Sincerely,

Sincerity might be both my greatest strength and deepest flaw. My concern with what lies beneath the surface is an aspiration, a compulsion, a phobia, a paranoia. I envy people who don’t care about being sincere, because they’ve got a lot more options. But I’m trapped in being me and can’t do anything about it.

The punishing truth about campus mental health policies

Recently I have seen several articles critical of Northern Michigan University, where last year students received emails warning them that talking about their struggles with mental illness could result in removal from the college  (see link below). I’ve been following this story with quite a bit of interest, because as a college student I was profoundly affected by campus mental health policies, and as a faculty member I’ve served on the committee charged with creating such policies.

What I think is missing from discussion of this news story is recognition that students who want to stay in school while suffering from mental illness are ostensibly punished for suicidal ideation, nonsuicidal self-injury, and other aspects of their disorders (such as eating disorder symptoms) in colleges everywhere. In fact, the only thing really striking about the NMU case is that the school’s punitive policies had been expressed to the students directly, transparently, and in writing, rather than in the usual stealth ways.

At the college where I work, for example, students aren’t explicitly prohibited from expressing self-destructive feelings, but there is a policy that justifies a mandated (involuntary) leave of absence for students with mental illness if they 1) place their own health and safety at risk, or 2) cause others ‘substantial distress’ above a ‘normal, everyday’ level, or 3) are returning from a psychiatric hospitalization. While #1 is well-intended, it isn’t objectively defined, and students find it unfair that some forms of self-destructive behavior (such as nonsuicidal self-injury or eating disorder) result in much more harsh consequences than forms of self-destructive behavior with less mental illness stigma (such as consuming dangerous amounts of alcohol). What #2 means to a student with mental illness is that if your roommate worries enough about you, you might have to leave school, whether or not you want to. And #3 means that if you seek help at an emergency room or elsewhere in order to get through a tough time, you might not be welcome back on campus when you feel the danger has passed.

The language of our policy really troubles me (and I’m sorry that my need for anonymity makes me unable to directly quote it for you). For example, I wonder whose standards get to determine what constitutes a ‘normal, everyday’ level of distress, since it certainly isn’t going to be the level of distress that students suffering from mental illness live with every day. Is the college really requiring students who are disadvantaged by extraordinarily difficult lives to put on a pretty face about it for the sake of their luckier peers?

But perhaps what is most disturbing is how easily a school that considers itself modern and inclusive can get away with legitimatizing bias against people with mental illness. At this college, students with mental illness who have violated no conduct codes nor fallen out of good academic standing can nevertheless be banished from the college just because others find their presence upsetting. The campus community would strongly object to a policy like this if it were directed against students on the basis of their gender, sexual orientation, race, ethnicity, physical disability, etc. It would even oppose applying this policy to students who persistently cause others significant distress by expressing abhorrent ideas. By adopting this policy specifically for students with mental illness, the college is telling these students that they cannot count on same basic rights as anyone else. And though the broader community doesn’t seem to care or notice, the targeted students really do take this message to heart.

I struggled with mental illness for my entire time in college. And one tearful night mid-semester in my third year, when my residence hall leader asked if I had any suicidal thoughts, I answered honestly. As a result I was faced with eviction, which unsurprisingly did wonders for my mental state, and I “voluntarily” withdrew from school because I had few other options. I still have a lot of questions about what happened back then. Did my undergraduate institution genuinely act in the interest of its students when it required me to decide between denying my suicidal thoughts or being forced to leave? When I admitted feeling suicidal that night, was I asking to be removed from college and placed in the mental health system for my own good? Or did I just make a stupid mistake that dramatically changed years of my life in a largely unwelcome way? Decades later I’m still not sure.

There are sometimes very good reasons to require students to take a leave, to protect those who aren’t able to freely choose protection. Indeed, my own sad story might have been even worse if I hadn’t been forced to withdraw when I did (we will never really know). Regardless of the intent of mandated mental health leave policies, though, the students faced with them quite reasonably feel disenfranchised; and the fact that these students realistically fear being punished if the college knew the extent of their suffering prevents them from getting help. I don’t know what the answer to this problem is, but the problem is far more complicated and widespread than either the administrators or the students closest to these policies are going to be willing to admit.

Reference: http://nymag.com/scienceofus/2016/09/a-school-is-threatening-to-punish-its-suicidal-students.html?

