the arrangement of nerves in a leaf

neednothavehappenedtobetrue:

crown-of-weeds:

crown-of-weeds:

Imagine the federal government holding conversations about your privacy - except yours is the only voice not at the table. This is what people with psychiatric disabilities are facing as the House Energy & Commerce Oversight Subcommittee takes up the issue of mental health and privacy rights under HIPAA.

Rep. Tim Murphy, Chair of the House Energy & Commerce Oversight Subcommittee, is holding a hearing this Friday to try and argue that the HIPAA protections that protect the privacy of people seeking mental health services are unnecessary and a threat to public safety. Regrettably, Chairman Murphy has a  history of threatening the rights of Americans with psychiatric disabilities. This Friday’s hearing is a continuation of a roundtable Rep. Murphy organized last month to try and showcase the inaccurate idea that people with psychiatric disabilities are more likely to commit violent crimes. Although empirical evidence shows no such link between psychiatric disabilities and violence, the roundtable made no acknowledgement of this simple fact. Furthermore, of all of the many witnesses called to testify, not a single person with a psychiatric disability was invited to share their perspective.

When a caller on C-SPAN’s Washington Journal program asked Rep. Murphy to explain his rationale for excluding the voices of people with psychiatric disabilities from the witness panel, he dismissed the need for the voices of people with disabilities themselves, claiming they would be incapable of testifying and that the most important conversation is one about parents and families’ experiences!

There is a time and a place for discussing improvements to the availability and quality of mental health services. A conversation about violent crime is not that time nor that place. It is inexcusable for public officials to use public safety as justification for an attack on the civil rights of an already marginalized and stigmatized population. Tell Chairman Murphy and Ranking Member DeGette of the House Energy & Commerce Oversight Subcommittee that the disability rights principle of “Nothing About Us, Without Us!” apply in mental health policy too. Don’t let our voices be forgotten.

Sign the petition and shut this shit DOWN.

Hey guys, don’t just reblog—sign the petition! They’re aiming for 2,000 more signatures, tumblr can make this happen right? We all agree that privacy is a constitutional right which extends to medical records? Right?

signal boosting again, seriously guys, please sign and signal boost

it takes like a minute to sign you can uncheck the box and then they won’t e-mail you anything please do the thing I would really appreciate it. 

you guys are A+ please do the thing. 

(via fyeahqueermusic)

brute-reason:

[Content note: depression]

People struggling with mental illness (or any sort of illness, or anything crappy, really) are constantly exhorted by well-meaning people to find the “silver lining” in their experience. This often takes the form of tropes about “learning who your real friends are” or “learning how to fully appreciate life” or “understanding what’s really important in life” and on and on.

For a long time I resisted the entire notion of finding “lessons” or “learning opportunities” in my decade-long struggle with depression. (Yes, decade-long. Yes, I’m 22.) Part of this was because the people who demanded that I do so were just so damn annoying, frankly. No, I will not spin you a convenient story about What Depression Has Taught Me to make you feel better when you see my tears or my scars.

But mostly I resisted because I felt that admitting that I’ve learned things from this experience requires intentionally forgetting the fact that most of it had no meaning. There is no meaning to losing half of your life to something you can’t even see or prove to people or sometimes even describe in words. There is no meaning to having most of the memories of your life discolored, blurred, and tainted by a misery and terror that had no name. This is not the stuff of inspirational memoirs or films. While some people suffer for political causes or for their children or in order to produce a great work of art, I suffered for absolutely no reason at all.

But, of course, I did learn some things. Maybe I would’ve learned them even if I’d had a more normative emotional experience, but right now it really seems like I learned them as a result of being so miserable a lot of the time. And while I reserve a very special fury for those who implore us to create meaning out of meaningless suffering and produce “lessons” and “silver linings” and “bright sides” carefully repackaged for their consumption, I think these are lessons that are worthwhile to share.

Lesson 1: Not everything your brain tells you is accurate.

