How Do I Talk to a Friend or Family Member With An Eating Disorder? (Or You Suspect They Do)

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This is 2017’s National Eating Disorders Awareness Week, and I’m excited to be writing a few posts based on requests.

My first post is how to talk to a friend or family member with an eating disorder or who might have one… from my perspective as someone in recovery. While I was struggling through the years, I heard from friends and family that they felt powerless. It was like watching a sinking ship and not knowing if they could do anything to stop its demise.

While it is impossible to cure another person, friends and family members are NOT powerless. I think about the camp counselor who talked about her own eating disorder openly without shame while I was symptomatic but not yet diagnosed; the friend who reached out to the school administration when she was concerned about me; my mom who spent countless hours trying to understand why I wouldn’t eat. I might have resented them at the time, but now I know that they planted seeds that would bear to fruition later. I didn’t enter recovery in their timing, but it did happen.

I will forever have memories of friends, family members, professors, and co-workers expressing their concern to me over the years. If you think that your words don’t make a difference or impact to someone deep within an eating disorder, you’re wrong.

I will give a cautionary note, however. For every good friend who expressed concern and gave me unconditional love during my journey, there was another who met me with insensitivity and stigma.

Talking to someone with an eating disorder can be a tricky endeavor. On the one hand, you want to express love and concern, but you don’t want to do so in a way that is off putting or hurtful.

In this blog post I will be outlining some “do’s and don’t’s” derived from years of experience of what has and hasn’t helped me.

  1. Do ask about it…

… but try not to probe or make assumptions.

Bringing up your concerns with someone you believe to be struggling can be anxiety provoking. It is a whole lot easier to pretend everything is okay. However, if you have a sinking feeling that something is wrong, and you are close enough to the person to broach the subject, by all means consider it.

Before you do so, consider these two things:

a) Don’t push it– If you bring it up and are met with defensiveness, it might not be the right time to talk. People with eating disorders can be highly secretive. In my deepest stages of denial and shame, I avoided all conversations about how I was doing. I remember how one time prior to admission to residential treatment, a teacher asked if I had an eating disorder. Taken aback, I mumbled something about having a rare digestive disorder. I wasn’t ready to admit how out of control or scared I was. Eight years later, I still remember that conversation as formative. She did not push the issue but expressed concern, and that meant a lot. Even though I wasn’t in a place to talk about it at the time, I respected her for bringing up the subject.

b) Check your assumptions– In society, we tend to associate eating disorders with “thinness” (whatever that means), but that’s just not accurate. Most people with eating disorders are not underweight. Anorexia is the most rare eating disorder, and bulimia and binge eating disorder are more common. People with eating disorders often fluctuate between periods of restriction, bingeing, and purging. I know some of my most symptomatic, out of control times were when I looked healthy. Don’t automatically assume that someone’s thinness is anorexia. It might as easily be a thyroid issue, an autoimmune disease, drug abuse, or simply body type. Similarly, don’t assume that someone doesn’t have an eating disorder because they appear to be healthy.

I have a “spidey sense” in my judgments about whether someone has an eating disorder, but I can be wrong. I am also careful about bringing up the subject of a possible eating disorder. Far before I bring that topic up, I make sure to talk about my own experience, normalize the reality of eating disorders, and check the facts.

. . .

2. Do seek consultation…

… but avoid gossip.

I can’t tell you how horrible it feels to know that people have been talking about you in the whispers you slightly overhear as you pass by and in hushed conversations you know have happened. I think by all means people learn more about eating disorders if they suspect a problem in a family member or friend. Education is important. Talking to a dietitian, therapist, or an organization like the National Eating Disorders Association can be a great move. HOWEVER, when that trickles into gossip and shaming, it stops being helpful.

Sometimes a family or friend group might need to get together to discuss how best to broach the subject with a loved one, but as soon as it turns into judgment and teasing, it can become toxic.

