After 11 years in New York City, at the age of 46, I was ready for a change. So I decided to move to the city that had fascinated me since my childhood in rural Maine: New Orleans.

In New Orleans, I imagined as I packed up my small apartment, I would live in a place with lofty ceilings, shuttered windows, slowly spinning ceiling fans, and, that precious luxury in New York, a yard. Or a porch. Or a balcony. In any case, not a fire escape.

In New York, I worked long hours as a copy editor. In New Orleans, I envisioned life, like that ceiling fan, moving at a gentler, more rhythmic pace. Instead of getting by in a city that often treated strangers with indifference, disdain, or outright hostility, I would finally feel like I had found a place to call home, a place that greeted strangers with warmth. I would host parties with my roommate and partake of everything that made New Orleans New Orleans: live jazz in small clubs, costuming on Mardi Gras day, and eating grilled shrimp po’boys from the corner store, boiled crawfish in someone’s backyard, hot beignets when friends came to town, and creamy, buttery bowls of that Southern staple, grits.

It all came to pass: a fine apartment, parties, and the food. Except the grits. I had been living in New Orleans for a little over two years before I finally ate them, in a psychiatric facility in Broussard, Louisiana.

Of course, the move from New York was challenging, and it took a year before I felt settled in New Orleans. But when I did, I felt like I had finally arrived in a place to call home. I pitied people who had to make their homes elsewhere, in staid cities or relentlessly ambitious ones. Anyplace else seemed drab in comparison.

I loved the architecture—the Creole cottages, the shotgun houses, the Garden District mansions. I loved the graveyards with their sunbaked mausoleums that contained the bones of generations of families, and the lizards that scuttled across the marble and stones. I loved the music that defied time, drifting from houses in the morning, the midafternoon, the evening. I loved how saying “hello” or “morning” to someone you passed on the sidewalk and had never seen before was just a part of being part of the city’s flow. I loved the French Quarter apartment a new friend and I found. The wraparound balcony allowed us views of both Esplanade Avenue and Burgundy Street, and I would lift one of the floor-to-ceiling windows in my bedroom to access it. I loved the strands of Mardi Gras beads that dangled from people’s porches and fences and from the trees on St. Charles Avenue; I even loved the beads of broken necklaces that lay in the street when my bike tires crushed them; they gave a satisfying pop, one last burst of color.

And perhaps most of all, I loved who I was in New Orleans. As an adolescent, I’d been so afraid of people that whenever someone knocked on our front door, I’d hide, crouching low beneath a window or wedging myself behind the chimney. When I left home, that fear released its grip ever so slightly, but I still spent decades believing I shouldn’t occupy too much space or attract too much attention because I wasn’t worthy of it.

In New Orleans I felt free to expand. Although everything in New Orleans felt new to me, I knew I hadn’t discovered any of it. New Orleans had allowed me to discover myself. I finally felt like I belonged, especially on Mardi Gras when the celebration and the liberation from the everyday courses through people, linking them all.

My second Mardi Gras, when I’d been living in New Orleans for a year and a half, I came up with a theme for my costume: Death Takes a Holiday. I strolled with friends through the Marigny and the Bywater in a green lace bra and a multicolored sarong with thin black suede gloves, a small, tattered black silk umbrella, and a black veil as my accessories, and beach-ready flip-flops. Crossing back over the railroad tracks that run parallel to Press Street, I lay down for a photo after positioning my arms, legs, and umbrella carefully. I may have resembled a colorfully attired corpse, but I had never felt so triumphantly alive.

Early one morning when I was headed to my favorite coffee shop for my daily mocha before I began work, I passed two young women, both dressed in strapless black evening gowns with elbow-length black gloves and high heels. They were still giddy from whatever evening they were just returning home from. “How are we ever going to live anywhere else?” one woman asked the other, and I understood exactly what she meant.

Broussard is 140 miles southeast of New Orleans, roughly a two-hour drive. But in respects other than geographic, it’s much further away. Broussard is part of Cajun country, something that patients from the area—which was most of them—remarked on.

“I’m a coonass,” one of the patients said with a laugh as we stood around the nurses’ station waiting for a technician to unlock the room where we ate our meals and, during recreational therapy, colored worksheets or painted ornaments. She was a woman in her early sixties who applied her makeup at the nurses’ station every morning; her Michael Kors wardrobe had drawn several comments from the techs when they were unpacking her suitcase and cataloging its contents shortly after her arrival. The only other time I had heard “coonass” spoken with pride and affection was in a roadside bar in a random little town, where a patron had introduced herself to me and my road-tripping friends from New York.

When the other patients found out I was from New Orleans, their response was “How did you wind up here?” They weren’t asking how I had wound up in a psychiatric hospital—we were all there for a mental affliction or an addiction or in some cases both. They couldn’t understand what I was doing so far from the city.

I had trouble understanding it myself. I knew the immediate series of events that had brought me here: the four-month slide into deepening depression, as the antidepressant I’d been on for the past 21 years resisted any add-on medication my psychiatrist prescribed; the decision to commit myself; the snarled plans, and the trip to the hospital emergency room. But what I couldn’t quite fathom was how my sense of myself, solid and secure, had vanished so quickly. Just six months earlier, I’d been playing pool, badly but joyfully, and dancing with strangers to live blues music at a house party. Slowly but steadily, I was consumed by depression until there was nothing left except for an unrelenting sensation of helplessness and terror, and the total absence of joy or even simple pleasure.

Depression caused me to contract, to draw inward and retreat from the larger world, which seemed to have no place for me. But the island of my depression was no secure place either—it had shrunk rapidly, leaving me without firm ground to stand on. Instead, beneath my feet was . . . emptiness, a void that made living moment to moment excruciating. I would get into bed at 3:00 p.m., with the intention of taking a brief nap, but five, 10, 18 hours later, I was still in bed, terrified and trembling, unable to move.

Depression caused me to contract, to draw inward and retreat from the larger world.
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Even if I could get out of bed, what was the point? Life had been leached of all color and texture; it was just an unending stretch of bleak terrain that I would have to drag myself across until I died, whether naturally or by my own hand. The desperation required to commit suicide, that I had in excess; the energy, though, I was unable to muster.

A “good” day had become one in which I felt a brief lift, not so much a release from depression as a temporary cessation, the hint of freedom. And those good days felt fragile, like a moth’s wings coated with a powdery substance that could be disturbed by the slightest touch.

Thirty-six hours before I entered the psychiatric facility, I went to a corner store and picked up a grilled shrimp po’boy—dressed and on French bread, of course—for dinner, and a Klondike bar for dessert. I had made plans to commit myself, so this felt like a last meal, a few of my favorite foods, before I left my current life and went someplace unknown, someplace that scared me. And though I, unlike an inmate on death row, would return from the facility, I wouldn’t come back the same as I’d left. It was a death of sorts, so I fed myself well.

I had spent the day readying myself for a week as an in-patient at a local facility with one open bed: setting up my e-mail with an out-of-office reply, notifying a few friends, packing. (What does one wear on one’s first day in a psychiatric facility? I texted a friend. A fly-as-hell pinstripe suit and wingtips, he responded.)

I felt optimistic, almost cheerful, for the first time in months. With the decision to commit myself made, I experienced a surge in energy. Spending a week in a psychiatric facility would be similar to the three years I’d spent getting my MFA in creative writing—a different objective and environment, of course, but both were about commitment. Each was an immersion in something not necessarily taken seriously or acknowledged as essential in the larger world. Mental health, writing: both were challenging to focus on and make any headway on when work deadlines had to be met, laundry done, meals made, dishes washed, the trash taken out, the cat fed.

The next morning, though, the empty bed had been filled, and the events that followed felt torturously drawn out: My roommate and I went to an emergency room, where we waited seven hours before a facility with an open bed was found; it was another five hours before a vehicle arrived to take me to the facility, and two and a half hours more before we arrived at the facility.

By then, I was a shivering wreck, just able to shuffle from the backseat of the vehicle in the hospital-provided boxy blue paper top, equally shapeless paper pants, and bright-yellow socks with traction soles to the entrance, where a tech was waiting.

Forty-eight hours after my last-meal shrimp po’boy, I was served a plastic bowl of grits. Like most of the food at the facility—the grainy reconstituted eggs, the limp white bread, the dry, puck-shaped sausages, the chilled, juiceless tomato slices—the grits bore only the most tenuous resemblance to actual food. In color and texture, they were almost indistinguishable from the oatmeal that was also served.

The food was awful, visually and nutritionally devoid of any value. Lack of color might almost have been a requirement for a food to be served at the facility; everything scooped or spooned or ladled onto our trays was some shade of beige. The occasional splotch of color—boiled beets or peas and carrots, like those that had been a staple of the Swanson’s TV dinners of my childhood—was something to be remarked on. The only other color came from the Styrofoam cups filled with startlingly vivid “juice,” which was actually Hi-C.

Yet I ate everything on my plate, forking the food into my mouth with barely a pause to chew and swallow. There was desperation in that ceaseless action—the food, however unsatisfying, was something to focus on, a brief respite from the unbearable emptiness of the rest of the day, when, except for the hour-long group therapy sessions, there was nothing to do but sleep or pace the hall from one locked door to the other or sit in the common room with the always-on TV and the plastic containers of blunted crayons and AA pamphlets.

Five days after I entered the facility, I was released with a new medication and an admonition from the sleek, prosperous-looking psychiatrist to “have more faith in yourself.” I experienced some relief at leaving the facility with its shoddily patched walls and stained bedsheets, and returning to the color and lights of New Orleans. But the relief was short-lived. My apartment had ceased to feel like a refuge; instead I was a trespasser in a space that was totally indifferent to whether or not I was there. The artwork and knickknacks I had accumulated over the years and placed on the walls and mantels to mark my new home had turned into clutter, and I couldn’t imagine ever being motivated enough to get dressed in the clothes that hung in my closet and filled my bureau drawers. The horrifying void had begun to close up, but the lead blanket of depression refused to lift.

I felt equally alien outside the apartment. The unhurried pace with which people walked and talked had delighted me just a few months before. Now it grated. Charming eccentricities struck me as affectations. I couldn’t walk through the Quarter without becoming agitated by the tourists, tour guides, buskers, and other street performers. Did there have to be so many of them? And what did they have to be so enthusiastic about? I could no longer grasp happiness as a concept, let alone as an emotion.

The horrifying void had begun to close up, but the lead blanket of depression refused to lift.
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Misery and hopelessness, those I grasped. Whereas before, I’d admired women in evening attire, now I noticed a different sort of city resident: the men and women who had come to New Orleans and bottomed out on drugs or alcohol, and who slept curled up in entryways or sprawled on the sidewalk. The man with short dreadlocks who kept up an indecipherable monologue as he sat on the bench outside the 24-hour bar whose neon sign I could see from my bedroom window, its red glow serving as a marker for both late-night bedtime and early-morning wake-up, he was trapped too.

Yet New Orleans hadn’t changed; it was the same city it had been before my breakdown. It was I who had changed, perhaps unalterably. I had entered the facility desperate for change, but this was not what I had envisioned. I was a stranger to myself now, so how could the city and its residents not feel foreign?

Every day, I woke up, forced myself out of bed, meditated, took my medication, went to intensive outpatient therapy, came home, worked, went for a walk through this alien-to-me city, noted the sidewalk and stoop sleepers, then returned home again. After I got back, I would use the toiletries from the facility, which had been handed over to me, along with the gray plastic tub they had been stored in, upon my discharge. The apple-strawberry-scented body wash/shampoo, the alcohol-free mouthwash, the body lotion that smelled cloyingly like baby powder, the travel-size tube of toothpaste—I used them all. I even used the rough-bristled hairbrush—not on my hair, though, but to scrub at the grime that had accumulated in the sealant encircling my bathroom sink.

