And this time, I wrote about it in a guest post for the American Psychological Association.

If you really want to know how I’m doing right now, look at my thumb. It always betrays me. My face will, from four decades of muscle memory, arrange itself in a way that will not cause you worry. My voice is calculated to extract any upset so it will not leach in and erode your wellbeing. But my thumb can’t lie.

More specifically, the skin to the right of my right thumbnail, and if things are especially dire, the left of the left one, too. If it’s smooth and un-pocked, I’ve been OK for at least a few days. Roughened, but not raw means there was a tough patch in the recent past but I’m on the upswing. Actively bleeding, I’m doing my damndest to keep it together in front of you, and bandaged—I’m trying to protect me from myself. And you from having to look at it. Or really look at me.

I pick at my skin when I’m anxious, which is the rule rather than the exception. Particular things trigger it: running late, leaving the house, running late because I was afraid to leave the house, crowds, phone calls, being called into meetings, stepping away from my desk, the IRS, my husband going on an airplane, walking under scaffolding, deadlines, haircuts, being handed a baby, narrow lanes of highway traffic, and more, so much more. But also nothing. The panic just strikes from nowhere, like a yowling, feral cat with a stepped-on tail. My heart hammers and my throat closes and I suppose the only thing I can think to do is sink my nail into my skin and dig until I’m flinching and distracted.

It could be worse—I know this all too well—but it’s not good and I’m trying to find a better way to be. Talking helps. I’ve come to understand that over the past few years as I’ve gotten less and less apologetic and infinitely louder about the fact that I’m not OK, and that I’m OK with that. It seems to relieve the pressure not just for me, but for the other people, loved and strangers, I see walking around with their jaws tight, lips bitten and fists balled. The more we can say the words, let them dissolve into the air around us, the less we have to draw our own blood, inflict misery on our own brains and stomachs and skins in order to hide the pain we’re in.

So I’m typing these things out into the world in the hope that anyone who needs to read them can stop and unclench just a little bit. There may be a little bit of blood on my keyboard and on the hand I’m reaching out, but it’s here if you need to hold onto it for a little while.

Read it at YourMindYourBody.org