It’s October, the spookiest time of the year, and also the prime time for a resurgence in harmful stereotypes about disabled people in the media. I love Halloween, and like many people, I’ve been dutifully scaring myself silly this month with new shows like The Haunting of Hill House, and a re-exploration of Stephen King’s back-catalogue. But in nearly all of the terrifying films, books, and TV shows currently dominating our leisure time, it’s impossible to ignore one pervasive trend: the looming spectre of the “Evil Cripple.”

Quite frankly, we disabled people are everywhere right now, but not in the way many of us would like. If we’re not wielding chainsaws and going on murderous rampages, then we’re plotting world domination from our wheelchairs and reveling in a variety of gruesome deaths. The recurring tropes of disability = evil and disfigurement = morally bankrupt are stereotypes as old as culture itself, but what exactly is so scary about us? Well, come with me on a spine-tingling trip through history, that begins thousands of years ago, within the creeping mists of time…

Horror films and books play heavily on the idea that religious texts and arcane tomes are gateways to magic and evil, but the idea of disability as punishment is one found in almost all religious stories. In these parables, sinners are struck down with blindness, leprosy, or paralysis as a punishment for perceived sins, and healing is only offered when they repent and beg for forgiveness. In fact, early Puritan writings suggested that disabled people were innately driven towards evil, and that a child born with a disability was being punished for intrinsic impulses towards immorality.

In folktales and fairytales, too, limping crones lure children to their deaths, and disfigured characters like Rumplestiltskin use their cruelty and cunning to entrap the more moral characters of the story. Often, in these tales, disabled and disfigured people are fueled by jealousy and bitterness, and so turn their hatred onto the pure and blameless members of society. The over-arching message? Disabled people are inherently evil, and as such, we are scary.

Early Puritan writings suggested that disabled people were innately driven towards evil
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Unfortunately, this lazy trope, which positions disability as being caused by, or being the cause of, malicious wrong-doing, is one that repeats itself in popular culture, and feeds into the false idea that disability is inherently a bad thing. In Stephen King’s The Green Mile, callous jailer Percy is punished for his cruelty to the inmates by being rendered catatonic, while the sweet-hearted wife of the prison’s chief warden is saved from her brain tumor because, we’re meant to infer, she deserves to be.

In the Texas Chainsaw Massacre, Leatherface is a disfigured character who tortures people to death and tries to wear their faces, because of course, if you have a facial disfigurement you must be filled with self-loathing, as well as a burning hatred for those who don’t. We know that Freddy Krueger is evil because he’s disfigured; the Phantom of the Opera becomes a villain because he can’t possibly reveal his scars; and Jason Voorhees, with his disfigurement hidden behind a mask, demands your attention with murder.

But it isn’t just physical disabilities that history and, by extension, the entertainment industry, consider frightening.

One of the most famous horror tropes is the mentally ill and therefore murderous antagonist. Often a serial killer, like Hannibal Lecter, or occasionally possessed by demons, like Emily Rose, if there’s one things the horror genre has taught us, it’s that mentally ill people are to be feared. But there’s a particularly sad irony in this stereotype, since throughout history, mentally ill men and women have been the ones most frequently harmed by society.

Take Bethlem Hospital, better known as Bedlam Asylum, for instance. Most of us know that Bedlam was a terrible place, where people were locked away in squalor, without treatment, and routinely abused by their gaolers. What many people don’t realize, however, is that before Bedlam, locking away patients with mental illness was considered to be a humane way of isolating them from their abled peers, for the very simple reason that mental illness was thought to be contagious.

As a result, many people suffering from mental health problems were subject to torture or murder, as it was feared they might infect others. Isolation was considered to be a more compassionate alternative to a variety of so-called therapies, from blood-letting, to starvation diets, to trepanning, an ancient practice in which a portion of the skull is removed. Yet despite this, the horror genre is rife with depictions of psychopaths committing mass murder, or people with multiple personalities slaughtering their families.

Perhaps, you might think, that these stereotypes are no big deal. But the fact is that the horror genre is the only genre in which disabled people are regularly represented at all. In 2015, a report by the Media, Diversity, and Social Change Initiative found that of the top 100 movies that year, only 2.4% of disabled characters spoke or had names, despite the fact that 1 in 5 people around the world are disabled.

The entertainment industry, in particular, regularly comes under fire for allowing abled actors to “crip up” and play disabled roles, thereby denying disabled actors the opportunity. The problem has become so bad, that the Ruderman Foundation recently reported that an incredible 95% of disabled characters on television are played by able-bodied actors.

The fact is that the horror genre is the only genre in which disabled people are regularly represented at all.
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Similarly, while most horror films depict mentally ill people as violent, cold-blooded killers, the reality is that they are far more likely to be the victims than the perpetrators of violent crime. The stigma around mental health issues also makes recovery harder, and according to the Mental Health Foundation, nine out of ten people with mental health problems believe the stigma around them has a negative impact on their lives.

While Halloween is a great excuse to terrify ourselves and indulge in dark stories, it’s worth remembering that while horror entertainment frequently depicts disabled people negatively, there’s essentially no other popular media to counter-act these depictions. While there are countless disabled and disfigured people portrayed as killers and villains, we rarely ever get to be the heroes, and frequent negative representation breeds ongoing stigma and prejudice.

Stories of disability as a moral punishment, in particular, feed into the idea that disabled people deserve suffering, or even that the lives of disabled people are nothing but suffering, and so we are either to be pitied or punished. Neither of these things is true, and isn’t it about time we stopped using disabled bodies as a short-cut to cheap scares? The chances are we’re probably not going to murder you or wear your face as a mask, but we are pretty tired of always being the bad guy. Really, the only thing frightening about disability is the archaic attitude the entertainment industry still has towards it – in both its depiction of us, and its refusal to offer us a chance at employment.

Cognitive disability is typically decorative in the horror genre—a surface on which to project our fears—but ‘Hereditary’ is one of the first horror films to complicate that narrative.

Warning: there be some spoilers ahead!

For me, the most haunting image of disability ever depicted in a horror film is a sequence in Stuart Gordon’s From Beyond (adapted from H.P. Lovecraft’s short story). A woman peers at the inmates of a psychiatric institution through the tiny windows of their rooms, their aggressive performances of mania framed like paintings in a gallery. The imagery sticks with me for its tidy encapsulation of the attitude toward cognitive disability in the horror film.

Cognitive disability — specifically, a stylized form of cognitive disability that I will refer to as madness — is decorative in the horror film, a surface on which to project our fears. Unfortunately, this particular depiction of madness serves as little more than a colorful, sensational accoutrement, reducing disability to a storytelling or stylistic device, playing into a medical model of disability that reduces its complexity into a series of external expressions to be controlled and eliminated.

Ari Aster’s excellent film Hereditary risks the same fate and interpretation.

On the surface, Hereditary appears to be a film in which disability constitutes a prop in a play of terror, only to be overwritten and forgotten in the presence of overwhelming supernatural explanation. But to ignore the role of real mental illness in Hereditary would be to miss a salient facet of the disabled experience and the role of mental illness in horror cinema.

Terminology is important here, because different terms imply different models: I use “mental illness” deliberately because that is, I think, the lens of certain characters in the film, and it seems the most apt term to describe Annie’s relationship to the idea of cognitive disability, which dominates the early film.

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To ignore the role of real mental illness in Hereditary would be to miss a salient facet of the disabled experience and the role of mental illness in horror cinema.
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When Annie lays out her family history, she uses clinical terms to describe her family members’ various mental states — psychotic depression, schizophrenia, etc. — in a subdued scene that minimizes sensationalism and emphasizes Annie’s process of medicalizing, rationalizing, and therefore managing her family according to one of the most prominent models of disability.

Tobin Siebers, noted professor and disability scholar, usefully lays out the two major models of disability: “the medical model defines disability as a property of the individual body that requires medical intervention,” while “[t]he social model opposes the medical model by defining disability relative to the social and built environment.”

Siebers suggests that “the next step is to develop a theory of complex embodiment that values disability as a form of human variance.” Hereditarydramatizes a shift from the medical model — e.g. Annie’s representation of her family — to a model of complex embodiment exemplified by the film’s ending.

Disability theorist Robert McRuer suggests there is a transient nature to disability in the dominant cultural imaginary: “According to the flexible logic of neoliberalism, all varieties of queerness — and, for that matter, all disabilities — are essentially temporary, appearing only when, and as long as, they are necessary”; this may be enacted through the “miraculous cure,” as Martin Norden calls it, or through disavowal of a disability that was never really there in the first place.

Take the third Nightmare on Elm Street film, Dream Warriors, which is centered on teens incarcerated in a psychiatric facility. The terror the teenagers feel for the murderous Freddy Krueger— who hunts them in their dreams — is mistaken for mental illness, and the children must battle the staff whose misconceptions could (and sometimes do) prove fatal to them.

