Good day, dear friends. I hope you’re well and happy and healthy. I’m coming off a long and very relaxing weekend filled with a balance of relaxation and adventure. I’m feeling a little Monday-morning-quarterback wishing I had been more productive but in the moment I chose relaxation and I trust that was right for me.  I know what I need to recharge.  Why does that matter?  Today, we are discussing severity in mental illness and how it impacts people differently.


Today I wanted to talk about something I see in therapy a lot and that makes me sad. Because I work in an outpatient setting, I see people with greatly varying degrees of illness. We usually refer to this as severity. There are some people who have severe mental illness and some for whom it is more mild. When determining how severe the illness is (and this changes frequently- our illnesses may be very severe during one year of our life and then when we add protective factors-like therapy, support, and medication- it gets much less severe), we consider how big of an impact it has on the person’s life.

Does it interfere with them bathing, dressing, eating, cooking for themselves, going to work or school? Then we label it higher severity. In some cases, it’s even necessary to change levels of care. If this has ever happened to you, please don’t take it personally. It is not that your therapist is sick of you, thinks you’re too “lost” to help, or anything like that. They make recommendations based solely on what is best for you.


In the same way that a primary care doctor would not try to fix a collapsed lung in their office, outpatient therapists will recommend hospitalization or community mental health services if we feel that we can’t provide enough services to help the person. It’s really an act of caring. We refer to another program only when we feel we are doing the person a disservice by not providing the best possible care for their health. If we can’t provide it, we want them to be somewhere where they can get it.

Last to Ask for Help

One of the problems with this is that I often see people with mental illness (who are, by a large, very conscientious, last-to-ask-for-help, more-concerned-about-others’-needs than-their-own group of people) that is mild or moderate questioning if they really need therapy and leaving too soon or never coming in at all. There’s a difference between thinking “I’m feeling much better. I’ve met my goals and can maintain my gains without professional support” and thinking “I don’t really need this. I’ll be okay. Someone probably needs that spot more than me”.

There are so many thinking errors here. The first is that you don’t deserve help because you aren’t sick enough. Don’t wait until it’s an emergency. That old saying “An ounce of prevention is worth a pound of cure”? It’s very true in mental health, too. Just because you don’t absolutely need something doesn’t mean it’s not a worthwhile investment. My car doesn’t need an oil change every 5000 miles (I use a synthetic, y’all, it’s okay) but that doesn’t mean that taking good care of it shouldn’t be a priority. Please don’t talk yourself out of caring for your health because you’re not “sick enough” or your misery doesn’t seem comparable to someone else’s.

Only So Much to Give

I see people who feel ashamed or less than worthy because they’re not “keeping up” with either their own expectations of productivity or the expectations have set for them. But the truth is, they might have less energy or it might take them more energy to accomplish the same tasks. There was a post that circulated facebook for a while about chronic illness being like having a certain number of spoons each day and while healthy people can find or make more spoons, people with a chronic illness (whether that be pain or asthma or depression or anxiety or what have you) are stuck with whatever number they get.

So let’s say you start the day with 20 spoons and it takes 5 to get out of bed and shower, 3 to make a decent breakfast (more than cereal), another 2 to get to work on time….you’re 1/2 way out of your energy for the day by the time you get to work. Instead of writing a story in your head that you’re weaker or less worthy because of this, can you look at yourself through eyes of love. You are a warrior! If you can make it through the day on fewer spoons than others, you’re strong, not weak.

You Are Worthy

You are just as worthy as the person who seems to have boundless energy and makes it to two after-work activities each night. You keep plowing through and finding joy even when doing the dishes after dinner might not be something you have in you. That does not make you less worthy of love. Sometimes we’re sick enough that these things are very challenging and/or totally inaccessible but not sick enough to feel like we’re off the hook. This is absolutely 100% NOT to say that people with more severe illnesses have it “easy”. It’s just that mild and moderate illnesses have their challenges, too.

So, just to help validate some people who may feel like they’re not “sick enough” here are some signs that you may be blaming yourself for, but are really due to high functioning depression or anxiety:

  • Having a hard time making small decisions like what to have for dinner
  • Spending a lot of time in your own mind thinking about “what-if”s.
  • Feeling “OK” but not being able to remember the last time you felt at peace or really joyful
  • Feeling like you know what you want to do or need to do, but not being able to take action.
  • Everything you do (school, work, housework) feels like a monumental chore. A colossal task that is overwhelming.
  • You’d rather not spend time with others but feel like you “should” make yourself.
  • Feeling like an imposter- people only like you because you’ve somehow “fooled” them about who you really are.
  • Procrastinating but not having any fun while you’re avoiding work/school
  • Needing a lot of reassurance (checking on others frequently, asking if you’ve upset someone)
  • People pleasing
  • Not being able to say “no” even when your schedule is overloaded.
  • Tiring yourself out by overthinking
  • Feeling inadequate frequently or a pervasive feeling of not being good enough

If these sound like you, check in with someone! Perspectives Therapy Services has a number of therapists that will help you.  They’re a sign that your mental health could use some TLC. I hope you all have a wonderful week and thanks again for reading along.

Kayla Valley is a Licensed Master of Social Work (LMSW) who works at the Highland location of Perspectives Therapy Services. She became a therapist to help people struggle with the depression and anxiety that she understands intimately. She loves being a Michigander and is an avid sewist who loves spending time with her cats and sugar gliders.

Perspectives Therapy Services is a multi-site mental and relationship health practice with clinic locations in Brighton, Lansing, Highland, Fenton and New Hudson, Michigan. Our clinical teams include experienced, compassionate and creative therapists with backgrounds in psychology, marriage and family therapy, professional counseling, and social work. Our practice prides itself on providing extraordinary care. We offer a customized matching process to prospective clients whereby an intake specialist carefully assesses which of our providers would be the very best fit for the incoming client. We treat a wide range of concerns that impact a person's mental health including depression, anxiety, relationship problems, grief, low self-worth, life transitions, and childhood and adolescent difficulties.