Two months after I was discharged from the facility, Mardi Gras took place. Mardi Gras the year before had been a magical day for me, but that magic was no longer accessible, and the idea of being surrounded by people celebrating felt almost unbearable. I considered leaving town and visiting a friend in Los Angeles to avoid the event.

In the end, I stayed. Less because of any determination to try to catch some of the Mardi Gras spirit, however faint, but more because the idea of traveling was impossible to wrap my head around. My costume was haphazard, thrown together just the night before. My roommate loaned me a sequined, sleeveless navy-blue floor-length dress and tacked a cloud of mauve tulle to it at the shoulders, leaving enough tulle free that I could pull it over my head like a veil. The lavender wig was the same one I had worn last year.

The joyous mood that day seemed to link everyone. Except for me. I kept moving with my friends and with the crowd through the Bywater and the Marigny, into the French Quarter, down to the banks of the Mississippi River, although each moment was agonizing. The music and dancing and costumes that had delighted me last year now felt like sensory assault. I kept the tulle pulled over my head as though it could render me invisible.

A tall, slender man dressed as a jester scaled houses and the occasional church, where he proceeded to display his bare ass to the people below as he thrust his hips at chimneys, balconies, and facades. Most people seemed to tolerate him, occasionally cheering his repetitive motions. Everywhere the parade went, there he was; I couldn’t escape him and his lewd antics. “Oh God, he’s humping another building,” I said to my friends in desperation. What if I was dead, I wondered, and this was the last thing I had seen before I died and now I was condemned to see it again and again and again in my living death?

In the Quarter, people spilled from Fahey’s Bar onto the sidewalk. A man costumed as Ignatius J. Reilly, the hapless protagonist of A Confederacy of Dunces, down to the hunting cap and thick wool scarf, was grilling hot dogs for people, no charge. I ate one, and for all I could taste it, it might as well have been filled with sawdust.

Esplanade Avenue is flanked by century-old houses whose dignity suggests ancestral superiority lies in their very foundations. My apartment was in one of those houses, though its façade belied its worn interior.

After the breakdown, I often saw the man with the dreadlocks who talked to himself roaming Esplanade. Sometimes he would disappear for a few days or even a few weeks. The first time he reappeared, his head had been shaved. Other times he returned with a cell phone or a backpack or headphones.

There were days when I walked past him as he slumped, silent, on a stoop and we made eye contact. I could see he had surfaced, however briefly, from his delusions. He was present, as torturous as that present may have felt. When our eyes met, he would acknowledge me with a quick nod of his head and then one or both of us would look away.

Lying in bed at night, waiting for the brief reprieve of sleep, I kept hearing him, his voice rising up from Esplanade as he traveled his route. Often his monologue was interrupted by a burst of three syllables: ooh ooh ooh. I listened, and recognized his disconnection from what surrounded him. Yet he was still out there, just as I was in my own home, taking one step after another, a stranger in a world rendered foreign by his brain.

Ilya Mechnikov, a scientist arguably quite ahead of his time, shared a Nobel Prize in Physiology or Medicine in 1908 for his work on human immunity. His research interest was garnered by his (not arguable) horrid experiences with diseases caused by bacterial infection. After his first wife died from tuberculosis, he attempted to take his own life with an opium overdose, but managed to live. His misery didn’t end there however. When his second wife developed typhoid fever, he wanted to die with her, and inoculated himself with a tick-borne disease. They both survived, but it made him realize the salient significance of the body’s natural immune system.

In the wake of their bodies’ perseverance, Mechnikov grew dedicated—obsessed—with research in human immunity. During the cholera epidemic in France in 1892, as part of his self-experimentation, he drank a culture of Vibrio cholera, the bacteria responsible for the disease.

He didn’t get sick, so he gave the culture to a volunteer in his lab—who didn’t contract cholera either—but a second volunteer became stricken with the disease and subsequently died. In further lab experiments, he found that some microbes stimulated the growth of cholera bacteria and some hindered it.

He thought the human gut flora was responsible for this and hypothesized that if ingesting a pathogenic culture can make you sick, then surely a good one should promote health. “With the help of science man can correct the imperfections of his nature,” he wrote.

The use of fermented foods—which in essence and most cases are cultures of “good bacteria”—has been around for centuries. Research shows written records of the health benefits of fermented milk (yogurt) and fermented milk products date as far as back as 6000 BC in ancient Hindu scripts. The Greeks made written reference to fermented food products in 100 BC, and it is reputed that Genghis Khan fed his army fermented mare’s milk because he believed it instilled bravery in them. It was not until the 20th century, though, that a Bulgarian medical student—Stamen Grigorov—discovered a lactic acid bacteria (Bacillus bulgaricus) in yogurt cultures.

Bacterial fermented foods, thought to promote digestive health, are prevalent throughout history and ubiquitous in every corner of the globe, from Eastern European sauerkraut to Korean kimchi to Japanese natto.

In current times, a growing body of research shows that maintaining a healthy gut and microbiome with diet can have a significant impact on health and well being. Further, it is contended that the right balance of gut bacteria can help stave off disease.

The Second Brain In Our Gut

A microbiologist once told me, “You are over 90% bacteria and about 10% human.” What? Really? I then looked it up and found out it was indeed true. We have 10 times more bacterial cells cohabiting our bodies than human cells. The human microbiome is collectively the 10-100 trillion microorganisms, mainly bacteria, living in our gut weighing between one to three pounds; every microbiome is specific to a particular environment (all microorganisms interacting with each other in a particular area in the body, such as the gastrointestinal tract or gut) or body part.

The microbiome also refers to the combined genetic material of the microbiota in that environment or organ. These trillions of bacteria interact and communicate with the enteric nervous system or what scientists have labeled the “second brain.”

As Michael Gershon, Professor of Pathology and Cell Biology at Columbia University and “father of neurogastroenterology” writes, “Once dismissed as a simple collection of relay ganglia (a cluster of nerve cell bodies), the enteric nervous system is now recognized as a complex, integrative brain in its own right.”

The enteric nervous system comprises about 500 million neurons or two-thirds the amount found in a cat. It is embedded in our gastrointestinal tract—starting at the esophagus and ending at the anus.

Together, the second brain in the gut and its microbiome have a significant effect on the brain, influencing mood, behavior, and disease. As such, the National Institute of Health (NIH) in the U.S. launched the Human Microbiome Project in order to identify and characterize the human microbiota.

The Great Brain-Gut-Microbiome Connection

Recent evidence shows that the brain interacts with the enteric system in the gut (second brain) and the gut microbiome in a bi-directional manner. It’s a three-way communication circuit called the Brain-Gut-Microbiome Axis and involves three systems—central nervous, gastrointestinal, and immune. A common example of a brain-gut interaction is that “butterflies in your stomach” feeling. Your palms are sweaty and trembling, your heart rate increases, your skin becomes pale or flushed, and you (maybe) feel like you want to throw up. This is part of the fight-or-flight physiological stress response and evidence of how our gut is related to how we feel.

So just how do the microbes in our gut influence mood? In truth, scientists are not 100% clear on how these microbes directly influence our brains, but they propose that it’s through multiple pathways. For example, it is well known that the four main chemicals associated with happiness and mood in human beings are dopamine, serotonin, oxytocin, and endorphins. Research shows serotonin (although its function is complex as it is involved in many physiological processes) to be a mood regulator playing a major role in the treatment of depression and susceptibility to both depression and suicide.

The enteric nervous system in our gastrointestinal tract is now recognized as a complex, integrative brain in its own right.
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And guess what? About 90% of the body’s serotonin is made in the digestive tract; researchers at Caltech showed that gut microbes are integral in serotonin synthesis. Similarly, gut bacteria are implicated in the synthesis of other chemicals and neurotransmitters involved in mood regulation and disease. Further, scientific findings in the journal Behavioural Brain Works illustrated that some bacteria affect how these mood compounds are metabolized. Perhaps the most fascinating finding, however, is that some microbes can activate the vagus nerve, the longest cranial nerve in the body and a main line of bidirectional communication between the brain and gut.

90% of the body’s serotonin is made in the digestive tract.
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Advancements in genome sequencing technology is enabling research into the impact of the gut microbiome on disease. By mapping the genome of the gut microbiome in diseased vs. healthy humans and animals, conclusions on the role of the gut microbes in disease proliferation can—and have been—deduced. And a very interesting way to glean this information is to analyze feces.

Your poop can be very informative. One study using genetic analysis of clinically depressive folks’ poop compared to those who aren’t, found several correlations between the human fecal microbiota (representative of gut microbiota) and depression. Although they report that their findings need to be further tested in larger cohorts, their results were specific for a particular strain (sub-type of microorganism) and genus (group or class of species):

 “The Oscillibacter type strain has valeric acid as its main metabolic end product, a homolog of neurotransmitter GABA (γ-aminobutyric acid), while Alistipes has previously been shown to associated with induced stress in mice.”

“Valeric acid structurally resembles GABA, and has been shown to bind the GABAa receptor. Therefore, it is possible that bacteria involved in valeric acid production and/or metabolism could also be associated with depression.”

The work of professor Bernhard Lüscher and colleagues at Penn State University shows that enhancing the activity of GABA in the brains of depressed mice has antidepressive effects, similar to that of antidepressive drugs, bringing mice back to “normal” behavior. Noteworthy is that GABA is implicated in mood disorders and its agonists have been shown to be antidepressive and antimanic.

This includes less of a certain type of bacteria in human fecal microbiota in depressed individuals compared to healthy ones.

Your poop can be *very* informative. Studies have found several correlations between the human fecal microbiota and depression.
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What is even more interesting is that researchers at the University College Cork in Ireland showed that if you transplant the microbiome from a depressed individual to animals, these animals will exhibit the same behavior of the depressed individual. These include anhedonia (not wanting to do the things you usually take pleasure in) and anxiety-like behavior.

This study also showed that depression is associated with decreased gut microbiota richness and diversity. Further, in humans, fecal microbiota transplants—introducing healthy feces into the microbiome of a diseased person—have been successful in the treatment of gastrointestinal disease and colitis and clostridium difficile infection with an efficacy rate of almost 90%.

Auxiliary Advances

Across the globe, the International Diabetes Federation report 425 million adults (or 1 in 11 adults) with diabetes while the CDC reports 30.3 million in the U.S. (with over 100 million living with diabetes or prediabetes) and 3.4 million in Canada, according to Diabetes Canada.

Diabetes and obesity are oftentimes linked as it is well-documented that obesity has a strong correlation between insulin resistance and diabetes. In a promising and growing area of research using humans, a small clinical trial in the Netherlands showed that a fecal transplant from a lean donor can temporarily improve insulin resistance in obese men.

In another growing area of research, large differences are seen in the gut microbiomes of people with Parkinson’s disease compared with healthy individuals. Further, a study published in the journal Cell show that when fecal microbes from persons with Parkinson’s disease was transferred to mice, they exhibited more severe symptoms of the disease and the aggregation of α-synuclein in the brain. (The formation of plaques in the brain via aggregation of α-synuclein is found in persons with neurodegenerative diseases including Parkinson’s, Alzheimer’s and dementia.) Meanwhile another study revealed that probiotic supplementation in patients with Alzheimer’s disease showed improved in cognitive function.

But Just How Did We Get Our Microbiome Anyway?

It has been shown that the vaginal and maternal gut microbiome changes significantly during pregnancy. Science journal PLOS|One as well as a Finnish study in Cell, respectively, showed that pregnant women exhibit lower vaginal bacteria than nonpregnant women as well as a lack of population diversity in gut microbiota.

In the International Journal of Obesity, researchers found that children exposed to prenatal antibiotics in the second or third trimester had an 84% higher risk of developing obesity compared to children who were not exposed. Further, Caesarians were linked to 46% higher risks of developing childhood obesity; your first microbe colonizers are acquired via exchanges with your mother largely during the birthing process, when you are—quite literally—slathered in vaginal bacteria.