Dream Warriors encapsulates the ways that disability functions as a veil to be discarded and a label to be rejected: The protagonists aren’t actually “crazy,” not like those people — namely, the “hundred maniacs” said to have fathered Freddy Krueger. If Hereditary at first appears to be just such a film — in which disability appears early and is later discarded — closer readings reveal it to be a much more nuanced take on disability.

Where so many horror films use disability as a cover for or diversion from the supernatural, Hereditary is both part of a tradition of films that use horror to explore mental illness as lived phenomenon and part of a recent wave of body horror films that redefine the imagery of the genre.

Mental illness in horror is madness; not madness in the way that the word has been re-appropriated by, for example, a variety of groups and movements that have used the moniker “Mad Pride” in celebration of mental illness, but in the (arguably related) sensational, exploitative sense, preceding scientist or doctor: madness as the horrorization of disability.

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Madness is a cloak in horror cinema: It drapes its subject in meaning; it’s an easy shorthand for a medium whose mantra is show, don’t tell. The villain is mad: dangerous, unpredictable, shattering the boundaries of acceptable behavior. Whether in the tradition of tinkerers like Dr. Frankenstein or killers like Norman Bates, mental illness is stylized into madness (or perhaps the reverse: style goes mad) and then violence is projected onto it.

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'Hereditary' is both part of a tradition of films that use horror to explore mental illness as lived phenomenon and part of a recent wave of body horror films that redefine the imagery of the genre.
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It is a well-worn truth that mentally ill people are more likely to be the victims of violence than to inflict it themselves, but the problem with the “madman” trope is as much in its hollowness as in its inaccuracy: It is all surface and no depth, fleeting and ephemeral. However, there is another strain of horror, which I’ll call mad horror, that explores madness in a different way: namely, as an experience, a “complex embodiment” in which a person lives.

Mad horror cinema can be traced at least back to The Cabinet of Dr. Caligari(1920), in which the exaggerated, subjective sets that have come to define German Expressionist cinema are the representations of a mind in the throes of madness.

Caligari, through its use of exaggerated, counter-realistic design, narrates the process of rendering mental illness into madness; it is the process of, in Siegfried Kracauer’s words, the “transformation of material objects into emotional ornaments,” the visualization of the ostensibly invisible. Caligarihelped set a precedent in horror for the visualization of cognitive disability in everything from cinematography and lighting to physical sets and props (since Caligari, sound cinema has allowed for the use of sound effects to signify madness as well).

The projection of madness into the physical environment of Caligari is echoed in Hereditary through Annie’s hyperrealistic miniatures and her daughter Charlie’s grotesque dolls. If Annie’s gallery of perfectly lifelike imitations reflects her attempt to maintain sanity in her family, Charlie’s suggests an abnormal mind that foreshadows an alternate reading of the film.

As much as it is the story of a coven of witches conspiring to place the spirit of Charlie (who was really a king of hell all along, or something) into Annie’s son Peter’s body, Hereditary may also be Peter’s slow break from reality, probably triggered when Peter accidentally kills Charlie. From this standpoint, it makes sense that Peter would symbolically resurrect Charlie the only way he can: within his own body.

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Peter’s descent into madness echoes mad horror films like Repulsion and more recently films like Black Swan and Darling: films that explore mental illness as a lived, physical experience, in which the horror is derived from one’s mental state. Hereditary — in presenting multiple possible readings — is a film that revels in the slippages between psychosis and the supernatural and the indeterminate nature of that boundary.

The line between those two phenomena has always been tenuous in the horror genre, but Hereditary takes that boundary as its secret subject. Before Hereditary, David Cronenberg’s Videodrome more overtly explored the same slippage between reality and hallucination. “There is nothing real outside our perception of reality,” Brian O’Blivion tells Max Renn, suggesting that reality is just one shared hallucination.

Hereditary follows in Videodrome’s footsteps both by exploring madness as something lived rather than merely seen and by disrupting the line between the real and the unreal and that between body and mind.

In his book Crip Theory, Robert McRuer argues that:

“[a] system of compulsory able-bodiedness repeatedly demands that people with disabilities embody for others an affirmative answer to the unspoken question, ‘Yes, but in the end, wouldn’t you rather be more like me?’”

McRuer, by contrast, proposes the radical possibility of taking pleasure in disability, that “disability and queerness are desirable.” (McRuer’s focus on queerness — in addition to disability — is actually quite relevant to a film centrally concerned with the breakdown of a traditional nuclear family unit.) This desirability is central to Cronenbergian body horror, particularly the oeuvres of Cronenberg and Clive Barker.

Hereditary — along with recent films like The Neon Demon, The Lure, and Get Out — is a kind of post-Cronenbergian body horror focused less on dramatizing transformation visually on the body, but rather on redefining the relationship between self and body and between body and image.

Less sadomasochistic than their predecessors, post-Cronenbergian body horror (which actually may be said to begin, ironically, as far back as Cronenberg’s own Dead Ringers) focuses less on pleasure and more on the uses and abuses of the (literal and metaphorical) social body, like the dehumanizing cult of female beauty in The Neon Demon.

Hereditary explores not only the mad body but the familial body, specifically that of the nuclear family, whose supposed safety and stability — signified by Annie’s rigorous models — is seen to be, in reality, tenuous at best (while the models themselves comment on the constructedness of the nuclear family). That the film ends on a coven chanting around Peter at the coronation suggests that the conventional family has given way to a non-conventional family just as Peter has entered a non-conventional mental state. As in Hereditary’s predecessors, this ending may not be undesirable to those actually experiencing it.

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'Hereditary' explores not only the mad body but the familial body, specifically that of the nuclear family, whose supposed safety and stability  is seen to be, in reality, tenuous at best.
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Like Caligari, Hereditary has a frame of sorts, opening on a pan through a room full of miniatures before settling on a model of Peter sleeping in his bed, from which the action seamlessly begins. By framing the entire film as, quite possibly, an exhibit of Annie’s art, the film blurs the line of narrators: is the film Peter’s, or in opening on Annie’s model of Peter, is the film Annie’s?

Hereditary is a familial intermingling of consciousnesses — Annie’s, Charlie’s, Peter’s — that defies representations of mental illness as surface level stylization or as a problem in need of a cure and in doing so, resists the stigmatization of disability so prominent and dangerous in the horror genre. Despite a fraught and complicated history, the horror model of disability can offer a surprisingly nuanced and empowering way of looking at the experience of madness.

It’s been two years since the height of my mental crisis, when I tried to commit myself to the mental ward because I was suicidal, only to be turned away because I hadn’t performed my “crazy” satisfactorily enough. Instead, I was sent out the door, a mental-ward reject, with a few pamphlets stuffed in my hands, left to navigate the mental-health labyrinth on my own.

Back then, all my days found me contorted on the bed in the fetal position, exhausted of tears, and rail thin as my body had even lost the ability to hold down food. It wasn’t the first time I had experienced a mental crisis — but it was the worst time.

As kids, we were often instructed in sound life-saving emergency disaster training. Handy epithets spoken in childhood — “Do not struggle in quicksand”; “Break glass in case of fire”; “Never run with scissors” — are all intended to see us into old age safe and sound. However, as an adult, I found myself wholly ill-equipped when my life had become a raging dumpster fire. There was no “Stop, Drop, and Roll” poster to draw upon in mental crisis.

It wasn’t the first time I had experienced a mental crisis — but it was the worst time.
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I’ve had plenty of time to reflect on how my life had spun so out of control to bring me to this climax, and in doing so, how I had to relearn to live my life in a 180 degree pivot from how I lived before. I can now trace how I was able to forge my own path to stability: the resources I would ultimately discover and draw upon, and how that saved my life.

Ultimately, I was able to come up with a plan to save my life in crisis. Now, I hope my own narrative, and the crucial lessons I learned, can help others, too. Here are some guidelines I’ve developed around Stopping, Dropping, and Rolling in mental crisis.

One of the most significant factors that contributed to my crisis was that I had spent years exhausting myself to “front” and “pass” as “normal” in every facet of my life: school, interpersonal relationships, and my career. My bipolar disorder diagnosis was a closely guarded secret, and at the time I felt that if I just performed competence long enough — if I proved myself indispensable, and outperformed and outshone everyone, particularly at work — my erratic quirks would be forgiven and I would not be marred with “crazy cooties.” And in the eventuality I was outed by my own behavior, I’d have already long proven a legacy that I was the “right kind of crazy.”

I’d totally bought into the capitalistic myth that my value lied in productivity. Every entry on my CV added to an inflated sense of self-worth. And yet, to sustain this grinding level of productivity, I was ping-ponging myself into rapid cycles of hypomania/mania/mixed-states again and again over a four year period. And at the end of each cycle, the suicidal periods grew longer, harder to bounce back from, and more excruciating to bear.

