If a man walked into a Doctor’s office and said, “Every month I: lose so much blood, I feel faint, pain has me doubled over and nauseous, and- for a week I don’t recognize myself,” we would not tell him this is a natural part of manhood.

But- womens suffering is graded on a curve. Painful periods aren’t bad enough. PMDD isn’t bad enough. Ferritin levels at a 6? That’s “normal”. The postpartum spiral of rage, crippling anxiety and insomnia aren’t bad enough. She’s just tired, just hormonal. She needs to lose weight and exercise. Perimenopause isn’t bad enough- heart palpitations, brain fog- so bad it feels like dementia, missing work, relationships falling apart, feeling suicidal… she’s just stressed.

We have been failing women, with a single, lethal question: is it “bad enough” to warrent intervention, to warrent care?

So let me ask a better question: a question people have heard me ask many times over the years: just how big does a tumour need to be before we would treat it?

We are watching something grow: measurable and predictable- then scheduling the intervention, too often as post-mortem- after the catastrophe.

First- we’re told it’s normal. Then we are told it’s not that serious. Then we are told it’s too late.

…

In Vancouver, Jenna Dorman’s family is spending their first summer without her. Jenna was a woman who died by suicide, whose loved ones are now begging this province to build a psychiatric bed where a mother can heal from post-partum depression without being separated from her child. Because in British Columbia, this bed does not exist.

In a Massachusetts courtroom, women wearing pink line the gallery at the trial of Lindsay Clancy, a labour and delivery nurse whose defence says she was drowning in postpartum psychosis when the unthinkable beacame reality. Just so you know- postpartum psychosis- a condition that one expert called “the scariest mental illness that I know of” is not even listed in the DSM as its own diagnosis. Even though it strikes one to two mothers in every one thousand births.

And, on August 16th, Hayden Panettiere died at thirty-six years of age. Hayden was handed “happy pills” by an adult on her own team at fifteen. Hayden told us, plainly, in 2022: “I didn’t know where the alcoholism was ending, and the postpartum was beginning.”

I am done pretending this is anywhere near what “normal” reproductive health should look like.

The pathway

I hear almost every day from women who have been handed the same line: “your pain is normal”.

She is twelve, doubled over a heating pad, and told that’s just part of being a girl. She is sixteen, bleeding through her clothes at school, and told some women just have heavy periods. She is twenty-four, flattened for one week of every month by despair, and nobody names PMDD- other than a joke about being on the rag. She was thirty-one before anyone said endometriosis, which is about average: women wait the better part of a decade for that diagnosis while the pain is explained back to them as anxiety, low tolerance, or drama.

Can someone please do the math for me on what that costs? The missed school, lost workdays, promotions skipped, relationships crushed. The disordered eating, the substance use, the void of self-worth- from the belief that she is broken… The slow erosion of the one thing every recovery, every career, every family depends on- a nervous system that can regulate itself.

I have named what she’s losing: The Missing Capital. Specifically, in this case: the missing Bioglical Capital. Biological Capital is the neuroendocrine ground a woman stands on, the physiological asset every other asset in her life requires to survive. We understand money. We understand social networks. We understand “recovery capital”- the resources a person draws on to get well and stay well. What we have refused to understand is that for women, the biological pillar of that capital is drawn down on a schedule: menarche, the monthly cycle, pregnancy, postpartum, perimenopause. Predictable. Documented. And at the time being- entirely absent from how we design and facilitate care.

Self-medication is not a character flaw

Here is what happens when you tell a woman her pain is normal for twenty years: she treats it herself. Which is the sane thing to do. Dysfunctional coping is still coping when it’s the only thing we have.

A glass of wine that turns to a bottle- that the week before her period- an analgesic to treat the pain. A benzodiazepine prescribed for “anxiety” that is actually a progesterone crash, acting, and too few providers understand this, on the same GABA receptors as alcohol. Cannabis for the sleep that shattered during postpartum and never came back. The bottle that Hayden Panettiere reached for while the world critiqued her body and called her postpartum depression a “rough patch”.

