone who had lived in one most of her life, and understood that her recovered body would likely be a fat one.

“I needed them to acknowledge, just ACKNOWLEDGE, that recovering in a fat body is terrifying in a world that hates fat people,” she texted me once.

Instead, she said, they remarked that she needed to “take her therapist hat off” and suggested that she was being difficult, and lacked commitment to her own recovery.

Being surrounded by a treatment team that couldn’t validate her fears, suggested that she restrict her intake, and questioned her investment in recovery, began to erode her sense of faith that she was supported.

Shira accumulated two more strikes as she continued to struggle. And rather than ask how they could better show up for her, they called her in for a meeting, and immediately blamed her for not progressing quickly enough.

That’s when they told Shira she needed to start calling residential centers, and ‘prove’ that she wanted to recover.

I remember how she described the heartbreak, realizing that her treatment team didn’t at all honor how hard she had been working, nor did they hear her when she explained how she needed the space to talk about recovery in a larger body.

She felt defeated, wondering if she had failed. Calling her outside providers, the feedback from her external therapist and dietician was unanimous: Shira didn’t need to go back to residential. She needed trauma-informed, size-conscious care at the outpatient level.

Having accrued three strikes, though, the contract dictated that Shira couldn’t continue in their program.

Shira didn’t want to give up. After meeting with her therapist, she sent a powerful email to her treatment team at the center, explaining that she would like to come back.

She reiterated her commitment to her own recovery, expressing that she simply wanted a care team that could affirm her experiences of fatphobia in the outside world, and one that could create an environment that had more consciousness around what might trigger someone in a larger, recovering body.

After sending that email, she heard nothing for two days. Wracked with guilt and self-blame, she relapsed — hard.

How could she not? In their last meeting, she was blamed for being unable to “comply” with treatment, and was told over and over again that her “manipulative” eating disorder was making it difficult — if not impossible — to help her.

When she finally heard back, she was invited to meet with her treatment team again… one week from then. Mind you, Shira’s outside providers have been contacting the center, warning them of the relapse and acute state that Shira is in.

This is the same center that told her that she needed to come to their center within an hour of her plane landing, for fear of being left with any lapse in care. Now, they’ve told her to wait an additional week to “discuss” the future of her care.

When Shira asked what she should do to keep herself safe in the meantime, the answer was short. “You left,” they told her, not acknowledging that the contract they had her sign meant she was being kicked out.

She was told to rely on her outside providers, suggesting that maybe they could’ve come up with an alternative if she hadn’t left.

Once again, the buck was passed.

Shira spent that entire week unable to afford much care from outside providers and, in an acute relapse, she unraveled quickly.

She and I held out hope, though. After all, why have a meeting at all if not to discuss how they could help her? I had read the email Shira sent, and it was gracious and encouraging, emphasizing that she was hopeful that they could find a path forward.

Clearly they were going to regroup and find a way to support her, I thought. Her email was so reasonable, and it was a powerful moment of self-advocacy for someone who struggled to find her voice.

But I thought wrong. After a week-and-a-half without care, now navigating a dangerous relapse brought on by her traumatic treatment experience, Shira attended a “meeting” with the center.

I put “meeting” in quotation marks, because it wasn’t a meeting at all. They, instead, took it as an opportunity to reiterate her failures under their care.

They told her that they would be discharging her and revoking her scholarship. Their rationale? She was ‘non-compliant.’

They went on to tell her that it was a “slap in the face” that, after being given a scholarship, she wasn’t trying harder. Shira listened, heartbroken and in shock, as she was told that she was to blame for her treatment being unsuccessful.

They would not be helping her secure care elsewhere. They called her into a meeting to simply tell her she had failed.

They knowingly allowed Shira to relapse for a week-and-a-half with a deadly mental illness, and kept her in limbo with no intention of helping her, for what reason, exactly?

They could’ve told her from the beginning that she needed to arrange for some other form of care. They could’ve offered some kind of contingency support to transition out of their care. They, at the very least, could’ve called her on the phone earlier rather than have her wait.

“She’s in a bad way,” one of her outside providers warned them that week, impressing upon them the dire stakes. During that week, Shira was fainting, and again at risk for serious esophageal injuries due to her purging behavior, which had reemerged fiercely during the relapse as she struggled to cope.

No one can know for certain why a clinical team would deliberately string someone along in an acute crisis in that way.

Only they can answer to that.

That’s where we find ourselves now: Shira was abandoned by her day treatment team, and she cannot afford another program.

Furious doesn’t even begin to describe how I feel, watching this all unfold from a distance.

Shira is dying — there’s no other way to describe what happens to our bodies in these states of ED relapse. And the hope she once carried for a life on the other side of this was pummeled by clinicians she had trusted to support her.

But somehow, she still wants recovery. After everything that’s happened, she still wants to fight. Not that I’m surprised, because Shira already sacrificed so much to get to where she is.

But after everything she’s endured, both at that center and others, I wouldn’t have blamed her at all if she’d given up.

And this is the part where I get extremely, uncomfortably honest with you all: I don’t want to lose Shira. I can’t lose Shira.

That’s why I’m part of a team of friends and advocates in the community that’s started a GoFundMe to support her treatment.

This is the first fundraiser like this that I’ve ever been a part of, and believe me, I wouldn’t be asking if this weren’t important to me.

I believe that the advocacy and clinical work that Shira does is invaluable, and it’s work I want to continue doing alongside her. I want to believe that those of us with mental illnesses can recover, and go on to help others — as healers, as writers, and YES, as therapists.

