Unpacking the Spoons

Most of you have already heard the spoon metaphor by now. It was originally coined to describe what it’s like to have a chronic illness, although since then it has been used to describe mental illness as well. It’s an incredibly helpful tool, but I’d like to take a minute to expand on why those of us who have illness of one kind or another use up our spoons so quickly. There is an invisible aspect to illness that most of us don’t talk about. It’s oddly taboo, particularly for mental illness. Let’s shed some light on it shall we (I’m going to confine this discussion to my particular mental illness because that’s what I have experience with, but I know that this type of thing is applicable to all sorts of different illnesses).

When you’re mentally ill you have to think about more things. Let’s look at some examples of things that I have to think about on a regular basis that most people are blissfully unaware of: (trigger warnings for ED and self harm)

1.Are my hands shaking? Will someone notice? How will I explain it if they do?

2.Will the clothes that I’m wearing expose any of my scars or current cuts? Am I going to be somewhere that I care?

3.Will someone use the word “purge” today? How will I deal with this trigger if it comes up?

4.Will someone talk about my body or eating habits today and how will I quickly escape the situation if that happens?

5.If I eat something, will my stomach be able to keep it down or will it get uppity because it’s not very good at digesting anymore?

6.Will it look suspicious to my family or friends if I go to the bathroom immediately after a meal?

7.If I stay at someone’s house, do I have my meds? I cannot stay at someone’s house unless I have my meds.

8.If others want to do a physical activity, will I be able to keep up? Will I start feeling faint?

9.Did I bleed on my sheets or my pajamas after I cut last night? Can I get that stain out? Did it get on my computer, and will other people notice if I bring my computer out? Also gross.

10.Can I leave the house today without overwhelming self-hatred based on how I look in these clothes?

11.How distracted will I be today by my body? If my thighs rub together while walking, will I still be able to keep it together, or will I start having some really bad thoughts?

12.Will there be calorie counts listed somewhere that I go today?

13.How do I get all my hours in at work and get to 5-10 hours of therapy a week? How do I explain to my boss and coworkers that I’m not lazy it’s just really hard to find good times for appointments?

14.I usually get tired at around 9:00 (probably from nutritional deprivation among other things). Can I go out and socialize tonight? How can I see my friends when I have a full time job and I can’t stay awake past 11?

15.Was that slight chest pain just some anxiety or other minor something, or am I finally getting the irregular heartbeat that is supposed to come with my eating habits?

16.What do I say if people bring up food habits? Fasting? (yes this has happened, e.g. how long have you gone without food). How do I keep myself from blurting out “yeah, I ate once a week for a couple months once”?

17.How much do I tell people?

18.If someone hugs me, will they be able to feel my fat? Will I be ok with it, or will I want to pull away (most of the time it’s pull away. Then I have to be polite)?

19.If I purge, will I smell like puke? Will I be able to get those nasty stains out of my clothes (yes, it gets everywhere. yes it is gross)? What happens if my boyfriend tries to kiss me?

20.How much of my day will I waste thinking about food and debating whether or not to eat and how much to eat? This varies from about 1 hour to my whole day, depending.

21.Sometimes I even waste my brain space wondering if what I expel from my body is the same as what I put into it (yes I am talking about poo).

22.How many layers should I wear? I’m always cold, but I can’t regulate my body temperature at all so I swing to really hot if I’m under blankets or layers.

23.Can I handle looking at myself in the mirror today? Will I look like a complete idiot if I get dressed and leave the house without a quick mirror check?

24.Will someone notice if I start poking at my wrists or my hips to feel the bones? Can I feel my bones? Am I too fat if I can’t feel my bones?

25.Have a fasted/restricted today? How long has it been since I last ate? How much did I eat? If someone tries to give me breakfast, how can I say no?

This was just a list I came up with off the top of my head. Imagine trying to get out of bed while thinking about all these things, plan your day while thinking about all these things, accomplish work while thinking about all these things. THIS is where the spoons go. The reason that doing simple tasks requires so much more energy and effort is not just the physiological difficulties of depression or illness (and yeah, those things often do come with some serious fatigue or pain), but also the fact that everything is inherently more complicated. You are constantly trying to protect yourself from whatever threat your illness brings. You have to plan ahead like nobody’s business. You have to be assessing what’s going on around you and what’s going on internally to make sure you’ll be ok.

With mental illness, many of these thoughts are intrusive, paranoid, and irrational. Unfortunately that doesn’t mean you can turn them off and that doesn’t mean that you’re expending less emotional energy by having them. These thoughts are intrusive, distracting, and oftentimes pervasive, which means you’re taking a lot of your executive function to refocus your brain on the task at hand. All the time. Over and over.

