Writing about mental health from a feminist counselling perspective
June is Migraine and Headache Awareness Month here in Canada, an opportunity to raise awareness through education and research on the nature and impact of headache and migraine disorders, as well as support and advocate for people living with this type of chronic pain. For those of you who might not know, I have a personal history in dealing with migraines. I’ve always had them but, a few years ago, chronic stress and burnout led to daily, high intensity migraines that wouldn’t go away. Since then, things have improved for me, but as a chronic pain condition, this is something I have to live with. Here are 4 things I’ve been doing to navigate migraines in the last year:
1. Neurologist care
I’ve been getting by pretty well with the support of my GP, but back in September we decided that if I’m going to try one of the injectable migraine treatments, I really needed to talk to someone who was an expert in the area. In Edmonton, this is Dr. Michael Knash, a neurologist who specializes in migraine and headache. He was able to assist immediately with finding the right dose and sharing with me some options for getting medication coverage.
One thing that I was surprised to learn is that not all neurologists have the same training or expertise, so it's important to find one who specifically works with migraine. You can watch this video from the Pain Society of Alberta where he talks about options for treating your migraine attacks at home.
2. Therapist support
Fortunately, my existing therapist has experience working with migraine . I’m so grateful that she’s able to have direct conversations with me about therapy, pain, and when I’m holding unrealistic expectations about what my relationship with chronic pain should be.
She also reminded me that stress is a part of life, and if my plan included never being stressed, it wasn’t going to work. We’re both big advocates that migraine treatments should work despite the daily stressors of living in Alberta, being a parent, and being a therapist. Her reminder to me was that treatment of chronic pain is a gendered issue and that I needed to go back to my doctor if my current medication was no longer working. This was also a reminder that what works for a while in terms of treatment may not always work, and if severity or frequency of pain increases, it’s a good idea to revisit medications and treatment plans.
3. Guided visualizations
I continued to use the guided visualizations from Curable Health. Curable is an online program and app that provides professional help to people living with persistent or chronic pain. They use a biopsychosocial approach that addresses pain from multiple angles (psychical, psychological, and emotional) to provide science-backed lessons and techniques.
My favorite is the control room visualization, where you turn down the volume on pain and shut off the alarm. Most of my clients know I’m a big fan of using imagination work to assist healing, because through imagination, we create a new physiological response and allow our lower brain to take in alarm-reducing cues. That’s what Curable’s visualizations help me do.
4. A sustainable work schedule
Making our work schedule sustainable seems to be a huge conversation in the psychology circles I’m in right now, and I’d love to share what sustainable looks like to me. First, it’s individual, and second, it changes over time.
I used to work longer hours 4 days a week. Now I’m doing fewer hours per day on a 5 days a week schedule. At different points over the years, my capacity has changed, and what works best for me to be present and engaged has changed. One of the key strategies I’m using is not filling my schedule to capacity. A full schedule for me would be 6 clients per day. But I know that this leaves zero room for inevitable parts of life and this job, including days when I’m in pain and room for urgent appointments or reports. So I only leave 5 spots open on my online calendar, and I book the 6th by my discretion. That way I can really have a look at what the day and week looks like to help me decide if it’s within my capacity or not. I also book regular time off each month and a longer period at the end of the year to fully put responsibilities away and focus on recharging.
If you too live with chronic or persistent pain: what are some of the things that help you navigate it?
One of my hopes as we go forward into 2022 is that we can all find more peace with food and our bodies. I know fat bias and stigma make this incredibly challenging, but there are everyday things we can do to let go of shame-fueled beliefs around our bodies and embrace body acceptance. Some of this involves saying goodbye to things that make us feel worse about it (i.e., curating our social media feeds) and some of it involves surrounding ourselves with what supports us to feel better.
If you’re aiming to have a more compassionate relationship with food and your body, here are some resources that may support you in journey:
1) Maintenance Phase is an excellent podcast hosted by journalist Michael Hobbes and activist Aubrey Gordon. They debunk popular nutrition advice, health fads, and wellness scams. Aubrey also has a book out, What We Don’t Talk About When We Talk About Fat, where she explores fat activism as a way of fighting for social justice.
2) The F*ck It Diet is a book by Caroline Dooner where she explains how dieting makes us more fixated on food, and lays out a pathway to move away from the restrict/purge cycle. If you’ve worked with me before, you know one of my life mottos is “listen to your body”. This includes learning to listen to our hunger and fullness cues, trusting in our body’s wisdom, and getting out of the pattern of constant restriction.