A note about consultation: It is strangely easy to read an article from BuzzFeed or some other reputable source (joke, but in full disclosure, I love BuzzFeed) and think you’re Dr. Phil or something. “Is it about control?” I’ve had people ask me in condescending tones. As if that comment is unique and your therapist hasn’t talked about control 900 times. Eating disorders *can* have an element of control, but it is ALWAYS much more complex. Eating disorders are associated with a cluster of things that may or may not be related: psychological factors, personality types, presence of past trauma, significant stressors, biological predisposition, family history, etc. A cursory look at a non-scientific article or watching a horrible Lifetime movie about anorexia cannot make anyone an expert.

. . .

3. Do express concern about eating habits…

… but don’t do so during meal time. 

Eating with someone you’re almost sure has an eating disorder is difficult and uncomfortable.

It is SO tempting to reach across the table and critique a meal choice, or say something like, “Is that all you’re having?”, or, “Why aren’t you eating more?” In my experience, those conversations are never helpful. The person with an eating disorder, who is likely anxious from the experience eating out, is on guard and gets defensive fast.

I get it– meal time seems like the most logical time to express concern. After all, it is commonly thought that meal time is in fact the problem. When I was deep into my eating disorder, going out to eat was SO MUCH more than an hour at a restaurant. It was the fasting before and after; it was the fear of eating in front of people; it was planning a binge later in the night so I didn’t have to eat in front of people; it was looking up the menu online beforehand; it was counting calories hours before I stepped foot in the restaurant.

It is better to bring up the specific behaviors later in the day when meal time is over. Stick to the specifics about behavior and don’t make it personal. An example: “I noticed when you were at dinner tonight, you ordered a low calorie entree, and you kept putting parts of the meal in the napkin on your lap.” –> I know, easier said than done!! I’ve been the recipient of a lot of insensitive mealtime comments, but I’ve also given some insensitive mealtime comments to friends I knew were struggling. I get it: Frustration can mount in the moment at mealtime, but try to hold off until later. You’ll end up having a much better conversation.

. . .

4. Do focus on food…

… but look at the greater picture, which has a whole lot more to do than just food.

Someone I knew in graduate school said something to the extent of, “I don’t know why families don’t lock the family member with an eating disorder up and force the person to eat.”

While that is absurd, I have heard so many comments that are similarly invalidating and off base:

“Just eat.”

“It’s not that hard.”

“Don’t make this such a big deal.”

That approach doesn’t work.

Eating disorders are both about food and not about food. Of course, eating disorders are highly related to weight and food habits (that’s why they’re called eating disorders) but in some respects have little to do with food.

Restriction was my teenage coping mechanism to deal with a lot of internal chaos– undiagnosed generalized anxiety, crippling OCD, existential anxiety, depression, and feelings of hopelessness, and worthlessness.

In my years of being symptomatic, I was way more likely to talk about those things than my eating habits. I hated when people would make it seem like gaining weight or eating would solve all of my problems. My eating disorder served multiple functions in my life, and until I dealt with those, I didn’t get truly better.

On the other hand, eating disorders are necessarily about eating.

If someone is underweight or malnourished, it is impossible to look adequately at the big picture. Medical, nutritional recovery is a precursor to psychological recovery.

Sometimes in more psychoanalytic approaches to recovery, it is conceptualized that when a person deals fully with the psychological parts of the eating disorder, the symptoms will dissipate. That also doesn’t work.

If you are bringing the subject up with someone, consider the rather paradoxical statement that eating disorders are about eating, but they don’t give us the full picture of what’s going on.

. . .

5. Do take action if necessary

… but think it through first.

Eating disorders are dangerous.

Period.

It is well-known that anorexia has one of the highest mortality rates of all mental health issues, but it is definitely possible to die of bulimia or binge eating disorder too.

The first thing I tell people who haven’t gotten into treatment is: SEE A DOCTOR.

Eating disorders can be associated with some serious medical complications that can kill including (not an exhaustive list): potassium/ electrolyte imbalance, low heart rate, low blood pressure, and general heart abnormalities (that’s why people with eating disorders must have regular EKG’s).

