"Party Like a Shrink"

Mental Health Literacy as a Harm-Reduction Strategy

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Note: “Party Like a Shrink” is a modified version of a speech I gave when I was asked to speak on the topic of mental health and party culture.

Introduction: What is Harm-Reduction?

When I became a therapist, I was amused to learn that people think that being mentally healthy means you don't like having a good time. Let me clear: as a licensed and practicing psychotherapist, I love to have fun. When it comes to the pleasurable aspects of our lives– sex, drugs, and love– I believe mental health literacy is an essential harm-reduction strategy. What does that mean? Harm reduction refers to “a range of intentional practices and policies designed to lessen the negative consequences associated with behaviors.” From what we know, harm-reduction works. Drinking water in-between cocktails works at preventing bad hangovers. Condoms work. An AIDS campaign of “cum on me, not in me” worked. It lowered transmission rates. While harm-reduction may not work in every situation, it does work in many situations when it comes to physical health. I see no reason why it cannot work when it comes to mental health. 

I titled this essay “Party Like a Shrink” because I want to dispel the myth that to be mentally healthy you must be sober, celibate, or straight-edge. Of course, there’s nothing wrong with any of those things. If you are someone who indulges, mental health literacy can inform you how to party smarter. If you know what I know— about mental health— you can protect yourself and lower the odds of developing a mental disorder while enjoying life on your own terms. To teach you what I know, I am not going to lecture you. Instead, I am going to share three patient stories with you. I will speak in generalities and change names and details to keep everything confidential and ethical. These stories are inspired by real clinical experiences.

Of course, this talk is not a replacement for psychotherapy. I also want to be very clear about something: There is nothing inherently unhealthy about having a good time. What predicts mental illness is not an affinity for hedonism, but how you navigate your relationship to it. Furthermore, nothing about this essay implies that I’m perfect or don’t have my own things that I am working on. I am discussing this topic from a purely clinical perspective. 

Aaron and the Craft of Self-Attunement

With that, let me tell you the first of the three stories, about my patient I am calling Aaron. The lesson to be learned from Aaron is about something called self-attunement. When Aaron came to see me, he wanted to tell me about his girlfriend and how they wanted to open their relationship. They wanted to have sex with other people. After a while, Aaron let me know that whenever he and his girlfriend experimented by having a threesome, Aaron had difficulty getting out of his head. He had erection difficulties and if he managed to get hard, he was rarely able to orgasm. The handful of times that they dabbled with threesomes or played separately, Aaron found himself preoccupied with self-conscious thoughts. On the other hand, his partner really began to like the idea of being open. She loved it. The more she loved it, the more anxious Aaron got because he didn’t feel like he could perform. Aaron was ambivalent if he wanted to be open at all now that he saw what it was like to navigate an open relationship. He stopped using hook-up and dating apps and stopped initiating sexual activity with his partner. 

As I worked with Aaron, I noticed that he was very good at convincing himself that his feelings were wrong. Do you ever do this with sex or in life? Talk yourself out of how you are feeling? When Aaron and his partner were exclusive, he would make it wrong. He didn’t feel like he was doing what open-minded people who live in ?Brooklyn were supposed to be doing– being open. When they were open, he would feel jealousy or insecurity. He would say things like “it’s not right for me to tell my partner what she can and cannot do with his body if we’re open” and “if I’m insecure, that's my problem, I don’t want to burden my partner with my problems.” His reframes did not help him at all. He was experiencing clinically significant levels of anxiety and losing sleep. A big part of my work with him was building a sense of esteem to own what he was feeling. This is the craft of self-attunement. 

If you are a parent, attunement is your ability to be aware of and respond to your child's needs, especially when the child cannot necessarily articulate their needs. Self-attunement is the ability to listen to your nervous system and discern your own needs. This is often easier said than done, since what we need and what we want may not always be aligned. What we need can also vary depending on context. Many people will spend considerable time in therapy just learning to discern what they need and enjoy. 

Many people become practiced and talented at suppressing their own needs. This certainly seemed to be the case with Aaron. I told Aaron about two couples with whom I am friends– one is in an open relationship and one is not. My friend who is in an open relationship, when he sees someone touching his partner in a sensual way on the dance floor, he gets hard. At the very least, it fills him with delight to know that his partner is enjoying himself. That feeling of delight is sometimes called compersion– the opposite of jealousy. My other friend is in a monogamous relationship. He told me that the idea of his partner being sexual with someone else made him want to vomit. 

We cannot judge either one of my friends for having relationships that work for them. As they practice self-attunement, they give themselves permission to be flexible in those needs. Sometimes, my friend who is open, doesn't want to share his partner. He communicates that. Sometimes, my other friend, in the sanctity and privacy of his monogamous commitment, will fantasize about other people out loud while having sex with his partner. It is one thing to understand intellectually what you want or need. It is a completely different thing to experience asking for it. My work with Aaron reminds me that when it comes to sex and eroticism, people often are better off discerning what they like, not what others expect them to enjoy. 

It’s also important to note that Aaron’s anxiety did not get better because he continued to avoid how he was feeling. The literature is clear. When it comes to something like anxiety, avoidance almost always makes it worse. The lesson we can learn from Aaron is that being out of attunement with yourself is a one-way ticket to mental distress. It does not matter if you are wired for polyamory or monogamy. If you are out of alignment with yourself, your mental health often suffers. Like the great Carl Rogers said, “The curious paradox is that when you accept yourself just as you are, then you can change.” By learning to identify his own desires, Aaron was able to better attune to himself. When he did this, his anxiety, his erectile dysfunction, and his delayed orgasm went away. Today, Aaron isn’t totally open with his partner, but they are not monogamous either. He is practicing the craft of self-attunement. His relationship, his sex life, and his mental health are better for it. 

Bobby and the Pleasure-Pain Dynamic

Next, I am going to tell you about my patient Bobby and the Pleasure-Pain Dynamic. When Bobby came to see me, he was concerned about his drinking.