Guest Blog

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


Texting Can Actually Help People Who Shut Down: A Guest Blog by listener Paul S.


If you’ve ever been rendered non-verbal by any sort of meltdown, shutdown, or panic attack in the presence of other human beings, you know how the actions of well-meaning people can only make matters worse. I imagine that when a relatively normal person sees someone in visible distress, their instincts are to immediately try to comfort you, calm you down—by doing all the wrong things. People start asking you “What’s wrong?” and, when they get no verbal response, sometimes even become even more insistent. They may try to touch your shoulder. I’ve had people try to hug me (note: if you see someone having a meltdown/shutdown/panic attack, that is just about THE WORST thing you can possibly do). All you want to do is flee to a secluded little corner, maybe run to the next room, grab the pillows off the couch and hide behind it while rocking back and forth sucking your thumb, away from the sound and touch of anyone else so you can ride the waves of overwhelming dread until it subsides, but people want to help.


I know I can’t speak for everyone, but in these situations, as long as I can get sufficiently far enough away to be sure no one is following me, I can sometimes muster up enough strength to send a text to somebody, who by this point is probably quite alarmed at my strange behavior. If you know the person well, a few words is all it takes for them to understand you need to be left alone in peace for a little while.


If you don’t know the person quite as well, however, it takes way too much energy to explain what happened, so why bother?


There are a couple of ways I’ve found to get around that second scenario. One is to have a text template saved somewhere on your smartphone, explaining what is happening in your head and instructing them to be gentle, quiet, not to touch you and, if needed, help you find a place to escape to for a little while.


More recently, I’ve been using an app called Emergency Chat (Note: This is in no way meant to be an official, commercial endorsement of Emergency Chat. I have nothing to do with its developers or distributors. Besides, it’s free; how would they have the money to pay me anyway?),  which you can get for free for Androids and iPhones. Upon opening the app, it displays a message, which you can customize. (sample screenshot of the one I wrote, slightly modified from the stock template that comes when you first use the app). It’s much faster than trying to find a text file on your phone, and an added bonus is that it actually acts as a sort of texting platform, i.e. you can even hand the phone back and forth exchanging typed messages with the other party without the need to actually speak.






I only jumped on the smartphone bandwagon a couple of years ago, and with all the mood trackers, medication reminders, and other apps like the one described above, it has drastically changed and improved the way I record, review, and analyze my moods and lifestyle, in ways that are surprising and often ingenious.












Recovering from Religious Harm

Recovering from Religious Harm

Do you ever wonder about whether religion has had a harmful effect on your life? If you have experience with controlling, authoritarian religious indoctrination, it may very well be true.

I’ve been working with people recovering from religion for over 20 years, and a few years ago, I noticed that some symptoms actually looked a lot like PTSD. I coined the term Religious Trauma Syndrome, or RTS. It refers to the damage done by religion as well as the trauma of leaving religion. Here are some examples:

“I feel angry, powerless, hopeless, and hurt – scars from the madness Christianity once had me suffering in.”

“It took years of overcoming terrific fear as well as self-loathing to emancipate myself from my cult-like upbringing years ago.”

“There is a lot of guilt and I react to most religion with panic attacks and distress, even photos, statues, or TV…. I guess although I was willing it was like brainwashing. It’s very hard to shake… It’s been a nightmare.”

So why is this problem not recognized and discussed? At present, religion is still seen in our society as either helpful or benign. There is no training in psychology programs for treating religious trauma and most therapists do not understand. In fact, therapists sometimes suggest religion to treat psychological problems.

Yet there are serious issues in religious dogma and practice that affect mental health. Fundamentalist Christianity is a good example. I call the two biggest problems “the horror” and “the terror.”

“The horror” refers to the way believers are taught to despise themselves. You are taught to think you are born bad and need of saving – there is no good in you at all and that is why Jesus had to die. Even after you are “saved” you always have to work to be good enough. This is devastating to a healthy sense of self, which is necessary for personal identity and mental health.

“The terror” refers to the overarching fear that is taught – fear about the world, other people, the future, and most of all, eternal damnation in hell. This is the terrifying backdrop of the entire religion, no matter what is said about love. You may hope to escape punishment but you never know for sure and so you always have anxiety. After you leave the religion, this terror can haunt you for years and be debilitating.

Christianity can also cause an existential crisis by creating a false reality and making wild promises. You get told you will have a perfect relationship with God, you will become perfect, God has a perfect plan for your life, you can spend all your time working for a huge cosmic purpose, and eventually, you will live for eternity in a perfect place. Alternatively, you are told there is no other coherent way to think about life; there is no meaning in life outside this framework. Thus when a person leaves the faith, they feel lost and scared. The challenges of ordinary life are exaggerated, and finding new meaning in life seems impossible.

As one person said, “I get depressed and upset. Jesus no longer saves me. God no longer created me. What purpose is there? What am I left with? What do ex-Christians fill the hole with? So we are here for no reason, no divine plan. Reality is harsh. . .it’s like having your entire world turned upside down, no, destroyed.”


Added to this is the problem of losing a support system. Church is often a person’s social life and families are often still in the faith. Finding new connections in “the world” can be daunting.