3) For those who are hoping for a more personalized approach, you might appreciate reaching out to a HAES dietician like Selene Yan of Embodied RD. I recently connected with her and love the somatic wisdom she brings to her work with clients – it’s very much in alignment with the type of work I do and I think many of you will appreciate it too.
4) In this blog post, I share a series of strategies you might turn to when you feel shame about food, as well as some reminders of the things that never help. The most powerful way of dealing with shame in the long-term is by building up our resilience to it. If that’s something you often struggle with, I have an online course called Shame Resilience Skills where I share 6 concrete tools you can use everyday to complement healing.
More resources to support you
I initially sent out this brief list on my newsletter, and in response I received some extra resources that some folks consider fundamental reading, especially around the origins of anti-fat beliefs and racism.
5) In Fearing the Black Body, sociologist Dr. Sabrina Strings explores the origins of fatphobia and the cult of thinness through history as linked to Western white supremacy.
6) Belly of the Beast by Da’Shaun Harrison is another book that takes a contemporary look at the intersections of race, police violence, gender identity, fatness, and health, specifically in the USA.
7) When talking about body acceptance, we can’t forget to mention the Health at Every Size (HAES) philosophy, supported by ASDAH (Association for Size Diversity and Health). The HAES pledge has three components: 1. Respect (celebrates body diversity; honors differences in size, age, race, ethnicity, gender, dis/ability, sexual orientation, religion, class, and other human attributes); 2. Critical Awareness (challenges scientific and cultural assumptions; values body knowledge and people’s lived experiences); 3. Compassionate Self-care (finding the joy in moving one’s body and being physically active; eating in a flexible and attuned manner that values pleasure and honors internal cues of hunger, satiety, and appetite, while respecting the social conditions that frame eating options.) Individuals can take the pledge to show their commitment, and be signed on to their database so people looking for their services can find them.
8) Megan Jayne Crabbe has what looks like a great newsletter on mental health, social media, bodies, relationships, feminism and healing. I've been following her IG account for years now and enjoy her compassionate and thoughtful approach to body acceptance.
9) In the Food Psych podcast, Christy Harrison brings a different guest every week to talk about their relationship with food, the harm of diet culture, experiences of recovery, fat acceptance, and more. Christy also has a book out on the topic, Anti-Diet.
10) Roxane Gay’s book Hunger: A memoir of (my) body is an intimate look into the author’s relationship to food, weight, and her body in connection with her experience as a survivor of sexual trauma, but it also explores learning to take care of yourself.
Were you familiar with any of these resources? What did you think of them? Do you have any other favourites? I’d love to read your thoughts in the comments!
*This post was edited on March 15, 2022.
As the weather continues to shift, I’m having more conversations about coping with the change of season. Especially, I’m having conversations about how as it gets colder and darker, our routines of care and connection can be thrown off. For example, you might be one of many people who used to go for a morning run or bikeride but who are now finding it too chilly to do so. Maybe you used to walk your dog at night after the kids were in bed but it’s too dark now. Or, maybe you used to get your social connection by hanging out with friends at the lake but now that’s just not happening anymore. You might be one of many people who’s missing out on time in connection with your body, with nature, and with others.
So, what to do? I think we can take a moment to notice these changes and the effect they have on our mood. These are especially profound for anyone already dealing with a mood disorder like anxiety, depression, or bipolar disorder. Then, we can ask ourselves how else we might be able to go about fulfilling these needs, even imperfectly.
Time in connection with your body:
• Massage lotion into your body
• Stretch every morning
• Have a dance party in your living room
• Go for a nature walk
• Listen to your discomfort and name it
• Use your breath to bring your attention inward
• Use mindfulness to notice your body’s needs (and meet them)
Time in connection with nature:
• Look outside and notice one thing that you like
• Open a window and smell the air
• Open the door and take 5 breaths (yes, chilly breaths!)
• Walk around the block
• Play in the backyard with your animal
• Sit on your balcony and drink coffee
• Collect leaves and bring them into your home
• Water indoor plants
Connection with others:
• Write handwritten letters or cards
• Read the same book as a friend or family member and share your thoughts
• Play a game together or share a drink over video
• Go sledding, snowshoeing, cross country skiing, snowboarding, or skating
• Go for a physically distanced walk in nature
• Sit around a firepit together and have some hot chocolate
Photo credit: Mateusz Salaciak on Pexels
Medication is a topic that's come up a lot in the last few months, and I wanted to put my thoughts to paper. A lot of people have been wondering if it's time for them to try anti-depressants, and my thought is this: it's okay to try. You're allowed to ask for help. Doing so doesn't mean you're "giving up" and it definitely doesn't mean you failed.