I will reiterate here that someone of average weight, overweight, or obese can die of an eating disorder as well. All of the above medical problems can happen to a person at 70 pounds or 370 pounds.

That is why if you truly suspect a loved one or friend has an eating disorder, don’t stay silent.

In all three of my three major anorexia tail spins, the initial descent into the illness and two subsequent relapses, I needed intensive medical intervention to get back to normal. Two of those times, it was not of my own choosing. Friends, family, and even my school had to intervene on my precarious downward spirals, and thank God they did. Otherwise I might not be here right now.

With that said, if you are seriously concerned about someone who is NOT getting treatment for an eating disorder, there might be cases in which you should advocate for medical consultation or even hospitalization.

For someone with a SEVERE and UNTREATED eating disorder, it could be that lovingly suggesting a trip to the doctor or ER for a medical evaluation is what is needed in the moment. Or, perhaps looking up residential treatment options and calling the person’s insurance company for help.

** Now: Before you attempt this kind of conversation with someone, heed caution! Most people who are diagnosed with an eating disorder have a treatment team or are getting support of some kind. If that is the case, step back and offer support in other ways. Suggesting hospitalization or a doctor consultation additionally has a high likelihood of pissing off the person’s eating disorder, so be prepared that you will likely be met with resistance.

There are some cases when this kind of conversation happens more organically: For example, if a friend passes out or complains of heart palpitations.

. . .

I think the reason many people don’t express concern to a friend or family member about what they’re seeing is out of fear. I get it– it’s scary. People don’t inherently know how to bring it up or what to say.

You are brave and caring to consider having a conversation that might save a life. Sometimes simple comments can go a long way, things like:

“I love you, and I’m concerned about you.”

“It seems like you’ve been struggling lately, and I want to help.”

“If you ever want to talk more about what’s  been going on for you, I’m here for you.”

For more information or to take a free screening, check out NEDA’s website.

In keeping with the National Eating Disorders Awareness Week slogan for this year, I’ll finish with this: “It’s time to talk about it.”

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Myths About Eating Disorders: Debunked

Knowledge is power, but when it comes to eating disorders, there is a lot of misinformation that is out there. Sadly, this lack of knowledge of accurate information about eating disorders can even extend to health care professionals. With conflicting messages about what is true, it can be hard to sort out what information is accurate.

Because I have lived now over half of my life with an eating disorder, I’ve learned a lot of stuff (mostly out of necessity), and I have become aware of some eating disorder myths and stereotypes that exist. In this post, I am going to go over a few of these myths and debunk them.

 

What are eating disorders?

Myth:

Anorexia means starving yourself and being emaciated. Bulimia is bingeing and purging. And… that’s all.

Reality:

Eating disorders are most commonly described as complicated biopsychosocial mental health conditions that impact all bodily symptoms, the brain, and can have devastating consequences such as death. The most commonly recognized eating disorders are: anorexia, bulimia, binge eating disorder, and EDNOS/ OSFED (eating disorder not otherwise specified/ other specified feeding or eating disorder). Eating disorders involve some type of dysfunctional behavior(s) around food, including restricting food or caloric intake, fasting for long periods of time, using compensatory behaviors after eating such as purging, laxatives, diuretics, or overexercising, and/ or bingeing, or eating a large amount of food (of course there is social construction around what is considered “large”) in a discrete period of time.

Many eating disorder behaviors overlap. People who have suffered from an ED for a considerable length of time frequently experience diagnostic cross-over. Thus, these symptoms are neither clear-cut, nor are they necessarily noticeable. Eating disorder behaviors are often done in secret. Also, people with bulimia or binge eating disorder may not be over- or under- weight. Similarly, those who struggle with anorexia may not be emaciated.

It is important that people educate themselves about the impact of eating disorder behaviors and rely less on stereotypes of how eating disorders are culturally portrayed… namely how someone with an eating disorder “should” look or behave.