Most people, I think, go through life without giving much thought to whether or not their perceptions are providing them with the most accurate possible picture of reality. But sometimes our brains are pretty crappy at this. Of course, I would’ve learned that without the help of depression, because I study psychology. So I’ve known for a while about stuff like the fundamental attribution error, the halo effect, anchoring, confirmation bias, the Dunning-Kruger effect, thefalse-consensus effect, the just-world hypothesis, in-group favoritism, the hot-hand fallacy, the Lake Wobegon effect, status quo bias, and all sorts of other biases, fallacies, and errors.

But what really brought it home was depression. While the cognitive errors I’ve listed are generally adaptive and keep people happier, depression was the opposite. Instead of telling me that people like me despite evidence to the contrary, my cognitive distortions told me that everyone hates me despite evidence to the contrary. Rather than telling me that I’m above-average in most things, they told me that I’m below-average in most things. On any given day I would invariably feel like the stupidest, ugliest, least likable, most worthless person alive. True story.

At some point it occurred to me that I would never recover if I didn’t learn how to treat what my brain said with a healthy amount of skepticism. So I started to. (Perhaps not coincidentally, this was the time in my life when my political views evolved the most, because I also started challenging my knee-jerk reactions to various issues in our society.) Of course, this is a lesson that is not limited to folks with mental illnesses, because everyone’s brain does this to them at some point. For many people, including some of those who proudly label themselves “skeptics,” thinking critically about what happens inside one’s brain does not come nearly as easily as thinking critically about what happens out there in the world.

So, for me, this meant a lot of time spent repeating to myself, “Yes, I feel like Best Friend hates my guts, but that’s just a feeling and it’s not necessarily true” and “Yes, not getting that internship makes me feel like I’m a complete failure who will never amount to anything in her chosen field, but that’s just my brain lying to me again” and “Yes, Partner wants to see their friends rather than me tonight, but this doesn’t mean that Partner doesn’t care about me and doesn’t want to keep seeing me anymore.”

Pause, rewind, repeat, and there you have my recovery.

Lesson 2: Your feelings are valid.

Does this seem like a contradiction to the previous lesson? It’s not. Unfortunately, when confronted with the apparently irrational emotions of others, many people immediately jump to the conclusion that those emotions are WRONG. (These people should never try to be therapists.)

However, just because someone’s emotions do not seem like a “rational” response to what they’re going through, that doesn’t mean there’s no reason for them. That reason can be whichever complicated and still-misunderstood brain processes cause depression. It can be that those are the emotions they saw expressed in their families growing up, and learned to mimic at an early age. It can be that last time this sort of thing happened, it ended terribly and now they’re freaking out over this seemingly minor thing because it could end that badly again. It can be that what’s currently happening to them is reminding them of something else entirely.

Or it could be for any number of other reasons that you do not know, and that the person having the “irrational” feelings might not know either. So why assume?

It’s important to remember, too, that there tends to be a pattern to the emotions we decide are “irrational” and “inappropriate” in others. Anger from a woman or a person of color is perceived differently than anger from a white man. Sadness from a woman is perceived differently than sadness from a man. Archetypes like the Angry Black Man and the Hysterical Woman are sometimes so deeply ingrained that we don’t even notice ourselves applying them.

But all emotions are valid. Some are less adaptive than others, some we want to change, some can contribute to unacceptable behavior if we don’t address them, yes. But they’re all valid, and telling others (or ourselves) that some emotions are not okay to have doesn’t help in changing them.

Lesson 3: Sometimes you have to keep your mental health in mind when making decisions.

This is the one I’ve resisted the most. I had to quit studying journalism because it was giving me panic attacks, and I chose not to pursue a PhD in part because I didn’t think I could handle it emotionally (well, and because the thought of it just bored me). When it comes to my personal life, my mental health is a big part of the reason I gave up monogamy, although I’m now glad I did for many other reasons. It’s also part of the reason I never studied abroad, gave up many other opportunities, and chose to move to NYC.

