Boundaries Mean Cruelty

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One of my favorite blogs in the world is Captain Awkward. It’s an advice blog, a format I rarely read, but in this case it deals primarily with scripts and suggestions for setting boundaries. Sure, there’s lots of variations on that, but almost across the board it’s about making space for yourself, aimed at introverts, weird and awkward types, the socially anxious, and those who live in the world of oppression. It’s fantastic and you all should check it out.

Thanks to the help of Captain Awkward, a lot of DBT, and a pile of friends who openly talk about self care and openly asking for what we need, I’ve started to practice boundary setting as often as possible. It’s amazing how difficult it is to open my mouth to simply say something like “please don’t talk about calories around me,” but there you go. The internalized people pleasing is strong in me.

I’m getting better. I can tell friends that I’m not up for hanging out if I need to, I can tell my boyfriend when I don’t feel comfortable with something, I can even to some extent enforce my boundaries in the online world. But for some reason it all breaks down when it comes to my family. My family has always been pretty close, and we like to get together. We like to party. We like to eat a lot of food together. And we like to spend a great deal of time together, especially around the holidays.

Now through the process of reading about the fleeting thing called “normalcy” I have gleaned that my family goes a bit above and beyond in terms of holiday activities. I, on the other hand, am fairly socially anxious and spending many days in a row with the extended fam can be a drain.

So this year I’m opting out of some of the festivities. I’m making sure I see all the out of towners, get some immediate family time in, and trying to fit in friends too. But I’m skipping almost half of our events.

Part of me is convinced that the message I’m sending by setting this boundary, by saying that I am an adult with a job and friends and responsibilities and in order to take care of myself I need to take these steps, I am telling my family that I don’t love them. Part of my brain still reads “setting a boundary” as “cruelty”.

I know that by taking time to myself I am doing my best by everyone. I’ll be a happier, friendlier, more outgoing human being in the times that I do see my family. I’ll be able to be more present with them and actually (hopefully) have good conversations and interactions instead of living in a state of stress and anxiety that makes me antisocial and cranky. I know that one day of good time together is better than a week of time struggling to cope.

So why is it that I still read it as inappropriate? Why do I still read the boundary setting as taking something away from other people when in reality my time is not something that I owe anyone, it’s something I choose to give to others? Somewhere along the line society has convinced me that certain people deserve my time, no matter what that means. Not only that, but they deserve my time in a fashion that is acquiescing and non confrontational.

This is not to say that my family demands some sort of creepy submission, but that challenging your family, setting boundaries, or even just asking someone not to do something is viewed as hostile by many people. Not showing up is seen as a sign, and it’s not a good one.

I don’t know what it is about family that triggers the “you should not be an independent human being, you owe all your time to these people” script in my brain. I don’t know if this is something that happens to others, the selective way the mind chooses people you cannot be an adult with. But I know that it isn’t healthy to feel like I’m five again whenever my family asks me to do things, certain that I don’t actually have any choices but petulantly running to my room or doing what they ask.

So I’m sticking with my boundaries. Discomfort be damned.

No, This Is Not How To Raise Awareness

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Ugh. Ugh ugh ugh. Eating disorder coverage has been getting better in the past few years. I’ve seen stories covering orthorexia, binge eating disorder, bulimia, and EDNOS, as well as some that include the oh so shocking fact that eating disorders don’t just happen to people who are skinny, and sometimes they’re not motivated by weight loss, dieting, or models.

So I was deeply unhappy to see this art series that purports to draw attention to eating disorders but is exclusively composed of skeletal Disney figures. Sure, it’s great that it includes men and women of color, but there is such a small percentage of people with eating disorders who actually look like that, whose BMIs have dropped down into the “you need to be hospitalized” realm that I can’t help but feel that it just limits our perception. Beyond that, it perpetuates the horrible, horrible idea that you can diagnose a mental illness by seeing how skinny someone is.

Newsflash: eating disorders are not defined by someone’s weight. Weight is actually one of the smallest components of diagnosis (there are lots of other criteria! And lots of different disorders! Some of which include NO weight component!)

It is not outreach or advocacy to continue to portray eating disorders in stereotyped ways. This is not helpful.

For real information on what eating disorders are and what they’re like, try NEDA, Science of Eating Disorders, or just check out my back log of blogs tagged with “eating disorders”.

