Guest Blog

The Negative Voice in My Head: Guest Blog by Carly C.

Occasionally when I’m writing, I run into a mental roadblock. It starts innocently enough: what’s the point here, why am I writing this, what do I want the reader to gain from this? This is common for writers or creators of any type, and it’s healthy. It helps us stay relevant.

But I’m also a master of finding the unhealthy. This line of thought frequently warps in my mind, becoming: why am I trying, this is crap, I am crap (except worse because I can’t be flushed down a toilet), no one wants to read this, none of this is important, I have nothing important to say, it would be offensive to ask someone to read this because I am not worth any amount of time from anyone, I am worthless.

Besides being a writer, I’m the worlds foremost expert on precisely just how much I suck. I compare my work to the work of others in unforgiving death matches that lead to me lying on the couch staring into space trying to justify to myself why I should continue living. I don’t know why I go through this, or why I can’t stop it, but it’s a something I deal with daily. I compulsively read CVs and Wikipedia articles and interviews with writers and creators that I love, trying to figure out the formula to their success—of course, I do this instead of writing.

They always have interesting lives. They’re high achievers, they overcame steep obstacles, they have some interesting life quality that gives them the perspective they’re famous for. I don’t see this in myself. My life’s not interesting, I live it and I’m bored with it, so I must not be important or interesting in any way. Pretty much everyone’s life can be interesting when distilled to a CV, or a Wikipedia page, or an interview. But mine wouldn’t be, even if I were important or interesting enough to have a Wikipedia page. I’m a piece of garbage and no one cares about me.

This voice in my head breaks down under scrutiny. For starters, it’s only triggered when I try to write, which is something I care about more than anything in the world. I’ve never contemplated suicide after over-cooking my spaghetti noodles so I know I have an off-switch somewhere. It’s also very easy to argue with: am I really producing crap? Probably not, and it’s disingenuous to compare my tweets to King Lear. Am I really a piece of garbage? I mean, I guess I might have value as a person that isn’t dependent on my writing. Am I really a failure? No, not really. Most of the time, I’m so afraid to fail I stop myself from even trying.

Despite knowing the counterarguments, on some level I still believe the things my inner voice tells me about myself. If the key to succeeding as a writer is working hard and being fearless, it feels more comfortable to have control over my own failure than leave it up to chance. So I’ll verbally abuse myself into stagnation before I allow myself to earnestly try. Every success is cast off as chance and every failure, no matter how small or imagined, is held up as the emblem of Truth. My own mind is the biggest obstacle to me. Even now, I’m fighting the urge to throw my computer into the path of an oncoming train rather than finish writing this essay. Every word is a grapple with my emotional center, which is setting off fireworks inside my head and screaming no one cares, stop writing, don’t even try because no one cares, you will never be successful at anything because you’re not worth it. Self-doubt is a self-fulfilling prophecy.

In dark moments with thoughts like these, when the voice wins and I stop writing and curl into a ball on my couch, sobbing at the injustice of my own self-hatred, I wonder if my heroes ever felt this way. I wonder if Shakespeare contemplated killing himself because he thought Macbeth was just that offensively bad, how many times F. Scott Fitzgerald burned manuscripts of The Great Gatsby and vowed to never write again, or if Lin-Manuel Miranda ever looked up from his computer while writing Hamilton and asked himself why he was even trying. I don’t know the answer, but somehow my heroes were able to overcome and if I really want to be like them I suppose I’ll have to find a way also.


Carly is a writer from Indiana. You can follow her on Twitter @neutronsoup


I Can’t Stand Up To My Sexually Abusive Dad & I’m 29: Nikki’s Story

I think most people are aware of or can imagine, how awful it is to experience abuse. For me and a lot of survivors that’s just the beginning of a long, isolating, painful journey. My dad started sexually abusing me around 10, I’m 29 now. I was a pretty quiet, shy, nervous kid naturally but that became debilitating once the abuse started. I was sure my mom was going to blame me and I would be in trouble if I told her what my dad was doing. I was the type of kid that hated getting in trouble so I usually followed the rules. 

