Tag Archives: mental health

Test Day dizzaz, feat. childhood trauma, feeling my feelings, and several bonus book recommendations

[Childhood abuse + trauma]

One of the biggest obstacles to my training is my dad, a man I haven’t seen or spoken to for years. And yet!!! His voice lives inside my head. Still. All these years later. This voice is what trauma expert and therapist Pete Walker calls the inner critic.

My dad was mean. When I was growing up, he was a deeply unhappy person (he might still be, I don’t know), himself the product of trauma before he became the perpetrator of it (so the cliché and cycle go). In addition to unpredictable episodes of physical violence and psychological terrorism, he ridiculed and demeaned me constantly, never missing an opportunity to point out—to me, and to others (and, not infrequently, to me in front of others)—how inept, inadequate, and incapable I was.

Everything I showed interest in was stupid and worthless, just like me. Nothing I did was, or would ever be, good or right enough, because, his logic went, I wasn’t, and never would be, good or right enough. Or was it the other way around? I wasn’t allowed to have or express ideas, opinions, or feelings. Feelings were especially off limits. Mine were, my dad made clear, incorrect, unwarranted, and an overreaction. Always. No matter what.

What’s wrong with you? and Why would you do that? and What were you thinking? and You fucking idiot are things he’d say to me regularly. He called this “tough love” and “just joking” and “character building” and his “opinions.” It was abuse, it was unavoidable (he kept my mom and me isolated) and relentless (I’m an only child), and it traumatized me.

Contrary to the mythology of the popular saying, that trauma didn’t ~make me stronger~. It beat me down, sometimes literally, and broke me. For a very long time, it deeply and negatively impacted every aspect of my life.

In mid-2020, I started therapy specifically to unpack and process my childhood and the trauma it left me with. I’ve put in a lot of work over the past two and a half-ish years, including the (very hard) work of building confidence and learning to recognize and silence my inner critic—my dad’s voice. That voice came out screaming on Monday.

Monday was Test Day. This was technically unplanned, but not entirely unexpected. Orginally, I was supposed to test Tuesday. But I felt good on Monday, and when Coach asked me how I felt I said, “What if I test today?”

I didn’t think twice about it, honestly. I had the best training week of my life last week. I walked in the gym Monday morning excited and, even though it wasn’t supposed to be a test day, I was prepared for it to be. I was rested and nourished. I felt good. Confident, even.

The fact that I was testing with the head barbell coach and not the coach I’ve been working 1:1 with for the past several months didn’t phase me. Neither did the small crowd of fellow gym-goers, including several competitive athletes, watching me and (quietly) cheering me on as they worked out nearby. Just a few months ago, with a little less trauma processing under my belt, these things would’ve stressed me the fuck out. There’s no chance in hell that I would’ve suggested to move my test day up a day, and if it had been suggested to me, I would’ve made every excuse in the book to avoid it. Just a few months ago, I didn’t have the confidence in myself that I have (most days) now.

I ended my session on Monday feeling just as good as when I started it. Maybe better. I was happy with my total, my form and technique felt solid, I failed only one attempt (my final jerk), my body felt good, and my pelvic floor held the entire time. I was proud of myself.

And then I watched the videos of my lifts. Usually I do this between each attempt/set. For whatever reason, on Monday I didn’t. I waited to watch the videos until I was in my car. And when I did, my inner critic—my dad’s voice—immediately began berating me.

I sat there for at least 20 minutes, alone in my car, watching and rewatching the same seconds-long clips, picking apart every single element of each lift, thoroughly embarrassed that I’d lifted LIKE THAT in front of so many people, who—isn’t it obvious?—are all better than me at everything on the planet, especially lifting. I felt like a fool for having believed them when, an hour earlier, they’d high-fived and fist-bumped me and told me Good job! and Looking strong! There was no possible way, my inner critic told me, that they’d meant it. I had not done a good job. I did not look strong. I never would, or would be.