For many of us who are dealing with a low spoon count, we don’t even realize that this is where the spoons are going: all we know is that things feel hard. They feel exhausting. We’re more worn out than other people even when we’re doing what appears to be less. Again, the key appears to be patience with yourself and with others, as well as clear communication about what you’re feeling. Many of us don’t want to speak up about the things that are hard for us, whether because we don’t want to appear weak or because there is a strong taboo against them (most of the things listed above fall into this second category). If we can get better at telling others what we’re really feeling, maybe this whole spoons thing will start making more sense to everyone.


“Mental Illness is Not Biological”

I am a big proponent of being careful with language. I don’t think that we should oversimplify something simply because it sounds better or is better marketing. Especially when it comes to mental illness, we are so sloppy with our language as it is that I think we must be careful. I don’t like the idea that we should describe mental illness as “a chemical imbalance” because it deeply oversimplifies things. So I was fairly dismayed when I sat down to read an article in my local paper about the need to talk more about mental illness and it simply repeated over and over “mental illness is not biological” and that we need to spend more time talking about the pharmaceutical industry.

Many people do not pay enough attention to the biological factors of mental illness. Yes, we recognize that genes can cause a predisposition, but more than that, basic biological systems can deeply affect your mental health. A few examples: sleep deprivation can easily cause symptoms of mental illness. It can deeply affect mood, emotional stability, depression, anxiety, and other brain functions. Continual sleep deprivation can spur a mental illness. I’m not sure what one would call that if not a biological factor.

Similarly, food deprivation is deeply correlated with some serious signs of mental illness. In the hunger studies performed at the University of Minnesota, individuals who willingly deprived themselves of food became depressed, anxious, obsessed, violent, withdrawn…they had diagnosable mental illnesses that were not present before the removal of food. Again, this seems to be a strictly biological change that triggered a mental illness.

Factors like these are often heavily discounted when we talk about mental illness, particularly when we’re attempting to recover from mental illness. Not enough time is spent focusing on the fact that if you don’t have a healthy biological basis with adequate sleep, nutrition, and exercise, it is significantly more difficult to have a stable mood and recover from a mental illness.

In addition, we do know that genes play some role in mental illness. We know from twin studies that many mental illnesses are far more likely to occur in an individual if they have close family members with that mental illness. For some mental illnesses, we have identified specific genes that might be linked to that mental illness. The most likely theory about mental illness right now is that we are genetically pre-disposed to an illness (to varying degrees depending upon the person) and social or environmental factors then can trigger that mental illness. And yes, neurotransmitters and brain chemistry are implicated in that mental illness. Yes, there are physical processes that have been disrupted when we are talking about mental illness. No, it’s not just a chemical imbalance, yes it is more complex than that, but of course it’s biological because our brains are a biological organ.

This is intensely frustrating, because it makes it seem as if the social factors that affect our mental health have no bearing on the physical existence of our brain. In fact studies done on chimps have shown that certain brain chemicals are altered over the course of years by trauma or isolation (if a chimp is isolated at a young age they will have different levels of certain brain chemicals when placed in isolating situations than a chimp not isolated at a young age and these effects last for many years). This is a physical change brought on by an environmental factor.

Of course it’s important to be careful not to oversimplify, but obscuring that there clearly is a biological factor to mental illness is not helpful either. In addition, the fear of labeling mental illness as biological plays directly into the fear of overdiagnosing and overprescribing. When we repeat over and over that mental illness is not a biological illness that revolves around neurotransmitters and brain chemicals, we become even more paranoid about prescribing medication (something that people are already worried about in the case of things like ADHD and Xanax). Speaking as someone who takes medication, this is incredibly damaging. Medication can be a complete life-saver: it made my anxiety manageable and so it gave me a window to actually begin dealing with some of my underlying issues. I was afraid to begin taking medication because I didn’t want to “alter my brain”. Repeating the myth that pharmaceutical companies are out to get us all and that medications are not the proper way to treat mental illness reinforces that stigma.

Of course we should include various kinds of therapy when we’re working on mental illness, but it is actually incredibly difficult to get medication for many mental illnesses and particularly difficult to get insurance to cover it. People are already afraid of medication. People are already afraid of being turned into zombies by pills or having unknown side effects. It is possible to advocate for improved standards for pharmaceutical companies AND accept that medication can be an incredibly important part of treating mental illness.