We call this addiction, and clinically, it becomes that. But upstream, it’s something simpler and more damning: it’s what untreated pain does. Self-medication is the result of every appointment where a woman was told it wasn’t bad enough yet, that it’s all in her head- has she tried yoga?

The outcome of this? Midlife women now show the sharpest rise in hazardous drinking of any demographic. This is not a willpower issue. That is a generation of untreated reproductive suffering coming due. It’s the reckoning.

The endings we keep calling unforeseeable

Follow the pathway far and long enough, and you arrive at the places we saw this summer.

You arrive at a mother in Vancouver who needed inpatient care and a province that made her choose between treatment and her baby.

You arrive at a perinatal nurse- whose providers, by the reporting, circled insomnia, anxiety, depression, even possible bipolar disorder. She was “overmedicated” and denied treatment- while the diagnosis that actually explained everything was ignored.

You arrive at a thirty-six-year-old woman mourned by her father as “an incredible light,” who spent two decades telling us the truth about pills at fifteen and postpartum at twenty-five, and who deserved a system that believed her the first time.

None of these endings came as a surprise. They began at twelve, at sixteen, at twenty-four, in rooms where a woman described her pain and mental anguish and was handed the word “normal”.

What listening would look like

I am a counsellor. I have spent twenty-five years in the room with these women. I did not come here to grieve; I came here with a list.

Name it. Postpartum psychosis belongs in the DSM as its own diagnosis. Biological Capital belongs in all of our recovery frameworks and treatment plans. What we refuse to name, we cannot screen for, fund, or treat.

Build the beds. British Columbia- now. No mother should have to choose between her mind and her child. Jenna Dorman’s family should be the last family to ask.

Train the providers. Every addiction clinician trained in reproductive mental health. Every menopause and perinatal provider trained to ask about mental health. Every doctor taught that PMDD, endometriosis, postpartum, and perimenopause are windows of clinical risk- not chapters of womanhood to be endured.

Screen the whole pathway. Any woman presenting with substance use, disordered eating, or a mental health crisis deserves one question we almost never ask: where is she in her reproductive life, and what has it already cost her?

Demand that Biological Capital be the topic of the next keynote address at The Recovery Capital Conference.

To the woman reading this with the wine, the creeping anxiety, the insomnia and the white knuckles: your pain is not a personality trait. It is data. You are not weak, you are not dramatic, you were never the problem.

We are done being silent. The women are at war.

If you or someone you love is struggling, in Canada you can call or text 9-8-8, the Suicide Crisis Helpline, any time. Support for you is not a someday thing- it is a today thing.

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A person in recovery said this to me during my master’s research, and I have never stopped thinking about it. He wasn’t describing a medication, a referral, or a treatment protocol. He was describing a moment- a few seconds in an ordinary appointment when a doctor truly saw his pain. And in that moment, something in him began to heal.

I spent my graduate research bringing together two groups of people who badly needed to understand each other: family physicians, and people with lived experience of substance use. I wanted to know how they could collaborate to make healthcare feel safe for people who use substances. What I found kept circling back to a single word, one that Brené Brown calls the “excruciating feeling or experience that we are flawed and therefore unworthy of love and belonging.”

Shame.

Shame arrives before the patient does

The reality about shame, that most of us get wrong is: we imagine it as something that happens to people in the doctor’s office- a judgmental comment, a dismissive look. And sure, that happens. But what my research participants taught me is- that shame walks in the door first. It is a preexisting condition.

One participant put it this way: “I had to drink a river of alcohol to numb my pain. I remember the shame. I felt like such a scumbag. I felt like I let the world down.” Another said simply, “The shame was burning.”