I want Shira to continue to be a shining example of what happens when those of us who are wounded go on to become healers.

But Shira needs help — desperately. And somewhat selfishly, I don’t want to do this whole recovery thing without her.

I want us both to get better. I want us to start our own treatment center one day (I’ll admit, Shira is making me seriously consider becoming a therapist myself), to fight for policies that protect people like us, and hold accountable any and all clinicians who do harm to their patients.

I have already watched so many of my friends die, fighting to the very end to access care. I don’t know how many more people I can lose this way.

I know you probably see hundreds of GoFundMes every week, floating across your screen. And I won’t try to convince you they aren’t all worthy of your support.

But this one, for me, is personal. Because of everything Shira represents, but more than that, because of everything she’s done to pull me out from the depths of my anorexia, even as she struggled with her own.

Please help Shira, so she can continue to help, uplift, and empower others.

I don’t want a fatphobic, negligent system to be the reason her precious light leaves this world. I don’t want Shira to become a statistic, exemplary of all the ways this system fails so many of us.

She deserves to live. She deserves compassionate, trauma-informed care. We all do.

And she still has a chance — and all she wants is to recover, so she can dedicate her life to helping others do the same.

To learn more about the fundraising effort and Shira’s amazing work, take a look at the GoFundMe I helped create.

And if nothing else, I want to make one thing crystal clear: Neither of us are going down without a fight.

Because no one, especially at their most vulnerable moment, should have to go through what Shira has. And we both want to keep fighting to change that.

And we fucking will.

People-pleasing can be a result of trauma. It’s called ‘fawning’ — here’s how to recognize it.

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When I recently wrote a Twitter thread about my people-pleasing tendencies, I didn’t at all expect for it to go viral. Yet that’s exactly what happened.

As I shared my experiences with trauma and people-pleasing, I was hit with an avalanche of emotion. So many of you could relate to this phenomenon known as “fawning,” and it became immediately clear that we needed this resource to exist outside of Twitter.

So let’s keep the conversation going. I’m going to share both the original thread, as well as building on it. Let’s talk about the link between people-pleasers and emotional abuse.

Confession: I am a people-pleaser.

It took me a long time to realize this, though. Because I’m opinionated! And I speak my mind! I’m an “open book” about a lot of what I’ve been through. Clearly I don’t care what people think… right?

But in the last year, I’ve come to understand that people-pleasing is a lot more complex than that. We all curate our lives to some extent. And for people-pleasers, the ways in which we do that “curating” piece often stems from a place of fear.

Most people know about fight, flight, and freeze — but another trauma response, “fawn,” is at the core of what people-pleasing is actually about.

To avoid conflict, negative emotions, and re-traumatization, people who “fawn” when triggered will go out of their way to mirror someone’s opinions and appease them in order to deescalate situations or potential issues.

For me, this meant that the more invested I was in an emotional connection, the less likely I was to criticize that person, vocalize when my boundaries were crossed, express unhappiness with their behavior, or share anything that I felt might damage that relationship.

This could come across as being excessively nice and complimentary, overly-concerned with another person’s happiness, and waiting for cues in conversation to determine if something was “safe” to share or disclose.

You could say that people-pleasers are sort of ’emotional chameleons,’ trying to blend in in order to feel safe.

We try to embody whatever articulation of ourselves feels the least threatening to the person that we’re trying to be close to.

This can show up in a number of ways. People-pleasers are often really warm, encouraging, and generous people. They tend to overextend themselves and say “yes” to everything and everyone, eager to make those they care about happy and comfortable.

This tendency usually stems from childhood. They often grow up in very controlling and chaotic environments, and internalized the idea that if they were perfectly good or well-behaved, they could minimize conflict and secure love and attachment.

When you have this tendency to defer, make yourself subordinate, try to become smaller, ignore your boundaries and intuition, and minimize your own needs… you are profoundly vulnerable to emotional abuse.

This vulnerability to abuse is often a continuation of the familiar, chaotic dynamic from earlier in life.

When you are excessively concerned with pleasing others, you learn that in order to be effective at this, you have to shut down your gut instincts, your values, your emotions — because being an individual, rather than a mirror, doesn’t serve you in securing the love that you want.

That’s why people-pleasers can become drawn to abusive relationships, and repelled from relationships that are abundantly loving. We’ve internalized the idea that love has to feel “earned” in order to feel secure.

In other words? If love is given too freely or easily, it doesn’t feel safe.

This means people-pleasers can be drawn to relationships that are controlling (they feel safest when they defer to others), emotionally-withholding (they are driven by the need to “secure” affection, and feel elated when they do), and even abusive (their lack of boundaries is exploited).

Another part of being vulnerable to abuse is that people-pleasers are so easily gaslit, because when they are inclined to suppress their own instincts, values, and beliefs, they’re infinitely more likely to defer to an abuser’s version of events or narrative.

This also means that “fawn” types often go through cycles of restricting emotionally (I can’t be “too much” for others) and then purging emotionally (“unloading” onto a trusted person) because the expectation to be perfect and to repress gets to be too much.

I think this is why so many of us have eating disorders, too. The ways in which we restrict and purge emotionally can be reflected in the relationships we have to food. It’s driven by this internal battle of being “too much” and “not enough.” It’s fundamentally the same fear of simply being.

It’s important to understand that fawning isn’t intended to manipulate others.

It’s not exactly dishonest, either. Every single person presents a version of themselves to others. This merely describes how trauma informs that presentation on an often unconscious level.

