Between A Rock and a Hard Place: Triggers

Yesterday I was hanging out with my partner’s family having lunch and chatting. I generally like Partner’s family, and they’re very kind people. But I’ve only known them for a few months and I haven’t established a very close bond with them yet. That means they’re mostly unaware of my mental illness. It’s not uncommon for people with mental illnesses to be around others that have this level of acquaintance: you know them, you care about what they think, you respect their opinions, and you want the relationship to grow. But they don’t know about your mental illness.

Most of the time that’s totally fine, especially since it’s not too hard to decide that if someone is a total butthead about mental illnesses and runs around spewing stuff like “it’s all in your head” or “just smile more” you can decide that you simply don’t want to invest in the relationship and stop hanging around them. But sometimes you end up in a circumstance in which someone that you want and need to build a relationship with inadvertently starts triggering you.

So yesterday when the conversation turned to calories and weight loss, I really wasn’t sure what to do. These conversations are nearly always triggering to me, to one degree or another. Sometimes I can keep my reaction under control, but usually it means that I’ll spend the next hour to day thinking about calories and weight loss and fighting with myself over my own caloric intake.

What do you do when you’re in a situation in which you can’t disclose your discomfort without outing a whole other pile of things, but you can’t leave without harming a relationship? Are there tools available? Sure I could have set a boundary by just saying “Hey, I really don’t think weight is that important. Could we talk about something else?” or just changing the subject, but when you’re not in a position of power or comfort, that can be extremely difficult. There are all sorts of situations where it’s nearly impossible to set boundaries like that without risking social repercussions.

There are lots of distress tolerance skills that seem really applicable here, things like breathing exercises, soothing oneself with nice sensory experiences (finding the soft blanket in the room and cuddling it), taking a brief mental vacation until the topic of conversation is over, distracting yourself in some fashion (if there are kids around it’s always a good excuse to say you’re just going to go play with them). It’s hard, and it might require limiting time around people you’re not sure you can trust with your mental and emotional health, but as relationships get closer you can start setting clearer boundaries.

The problem in my mind is that it’s still considered socially unacceptable to discuss your mental health in a casual way. It creates situations like these where there will always be unspoken needs because we’re not allowed to speak of mental illness. While physical illnesses aren’t always treated much better, it isn’t considered totally weird or unacceptable to say “hey, can we not have nuts for dinner since I’m deathly allergic and will have a horrible reaction.” It’s considered healthy, logical, and reasonable, rather than oversharing, being demanding, or straining a relationship. For some reason saying “I have the equivalent of a mental allergy to this conversation, can we please stop talking about it?” is awkward and unacceptable, something that opens you up to questions about whether your problems actually exist, or even can lead others to purposefully trigger you.

This might be one of the smaller areas in which mental illness stigma exists. It’s the little times that you have to bite your tongue and just deal with other people metaphorically standing on your feet by discussing triggering or difficult things. But those little moments add up. Each time they happen you have to have an internal dialogue about what you’ll do and how you’ll cope. It uses up important resources. And it normalizes the idea that you don’t deserve to be able to ask for things, even if others aren’t directly sending that message. The unspoken rules of relationships say that until you know each other well, you act polite.

I’m going to try to make a promise to myself that I will attempt to be better at boundary setting, even in situations like these where it’s possible that it will harm the relationship. I don’t have to be rude, mean, or demanding, but letting people know what is harmful to me can go a long way towards normalizing the idea that it’s completely ok to have needs and wants, as well as openly express those needs and wants. It’s even ok to just say that you have a mental illness and invite no further discussion.

This kind of rock and hard place situation doesn’t have to exist. There is no logical reason that disclosing an emotional need should be inappropriate or unwise. So I am going to change something I don’t like by changing my own behavior.

Musings on Mental Health Activism

In a perfect world, all people would have a basic understanding of mental illness and respect that it is very real and painful. In a perfect world, if someone disclosed their mental health status and said that it affected their decisions and life, other people would respect that without requiring evidence, gory details, or an exact explanation of how serious it really was (are you sure it wasn’t all in your head?)

Alas, this is not the world we live in. Disclosing mental health status often comes with a round of questioning and well intentioned but utterly unhelpful suggestions (have you tried exercising?) that can quickly put one on the defensive. I personally have felt pressure when writing about my mental health to engage in the “just how bad was it?” defensiveness, pre-emptively listing out symptoms and consequences to illustrate that no really, this needed to be taken seriously.

Nearly every article I read about mental illness feels the need to either specify that depression is a serious illness (if it’s a scientific or research based piece) or take a large chunk of its time to describe the internal experience (if it’s on the subjective side). There’s certainly nothing wrong with that impulse, and subjective descriptions of mental illness are incredibly important to increasing awareness and understanding, but almost never do I see someone write about an experience they had that was influenced by their mental illness without focusing heavily on symptoms and vivid, graphic descriptions.

This makes sense to some extent, but it seems odd to me that we cannot have mental illness be an influence in our lives without going the extra distance to explain the exact details. In the world as it stands, there is not enough understanding of mental illness to mention it as a factor without making your statement/article/conversation about mental illness.