Yes, Mental Health Stigma Exists

I am all about speaking openly about mental illness and mental health. I love doing it. I do it constantly. I practice it in person and on my blog and in my social media. Aw yes, mental illness talk.

So when I saw an article yesterday entitled “Talking About Your Mental Health Isn’t Brave” I couldn’t help myself. I had to click. Sometimes I’m a masochist. It wasn’t quite what I expected. The thrust of the article is that it should be totally normal to talk about your mental health. Great! Awesome!

But underlying that was a secondary thrust that suggested there is no stigma about talking openly about your mental health because the writer has never experienced it, and so the REAL stigma comes from people saying it’s brave. That logic pretzel there guys, it is a doozy.

It’s one thing to say that you think talking about mental health should be normal and that you don’t want to be called brave for doing it because you don’t want to draw attention to it. It’s another thing to deny that discrimination and stigma exist when thousands of other people have anecdotal evidence and there is evidence from psychological studies and surveys suggesting that it’s very real.

When people can still be fired for their mental health, when physical health problems are routinely ignored if someone has a mental health diagnosis, when shooters and violent criminals are labeled “crazy” without any evidence, when misinformation abounds, it is simply irresponsible to suggest that stigma doesn’t exist because you personally haven’t experienced it.

It might not seem like a big deal, but for an already vulnerable group of people who don’t think they can trust their emotions, being told again that their experiences of prejudice and discrimination don’t exist can have lasting consequences (along the lines of gaslighting). It also signals to others who might have discriminatory attitudes that they can just keep doing what they’re doing because nothing is wrong. And worst, it suggests to those who have experienced stigma and discrimination when they come out about their mental illness that they really shouldn’t say anything because if they did it right then nothing would have gone wrong.

It’s great to tell the stories of being open. It’s great to let people know that there is the possibility of a good reception. When I’ve been open with my friends and family and even coworkers, they’ve been understanding and sympathetic. But in no world do I imagine that means that everyone will have this kind of experience, and if I did then I’d need a serious refresher on “not being the center of the universe”.

So no dude, it isn’t boring or normal to talk about your mental health. For lots of people it is brave. Get over it.

Navigating the Holidays with Social Anxiety

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It’s almost Christmas, or whatever midwinter holiday you might celebrate. It is the season of parties and socializing and food. In the next two weeks I have almost an entire week’s worth of days that include a family social event. I love my family, but it is a rare month that I can handle that much socializing with any group of people, much less with the extended family that I see once a year at most.

I know that I am not alone in finding the whirlwind of mandatory socialization stressful. I’m sure I could duck out if I needed to, but I do love my family and I certainly don’t want to insult or offend any of them. So what’s a girl to do when saying yes all the time will result in mild insanity but saying no means making people sad?

The holidays are essentially the perfect mix of things to set off anyone with a mental illness. Lots of people, lots of demands, high expectations, low tolerance for unhappiness, and lots of different personalities crammed together means tension. There’s lots of food, lots of alcohol, and often many small children heaped into a small place. There’s noise. There’s smells. There’s the probing questions about what you’re doing with your life (not much thanks).

I haven’t yet figured out how to do the holidays since realizing that I’m constantly stressed out and being around lots of people I don’t know that well stresses me out more. But I’ve found a few techniques that are helpful. Most of them center around boundaries.

If there are family members who know you have anxiety or an eating disorder or depression or whatever, have a little pre-holiday check in to see if you can make some plans. Is it possible for you to disappear to a bedroom for an hour or two to read if things are getting overwhelming? This is how I first read The Fault In Our Stars (I do not suggest this as “emotional downtime” reading material), and also how I got through Christmas day two years ago. I’d also suggest prepping an excuse if you need to make a dash. There’s nothing wrong with coming to a gathering for an hour or two, deciding you’ve hit your limit, and saying you have somewhere else to be/aren’t feeling well/have a really important hairwashing date.

It’s also ok to pick and choose which events you want to attend. There might be relatives who are only in town for the holidays, or friends you haven’t seen in a year, and you may want to prioritize those people. But if you have a limited supply of holiday cheer and your best friend invites you to a holiday party with people you’ve seen once a week for the last two months, you can put them off until next week. Sorry to everyone who got me at Thanksgiving. I’m saving my energy for the family that’s only in this state once a year.

