Tell Your Therapist They’re Wrong

This article is giving me life today, and not just because gratitudes lists make me throw up in my mouth every time I think about them.

It also is giving me life because it reminds me that sometimes mental health professionals are just wrong. Wrongwrongwrong. And it reminds me that it’s rare for us to teach people who are receiving mental health services how to advocate for themselves or determine if their therapist is wrong.

Now before anyone gets huffy, the usual disclaimers: I am PRO mental health professionals. I know these folks work their butts off, and that they can and do save lives. I know that we should encourage folks to see mental health professionals, and to reduce the stigma attached to seeking treatment. Yes to all of that.

But all of that being said, mental health professionals are human. And humans don’t really understand brains all that well just yet. Brains are widely varied, and every technique that we have for treating mental illness will only work on some people. Beyond that, mental health professionals work with hundreds if not thousands of people over the course of their career. Unless you’ve been with them for a hecking long time, you are going to have a MUCH better understanding of your personal quirks and preferences than they are. Sometimes they’re just tired or distracted, or they forget your personal preferences.

Which is all to say that sometimes mental health professionals make mistakes. Or they make a good suggestion but it turns out it doesn’t work for you. Sometimes you need to tell your therapist “No. That doesn’t work for me.” It can be completely mind blowing the first time you realize it’s ok to say no to your therapist sometimes. It’s empowering to realize that you are an individual and sometimes the struggle you’re facing (especially if your mental illness is proving especially difficult to shake) might not be because there’s something inherently wrong with you, it might be because the techniques that have been suggested aren’t right for you. I just want to remind people who are struggling or feeling like therapy isn’t working; you can tell your therapist. You can ask for something different. You deserve strategies that will work for you.

Of course it’s also incredibly hard to say no to your therapist.

The first reason it’s hard is because sometimes things feel uncomfortable or difficult or like they’re not working because growth and change are hard, slow, and difficult. There are times you may WANT to tell your therapist “nope, I’m not going to do that, I don’t like it,” but once you try the suggestion it ends up being helpful. It’s really challenging to suss out when you just don’t WANT to do something, versus when you’re really on target that it won’t be helpful or that it will be actively discouraging and a waste of time or energy.

Part of the work of therapy is tuning up your inner compass so that you can trust it to send you in the right direction. I know after many years of hearing mantras and positive thinking slogans in therapy, that those just make me angry. I’ve tried it, it wasn’t effective. I’ve learned to trust that when people suggest something that sounds saccharine or something that ignores how hard life actually is, it will not be for me. On the other hand, I was very skeptical of mindfulness when I first heard about it, but when it was presented to me in a scientific way it made a lot more sense and has been quite helpful. I’ve become more open to things that have mixed evidence for them.

A big part of doing this is simply trying a lot of different stuff and seeing what works. But once you’ve done that, you start to have evidence of what is effective for you and what isn’t, and you can start to trust your instincts about what types of treatment you want to put your time, energy, and money into.

Which means that you can start advocating for yourself.

Here’s where I want to get practical, and it’s the second element of why saying no to your therapist is hard. It’s because self advocacy is a skill. There are absolutely things that everyone can do to advocate for themselves in therapy from the very beginning, but there are also skills you need to practice and things to learn about yourself before you’ll be really effective.

Telling your therapist that they’re wrong is one of the more challenging pieces of self advocacy, because it can often feel like the therapist has the power in any given situation, or like you need to respect their position. It can be helpful to remember that you are paying them for a service, and beyond that that BOTH parties are integral for the success of that service. The trust you feel for your therapist is one of the highest predictors of success in therapy, and if you can’t let them know you disagree, that trust is breaking down somehow.

But there are things you can do to make it a little bit easier. There are lots of ways to advocate for yourself in therapy, and I may touch on those in future posts, but for now I’m going to focus on speaking up when you think something isn’t working or you disagree with your therapist.