In addition, as research shows, any disturbance to this microbe exchange such as delivery by C-section, perinatal antibiotics and formula feeding is linked to an increased risk in metabolic and immune disease. After birth, a child’s microbiome continues to grow and is changed by ingestion of the microbes in breast milk which stabilizes neonatal gut microbiome. As we grow older, our gut microbiomes can change throughout life depending on diet, environment and the drugs we may take, such as antibiotics.

So How Do We Promote A Healthy Microbiome?

There is still a lot of ongoing research on the brain-gut-microbiome connection, but it’s quite clear that the gut microbiota can have a significant impact on mood, health and disease. So here are a few ways—and foods!—that will keep your gut microbiome healthy and thriving:

1. Probiotics – research shows they can be used to maintain a healthy gut and restore the gut microbiota to health (after disruption as in the case of illness and the use of antibiotics).
2. Prebiotics foods – these cause the growth and stimulate the activity of beneficial microbes in the gut.
3. Whole grain foods/foods high in fiber – these have been shown to promote the growth of specific bacteria only digested by certain bacterial types. For example, apples and artichokes have been shown to increase Bifidobacteria (a good bacteria) in humans.
4. Fermented foods – people have been eating these foods for centuries. They have been shown to reduce the number of disease-causing bacteria in the gut and promote the growth of beneficial bacteria. It has been shown that people who eat a lot of yogurt have less of the bacteria linked to inflammation (Enterobacteriaceae).
5. Diversity in food – a diet comprising a diversity in food leads to a diverse microbiota which is considered healthy.
6. Polyphenols in red wine and grapes – these have been shown to improve specific beneficial microbiota.

Content warning: Suicide, self-harm

I tried to throw myself in front of a train on my 30th birthday. It was the 1 train at 28th St. in New York, just a couple blocks from GLAAD (Gay and Lesbian Alliance Against Defamation) where I was an assistant. That was two decades ago. I came close to attempting it twice more—once in 2014 and again in 2016. I planned it for weeks, edging closer as I waited for the train to work. Felt the calm.

On jump day, I’d back up when I felt the rumble, get a running start—then stop short. I spent an hour, two—time was gauzy—trying to get myself airborne. A chain kept pulling me up short, the kind that allows backyard dogs just so close to the fence. At the time I thought it was God. Maybe I was more afraid than I’d thought. Whatever.

It pissed me off. I felt like even more of a failure—I couldn’t even end myself right. I wanted to take every pill in my house, but I couldn’t do it. I was too afraid I’d end up profoundly disabled, but still here. So I punked out. That’s what I told myself. I’d landed in my own purgatory; I‘d found a way to end my pain, but lacked the confidence to follow through.

More research was needed to assure my success.

Reasons to jump in front of a NYC subway on your 30th birthday:

• Being ostracized by your family after coming out

• Self-loathing for not becoming the Someone you were expected to be, what your Ivy League/Fulbright path foretold

Reasons to nearly take every pill over a decade later:

• Living with still unaccepting parents as my 50th birthday careens towards me

• Realizing that, desperate to restore the family friendship I lost, I sabotaged my success just to stay in that house

Foundational reason for either method:

• Taken down by an undertow of shame

Stigma is a silencing bully. World Mental Health Awareness Week (October 7th – 13th) aims to lift the stain suicide casts. Kate Spade. Anthony Bourdain. These are public deaths that have focused collective attention on depression’s brutality. Finally. More of us are sharing experiences, confronting myths. Hopefully, we’ll be heard, felt, understood. I was hospitalized after my near attempts. I’m stabler than I’ve been in two years, even if I’m not quite happy. Yet.

Here’s What helped // And Other Things to Try with Your Depressed Person

When others understood that being suicidal didn’t mean I wanted to die.
Sounds completely illogical, I get you. I’d attempted. I must’ve wanted out. Nope. Not really. Humans have or need ways of pushing through. Our methods aren’t always healthy. Suicidal thoughts were how I coped. Most, maybe even every time, when those thoughts sparked on, I wanted many things that weren’t death: to be invisible and free; to make everything just stop; to swipe right and change a bunch of past decisions. I detested myself. Hauled around bone-deep sadness while drowning in that shame tsunami. The app I needed doesn’t exist. And the world doesn’t pause. But I could fantasize about leaving it. And that was relief.

Compassionate listeners.
There’ve been a number of kindly homo sapiens who, hearing that I was depressed, listed the sparkly fantastic reasons I shouldn’t be: my long life ahead, people who’d miss me. I’d feel dismissed from my own story. That’s what they thought I needed. They didn’t know the certainty of my heart: I was garbage deserving of suffering. This life awaiting me sounded like a sentence to years of kicks in the face. My brain kept a ledger of how I’d failed those same people who’d mourn my death. Being reminded that they’d miss me layered on guilty pressure.

Being suicidal didn’t mean I wanted to die.
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I never wanted to hurt my people. But they weren’t living in my skin, in my torture. I couldn’t live for them. The most valuable listeners were capable of hearing the whole truth—they wanted details about my suicidal thoughts. They didn’t try to fix me. Without engulfing me in their worry, they’d ask what problem I envisioned solving by dying. They knew talking about suicide wasn’t the action.

Talking meant I was alive. Being alive kept open the possibility of creating a plan to keep me safe. Understandably, this commitment to listening is difficult. If you’re that listener, know your limits. Care for yourself while keeping your person well.

Just be there.
After my last hospitalization in 2016, a crew of friends encircled me. Together, they coordinated my post-discharge safety net: exchanged emails, checked if I’d gotten out of bed, encouraged me to try to leave my apartment. There were daily texts that made me laugh. Their efforts seemed irrational to me; I felt unworthy. But the messages and invites were soothing. Honestly, at times what I needed most was to just not be alone, to have another person near while I journaled, watched tv.

Helping through tough moments.
Suicide can be a slow building impulse, a moment of breaking the final straw. Depression warps and lies. It pulls me into spiraling webs of self-hatred. I’d lose my keys then get angry at my stupidity. That’s why I’m an embarrassment and I haven’t done anything with my life and I’m a fuck up and won’t ever be anything more and I don’t deserve to live. Multiple times, daily.

My every action was a test of my earthly value. Having someone gently walk me through my thoughts— “Gail, how did losing keys become a reason to die?”—dislodged me. Afterwards, I saw the loss for what it was. Knowing you’ll guide them through life’s hiccups can change a lot for your person.

Hugs. Seriously. Lots.
My best friend would text during her work day, asking if I needed a hug. We’d meet-up and she’d deliver! She’d check in before returning to work. She’d tell me she loved me. Just having those 15 minutes in my future could get me moving on days I preferred to hibernate and let my brain spin.

The world doesn’t pause. But I could fantasize about leaving it. And that was relief.
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Therapy and meds.
Drugs are good. They can be. Meds at least helped me begin functioning. Leaving my bed became slightly less onerous. I could shower, get to therapy. Think about this: It’s someone’s job to just listen to you. Finding the right fit might take time, which can suck. But, once I did, I felt safer. My darkness found a sheltered place with her, even those deeper thoughts I kept from friends. Most importantly, I got diagnoses explaining the ways that my illness bamboozles my mind.

Placed in a DBT (Dialectical Behavioral Therapy) group, I learned tools to manage my condition.

Maybe try gathering therapy resources for your person. Don’t push. Let them take time. Let them talk about any resistance they might have. Again, listen. Explore what might make it easier. Also, consider who your person is and how to make therapy comfortable. As a blacktina lesbian, a gay-friendly therapist of color was non-negotiable for me. Sometimes therapists without this background were unintentionally offensive, didn’t grasp the weight of particular issues. Therapy became stressful. Reach out for suggestions in seeking appropriate care.

An empathetic family is the greatest support. Unfortunately, my family wasn’t. The willingness to educate yourself for a relative is tremendously loving. There are dozens of useful sites and organizations. But one of the best sources is your person.

Consider who your person is and how to make therapy comfortable. As a blacktina lesbian, a gay-friendly therapist of color was non-negotiable for me.
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Ask. Listen: what’s needed, what would feel good, what might be helpful.
Sometimes they may not know. Depression numbs me. Making decisions becomes exhausting. It’s ok if your person is in that place. Just let them know you’re there. Maybe help with daily tasks. Support doesn’t have to be huge.

What’s not helpful: being a dick.
Listicles of statements to avoid are at your Googling fingertips.I even found a moving podcast by survivors of suicide attempts and losses about providing support. For me, labeling the act as selfish is the most damaging. Picture saying that about a person with cancer. Bizarre, right? Depression is cancer—a beastly, soul-chomping tumor, requiring Justice League strength to survive.

Remission, cure or death are the only outcomes from either illness. Calling a suicidal person selfish heaves on even more guilt. Focuses on the emotions of others, rather than the sufferer. Hearing this, your person could isolate instead of reaching out. And that could be tragic.

Since 2016, I’ve completed programs involving daily therapy—group and individual—plus meds management. I’m calmer, sleep better, am regaining some appetite. I’ve learned a lot. Yet, I’m not cured. I’m not drinking iced lattes, paddling my golden canoe while bluebirds pay off my grad school loans. With my therapist’s help, I see my depression as a manageable illness, like diabetes. I still struggle, just not from a bear trap in a grimy cell.

Labeling suicide as selfish is the most damaging. Picture saying that about a person with cancer.
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Working out, doing things I’m good at, making decisions slowly—these help me manage. The suicidal thoughts still spark, but now they’re signals that self-care is needed. I know people who’ll treat me well, tenderly before I sink. Ultimately they offer kindness, empathy and compassion.

And I’m sure you’ve got that in you, too.

If you or someone you know is in a mental health crisis…

National Suicide Prevention Lifeline – Call 800-273-TALK (8255) to speak with a trained crisis counselor 24/7 who will listen empathetically and without judgment. Your call is confidential and free.

Crisis Text Line – Text NAMI to 741-741
Connect with a trained crisis counselor to receive free, 24/7 crisis support via text message.

Content warning: suicidal ideation

It’s 2006, maybe. I’m 25. The gas station clerk is gabbing with a state cop about the heroics of first responders. All I want is my coffee. She tells me, in the hushed reverence reserved for church: “I’ll never forget where I was when the towers fell.” The man with greasy hair has finished filling the tank on his moped and echoes the sentiment. While I pay, they lose themselves in remembrance.

They don’t notice when I leave.

Admission: I remember and feel very little about the events of 9/11.

Before you gasp, before you throw your rocks, know that this isn’t about any lack of sympathy for those affected by that terrible day. It’s about where I was, and who I was, then.

Allow me to explain.

Of course I’ve seen the towers fall. Who hasn’t? Every year, there are the airplanes, and still photos of the man cartwheeling toward the street so far below, and the conflagration in the window from which he jumped. There are tributes to the brave men and women who ran into the building while others were running out. Terrified onlookers covered in smoke and the ashes of human remains. War coming to us, death to ours.

And people feel. Normal people feel. Right? They feel for the victims, for the survivors, for an entire city. They feel what they felt as they watched it unfold the first time. The images transport them back to that day, and they are once again shocked, confused, and scared out of their minds.

But if somebody knows where I was when the towers fell, it’s not me.

I mean, I can guess where I was, approximately, given the date. In 2001, I was 20 years old, which meant I had already dropped out of college due to extreme anxiety. At age 20 in September, I was a year and a half past being raped, and a year and a month past the prosecutor accepting a plea deal that gave the rapist “time served.” I was roughly a year and eight months out from the breakup with the first man I ever loved. The only man, it would turn out.

My friends and family act as my memory during this time; the historians who try to help me piece together what my life was like then. “When your sister moved out for fear of finding you dead, you lived in this apartment.” “We bought you the trailer in this month, because you refused to come home.” “Your sister didn’t recognize you when you went to her graduation.” “You stayed in bed that whole year. You lost 75 pounds.”