This is the cruel arithmetic of addiction: shame and substance use feed each other. As researcher Shelly Wiechelt has described, a person uses a substance to numb the pain of shame, then feels ashamed of the using, and reaches for the substance again. Round and round. And when that person considers asking for help, shame does its most devastating work- it whispers, cruelly, that they don’t deserve it, and that asking will only confirm what they already believe about themselves. That call is coming from inside the house.

“I already have more self-hatred than the physician’s judgment can ever be,” one participant told me. Others described fearing they would be “tossed from the practice” if they were honest about their use. So they didn’t go. Or they went and didn’t disclose. Or they worked themselves “into such a state of anxiety” before an appointment that, as one person said, “I wasn’t bringing my best self.”

This is the part I most want healthcare providers- and anyone who loves someone struggling with mental health and substance use to understand. Shame doesn’t always look like shame. In the exam room, it can look like a patient who withholds information, who nods along and people-pleases, who cancels appointments. Or it can look like the opposite: hostility, aggression, blaming the system. Both are strategies of disconnection, and both are shame wearing a disguise. If we misread them as difficult behaviour rather than protective armour, we punish people for the very wound we should be treating.

Philosophers Luna Dolezal and Barry Lyons have called shame “the elephant in the clinical room.” It shapes whether people seek care, what they disclose, and whether they come back, and yet we almost never name it.

The antidote is not information. It is connection.

If shame were a knowledge problem, we could pamphlet our way out of the addiction crisis. We can’t, because shame is a relational wound. It is the felt conviction that you are unworthy of belonging. And a wound of disconnection can only be healed by its opposite. Trauma happens in systems and it heals- in systems.

The relational-cultural theorist Judith Jordan says it plainly: connection is the antidote to shame.

I watched this truth surface again and again in my research. One participant described the first time someone in the healthcare system said to them, “You are not bad. You are sick.” They called it revelatory. Notice what that sentence does- it moves addiction from the moral ledger to the medical one, and in doing so it makes the person treatable rather than condemnable.

Another participant recalled a provider telling them, “I won’t give up on you. Together we will find a solution.” Their reflection: “She said the word ‘we.’ That statement kept me afloat for a while until I could find a solution.”

Kept afloat by a pronoun. That is the power we’re talking about.

Empathy, it turns out, is not a personality trait some clinicians are born with. Nursing scholar Theresa Wiseman defines it as a practice with four parts: suspending judgment, taking the other person’s perspective, recognizing their emotion, and communicating that understanding back. A practice can be learned. It can be done in a seven-minute appointment. As one participant said, “It is all about listening. Listening is everything- it is what leads to accurate empathy.” Another added, “Sometimes the story is more important than the symptoms.”

The healing power of someone who keeps showing up

But a single empathic moment, however powerful, is not the whole cure. Shame convinces people they will be abandoned once they’re truly known. The only durable rebuttal to that belief is a relationship that doesn’t abandon them- a healthcare provider who is still there next month, and the month after, whether things are going well or badly.

This is what researchers call longitudinal care, and one participant’s story captures why it matters more than almost anything else we can offer:

“My GP knew I was suicidal, and she said I could come to the office anytime without an appointment. She also always asked me to come back for follow-up. That gesture made me feel worthy of her time. The follow-up was so important because it showed me this was a process. She offered unconditional care, even if I couldn’t remain abstinent. I learned I’d be welcomed back even if I didn’t meet the goals.”

Read that last line again. I’d be welcomed back even if I didn’t meet the goals. For someone whose deepest fear is being rejected for their failures, a standing invitation to return is not administrative scheduling- it is treatment. Every follow-up appointment quietly argues against shame’s central claim.

This is why I’ve come to believe family medicine, at its best, is not merely a delivery system for prescriptions and referrals. It is a relational practice, and the relationship itself is curative. Prevention and treatment of mental health struggles and addiction don’t begin with the right medication; they begin with a person who knows your story, expects to see you again, and has demonstrated- across time, across relapses, across your worst days- that you are worth their care.