 

Who gets eating disorders?

Myth:

Privileged white adolescents.

Reality:

Anyone! While eating disorders are most represented in the media as occurring in Caucasian women of upper or upper middle class SES in a Western country, people of all races, sexual orientations, genders, economic statuses, and ages can develop eating disorders. There is a serious lack of representation of other eating disorder voices, which is why I’m really happy that this Marginalized Voices Project exists. We need to get better media representation of what eating disorders are like and who they affect.

Males, older women (40+), as well as people who are gay and of other racial groups, who have EDs are getting increased attention because—well, they get eating disorders too. Sadly, treatment is not necessarily tailored to them, and it needs to be.

 

What are the causes of eating disorders?

Myth:

Eating disorders are caused by Western media, trauma, families, or other environmental factors.

Reality:

Eating disorders cannot be pinpointed as being caused by one given factor. If you’ve ever taken a statistics class, maybe you’ll remember that correlation does not imply causation. Just because eating disorders exist (or are identified) in predominantly Western-influenced cultures, that doesn’t mean that culture CAUSES eating disorders.

Similarly, any risk and precipitating factors—a traumatic situation, an unhealthy family system—cannot be said to CAUSE an eating disorder. Perhaps these factors may increase the likelihood of an eating disorder developing, or they could be precipitating factors, but they are not the cause or fault of culture, or a family, or trauma.

I would also heed caution in that there has been an increase of media coming from companies such as Dove challenging cultural perceptions of body image. This is all good. I am a fan of challenging the oppressive body-image status quo. However, there is a difference between eating disorders and disordered eating or general body image issues. A girl might have negative feelings about her body from reading fitness magazines, but that is completely different from that girl developing a serious eating disorder.

Also, there is a significant biological basis of eating disorders that is still being explored. One study by Bulik and colleagues in 2006 suggests that anorexia is among one of the more heritable psychiatric disorders (0.56 as reported in her study).

All that to say, in general, there are a lot of unknowns when it comes to a cause or causes of eating disorders. My stats 101 lecture for the day: Be very, very careful about language pertaining to causation. Eating disorder research is being conducted because so little is understood still. There is not enough available knowledge to determine that something is a cause (or even causes) of an eating disorder. Talk about risk factors, talk about precipitating factors, talk about comorbid conditions, that’s fine. But talking about a cause suggests that 1+ factors completely explain the manifestation of someone’s eating disorder, and that is not something that can be said at this time.

 

What are the treatments for eating disorders?

Myths:

Once you have an eating disorder, you never get over it.

or 

You just need to eat.

Reality:

Eating disorders can be treatment resistant. I am living proof of that. However, treatment can also be effective. Recovery is possible. People don’t have to struggle with eating disorders forever and ever until they die. Recovery is not easy, and it may take time… a lot of time. Like years. Maybe more. But it can happen.

While eating disorders can be difficult to treat, certain treatments have been shown to be effective: CBT, DBT, family-based therapy, perhaps even acceptance and commitment therapy. I have more thoughts pertaining to this, but right now I will just say that there are some good options out there. I have been privileged to have seen a lot of great therapists who specialize in eating disorders, and I have been a part of treatment programs that have used all of the above treatment modalities.

People with eating disorders are not lost causes. They are not resistant, difficult, or frustrating. They are hurt and scared. They are in desperate need of empathy and understanding.

Notice that none of the treatment I have mentioned involves locking people up and force-feeding them. I had an acquaintance who once said, “If I got an eating disorder, my parents wouldn’t have put up with it. They would have just locked me in my room until I ate.” Honestly, good luck with that. Because I’m pretty sure that’s not addressing the problem. As in, I’m totally sure. That’s not going to work.

For whatever reason, people can have this mis-perception that the problem is the food, and all we need to do is make these people freaking eat. I both agree and disagree with that– it both is and isn’t about the food. I do not think that people can delve into root causes of their eating disorder while engaging in eating disorder behaviors, but I also don’t think that magically eating will fix everything.

