No Such Thing

When people talk about mental health treatment, whether it's medications, supplements, diets, coping skills and management strategies, or even an old wives' tale that worked for them or someone they know, they tend to talk in absolutes. They say things like, "X always works." Or "X works for everyone." Or even, "Z never works."

When I had to be evaluated by a crisis counselor in the beginning of my mental health treatment, he was stunned when he found out I had tried Lexapro and it hadn't worked for me. He literally said, "But Lexapro works for everyone, so I don't know why it didn't work for you." (And, yes, I felt like it was somehow my fault the medication that "works for everyone" didn't work for me.)

We shouldn't speak in absolutes about things in general, but we really shouldn't speak in absolutes when it comes to mental health treatment. It would have been much more accurate and felt much less like he was blaming me for something I had no control over if the crisis counselor would have said something like, "We see a lot of success when we use Lexapro to treat X, Y, and Z." If he would have said something like that, I wouldn't have spent weeks afterward feeling like I had done something wrong and like there was something extra that could be wrong with me that would make my OCD and panic disorder harder to treat.

It wasn't my fault that the medication that "works for everyone" didn't work for me. I have absolutely no control over how a medication interacts with my brain. I have no control over whether or not I experience side effects or whether or not a medication works for me at all. You can do everything right: take as directed, switch up the time of day you take a medication like I was directed to, do whatever else the prescribing professional tells you to do, but still, sometimes that medication just doesn't do what it was designed to do with your brain. That's why (generally) more than one medication exists to treat the same condition, and why finding the right treatments is a trial-and-error process. 

Everyone's brain is different. Even in two people with the same mental health condition, we often see different symptoms and different triggers, and we see that the mental illness feels different for each of those people. So, of course, when we think about how the same mental illness looks different from person to person, it makes sense that a thing that "works for everyone" doesn't actually exist. How can it when each person's brain and each person's experience with mental illness is different?

I'll end with this: There is no such thing as a medication, supplement, diet, or a set of management techniques and coping strategies that truly works for everyone. Every brain is different. Just because something with a high success rate doesn't work for you doesn't mean you did anything wrong or that something else is wrong with you. Finding the treatment or the right combination of treatments is a trial-and-error process, not a one-size-fits-all experience.

Just Because You Don't See It

Even at my worst with my mental health, I was still able to get up, go to college, and keep up with my homework. I was still able to have fun on the weekends. Even now, I'm able to get my work done and be decently productive at home by making dinner, keeping up with my exercise, and keeping up with my household chores, even on my bad days.

I am a person with high-functioning mental illness. That means from the outside looking in, I don't appear to be a mentally ill person. From the outside looking in, I appear to be just a regular perfectionist, who is perceived as "normal" by many societal standards. People who aren't my mom, my therapist, or my cousin Amy typically don't see me struggling with my mental illness unless it's a REALLY bad day for me, or I'm exhausted to the point that I can no longer hide the fact that I'm struggling. 

The fact that people don't see me struggling and the fact that I am still able to be generally high functioning tends to make people think that my mental illness is much less significant than it actually is. They tend to assume that, because I do a good job of functioning "like a normal person," my mental illness doesn't interfere with my life. They think of it sort of like how people have high blood pressure. As in that the issue is there, but it doesn't stop a person from living their life the way they want to live it. 

This is another big misconception about high-functioning mental illness. (The top misconception is that high-functioning mental illness doesn't need treatment.) High-functioning mental illness absolutely interferes with people's lives. Many people with high-functioning mental illness struggle just as much as the people with mental illness that aren't considered high functioning. The only difference is that people with high-functioning mental illness are better at concealing the struggle.

Many people with high-functioning mental illness, like me, exert a tremendous amount of energy to appear normal in public settings and in front of people outside of our immediate comfort zone. There are often a lot of moments throughout the day when we "power through" symptoms for the sake of getting something done. There are also quite a few moments when we have to take a second to think, "How can I manage this symptom of my mental illness right now in the least noticeable way?" (A lot of times for me that looks getting up and moving around or taking a couple of seconds to focus on breathing or doing some grounding techniques quietly in my head. For others that's being busy all the time, which is actually ignoring your mental illness and not actually managing it, which is unhealthy.) Then we try to engage in better self-care and symptom management at home.