The “fawn” response is driven by fear, not a hidden agenda. The “fawn” type is less about manipulation, because it’s not being used to overpower someone. Instead, it’s an excessive relinquishing of personal power, driven by fear and a desire for validation.

For example, someone who runs personal errands for their boss — despite it not being part of their job description — is not manipulating their boss into liking them. (It won’t work anyway.) Their boss, testing those thin boundaries, is exploiting their need for approval.

In more intimate relationships, this can show up as “fawn” types gravitating towards hot/cold dynamics, where affection and love are offered unpredictably.

This is where the emotional abuse piece comes into play. I wrote about this dynamic previously in my controller/pleaser article.

You have someone who is controlling, who feels safest in relationships where they call the shots, and feels loved when someone is actively seeking out their approval.

Enter: The “fawn” type.

An abuser will offer validation and love to keep the fawn type tethered. They’re usually the sort of person that feels distant, so the affection they offer to the fawn type comes across as special or unique.

But they’ll withdraw that affection before things feel stable, to ensure that the pleaser will continue going out of their way to “fawn” and secure that affection again. An abuser in this scenario feels safest when someone is actively pursuing them, so they get to replicate this sense of control and security over and over again… each time they withdraw their affection.

In the process, the fawn type is repeatedly giving over their power and autonomy so the abuse can continue. All the controller needs to do is rotate between withdrawing affection and, at the right moment, offer it abundantly.

I know this dynamic better than anyone, really, because it’s come up in my life repeatedly.

I’m sharing this because, holy shit, my friends, the number of traumatic relationships I’ve thrown myself into — professionally, personally, romantically — to get stuck in this cycle, with my self-esteem pulverized, has made my heart so heavy.

It took stepping away from a friendship that had so thoroughly gaslit and demolished me — while plummeting into the deep depths of anorexia — before I realized that chasing controlling, emotionally unavailable, even abusive people was crushing my spirit.

I sought out the most emotionally inaccessible people, and I threw myself into the pursuit, somehow believing that if I could secure the love and affection of the most unattainable person, it would indisputably prove my worthiness.

It’s a painful cycle. But for me, simply being aware of it was the first step towards healing.

If you’re reading this and saying, “Holy shit… it me. Oh god. What do I do?” Don’t panic. I’ve got you.

For starters, I’m going to ask you something: Which of your friends do you cancel on?

Personal experience: I had this tendency to bail on friends, partners, acquaintances, whoever, that were the most generous, warm, and emotionally-available.

I avoided those relationships where love was free and easy. Because it didn’t feel “earned,” so I didn’t feel “worthy.”

Which isn’t to say that everyone with this trauma response does this, but humans often seek out the familiar. Which means many of us tend to avoid what feels unsafe. For people-pleasers, we’re so used to working endlessly hard in relationships — it’s disorienting when we aren’t asked to.

I made a google doc (no, I seriously did) where I listed out people who were “way too nice to me.” And then I asked myself, do I like this person? Do I enjoy their company? If I did, I sent them a text message and told them I wanted to commit to spending more time with them.

I was completely honest about my process with those folks, too. I said, “Listen, I get really scared when people are nice to me. You’ve always been SO nice to me, and I get afraid of disappointing you. But I want to change that, because I just enjoy your company so very much.”

In my phone contacts, I put emojis by their names. I put strawberries next to people who were super loving. I put seedling emojis by folks who taught me things that made me think/grow. So when I saw a text from them, it reminded me that I should prioritize that message. 🌱🍓

And?

My life completely changed… in every imaginable way.

My ‘strawberry people’ went from being sort of friendly to becoming chosen family that I can’t imagine my life without.

With the help of some amazing therapy (trauma-informed therapy, if you can access it, is a game-changer), I grew to love myself so much — because that love was being modeled for me in a healthy way.

I’ve struggled with addiction and eating disorders, because I’ve taken this out on my body as much as I have my mind. When you have an overwhelming sense of being “too much” and “not enough” all at once, it’s not surprising when you try to numb every emotion and shrink yourself down.

And my strawberry people (who are now all in a group text together!) have been there every step of my recovery. I reached a year in my sobriety this last month. And I’m finally medically stable after being severely malnourished from anorexia nervosa.

Choosing love — unconditional love of self, and being loved unconditionally by others — literally saved my life.

It all began just by affirming, “I am enough, here and now, and I deserve love that doesn’t hurt.”

It’s not an easy process by any means, but I can’t begin to tell you how much happier I am as a result.

If this all sounds familiar, I do have some recommendations on next steps — because this blog post is really just the tip of the iceberg.

I genuinely believe that every single person should be reading Pete Walker’s book about complex trauma. It’s called “Complex PTSD: From Surviving to Thriving: A Guide and Map for Recovering from Childhood Trauma,” and it’s absolutely incredible.

So much of what I know about complex trauma and fawning is from the groundwork that Pete laid out in that book. I have a few of his other books as well, and he’s uniquely positioned as both a trauma-informed clinician and as a survivor of complex trauma.

I also have a few blog posts around complex trauma that I think are really useful in this conversation…

People-pleasers can be drawn to toxic relationships. It’s important to know why: This one breaks down the pleaser/controller abuse dynamic, in case that cycle sounds familiar.

Am I traumatized enough for a Complex PTSD diagnosis? A lot of people who are knew to complex trauma wonder if they’ve “suffered enough” to describe their experiences as trauma. I get it! And I’m here to unpack that question for you.

