At a therapeutic farm in Georgia, troubled teens are possessed by demons, depressed because of technology—and allegedly mistreated by their caretakers.

This is the first in a two-part series examining the therapeutic Christian boarding school Shepherd’s Hill Academy. Read the second part here.

O n August 22, 2014, Trace Embry, executive director and founder of the therapeutic Christian boarding school Shepherd’s Hill Academy (SHA), wrote in the school’s monthly newsletter:

“It’s been awhile since we’ve dealt with anything overtly demonic here at SHA, but it appears ‘Old Dark Eyes’ has paid us another visit.”

Embry was referring to two boys arriving to SHA on the same day who, he said, brought with them “baggage from the dark side.” He solicited prayers so the team at SHA could properly minister to these boys, as “mere counseling and psychology will fall short.”

Little did they likely know that in coming to SHA, those boys would be relinquishing their basic human rights — and that no one would be around to defend them.

SHA, formerly known as Shepherd’s Hill Farm, provides year-long residential care for kids grades 7-12 on an 86-acre farm in Martin, Georgia. According to a December 2016 episode of SHA’s weekly podcast License to Parent (L2P), which is co-hosted by Embry, tuition is $88,900 per student per year. Licensed for a capacity of no more than 36 students, SHA is intended for teens who are “troubled,” the word the academy uses to describe those with ADD, ADHD, oppositional defiant disorder, reactive attachment disorder, post-traumatic stress disorder (PTSD), bipolar disorder, anxiety disorders, Asperger’s syndrome, anger management, and generally rebellious behavior.

Embry believes the demonic forces operating within contemporary video games and pop music, and in the media at large, are the root cause of many of the mental and behavioral health issues affecting today’s teenagers. Students at the academy are intentionally isolated from society and undergo a mandatory media and technology fast. They begin their first 10 months in the Outdoor Therapy Program, where they live in “structurally sound rustic cabins” without any electricity or running water. They are only allowed access to shower facilities, a cafeteria, and classrooms on the main campus. As Embry told Katherine Albrecht last November, when participating in this outdoor therapy program, the teens “don’t have access to technology. No electricity whatsoever except in the classroom from 8 a.m. to 3 p.m.”

Students at Shepherd’s Hill Academy are intentionally isolated from society and undergo a mandatory media and technology fast.
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The boys and girls remain separated and under constant staff supervision throughout their stay, even after the intensive 10-month wilderness program. During this time, the boys “contribute to the maintenance, repair, and/or construction of” the campsites, while the girls cultivate a garden, learn beekeeping, sewing and quilting, and take care of the academy’s barn. Each student also takes part in the Equine Therapy Program. After the period of rustic living is over, the students graduate into the Next Step Program, where they live in houses on the main campus, designed to mimic the environment they will return to when they go home.

Established in 1994 by Trace and his wife Beth, Shepherd’s Hill didn’t begin enrolling teens in crisis until 2001, and it operated unlicensed for 10 years. It was not until September 2010 that Georgia’s Department of Human Services was made aware of the wilderness camp’s existence, when a social worker filed a complaint concerning SHA’s illegal operation. It took another 15 months for the school to become officially licensed; it stayed open and operating that entire time.

SHA is now fully licensed by the state of Georgia, but it has surfaced several ethical concerns, including the lack of appropriate care for teens with mental health issues, abusive treatment, and anti-LGBTQ practices similar to those practiced at conversion camps.

The Devil In The Details

Like many schools that specialize in care for troubled teens, SHA provides a checklist on its website for parents to consider while searching for help for their child. Among the more credible warning signs mentioned — like threats to self or others, drug addiction, and violent tendencies — are attributes of typical adolescent behavior, like opposition to the belief system of the family, not wanting to participate in family activities, defending peers, and general disobedience.

The Alliance for the Safe, Therapeutic and Appropriate Use of Residential Treatment (ASTART) — a volunteer organization that works to protect children from abuse and neglect in residential programs—warns parents against relying on checklists like this. The organization also stresses the importance of considering all possible factors that may be contributing to a child’s change in behavior.

“If you are very worried, frustrated, angry, confused, or emotional in other ways, you may see behaviors as more extreme than they really are,” the alliance writes. Removing a child from their home environment and sending them away can amplify “strong resentments in your child,” and impair an already capricious parent-child relationship.

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SHA’s vaguely defined parameters for removal from the home also enable parents to punish their children for religious disobedience. If a teen no longer wishes to participate in church activities, or begins to openly question their faith and their family’s biblical principles, a parent or guardian could label that behavior as rebellion and subsequently send their child to a place like SHA. If the teen also began spending more time with friends who don’t share their parents’ belief system and started to act out at home in response to the unyielding and volatile environment, a parent could be convinced after consulting SHA’s website that their child needs a Christian wilderness atmosphere to return them to the path God has chosen for them.

If any of this sounds like an overreach, consider Embry’s own words.

During a three-part series on L2P, Embry and his podcast co-host Rich Roszel said that reading the Bible is foundational to healing the students at Shepherd’s Hill. When asked about the most important and effective method of therapy used at the farm, Embry said, “It’s the knowledge of, and a healthy submitted and committed relationship with the God who created them, through Jesus Christ.” He then boasted that the pastor from the pulpit of his church “said the best kids on the planet would do well having a year at SHA. It’s really a discipleship clinic.”

In its reliance on religion and technology-fasting to treat “troubled kids,” SHA has advanced dangerous ideas about mental health.

Embry has specifically written and spoken often about anhedonia, the inability to feel pleasure that’s a common symptom of many mental illnesses — most notably, depression. According to Embry, most students who come to SHA, whether they were formally diagnosed beforehand or not, are struggling with anhedonia due to being overly dependent on modern technology, and the medication their doctor prescribed is, as he’s put it, “making it worse.”

Embry focuses on technology as a cause for mental health issues in teens, and Bible study as a treatment, despite scientific evidence contradicting his stance.
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In August 2013, Embry stated in his podcast, “Anhedonia is not ADD, ADHD, or even depression, although the symptoms are very similar. Anhedonia is a destruction of the pleasure center in the brain, which comes from unbridled multitasking on today’s popular electronic gadgets.”

The source for Embry’s views on anhedonia is Dr. Archibald Hart, former dean of Fuller Theological Seminary’s School of Psychology. In an appearance on L2P in July 2010, Embry asked Dr. Hart what he thought of anhedonia being misdiagnosed by doctors. Dr. Hart replied, “Oh, 100 percent. They might call it depression, put you on an antidepressant, which is the last thing you should do.” Hart added, “There is no medication for anhedonia. It’s a lifestyle change.”

Unsurprisingly, the science doesn’t support Embry or Dr. Hart.

Dr. Jean Kim, a clinical assistant professor of psychiatry at George Washington University (GWU), confirms that anhedonia “isn’t anything accepted or recognized by the general medical community as an official illness. [Embry] seems to be misappropriating aspects of neuroscience that are partly accurate to serve his own pitch.” Dr. Ronald Pies, professor of psychiatry at SUNY Upstate Medical University, seconds this: “We know that serious psychiatric illnesses, such as bipolar disorder and schizophrenia, have existed for hundreds, if not thousands, of years, long before ‘technology’ came about.”

