Hey all,

Recently I've had a really dark period from (ab)using drugs to hide from the pain and feel good about myself. Friends noticed me becoming distant and needlessly shouting into the (social media) void.
One friend wrote me a long message about all these things and his conclusion was that he thought I might be a narcissist. I broke down entirely, the following days were a roller coaster ride of trying to deal with it with high and lows, talking to friends if they also noticed these things but ultimately I couldn't shake the feeling that I had to give in to my friend's accusation to mend our now wounded relationship. People pleasing is in my nature and putting others in front of my own needs is what I deal with and I cope with low self-esteem.

My therapists all said that the accusations is not something they can see myself in but regardless of this I ended up having a suicide attempt. I saw myself as a bad person and that feeling became over-encumbering.

I'm better now, and I feel closer to friends and family after some much needed talks and quitting drugs altogether.

That said, what are your takes on the overlapping diagnoses. It made myself very paranoid and made me spiral at a low point.

Before we start, no, I don't mean "bring politics into" mental health. Politics obviously covers mental health issues, practices, and institutions. However, I've come to realize a certain approach to mental health has taken root in discussions around mental health. This approach is based on the criticism of mental health from an ideological point. It centers on the idea that mental health is treated only as a chemical imbalance in the brain, and that sociopolitical conditions aren't considered. One of the most prominently figures cited for this is Mark Fisher.

“The current ruling ontology denies any possibility of a social causation of mental illness. The chemico-biologization of mental illness is of course strictly commensurate with its depoliticization. Considering mental illness an individual chemico-biological problem has enormous benefits for capitalism. First, it reinforces Capital’s drive towards atomistic individualization (you are sick because of your brain chemistry). Second, it provides an enormously lucrative market in which multinational pharmaceutical companies can peddle their pharmaceuticals (we can cure you with our SSRIs). It goes without saying that all mental illnesses are neurologically instantiated, but this says nothing about their causation. If it is true, for instance, that depression is constituted by low serotonin levels, what still needs to be explained is why particular individuals have low levels of serotonin. This requires a social and political explanation; and the task of repoliticizing mental illness is an urgent one if the left wants to challenge capitalist realism.”

― Mark Fisher, Capitalist Realism: Is There No Alternative?, 2009

This, I think, is true to a degree. Denying the mental or physical results of certain policies benefits the rich. However, this criticism, whether intended by Fisher or not, is often used to reduce psychiatry and psychotherapy to mere, atomized, asocial, apolitical practices.

First of all, this hasn't been true in my case. Sure, I have my criticisms of the procedure and the practitioners, but I've talked about a variety of sociopolitical issues in therapy. I mean, how can you not talk about these issues? There are obviously social patterns in a population, and if they're not bad practitioners, the psychiatrists pick up on them. This doesn't mean that I talked about political theory in my therapy, but among numerous topics, I talked about things like the male gender role, the attached aggression and violence, the effects of emotional repression as a result of traditional roles. I know people who extensively talked in therapy about gender roles, queerphobia, and the associated problems.

Therapy helped me on political issues too. I used to be much more repressed, unable to express my disapproval, unable to handle any conflict. But with the help of psychiatry, I started expressing my opinions, including my disapproval, more and more. This included standing up for myself, and while there are many power structures I can't overcome as an individual, this change helped me better stand up for myself against people who have power over me. It also helps me feel not as much like a piece of shit when I can't, because learning to face my emotions helps me realize I have limits.

But, according to the Fisherian argument I've seen repeated countless times, this isn't what psychiatry does. It just treats you like an asocial animal, which is not true at all. If anything, psychiatry emphasizes, again and again, that humans are social animals, therefore, have social needs, and that not meeting those needs will lead to mental problems. Seriously. Search "humans are social creatures psychiatry" on whatever search engine you use and also on Google Scholar. You'll find, page after page, pop article and scientific article, talking about the importance of this.

The second thing I want to mention is that links between inequality and mental health are an important area of research. You can search for keywords like "socioeconomic status mental health" and "inequality mental health" on Google Scholar to see many articles written about this. You can alternatively replace "socioeconomic status" with "SES" and "mental health" with "mental illness" or a mental disorder of your choosing.