I drove home feeling utterly defeated. When I got home, I sat on my couch and, while watching the videos of my lifts on repeat, I cried. The voice inside my head was critical and unforgiving. Instead of being snappy and solid and sharp, my lifts looked slow and heavy and sloppy—and right out the gate, from the very first pull. Truly, a rookie move/mistake that I hadn’t, before yesterday, made once—literally not a single time—in all the months that I’ve been training at this gym. Instead of being able to see this for what it was—an off day—I took it as proof that I’m a failure as a person. I was, for the first time in a long time, fully inside a C-PTSD emotional flashback: drasticizing and catastrophizing and spiraling; consumed by all-or-nothing, always/never thinking. All of the hard work I’d put in and good training sessions I’d had over the last several months had been a fluke. This one single fuck-up of a lifting session was the real me.

The voice inside my head: You’re never going to get better at this. You should just quit. You aren’t cut out for this. Why do you keep trying? You’re making a fool of yourself. You’re such a fucking loser.

I know that it sounds dramatic now. All of it. It did not feel that way in the moment. Such is the nature of trauma.

As soon as I recognized what was happening—an emotional flashback/shame spiral—I put my phone down, made myself food, watched some TV, finished the book I was reading, and let myself feel however I felt, which was mostly frustrated and disappointed, for the rest of the day. I didn’t try to toxic positivity or affirmation my way out of it.

And you know what? I woke up Tuesday feeling a lot better and brought my ass right back to the gym to start my new block of training. And you know what else? I did really well. I didn’t make any of the rookie moves/mistakes that I made on Monday (which isn’t actually that surprising because they’re mistakes I’d stopped making regularly a long fucking time ago). My overhead positions were crispy. I was tight in the catch. My lifts were solid and snappy and sharp. I had the best front squat session of my life (so far). I left the gym feeling good about the training day, and about myself.

What’s my point? There are several. I have zero spoons remaining to get into all of them right now. The main one—at least for today—is this: It’s okay to feel your way through your feelings. It’s okay to not immediately try to change them or fix them or understand them or find some hidden lesson or silver lining in them.

There’s a lot of emphasis in the fitness world to “good vibes only✌️” your way through, well, everything, and very little room for “bad” or “negative” feelings, WHICH ARE TOTALLY NORMAL AND HEALTHY TO HAVE BY THE WAY. Too often, having “bad” or “negative” feelings is weaponized into a personal characterological or moral failing, which is just so gross and unhelpful. It’s insensitive, invalidating, and dismissive—at best. I’m proud of myself for recognizing what was happening as it was happening, putting my phone down, cutting myself some slack, and allowing myself to feel my way through my feelings, without judging them or myself for having them. That, my good bitch, is a whole different type of—and pretty damn big—PR.

(For the record: No, my lifts didn’t actually look THAT bad. It’s clear from the videos that my body wasn’t as prepared to test that day as I thought it was AND that I’ve gotten stronger and improved my technique in a pretty short amount of time.)

*

Four books that I’ve found particularly helpful in better understanding attachment wounds and complex trauma (C-PTSD):

  • Complex Trauma: From Surviving to Thriving by Pete Walker.

    The editing, organization, and formatting of this book are inconsistent, which I found made things difficult to follow at times. The information is solid, though, and I recommend giving it a read.
  • Polysecure: Attachment, Trauma and Consensual Nonmonogamy by Jessica Fern.

    Please don’t be scared away by the title or subtitle of this book. You don’t have to be nonmongamous, or even interested in nonmonogamy, to gets something from this book. You just have to be a person who has relationships, of any kind, with other people.

    Personally, I liked this book a whole lot more than Attached, which is the more mainstream go-to book about attachment theory. I think it feels more inclusive and less stereotyped, especially with its use of language, and I especially appreciate that Polysecure looks at attachment theory and wounds through the lens of non-normative relationship structures. I believe this is important because it (1) reminds us that we have and benefit from all sorts of relationships, not just traditional romantic/sexual ones, and (2) shows how attachment wounds and relational trauma can show up in ALL of our relationships, including those with friends and family members and neighbors and people we work with, etc., and therefore impact all different aspects of our lives.

RIP (?) Twitter

Note: All links in this post lead to open access information that is *not* paywalled, and open in a new tab.

There is a very real risk that Twitter as we know and have known it will become unusable in the near future. This has been the general sentiment and concern since Apartheid Clyde (Elon Musk) bought the platform a month ago. That sentiment and concern came to a head late last week when many of the company’s remaining employees quit after Musk issued another ridiculous ultimatum (stay on board and be “hardcore” or quit and get three months of severance pay), leaving entire departments and teams and a number of critical systems unmanned.