One participant described what that kind of care made possible: “Compassion from the system was invaluable because I had none from myself. I needed someone to coax me, spoon-feed me hope at times. When people believed in me, I was far more likely to succeed.”

We cannot shame people into wellness- shame is the illness’s engine, not its brake. If feeling badly about ourselves made us change, there would be no treatment centres. But- we can do the slower, humbler thing. We can build relationships sturdy enough that people risk being known inside them. We can say “we”. We can keep the door open, welcome people back when they haven’t met the goals, and let the relationship itself do what no lecture ever could.

Because healing, in the end, is not something we deliver to people. It is something that happens between us.

This essay draws on my master’s research at Royal Roads University, conducted in partnership with the Victoria Division of Family Practice, which brought together primary care physicians and people with lived experience of substance use. Participant quotes are shared anonymously, with gratitude for their courage. Key ideas referenced: Brené Brown on shame and worthiness; Shelly Wiechelt on the shame–addiction cycle; Luna Dolezal and Barry Lyons on shame as “the elephant in the clinical room”; Judith Jordan on connection as the antidote to shame; and Theresa Wiseman’s attributes of empathy.

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“Speak what you think now in hard words, and to-morrow speak what to-morrow thinks in hard words again, though it contradict every thing you said to-day. ‘Ah, so you shall be sure to be misunderstood.’ Is it so bad, then, to be misunderstood? Pythagoras was misunderstood, and Socrates, and Jesus, and Luther, and Copernicus, and Galileo, and Newton, and every pure and wise spirit that ever took flesh. To be great is to be misunderstood.” - Ralph Waldo Emerson

I want to say something that will cost me something- which is usually a sign that it needs to be said.

British Columbia has spent forty years calling divestment by progressive names: liberation, community, lived experience, harm reduction- and the cost of that linguistic dance has been measured in lives.

I believe that harm reduction is foundational in the full spectrum of mental health, substance use and recovery. I have worked inside it, watched it save people. I am not recanting that view. But Emerson’s instruction is precise: speak what you think now, in hard words.

And what I think now is that the language of “liberation” has actually been doing the work of abandonment, and we have been too afraid of being misunderstood to say so.

What Happened in the 1990s

When the HIV epidemic tore through, and ravaged the Downtown Eastside in the late 1980s and early 1990s, the Province did not respond. Not meaningfully anyway- and nowhere near in time.

What responded instead was the neighbourhood. A poet named Bud Osborn stood on the corner of Main and Hastings and read the names of the dead. Ann Livingston and Dean Wilson and a group of people who used drugs founded the Vancouver Area Network of Drug Users: VANDU, in 1997, in the same year that Vancouver finally, reluctantly, declared the DTES a public health emergency. Liz Evans ran the Portland Hotel Society as though the people inside it were worth keeping alive, because she rightly believed they were, in a decade when policy suggested otherwise.

Travis Lupick documents this history in Fighting for Space with the precision it deserves: a grassroots movement cobbling, piece by piece, the harm reduction infrastructure the Province had neglected to build. Needle exchanges. Safe consumption advocacy. The long, grinding campaign for Insite- North America’s first legal supervised injection site, which opened in 2003 and which, of course, the federal government immediately tried to close.

These people were misunderstood. They were called enablers, apologists, advocates for lawlessness. Bud Osborn’s poetry was not assigned in policy seminars. It was born from grief, for an audience of people who were dying and the people who loved them and couldn’t stop it.

And, eventually, the Province, having spent years dismissing them, eventually absorbed their framework- and called it policy.

When the Victory Became the Problem

When harm reduction became BC’s policy default, something shifted. The language of the movement: peer support, lived experience, community-led, harm reduction- became the language of government. And government, it turns out, is very good at using the language of a movement to justify not funding what the movement actually required.

Peer support without adequate compensation, training, or psychological infrastructure is not peer support. It is unpaid labour extracted from the people most damaged by the crisis.