I’d totally bought into the capitalistic myth that my value lied in productivity.
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Healing from life-long trauma and prioritizing mental health takes work, and I had no time (or the means) to take a leave of absence to address my well-being, because once I did, the cat would be out of the bag, and then I would be stuck with the reputation of being sick, unreliable, defunct. Unhireable.

After years of whiteknuckling it through one toxic and exploitative work situation after another — all in an effort to prove I had value — I was barely holding on when the thread finally snapped and I plunged into a mental abyss. I became paranoid, delusional, suicidal, and unable to get out of bed to brush my teeth. I didn’t know if I would survive this crisis, but I knew I would not survive the next one. I believed I had only two choices: end all my pain swiftly, or finally prioritize my mental health above all else and confront my history of trauma head on.

If only I could “fix” myself, life could go back to the way it was (back to the whiteknuckling grindstone, that is). I became so eager to conquer my illness that the psychiatrist I was finally able to temporarily access remarked I was one of the most pro-active mentally ill people she had come across. Of course I was! I wanted to get this nonsense over, heal, and get the show back on the road!

But ironically, in my diligent efforts to become “better,” I learned I had to perform something else: my illness.

Once in deep sickness, I was forced to expend the non-existent energy I had accessing any resource available: getting to various appointments with community case-worker agencies, mental health and social support programs, food banks, and so on, all the while having trouble crossing the living room without crumbling in despair. I began to miss crucial appointments, not because of an unwillingness to get well, but because I was just that sick.

At the same time, the mental-health system was putting stumbling blocks in my path to wellness by demanding that I prove I was “sick enough” to warrant care. For example, my family doctor had been continually dismissive of my concerns of being waitlisted for a psychiatrist to manage my medications over a six-year period in which I made regular appointments with him to ensure he was actually referring me, and taking my mental health seriously. In the height of my crisis, I lashed out regarding the lack of progress. He then put the onus back on my shoulders, stating that it hadn’t been enough for me to continually make appointments to ask for the help I felt adrift from, because I had failed to perform my requests with tears and anger in order to demonstrate I really required assistance. In this moment, I did not have the energy to point out that I had demonstrated tears and anguish in his office a year and a half prior on this issue, to which he had said the exact same thing to me.

In order to get out of this toxic cycle of performativity, I distanced myself from the goal of “fixing” my mental health. I still strove to meet appointments, but I did not shame myself when I was simply unable to make them, even when mental-health supporters would condescendingly suggest that I lacked commitment. If I lost my spot with a mindfulness program I had waited four months on a waitlist to join, because my apartment flooded the night before and triggered mania, so be it. I would download a free mindfulness program. If I slept through an 8:30 in the morning CBT group session because I couldn’t stop a six-hour crying jag till past 3 a.m., fuck it. I would find exercises online to do when the tap of tears had run dry. If I was a no show to a very important psychiatrist’s appointment because I had eaten bad meat as it was the last of the food I had left and now had the shits, tough titties — I had been waitlisted eight years for access to a psychiatrist, what was another week? If I could not travel to make it to group therapy sessions in person, I would find mental health support groups on Facebook.

How To Help The Cause When You Need Help Yourself
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In fact, it was through the mental-support networks I was forging online that I was finally being told: “Your life has value. You have intrinsic value. Your only job today is to make it through. And again tomorrow.” And it was through these online support forums, as well as openly talking to anyone I came across physically about my struggles, that I started to learn, through word of mouth, how to navigate the labyrinth of a broken mental-health-care system: the hacks to getting care, which programs to avoid, and which to pursue.

In baby steps, I began to put one foot in front of the other with one directive in mind: simply being. I learned to stop performing both wellness and illness. I began to trust I had value even when I was completely dysfunctional. Even if I was a “burden on society.” I started making mental wellness programs work for me rather than making myself work for mental wellness programs. And I learned to opt out of any judgement that I was not trying hard enough, to accept I was sick and limited, and to reject the notion I was failing or had failed.

During this quest to “fix” my mental health, I discovered, in addition to my bipolar diagnosis, that I also had Complex-PTSD. In a free therapy program for survivors of sexual assault, I learned I had the right to protect my mental health above all else, unabashed and without guilt and shame.

I discovered in therapy that during my childhood trauma, I hadn’t been empowered to protect myself, and that the adults in my life failed in their job of protecting me. Now I was locked in a pattern of waiting for the adults around me to step up and treat me right, while desperately trying to prove my value and worth to convince people in my life that I deserved not to be abused and mistreated. However, as an adult myself, I now could develop the tools to protect myself: namely, not waiting for others to treat me right. I began to learn how to control triggers and enforce boundaries, but most important, I learned to protect myself by giving myself permission to leave toxic situations, including dropping friends, family members, activities, work situations, and even a promising career that had proven harmful to my mental health.

Now I give myself permission to protect my mental health first and foremost over the feelings of all others. For example, I used to be plagued with guilt if I defriended anyone on Facebook, believing that it was my job to tolerate toxic behavior. But now I am unabashed at hitting that block button if their continued presence on my feed will risk triggering my PTSD, whether it is intentional or not. I do regret when it becomes necessary, but I no longer allow guilt to prevent myself from prioritizing my mental health. I am often sick, and I can’t handle much. It is as simple as that. And that’s okay.

While Shonda Rhimes (who I love) was extolling the Year of the Yes, this period of my life became my Year of the No. I had spent my whole life saying yes to things in order to conceal my bipolar disorder; now I had to learn to say no to everything, including opportunities I would have killed to have had prior to my breakdown. This was the hardest struggle for me to overcome, coping with an identity crisis centered around a crucial question: “Who was I if I was not the me I had been fronting to be all along?”

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Now, I can no longer aspire to the grand designs I had in mind for my career, and I’m becoming content with that, defining myself instead by qualities outside the parameters of work — my warmth, my sense of humor, my great capacity for love, just breathing. I now only take on projects that I can fit around my mental health, and write what I can only when I can. And fuck the word count/Sword of Damocles hovering over my head.

I now allow myself to be unreliable, the person you can’t count on to make it to the party or meeting, the friend who will drop the ball because she can’t get out of the house. I hate disappointing friends, but I can only hope they understand my fragility and value me anyways, and that I’m there for them when I can be, even if that might not be very often.

Most important, I stopped apologizing to my loved ones that I was sick and stopped acquiring an overwhelming sense of “social debt.” I’ll strengthen the connections of my network only when I have the strength to.

One of the most important things I had to learn was to stop becoming terrified by my suicidal thoughts, resist the shame spiral of guilt, and compartmentalize them.

When I was in the height of my mental crisis, suicidal ideation would send me into a panic. I still often have intrusive thoughts of suicide, but now instead of having a heightened panicked reaction, I focus on settling my mind and resist judging these thoughts to nip the dread in the bud. For example, I’ve come to realize that I have a heightened sense of morbidity the first hours of waking. In the past, these fantastical scenes of death playing out in my head would serve as evidence of how “broken” and “fucked up” I was. Now, when finding myself caught up with intrusive thoughts, I remind myself that I have these horrific fantasies every morning, and that soon my mind will settle down.

Over the last few years, I’ve learned to live with this frenzied hissy cat in the back corner of my mind that sneaks in at the most inopportune times. Sometimes I speak soothingly to this beast. Other times I shout it down. And by acknowledging these intrusive thoughts, by resisting giving into panic simply over their continued existence, I deny them from snowballing into sheer terror. And on the rarer occasion nowadays when they do snowball to terror, I give myself patience, and have a mental crisis plan in place. Also pharmaceutical products help.

Two years after the height of my mental crisis, my identity and self-worth no longer hinge on how well I perform. I finally realized that I can never afford to put my mental health at risk again in the creative industry, which grinds people into ashes with precarious contracts, unreasonable demanding hours for months at a time, and high-stress, volatile, hostile situations in a culture that demands its workers put their mental well-being at constant risk but will label you as a failure you if you dare get caught getting sick.

Instead, I concentrate on being, not doing; on sustaining myself through low-stress work that just meets my needs and through creative activities that nourish me but won’t pay the bills; on sustenance and well-being versus adding entries on my CV to prove to others I have value based on how other people see me; and on rejecting performing to others how well I’m managing my mental health. I allow myself to be unreliable, to do no more than I can, and to resist shaming myself for not doing more. If that means at times, even for days or weeks, that I can’t get out of bed — I don’t.

My identity and self-worth no longer hinge on how well I perform.
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I still struggle, but I’ve allowed myself to be okay with struggling, reframing it away from failure to doing only what I can within my limitations. I’m no longer hell-bent on fixing or curing my mental health.

Now, I’m managing my mental health the best I can without shame.

Art and mental health have a long history of association. Often, the two are even seen as dependent on one another — without misery, the ideas goes, one cannot create.

This perception, which is rooted in a dangerous romanticism, may have some basis in reality — people with bipolar disorder, for instance, have reported high levels of creativity during manic episodes. But scientists have also criticized research suggesting a direct link between mental illness and creativity, and warn against such broad-stroke conclusions.