Many of the employees who “chose” to stay are in the States on H-1B visas, meaning they must remain employed to remain in the country, which means they likely didn’t really have a choice. Last night, on Thanksgiving Eve here in the States, Musk fired a number of those employees, with no notice and only four weeks pay (v. the three months of pay they would’ve received had they not “chosen” to stick around when given the “choice” last week).

If you have no idea what I’m talking about, here are a few articles to better understand what’s happening at Twitter.

Why do I care? And why should you, even if you don’t use Twitter? FOR A WHOLE BUNCH OF REASONS!!!

Much of it boils down to community, mental health, care, safety, and general/overall wellbeing.

Twitter is a lifeline for a lot of people. It’s vital for community and connection for many marginalized and disenfranchised folks—Black folks, Indigenous folks, and other people of color; disabled and chronically ill folks; queer folks; social activists; mutual aid organizations and facilitators; freelancers; artists; journalists; writers; and sex workers.

For many of us, especially those of us for whom the “real” world isn’t safe or accessible, Twitter is real life. It’s where we congregate and socialize and network and connect and build community. It’s where we find social, emotional, intellectual, and financial sustenance. It’s a place where we can make friends and family, and find help and answers. Twitter has been especially important to so many of us throughout the pandemic, WHICH IS STILL HAPPENING BY THE WAY, because it’s been a source of consistent, immediate, and reliable information about Covid, Long Covid, and disability, providing instant access to both scientific research and anecdotal evidence from care providers and patients—and has been a safe way to socialize.

“Can’t you just go elsewhere?” Yes and no. There are other places to hangout online, sure. There’s nothing else out there (yet) like Twitter. The places that people most often suggest as alternatives cannot (or at least, don’t currently) compare to the way that certain communities use Twitter.

One of the things that’s unique about Twitter is that it’s not siloed or federated. You don’t have to join certain groups or sections of the site. Everything’s just kind of…there. In the open. This makes finding community and information much easier. Another thing: its immediacy. Things happen—and travel—in real time on Twitter at a scope, scale, and speed that they don’t elsewhere. And, unlike most of the other popular social media platforms (at least, the ones that are popular here in the States), Twitter isn’t about aesthetic or performance or curating only the most palatable moments of life. It’s a place that a lot of us feel we can go to be real, without pressure to turn ourselves and our lives into ~**~content~**~.

This Washington Post article does a good job of explaining why Twitter is so important to disabled folks in particular. If you take only one thing from this piece, let it be this:

“Twitter has long been uniquely suited for people with disabilities in a way that can’t be easily replicated elsewhere. Because it’s primarily focused on the written word, it’s easier to use for blind people, deaf people and those who struggle with speech or fine motor control issues, compared with social media sites like TikTok and Instagram, which emphasize visuals and audio.

Twitter also has broad reach. Platforms like Reddit and Mastodon group people into specific community spaces or servers, making it harder for posts to gain the attention of the general public.”

Plus: there’s the extremely resource-intensive labor of starting over.

The platform is also essential for public safety. Tons of people, communities, and governments rely on Twitter for mass and instant global communications, coordinating emergency/disaster response efforts, and real-time organizing and mutual aid facilitation.

For a few messy hours late last week following the news that entire teams of engineers had quit or been fired, it felt likely, even imminent, that the site would completely collapse from a technical perspective. Today, that scenario seems a little less, but by no means entirely, unlikely. The more immediate concern now is that Twitter will become an unsafe and inhospitable space for those of us who rely on it most for community, connection, paying bills, and general quality of life—especially during the ongoing pandemic.

Gutting staff (including content moderators), canning policies (like ones governing hate speech), and reinstating people/accounts who were suspended or banned—all things that Musk has done and continues to do—have huge potential to turn Twitter a cesspool of fascism, white supremacy, ableism, homophobia, transphobia, and other such -ists and -isms and -phobias. A lot of this is already playing out, this Wired article explains.

