“Thank you for your vulnerability, Dr. Marich.”
Since coming out unapologetically as a woman in recovery from a dissociative disorder in 2018, I’ve received so many messages and social media replies that begin with this greeting. Being “out” has many meanings and layers for me—I’ve never hidden the fact that I’m in recovery from alcoholism and drug addiction, even though my advisers in the mental health field cautioned me about the perils of broadcasting it. In 2015 I made the decision to come out in every area of my life—to my professional following and to my conservative family—as bisexual, even though I never kept it a secret from my friends. Inspired by a Robert Ackerman teaching, I realized that I could not be a healthy woman in long-term recovery unless honesty prevailed about everything. And this led me to coming out with the dissociative disorder. Dissociative disorders are still highly stigmatized and largely misunderstood in the mental health professions, let alone by the general public. So many clinicians are afraid of us destabilizing and if the public even recognizes what a dissociative disorder is, old school portrayals of multiple personality disorders as seen in the movies generally serve as the association. In reality we are just people with many parts that form to protect the core self or to meet a need, generally in response to trauma. Sometimes the parts play well with each other, other times they don’t. With each vulnerable step I’ve taken further out of the shame closet, especially as a public figure in my field, I’ve learned an important lesson about vulnerability—people are simultaneously in awe of it and terrified of its power.
In this piece, which I write on my eighteenth recovery anniversary, I share what being out in my position has taught me, and continues to teach me about vulnerability. Before deepening this exploration, let’s get on the same page about what vulnerability means. Even though Brené Brown has made the word vulnerability popular in her stellar work over the last decade, people do not seem aware of its true meaning. Vulnerability is not just something you can simply define by one of Brené’s often-memed quotes. Vulnerability is more than just taking a risk or putting yourself out there into the metaphorical arena. At its core, being vulnerable is about engaging in trauma work, aware that this healing work can and usually does cause more pain in the process. If you’ve ever taken a course with me or have read one of my books, you know that I am a language nerd, and that my working definition of trauma is any unhealed wound—physical, emotional, sexual, or spiritual. This simplified definition derives from the word origin of the English word trauma—it comes from the Greek word meaning wound. Well guess what? Vulnerability comes from the Latin vulnarare, meaning to wound; another form, vulnerabilis, means injurious or wounding.
While the pop psychology understanding of vulnerability implies that one might get hurt if they want to take risks to grow, I will go a step farther and contend that hurt of all kind is inevitable. Here’s the lesson I’ve learned in my processes of coming out: Vulnerability is facing our wounding head-on and then deciding what we’re going to do in response to its impact. Are we going to ignore the wounds and thus open ourselves up to being hurt even more, or will we take the chance of feeling the pain we’ve stuffed down all the way through in order to experience freedom on the other side? I will spare you the details of my entire trauma narrative, yet I'll paint enough of a picture to qualify. By age four it was clear to me that I was too sensitive to survive the life I’d been dealt. By age nine I was already thinking of ways to destroy myself because I didn’t feel safe either at home or at school, and by 19 I was in full-blown addiction, the ultimate response of a developing brain that was bonded to dissociation in order to survive. I was born suseptible; life made me increasingly more vulnerable. Hurt was my baseline, and even though I got sober at 23, it wasn’t until 25 that the chronic suicidal ideation largely dissipated. Had I kept all of this bottled in, assuming I would have survived past my thirties, I’d still be hurting, albeit in a much more pervasive way and I’d not be writing this today as a sober woman. Sharing the pain with others is imperative, and I first learned how to do this privately with an amazingly trauma-focused sponsor in a 12-step program, then through high quality trauma therapy. I agree with Brené’s fundamental teaching that shame cannot survive when it is shared in safe spaces.
So why choose to be so public? Isn’t that the opposite of a safe space? In many ways, yes. Even though speaking freely about one’s recovery can be encouraged in certain circles, there is still a faction of the mental health field that is extremely uncomfortable with the practice. A painful lesson I’ve learned is that some people, including other professionals, can be downright hateful with their comments, or dismiss me as someone who can’t be trusted because I am either too unstable or I make it all about me. Some of these comments have been shared directly with me, in public forums or at conferences. Others have suggested that what I have to share from my lived experience isn’t as valuable as what the literature can back up with numbers and protocols. And others get downright silent and squeamish when I talk about surviving a clinically significant dissociative disorder and all that accompanies it (e.g., suicidal ideation, self-injury, addiction). A great deal that has been said behind my back has also been relayed to me—particularly that I have no boundaries for sharing so much of my story, or that it’s dangerous that I’ve let myself be the client in EMDR demonstration videos, letting colleagues work on me.