I think of people with high-functioning mental illness as ducks treading water. We see the duck's body, appearing to just sit or glide across the water, relaxed and serene. What we don't see are the duck's feet, paddling and kicking in a frenzy to keep the duck afloat underneath the calm surface of the water. That's what it's actually like living with high-functioning mental illness. All the struggling and the work to be high functioning with our mental illness is there, but most people don't see it.

I'll end with this: Many people live with high-functioning mental illness. This means that people outside of their immediate comfort zone or their therapist don't typically see them struggling with their mental illness, which can lead to the idea that their mental illness doesn't really impact their lives or that it's less severe. This isn't the case. People with high-functioning mental illness still struggle just as much as everyone else living with mental illness. Just because you don't see it doesn't mean someone isn't struggling. 

Terms and Conditions Apply

I was talking about mental illness with someone the other day. We were talking about some things I had seen in online forums in which people were saying that they wouldn't want to date someone with disabilities and/or mental illness. Naturally, the conversation turned to whether or not you should tell a potential partner that you have a disability and/or mental illness. 

I know why many of us that live with a disability and/or mental illness are reluctant to disclose that to potential partners. As someone who lives with cerebral palsy as well as OCD and panic disorder, I'm extremely familiar with rejection and the fear of rejection because of those things about myself. There is still a stigma around both disability and mental illness that quietly says we're too much work, and that stigma can make disability and mental illness a deal breaker for some potential partners. However, even knowing that disability and mental illness might be deal breakers for a potential partner, I would still disclose those things about myself as early as possible. 

Sure, it can be scary to tell a potential partner these things because they might decide they no longer want to pursue a relationship with us. But, let's be honest, someone choosing up front not to pursue a relationship with us because of those things is going to be better for us because they obviously wouldn't be able to be as kind and patient as we needed them to be on the bad days, which would have negatively affected our mental health anyway. It's better to let the people that aren't good for us weed themselves out before we're emotionally invested. 

Also, just from a practical point, by keeping our disability and/or mental illness from a potential partner and entering into a relationship with them, we've basically ensured that we're going to have an unpleasant time in that relationship. A partner can't help us or accommodate us if we don't let them know that we need that from them. This is going to possibly put us in danger of ending up in situations that we shouldn't be in or literally can't be in without unpleasant consequences related to our disability or mental health because our partner didn't know about our mental health or disability limitations.

For our partner, when they find out that we live with a disability and/or mental illness that we didn't tell them before they agreed to be in a relationship with us, it could damage the relationship. Finding out that we kept such important information from them like some dirty little secret is likely going to make our partner feel hurt, lied to, and even betrayed and that big secret will more than likely break the trust we've worked to build in the relationship. It may even leave them wondering what other important things we've kept from them.

Each partner needs to be able to give consent to enter into a relationship, like informed consent is required before any procedure or research. A relationship is basically a contract between two people that has terms and conditions that apply (usually called their deal breakers and boundaries). Just like with any contract, people have to know ALL the terms, conditions, and risks of that contract before they enter into it, or the contract is no good. Mental health and disability are part of the terms and conditions that a potential partner needs to know about before they can give the required informed consent to enter into the relationship contract.

I'll end with this: Finding good, healthy relationships can be difficult for everyone, but it can be especially difficult for those of us that live with disability and/or mental illness, which can often make us want to hide those details about ourselves from our potential partners. We really shouldn't hide those things from our potential partners. Giving them all the "terms and conditions" is so important because this allows our partner to give actual informed consent to try out the relationship with us, and it allows us to select a partner who is willing to make the necessary room in the relationship to accommodate our disability and/or our bad mental health days to (hopefully) ensure the relationship is fun and healthy for everyone involved.

It's a Full-Time Job

Most people tend not to think about their mental health until they go through a period of poor mental health. Most people think of mental health as something you only really need to devote any time to managing if something goes wrong. They view mental illness in the same way, meaning that they think you don't really have to devote time to actually managing mental illness unless you're struggling with that mental illness. This isn't really an accurate way to think about managing mental illness or mental health in general.