As I was drafting this post Musk reinstated a handful of accounts that had been permanently suspended for, among other things, hate speech and inciting violence—Donald Trump, Kanye West, Jordan Peterson, Andrew Tate, etc. Just before I hit “publish” on this post, The Oregonian reported that Musk has granted “amnesty” to those previously suspended accounts. Since Musk took over, there’s been a sharp rise in unmoderated hate speech (use of the N-word was up nearly 500% in the 12 hours following Musk’s takeover, and there’s also bee a significant rise in anti-Semitic, misogynist, and transphobic language on the site). Brookings points out that this “speaks to how fringe, alt-right networks not only feel empowered by Musk’s takeover, but protected as well.”

The same article closes by stating:

“Collectively, recent changes to and at Twitter disrupt the ability for marginalized people to find community, produce useful discourse to share ways to foster equality, and protect themselves from hate speech and trauma. Musk’s acquisition of Twitter and his potential plans to loosen moderation guidelines will continue to increase the use of hate speech and likely inhibit the ways that marginalized groups have organized and mobilized on the platform to resist harmful language and discrimination in their everyday lives.”

Twitter isn’t perfect. It never has been. It’s always been home to misinformation, trolls and bots, and hate. But not quite like this. And it’s terrifying. It’s not just the prospect of losing Twitter that’s concerning. It’s who we might lose it to, and what that could mean for individuals (people absolutely will die as a result of Musk’s unmoderated, “absolutist” free speech Twitter), and for democracy and humanity. I know that will sound dramatic to some. It’s not.

I’ll leave y’all with this thread that details lies Elon’s peddled about his credentials and why this is part of what makes him such a dangerous person, and the following embedded tweets from others who are also concerned/sad/pissed about what’s happening at Twitter. (Yes, I’m aware of the irony of embedding tweets into this post. The labor to screenshot, crop, upload, and ALT text all of these tweets, some of which are multi-tweet threads, requires more resources/spoons than I have available right now.)

Having a panic attack on the trail (0/10, do not recommend)

Remember when I tried to hike Elk Mountain/King’s Mountain Loop back in May and didn’t finish? That’s because I had a panic attack—3,000 feet atop exposed trail in inclement weather while hiking with someone I barely knew. DIZAZZ.

Photo of Tillamook State Forest taken from about 2,500 feet atop Elk Mountain Trail. The sky is gray with heavy, low clouds. The trees are various shades of green.

I feel like the weather had a lot to do with it. I’m not really afraid of heights—not when my feet are literally on the ground, anyway. I don’t like flying, and I don’t like driving on elevated roadways (bridges, windy sides of mountains, etc.). But if my literal feet are on the literal ground, I’m usually okay with height. Unless, apparently, there’s weather involved.

For the week prior to this hike, my hiking partner and I checked the weather daily. We knew this was going to be a tough hike (it’s rated “hard” on AllTrails, which we presumed, from the comments, was due to the elevation gain), and neither of us wanted to hike in pouring rain or super cold temps. We were prepared to delay the hike if we felt the weather called for it. It was chilly the day we attempted this hike, and a bit overcast when we began, but overall, the forecast seemed okay. Remember, we were under the impression the elevation gain would be the most difficult/technical thing we’d encounter.

Reader: We were wrong.

There were several stretches of incredibly narrow and steep trail that was exposed and required scrambling. I’m not saying this is the most technical or challenging trail on the planet. I’m saying it wasn’t what we expected, and personally, I wasn’t prepared for it. I think if the weather had been dry and warmer, this would be a non-story because we would’ve finished the hike. That’s not what happened.

Right as we reached what felt like the most technical part of the trail (steep grade, steep drop-offs, steep scramble), the fog rolled in and the rain started coming down. And with the change in weather and terrain, I felt the panic attack coming on. It’s an unmistakable, alarming feeling, especially when it presents with derealization, like it did that day.

A lot of resources describe derealization as feeling like “a dream.” To me, derealization feels less like living in a dream (“dream” has too positive of a connotation to me for what the actual experience feels like) and more like being stuck or suspended in a liminal space. When it’s happening, the more aware of it I become, the worse it gets—the further away from reality and outside of myself I feel, which freaks me the fuck out, and the more I begin to worry (panic) that I’m going to break with reality and that if I do, I might not ever make it back.

But wait, there’s more!

As the psychological pieces of the panic attack become more pronounced, the physical aspects of it kick in. Often, I start shaking uncontrollably, as adrenaline and cortisol start pumping through my body. My field of vision narrows, and can become unclear and spotty. Sometimes, my hearing becomes impaired—voices and other noises around me can sound diffuse and garbled, my ears might start ringing with a piercing sound.