I expected all of these criticisms when I wrote my coming out article in 2018. I have three very easy answers for these critics that I’ve realized in the two years of ardent advocacy work that’s followed: (a) academic work in dissociation is important, and so is lived experience—we lose our soul as clinical professionals when we minimize that, (b) I don’t share anything publicly that I haven’t first addressed privately; may I suggest you look at what bothers you the most about my disclosures and ask if this is revealing something unhealed in you, (c) why haven’t you let someone do a public demonstration on you? While I respect everyone’s right to privately work on what they need to, if you are a clinical trainer or public figure, showing your vulnerability, i.e., your wounds will always help to diffuse the horrific us vs. them divide that promotes mental health stigma in society. Add these all to the pile of lessons.
I am public for all of the people, especially other professionals, thanking me for being so open in my position of privilege about things that our field has kept shrouded in mystery and shame. Especially dissociation. This is a particularly powerful lesson I’ve learned about vulnerability—when you put yourself out there and take a further beating for it—people who are prepared to hear it will be challenged into healing action. I’ve bore witness to many professional “comings out” as someone with a dissociative disorder, often for the first time. There is so much fear that they will be misunderstood (at best) or terminated (at worst) in their settings or larger clinical communities if they speak freely. Many people with dissociative disorders keep their condition hidden from their partners and their families, scared of the ramifications. For many of us it’s just easier to label what we have as something else—like PTSD or a bipolar disorder.
Yet in reality, dissociative minds have a masterful capacity to solve complex puzzles—we are often the most brilliant thinkers and leaders in any of our chosen professions. We are the ones who, if unafraid, jump in there and get things done, watching the professional committees in our fields wax on philosophically and theoretically about what should be done. Our dissociative minds are made of heart and soul, and when that can be appreciated and worked with instead of denigrated, the world can and will be changed for the better. When I know that my public sharing can validate even one other person with a dissociative disorder or other condition that is accompanied by a great deal of dissociation, being vulnerable in the way I’ve chosen to be feels more than worth it. I live for the day when public vulnerability is accepted as the norm and not seen as something out of the ordinary; I work to make that future a reality. And while recognizing this mission as my life's work is one of the most important lessons of my coming out, it's not the most important.
Dissociation was the hardest "coming out" because of the stigma that surrounds it. My ex-husband threatened to use it against me. When he tried and failed, I was no longer afraid to speak up about the way my mind works. Going through that divorce and surviving these attempts to discredit me was severely wounding. Vulnerable feels like an insufficient word to describe the experience. While sharing the fruits of my healing so publicly seems to have helped others, being vulnerable in this way has been imperative to my own continued healing. Every time I share something publicly, I feel like I am baring my naked soul in a similar way that one might bare their naked body in public. Yet today I can look at that nakedness and appreciate the woman who is bearing it. And I hope that for as many years as I have left in this body, I will continue to “come out” and honor vulnerability in a way that challenges others while also strengthening my capacity to heal through the radical practice of being honest.
So here I am today…eighteen years sober, “adult years,” if you will. I am still sifting through the layers and healing them as they are revealed and peeled back. I remain a hopeless train wreck in the romantic relationship department. Every time I try to date, I’m reminded of what my late friend Denise S. used to tell me—our relational parts of our lives can be the last to heal because they were the first to get wounded. I stay in my own counseling to address these injuries, knowing that I’m headed in the direction of greater health. I am navigating the waters of our current social climate, and I take my role as an anti-racist professional committed to doing my part to end the sting of systemic racism. I also know that the greatest service I can provide is to continue to do my own trauma work and help others to do the same. That’s how I changed for the better as a human and as a citizen, yet I cannot rest on this progress. I’m currently taking a good, hard look at how I’ve benefited from the American system existing as it is. And I know that getting uncomfortable and yes, vulnerable, is required on my part to make a real difference. This may involve me losing more family members, more friends, and more colleagues. Being vulnerable has taught me and continues to teach me that when I put myself out there honestly, things will always work out as they are intended. And I will feel inevitably feel healthier and more restored to sanity in the process.
