I am writing about this here rather than taking this conversation to social media because I want this to be a space where people can digest the information without having to navigate comments that might spark feelings of shame, guilt, judgment, or anything else that takes away from the conversation itself.
As I have been watching the Lindsey Clancy trial, my clinician brain, my experience with childbirth, and my own experience navigating perimenopause have all had a lot to say.
And if you have ever had to navigate our healthcare system—or if you have loved a woman who has struggled with her mental or physical health, whether postpartum, during midlife, or simply with a medical concern—you may understand why I keep coming back to the same thought:
Our healthcare system is broken in ways that can have very real consequences.
The impossible position clinicians are sometimes placed in
As clinicians early in the trial have been questioned about decisions surrounding hospitalization, I keep thinking about the policies and criteria that mental health providers are bound by.
There are specific standards for medical necessity. There are criteria that determine who qualifies for hospitalization and who does not. There are certain words, questions, and thresholds that providers are taught to listen for when determining risk.
And every time a client walks out of my office when there are concerns about their safety, there is a part of me that hopes and prays I have made the right decision—and that the client will use the resources we have discussed if their situation changes.
That is an enormous responsibility.
It also highlights one of the problems I see within our mental healthcare system: we can become so focused on meeting criteria that we lose sight of the whole person.
How many providers are involved in someone’s care? What has been tried before? What helped? What didn’t? What has the person been telling other providers? What are they afraid to say? What gaps exist between their different providers?
These questions matter.
Yet too often, our healthcare system does not make enough room for the time and collaboration needed to ask them.
This is one of the reasons I believe you are seeing more clinicians move away from insurance-based care. Many of us want the ability to spend more time with our clients, be thorough, collaborate, look at the whole picture, and provide care without having every aspect of treatment dictated by criteria designed for a system rather than an individual human being.
And sometimes we are forced to find a diagnosis or a label when, in that moment, the most important thing is understanding the person sitting in front of us.
A woman can be functioning—and still be falling apart
This is where my anger really begins.
The idea that mental illness or a mental health crisis somehow becomes less real because a woman is still functioning in her daily life is incredibly dangerous.
A woman can go to work.
She can get her children dressed and off to school.
She can work out.
She can make dinner.
She can attend her child’s soccer game.
She can bake the cupcakes.
She can run a business.
She can laugh with her friends.
And she can be absolutely falling apart on the inside.
I know women who walk into my office carrying enormous amounts of pain, grief, anxiety, exhaustion, trauma, hormonal changes, relationship struggles, parenting stress, and life circumstances that would overwhelm almost anyone.
My office is often the place where they finally get to fall apart.
Then they gather themselves, walk back out the door, and continue doing all of the things life requires of them.
Functioning is not the same thing as being well.
In fact, some of the most high-functioning people I work with are functioning precisely because they have become exceptionally good at compartmentalizing, masking, pushing through, and doing what needs to be done.
They have learned how to keep moving even when they are struggling.
We often mistake that ability to keep moving for evidence that someone isn’t really struggling.
It isn’t.
A woman can be incredibly competent and incredibly unwell at the same time.
I know this personally, too.
There have been times in my own life when I have been the woman who looked completely fine on the outside while struggling on the inside.
Because therapists are human too.
We’ve conditioned women to hide their struggles
Women have also been conditioned for generations to put a smile on their faces and be grateful.
Think about the messages a new mother can receive when she says she is exhausted, overwhelmed, or struggling with how difficult motherhood feels.
“Be grateful.”
“Isn’t this what you always wanted?”
“At least your baby is healthy.”
The intention may not be malicious, but the impact can be profound.
A woman can begin to feel ashamed of having those thoughts at all.
So she doesn’t say them.
She smiles.
She says she’s fine.
She posts the picture.
She goes to the pediatrician.
She goes back to work.
And she keeps the hardest parts to herself because she is afraid of what people will think if they knew what she was really feeling.
I know because I was that mom.
I remember feeling like I needed to put a smile on my face and portray the happy family who had everything under control.
Thankfully, I was never anywhere near the level of crisis that some women experience postpartum. But I understand what it feels like to believe that you are supposed to be okay because you have a healthy baby and a life you are supposed to be grateful for.
And I think there is something important about recognizing that these expectations don’t necessarily disappear as our children get older.
Women continue to be expected to function, to care for everyone else, to keep the household moving, to work, to parent, to show up—and often to do it all while quietly navigating significant changes in their own bodies and minds.
And then there are the hormonal transitions we don’t talk about enough
This brings me to another area that has become incredibly important to me over the last two years: the impact of hormonal changes on women’s mental, emotional, and physical health.
I have become increasingly aware that we tend to talk about women’s reproductive experiences as separate events—pregnancy, postpartum, miscarriage, perimenopause, menopause—rather than recognizing that these are significant biological transitions that can profoundly affect the brain, body, mood, sleep, energy, cognition, and emotional wellbeing.