On this particular day, my Raynaud’s decided to join the party, too. Raynaud’s is a condition in which certain areas of the body—often the fingers and the toes—become cold and go numb. The affected area usually turns white or blue. Cold temps and stress both activate and exacerbate it. Here’s what it looks like on/for me.

Photo of my left hand, showing the effects of Raynaud's. The top 2/3 of my fingers is white, while the color in the rest of my hand is normal.

My Raynaud’s joining the party that day is significant because it meant that on top of intrusive thoughts, uncontrollable shaking, and impaired vision, my grip was shot, too. On their own and even though I was wearing very warm, waterproof gloves, the cold made closing my fingers challenging, and the rain made it difficult to get a grip on the scramble and tree roots, which I’d been trying to hold onto for stability. The numbness from the Raynaud’s meant I couldn’t feel my fingers.

So there I was, on the precipice of a mountain, about 3,000 feet above the ground in inclement weather, having intrusive thoughts, shaking uncontrollably, with literal tunnel vision, and unable to get a decent grip on the steep terrain around me thanks to (1) wet and cold weather that made gripping the scramble and tree roots I’d been gripping for stability up to this point incredibly difficult, and (2) my numb fingers that I couldn’t feel or properly close around the slippery scramble and roots. Also: wind. AND THEN: my trash-ass proprioception.

Proprioception refers to our ability to sense our body’s movement and location in space. It also plays a role in balance and coordination. I talk more about my proprioceptive differences in this post. Basically: Even in the best of times when there are no complicating factors, I have difficulty knowing where my body is in space, coordinating my movements, and balancing.

On top of all the regular panic attack-y things I was experiencing, I was trying to literally navigate this particular section of trail with proprioception that’s Not Great even when I’m not having a small personal crisis on top of a mountain in the wind and rain. At one point, I had three points of contact at all times, and eventually began scooting around the trail on my ass, trying to grip whatever I could—when there was something-ish to grip. Problem was, most of what was available to grip was roots, and because it was currently, and had for days prior been, raining, the roots weren’t exactly sturdy.

I knew that I needed my full attention on the trail. I also knew that wasn’t going to happen. I was putting so much of my energy and attention into trying to mitigate my panic attack. Ultimately, given all the variables—the panic attack + the Raynaud’s + my trash-ass proprioception + the elevation + the narrowness of the trail + the low visibility/density of the fog + the rain (the slipperiness of the trail and the scramble)—I didn’t trust myself to not accidentally fuck up in a situation that allowed zero room for error.

So I removed myself from the situation.

I looked back at my hiking partner and said, “I need to turn back.” With no questions asked and no shade thrown, she agreed. Which: THANK FUCK for a hiking buddy who isn’t a dick. Also, I’m proud of myself for making the decision I did. It wasn’t easy. It was the right call.

Learning I’m autistic has been such a game-changer (for the better) in so many ways. For example, it’s given me context for understanding my experiences, and more self-knowledge about how my brain and body do (and don’t) work together. And that context for my experiences and better understanding of myself has empowered me to make better decisions. Had this situation happened and I didn’t know I was autistic and how being autistic affects my proprioception (a word I didn’t even know before I learned I’m autistic), I almost certainly wouldn’t have made the same decision. I would’ve believed that turning back was weak and unforgivable—I would’ve tried to power through, and honestly, who the fuck knows what might’ve happened (autistic people are significantly more likely to die from injuries and accidents, and I’ve already passed the average life expectancy for autistic people, which is a whopping 36 years old).

I know that a lot of people think an autism diagnosis is a tragic thing. That it’s the end of the world. That’s because they’re uninformed. An autism diagnosis isn’t either of those things. In many, many ways, it’s life-changing (in a good way), and even life-saving, both directly and in-.

Anyway.

The panic attack was an all-around 0/10 experience—hard pass, return to sender, do not recommend. It taught me a lot about myself, though, and that’s 10/10 valuable information to have.

*

If something like this happens to you on the trail (or anywhere, really), you’re not crazy for it happening and you’re not stupid or weak if you decide to turn around and go back instead of trying to push through.