So: there are some treatments that exist for eating disorders that work. Maybe the treatments that exist could be improved, but eating disorders are not untreatable.

 

 

Why I Hate Insurance Companies

Insurance companies have a special place in my heart. A very, very special place. A special place that is shared with Megyn Kelly saying that Jesus is white, snowstorms in March, and the day that holiday drinks go away at Starbucks.**

I didn’t think twice about insurance companies until I developed an eating disorder. Since that time almost 13 years ago, my experience with insurance companies have coincided with anger 99% of the time. In fact, in my life, there has been a strong positive correlation between insurance company communication and deep hatred about humanity.

How shall I paint a portrait of how I came to feel so strongly? I will start with stories. One of my friends’ parents sold money saved up for her wedding to send her to treatment. Another friend was diagnosed with Bipolar Disorder at age 18, and as a result, she was denied insurance coverage for almost a decade because of her “preexisting condition.” Last year, after going through a hard time, I considered doing intensive outpatient treatment for my eating disorder. However, I “didn’t qualify” (aka I wasn’t “thin” enough). After probing, the insurance representative admitted that if I lost more weight, I would have a more “compelling case.”

These are only a few of the examples I have. I could list dozens more– people who have been kicked out of treatment because they no longer meet the criteria for anorexia (because when you’re 86% of your ideal body weight that’s “better”???), people who are dying because they cannot get treatment for their eating disorders. People whose families have taken out second mortgages, spent life savings, taken out loans– just to get mental health services. People who have to be at a life-threatening weight to qualify for insurance coverage of treatment.

When I developed an eating disorder, I had no idea how costly it would be to recover. An outpatient team is supposed to consist of a psychiatrist, general medical doctor, therapist, and dietician… that’s a lot of money. When you look at residential treatment, the picture gets way worse. It can cost about $1000 a day to be at a residential treatment facility, and if you have a severe eating disorder, you might need to stay for 4-5 months. The costs accumulate… $100,000, $200,000 for a residential treatment stint, $30,000 a year for outpatient treatment, and recovery can take 5-10 years. Plus relapses.

You should not have to be rich to recover from an eating disorder. 

Our system of mental healthcare is unacceptable. When I see people having to call Blue Cross or Aetna or HealthNet or whatever, bawling their eyes out, because they are refusing coverage for them to be a healthy, functioning member of society, you know there is something wrong. When an insurance agent is telling me that I need to get sicker because at my weight, my case doesn’t warrant treatment, you know there is something wrong.

How messed up is this? Let’s just pretend for two seconds that the diagnosis is cancer– can you imagine an insurance company saying, “Well, sorry, you’re in stage 2 of cancer, and you have to be in stage 3 before we cover treatment.” No!!!! You need to beat the cancer, and the earlier the recognition, the better! Why are mental health issues somehow viewed differently?

This boils down to something much greater– and much more complicated– than individual coverage. It relates to our priorities as a country and what we prioritize as a “right.” Do people have the right to recover from a mental illness, or do they have a right to receive the services they need? What do we value?

The answers to that question get deeply philosophical, political, and personal. Obviously my thoughts on this topic are far from innovative– mental health parity has been a subject of legislation for quite some time, and parity has culminated in 2 recent acts- the Mental Health Parity Act of 2008 and the Affordable Care Act. Discussion especially about the ACA is polarized. Even in my mental health policy class, talk about the ACA was politically charged. People are angry, happy, relieved, upset, furious– depending on one’s political ideology, the range of responses span across a spectrum of strong emotions.

I am not going to try to cover the entire topic of mental health treatment, parity, and coverage in our country. That could be a novel– or 10 novels. What I will do is speak to my personal experience of an eating disorder and emphasize humanizing people with mental illness, including eating disorders. Other conversations about coverage, and cost, and parity need to happen, but that is for future posts.