Being unfuckwithable

Last year I was bullied by several students who thought they could pressure me into giving them higher/easier grades. They tried everything they could, including manipulation, lying, disrespectful behavior, turning their classmates against me, and complaining about me to other faculty. In the end, all my students received the grades they had earned based on my syllabus and grading rubrics, so the bullies did not succeed. But the bullies did manage to make me feel so awful that I stopped bringing my class the level of enthusiasm and finesse that my non-bullying students deserved. Now that I am preparing for the Fall 2016 semester, I find that planning the course material is the easy part. What I am most worried about is preparing for how I’d handle it if a student tries to bully me, so that it doesn’t take so much of a toll on me and my work.

I’ve come to realize that while student bullies can be a challenge for any professor, I have a particularly hard time with them because after being mistreated early in life by my father, my more popular classmates, and others, I spent too many years believing I didn’t deserve any better. For instance, among the people I considered my closest friends as a teenager, several openly excluded me from many things because I wasn’t ‘cool’ enough, another threatened to hit me, and a third offered my boyfriend a secret sexual relationship on the side. How did I respond to my so-called friends when they behaved like this? I made efforts to please them by trying to accommodate the new terms they were setting for our friendship, and even gave them elaborate, hand-made gifts! Similarly, even after relationship partners repeatedly cheated on me or engaged in other manipulative behaviors, I stayed with them until they decided to break my heart by moving on.

I think this history helps explain why when someone treats me with disrespect (or worse), my first reactions are to freeze and to doubt myself, thinking that I must have done something to deserve it. But such reactions are particularly problematic in the classroom, because when my students begin to perceive cracks in my authority, their bullying attempts quickly escalate. As a result, even students who aren’t bullies have complained that I seem to lack the personality of someone able to stay in control of the class.

Armed with the realization that my students’ behavior is triggering painful memories, my plan is to try to focus on the ways the current bullying situations differ from the earlier ones being brought to mind. I do not care if my students like me; I do not need them to like me. I completely reject the idea that only naturally dominant, extraverted people can be effective college professors worthy of respect. Regardless of whether any student perceives me as authoritative-looking, I actually HAVE authority over my class, in that no amount of bullying will stop me from grading each student according to my own standards. I am hoping that reminding myself of these facts will help me feel less flustered and self-blaming the next time students try to pressure me, and in turn, help me come across as more authoritative over time.

No comment

A month ago I stopped participating in discussion forums about ketamine because I was finding them too stressful.  It was disturbing to me to see desperate people asking for and receiving medical advice from random strangers on the internet — because apparently they don’t have a doctor to ask (and sometimes don’t even think they should have to have one). But I also got really tired of having to defend my treatment and how I feel about it to random strangers. The worst are the ones who know just enough about ketamine research to express their opinions using scientific jargon, and then talk down to me when I don’t accept that kind of ‘splaining as a substitute for real empirical evidence.

My recent post “Going for depression treatment, not for tripping balls” was written largely in exasperation with posts by fans of intranasal/oral ketamine, who are for some reason personally invested in hyping up alleged dangers and problems with IV ketamine. (It seems inordinately important to them to believe that their treatment is better than IV ketamine, and to distinguish themselves from IV ketamine patients by characterizing us as stupid, risk-taking drug abusers.) Even after I left the discussion forums to avoid this shit, I’m still frustrated by people trying to post comments of this nature on my blog!

Comments are welcome here, but ultimately, this is my personal blog about my own experiences, not an open discussion forum. I don’t need to give equal time on my blog to whatever concerns you may have about the treatment that is saving my life. Since I don’t work for a health insurance company, I have no interest in using my blog to promote the obviously profit-driven (rather than science-driven or patient care-driven) views these companies have about ketamine treatments. Finally, I will not post comments that make broadly scientific-sounding claims without providing any actual references to published research. Moderating open discussions responsibly is hard, too hard for me to be willing to take that on now. But I’m also not willing to let my blog become a vehicle for spreading stigma and misinformation.

Not forgiving, but moving on

Many have suggested that forgiving my father would be a fundamental step in recovering from how he treated me. Of course my father is among those who have repeatedly tried to make this point with me, arguing that my failure to forgive him is yet another of my many self-sabotaging character flaws.

But I think the emphasis on forgiveness in our culture places an unfair and unnecessary burden on victims. Not forgiving doesn’t mean I am “stuck” in the past, on the contrary it means I am refusing to let my abuser continue to dictate the terms of our relationship. I am moving on by walking away.