When I first started to realize that mental health is a factor that I need to consider when making decisions about my academic, professional, and personal life, I felt abandoned and betrayed by my own brain. I understood intuitively that sometimes you can’t do things because they require physical traits or abilities that you lack or because you don’t have the cognitive skills or because you just lack access to those opportunities. But to have all those things and still give something up just because my brain doesn’t like it? That seemed ridiculous.

In fact, that way of thinking is just an extension of the stigma of mental illness. Just as we think that mental illness isn’t really “real,” we think that mental health isn’t really important. It’s reasonable, we think, to choose not to live in Florida because you can’t deal with the weather or to choose not to go running because it’s too hard on your knees or to choose not to be a physicist because you can’t do math worth a shit, but not getting a PhD because grad school would make your depression relapse? Not being a journalist because interviewing people gives you panic attacks? Not studying abroad because being away from people you love makes you suicidal? What the hell is up with that. Just deal with it.

So for a long time I did stuff that made me miserable because I was fighting so hard against the notion that mental health is something you need to take care of and cultivate, just as you would with your physical health. But one of the most important things I’ve learned how to do in college is knowing when to say “no” to things that sound fantastic but might break down the levees I’ve built up to keep the depression from flooding in.

Of course, sometimes it still makes me furious. I recently gave up a great opportunity for that reason; I badly wanted to do it but every time I thought about actually doing it, and the sacrifices it would entail, I broke down, sobbing, paralyzed, unable to say yes or no to it. Eventually I finally turned it down, full of resentment at myself and my useless brain, but trying to understand that my reason was a good one and that I deserve permission to make this choice.

Now, naturally, there are those who would tell me to Just Do It! and Get Out Of Your Comfort Zone! and blabbityblahblah, but those people will just have to trust me when I say that I know the potential dangers much better than they do. Mental illness is a whole ‘nother ballgame. When I want to Get Out Of My Comfort Zone! I try getting to know someone new or reading something I disagree with that makes me a bit uncomfortable. When I move to NYC, I can Get Out Of My Comfort Zone! by joining new groups or going to events where I don’t know people and seeing what happens.

That’s getting out of my comfort zone. Ignoring the fact that I have important needs when it comes to my mental health, though, is not “brave” or “spontaneous” or “gutsy.” It’s just irresponsible, just as it would be irresponsible go ride a motorcycle without a helmet or to not wash my hands during flu season.

So give yourself permission to treat your mental health with the care and concern it deserves. Of course, you might be aware that doing something could make your mental health worse and choose to do it anyway for any number of reasons, and that’s completely fine, too.

But so many of us struggle merely to accept the idea that it’s okay not to do things for the sole reason that they might worsen our mental health, and that’s something we have to overcome.

I really need to learn lesson three. I saw my psychiatrist yesterday and she was talking to me about not getting the job. And she was saying how she was glad I tried but that maybe they could tell I would be too anxious to be a cashier and maybe I need to look into other types of jobs that won’t make me so anxious. And that that is okay to do. It’s hard because I really wanted this job but I think she’s right. It would have been horrible for me to be a cashier. I have to remember that I am a person with social anxiety disorder and depression and to make decisions that take those things into account.

brute-reason:

There’s a certain scorn reserved for people who diagnose themselves with mental illnesses–people who, based on their own research or prior knowledge, decide that there’s a decent chance they have a diagnosable disorder, even if they haven’t (yet) seen a professional about it.

I understand why psychologists and psychiatrists might find them troublesome. Nobody likes the idea of someone getting worked up over the possibility that they have a mental illness when they really don’t. Professional mental healthcare workers feel that they know more about mental illness than the general population (and, with some exceptions, they do) and that it’s their “job” to serve as gatekeepers of mental healthcare. This includes deciding who is mentally ill and who is not.

Self-diagnosis also gets a bad rap from people who have been professionally diagnosed with a mental illness. They feel that people who self-diagnose are doing it for attention or because they think that diagnosis is trendy.

This actually bothers me much more than the arguments against self-diagnosis coming from professionals. Why?

Because the claim that people who self-diagnose are just “doing it for attention” or because they think it’s “cool” is the exact same claim frequently made about people who get diagnosed professionally.