If this happens to someone you’re with (on the trail or not), don’t be a dick about it. Don’t push them to “face their fear” or “get over it” or “just finish” because y’all “came all this way” or “made it this far.” Be kind. Be willing to turn back/leave with them. Don’t make any shitty, judgmental comments. You don’t have to “agree with” or understand it, you absolutely should respect it. I promise you, a person having a panic attack doesn’t want to be having a panic attack (especially in public), and isn’t “acting crazy” “on purpose” “for attention.”

“Pathological: The True Story of Six Misdiagnoses”

I recently read Pathological: The True Story of Six Misdiagnoses by Sarah Fay. It was…not what I was expecting, and I have mixed feelings about it.

Before we dive in: I recognize that mental health and mental illness are emotionally charged topics, and, in our society, politically charged ones, too. I also recognize that they’re complex topics. There is no one-size-fits-all approach or philosophy. I think there’s widespread consensus that we need a paradigm shift when it comes to mental health and mental illness, and many different ideas about what that shift should be and how that shift should happen.

I don’t have all the answers. Or any of them! I have my thoughts and my feelings and my opinions, which are informed by my experiences, which are informed by my unique combination of privileges, accesses, and opportunities. Some people will share my perspective, and some people will not. That’s okay!

There are many bits in this book that I think are informative and valuable, and there are some takes with which I disagree. I touch on a few of these takes below, and focus mostly on one.

Alright then. Shall we? Let’s shall.

A copy of the book "Pathological: The True Story of Six Misdiagnoses" by Sarah Fay is positioned on a book cart so that the front of the book is visible. The background of the cover is dark purple. The title of the book and the author's name are in tall, block letters, colored, from left to right, pink to blue. The subtitle is white and in a handwritten font, across the center of the book, between the title and the author's name.

Ostensibly, this book is a memoir about the author’s experience of being misdiagnosed over the years with six separate DSM diagnoses: anorexia, major depressive disorder, anxiety disorder, ADHD, OCD, and bipolar disorder.

This book is memoir in the loosest sense of the word. The author frequently references her personal experience, but there’s no introspection, reflection, nuance, or critical self-analysis that one expects from memoir, and no character development beyond the superficial (really, the only character “development” is the author ages, as one does in accordance with the linear progression of time). The author comes off as self-centered—not self-aware—in a way that’s frustrating (sometimes infuriating) and uncomfortable.

What this book actually is, is a history and critique—a rebuke, really—of the DSM. Many people know that the DSM, or the Diagnostic and Statistical Manual, is psychiatry’s “bible” and what clinicians use to diagnose mental illness. What many people don’t know, and what Pathological discusses, is that while the DSM has been branded as a definitive and scientifically sound document, it’s not. It has a problematic history, and remains a problematic—and scientifically unsound—document.

The main argument of the book is: Stop pathologizing normal human behavior, activities, and experiences. Which: YES! I agree with this. Emphatically. I understand that the DSM has a problematic history, and I agree that it remains a problematic document. I agree that there needs to be a paradigm shift when it comes to how we think and talk about, and approach, mental health and mental illness.

Where the author loses me is making the leap from “the DSM is a problematic document” to “not a single diagnosis in the DSM is real and its diagnoses aren’t helpful.” 

She makes this leap by staying stuck on only the scientific definition of the word “valid.” To Fay, all DSM diagnoses—with the exception of dementia and perhaps schizophrenia (her caveats)—are “hypothetical” and “opinions, not facts.”

I think that this is an extremely problematic take.

Using the scientific definition of “valid,” DSM diagnoses aren’t “real” in that they aren’t pathological. Meaning, Fay clarifies, they’re not medical disease or illness; there is no blood test or brain scan or other physical diagnostic exam that can conclusively diagnose anything in the DSM (with the author’s two caveats, noted above).

Okay. I understand that using this definition of “valid,” no DSM diagnosis is “valid” because no DSM diagnosis is pathological. And, per a previous paragraph, I agree that we should’t pathologize normal human behaviors, activities, and experiences. I don’t agree that an experience not being pathological means that it’s not real. And I don’t agree that grouping experiences using common language is unhelpful.

An experience does not need to be observable on a physical diagnostic exam to be “real” or “valid” in the non-scientific meanings of those words. These experiences are very real for the people having them, and they have an impact—often a significant, if not defining, one—on a person’s life. And in this ableist-ass economy, that impact is usually a negative one.