An essay that I wrote about this, called “On not talking to my father” was published in an on-line magazine on 9/30/15, though apparently the link is now dead and the essay nowhere to be found. Since this piece was far too difficult for me to write to let it just disappear, I’m going to re-post it below. (I’ll remove it from here if the published version is restored, but I have no idea if that will ever happen.)

On not talking to my father

A few years ago, I decided to end my relationship with my father. I would still be polite to him at family gatherings, but would not engage in private conversations with him or read his e-mails. I told him I needed to set these limits because he had hurt me so badly growing up and had continued to say things that took a toll on me — and because I had come to realize he was never going to understand, feel sorry, or change.

His primary response was to become preoccupied with the question of whether or not I thought he was a monster, and also to become very insistent that he was not one. For months, he repeatedly went on rants about this to anyone in the family who would listen. From my perspective, the whole monster/non-monster question was irrelevant, but also more evidence of the futility of trying to mend things between us. He was trying to reduce the concerns I had expressed to a ridiculous caricature that could be readily dismissed, and to frame the impasse between us as if he were the one being victimized. Once I reassured him that he was not a monster, his concern about my decision to keep my distance from him subsided, and we went several years with only minimal contact.

My father’s anger is extreme and extraordinary. When he thinks that someone is doing something wrong, he becomes fixated on the idea that everything is about to be ruined, and becomes completely focused on getting this person to change his or her ways. Typically, this involves a loud stream of insults and expletives, accompanied by dramatic gestures. Once in a while he kicks or smashes and breaks something, cries, spits, threatens suicide, or suggests that the person making the infraction may as well kill themselves (since they’re ruining everything anyway). Afterward, he explains the whole incident in terms of something having made him “blow up,” as if he had little control of his actions once that something occurred. Over time I’ve come to realize that he doesn’t even remember most of these incidents or what had triggered them – because those memories are obscured by whatever is making him upset today. The current issue is the only one that matters, and it obliterates everything.

Apparently, sometime in childhood, I developed a habit of constantly doing things that could ruin everything. I got off to a bad start by not being born a boy, an extravert, or athletically talented — so when I came home in tears because I was being bullied in school, my father lashed out at me for not having been popular or tough enough to have won the bullies’ respect. I was also somehow incapable of writing a college-level paper at age 14, and while I had excellent grades, I never did anything that would make me a star. But I have to admit that some of the ways I most seriously disappointed my father were by choice – choosing to not to be interested in sports, wearing what my friends were wearing rather than styles my father would have found attractive, becoming a psychologist rather than a medical doctor, and so on. Often I was so oblivious to the objectionable nature of my choices that my father’s hateful reactions to them took me by surprise. One Sunday morning when I was about 8, I was quietly entertaining myself with a craft project when my father came into the room, grabbed my creation out of my hands and threw it away, shouting “What the fuck is this garbage?!!” Another odd violation I once made was to put sugar on my waffles rather than maple syrup. Suddenly my father was yelling at me that I was stupid and going to get fat and lose all my teeth — and my attempt to explain that maple syrup contains just as much sugar did not help matters. In fact, as I got older and tried harder to defend myself, he started mocking my voice in some exaggerated aristocratic tone, and saying that I might have friends if I didn’t act so uppity.

After his explosions I’d go to my room and cry — a lot. I found it very hard to stop crying, in part because I knew that what I was expected to do was to come out of my room and smile and act like nothing was wrong. Even just thinking about that would get me to start crying again, because it felt like having to betray myself. My father never physically bruised me, and in the presence of others he was the charming, actively involved parent many kids might wish they had. The brutality I experienced about twice a week for more than a decade seemed invisible to everyone else and I was determined to bear witness.

Often, after these incidents, my mother would tell me that I had to stop crying because it was making my father upset. A few times my mother started crying too, and said that since the rest of the family couldn’t treat each other decently, she wished she could just leave us and live on an island alone somewhere. I couldn’t even imagine losing her, and I was frightened and ashamed to think that in her eyes, I had done something to deserve that. When I was hospitalized for depression, anorexia, and suicidality at age 20, and a therapist confronted my mother with questions about abuse, she finally acknowledged that my father had been emotionally abusive to me. It meant a lot to hear her say that — but even then, she was quick to say that my father had never intended to hurt me. Apparently she had married a rare specimen of man-toddler who was capable of all kinds of intellectual accomplishments and other admirable things, but simply could not be expected to control the tantrums of the two-year-old inside him. She was trying to say, in other words, that he wasn’t a monster, but someone worthy of our care and helplessly in need of our patience.