Stigma about mental health conditions is predominant, and at least in my experience, I have internalized a sense of self-stigma. I have this internal voice that taunts me, You are too much. Then how am I supposed to feel when my society, my government, is telling me that I am not good enough? Forget the cost, that message of de-valuing, the reminder that I need help, is so painful. I put so much on myself, why does society have to put that burden on me as well?

With all of the out-of-pocket costs I have paid over the years, I could probably have taken multiple world cruises. I have been privileged in having received help, but independent funding sources should not be a pre-requisite of the right to recover.

If I could boil what I want to do with my life, one social ill that I would like to see solved, it would be this: that people with mental health issues, invisible issues, would receive the coverage that they need. They would not need to get sicker or end up committing a crime and in prison or have to justify– beg– to third parties. They would be met as individuals– as humans– as members of society who deserve our help.  In our society, cash is king. Costly people and things are to be avoided economically. Even that label is stigmatizing. It denotes the idea that certain people who need help are burdens.

You cannot know someone’s story based on their scars. You don’t know what goes on behind closed doors– the pain the exists underneath. Invalidating that is invalidating that person’s right to exist as an integrated whole of a lifetime of experiences. Just because pain is invisible doesn’t mean it is less real, nor does it deserve to be treated any less than other diseases.

Why are people with eating disorders not given insurance coverage? Is it because the cost is a burden on society? Is it because eating disorders are increasing in our society? Or is it something deeper and more systemic about education and beliefs about eating disorders? I hear it in comments that “slip out” about eating disorders, often from well-intentioned people, “Why don’t you just get better on your own?” “Why can’t you just eat?” Is that a mistake, or lack of education? Or is there a deeper stigma that is underlying that is so embedded into our infrastructure, a sense of judgment around mental health issues?

I don’t know.

However, I do know that we make value judgments every day on who is “worthy” and “unworthy” of help and services. Our government does it, our world does it, our policies do it, families do it, and individuals do it. Groups do it, cities do it, and states do it. We need to cognizant of those choices and the implications that has on the humanity of the other.

In my lifetime, I would like to work so that the following words not need to come out of my mouth, “I want to move to Minnesota because their eating disorder coverage is really good since someone sued x insurance company.” It is so pathetic that law suits so that insurance companies “cave” and cover treatment for eating disorders (okayyyyy fineeeeee you’re dying of bulimia and anorexia, I guesssssss you can get help… but it better be cheap) is our primary modality of achieving parity. The fact that we have law practices designed to sue insurance companies about eating disorder coverage is good, but the fact that we need to have that at all is absurd.

I am not hopeless about our prospects of our country. I am reassured that we are working toward achieving parity through recent policy. The increased research, awareness, and education about eating disorders will penetrate into the system as long as we do not remain voiceless. In sharing struggles and advocating for each other and ourselves, I think we will find justice and healing.

 

**Disclaimer: I don’t actually hate insurance companies and those who work for them. Actually, my uncle works for an insurance company, and he is a great person. When I say “insurance companies” I am mostly referring to the systemic forces that underly America’s healthcare and our current system of private insurance.

If A Tree Falls

The last few days I have been thinking about this philosophical question: “If a tree falls in a forest and no one is around to hear it, does it make a sound?”

I first saw the short film, “Likeness,” directed by Rodrigo Prieto, a month ago, which is about a girl (Elle Fanning) with bulimia. **NOTE: If you’re thinking of watching it, and I will link to it here, I am telling/ warning you: it has disturbing images and shows purging. SO, be cautious before seeing it. If you’re worried about whether or not to watch it, maybe err on the side of not. That is my warning.**

Despite the disturbing content (I turned the volume down/ skipped through a few scenarios), this film spoke to something deep inside of me. Elle Fanning is at a party in the bathroom putting on mascara when all of a sudden her skin morphs into a peeling mask, and crying, she tries to rip off her own skin. It is haunting and raw, but it resonates.

It made me think of the tree falling question.