A good way to start is by simply disagreeing about small things. I don’t mean be argumentative, but if your therapist says something that you normally might have let slide, practice just saying “I don’t agree with that, but here’s what I think.” I’ve started to do this a lot in therapy, and I find that it’s far more productive than trying to argue with the therapist. It actually has made me feel a lot more comfortable when I say that and the session goes on without any kind of major repercussions. Those smaller, less important disagreements are a way to practice and to teach yourself that the world won’t end if you tell your therapist no, or let them know something isn’t working for you.

Another helpful thing to do if you’re worried that the strategies you’re getting aren’t helpful is to gather some data. I like to track things, which is why I use a daily mood tracker, a sleep tracker, a habit tracker…I like data. But it can be really helpful to note your mood or a target behavior before your therapist suggests something (e.g. a gratitude log), and then note if your mood improves or your self harm decreases over time after you’ve started using the technique. If not, you can bring that in to the therapist and say “hey, this isn’t working for me.” Having hard numbers to back you up can feel a lot more empowering than just a vague “I don’t feel better.”

Sometimes I like to try to think like a therapist to be a good self advocate. In that, I mean setting goals for myself, thinking of the steps that I can try to reach those goals, and checking in periodically to see if I’m making progress. Most therapists are required to have a treatment plan, but not all therapists share that with their clients. If my therapist is suggesting a new technique or skill, I want to know what it’s supposed to accomplish, what goal it’s bringing me closer to. You can ask to see your treatment plan, or just ask what the outcome is supposed to be for a given technique. That helps you evaluate if it’s working.

All of these are concrete actions, but for me the biggest shift was one in mindset, and it’s a mindset that the article I started with shows off well. Therapy isn’t about doing what’s “right”. It’s about doing what works for you. There are thousands of different therapeutic techniques, skills, and practices. If one doesn’t make you feel better, then STOP DOING IT. Tell your therapist. You deserve something that helps. Realizing that therapy wasn’t a class I needed to ace, but rather a service FOR ME was revolutionary. If it’s not working for you, you’re not broken. It is.

 

That’s Not How This Works Gilmore Girls

I’m a fan of Gilmore Girls. I started watching it back when it was still coming out, when I was just a little junior high girl who thought it was maybe an accurate representation of what grown up life was like (lol). So I was pretty excited for the new mini-series, and devoured it in a single day. Like most reboots, there’s good and bad to it, but I want to focus specifically on something that as an adult with more experience I now KNOW is not how the world works. Not even a little bit, not at all.

This mini-series of Gilmore Girls is the first time that the show portrays therapy (despite the fact that basically every character ever seen could have used a heaping helping of it from the opening sequence). I am pretty gunshy of media representations of therapy no matter what, but I have to say that I was particularly disappointed in this one because it a. had the potential to show a really positive therapy experience to a great number of people and b. broke some very fundamental rules of therapy without a thought, creating a misleading portrayal of therapy that (I think) could easily scare young viewers or viewers with no experience in therapy away from pursuing help if they have a mental illness or are simply struggling.

The first thing that concerned me was that we saw multiple therapy sessions, and never once did the therapist offer any actual suggestions of what Emily and Lorelai could do to repair their relationship, or of skills that Lorelai could use in her own life. Nearly every time we saw her she just smiled and nodded or said that time was up. The sessions between Emily and Lorelai appeared to consist of sitting in silence for an hour. Now I know that it’s not unheard of for clients to be reticent, and for there to be a lot of silence, but most therapists will do more than just sit there. They ask questions. They suggest interpretations of different events. They give actual concrete ideas of how to handle your emotions and things to do so that your emotions start to feel better. I’ve found it a common misunderstanding that going to therapy is just paying someone to listen to you. Sure, that’s part of it, but that greatly underestimates all the work that a therapist actually does.

