On my phone I saw a text from Joe, an uncle who I was especially close with, especially since my dad, his younger brother, died, ten years ago of a sudden heart attack. “Is everything alright? Anything I should know?” I was a little confused. “Umm yep, everything’s fine.”

It had been a rocky few years for me and my family, but things had been smoothing out and I had been keeping him up to date, so I wasn’t sure why he was asking. “Someone said you posted about cancer on Facebook? You were getting some tests?”

I chuckled. My seventy-something uncle doesn’t have any social media; I’m not entirely sure he understands what it’s all about. I have no doubt he’s better off spending his time writing poetry, beekeeping, and hiking in Sonoma with his wife of many decades. But he has his spies, lurkers who report to him the goings-on of the interwebs--I assume his millennial children or more tech-savvy boomer siblings.

“Cancer? No, I don’t have cancer. I just had a colonoscopy because I turned 45 this year. My first one.” “Oh, ok.” I inferred in the delay that he was confused. “I posted about it to raise awareness. Colon cancer is very preventable, but a lot of people don’t get screened, especially men.” “Got it, ok. That makes sense.” “I mean maybe it was kind of silly to post about it, but since I drove my mom to hers this year, and then she drove me to mine, I thought it was a nice story to share.” “Got it.”

I also used to work at the hospital system where I had the procedure and know a lot of people there, that I like staying connected to, that might see my posts about it. I wanted to thank them publicly for keeping the whole enterprise going as I know how difficult the work is. I wondered now, though, a few posts in, whether they just thought I was a crazy person.

I didn’t work there anymore, in fact I didn’t really work anywhere, except very little in my own business. After my daughter had been born in another one of their hospitals, it had fueled my passion for climbing the leadership ranks, ostensibly to make a bigger difference. Me and uncle Joe are both clinical social workers, but he’d taken the more intentional slow path of primarily building depth as a clinician. His brother, my dad, was always the one more comfortable with executives, and I followed in his footsteps. I’m also a bit more comfortable putting myself out there, which has included my published books, public speaking, and social media activity. As I prepare to release a new book this spring with similar themes, I’m feeling the urge to test the waters with my storytelling online. I wasn’t sure how to explain all this to him, but I sensed the text thread was coming to an end for the moment.

“Ok, I need to go make dinner, let’s talk soon.” Uncle Joe seemed satisfied that I did not, in fact, have cancer. As I lay there, staring at my ceiling, I reflected back on the day.

I could still hear the anesthesiologist coaxing me to breathe deeply as tears came to my eyes. I had been a happy-go-lucky patient up until a few minutes before, telling the nurses about my past work in primary care and building a mental health service for caregivers prior to and during Covid. I love healthcare workers, I am a healthcare worker. I wanted to be a good patient. I am a good patient.

After I changed I sent a pic of my feet to a friend that is also in the “grippy socks club.” Anyone that has spent much time in a hospital, especially a psychiatric hospital, can relate. It was familiar and I laughed it off, though I paused to consider why I still had a pair in my sock drawer at home.

Then came the needle sticks. By the third attempt, when the nurse finally got the IV in, my whole body felt like it was in a different but familiar hospital a few miles away with all the same logos. I shivered: my mind barely recalls that period, but my body holds it all in deep memory. The needle sticks brought me right back to that darkest period of my life. That was when the doctors gave me shock therapy, that always included getting poked for an IV to inject the anesthesia through.

What the fuck happened? I looked at the doctor, a bit younger than me. He reminded of the many physician friends I had made here, at various stages of their careers. I thought the whole doctor thing was cool, but I wasn’t intimidated by it. I definitely respected their extensive training, but I had talked to enough of them behind closed doors now that I was very aware of their humanity. I had loved my work at this place. But I had been trying to outrun my own demons for too long, and they finally caught up with me. I was also a human being working in a US healthcare system rife with dysfunction.

I had been supporting my family, but white-knuckling life--until I wrecked my motorcycle, got a head injury, broke bones, had surgery, had a prolonged manic-depressive breakdown, had a suicide attempt, and spent a year in and out of hospitals.

ECT was all over my medical records in recent years. Electroconvulsive therapy (ECT) is proven by extensive research to be very effective, but due to its side effects and reputation, it is only offered to the most far gone. We had just talked about it, me and the anesthesiologist. He had also been curious about my experiences with ketamine for depression. When my many hospitalizations and subsequent anesthesia sessions initially came up, it felt like a distant memory, something now in the stacks of my ever-growing pile of virtual medical records. I talked about it with some clinical distance and told him that it had worked and I felt much better, despite still being on long-term disability.

But now I was lying on my side on a table, surrounded by people in scrubs, being told to breathe deeply. My mind knew that this was a different procedure, and as much as I’m not into butt stuff, it seemed like it had to be more comfortable than the muscle aching, memory crushing, cognition blunting experience of ECT (until they get it dialed in right and it starts working, anyway). I also wasn’t depressed now, or coming down from a manic episode. I was just me at baseline, whatever that meant. I hadn’t been depressed since the end of 2024; I hadn’t been hospitalized, I hadn’t had ECT since then, and I hadn’t undergone anesthesia for any other reason. I had finished writing a book about the whole experience, and after sending it off to the publisher, was quite ready to leave it behind. But here, now, on this table--it was viscerally real. It all came flooding back. The months of lonely nights in the psych units, 3x a week IVs and shock therapy; I was totally adrift.

Later, sitting with my wife in the warm summer evening in our front yard, I recounted to her my revelation from the beginning of my procedure. I started to cry. “It was really scary. It’s like I was right back there. Back when I thought I might not come back to you.” She held my hand and nodded. She had been there, at the hospital, many days. It went on for so long that some worried I might not come back, either living as a shell of myself or giving in to my darker demons and following through on suicide. “But you did come back,” she said in an almost whisper. “You’re here with us now,” her gray green eyes softening. I nodded, feeling it deep down that I was right here, being a father and husband and finding my life again. I wasn’t working yet, well very little, maybe never, but that was ok. That wasn’t the most important thing.