Does someone’s pain matter if nobody knows it is happening?

So often, with eating disorders, and mental health issues in general, the pain inside is not outwardly visible. I know the experience of walking around in a trance, knowing that people have no idea about what I’m going through. I can engage in normal activities and act like a regular human being, and yet, there is so much more inside.

Maybe one reason I relate to Elle Fanning’s character in “Likeness” so much is because the director externalized her self-loathing, dysmorphic inner state onto the outer, her skin. If I’m being honest, the outward is more tangible and seems more real to me.

The outward is also more comfortable for our culture. This series of images came out on imgur entitled, “If physical diseases were treated like mental illness.” My favorite image is a picture of a person who has blood spewing from his stomach, and someone is saying, “It’s like you’re not even trying.” Of course, no one would ever say that to someone who is internally bleeding, and yet, as the images suggest, isn’t that exactly how people with mental illness are often treated? Neurotransmitters are over/ under firing, and the brain is malfunctioning, and yet people are blamed for their issues because they can’t be seen. People receive rhetoric like, “You’re so frustrating. You’re not even trying. Just get out of bed. Eat dinner. It’s not a big deal.”

Stigma toward mental illness is so prevalent. It hinders a healthy person’s willingness to be empathetic towards those with mental health issues, and then sufferers can internalize self-stigma, or stigmatize themselves.

The tendency to hide is evident for Elle Fanning’s character in “Likeness,” who is in serious emotional discomfort  and then proceeds to go back into the party and tell others she is fine. My professional/ recovery instinct is to tell her: Everything is not fine. You can confide in someone. You don’t have to go through this alone. … and yet, haven’t I historically reacted how this character does? It is so easy to hide if you can.

In a recent anorexia memoir I read, I saw the author’s tendency to invalidate her own experience of an eating disorder. Her book is peppered with times that she is screaming, Was this thing that I went through real? Can you see it? Does it count? Is it good enough? Am I good enough?

My own eating disorder has seemed similarly elusive. Some of my past relapses have been in response to the thought, “I want to see if I still can do it” (hindsight: not a fruitful thought). I can’t say, “I broke my bone on this date, and I got a cast, and I was in physical therapy until this month.” My healing has been in a jovial conversation, a good cry, the taste of quality food, and increasing amounts of life. Part of me longs for the certainty and tangibility that I don’t have.

Now back to the philosophical tree question… Okay, I took a (required) philosophy class in college. One. So I know pretty much nothing about philosophical dilemmas. And right now I’m more talking about people than trees, obviously. But, shouldn’t a tree that falls matter? Maybe no one can hear or see it right away, but doesn’t it ultimately impact the rest of the forest? And if nothing else, I would think that it would be known by and matter to God.

Just because the tears may be deep inside, don’t they still count as tears? If someone is imploding and no one recognizes it, isn’t that still imploding? Just because everything seems okay, and others recognize it as such, maybe everything is not okay. Shouldn’t that be okay? Suffering is hard to measure, but it still matters. It means something, even if it is silent. My therapist has tried to tell me this 800 times, calmly, and the last 100 times more forcefully. I believe her every time. The hard part is putting it into practice in my own life. It is so hard to validate something no one can see, even when I know it is real. Elle Fanning and I cannot be the only ones in life who have had the impulse to hide emotional pain.

I see how stigma about mental illness has affected individuals and our culture, so one of my professional goals is to fight this stigma that inhibits people from acknowledging their own struggles and friends and family from recognizing and responding to another’s pain. It is unacceptable that so many people have to suffer alone without an advocate.

What would a world look like where people are free to be open about the pain they face inside, where the lack of judgment and safety are normative responses? I believe that through education and outreach, more and more people will be able to come out of the closet and verbalize their own struggles, or they can support others.

Many times, when you are falling or hurting internally, you can’t just get yourself out of it, just like this poor little tree below can’t re-plant himself if no one heeds his cry. People need support and love during hard times. They need it from others, and they need it from themselves.