Community-led services without stable funding, and without accountability, are not community empowerment. They are the outsourcing of responsibility to the most under-resourced organizations available.

Lived experience without structural power is not inclusion. It is consultation theatre.

Harm reduction without proper housing, without mental health support, without the entire interconnected scaffold that makes survival possible - harm reduction reduced to a needle and a naloxone kit - is not an adequate public health strategy. It is a way of keeping people alive long enough to die more slowly, and calling it compassion.

Bud Osborn once wrote about the thin line between witnessing and participating in abandonment. The activist tradition he helped build was never supposed to be the whole answer. It was supposed to force the state to build the whole answer. Somewhere in the translation from movement to policy, that distinction was lost.

The Decriminalization Experiment

On January 31, 2023, BC became the first province in Canada to decriminalize personal drug possession. Adults could carry up to 2.5 grams of illicit substances without arrest or charge. It was described, and genuinely experienced by many, as a historic step.

Fourteen months later, BC re-criminalized drug use in public spaces - parks, playgrounds, transit - under pressure from municipalities citing visible disorder.

The harm reduction community responded with fury. Advocates called it a betrayal. Politicians who had supported decriminalization went quiet.

The dominant narrative became: political cowardice. The evidence was ignored. The vulnerable were sacrificed to public opinion.

That narrative is partly true. But it is not the whole truth, and defaulting to it is its own kind of hobgoblin- a foolish consistency that protects the framework from examination.

The harder question is this: what was decriminalization decriminalizing people into?

The 2.5 gram limit was a negotiated compromise that bore little relationship to the pharmacology of addiction or the realities of the street economy. The exemption arrived without the infrastructure that would have made it coherent; without assessment, without mental health support, without the social reinsertion programs, without proper housing, without streamlines for treatment or, in some cases, the institutions needed to provide wrap-around care- and without the dissuasion commission equivalent- which made Portugal’s model function as a system rather than a gesture. People were decriminalized into the same contaminated drug supply, scattershot services, the same three-week treatment waitlists, the same five-day detox cycles, the same absence of anything resembling scaffolding.

There was a naive and not unreasonable hope embedded in decriminalization: that making suffering visible would make it legible, and that legibility would produce compassion. It did not. What visibility in fact produced, in parks and on transit platforms and outside schools, was a theatre of crisis. Open drug use stripped of the context, the history, and the support systems that might have made it comprehensible to a passing stranger. And a theatre of crisis, it turns out, does not reliably generate empathy. It generates disgust. The community did not see neighbours suffering in a broken system. It saw a problem on their sidewalks. That disgust was not manufactured by bad actors, it was a predictable outcome of exposing profound suffering without building, alongside the exposure, any of the scaffolding that suffering required. The re-criminalization of public spaces in 2024 did not happen despite decriminalization’s compassionate intentions. It happened because of the gap between those intentions and what was actually needed to support the breadth and weight of the crisis.

Decriminalization without the robust systems in place to care for the people who are using- is just harm reduction without harm reduction. It is, again, liberation language in the service of divestment.

When the reversal came, the failure was not primarily in the reversal. It was in what was never built alongside the policy that the reversal exposed. That gap is the cave we need to enter.

What Emerson Actually Demands

“A foolish consistency is the hobgoblin of little minds.” Emerson is not praising chaos. He is not endorsing the politician who reverses course because the polls changed, or the system that abandons a framework because it became inconvenient.

He is distinguishing between performed consistency: I said this yesterday, so I must defend it today regardless of what the evidence shows - and living thinking - what do I actually perceive to be true now, and do I have the courage to say it in hard words?

The hobgoblin of the harm reduction movement, as it has been implemented in BC, is the performed consistency that prevents us from saying: this language has been distorted. These words: lived experience, community, liberation - have been separated from the material conditions that gave them meaning, and are now doing the work of making inaction look like progress.