A little bit of history: As a feminist therapist I've often tried to help look for the broader contextual reasons that people are feeling depressed (traumatic experiences from the past, current job situations, difficult relationships, state of the world, etc). In traditional therapies, this has sometimes been overlooked. Instead, psychologists of the past have honed in too much on the individual and forgotten the broader social context we live in. Way too many people (women and marginalized individuals particularly) were left feeling as though how they were responding to unjust situations was somehow wrong, or pathological.
At the same time, addressing the social context is just one way of working with depression. Since it's typically been an overlooked area, it's one that I as a feminist therapist tend to focus on. But there are also other, totally important management strategies that we can still use for depression. Medication can be one of those strategies some people use part of managing their depression. I also think it's important to say that trying medication is totally valid EVEN IF depression can be traced back to contextual factors. It might be that thing to help someone get out of bed in the morning and be able to do all the other things they know help them.
It's not the right fit for everyone, and I know it's important that it's part of a bigger depression management plan, but let's start here: it's okay to try.
P.S. Let's be super clear: I'm not a doctor! I can't give medical advice and I get no benefit at all from pharmaceutical companies, which is why I didn't name any. If you're curious about medication, please talk to an actual doctor. One that you trust. And make sure they know about any other substances you're taking including over the counter, naturopathic stuff, and any other drugs you might use.
Someone read all of the above thinking I wrote “meditation”, and hey, it still fits! So, there ya go. Meditation and mindfulness practices don’t have to be done in a particular way, in a particular place, or in a particular style. It’s mostly about bringing our attention to the present moment, without judgment. There’s a ton of research these days on the psychological benefits of meditation and mindfulness practices, giving us reason to think that this might benefit a lot of people. It doesn’t have to be your “go to”, but it’s okay to give it a try. It’s okay to give it a try at different times in your life, in different ways, with different people. If you want to.
Take a Break From Work
You're also allowed to take a break from work. Around these parts we call this "stress leave", and my thought? We have stress leave set up for a reason. That reason is so that we can use it when needed. I watch waaaayyyy too many people wait too long to step back from work and by the time they do, they're completely burnt out that even getting out of bed is difficult. At that point, it takes months and months and months to recover, let alone feel rejuvenated and do the healing work that's needed and think about new boundaries going back into work. If you're overwhelmed enough that you're thinking about taking stress leave, chances are you need it. I encourage you talk more to your doctor or mental health professional about your options!
ps. Not sure if I need to say this but what I'm sharing here is not intended to replace the medical advice of your doctor or healthcare provider. Seriously. Go talk to them!
This one may just seem like a plug for my own services, but that’s not my intention. The reason I wanted to include it is that it’s not uncommon in my office for clients to show up and feel bad for “using up my time”. So, I’ll make it clear. You’re not taking a spot from anyone else. I fully consented to being here. I’m 100% okay with doing it. And, I actually appreciate the opportunity to walk through life with you.
People sometimes worry that their problems aren’t bad enough for them to go to therapy. So I’ll be honest: I’m not a fan of waiting until it gets bad enough, if we can help it. Another way to think about it is there’s always going to be someone with “bigger problems”, and it doesn’t serve us to get into the comparison trap. We can recognize our privilege and acknowledge the gifts we’ve been given without dismissing our own pain and hurt.
So here’s my big message here, one more time: you’re allowed. You’re allowed to do the things. You can give yourself the nourishment you need and know that’s not selfish or indulgent. That’s doing the work.
Most of us here can’t help but notice the abrupt change in seasons we experienced at the end of summer. Many people walked into my office feeling “off” – for some, this was a subtle feeling of strangeness, while for others, it was a more profoundly felt environmental grief. We’re a part of nature and so of course, it makes sense that we’re deeply impacted by it, emotionally and physically.
I was sent a beautiful article that touched on environmental grief that you can check out here. For this post, I’m going to focus on how we can cope with change of seasons more generally.
Take the Time to Reflect
For me, fall equinox was a time to slow down and set some new intentions: rest, support, and self-regulate. Not because I’ve met all my goals for the year (that would be nice) or have somehow otherwise “earned” it. I don’t believe that we need to earn rest. I’m listening to my body now because I’m tired. Now is a time for me to keep slowing down, to let extra work fall away (just as the leaves fall...) and focus on these 3 intentions so that I can continue offering the presence of self with my clients that’s so important to my work.