My mom was extremely critical and judgmental. A lot of mundane problems were a lose-lose situation for me. I felt like I had to hide everything from her. Confiding in her either meant she’d brush it off, “your too young to be stressed”, or telling the extended family that came over for lunch, and having a good laugh. Even something as human as covering my face when I cried, got ridiculed. 

Whenever someone asks “when did the abuse stop?”, I can’t really answer that question. I feel so frustrated and ashamed that I don’t have the right answer. There’s hasn’t been a defining moment where I stood up to my dad or told my mom. To me it feels like it hasn’t stopped.

The circumstances are different and the abuse has evolved but I can’t seem to stop it. My dad is still inappropriate whenever he gets a moment alone with me and even if he isn’t it’s always in the back of my mind. I feel completely responsible for how many years this has happened. If I had told my dad “no” whenever he asked if I was ok with what happened. Or confided in my mom it could have stopped a lot sooner. I let it go on and still do. I feel like a traitor and so pathetic by being in therapy or sharing my story when I do nothing to keep it from happening again. 

I’ve told myself I didn’t speak up as a kid because my dad would go to jail, ruining their marriage and leaving my siblings without a dad. That’s easier than admitting I was too scared and powerless to say anything. There’s so many “what ifs” that keep me quiet today. What if no one believes me or thinks it wasn’t inappropriate and I’m just exaggerating and need to get over it. Or worse what if they do believe me and it tears apart my whole family. 

I’m not really sure where I go from here or what path I’ll end up taking. I wanted to end this on an uplifting, positive note about my story but it’s still unfolding. For now it’s just one day at a time. 


Inside the Mind of a 27 year-old with BiPolar II by Hannah Blum

 You are coasting along a straight path, then you struggle to get up that hill. The pain is almost a high. In a moment you have no energy, another too much. You feel like you are about to break, but you don’t stop, you know you have to keep running…

There are nights that turn into dawn in what seems like an instant. From reorganizing my closet to writing in my journal for hours, there are moments your mind is running so fast it is almost painful. You close your eyes, but your eyelids jolt, begging you to open.

So what do I do… 

Learning to harness my thoughts hours before sleep and avoiding stimulation. It works. It fails. A few solid nights of sleep is better than none.

Never content.

If God had bipolar, He would not have created the Earth in seven days. He would still be in the creative process. The day I graduated from the college, all I could think was “You can do better! You have to do more, Hannah!” Nothing is ever good enough, and relaxing while patting yourself on the back is nearly impossible. Being content in my mind is one step from slipping off the balance beam.

So what do I do… 

I breathe more often, and I breathe deeper. I have added exercise of mind and body like yoga.

Emotions run deep.

I hear a song and feel the pain inside the singer’s voice. I smell a flower and can feel its growth. I am sensitive to other people’s pain and hurt, to the point it keeps me up for nights. Sometimes I wake up in the middle of the night crying so hard I cannot breathe. I laugh as hard as I cry, I hurt as hard as I love.

So what do I do… 

I turn my pain into art by writing, drawing and creating to express these emotions.  Exercise gives me a healthy release.

Treading Water.

Every day my eyes open, and I have to tell myself to do everything I can to keep my head above water. I am one slip from falling to the bottom on a daily basis. Some days are harder than others, but I refuse to drown.

So what do I do… 

I keep moving forward. I keep active. I do not talk about my “struggle” often. I volunteer to help others outside of myself.

The lows are beyond explanation.

You are screaming at the top of your lungs but no one can hear you. It is not a headache, it is a cloud in your head that makes it almost impossible to see. You have no energy to speak. You are empty. You are numb. The light at the end of the tunnel seems so far.

So what do I do… 

Again, I turn these moments into some form of art. I set a goal for myself every day, and hold myself to it. I remind myself that tomorrow is a brand new day.

a self-portrait of the author with the words: Broken Mirror

The picture above is a picture from my journal days before I was hospitalized in 2010.  I have never shared it with anyone until now. Sending love to all my mental health warriors. You are bold. You are brave. You are brilliant. 

Follow this journey on Halfway 2 Hannah

This piece was published as a collaboration with The Mighty

We want to hear your story. Become a Mighty contributor here.