Whatever the link, what is evident is that art is an effective outlet for individuals with mental illnesses. An extensive literature review in 2010 noted that:

“There is evidence that engagement with artistic activities, either as an observer of the creative efforts of others or as an initiator of one’s own creative efforts, can enhance one’s moods, emotions, and other psychological states as well as have a salient impact on important physiological parameters.”

A National Center for Biotechnology Information review of studies similarly revealed that art therapy resulted in a “significant reduction” in depression and anxiety, as well as a “significant reduction of symptoms” for people who’ve experienced trauma.

While I get highly irritated by the suggestion that a few minutes of mindful coloring can cure debilitating illnesses, it’s clear that creativity can indeed provide a useful channel for exploring one’s self, which can help with the management of difficult mental health.

Treating Mental Illness Doesn’t Ruin Creativity

But what about sharing this creativity?

Increasingly in recent years, there have been high-profile art exhibitions, theater productions, books, photography displays, television shows, and movies exploring mental health, often written, produced, and performed by the individual at the center of the story. Losing It, a two-woman show about mental health written and performed by comic actor Ruby Wax and musician Judith Owen, has received rave reviews in London. Stephen Fry uses poetry to help deal with his bipolar and depression. And Lena Dunham has been pretty vocal about her mental illnesses, which she’s explored on Girls and in her writing. Finding art a valuable tool for themselves, these creators have decided to share their experiences with others.

It’s clear that creativity can indeed provide a useful channel for exploring one’s self, which can help with the management of difficult mental health.
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But the question is: What purpose does this serve? What is the role of art in presenting issues of mental health to the world? Is it catharsis, education, exploration, to trigger empathy, articulate the self — or none of these?

And at what point, if any, do such expressions become problematic?

As much as we believe that we are more open minded and liberal than ever before, mental illness continues to carry stigma, not helped by media portrayals in which it is readily associated with and even deemed the cause of violent crime and terrorism. It still scares us, and this is often rooted in a lack of understanding.

Art therefore offers a medium for crucial education. When Liz Atkin started handing out drawings that she had done to help deal with Compulsive Skinpicking Disorder on a London tube, she found conversations begin to emerge. She describes it as “a moment of connection, of advocacy for mental health.”

Guo Haiping, director of the Nanjing Tiancheng Outsider Art Center — an organization offering space for the mentally ill to create, exhibit, and sell their art — told Vice magazine that art helps people respect those with mental-health issues. “In the past people would help the mentally ill with a mentality of helping the vulnerable. This actually distanced them from us further,” he said. Through honest, relatable artistic expression, that bridge may be gapped.

What Animated Sitcoms Get Right — And Wrong — About Mental Illness

In their work looking at the role of arts in mental health settings in Ireland, Lydia Sapouna and Elisabeth Pamer suggest that art’s transformative power comes from seeing people beyond a diagnosis and reducing stigma. For this to happen, it seems clear that the art, and the person behind it, must be taken out of the clinical setting and into the world. As they say, people “need opportunities to engage with the world outside the mental health system rather than the mental health system becoming their world.”

Mental illness still scares us, and this is often rooted in a lack of understanding.
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Lois Saperstein, who started Arts Do The Public Good, echoes this, noting that creative expressions of mental illness can “show hope, possibilities, life’s challenges, ways to cope. As an educational medium and as a way to raise dialogues, it can bring people together and create change.”

The value of all this cannot be underestimated. But at the same time, the creative expression of mental illness raises difficult questions about voyeurism, exploitation, and the limits of the artistic medium.

Everyone experiences illness and wellness differently — and while art can give expression to an individual’s reality, writer and bibliotherapist Christine Cather warns that it can be dangerous to define everyone’s experience in this way. Karen Harvey agrees, stating that “It’s impossible for one person’s presentation of their experience of mental illness to speak on behalf of others because each person is unique.”

According to Katherine Vince from Balancing Acts, a theater production exploring the experience of depression, engaging in the creation of and watching theater can result in a wide variety of outcomes and benefits — for viewer and performer. She states that “it is also important, no matter what the subject matter, that when producing a performance we provide engaging entertainment because this is what enables spectators to escape into the worlds of the show.”

It’s impossible for one person’s presentation of their experience of mental illness to speak on behalf of others because each person is unique.
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But this artistic goal can itself be fraught; mental illness isn’t actually funny or entertaining, and any romantic stereotype suggesting otherwise is one that needs to be banished. The girl with a mental illness is almost always depicted as skinny and beautiful, with wide eyes and tight jeans, her long hair flowing, with a quirky and beguiling personality. This is a girl who boys gaze upon longingly, pining for what has famously been described as the “manic pixie dream girl.”

Particularly common when dealing with eating disorders, this presentation can suggest that illnesses are a choice of privileged and vain individuals, and can set them up as being attractive to vulnerable young girls. “I’m so OCD” has become a synonym for liking a tidy bedroom, while bipolar disorder is often conflated with dramatic (in an interesting sense) mood swings. Rather being viewed as brain-based diseases that have severe impacts on an individual’s life, mental illnesses are often portrayed as a quirky novelty.

I Don’t Want To Be The ‘Troubled Girl’ Anymore

I wonder, too, if it’s dangerous to present the experience of living with mental illness in the form of art at all, potentially suggesting that the reality can be summarized into a few sentences or images, and that by just seeing it audiences will really understand. In this way, it parallels “poverty porn,” in that people could feel they have gained some fundamental insight into the experience of mental illness, which they then promptly forget once they return to their own comfortable existence.

Still, while these issues complicate art’s role in portraying the experience of mental illness, this doesn’t mean the medium should be outright discouraged. Rather, it’s worth exploring how artistic expression can manifest in ways both valuable and harmful.

As I’ve said previously, art offers a place to explore the reality of being a human in this world, with all its ups and downs, and being able to express that reality is a fundamental right. Art clearly has multiple roles to play in portraying mental illness, including articulation, education, and storytelling. Moreover, it provides a vehicle for expression and communication, a way to engage in the world.

As human beings, whatever our position on that hazy spectrum, this connection to the world matters.

Content note: There’s some talk of mental health, suicidal ideations, and eating disorders in here so please be kind to yourself and make a decision that’s good for you.

“You do remind me a bit of tragedy,” read the AOL Instant Message on my computer screen. I was in my college dorm, about to go out for yet another Lucky Strike on the back steps with the other bad kids. “With your, like, big sunglasses and your scarves and stuff.”

It was, at the time, the greatest compliment he could have paid me.

I was listening to a lot of Bob Dylan then and like any number of girls in the last four decades, I identified closely with the character (because truly, it could not have been an accurate portrayal of a complete human) described in “Just Like a Woman.”

You know the details of this kind of character. TVTropes.com refers to her most closely as the Broken Bird, but even if you’ve never heard her referred to in that way, you’re certainly familiar with her traits.

She’s a kind of young, sorrowful Femme Fatale who, perhaps later in life, will turn her toughness into strength and power but for right now is just kind of…dark. She’s a Chill Girl with No Feelings (unless those feelings are sad, but she largely keeps the real emotions to herself). Like a Manic Pixie Dream Girl but much more sorrowful and dark and serious, she exudes sexuality and desire through her brokenness. She is brooding and fierce and somehow inspirational despite being deeply fucked up. She’s Penny Lane, she’s Marla, she’s Sam in The Perks of Being a Wallflower, she’s the woman in Chelsea Hotel №2, she’s the literal girl next door in Breaking Bad.

But perhaps the best name for this trope (for this lifestyle, really) is the Sexy Tragic Muse, who Anne Thériault described beautifully in this 2015 essay.

“She’s damaged, often as a result of sexual assault or other abuse by men. Her life carries with it some kind of Deep Lesson, usually a lesson that a male protagonist needs to learn…The Sexy Tragic Muse fetishizes women’s pain by portraying debilitating mental health disorders filtered dreamily through the male gaze. The trope glamourizes addiction and illnesses like depression, bipolar disorder, and schizophrenia — diseases that are distinctly unglamorous for those of us who live with them. The Sexy Tragic Muse is vulnerable, and her vulnerability is sexualized. Her inability to properly care for herself or make decisions on her own behalf is presented as being part of her appeal.”

And she was exactly who, in my teens and early twenties, I thought I wanted to be. And that has made it, as I approach 30, all the more difficult to get better.

When you’ve spent most of your life identifying with and even clinging to the worst of you, the most painful of you, it makes being well and healthy feel an awful lot like giving up.

There were, in the ‘80s and ‘90s, and still are to some degree, a limited number of role models for girls and young women to look to. In my most impressionable days, they seemed to me to be neatly deliniated into categories. Smart Girls, Good Girls, Rich Girls, Plucky Girls, and of course, Bad Girls. Troubled Girls. For a while there, it was Emo Girls, though that’s its own essay.

