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I've had psychotic episodes where I simply come across as depressed and a little confused. I've had them where I'm anxious and rocking and crying but I'm not loudly proclaiming my delusion.

I've had psychotic episodes where I thought my family was being stalked and I had to harm myself to appease the beings stalking us but nobody knew. My injuries were hidden and I simply stayed inside the house.

I've had voices make me feel terrible so I just cry and talk about what an awful person I am but that just looks like low self-esteem.

It can be right under your nose.

what would have to go wrong in your life, and how wrong would it have to go, for you to stop bathing? to stop eating? to let the garbage pile around you until you can no longer see the floor?

how bad would you have to feel, and for how long, before you would stand on the street screaming at anyone & anything? beating your fists on your head and crying? how bad would it need to be?

When I was 22 I hit a wall. I called the suicide hotline from my car so my roommates wouldn’t hear me crying. I explained that I could barely shower, feed, or dress myself. I needed immediate intervention.

They asked me if they could send an ambulance for me. They wanted to hospitalize me. I explained that I was a week away from finals. And graduation. If I were hospitalized, I couldn’t graduate. The inpatient program also didn’t allow phones or visitors, and I knew how disastrous it would be for me to lose contact with my family support system.

I didn’t need to be hospitalized. I needed daily solutions. Simple ones, even. I needed a few precooked meals in my fridge so I could use my menial energy to keep my body going. I needed a doctor to contact my school and ask if I could have some extensions on my class assignments. I neededna few excused absences so I could catch up on my lost sleep.

They told me there was an intensive program that allowed residents to live in an inpatient care facility and get daily help with tasks like eating, therapy, medication, and showering, while still leaving for work and school, but it cost $30,000. I told them half the reason I was calling them was because of my financial pressures and fear.

In about 10 minutes of back-and-forth, it became clear that they had no true solution for me. I could go into the hospital and an inpatient program which would interrupt my entire life, and which I knew did not create very good results and had traumatized some of my own friends, or, well, I couldn’t even go into debt for the other program. They didn’t accept any new patients without half of the cost upfront. So it wasn’t even an option.

No therapist or psychiatrists or social workers could fit me in for 3-8 weeks.

So I said thank you and hung up, emotionally spent. I felt utterly empty.

Sitting in my car I realized I had a choice, to live or to stop. Nobody was going to save me. Nobody was going to help.

So I went inside, and I cried myself to sleep, and when I woke up I still hadn’t made a choice. So then I did. I chose to live no matter how terrible, just in case things turned around down the road.

It was unspeakably difficult. I didn’t shower. I barely ate. I either slept too much or not enough.

But I did survive, and a year later I got with a therapist who started to make things a little lighter for me.

I still struggle now, but things are usually much better, and I’m glad I’m still here.

I just think it’s important to acknowledge that for many people, especially in rural areas, and for people without money, which is most people, that the “help is always available” line feels hollow. Because often times it isn’t, actually.

But that doesn’t mean there will never be.

Overall, we need to build an entirely new system for mental health support in this world.

But for now, ask yourself or your friend in crisis what might make things a little more bearable until help actually is available.

A meal? Emailing a professor? Clean laundry? What might make things a little lighter?

Getting a week’s worth of frozen meals, to get nutrients into your body, because you know meal prep (even the basics) will be too much.

Eating off of paper plates for a year, because it’s distressing to keep walking by all of your unfinished dishes, but you aren’t managing to get them done. 

Putting a bunch of cheap laundry baskets (or cardboard boxes) in different rooms, so dirty laundry is less obstructive to your space when it piles up, because you always have somewhere to toss it. 

Throwing out the container full of moldy food in the fridge, even though the container could be washed and salvaged, because you don’t have the spoons. 

Offering to do something you can manage for a partner, roommate, or sibling, in exchange for them taking care of a chore that is unmanageable for you.

Saying “I just can’t do  ____ right now” to the other people in your space who it will impact, to start a conversation about how else it can be dealt with. 

Getting extensions, even if you theoretically Can do the work without them, if it will mean less panic.

Cancelling plans and asking for space, rather than burning yourself out further or lashing out at friends.

Turning in an assignment “embarrassingly” late.

Throwing your laundry in the washer in a messy heap, then washing it on cold to avoid color bleeding, instead of sorting it. 

Starting, then not finishing, tasks. Picking up 2 pieces of trash in the living room without cleaning the rest, instead of saving it for a theoretical future time you can “do it all.” 

Saying “no” to things that sap you of energy, dignity, or autonomy, and not having a detailed explanation for why. 

Saying “yes” to things that are relaxing and pleasurable, and not having a moral-focused or self-conscious explanation for why.

Doing things for recreation that are healing. Discarding the idea that medicine cannot be fun, and fun cannot be medicine: Eating food because it tastes good, or taking a substance (as safely and mindfully- whatever those things look like personally- as you can manage) because it feels good, can meet needs and be therapeutic. 

Throwing away your planner, because you have unhelpful shame over forgetting to use it. Instead hanging a large piece of paper or corkboard or whiteboard next to your bed, to scribble disorganized reminders and doodles on. Or sticking post-it-notes to your mirror. 

Forgiving yourself for reactive behaviors and “bad habits,” because a) it’s more helpful to understand what needs your system is trying to meet than to feel guilty, and b) and and because one behavior- which may not be your ideal or ultimate goal- may help in avoiding a more harmful one.

Sleeping “too much” in order to avoid more acute forms of self-injuring. 

Self-injuring in a less harmful way than your first impulse, then caring for the wound. 

Smoking more weed than you hoped to, in order to avoid restricting food. 

Some of these things involve reaching out and self-advocating, and it can feel painful or even impossible to do that. Not everyone has access to people around them who can help. But if you do, it’s so, so worth it. 

And if you have friends who are struggling (or aren’t sure), making it clear to those around you that you’re willing to do these things: go buy a basic supply for them, email someone for them, make a phone call for them, help them clean something up… It can make a world of difference, and set up a culture where those same things will be reciprocated when you need them. 

These strategies are so important, especially when trying to survive within a toxic, overwhelming, or under-resourecd environment. 

So much self-work / self-help is a completely uphill battle without a foundation of environmental change.

If you’re struggling to change something about your reactions, mood, or behavior, while none of the realities around you have changed, and you have no more resources or access to safety than you did before: you are the norm, not a disordered exception. You are reacting normally. 

Reaching out to multiple people to brainstorm ways of establishing baseline comfort/safety/stability, to address unmet resource needs, build a better environment, or work together to survive or change a toxic environment, is more helpful than 1,000 different moralistic self-work tips you’ll read, or hear from therapists focused on an individualistic/pathology-focused model of mental health. 

Self-work and self-effective change are built organically off of those deeper, roots-level changes in access to resources, safety, and connection. 

but in my experience 95% of my hallucinations are getting spooked by very clearly hearing someone knocking on my door or calling my name from another room or hearing footsteps walking behind me which are "just" my brain recreating the horror of an abusive childhood

i was on the buss and i hallucinated bugs crawling all over my hands, so my friend pulled my hoodie sleeves over them with permission and held my hands through the sleeves to "keep them off". they used the logic you would in a real bug situation.

i went nonverbal in a bad one in class, so my friend wrote me a note to give to the nurse since the teacher wouldn't let her go with me.

i often am very paranoid about the delusion that meat is actually rotten, so my dad will sometimes eat a bit of it before me