What Not To Say to Someone Who Has Depression: A Guest Blog by Dr. Susan J. Noonan


I was recently asked by a journalist what I would recommend “never” to say to someone who has depression. That’s a very good question. In my recent book When Someone You Know Has Depression: Words to say and things to do (2016), I focus mainly on the positives. By that I mean statements that are encouraging and received well by a person in the midst of a mood disorder. Today I will turn things around and give you some examples of what doesn’t work, and why.


There are about three dozen negative comments I can think of off the top of my head, and they fall into several categories. Most family members and close friends mean well and are trying their best. It’s hard to stay positive when you are fatigued, stressed, or frustrated in dealing with the illness, but you want to avoid accidentally saying these things or blurt out snap clichés. They are not helpful to the person and often times make things worse by breaking down the trust and communication you are trying to build.


The first is to avoid saying anything that is dismissive or invalidating. Your family member who has depression has a right to his or her feelings and thoughts, even if you don’t agree with the content. When you recognize and disagree with the person’s impaired thinking, negative or distorted thoughts, don’t tell him how to think and feel. Gently show him that the errors in his logic are inconsistent with his life experiences. Instead of saying “No you don’t’”, or “How could you possibly think…” in response to something he says, it would be preferable to respond with “I hear you feel you’re ___. That must feel awful. Where do you think that comes from? What about the time___?” and offer some concrete evidence in his life that counteracts his statement.


Invalidating statements are things like “There are people worse off than you,” or “It’s all in your head.” This disregards her symptoms as being valid and imposes guilt upon the person for having them. It ignores the fact that 41,000 people who have depression died by suicide in the United States in 2015. Minimizing her thoughts and feelings by saying something like “Oh, everybody has a bad day” or “I was depressed for 3 days once” is another way of sending the message that her situation is not serious and legitimate. Another, “Don’t be so depressed,” “You have it so good – why can’t you just be happy?” or “Snap out of it” gives the message that he or she could just “will away” the illness, and dismisses it as the biologically based medical condition of the mind and body that it is.


Another category to avoid are statements that are judgmental, blaming or critical. These are comments such as “It’s your own fault,” “You’re just looking for attention,” “You need to get a job [or hobby, boyfriend, volunteer].” Or “You should get off those pills and stop seeing that quack doctor,” and “You should go to church and pray.” Try not to impose your personal opinion on your family member’s life and decisions during an episode of depression.


It is also not helpful for you to make assumptions or jump to conclusions about the person who has depression, how or what he feels or thinks, especially without the full facts. This is definitely not helpful and can ruin your relationship with him or her. One example is “You must have your period,” or “It’s PMS.” The comment “Just try a little harder” assumes that the person is not making an effort, which is also judgmental, critical and dismissive.


Here are a few additional comments in the “DON’T DO” list that you would do well to avoid.


  • Stop feeling sorry for yourself
  • Pull yourself together
  • Get your act together
  • Lighten up
  • Have you tried herbal tea? [or vitamins]
  • Just don’t think about it
  • Quit whining
  • But you look so happy all the time
  • This too will pass

And top on my list of personal disliked comments, merely saying…

“Hang in there!”

Susan J. Noonan MD, MPH is a physician and certified peer specialist, author of two books and blogs on managing depression for her own website, Psychology Today and The Huffington Post, and a patient with firsthand experience in mood disorders. Her recent book, When Someone You Know Has Depression: Words to say and things to do (JHUP 2016), is a companion to Managing Your Depression: What you can do to feel better (JHUP 2013). She can be reached at






A Letter To Her Suicidal 16 Year-Old Self: Guest Blog by Katie Hirshberg

A Letter To My 16 Year Old Self

In four months I will be 20 years old. Two decades.

This is an important year for me. Four years ago, I couldn’t see myself where I am today. Four years ago I didn’t have much hope.

My 16 year old self almost didn’t make it.

I wrote this letter for her. It’s extremely personal.

I like to think she’d be proud of the person she grew up to be.

Dear 16 year old Katie,

You’re in your junior year of high school and it’s proving to be just as difficult as people told you it would be.

For you specifically though, this year comes with a unique set of challenges.

This year you have developed depression only you don’t know that it’s depression you just think you’re a failure. You’re sad. You sleep a lot. You don’t eat enough. You hate yourself.