Embry’s views on anhedonia, though discredited by science, are fundamental to how SHA operates. In 2010, he wrote, “We at [Shepherd’s Hill] understand that if an anhedonic troubled teen cannot think critically, constructively, or creatively . . . God becomes an abstract too difficult and boring for the anhedonic brain to conceive or desire.” He earnestly believes the effects of anhedonia are preventing today’s youth from comprehending Christianity, and is the primary reason these teens are put under his care in the first place, because “culturally-induced (i.e. technology) stimuli is affecting our teens through anhedonia.”

This is why Embry has also openly advocated for religion as a substitute for professional mental health treatment. He proudly advertised on his blog that 70% of the students at Shepherd’s Hill are weaned off their medication. In 2010, he wrote:

“Stimulating a kid with the love, training, nurture, discipline, and truth of God’s Word, will, over time, transform a troubled teen far more efficiently and effectively than medications . . . This is why so many kids who come to Shepherd’s Hill Farm on bushel loads of medication can leave medication-free at the end of a year.”

Again, Embry’s assertions contradict scientific evidence. According to the National Institute of Mental Health (NIMH), “the results of a comprehensive review of pediatric trials conducted between 1988 and 2006 suggested that the benefits of antidepressant medications likely outweigh their risks to children and adolescents with major depression and anxiety disorders.” The experts at NIMH go on to stress that once a medication treatment is started, it “should not be abruptly stopped. Although they are not habit-forming or addictive, abruptly ending an antidepressant can cause withdrawal symptoms or lead to a relapse.”

Dr. Kim at GWU also warned of the potential harm that can occur from the methods used at Shepherd’s Hill:

“[Embry’s] advice/methods seem potentially harmful insofar as they don’t seem based in any sort of formal scientific or clinical evidence, or known medical-psychiatric neuroscience. Some general aspects of his treatment may still be helpful for some, but if it isn’t grounded in evidence-based research or scientific knowledge, it will be easy for him to veer into pseudoscience and even dangerous or harmful practices (like not giving someone with a serious psychiatric disorder who actually needs medication an appropriate diagnosis or treatment).”

While these views on mental health treatment are dangerous, Dr. Kim notes, “if [Embry] had a licensed professional screen clients and triage them for appropriateness into his program, that would be less worrisome.”

It’s troubling, then, that there are no clinical psychologists or psychiatrists on staff at Shepherd’s Hill; all personnel listed on the website under the Therapeutic Team are counselors, and it wasn’t until late last year that they all held a professional license by the state of Georgia.

Staff members oversee children with behavioral and mental health problems deemed severe enough to warrant year-round residential treatment with 24/7 supervision, but of the 21 members on the residential teams, according to their bios on the SHA website, fewer than one-quarter of them have completed educational programs related to mental or behavioral health.

More troubling than this lack of qualification, though, is SHA’s record of abusing its students.

Abuse Allegations

As part of its treatment plan, SHA has been accused of engaging in multiple forms of abuse. Kids who “act out” or defy God may be subject to physical punishment, humiliation, food restrictions, and more.

Angela Smith is the national coordinator for HEAL, an organization that works to expose abusive facilities designed to treat teenagers with behavioral problems. She confirmed via email that, “HEAL received a signed, under penalty of perjury document from a survivor of Shepherd’s Hill Farm.” The author of the statement has not returned our request for comment, but the full account is published anonymously on HEAL’s site. Within the testimony of the former student are specific allegations of abuse, the use of which Trace Embry has justified repeatedly, on his radio program, in newsletters to SHA’s community, and on the school’s website. All parents or guardians are required to sign a power of attorney document, essentially giving up their own rights as parents, upon enrolling their child at SHA.

Here are some of the abuses allegedly suffered by those who have attended the academy.

Corporal Punishment

In the statement, the survivor alleges that he was hit with a paddle by Trace Embry in front of other classmates for being disrespectful, an act of discipline for which Embry has openly advocated.

On L2P, Embry repeatedly dives into the topic of corporal punishment. For instance, on an episode dated September 18, 2012, he said parents should urge their local school boards to bring back paddling: “The [paddle] applied to the [posterior] of a disruptive and rebellious few, occasionally, might just make a better learning environment for the majority.”

A month later, Embry said, “I don’t feel it’s healthy, or wise, that a teen should feel that [corporal punishment] is ever out of the realm of possibility . . . There may be a circumstance that requires a parent to physically intervene in order to bring justice to a situation at home.”

Then, in April 2014, Embry stated, “Nowhere in Scripture is spanking, at any age when appropriately administered by a loving parent, ever condemned.” And in June 2015, he and his co-host Roszel interviewed psychologist and author John Rosemond on the topic of spanking; all three men advised parents to spank their children in private, where no one else can see them, so they do not have to worry about the Department of Human Services accusing them of abuse.

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On February 6, 2016, Embry declared spanking “an effective tool against foolishness and rebellion.” A week later, he argued that not considering corporal punishment as a form discipline is abusive, and because of Proverbs 23:13-14, punishing a child with a rod will save their soul from death. (Corporal punishment is technically legal in Georgia schools with parental consent, but it is in violation of the state’s Outdoor Child Caring Program [OCCP] licensure rules.)

Indoctrination

The survivor also claims in his statement to have interrupted a Bible lesson taught by Embry. “[He] raised [his] hand and said, ‘You are brainwashing us.’ Embry smiled and replied, ‘Yes we are! We are brainwashing you in the blood of the lamb!’”

In February 2014, Embry exclaimed, “It’s not uncommon for Christian parents to be accused of indoctrinating their own kids with dangerous ideologies and beliefs.” He then boasted that if training your children with biblical principles is considered brainwashing, “then I’m all for it.” On the December 29, 2014 episode of L2P, co-host Rich Roszel said, “[Shepherd’s Hill Academy] is a place where you can have kids’ brains reset to their original factory setting.” Embry replied, “I like that statement, too.”

On July 15, 2015, Trace Embry was a guest on Dr. Michael Brown’s radio program, The Line of Fire with Dr. Brown, where he said, “We brainwash [our students] with Jesus.”

Escort Service

During a school break at home, the survivor declared to his father that he did not want to go back to the farm; the next morning, “two very large men” came into his room. According to his account, they said, “We are bounty hunters to take you back to Shepherds [sic] Hill Farm.”

SHA advertises the use of a transport service to bring teens to the farm, using SafePassage Adolescent Services. The company writes on its website, “It is our experience at SafePassage that it is always better to wait until our Professional Transport Team is with you at your home to deliver the news through intervention that you have chosen to add a therapeutic component to their education.” To make sure the child remains unaware, the company advises parents to password protect their email and computer access, delete all cache history, and provide a phone number where a voicemail can be left without the child hearing.

Using these private “escort” or “transport” services is considered a warning sign for future abuse by the residential program by ASTART, which explains:

“The company typically sends two or more physically intimidating bodyguards to wake the child in the middle of the night, and force them from their bed into a waiting SUV — often in pajamas and handcuffs — while the parents look on…This is how the child learns [they] will be leaving home…This is a scene filled with tears and pleading and promises and begging. This is what many residential programs consider the first step in ‘healing family relationships.’”