You stayed in bed that whole year. You lost 75 pounds.

That was 2001. The year depression chewed my life, and swallowed my life, and regurgitated my life in gray.

Here’s what I personally know of myself, circa September 11, 2001: I was 20 years old, just barely, and I thought I had lost it all. Looking back, I recall just three memories from that time.

One. I get out of bed long enough to spread mayonnaise on a piece of white bread, and to make a sandwich of the cheap round turkey somebody had put in my refrigerator. I go back to bed.

Two. I am awake, briefly, and sit on the end of the couch. The television is off, and I stare without seeing in the direction of the door.

Three. One of the adjacent apartments becomes infested with bugs, and they invade our place. Maggots cover the ceiling. My mother tells me that was the last straw; they move me out the next day.

Here’s what I do not remember — the nationwide tragedy that is now simply known by its date: 9/11. At least, not in the way others seem to remember it.

A small story within a story: Toward the end of this somehow excruciating nothing, I tried to escape. I ate nearly 200 pills. I remember counting them then, but I forget the exact number. I ate enough pills to end my depression forever. Then I called a friend and asked her to wait with me until I died. My parents tell me my skin was gray.

Obviously, the friend found a way to get my address and to send help, and the doctor told my family if I lived through the night, I’d probably be fine. I lived, and a new psychiatrist detoxed me off of the 11 psychiatric medications my old psychiatrist had put me on. I had to be kept inpatient for some time.

Of course I’ve seen the towers fall. Who hasn’t?
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After that, we tried every form of therapy there was to draw me forth from the nearly catatonic nowhere in which I lived. Eventually, something (or things) worked well enough to get me out of bed and eating again. I returned to, and finished, college and received a graduate degree. Though I still struggle with depression, I’ve never fallen as far into the void as I was then.

Here’s why this story matters. While I was detoxing, I was smoking a cigarette (patients still got smoke breaks then), and then I was on a mattress on a floor, puking into a trash can. Six hours later. I’d had a seizure.

And that feeling — that where am I, when is it, why am I here confusion — that, for me, is 9/11 every year. I remember other people’s memories, and documentarians’ facts, and the constantly replayed videos. There are flashes of memories gathered secondhand, built on stories told to me by others, but it all feels more like dreams between lost time than a narrative. It feels like waking up six hours later, somewhere else.

But what I realize, now, is that this doesn’t mean I am distant from that day. Depression that deep is a purgatory of fear from which one never fully escapes, in the same way that people who lived through the attacks must carry the memory of that day’s terror in their bodies always. Like the guilt of the survivor who just happened to be late, or who had just left the building, or who just managed to live somewhere else, depression is the heaviness of unspeakable dust settling into your skin, and the panic of trying to catch your breath.

I don’t remember the events of that day perfectly, but I see the scars that it left behind. And where I do connect, what seems to make sense, what seems real, is the people. Wide-eyed and staring, trying to run.

The people, dreaming their ways through gray ash.

Content warning: discussion of suicidal ideation

Throughout my teens I was adamant I didn’t want children. I thought they were annoying, sticky money pits who had no business being near me. I was a sad and corny teen. Now, I’m 30. I’m still sad, but I’m not broke, and I have a husband. My feelings on the child situation have changed. I’m more open to it now. I think it was a combination of seeing other people with kids and, as I’ve gotten older, having more love to give — or something. I didn’t have the most stable childhood (or adulthood, for that matter), but I’m now in a position where I could give a kid a good and not-at-all toxic upbringing. I’m not desperate to have a baby — not that there’s anything wrong with that — but I’d love to try.

I traipsed off to therapy, excited to discuss starting a family. I’d only talked about it with my husband, and my therapist would be the only other person who’d know. Lucky her! I readied myself for all her joy and delight. I’d seen it before with my friends. They’d start with a goofy grin on their face and say something like, “We’ve stopped using birth control.” This would be followed by gasps and tiny squeals of glee: “You’re trying for a baby! We’re so happy for you!”

The Maternal Instinct Is A Myth And We’ve Got The Science To Prove It
theestablishment.co

With the same goofy grin that I’d seen from my friends, I proudly announced to my therapist that I wanted to start a family. She smiled, looked me dead in the eye, and said, “If you want to have a baby, you need to tell me around three months before you start trying.”

Ah, just how I dreamed it would be!

I have bipolar II, which means I experience frequent episodes of severe depression with a smattering of hypomania. Therefore, I need a longer lead-time to process and plan for the mental and physical changes that occur during pregnancy. I’d heard of postpartum depression, and I’d heard of people developing depression during pregnancy, but I haven’t heard anything about what happens when you’re already depressed and want to have a baby. But with that one decision — to try for a baby — my depression shifted to pre-prenatal depression.

The prevalence of mental illness cannot be overstated. One in six Americanssuffer from a mental illness, millions of whom are depressed — and according to an analysis carried out by a clinical psychologist at Oxford University, women are 40% more likely than men to develop mental health conditions.

With the one decision to try for a baby, my depression shifted to pre-prenatal depression.
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So it seemed odd that there’s not more out there about getting pregnant whiledepressed. The few stories I found scared the shit out of me. (One article was ominously titled, “Scary News For People Who Get Pregnant While Depressed.”) And, unfortunately, there’s no clear list of guidelines for depressed women who want to become moms.

As Bay Area psychiatrist Jill Armbrust explained to me, the plans for treating a person with depression who wants to get pregnant are the same as those for anyone who’s becoming depressed. “The difference being there would be more focus on and care put on the side effects of various medications.” This takes a lot of time and careful planning. “One usually starts with about six months of psychotherapy if you have that kind of luxury,” Armbrust advised.

The guidelines that do exist center on medication, of which I take a range to keep my mind intact, namely lithium, Latuda, trazodone, lorazepam, and clonazepam. I’d be a whole lot worse without them, and — with absolutely the intention of sounding dramatic — I may even be dead.

But it turns out these pills don’t mix well with pregnancy. My therapist advised weaning off the meds completely. My first thought was simply, “No.” I didn’t want to think about who I would be without medication. I tried to kill myself without medication. My brain flooded with questions: How could I create a new life when I’ve wanted to end my own? Will I turn into a monster? Should people like me even have children?

I found myself asking that last question a lot. Given my history of depression and suicide, was it safe or even fair for me to have kids? I wondered if there were any circumstances where therapists advised people against getting pregnant.

There are, though, as Armbrust explained, “It’s tremendously variable because of the stigma that even some practitioners carry.” While there’s no absolute answer to this, Armbrust suggests the only two reasons she’d advise against pregnancy: when the woman had unstable psychosis or an untreated substance abuse problem. She went on to say that she believes women with schizophrenia, bipolar, and depression — like me — are all candidates to be very good mothers.

I am fortunate enough to have a therapist, and (thanks to my husband) health insurance. Having a baby while depressed was going to be hard but not impossible.

So we began.

Confusion

My therapist said we would start by lowering the doses of my lithium, trazodone, and Latuda. However, I had to stop taking lorazepam or clonazepam, since both have been recognized by the U.S. Food and Drug Administration as drugs with “positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans.” The U.S. agency calls these Category D drugs, with Category A being the safest for pregnant women and X being a total no-go. But since I didn’t take lorazepam or clonazepam every day, I didn’t think that would be too bad.

The one I was worried about most was lithium. Lithium was the one that tied the room together. At the time of talking to my therapist, lithium was category C, the third of the five categories, so I could potentially keep taking it at low doses even if I did become pregnant.

My therapist assured me we’d get through it together and that she’d be monitoring me closely. She suggested I see an OBGYN and see what they thought. About a month later I was booked to see a nurse practitioner where I had a pap smear and a ton of questions. It isn’t common practice for an OBGYN to screen for depression at this stage, though Armbrust says this would be hugely beneficial, given that postpartum depression is so common. But when it comes to pre-prenatal depression, “It’s still considered stigmatized in a separate area of expertise.” Most of the time you have to volunteer the information yourself.

Given my history of depression and suicide, was it safe or even fair for me to have kids?
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I told the nurse about my psychiatric history, and that I was trying for a baby. Before I could ask her any questions, she stopped me: “Do not start trying until you are completely off your medication.”

“Even lithium?” I spluttered. She furrowed her brow, left the room to check. Three minutes later she came back. “Even lithium.”

My therapist was confused. “Even lithium?” she asked me. I nodded, and when she opened her laptop to check, she nodded, too. “It’s changed to a category D” — just like lorazepam or clonazepam.

This was the first of many conflicting pieces of information I would come across in my mentally ill quest to become pregnant. Distressed that no one had a clear-cut answer, I turned to the one place I knew would be even worse, though it seemed to be also the place where my doctors were getting their information: the internet.

LUV 2 B ONLINE

Here in the murky depths of online pregnancy forums is where I found other people with mental illnesses who were as equally as confused as me. Though there were still no clear answers, it was strangely comforting. Up until now, I’d been speaking to medical professionals who discussed coming off medication as though it were a procedure. However, in the forums I found people who were talking about it in terms to which I could relate. These were people who lived with schizophrenia, bipolar, PTSD, and depression. There were those who felt guilty about continuing to take medication and those who were OK with it. There were some who’d stopped taking their medication, had a bad episode, and had to go back on. And there were those who stayed off meds for their whole pregnancy but went back on after the baby was born. One thing was for sure, nobody had the “right” answer because the “right” answer is whatever works for you.

These conversations turned from medication to general feelings. Women talked about how they felt ashamed of feeling depressed when they should be happy and grateful that they managed to get pregnant in the first place. They talked about how they wrestled with their emotions on the inside and the judgment cast upon them from the outside. The judgment on the outside being other moms in the forum telling them they’re bad mothers for taking medication. It happens all the time and is not exclusive to pregnant mothers with a mental illness. If you’ve ever been on a parenting or pregnancy forum, you’ll know that, while they can offer solace and support, they’re also diabolical whirlpools of toxicity designed to drag you down into a complex sewer system of self-righteousness and unconstructive criticism.

Fear-Mongering Among New Mothers Is A Profitable Business
theestablishment.co

“So why even go on them?!” I hear you cry. Great question — but avoiding them is easier said than done, especially when forums are one of the only places I could go to read about other pregnant peoples’ struggle with mental illness (and I’m a sucker for shame). Even though pregnancy forums are bustling hellscapes, they’re (ironically) the only places some us can go to discuss “taboo” subjects such as mental illness.

It’s Not You, It’s Me

I decided the “right” answer for me was to come off all my medication before trying for a baby, including the lower-risk ones. After three months of careful planning and monitoring, I was entirely med-free for the first time in five years, when I’d tried to commit suicide. The few other times since then when I came off certain medications because I convinced myself I didn’t need to be on them, I experienced particularly bad depressive and hypomanic episodes, at one point landing myself back in the hospital.

Before, I didn’t tell anyone when I went off medication and decided to go cold turkey, which isn’t ideal. This time, it felt different. I had my therapist monitoring me closely. Still, being off meds contained all the terror of a manic episode without the mania, like walking a tightrope over the Grand Canyon with no safety net.

For the first time in five years, I started to feel — but not in a good way. I’d become so accustomed to my moods being regulated; it was like I had two bouncers standing in front of my mind, letting thoughts and feelings come in at a steady pace. Now the bouncers were gone, and everyone started to rush into the club and fuck shit up. I was overwhelmed and began to isolate myself. I talked to my husband, my therapist, a couple of friends, and a whole bunch of strangers on the internet. I retreated into the pregnancy forums where I could be among women who were going through the same thing as me. Out of everyone, the forums is where I felt the most comfortable. I didn’t feel like I was burdening people with my “issues,” I didn’t feel like I was boring anyone with my constant questions, but most importantly, I didn’t feel alone. I’d tried talking to other people, but with all these unsupervised feelings, it was hard not to get upset or angry.