It’s hard. Actually hard is an understatement. There isn’t really a word that describes what you’re going through accurately. It feels as though life is a mountain that you’re trying to climb with flip-flops on. You can’t get very far.

In the middle of the night one Sunday in April you will wake up and write a suicide note. You won’t end up going through with it. But you keep it on your laptop and read it every single day for a week. You will lock yourself in the bathroom one afternoon, bottle of pills in hand clutching your laptop reading the letter to your parents over and over. You think you might do it. But your mom comes home, knocks on the door, and makes you realize that she will lose everything if she loses you.

That night you tell your parents you want to go to therapy. You make a silent vow to yourself to make it to your 20th birthday. If you can just make it to 20, maybe things will be better. It’s only 4 years away; but it feels like a lifetime because every single day is a battle.

You go to therapy. You start to get better. You stop wanting to die. But, you still don’t really want to live either.

I’m writing this to you, my 16 year old self, who is caught somewhere between life and death, who hates herself, who is looking for love in all the wrong places, who doesn’t see a happy ending. Who doesn’t believe she will go to college. Who doesn’t think she has a future. Who thinks that when she does make it to 20 life will still be just as hard. Who thinks that her life will be cut short after only 2 decades on Earth.

I’m writing this to you now, 4 months before my 20th birthday.

16 year old Katie, I wish I could actually send this letter. I wish that there were a way for you to know that it will all be worth it.

I want you to know that, as cliche as it sounds, it does get better. As I write this I am sitting in my apartment in college over 300 miles away from home. I am happy. I am not just existing, I am alive.

When I celebrate my 20th birthday in four months, I won’t just be celebrating another year of life. I will be celebrating for my 16 year old self. I will be celebrating her choice to stay alive despite the weight of her pain. I will be celebrating the fact that I am still here, and that I want to be here.

16 year old Katie, I know that you are unhappy. But this unhappiness will be short-lived in the grand scheme of things. You will get through it. You will learn self-love. You will learn self-acceptance. You’ll learn to live.

It will all be worth it. And I am proud of you.


Your 19 year old self.

P.S – Surprise! You’re bi.

To read more of Katie’s blogs go to

Follow her on Twitter @Rosearium



Losing a Parent When You’re Four: A Guest Blog by Cassie Heath

Losing a Parent When You’re Four

When I was nine years-old I was rummaging through a clothing rack at Kohl’s  I came across a T-shirt that read “Daddy’s Girl”.  My throat burned.  I began to sob in the middle of Kohl’s. My mother frantically ran over to see why. I pointed to the shirt and in between breaths muttered, “I’ll never be a ‘Daddy’s Girl’.”

Five years earlier, on May 29, 2004, my father began to have what would be his worst and last asthma attack. My mother had to hurriedly take control; she gathered me and my younger brother into the backseat, and helped my struggling father in the passenger seat of our Lincoln.

Just keep him breathing. We’ll make it there soon.

We sped to the hospital, but not in time for his weak lungs. He was so tired, so feeble; the asthma attack was so great that he went into heart failure. My mother swerved the car and everything seemed to go in slow motion and white noise, like in those dramatic war scenes in action movies.  To this day I have never heard a scream with the kind of pain my mom had in her voice.

She gave him mouth to mouth; she yelled for help. The ambulance was called, and a nearby woman who came to support me and my brother told us to be strong, like Spiderman. She gave us Sprite.  Since then I’ve never liked Sprite very much.

The ambulance soon arrived, and the police drove us to the hospital. I remember being surrounded by a lot of family, and walking around outside with my aunt. She bought me an ice cream sandwich– I wasn’t able to eat one again for ten years. When returning inside, I pleaded with my mother to let me talk to him. She tried explaining to me that he wouldn’t be able to speak to me or hear me. I was so confused and hurt.

At the funeral he looked so perfect and porcelain; and then he was gone.

I am now seventeen and have relived his death every single day.  It will probably never leave my head. It plays repeatedly like a record. Some days, I can keep it to background noise, but on others it takes center stage and I have no choice but to surrender to it.  Since that day I have battled feelings of worthlessness and abandonment, depression, anxiety, and many others. I’ve been left with a barren emptiness in the pit of my soul.  Half of me feels gone. There’s no replacing that. No matter how hard I try.