One of the hardest parts of the holidays for me is that many of my family members are utterly unaware of the things that are important to me and end up saying incredibly hurtful things without realizing it (especially surrounding mental illness). Sometimes there isn’t any way to escape those comments, but often there will be another conversation going on, someone will be cooking, or you can escape to the bathroom if someone’s conversation is particularly triggering. Even if it’s just for a little bit it can help to move to a different setting. Last year I even went and spent time with children (of whom I am entirely terrified) to get away from some conversations that were too much for me.

Consider also planning some self pampering time. I’m aiming to schedule a massage, buy myself a kitten, get a new (and larger) bed, and also wear fuzzy pajamas as often as possible in the next couple of weeks. Your self care might look a little different, but if you know you have a stressful holiday party, make sure you’ve got a hot bath or a cup of hot cocoa waiting for you.

And most importantly for me, also consider cutting out a swathe of time to celebrate in the way you want to. For me, this will probably mean my D&D crew and my boyfriend, some handmade presents, and hot beverages. Low stress, low expectations, and the same kind of chilling that makes me happy all year round.

I also intend to spend as much of January as possible hermited away editing my book, so I have that to look forward to.

Leave your suggestions in comments, I’m always looking for more tricks.

Intersections: Mental Illness and Allyship

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I consider myself a white ally. I know I don’t get to pick this for myself. It is not a label but an action. I need to back up my attempts at anti-racist thought with behaviors. Trust me, I am well aware of my shortcomings as an ally: I have never been to a protest, march, or rally on behalf of people of color. I don’t write nearly as often as I should about questions of race. I rarely collect my people. Sure, I start conversations about race with my friends, I call out my family when they say utterly stupid things, and I try to make absolutely certain that everyone on all my social media platforms knows where I stand on racism. I try to retrain my brain whenever possible, educate myself, and question my problematic opinions.

But I know I could be a lot better. There were protests in the last few weeks for Michael Brown and Eric Garner, protests that I should have gone to. There was a conversation with a friend that I gave up on halfway through because it was too hard.  I know that at least one person in my family still holds to the belief that African American Vernacular is incorrect English, and I’ve stopped trying to correct them.

There are easy excuses. I’m tired. It’s hard. I’ve tried already. These are bullshit.

But where I hit a fence is this: that conversation that I gave up on last week? It wasn’t because I didn’t want to figure out how to get my point across, or because I thought my friend was entitled to their opinion. It was because my anxiety and depression took over halfway through and convinced me that if I didn’t agree with him, he would hate me and I was being a bad person. Like a very capable and competent adult, I spent a few hours crying instead of being the good ally I was trying to be.

The reason I didn’t go to the protests? The fatigue from my depression has been catching up with me lately and I’ve been sleeping 10+ hours every night. I haven’t been able to get out of the house to do even the basic tasks I need to complete for my own life. I tried to convince myself to get there, and I couldn’t escape my own malaise.

I don’t know if this excuses or exempts me from certain forms of allyship. Probably not. I don’t know if the intersection of my mental illness and other causes changes how I should behave in situations like these. Probably not. But I also don’t know how to practice self-care and prioritize my health while also working hard for others.

This all sounds like excuses to my ears, but I know there are others out there who expect themselves to always be the perfect activist. The conversation needs to be had.

 

Mental Illness Isn’t Your Scapegoat

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Let’s get the obvious out of the way: abusive relationships are horrible. We should do everything we can to provide people with information on what an abusive relationship looks like, how to get out of one, and how to stand up for yourself and your boundaries, as well as support for those who are trying to escape an abusive relationship.

There are many good resources out there on how to recognize unhealthy behaviors. There’s also lots of people out there doing work specifically with women and girls to remind us that we don’t deserve abusive relationships.

What is not a good response to abusive behavior is blaming mental illness. I can’t believe I have to say this, but it is 100% possible to have a mental illness, really any mental illness, and not be abusive. This includes individuals with Borderline Personality Disorder, Narcissistic Personality Disorder, and Antisocial Personality Disorder. Pointing towards abusive behaviors as intrinsically linked to any of these disorders is not backed up by facts (there are many abusers who use all of these same tactics and do not have any mental illness), and throws the rest of the individuals with mental illness under the bus in order to advocate for abuse victims.