She went inside to check on our daughters and I found myself staring up at the tall evergreen trees in my neighbors’ yards. I laughed to myself. “Geez, Josh.” It hit me all at once. I realized that my cancer “advocacy” on social media, while well-intentioned, wasn’t really about cancer at all. It helped distract me from how terrified I was of going under anesthesia and reliving all of that again.

Well, that didn’t really work out, but I did get some more followers out of it. I bounced back pretty quickly, but it got my attention. In my recovery, I need to attend to the trauma that I carry in my body, even if I am not conscious of it. The trauma of being a burned out healthcare worker recovering from moral injury and systematic betrayal is profound.

In 2018, I was passionate about my role building upstream solutions for physician and caregiver burnout and suicide, for a hospital and clinic group in the Seattle area, but when covid hit we scaled at lightning speed. This wasn’t upstream anymore. This was triage. We were pulling people out of the river. Suddenly I was drowning too, partly in the disillusionment of what I saw from my front row seat of the cracks of capitalist healthcare widening. As soon as vaccines rolled out, the world reopened, and I felt I’d carried my charge through, I let them know I was moving on. Soon enough I landed another gig that paid a lot more, but turned out to have some of the same challenges. I started riding my motorcycle more, at higher speeds, to drown out the noise, and the rest is history.

I made one more post, of me and my mom in the car eating my post-op meal, quoting Ram Dass: “We’re all just walking each other home.” I think that is the point of all of this for me. Get your screenings of course, don’t be a dumbass, but more than anything, invest in your relationships. In this world where AI is suddenly the answer for everything, stay connected to the humans that are going to keep checking up on you.

Oh, and fu#k cancer!

Stay Salty, my friends.

Josh

P.S. Also, don’t ignore your trauma, it may show up when you least expect it.

I’m not working much these days and when I do, it is mostly from home. The vocational rehab people call it a “work trial.” I have my own business that I am trying to resurrect, and now that I have begun, the few hours a week, I was allotted, feel like a lot. I wanted to dive right back in, but everyone told me to slow my roll. My wife is back in a demanding job after taking a few years off from her non-profit management career. My last full time role was on an executive track and pay scale as a Behavioral Health Director for a growing Primary Care Medical Group. I had been heavily recruited after a sustained professional rise as a clinician and leader in a big health system whose reputation was cemented during covid as an indefatigable smart passionate guy who could skillfully build teams across clinical and operational disciplines to scale national programs. I was having a moment. I thought I had mastered burning the candle at both ends and was running too hot to notice that I was running out of wax. Between my busy job, side job, and family life, I was juggling a lot. Even though the kids were bigger it was no longer hands on all the time, but the challenges shifted.

The only thing that seemed to calm my wound up nervous system was roaring around suburban back roads on my big BMW motorcycle. I had been riding for over twenty five years, on country roads all over the west, so that night I may have been overconfident in my skills. My friend and I had taken motorcycle trips together before we had kids. At the time, being on two wheels had felt like the ultimate freedom. Until I crashed and my whole life crashed too. The traumatic brain injury and manic depressive episode that followed, tore through my supposedly stable life like a hurricane, and left me drowning in hospital after hospital, a shell of my former self. Only ECT, electroconvulsive therapy, or electric shock therapy, could bring me back. I’m ok now, licking my wounds, finding myself again, but also finding a silver lining.

Home, on disability, I finally get to be the parent I couldn’t be when I was working so much. Certainly the father I never had, certainly the father my children deserve. My ego has taken a big hit, but I have to admit, I wouldn’t want to go back to that big shot job where I was rarely around and perpetually distracted. This summer, my older daughter, the quiet bookish one and I have been making a film. I finally slowed down to her speed and I’m appreciating how much is going on with her. I feel her starting to open up, trust me, in ways I never did when I when I might have been home, but not really there. Now I’m there all the time. I’m grateful that she puts up with my poor memory and executive functioning, mild mood swings, and need to sit and lay down a lot. I just get really really tired. Those are the moments I admit, once again, that I am not ready to work full-time yet, if ever. My lawyer, the one helping me to fight to keep my benefits says I shouldn’t feel guilty because I earned these benefits. But I live in America, I grew up in America. I know how people talk about people like me, especially if your disabilities aren’t immediately obvious.

I swerved to this cautionary tale about myself, because I hope that my dear friend’s little family gets the chance to do it differently. He and his wife have done everything right. Everything that our society tells us we should do. As did I, they came from humble roots with single moms, got good grades, went to college, even more schooling after that, and have steadily built their careers to the point that they have good jobs with great benefits and solid salaries. They even get family leave! But they don’t have their own family nearby and rely on professional childcare so they can both work full-time. My wife and I paid thousands of dollars per month for our girls to be in childcare so we could both work. I worked 2 jobs, full-time for a health system and then in my private practice after hours. I am only now understanding the toll that took on my nervous system and my relationship with my family. The cost of living in the Seattle area that had jobs in our fields, my home for most of my life, just kept growing. My student loans from state schools were astronomical and felt endless. I wish we had been able to put that money into a college fund or a down payment on a house. When we finally did get them both to grade school and bought a house, we borrowed from my retirement for the down payment.

If one of my friends loses a job due to layoff or disability or any other reason, I’m not sure how stable their situation would be. I had a very good job with all of those benefits, but the long term disability payments are half of my salary and I no longer get any health benefits from my company. Thankfully, I qualified for social security disability and now get Medicare, but I know it is only due to the thousands of dollars we spent on neuropsychiatric testing at my lowest point. Attorney’s fees have also eaten up nearly $25,000 to qualify for SSDI and battle what I now understand is standard practice of companies to lie, obfuscate, and mishandle claims to avoid paying any more than absolutely necessary, even if every one of your doctors says that you are no longer able to work. It is all totally legal because of ERISA, a law written in 1974 that governs employer benefits. The law was written with outdated ableist notions about disability that are, among other things, a cash cow for the long term disability companies that sell these plans to employers. In turn, the employer sells them to employees during the recruiting process. No one looks at the fine print, I sure didn’t. I was just excited to brag about my amazing offer with such incredible benefits that went on and on. Even our financial planner would finally get off my back.

