As a therapist I am a firm believer in the power of personal experience to connect with clients and remove barriers. Sometimes the best tool we have to teach others is through our own experience with tribulation. Still, when I first picked up Life is Trichy: Memoir of a Mental Health Therapist with a Mental Health Disorder, I thought the author, Lindsey Muller, may have gone too far.
I wondered why a therapist like Muller would disclose her most personal experience with potential clients, past clients, and strangers. Perhaps writing such a book is a show of courageousness, or perhaps a way to help “heal” her clients through her own experience. Whatever the case, Muller describes in detail her struggle with trichotillomania and other body-focused repetitive behaviors, called BFRBs for short, in a way that both lets us into her innermost experience and yet leaves out too much important information.
Trichotillomania is a disorder that causes hair pulling from various parts of the body, including eyelashes, scalp, beard, chest, pubic area, and other places that result in patches or bald spots. The mental health field currently considers it an obsessive-compulsive disorder triggered by anxiety, but also sometimes considers it a self-injurious behavior, or SIB.
Both BFRBs in general and trichotillomania in particular are complicated. We do not, at this point, always know what triggers the behavior, or how it should be treated. And, as Muller knows, we do not often discuss it.
That is why Muller discusses her challenges in a way that normalizes the experience of BFRBs. She uses very few mental health terms and writes more for a lay audience — and through the art of disclosure, aims to help readers better understand these conditions.
As Muller explains, she had a positive, healthy, calm childhood — nothing there that would seem to precipitate her hair-pulling behaviors. She had attentive and supportive parents. She went to a good school and got good grades, and was an overachiever. So why did chronic hair-pulling and skin-picking begin? What would trigger these behaviors if her life seemed to be good?
Muller suggests that her trichotillomania may have been triggered by brain overload, such as multi-tasking or engaging in a difficult task that requires sustained attention or brain stimulation. She also attributes it to a desire for internal homeostasis (balance) and low attentional demand (boredom). She provides a brief overview of the diagnostic criteria for trichotillomania and available treatment options — and she admits, to a certain degree, that her view of the disorder is different from that of other clinicians. Some experts believe the illness is caused by behaviors that become habitual and anxiety-related, or that they are related to ruminative thought patterns that trigger emotional responses.
As to how Muller overcame her trichotillomania, she remains vague. She states only that she grew tired of the hair-pulling, and it stopped.
It is useful that Muller reveals her internal thought patterns, feelings, and conflicting emotions that often accompany her BFRBs. That can help educate clients, parents, and families about the reality of living with trichotillomania. At the same time, by projecting herself to have been a well-adjusted child, Muller may make it hard for readers to relate to her.
Moreover, the way she seems to have easily overcome trichotillomania may alienate other sufferers. My own clients with BFRBs mostly report that their behaviors are very difficult to stop, and some even have suicidal thoughts that seem to be triggered by their BFRBs. If they could just “grow tired” of the disorder, they would. But, unlike what Muller claims happened to her, they do not.
And so Muller leaves us confused. She does offer a very personal look at what it’s like to be an otherwise well-adjusted person who suffers from trichotillomania. But when it comes to treatment, she leaves a lot out.
Life is Trichy: Memoir of a Mental Health Therapist with a Mental Health Disorder
Mindful Publishing Co., November 2014
Paperback, 192 pages