Seeing my father’s cruelty as merely incidental to his good intentions kept me trapped in self-doubt. Why was I too stubborn or stupid or spiteful to be grateful for the intensity of my father’s commitment to my well-being? When I was in high school, he had cared enough about my future to tear up a several-inch-thick college guidebook with his hands and leave it at my place at the breakfast table where I would find it the next morning in the presence of a friend who was sleeping over. Just looking at that pile of torn pages, the conviction and rage required to have done that was obvious. It was as if he symbolically tore me to shreds to show me how wrecked and useless he could see me ending up if I kept failing to take his educational/occupational advice as seriously as it was intended. Perhaps my friend, who probably didn’t have a father who cared enough to leave a hand-shredded book at the breakfast table, should have felt jealous?

My father cared so much about me fulfilling his dreams that he was incapable of appreciating the person I actually was — and this did not make me feel grateful, it made me feel hurt and angry. Yet because my father continued to hurt me without intending to or even knowing that he did so, my anger was targetless and voiceless, much like the nightmares I still have in which I’m trying to yell and unable to make a sound. As I got older and saw friends grieve the loss of their parents, I started to wonder if I would someday be glad that I was continuing to try to understand and comfort my father after more than 40 years as the recipient of his oblivious disdain. But eventually I decided that the answer was no. Although I can’t predict how I’ll actually feel when he dies, I’ve come to realize that I have the right, as well as a need, to not maintain a relationship with him.

After several years of not talking, my father and I were recently forced to spend a lot of time together while waiting to visit another relative in intensive care. As I watched him try to exert control over several family members’ lives — and disrespect their own choices — I felt overwhelmed by emotions from the past, and told him so. His response was, “I know I wasn’t perfect as a parent. But as a psychologist, what do you advise a parent to do when they have a child who is like a drug addict, throwing her life away?” I was so stunned by his question that my response was incoherent. But I know what I’d say now. If I were advising the parent of a child with a serious psychological problem, I would suggest that the child get professional help – the thing he repeatedly prevented and dissuaded me from doing when I needed it. Moreover, what he views as me throwing my life away were just examples of me making age-appropriate choices that happened to differ from his own preferences.

The thing is, even though I knew by early adolescence that I often disagreed with my father and the tactics he used to teach me lessons, I absorbed his lessons anyway. What he taught me is that I am undeserving, selfish, stupid, ugly, backwards, uppity, friendless, crazy, and unable to trust my own judgment. Not talking to my father hasn’t erased those basic views of myself, but it has definitely been a step in the right direction.

Going for depression treatment, not for tripping balls

I’m traveling nearly all day today to visit my doctor for a ketamine infusion, as I’ve been doing approximately every 3-5 weeks. I don’t look forward to doing this, so I tend to procrastinate on making the appointment and feel a bit anxious the night before, just as I would with an appointment for dental work or a mammogram. But I continue doing it because it has helped keep my feet on the ground (rather than in a depression hole) for most of a year, something no other previous treatments were able to accomplish. When weighed against the risk of falling back in that hole, the risks associated with this peculiar and poorly understood treatment are a reasonable trade-off in my case. If I had a less serious depression that could be reasonably managed any other way, the cost-benefit ratio would be much different and I wouldn’t be doing this.

I certainly don’t do this because I want to. The treatment sessions were interesting at first because they feel so different from anything I’ve experienced in waking life and I’m a generally curious person, but I have no desire to keep repeating them. If there were a way to get the benefits of this treatment without the hour of dissociation I would absolutely choose that. It would be so awesome if a ketamine metabolite (or something similar) could be developed as an antidepressant with the same benefits and lack of daily-life side effects as monthly IV ketamine – but with no trippy infusion, no needles, fewer risks, no traveling, lower expense, and no drug-abuse stigma. But at this point in time, empirically supported alternatives like this are not available.