I’m sure there are therapists out there who don’t do much, but if you find a half decent one, they will be doing actual WORK. They will help you create images to understand your emotions better. They will help you draw connections between different events in your life and your current behaviors. They will give you strategies for dealing with other people. They will challenge different beliefs that you have which might be leading to unhappiness. They will give suggestions of activities, mantras, exercises, etc. that can help emotions feel less powerful and can calm you. The conviction that therapy is “just talking” is a huge part of the reason people are resistant to it. Why would you waste your time doing that when you can do it with friends or family? But therapy, while it is talk based, is about learning. It teaches you what you’re supposed to actually do outside of therapy. This therapist was the WORST portrayal of a therapist that doesn’t do anything.

Beyond that, when Lorelai and Emily actually did say things, they out and out fought and insulted each other. They were passive aggressive and cruel. No self-respecting therapist would let those behaviors go unchallenged. The point of therapy for any relationship is to create a safer space where nasty behavior like that gets curtailed and you can actually speak civilly to each other to get at real issues. All of the things that Lorelai and Emily said were ripe for further discussion, and the therapist just let them hang there. The show for some reason did not address that this was an AWFUL therapist.

And finally, perhaps worst, was a serious ethical breach that happened in the show without a single note. When the therapist is auditioning for Stars Hollow: The Musical, she sees Lorelai, greets her, and asks Lorelai to put in a good word. NO. NONONO. Therapists are not allowed to acknowledge that they know patients outside of therapy unless the patient acknowledges it first for confidentiality reasons. Not only that, but it’s horrifically unethical to use your position as someone’s therapist (where you have power over them) to ask for favors from them. This therapist should lose their license.

I understand that TV does not perfectly mimic reality, but these are huge problems for the portrayal of therapy on TV, and they are damaging to people’s understanding of what they can expect and their openness to attending therapy. We can do better.

//giphy.com/embed/2fs2I4ujlBf20

via GIPHY

Getting to the Heart of Things: Am I Just Making It Up?

My therapist and I have recently been embarking on a long and poopy journey deep into the recesses of my brain to try to tease out some of the reasons my particular set of neuroses decided to express themselves through my body. Unsurprisingly, I find this a frustrating and unpleasant experience, as thinking at great length about the relationship between my emotions and my body makes me want to stick my tongue out and go “phooey. I just don’t like my body and that’s it.” But I am curious about what made it all circulate around my body. How did I go from needing control and perfection to needing control over food in particular and perfection in the form of an abnormally skinny body?

So we’ve been talking about blurry, early childhood memories, or tenuous connections between what I know I feel and how those feelings express themselves in behaviors, or my early family relationships and lessons. A lot of it feels like looking through darkly tinted glasses: I can make out shapes, but I’m not entirely certain what I’m looking at. I’ll be sure there’s a connection between my feelings of uncertainty early in childhood and my eventual eating disorder, but teasing out that relationship and the catalysts later in life seems impossible. Any given issue, like my need for control, has about 15 different large elements that could have been an important “cause”. We’ll spend an hour delving into a particular relationship or incident, and by the end of the time there will be something like a narrative that offers an explanation.

It’s helpful in that knowing where something comes from helps me tailor my self care and my coping mechanisms. I’m a control freak because I grew up around some volatile people? I’ve surrounded myself with very stable folks who will listen when I tell them I’m scared they’ll get angry with me if I do x action. I seek reassurance that their feelings are stable. Understanding what needs are going unfulfilled helps me to meet those needs.

But on the other hand, I feel like I’m making things up. With so many possible explanations, all of which can be turned into neat narratives, how do I know which one is right? Even more worrisome is the fact that memory is so very fallible. There are many examples of people suddenly remembering things that never happened during therapy sessions, and even if it’s nothing quite that sinister, it’s easy to reinterpret or misremember the past (especially early life) to match your current interpretations. Is it really helpful to try to delve back so far? How much accuracy can I have when I’m partially relying on secondhand information from my parents about my early life, supplemented with fuzzy, emotional memories.

