Response to a Review of Nagata Kabi's 'My Pancreas Broke But My Life Gets Better' (Patreon)

I wrote an extended response to what I considered to be a frankly offensive review on ANN that critiqued not just Nagata Kabi's work, but her as a person, and engaged in some offensive rhetoric about a real person's mental illness, most worryingly from someone who says he works with neurodivergent children and "people like Kabi". You can read the review here, though I do warn you it's got that kind of rhetoric.

I spent a while on my response and I think it might be interesting for people to have insight from someone who has dealt with the experiences I draw on, so I'll archive it here. I quote the review throughout, so cw ableism.

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Ok, I’ll go through this slowly. I guess to be  clear, I’m coming at this from the perspective of someone who has a lot  of the same disorders Kabi has, and who has loved ones with similar  issues.  I’ve had depression since I was eight and had some very bad  episodes where medication stopped working or something happened or just  inexplicably it got bad, it hit me hard, and I went backward on my  progress I also have severe anxiety (a lot better lately but), I have  ADHD (probably, anxiety can often be mistaken for that because there's  so much overlap so sometimes I wonder if the diagnosis I got was  completely correct). I grew up with an alcoholic parent. i'm in an okay  place right now. I do think it's possible to stop pushing yourself enough to make  progress when you're suffering from mental illness. I don't believe it's  helpful to not make efforts towards recovery. Kabi, however, is making  efforts, she just does not always succeed. I respect health care people, my father is a therapist, I’ve studied  psychology, I've been helped by plenty of good health care professionals  but I’ve also seen some callous ones and the havoc they wreak, which is  what concerns me about your approach toward a person you decided to  specifically connected with people in your care (and your children for  some reason?), but I’ll keep it from getting personal and simply state  my concerns. Let’s start. Quote:

Although  she describes the diagnosis and medical treatment for anxiety,  depression, ADHD, eating disorders, alcoholism, and subsequent  pancreatitis, I can't help but wonder if she is also even further  neurodivergent and is perhaps somewhere on the autistic spectrum. Kabi's  obvious emotional immaturity and repetitive self-sabotage would be  understandable in a young person in her late teens or early twenties,  but My Pancreas Broke finds her as a woman of 33 years making the same  mistakes and the same very poor decisions.

You think committing emotional self-sabotage and having emotional  immaturity isn’t explained by her disorders? Also, why are you trying to  diagnose someone you literally haven’t met in person? And I’ve met  plenty of autistic people who have a lot of emotional maturity and don’t  self sabotage, so that’s an odd thing to say.   Emotional immaturity and self-sabotage are very common for people  dealing with anxiety, depression, eating disorders, alcoholism and ADHD,  Poor emotional regulation is literally one of the symptoms of most of  these conditions. People with those conditions often have a lot of  trouble socializing which yes, leads to arrested development. Poor  decisions are a staple of these conditions. Self-sabotage is a huge  thing people with addictions do! It does not matter if you’re 30 or not.  I’m 32 and that sure doesn’t stop me from feeling my symptoms. It’s utterly bizarre you say this isn’t understandable, and I’m very  concerned about someone working with mentally ill people saying this.  You seem to think because you work with neurodivergent children you understand neurodivergent adults. Those kids are going to grow up and  they will still show the same symptoms, I’m sorry to say.

Sure, it provides her with an income, but I worry about the  psychological cost. She already records how much she worries her manga  impacts her mother (the first couple of volumes made her cry).

“Sure it provides her with an income” yeah I mean that’s not a big deal  or anything. Why doesn’t she just stop? Who needs money? I hope repeating that makes you realize how bizarre that is to say, especially  for someone who really struggles to hold a job where she has to interact  with people, which is most of them. Income is kind of important, and  being wholly dependent on relatives is terrible for a depressed person's  guilty brain (as someone who was briefly). .Also, telling an artist to give up their passion because it hurts shows  very little understanding of artistic passion. Kabi has stated several  times she wants to try to work on nonfiction little less and work on her  fiction manga, and feels bad for not doing so, but she keeps struggling  with writing fiction even when that’s her goal.   Writing fiction (and writing at all) is really hard when you’re severely  depressed and anxious. In my worst stretch of depression- the time when  every second I was alive was agony and I had to go to outpatient- I  couldn’t write at all, and it killed me because I so desperately wanted  to,  and wanted to share my writing, yet I'd lost that ability and was  sure I'd never get it back. I really feel for Kabi that she’s struggling  to do what she wants and feeling constantly guilty about not being able  to do it.