On The Fear Of Pregnancy Loss During The First Trimester
theestablishment.co

When it comes to your pregnancy, everyone you meet is an expert on you and your body. You tell people you’re trying, and immediately they’re all, “You’ve got plenty of time,” or “Relax, it can take up to a year.” As with everything in life, if I want your opinion, I’ll ask for it, but please know I’ll never ask because I never want it. I knew getting pregnant could take a while. Sometimes it happens instantly, other times it can take years. Either way, the wait can be excruciating. And when you’re flying solo without your antipsychotic medication, the wait becomes dangerous.

Every day I’d wake up and wonder if today were the day I’d lose it. I hoped I wouldn’t have to be hospitalized again. I begged my mind not to have an episode. For me, getting pregnant wasn’t a race against time, it was a race against mind.

After only a couple of months, I felt unstable. I started to feel sad. Not depressed, just sad. I assumed this was part of my unregulated moods, but the sadness lingered. Before long, I felt myself sliding into dangerous territory. The sorrow had morphed into depression, and without any medication to block it, the depression began to pick up speed. I still wanted to have a baby, I just didn’t know if I would be around to have it. I talked with my therapist, and we decided to give it one more month before I went back on the meds. One more month would make it three months total of being off meds, and whether I became pregnant or not, I felt proud I’d made it this far. Those three months were both terrifying and challenging, but nothing prepared me for what happened next. I got pregnant.

Uncomfortably Numb

Even without a mental illness, pregnancy can mess with your head. There’s the hormones, nausea, and the ever-changing body, which can be hard to process for anyone. But here I was, with no control over my body or mind. Everything started happening so quickly. I felt as though I was losing myself. I was happy and grateful we’d managed to get pregnant in a relatively short amount of time, but I was also depressed and disconnected. I remember staring blankly at the eight-week ultrasound. I knew I should be feeling something, but it just wasn’t happening. It was like I was experiencing phantom feelings. I’d already disassociated from the pregnancy, a pregnancy I wanted and planned. I started to experience a familiar numbness, the same numbness that enveloped me for the first 20 years of my life. I couldn’t even feel shame anymore.

Just like pregnancy, everybody experiences mental illness differently. And while I am fortunate enough to have a therapist, health insurance, and an OBGYN, the only person who was going to come up with the “right” answer was me. I’m now four months along and still off medication. Things aren’t perfect. (Is any pregnancy?) I still struggle with depression, and managing without meds does not mean I’m “cured.” I will always have bipolar, and anxiety, and PTSD, but there are things I can do to lessen the mental strain while I’m pregnant.

Just like pregnancy, everybody experiences mental illness differently.
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I continue to work hard at therapy. I try to eat healthily and exercise as much as I can. And I’m starting to increase my social support system beyond the confines of the internet, which has been daunting, but it’s helping a lot. And although I feel good now, I don’t take for granted that it could all change.

I want to be clear: Nothing can or will replace my medication. Even now, going back on medication is still an option, and once the baby is born, the plan is to start taking them again. The most important thing is my health. If I’m not healthy, then there was no way this baby could be either. I considered starting back on a low dosage of lithium, but I before I made that decision, I wanted to work on my mental health one last time. Again, I do not judge anyone who continues or goes back to their medication. If that’s what’s best for them, then that’s the right decision.

These are just things that help me personally, but who knows, it all may change. I’m taking it one day at a time. That’s the way it is with depression. There’s no cure; there’s just what works for you, for now.

Getting pregnant wasn’t a race against time, it was a race against mind.

Kewei Hu / Unsplash

Content warning: discussion of suicidal ideation

Throughout my teens I was adamant I didn’t want children. I thought they were annoying, sticky money pits who had no business being near me. I was a sad and corny teen. Now, I’m 30. I’m still sad, but I’m not broke, and I have a husband. My feelings on the child situation have changed. I’m more open to it now. I think it was a combination of seeing other people with kids and, as I’ve gotten older, having more love to give — or something. I didn’t have the most stable childhood (or adulthood, for that matter), but I’m now in a position where I could give a kid a good and not-at-all toxic upbringing. I’m not desperate to have a baby — not that there’s anything wrong with that — but I’d love to try.

I traipsed off to therapy, excited to discuss starting a family. I’d only talked about it with my husband, and my therapist would be the only other person who’d know. Lucky her! I readied myself for all her joy and delight. I’d seen it before with my friends. They’d start with a goofy grin on their face and say something like, “We’ve stopped using birth control.” This would be followed by gasps and tiny squeals of glee: “You’re trying for a baby! We’re so happy for you!”

The Maternal Instinct Is A Myth And We’ve Got The Science To Prove It

With the same goofy grin that I’d seen from my friends, I proudly announced to my therapist that I wanted to start a family. She smiled, looked me dead in the eye, and said, “If you want to have a baby, you need to tell me around three months before you start trying.”

Ah, just how I dreamed it would be!

I have bipolar II, which means I experience frequent episodes of severe depression with a smattering of hypomania. Therefore, I need a longer lead-time to process and plan for the mental and physical changes that occur during pregnancy. I’d heard of postpartum depression, and I’d heard of people developing depression during pregnancy, but I haven’t heard anything about what happens when you’re already depressed and want to have a baby. But with that one decision — to try for a baby — my depression shifted to pre-prenatal depression.

The prevalence of mental illness cannot be overstated. One in six Americans suffer from a mental illness, millions of whom are depressed — and according to an analysis carried out by a clinical psychologist at Oxford University, women are 40% more likely than men to develop mental health conditions.

With the one decision to try for a baby, my depression shifted to pre-prenatal depression.

So it seemed odd that there’s not more out there about getting pregnant while depressed. The few stories I found scared the shit out of me. (One article was ominously titled, “Scary News For People Who Get Pregnant While Depressed.”) And, unfortunately, there’s no clear list of guidelines for depressed women who want to become moms.

As Bay Area psychiatrist Jill Armbrust explained to me, the plans for treating a person with depression who wants to get pregnant are the same as those for anyone who’s becoming depressed. “The difference being there would be more focus on and care put on the side effects of various medications.” This takes a lot of time and careful planning. “One usually starts with about six months of psychotherapy if you have that kind of luxury,” Armbrust advised.

The guidelines that do exist center on medication, of which I take a range to keep my mind intact, namely lithium, Latuda, trazodone, lorazepam, and clonazepam. I’d be a whole lot worse without them, and — with absolutely the intention of sounding dramatic — I may even be dead.

But it turns out these pills don’t mix well with pregnancy. My therapist advised weaning off the meds completely. My first thought was simply, “No.” I didn’t want to think about who I would be without medication. I tried to kill myself without medication. My brain flooded with questions: How could I create a new life when I’ve wanted to end my own? Will I turn into a monster? Should people like me even have children?

I found myself asking that last question a lot. Given my history of depression and suicide, was it safe or even fair for me to have kids? I wondered if there were any circumstances where therapists advised people against getting pregnant.

There are, though, as Armbrust explained, “It’s tremendously variable because of the stigma that even some practitioners carry.” While there’s no absolute answer to this, Armbrust suggests the only two reasons she’d advise against pregnancy: when the woman had unstable psychosis or an untreated substance abuse problem. She went on to say that she believes women with schizophrenia, bipolar, and depression — like me — are all candidates to be very good mothers.

I am fortunate enough to have a therapist, and (thanks to my husband) health insurance. Having a baby while depressed was going to be hard but not impossible.

So we began.

Confusion

My therapist said we would start by lowering the doses of my lithium, trazodone, and Latuda. However, I had to stop taking lorazepam or clonazepam, since both have been recognized by the U.S. Food and Drug Administration as drugs with “positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans.” The U.S. agency calls these Category D drugs, with Category A being the safest for pregnant women and X being a total no-go. But since I didn’t take lorazepam or clonazepam every day, I didn’t think that would be too bad.

The one I was worried about most was lithium. Lithium was the one that tied the room together. At the time of talking to my therapist, lithium was category C, the third of the five categories, so I could potentially keep taking it at low doses even if I did become pregnant.

My therapist assured me we’d get through it together and that she’d be monitoring me closely. She suggested I see an OBGYN and see what they thought. About a month later I was booked to see a nurse practitioner where I had a pap smear and a ton of questions. It isn’t common practice for an OBGYN to screen for depression at this stage, though Armbrust says this would be hugely beneficial, given that postpartum depression is so common. But when it comes to pre-prenatal depression, “It’s still considered stigmatized in a separate area of expertise.” Most of the time you have to volunteer the information yourself.

Given my history of depression and suicide, was it safe or even fair for me to have kids?

I told the nurse about my psychiatric history, and that I was trying for a baby. Before I could ask her any questions, she stopped me: “Do not start trying until you are completely off your medication.”

“Even lithium?” I spluttered. She furrowed her brow, left the room to check. Three minutes later she came back. “Even lithium.”

My therapist was confused. “Even lithium?” she asked me. I nodded, and when she opened her laptop to check, she nodded, too. “It’s changed to a category D” — just like lorazepam or clonazepam.

This was the first of many conflicting pieces of information I would come across in my mentally ill quest to become pregnant. Distressed that no one had a clear-cut answer, I turned to the one place I knew would be even worse, though it seemed to be also the place where my doctors were getting their information: the internet.

LUV 2 B ONLINE

Here in the murky depths of online pregnancy forums is where I found other people with mental illnesses who were as equally as confused as me. Though there were still no clear answers, it was strangely comforting. Up until now, I’d been speaking to medical professionals who discussed coming off medication as though it were a procedure. However, in the forums I found people who were talking about it in terms to which I could relate. These were people who lived with schizophrenia, bipolar, PTSD, and depression. There were those who felt guilty about continuing to take medication and those who were OK with it. There were some who’d stopped taking their medication, had a bad episode, and had to go back on. And there were those who stayed off meds for their whole pregnancy but went back on after the baby was born. One thing was for sure, nobody had the “right” answer because the “right” answer is whatever works for you.

These conversations turned from medication to general feelings. Women talked about how they felt ashamed of feeling depressed when they should be happy and grateful that they managed to get pregnant in the first place. They talked about how they wrestled with their emotions on the inside and the judgment cast upon them from the outside. The judgment on the outside being other moms in the forum telling them they’re bad mothers for taking medication. It happens all the time and is not exclusive to pregnant mothers with a mental illness. If you’ve ever been on a parenting or pregnancy forum, you’ll know that, while they can offer solace and support, they’re also diabolical whirlpools of toxicity designed to drag you down into a complex sewer system of self-righteousness and unconstructive criticism.

Fear-Mongering Among New Mothers Is A Profitable Business

“So why even go on them?!” I hear you cry. Great question — but avoiding them is easier said than done, especially when forums are one of the only places I could go to read about other pregnant peoples’ struggle with mental illness (and I’m a sucker for shame). Even though pregnancy forums are bustling hellscapes, they’re (ironically) the only places some us can go to discuss “taboo” subjects such as mental illness.

It’s Not You, It’s Me

I decided the “right” answer for me was to come off all my medication before trying for a baby, including the lower-risk ones. After three months of careful planning and monitoring, I was entirely med-free for the first time in five years, when I’d tried to commit suicide. The few other times since then when I came off certain medications because I convinced myself I didn’t need to be on them, I experienced particularly bad depressive and hypomanic episodes, at one point landing myself back in the hospital.

Before, I didn’t tell anyone when I went off medication and decided to go cold turkey, which isn’t ideal. This time, it felt different. I had my therapist monitoring me closely. Still, being off meds contained all the terror of a manic episode without the mania, like walking a tightrope over the Grand Canyon with no safety net.