And we don’t do a particularly good job preparing women for them.
I work with postpartum women who have experienced miscarriage or the death of an infant.
And I think about how often women are sent home after these experiences with very little understanding of what their bodies are still going to go through hormonally—even though they may not be bringing a baby home.
The body doesn’t simply stop the hormonal process because the outcome of the pregnancy changed.
There are enormous physical and emotional changes happening, and yet women are often left to figure this out themselves.
It is almost unbelievable to me that I know more now about hormones and the brain and body than I did after giving birth to my own children.
I went home and focused on being a mom.
When I cried, I didn’t understand why.
When I was sad, I didn’t understand why.
When my hair was falling out, I didn’t understand why.
I didn’t understand the roller coaster happening inside my body.
And it wasn’t until I began navigating perimenopause that I started to truly understand how profoundly hormonal changes can affect us mentally, emotionally, and physically.
The irony isn’t lost on me.
I went through one major hormonal transition when I became a mother, and years later I found myself experiencing another major hormonal transition—and only then did I begin to understand pieces of what I had experienced years earlier.
How is this not something we are taught?
Women deserve to be heard
This is an area I have become incredibly passionate about.
If you are in my office, you probably know that this is now part of my assessment:
Where are you in your menopause journey?
Because we cannot separate the mind from the body.
We cannot understand what is happening psychologically without sometimes understanding what is happening physiologically.
And you cannot fully appreciate how disorienting hormonal changes can be until you have experienced them yourself.
This is not to say that every emotional or mental health symptom a woman experiences is caused by hormones.
It is to say that hormones are one piece of the picture that deserves to be considered rather than dismissed.
And the same is true of being dismissed by a healthcare provider when you know something isn’t right.
When you say, “I don’t feel like myself,” and the response makes you feel as though you’re imagining it.
I experienced this myself.
Over the past two years, I have tried to collaborate with my physicians, bring resources and questions to appointments, and advocate for myself.
I have been told things like, “You can’t stay young forever,” or “I think body image is going to be the hardest part of this for you.”
Maybe parts of those statements were true.
But they weren’t answers to what I was asking.
I was trying to understand what was happening to me.
I wanted my providers to be willing to explore the information I was learning and consider whether there might be another piece of the puzzle.
When that didn’t happen, I ultimately chose to find different providers.
And I am incredibly grateful for the providers who listened, collaborated with me, answered my questions, and became part of my healthcare team.
But I also know that not everyone has the time, energy, resources, confidence, or knowledge to keep searching for answers.
And that is where I believe we have an enormous problem.
So why am I writing this?
You may be wondering what the purpose of this email is.
It is this:
I want my clients to know that they are allowed to use their voices.
You are allowed to ask questions.
You are allowed to ask why.
You are allowed to ask what else could be contributing to what you’re experiencing.
You are allowed to interview your healthcare providers.
You are allowed to seek a second opinion.
You are allowed to fire a provider who repeatedly dismisses you.
You are allowed to bring someone with you to an appointment.
You are allowed to ask your partner to learn alongside you.
And you are allowed to say, “Something isn’t right, and I need you to listen to me.”
I am passionate about helping women understand what is happening to them so they don’t immediately assume they are crazy, difficult, weak, or failing.
I am passionate about helping clients understand the healthcare system, including the limitations that insurance can place on care.
I am passionate about helping women become informed participants in their own healthcare.
And I am passionate about the men who love these women learning, too.
Because sometimes the person sitting beside a woman in the doctor’s office needs to understand what she is experiencing just as much as she does.
This is bigger than one case
As I watch this trial, my heart breaks for this family.
There is so much tragedy here.
And regardless of where anyone lands on the legal questions surrounding this case, watching the testimony has brought up something much bigger for me.
I keep seeing reflections of the systems I encounter every day in my work.
Systems that can miss people.
Systems that can reduce complex human experiences to checkboxes.
Systems that don’t always communicate with one another.
Systems that don’t always listen when women say, “Something is wrong.”
And systems that sometimes expect a woman to prove she is struggling badly enough before she is worthy of receiving the care she needs.
That is what has been sitting with me.
And that is where I feel the fire in my belly.
I don’t know exactly what change will look like.
But I know I want to be part of it.
I want women to speak louder.
I want the people who love them to listen more closely.
I want providers to collaborate more.
I want women to understand their bodies.
I want mental health and physical health to stop being treated as completely separate conversations.
And more than anything, I want women to know that they can be functioning and still need help. They can be capable and still be struggling. They can be smiling and still be hurting.
We have to stop using someone’s ability to keep showing up as evidence that they must be okay.
Because sometimes showing up is simply what a person has learned to do while they are surviving.
If any part of this resonates with you, I hope you’ll let it be an invitation to become a little more curious about your own experience—and a little less judgmental of yourself.