Managing my mental illness is a full-time job, at least for me. I have to do things every day to manage the symptoms of my OCD and panic disorder. The list of things that I have to do includes making sure I'm getting enough rest, making sure I'm eating the right foods, making sure I'm exercising, making sure I have enough "wiggle room" in my schedule to deal with a sudden unexpected spike in anxiety or a full-on panic attack, and making sure I'm using the healthy management strategies and coping techniques that I've learned in therapy. In addition to that, I also have to keep up with my therapy appointments and make sure I'm working on the things my therapist and I talk about in therapy while I'm between sessions. 

In addition to all the things I mentioned in the previous paragraph, I always have to take my mental illness into account for every decision I make. I have to ask myself, "Will doing X negatively or positively affect my mental health, or is this something I won't know until I try it?" If the answer is that something will negatively affect my mental health, then I can't do that thing no matter how much I want to. If the answer is that I don't know if something will negatively affect my mental health until I try it, I have to ask myself, "Do I currently have the internal resources to be able to safely manage any possible negative mental health consequences if I try this thing?" (Because it's never a good idea to forge ahead with something when you don't have the internal resources to manage the possible negative effects.)

This is EVERY DAY, whether I'm in a period of good or poor mental health and whether or not I'm experiencing symptoms of my mental illness. (I do even more things to manage my mental health on the bad days.) This isn't something I can take a day off from or only do when I feel like it. (And, yes, managing my mental health and being a paralegal can feel like I have a full plate depending on how well I'm doing with my mental health. It's like having two jobs at the same time.)

When I don't treat managing my mental health like the full-time job that it is, I always regret it. When I don't do the things that I need to do every day to manage my mental health, I don't function at the level that I consider to be my normal. I experience more spikes in the symptoms of my mental illness, and I end up existing in survival mode. I can lose days and even weeks in a blur of anxiety, panic, and unhealthy spirals. I'm also unable to be fully present in my life and my relationships with other people because nobody can be fully present in the external world when they're literally fighting to survive their internal world.

I know it can sound daunting when I refer to managing my mental health as a full-time job. It may even seem tedious to have to think about this THING every day and do stuff so this THING doesn't severely impact your ability to thrive and fully experience life. But...we all deserve to live as fully and as happily as we can, and we deserve to be able to be fully present in our lives as often as we can instead of just surviving. 

I'll end with this: People tend to think about managing their mental health as more of an occasional hobby instead of a full-time pursuit. This isn't a good way to think about managing your mental health for anyone, but it's an especially bad way to think about managing your mental health when you live with mental illness. A mental illness that you don't work on or think about until it's interfering with your ability to function can derail your whole life for months or even years. Adequately managing mental illness so that you're not constantly fighting to survive it requires work EVERY DAY, like it's a full-time job.

If You Don't Love Yourself

I know we've probably all heard the saying, "Nobody will love you if you don't love yourself." It's been around for longer than I've been alive, I'm sure, and at this point, it's viewed as good advice to people who are having trouble finding love and/or maintaining healthy relationships. I've heard it in movies. I've seen it in books. I see it online a lot.

Those of us that live with mental illness, trauma, and who have survived abuse or bullying know how impossible it can feel for us to love ourselves. All of these kinds of things that we live through can make us hate ourselves because we feel that we're "broken" or we're "damaged" or we're "worthless." Mental illness can literally tell us we're so terrible that we SHOULD hate ourselves. 

As someone who has lived with a mental illness for my entire adult life, and as someone who has only recently gotten to a place where I can say that I LIKE myself and truly mean it, the above-mentioned statement has always felt more like a judgement than an actual useful piece of advice. It almost feels like the statement is telling me that because I'm unable to love myself, then that means that I don't deserve to be loved by anyone else either. When the reason someone is unable to love themselves is something outside of our control like a mental illness, trauma, or some kind of abuse, the idea that nobody will love us if we don't love ourselves can be particularly damaging. It can support the faulty belief that we're inherently unlovable and that, even if someone tries to love us, we don't deserve it.

It took me so many years to get to a place in my healing journey to be able to see that the above-mentioned statement isn't the useful piece of truthful advice that people think it is. What it actually is, is a myth that needs to be debunked. 