Here’s something that a very literal, black and white, absolute thinker like myself has trouble with: there is no correct answer to the how of my personality. A life cannot be reduced to a couple of simple equations that can be solved if you plug in the correct self care. There is no correct narrative about my life. I do not make sense and I never will. These are not judgmental statements. Ambiguity and randomness are facts of life. We just don’t like to admit that they apply to ourselves, especially when they end up creating pain in our lives.

So is there really any point in trying to make sense of all the billions of small factors that combined to give the world my current self?

I think there is. Each narrative contains some elements of the truth. This week I may focus on some of the difficulties my parents had when I was a child and the ways that it impacted my sense of stability. Next week I may focus on my natural tendency towards order and how it expressed itself as far back as I can remember. The week after I might think about the difficult relationship I had with my brother as a kid. Each of these things contributed something to the way I am right now. When I find answers, I like to hold on tight to them. This is how it is. I don’t get to do that with these kinds of answers. Each one is just a partial, flawed answer. I have to be gentle with them, or they will fall apart. Each time I try to grab onto one too hard and say “this is who I am, this is why I am,” it stops making sense.

The multitude of narratives also helps protect against all the bits that I don’t remember quite correctly. I have to fit competing narratives together, which means parts that don’t make sense get challenged. Any time I become completely convinced that one thing explains all of me, I have to remember how easy it is to tweak my memories to fit.

Of course trusting myself to figure it out in a reasonable manner is even harder as someone with anxiety and depression: I don’t trust my abilities and my brain. This is a hard task to begin with, but for those of us in therapy who really need to undertake it, it’s even harder. It’s easy to imagine that we’re lying to ourselves to make life easier or explain our behaviors away. I once again appreciate the importance of having a therapist I trust. I once again appreciate that this long term work of building a life that balances out my difficulties is impossible when I’m in crisis. I once again appreciate that nuance is necessary even if I hate it.

Posts like this leave me unsettled because there’s no conclusion. I do think that speaking openly about what therapy is like and how it can be difficult is important. I also want to recognize that therapy changes over time. I have been in therapy for almost 5 years straight now, and while ideally therapy is not unending, I have been working on distinct and distinctly important things throughout that time. This feels like it’s close to the end, and that’s exciting, even as I realize that there’s a strong possibility I’ll never be done with the work of accepting that I will never make sense of myself. So no, I’m not just making up stories to make myself feel better. There is some element of self creation in the narratives I choose to talk about, but the overlapping narratives give me some insight into the truth, as far as it exists. That may be the best I can do.

Creating a Sensory Diet: Lessons from Autism

After my recent post about similarities between ASD and BPD (so many acronyms), I’ve started to wonder about the usefulness of making these comparisons. Sure, it’s interesting to speculate and helpful to see the ways that people are similar, as well as understand where diagnoses can go wrong, but as a total layperson my contributions might have to be a little smaller than all that.

So here’s what I’m going to do for myself, as well as some suggestions for how other folks can learn from the parallels between borderline and autism.

I am a highly sensitive person. I don’t mean emotionally, although that’s also true, but I’m talking about physical senses. I love roller coasters, climbing, and other moving fast/adrenaline style adventures. I’m highly light sensitive and averse. I have lots of issues with textures (this is why I don’t eat tofu). Most perfumes and scents make me sneeze. I hardly have it as bad as some people, but I’m definitely on the “strong senses” end of the spectrum.

It’s extremely common for kids on the spectrum to have sensory difficulties, whether extreme sensitivity or under sensitivity or a mix of the two in various senses. And since it’s so common for those with autism, one of the more common elements of treatment is a sensory diet, or another way to help a kid or adult regulate and organize their sensory experience.