To add further support to my argument, let's look at the textbook "Psychology, Global Edition, 5th Edition" of Pearson, which is a very widely known publisher. It has an entire chapter dedicated to social psychology (Chapter 12). The chapter about psychological disorders, Chapter 14, has the following listed as one of its learning objectives (emphasis mine): "Compare and contrast behavioral, social cognitive, and biological explanations for depression and other disorders of mood."

Let's also look at WHO's mental disorders page (emphasis mine).

"At any one time, a diverse set of individual, family, community, and structural factors may combine to protect or undermine mental health. Although most people are resilient, people who are exposed to adverse circumstances – including poverty, violence, disability, and inequality – are at higher risk. Protective and risk factors include individual psychological and biological factors, such as emotional skills as well as genetics. Many of the risk and protective factors are influenced through changes in brain structure and/or function."

I think one of the other negative things about this argument is that, it denies the possibility that some people face mental illness not mainly as a result of social issues, but as a result of some biological unluck. I haven't checked it out specifically, but I think mental illnesses aren't necessarily mainly a result of social conditions or trauma. I can't claim this with certainty, but neither can the opposing side. However, my approach leaves a possibility open for people who may be experiencing exactly this. Therefore, without knowing, it doesn't claim that certain experiences can't exist.

Before I finish, I want to say that I don't deny the existence of bad practice. I've heard many stories of bad psychiatrists, and even if I hadn't, it would be unrealistic to think they wouldn't have such a problem, considering the problems in education and funding. However, my point is, it's not realistic to say psychiatry overlooks the social reasons for mental illnesses. There may be problems, but in no way they are a shared, distinctive feature of the field.

And last of all, this may be harsh but I think it needs saying, Mark Fisher fell victim to suicide. He's not exactly an epitome of healthy coping mechanisms, and his criticisms about mental health should be evaluated with that in mind. I often think intellectualization tends to come in the way of mental health for, well, intellectual people.

Edit: The last paragraph was poorly explained. I further elaborated here.

Does anyone else completely disagree with that sentiment?

I see it a lot in these communities, and I definitely am not trying to yuck on someone else's yum, but I just don't relate to it. Maybe someone else can explain it better than me?

Like, I feel almost totally defined by borderline. I struggle so much with life because of this disorder. It takes so much time and energy away from being able to focus on normal people things, to the point that I feel unable to live a normal life without a ton of help and therapy.

So I just feel that I really am my BPD.

PS: not trying to stir a pot or anything, it's just a thought I had and wanted to talk about

Hey folks, I have been following The Trevor Project's survey for a few years now and their 2023 one is just presented in a fantastic, easy to read and understand way so I think it's a great resource and worth sharing

The Trevor Project 2023 Survey on Mental Health in LGBTQ young people

BUT, I'm also looking for similar reports focusing on other minoritized populations in particular, or (whether in part or in full) focusing on the age ranges covering college students. I'm struggling to find something nearly so comprehensive, but I'm also not sure I'm looking in the right way. The Steve Fund seems to be a great resource for mental health for students of color, for example, but doesn't have obviously available data like this

Symptoms from my diagnoses of bipolar 2 and social anxiety disorder kept me from working, socializing, forming relationships, and living independently for more than a decade.

I worked my ass off to improve my wellness, and for the past 6 years I have worked as a Peer Support Specialist for 2 different public agencies. I tell my story to other people with mental health and substance issues as part of my work. If anyone’s interested, I’d love to share it here too.

I have a very close friend that has been in the deepest troughs of depression for the past couple of years. They live about an hour away, so though my wife and I try to physically show up to support them whenever we can, that's much less often than we'd like. Their support network is thin, and day-to-day basically consists of only their partner, with whom they live, and who is visibly fraying at the seams.

