988 is the New Suicide Hotline, but be careful what you say

This past week the National Suicide Prevention Line became easier to use. All you need to do is dial 988 or text 988 and you can be connected to a trained listener. 

However, be careful what you say to them. They are mandatory reporters which means they have to report abuse, violence or self-harm. If you say the wrong thing, they might call 911 on you. Before you say, post, or text anything, think twice. How is the other end going to respond? If you do not want emergency first responders at your door, please think twice about how you phrase things. 

Talking to someone when you feel at your lowest helps. They can point you to resources in your community. 988 is an important resource for everyone who wants better mental health to know. You can talk about bullying at your school or your insensitive boss. You can talk about a family member in crisis and how to deal with them. You can talk about how hard it is to live in your violent neighborhood and you can talk about how hard unemployment or under employment is. 

Mental Health Q & A: Dear Lex

Dear Lex,

I’m compelled to trace certain numbers in the air, twirl my pen and touch the corners of paper. This is all to cope with my generalized anxiety disorder (GAD). The bad thoughts start coming and I am compelled to get relief by doing these things. The thoughts never stop. The compulsions happen in infinitum. I just cannot stop. I’ve tried listening to music to interrupt my thoughts, meditating, running, strength training. All this works for a minute. But when I am working or idle, I am back at it. OCD is driving me crazy. I also repeat myself over and over to reassure myself that everything will get done today. I need to try freewriting more like I am doing now to occupy my fingers and thoughts. Whether typing or through a journal this serves to stop the thoughts and give me something else to focus on. I also love to play with pens and pencils twisting them in the air, making shapes with them. 


Dear Compelled,

You need to find out exactly why these thoughts occur. Next time, one occurs, start freewriting about why you think you are having the thought. If you can pinpoint the why of the thought, you can self-talk next time it happens. You can say to the thought “I know this is distressing but it is not what I want to focus on right now. Please go.” Or “Everything will be fine. I don’t need to do this now.” Or you can allot time to do the compulsion as a reward for doing actual work. Though, the latter is not recommended. You don’t want to reinforce negative behavior. Exercise, writing, meditating and listening to music all will help. It sounds like you have started to develop some coping mechanisms naturally. 


If you have questions for Lex, please email me on the contact form on this blog. 

Swiss photographer Captures Manic Depression on Film

Courtesy of Matthieu Zellweger, a photograph in the “Worlds Beyond” collection

Matthieu Zellweger

Matthieu Zellweger, Ph.D., a Swiss scientist and photographer, shoots haunting, surreal and journalistic pictures of manic depression that make it seem like the subjects are experiencing unreality in real time. The pictures in “Worlds Beyond” featured in the scientific journal the Lancet are staged but give one the feeling of experiencing the states in which the subject has experienced. His journalistic work on the subject were documented in “Invisible Handicap,” which can also be viewed on his web site. The pictures have a haunting beauty of this otherwise mysterious, sometimes frightening illness. The surreal-like quality of “Worlds Beyond” helps bring one immediately into the mind of the subject. I interviewed Matthieu about “Worlds Beyond” after reading his essay in Navigating Bipolar Country by Merryl Hammond. His work has been featured around the world in many publications such as the New York Times. Here is a transcript of our chat. 

AZ: Where in Switzerland are you?

MZ: In Rolle, near Geneva, in the French-speaking part of Switzerland

AZ: What type of cameras do you use? digital, print or both? 

MZ: Both, depending on the specific project. The project “Worlds Beyond”, and the eponymous book was shot only digitally, however.

AZ: Where did you do your education for photography and health science?

MZ: I am an autodidact photographer. As an adult, I participated in a few carefully selected Masterclasses. For the health science part, I was educated and trained in Switzerland (Ph.D) and Japan (Post-doc).

AZ: What is your process for creating the dreamy effect in your work?

MZ: Slow speed, mainly, and the right amount of movement, lighting and instinct.

AZ: How do you capture people going through manic episodes? 

MZ: I met only few people during manic episodes. All people featured in the book were in a stable period of their life and/ or disease. For people during manic episodes, I asked for permission, then usually secured a second and a third level of consent by, for instance, contacting the person again at a later stage or asking the doctor looking after that person if the consent was acceptable or not. Some pictures that I have shot around people unable to give a suitable agreement were simply never published or used.

AZ: What was your interview process like? 