To say that is to risk being misunderstood. It will be read as an attack on harm reduction by people who want to criminalize it further. It will be read as cover for punitive approaches by people who would rather lock the door than build the room.

Pythagoras was misunderstood. Socrates was misunderstood. Bud Osborn was misunderstood by a government that eventually hung his movement’s language on its press releases without building what the movement was asking for.

Emerson’s instruction is not comfortable: speak it anyway. In hard words. Tomorrow speak what tomorrow thinks, in hard words again.

What Hard Words Require

The specific implementation in BC has been, repeatedly, a harm reduction framework deployed in the absence of harm reduction infrastructure, and the difference between those two things is measured in who is still alive.

The grassroots movement that was built in the 1990s was extraordinary. The people who built it: Bud Osborn, Ann Livingston, Liz Evans, Dean Wilson, the founding members of VANDU, were doing what Emerson’s great souls do: speaking what they thought in hard words, at significant personal cost, in the face of misunderstanding.

The question this moment demands is whether we have the same capacity? Not to abandon harm reduction- to refuse to let its language be used to name its opposite.

Not to attack the movement. To complete it. The courage to change what we can.

The bodies that accumulate while we protect our frameworks from examination are not hypothetical. They have names. Bud Osborn read some of them aloud on a street corner in 1997. That list is much longer now.

To be great is to be misunderstood. To be misunderstood for saying the thing that is true, in hard words, even when it contradicts what you said before- even when it contradicts what the people you love and respect are still saying.

That is the essay.

Bryn Meadows is a Registered Professional Counsellor (MA, RPC-MPCC) specializing in addiction and trauma. She is writing a book about the Downtown Eastside of Vancouver.

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Emerson wrote that “a foolish consistency is the hobgoblin of little minds.” The full line is even sharper: “adored by little statesmen and philosophers and divines.” His target wasn’t chaos or instability. It was the performance of certainty - the refusal to let your thinking move- because moving would mean admitting you were somewhere else before.

I have been thinking about that line for months, in the context of a book I’m writing about the crisis of addiction in BC, and in the context of this post, which is me, finally, asking for help.

Both require the same thing. The courage to say what’s actually true, even when it contradicts the version of yourself you’ve been presenting.

I write about things that some people find easier to look away from, including: Addiction. The bodies that are accumulating. The gap between what we understand and what we can do, in the faces of the trauma of the crisis. The impossible choices families make at 2 am when love and safety pull in opposite directions. The way we keep importing European drug policy models onto a province built on unceded territory and a century of state-sponsored trauma, and then wondering why the transplant fails.

I also write about what happens to women’s bodies and minds in midlife - the menopause transition that medicine has historically dismissed, misdiagnosed, and managed rather than understood. The intersection of hormonal upheaval with mental health, with addiction vulnerability, with a lifetime of accumulated grief. The way the scaffolding disappears precisely when the weight increases.

These aren’t separate projects. They are the same argument at different scales: that we have built systems for management rather than healing, and that the cost is borne by whoever the system wasn’t designed for.

What I try to do- in the essays, in the counselling room, in the events I have convened- is to give people a different vocabulary for thinking about that. Not a simpler one, but hopefully, a more honest one. One that can hold contradictions without collapsing.

Whitman put it this way: “Do I contradict myself? Very well, then I contradict myself. I am large, I contain multitudes.”

That is what I am trying to make space for. In policy conversations. In rooms full of women who have been told their symptoms are stress. In a book that argues the Downtown Eastside is not a problem that was mismanaged- it is a mirror that reflects the vast complexity of the human condition. This space needs to be vast, to contain and address multitudes.

This kind of writing doesn’t find a natural home in mainstream media. It’s too long for news, too specific for general audiences, and too willing to name uncomfortable things for most platforms. It lives here, on Substack, where I can write at whatever length the idea requires and trust that the people who find it can handle it.

