Escape from ‘codependency’ treatment

At the time of my first hospitalization for depression and suicidal urges, during my junior year in college, I was badly broken by the loss of a relationship, again.  The term ‘codependent’ was a hot new thing back then, so both in the hospital and subsequent residential treatment I was required to participate in addiction groups. I had no problems with substance use — I was just supposed to mentally substitute the idea of a boyfriend in the place of alcohol or drugs whenever they were mentioned by the group or in the reading materials. People kept telling me: “You can’t love anyone else until you love yourself.”

As someone who was raised to hate myself, I found that statement a vicious circle, a trap, one of the most depressing things ever. I was a psychology major and I knew enough about unconditional positive regard and secure attachment and so on to know that people don’t develop healthy self-concepts in a vacuum, they do so through loving relationships. What is a person supposed to do, then, if they didn’t receive what they’d need to love themselves, and therefore aren’t equipped to love others but only get addicted to them and hurt by them?

The impossible instructions I got were that I shouldn’t be allowed to become really attached to anyone until I had spent enough time alone to somehow figure out a way to love myself. OK, not entirely alone, because I could still have my therapist, and my addiction group. As if their alienating piles of pamphlets about alcohol and higher powers were going to comfort me, let alone help me feel something for myself that I didn’t know how to feel.

I felt that I was being criticized and blamed for still wanting relationships. I was being seen as leaving too large of a relationship footprint — after all, in my hand, a loving hand became nothing more than a dangerous substance! In this view, my basic need to connect with others was destroying more than it was helping, making me a burden. Seeing myself this way only strengthened my wish to die, and I started fantasizing about ways I could get myself killed and turned into food for homeless cats.

What I did instead was leave residential treatment with another patient, to start a life together – after we signed forms acknowledging that we were going against medical advice by doing so. Our relationship, which didn’t last, was difficult even from the very beginning. But it was a way out and a way forward for both of us.

I fully understand that people with low self-worth are in danger of being mistreated in relationships, and are unlikely to be able to enjoy or give as much healthy love as others without this vulnerability. Treatment should help us to get better at recognizing when we’re at risk and thriving when we’re not. But a treatment that teaches us we’re unfit to be in relationships is not going to improve our self-worth or our relationship skills. I was lucky to escape.



Chris Cornell’s death hit many of us quite hard, and one of the things I keep hearing is that it was especially hard because he was someone who had beaten his demons. I saw very similar comments when the toxicology report recently came out about Carrie Fisher’s death.

There is no denying that it is hard. Mental illness is really hard. But that so many people consider relapses and suicide risk shockingly unexpected outcomes of mental illness suggests a profound misunderstanding of what it means to battle it.

Despite what movies might have led you to believe, mental illnesses like depression and substance use disorders don’t have a single cause — and treatment rarely is a matter of exorcising particular demons (or memories). Even psychologists who believe that there is something to be gained from reaching into and airing out a traumatic past believe that this process requires repeated, painful efforts over a long period of time, and that success in this process is rarely complete or permanent.

Rather than derive information about surviving mental illness from movies attempting to depict therapeutic treatment, consider the horror genre.  When it seems as if the evil creature has been killed, but it comes back alive after you’ve breathed a sigh of relief, that is what battling mental illness is like. When you’ve discovered that the threats are coming from inside the house, from a place or person you trust, that is what battling a mental illness is like.  And we’re often talking about recurring battles over a lifetime, in which the enemy might lay low, call a truce, and fraternize with our side for a time. We need to celebrate each battle that is won without prematurely assuming that the war has come to a happy end. Labeling someone as a “success story” might make it more difficult for them to ask you to be there at their side, ready to continue the fight, when the enemy silently regains enough strength to attack again, as it often does.

And just because we’ve won the battle doesn’t mean we’ve won the war.


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.


Surviving until I could make my life worth living

I’ve spent most of my life wishing I were dead, and as a college student I tried to kill myself. The story of my survival, and of my promise to never try to take my life again, is posted today on the Active Minds blog, here:

Since this seems to be a broken link, below you’ll find what used to be posted there:

According to the Interpersonal Theory of Suicide (Van Orden et al., 2010), desires for suicide arise from a combination of perceived burdensomeness and thwarted belongingness. The capability for suicide is separate from this, and many people experience persistent desires for suicide without capability for it. That was the case for me for most of my life.

I’ve almost always felt like a burden –which makes sense considering that my father, frustrated that I didn’t have the attributes he had wanted in a child, frequently said I was a burden. When I cried, he reminded me that unlike many children in the world I wasn’t being beaten, wasn’t impoverished, had both my legs, etc. He taught me to see my depression as another sign of my selfishness, and did his best to prevent me from getting help.