Let’s take autism as an example. I’m autistic. Or, using the pathologized language of the DSM, I have Autistic Spectrum Disorder (autism isn’t a disorder or a deficiency, it’s a difference). There’s no blood test or brain scan—or other diagnostic imaging or lab—that can conclusively confirm, or “diagnose,” autism. Because being autistic isn’t an illness or disease. It’s not pathological. That autism can’t be definitely measured by and irrefutably proven using a physical diagnostic exam doesn’t mean my experience of being autistic isn’t valid or real. Same goes for the other DSM diagnoses. To argue otherwise is hurtful and harmful. That’s called gaslighting. Gaslighting is abuse. Abuse can cause trauma.

DSM diagnoses are labels. Sometimes, labels can be limiting. Often, especially in the context of understanding who you are, and extra especially in the context of invisible and intangible aspects of identity, they’re incredibly useful. Spend some time scrolling through #ActuallyAutistic, #DisabilityTwitter, and #NEISVoid on Twitter and you’ll see how powerful having language for your experience can be.

Pathologization aside, DSM diagnoses are life-changing, even life-saving, for many because those diagnoses—those labels—give people language, context, community, and permission. Receiving my DSM diagnoses was the single-most affirming and empowering experience of my life (to date, and pathologization aside). They came with stigma and stereotype, sure. They also gave me the four things I mentioned above: language, context, community, and permission.

Language to describe my experiences.

Context for why I have the experiences that I have.

Community with other people who have similar or same experiences.

Permission to stop masking, to unlearn ableist attitudes, to cut myself a fucking break, to be me.

Doing away with—or refusing/rejecting—DSM diagnoses, as the author suggests, and indeed does herself, means doing away with those labels and the affirming and empowering—and sometimes life-saving—benefits they can offer.

Also, can we just take a moment to talk about the irony of the author writing an entire-ass book arguing that we should stop pathologizing normal human behavior, activities, and experiences, and then using outdated and pathologizing language throughout. LOL!

Not once did Fay make an effort to reframe pathologizing terms with less loaded and more neutral, understanding, and inclusive language. She doesn’t even address it in passing. It’s like the idea simply never occurred to her. Wild.

Reframing pathologizing language is easy. SO easy.

We can say “co-occurs” instead of “comorbidity.”

We can say “traits” or “experiences” instead of “symptoms.”

We can say “difference” instead of “deficiency.”

People can be “supported” and “accommodated” instead of “treated” or “managed.”

Fay knows language is important. She must. Her whole book is framed using punctuation as a device to illustrate exactly this. If punctuation matters, so too must the words it punctuates. And the author—A WRITER, AKA A PERSON WHOSE WHOLE ENTIRE JOB IS LANGUAGE—obviously understands this. That she neglects to acknowledge or elaborate on it is, in my personal, unsolicited, and correct opinion: deeply irresponsible.

If your goal is to stop pathologizing non-pathological things, one of the easiest and immediate ways you can help to do this is to change the language you use when writing about said things. It’s, like, incredibly fucking obvious that using pathologizing language to talk about non-pathological experiences…perpetuates the pathologization of said non-patohlogical experiences, no?

It’s also wild/frustrating to me that Fay fails to discuss—or even acknowledge—one: that health is holistic and intersectional, and two: the ways society and our environment can intersect with and impact our health. We can’t talk about mental health without also talking about other aspects of health, like physical and emotional health. Nor can we talk about any aspect of health without acknowledging that every aspect of our existence influences every aspect of our health.

To her credit, Fay does mention the medical model of mental illness. To her discredit, she does so only once—in passing and with no explanation or elaboration, 213 pages in—and she doesn’t mention or explain the social model of mental illness at all.

Essentially, the medical model says “the problem is you and your brain and/or body.” The social model says “the problem is society/your environment.” Obviously this is a very reductive and overly simplified description of these models. Please do your own research. This paper from Andrew J. Hogan gives a good overview of the history of the medical and social models. You might find it a helpful place to start.

To her credit, Fay does discuss the Big Pharma aspect of the Mental Health Industrial Complex. To her discredit, she doesn’t acknowledge or discuss capitalism’s role in mental health beyond that. There’s seemingly no awareness on her part of how our capitalist society contributes to (creates?) and reinforces/perpetuates the mental un-wellness that it pathologizes and then packages and sells to us as being a result of our supposedly inherently faulty brains, without the slightest consideration for the ways the shit-ass social conditions and contexts in which we live and seek care affect our health.