We need to recognize that mental illness is complex, requires a number of kinds of treatments, and involves a variety of factors including the biological, social, environment, genetic, chemical, and situational. While it is important to move past the “chemical imbalance” trope, that doesn’t mean completely removing any mention of chemistry or biology from our descriptions of mental illness.

Gratitude: Mental Illness

It’s Thanksgiving this week, and I’m going to be cliche and talk about gratitude. I’ve unintentionally spent some time earlier this week looking at an experience that I was grateful for, but today is going to be a difficult exercise for me: I want to talk about something in myself that I am grateful for. This isn’t easy, but I suggest all of you try it as a way to see those things in yourself that are good.

I spend a lot of time griping about my mental health, but after a lot of thought, I am grateful that I was born this way. My mind is quite often a bitch to me, but I’m glad that it is the way it is. Despite the fact that my mental health is probably my biggest hurdle in life, it has forced me to become a better person, to learn many things that I otherwise could have easily avoided, and to simply be kinder.

I certainly can’t say that if I was given the chance I’d choose my mental illness, and I’m not saying I enjoy my life the way it is, but if I’m being honest with myself, I’m a better, more selfless, and kinder person because of my mental illness and the places it has taken me.

First and foremost, my  mental illness has required that I spend time with myself. I have spend more hours than most people could imagine delving into my deeper fears and insecurities, ripping apart all the myths and lies that I tell myself, and examining why I do the things I do. I have become a far more facts-based individual due to therapy. I have become better at assessing myself and my situations. Because I’ve simply had to really BE with myself, in an entirely present way, I’ve figured out what I don’t like about myself and made improvements, and because I’ve spent so much of this time with a trained professional, I’ve also started to notice when my perception is a little off.

I’ve also had to spend a lot of time with therapists who are unafraid to criticize me and my coping strategies and who want me to improve my relationships. This means a whole lot of real, honest feedback about who I am and how my behaviors affect other people. Because of this, I often get to think about things I screwed up without falling into a guilt trap and with someone there to help me brainstorm immediate techniques to improve the situation.

While I have spent a lot of time thinking about myself, I have also spent a lot of time thinking about how other people influence me and how I influence others: I have learned to shift the perspective away from me, me, me. Your actions aren’t about me, and my actions are small. I have learned that often I should be thinking about someone else instead of about making myself smaller to fit someone else in.

In addition, I’ve found that I understand emotions better, both my own and other people’s. This makes me far more effective at Not Fucking Shit Up. I’m extremely grateful for that.

I can’t imagine that I would be doing the things I’m doing today if it weren’t for mental illness. I would be locked away reading books somewhere instead. I’m so glad that mental illness has forced me to engage with the world, that it’s led me to my VISTA year, and that it’s demanded of me that I do more for others.

But the thing I’m most grateful for is the compassion I feel I’ve gotten for people whose brains don’t process quite the same as mine. After seeing the confusion and frustration in people’s faces when they try to comprehend what I’m thinking and feeling, I don’t want to be the person that dismisses another’s pain or struggle. While those experiences were horrible, I’m grateful that I think I’m a better person for it.

My mental illness itself has not given me much, but it has forced me into situations that have given me tools to help myself and to help others. I am grateful. I would never have thought so deeply, been nearly as effective, or been so perceptive without the drive of mental illness behind me. I’m grateful that I now have a habit of therapy behind me, that going forward I will now how and where to find appropriate tools to improve myself, and that I will continue to reflect on myself in this way. I’m grateful that when I ask others to go to therapy now, I have the weight of my own work behind me. I’m grateful that I am in a better position to help others now.

So thanks mental illness. You’ve made me a better person.

Support Is a Two Way Street

Over the weekend I was on a panel for FtBCON about supporting individuals with mental illness. It was really fun to participate in, and I feel like I got some good insight from others, as well as solidified some of my own feelings about what’s helpful and what’s not, but there’s one thing that I feel is extremely important about supporting someone with mental illness that we didn’t touch on at all (it was a one hour panel, there’s only so much we can do). But I think that this topic is something that we need to talk about because it will make life easier for support people, it will reduce some of the guilt and shame for people with MI, and generally it will strengthen and solidify relationships to last beyond the end of an MI.


Support is a two way street.


Ok, obvious thing is obvious, but many people, particularly support people, forget this. Any relationship you’re in requires a give and take of support and being supported. This is true EVEN if the person you’re in a relationship with has a mental or physical illness and needs more support than the average bear. A lot of the time support people think that they can’t burden their friend/family member/lover with any more troubles, and so they keep all their own difficulties to themselves. They want to protect their loved one. They think it’s showing that they care: they will take care of you through anything, but they won’t ask anything in return.