So what I’m going to try to do for myself is create a sensory diet. Once again, I’m finding that the curb cut effect is in full force. Sensory diets are probably great for just about anyone who finds that they’re not getting sensory needs met. I’m not diagnosable, but I definitely need more movement, tactile input, and help with my internal regulation (hunger, temp). After looking at some of the resources for folks with autism, I found a starting list that sounds like it will be helpful to me:

-emotion cards

-notebook and pen

-fidgets

-fuzzy socks

-candles

-be a burrito

-climbing/monkey bars/proprioception

-hammock or rocking chair

-be upside down

-piano

-go outside: water sounds

-exercise

-swimming!

That’s just for a start, but you get the idea. The bonus? I’m also using these sensory regulation tools for self soothing when my anxiety starts to go off the rails. I find it incredibly helpful to focus on very concrete, very basic things like the senses when I’m trying to combat anxiety. I can argue with just about anything else, but sensory input gets to the heart of the matter. So instead of making a self soothing box with affirmations or art work, which has never felt useful to me, I’m creating a sensory box with soft things and fidget and reminders of how to move my body effectively.

 As a side note, I would like to invite anyone with autism to let me know if this is appropriative at all, but my understanding of neurodiversity and its tenets is that stimming/sensory needs/other things autistics speak out about are often needed by lots of people, and the more we can integrate them into society at large the better.

On the flip side, I also think there are elements of the most common BPD therapy, DBT, that could be incredibly helpful to those who struggle to communicate or identify feelings, those who don’t find socializing super easy, or those who aren’t great at self soothing. DBT gives strategies like concrete and easy steps to set a boundary, and encourages patients to identify their values and needs. It suggests that people think about how physically different emotions feel to them so that they can use the physical reactions of their body to identify and communicate an emotion when it’s happening. It suggest methods to combat black and white thinking, like making pro and con lists, or writing out/reviewing facts about what is happening. While some of these things might require adaptation for people with autism, they could enrich that therapeutic experience.

Of course it makes sense for treatments to be individualized based on the diagnosis present, but I always wonder why there isn’t more cross pollination between diagnoses. Some of the techniques used for feeding therapies could be useful for eating disorders, DBT is useful for bipolar and eating disorders, autism treatments might be helpful for lots of people who feel quickly overwhelmed. I would love to see more communication between communities within the larger mental illness umbrella.

You Can’t Fix It Today And It’s Not Yours To Fix Anyway

I’ve got a proactive personality type. When I see a to do list, all I want to do is start getting stuff done and checking off items. This can be really helpful when it comes to work or chores, but it’s not really a very helpful mentality when it comes to relationships.

Here are some things that I’m learning about relationships right now. They may be helpful to other people, they may clarify to others why a friend or family member acts the way they do, or they might just be me clarifying to myself what I think and what I’ve learned. But I’m going to write them here anyway because I find it helpful.

When you are in a relationship (of any kind: romantic, friendly, family) with another person, it’s likely that the other person will have times of difficulty and problems in their life. It’s even possible that they might have some serious work they need to do in terms of their emotions and mental well being. They might realize they’re depressed, they might decide they want to improve their communication skills, or maybe they have some really unhealthy habits in relationships. Whatever it might be, it’s highly likely that someone you are in a relationship with will have some personal long term problem that they try to solve.

Oftentimes when that happens, it’s easy to see it as a problem in the relationship. Even if you know that at least partially it’s something that the other person needs to own, if it causes stress and difficulties in the relationship, it’s easy to see it as something that both people need to work on, as something that you can help to solve because it is affecting you.

For the go-getters among us, it also is easy to think that it needs to get solved. Every day that goes by without closure, without a normal, safe conversation, leaves us feeling off balance and worried. Lesson #1: you cannot fix this yet. You can and will tolerate those feelings of discomfort if you want a healthy resolution. Things like depression don’t fix themselves overnight. They take years of serious therapy, and if someone you love is trying to sort through a big issue like not knowing how to communicate or serious anxiety, it will be at the very least months before you start to see the pay off of hard work. You just have to wait.