Thwarted belongingness has been a longstanding problem for me too. Growing up, I felt as though no one in the world could accept or understand me, and this made me vulnerable to putting up with rather rotten behavior on the part of friends and romantic partners who had once thrown me a few crumbs of kindness. Repeatedly, after a friend or partner started to bully me, threaten me, use me, cheat on me, abandon me, or otherwise treat me badly, I assumed I somehow deserved it (for being too boring, too needy, insufficiently giving, and so on). I would then spend several years mourning the loss of what we’d once had, just hoping that somehow they’d come back and care about me again that tiny little bit.

Of course, interpersonal problems – such as feeling like a burden and feeling alone — go hand in hand with depression, which I’ve had since childhood. Often interpersonal problems are the stressor that makes someone with a vulnerability to depression begin to have far worse symptoms than before. Depression also has a way of exacerbating interpersonal problems and separating us from others. Some people become frustrated with our depressive behavior and reject us, and because we fear this happening, many of us pre-emptively back away from people who might have been accepting if we had let them.  

I’ve had several severe depressive episodes, but the only time I ever tried to kill myself was in college, because it was then that I felt most alone. Everyone I knew was facing their own changes, going in different directions.  I felt that no one could stand to be around me, and I couldn’t stand to be with myself either. I felt sure that I was a burden and that my death wouldn’t matter much to anyone.  But I survived and afterwards just went on as if nothing happened.

Though I continued to have very strong suicidal wishes, I never made another suicide attempt because I started to worry that killing myself might make me MORE of a burden, rather than less. First I thought that I couldn’t kill myself because I didn’t want other people to have to clean up the messy state in which I keep my personal belongings. Then I told myself that I couldn’t do it because my cats needed me. Finally, I started believing that it would cause other people emotional pain if I killed myself, and I resolved never to do it, no matter how much I didn’t want to live. 

While my depression and isolation were still quite severe, I remained very tempted to kill myself and was afraid that I may not be able to resist. So during my third year of college I admitted myself to the hospital and then went to live in a residential treatment center. From there, I resumed college classes and applied to graduate school in psychology.

Today I am a college professor. I work hard to manage my mental illness, with ongoing treatment and making healthy lifestyle choices (including carefully choosing caring people for companionship). Without depression clouding my vision, my long-held assumption that I am a burden no longer seems indisputable, because I think I do make a difference for my students and other people close to me. I’m not just waiting to die, but trying to make the rest of my life one worth living.

Re-thinking self-injury

Deliberate self-injury is puzzling to many people. Heck, it is still somewhat puzzling to me — even having experienced it – for reasons I’ll explain below. Of course the experience is unique to each individual, so I’m not saying that my own is necessarily typical, but I think it may be helpful to talk about anyway. Also note that I am deliberately going to omit the details about what I did to hurt myself, because I don’t think those details are helpful to talk about.

There have been two distinct periods in my life when I was frequently self-injurious. One was during my third year of college, and the other was over twenty years later. Not coincidentally, these are also the two periods in my life in which my depression eventually became so severe that I required hospitalization. I didn’t have more than passing thoughts about hurting myself during the decades in between, or in the years since.

I only started having problems with self-injury after I survived a suicide attempt and promised never to try to kill myself again. When self-hatred and self-disgust were so strong that I really wanted to die, injuring myself just seemed like the healthier of the only two options I could think of. In this (extremely limited) sense it worked, and in its aftermath I often felt more welcome to remain part of the physical and social world.

To those who would dismiss self-injury as a form of attention seeking, I’d counter that I almost never told anyone about what happened, and that the only times I did were in a proactive effort to stop. I also want to emphasize that there are biological factors involved. In my own experience, I think among the reasons I had such powerful urges for self-injury at these two distinct points in my life were things like extreme sleep deprivation and going through withdrawal from antidepressant medication (Nardil).

What is most inexplicable to me about my self-injury experiences is that they really felt as if I were being taken over by forces much more powerful than myself.  I also felt as if my self-hatred and self-disgust were strong enough to destroy the whole world if not given a more limited outlet.

Looking back now, it is clear that the thoughts/feelings I had about self-injury, and about suicide being its only alternative, weren’t quite realistic — and I’d like to think that next time I’d be less inclined to consider self-injury as a readily available outlet for my internal pain. Instead I’d want to consider other possible ways of making it through each hour at a time, ways that would ultimately make me feel better able to cope. For me this involves promising myself that next time I won’t work so hard to hide my struggle with self-injury, but instead ask carefully selected people to help distract me, wait with me, and guide me through those times. Though my depression has currently receded and self-injury is now quite far from my mind, I want to learn from this especially difficult aspect of my past to be better prepared for the future. Because sometimes life don’t leave you alone.