Many of my colleagues who live South of here speak about letting ourselves move with the rhythm of the seasons. For example, there may be a naturally “turning in” or cozying that we do in the winter months. At the same time, this is my perspective: as residents of Edmonton we’re in kind of a unique situation. Yes, it makes sense to move with the seasons to some degree. At the same time, I think we can really start to suffer when we’re alone or in our beds for too long, and the winter IS long here. We miss out on social connection, we miss out on being with nature, and if a lot of that time in our homes is in front of the tv, we can really miss out on being with ourselves.
It seems like a real balance – allowing ourselves to cozy in at times, while also stretching our comfort edges and ensuring we get outside at times too. The change of seasons gives us a clear chance to reflect on what we need and how we want to move into the next few months.
Get Your Routines in Place
Okay, so now you know that winter is coming. Time to get your routines in place. Bring your SAD lamp out of its hiding place. Sign up for the dance class that’s going to get you out of the house over the winter and keep your body warm. Organize that book club that helps you keep connected. Okay serious note. If your depression symptoms are worse over the winter, I’d seriously consider investing in a SAD lamp. If seasonal depression is truly at play, it’s one of the most supported treatments in the research.
And did you catch the three other things I put in there? Movement, being in nature, and social connection. These are often missing in winter and worth thinking about how you might integrate them. Of course, it’s up to you to consider the routines you need in place to feel whole.
I think it’s also super important to actually carve out time for this daunting task. Personally, I spent an entire day getting the routines in place and on the calendar. From my perspective, it’s worth the investment, and best to do early, before it’s hard to find the energy for.
Give Yourself Something to Look Forward to
Okay, while you’re planning all those necessary daily and weekly routines, are there parts of fall and winter you can actually look forward to? Maybe you love making your way through the corn maze and listening to the sound of the leaves crunching under your feet. Perhaps the quiet of the snow is really peaceful for you, and you’re looking forward to some cross-country skiing this year.
If finding something about fall and winter specifically seems to daunting at the moment, you can still find things over the next 6 months to look forward to. It might be a trip to the mountains, a vacation somewhere warm, tickets to the ballet, or some good local craft shows and holiday festivals. And of course there’s Halloween – a lot of my clients love dressing up, carving pumpkins, and having an excuse to get together with friends. If there’s even one thing a month you can look forward to, that’s wonderful. Again, I really encourage people to take the time to sit down and plan this out. Often, we can fall into a trap where we don’t end up organizing the things we need until we’re already in need of them, and then we’re more likely to run into barriers.
None of the things I’ve suggested are mind-blowing, I realize that. But I wanted to be the Psychologist in your ear saying, “you’re allowed to have things to look forward to. You’re allowed to take this time for yourself.” I hope it helps.
So I don’t know how many of you have seen a counselor, or if you ever wonder what goes on in the world of a psychologist OUTSIDE the therapy room (“do they really do all the meditating they’re telling me is so beneficial?”) but I’ve got a little bit of insight that I’d like to share with you. I have noticed that in psychology, self care gets talked about a lot… but similar to other helping fields, the actual practice of putting ourselves as a priority is not so good. There’s a lot of TALK about work-life balance, but the structural systems within the workplace – be it nonprofit or private practice – make it really hard to actually have balance. Now, in my early 20s, I was excited enough about the work, and energetic enough, that I could “buckle down and push through”. But by the time I turned 27 – not that old – the effect of “pushing through” was starting to wear on me.
"I can be so caring to my friends, my family, to anyone who needs it... but me? I don't deserve it..."
I hear this kind of sentiment time and time again from clients. The idea of self-care is nice, and they agree with the theory of honoring our own needs... but as an actual practice? Well, that's for other people. I mean, who am I to take up space, to have a voice, to need a break sometimes? If I really allow myself that, isn't it indulgent? What if it takes support from someone else who needs it more?
Nicole Perry is a Registered Psychologist and writer with a private practice in Edmonton. Her approach is collaborative and feminist at its heart. She specializes in healing trauma, building shame resilience, and setting boundaries.
About the Blog
This space will provide information, stories, and answers to big questions about some of my favorite topics - boundaries, burnout, trauma, self compassion, and shame resilience - all from a feminist counselling perspective. It's also a space I'm exploring and refining new ideas.
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