This is “trauma, not therapy,” ASTART insists. This is harm, not healing. ASTART goes on to describe the trauma of those who have been escorted to a residential program:

“They experience years of nightmares, flashbacks, emotional ‘numbing,’ inability to concentrate, angry outbursts, difficulty sleeping or other symptoms — primarily, survivors say, because of the trauma of being forcibly taken against their will, by strangers, to a completely unfamiliar place, and kidnapped with the knowledge and permission of their parents — parents who are supposed to be the child’s trusted protectors.”

Special Meals And Clothing

On October 6, 2015, Embry released a video in which he argues, “One of the consequences we’ve found at Shepherd’s Hill Academy to be quite effective when a major offense takes place — is what we call a ‘special meal.’” He goes onto say it consists of unseasoned beans and greens and stresses, “There’s nothing mandating your child’s right to a gourmet meal every time he comes to the table.” He used the same script in a daily feature from May 2014 and then again, in December 2015.

In his statement, the survivor said he was put on “‘special meals’ for a month and a half.” These meals consisted of a can of beans or a can of vegetables, bread, a piece of fruit, and water.

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Dr. Kim expressed concern for this form of punishment, saying, “any sort of punitive or aversive conditioning isn’t a good thing for children or teens. And any sort of controlled meddling with dietary behaviors (other than something obviously medical, like a food allergy) can potentially exacerbate or worsen eating disorders.”

Over the years, a handful of former students have spoken out about abusive practices at SHA on various comment threads and blogs, most of which are no longer maintained. A young man by the name of K. Hicks told a similar story in 2010. (I reached out to Hicks, but he has not replied.) He claims to have enrolled in SHA in May 2005, during which time he and another student ran away. The local police department and Embry caught them and returned them to the farm. They were punished with “three weeks of orange jumpsuits, two weeks of sandals, and a week and a half of shackles.” They were also given “two weeks of special meals.”

Forcing students to wear these special clothes, rather than their own, is another form of punishment. In a newsletter from October 2015, Embry recounted an incident concerning a student who had run away while at home visiting his parents over a weekend. The local police department picked up the boy at a “restaurant after hours of hiding in a wooded area. He was then promptly returned to SHA, where he is now donning a bright orange jumpsuit.”

Physical Restraints

In June 2014, Embry wrote of a student in the SHA newsletter who “went berserk when the student couldn’t convince the parents that going home was the best option.” As a consequence of this episode, he said, some of the counselors were punched and scratched, and, “The wavering parents were a tick away from taking Junior home; but, were strongly advised to buck up and stand their ground.”

After the parents were encouraged to not allow the student to return home with them, Embry wrote, “An insightful parent understands that rebellion like this is a carnal desire fueled by succumbing to a spiritual battle — albeit an unholy spiritual victory.” He went onto say, “This student had to be physically restrained. It wasn’t comfortable; but, knowing that outbursts like this weren’t going to be tolerated, it sent a message of love to this student’s spirit that, in due time, is likely to be articulated in the flesh.” He later writes, “The real problem in most cases is not that parents take things too far; but that, often, they don’t take them far enough…”

In November 2015, Embry recounted an incident that occurred a month prior. During a chapel service, a boy who had only been in the program a few days was “triggered by something.” A counselor then escorted the student out, where Embry joined them.

“After the three of us exited the chapel, that’s when the boy began to shout a litany of profanities and other scary threats. When it looked like the boy was going to get physical, Frank was quick to secure everyone’s safety. That’s when the intensity and the volume of the boy’s displeasure increased…After talking the young man down, I put my hands on him and prayed for him as other staff arrived. Though I had already told him that we would meet him at every turn — and for as long as we needed to — I could feel his body go soft as I was praying.”

Embry has, not surprisingly, refuted claims of abuse; on SHA’s website, he states that the school is accountable to God, SHA’s board directors, and to state and federal regulators, and says allegations of abuse are false.

Conversion Therapy

SHA doesn’t just seek to mistreat kids with mental illnesses and non-religious beliefs; it has also targeted those who are LGBTQ via conversion therapy practices. On SHA’s application for admission, administrators specifically ask parents to, “Select the sexual orientation your child claims.” Included in the list among homosexual, bisexual, and heterosexual are the options of “transgender” and “currently sexually active.”

The term “conversion therapy” often conjures stark images of forced institutionalization, castration, and electroconvulsive shock treatments being administered to helpless individuals. While these methods were more prevalent in the past than they are today, all forms of reparative therapies are incredibly harmful.

According to Just the Facts about Sexual Orientation and Youth: A Primer for Principals, Educators, and School Personnel—a publication endorsed by the American Psychological Association (APA), American Counseling Association (ACA), American Federation of Teachers (AFT), and 10 other prominent organizations — “reparative therapy and sexual orientation conversion therapy refer to counseling and psychotherapy aimed at eliminating or suppressing homosexuality. The most important fact about these ‘therapies’ is that they are based on a view of homosexuality that has been rejected by all the major mental health professions.”

According to guidelines from the National Association for Research and Therapy of Homosexuality (NARTH), methods of reparative therapies deemed favorable in these conversion programs include medication, hypnosis, sex therapies, and behavior and cognitive therapies. But these methods can produce dangerous effects — especially on adolescents who face rejection from their families. As noted by the National Center for Lesbian Rights (NCLR), “Research shows that lesbian, gay, and bisexual young adults who reported higher levels of family rejection during adolescence were more than eight times more likely to report having attempted suicide, [and] more than five times more likely to report high levels of depression…”

Despite the evidence to the contrary, Embry regularly discusses the immorality and sinfulness of LGBTQ people on License to Parent, often interviewing “doctors” who rely on pseudoscience to make their case against any sexuality and gender identity that rejects a cisgender, heterosexual criterion. Oregon, California, Illinois, and New Jersey have laws that ban conversion therapy for LGBTQ minors. In 2016, Embry interviewed David Pickup, a supporter and practitioner of conversion therapy and the lead plaintiff in a lawsuit that sought to overturn California’s ban on conversion therapy for minors. In 2015, he talked with Christopher Doyle, director of the International Healing Foundation, a non-profit that’s “dedicated to helping people in their struggles with sexual orientation,” who Embry called a “key figure in the conversion therapy movement.”

Embry invites these anti-LGBTQ activists to the school as well, such as in May 2016, when he invited Ciara Leilani to speak to the students at Shepherd’s Hill. Leilani says on her blog that she “lived as a lesbian in a homosexual lifestyle for 20 years. A lifestyle of choices that kept [her] further from [God’s] truth.” Now she is a Christian blogger and founder of the religious non-profit Kingdom Asylum Ministries.

On an episode of L2P that aired after she spoke to SHA students, Leilani said that not long after she promised she would abstain from sex with a man outside of marriage, a “lesbian encounter” took her by surprise. She discussed her “radical deliverance” when she turned 34 and explained she “knew [God] was tangibly in the room” with her. When asked about the supernatural deliverance she referenced, she recalled, “I know I had many demonic spirits that occupied my body, my soul, and I had no control. I was set free from lust and perversion immediately.”

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This isn’t the first time students were exposed to sexual orientation fear-mongering—and exposure to the extreme views of guest speakers is the least of it. Embry has, on more than one occasion, publicly stated that he practices a form of conversion therapy at Shepherd’s Hill.