To be clear, I’m not saying that people never label themselves as mentally ill for attention. Maybe some do. Maybe a significant proportion of people who self-diagnose don’t really have a mental illness at all. I’d have to see research to know, and from my searches so far I haven’t really found much research on the phenomenon of self-diagnosis. (But I’m taking note of this for my master’s thesis someday.)

However, there’s a difference between someone who’s feeling sad for a few days and refer to themselves as “depressed,” and someone who’s been struggling for weeks, months, or years, and who has read books and articles on the subject and studied the DSM definition of the illness. The former may not even count as “self-diagnosis,” but rather as using a clinical term colloquially–just like everyone who says “oh god this is so OCD of me” or “she’s totally schizo.” (This, by the way, is wrong; please don’t do it.)

(It’s also likely the case that some people self-diagnose because they have hypochondria. However, the problem is not that they are self-diagnosing. The problem is that they have untreated hypochondria. Maybe diagnosing themselves with something else will get them into treatment, where a perceptive psychologist will diagnose them with hypochondria and treat them for it.)

Even if some people who self-diagnose are wrong, I still think that we should refrain from judging people who self-diagnose and take their claims seriously. Here’s why.

1. It gets people into treatment.

I wish we had a system of mental healthcare–and a system of social norms–in which everyone got mental health checkups just as they get physical health checkups. For that, two main things would have to change–mental healthcare would have to become affordable and accessible for everyone, and the stigma of seeing mental health professionals (whether or not one has a mental illness) would have to disappear. (There are other necessary conditions for that, too–the distrust that many marginalized people understandably have for mental healthcare would have to be alleviated, and so on.)

For now, going to see a therapist or psychiatrist is difficult. It requires financial resources, lots of time and determination, and a certain amount of risk–what if your employer finds out? What if your friends and family find out (unless they know and support you)? What will people think?

Because the barriers to seeing a professional are often high, many people need a strong push to go see one. Having a strong suspicion that you have a diagnosable mental illness can provide that push for many people, because nobody wants to go through the hassle of finding a therapist that their insurance covers (or finding a sliding-scale one if they don’t have insurance), coming up with the money to pay the deductible, taking time off work to go to the appointment, dealing with the fear of talking to a total stranger about their feelings, and actually going through with the appointment, only to be told that there’s “nothing wrong” with them.

As much as I wish things were different, the reality right now is that relatively few people go to therapists or psychiatrists unless they believe that they have a mental illness. If self-diagnosing first gets them into treatment, then I don’t want to stigmatize self-diagnosis.

2. It helps them find resources whether or not they see a professional.

In the previous point, I explained that for many people, self-diagnosing can be a necessary first step to getting treatment from a professional. In addition, once people have diagnosed themselves, they are able to seek out their own resources–books, support groups, online forums, etc.–to help them manage their symptoms. This can be extremely helpful whether or not they’re planning on getting treatment professionally.

While psychiatric labels like “depression,” “generalized anxiety,” and “ADHD” have their drawbacks, they are often necessary for finding resources that help people understand what they’re going through and help themselves feel better. If I’m at a library looking for books that might help me, asking the librarian for “books about depression” or “books about ADHD” will be much more useful than asking them for “books about feeling like shit all the time and not wanting to do anything with friends” or “books about getting distracted whenever you start work and not really having the motivation to finish any of it and it has nothing to do with laziness by the way.” Same goes for a Google search.

It’s certainly fair to be worried that people looking on their own will find resources that are unhelpful or even dangerous. But I think this is less of a problem with self-diagnosis per se, and more of a problem with the lack of scientific literacy in our society, and the lack of emphasis on skepticism when evaluating therapeutic claims. For what it’s worth, going to see a mental health professional will not necessarily prevent you from encountering quackery and bullshit of all kinds. And in any case, the blame does not lie with the people who self-diagnose and then fall for pseudoscientific scams, but with the people who perpetrate the scams in the first place.