It sucks. It feels miserable. I am at least in part writing this blog so that I can refer to it in the next months to remind myself that I just have to wait, and show up, and keep offering any support I can. But when I try to hurry the process or force conversations that will “resolve” things, or expect the other person to be totally “fixed” after we talk things out once, I’m going to be disappointed and I’m just going to be more hurt. Recovery takes time.

But even more than that, no matter how hard you want to fix the problem, no matter how much it might seem like you know what the other person needs to do or feel like you can explain just the right way, this is not your problem to solve.

Some relationship problems are for both people. Figuring out how to communicate with each other, negotiating boundaries and support, working through finance things, talking through intimacy and sex, making long term plans about how you want your relationship to look…these are all relational issues. One partner is depressed/anxious/dealing with serious problems at work or home or school is not a relational issue. Of course if one partner is dealing with problems, it makes sense that they would ask for support, talk about it, and try to deal with how it affects the relationship. But the hard work of dealing with the root problem? That’s their work.

I don’t get to cure someone’s depression. I don’t get to force them into therapy and make them talk. I don’t get to deal with their employment or money problems. These are not for me to solve. Just as I need to learn how to relinquish my need for control when it comes to timing, I also need to learn to relinquish my need for control when it comes to problem solving. I can ask, support, help, cajole, explain how a problem affects me…I can make my opinion known that something is a problem. But my family/friend/partner’s problems are their own and they get to own them. And if I expect them to deal with those problems the way I would, at the pace I would, or simply because I would, I am going to be hurt and disappointed.

So despite my huge need to make it better, work on it until that uneasy feeling disappears, I simply can’t. And neither can you. This problem is not yours.

Treating Depression Is Not Medicalizing Sadness

One of the criticisms I often see leveled at therapy and medication is that it’s turning basic human emotion into an illness. There was a huge outcry of this when the DSM V took out the grief clause from the diagnosis of depression (previously one could not be diagnosed with depression 6 months after a major loss), people often throw this at ADD, and in this otherwise lovely article about chronic depression, one psychiatrist refers to diagnoses like dysthymia as follows: “The ‘thymias’ which the DSMs discover – cyclothymia, dysthymia – are helpful for private practitioners in the States. They provide another disorder to be diagnosed, treated and billed for.” The author follows this up with “We’ve reached a point where if you are not actively experiencing ‘happiness’ then you feel you are ill. And if your friends and family think you aren’t happy enough or making them happy enough, they advise a trip to the doctor. “

Now don’t get me wrong, I do think there are many ways that our society fetishizes happiness. Many people find ways to run away from any negative emotions, and those who do act down or angry or sad are generally encouraged to do whatever they can to change that. Those of us with fairly pessimistic temperaments are accused of self-sabotage, of choosing a bad attitude, of being debbie downers. No one really much wants to be around us and we are informed in no uncertain terms of that fact.

But where I do want to differ from these criticisms is that they seem to equate the treatment of depression, even low level depression, with our society’s inability to handle negative emotions. These are two very different things. There’s an odd perception from those who haven’t actually experienced therapy that it’s about getting rid of all the bad feelings and that the end goal is to create someone who is happy clappy skippy doo. At the very least, people who go to therapy are supposed to come out “well adjusted” which for some reason is often associated with a Stepfordish oddness or calmness. We imagine Chris Traeger bouncing around like a hyperactive puppy when we think of those who have overcome depression.

parks and recreation animated GIF (not me)

In reality, this is exactly the opposite of the experience that I have had with therapy, and I suspect that many other people have had to delve into some extremely unpleasant emotions as a result of therapy. One of the main elements of therapy for me has been learning that negative emotions are necessary, provide information, and can be tolerated. I have learned tools to be able to feel bad and not immediately spring to fix whatever is wrong (which oftentimes is nothing).  My therapists have repeatedly told me that they want to find the appropriate place for all of the elements that make me up, including such winners as ennui, existential angst, and an overactive sense of guilt.