10 ways to reach out when you’re struggling with your mental health. If you’re struggling and not sure how to connect with your “strawberry people,” I have an entire resource about it.

If your goal in therapy is to ‘be happy,’ here’s why you might want to rethink that. People-pleasers also tend to be perfectionists in the ways they approach recovery. This article I wrote can help with goal-setting as you start to untangle trauma stuff!

I also do a bit of blogging about recovery, especially as it relates to disordered eating, over on Instagram and Twitter.

Most of all though, I just want to validate the hell out of you.

I understand the very difficult cycle that we find ourselves in when we’re consumed by this idea that we need to be “exactly enough,” and that, if we measure it out correctly, we’ll never hurt or be hurt again.

But relationships involve putting ourselves in harm’s way sometimes. What they shouldn’t involve, though, is self-harm — and ultimately, that’s what “fawning” does. We’re harming ourselves. We’re making ourselves smaller, we’re self-silencing, and we’re punishing ourselves.

You are allowed to have all the feelings. You are allowed to take up all the space. You’re allowed to be everything that you are and then some.

The right people — your people — will love you even more when they see how expansive your life becomes when you give yourself that space.

It doesn’t happen overnight. It’s a process! But I want you to know that it’s a process you can begin at any time.

It’s never too late to give yourself permission to be, to show up more authentically, and to find those who will celebrate you for it. I promise you that. 🍓

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Photo by Kylli Kittus on Unsplash.

Dear Body: A peace treaty with my queer, trans, and recovering body.

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When we entered into this world, I can’t imagine that we feared becoming more. Back then, the moon was full and the world was fuller; the majesty of being small was only in relation to everything that was still unknown.

We had not yet been told to fear hunger. We knew hunger in the way we know our names — you always answer to it.

Body, this is my olive branch to you.

/

I was 27 years old when “anorexia nervosa” appeared on my medical chart. In a quiet moment, staring at a flickering screen, I listened to my breath empty out of my body, a mix of relief and petrification.

Someone named what I could not: I was hungry.

The kind of hunger that moves in like an eclipse, enveloping your whole world in empty shadows. The kind of hunger you invite because staying small, in a cocoon or a corset of your own painful design, feels safer than stepping into the fullness of your life.

Your stubbornness and mine, colliding day after day. I ask you to die; you demand to live. I ask you to diminish yourself; you hold the line. I ask you to hide; you remain tangible. I am angry at every headache, every dizzy spell, every time I nearly fell down on the train. I am angry that you keep me tethered here.

I mistook your refusal to allow me to starve as a weakness, but I’m breathless now, looking back at all the ways you would not back down from survival. All the times you revolted, sounding every alarm, as if by sheer force of will we might find the urge again to live.

Body, I am in awe of you.

/

You are daring and spectacular. You’ve shrieked in defiance of every label you couldn’t hold. You held the truth of “boy” before I could feel it for myself. You were uncompromising in the truth of what you carried, chest open on an operating table, with a river of bright red blood exposed by two perfect incisions.

The truth of the body, you whispered, runs deeper than the mind. When I woke up, shrouded in the fog of anesthesia, I felt us move closer — like two pieces of a puzzle, surrendering to each other — and I was not afraid. The shape was new and the picture was clearer.

The bottom of the glass, the bowl, the bottle was not enough to dissuade you from being. When I hid, you followed; when I silenced you, you boomed and bellowed like thunder. I am still here, you sighed. You would not disappear. You would not dim.

Body, you are a vision.

/

When I began to eat again, I could feel you coming back to life. The noise was ecstatic and overwhelming. Sometimes I raged with so much hunger, it scared me. It was the first time I knew myself as an animal first, above all else.

Somewhere along the way, I’d forgotten that you needed me, that I needed you, that we were bound to each other. You were so patient still. You promised me a home when I had nowhere else to go. You promised me a vessel for the adventure of a lifetime. You were the light that drew me back, like a moth continually pulled from the darkness again, and again, and again.

Sitting in the dark with me, you waited. A lighthouse on the cove, a flare popping open in the sky, a smoke signal spiraling — every pang of hunger, every shaky hand, every heart palpitation and terror a subtlety that said, “More than this, Sam, we need more.”

Body, your courage stuns me.

/

I realized I was truly starving when I couldn’t shake the tunnel vision. Had the walls around us been any smaller, it might have become a casket. Back then, the world was a single dimension, an endless stream of self-imposed calculations. They were abstractions I used to comfort myself, to convince myself that I’d done good.

I will be exactly enough, I told you.

For the boys who couldn’t love me, the parents who couldn’t understand me, the world that couldn’t see me. I will make myself so small and inconsequential, I’ll be as harmless as the fly that sits on the windowsill. I will be the closest thing I can to being nothing, because to be nothing means that I will never take up more space than I deserved, more love than I’d earned.

But you refused. You kept the lights on. I shattered every lantern; you reassembled the pieces.

And stubbornly, you survived, so that I might one day understand that worthiness is not awarded like a ribbon at the spelling bee.

There is space here. There is love here. And both are the gifts of being.

Body, teach me.

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I am learning to love you back. I pause to feel the spaciousness between each breath.

“Marvel at this,” you remind me, eyes fixed on the horizon. “Let me show you.” One bite at a time, you restore me. The warmth returns to my belly. The sweetness to my laugh. The glow to my cheeks.

I will not pretend that I’m not afraid. There are days when I will be withholding. Being alive is a tremendous responsibility, and every so often, it scares the hell out of me.

To be a breathing, feeling, trembling animal is something none of us are prepared for. We enter this world screeching and gasping and blue, and spend a lifetime learning to breathe our way through it.

