I am a therapist, but I am not your therapist. Therapy, in my opinion, is not just about the information I give, but also about the highly individualized relationship I build with each client, getting to know their unique needs, strengths, and challenges. This column is not meant to substitute individual therapy. When in doubt, speak to a therapist about these issues — preferably someone who knows you, who you feel safe with, and who is equipped to support you exactly as you are.
** All of the questions I received were complex, and profoundly honest. Thank you for your submissions. The questions answered in this month’s column were edited for length and privacy, while attempting to preserve the original question.
Dear Feminist Therapist,
Since I was raped, I’ve found it really hard to be around lots of people. I’ve been staying home more, prefer to be on my own, and find it difficult to interact with people in the way I used to — being at home or on my own has also felt a lot safer. This has been really frustrating for a few reasons. First, I wasn’t raped in a public place so it feels like my anxiety doesn’t make any sense. Second, people in my social circles haven’t been able to understand this, and don’t understand why I’m not coming out as much as I used to. I know they’re trying to be supportive, but it has made me feel pressured — like they just don’t understand me. I can’t figure out what to do about all this. Am I letting the anxiety control my life? Are my friends right? Am I actually taking care of myself?
– A
Dear A,
I’m so glad you wrote in — I am really impressed by your question, and think a lot of people wonder about whether their coping behaviors are perpetuating their problems or helping to resolve them. It is very normal for there to be anxiety after having been through a trauma. Up until the most recent version of the DSM came out, PTSD was classified as an anxiety disorder because of the way that it presents itself. It is important to understand that part of having trauma (and PTSD in particular) is that avoidance or withdrawal is a key symptom. On the other hand, when we’ve been hurt, it is very important that we be able to protect ourselves and take time to heal. Two key components of what defines trauma is that it makes us feel overwhelmed and powerless — taking care of yourself or getting out of overwhelming social situations can make us feel less overwhelmed and more in control, effectively giving us a temporary emotional antidote to the trauma.
Removing ourselves from situations that cause us anxiety can be a function of the anxiety (withdrawal and avoidance) that actually fuels it by making certain parts of our brain/body believe we cannot handle the stressful situation and that the only way to feel better is to avoid it. But removing ourselves from overwhelming situations that prevent us from healing can also be exactly what we need. It’s a delicate balance, and one that I recommend talking to a therapist about so that you don’t have the make choices alone and can discern the confusing difference between avoidance and self care.
The other piece that you’re mentioning is that people don’t often understand how trauma works, how it affects us, and what we might need to heal. If you have people that you feel close to and comfortable with, you could try connecting and spending some time together — if it feels safe, tell them you’re struggling, and that things that used to be easy feel difficult and painful now. People generally respond well when provided with suggestions about practical ways they can help. Maybe it would help them to know that you still want to be invited out to events, but you don’t want to feel pressured to attend. Or, you could tell them that right now, hanging out one-on-one is a better way to spend time together.
The sociocultural pieces here are obvious: we exist in a culture that breeds trauma (particularly sexual trauma for girls and women) but currently we don’t have an adequate sociocultural narrative that provides support for the people who are most hurt. Women, often on the receiving end of relational or sexual trauma, commonly find their ways of coping are silenced, pathologized, or dismissed. Even in their efforts to heal or get their psychosocial needs met, women are often hurt again by a society that perpetuates trauma and abuse and doesn’t know how to help people heal.
Thank you for asking your question. I have hope that just in asking this question, someone might learn how to better support people in their lives who have stories like yours.
~~~
Dear Feminist Therapist,
I have never been to see a therapist (I’m not sure if I’m ready for that yet), but I read lots of books about mental health. The term “self-care” comes up a lot, and I’m not sure why, but I feel uncomfortable with it. At the same time, I’m intrigued. Basically, I have a reaction to something I know nothing about. A lot of people seem to have this kind of reaction, and I tend to think that uncomfortable feeling is there for a reason. I’d like to hear your take on what “self-care” is and why I might feel uncomfortable with the term. Thanks.
– D
Dear D,
Whether or not you are aware, your questions are politically loaded. I’m delighted by your awareness of your own discomfort and your willingness to examine what that it might reveal.
First, “self-care,” as a construct, denotes the behaviors, thoughts, and feelings associated with caring for ourselves. That can mean all sorts of things — caring for one person might look different than how another person cares for herself. We all need different kinds of care, but we all need care.
I believe that, in patriarchal societies, women are socialized to disappear. For a long time — and even still — the idea that we as women can “take up space” has been particularly unpopular. Women, historically, have provided most of the relational care for members of their families and communities — often this has come at a cost to themselves. It’s not surprising, then, that women struggle with self-care for a variety of reasons. For some of us, taking good care of others and not asking for anything in return, even from ourselves, has been like a badge of honor: we take pride in not needing care. For others, our difficulty accepting care (from others or ourselves) reflects a deeply held belief (shaped by our interpersonal relationships and sociocultural context) that we are not worth caring for. Whatever the reason, difficulty or discomfort around self-care tells us something about who we are as a “self” and what we believe we need, don’t need, deserve, or don’t deserve.