This person (I'll just call them John for the sake of readability) is currently on medication for their depression and OCD (I'm nearly certain it's Lexapro, can't remember for sure) and has on and off therapy, though they often find themselves at odds with their therapists' perspectives. Some of this is because it feels like the profession has been flooded with folks who lack experience with patients with severe chronic mental illness, and some of this is (I suspect) John's illness distorting their thinking, leading to frustration and anger in the moment that doesn't make sense in retrospect.

John had a particularly bad day yesterday, and after I spent some time with them, we started talking about how they felt like they needed considerably more support than they were able to get in their current situation. Unfortunately, the only option he was aware of was "group homes", which seems like a pretty broad term and I don't know much about what they look like (or how successful they are at helping people like John).

I'm trying to get a sense of the spectrum of options available for people like John who are suffering from severe chronic mental illness. On the one end, there's what we're doing now; regular psychiatry and counseling, and on the other end, I guess, is involuntary in-patient behavioral health/medicine clinics. Being involuntarily committed to such programs has been a source of trauma for them in the past, so I'd like to avoid anything even close to that end of the spectrum, if possible. I know that there are, for example, 90-day rehabilitation centers for folks with substance use disorders (I have a family member that found a lot of success at one of these), but do similar programs exist for folks non-substance-related mental illness? Does anyone have personal experience with any of these programs?

Thanks in advance to anyone who takes a moment to read and share their thoughts; I know this is a really challenging topic.

For the past 3 years I haven't worked in any full-time job because I've been trying to sort my mental illness problems and I started a new Master's degree. Now that I am working on my thesis and my savings are running out, I want and need to find a job.

The problem is that my mental health still isn't where I wanted it to be. I don't think I can work 8h per day. For example right now I'm trying new medication and after around 3 hours of focused work I get tired and sleepy.

I've been applying to many jobs and I feel I'm close to getting one as I'm having multiple interviews per week. So far I've explained the gap in my resume as being severely I'll and needing time to get treatment. But I never tell interviewers exactly what my issues are or that I'm still figuring out how to be at the level of a normal person.

I've been hearing a podcast about a guy who faces the same issues as me and his strategy was to be upfront with his employer and tell them when he is entering a dark period and needs to work less. He works in the effective altruism industry which I think is very different from the rest. I think that if I am as upfront as he is I wouldn't get a single interview.

Tell me what you think. Thanks.

Is this what therapy looks like for other people?

I can't tell you how often I've come to the edge of sharing the following experiences--destructive, traumatic, bizarre: all the opposites of what therapy is supposed to be. For months after the latest incident, I've needed to tell someone. I've struggled so hard with life and with putting things into writing, typing and erasing H-E-L- into the title field on Tildes over and over. Where do you go when therapists are the problem? Then, this morning, I woke up with this idea of squeezing the facts into a lightly comedic lyric. Try as I might, I guess I can't deny my métier. (I can clarify what gets lost in the parody.)

Sing along if you know the tune and have a high tolerance for aural ipecac from the 1980s.

To all the shrinks I’ve known before,
I was ten and your help I begged for.
You said, “Those aren’t real issues,
Please spare some of my tissues.”
You were a shrink I’ve known before.
To all the shrinks who somewhat tried,
Who thumbed their whiskers as I cried,
One had a light-bar toy
And called me a scared boy.
He was a shrink I’ve known before.

The winds of fashion keep on blowing,
With each conference you attend.
The only constant is me going.
What won’t I do for friends!

To the shrink who said, “talk speedier,”
Then stalked my social media,
You came to session with the flu,
And so I got it too.
Now you're a shrink I’ve known before.
One hid his grins with coffee mugs,
While second-guessing my psych drugs.
He phoned the very dude
With whom I had a feud,
Now he’s just a shrink I’ve known before.

The pandemic brought us video,
Any doctor can be seen!
But it’s the same as ab initio,
Behind or just off screen.

To the one who should have HIPAA claims,
Whose spouse listened outside the frame,
I heard him eating lunch,
But you dismissed my hunch,
Now you’re a shrink I’ve known before.
To all the shrinks I’ve known before,
Who apparently could not close doors,
You broke my fragile trust,
So say goodbye I must,
To all the shrinks I’ve known before.