Photography and Body Art by Michael John Gargano
This last year and a half has been an unending nightmare. I was “outed” as a person with a borderline personality disorder (BPD) by an angry classmate who I had trusted with this information. In the clinical psychology world this can destroy your career. What happens then to a clinical psychologist in training who outs you as a person who has been given a highly stigmatized mental health diagnosis? Nothing.
After what I thought was a minor disagreement, a colleague who has dealt with mental illness themselves and currently works with therapy clients, shared my mental health history and other personal information with other colleagues. Initially, I attempted to have an open discussion with this colleague. After several attempts at confronting this person, they became increasingly abusive. This colleague has since pushed me in the students' lounge, consistently rolled their eyes when I speak in class, shut me out of conversations and given me the silent treatment. Furthermore, they have isolated me and ruined my professional relationship with others in the program. In short, I am being bullied.
BPD is a highly stigmatized diagnosis. Although I do not identify with it and do not consent to this diagnostic assignment, it was given to me as a teenager. I experienced multiple levels of ongoing abuse, neglect and self-harm. These experiences spilled over onto my psychiatric treatment. Due to the many mistreatments and constant dismissal of my experience within the psychiatric community, I now consider myself a recovered psychiatric survivor.
As clinical psychologists we are trained to practice five principal ethical principles: benevolence and nonmaleficence; fidelity and responsibility; integrity; justice; and respect for people’s rights and dignity. Yet, two years into a doctoral clinical psychology program I have heard many horrifying things about people with BPD. The most common label is that “borderlines” are manipulative, needy, irrational, difficult, clingy liars; and incapable of completing graduate school or even undergraduate. Another misconception is that people with self-harm scars must have BPD. Diagnoses are reductionist labels. Although for many people they provide an answer to their troubles, for many others they add to their troubles.
Going back to where I started, I was “outed” without consent. After six months I finally got fed up and told my advisor what was happening. They advised taking meaningful action against this person. A school appointed psychologist told me to “suck it up.” I had done that for many months, wanting to respect this person's need to be angry and tolerating their continued abuse. Only one other colleague knew, but they remained close with the other colleague. I met with the program director, but there was not much they could do due to lack of evidence, and I did not want to disclose further details about my history, partly for fear of additional stigmatization.
I have enough going against me as it is for the clinical psychology field. I am a Latinx woman with little U.S. connection and Spanish as a first language. In addition, I have scars, the result of violence, abuse, self-harm and more. My scars can be seen and judged by anybody who pays close attention, which psychologists are trained to do. For the last year and a half, I have felt powerless. Some colleagues have caught up with the hostility but besides offering moral support have not done anything proactive to help stop the bullying colleague or be an ally.
Some colleagues have expressed that they do not want to fall at odds or be shunned by others, basically end up in the position I am in. What worries me is that not only myself, but our patients, are being put in these positions as well, dehumanized by the very professionals charged with helping them. The clinical psychology field seems to have an us (the healthy ones) versus them (the mentally ill) perspective. The field feeds and exists on the ideal that clinical psychology helps others heal, but in reality, they look suspiciously at those who have been able to heal, survived the system and have a desire to do the same for others. The field exists within the same authoritarian hierarchy as many other systems that perpetrate injustices. At one point a PhD student who disclosed their given diagnosis was told that by sharing that information they had created a “burden” for their colleagues. They mentioned how their mentor and “lab mates” had joked about their given diagnosis and how they felt the need to disclose their given diagnosis in order to make them stop. In addition, a historic lack of all expressions of diversity race, gender, cultures, economics, languages, sexual orientation and psychological experiences permeates the field to the detriment of the patients.
The ethical principles that rule clinical psychology are practiced as long as providers are the sane/normal ones and the patients are crazy and incapable. This has been further demonstrated by research on mental health provider stigma which may also take the form of prejudice and discrimination. For the last year and a half, I have felt isolated, betrayed, powerless and for the most part, defeated. I considered dropping out on multiple occasions. A quick Google search showed that there are not many clinical psychologists with lived experiences who are “out.” This made me wonder, how many of us are living in the shadows, quietly listening to others in our field making deprecating comments about people like us and being marginalized and bullied. Additionally, I wonder how “out” I actually am, how many people know and how will the labeling ultimately affect my career. These thoughts keep me up at night and I have debated many times whether or not to “officially” be out, and at least regain my narrative and speak out. Within our field it seems that labels or given diagnoses place a person within a box, context, or circumstance and the person's personal experience are most often discredited and dismissed.