To her credit, Fay does discuss off-labeling and over-prescribing, and the very real problems that too many people with too little education and training are permitted to diagnose using the DSM, and many people doing the diagnosing are misdiagnosing (lots of overlap between those last two things). I don’t think she digs as deeply on these last two things as she could have. There’s a lot of talk that it’s happening, and very little talk about why it might be happening. And certainly no talk about ways we might approach change.

I’m also confused by her suggestion to eliminate spectra, and I don’t think she adequately acknowledges her privilege, or the impact that gender, sexual orientation, race, and/or socioeconomic status in particular have on clinicians’ tendency to pathologize peoples’ behavior and experiences. The few mentions she makes of these things feel very superficial, contrived, and CYA-y.

As I read, I kept waiting for Fay to disclose her “real” diagnosis. Spoiler: That never happened. There is no neat ending. Which: fine. I don’t need a neat ending. I do like a cohesive and coherent one, and I don’t feel like I got that from this book. At the end of the book (literally), what we get from Fay is her rejecting therapy and all her diagnoses. She waits to do this until the epilogue.

“When I stopped labeling and talking to myself as a sick person, I no longer was one,” she writes 250 entire pages in. “I reject a diagnosis because none has been proven, but I have or had a mental illness—broadly and without definition,” she continues two pages later.

I have mixed feelings on this. Part of me feels like this is an extremely privileged decision that gives off very toxic positivity “denial disguised as ‘the power of positive thinking'” energy. Maybe it’s her delivery, though, not her message. Part of me gets it. Over the years I’ve had therapists insist—though not formally diagnose—that I was depressed, and “suffering” from PTSD. I knew in my bones that neither of these diagnoses fit—so I rejected the suggestion, and, eventually, found new therapists (a very privileged move).

I don’t know. To me, Fay sounds angry, perhaps scared and alone, and full of internalized ableism. And I think those things overpower the main message of her book.

(Honestly, I was waiting for Fay to reveal that she’s autistic. Each of the six DSM diagnoses that she outlines in the book either commonly co-occur with autism, or are commonly misdiagnosed before a person learns that they’re autistic. And the way she talks about her life experiences, both past and present, sound like so many other experiences that autistic people describe having.

I cannot stress this enough: Although it’s included in the DSM, autism is not a mental health condition/illness. Autistic people often experience adverse mental health conditions/illness as a result of living in an unaccepting and ableist society, but autism itself is not a mental health condition/illness.

I recognize that the phrase “mental illness” is…pathologizing. As are the words “diagnosis” and “diagnoses.” I also recognize that it’s the language that we have right now, to best convey the significance of many peoples’ experiences.)

Overall, I think the book is worth reading or listening to. While Fay fails to acknowledge or discuss many aspects of her argument that I think are crucial to the conversation she’s trying to have, she does make many excellent points about a few things. The book is well-researched, and the information she provides re: the history and usage of the DSM is especially important and valuable—albeit devoid of critical thinking or meaningful calls for action. Plus, there are things she discusses in the book that I’ve not touched on at all here. Respectfully, you should form your own opinion about the book by reading the book, not this post.

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Fay uses punctuation as a device to frame the argument that language (or, I guess, punctuation) matters. It’s an interesting and fun choice. Given my love for language and history, I’m surprised it didn’t work for me.

Two books about the history of punctation that I’ve read and love and enthusiastically recommend to my fellow word nerds:

Semicolon: The Past, Present, and Future of a Misunderstood Mark by Cecelia Watson

Shady Characters: The Secret Life of Punctuation, Symbols & Other Typographical Marks by Keith Houston

While we’re at it, a rec for a book about the dictionary and how—and why and when—words end up in it:

Word by Word: The Secret Life of Dictionaries by Kory Stamper

And two books that are, broadly, about mental health, and that I think offer a more nuanced, responsible, and compassionate take on such a complex topic:

Divergent Mind: Thriving in a World That Wasn’t Designed for You by Jenara Nerenberg

The Collected Schizophrenias: Essays by Esmé Weijun Wang