This article at Self Care Haven has some great information about techniques that many abusers will use. Unfortunately, it couches it entirely in language of “narcissists” and how those individuals behave, rather than recognizing that any abusive individual can make use of these tactics (and many do), and recognizing that a diagnosis of Narcissistic Personality Disorder is not a life sentence to being an abusive person who cannot have real relationships.

Abuse is a pattern of behaviors and interactions. It is not a personality. We don’t get to simply label any behavior we deem bad as “mental illness” in order to ignore how we as a society have contributed to it or in order to brush off any support we could provide for someone to change. I am all for speaking openly about mental illness and the challenges it can present in relationships and everyday life, as this is the best way to improve treatment and diagnosis of mental illness, but more often than not we use the label of “mental illness” to close a conversation about a difficult or painful topic.

Gun violence? They were mentally ill. Start a registry.

Domestic abuse? Mentally ill. Don’t date people with personality disorders.

Do you just disagree with someone? They’re probably mentally ill too.

Here’s the truth: even the personality disorders that make it most difficult to hold down relationships are not a life sentence. Borderline Personality Disorder, which has long been seen as the land of the manipulative and angry, has an evidence based treatment that has high success rates. Many people with BPD have totally functional lives with families, jobs, and everything else a healthy human being might want (ok, maybe not everything, but they lead fairly boring lives for the most part).

There are absolutely highly functioning individuals with Narcissistic Personality Disorder, or Antisocial Personality Disorder. There’s evidence that Cognitive Behavior Therapy can reduce symptoms and increase functioning, allowing patients to form better and healthier relationships. More study is definitely needed, but instead of broadly labeling personality disorders (especially ones that already come with a lack of empathy and distrust of others) as breeding grounds for abusers, perhaps we could put some effort into finding treatment for people who have these disorders.

None of this is to say that people who have mental illnesses should be excused of abusive behavior. But providing information about abusive behaviors and giving tools and support to victims is not mutually exclusive to providing mental health treatment options to abusers, and absolutely does not require that we assume a certain mental illness necessitates abusive behavior.

There are some parallels here to threats of suicide or self harm. If you have a mental illness, there is a possibility you will feel urges to enact these behaviors. Letting a partner or friend know that you are feeling the urges is definitely a good idea. Threatening the behaviors in order to get your partner or friend to do something is not ok and cannot be excused by mental illness. The urges are the same, the behaviors are different, and choosing the healthier route is a skill that can be learned. Similarly, the urge to use and manipulate people might be a hallmark of a personality disorder, but the urge doesn’t necessitate the behavior.

We can do better in how we talk about abuse.

Cross Cultural Eating Disorders

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It’s commonly held knowledge that eating disorders are a Western phenomenon. They came about because of beauty standards, small models, and photoshopping. They’re on the rise! Panic! It’s an epidemic!

Only this isn’t necessarily supported by a hard look at the data. One of the problems with assessing whether or not eating disorders exist in other cultures is that the diagnostics for the disorders were developed in the US and Western Europe, leading to a focus on the presentations that we tend to see in those places. As an example, one of the diagnostic criteria for anorexia is “Intense fear of gaining weight or becoming fat, even though you’re underweight.” While this is the motivation for many people to refuse food, it is not true of everyone who displays many of the symptoms of anorexia, and may simply have different motivation.

There are a few different sources of data that contradict the idea that eating disorders are culturally bound or that they are caused by Western beauty ideals. We can look at history or we can look to minorities or other countries that may not have been wholly influenced by Western concepts.

Historically, we have strong evidence that people have been choosing to starve themselves for hundreds of years. The book Fasting Saints and Anorexic Girls traces the history of self starvation from the earliest records through to the first recognition of eating disorders as psychiatric conditions. While the book suggests that these are distinct phenomena because in the past few people have practiced self starvation due to a fear of fatness, behaviorally it shows many parallels.

One particular group of individuals that have similar behaviors to modern patients with eating disorders are religious fasters. These tended to be young women who had little control over their lives in many ways and who chose to abstain from food for extreme periods of time in order to be morally better by ignoring their bodies and focusing on their spirits.

