When talking about forms of pain and suffering that are often seen as “invisible” in our society, you’ll usually hear me use the word “invisibilized” rather than “invisible.” While this may seem like a minor word choice that’s just about semantics, for me it feels like an intentional decision that is a core part of my therapeutic approach.

Some forms of pain and loss are commonly visible in our culture. It’s customary to wear black and have a funeral when mourning the death of a loved one. Vigils and memorials are often held for public tragedies. Survivors of cancer or other illnesses may be encouraged to wear items indicating their lived experience to 5Ks or awareness events. But not everything gets the same treatment. The forms of suffering, pain, and loss that are recognized by our society and spoken openly about, and of course, whose pain gets recognized, often reflect deep biases and oppressive systems. It represents a hierarchy of whose pain matters more that we collectively participate in and contribute to. 

Let’s take perinatal loss as an example. Generally, later term losses are more widely recognized as deaths that cause suffering and trauma. The presence of a baby bump or a fetus who looks closer to being a full-term baby is seen as evidence that an individual has died, not just a potential human. Culturally, we talk about early pregnancy losses as if they are “invisible” and therefore less real.

But it’s an active choice to look at early pregnancy loss this way. Pregnancy is a very real, drastic change to the body and mind. Many people experience concrete, identifiable changes to their physical health, mental health, ways of processing information and sensory input, and identities. These changes occur because a person’s body has begun the process of creating life, and is now in a very distinct state from not being pregnant. We as a culture could make the choice to see this - to recognize the very visceral reality of so many people’s first trimester experiences, to acknowledge the relationship being built between the pregnant individual and their baby, to empathize with the gravity of the loss of that. Instead, we often discount it. We didn’t see an external bump or baby, so we choose not to see the pregnant person’s internal reality either.

I think the word “invisible” lets us off the hook. It allows us to pretend that there’s something inherently “invisible” about the experience of first trimester loss - as if the issue is that it’s just not noticeable enough to catch our attention. Rather than a choice we collectively make to invisibilize - to turn our attention away from some types of pain.

I want to be clear. I don’t think you’re a bad person if you’ve discounted early pregnancy loss or made comments implying it’s less of a “real loss” than later term loss. I’m sure almost everyone has done this unintentionally. It’s impossible not to pick up the biases that we’re all surrounded with, including around which types of pain “count” and whose pain is most deserving of being listened to. It’s only human for us to have those biases and for them to affect others. Naming invisibilization as a choice is not about categorizing anyone as a bad person, but instead viewing it as something we can unlearn and choose to work on doing less of.

Let’s take a look at how this applies to one of my other therapy specializations, eating disorders. The idea that we can tell whether someone has an eating disorder, what type of eating disorder it is, and how severe it is, by their weight or shape is deeply entrenched in our culture. Thus, we often discuss eating disorders occurring in bodies not deemed “underweight” according to the BMI as “invisible.” Anorexia Nervosa occurring in people who are not in the “underweight” category is referred to as “Atypical Anorexia” (despite being the most common type of anorexia by far), and often described as “hidden” or more difficult to catch.

But the reality is that there is nothing inherently more “visible” about eating disorders in a smaller body size or less “visible” about eating disorders in a larger body size. Body size diversity is part of human diversity, and weight is much more influenced by genetic and biological factors than individual behaviors like eating and exercise. People can be in smaller bodies or bodies categorized as “underweight” according to the BMI for many different medical, genetic, or mental health reasons. People in larger bodies can and do have restrictive eating disorders, and the effects of restrictive eating disorders are equally severe at any body weight. When we assume the presence or severity of an eating disorder, or lack thereof, based on body size, that is coming from anti-fat bias. It’s coming from the misconception that weight is reflective of eating and exercise habits. 

That misconception has been ingrained in all of us, so you’re not a bad person if that’s influenced how you think about who might or might not have an eating disorder. But once we have access to different information, we have access to more choice and agency. We can decide to continue ignoring the possibility of - invisibilizing - starvation, malnourishment, shame and distress around food, and serious medical consequences of undereating in people whose bodies are not deemed “underweight.” Or we can turn our attention to those possibilities. We can visibilize eating disorders in people of all sizes by choosing to see the pain, suffering, and medical risks that accompany undernourishment regardless of weight.

So why is this central to my therapeutic approach? For a couple reasons.

One is that the terms “visible” and “invisible” sound like inherent, intrinsic traits to different types of struggles or types of pain we may experience. It sounds like the type of hardship we are dealt is either visible or invisible and that’s that, that’s just how it is - we just have to accept it. I believe that using the language of “visibilized” vs. “invisibilized” makes space for anger and grief. Invisibilization is an active form of harm that is being carried out. It is not neutral and does not arise in a vacuum but rather linked to all kinds of oppression and biases. Acknowledging this can allow us to feel the very valid emotions that come up in response to being harmed, rather than solely blaming our bodies for not displaying our suffering in a way that others choose to see.

Another reason this is central to my therapeutic approach is that while we cannot ultimately control what others choose to visibilize or invisibilize, we do have agency around what we choose to visibilize. Therapy is a space where together, we can collaboratively figure out how to visibilize what you’ve been told doesn’t count or isn’t real or should be moved on from. Visibilizing your suffering doesn’t have to look like publicly announcing it on social media or in your workplace (although it can!). It might be sharing with your close friends and family who are willing to put effort into understanding your experience rather than leaning into their own prior assumptions. It might be creating artwork, joining support groups or advocacy groups focused on what you’re struggling with, listening to podcasts or reading books that validate your experience, or just naming the gravity of your experiences aloud in our sessions and to yourself. For a personal example of my own, take a look at my “mom” mug story.

I invite you to think about how you can resist invisibilization of all kinds of losses, illnesses and disabilities, and identities, and how you can visibilize what matters most to you. If these are areas you want to explore further in therapy, I encourage you to reach out to me via my contact page.