But I will not abandon you. I will come back, again and again, as many times as it takes to live.

That is what I can promise you.

I’ve teased apart the taste of honey when drinking my tea. I’ve let raspberries slowly dissolve on my tongue; I’ve savored every bite of a sponge cake flavored with cardamom and pistachio, so decadent you wouldn’t trade it for anything.

I’ve learned to cherish the warmth of someone’s chest against mine, the ephemeral magic of a song so loud it reverberates inside me, and the ripeness of a pea-pod from a stranger’s spring garden, sliced open between my teeth.

When you speak to me, the cadence has become familiar — I need, I want, I am, we are. Together, we move with clumsy but purposeful choreography.

And I know now to hold the gratitude for where you’ve carried me. I know that you are not an anchor, but rather, an altar. You house everything that is sacred in me.

Body, you are a blessing.

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This blog post was sponsored by Eating Recovery Center in honor of this year’s Eating Recovery Day on May 7th! The theme, #MyRecoveryLetter, is an open invitation to reflect gratefully on what has helped us in recovery. I invite every one of you to share your own letters to whomever or whatever has helped you in your journey!

Struggling with food? Body stuff? Or just need someone to talk to? The National Eating Disorder Association (NEDA) is a wonderful place to start. They’ve been an incredible resource for me — and I hope they’ll be for you as well!

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Hey, before you go…

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!

Photo by Chris Jarvis on Unsplash.

7 (Totally Wrong) Reasons I Didn’t Think I Had An Eating Disorder

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When I was diagnosed with an eating disorder, there was one question I just couldn’t get out of my head: “How did I miss this?”

Coming out of denial has been such a terrifying process. It’s like discovering that I’d fallen asleep at the wheel, and, eyes open now, I’m forced to assess the damage I can’t even remember causing.

One minute, I swear, I was on the road — the next, there are wires attached to my chest, and I’m getting an EKG and wondering how the hell I got there.

The shock comes in waves, and some triggers feel more sensitive than others. My stomach drops every time I hear my dietician say the word “refeeding.” I cringe when a doctor says “starvation.” They feel like heavy words, too grim, and the gravity hasn’t set in for me just yet.

I can’t decide what scares me more — the fact that I’m so malnourished that I have to reintroduce my body to food, as though we’re strangers to one another, or that my fear of food still, at times, outweighs my fear of destroying my own body.

How could I have fallen this far down the rabbit hole and not noticed?

I want to share what I’ve realized about my own denial, not just to get it off my chest, but because I think it speaks to the larger issue of how eating disorders are characterized.

Because as I began to unpack the reasons why I missed the signs, one thing became obvious: It’s not that I missed it.

It’s that our culture never gave me the tools to recognize an eating disorder in the first place.

1. My eating disorder wasn’t as ‘obvious’ as I thought it would be.

My eating disorder didn’t present in what I considered the “typical” way.

I wasn’t obsessively weighing myself, I wasn’t counting every calorie that I consumed, and I hated exercise. I didn’t cry if I ate a slice of pizza or have a deep-seated fear of butter. I didn’t fit the stereotype, which made the denial much easier to cling to.

My relationship to food and my body, though, was still dysfunctional.

Food caused me so much anxiety — the decisions involved, the binary of “good” and “bad” foods, having “too much” of something and “too little” of something else, and all the pressure of making the “right” choice.

Even with all of that anxiety, I pointed to the fact that I wasn’t trying to lose weight as “proof” I didn’t have an ED. I just wanted to stay exactly the same — which I insisted wasn’t about my body image or a fear of fat.

If I was always just a little hungry, I reasoned, I could prevent my body from ever changing. No one told me that an obsession with size, even if it’s not about getting smaller, is still an obsession rooted in a fear of fat.

Basic things like cooking or even looking in the pantry could send me spiraling. That anxiety led to cycles of restricting, in which I would eat very little, just to avoid the obsessive, overwhelming thoughts that emerged each and every time I had to make a decision around food.

It escalated, too, to the point of being unable to feed my own cats, for fear of making the “wrong choice” for them.

My partner is still solely responsible for determining what our cats eat and giving them food, because the panic I felt about their diets became too unmanageable for me.

My eating disorder also wasn’t as static as I expected. I had periods of time that I ate more, but as my life stressors increased, my restricting did, too. I thought eating disorders had to be constant and consistent, and mine wasn’t. I figured that let me off the hook, because it was “just stress.”

All of this is still dysfunctional, but in my mind, I could only picture the stereotypes that I had heard. I could eat pizza and ice cream! I could eat takeout! I wasn’t vomiting!

I was quick to point to the things that normalized my behavior, but eager to deny the things that were clearly disordered.

2. My body didn’t ‘look’ sick.

The one thing that still boggles my mind about eating disorders is that they truly have a mind of their own.

I knew, logically, that eating disorders can impact anyone of any body size. But I still denied having a problem, because the body that I saw in the mirror didn’t look emaciated.

Where was my terrifying “before” picture? And even if I tried to get help, who would believe me if I wasn’t “thin enough”?

But eating disorders don’t describe a type of body — they describe a specific relationship to food and to our bodies that causes psychological distress.

It took a long time before I was willing to accept that my body didn’t reflect whether or not I had an eating disorder; my state of mind did.

3. Everyone around me had disordered eating.

Disordered eating is everywhere. Skipping meals, weight loss resolutions, detoxes and fasts, even smoothies that replace meals are totally ubiquitous and, at times, inescapable.