For the first time in five years, I started to feel — but not in a good way. I’d become so accustomed to my moods being regulated; it was like I had two bouncers standing in front of my mind, letting thoughts and feelings come in at a steady pace. Now the bouncers were gone, and everyone started to rush into the club and fuck shit up. I was overwhelmed and began to isolate myself. I talked to my husband, my therapist, a couple of friends, and a whole bunch of strangers on the internet. I retreated into the pregnancy forums where I could be among women who were going through the same thing as me. Out of everyone, the forums is where I felt the most comfortable. I didn’t feel like I was burdening people with my “issues,” I didn’t feel like I was boring anyone with my constant questions, but most importantly, I didn’t feel alone. I’d tried talking to other people, but with all these unsupervised feelings, it was hard not to get upset or angry.

On The Fear Of Pregnancy Loss During The First Trimester

When it comes to your pregnancy, everyone you meet is an expert on you and your body. You tell people you’re trying, and immediately they’re all, “You’ve got plenty of time,” or “Relax, it can take up to a year.” As with everything in life, if I want your opinion, I’ll ask for it, but please know I’ll never ask because I never want it. I knew getting pregnant could take a while. Sometimes it happens instantly, other times it can take years. Either way, the wait can be excruciating. And when you’re flying solo without your antipsychotic medication, the wait becomes dangerous.

Every day I’d wake up and wonder if today were the day I’d lose it. I hoped I wouldn’t have to be hospitalized again. I begged my mind not to have an episode. For me, getting pregnant wasn’t a race against time, it was a race against mind.

After only a couple of months, I felt unstable. I started to feel sad. Not depressed, just sad. I assumed this was part of my unregulated moods, but the sadness lingered. Before long, I felt myself sliding into dangerous territory. The sorrow had morphed into depression, and without any medication to block it, the depression began to pick up speed. I still wanted to have a baby, I just didn’t know if I would be around to have it. I talked with my therapist, and we decided to give it one more month before I went back on the meds. One more month would make it three months total of being off meds, and whether I became pregnant or not, I felt proud I’d made it this far. Those three months were both terrifying and challenging, but nothing prepared me for what happened next. I got pregnant.

Uncomfortably Numb

Even without a mental illness, pregnancy can mess with your head. There’s the hormones, nausea, and the ever-changing body, which can be hard to process for anyone. But here I was, with no control over my body or mind. Everything started happening so quickly. I felt as though I was losing myself. I was happy and grateful we’d managed to get pregnant in a relatively short amount of time, but I was also depressed and disconnected. I remember staring blankly at the eight-week ultrasound. I knew I should be feeling something, but it just wasn’t happening. It was like I was experiencing phantom feelings. I’d already disassociated from the pregnancy, a pregnancy I wanted and planned. I started to experience a familiar numbness, the same numbness that enveloped me for the first 20 years of my life. I couldn’t even feel shame anymore.

Just like pregnancy, everybody experiences mental illness differently. And while I am fortunate enough to have a therapist, health insurance, and an OBGYN, the only person who was going to come up with the “right” answer was me. I’m now four months along and still off medication. Things aren’t perfect. (Is any pregnancy?) I still struggle with depression, and managing without meds does not mean I’m “cured.” I will always have bipolar, and anxiety, and PTSD, but there are things I can do to lessen the mental strain while I’m pregnant.

Just like pregnancy, everybody experiences mental illness differently.

I continue to work hard at therapy. I try to eat healthily and exercise as much as I can. And I’m starting to increase my social support system beyond the confines of the internet, which has been daunting, but it’s helping a lot. And although I feel good now, I don’t take for granted that it could all change.

I want to be clear: Nothing can or will replace my medication. Even now, going back on medication is still an option, and once the baby is born, the plan is to start taking them again. The most important thing is my health. If I’m not healthy, then there was no way this baby could be either. I considered starting back on a low dosage of lithium, but I before I made that decision, I wanted to work on my mental health one last time. Again, I do not judge anyone who continues or goes back to their medication. If that’s what’s best for them, then that’s the right decision.

These are just things that help me personally, but who knows, it all may change. I’m taking it one day at a time. That’s the way it is with depression. There’s no cure; there’s just what works for you, for now.

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]]> https://theestablishment.co/why-we-must-walk-away-from-destructively-dependent-relationships-62fc6782ef3e/ Thu, 04 Jan 2018 14:48:43 +0000 https://theestablishment.co/?p=2572 Read more]]> My instincts were screaming at me to move forward, but I was scared to leave. I was afraid of what he might do.

By Nicole Schmidt

Content warning: suicidal ideation

My last relationship was riddled with problems — but for the year and a half we were together, I told myself that the bad times were overshadowed by the good days.

We met while I was studying overseas in New Zealand, and after I left to go back home, we decided we weren’t ready to let go of each other. In the beginning, while we were still on the same continent, everything was easy, and being together felt intuitive. He was older than me, but it didn’t seem to matter because we connected in a way I convinced myself could never be replicated with anyone else. I fell in love with his mind — he was well spoken, creative, kept me intrigued, and made me feel special.

For every good trait, however, I later learned there was a flaw that carried more weight. When he drank, which was often, he had two sides: He could be vindictive and derogatory towards me, or deeply displeased with his own life. I preferred the latter because I knew that the sadness would subside the next morning. The slurs he hurled at me, though, made themselves cozy in the back of my mind; “slut” was his go-to. He didn’t trust me around other men and constantly criticized my feelings by telling me I didn’t love him enough.

I made excuses for him by focusing on all of the times he said I was perfect, that I was the only person who made him happy. But this fixation, too, had a downside: I’d lost my ability to see just how emotionally abusive my relationship had become.

His history with chronic depression and anxiety was something we talked about often; he spent the entirety of his twenties drowning in it, unable to leave his room for days on end. He was a long way from being okay, but he assured me that things were better now. At first, I thought it was something I could handle. Still, there were times when he’d piece together his darkest thoughts and talk about leaving the world.

I’d lost my ability to see just how emotionally abusive my relationship had become.
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Tear-filled conversations about suicide often transitioned into him planning for a future he refused to think about without me in it. Those days were the hardest. They left me feeling scared and overwhelmed — like I’d taken on the sole responsibility of keeping my partner upright. His life was at a standstill before we met. He had three university degrees, but hadn’t held a steady job in years because he felt like he had nothing to work towards. Our prospective future was his first real plan, and that brought ambitions — like cutting back on drinking and finding a proper job — to the surface. He wanted to move in together after I finished my degree, maybe even get married.

But there’s an unsettling pressure that accompanies being someone’s main source of motivation and happiness. Good days became more frequent, but when he was having one of his bad days, I became what he depended on. His problems always took priority over the other things in my life, because if I wasn’t there, he made me feel guilty by telling me I didn’t care enough. It consumed most of my free time and all of my mental energy.

My instincts were screaming at me to move forward, to stop answering calls in the early hours of the morning, to refrain from constantly wondering whether he was okay. I neglected my emotions until the pressure to help him be okay — to be there whenever he needed me, to reassure him constantly of my love — finally made me see that the person who once made me feel so special had become the source of so much fear and sadness.

Still, I was scared to leave. I was afraid of what he might do if I did.

We had plans to see each other at the end of the year for the first time since I’d left, but as the date got closer I started to ask myself whether I could ever really be happy in the relationship. I knew that no one person could give him the true stability he needed, and finding any sense of balance between us seemed like an impossible task.

When I finally did leave him, I felt a sense of ease. I could breathe again. But all of those previous fears became real a few weeks later when I woke up to his name on my phone screen. When I saw his text, everything unraveled.

“It’s time to leave this behind once and for all…I’ll always love you but you did the wrong thing by me,” the message read. “All I ask is your forgiveness for what I’m about to do. It breaks my heart that I wasn’t good enough for you.”

Frantic calls and texts went unanswered. Minutes spent on hold with the police dragged on. My mind wandered. I questioned my decisions and my self-worth. I cried until my body was numb. When I finally willed myself out of bed for work, I couldn’t help but feel disconnected from everything around me. I spent the day trying to quiet my thoughts, which seemed impossible.

After 12 hours, it was the who police confirmed he was alive. They showed up on his doorstep and found him drunk and unharmed inside.

The episode was devastating and frightening — but also clarifying. Suicidal ideation is a very real issue rooted in mental illnesses too often stigmatized, and threats must always be taken seriously and handled with compassion. At the same time, the scenario forced me to understand the importance of boundaries in my life — and how toxic his dependency on me had always been.

Sue Johnson, clinical psychologist and founding director of the International Centre for Excellence in Emotionally Focused Therapy, told me that when partners delve into extremes, they’re often driven by insecurities and a need for control. It’s natural to rely on another person for comfort, support, and affection, she says, but there’s a very important difference between constructive and destructive dependency. “Relationships don’t work on a level of threat. Relationships work when you help people feel safe…You can’t demand someone love you.”

There’s a very important difference between constructive and destructive dependency.
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Some relationships can be consuming to the point where any real sense of perspective vanishes. Mary Andres, a professor of clinical psychology at the Rossier School of Education, described it to me as your brain going into crisis mode: When you’re busy reacting to the emotional demands in front of you, trying desperately to hold up another person, it’s easy to feel depleted. Eventually, you can reach a point where you stop using your frontal lobes, which are responsible for problem solving and judgement. Andres spoke about one woman she worked with who spoke about her own life as if she wasn’t the protagonist — her partner was front and center in every problem and every thought.

“When you’re involved with a toxic person and they’re telling you that you should be able to make them feel okay, that’s a fallacy,” Andres says. “If we listen to them, we’re letting them define our reality…It’s difficult to make decisions when you’re in that place.”

At the same time, when you have someone begging you to rescue them, to be their entire world and sense of stability, saying “no” feels morally wrong. And so walking away — the most important thing you can do in such a situation — also ironically becomes the hardest part.

But as Andres emphasizes, ending an emotionally abusive relationship isn’t selfish; it’s the best thing for both people involved. “You’re saving your own life and it might be a precursor to the other person getting the help they need. A person has to experience loss to get incentive to make a difference,” she says. “But it’s not easy.”

As for me, it’s been 10 months since I left my partner, and I still sometimes wonder whether he’s okay. But the difference is this: that thought no longer takes priority in my life, because I know that my happiness is important, too.

Leaving was difficult — but it helped me realize that staying with someone out of guilt and obligation isn’t love.

I bought a psychedelic mushroom grow kit. You know, the funny mushrooms that take you on a trip. I heard they could make my mind right.

Since 1978, psilocybin—the active ingredient in psychedelic mushrooms—has been illegal in the United States. According to the U.S. Dept. of Justice archive:

“Psilocybin is a Schedule I substance under the Controlled Substances Act. Schedule I drugs, which include heroin and LSD, have a high potential for abuse and serve no legitimate medical purpose in the United States.”

Today, the State is actively withholding psilocybin treatment that could fundamentally change the lives of those suffering with depression , a treatment that has already helped droves of people — like me — who never thought they’d shake their psychological shadows.

David Nutt, the director of the neuropsychopharmacology unit in the division of brain sciences at Imperial College London, is a pioneering researcher who studies the use of psychedelics to treat mental illness.

Nutt summarized the findings of one of his studies around chronic depression:

“We treated people who’d been suffering for 30 years, and they’re getting better with a single dose. So that tells us this drug is doing something profound.”

Robin Carhart-Harris, a research fellow at the same London institute, echoes the staggering impact of psilocybin on the patients’ psyches. After one week, all 12 participants reported an improvement in their depression and two-thirds of the people were depression-free. By three months, about 58% showed improvement — five were in remission while five relapsed. “The efficacy of the treatment is impressive,” says Carhard-Harris.

Additional studies at NYU and Johns Hopkins that centered around depression and cancer — which involved 80 patients collectively — found that a single dose of the medication can lead to an immediate reduction in depression and anxiety and that the lingering positive effect can last up to eight months. Dr. Stephen Ross, director of addiction psychiatry at NYU Langone Medical Center, called this depression treatment “unprecedented,” insisting that “we don’t have anything like it.”