Poor, white, and pretty rural, I saw myself a bit in several, but never fit quite comfortably in any one. I was smart (though numerous outside forces attempted to tell me I wasn’t, or at least, that I wasn’t the kind of smart that counted), I was plucky, I was good…but I was also emotionally treading water, beating my stout legs against a then-undiagnosed mental illness.

The Dangers Of The ‘Cool Girl’ Ideal
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Going to college has a kind of sharpening effect on a person’s characteristics, or at least, the ones they make the most visible. You come into clearer focus when hundreds of new eyes set upon you and decide who you are and what you’re like.

It was when I moved away that I really found myself identifying with the Troubled Girl. After all, she is always kind of the best character if we’re being honest with ourselves. The Troubled Girl taps into the centuries-old idealization of the Starving Artist; she’s a kind of new beat poet. In the bulk of teen lit and media, the girl who has it going on in the traditional sense is nearly always cast as dull and one-dimensional; the (still hot) Troubled Girl likes cool music and does cool things and attracts cool boys.

See: Vanessa in Gossip Girl. See: Ramona Flowers in the Scott Pilgrimuniverse. See: Mimi in Rent.

Unfortunately, the Sexy Tragic Muse must also look a certain way to be fully realized. The specific traits of such a character are rote and easy to identify. This character is:

— Thin (always and in the extreme; it is very necessary that she be thin)
— White (always except in the very rare occasion when she is a hyper sexualized, exoticized non-Black woman of color)
— A user of something (coffee, cigarettes, alcohol, drugs, all of the above, especially if it fuels the aforementioned thinness)
— Hot (necessarily)
— Modified in some way (tattoos, piercing, unnatural hair color)
— Unwell in some way (that must be somewhat sexualized, as well, like depression, bipolar, a restrictive eating disorder, addiction, or cutting; more on this later)

This was, in essence, a trap for every single thing I prized the most as a teen. I wanted to be smart. I wanted to be desired. I wanted to be thin. And I wanted my chaotic inner life to make sense among all of it.

This is the ultimate, dangerous trap of the Sexy Tragic Muse or Troubled Girl ideal — it creates space for people in pain where there’s no other space and allows them to hang on to it with both hands. It’s a map for depression and eating disorders and anxiety and substance abuse and hurting.

The Sexy Tragic Muse must also look a certain way to be fully realized.
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When the currents of overwhelming emotions that beat inside of you like a second pulse are sexualized and made to match with other cultural values—attractiveness, the ability for a woman to be a kind of Swiss Army knife, the impacts of rape culture as Not That Bad—that are difficult and toxic, you may find yourself bound up in your pain like the shell of a moth affixed to a web.

It’s not only understandable that a young person would identify this trope, it’s practically a given.

Unfortunately, we have yet to develop a way to grow out of it or beyond it. Sexy Tragic Muses aren’t depicted with a path to a healthy life. They tend to fade away, or live Sadly Ever After, or die.

Here’s the honest truth about life as a Troubled Girl: It’s not really a way that a fully-realized human being can be, and it’s certainly not a way that a person who is loving and caring and helpful and effective can be. But when you identify so thoroughly with a one-dimensional idea of a person, you begin to fear than your other dimensions are boring or undesirable or otherwise repellent in some way.

My body and I have been at odds for some time now, and like a lot of people who have lived with an eating disorder, I’ve gone through fits and starts when it comes to getting better. I’m a pretty firm believer that, a lot like living with mental illness, there’s no such thing as being “cured” entirely. However, there is the possibility to get better.

In the last few months, I’ve been taking a hardcore stab at it. Again. And it’s going well—I’ve got my meds and my mental health apps and my exercise routine and my healthy diet all hammered out—except for the fact that every single day, I still have to remind myself that I don’t want to be the Troubled Girl anymore.

The Sexy Tragic Muse represents a lot of things we collectively covet (thin, hot) but her traits are also specifically, systematically designed to keep her from becoming anything more than human. When we sexualize and revel in emotional pain, we all but ensure that the people who live with it can never experience anything else.

Here’s the honest truth about life as a Troubled Girl: It’s not really a way that a fully-realized human being can be.
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The Sexy Tragic Muse is not a good friend or partner. She’s not good at her job. She’s not a productive community member. She can’t be, because, by definition, she’s unwell and able to do anything but emote and maybe fix a sad boy’s heart or give a nice boy a chance to redeem himself.

Though I hit the peak of my Troubled Girl status a decade ago, it’s still evident that these ideals are pervasive. A recent series of advertisements for the startup Fiverr make it clear that the idea of being unhealthy as a point of pride is still alive and well, even if it looks a little less emo than it used to.

This is the pernicious nature of tropes like the Sexy Tragic Muse, which all but demand a certain kind of weakness (hunger, exhaustion, reduced lung capacity due to cigarette smoking) to portray strength or beauty or desirability. The Sexy Tragic Muse might look a little different in Silicon Valley—call her the Sexy Tragic CEO or the Sexy Tragic Founder or the Sexy Tragic Gig Economist—than she does on a college campus, but the idea is the same and it’s one that is designed to be limiting.

These tropes are seductive; they create thought patterns that are difficult to shed and easy to take advantage of. But this is a choice that I’m making (and in part, I’m writing it for accountability, so welcome to my process).

In order for me to be my healthiest self, I have to be okay with shedding the trope that has kept me from getting better by encouraging me to stay within dangerous parameters.

And I suspect I’m not alone.

There’s too much tragedy in the world to create more for the sake of sexiness.There’s plenty of sadness in the air to wear it like perfume. There’s too much trouble in me already to cultivate more for the sake of an imaginary ideal meant to keep me simple.

Unexamined bias and privilege play massive roles in not only who gets to diagnose mental health disorders, but who defines their criteria.

I grew up in a household full of people who were emotionally volatile and abusive. At any time, for no particular reason, I could be screamed at, guilted, shamed, or bullied — sometimes all four at once. I survived this by adapting, as humans do, to my environment, becoming hyper-vigilant, avoidant, and very anxious. I walked on eggshells at all times, constantly analyzing every slight change in a person’s facial expression, body language, and tone of voice. My alert level was always at orange.

Now, in adulthood—and generally surrounded by people who are not terrible—these habits and impulses still interfere with my attempts to build a happy life. Unfortunately, they’re very hard to break, and my alert level can’t just be turned down. I am, officially, mentally ill.

If this all sounds familiar to you, I’m not surprised. I’ve met many people who have had very similar experiences and now suffer from anxiety and/or depressive disorders. It’s to the point that the people in my life who don’t struggle with mental illness are out of the norm.

Speaking of “out of the norm”… Donald Trump is president of the United States.

For the past few months, nothing has seemed normal. He breaks well-established political norms on a regular basis. He says terrible and blatantly cruel things. He lies all the time. He puts completely incompetent people into positions of power.

In short, he’s not behaving at all like he should.

Speaking of “out of the norm”… Donald Trump is president of the United States.
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And as a result, since his rise to leading Republican presidential candidate, the thinkpieces and compulsive conjecturing on his mental health have been published with increasing frequency and alarm. Paul Krugman has called Trump “obviously mentally ill” on Twitter, #DiagnoseTrump campaigns and petitions have gone viral, and last month California congressman Ted Lieu made news when he pushed for legislation requiring a psychiatrist in the White House.

In attempts to make sense of Trump’s abnormal behavior, journalists and assorted other media figures have scrambled to ask any and every person with any kind of background in psychology what they thought about Trump’s mental state. Such inquiries and articles have only intensified since Trump took over the country’s helm.

To a point, I get it. The United States appears to be in chaos and human beings have a need to make sense of things. Further, mental illness has a long history of being used as a handy scapegoat to explain Bad Things. In particular, it’s been increasingly used to explain away the mass shootings committed overwhelmingly by white men. Before that, it was routinely used to describe anybody who committed a heinous enough violent act to get in the news.

The president is behaving in a way that lies far outside the boundaries of what we conceive of as “normal,” particularly for a person holding the highest office in the land. His actions are scary, and collectively as a society we are attempting to make sense of something that seems to make little recognizable sense.

Some Arguments Against Calling Trump ‘Crazy’ Do Added Harm

Around Inauguration Day, speculation that Trump has Narcissistic Personality Disorder seemed to reach a fever pitch. But Dr. Allen Frances, M.D.—who contributed to developing the criteria for the disorder in the the Diagnostic and Statistical Manual of Mental Disorders — weighed in, tweeting that Trump does not fit the criteria for the illness as he is not impaired. Highlighting his expertise in this area, Frances claimed that Trump was “bad, not mad.”

Indeed, it is difficult to say that someone is impaired when they can reach one of the greatest achievements in the world.

This got me thinking. What is mental illness in a society where someone like Donald Trump could become the U.S. president? How can someone who behaves so badly—so consistently inappropriately and erratically—be considered mentally healthy, or at least mentally competent enough to become the leader of the world’s biggest superpower?