MZ: For the pictures in the book, I only selected people whom I had already met and interviewed for the first, journalistic part of the project. They were all in a stable period of their life and/ or disease. I recontacted them and asked if they would be willing to share with me some details of their choosing on their own manic phases. Then I reconstructed images based on these details and, with their agreement, staged them. All the pictures in the book are thus deeply personal to the subject on the pictures because they are reconstructed using elements specific to that one person and nobody else. The images are also staged, posed and later validated by the people who participated. In that sense, they are not journalistic, but artistic. The journalistic images of this project are kept separate in a project titled “Invisible Handicap”.

AZ: What is it like to play the voyeur in someone experiencing unreality?

MZ: I do not know. The role of a photographer is to uncover realities that society prefers to ignore, to show the invisible. My work ethics is such, however, that I am extremely careful to secure the agreement of all parties before I start shooting. This is even more the case for staged pictures, such as the ones in “Worlds Beyond” inasmuch as the protagonists in the pictures took an active role in giving me details about their manic phases, agreed to the project and the pre-arranged shootings, etc. This was very much a collaborative effort. 

AZ: How is photographing mental illness unlike documenting your other work?

MZ: Mental illness is, as one protagonist put it, an invisible handicap. It is more delicate to show something invisible.

AZ: What countries did “Worlds Beyond” take place in?

MZ: Switzerland, UK, USA

AZ:Was it exhibited in any place besides the Lancet? like a gallery?

MZ: It was not, but it was widely featured in newspapers, magazines, television. It still may be exhibited at a later stage. In addition, the third part of the project, “His Name Was Alban” was exhibited in Switzerland and printed as a portfolio of conceptual, fine art photographs.

AZ: What was your thinking about capturing manic depression using the blurry effect?

MZ: I did capture it in many different ways, since the entire project had three chapters: “Invisible Handicap”, “Worlds Beyond” and “His Name Was Alban”. Only the latter two use the blurry effect. Initially, I saw it as a suitable way to distinguish the journalistic images from the staged ones. Later on, it became clear that it was rather adequate to describe the inner mental space of someone who had, literally, taken me into their mind.

AZ: What is your favorite photograph in “Worlds Beyond”?

MZ: Not sure I have a favourite one. They all tell a story, perhaps several stories, to the extent that they talk about one person and about the connection that I established with that one person, the trust they placed in me and, sometimes, the friendship that resulted. 

AZ: You have a scientific background. How does it interplay with your art?

MZ: It helps me start a new project by exploring quickly the state-of-the-art knowledge on a question I might ignore all about. It also guides my choice of topics to photograph.

AZ: Have you documented other health related stories in photography?

MZ: Yes, several: stillborn children; domestic violence inflicted upon men; depression; suicide survival.

AZ: Who are your photographic inspirations?

MZ: Anyone able to tell a story, stir emotions and surprise me by taking me on a journey with a photo essay.

To view his “Worlds Beyond” series please visit https://matthieuzellweger.com/en/photographies/worlds-beyond. To view his other work, visit http://www.matthieuzellweger.com. Matthieu Zellweger is represented and distributed by Haytham-REA, Paris.



Dear Future Husband

Disclosure in Romantic Relationships is Important to Increase Understanding about Mental Illness

My mania plays out in rapid speech, racing thoughts, odd ideas at all hours, little to no sleep. My manic hypersexuality has led to a one-night stand and many unpleasant relationships, the kind where it’s ticklish when you later bump into him in the supermarket. I was married to my manias, with no hope for a “normal” life with a “normal” man. That’s why when I met Robert at the synagogue where I worked, I felt ambivalent about entering a new relationship with anyone. 

In college, I was diagnosed with rapid cycling, type 1 bipolar disorder. I dated but the relationships usually ended before I disclosed my illness. I left men wondering about my eccentric behaviors, wild nights, and strange ideas about the world. I felt broken.

There was also this: I couldn’t have children. My psychiatrist had warned me that pregnancy could worsen my moods and psychosis and getting off meds was not an option. If I got pregnant, I would likely end up hospitalized, which my family was trying hard to avoid. Having been hospitalized a few times, another might break us emotionally and financially. 

My father reassured me that couples without children had more freedom. He said, if you want to nurture someone, adopt a cat. I didn’t want to be a spinster with her cats; but I didn’t need more bad relationships. 