In a newsletter from August 2015, Embry wrote about a three-week series he did with SHA students on homosexuality. After this series, he wrote, three students approached him. “The result was that all three kids, two girls and one boy, renounced any future plans to pursue that lifestyle!” He stressed that despite what “liberal-minded people may imagine,” all he did was “share the truth in love” about the topic. “I never coerced or used shame or fear tactics to invoke these renunciations,” he continues. “There’s so much confusion about this topic; unfortunately, much of it comes from those who would call themselves ‘trained professionals’ and now unfortunately, from our own American lawmakers.”

He then writes about mental and behavioral health conferences he attended, where, according to his views, political correctness, lack of common sense, junk science, and the “spirit of the enemy” confound LGBTQ issues. He proudly deadnames and misgenders Caitlyn Jenner, writing, “After [Caitlyn] Jenner was hailed as a hero, I finally had to speak up. The Emperor’s New Clothes was exposed by little ole me. I asked why a conference full of well-educated people are now defining heroes and taking their mental health cues from an individual who is emotionally disturbed and on suicide-watch as I spoke?”

Ending the newsletter, he insists that the Supreme Court ruling that brought marriage equality to all 50 states has made it harder for SHA to do the work that they’re doing. “Already, secular associations are strong-arming SHA to agree to unbiblical policies in this area.” Finally, while referencing a now-debunked 23-year-old study that falsely predicted a shorter lifespan for gay Americans, Embry fears, “Without some drastic and immediate action, SHA may never be allowed to steer another kid out of a lifestyle” that is “proven” to be more detrimental to a person’s life expectancy than cigarettes.

Students have been exposed to sexual orientation fear-mongering, and Embry has publicly stated that he practices a form of reparative therapy at Shepherd’s Hill.
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A month after writing about his three-week series that convinced three students to renounce their queer identity, Embry raved about another student making the same commitment, writing, “[A]nother SHA student renounced any further pursuit of that lifestyle, making her the fourth student in two months to do so.” Two months later, Embry wrote, “While several students have renounced their homosexuality in recent months, yet another did so in October. This same student, along with many others, have come to Christ also.”

Students at SHA are persistently encouraged to renounce any part of themselves that does not align with a cisgender heteronormative identity. Current technology, the media at large, and the ways in which teenagers interact with their peers in the 21st-century are seen as demonically influenced and the root cause of the “troubled” students at the farm. Pseudoscience and the “experts” that propagate these dangerous concepts are exalted due to their claimed biblical origins, and religious indoctrination is seen as the most important and effective method of therapy. Meanwhile, allegations of abuse mount.

Most distressingly, all of this has been given the stamp of approval by the state of Georgia — and SHA is, in having its dangerous practices sanctioned, far from an anomaly.

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.

A middle-aged woman roamed the streets with a bag of colorful wax crayons. She stopped at public walls and gates, filling them with what seemed like incoherent sentences, insignificant dates, and fragments of a geography lesson. When the walls were painted to cover her marks, she returned. Scribbling, re-writing, and overwriting on them again and again.

This the story of Deepa Saxena, a former teacher who, for the past ten years, has been inscribing her words on the walls of Meerut; a small town in Northern India. When asked why she continued to do so, Saxena, who was diagnosed with schizophrenia, told the Times Of India in 2014, “I write on the walls for I’ve no one to talk to, nobody wants to listen to my story. I need some way to express my thoughts, which is why I pen them down on the walls.”

A year later, Palak Mittal, a Delhi-based photographer, would decide to listen and tell this narrative of mental anguish through her haunting photo series —The Woman Who Conquered Town. Mital was visiting Meerut, her hometown, for the summer holidays when she first noticed  

Saxena’s writings on almost every street wall in the town’s cantonment area; at times as far as a 5km radius. She found it odd that nobody talked about these writings, and when she asked around the answer was curt if not unconvincing; it’s by the crazy lady in town.  

While the common consensus seemed that Saxena’s mental illness was a result of being abandoned by her husband, Mittal later found that she was never married. As Mittal sifted through urban legends and facts, some part of the truth began to reveal itself. “Her parents were very selfish and dependent on her. She never really invested in her own personal life. When everyone she knew went away or died she became lonely,” says 23-year-old Mittal, who was in touch with Saxena’s family friend. “Though I have never really spoken to her personally because  I don’t think it’s fair for me to bring back her trauma.” She prefers to refer to Saxena as ‘the lady.’

Mittal’s photo series is a heartbreaking revelation of apathy not only towards Saxena but to most people who seek mental health care in India. An estimated 150 million people across India — that is larger than the entire population of Japan— are in need of mental health care interventions, both short and long-term, according to India’s latest National Mental Health Survey 2015-16. The survey also found that, depending on the state, between 70% and 92% of those in need of mental health care failed to receive any treatment. Which further accounts for the reason why in India one student commits suicide every hour.

However, Mittal has stayed away from statistics in her work. “Mental health has always been something that has been going on in somebody’s head and you really cannot see it,” she says. “That is why I think photography is the best medium for this story. Here the suffering is tangible.”

I caught up with Mittal to chat about her experience of capturing these wounded walls of Meerut, the stories she uncovered through them and India’s relationship with mental health conversations.   

Payal Mohta: Did you find that that Saxena’s writings were able to tell her story?

Palak Mittal: The writings on the walls might seem hazy but if you study them closely they are very precise. They state clear bank details, dates and people’s names, in both English and Hindi. The lady is calling those people out who refused to help her and even financially cheated or deserted her. Another theme that recurs is of marriage and divorce. There is this one phrase that she wrote that keeps coming back to me —’Why Indian Girl Must Marry.’ It’s so relatable because women across different sections of Indian society find that marriage becomes more of a regulation that comes with age rather than choice.

What was the most challenging part of shooting the story?

The biggest challenge of this project was to be able to capture and allow the viewers to know the magnitude of it. The lady has written all over town, sometimes as much as through a 500 meter stretch of walls. To show this scale with my camera took a bit of strategizing. I finally decided to do a few panoramic photographs where a wider area can be captured in a single frame.

Did you find yourself drawn to any one particular wall?

Yes, I did. There are these set of walls belonging to a convent school around my home which has verses from the Bible inscribed on it. These phrases are written in English and then translated into Hindi. It is on these walls that the lady has written and rewritten. As a photographer, this was visually very interesting for me because it reflected an ironic juxtaposition; messages from God on selflessness and kindness existing with the lady’s unanswered calls for help.

What did you find most tragic about the story?

The people of Meerut knew that there is this lady who roams the street and writes on walls for years. They treated it like a monotonous activity. Nobody cared or bothered to know more about what troubled her or rather did not want to take any responsibility for it. That is for me the most tragic part of the story.  

Every time I broached the topic of why nobody had tried to help her in the past in Meerut, people had a standard excuse—she didn’t want help herself or nothing seemed to work for her. My town’s mentality became evident; everyone was just so consumed in their lives they didn’t want to genuinely reach out to her. This, of course, represents in many ways the larger perspective of Indian society on mental health — it’s not looked upon like a disease that can be treated with counseling and medicine. The dominant belief remains that people just go mad.

How did the people of Meerut react to your photo series?