It is difficult to say that someone is impaired when they can reach one of the greatest achievements in the world.
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I posed these questions to Dr. Allen Frances himself over email. His response smacked me right out of the bad path I was going down of framing Trump’s behavior in terms of mental health.

“It is a great, and frequently made, error to equate bad behavior with mental illness. The mentally ill only rarely behave badly and people who behave badly are rarely mentally ill. And as many people have pointed out, talking about bad behavior as though it’s an inevitable quality of the mentally ill does us a lot of harm.”

This was certainly true in my experience. As a kid and as a teen, I was so terrified of getting in trouble that I never so much as shoplifted a candy bar, I didn’t try weed or alcohol until I was in college, and I drove myself into the ground to get nearly all A’s throughout middle and high school.

Still, concerning Trump, my initial question hadn’t been answered. What does “mental illness” even mean in a society that elected Donald Trump to the presidency? What is it in a society that’s sick enough to have put an administration into power that ticked off most of the hallmarks of fascism off in less than a month?

New research into stress and trauma is leading a number of psychologists to believe that many incidents of mental illness are the result of behaviors and stress responses learned during traumatic incidents and/or abusive or highly stressful environments that are maladaptive in one’s larger society.

Again, this resonates with my own experience. I now work in a place where I have never been treated badly or screamed at or even scolded, yet I still feel like I have to walk on eggshells. Despite all evidence that it’s a safe place, I have trouble asking for help or admitting to making any kind of mistake, which impedes my ability to work.

The role of trauma and stress in mental illness formation was further explored by psychology professors Bruce J. Ellis and Marco Del Giudice in the 2013 paper “Beyond allostatic load: Rethinking the role of stress in human development.” In it, they argue that the standard idea that the intense stress responses learned in a volatile childhood environment result in toxic and maladaptive behavior patterns in adulthood is too simplified. They explore the idea that what are considered to be “maladaptations” could instead be viewed as differences in skill types—and at times even represent advantages:

“…maltreated children score lower than comparison groups on standard tests of intelligence and executive functions. Yet such children may show enhanced ability to detect, learn, and remember stimuli that are ecologically relevant to them. This includes enhanced perceptual sensitivity to angry facial clues, increased anticipatory monitoring of the environment in the context of interpersonal hostility, greater accuracy in identifying facial expressions of anger based on degraded visual information, greater speed in accurately labeling fearful faces, enhanced recall of distracting aggressive stimuli, and greater accuracy in identifying an adult in a photo line-up with whom they previously had a stressful interaction.”

Sounds like me.

But, of course, not all stress is caused by family. What if all of society is a highly stressful environment for someone? What about, to name just a few groups, black Americans, trans people, and Latinx immigrants? Could they ever be considered “truly” mentally ill while living in a society that openly treats them far worse than my family treated me? If members of various marginalized populations are highly anxious, stressed, suspicious, or even hostile all the time, is that not a normal, adaptive response to the threats they’re under just by existing?

Why I’m Done Being A ‘Good’ Mentally Ill Person

To glean more insight on the matter, I spoke with sociologist Dr. Nancy Heitzeg, author of The School-to-Prison Pipeline: Education, Discipline, and Racialized Double Standards, on how white privilege interacts with the diagnosis of mental illness. In her text, she demonstrates how white people tend to be “medicalized,” or diagnosed with some kind of illness that renders them not responsible for their actions — let us not forget the infamous case of “affluenza” in which a wealthy teen was sentenced to rehab after killing four people on a drunken joy ride — while people of color, particularly black individuals, are “criminalized.”

In the introduction of her book, she says:

“This trend toward criminalization for people of color and medicalization for whites provides the larger socio-political context for the school-to-prison pipeline as youth of color, particularly Black males, are increasingly ‘criminalized’ within the context of schools, while their white counterparts are ‘medicalized’ for the same disruptive behaviors.”

Dr. Heitzeg expanded on this in our conversation, explaining how even when black and other marginalized children are diagnosed with illnesses rather than being immediately funneled into the juvenile justice system, a diagnosis is more likely to function as a stigma than as a way to excuse behavior.

“When you look at black children, there’s a tendency to label them with learning disabilities and behavior disorders or disturbances,” she said. This kind of diagnosis only serves to label them as ‘problem children’ who should be given up on, rather than sick kids who just need some extra help. “The medical model is helpful for some but can be a double whammy for others.”

This further complicates things. If there’s so much bias in how people are diagnosed, how can we know who is ill and who is not? What about the fact that many of the people who do the diagnosing are privileged white people? How much privilege do the people writing the criteria for diagnosis have?

Dr. Heitzeg’s response to that question told me enough: “Don’t get me started.”

If there’s so much bias in how people are diagnosed, how can we know who is ill and who is not?
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It’s not just about race, either. Women, for instance, are often misdiagnosed with personality disorders for being “overdramatic” (thanks to a generous dose of medical misogyny from the historically male-dominated field of psychiatry) and autistic kids are often initially misdiagnosed with mental illness. And it’s important to keep in mind that higher level mental illnesses such as personality disorders and schizophrenia are significantly more stigmatized than my mood disorders.

In the broader social justice community, talk of mental illness still seems to be fairly surface level, rarely taking these many nuances into account. Mental illness is considered to be an axis of oppression, and neurotypicals — people without mental illnesses, autism, or any kind of “intellectual” disability — are the oppressors. But I feel a bit weird talking about “those neurotypicals” because who actually is neurotypical when our system of diagnosing mental illness is so imprecise and so subject to prejudice?

Not only can you not tell if someone has a mental illness by looking at them or how they behave, they themselves may be mentally ill and not know it. And some of us who have been labeled with an illness may in fact not have one, either because we were misdiagnosed for being female and upset, because we’re actually autistic but present differently because we’re not white boys, or even because we’ve fully recovered but can’t shake the stigma.

So is Donald Trump mentally ill? That’s not the conversation we should be having.

We should be talking about his white-supremacist-backed bigot horror machine administration and how his policies threaten the lives and livelihood of millions of people globally. And while we’re at it, we also need to have a deeper conversation about what mental illness is, including how it’s defined, who gets to define it, and how that definition changes with privilege — or a lack thereof. It needs to be a lot more than just “don’t use words like cr*zy” and “don’t compare us to Donald Trump.”

Although seriously, please, stop doing that.

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

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

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

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

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

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

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

Someone like you.

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

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

Replace ‘Crazy’ With The Adjective You Actually Mean

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In other words, no one is really winning.

Being ‘Difficult’ Intersects With Other Axes Of Oppression

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Content warning: suicidal ideation

I have not disappeared, though I wanted to once: I was locked in a room under 24/7 video surveillance with a thin mattress on the floor, eating bland spaghetti with a plastic spoon (though not really eating since I’d stopped that, too) because I kept cutting my wrists with the tines of a fork in the hospital cafeteria; or swallowing fistfuls of pills — Lithium and Ambien and anything else in the medicine cabinet; or eating an apple, and only an apple, a day and then throwing it up; or jumping into a frozen lake — a failed Ophelia.

I kept trying to disappear for good and my doctors kept locking me away. “We need to stop you from killing yourself,” they said, earnestly believing they could help me resurface from Bipolar’s concurrent mania and depression.

I have my hospital records from those years, six inches thick. My attending psychiatrists’ notes are repetitive in their simplicity: “Generally unresponsive. Resists the group therapeutic milieu. Paces the hallway for hours. Counts steps. Rigid focus. Chronic, recurring, persistent. Stabilization unlikely. Husband informed.” I could, in my various doctors’ eyes, read their real diagnostic assessment: “What a waste.” My records, in all the emergency room intakes, include details about me such as, “young, pretty, well-groomed, thin, professor, PhD, published writer.” Details that don’t add up to a patient locked in a safe room banging her head against the cinder block wall in an attempt to stop her brain from hurting so much and all the time.

I have not disappeared, though I wanted to once.
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At the time, I believed the doctors’ assessment because I didn’t know anyone who had survived — much less thrived — in spite of or because of Bipolar Disorder. Then I rediscovered Carrie Fisher. As a kid, I’d idolized her as the fierce Princess Leia, asking my mother to braid and loop my hair around my ears like hers (as I know many, many young girls did), but I grew up and stopped believing in galaxies far far away and instead disappeared inside my own black hole.

Meds didn’t work, but Fisher’s book, Wishful Drinking, did — a gift from a friend while I was an inpatient about to go through my own long bout of electric shock treatment. I read her brave, in-your-face account of her own difficulties with addiction and mania and depression, and her own course of electric shock treatment. She transformed her pain and shame into a generous, funny, self-forgiving story, and lived a large life because she’d managed to turn away from a little death.