Now, just in case you are one of those people who is going to try to tell me that taking much smaller doses of oral or intranasal ketamine at home on a frequent basis is a good alternative to monthly IV ketamine in a doctor’s office, I’m not going to consider that until I see some research evidence on the effectiveness and safety of this approach for treating seriously depressed human patients. At this point in time there is NOT EVEN ONE published study evaluating taking ketamine at home, and my disorder is too severe for me to voluntarily take a chance on a remedy without empirical support. Yes, there is one study to support doctor-administered intranasal ketamine, so I do have the option of traveling all day to dissociate on that every month in a different doctor’s office. But why? The IV treatment is working, and I have no good reason to switch. I’m certainly not going to switch just to avoid having random strangers label me as a self-destructive drug abuser.

The drug abuse stigma many people seem to attach to my depression treatment is hurtful and to the best of my knowledge, unsubstantiated. Yes, there will be irresponsible clinics administering IV ketamine more readily than they should and some patients will end up abusing it — but that risk also occurs with many other medications (including anxiolytics, stimulants, sleeping pills, and the currently available forms of oral/intranasal ketamine). If you are one of those people who is going to feel compelled to tell me that IV ketamine poses a uniquely unacceptable and stupid addiction/abuse risk, I’m going to need you to cite empirical sources to explain how this risk (a) is worse than with the many addictive medications patients can use unsupervised at home, and (b) outweighs the benefits of the treatment.

Some of the scary claims being made about the addiction risk of  IV ketamine treatment — in unmoderated discussion forums and in obnoxious comments that people have unsuccessfully tried to get posted on my blog — could easily be the basis for an updated ketamine-centered version of the 1936 movie Reefer Madness, with subplots that sound like paranoid conspiracy theories. Even when the people making these claims are doing it out of a desire to protect the public from harm, their Ketamine Madness story overlooks how harmful depression can be without effective treatment. It also overlooks how harmful it can be to stigmatize others for their health conditions and healthcare needs.

Stigmatizing IV ketamine is likely to prevent depressed and suicidal patients who have run out of other treatment options from getting potentially life-saving help. And if mental health professionals share these stigmatizing attitudes, they’ll be pushing some of their most desperate patients to take the underground route of seeking the medication from a sleazy clinic with inadequate psychiatric care and frightening consequences. For many of us with severe, treatment-resistant depression, IV ketamine may be the last or best available option we have while waiting for research to develop better solutions. We need doctors who are open to working with us and to helping us make safe, reasonable decisions about ketamine. We need the support of our families, friends, and others in our community when we pursue treatment. Stigma is probably the last thing that we need.

Ketamine for depression: Tough talk and a warning

Ketamine infusions aren’t anything like going to a spa or meditative retreat for rejuvenation, deep insights, or personal growth. They are a medical procedure for a serious illness, with many similarities to going for ECT.  I feel the need to say this because as someone who really believes in the future of this treatment I think a lot of the public hype about it is becoming dangerous.

People seem to be expecting ketamine treatment to be the definitive answer for their suffering when nothing in life really works that way.  They are waiting to experience some kind of sign during or right after their infusions, rather than understanding that all recoveries require time, effort, adjustments, and so on. But more frightening is the related tendency for people to downplay the need for psychiatric supervision while receiving this treatment. Depressed people are being tempted to seek help from anyone who can administer ketamine without seeming to realize how risky this is. Too many are relying on internet forums for crucial information and support because they lack sufficient professional care. And some of the patients doing improvisational ketamine treatments with inappropriate providers don’t seem to have exhausted other proven options, such as psychotherapy (or TMS, ECT, and so on). Taken together, these trends are very alarming.

Doctors need specific expertise to be able to provide ketamine treatment effectively and safely. They also need to be closely monitoring your mental health, overseeing all your various medications, and addressing your questions/concerns (or communicating with a mental health professional who has responsibility for these aspects of the treatment).

If your depression is severe and treatment-resistant enough to require an experimental treatment like ketamine, it is definitely serious enough that you need psychotherapy and/or another form of careful monitoring by a mental health professional. Please, the possibility of hospitalization ought to be kept in mind, at least as a back-up plan, if you are thinking you need to start this treatment. That people’s first impulse is instead to find some doctor willing to play around with giving them ketamine as part of an uncharted and incredibly expensive do-it-yourself project suggests that the hype about ketamine being a quick and easy miracle cure has gone way too far.

I understand all too well that people suffering from depression feel very desperate. And I know that some of the doctors hanging up their shingles as ketamine providers genuinely believe they are going to help these people (and not just cash in on their desperation). I am just afraid that people are going to end up getting really hurt.