To pay the lawyers and pay our bills, we had to get a second mortgage on our home. If it was just me I would go back to my rural hometown and live in a trailer, I really don’t care. But I had an understanding with the system that if I took a job with these benefits, my kids could stay in their schools with their friends. My wife could stay in the comfortable home that she had dreamed of since our engagement. They sacrificed, as did I, for that job, but I fear that they will be the ones to pay the price. The fight is ongoing. This is a fight that many people have the in the shadows, which is what these companies count on. I, for one, am going to keep talking about it. In the hopes that we can rewrite ERISA and hold these wealthy insurance companies accountable for coming through for eligible people in their most vulnerable hours. Taking advantage of people with disabilities should be bad business.

In the mean time, I look forward to working to better support young families. As I reopen my counseling practice, I’ve had a number of calls from young dads looking for help. I’ll do what I can, but the status quo needs to change. The next generation is watching and they aren’t having kids. My girls and I are so excited to welcome our friends’ new baby soon and look forward to offering all the support we can. Let’s create a future for families.

Stay Salty, my friends,

Josh

Bogeyman

I have been noticing republican leaders, particularly JD Vance, turning up their attacks on the so called “radical left” lately. In speeches and articles they decry the bogeyman of the alt-left that is out to destroy America. He is preparing for a presidential run that will, do doubt, center at the premise that if we don’t elect him, the foundations of our country will burn in rainbow tinged flames. Trump, ran, and won, on this premise. It is a great way to get elected. We’ve seen what has happened, a looted and stagnant economy, another endless war in the Middle East, and a society with mostly shared values pitted against itself. As the provisions of the big beautiful bill start to kick in, we’re about to feel the pain.

I just revisited this excellent 2025 magazine article by that began with remarks Trump gave at a 2020 Turning Point USA rally. “Trump repeatedly referred to the “radical left.” He hailed the attendees for refusing “to kneel to the radical left.” He declared, “The radical left demands absolute conformity from every professor, researcher, reporter, journalist, corporation, entertainer, politician, campus speaker, and private citizen.” He asserted the “radical left” hate “our history, they hate our values, and they hate everything we prize as Americans.” And the “radical left,” he maintained, was “waging war on timeless American values like freedom of speech, which is what we’re just talking about. Anyone who dares to speak the truth is canceled, censored, de-platformed, fired, expelled, harassed, abused, boycotted, deprived of a livelihood, or even physically assaulted.” -Mother Jones: https://link.motherjones.com/public/41648170

Love Child

I live in the Pacific Northwest. My parents were hippie boomer summer of love children from California who moved to Washington in 80’s to live off the cheap land. Decades later, my family bought a 70’s era split level in Snohomish county in a suburb of Seattle called Bothell in 2020 at 2.8% interest. I grew up in a rural small town in Island County. My wife and I lived in the city of Seattle for 15 years, after meeting in Olympia while attending The Evergreen State College. We started our non-profit management careers (she in arts, me in human services) there and moved every couple years trying to avoid a bad commute through city traffic. I quit my first director level role in 2009 to follow my dream of being a therapist and took a front line job in community mental health working with individual with severe mental illness and developmental disabilities. I was inspired by my little brother, who has schizophrenia. His traumatic journey from jail to mental hospital to the streets had broken my heart. I vowed to never feel so helpless again. I would learn the skills, the system, I would be superman for anyone in my family or on my caseload that ever had such problems again.

I attended graduate school at the University of Washington and it turned my intellectual world upside down in all the right ways. I was so aware of our many blessings, standing with Mary and our new baby girl after graduation in 2012. I, an Xennial, told consistently to follow my dreams and the path would follow, may have been a bit naive. But it worked out. I knew how to grind. I’m good with people. I’m good in a crisis. I learned in graduate school, at a new level, why my whiteness and my maleness and my middle classness gave me a leg up. I had no trouble getting jobs in my field and the promotions kept coming. I realize now that I was also very good at making everyone, but especially those above me in leadership, feel comfortable.

But I was also running scared, hiding a severe disability that my skin color and my gender and my charm and my vocabulary and my education and my beautiful wife could only distract from for so long. I was diagnosed with bipolar disorder by a psychiatrist after a suicide attempt in my mid twenties. I started lithium not long after. I had never been particularly athletic but my grandma’s friends had been calling me handsome since before it was appropriate. In my early hypomania fueled travels around the world, I had no trouble finding companionship. When I first met my wife, inebriated at a college party, I hit on her shamelessly. When I unexpectedly ran into her the next day, sober and embarrassed, she asked me out. I had a taut jawline and a 32” waist.

At high school graduation on my 18th birthday, I don’t really think I knew, a slim 6’2” college bound honor student, what everyone else saw when I walked off that stage. The sports and theatre star, the youth group leader, the natural helper, the kid getting a W-2 since he was old enough to work. This young man was going to make it. It had been hard, making it work at home with a single-mom, but we made it together. I was on my way. I had done everything right. Everything that our society, especially my conservative neighbors and friends, that had treated me like family told me I had to do. I was “on the right track.”

Then a bomb went off in my brain when I was nineteen.

After the suicide attempt that landed me at the psychiatrist, the medications that I was told I had to take to stay sane had long lists of side effects. Most of them didn’t show up, but I did always gain a lot of weight. New things to be ashamed of in a society that is ever more health and image conscious. But the meds kept me stable, more or less. I finished school, got a clinical license, and moved back up in to healthcare management at large integrated health systems. I was making 6 figures by forty and doing important work improving the mental health system that I cared about. I was also struggling with my weight, with burnout, and with the specter of depression that always felt like was lurking. I worried how long I could put in the intensity required for ongoing success that this level.