Is there a happy ending, or a light at the end of the tunnel? I don’t know. I’ve cycled through the five stages of grief, even after twelve years, and I probably will for the rest of my life. Was there some greater purpose in my enduring this cruel experience? I don’t know. I’ve always told myself that I’ll somehow use my experience to help other people, but I guess I won’t know until my purpose greets me. If I am sure of anything, it is that my father would want me to utilize my potential, do great things, and attempt to heal my soul. With that, I just have to devote myself to becoming a stronger version of me, one step at a time.

Twitter- @cassieheath


When A Shopping Addiction Isn’t Funny: Guest Blog by Kaitlin Bentley

Most people know the difference between “wants” and “needs.” I am not one of those people. My room is littered with the remnants of shopping binges; boxes of makeup and skincare collecting dust, books sitting unread for months, hobbies I grew tired of before I even emptied the bag. I’ve formulated strategies over the years to curtail my spending, ultimately failing as I justify a purchase out of my own personal budget, or worse, taking my mother’s credit and debit cards to get that one last fix…that one purchase that would somehow magically change my life once and for all.

Our society often writes off compulsive spending as “retail therapy” and to a certain extent I have used shopping as therapy. Every rejection I’ve ever felt has resulted in a trip to the mall or being up all night obsessing over whether or not to hit “submit” on an order for makeup at Sephora. Positive events in my life have also involved shopping, surely I needed a new outfit for the baptism of a friend’s new child when my closet was already full of dresses and I have Rubbermaid bins full of barely worn clothes in my room. Whatever is going on in my life can be justified with sacks of new items.

I graduated high school in June of 2006 after years of outpatient and inpatient treatments for depression, anxiety and (at the time) suspected bipolar disorder. Senior year was a particularly bright one for me, getting a jump-start on my college experience taking Psychology 101 after school twice a week finishing the course with an A. College was the first time in my life I was able to meet a diverse group of friends whom had the same interests as me, I was no longer the loner I was in high school but I still felt a driving need to keep up a certain image I had spent years cultivating for myself.

Barely an adult, the credit cards started rolling in. This was a couple years before you needed a cosigner if you were under 21, and I was the prime target. The first card I got was a Visa Capital One with the famous Van Gogh painting of The Starry Night as the background (I’m sure this is what he intended his most famous work to be used for). I ran my fingers over the numbers, examining every minute detail eventually flipping it over and signing my name with swift precision.

My friends and I would make the half-hour trek from our rural NJ town to the closest mall sometimes multiple times a week. I did not start driving until I was 21 so I would buy things for them on my card as my way of thanking them. Before long, I was in over my head hitting my $700 limit in a matter of weeks trying to figure out how to pay it off on $7.50 an hour about 15 hours a week at a local grocery store. I was repeatedly threatened with lawsuits and non-stop phone calls to my home. I cried to my mother who reluctantly gave in and helped me dig myself out of the hole I’d gotten myself into, she herself no stranger to thousands in credit card debts.

As my credit rating was plummeting, I still continued to find ways to shop with whatever money I had from my meager paycheck. My mother would hand over her Penny’s or Victoria’s Secret card trusting me with a limit she’d give me…I rarely ever kept that promise and went over countless times. If I wasn’t at school, work, or a concert I was shopping. If I wasn’t shopping, I was thinking about shopping. This was when I started losing touch with many friends. All the time I’d spent trying to perfect this image I had crafted for myself, I barely noticed when my phone stopped ringing(if the phone company hadn’t turned it off from lack of payment). The more estranged from people I became, the more I used shopping to soothe my loneliness. I never had any money to do anything other than shop. My parents were fed up, I later told my mom “nobody could hate me as much as I hate myself” after an evening of screaming about my running tally of debts with my parents.