Carrie Fisher is why I can write without shame that I have Bipolar Disorder. From 2007–2011, I was hospitalized more than 20 times. Her recovery inspired mine. Since 2011? I no longer drink booze and now eat to sustain my body. I take my prescribed medication (only one now, Lithium, compared to my unstable, acute phase, which had included Lithium, Abilify, Trazadone, Klonopin, Seroquel — all at once — and which at times left me in a deep, drooling fog). I am stable. But I am also stable because I am living a visible life again. Though Carrie Fisher wrote fiction, it is her truth that I follow.

My doctors couldn’t see that what was killing me was not just Bipolar Disorder and my anorexia, but the absence of desire and love in the dumb, dark silence of the underground bunker that was, in part, my unhappy marriage. I was forever wondering if I was good enough, pretty enough, thin enough, smart enough, confident enough, lovable enough for my then-husband. By the end times of our marriage, though still sharing a home and wearing our wedding rings, my husband had already left me for a flesh and blood woman instead of a ghost-wife made of smoke and ash.

My illness, and my suicide attempts — active and passive — offered an escape from myself and from a marriage likely made too young. That I was too young to be tied to a husband — and one who wanted the perfect, pretty me (or that’s what I believed he wanted) — exacerbated the escalation of my Bipolar Disorder. I was 22 when I met my husband, just out of an abusive relationship, and he seemed like the answer to all my pain and loneliness — he saw me, for a few years, as someone who was beautiful and desirable. I felt seen when for so long I had been invisible in that abusive relationship, feigning happiness, despite the degradation and bruises.

Of course, that statement — he saw me — reveals the source of so much of my later pain and need to escape through my own death, the only way I could see out of my bunker. How else could I say, “Cut!” and abandon his script — happy wife, happy life, no strife? How could I have imagined divorce when I was unstable and taking care of two very young children? How could I have imagined our ending as something other than failure and contraction, when, in fact, it might be necessary and expansive?

I relied on my husband to show me myself, rather than holding myself in my own mind’s eye, fixed with intent on a life of my own. Consequently, for years, my inside self, my Bipolar self, was invisible, and my husband was the only one who saw its ravaging effects — cuts on my arms hidden under long sleeves, meals thrown up in the toilet, hours spent ruminating over suicide methods. Carrie Fisher was still Princess Leia and Wishful Drinking was not yet a life-saving gift; I didn’t yet know that stability comes not just from giving up substances and behaviors that kept me sick, but living my truth in the open, sleeves pushed back, and writing my story, too.

I relied on my husband to show me myself, rather than holding myself in my own mind’s eye, fixed with intent on a life of my own.
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Those doctors couldn’t see that what I wanted was a noisy naked life, with my inside self aligned with my outside self. It was impossible for them to see this as I was a shadow on a negative; if you held that negative to the light, you might wonder: Is that her? Likely, you wouldn’t see me at all. Before my last hospitalization, I remember standing in a dressing room trying to find a dress that would fit my body because everything, even the smallest of sizes, was too big. I looked in the mirror, and then quickly away, unable to see myself because what was visible was not a body but a ghost — there was nothing beautiful or desirable left. In the throes of manic depression, I felt a tragic satisfaction: Soon, soon I would disappear.

We wear our wedding ring on our left hand’s fourth finger because the vein, vena amoris, runs from the heart to this finger. But that wedding ring around my finger, beautiful as it was, with a vintage diamond (I picked it out myself), was a cinch cutting off the supply of sustaining blood from the heart. When I finally took off the ring, selling it for so much less than its worth, I understood that its worth depended on its disappearance and my worth was in my reappearance.

The most important romance now? I take me for my beloved in sickness and in health.

When I learned of Carrie Fisher’s death, I mourned my fierce princess but more, the warrior who showed me how to transform invisible pain into visible strength. The etymology of “visible”: “a condition of being seen, conspicuousness.” In an interview with Terry Gross on NPR’s Fresh Air, Fisher said, “I think I do overshare and I sometimes marvel that I do it. In a way, it’s my way of understanding myself. I don’t know, I get it out of my head. It creates community when you can talk about private things.”

I take me for my beloved in sickness and in health.
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Also under “visible”: “range of vision under given condition.” When we tell our true stories, our invisible selves manifest, and vision expands because we are no longer cinched by the conditions of secrecy, shame, and silence. “Visible”: “prominence, fame, public attention.” Carrie Fisher used her celebrity to help me — that woman once locked in the safe room, almost locked away for good in a state institution (truly invisible) — to find my way back into a life of my choosing.

I am here. You can see my shame and beauty, my regrets and joy, my teetering in the dark and exultation in the light. I am visible. My heart is my sleeve. This becoming is an unbecoming: an unraveling into a noisy, honest, authentic, raucous, give-no-fucks, almost-45-year-old, single, stable, sane, sober self. My thumb is on my throbbing pulse, and I am wet with longing. My desire runs wild and it is for myself.

I am here. You can see my shame and beauty, my regrets and joy, my teetering in the dark and exultation in the light. I am visible.
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I sit here, writing this on the cusp of another new year, on the cusp of another chance to love myself with abandon. I am eating an orange split into two halves, one in hand and one in mouth, juices spilling down my chin. This is what I taste like, flesh and blood, sharp and sweet, and I devour each half whole.

In the last couple years, few genres have done more for accurate depictions of mental illness than cartoons. But is it enough to fundamentally shift our collective understanding of depression, anxiety, and other kinds of neurodiversity?

There are two shows currently airing that have been examined many times by the proverbial mind of the internet; they’ve been celebrated for their refreshing takes on mental illness. I speak of course of Netflix’s BoJack Horseman and Adult Swim’s Rick and Morty. Their titular characters (in the case of the latter, Rick) are narcissistic, depressed addicts, and the writers pull no punches in showing them in pretty unforgiving lights.

I love both of these shows. BoJack and Rick Sanchez — for better or for worse — resonate with me at times. The apathetic nihilism they subscribe to, the subtle, but consistent low-key feeling of wanting to die — it all makes me laugh. It’s all hallmarks of my mental illness.

BoJack Horseman (Will Arnett) is an aging former sitcom star living on residuals and bourbon; the show begins after he decides to hire a ghostwriter to publish his memoir. Throughout the three seasons he’s rude and caring in almost equal measure; his vulnerability belies the fact that what appears to be crushing narcissism is actually a deep sense of self-loathing.

This particular paradigm comes to a head in the penultimate episode of the first season, “Downer Ending,” where, after a very bad trip, BoJack seeks out his ghostwriter Diane Nguyen and begs her to validate that he is not messed up beyond repair.

In the last couple years, few genres have done more for accurate depictions of mental illness than cartoons.
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“I know that I can be selfish and narcissistic and self-destructive, but underneath all that, deep down, I’m a good person, and I need you to tell me that I’m good, Diane.” The monologue stretches for more than an easy sitcom beat — awkward and stilted — and Diane doesn’t know how to respond. The show bleakly cuts to the credits before she can say anything.

BoJack even manages to crystallize the idea that things can seem perfect on the outside — a person can have everything technically together — yet depression remains a part of them. There is a particular exchange between BoJack and his friend Mr. Peanutbutter in “Let’s Find Out” that beautifully illustrates this painful conundrum:

Mr. Peanutbutter: Oh, and it doesn’t for you? You’re a millionaire movie star with a girlfriend who loves you, acting in your dream movie. What more do you want? What else could the universe possible owe you?

BoJack: I . . . want . . . to feel good about myself. The way you do. And I don’t know how. I don’t know if I can.

I could list more of the many painfully real and misanthropic things he says over the course of 37 episodes, but I think, in the second season finale, BoJack sums himself up best: “I don’t understand how people . . . live. It’s amazing to me that people wake up every morning and say, ‘Yeah, another day, let’s do it.’ How do people do it? I don’t know how.”

Honest and raw, it distills his overall philosophy down to its purest form, which is that ultimately, he’s not entirely sure that he wants to live.

Meanwhile over in Rick and Morty, Rick Sanchez (played by Justin Roiland), plays a terrible influence of a grandfather; he’s introduced as a careless, alcoholic genius who has just returned to his daughter Beth’s life after a mysterious 20-year absence. At first, he seems just seems like an asshole, nothing deeper to find underneath the booze and the insults he hurls at his own grandchildren. But if you’re like me, and you push people away before they can get close enough to hurt you, that’s already evidence that he’s going to be more complicated than he seems.

For being billed as a comedy, Rick and Morty sneaks up with poignancy when you least expect it.

In the tenth episode, “Ricksy Business,” Beth and her husband Jerry go out of town so Rick and Summer (Morty’s older sister) decide to throw a party. Rick repeats a catchphrase that has been present throughout the season: “Wubba Lubba Dub Dub.” Birdperson, a humanoid bird that’s one of Rick’s only real friends, tells Morty — who’s convinced it’s meaningless because Rick truly doesn’t care about anything — that in his language, it means, “I am in great pain, please help me.”