So what is to be done?

  1. The first thing is to understand what you are going through. In addition to the above, you can read about RTS at my website.
  2. Realize that you are not alone. Many people are leaving religion and going through these issues.
  3. Understand on a deep level that what you are going through is NOT YOUR FAULT.
  4. Take time to get informed. Read about the issues and also stories of others who have left the faith. is one place.
  5. Realize there is hope. On my website there are “messages of hope” and video testimonials.
  6. Find ways of getting support. This could be individual counseling from someone who understands, a support group, or a retreat. Check online or in your community.
  7. Know that people do get better and it does not have to take a lifetime.


Marlene Winell, Ph.D. is a psychologist, retreat leader and author of Leaving the Fold: A Guide for Former Fundamentalist and Others Leaving Their Religion.


Meth-Induced Psychosis- en Español: Fond Memoirs of an Ex East Oakland Therapist

Meth-Induced Psychosis- en Español: Fond Memoirs of an Ex East Oakland Therapist

The city of Oakland, California is famous as one of the top five most dangerous cities in the United States and is referenced in rap songs, home to the Oakland Raiders with the wildest fans, and has distinctly different neighborhoods, ranging from north Oakland that houses some of the best Ethiopian and Eritrean restaurants- to Rockridge, a neighborhood of rather affluent people and expensive boutiques. In east Oakland, the neighborhood of Fruitvale is heavily populated by Latino immigrants, fruits stand on corners selling tropical fruit topped with hot chile and lime, a lady yelling out all the flavors of cream she can fill your hot churro with, and the “elote” (corn) guy with the horn and bells on his cart that people run outside just to flag down. There is a large amount of poverty, crime, highly stressed households, and low paying jobs. Due to the stressors of living in a dangerous city with frequent gun shots in the distance, robberies at gun point, and lack of mental health services, street drugs serve as the remedy for many to escape from the overwhelming environment and economic struggles.

I worked as a therapist in east Oakland for the last few years and the amount of people complaining of psychotic symptoms seems to have skyrocketed dramatically. Whenever a client reports to me that they are hearing voices, seeing moving shadows, feeling radiation, or having paranoia and delusions, I always check for meth to rule it out. Why? Meth is one of the most commonly used stimulant drugs right now due to its low price, lasting high, and abundant availability. Studies show that the use of methamphetamine can induce a psychotic break and leave someone with a lifetime of symptoms appearing very much like schizophrenia even years after stopping meth use. The majority of folks that start to show psychotic symptoms from an organically occurring psychotic illness is around age 19, give or take a couple years. When I see someone older say they just started hearing voices, I have to investigate.

A gang-affiliated Mexican female who grew up in deep east Oakland once told me in a session “What the fuck, Grace! This is bullshit! I used crystal before and it didn’t make this happen? I can’t stop these creepy ass voices telling me to do nasty shit! It makes me just wanna do it so they shut the fuck up! Then I yell back and them to shut the fuck up and then people think I’m loca.” Some people can use stimulant drugs for years and have no psychotic break but for the unlucky bunch for whom it triggers a break, antipsychotic medication and therapy for coping with psychosis are often required to alleviate symptoms.

Medication compliance can be tricky with folks who are new to taking psych meds and there is often a sense of shame around what it means about oneself to take psychiatric medication. This is particularly common in the monolingual undocumented Spanish speaking community who often report, “Pues Graciela, no me gusta tomar pastillas” (Well Grace, I don’t like taking pills). Culturally, its odd to take pills and natural remedies are preferred, not limited to doing a “limpia,” a cleansing using burning herbs performed by a traditional healer. Some try religion and church to see if they can get relief and “pray away” the radiation from the F.B.I. who, apparently, have been parked outside our therapy session for the last hour.

Methamphetamine, crystal, crank, ice…whatever you call it was referred to as “azucar amarga” (bitter sugar), by a Salvadorian male who developed psychosis after feeling intolerable sadness and abandonment after his girlfriend cheated on him and got pregnant by the other man. He stated that he was saving up for an engagement ring for her and would talk about having children together who could go to college in the U.S. and have the opportunities he didn’t have. He worked a minimum wage construction job where his boss called him a “stupid Mexican,” reminding him of the major cultural tension between his country of origin in Central America and Mexico. “Lo odio cuando me llaman Mexicano” (I hate when they call me Mexican), he commented, triggering his memory of being robbed and pistol-whipped when passing through Mexico on foot in the sweltering heat, trying to make it to California. He would share that he would sometimes hide in the “porta potty” to text her that he loved her and referred to her as “mi reina” (my queen). In Spanish he told me, “I feel like meth is comparable to my ex-girlfriend…they both were beautiful, thrilling, and seductive, but ruined my life and left my mind forever fucked.”


If you or anyone you know needs help with meth you can contact,

Crystal Meth Anonymous (CMA)
Call 211 to ask for local substance abuse treatment resources
Phone your health insurance company to gain a referral


Grace Pacheco, MFT is a bilingual psychotherapist with a private practice in Pinole, CA and sees individuals, couples, families, and performs psychological evaluations in collaboration with immigration attorneys. You can learn more about her by visiting her website at