Here’s the clear and defining line between depression and normal, healthy sadness: depression affects your ability to function in your life. Whether that’s because it’s major depressive disorder and you have reached a point where you can’t shower in the mornings or whether that’s because it’s pervasive depressive disorder and you’ve felt low level emptiness your entire life and you just can’t handle it anymore, what makes something a problem is when it starts to interfere with someone’s life in a negative way. Now this isn’t as clear and defining of a line as we would like, but there it is and most individuals would be able to tell you if they feel like their emotions are getting in the way of their life.

Treating depression, whether with medication or with therapy, is about allowing an individual to function again. A functional human being feels painful feelings sometimes. One of the most obvious examples of the ways in which treatment of depression is actually antithetical to happiness obsessions is in mindfulness practices, particularly DBT. These ask an individual to simply notice their feelings without judgment, letting them happen without trying to change them.

One of the many reasons that people often end up in therapy or on medication is because they have been too afraid to honestly look at their negative emotions, feel them, and let them go. Of course there are some therapists and clinics that may go too far and end up treating any negative emotions as problematic, but overall the profession’s aim is to help people who are struggling.

The other piece of the puzzle is medication, which many people view as a “quick fix” for those who refuse to deal with their problems and just want to be happy all the time. Now I haven’t been on every medication ever so I can’t speak to all experiences, but that really is not how medication works most of the time. I have never had medication actually lift my mood, it simply has held back some of the negative so that I have space to work towards positive for myself. It allows me to go about my daily life in a relatively normal manner so that I can find ways to be effective long term. Again, it’s about keeping depression from drastically impacting my life.

Perhaps the reason that so many people point towards the prevalence of therapy and medication in our society as evidence that we refuse to be happy is because of a basic misunderstanding of what those treatments do. If someone’s emotions are keeping them from achieving their goals in life, from having relationships, from effectively doing their jobs, then the aim of treating those emotions is to help that person live their life. That doesn’t require happiness, but it does require the ability to cope with negative emotions.

I do think that it’s important to address our societal phobia of sadness, grief, and pain. But the way to do that is not to throw the mentally ill under the bus by implying they are running from their negative emotions when they seek out treatment. A diagnosis of depression does not say “this person is too sad”. It says “this person can’t function the way they would like to because their emotions are consistently out of control”. There is a world of difference between those two statements.

Ok, maybe I’m a little bit Chris Traeger.

Don’t Tell Me What To Do With My Body

People do stupid things on the internet. LOTS of stupid things. I recognize that this is a fact, however despite that fact, I think we can do better. I have been on the receiving end of a fair amount of these stupid things lately, and I think it’s important to remind y’all of some basics of internet etiquette, and just general life etiquette. I don’t like to have to tolerate people aiming stupidity my way, and I really do think that if we refuse to tolerate unacceptable things, others are less likely to do unacceptable things. Today, I particularly want to discuss reactions when someone discloses to you things that they might be doing for their mental or physical health.

 

The biggest thing that I want to talk about is unsolicited advice. I understand. You want to feel helpful. You want the other person to feel better. If you think you have an idea, why wouldn’t you share? You could make a difference, right? And what if they’re doing something that you don’t agree with, going to an alt med place? Then it’s your DUTY to tell them they shouldn’t be going there. Right? It can only be good to offer suggestions and advice to someone who’s struggling and who’s told you that they’re doing things to try to improve their health.

 

Wrong.

 

Individuals who deal with physical or mental health problems, in all likelihood, have a far better understanding of their condition and the available treatments than you do. They spend a lot of time immersed in it, thinking about it, researching it. They have not made the decision to go to therapy/go to the chiropractor/take meds/etc. without some thought and without weighing the other options. They most likely have heard the suggestion you’re making before, either from other well intentioned individuals or from their doctor or from their family or from the internet. It’s likely they have a good reason that they are not currently doing what you’re suggesting.