I dropped out of school in 2009 shortly after getting a job working at a treatment facility for emotionally troubled teens. I figured this would be a great place for me to get started in the field I wanted to eventually go into while I “got my shit together.” By this time, I’d gotten most of my bills under control and I was making decent money for a millennial still living at home with no car payments or any real responsibilities. As you may have guessed, I still continued to spend money and now I had even more to spread around. My shopping habits became a running joke amongst my coworkers. I’d work an overnight shift and drive straight to Marshall’s when I clocked out waiting in my car for them to open while I ate a fast food breakfast. I’d go to the mall and return to work at closing time. I was growing more depressed and irritable, calling out of work sometimes multiple times a month because I was so exhausted. I recall my mother pointing out on one of our rare shopping trips together that my pupils were dilated. I wasn’t tripping on heroin or drinking excessively but I was experiencing the same high. How could something so wholesome become so damaging? Why was I only happy with “things?” I’ve cried myself to sleep many times over the years with these questions floating around in my head.

My family life really started to unravel at the end of 2011 when my mom moved out with my brother and sister citing my outbursts as part of the reason. My brother was 17 and still in high school; having his own emotional meltdowns, DYFS was keeping a close watch on my family…an experience almost mirroring my own in high school. During this time, I lived with just my father. My dad rarely ever came upstairs, even when my mother still lived in the house he was always in his little office on his computer or watching a movie. I never had the greatest relationship with him and frankly, I was always kind of scared of him. He had a temper and was always making degrading comments about my weight. My mother was always my protector and she was gone. It was only second nature for me to keep on shopping at this point and at a more ferocious pace, unless I wanted to interact with dad.

It didn’t dawn on me that something was amiss with my father until I came home from one of my sprees one day to find the entire upstairs of the house engulfed in smoke from an empty pan sitting on the stove set to high, with a spatula melted to it. After I aired out the kitchen, I ran downstairs yelling to my dad about his absent mindedness. He acted like it was the most natural thing to do; almost burn down your house in pursuit of a grilled cheese sandwich. He just stared at me doe-eyed. Eventually after 25 years working for Verizon my father just stopped going to work, he didn’t have an answer for me. My sister and I thought he was going through a very serious clinical depression but he continued to decline in cognitive functions. My mother moved back into the house after about a year in her apartment across town to further focus on my dad’s medical treatment which would yield nothing until the spring of 2013 when he would finally be diagnosed with early onset dementia and was whisked off to a nursing home Medicaid would cover the cost of. The next time I saw him would be the photo my mom took of him moments after he left this life.

In this time span my anger towards my parents, particularly my mother, was at a boiling point. I know she happened to have a lot of guilt during the time she was gone, giving us all new cell phones and hundreds of dollars to go to the county fair, getting me my precious Lola-a Papillion puppy when I mentioned my desire for another dog. I’d grown to see possessions as a distorted display of love. I left my job of five years in the summer of 2013 and would go for almost two years searching for something new. Mom and I often took our stress out on each other. She’d scream at me about not looking hard enough for a job, I’d scream back. I couldn’t cope so naturally I began to shop again, except this time it wasn’t with my own money. I started swiping mom’s credit and debit cards to buy things online that I knew she’d never let me get if I just asked (this was where the anger comes into play). She threatened to press charges so many times I’ve lost count and I often wonder if it would have been in my best interest to go to jail. In one of my many meltdowns after getting caught I sincerely meant it when I said I deserved to go to jail. I realize that my mom loves me too much to have followed through which makes the guilt of everything I’ve ever put her through feel so much more painful.

I wish I could end this post with some big cliché triumph where I lay out some big life changing plan that worked for me to overcome my shopping “sickness.” The truth is there isn’t much literature about Compulsive Spending (or Oniomania if you want to get fancy) that I’ve found in my independent research over the years. In doing some research for this blog I found a couple of posts with titles like, “How to know if you have a Shopping Problem” and, of course, a Wikipedia page that I’m a little skeptical about. I went as far to even google: “CDC Shopping Addiction” it seems like something the CDC would at LEAST write a little blurb about in our consumer-driven culture, but what do I know?

The problem with an addiction to shopping is everybody has to (eventually) go shopping for something whether it be new socks or a toaster. My temptation to shop can be even higher at times because I now work part-time at a clothing store in the same mall I spent most of my twenties in. I don’t think I’ll ever be “cured” but through my work with my nurse practitioner and new therapist I’ve become more self-aware of my triggers. Earlier this year I was diagnosed officially with bipolar disorder and I feel good on the current medley of medications I am taking. My anger and subsequent spending with it have declined quite a bit and I don’t feel this constant cloud of “numb” shrouding me. I am working on some DBT exercises with my therapist-she wants me to join a group but I’m not there yet, it makes me too anxious.