Unfortunately this tactic will make both parties feel like shit. First and foremost, a relationship with someone with an MI is a relationship, and any time you have massive inequalities in a relationship, that relationship is likely to not work or to lead to unhappiness. In very few other circumstances would it be considered acceptable to treat one party like a child and expect to be able to have an adult relationship.


If you try to protect the other person and you don’t allow them to offer support, both people will end up hurt in some fashion. It will make the support person resentful, afraid, and give them feelings of complete responsibility for the other person. It leads to lots of burnout and means that in the long run your relationship is likely to fall apart because the only thing sustaining it is sympathy or “fixing”. And from the perspective of the person with the disease, it feels incredibly condescending, isolating, and lonely. You never really get to hear about the other person. You don’t get to feel useful. You feel like you’re less than the other person or a drain on them. You feel like you’re ruining their life, or like they don’t actually want to be around you but they feel obligated. You feel like they don’t trust you to be adult or helpful or positive. It’s horrible.


Support people: you are allowed to make requests, set boundaries, and ask for support with someone who has a mental illness. Not only are you allowed, but you should. Being a support person is HARD work and if you aren’t willing to take care of yourself and be open and communicative about how you need to take care of yourself, it will not work. If the other person repeatedly makes demands that are too much for you or that you feel are enabling them, you are allowed to say no. If you’re having a horrible day, you’re allowed to call them and ask if you can vent or hang out or go to the movies. However just like any other relationship, you need to remember that when you do these things you should be gentle and validating of the other person.


People with mental illness: your mental illness is not a get out of jail free card. I know that sometimes it feels like you can’t add any more onto your plate. That’s ok. That’s when you get to set your own boundaries. But you have to step up for your friends and family when you can and how you can. All of us have something that we can give to others. All of you have something about you that draws your loved ones to you. Remember that and remember that if you want to maintain a strong and healthy relationship with someone then you owe honesty, support, and respect to them.


One good example of this is something that is really hard for everyone: opening a dialogue and asking for more information. Support people often find themselves a little lost and confused about what’s going on in the mind of the person they love. In this case, they need something. They need more information to feel some certainty, some understanding, and to be able to help more effectively. Lots of people are afraid of doing this because they feel it might set something off. However just like the person with the MI, the support person needs to listen to their own emotion of confusion and plan out strategies for how to ask for something. In this case, they should probably alert the other person ahead of time, ask without accusation, and try to maintain a curiosity about what’s happening with the other person.


Oftentimes we forget that the person with the MI is learning a great deal through therapy or skills training or simply dealing with their day to day life. They pick up on lots of skills and coping mechanisms. These often involve ways to take care of themselves, particularly in a relationship. However these are skills that are generally good for everyone. Learning how to be kind and giving, learning how to hold to your values, learning how to request something, learning how to set a boundary: these are all things that we should be taught clearly as children but most of us aren’t. And so just like the individual with the illness has to learn new things, so do the support people so that they can be more effective both for themselves and for the person they’re in a relationship with. People with MI want to be able to support and help others. It helps us remember we’re not useless. Giving us clear ways to give back does a lot for us, and it will do a lot for you.

Intersectionality: Food Ethics and Mental Health

Something that has come up a great deal in my personal life recently has been people criticizing my choices in terms of eating and exercise. As you might imagine this is fairly difficult for me to hear as someone with an eating disorder, but it’s caused me to spend some time thinking about the intersections of mental health and food ethics. America as a culture does not spend a great deal of time focusing on how the way we eat and how we relate to food can affect our mood, mental health, and overall life quality. What we do spend a lot of time doing is shaming each other for our food choices: whether on the basis of health, ethics, or aesthetics. There are debates over vegetarianism and veganism, about health and obesity, and about whether people on food stamps deserve their food. What we don’t talk about is what we can do to make food an experience that enhances people’s lives.

Food is often an extremely emotional experience. It combines taste, smell, sight, and texture into what can be an extremely intense experience. However unlike most experiences that deeply engage our senses, it is something that is required of us every day. It’s easy to write it off because we spend so much time doing it. But truly good food experiences can change your life. Many people try to approach food simply as fuel for their bodies and nothing else, but food can be incredibly powerful.

Food has cultural connotations, and often it’s part of the glue that brings people together. Food can be an extremely important part of memory, and is often plays a role in memories that hold special meaning. We use it for celebrations and for rituals, as reward and punishment. For most of us, food is emotional, and for those who take all the emotion out of food, it can seem like it’s missing something. The emotions of food are part of friendships and families, and you can miss out on a lot (like a dessert with a sweetheart or a dinner with your family) if you try to excise emotion from food.