Here’s where I get hung up.

As someone who wants to increase understanding and awareness of mental illness and mental health issues, as someone who is aware of these dynamics and the ways in which stigma against mental illness contributes to the requirement that mentally ill people prove how hard things are for them every.single.time, do I proceed by molding myself into the Good Depressed Person and patiently describing over and over (in the level of detail required by my listener to really understand) what it’s like in my head? Or is there something radical in simply letting myself say “I am depressed and that led to x, y, or z” without backtracking, explaining, or questioning myself?

There may be space for both of these options in the world of mental health activism. It’s easy to see how speaking openly about the internal experience of mental illness is part of activism. It very clearly increases awareness and understanding, and can help others respect the seriousness of a mental illness, as well as the fact that it is not a choice or a lifestyle. There are downsides though. I worry that making personal stories a constant factor in every discussion of mental illness sets an unhealthy precedent that people’s stories are required to be public. I worry that we’re painting a picture of mental illness that feeds into certain romantic notions of things like anorexia, while playing into the voyeuristic pleasure some people get in hearing about disturbing and graphic symptoms. I see this especially in discussions of self harm when the questions immediately turn to how deep, how often, where, pics.

It might be that having both tactics is the best choice so that we can continue to educate others about mental illness in a serious way while also recognizing that sometimes it isn’t the only or overwhelming factor in an individual’s life. Sometimes it’s just a part of life, like a twingy ankle or allergies. It gets in the way, but it doesn’t destroy.

Again, ideally, this could be a great way to move forward in activism. The problem comes with the lived experience of trying to mention your mental illness without defending it. People push. People overlook it. People argue and debate and yell after you’ve said you’re triggered. People invoke all the stereotypes of mental illness that you’ve been working so hard to fight against (lazy, taking the easy way out, not trying hard enough). These things, even if you know that they are unwarranted and are ignoring a very real factor (mental illness) hurt.

I don’t think anyone is obligated to always educate others when they talk or write about their mental health. You’re allowed to say “this thing triggered me, which relates to the rest of what I’m talking about in ways x, y, and z” without having to explain how your triggers came to be, what triggering looks like for you, and exactly how real and serious the experience was. I just don’t know how to let people do that while protecting them from the less informed folks who will take that as an opportunity to berate them for not liking triggery thing, or for not being able to cope with a situation, or whatever the case may be. And I don’t know how to recognize that people 100% have the right not to explain themselves while also knowing that these incidents might not help the larger aims of mental health activism.

This is the forever balancing act of oppressed groups that want to make things better. In order to gain the rights and treatment you know that you should have, you often need to play by the damaging rules of society as it is, putting you in a place to get hurt and perpetuating those same rules. How radical can we be in acting as if the world had already accepted us? While it might be idealistic and forward thinking to expect everyone to know about mental illness, does it actually do anyone any good when it comes to securing rights and reducing stigma?

There are no clear answers here about the “right” way to approach discussions about mental health or activism, but I wish we knew better how to help improve the world around us without making ourselves so vulnerable.

Boundaries Mean Cruelty

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.

The Disgust of Dirty Food

Note: this post has a lot of thoughts packed together that have not been clearly pulled apart. I’m really intending to write more about this, and a lot of these thoughts are preliminary attempts to work through some ideas that I think are extremely important. Any insights are welcome.

 

In my DBT group we’ve been talking a lot about emotions recently: how to identify them, what they do for us, how to regulate them, etc. One of the emotions that we went over which was a little surprising to me was disgust. I suppose that somewhere in my mind I knew that disgust is an emotion, and actually a fairly common one, but as I looked at the prompting events of disgust, the physical symptoms of disgust, and the interpretations of disgust, I realized that disgust is a hugely important element of eating disorders, and that there is a wide body of literature that discusses some of the roots and backgrounds of disgust that never gets touched on in eating disorder treatment. It’s pretty clear that people with eating disorders often feel disgust towards themselves or disgust towards food, but what is disgust? Where does it come from? What purpose does it serve? And what can this tell us about eating disorders?

 

So what is disgust at its most basic? In general, disgust is the feeling we have towards things that might contaminate or poison us. Likely we evolved this feeling for a really good reason: to avoid things that would kill us if we ate or touched them. In many ways, disgust has to do with bodily boundaries. You want to keep the good things on the inside and make sure that the bad things remain on the outside. We are disgusted by things that break down our boundaries: things that can come in through our mouths or ears, things that come through our sexual organs, things that break our skin and leave us without a boundary, or things that can get inside our body through our skin in some fashion or other. The purpose of disgust is therefore beneficial: it can keep us safe from potential pathogens, from sexual fluids, or from things that may invade our bodies. We want to remain pure, because purity will keep us safe and keep our boundaries intact.