Why Veterans With PTSD Are Turning To Cannabis

Although these revolutionary medical studies provide convincing evidence that psilocybin can be an effective treatment for depression, NYU and Johns Hopkins researchers emphasized the “danger” and illegality of psychedelic mushrooms, cautioning, “…the drug was given in tightly controlled conditions in the presence of two clinically trained monitors… [The researchers] do not recommend use of the compound outside of such a research or patient care setting.”

Also, both studies stressed that their research was for terminally ill cancer patients, not average sad people, like me.

About 15 years ago, I was diagnosed with depression. Science, family, friends, and television commercials for pharmaceuticals agreed: Depression resulted from a chemical imbalance. As a depressed person, I understood my condition was physical, and not something I could sleep away. (Although I tried.) So, after sharing my detailed descriptions of worry and grief with a soft-spoken and apparently concerned doctor, I received the permission I needed for my only option to heal—a prescription for Prozac.

When it comes to health care in the U.S., we’re not given many opportunities to think outside the box. For physical and emotional pain alike, prescribed drugs are widely accepted as a primary solution for people who seek relief. You are diagnosed, placed in a box, and given the “right pills.”

At the time, I was in law school in Philadelphia. Not only did I hate school and my accidental career path, my father was recently diagnosed with colon cancer, and I felt every part of life slipping from my control. Therapy helped, and the drugs numbed the symptoms of depression.

When it comes to health care in the U.S., you are diagnosed, placed in a box, and given the ‘right pills.’
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But after law school, having rejected the law and earning most of my income under the table as a private teacher for children in the M.OV.E. Organization, I was uninsured for more than a year. Even after I found more stable jobs, I never quite found my bearings in one city, bouncing from coast to coast, and confronting periodic reminders that my depression was still very much untreated.

Although I was coping and getting along okay, I occasionally searched online for something like, “local mental health service providers,” trying to find a therapist — or any kind of solution to this overbearing pain that haunted me on my worst days. Honestly, sometimes even the research itself was too much to bear. So in truth, I didn’t try too often.

And even finding a therapist was no guarantee for treatment. After one decent session with a doctor I liked, my insurance company refused to pay for treatment. More than a year later, after a tolerable session with a doctor who was both arrogant and racist, she refused to treat me because “we wouldn’t be a fit.”

I began coping with symptoms of depression and rejection.

In New York City, about five years after the initial diagnosis, I found a doctor who offered a “trial session,” which was a common routine. I’d pay out of pocket; he’d listen for an hour, then recommend a treatment over the course of some months. My insurance company would consider his opinion, then decide if the whole thing was appropriate. I’d remain somewhat of a bystander in the process.

Like my earlier attempts to heal within the system, I committed to it.

I spilled my guts and tears on his couch. I told him about being diagnosed with depression years earlier, my father’s death, growing anxiety, insecurity and loneliness — the works. He talked at a normal volume, in non-condescending tones. Although I didn’t think he could relate to my grief, I liked the way he listened.

“Finally, I’ll get this thing under control,” I thought. “He’ll help.”

We planned to start treatment in a week or two. He only needed to mail a confirmation, which arrived just a few days later. I wasn’t surprised until a check fell out — with my signature on it.

The doctor’s handwritten note explained that my insurance would only cover a small portion of my therapy. And since I was super messed up and not super rich, he knew it wouldn’t be possible for us to continue. He kindly returned my non-refundable fee for the trial session, explaining, “I feel terrible about this and can’t justify taking your money. I hope you find the help you need.”

I was sad, frustrated, helpless, and now pitied. I cried fiercely over that letter. He was the last therapist I would ever see.

Since then, I’ve forged my own path to recovery, involving temporary drug relief, plenty of self-discovery, and a fair share of scientific research. In the process, I’ve become aware of the box in which I’ve been trying to heal, one that was designed by cold-hearted, American insurance providers and pharmaceutical companies that make commercials with happy white women on beaches.

Now? I’m growing psychedelic mushrooms in my living room.

Since I migrated from the U.S. to The Netherlands several years ago, I can legally purchase a grow kit for magic mushrooms at a lovely, pro-woman and pro-healing herbal shop that’s a short walking distance from my apartment. I explained to the shop’s owner that I read about the benefits of taking magic mushrooms in microdoses to treat symptoms of depression, so I wanted to try them for the first time.

“Oh, yes, absolutely!” She exclaimed. “I know several people who use mushrooms this way. They can give you a spiritual experience in larger doses, and a healing experience in smaller doses.”

It’s what I hoped to confirm; my online research included piles of papers and personal accounts from people hailing from all parts of the world, all treating their depression with psychedelic mushrooms.

I took my first mushroom kit home and quietly hoped for relief — from depression and the limitations of American health care.

I started my homegrown treatment with a full trip, eating about 4 grams of mushrooms. That night, over the course of several hours, I recorded an emotional conversation with myself. I worked through some of the sore spots and identified a source of generational trauma, including a connection with my father and previous generations, all of whom dealt with a depression that reaches back to slavery and unfulfilled promises of freedom.

I questioned my self-doubt. I cried over unaddressed pain. And I laughed at the absurdity of the situation. By the next morning, I felt like I had been through months of therapy.

From there, I turned the mushrooms into pills, creating microdoses of 0.2 grams. I started by taking a microdose every 2–3 days. Now, after several months of consistent doses, I’m down to an average of one microdose per week.

I started my homegrown treatment with a full trip. By the next morning, I felt like I had been through months of therapy.
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In addition to increased focus and energy, the mushrooms have brought me levity and gratitude. Unlike Prozac, which felt like placing a blanket over my problems, the mushrooms have lifted away a burdening weight. Although I can’t say all problems are solved by swallowing a mushroom microdose, they provide me the needed perspective and clarity to perceive (internal) barriers and negative thoughts, and then address them.

At some point, I expect I’ll no longer need a dose every week or every month, or even at all. But for now, as long as I experience the benefits of the treatment, I’ll continue microdosing.

And, in the meantime, I’ll participate in the growing movement to legalize psychedelic mushrooms in the U.S., because other treatment-seekers deserve relief from their depression, a mental illness that affects 6.7% of the U.S. population age 18 and older.

The magic of these mushrooms shouldn’t be kept under lock and key, but warm on a windowsill.

Those who can’t ‘pass’ as reasonably sane are given less agency, respect, and dignity as they navigate psychiatric care.

I ’m being buckled into a stretcher; restraints are being placed around my ankles when a nurse walks by.

“You don’t really have to use all the restraints,” she says to the EMT, gesturing to me with a wink. “He’s one of the good ones.”

Not like the screamer down the hall, who the nurses took up ignoring after a while. Not like the runner who tried to make a break for it past the security guard. Not like the kicker who had to be sedated after an IV mishap. Not like the cutter who tried to self-harm during the shift change.

When I was in the emergency room, I learned that if I was good, I got as many juice boxes as I wanted and Ativan — a benzodiazepine designed to help those with anxiety — every few hours. On the dot. The nurses would smile at me and bring me extra blankets; the doctors would comment on how “bright,” “articulate,” and “lucid” I was.

They liked me. They liked me because unlike the others, I was relatable, almost familiar — had we met under different circumstances, we might even be friends.

They liked me. They liked me because unlike the others, I was relatable.
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Once a doctor even said to me, baffled, “They aren’t sending you home?” When I shook my head, he asked, “How does someone like you end up in the emergency room, anyway?”

Someone like you.

The notion of “good ones” is a lesser-known reality about mental health, as it plays out in psychiatric settings. The good ones are compliant, friendly, “higher-functioning.” And then there are the really “crazy” ones.

The ones who are too loud, too unruly, too much.

Replace ‘Crazy’ With The Adjective You Actually Mean

I used to try so hard to be “good.” It was something I was quite adept at. It started when I was a teenager, so ashamed of my mental illness that I did everything I could to conceal it. The charade was so successful, no one believed me when I first said I was sick.

This is what happens when you’re a people-pleaser who believes your value rests in what everyone else thinks, and that belief collides with the stigma that says mentally ill people are inherently less valuable. If they are seen for what they “really are.”

I kept it up for years. I played the role well. Too well.

I’m in the emergency room for being deeply suicidal — prompting an intervention by loved ones — and a medical doctor now immediately wants to send me back home.

The attending nurse dotes on me like I’m her long lost nephew. She offers me a special lasagna dish they don’t usually serve, she says, because she remembers that I’m vegetarian and the usual veggie option is terrible. The screamer down the hall is sobbing, “HELP, HELP, OH GOD, PLEASE HELP,” but the nurse realizes she’s forgotten my juice box, and she dashes off quickly to get it.

As if it’s the most important thing in the world. As if the only people that matter are the “good ones.”

That moment will stand out in my mind forever. It was the moment when I realized that as long as we divide mentally ill people up into “good” and “bad” — or with coded language like “high-functioning” and “low-functioning” — we replicate the oppressive hierarchies that harm all of us.

The internalized stigma that compelled me to “perform” sanity was the same stigma that can lead to neglect and abuse in psychiatric settings, and further marginalize the most vulnerable mentally ill people.

Maybe that nurse had a reason for getting the juice box instead of going two rooms down to check on the person who was screaming for help. I can never really know.

But what I do know is that these hierarchies exist — illustrated in many interactions just like that one — and my participation in that hierarchy, both to my own benefit and detriment, has very real consequences.

The internalized stigma that compelled me to 'perform' sanity was the same stigma that can lead to neglect and abuse in psychiatric settings, and further marginalize the most vulnerable mentally ill people.
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Trying to be “good” may have gotten me more blankets or special lasagna, but it says something sinister about how the stigma around mental illness operates.

Here’s what I’ve learned — and why I believe we need a more nuanced conversation about privilege and power as it shows up in mentally ill folks.

I Have (Some) Privilege Because I’m Positioned As The “Exception”

I struggle with severe mental illness and that, of course, comes with significant marginalization and strife. But because I’m so often perceived as friendly and functional, and therefore a kind of “exceptional” mentally ill person, I still benefit at the expense of other mentally ill people.

Namely, because I’m positioned as not “like them,” I am often treated better as they are simultaneously othered.

We see this kind of ableism most distinctly when we categorically divide up disabled people into “higher” and “lower” functioning — which can be a coded way of saying, “These are the people that can conform to society’s expectations of what a ‘typical’ person should be, and these are the people who fail to do that.”

I directly benefit from the ableist assumption that I am “exceptional” because I often present in the narrow way society holds up as the ideal — an ideal that expects psychiatrically disabled people to conceal their disabilities.

I directly benefit from the ableist assumption that I am ‘exceptional.’
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It seems to me that we want mentally ill people to not only be passive, but invisible for the comfort of neurotypical people, and especially for the ease of clinicians.

As long as I’m considered relatable, compliant, and friendly, I can expect to be treated with a lot more dignity than my other mentally ill counterparts. Kind of like the Zooey Deschanel of mental illness, where mental illness makes me brilliant and quirky — not a burden or someone to be feared or mistrusted.

And let’s be real — my success as a mentally ill writer rests heavily on the perception that I am just the “right” amount of “crazy.” The kind that inspires, the kind that allows me to give a TED Talk to a packed audience; not the kind that terrifies you while you’re on the metro because I’m talking to myself.

(But for the record? I, like most mentally ill people, have had moments of both.)

I have to acknowledge that while I do experience oppression as a mentally ill person, I am treated with more compassion, have access to more resources, and have the trust and faith of my clinicians because I can “pass” as reasonably sane in most situations.

As long as I’m considered relatable, compliant, and friendly, I can expect to be treated with a lot more dignity than my other mentally ill counterparts.
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On the other side of the coin, the people who can’t live up to this ideal are perceived as “difficult” — often written off, misdiagnosed, or pushed off onto other clinicians — and are given less agency, respect, and dignity as they navigate psychiatric care.

Respectability politics are a real thing. And mentally ill folks are by no means immune to it.