For some reason, these emotions often get ignored when we talk about how people should eat. If anything, we look on these emotions as negative: we make fun of people who “eat their feelings”. There appears to be a stereotype that having an emotional relationship with food is inherently negative. However there are absolutely healthy ways to feel emotional about food, and loving food does not mean being unhealthy. Too often we hear about health or ethical implications without any mention of the actual experiences of eating. This is not a culture that celebrates how fucking delicious it is to bite into a piece of warm chocolate cake, or how comforting it is to smell the scent of a childhood meal.

And when we’re looking at mental health, this is important because these internal experiences are often what sets someone with a mental illness apart from anyone else. When we talk about the ethics of food and the ethics of health, we often forget that the experience of food can be powerful, and that when someone has a mental illness, this is something extremely important to take into consideration. We ignore the potential emotional benefits we can gain from eating, and we ignore the potential harm that can appear when we guilt or shame someone or deprive them of food they love.

Now there’s one really obvious example which is eating disorders. When you’re trying to recover from an eating disorder, if you can eat a reasonable amount without feeling guilty, you do it. This is a matter of your health and potentially your life because every piece of food is a struggle. If a piece of bacon or a slice of cake is what entices you today, everyone better fuck off on telling you that you shouldn’t eat it because that piece of food could be the only thing you’re willing to eat today. This is not a choice, this is a jerkbrain doing things to you. If someone is trying to recover from an eating disorder and you try to tell them which foods are appropriate for them to eat or not to eat, all I can say to you is go fuck yourself. You’re asking that individual to put themselves in harm’s way by cutting out more food and creating new food rules. You’re asking them to prioritize something over their own safety and health. This is a clear place where food ethics need to be flexible to allow for someone’s health and happiness.

But there’s more to the intersectionality of mental health and food than just eating disorders. Because of the emotional nature of food, it can either be used as an incredibly helpful tool for managing emotions or as an intensely negative coping strategy that damages the individual. Now this is different from using food to hide from your problems, but as part of a larger program of dealing with the root causes, including good food and good food experiences in your treatment can be really useful.

I’m going to use an experience from my own life because it’s what I know best. I try my best to eat vegetarian, because ethically I feel it’s the right decision. For eating disordered reasons this isn’t always possible. However when I do eat meat I eat ethically raised meat. I have one exception to this rule. When my dad makes spaghetti sauce from his family recipe, he almost never uses ethically raised beef. I eat the spaghetti sauce anyway.

For a lot of people this looks like I’m selling out on my values. Many people have told me that it’s inappropriate and that there is no excuse for not being vegetarian or even vegan. It looks like I’m prioritizing my own enjoyment of food over the life of another being. But here’s the thing: one of the few times that I feel safe, comforted, whole, and welcomed is when I am with my family eating the same food we ate when I was little. From the perspective of someone in my position, this is far more important than you might think. My depression and anxiety are very real and very life-threatening, particularly because they come with a side-helping of self-harm. Finding moments in my life where I can qualitatively feel like an acceptable human being is extremely difficult, but very important. When I don’t have these moments I start to become dangerously depressed, sometimes to the point of suicidal ideation. Taking away my ability to share this experience with my family is taking away one of my best coping skills to keep myself from potentially putting myself into the hospital.

This is where understanding the emotional and internal experiences of food can go a long way towards understanding intersectionality and towards having compassion towards people who don’t have your privileges. It may seem insane to someone who does not have a mental illness to consider the idea that a delicious mocha could be part of combatting suicide. But when you’re in the experience, you understand that the little things are the most important. The danger of mental illness is real. Mental illnesses do lead to death, injury, and pain. When we ignore the intersectionality of mental illness and food, we go a long way towards removing some of the most basic resources that the mentally ill have.

For people not in these situations it might seem selfish to prioritize your enjoyment of a steak over the life of a cow. However one of the messages that’s incredibly difficult for those with mental illness to internalize is that our own self-care is important, and often integral to our health. Allowing ourselves to make the choice to eat something that nourishes us mentally as well as physically can be a huge step, and when we’re told to cut out many parts of our diet, we lose out on the ability to easily do this. Asking us to give up simple pleasures, or criticizing the arenas in which we can find joy is asking us to prioritize other things over our own ability to function or even our own life depending on our disease.

When you live with a mental illness, often your entire life becomes about survival. This means that choices which seem to be easy or low cost for others are choices about self-defense for us. Every time we choose something that brings us joy, support, or a feeling of safety, we are choosing our own life. When you tell a mentally ill individual that they should abandon something that helps them feel good, that they should feel guilty for eating something that makes them happy, it reinforces to us that we don’t deserve good things.