When I first emailed Paul about my story I honestly never thought he’d reply to me let alone ask if I would want to do a guest blog, I had my reservations. What would my extended family think? My friends? Strangers on the internet? People might make assumptions about the kind of person I am because of an illness I have, but my hope is that someone else who is struggling with Compulsive Spending finds some sort of comfort in this post knowing that they are not alone and I understand the constant pressure to want to literally buy yourself a new life.


Follow Kaitlin on Twitter @Depressionista


Crossing The Line in Therapy: A Guest Blog by Mark Rubinstein M.D.

Crossing the Line in Therapy

Sometimes Rules Are Meant to be Broken

by Mark Rubinstein, M.D.,

Author of Bedlam’s Door

As a practicing psychiatrist, I was treating Alice, a 38-year-old, unmarried artist living in a Manhattan loft. She was depressed about her career and life’s direction. Above all, she was distressed that she’d been unable to sell her oil abstract paintings, although she’d displayed them at shows and at a prestigious gallery. Things had become so dire, she thought she might have to sell her apartment so she could pay for ordinary living expenses, and continue painting.

She was seeing me once every two weeks for supportive sessions. I become somewhat alarmed, when in addition to her lack of career success, a relationship with a man—a fellow artist—fell apart and Alice became despondent.

Over the next few months, her financial status worsened. The real estate market was headed to record lows, and she was desperate for money. Alice took a part-time job as an office temp, but that barely helped pay her bills. Because of her financial plight, I progressively lowered her fee. I had to charge her something for her to maintain a sense of self-respect.

Despite her best efforts, her career did not progress, even though she was a talented artist. She came to such a low point, financially and emotionally, I began considering if there was something I could realistically do to lighten her burden.

I was fully aware of the admonition that a therapist should not enter into the “real” life of a patient. There should be no social relationship; no sexual relationship; and no business dealings with someone in treatment. The therapeutic dynamic required freedom from such real-life interactions which could place the treatment in jeopardy. It’s considered an ethical violation for a therapist to engage a patient outside the office.

But desperate times call for desperate measures.

Alice’s financial situation was by now so precarious she was barely able to pay her co-op maintenance.

I decided the most ethical and caring thing to do was to get involved.

I made arrangements with Alice to bring my wife to her loft studio where we looked over a number of paintings. We purchased three pieces. In essence, I became a “customer” of hers. I realized the potentially difficult—even treacherous—relationship I’d allowed to develop, but felt Alice would probably decompensate emotionally if her travails continued much longer. In so doing, I created a boundary violation (mixing “business” with Alice’s therapy), but felt I was working toward a far greater good.

Fortunately, the money Alice earned from our purchases was enough to tide her over for the next few months, and she soon sold a few paintings. Her fortunes improved over the next two years, as she sold more.

Eventually, Alice sold her loft at a much higher price than she would have received, if she’d disposed of it under the desperate circumstances of a few years earlier.

Fortunately, my breaking the rules helped Alice find her financial and psychic equilibrium.

As a psychiatrist and therapist, it became clear that one should not always stick by arbitrary rules. Yes, sometimes rules can and should be broken.

© Mark Rubinstein, M.D., author of Bedlam’s Door: True Tales of Madness and Hope

About the Author:

Mark Rubinstein, M.D., an award-winning novelist, a physician and psychiatrist, is the author of a non-fiction book, Bedlam’s Door: True Tales of Madness and Hope. For more information, please visit and follow the author on Facebook and Twitter.



Mental Illness Portrayed in Film: A guest blog by therapist Paige Zuckerman

Crazy in Celluloid: misrepresentation of mental illness in film

Consider your favorite “crazy” movie character, perhaps you conjure-up the image of a leering Psycho Norman Bates or a charismatically chaotic Joker in The Dark Knight. Whatever image comes to mind, there’s likely to be several common tropes imbedded in it.