Family, friends, and romantic partners can and do love their loved ones that don't love themselves. They often love them in spite of the fact that they don't love themselves. They love them because they can see all the good bits that people who don't love themselves have been conditioned not to see. They love them because humans are inherently loveable. 

The above-mentioned statement gets something wrong about love, to me. What it gets wrong is the transformative, healing nature of (healthy) love. It's the love we receive from others, especially the love we receive when we feel broken, damaged, or worthless because of our mental illness, our trauma, or the past abuse that we survived, that can help us on our journey of healing. It's that love that isn't conditional on our (self-assessed) worthiness or wholeness that can help us see that we deserve to love ourselves as much as these other people are choosing to love us.

I'll end with this: We should all be able to love ourselves, but, boy, do I know how hard that is to actually do, especially if we live with mental illness, have been through trauma, or have been abused or bullied. When we don't love ourselves, it can be hard to believe that someone else might love us, especially with the statement, "Nobody will love you if you don't love yourself," weaved into society like a mantra. But...that statement is a myth. People can and do love us (in a healthy way), often in spite of the fact that we don't love ourselves, and it's that love that isn't conditional on our (self-assessed) worthiness and wholeness that can help us heal so we can grow into loving ourselves. And remember, even when you don't love yourself, you still deserve love from yourself and from other people, no matter what your mentally ill, traumatized, or abused brain tells you.

I'm Not Qualified for That

 I have an undergraduate psychology degree AND I live with clinically diagnosed OCD and panic disorder. When people find out these facts about me, many of them will ask some variation of the question, "Can you diagnose someone for me?" Sometimes it's asked in the way people often ask someone who is fluent in another language to say something on the spot, like asking a person to showcase an interesting talent just for fun. Other times, it comes from a place of legitimate concern for the person they're asking me to diagnose. Sometimes, they're asking for themselves, to figure out if they have one of the mental illnesses that I have.

I'm not qualified to diagnose anyone with mental illness just because I have an undergraduate degree in psychology. In order to diagnose someone with mental illness, I would need to have an advanced degree like a master's degree, Ph.D. or even a Psy.D. in clinical social work, clinical psychology, or mental health counseling with a certain (VERY LARGE) number of hours practicing clinical mental health counseling under the supervision of a licensed mental health professional to obtain a license to practice. It would be unethical for me to diagnose anyone without having the required experience and credentials. 

Living with mental illness also doesn't give me the required expertise to diagnose anyone. I only have knowledge of what mental illness is like FOR ME. Other people with the same mental illness will have a different experience. Additionally, some people don't fit with the traditional symptom outline of a condition, which only a mental health professional would be able to figure out. Saying whether or not someone has a mental illness just based on my personal experience with that mental illness would be wildly inaccurate and unethical at best and disastrously alienating to someone at worst.

Another reason I wouldn't diagnose someone else with a mental illness is because, for the person on the receiving end of the observation and diagnosis, it can be breach of trust and a boundary violation for them if they weren't the one asking for the diagnosis. Nobody should be discussing anybody else's mental health without their consent. Nobody should be observing someone else without their knowledge and consent so they can then discuss whether or not the person in question has a mental illness with that person's friends or family. 

Diagnosing someone with a mental illness is a serious thing. It's not a party trick, a nice bit of gossip, or something people should be speculating about. Speculating about the PRIVATE matter of someone's mental health and whether or not they have a mental illness can have a profound effect on the person's self-esteem, their self-worth, and their ability to trust other with sensitive information. It can also affect a person's relationships, employment, and quality of life if the speculations make their way around someone's work or social circle as fact.

I'll end with this: Just because I have an undergraduate degree in psychology and live with clinically diagnosed mental illness does not mean that I am qualified to observe and diagnose other people's mental health conditions. Only an actual mental health professional with an advanced degree, a set number of supervised counseling hours, and a license to practice mental health counseling should be diagnosing mental illness. It's also a breach of trust and a boundary violation to discuss someone's mental health and/or attempt to diagnose someone with a mental illness without their knowledge and consent, even if you mean well.