Food is incredibly personal and incredibly emotional. It can be used in intensely positive ways and intensely negative ways, and we don’t always get a choice in what foods bring up what emotions for us. For the mentally ill, this can mean that shame and guilt around food is even more damaging than it might be for any other individual, and can have serious consequences.

While many of us want to make our society better and healthier by encouraging good eating, ethical food choices, and positive food culture, it would do us good to remember that these conversations may have different consequences for someone struggling with a mental illness than for anyone else.

Will Follow Rules for Rights



This morning I was looking at the twitter explosion over the Texas abortion bill and ran across this tweet from @rare_basement. I don’t know how to explain what this tweet means to me or my neuroses. I don’t know how to explain how this sums up all the intersectionality of my gender and mental health. But I’m going to do my best.


This is the lie I’ve believed all my life. No, I am hardly the most oppressed person in the world, but I grew up in the 90s, when girls were told that “you can be anything if you believe and work hard!”, despite the fact that sexism is still alive and well and making life incredibly difficult for women. But boy did I fall for that line. I still believe it, despite trying to make myself grow up over and over again. Because you want to know what happens when you buy into a cultural myth that disappoints you repeatedly, one that tells you that you’re responsible for your disappointments? You begin to think you’re the problem.


The line that oppressed minorities are fed is that hard work will get them whatever they want, including the rights and freedoms that have been denied to them in the past. This is the myth of meritocracy. Unfortunately, it’s not true, and minorities simply are denied rights and freedoms, as well as opportunities, because of their status as oppressed. But the myth puts all of the responsibility for these problems back on the oppressed: it tells them that they haven’t followed the rules appropriately or they have not worked hard enough.


This is the worst form of victim blaming because it can make everything an individual’s fault, and it can obscure from the individual the larger forces that are at work. And in my mind, the most insidious part of it is that it essentially sows the seeds for mental illness. One of the traits of many people with mental illness is personalization: thinking everything is either your fault or aimed at you. This myth directly tells you that everything is your fault. It builds personalization from the ground up and repeats it over and over until it’s been hammered into you. What’s worse is that it doesn’t just wait around until something bad happens and then tells you it’s your fault. It points to structural inequalities that already exist, and when those begin to affect you it tells you that you should have known better and followed the rules so that you didn’t make these problems for yourself. It retroactively blames you for problems that were there before you were born, so you are suddenly responsible for a disturbing amount of things.


An additional problem with this is that the “rules” for oppressed populations are contradictory and impossible to follow. No matter what you do, you’re doing something wrong and thus don’t deserve rights and freedoms. An example of rules for women: Be good looking but not shallow, and definitely not overly sexy, and definitely don’t flaunt your body but don’t be a prude either.


Is it any surprise that we have a generation of girls who have grown up thinking that they are constantly not doing enough, not right, or need to be perfect? A generation of girls who catastrophize everything? If you were told throughout your whole childhood that you’ll be treated with respect, dignity, and liberty if you follow the rules and then are NOT treated with those things no matter how hard you tried, doesn’t it seem logical that you would conclude that you had done something wrong? What amps up the anxiety of this is that you don’t know what it is you did wrong. You can’t figure out what went differently between the times when you got what you wanted and the times you didn’t (hint: the difference was probably not you, it was the circumstances outside of your control), so you get paranoid that at any point you might be doing something horribly wrong and you don’t know it. You might be messing up the rules which can have disastrous consequences. And if you don’t follow the rules exactly perfectly, if you don’t get straight As and no detention ever and dress modestly and act politely, then it’s your fault if you get raped or harassed or if you get denied a job.


This is an enormous amount of responsibility and guilt for any individual to take on. It leads almost directly to a paranoia about one’s actions, to a sense of personalization about everything, to perfectionism and to anxiety. For a while I wondered why nearly every girl my age was a budding anxious perfectionist, but this quote makes it so clear to me: we are because we know we have to be in order to be deemed acceptable and in order to try to keep ourselves safe.

Another problem with this message is that it tells minorities that their feelings are not valid or right. When your rights are denied, you have every right to be angry and upset, but this myth tells you that feelings of anger are always wrong because you are always at fault. You don’t get to be angry ever, except with yourself, because society can never do you wrong if you play by the rules. This undermines so much of an individual’s identity, confidence, and emotional understanding that you can be left with no conception of what an acceptable feeling is. In DBT when we talk about the circumstances that can trigger a mental illness, an invalidating environment is one of the first things that comes up every single time.