So, when Robert walked into the synagogue that day, my back was up. He was six-foot-four with sweeping brown hair like Hugh Grant in Notting Hill. I couldn’t help but feel attracted to him physically. I chatted with him like he was just another congregant, brushing off his flirtation. I pretended not to notice his advances. He brought in gifts, cards and made a donation to the synagogue when my grandfather died. 

Inevitably, my hypersexuality kicked in and I decided that Robert would be good to fool around with, a friend with benefits. I agreed to a date at Starbucks, although I still wanted to play hard to get. Over conversation I learned his brother, mother, sister-in-law, and dog had recently died and he lived alone. This was perfect for fooling around, I thought. If we went to my place, my overbearing Jewish mother would be home. 

The date went well, and we talked over Messenger every night from there on. We shared this kinetic sexual energy plus I could talk to him about anything. One night, we fought about how I was putting him off.

He called me “crazy.”

I knew it was the time to disclose my bipolar. I felt myself falling for him and this would be the way to avoid heartbreak; I could disengage without too much hurt on either side.

So, I sent him an email, something new for me. I usually slammed the door in men’s faces well before I had to hear their reaction. 

Dear Robert,

I think I love you despite our differences. But there is one thing you should know about me before we move forward in our relationship. I have this thing called bipolar disorder. It doesn’t change who I am or my love for you, but it does come with intense swings of high emotion. I can understand if you have fears about getting more involved with me. There is most likely going to be trouble sometime in our love story, but there will be good times as well. I hope this doesn’t change your mind about me.



Then I waited.

I received his email a day later. He wanted to talk at his house over dinner. I was terrified, but  agreed to go, figuring he just wanted to let me down in person, like a gentleman. When we talked, I painted a picture of what my illness had been like and what would become if I went off lithium and my antipsychotic. 

To my astonishment, he responded with unconditional love. He divulged that his brother had struggled with mental illness and alcoholism. I didn’t promise him that my illness wouldn’t rear its ugly head in our relationship, but I promised honesty. 

Six months later, I introduced him to my psychiatrist. Another few months later, we were engaged. We have a loving, fun marriage for 11 years and adopted a kitty named Sunshine. 

Boundaries Strategist and Psychological Safety Consultant Talks about Struggle with Mental Health System

Katrina Strohl

“Because Black people are less likely to be diagnosed with ADHD at younger ages they are more likely to develop a substance use disorder,” Strohl said. “It is systemic to associate certain groups of people with certain substances such as marijuana. We need to have a better conversation about substance use.”

Katrina Strohl

Katrina Strohl (They/She/He) is the creator of the podcast Absolutely Not! About setting boundaries in the workplace and emphasizing the vocabulary needed to name harm in those spaces. Katrina is a psychological safety consultant, boundaries strategist, and mental health advocate who identifies as Black and Samoan and Queer. In 2018, she tried to end her life and while in the hospital was diagnosed with Post-Traumatic Stress Disorder PTSD, Major Depression Disorder, and substance use disorder. But more recently, she was diagnosed with Attention Deficit Disorder and Hyperactivity ADHD. Katrina is a veteran who served as an aviation structural mechanic in the US Navy. 

During Katrina’s first hospitalization, she was one of two Black women and was constantly called the other woman’s name. 

“We are at the lowest point in our lives and constantly dehumanized,” Strohl said.

Most of the time during the hospitalization Katrina spent going to sessions and lying their way out of the hospital. Katrina was a single mother of a three-month old son and they needed to get back with their son. The hospital let her go in four days.

Two months later Katrina took their own life again. Katrina had no support as a single mother and when they had to breast pump or take their son somewhere Katrina’s employer in the office she worked as an administrative assistant didn’t understand. They brought Katrina into a room and criticized and berated Katrina. 

“I felt like I didn’t have a place on the planet anymore,” said Strohl.

During her second hospitalization, Child Protective Services got involved and made Katrina prove that their son lived in a happy, safe family or he would be taken away. 

“This is when I decided I needed to move forward and figure out what we needed to be safe,” Strohl said. 

“I left the practitioners who diagnosed me with PTSD, MDD, and substance use disorder because they weren’t helping me,” Strohl said. “They didn’t give me resources I needed to feel better.”

Katrina then went to a few white, women therapists who acted dismissive whenever she brought race into the picture. 

“A Black woman therapist was the first person who taught me about boundaries that most people learn in their first therapy session,” Strohl said.