I started riding my motorcycle more. Drowning out the stress with the sound of the wind blowing past and through my helmet, pounding against my chest at high speed. It calmed my soul it to the core. Until my accident. Then the severe manic depressive breakdown that came in the aftermath of my traumatic brain injury. My life unraveled into a series of hospitalizations that only abated after a long inpatient course of electroconvulsive therapy. But the damage was done. My career was over.

The letter from social security came one day. “Severely and Permanently disabled”. I had two generous long-term disability plans from work too, based on my high income, but it’s taken attorney intervention to keep them paying. I take none of the benefits for granted, knowing they could disappear anytime. I am now on a “work trial” with the vocational rehabilitation program to reboot my small business, but it is just a few hours a week of consulting and counseling. I get recruited for bigger jobs all the time, and sometimes I am tempted to apply, but my doctors and my family are insisting that I take it slow.

Disability Lifestyle

I go into this tangent about myself because it is part of the point I am hoping to make here. There is this “us and them” sometimes in liberal culture. Early in my career it was “people with disabilities” and “caregivers” later it was “patients” and “doctors”. In the frequent discussions I hear about the “unhoused” it goes unspoken that the people having the discussion are “housed.” The people talking about the disabled are “not disabled”.

I was a high functioning professional, father, husband, etc who was officially “making it” despite a challenging history. I had a disability, but somehow it didn’t feel like it really counted. And then I became severely disabled over a very short period. It has taken me years to get back to being a functional human, progress I don’t take for granted. I credit my family, especially my wife, my not-so rock solid benefits for paying our bills and letting my children stay in their home and schools, and my amazing provider team (some of whom I have to pay in cash now because Medicare doesn’t pay them what they’re worth).

The Man

Years ago, when trying to escape my first executive role, I was interested in being a therapist. People in the know kept telling me to go to social work school. I’m glad I listened and did my research. Now, years after my MSW program, I go online and see therapists, mostly from other disciplines, decrying their lack of training in navigating systems. They struggle to makes sense of the complex challenges that vulnerable people face in society. Social Work taught me a lot. It gave me a framework, micro/mezzo/macro and person in environment, to make sense of the challenges that humans run into. I also found myself frustrated, at times, when my professors’ lectures too often veered back to white men being to blame for everything.

A term I recently learned, “apex fallacy”, is that the characteristics of those in power are often inappropriately generalized to the rest of the population. Yes, Boomer and Gen X white men happen to have most of the wealth in this country. Yes, white guys happen to have overly saturated the podcast universe. But does that mean we all have the same amount of power? Do we share the same values? No.

What my experience of disability has taught me is that sometimes we cannot pull ourselves up on our own. Sometimes we are so sick, so flat on our face, that having the help of others is necessary. In my grad school application essay, I spoke of people whose “bootstraps were broken” in a society where they are told to pull themselves up. I proposed that I would be a “mender of bootstraps.” I was, and I am. But I have some motorcycle boots in my closet with leather straps at the top that I still need help getting on sometimes. I am mending my own, and sometimes I need a hand.

So how does all this relate to Trump and Vance? My liberal politics do not make me a radical leftist. They are the radicals that pulled the center so far right we don’t know what is anymore. What is comprises the alt-right has become a terrifyingly violent chorus of idiots that make me very nervous. In the recent Netflix doc about the Manosphere my big take away is that the influencers profiled, who have cash to spare, sports cars and many girlfriends, is that they are not acting like men. We shouldn’t treat them as such. They are acting like adolescent boys. They are immature. Most acknowledge they didn’t have a present father figure. Maybe reframing their behavior this way will help those of us that have different values to engage, not agree, but engage with these lonely men and help them grow up. In the meantime though, they and their followers are voting for slash and burn leaders that are violently restructuring our country.

Politics

The far left, I agree, are very passionate and at times can act very judgmental and hostile towards anyone that disagrees with them. But we may need them to be a counterpoint for the tug of war with the alt-right.

But what about those of us stuck in the middle? I feel like Barack Obama was the last politician to give us a clear vision of hope for the future (see my prior article aka letter to him here) that was dead on with my values.

I want to be very clear -- I don’t give a shit about political correctness. But RESPECT is a core value of mine.

Tolerance is not a word I use for LGBTQ+, BIPOC, immigrant, disabled or others that look different than me or my family. I do not tolerate these folks. I LOVE them. They are part of my community. They are my co-workers, my friends, and my family. They are not the other.

My favorite human in the whole world (RIP) was trans- I don’t quite understand, but I don’t have to- I loved them and respected their process. This is a hard line for me, you can fuck right off if you act like a bigot. Keep it to yourself. As far as the girls sports issue, I have 2 daughters (9,14) in sports, and while this hasn’t come up in our league I have been thinking a lot about it and am open to discussing the nuances of this issue.

I reserve tolerance for some people that I like, whose views I don’t agree with. This goes mostly for close friends and family who are conservatives. I’ve known them for decades and I understand why they have this world view. We mostly just avoid talking about politics, and that is ok. We have a lot of shared values otherwise.

The Net

I believe we should have a social safety net. I am a social worker, after all! That includes a healthcare and long term disability system that works for everyone. This includes REAL mental health parity where professionals are paid at the same level of their healthcare peers. Having worked in these systems for 20+ years I am well aware of the ways that bureaucracy stifles innovation, it gate keeps care, but it’s slow movement also assures solid structures are hard to tear down. People complain a lot about the way things are, but don’t realize that all this dysfunction is making a small group of people an awful lot of money. Believe me, I got a front row seat. We can keep putting lipstick on a pig, but real change is going to face some significant and well funded hurtles.

Our education system also has a lot of problems. I am most keyed in to issues in special education, but I am aware of many others. My kids go to public schools, and while I feel blessed we can afford to live here, it is alarming how much higher quality the education is than the one I received in a rural area. I know things are much worse in high poverty areas in middle America. A poorly educated workforce and voters only contributes to the crisis we are deep in now.