It’s no surprise that oppressed populations have some mental health problems different from those of privileged groups: they’ve been put into a situation where perfection is expected of them, everything is personalized, and their feelings are invalidated. It’s the perfect storm, and yet we sit around wondering why women feel so bad about themselves. This is somewhat akin to leaving tripwires everywhere and then asking why people keep falling.


We as a society need to start discussing and addressing the mental health effects of these expectations of women and other oppressed individuals because they are creating mindsets that are rife for mental illness. They are creating expectations of perfection in individuals, they are telling individuals to personalize everything, they are heaping guilt and responsibility on individuals who should be looking at the societal discriminations for their difficulties.

Follow Up: Mandatory Mental Health

A couple of notes here: I’ve noticed that I’ve been posting a lot and then having more thoughts come to me immediately afterward I put something up. I think that what this means is that I need to spend more time with each post before I hit the publish button. I probably flood this blog anyway, so I’m going to cut down how much I’m posting so that I can devote more time and energy to editing and putting up quality rather than quantity. I will be posting a fair amount on Teen Skepchick this week, and I should have posts going up at The Fementalists and CFI On Campus as well, so never fear you will have your overdose of my writing. With that explanation, here is my single post for the day.

I recently posted that I thought it could be beneficial to institute mandatory mental health education in schools. In my initial post, I didn’t flesh out some of the serious benefits that we could see from instituting this kind of policy, and I didn’t really explore how we could implement it either, but rather focused on the first flash of an idea. In order for this idea to have any kind of impact, it needs to have some feet under it. I need to identify who it will benefit, how it will show benefits, and what might stand in its way. That’s what I intend to do here.

There are many practical benefits to adding a new . The first chunk of these benefits falls under the heading of “preventative treatments”. As it stands today, it is extremely difficult to get any kind of mental health treatment unless you are already overwhelmed or in a non-functioning state. We don’t hand out diagnoses to people who are showing signs of something and want help to keep those signs under control: we hand them out to people whose symptoms have gotten out of control. Unfortunately, a DSM diagnosis is the only way for many people to get help. By the time they get to this point, they’re often already in a state of crisis.

To take a stark contrast, we spend a great deal of time thinking about preventative measures in our physical health: we tell our children to wash their hands, to stay home if they’re contagious, to eat healthy and exercise, and to get vaccines. For some reason this logic isn’t extended to mental health even though there is a great deal of evidence for the biosocial theory of mental illness: we start with some predisposition that makes us vulnerable to mental illness, but our environment can either tip us into it or help us away from it. The messages that we are sent about our emotions and our worth make a huge difference in determining the severity of our emotional difficulties. Adding education to schools can help send positive messages to kids about accepting their emotions and about how to handle emotions. It reduces the stress level of the environment, or at the very least provides kids with some tools to diminish the stress levels in their personal environments.

There are many people who could benefit from this kind of preventative care. First, those people who are vulnerable to mental illness need all the help they can get to build a healthy and safe environment for themselves. This NEEDS to start as a child. Much of the evidence about mental illness suggests that childhood is one of our most vulnerable times and it’s when we begin to develop our patterns and understandings of emotions. Providing some extra help to children could mean significantly fewer individuals who fall into diagnosable states as they grow older. While we can only do so much to provide kids with safe and happy family environments, schools do provide an ideal location to teach the skills to help handle less than ideal environments. Giving a vulnerable child the skills to not fall into the place of crisis that a diagnosis requires would be a huge improvement in quality of life.

In addition to those children who may at some point gain a diagnosis, or who need help to not fall into a diagnosis, there are also individuals who have serious struggles with their emotions and mental health but who will never have a DSM diagnosis. They’re hovering in the uncertain place where they’re not destroying themselves, but they’re certainly not healthy or happy. People with subclinical symptoms, or who might have a bad environment but higher tolerance. Oftentimes these individuals can’t afford therapy or simply don’t have very many resources to help them learn about emotional regulation. With some regular education and practice at emotional regulation, these kids could grow into much happier adults. They deserve help to flourish just as much as anyone else.

Finally, the general population of kids (and the adults that they become) could benefit from learning emotional skills. Obviously we all feel better when we can regulate our emotions and tolerate distress. But the most important section in my mind is learning about interpersonal relationships. If the bullying epidemic in this country tells us anything, it’s that we haven’t been stellar at teaching our kids about interpersonal relationships. We’re constantly talking about how to decrease bullying, and asking all children to learn how to get what they want and need in a more appropriate fashion can only help. In addition, as a recent college grad, I can promise you that 99% of the jobs that I’ve been looking at list “work well in a group” as one of their requirements. Our world is very much about connection right now: technology seems to be thriving on the concept of connecting. So giving our kids the skills to navigate the world of constant connection would be extremely helpful, both for their future work lives, and for their current personal lives.