This point is especially important given that many people will not be able to access professional mental healthcare services for various reasons. Maybe they can’t afford it; maybe they work three jobs and don’t have time; maybe they can’t find a therapist who is willing to accept the fact that they are trans*, kinky, poly, etc. Maybe they are minors whose parents are unwilling to get them into treatment. Maybe they were abused by medical professionals and cannot go back into treatment without worsening their mental health.

There are all kinds of reasons people may be unable to go and get their diagnosis verified by a professional, and most of these are tied up in issues of privilege. If you have never had to worry that a doctor or psychologist will be prejudiced against you, then you have privilege.

3. It can help with symptom management whether you have the “real” disorder or not.

At one point when my depression was particularly bad I noticed that I had some symptoms that were very typical of borderline personality disorder. For instance, I had a huge fear that people would abandon me and I would bounce back and forth between glorifying and demonizing certain people. If someone made the slightest criticism of me or wasn’t available enough for me, I would decide that they hate me and don’t care if I live or die. I had wild mood swings. That sort of thing. It’s not that I thought I actually had BPD; rather, I noticed that I had some of its symptoms and wondered if perhaps certain techniques that help people with BPD might also help me.

Luckily, at this time I was still seeing a therapist. So in my next session, I decided to mention this observation that I had made, and the conversation went like this:

Me: I’ve noticed that I have some BPD-like symptoms.
Her: Oh, you don’t have BPD.
Me: Right, but I seem to have some of its symptoms–
Her: No, trust me, I’ve worked with people with BPD and you do NOT have BPD.

I suppose I could’ve persevered with this line of thinking, but instead I felt shut down and put in my place. I dropped the subject.

So determined was this therapist to make sure that I know which mental illness(es) I do and do not have that she missed out on what could’ve been a really useful discussion. What she could’ve done instead was ask, “What makes you say that?” and allow me to discuss the symptoms I’d noticed, whether or not they are indicative of BPD or anything else other than I am having severe problems relating to people and dealing with normal life circumstances.

The point is that sometimes it’s useful to talk about mental illness not in terms of diagnoses but in terms of symptoms. What triggers these symptoms? Which techniques help alleviate them?

So if a person looks up a mental disorder online and thinks, “Huh, this sounds a lot like me,” that realization can help them find ways to manage their symptoms whether or not those symptoms actually qualify as that mental disorder.

This is especially true because the diagnostic cut-offs for many mental illnesses are rather random. For instance, in order to have clinical depression, you must have been experiencing your symptoms for at least two weeks. What if it’s been a week and a half? In order to have anorexia nervosa, you must be at 85% or less of your expected body weight*. What if you haven’t reached that point yet? What if you don’t have the mood symptoms of depression, but you exhibit the cognitive distortions associated with it? Acknowledging that you may have one of these disorders, even if you don’t (yet) fit the full criteria, can help you find out how to manage the symptoms that you do have.

4. It helps them find solidarity with others who suffer from that mental illness.

I understand why some people with diagnosed mental illnesses feel contempt toward those who self-diagnose. But I don’t believe that sympathy and solidarity are finite resources. If someone is struggling enough that they’re looking up diagnostic criteria, they deserve support from others who have been down that path, even if their problems might not be “as bad” as the ones other people have and/or have not yet been validated by a professional.

Acknowledging that you may have depression (or any other mental illness) can help you find others who have experienced various shades of the same thing and feel like you’re not alone.

My take on self-diagnosis comes from a perspective of harm reduction. The idea is that strategies that help people feel better and prevent themselves from getting worse are something we should support, even if these strategies are not “correct” or “legitimate” and do not take place within the context of established, professional mental healthcare.

We should work to improve professional mental healthcare and increase access to it, especially for people in marginalized communities and populations. However, we should also acknowledge that sometimes people may need to help themselves outside of that framework. These people should not be getting the sort of condescension and eye-rolling they often get.

~~~
*The diagnostic criteria for eating disorders are expected to improve with the release of the new DSM-V, but I’m not sure yet whether or not the 85% body weight requirement will still be there. In any case, this is how it’s been so far.