While there were hints at a more vulnerable side of Rick peppered throughout the season, it’s that finale that finally comes out and says so. After that, no facet of mental illness is too dark for the show to explore.

In the second season premiere “A Rickle in Time,” in order to merge multiple timelines and counter the chaos that’s been created, Rick gives his time-stabilizing collar to Morty, telling him, “be better than me!” while hurling towards nothingness; yes, he ends up fixing his own collar, but the fact that he was so quick to sacrifice himself to the — literal — void says a lot. It shows how much he, perhaps begrudgingly, cares about his grandson. But it also tells us how little he cares about his own life.

Rick may talk a big talk about how he looks out for number one, but, like his plan to save his grandchildren instead of himself, most of the time he’s just aimlessly hurling towards nothingness. He doesn’t necessarily search for ways to die, but he doesn’t not search for ways; his adventures are often life-threatening, and if those don’t kill him, the alcohol probably will. You don’t need to make a plan to die quickly to be suicidal.

“Auto Erotic Assimilation” literally ends with Rick building a machine to kill himself, testing it on an alien, then plugging himself into it, only to sadly collapse and narrowly miss its death rays, as Jerry putzes around the front yard, completely oblivious to Rick. The audience laughs, I imagine, to keep from crying. This small moment is a microcosm of the show: Someone who’s brilliant, but very depressed, thinks that nothing in life matters anymore, and the only thing that saves him is the randomness of his muscle reflexes, while the universe continues to — unfortunately — unfold around him.

I won’t deny that mental illness among men is its own phenomenon, with its own unique stigmas. Mental illness is often not taken as seriously as physical ailments, and men frequently deny mental health problems out of fear of looking weak. Depicting men with depression at all — especially in a way that resonates with actual depressed people — is a huge step forward and not one I consider inconsequential, even more so for Rick who is confirmed as openly pansexual (and therefore, part of a marginalized group that statistically, is more likely to be depressed).

But as a woman who struggles with mental illness, I find myself relating to these men — messy, aloof, rude, and usually drunk — far more than “sad woman” characters who are so debilitated by mental illness they’re unable to accomplish small, daily tasks until one day, they are simply no longer sad.

But that’s not how mental illness works (or at least, not how mine has ever worked). Life is hard with depression, but a lot of us still manage to get out of bed most days. To depict depression as an illness that is always so immobilizing that we cannot function, does nothing to help normalize depression as a thing 350 million people live with. We certainly don’t all experience it the same way, and I would never try to speak for all of us, but I can speak for myself: Rick, BoJack, even another titular narcissist, Sterling Archer — they’ve all helped me come to terms with my own depression and realize that just because I’m not bedridden doesn’t mean I don’t have unchecked mental health problems.

To depict depression as an illness that is always so immobilizing that we cannot function, does nothing to help normalize depression as a thing 350 million people live with.
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I just wish one of them had been a woman.

BoJack’s Diane (Alison Brie) is the closest thing these shows have to a female character consistently living with mental illness, as opposed to suffering a “bout of depression” for the sake of a story arc. BoJack even accuses her of “fetishizing sadness” and she admits in the third season that her friendship with BoJack is toxic for the both of them because of who they are.

But even she is her most relatable — hiding out at BoJack’s in shame, wearing sweatpants, drinking in the morning — for just a few episodes. Meanwhile BoJack is constantly self-medicating and fucking up and just trying to be happy. Of course, the show is called BoJack Horseman, so it is not surprising that he would be the most developed, flawed, and ultimately, nuanced.

But why is the show about BoJack? Why isn’t there Netflix’s Diane Nguyen?

When we finally choose to reconceive of our depictions of mental illness, to write characters that are messed up in the real ways we’re messed up, dealing with life in the real ways we deal, why do they need to be men?

When we finally choose to reconceive of our depictions of mental illness, to write characters that are messed up in the real ways we’re messed up, dealing with life in the real ways we deal, why do they need to be men?
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I will, of course, continue to watch both BoJack and Rick and Morty. Their protagonists flub their way through life in a way I understand and that’s meaningful. But I am still waiting for the show that gives me a depressed addict, a character whose problems cannot be ignored or easily fixed, someone who’s crude and tactless and self-destructive, so unsympathetic that they somehow garner sympathy in spite of themselves — and they also just happen to be a woman.

I grew up against the sprawling backdrop of the cornfields, in a college town 75 miles west of Chicago. Despite my physical disability, my father made sure that I had a normal childhood — the kind that feels like the perfect home movie when you look back years later as an adult. We chased lightning bugs in the summer and sledded down snow hills in the winter.

Life was simple.

And then my father was diagnosed with sinus cancer and died by suicide about a month after finishing treatment. After that, things weren’t so simple anymore.

People talk about all the things that happened before the suicide . . . what led to it, the warning signs, etc. But what about what happens after? The devastation. The people who are left behind to reassemble the shattered pieces of a life they thought they knew. A life they know, down to the very core of their being, will never be the same. Ever again.

How are we supposed to cope? How can survivors even begin to make sense of all the pain and confusion? That gnawing, sinking feeling in your heart? It just won’t go away. Where’s the instruction manual for navigating this dark, unfriendly terrain?

My father’s death wasn’t pretty. His death was ugly, the kind of ugly that makes you just want to run away. It’s the kind of ugly so dark and unimaginable, you never see it coming. The kind that can make you feel like you’ll be lost forever in a sea of grief. It renders you powerless as its tide pulls you out farther and farther, and you begin to wonder if you’ll ever make it back alive.

How are we supposed to cope? How can survivors even begin to make sense of all the pain and confusion? That gnawing, sinking feeling in your heart?
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There were no final days spent sitting by his bedside, where we all were able to say everything we wanted to say to each other. There was no comforting hospice care. Those loose ends left dangling at the end of every life? They weren’t neatly tied up in a pretty box with a bow on top; in fact, many of those loose ends are still dangling more than a decade later, whipping around wildly in the air.

He got to say all his goodbyes in a letter he left us. We didn’t. He got his “closure.” We didn’t. Instead, he left us with open, gaping wounds. People say that with suicide, a letter is helpful. They say that the survivors who get one are lucky, as not everyone leaves their words behind. But my father’s letter just painted a confusing portrait of a man who, it turns out, I didn’t even know — a portrait of a man who wasn’t my father.

His letter left me with more questions than answers, in the end.

More consuming than even my father’s actual death, I’ve come to realize, is processing the way he died. No one wants to feel like their loved one would rather leave than stay; it’s the ultimate heartbreak, the kind that bears down on your shoulders, leaving you unable to breathe. It wasn’t supposed to be like this, he wasn’t supposed to die like that. The superhero doesn’t give up halfway through the movie — he gets up and keeps fighting. Our story, at least the chapters with him, were not supposed to end this way.

Since my father’s death, some friends and family haven’t talked much about him. It’s either because they don’t know what to say, don’t want to upset us, or, perhaps, it’s just too painful for them. But this denial, their failure to speak of him, is something I struggle to accept. How can someone be such an important part of your life and then just vanish from it? People act like my father never existed at all. Sometimes I just want to scream, “CAN’T YOU SEE IT?? HE’S STILL HERE!”

And he is here — in everything I do, in all my little quirks that remind me of him, in my red hair that he passed down to me.

More consuming than even my father’s actual death, I’ve come to realize, is processing the way he died.
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Memories are my way of keeping my father alive. They make the past feel within reach again, a necessary comfort when you feel like your life now and your life with your loved one are two completely separate existences.

The word “suicide” is like a black hole of sorts. It’s expansive, never-ending, and dark; no matter how much you talk about it, there’s always more to say. Always. I wish I could say that I know no one can relate, but unfortunately, I know far too many of you can. Suicide is the tenth leading cause of death in the United States. We are, in fact, in the middle of an epidemic, with suicide rates at a 30-year high.

So I know that many of you are grappling with what to say, trying to find the words to comfort a family member, a friend — possibly even yourself. It’s been 13 years since my father’s suicide, and I still fumble, every single day, to find the right words. So today, I will write them. Not just for my father. But for me and for you — and for the millions who live with the effect of suicide every day.

Suicide changes you forever.

The idea that a loved one died so unexpectedly and so violently shakes you to the very core of your being, and as much as you may wish to deny it, you’ll never be the same person ever again. I never really understood this until I grieved my father. Slowly, however, I realized that not only was I grieving my father’s death, but I was also grieving the loss of my “old life.”

I think, in the end, the real journey I’m on is learning to say goodbye to my old life, not just learning how to say goodbye to my father. It’s important to remember that sometimes, I — you, we — need to try saying hello to our new lives, if just to see how it feels.

And please, please continue to talk about your loved one. Whether you’re angry or sad or reminiscing about happier times, it’s important to keep your loved one with you. Keeping quiet is akin to letting the suicide win. Don’t let it. You owe it to your loved one — and most importantly, you owe it to yourself.

For the group of us who knows so intimately that life will never be the same, my heart is with you.