So beyond helping our kids and future citizens be happier and healthier, what else do we get out of adding mental health education to our schools? I know that politics right now is about money, money, money, pragmatics, the economy…we can’t just go throwing money at things without some guarantee of a return on our dollar. But I have news: this will likely save us money. I don’t know if you’ve noticed, but mental healthcare is EXPENSIVE. My experience is primarily with eating disorder treatment, and I know that it’s come near to bankrupting a fair number of families. Most of the money for treatments is coming from insurers, and thus drives up the cost of insurance for everyone. Therapists are damn expensive, and once a mental illness becomes thoroughly entrenched it can take many, many years of therapy and work to get it under control. That’s a huge amount of expense both for individuals and for the community. If we can prevent some mental illnesses from ever occurring, we can save a great deal of money.

In addition to the cost of treatment, mental illness itself can be expensive, both individually and societally: individuals who are struggling can have a harder time getting and keeping work, or may spend money on things they don’t want (BPD can lead to excess shopping, addiction leads to money spend on substance of choice, BED means money on huge quantities of food). If someone is desperately fighting for their own mind, they’re likely not contributing as much to society as they could be (this is in no way meant to shame individuals with mental illness. Your job is to bring yourself back to health, not to contribute to society on a monetary level. If someone had a debilitating physical illness you wouldn’t shame them because they can’t work as many days. This is simply to say that when we’re very ill we’re not at our best). But if society wants its members to be as productive as possible, holding down jobs and putting money back into the economy, preventing mental illness is a really good way to do this.

But maybe money isn’t your thing. Maybe you’re more interested in the people than in the money. Well first of all go back and read the first few paragraphs about how we could make a lot of people happier and healthier. Still not enough? Ok, I’ve got another. The most immediate and concrete would likely be an improve in grades. Now I don’t know of any studies on the relationship between mental health treatment and grades, but I’m gonna go out on a limb here and say that when you’re fighting a mental illness or fighting to stay out of a mental illness, you’re more likely to struggle in school or at work. Now there are absolutely people who can keep up good grades while struggling. Some mental illnesses tend to push people towards perfectionism, and those individuals appear highly competent while in the throes of a mental illness. I myself managed to keep up above average grades through all of college while dealing with an eating disorder, depression, and generalized anxiety. But the worst grades of my life came at the time when my mental health was at its worst. This is not a coincidence. If we want our children to be well-educated and to be as successful as possible, we have to help them to be able to focus on school when they need to, and to have ways to deal with whatever else might be going on in their lives.

In addition, spending time with one’s own emotions can really help to create more empathy for others. Again, I am speaking from my own experience here, but I find that the more I learn about understanding where my own emotions come from, the more I find myself curious about why others are upset or struggling. If even half of the kids in these classes gained something, we would have a significantly more empathetic and supportive community for others who might still have difficulties. And if every child went through something very like therapy at a young age, we might be able to decrease some of the stigma against mental illness and against therapy.

Now obviously there would be a cost here. It’s not free to get a therapist into the schools, or to further educate our already over-burdened teachers to handle one more thing. But adding a single additional school therapist who did one hour of work per week with each classroom would not break the budget (possibly two for larger schools. Keeping therapy groups small is REALLY important), and it could lead to some serious improvements. Therapists are expensive, but if we get all of the benefits outlined above it seems that it would be well worthwhile.

The ideal way to do this seems to me to have one therapist who is entirely devoted to education and preventative work, who conducts classes with small groups of students to teach them different skills, check in about their week, and assign them a short piece of homework to practice an emotional skill during the week. This would be a highly demanding position for one therapist to build close relationships with a large number of kids, but if schools were capable they could add more therapists for more students. Even if it didn’t exactly mimic a traditional therapist/patient relationship, it could still be a useful way for kids to simply have a time to check in, learn how to talk about emotions, and get some emotional education. It absolutely seems to be a cost effective measure to improve grades across the board (because this seems to be a measure that would benefit all kinds of students, and engage those with some interest in psychology at an early age) and to prepare kids for jobs and life.

Now I am obviously not a school administrator or policy maker. I have never been in the position to create a budget for a school. So I would love to hear input from those people who might have more experience with these sorts of things: do you think it would be a cost effective measure? Could it help to lighten the load of some of the other school counselors to do some preventative measures? How could we try to push for this change to be made?