In my experience, people are more likely to act ok, than they are to fake being sick or disabled. The entire infrastructure of our services system is built to keep people out. Through complicated and high standards and administrative burden, it is very difficult to receive public services in the United States. If we made it easier to get help, I believe people are more likely to get back on their feet and find independence. All the fear of dependence is keeping a lot of people on the dole. If services were available to all people, as social security is, they would be higher quality.

Higher education costs spiraled out of control, partly due to subsidized student debt. Allowing our brightest minds to graduate with massive amounts of debt is no way to run an economy, or a country.

Yes, the wealthy people and corporations who benefit the most from capitalism should pay their fair share of taxes.

I am not a communist, a socialist, or even all that radical. I’m a realistic. I’d like a healthcare and disability system that works for all people (we’ll all need both at some point), a fully funded education system (through higher ed) for everyone, and a housing and human services system that helps people back up when they fall. That sounds like freedom to me.

“Call me a dreamer, but I’m not not the only one.” - John Lennon

Dr. makes some great points in this opinion piece in the NYT, but I wanted to add something that I fear is missing from this discussion. Serious mental illness, the real raw ER crisis, inpatient, mania, psychosis, unrelenting depression, suicide attempts, the debilitating symptoms that require specialist treatment to regain much of a "normal" life at all... these now seem more stigmatized than ever. It is 2026 and asylums are seriously back on the table.

If suddenly all, or at least half of us are mentally ill, it is a big problem, but society seems to think the answers are pretty basic. Exercise, eat well, build community. These are what any human needs to stay healthy amidst the normal ups and downs of life. Sure, those are very important, but when I was diagnosed with bipolar disorder 20 years ago, I wasn't able to engage in any of those things without lithium and psychotherapy under the care of my psychiatrist. It wasn't just in my head, I was really really sick. In fact, anytime I do pretend it isn't a real disease, it gets me in a lot of trouble. Every day I struggle to accept the diagnosis and talk about it publicly. A disease I very clearly inherited, yet I blame myself for every day.

In the last ten years, as a licensed therapist, I've spent a lot of time telling the worried well that they don't have anything seriously wrong with them. I am credible because in my work I have been up close and personal with schizophrenia, mania, depression, and any number of other issues. They are relieved, and there are always other things to talk about... "normal" human challenges… relationships, goals, etc.

VC/PE/tech took over the mental health industry with a vengeance during COVID. It is doing it's best to squeeze what little profit it can before it sells us out for spare parts. As part of this takeover, therapists are more incentivized than ever to see this "worried well". Enhanced EAP programs have cropped up as well as any number of platforms that help licensed therapists connect virtually to clients and bill employer based insurance. Group practices are thriving because a supervisor can bill for associates under their contracts. The Medicaid-funded community mental health system, that I came up in, is being gutted of its workforce because of these forces. Pre-licensed therapists are not interested in working in this setting because they have other options for their clinical hours, so only the interns and managers remain. There is a growing movement of “private pay only” therapists led by colleagues of mine that I respect who are done being abused by the insurance based system. I don’t blame them.

I got several calls this week from people that said that they had reached out to many other therapists and no one but me would treat bipolar disorder. These folks were not unstable, they had psychiatrists, but things had gotten pretty bad in the past and they needed therapy to keep things going the right direction. It is so strange to me that the more complex illnesses are paid the least to treat (because they often have less resources) and there are the least specialists available. This is not the case in physical medicine at all. Stigma drives policy and we are still light years behind our purported values.

Just take a walk down any major street in America and it will be in your face. Mental Illness exists, but we're going about addressing it all wrong. We should be putting most of the resources towards the sickest people. Instead we've let the markets decide, and they're going to keep entertaining healthy people's "shrinking" fantasies while the really sick are given a shrug and hopes and prayers.

I know I am doing well when ordinary life problems are my biggest problems. It’s ok to have a hard day. It’s ok to be human. But let’s not forget that some of us do need A LOT of help in this department, and if you care about mental health you should be standing up for those of us that can’t take it for granted.

Stay Salty, my friends

Josh

https://www.nytimes.com/2026/07/26/opinion/mental-health-exercise-charity.html?unlocked_article_code=1.11A.oTu_.5abf45g4DOmW&smid=nytcore-ios-share

Do you think you're successful because you stayed in school, worked hard, and are smart? Nope. You're just good at following instructions, making decision makers feel comfortable, and ignoring the signals that your family and your body are giving you that you're way over capacity. Gender, race, class, sexuality, citizenship, etc likely helped put some wind in your sails too. But you made it. Now What? Can you hang on, go the distance, or are you going to be just one more cautionary tale whispered about at holiday meals?

Are you one diagnosis or layoff away from it all being taken away and being left grappling with what your identity ever was at all?

My fellow honor students, my fellow grad students, my fellow professionals who listened to all those well meaning teachers - we've been duped.

Do we know how to think at all?

The quote below also goes for a government contracting system so steep with administrative burden that only people educated in it can navigate. Much of what counts as a successful education these days is just the ability to follow an ever more complex set of instructions. This is not producing the thinking we need to solve big problems. Maybe this is why we've designed AI that is really good at summarizing complexity. And it will take all the really boring but stable jobs that fill that niche.

Is depending on all this artificial intelligence making the humans dumber?

Where will the original ideas come from?

Not from AI.

Not from the current education system.

My kids go to public great schools that are preparing them for colleges we can't afford anyway. I'm not sure higher education is ready to meet this generational moment anyway, but not for the reasons the administration is saying.

How do you prepare for a trip to a place you’ve never been, that no one has ever been? You pack a bag with the essentials, you bring your experience and your wits, and you stay curious.

Stay Salty, my friends…

Josh

P.S. My kids and I are going to walk to the free library now and start a summer book group. One day at a time.

The legacy of DOGE is an ongoing paranoia now in government - at the city, county, state, and federal level - that they will get in trouble for not having enough systems in place to prevent fraud. I have had multiple conversations with gov't workers in the last few weeks to this effect. Note, of course, that all this extra paperwork doesn't mean fraud is prevented. It is mostly about keeping up appearances.