Thankfully, I never received any backlash. It was more positive feedback than I ever expected. I became sort of popular in town which made me really happy because that meant that finally people were addressing and talking about mental health, one way or another. So many people from Meerut, including friends, family, acquaintances and complete strangers reached out to me and appreciated my work. Though what was common in all these interactions was a sense of guilt in the locals, of having ignored a story of suffering in their own backyard.

I think why people reacted to my story in this way was also because of its digital reach. Suddenly it was in their newsfeeds and insta stories and as we are on our phones most of the day, people just could not ignore it anymore. For better or for worse at least in this way mental health was addressed and talked about. That was all that was needed.  

Do you continue to photograph Saxena’s writings?

The lady doesn’t write anymore. It’s been a few years since she has recovered and now is completely stable. But if you turn around a corner in Meerut, at times you will still find her writing. It tends to live on.

I.

I have a recurring dream that goes like this: first shot, the absence of light. Cut to hospital corridors tinted peach at dusk, abandoned wards, the sun’s last rays flickering like a dying flame. Pan left along the windowed expanse: Manhattan’s inky skyline, the Hudson River, cherry trees unfurled and shaking. Cut. I enter with only my hands, outstretched, to guide me. Walk for years. Long shot: a bed-bound man. I can never see his face because he’s too far away, or because my eyes are closed. Maybe those reasons are one and the same. Monitors beep in the distance. Zoom out. The scene is filtered in the glow of evening light.

II.

Here’s the funny thing about myopia: it obscures in more ways than one. When I put on glasses for the first time, what stunned me wasn’t my sudden clarity of vision but the past ignorance this implied. How had I gone so many years without discovering my nearsightedness? Habituation no doubt played a role. I came to squint reflexively, accept blurred lines on the chalkboard as a matter of course—in short, I normalized an unclear world.

III.

I’ve struggled with social anxiety for as long as I can remember. Most people experience it at some point in their lives, but mine was debilitating. While pleasantries slipped off others’ tongues, I always seemed to botch them with my glassy smile and cluttered speech. My awkwardness turned me into a slightly robotic figure, skittish, the sort of person who only drew attention through absence.

Why? It’s become a well-worn exercise—probing my past in search of understanding. To this day, I have no satisfying answer. And in any case, an answer hardly would have changed my reality. It’s exhausting to live the way I did, perpetually on the lookout for exits, unable to uncage myself from overanalysis and self-recrimination. The problem with misery is that you think it’ll never end. This myopia is paradoxically the source of its power: it builds you up even as it wears you down, situating your feelings and impressions at the center of everything and erasing what lies on the periphery. It’s one of the many cruel tricks of mental illness.

The problem with misery is that you think it’ll never end.
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To self-pity is to condition your sense of self on suffering, is to smash the best parts of yourself and clutch at the pieces. A friend of mine, speaking of his problems, once said: I’m not special. I’ll get through it like everyone else. And though I was incredulous at the time, he’s right.

I don’t mean to suggest that your troubles are insignificant if someone else has it worse. Unhappiness isn’t zero-sum, but the danger lies precisely in misery’s lack of bounds, its recursive nature. To justify its existence, you necessarily replay past humiliations and excavate old wounds. As a high school student, I’d think—almost as a mantra—I’m so, so alone. I thought about sitting alone at lunch day in and day out, emerging from the most trivial social situations flushed and overwhelmed, overinterpreting even the smallest acts of kindness. I thought about unironically googling “how to be less awkward.” I thought about these indignities and grew increasingly ashamed. Misery thinks only of itself. Misery wages a war of attrition, and the enemy is yourself.  

IV.

Shortly after my 18th birthday, the doctors said there might be something wrong with my heart. I don’t remember ever having been so afraid. Well, that’s not entirely right. There was one other time. Eight years old, visiting my great-grandfather in a nursing facility for the chronically ill. I still remember the welcome sign: COLER-GOLDWATER, block letters separated by a garish red heart. How my great-grandfather’s room had overlooked the Hudson River, Manhattan’s outline straining through the fog. There were elderly people, which was to be expected in a place like that, but some were only children. And it was the children from whom I averted my eyes. I’d understood, even then, that they would live out the rest of their days among the aged and the dying and the unbearably beautiful cherry trees. So it wasn’t the patients I feared, but the flimsiness of the human body. How it breaks down and ultimately betrays you.  

V.

Ten years after setting foot in Coler-Goldwater, I faced a health scare of my own. To have social anxiety is to be continually let down by the body. Certain tics—twitching hands, a propensity to cut myself off in the middle of sentences—reveal my discomfort. But when the root cause is psychological, there’s always some way to make it stop.

Controlling the body is a question of controlling the mind, however difficult that may be; convince yourself it’s fine, you’re safe, and you can still the tremor in your voice.

To have social anxiety is to be continually let down by the body.
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Physical health is a different matter altogether. If there was indeed a problem, I could hardly tell my heart to fix itself. My primary care physician had referred me to a cardiologist, who ran a battery of tests. For a three-week period, I could do nothing but wait. I was scared of my helplessness and appalled by how oblivious I’d been. In my relentless misery, I’d failed to see just how lucky I’d been to be physically healthy, surrounded by people who cared. I’d taken my health, my family and my friends for granted, tarnished what should have been the best years of my life.

While waiting for the results, I made vows on conditionals: if I’m okay, I’ll never be afraid again. Which is to say: I’d stop sending phone calls to voicemail, start looking people in the eye, listen to my therapist, subject myself to the mortifying process of understanding and being understood. I’d try, really try this time.

VI.

The hospital where I got my cardiac MRI was a worn, stately building with ivy creeping up its facade. Two technologists asked what I was there for, and I said a heart murmur, feeling strangely disconnected from the weight of those words. “It might be benign,” said the taller one: a laughably anodyne remark. I smiled, bobbed my head. They inserted an IV into my right arm, gave me earplugs and a set of headphones for music. “We’re going to take over your body,” they said. It was meant to be light-hearted, but there was an undeniable truth somewhere amid the levity. Inside a hospital, you forfeit all control: it’s the ultimate form of surrender, of letting go. And maybe that’s what spooked me at Coler-Goldwater all those years ago, even more than the prospect of frailty and decline. I’d never learned how to let go of anything. If given a choice between holding on and letting go, I invariably chose the former, even if that meant pain, even if that meant pyrrhic victory.

One of the technologists slid me into the tube, enclosed me in a semicircle of white, whiteness that just went on and on. I kept a tight rein on my thoughts, cleared my mind until it was blank as snow, because if I considered the possibilities I’d be going down a path from which I might never return. Breathe in, try not to worry, breathe out, hold your breath as directed. The technologists circled the machine like vultures. At some point I lost track of the eighties songs blaring through the headphones and let the clattering sounds from the MRI become white noise, signifying nothing.

VII.

A few weeks later, I returned to the cardiologist, hands folded nervously in my lap. When he entered the room, he smiled, and that’s all I could fixate on. He said something about a perfect heart, and I wanted to nod blithely, hold his patronizing kindness at arm’s length, but teared up instead. Until that moment, I’d put my life on hold. It had been—if not a still, at least slow-motion. I’d lost interest in concepts as tenuous as the future. Because what if I never got there? Why invest in uncertain days? Now I could hit play at last.

VIII.

Coler-Goldwater Hospital, that specter of my childhood, exists no more. A college campus has risen in its place, and people who know nothing of its past will trod those tree-lined lanes. A photographer deemed the complex historically significant before its demolishment, captured photo after photo of those haunting halls. Sometimes I click through each image and wonder if there was a lesson to be learned.