When you’re immersed in diet culture, recognizing that you have an eating disorder can be impossible when everyone around you is validating your mentality, however unintentionally.

Being transgender especially, it’s normal for people to struggle with their bodies, and to push themselves to change as quickly as possible, no matter what it takes. And while gender dysphoria is a very serious struggle, I often used mine as an excuse to dig deeper into my eating disorder.

“It’s not an eating disorder,” I’d tell myself. “It’s just dysphoria.” But these aren’t mutually exclusive — in fact, this is why transgender people are at such an extraordinarily high risk for eating disorders.

How could I know that what was happening to me was dangerous if everywhere I looked, it was presented to me as normal and even desirable behavior?

4. My justifications for restricting seemed totally reasonable.

My eating disorder was really good at pointing fingers. For every disordered behavior or thought I had, I could always come up with a hundred excuses for why I engaged with food that way.

I went vegan for ethical reasons. I just hate cooking, okay? The kitchen is too messy. I’m saving money by skipping lunch. I don’t really have any food in the house. I’m a picky eater. I’m just lazy. I’m not good at meal planning. I’ve been so busy. I’m just saving room for dessert. I just prefer snacking throughout the day. I don’t need that. That doesn’t have vegetables. I’ll eat later.

I think a lot of people imagine that an eating disorder is a deliberate and conscious decision like a structured diet that spun out of control, but in reality, it’s a lot sneakier for many of us with EDs.

I didn’t wake up one morning and decide that I was going to stop eating. Rather, these little excuses that popped into my head enabled my restricting one meal at a time. And before I knew it? I had a much bigger problem.

My eating disorder wore down my defenses a little bit at a time — look how much creamer I put in my coffee! That’s practically breakfast! — which allowed it to escalate in an insidious, practically unrecognizable way.

It wasn’t until I was sitting in the doctor’s office, trying to explain what I was eating on a typical day (“Trail mix,” I explained, “and then I eat ice cream if I think I might faint”), that it finally hit me that I’d been duped.

5. It became my ‘new normal.’

Eating disorders are built on a house of lies, but if it’s the only house you’ve ever lived in, you just won’t see it that way.

One of the things that’s been most jarring about eating disorder recovery is realizing how skewed and even broken my barometer was around food.

I don’t remember what it’s like to feel “full” because I’ve spent so long being hungry. Things that I considered “a lot of food” turned out to be very little food to everyone else. I didn’t understand the difference between a meal and a snack.

I was convinced that hunger wasn’t a prompt that our bodies give us to eat, but rather, something that I had to fight to suppress by calculating the minimal amount of food I would need to manage. In other words, to me, hunger wasn’t natural — it was an ailment or a problem to “fix.”

When you have a relationship like this to food and to your body for a long time, it becomes the only reality that you know.

It’s like when my dietician asked me to have a nutritional shake and trail mix for breakfast, and I blurted out, “In the same sitting?” Hearing myself say that made me realize that, all along, I’d constructed rules that were strictly define by my fears, rather than the reality of what my body needed.

Recovery, for me, has been about completely dismantling that house of lies. It’s learning to be skeptical of everything you believed to be normal, and rather than allowing your eating disorder to dictate what “normal” is, it’s letting your body guide you to create an entirely new paradigm.

That paradigm is one that doesn’t react to hunger from a place of fear and trauma (fight or flight), but rather, from a place of body trust.

6. Having an eating disorder didn’t feel the way I thought it would.

I genuinely believed that if I had an eating disorder, I would have felt miserable all the time.

I was supposed to be angry, volatile, depressed! Instead, even in the midst of my disorder, I didn’t have the extreme despair that I assumed would accompany something as serious as an eating disorder.

But the reality is, eating disorders don’t always co-occur with a mood disorder. Mine didn’t — I have obsessive-compulsive disorder, not depression.

So if you’re expecting yourself to be constantly depressed? That may not be how EDs show up for you specifically.

You might actually feel “fine” — but it doesn’t mean that you are.

Mood swings can be part of it (and I certainly had my fair share), but some of us are more likely to experience emotional numbness, anxiety, irritability, restlessness, or even euphoria, rather than depression.

There is so much happening chemically in the midst of an eating disorder, it can be hard to predict how our emotions will respond, except to say that they can be super unpredictable.

Eating disorders are coping mechanisms, and as such, there really is no way you are “supposed” to feel in order for your eating disorder to be valid.

Truthfully, I felt the most depressed and despondent in recovery, when I first tried to start eating again. When I had to actually sit with my fear and discomfort instead of restricting, that’s when my mood absolutely crashed.

The misery that I felt when I started in recovery made it even harder to believe I had a problem, too. I kept thinking, “If this is treatment, shouldn’t it be making things better?”

But I promise you, that’s normal! Sometimes it does get worse before it gets better — and that’s just part of the process.

7. I thought I ‘knew better.’

I wrote about this in my last blog but it bears repeating: Anyone, even mental health advocates who write about this shit for a living, can have an eating disorder.

One of my gorgeous friends in recovery said to me recently, “Sam, you’re talking about eating disorders as though they aren’t mental illnesses.”

And that was the crux of the issue, really — I believed that if I had the right attitude, the right meal plan, or shared enough body positive Instagram posts, I could worm my way out of having an eating disorder.

But eating disorders are mental illnesses and they have to be treated as such. Reading a book or taking a selfie in a crop top can be empowering, and it can open the door to recovery, but eating disorders require more than positive thinking.

I needed help.