The book includes some quotes from people who chose to restrict their food intake in times past, and concerns about morality, space, selfhood, and perfection come up again and again, just as they do in current conversations about eating disorders. Many of the experiences are couched in religious terms, but the underlying fears (“I am not good enough”, “there is something wrong with my body”, “I need to be better”, “I don’t want this life”) could just as easily be pulled from a study of eating disordered patients today.

Individuals throughout history have chosen to abstain from food, often falling into something like depression and priding themselves on their ability to go without for long periods of time. Their motivations have changed as their social milieu has changed, going from religious, to entertainment, to aesthetic. However many of the sentiments that these individuals express ring similar across time and space.

“It’s like I never knew what self-respect was all about until now. The thinner I get, the better I feel . . . I’m proud of my stoic, Spartan existence. It reminds me of the lives of the saints and martyrs I used to read about when I was a child . . . This has become the most important thing I’ve ever done.” This kind of quote could easily be from a religious faster or a modern individual with anorexia.

Over at Science of Eating Disorders, Tetyana posits “Religious and spiritual reasons are not the only factors that could be contributing to AN in non-Western countries (or Western countries before the ‘thin ideal’). Personally, it would seem to be, that anorexics in those times, would just attribute their desire for weight loss to those reasons much like today it is often attributes to a fear of being fat. But, both of those could just be post hoc rationalizations on the part of the sufferer, to make sense of their otherwise perplexing desire to restrict their intake and lose weight. That’s my feeling.”

I’ve written elsewhere about how restricting food made me feel powerful, godly. I often imagined that my body was not subject to the same requirements that others were. Only the weak needed food, but I decided my morality, my meaning, and my body for myself.

“Comparable to the ascetic practices in the history of Christianity are the fasting practices in the Chinese Daoist tradition (Eskildsen, 1998). These practices sought to transform the body as a means of gaining immortality…  The history of Chinese thought thus suggests that, in certain traditions at least, the emaciated body has been highly valued and pursued in a manner highly reminiscent of Western observances.”

But in addition to historical examples, we can also look at current cases of eating disorders in non-Western countries. It’s a common trope that these are rare, and when they do appear they are evidence of growing Western influence in the country. The problem with that assumption is that many individuals who might be diagnosed with an eating disorder but lack fatphobia are not given the diagnosis. The unthinking assertion that the rise of eating disorders correlates to increased Western influence doesn’t look at the lived experiences of individuals in non-Western countries.

Again, from Science of Eating Disorders:

“For example, one study found that in British Asian girls, dietary restraint was correlated with traditional (rather than Western) values (Hill & Bhatti, 1995). This finding was supported in a study by Mumford and colleagues (1991) who essentially found the same correlation. On a Caribbean Island, with little Western media, Hoek et al (1998) found that the prevalence of AN was comparable to Western countries and a study by Apter et al (1994) showed that a group of village Muslim women (with minimal exposure to Western values) had eating pathology scores that were indistinguishable from patients with AN.”

Many of the patients quoted in this article don’t talk about a strong desire for thinness or weight loss, but point to their bodies as the site for other struggles in their lives, particularly around control and selfhood.

“… food restriction arose from a sense of powerlessness in the family context, it is possible that the patient experienced her emaciation as egosyntonic, with her low body weight consonant with the goal of not wanting “to ‘give in’ to her family, especially her mother, who forced her to eat even when she was not in a mood to.”

Again, these individuals exhibit many of the same behaviors as individuals diagnosed with eating disorders in the Western world, but don’t show the obsession with thinness or fatphobia that we assume is an essential part of an eating disorder.

An eating disorder is a coping mechanism that allows an individual to survive extremely difficult situations or feelings. Physically, it has effects that make it easier to live through strong emotions: it numbs out painful things, it leaves you sleepy and sedated, and it also provides a kind of high that makes you feel accomplished and safe. These are biological results. They are the same no matter where you are or when you’re living. And they are effective at helping someone survive a difficult situation no matter what kind of difficult situation that is: it could be not living up to religious expectations or not fitting into a beauty ideal.

And so I am continually dismayed at ridiculous articles like this that seem to think eating disorders are not only limited to the West, but also limited to young, naive, shallow teen girls who can’t figure out how to do basic things like feed themselves. Diagnosis, demographics, and etiology are complex and confusing. If you don’t know a little something about mental health, don’t write about it.