I’d lost interest in concepts as tenuous as the future.
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It really is easy to forget. I’m now a sophomore in college, and the fear of that summer—as well as the promises I made to myself—are but a memory. A lot has happened in the two years since then. I’ve switched majors, backpacked a part of the Appalachian trail, taken a liking to coffee, met people who care for me far more than I once cared for myself. I’m more open about my anxiety. I tell myself it’s nothing to be ashamed of, and some days, I almost believe it. There’s a line from a French documentary that goes something like this: I can’t see very clearly, but I see. And I do, I finally do. The sun rises and sets; the days grow shorter and longer and shorter again; the leaves change color, wither, and die. And through it all, I’m still here. What else is there to be grateful for?

Some things remain the same: I still worry too much, fume over petty slights, pretend not to see people in passing because I don’t quite know what to say. But I’m no longer as distrustful of sentiment, no longer as scornful of hope—now I believe that everything will somehow be okay, that the world will carry me along instead of passing me by. And so, when I want to do nothing but hole up in my room, I put on my sneakers and go to the gym, or reach out to a friend, or walk downtown and take in all the beauty there is to see. There’s no time to dwell.

CW: Self-harm, cutting

A year ago, I stood in my kitchen and called my friend Liz to tell her I had not hurt myself in a year. It was a realization that had dawned on me earlier in the day, and I needed to share the news. Liz told me she was proud.

It had been a rough week, preceded by a rough month, and I had a long history of reacting poorly to emotional stress. My friends almost expected I would self-harm. I almost expected as much as well. I had been a cutter most of my life. It started in elementary school when I would scratch red claw marks into my hands and arms as punishment for egregious sins, like missing the bus or getting a C- on a math test. In high school, I graduated to sharp objects like knitting needles and steak knives. By college, I routinely used the X-acto knife I bought for an art seminar to leave brutal, bloody cuts on my arms. The scars are still there, thin white lines that ensure my mental health history is unconcealable. While I could never hide the self-harm, this also meant no one could ignore it. My friends were always incredibly supportive and, that night, Liz’s pride was the small victory I needed.

“Erin,” Liz said, “That’s amazing.”

And I felt amazing, for a bit, but later reflected on how I had treated myself that week. My internal monologue was a vicious, abusive cycle where I constantly reminded myself of my empirical lack of worth. I spent two hours a day at the gym, engaging in vigorous aerobic activity with the elliptical’s incline and resistance maxed out, and ate almost nothing. It was part punitive—a way of hurting myself for perceived sloth—but also impulsive; I felt a need to be in physical pain, one I could not control.

I did not cut myself, but was it fair to say I had not hurt myself? Without the physical marks, no one was aware anything was amiss. My self-harm had not gone away. It had become invisible.

I often feel trapped in a loop in which one form of self-harm usurps another, cycling through negative behaviors without real improvement. I do not understand what drives this desire to hurt myself. The why of self-harm is a question often asked, but the why of any psychiatric condition is multi-faceted and often unclear. With self-harm, the normal level of scientific ambiguity is magnified by the fact that self-harm has only very recently been studied as a disorder in its own right. Once seen only as a symptom of other disorders, Non-Suicidal Self Injury (NSSI) entered into the DSM in 2013 as a topic for “further study” after research took off in the early 2000s. The International Society for Self Harm was formed in 2006 to foster more communication and collaboration among professionals who studied self-harm.

“NSSI serves a function for the individual,” said psychologist Lori Hilt, an Associate Professor at Lawrence University who has researched self-harm. “Self-punishment is one function, and it’s also commonly used to decrease acute negative effect (e.g., anxiety).”

As for whether it’s common for self-harm to take other forms, Hilt told me the behavior is frequently comorbid with other maladaptive behaviors.

Without the physical marks, no one was aware anything was amiss. My self-harm had not gone away. It had become invisible.
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“There are many other behaviors that might be able to serve similar functions,” she said, “For example, binging, purging, and other eating disorder-type symptoms often co-occur with NSSI. Other indirect forms of self-harm include substance use and risky sexual behavior. These self-harming behaviors…may serve similar functions for the individual.”

But what are those functions, exactly? I have been suicidal before and, while I no longer actively feel those emotions, I can explain them retroactively. I cannot do the same when it comes to self-harm. Cutting feels like it was something that happened to me rather than something I did.  

Joan Didion once wrote, regarding her daughter’s alcoholism, not even doctors can argue alcohol is not an incredibly powerful anti-anxiety agent. Didion was not advocating for heavy drinking, but trying to show readers how addiction happens. I sometimes walk people down a similar path when explaining why I cut. The main reason I kept up with it for so long was that it worked so well at curbing my anxiety. It provided me the same instantaneous anxiety relief some find in alcohol. Self-harm can simultaneously occur with various substance abuse disorders and Hilt told me some research does indicate self-injurious acts can release feel good chemicals in the brain like endogenous opiates.

“This is part of the body’s natural response to pain/injury, but it can be positively reinforcing,” she said, “Regarding anxiety relief, what is most likely going on is a shift in attention from the feeling of anxiety to the present-moment experience of pain, seeing blood, etc. This shift to something concrete is probably what takes away the feelings of anxiety temporarily.”

The period when my cutting stopped coincided with positive changes in my life. I got out of a toxic relationship. I started taking mood stabilizers. I tried to adopt a healthier diet. Hilt mentioned that self-harm is common in individuals who lack other coping skills and therefore turn to quick fixes to handle stress. I would like to think I discovered long term fixes preferable to the immediate release of drawing blood, but part of me wonders if I’ve ever actually stopped self-harming.

Around the time I stopped cutting, I began going to the gym six days a week. Exercise no doubt has a litany of benefits, but for a time my workout routine was obsessive. I worked out almost three hours a day while eating less than 1,200 calories. I once passed out in the locker room after a particularly brutal session. I wasn’t cutting, but I was hurting myself. People just overlooked as much and, in fact, often complimented me on my dedication.

Did the mood stabilizers and lifestyle changes improved my mental health or did I simply trade one form of self-harm for a more socially acceptable variety?

Cutting feels like it was something that happened to me rather than something I did.
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I should prefer my self-harm is invisible as it’s so stigmatized. People are willing to accept my bipolar disorder and anxiety are beyond my control, but rarely extend any sympathy towards cutting. I once had an ex-boyfriend smack his hand against a desk while screaming cutting was a choice. At an office job, a manager once suggested our publication write a list called “Best Songs To Cut Yourself To.” These reactions stem from the same notion self-harm is a self-indulgent, easily controlled behavior worthy of both scorn and ridicule.

Invisibility protects me from stigma. It does not, however, protect me from myself.

We want the narrative of mental illness to follow a trajectory that ends in cure, but not every story is one of triumph. Many end with ambiguity, partial victories, and ongoing struggles others do not always see.

I do think I am getting better, but progress is slow-going and marked by setbacks and hurdles. Hilt told me the most effective treatments for self-harm involve teaching better coping skills and I am taking active steps—therapy, mindfulness, positive self-talk—to do just that. But I still routinely indulge in emotional self-abuse via a nasty internal monologue. I still do not like myself on many days.