 

However disgust has expanded from these origins into moral and religious contexts. Particularly in the Abrahamic religions, this moral tint to disgust came from Judaic purity laws, which mixed together the disgust emotions of purity with other moral issues in order to strengthen both. Judaism extended conceptions of purity and boundaries from literal filth into things that they believed would keep them spiritually pure, as well as keep their society as a whole safe from contaminants. Holiness was equated with purity, because purity is health and safety. If you look at Leviticus or other law books in the Old Testament, most if not all the laws are about keeping different things from mixing together, or from keeping impure and bad things out. A clear example of this is that a woman on her period is expected to remain separate from the community, and anyone who touches her must ritually cleanse himself (Leviticus 5:19-20). In general, blood is considered a pathogen. It’s not something you want to touch. However in order to enforce that boundary, religious law was invoked to create an ethical and moral consequence to becoming impure.

 

So early religions often had purity concerns as a way to enforce this sense of disgust and keep individuals safe. However these purity concerns grew into much more than that, and they took the sense of disgust and expanded it to apply to anything that was considered unethical. Again however we see a lot of questions about purity. When someone lies, you are not likely to feel a whole lot of disgust (even if it’s about something pretty horrible). When someone is raped, or brutally murdered and mutilated, or even humiliated, we feel a great deal of disgust for the perpetrator. These are instances in which someone’s boundaries are violated, either literally with rape, or their body’s boundaries are destroyed in the case of mutilation, or their boundaries of self-respect and self-identity are violated in the case of humiliation. This might be part of the reason we find sexualized immorality more disturbing and disgusting than other sorts of violence or crime: because sexuality is nearly always associated with penetration of some sort.

 

So we have these conceptions of boundaries, and this idea that we need to keep certain things in and other things out, and when things get inside our boundaries or threaten our boundaries we feel disgust. What does this have to do with the disgust of an eating disorder? In my opinion, everything. Eating disorders are all wrapped up in the concept of disgust. If you’ve heard someone with an eating disorder talking about food or about how they feel after they eat, they tend to use words like sick, gross, icky, nasty. They are words that connote disgust. Many eating disorder patients act as if food is unsafe or will hurt them in some manner. These together seem to indicate that people who are avoiding food they deem disgusting to keep themselves safe are concerned with keeping their bodies pure.

 

Food is one of the few things in our lives that we have to put into our bodies. We feel disgust towards eating things that might be a danger to us, and many religions have put purity taboos on certain foods. Food is all wrapped up in questions of boundaries and what is acceptable to put into our bodies. Particularly in modern America, there is a narrative about good food/bad food, which paints certain foods as toxic. These could be foods with chemicals or foods with fats or foods with sugars, but the language around them generally labels them as poisonous. In conjunction with this, there exists the idea that women in general need to be pure. They need to be saintly. They must be morally good, sexually good, and they absolutely can’t let bad things into their system because it could ruin their beauty and worth. If you look at the sheer number of cleaning commercials aimed at women, you might have some indication of how cleanliness is apparently the basis of our self-worth.

 

For many people with eating disorders, the food becomes a question of worth, of morality, and of saintliness. The less you eat, the better you are as a person. The more saintly you are. The more pure you are. This rhetoric makes perfect sense in the context of disgust: we feel disgust at things that come inside us, at things that are foreign in our bodies. If you begin to identify food as something foreign that you can choose to let into your body or as something that you can keep out, you begin to think that you can keep yourself safe, just as religions with certain food rules do, by keeping the bad things outside of your body and by being in control of the boundaries of your body. That sense of bodily integrity is one of the most important feelings of control that we get as human beings. The most important thing we can control is how our body interacts with the world around us: what we put in it, how we keep others out. These are the most important for our safety, as well as for our sense of individual identity. When these things are violated, of course we feel disgust. And when you’re barraged with the idea that the world outside of you is dangerous, dirty, and bad, and that you need to be clean, this feeling of disgust can get out of control.

 

If an individual is feeling as though their boundaries are violated often, or they feel as if they have no control over the safety of themselves as an identity or as an individual, they may take radical action to make themselves feel safe by keeping out the bad. This can take the form of an eating disorder. And the feedback loop on it is strong: you feel disgust towards something, you don’t eat it, and you feel safe and secure because you didn’t die. This is also given a moral element by stories of asceticism. Keeping the whole world out of your body has come to be equated with spirituality, with purity, and with saintliness. It apparently makes you better than other people if you keep your body clean from anything associated with the world (because the world is dirty). Restricting taps into this cultural conception, and allows you to feel morally superior for every time you skip a meal. It also tells you that you’re protecting yourself from anything that is unclean or dirty.

 

We don’t often think of America as having a strong purity culture, and our purity rules are not clear: we have a variety of different rules that are not always consistent. It’s no surprise that many people feel confused about what is appropriate with food and purity. It’s no surprise that with all the shaming that happens around food, some people feel that the only way to be safe is to cut food out entirely.

 

I believe that there are important insights to be gained from the disgust towards our own bodies as well, and that these might have ties to sexuality, sexual morality, boundaries, and the world as dirty. I’m hoping to do two follow up posts to this one, on identity and purity, and on sexuality and purity.