Recently I watched the new trailer for the next M. Night Shyamalan film Split, set for release in January 2017. I was deeply conflicted, immediately by the implication of dissociative identity disorder being given that tired title of ‘split personality.’ Furthering my frustration, the lead actor (James McAvoy-a personal favorite) has often performed mentally ill characters with a deft balance of grit and compassion. However, apparently at the hand of a thriller/horror genre director, the film rests upon common problematic narratives of “madness.” I’m aware there’s a typical Shyamalanian ‘twist’ at the end, but does said supernatural edge make amends for the recapitulation of Hollywood’s worst psychological misapprehensions?

There’s more to this issue than my annoyance as someone inside the ‘real world’ of mental health. There’s a larger socio-cultural narrative we craft in our various forms of storytelling. We are existing in an era of pervasively accessible media intersecting with acts of terrorism, authoritarian brutality, racial and gender violence. How are we using our gifts as storytellers to portray those within our population who are in pain? Are we coloring them as malicious and fractured or as troubled fellow humans worthy of empathy and ethical intervention?

In considering numerous films headlined by a character struggling with mental illness, it becomes clear that several misrepresentations pervade. The first and most common is that ‘crazy’ is tantamount to dangerous. Based on this schema, anyone suffering with mental illness is intent upon gruesome violence. This is most commonly depicted via male characters or those who embody traditionally masculine traits. You’re in this camp, M. Night! The next misinformed mechanism is the assumption that people ‘snap’–or that mental illness is often of sudden, sharp onset. The reality–mental health issues are often progressive and insidious….and wholly treatable. A third and especially infuriating ignorance is the narrative that people with mental illness are exploitable and tokenized, often sexually. This is markedly common in portrayals of females with mental health issues. Thus we see sexism and misogyny intersect with the marginalization of people with disabilities. As a Feminist and a therapist, I am troubled by the potential impacts of these messages.

My gripe transcends impoverished depictions of those suffering mental health issues to include those who treat them. Historically, film has been a predictable perpetrator of the narrative of psychiatrists, therapists and support staff being incompetent or even cruel. Perhaps the all-time most hackneyed embodiment of the ‘therapist’ has been as a powerfully transgressive authority figure who sexually exploits clients. This is a threadbare and ignorant take on the very real, yet entirely manageable phenomenon of transference and counter-transference. The truth is that the profound majority of mental health professionals are ethically conscious, collaborative folks who just happen to value creating safe spaces for us to explore our deeply human luggage.

The somewhat positive news is that consultation and collaboration with mental health professionals is gradually becoming an industry practice. Just as the film industry will fact-check their historical references, many producers and directors are seeking assistance to more consciously craft their characterization of emotional pain. I vote we make that a universal standard!

When we take a moment to step-back and examine how ubiquitously psychology is woven into our storytelling, we have an opportunity to create richer narratives that honor the complex tension of it. If those who hold the privilege of publicly telling human stories choose to remain complacent, we’re likely to perpetuate discrimination and hatred of those worthy of our kindness and compassion. We can do better. In an effort to further our consideration of this issue, here’s a few of my recommendations to absorb and deconstruct:

Did it better:

Benny & Joon: a compassionate perspective on the worthiness of people living with occasionally debilitating mental illness and their potential to be creative, loving and contributing to society. Also an apt depiction of the challenges for loved ones and caregivers.

Filth: veering from grandiosity to angst, addiction and impulsivity in the face of losing one’s family and suppressing early childhood trauma is reflected with a beautiful balancing act only Irving Welsh and McAvoy can muster!

Cake: the slow-burn emotional erosion from a major medical trauma and chronic disability are not laid-out with histrionics, just honesty.

Did it worse:

What About Bob: too many issues to mention, from the ridiculous depiction of the mentally ill character to the laughable treatment. If you suspend disbelief entirely it’s only a good laugh, not a total mess.

In Treatment: They could have done right by the therapeutic process here if they hadn’t gone down that old ‘sex with your client’ rabbit hole.

Suckerpunch: traumatized characters are sexualized, infantilized and brutalized and caretakers are criminally unethical and abusive.


Paige Zuckerman, CMHC

mental health therapist, contributing writer and fellow human, Salt Lake City, UT

IG: ShrinkPaige