One thing they could say if I “come out” is “Here she goes, the manipulative needy woman, needing attention,” as psychologists have previously said about individuals with a given diagnosis of BPD. These are the same beliefs that maintain the status quo, that create systematic barriers for individuals with lived experiences to speak out, get help and recover. These are the same mechanisms which perpetuate abuse within our mental health system. The field needs to change, clinical psychologists need to be held accountable for their role in keeping the status quo, and maintaining inequalities. In my opinion, clinical psychologists need to be challenged from the minute training starts, any training.
Individuals with lived experience in mental illness should be at the forefront of this change and leading these conversations, we are the ones who have been through the system. Even if our perspectives of how the mental health system should be revolutionized digress, they matter. Instead the field of clinical psychology, which often promotes healing and recovery, ironically keeps us marginalized as being “unable to recover.” Moreover, from what I know, many schools do not ask that clinical psychologists attend therapy themselves and for that reason many have never been in the patient’s role. Is this not hypocritical and counterintuitive? I am calling my field out for its hypocrisy and continued dismissal of marginalized voices. The field already exists within a Westernized white developed bubble and it is time to put a stop to all of this. Simultaneously, I am calling out my colleagues and future clinical psychologists for their continued participation in these practices. As it is, the clinical psychology field continues to promote and monetize the dehumanization of mentally ill people.
When will the dehumanization of people with lived experiences in mental illness stop?
If there was a category in my high school yearbook for “Most Likely to Become a Junkie,” I would not have been a contender. Indeed, I was voted “Class Brain.” And none of my smarts could prevent me from developing an addiction problem on top of an already budding mental illness. I spent the Fall of 2000 in a state of suicidal use, not caring whether I’d ever wake up. Even as I tried to get sober and well shortly after turning 21, I didn’t think I’d make it past 24.
These period of days from July 4-July 8 are quite celebratory. Most everyone in the U.S. is in a festive place on July 4th, my belly button birthday is July 6th, and my sobriety anniversary is July 8th. This year I turn 40, a momentous occasion for me who once believed I couldn’t ever survive this long. And I celebrate 17 years of sobriety. At the start of these special days, my spirit was somewhat dampened when I saw a friend post a “joke” from a parody account set up to represent an Ohio municipality. The post apologized to members of the city for having a scaled-back fireworks display this year, due to the fact that they’ve spent so much money on Narcan. And they “thanked the junkies” for ruining everyone’s freedom celebration.
I have a very crude sense of humor and I am not a person who easily offends. And this “joke” infuriates me in a way I struggle to put into words. Whenever you talk shit about alcoholics or addicts due to your own ignorance, misinformation, resentments, or unhealed wounds, you are also talking shit about me and scores of people that I love. There are many others who would look at me and the life I’ve built today and say, “But Jamie, you’re different.”
I’m really not.
Yes, I am successful by every conventional American definition of the word.
That’s because recovery defines my lifestyle today.
And it began in a place where I was just as desperate as any other “junkie” who may need revived in the back of an ambulance.
People who meet me now or only knew a very public version of me as a child can have difficulty attuning to this reality. A few years ago after marriage equality became the law of the land, I attended my first same-sex wedding in my hometown. The ceremony was beautiful. I cried through most of it, not ever believing I would see this in my lifetime. And my illusions of liberal paradise were short-lived. I was seated randomly with one of the groom’s family members. He came around at the beginning of the reception and introduced me, “Dr. Jamie Marich,” to everyone at the table. He gushed about how accomplished I was, that I was an author, and everyone at the table seemed impressed.
Towards the end of the meal, the opiate crisis came up as a topic of conversation. One of the family members stated quite bluntly what a travesty it was that we wasted so much money on Narcan, especially for frequent fliers.
“They should just let the junkies die already.”
Of course this was not the first time I’d heard talk like this. A few years prior at an extended family event, I heard someone opining that the government should euthanize people who fail treatment after three tries. And yet this was at a gay wedding, where most in attendance seemed to be tolerant.