While my scars are now faded, this does not indicate unambiguous triumph. As further research illuminates causes and searches for effective treatment, myself and many others—visible marks or not—struggle each day with the seemingly endless internal urge to hurt ourselves.  

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.

Why Are We Used To Violence But Caught Off Guard By The Existence of Hurt?

We’ve gotten used to violence as background hum, yet we are unprepared to recognize and live alongside people who have been hurt.

flickr/Brian. R

W hen ardent defenders of gun rights don’t want to talk about what’s wrong with guns, they talk about what they think is wrong with the people who make the news for using guns the way they’re made to be used. Often there’s a quietly intense litany of curses — “crazy,” “nuts” — meaning the individuals in question do not count among the “normal.” During this part, they always spit the word “sick” as though there is nothing more wretched and strange than being mentally unwell. Being me. Being among what is actually an enormous and ordinary population.

A disdain for those deemed abnormal is animating the conversation. After the massacres in Las Vegas and Parkland, the idea of bringing back asylums has found new support, in thoughtless one-offs but also in serious proposals in trustworthy outlets. A few Parkland survivors, too, suggested targeting the mentally ill for increased surveillance by law enforcement. There is a troubling desire to deal with the disorder that is gun violence by putting people on notice for their diagnoses.

It can be hard to define disorder, both in the clinic and in talking about what we will and will not put up with as a society. It takes nuance to distinguish disorder from wellbeing on a continuum of possibilities and amid the deep inflections of culture and social context. (Are you depressed, or going through a rough patch? Are you fasting because of anorexia or a religious observance? Is an unlivable minimum wage a spur to betterment or a sign of breakdown?)

But carefully defining disorder is core to grappling with the U.S. gun problem — and envisioning a less disordered, more just world. What do we admit into the fold of normal? What do we map to the edges? And what are we seeing all upside down?

For all the people who marched and spoke out for gun control, there may remain as many with a stoic, fatalist understanding that tragedies like gun violence are to be expected. But this understanding coexists with the idea that the various kinds of hurt seen as the causes and effects of gun violence — mental illness as well as the wounds that follow the path of a rifle round — are not a part of ordinary life. We’ve gotten used to violence as background hum, yet we are unprepared to recognize and live alongside people who have been hurt. We’re caught in a chilling dynamic of hurt disseminated and then obscured.

How We Learn To Love ‘Good’ White Men With Guns

It must be said again up front that the link from mental illness to gun violence is far from straightforward. So entwined are our ideas of mental illness and shocking violence that the question of whether a violent individual is mentally ill is often answered by the fact of their behavior. It is true that reports of mental illness are common among those who carry out some of the most devastating mass shootings. But there remain many mass shooters who do not have an established diagnosis; and among perpetrators of smaller-scale violence, who far outnumber mass shooters, rates of mental illness are unusually low. Even severe mental illness is not enough to explain the pronounced patterns of gun violence unique to the U.S., because concomitant disadvantages are part of the picture. Using the single variable of mental health as a net for identifying danger captures far too many people who were never going to violate the social contract.

The wrongful dread of mental illness as this seed of unthinkable acts makes it difficult to conceive of mental illness as an ordinary characteristic, found abundantly among friends and neighbors and maybe even in ourselves. When I was struggling to get a handle on my major depressive disorder, I understood the concept of “needing help” to mean possessing shortcomings terrible enough to require professional intervention. I shrank from crucial medical care because accepting it would have felt like admitting monstrosity. I did not realize how common my illness was. Nor did I realize that monstrous tendencies inhabit every human being, not just the ones we would make outcasts.

The unseen ordinariness of mental illness, and other illness, can explain gaps in care. Sickness is implicitly seen by too many lawmakers as what happens when you have done something wrong, not a quotidian fact of numerous lives regardless of how they have been lived. If serious illness were seen as truly ordinary, it would not be so hard to afford. Nor would disability be so often a sentence of poverty. Workers would have the right to get sick yet stay employed. Swaths of public life would not still be inaccessible to people with disabilities, and the Americans with Disabilities Act would not be at risk of getting fundamentally undercut.

The people who survive gunshot wounds are no exception to this neglect. The tens of thousands who die every year in the U.S. because of guns are staggering enough, but these dead represent only 20% of those who have gone through the trauma of being shot. Many of the survivors deal with chronic pain and posttraumatic stress combined with health-care insecurity, as detailed by sociologist Jooyoung Lee. Many are uninsured or underinsured and struggle to control their pain, and some may become desperate to find relief; one leapt into traffic in order to be admitted to a hospital for pain treatment. “In addition to feeling victimized by their shooters, gunshot victims also felt victimized by a health care system that did not continue to care for them,” Lee writes.

Even more numerous than the dead and wounded are those who care about them. Some time ago, a rare dear friend to me gained access to a gun, and left us. They were 17, I was also 17. I still dream about it. Impossible to trace the immense shape of the loss. But here is a fragment of it: Not long afterward, I sought out a doctor and asked for a new prescription for an antidepressant. I am trying to say a gunshot has a long echo.

Each of these hurts is elided by inaction. Despite a richness of resources we are at least adjacent to, the threshold at which our current leaders begin to pretend to want to address the health and safety of the hurting, including those with mental illness or physical wounds, is a critical mass of tragic headlines and town hall callouts where constituents beg for access to medicine or for protections from weapons that will continue to inflict injury. The rest of the time, the everyday fact of hurt is, it seems, too atypical to acknowledge through meaningful action at high levels.

Dear Congress: I Don’t Need An Effing Gun, I Need Health Care

“Illness is the night-side of life, a more onerous citizenship,” wrote Susan Sontag. “Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.” If only Sontag’s view were more widespread.

Next to the refusal to see illness as ordinary is the reluctance, especially among those whose foremost sympathies lie with a couple lines on a centuries-old document, to see current levels of gun violence as disordered. Gun deaths in the U.S. have been repeatedly excused as the price of our exceptional freedom. These deaths now threaten to outpace those from car crashes. Few of the records of people shooting each other are defensive or can be in any way justified; far more incidents are murders or suicides. The violence is absolutely beyond a passing side effect of patriotic or honorable necessity.

Yet the prevailing understanding has been that this violence is impenetrable and inevitable. This violence is not to be challenged, but accommodated. For all the dismay felt across the ideological spectrum after every tragedy, there remains a current of deference. There is a greater willingness to carve out gun-shaped spaces across the lives of the potentially vulnerable than to, say, reinstate the ban on assault weapons. School shootings are to be met with backpacks that are bulletproof or see-through, behemoth panic rooms wedged beside students’ desks, something something CPR, calls for more empathy not from potential shooters but from potential victims, and buckets of river rocks in every classroom for dispatching threats by stoning. Believing violence to be inevitable also looks like increasing the presence of police in schools, which brings further risks of violence toward and criminalization of students of color and students with disabilities.

These measures are sometimes called hardening the target. They amount to a crouch that braces against onslaughts of our own making as against the uncontrollable weather. It is imaginatively flat.

There is a greater willingness to carve out gun-shaped spaces across the lives of the potentially vulnerable than to, say, reinstate the ban on assault weapons.