“…It’s an art to live with pain,… mix the light into grey,..
Lost 9 friends we’ll never know,.. 2 years ago today
And if our lives became too long, would it add to our regret?
And the young, they can lose hope cause they can’t see beyond today,…
The wisdom that the old can’t give away, Hey,…
Constant recoil…Sometimes life don’t leave you alone…”

Love Boat Captain by Pearl Jam (2002)

Medication sickness

I’m “sick” today — not with anything contagious — but with flu-like symptoms from trying (again) to decrease my dose of Mirapex. I had tried this last month and chickened out when I started feeling so lousy, but I’m trying again now in order to be finished with these withdrawal effects before classes start. (I’m not necessarily aiming to go off of Mirapex completely, but hoping that lowering the dose might stop me from compulsively grinding my teeth all day, a problem that I’ve clearly developed as a side effect of the drug.)

As I wrote recently, I find the temporary side effects of ketamine to be minimal compared to what I’ve experienced on FDA-approved medications. So while I have my Mirapex sickness on my mind, I thought this might be a good time to describe what I have been through with some of the medications I’ve tried. After all, feeling sick is a relatively mild withdrawal effect compared to the intense self-injurious urges I experienced while withdrawing from Nardil, and remembering this may help me maintain a sense of perspective.

  • Abilify: Pronounced weight gain (and when combined with Nardil, an inability to sleep for more than 2 hours at a time even with sleeping pills).
  • Ambien: After about 10 years of taking it, I suddenly started doing odd/scary things while asleep, like trying to cook or dye my hair.
  • Effexor: Compulsive tooth grinding, chronic GI problems, tension, sleeplessness, and headaches if I was even slightly late to take my next dose. Years ago I spent several months trying to slowly taper off of Effexor, and still, the headaches I experienced were unbelievable. I was only willing to use Effexor again when my doctor promised that to go off of it, I could first switch to a related medicine not associated with such severe withdrawal. (She had me switch from Effexor to Fetzima, and then withdraw from that, and this process was fine.)
  • Emsam (the MAOI skin patch): I was allergic to something in the adhesive, so I’d get an itchy red rash under the patch that would remain several days after the patch was removed. After 6 weeks of using Emsam I had patch-shaped red rash marks pretty much everywhere.
  • Imipramine: persistently dry mouth and sleepiness (with no clear benefits)
  • Mirapex: compulsive tooth grinding, flu-like symptoms while reducing the dose
  • Nardil: For a while this medication really helped me, and having limited options I was on it for years despite seriously annoying dietary restrictions and numerous side effects. My side effects included sudden leg cramps while sleeping, micro-sleeps during the day, fainting upon standing, hands and feet losing circulation (one time resulting in a bone fracture in my foot), hospitalization for a blood-pressure spike caused by eating soy sauce, intense dreams, chronic GI problems, and trouble sleeping. The withdrawal effects were also unexpectedly severe; I experienced extremely intense urges to injure myself, intense enough that I often couldn’t resist. The timing of this was very clear: several days of self-injurious behavior started each time that I decreased my Nardil dose.
  • Navane: Unexpected lactation requiring carrying around an extra jacket.
  • Parnate: Feeling feverish and weak for about 1-2 hours after taking each dose. And intense dreams that had me frequently yelling and kicking in my sleep. I thought this drug helped so I stuck with it for several months, but the side effects never went away.
  • Paxil: Nausea, GI problems, feeling emotionally numb and really spaced out (with no clear benefits)
  • Prozac: Anxiety/tension and GI problems (with no clear benefits)
  • Wellbutrin: Trouble sleeping. And also a seizure, that happened right in the middle of giving a presentation during graduate school.

Ultimately, medications have been helpful for me — sometimes a little and sometimes a lot. But living with this stuff sure isn’t easy.

Seeing it

“For a long time I’ve felt certain that my life is simply not worth what it costs to keep going, but I’m staying here to fulfill what I see as my obligations.”

These were my closing words to an unsent letter I wrote a few years ago. The “obligations” that the letter refers to were to never put the people I care about through the pain of my suicide. I had survived a suicide attempt in college, but over time I had resolved to never kill myself no matter how much I wanted to.

Re-reading my letter now I’m not surprised that I wrote what I did, since I’ve felt like a burden for nearly all my life and have had chronic depression with recurrent suicidal desires.

What does surprise me, though, is the context in which I wrote this.

First, I wrote this in the early months of a depressive episode that eventually became so extremely severe that I guess I had forgotten just how bad it had been even the year before.

But more than that: I wrote this letter on the day that I got my job as a college professor, a job I had been working towards for two decades. Most of the letter describes how the job offer was wonderful and far exceeded my greatest hopes. But as a person who has suffered from depression since childhood and who was several months deep into a depressive episode at the time of my job interview, even having such a clear cause for celebration could not stop me from feeling that I’d rather be dead.

When you’re living with depression, in the whole thick mess of depression, you know your own depression but can’t really see it — because it becomes a part of you and a part of your vision. Looking at this letter now, I actually see it.