Katrina doesn’t take medication anymore and has a new Black woman therapist; the old one turned out to be homo/transphobic. This therapist correctly diagnosed her with ADHD. This was shocking to Katrina but she felt it rang true when her therapist asked her during her evaluation if she felt like she had a motor inside her that never stopped. Katrina cited an article that said Black children are less likely to be diagnosed with ADHD and it often leads to suicide. 

“I’m still processing the diagnosis and I cried a lot in the final assessment because it rang true,” Strohl said.

“Growing up there was an ugly stigma toward ADHD in the black community,” Strohl said. 

“Because Black people are less likely to be diagnosed with ADHD at younger ages they are more likely to develop a substance use disorder,” Strohl said. “It is systemic to associate certain groups of people with certain substances such as marijuana. We need to have a better conversation about substance use.”

Today Katrina is self-employed and works with organizations to make them aware of what psychological safety looks like and how to create boundaries for employees. 

“I create boundaries in everything I do. Every facet of my business helps me hone into who I am.”

“I have to figure out new boundaries because I live with ADHD.”

“With the PTSD, I cannot be in emotionally activating conversations for longer than 45 minutes and I cannot be interrupted or my thoughts will derail.”

“Sometimes my work makes me sad and the responses I get from my posts on social media is eye-opening as people with my shared identities and lived experience have been through the same things.”

Katrina knows their work is creating a safer world for their son to grow up in. Katrina can be found at http://katrinastrohl.com.  

From Not Good Enough to Enough

How reframing my inner dialogue makes all the difference

I’m an over-thinker as most bipolar people are. My inner critic constantly berates me. I let him, who I call Arthur, live rent free in my head. As a result, I don’t feel good enough, like my writing is not good enough for publication. It’s an endless cycle. 

Since being diagnosed bipolar 1 over twenty years ago, it’s a struggle to accept compliments or believe in myself. I simply have had made too many mistakes, had disastrous manias, and despairing depression. It’s hard to love yourself and find your purpose when mania has made you a slut, an imposter, and a generalist with no follow through. 

I want to become someone who commits and completes projects not someone so embodied by imposter syndrome that she feels her voice is not needed in this world, that she does not deserve the good that will come from her hard efforts. 

I use affirmations in a journal daily, practice gratitude, and meditate emptying my shell of all negative thoughts about myself. But sometimes my inner critic can be so powerful. 

My therapist suggested a combination of dialectical behavioral therapy (DBT) and cognitive behavioral therapy (CBT). She said I have to reframe my inner dialogue and stop ruminating on the negative. She said I needed to make a list of the past events that trigger my thoughts and then write a conversation with each of them, a sort of saying good-bye but also learning the lesson they taught me. 

Since I am a writer, I thought having this conversation with my inner critic would be as easy as telling him to pack up and go. How wrong I was. I sat with my notebook blank for a long time in the coffeeshop. I was afraid of my own power, fearful of letting go of what would happen if my words became a self-fullfilling prophecy. After five minutes of twiddling my pen, I began to write in my perfect journal with my sketchy handwriting. 

I began telling my inner critic how he was hurting me and my career as a writer. He answered me back with snide comments and slurs I cannot write here. But somehow through writing a conversation with him I realized some truths about myself. 

I broke through my resistance by telling myself that I am enough. I just needed to cut through the bullshit and show up in this world giving it my all. I needed to work harder than the rest but not feel I had to be smarter than them. Giving my all was all I needed to do, to be. 

I had to stop comparing myself to others and caring more for what others were doing. I needed to put myself first. One of my favorite authors Dani Shapiro says one must write in the dark before they can truly understand and experience criticism or praise of their work. I had to put myself in this proverbial creative cave by not caring about what others thought of me or how their work was somehow better than mine, how their voice was somehow more relatable. 

Of course, writing in the dark in the days of social media and a constant barrage of news and features on others doing extraordinary things can be hard. The blue light of the pulsing tweets and posts made head spin with envy and self-doubt. My therapist suggested as a rule I only go on there once a week and spend only 15 minutes scrolling. She also suggested I stop checking other people’s web sites and blogs incessantly. I needed to put me first. 

I began to incorporate these ideas into my daily writing schedule and I found that my writing became deeper and insightful. I found that I could remember more of what really mattered. I found that telling myself that “I am enough” gave me the power to tune out the other voices, especially that of my inner critic. 

So, get yourself a notebook and a pen and begin to have this self-conversation today. Don’t wait! After all, you are enough.