All these imaginative shortfalls converge in the worst way. The costs of gun violence, from physical to financial, are immense, yet numerically murky. These wounds not only are seen as inconvenient outliers but also have not been adequately quantified, thanks to the ongoing inability of federal agencies to research gun violence. This lack of clarity on consequences muffles the urgency of acting on the problem.

The rhythm of violence inflicted while its effects are obscured is often wielded by the privileged and powerful. We see this with sexual predators. We see this in the increasing permanence of war and the failure to care for veterans, or to reckon with the damage left behind. We see this as the right of the police to freely execute black people, made normal every time yet another officer responsible is released without charges.

And it’s in privilege and power that we might begin to find an explanation for the seeming inability of a nation to connect the dots from gunshot to wound. Gun laws in the U.S. have long operated in service of white supremacy. The majority of mass shooters are white men, and about half are domestic abusers; and men constitute the vast majority of shooters overall. But the group most vulnerable to gun violence is young, working-class black men.

Many noted the contrast between the widely cheered protests spurred by the well-off white neighborhood of Parkland and the less-popular movement for black lives, rooted in Ferguson. Gun violence as it most often occurs elicits so little material response because the aggressor or the injured can often be subsumed into structures of oppression. If those who remain in that imaginative crouch shifted the landscape of their sympathy, perhaps the violence we have come to know as everyday would seem more strange. The people who have been hurting the most could finally make their way from the periphery to the focus.

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]]> https://theestablishment.co/when-youre-depressed-and-trying-for-a-baby-850c54709a2c/ Fri, 13 Apr 2018 01:33:11 +0000 https://theestablishment.co/?p=1689 Read more]]> Getting pregnant wasn’t a race against time, it was a race against mind.

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
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“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
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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/my-fight-against-an-eating-disorder-that-has-nothing-to-do-with-food-330238d8b5b7/ Fri, 15 Dec 2017 23:53:33 +0000 https://theestablishment.co/?p=2809 Read more]]>

Most people know about bulimia and anorexia. But few know about pica.

flickr/theilr

When I was younger, I would lie in bed and read stacks of Archie comics. Then I would slowly rip off pieces of the back covers and eat them until there was nothing left. I knew the dyes in the paper couldn’t be good for me; still, I couldn’t stop.

I ate many kinds of paper back then, but comic covers were undoubtedly my favorite. I relished the paper’s grainy taste, and the way it dissolved into a wet, chewy mass in my mouth.

And it wasn’t just paper that I craved—all kinds of non-food items routinely ended up in my mouth. Years later, while reading the book White is for Witching by Helen Oyeyemi for a university course, I would finally discover that my need to eat things had a name: pica.

I’ve been consuming items that aren’t food since I was a toddler eating sand. After entering school, I switched to pencils and erasers. I once had a plaid teddy bear; on its head was a little loop of material that could be used to hang the bear up. There’s a photo of me in my kindergarten classroom with the bear hanging from my mouth, chewing away on the loop. I also have an oversized comfortable jacket I stole from my dad when I was young, the corners of the collar chewed off to reveal the fluffy stuffing inside. I loved the feeling and taste of cotton fibers — they were so chewy, and I enjoyed pulling them out one thread at a time.

I remember the hot shame and guilt I felt when people caught me in the act — when yet another teacher told me to take that pencil out of my mouth, or when my best friend shot me disgusted looks as I chewed on a pink eraser until it disappeared. I would mumble words while gnawing on small bits of plastic at the back of my mouth; if people asked what I was eating, I’d panic and swallow. Once people tried to keep me from eating things, I started to slip items into my pockets to eat later when no one was around.

Why I’ve Made Myself Nearly Bald

When my mom told me to stop relentlessly chewing my hair, I began hiding behind books or my hands so she wouldn’t catch me in the act. Over time, I started cutting my hair shorter and shorter to keep it away from my mouth; when I decided to grow it out past my shoulders during the first year of university, I couldn’t help but pull out chunks of hair again to chew. A few months later, I cut it off into a short undercut, putting the hair safely out of my mouth’s reach once and for all.

No matter what I ate, there was a ritual to it, a process, that drew me in; each different substance had to be consumed a different way. I was careful to follow those rituals, whether it was slowly tearing strips off the Archie comic paper, or biting off tiny pieces of plastic and chewing them until they were malleable and could be swallowed.

When people think of eating disorders, they typically think of anorexia and bulimia. But millions struggle every day with other, lesser known disorders, like Ruminating Disorder (which involves people re-chewing regurgitated food) and Orthorexia (an obsession with proper or “healthful” eating).

Among these little-known disorders is pica, described by NEDA as “an eating disorder that involves eating items that are not typically thought of as food and that do not contain significant nutritional value, such as hair, dirt, and paint chips.” The disorder only encompasses items, NEDA emphasizes, that are not part of “culturally supported or socially normative practice (e.g., some cultures promote eating clay as part of a medicinal practice).”

Why Should You Become An Establishment Member For $5 A Month?

The roots of pica are varied. For some, the disorder is rooted in a need to correct a nutritional deficiency; iron-deficiency anemia and malnutrition are listed by NEDA as the two of the most common causes of pica, and this can cause pregnant women, too, to develop it. Pica has additionally been linked to autism spectrum disorder, intellectual disability, and schizophrenia, as well as trichotillomania (hair pulling disorder) and excoriation (skin picking) disorder.

Whatever the cause or risk factor, a lack of understanding about pica means many face stigmatization, and are unable to find help if they need it. This is especially concerning considering the condition seems to be growing in prevalence; one study found that hospitalizations for pica jumped a staggering 93% between 1999 and 2009.

Hospitalizations for pica in a 10-year span jumped a staggering 93%.

Health consequences include mechanical bowel problems, infections such as toxoplasmosis and toxocariasis, intestinal obstruction, and poisoning. In rare cases, it has even led to death. (In one documented case, a man died after consuming five kilograms of coins, necklaces, and needles; in another case, a man passed away after swallowing 10 buttons, a drawing pin, pieces of chain and bone, and a large amount of black foam rubber.)

Treatment varies depending on the circumstance. NEDA suggests first testing for mineral or nutrient deficiencies and correcting those; if that doesn’t work, it recommends turning to behavioral interventions.

My own recovery process hasn’t been easy — but it’s put me in a much better place now.

When I spoke with my mom to write about my experiences, she thought my pica stopped by the time I was 10 or so. In truth, I struggle even now.

I still put things in my mouth — like bottle caps and plastic earring backs — but for the most part, I just chew on them without swallowing. I’ve also started eating raw potatoes and raw pasta, which emulate the taste of non-food items. And to mimic what it’s like to break down dense, hard plastic through chewing, I’ve shoved handfuls of unpopped popcorn into my cheeks, moving the kernels around my mouth and grinding them into powder.

What’s really helped me is identifying the root of my pica: anxiety. Ritualistically chewing non-food items, I’ve realized, helps me feel in control when my mental state does the opposite. Since then, I’ve taken the time to manage my anxiety in healthy ways; with this progress, I’ve become less inclined to consume paper, or erasers, or strands of my own hair.

Eating disorder recovery is rarely linear, and I sometimes still eat non-food items, especially when I’m feeling particularly anxious. But these days, more often than not, my Archie comics remain just for reading.

If you think you might need help for pica or any other eating disorder, call the NEDA helpline at (800) 931–2237.

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