It’s worth noting that the construct of “self” varies from culture to culture, so what we believe about self-ness in Western cultures is typically more individuated than other cultures that see the self as a reflection of community relationships (“who I am is who we are.”) These cultures see caring for others as a way of knowing who/what the self is. So your reaction could be a rejection of our narrow definition of self, and the fragmented nature of our very individual and disconnected lives.
As a therapist, it’s been helpful for me to understand self-care in my work. All day, I care for others and notice that when I have not taken time to care for myself, I get depleted, frustrated, impatient, and hopeless in my work. A useful metaphor (although imperfect) is of oxygen masks on airplanes: flight attendants always remind us to put our mask on first, before we help another person with their mask. The more intense the work I do, the more I need to make sure my “oxygen mask” is on before I help others put theirs on.
Self-care is different for everyone, but does not have to be extravagant, expensive, time-consuming, or creative. It can be as simple as doing something you normally do (like having a bath) but with the added intention of being caring and kind to yourself. Sometimes the best self-care is when we take time to slow down and breathe for a few moments before and after a difficult meeting, stretch before bed, go for a walk when feeling stressed, or schedule a fun activity after a demanding week. Try doing an activity of your choosing with the intention of being caring for yourself, and see how it feels. Perhaps the feeling you will have will clarify the source of your discomfort, or eradicate it all together.
~~~
Dear Feminist Therapist,
I’ve recently been diagnosed with borderline personality disorder and I have a history of depression. I feel good knowing that what I’m going through has a name, but also really conflicted about how the system of diagnosis pathologizes the female experience. I’m angry that something as big as my experience of being alive can be narrowed down to a few words — a box, if you will. But I’m also so glad that I’m not the first person to feel life is always so hard. I’m struggling with the idea of having a diagnosis, and would love your thoughts on that.
– G
Dear G,
I hear so much of myself in your story. These are complex things you are wrestling with: some existential, some political, some just very human. I believe that we all want to be understood and feel like our experience of pain makes sense to someone. Our systems of diagnosis, and how people often respond to those specific disorders, can be incredibly dehumanizing and objectifying. As discussed in the question above, our culture often pathologizes people’s normative reactions to experiences that the culture is responsible for shaping. This can leave people feeling like they are the “sick” ones, when actually they are responding appropriately to the traumas, stressors, isolation, and sadness of living in this culture. (I often wish there were ways to diagnose cultures!)
Although you may already know this, our understanding of what a mental illness is and the criteria that shape a diagnosis are all constructs shaped by sociopolitical forces. For this reason, I don’t always find it helpful to use diagnoses (or provide them for clients) unless it actually benefits them in some way (getting funding, support, normalizing their experience, etc.). Rather, I choose to see the person first, the story of her life, and how she has responded to, and coped with, suffering and distress. Sometimes it can be useful to look at how one’s coping and response is causing her more suffering and draw on empirical evidence to understand what are the most ethical and effective ways to help her make the changes she wants to make in her life. And, like I said, if having a diagnosis (a fancy way to group clusters of symptoms/specific responses/coping behaviors) actually helps a person, then it may be appropriate to do so. But only in a way that helps to humanize and heal the person, not limit, objectify, label, or shame them.
I must confess that I find it difficult to work within a system and use language that I believe is often harmful. It presents ongoing moral and ethical dilemmas, requiring constant assessment in order to figure out whether what is being done is actually helpful. While you may have been given these “labels,” you can choose to reject them as definitive descriptions of the complexity of who you are. Instead, you have the option to use them only when it is helpful and healing for you, like when exploring treatment options with care providers or informing loved ones about what you may need from them.
I like the idea of person-first language as it reminds us that we are people, not just clusters of symptoms. For example, instead of saying “the schizophrenic over there,” we might say “That’s Joan”, and then later, if appropriate, “Joan has been diagnosed as having Schizophrenia.” It may be helpful for you to apply the example of “person-first language” to yourself, reminding yourself that you are a whole person and that the diagnosis, although political, is just a way for a very small sliver of people to better understand how to help you. That said, we need to continue to challenge normative reactions to sociopolitically charged stressors, while also making it safe for people to talk about their stories and pain in ways that help us understand them. We must, as a feminist community, continue to look at how women’s experiences of oppression are marginalized or dismissed, and contribute to a cycle of silence and further oppression.
You can send your questions for Hillary, our Feminist Therapist, to [email protected] or [email protected] with the subject: “Feminist Therapy,” or tweet her @hillarylmcbride using the hashtag, #feministtherapy. (We will anonymize your questions, unless you specifically ask us to include your name.)