Eating disorders are so much bigger than an attitude adjustment. It’s asking you to create an entirely new relationship to your body, to your food, and to the world around you. That is a lifelong process — but a worthwhile one, too.

I’ve had an eating disorder most of my life, and yet it was unrecognizable to me.

And I can’t help but feel that, in a culture that was simply more informed about what eating disorders are and the diverse ways they show up, we’d all be much quicker to recognize them in ourselves and our loved ones.

That’s ultimately why I’m sharing my experiences so openly. I want each one of us to be able to embrace recovery, knowing that our struggles are valid regardless of how they compare to anyone else’s.

Please know: If you’re struggling with food for any reason — if it scares you, makes you angry, overwhelms you, whatever it is — there’s no harm in reaching out and talking to someone.

I’d recommend getting in touch with the National Eating Disorder Association, where you can chat with folks who are the experts in recognizing these complex disorders.

You deserve whatever support and affirmation you need to have a safe relationship with your body and with food.

And I hope that someday, we’ll live in a world where those relationships are modeled for us, so that we never have to question what that looks like.

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Want more real talk about recovery?

The conversation continues over on Patreon, where I film weekly videos talking about mental health, recovery, self-care, and more. This week’s video dives deeper into how social media can perpetuate denial in recovery — go check it out!

Photo by Toa Heftiba on Unsplash.

I preached body positivity — and sunk deeper into my eating disorder at the same time.

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I don’t usually write about my mental health when things are “fresh.”

Not in the last couple years, anyway. I prefer to let things marinate, and to make sure that the words I choose are empowering, uplifting, and most importantly, resolved.

I prefer to give advice when I’m on the other side of something — largely because I know I have a responsibility to my readers, to make sure I’m nudging them in the right direction. I know this blog can be a lifeline for folks who need something hopeful. I try to remember that.

But sometimes, when I perfectly package that hope for an audience, I can delude myself into thinking that I’ve cracked the code and, therefore, can tidily leave a struggle in the past. The perfect conclusion to the chapter, as it were.

“I know better now,” I think to myself. “I’ve learned my lesson.”

If you were to Google “transgender body positivity,” I’m fairly sure more than a few things I’ve written will come up. I’ve been interviewed for podcasts and articles, and hoisted up as an example of a trans person who — in a simple shift in perspective and following the right insta accounts — came to redefine his relationship to food and to his body.

Three articles that appeared in a Google search for "transgender body positivity," all written by Sam.
I wrote all three of these. Delightful.

That version of events is one that I love, because it’s so simple and comforting. One shiny, bright epiphany, and I emerge victorious, having evolved beyond any worldly, frivolous concerns about my stretch marks or eating ice cream for breakfast.

“Fuck you, diet culture!” I jubilantly exclaim. “I know better now. I’ve learned my lesson.“

When you are a mental health advocate and writer, especially in such a public way, it’s easy to trick yourself into thinking that you have all the answers to your own problems. But that illusion of control and self-awareness is exactly that — an illusion, and a deceitful one at that.

It’s easy to point to the years I’ve spent in this space, and everything I’ve published about this exact thing, and insist I’ve got things under control. It’s not my first rodeo, pal. Or second. Third. Fourth. (I’ve got experience on my side.)

If I can support others through their recovery, surely I can navigate my own. Even as I write that, I know it’s patently ridiculous — giving good advice is much easier than applying it to yourself, especially where mental illness is concerned.

But the version of me that I prefer is the one that said in this interview, as recently as last June, “When you get to the other side of whatever you’re struggling with, you’ll see that not taking those chances — living only half the life you could’ve been living — is a lot scarier than any disaster you imagined would come from eating that slice of cake or whatever it was.”

Says the person who is, really and truly, living in that fear in a life half-lived right at this very moment.

Body positivity has felt like a relationship I dove into at such a young age, long before I knew myself or even my eating disorder. And once I was in too deep, having positioned myself as triumphant, I didn’t know how to step back enough to ask for help.

I wanted to believe it was like an incantation I could say in front of the mirror several times — “all bodies are good bodies! all bodies are good bodies! all bodies are good bodies!” — and POOF! I was absolved of any guilt, shame, or fear I felt around food or my body.

I could say all the right things, like a script that I’d rehearsed, and love the idea and the image of myself when I peered through those rosy-colored lenses.

But where eating disorder recovery is concerned, a script — even when memorized — is not a substitute for the work.

And no amount of Instagram memes and photos of belly fat could touch on the old, painful wounds that had positioned food as my enemy, and my body as the site of a war.

Which is all to say, I am not recovered. The work hadn’t even begun. In fact, I used my proximity to body positive spaces to disregard the very idea that I needed help — and I’m paying the price physically, mentally, and emotionally now.

I wore body positivity like an accessory, to project the image of myself that I wanted to be, and my eating disorder reveled in the idea that I could suspend the reality of my illness simply by curating my social media accordingly.

My understanding of body positivity — and by extension, its roots in fat acceptance and liberation — was shallow at best, but only because my eating disorder thrived so long as I sustained the illusion that I knew better. This was yet another way of convincing myself that I was in control, that I was smarter than my ED.

My disorder had a vested interest in lulling me into a false sense of security. I couldn’t have an eating disorder, I thought — disordered eating, maybe, but who doesn’t? I couldn’t because I was evolved. As if mental illness ever gives a fuck about the books you’ve read.

Eating disorders have a way of sneaking up on you. That realization is a new one for me — not because I didn’t logically understand that, but because I’ve only come to accept it in the context of my own lived experience in the last few days.