 

It’s incredibly condescending when you swoop in and tell them what they should be doing, as if they had not already consulted with a doctor or therapist or family members and thought about it for themselves. It is incredibly condescending to assume that this means you know more about their body or mind, and how to treat their body and mind than they or their doctors do. It’s also incredibly condescending to assume that they have not thought through the treatment options. PARTICULARLY online, where you likely know little to nothing about this individual except the information they have just provided you, it seems incredibly offensive that you would assume you can diagnose or treat them, when they live with their own symptoms and treatment plan and understand the pros and cons of what they’re doing far more intimately than you ever will.

 

In addition, if you feel the need to criticize what they’re doing already, remember that you don’t know why they are doing it, and you have no idea how effective it is for them. You might not like the idea of meds. That’s wonderful for you and you don’t have to take them. But you have no idea whether or not meds have saved the life of the person you’re talking to. Keep it to yourself, because they are taking the treatment path they are for a reason. Particularly if you’re worried about something that you feel is potentially useless, remember that you’re talking to an intelligent human being who has their own agency and who may know that they’re getting a placebo effect and embrace that shit. Assuming that everyone who engages in a certain therapy or treatment needs to be educated by you is really quite vain, and assumes that everyone who does it hasn’t done their research or is stupid. If you’re really worried about someone’s actions, ask them why they feel they should go and what they get out of it, and if you’re still worried then ask if they’d be willing to hear a suggestion. I tend to find these behaviors particularly hilarious when carried out by self-proclaimed skeptics who also happen to not be doctors. If you are not qualified to give health advice, then stop giving health advice. Being a skeptic does not qualify you to give health advice.

 

Health and healthcare are incredibly personal choices. They belong to an individual and their doctor, and any other close friends or family they choose to share with. And IF someone is kind enough to disclose to you that they have to do xyz for their health, but they DON’T ask you for any sort of feedback on it, then the correct response is to be happy for them that they’re doing something to improve their health, or ask if there’s anything you can do to help, or perhaps ask them how it’s going.

 

Just because someone has spoken about a particular treatment does not mean it’s up for discussion. Particularly for people who struggle with chronic or severe disorders, their medical treatment may be a huge part of their life. It may be something that comes up often in conversation because it’s a huge part of their life. I know it’s difficult for me to go half an hour without mentioning therapy because I spend a large percentage of my life in therapy. It’s part of who I am. And I’m not interested in hiding that element of myself. Particularly because I know of the stigmas against mental illness, I often disclose strictly for increased visibility of the mentally ill. In no way does the fact that you know that I have a mental illness or that you know I go to therapy give you license to comment on whether it’s a good idea for me or not.

 

There are some exceptions to this. If someone actively solicits information or advice, then GO FOR IT. If someone is complaining about how horrible their treatment is and how it’s not working at all, then it might be an appropriate time to jump in with an alternative suggestion. Or if someone is doing something that might actively endanger them or another person, then gently pointing out some of the alternatives or problems with their choices is appropriate.

 

So with all of this said, please try to remember that when someone mentions their health, that is not an open invitation to comment or criticize. Even if they say it in a public forum. It should be fairly clear when they’re discussing their health choices in a way that opens it up to conversation, usually prefaced by something like “can we talk about my health choices?” Just because someone says something where you can hear/read it, doesn’t mean they want your feedback and doesn’t mean you’re not a condescending ass when you act like you know more about their health and life than they do. Particularly when you’re talking about what they should or should not do with their body, you can butt out until asked.

 

For these reasons I’m going to be updating my comment policy as follows: if you offer me unsolicited health advice, PARTICULARLY about my mental health, my meds, or my therapy, I will delete your comment. This is my own space on the internet and I have the right to keep it as safe for myself as possible. You have the right to give people as much advice as you want about health in your own forums, but this is my forum and I don’t have to listen to it.