Being Seen As ‘High-Functioning’ Can Still Be Harmful In Its Own Way

It took a long time for me to realize that being “respectable” as mentally ill hasn’t always served me.

It’s the reason that folks have reacted with disbelief when I say that my mental illnesses are severely debilitating. It’s the reason that doctors disagree about whether or not I’m dysfunctional or suicidal “enough” to be hospitalized. It’s the reason that I don’t always receive the support or care that I need, because I’m assumed to be better off than I actually am.

The first psychiatrist I ever saw said she was reluctant to prescribe any medications to me because I had good grades in school. Her words exactly: “What do you even need me for?”

We Need A Review Site For Psychiatric Hospitals — So I Built One

As a rule, before we get into the nitty-gritty of what I’ve been through, many clinicians are disarmed by my presence — some even questioning why I’m there in the first place, because I don’t “look” mentally ill.

On the whole, my treatment is a lot more competent and compassionate because I present in a way that’s more “approachable” and less “difficult,” but that doesn’t mean that I’m not presented with my own challenges.

The difference is that those challenges are still a result of stigma — namely, that mentally ill people must be dysfunctional, difficult, and unrelatable. My erasure is intrinsically bound up with the kind of ableism that ensures that “lower functioning” mentally ill folks don’t get the support that they need.

This kind of erasure ensures that I struggle to be seen as a patient, whereas other mentally ill folks struggle to be seen as human.

In other words, no one is really winning.

Being ‘Difficult’ Intersects With Other Axes Of Oppression

When we talk about who “looks” mentally ill, who presents as or is expected to be functional, who is “trustworthy,” and who is “difficult,” we can’t really ignore the fact that all of this language is situated in such a way that it plays into existing biases around race, class, gender, education, and more.

This looks like the ease with which clinicians disproportionately diagnose people of color — especially black people — with psychotic disorders, yet major depressive disorder largely goes unnoticed in these same populations due to the cultural incompetence of their clinicians.

This is why we see “difficult” women being misdiagnosed as borderline or histrionic. This is why poor folks and folks of color disproportionately wind up in prison, while white folks with class privilege (like myself) wind up in hospitals.

Who gets to be “good” and “relatable” — and conversely, who is deemed “difficult,” “crazy,” or “bad” — becomes very apparent when you take a look at who holds the most privilege and power in society.

Mental illness can and often is weaponized against the most marginalized among us, and undeniably impacts the kind of care we receive.

When I walk into an appointment with a clinician, I’m not considered “threatening” — that ER nurse can treat me like her queer little nephew because she could easily imagine that I was. It wasn’t just about how I behaved, but how I was perceived.

And when you are a college-educated, transmasculine white person, you are given the benefit of all different axes of privilege, in which people are conditioned to believe in your inherent goodness, empathy, safety, and intelligence.

Who gets to be ‘good’ and ‘relatable’ — and conversely, who is deemed ‘difficult,’ ‘crazy,’ or ‘bad’— becomes very apparent when you take a look at who holds the most privilege and power in society.
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When I was placed in the ambulance the first time I was committed, the EMT told me he’d unhook my restraints — just seconds after putting me in the ambulance — because “I probably wouldn’t punch him.”

In a single loaded statement, I was acutely aware of the fact that my perceived “safety” had everything to do with his immediate impression of me — and nothing to do with how mentally ill or unsafe I might actually be.

Much of mental health care has to do with quick assessments and judgment calls. But who gets the benefit of the doubt — and how patients are ultimately categorized, diagnosed, and cared for — can be deeply impacted by existing prejudice.

And because of that, my experiences as a mentally ill person will always be shaped by the hierarchies that exist both within this community, as well as the ones systematically designed and enforced outside of it.

I’m seen as “one of the good ones.” But that’s due, in large part, to the privileges I already have.

My experiences as a mentally ill person will always be shaped by hierarchies.
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So no, I no longer revel in being seen as the “exception” — sipping on a juice box, propped up by an extra pillow — looking for the approval of my clinicians and nurses.

I don’t delight in being anybody’s “favorite patient,” as flattering as that might seem.

I recognize my perceived “goodness” for what it actually is: Undeniably harmful, bound up in somebody else’s oppression.

DECEMBER

New Orleans is magic, and so I drag myself a thousand miles southward to beg the help of its witches, soothsayers, voodoo priests, and mediums on the tail end of a Christmas season.

This year was not kind to me, and has me looking for a new kind of magic. The old magic, by which I mean medicine, is on its way out. SSRIs settled my brain, but their side effects were fierce and unyielding. I, with the supervision of a doctor, am going off.

At least for a while. At least until we find something new that works.

I choose a crystal shop in the French Quarter, a place called Earth Odyssey a few blocks from the riverside. I’m a sucker for stones, crystals, pendants, and rocks, and Earth Odyssey is full of them. At a quarter to two, I request a psychic. I don’t call ahead because I’m tired of planning. I’m tired of holding myself together with doctors; with spit and grit and grime. I’m tired of finding new ways to heal myself.

I’m tired of finding new ways to heal myself.
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My reader’s name is Kay. The woman behind the counter tells me “she’s one of our best,” and I believe her. Kay calls me into her tent. She calls me “my dear” like an auntie, and for once in my life, it doesn’t rub me the wrong way. She asks for nothing, not even my name.

“I don’t usually use these cards,” she says, pulling out a bold, vividly orange set, “but they’re calling to me today.”

“You’d know better than I do.” I mean it like a blessing.

Kay moves fast. She tells me that she likes to read first and ask questions later. She flips one, two, three cards, and doesn’t stop. The images come rapid fire, without order or arrangement. “You have a good heart, resourceful. I see a temple.” She marks the outline of a Chinese temple with her hands. “Very empathetic. You feel what other people feel.” And then she slams her hands on the desk. “Oh, you’re an empath.”

No one has ever called me an empath before, but perhaps that’s because, on and off for the last 15 years, I’ve chosen doctors over mediums. I’ve been lectured, patronized, named — but not yet cured. As my options have dwindled, I’ve increasingly turned to magic and tarot.

I want to tell Kay that actually, I’m not an empath, I’m “manic-depressive;” I was diagnosed last June. Before that, I was just a clinically depressed neurotic with an intense anxiety condition. Or something. What we know for sure is that I’m an emotional burnout with a mood disorder, and that I took the medicine because I wanted to stay alive.

I want to stay alive.

JANUARY

Jessica Reidy isn’t a psychic, but she reads tarot cards in the Romani tradition. It’s been two weeks since I started off medicine, and almost a month since I left New Orleans. I sit with Reidy in her Brooklyn apartment to reaffirm what I already know. Because I need to know it in a different way. Because I need to hear it again.

“In my family, fortune telling was a trade I learned as a child,” she explains. “My training began when I was five and was quite rigorous — dream analysis, prayer, and meditation accompanied with hours of studying and learning the lines and symbols in palms, tea leaves, and cards. My grandmother took it unusually seriously because of our family’s legacy of healing and medicine work. Though traditionally we read playing cards, not tarot.”

She sets the cards down and says, “this is an intense arrangement. Not bad, just intense.”

Reidy talks for half an hour about my pain. She offers insight on creativity, balance, and growth. At the end, maybe sensing my distance, she says, “sometimes we don’t let ourselves cry because we’re scared that we’ll never stop,” and it hurts to hear because it’s so true. Mostly though, after years of talk therapy, it feels good just to listen.

After years of talk therapy, it feels good just to listen.
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Indeed, it’s a huge relief to hear something about my problems from someone who isn’t trying to save me. Roma, too, have their own pain. Reidy certainly does. “I’ve had a colorful life with probably far too much trauma, heartache, and fear, and it’s rare that a client comes in with a problem that I haven’t already been through myself,” she says. Reading with her is a bit like speaking to an intuitive older sister — one who’s already been to the mountain.

“It is not about psychism or reading the future,” she explains. She says that fortune telling and performance were some of the few trades that Roma were historically permitted to practice. Tarot isn’t magic, any more than the Roma themselves are. Rather, tarot acts as “an informal therapy session issuing tools and metaphor to better interpret a person’s problems, to see the patterns in their life, opportunities for healing, and to make room for synchronicity. We think of it as creative problem solving with a dash of intuition,” she says, and that’s exactly what it feels like.

“I think everyone I see is looking for healing or comfort in some form,” she continues. “People usually come to me when they are at a crossroads, which involves some kind of suffering. Really, everyone’s question boils down to How can I be happy?”

I want to be happy.

I’m not happy yet, but I definitely feel better than I did when I tried to leave medicine cold-turkey. I was 25, and my descent into madness was swift and unyielding. I dragged more than one friend down with me, and refused to admit something was wrong until it was almost too late.

This isn’t uncommon. In her excellent memoir about living with bipolar disorder, An Unquiet Mind, Kay Redfield Jamison writes that “it quickly came down to a choice between seeing a psychiatrist or buying a horse. Since almost everyone I knew was seeing a psychiatrist, and since I had an absolute belief that I should be able to handle my own problems, I naturally bought a horse.”

I bought a deck of cards.

FEBRUARY

Jenna Lee Forde is finishing up her grad work at York University, where she explores the intersection between tarot, queerness, and self care. “My relationship to tarot is focused around using it as a resource for self care, healing, and specifically a divination tool that has a beautiful history of female artists illustrating the cards,” she says. “I most recently got interested in tarot when I was in an abusive relationship that left me with little emotional resources to take care of myself.”

While queer trauma and mood disorders are not intrinsically linked — a distinction I make emphatically in an age of “conversion therapy” — I sought insight from Forde because I knew that she had survived something. “For me, tarot enabled a space for peaceful contemplation,” she says, “and for many trauma survivors, including myself, the process of disassociation and dysregulation are fairly normative parts of our embodied experience.”

Forde’s pain is not my pain, but I know what it is to soar above my body. I know what it’s like to detach into the abrupt high of psychosis, only to slam forward under the weight of endless sobbing depression. I know how to let loose, and I am learning to be reeled in. I am learning to be saved by psychiatrists and doctors.

I know what it is to soar above my body.
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I try not to hate it. My doctors want to save me in the ways they know how, which feel patronizing and, at times, ruthless. They like to remind me that there isn’t a cure. No matter how many coping mechanisms we find, how many medicines I take, I cannot be cured. I need medicine, and I need them. Or else I will spiral. Or else I will destroy everything.

It’s been months since my trip to New Orleans, and I am completely medicine-free. It’s tempting to cut and run, but I keep coming to my therapy sessions. I stay out of duty. Or out of fear.

Forde herself is skeptical. “With the psy-complex, there very little emphasis on mindfulness practices that work to empower trauma survivors to find their own unique methods for healing,” she says. “I think tarot is a tool that can be used in conjunction with mindfulness or mindful based practices.”

I want tarot to be therapy, and it isn’t. Not fully. Tarot is listening; it’s problem solving. And at least that’s something. “If making sense of our life means finding calm ways to organize our disorganized and traumatized parts of ourselves, I definitely think that tarot and the ritual associated with using the cards can create that space,” says Forde. “Keeping my cards in a sacred spot, breathing and grounding and taking in the images and the knowledges from other interpretations of the cards can be a great way to make sense of my life.”

What I want from tarot is what I’ve always wanted from doctors and therapists and social workers: to be told that I’m going to be okay on my own terms. To be told that I am capable of saving myself, even if it is very, very hard. To be told, as Kay did in a crystal shop in New Orleans, that “you’re going to be fine, my dear. You have a deep fear of falling apart, but you’re going to be fine.”

Author’s Note: I cannot stress enough how important it is to consult a medical professional before making any changes to your prescription. My successful come-down was due in large part to a team of psychiatrists and social workers. I am also in the midst of negotiating different medicines. Tarot should only be considered as a tool of self-healing, but not as an alternative to therapy or, when necessary, psychiatry.