But the real cost of this? Many of the programs cut were actually helping people. There are now programs not funded that would have helped many people. The bogeyman of fraud is a convenient straw man for our society's inability to care for our most vulnerable. This world doesn't need any more auditors, accountants and soulless office parks. We need more social workers, teachers, and housing for families.

Give me love and liberation over soulless spreadsheets any day. Call me a dreamer…

I’m presenting at a conference on Friday for the first time in a while, and it has me thinking about how I want to present myself. I mean, it is a talk about how we present ourselves, the hats we wear, especially as professionals and people with disabilities. It isn’t in-person, so I don’t even have to put on pants, but I figure I should get in character (put on shorts, at least!).

I’m a tall, well educated, white man who walks and talks with the confidence of someone who has been a licensed clinician and healthcare executive most of my 20-year career. Old women have called me handsome since before it was appropriate. The attention stopped after the medications for my bipolar disorder quietly destroyed my metabolism. But no matter how overweight I got, I always looked good in a suit. More often in the last couple decades, I would have opportunities to travel to conferences and speak on stages to groups of other people wearing suits. I mostly wear a hoodie and sweatpants these days, driving my kids around the suburbs with occasional excuses on my calendar to put on real clothes. My wife and daughters also throw me serious shade if I try to dress in the wrong outfit for any occasion. In the Seattle suburb where I live, a casually dressed man fades into the green trees and overcast backdrop easily.

But when I pull on a button-down and a blazer and offer my thoughts, there is no question that I have authority and expertise. Even when I ramble and the cognitive symptoms of my traumatic brain injury peek out. I diffuse any attention that my deficits might get with a thick layer of dry humor and mayor-level charm. I’ve been taking acting classes since I was a kid, but the greatest lessons I ever got in putting on a show, was from the doctors in the clinics I staffed and the CEOs in the board meetings I sat in on. It takes some self-assuredness to be able to say, “I’m in charge, we have a plan, you can trust me.” As I got to know them, I learned that yes, they were experts, but they also had their own very human struggles with self-confidence in harshly competitive fields.

I can tell you now, after considerable time in these rooms and in reflection, that there is actually no one in charge, there is no plan, and be real careful about who you trust. There may be some good folks to guide us, with some wonderful ideas of where to go, but we need to reevaluate who is given the reins.

We don’t need different people in pantsuits doing the same old stuff. We need a new approach to leadership. It’s not just about getting fewer people who look like me in the board room. That is DEI 101, and a worthy start, but I fear some of those efforts are blowing up in our faces now. We need people with different backgrounds, who think differently, to have great debates and set us on a new path. Denzel talks about how race isn’t just about race, it’s about culture. It’s about where you grew up, your customs, your experiences. Everyone deserves a place at the table.

As those of you that don’t look like me, don’t talk like me, and whose families are different than mine envision a new future, I hope you can include people like me. The charming white guys in suits who are also trying to survive in this f*cked up world. The guy with a disability who at first glance just looks like another a**hole who cut the line, but is actually just trying to keep his children alive when the world expects him to be superman because he once fit in the costume.

So, as for my presentation Friday… I’ll probably wear pants, but I’ll skip the blazer in favor of something that is a little more reflective of how I am showing up these days. Maybe a flannel and jeans with my best sh*t-kicking boots.

Stay Salty, my friends…

Josh

P.S. There is certainly work to do, but I’m also really here for the after-party. That is where the real connections happen. But can we start early? Like have a potluck or something? I don’t have an early bedtime, but I need to be in sweatpants by eight to tuck in my kids and then allow my nervous system several hours to reset in front of the magic box of light before I can sleep.

@saltysocialworker

salty (SAWL-tee) adj. A seasoned one, a salt of the earth sort, wise beyond their years, who is earthy, witty, and able to kick some a** should it become necessary.

—Urban Dictionary (2026)

Dear Mr. President,

First of all, I wanted to say that from what I can see you are looking happy and fit and living your best life in retirement. Your presidential center looks amazing, and I can’t wait to visit when I am in Chicago speaking at a conference in April. But alas, I’m not writing about all of that.

I know you grew up with humble means and are quite wealthy now, but you may have heard that the struggle is more real than ever for most of the rest of us. Since I had to go on disability, even with my wife going back to work, my family has been struggling to hold on to our house and the community and schools our daughters are thriving in. The middle-class life you helped this son of a broke single mom believe we could achieve feels more fragile than ever.

I started graduate school the year you were inaugurated, and finished in the middle of your first term with six figures of student loans, a new baby, and fire in my belly to bring your vision of hope and change to life. I’m proud of the programs I built and the people I helped as a social work leader and clinician, but feel like I was sent into a raging inferno with a fire extinguisher. Between the strain of working in broken systems and the demands of sending kids to expensive childcare while affording rent in an expensive city and unrelenting school debt, all of that naive optimism about achieving the American dream, while making a difference, began to crush me and my wife.

And then Trump was elected. Twice, with whatever happened in the middle there with your VP. What a nightmare our politics has become. But I fear he is getting a blank check from conservatives because liberals got lost somewhere along the way and lost the trust of too many people in the middle. They’re not playing now, and we shouldn’t either.

From what I can tell, the current administration is doing not just all they can to destroy gains made during your presidency, but is attempting to roll history back 100 years. It’s terrifying and confusing, but it’s also demoralizing and disabling. Everyone I know, knows there is a problem but no one seems to know what to do. I don’t have the energy to join my mom’s boomer hippie protest group at rallies and I’m not sure the point of shouting at traffic anyway.

We need direction. What’s the plan now? From what I can tell you are the only credible leader of the Democratic party. In a room full of neophytes and hustlers jockeying for the spotlight, you are still the only one who deserves our attention. One of them may be our next president, but you will always be THE MAN.

You are the leader of this party. You don’t need to ask permission. We trust you. We adore you. We admire you. Tell us how to get out of this mess. We will follow your lead. You’re charming, sure, but you’re also really smart. Time to pull together a team and set a new course. You may have dropped the mic, but it is time to pick it back up.