My stomach churned, unable to finish my meal, realizing just how much of a stigma problem we still have on our hands. I found myself in that familiar position of freeze, wanting to say so much, yet fearing danger if I did. I wanted to ask that guy, “What if it was your child in the back of that ambulance,” or challenge him with, “And what issue is happening in your life that you’re failing to address? I’m sure your stuff is causing harm to those you love, just maybe in a different way? Have you ever considered that scapegoating addicts may help you feel better about yourself and the role that people like you play in perpetuating a trauma epidemic that people take opiates for?”
At one point the mother of the person making the comment said to me, “I’m sorry if this is upsetting you, this isn’t the best dinner conversation.”
In fairness, the mother, a nurse, challenged her son and also seemed put off by his comments.
“What’s upsetting to me,” I finally managed through that pain of freeze, “Is that I am a person with 15 years in recovery. Alcohol and opiates. And I could very well have been one of the junkies you’re talking about.”
Everyone seemed embarrassed and tried shifting the conversation to congratulating me on my recovery and how “well I had done.”
I’m just glad I had the chance to start somewhere.
I never needed Narcan or professional assistance to come out of an overdose or withdrawal, but I was getting close to the point where I could have. And many people in my network of recovery today, including sponsees who are working to make a difference in the world, required professional assistance for their lives to be saved. Yes, some of them had to go through the system of care multiple times before they got it. And I’m so glad they did. Because many parts of the medical and care system (however flawed they may be) did not give up on them, they eventually learned not to give up on themselves. A person I interviewed for my dissertation research was pronounced dead on arrival twice during overdoses, and would go through twenty-six rounds of professional treatment. And she eventually got access to the proper trauma-focused treatment that she required, later going on to make a big difference in her community.
Every day I get to see what happens when we don’t give up on people. Many people who work for me or with me are in long-term recovery. As a professional serving people at all levels of recovery from addiction and mental illness, I am privileged to behold miracles and know that recovery is possible. I know that it can be frustrating—for as many recovery stories as I witness, I see just as many people struggling to get it. And I’ve known way too many people who have died far too young. If you are a first responder, work in the hospitals, or in criminal justice, seeing the consequences of addiction play out in full living color, I realize that you may be jaded. It’s not easy trying to deal with people who are in the grips of it. I invite any of you to come and hang out with people like me some time. See what happens farther down the road when people get well.
I also recognize that an addict or alcoholic may have caused great pain in your life and this can be a hardening experience. I am the first to admit the damage that we can cause in the lives of others around us, and I realize that no apology can ever begin to heal those wounds. For those of us who make it through, we do our best to make amends through changed behavior. And please realize that even those of us in recovery have been impacted by the consequences of others’ addictions. I’ve been married to two people in active addiction. The son of my recovery sponsor was killed by a drunk driver. And although there has been pain to wade through, we’ve both chosen to be part of the solution, which first and foremost means being present for people who need recovery.
There’s always a fear when we advocate for these compassionate approaches to recovery that such softness will only give people more excuses. So let me share the piece of direction that changed my life which, I believe, embraces the delicate balance between validating and challenging people. When Janet, my first recovery sponsor, heard the story of my life and the progression of my disease she said, “Jamie, after everything you’ve been through, it’s no wonder you became addicted. What are you going to do about it now?”
People only respond to challenge and direction when they have first been validated and humanized. It’s not the other way around. Shame fuels the progression of addiction, and the comments and jokes on social media—no matter how innocuous they seem to you—are part of the problem. Intoning the wisdom of Anais Nin, shame is the lie that someone told you about yourself. For most of us, that starts with unhealed trauma and escalates by contact with others who would have us believe the lie. We say in the treatment field that guilt is when you feel bad about the things that you do, and shame is when you believe that you are those bad things. Shame teaches that those messages of defectiveness define you.
I’m grateful that I hung around long enough to learn the difference. And I’m even more grateful that I met people along the way who helped me to uncover a deeper truth about who I really am. For as much professional therapy as I’ve received and as much time as I spend growing in my spiritual practice, I am further grateful that I can still acknowledge my vulnerability. I am only human. If I stop taking care of myself, the chance is very real that I could be in the back of an ambulance, even after seventeen years in recovery, for reasons connected to my addiction and mental health.
To the people that will inevitably need revived from an overdose somewhere in the world today, I send you my love, my empathy, and if you want them, my prayers.
We are not separate.
Institute for creative mindfulness
Our work and our mission is to redefine therapy and our conversations are about the art and practice of healing. Blog launched in May 2018 by Dr. Jamie Marich, affiliates, and friends.