It's like she's learned nothing from her previous experiences, and even  when her family and medical staff do their best to help her, she insists  on running away from the hospital

“she insists on running away” yeah I sure ripping out her IV painfully,  bleeding everywhere and fleeing from the hospital was something she  stubbornly insisted on doing, and not something that’s explained by a  severe anxiety bought on by incredibly stressful conditions. She just really wanted to do that! When someone relapses or has an episode, it  means they learned nothing and aren’t trying at all! Kabi was a patient in the hospital during the beginning of COVID and  thus could not even see her family or go outside. Her support system was  completely gone, she was trapped in a place full of sick people at the  height of a brand new pandemic. I can’t imagine that kind of hell as  someone with anxiety. She would hear people shouting about patients  dying or getting sick and she could. Not. Leave. She had very little to  offer her relief from her brain eating itself alive and she was also  starving. I might have ran in this situation too.

Kabi knows what she needs to do to get better, but lacks the courage or conviction to do it.

What an absolutely awful thing to say about someone with a mental  illness or an addiction. If you struggle and relapse, you’re just a  coward. If you struggle and relapse, you just don’t have conviction. As if it's that simple. I hope you never say something like this to the people in your care. Having support and knowing what you need to do  doesn’t just make you magically get better or mean you can automatically, easily do it. People seem to think if you go to therapy,  take some medication, and follow a manual you’re cured.  I do all the  “right things” and I still have setbacks. And sometimes you find doctors  who crush you with statements like this and set you back even worse--  I'm lucky I've never had one, but my friends sure have. Recovery isn’t a straight line, finding the right coping mechanisms  isn't a straight line, and the fact you don’t seem to understand this  yet work with mentally ill and neurodivergent people concerns me.  Lifelong mental illness means you’ll inevitably get worse sometimes and  have to claw back up. It is inherently extremely repetitive! It means  you’ll do stupid things. You’ll backslide. If my mother—or even a  stranger-- had told me “well, you just don’t want help. You just don’t  have courage and conviction” while even going to therapy or going  outside for a few minutes was so hard for me and taking every ounce of  energy,  I might not be here today. But she didn’t. And I made slow  progress because she showed me empathy and understanding. Staying alive under these conditions takes courage, and Kabi is still  alive, and Kabi is still trying to get better.  She has a therapist.  She’s on medication. She’s staying sober at the end of the book which I  imagine is incredibly hard considering Japan’s drinking culture. She's  constantly trying treatments, even if she gets overwhelmed and can't got  through with them all. All of that takes courage and conviction. But  apparently if she gets overwhelmed the first time she goes to a support  group meeting and leaves, that doesn’t matter. Could she be doing more?  Sure, maybe, but it’s not a straightforward process, and trust me, when  she fails and flees she’s more frustrated with herself than you can ever  be with her. The fact she sometimes fails doesn’t negate that she  tries.   Kabi is also openly discussing her mental illness in a country that  often stigmatizes it even more than the US does. That's incredibly  courageous.   Her work has helped many people feel less alone, including me. The fact  that she explores how recovery isn’t a straight line is actually  invaluable, because so many people, you included, seem to not get that.  The fact she is honest about the ugly, raw, repetitive parts is helpful,  because a lot of people don't want to talk about that.   And a lot of the reason her mental health got worse was COVID, which  did lead to a huge mental health crisis in SO many people. She is not  alone there, as she points out in her book! Being isolated like that led  to the worst mental health crisis of my life, so man do I get it. Thinking about how Kabi might feel if she came across this review (or  even someone in a similar place to Kabi) really breaks my heart,  especially considering the guilt she often expresses and her low opinion  of herself. Especially since you say she’s probably going to kill  herself which is just terribly insensitive. You’re not criticizing her  art, you’re criticizing her as a  person and offering armchair psychoanalysis, (while hyping up how your  professional position as if it gives you some insight into her). That’s  not something a reviewer should do. It's fine to say the recap is repetitive, I agree. It's fine to say it's  frustrating to read, or that it's repetitive or painful to read, to  engage with it as art, ask what Kabi is trying to express-- but instead  you scold and diminish Kabi's struggles, insult her and engage in  frankly offensive rhetoric about mental health..   Quote:

Once she finally comprehends something that seems obvious or second  nature to the rest of us, the breakdown of her cognitive process is  always fascinating.

The fact you assume everyone is neurotypical like you by saying the “the  rest of us” see how silly and obvious Kabi’s problems really shows how narrow your viewpoint is. That statement is also weirdly condescending.  I’m hope you rethink things. I said my piece, and I'll leave it at that.