Share

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Your ground game, your oratory, and your vision are unmatched. We need you now, more than ever. From one father to another, please, Mr. President. Time to take us home.

-a disabled dad and salty social worker who still believes in hope and change.

It's her third summer there and she's already talking about being a counselor. Having peers who just GET IT without having to explain has been so wonderful for her confidence.

It did this salty old camp counselor's heart a lot of good to see them readying the cabins and campfire for the week while excitedly meeting lifelong friends for the first time.

Have a great summer everyone, especially those of you with special needs kids. It's wonderful when we find those magical places that we can trust to care for our (not so) little ones.

And remember to par-tay when they're gone!

excerpt… see link for full essay (no paywall)…

On a whim during a recent trip to LA to hang out with my rockstar nephew and attend a ketamine assisted psychotherapy training, my nephew and I decided to get tattoos. We were at a diner and he offered to buy breakfast if I bought the tattoos. I had never had any interest in having a tattoo but now I knew that I wanted a sea turtle etched into my skin. I knew now that my dad Sandi was always with me and I wanted a daily reminder.

Share The Salty Social Worker

Our heavily tattooed waitress directed us to a parlor on the other side of Hollywood and we set out to get inked, laughing at the crazy impulsiveness of our plan. A couple hours later I stood shirtless in that tattoo parlor smiling. Above my heart, there was a tattoo of a sea turtle, with a flowering shell that has a heart at its center.

Full article here (no paywall): https://www.spiritualmediablog.com/2021/12/20/under-the-needle-the-lesson-that-ketamine-tattoos-and-a-sea-turtle-taught-me-about-recovery-and-love/

Stay Salty, my friends.

Josh

We need to have an honest conversation about mental health in this country. It is terrifying to imagine the vulnerability that will take. Mental illness is not cancer, but it is. It has the potential to lurk in the dark of all of our lives, in our families, cropping up when we least expect it and doing lasting damage.

It is scary. But the truth is, we know how to treat it. If treatment happens quickly the damage is less severe, in fact not so severe at all. This is a system that is a part of the mainstream of healthcare in our society, but also apart from it. There is already lots of overlap, but very little coordination.

Change will necessitate changing laws, changing payment systems, changing the way the mental health industry does business, but most importantly changing hearts and minds.

Full article on medium here (no paywall): https://medium.com/@jphcutler/a-way-forward-a98fe34f1882?sharedUserId=jphcutler

Stay Salty, my friends.

Josh

[How is ACT different than other psychotherapies?] Rather than disputing and trying to change thoughts, clients are taught to unhook from them in a process called defusion. I tried these techniques with my clients, who were very responsive. People started to feel better, faster. I have since read up extensively on ACT and taken several courses — it has been transformational, both personally and professionally.

So what is ACT? It is one of the third-wave Cognitive Behavioral Therapies (along with Dialectical Behavioral Therapy, Mindfulness Based Cognitive Therapy, and Behavioral Activation Therapy). According to co-founder Steven Hayes, PhD: “ACT uses acceptance and mindfulness processes, and commitment and behavior change processes, to produce greater psychological flexibility.”

Entire article available on medium (no paywall): https://medium.com/@jphcutler/act-is-awesome-1c5e7a8a2b27?sharedUserId=jphcutler

Stay Salty my friends,

Josh

[There is] this fellow named Chiron, the centaur whose myth forms the archetype for a medicine man cursed with eternal pain who dedicates his life to helping others with theirs. As the story goes, this teacher and physician was accidentally pierced by a poisoned arrow belonging to Hercules. Immortal Chiron couldn’t die, but instead was forever wracked with the pain of burning poison in his veins.

Eventually, Hercules made a deal with Zeus that allowed Chiron to exchange his life for cursed Prometheus’, who was being eaten by eagles every evening and regenerated every morning as punishment for gifting mortals the power of fire. Chiron took up the chains of Prometheus and was allowed to die, picked apart by the eagles until he was no more.

This story helps me to make meaning of my own journey. A teacher once pointed out to me that many going into this field do so to search for a cure to their own struggle and/or that of their family. This is not the place to find it.

Read my entire essay on medium (no paywall): https://medium.com/@jphcutler/chiron-the-wounded-healer-5020e4e31f12

Stay Salty my friends

- Josh

I clicked on the post and read the copy.  I was not in the market for this tool, but my childhood friend James was selling it.  He still lived in the rural county we grew up in and had a little farm of his own, in addition to his day job as an engineer.  I often saw him buying and selling tools on marketplace and typically didn’t have more than a passing interest.  But this one was special.

My mind flashed to a moment when as middle school boys in the 90’s we convinced our parents to rent us a rototiller.  We had gotten into off-roading these big remote control cars with nobby tires and we wanted to build a racetrack.  Miraculously our parents agreed to the project.  

I see now what our parents saw, a project that would keep us outside for hours and days and weeks and otherwise out of trouble.  Every night we collapsed with dirt under our fingernails and slept well.  That was a glorious summer.  

In the years to come, we rode dirt bikes on that track, beginning a love of motorcycles that would later alter my life profoundly.  But that summer, that moment in time, felt like it went on forever.

The rototiller, loud and difficult to maneuver, cut deep grooves in the earth, leaving mounds of dirt in its wake.  We used rakes and shovels to shape jumps and berms and long straightaways out of the moist Pacific Northwest soil.  We had a project and it was awesome.  

At the end of every day we would have a race and show off all the new features of our private track.  There were no losers those days.  

As I took another swallow of coffee, I couldn’t help but wonder what projects might be in store my time to come.  What random object or reference might take me back to a special time of purpose and comradery in some future yet to be lived.  I have no need for another rototiller, but I’ll forever be looking for friendship in the context of shared purpose.