The Other Part of Prevention

*TRIGGER WARNING: Mentions of suicidal ideation and suicide.*

When society as whole focuses its attention on suicide prevention, like right now, for Suicide Prevention Awareness Month, it tends to focus on only one part of suicide prevention. Society likes to treat suicide like some tragic, unexpected event that's pretty much only associated with mental illness. Treating suicide this way makes society as a whole tend to only focus on the human connection and emotional support aspect of suicide prevention. Society stresses that we should all check in with our loved ones, that we should make sure people know they aren't alone, that we should make sure everyone knows that they matter, and to make sure we destigmatize mental illness so that everyone knows it's okay to "get help." (The definition of "help" meant by society in this instance is only mental health treatment.)

These things are great, and they DO help some people who are struggling with suicidal ideation and who are fully suicidal, but just doing those things isn't going to prevent every suicidal person from following through. In order to truly prevent suicide, we, as a society need to do a better job at fixing the underlying issue that is causing someone to be suicidal in the first place, because people can be suicidal for a reason that doesn't have anything to do with mental illness.

Some people are suicidal because they don't have access to housing. Some people are suicidal because they don't have access to adequate food for themselves and their family. Some people are suicidal because they don't have access to a certain type of healthcare (including gender-affirming treatments, abortions, and substance abuse treatment) and/or medications that they need. Some people are suicidal because they don't have access to services to help them with a school-related issue. Some people are suicidal because they can't find work. Some people are suicidal because they're trapped in an abusive relationship with no way out without some kind of assistance. Some people are suicidal because they're trapped in poverty.

The other part of suicide prevention that society leaves out (probably so nobody has to acknowledge that suicide isn't just a tragic event that only affects the mentally ill and is often related to lack of access to resources and society/government shortcomings when it comes to helping people meet even their basic needs), is that IN  ADDITION TO emotional support, people often need some type of tangible support or help from a service like social services or government programs in order to fix the underlying issue that makes life unlivable. At the very least, people need someone (friends/family/volunteer community workers/social workers) to help facilitate access to the things that would fix the reason life felt unlivable for them. If people are treated in in-patient facilities and improve there, but then they're just plopped back out into the same situation with the same underlying issue that made them suicidal with no access to the thing that fixes the underlying issue, then, society hasn't done all it needs to in order to prevent that person's suicide. 

When I was struggling with suicidal ideation, everyone did everything that the pamphlets and websites told them they were supposed to do to help someone in my situation. I went to the ER and was evaluated by a crisis counselor. People were extra kind to me, and they made sure I knew they loved me. My mom took FMLA leave from work when I needed her. Then when she had to go back to work, she had other people come and sit with me so that I was never alone at home. Yes, I'm grateful for these things, and they made me feel safe at a time when I was terrified...but these things aren't what actually saved my life. 

What actually saved my life was a phone call. My mom talked to a family friend about what was going on with me. This friend had a good professional relationship with some mental health professionals that I had tried and failed to gain access to on my own. This friend made one phone call, and I had an appointment the very next week with that therapist that I hadn't previously had access to. (Thank you for helping save my life, Candice.) If my friend hadn't made that phone call and connected me to someone that helped the actual reason that I was dealing with suicidal ideation, I probably wouldn't be here today, even though, according to society, my support system was doing everything "right" to make sure I remained alive. 

There was a reason that life felt unlivable for me. I was in therapy, but the kind of therapy I was in was not working for me, but it was all I had access to. I needed access to a different kind of mental health treatment that I had tried and failed to gain access to. All of the kindness, check ins, and the emotional support weren't going to fix the reason I was dealing with suicidal ideation, because the only thing that could fix that was access to the treatment I needed. 

I know I was one of the lucky ones because all it took was a phone call from a friend to help me access what I needed to survive. This is actually how all of society should function when it comes to suicide prevention, though. Nobody should have to be lucky to have what they need to no longer be suicidal.

I'll end with this: Suicide prevention is more than just making sure someone has human connection, knows they're loved, and has emotional support. Suicide prevention is access to resources and services that actually treat or fix the reason someone feels like life is unlivable. Sometimes that reason is mental illness, but a lot of other times that reason is related to reality-based problems like lack of access to housing, healthcare, food, education, and other societal issues.