And I wish I could say that this epiphany came to me on my own, inspiring me to reclaim my life, but there’s no such heroism here. It came to the surface only because my doctor asked the right questions during a routine checkup, and my bloodwork revealed what I feared to be true — my body was coming undone in the absence of adequate, much less nutritious, food.

“I don’t understand how people decide when to eat,” I confessed to my therapist. His eyes widened with deep concern.

“They eat when they’re hungry, Sam,” he said gently.

At some point or another, I had utterly forgotten that simple, basic fact. There is a mechanism in the body, intended to guide me, and I’d cut all ties to it completely.

I don’t share this as a criticism of myself, but rather, as a very simple truth: Many of us who are lauded as faces of recovery are still, in many ways, right in the thick of it along with you.

Sometimes what you’re seeing is not a portrait of success, but rather, a small piece of a more elaborate, messy puzzle that we’re frantically trying to assemble behind the scenes, so that no one notices that we’re in pieces.

My eating disorder recovery is, in truth, in its very infancy. I’ve only recently stopped using “disordered eating” to obscure the reality, and this morning, finally spoke to a dietician that specializes in EDs.

This morning.

Today is, in actuality, the first real day of recovery. That’s three years after, by the way, I wrote these words: “No more justifications. No more excuses. Not another day . . . this is not control.”

I know there are readers who might have looked at my work in body positivity, and absorbed the misguided notion that eating disorders (or any kind of body negativity or food aversion) are simply mazes that we think (or in my case, write) ourselves out of.

If that were true, I wouldn’t be sitting here, sharing with you a very uncomfortable truth about recovery: There are no shortcuts, no mantras, and no quick fixes.

And as we glamorize the idea of an easily attainable self-love — as though it’s just one perfect crop top away — we miss the deeper work that must be done within ourselves, that no amount of sparkly, inspirational quotes we retweet can replace.

Trauma is not on the surface, and to strike the heart of it, we have to go deeper.

This is an awful and uncomfortable truth that I am coming to grips with — mainstream, watered-down body positivity can open the door and invite us in, but it’s up to us to do the real work of recovery.

And that begins not externally, but within us. Recovery is an ongoing commitment that we must choose every single day, deliberately and courageously, with as much rigorous honesty with ourselves and our support systems as humanly possible.

No matter how we curate our social media to remind us of where we’d like to be, the aspirational vision we create is never a substitute for the reality that we’re living in.

As is so often the case with eating disorders, I’m realizing, the aspiration — that “what could be” — so often becomes a compulsive, maddening drive, where we live in a future that we never arrive at.

And unless we commit ourselves to being grounded firmly in the present, even (and especially) when it’s uncomfortable to be here, we relinquish our power and fall under its spell.

My ED loved the naïveté of Insta-friendly body positivity, leveraging that illusion of safety to delude me into thinking I was in control, that I was better than all this.

And I can’t say I’m surprised by it — EDs seem to take many of the things we love (ice cream, yoga, fashion) and turn them against us in some way or another.

I don’t have all the answers, except to say this: We are works in progress, all of us, even those that you look up to. A pedestal is a lonely place to be, and loneliness, I think, is where eating disorders (and many mental illnesses) often thrive. I’ve been up here for too long, silently waiting to fall or for it to crumble underneath me — whichever came first.

As I make my descent, slowly climbing down from the pedestal and stepping into the light of my recovery, I’m going to embrace the truth that every one of us needs to remember: It is okay not to be okay.

It’s okay to not have all the answers, even if the rest of the world expects you to, even if you expect yourself to.

I am not, as some people have described me, “the face of transgender body positivity.” If I am, I don’t want to be — I don’t want any of us to be if that means we’re not allowed to be human.

I want you to scrub that image from your mind and, instead, know where I really was yesterday: Clinging onto a nutritional shake for dear life (literally — it’s kept me alive these last few months), having not showered for three days, while texting the words “I think I need help.”

So many of the advocates you look up to have had equally unromantic but profoundly brave moments just like that.

We do every single day, whether we have a selfie to prove it happened or not. (Some of us have group texts, and trust me, we are all on the Hot Mess Express together. Promise.)

If you’ve felt like you’re not allowed to “fail” (or rather, have an imperfect, messy, even fucked up recovery), I want to give you permission to live that truth, with every bit of honesty and vulnerability that you need.

It’s okay to let go of performing recovery. And trust me, I know how big of an ask that is, because that performance has been my security blanket (and the source of my denial) for so, so long.

You can surrender to the doubt, the fear, and the discomfort that comes with doing the work, and give yourself permission to be human. You can let go of that control and — I’m told, anyway — it will all be okay.

And this amazing community of recovery warriors that we’ve created with our memes, our inspirational quotes, and our crop tops? We will be right here, waiting to support you.

I can’t say that I know this for certain (hello, Day One), but I have a strong suspicion that this kind of honesty is where the real growth happens. And wherever there’s growth, I’ve found, that’s where the healing truly begins.

And that’s what we deserve, every one of us. Not the aspirational kind of healing, but the deeper stuff.

I want that for me. I want that for all of us.

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Struggling with food? Body stuff? Or just need someone to talk to? The National Eating Disorder Association (NEDA) is a wonderful place to start. They’ve been an incredible resource for me — and I hope they’ll be for you as well.

Before you go…

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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.

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

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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.

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

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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.

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.

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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.

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

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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.

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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.

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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.

 

Screenshot 2018-03-03 at 10.35.49 AMAnd 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.