I sent James a funny note about his marketplace post, regarding some kids somewhere needing to build a racetrack.  He wrote me back a pithy reply.  I miss him.  He was in my wedding, and we run into each other occasionally, but I don’t see him much now that we’re both busy dads trying to make it.  

As I finished my coffee, I am reminded that those long Whidbey Island summer days are priceless to me.  Today though, I enjoy seeing the spring buds emerging on the trees out my suburban kitchen window.  I stepped on to my back deck and saw the project that my kids and I had started in the yard during Spring Break.  Bricks and dirt that need to be cleared for an expanded lawn for parties and play. I’m counting the days until summertime when we can really dive in and get dirt under our fingernails.

Here’s to the projects and the people we do them with.

joshcutler.net

#seattlegirl #PNWdad #parenting

In this powerful and deeply personal episode of Hey Man; It’s Ok, Sky and Ryan a licensed therapist open up about survival, shame, and resilience.

For the first time, Ryan shares the full story of his suicide attempt 12 years ago—a moment that nearly ended his life but ultimately reshaped his purpose. From his days as a VIP host in Las Vegas nightlife, through years of chronic pain and dependency on prescription opiates, to the miraculous survival of a gunshot that should have killed him—Ryan’s journey is one of struggle, healing, and hope.

Together, Sky and Ryan explore what it means to confront shame, embrace vulnerability, and find new meaning in life after loss. This episode isn’t just about survival—it’s about what happens next, the power of connection, and why it’s never too late to rewrite your story.

💬 If you or someone you know is struggling, please know you’re not alone. Resources are available. 📌 National Suicide Prevention Lifeline (U.S.): Dial 988

Hey Man; It’s Ok

https://rss.com/podcasts/heymanitsok/2201174/

It got me thinking of suicide prevention month and what we can do for men. A start would be creating more spaces (and times) for us to just hang out as men. The bonds we create may be the difference between life and death for someone. Our nervous systems are always seeking safety. Put people in environments of supportive caring people and they thrive.

That is how we end suicide.

Men, we need to hang out.

I unpacked a box that was buried in our garage today. It had been there, untouched, for over a year. Determined to create some order of our family chaos, I dove in. I was soon holding my breath. I wasn’t sure if I could face this particular box. Notebooks and folders and loose papers full of handwritten notes spilled out of it. I quickly recognized what this was and why I had been avoiding it for so long.

Between the end of 2022 and the middle of 2024 I was hospitalized five times, was in two residential programs for a month each, and returned to the hospital many times for surgery and procedures. I went under anesthesia 40+ times. I also had hundreds of outpatient appointments. It was surreal to sift through the discharge summaries and find handwritten notes by me on various things. Especially since I have little memory of any of those experiences.

The motorcycle accident that sent me to the ER and broke my shoulder and fingers also left me with a severe head injury that hurtled me into the most intense manic depressive spiral I’ve ever experienced. I partied hard until the darkness enveloped my soul and nothing could turn the lights back on. I spent 2 years in bed. I was not myself. My recovery included lots of treatments but notably it was ECT that brought me back to life. Electroconvulsive (shock) therapy was the silver bullet I needed. It also contributed to a lot of memory loss.

As I stand in my messy garage, 8+ months since my last trip to the hospital for ECT, I am deeply grateful. I’m alive. I’m living my life again. I am coming to the end of a great summer off with my kids, one I don’t think they will let me forget. I’ve gotten to know my children in a way I never could have when my career was firing on all cylinders. The gifts of this life altering experience are more numerous than I can name.

As I page through the notebooks from the hospitals and the treatment centers I am reminded of how lucky I was to have received good care. I know how broken the health care system is after working in it for twenty years. Between my social work background and steadfast wife we soldiered through. But even though I am 1000% better, recovery has been slower than I would like. I still get easily fatigued and nap a lot, my memory is still a work in progress, and my frustration tolerance is pretty low. I’m not back to paid work. However, my original chief complaints have been addressed. My shoulder has a bad ass surgery scar and some screws that are holding tight and my clinical depression has been in remission for over a year. The TBI symptoms continue to improve. Some memories are coming back, others I just get reminded of over and over by my very patient wife.

I nearly died in that accident and again a few months later when I almost jumped off a bridge. I am back to loving my life and have stopped taking anything for granted. I understand how easily people can fall through the cracks now, when they are not themselves for an extended period. I am grateful for my long-term care providers and my family and friends for holding me up until I could stand on my own. Recovery is possible. It happens every day. Recovery is also slow and requires vast amounts of patience from everyone involved.

Thank you to all of you who are caregivers, whether professionally or for the people you love. As Ram Dass reminds us “we’re all just walking each other home.”

Randy shares his transformative journey from being a left-brained physicist to embracing the emotional and spiritual dimensions of life. He discusses how spirituality helped him overcome depression, the importance of understanding and integrating emotions, and the role of intuition in leadership and personal growth.

The conversation delves deep into the challenges and rewards of embracing one's vulnerability and emotional wounds to find true inner strength and love. Join us for an enlightening discussion that touches on mental health, the law of attraction, and the balance between masculinity and emotion.

#MentalHealth #Spirituality #EmotionalHealing #Leadership #Intuition #Vulnerability #PersonalGrowth #Mindfulness #SelfCare #InnerStrength

00:00 Introduction and Host Greetings

00:15 Ryan's Spiritual Journey

01:38 Introducing Randy Lyman: The Spiritual Cowboy

01:50 Randy's Transformation from Physicist to Spiritual Seeker

04:09 The Power of Emotions and Intuition

05:48 Randy's Epiphany and Emotional Release

07:31 The Third Element: Thoughts, Body, and Emotions

11:50 Embracing Pain for Healing

17:32 Vulnerability and Leadership

19:28 Ryan's Leadership Challenges and Lessons

23:09 The Importance of Intent and Apology

24:01 Turning the Other Cheek: Finding Forgiveness

28:03 Healing Through Gratitude and Journaling

30:31 Embracing Vulnerability and Love

39:39 Balancing Masculine and Feminine Energies

44:26 Parting Thoughts and Resources