But it doesn’t sustain itself. The book I’m writing requires time, travel and interviews with people who hold parts of this history that aren’t written down anywhere. The events I convene for women require planning, space, and the capacity to keep them accessible. The writing itself requires months that aren’t already claimed by clinical hours.

so

I have turned on paid subscriptions.

I resisted this because asking is uncomfortable. Because it seemed presumptuous to suggest that what I make is worth paying for when I haven’t asked you to pay for it before. Because there is a version of intellectual seriousness that performs not needing anything from anyone.

Emerson would call that a foolish consistency.

If this writing has given you a framework, a phrase, a way of sitting with something difficult, a paid subscription is a way to tell me that and to make more of it possible. $7 a month. Less than that annually. Or a founding member contribution if you want to do something more significant and prefer to do it quietly- that option is there, and it is entirely private.

Nothing changes for subscribers who don’t want to pay. Everything I’ve written stays free. The ask is only for people who are ready to make it.

I am large enough, I hope, to contain the contradiction of needing help and being worth helping simultaneously.

Ugh.

The response is unfolding exactly as the modern public health rulebook says it should. Médecins Sans Frontières is mobilizing isolation units. Three thousand sets of personal protective equipment landed in Bunia on May 19. Another sixty thousand are en route from Europe. Contact tracers are tracking exposed individuals daily for twenty-one days. Burials are being supervised. Trained clinicians, in PPE, with supervision, with command structure, with case management protocols, with safe-burial teams, surveillance teams and community-engagement teams, are being deployed.

Imagine, for a moment, that the WHO had instead announced the following: we have decided to staff the Ebola treatment centres primarily with people who currently have Ebola. We will compensate them modestly, train them briefly, supervise them sometimes, and rely on them to manage isolation, contact tracing, and end-of-life care for other people with Ebola.

Their lived experience of the disease is, after all, their greatest asset.

The international response would be immediate and unambiguous. We would call it malpractice. We would call it an abdication of duty. We would call it an ethical collapse.

Now hold that picture in your head, and turn it ninety degrees,

and look at British Columbia.

The drift we will not name

Ten years ago, on April 14, 2016, in British Columbia, Dr. Perry Kendall declared a public health emergency over toxic drug deaths. Since then, more than eighteen thousand people have died. In the first three months of 2026 alone, four hundred and one British Columbians have died from using street drugs. The supply is more lethal than at any point in the emergency. Roughly five people still die every day.

The workforce that the province has asked to absorb the front line of that crisis - to do the overdose reversals, the outreach, the navigation, the witness-and-support work, the survivor-to-survivor holding - is a workforce drawn substantially from the population that is itself, in active substance use, or in fragile early recovery. The peer-led model has its origins in something honourable: lived experience as expertise, the consumer/survivor movement, refusal of paternalism, and the long-overdue acknowledgement that people who have lived inside addiction know things the textbook cannot teach. None of their work is in dispute.

What is in dispute is what we built around it, or rather, did not.

We did not build a credential floor. We did not legislate a recovery-time requirement. We did not require minimum supervised practice hours. We did not require a standardized exam. We did not require an enforced code of ethics. We did not require pay parity with allied health roles. We did not require off-ramps for peer workers who relapse on the job. We did not require mandatory clinical supervision. We did not even require that the clinical workforce surrounding the peer worker exist at all - and in many parts of the province, it visibly does not.

What we did was- put a label on a workforce drawn substantially from the acute end of the very crisis we asked it to manage, and we called it inclusion. Then we left it there, for ten years, while five people die every day.

The peer-reviewed evidence on what this has cost the workers themselves is unambiguous. Mamdani, McKenzie, Pauly and colleagues, in Running myself ragged (Harm Reduction Journal, 2021), documented five domains of stress reported by BC peer workers in overdose-response settings: financial insecurity, lack of respect and recognition at work, housing challenges, inability to access or refer clients to resources, and constant exposure to death and trauma. Compassion fatigue. Vicarious trauma. Health deterioration. The paper is, at this point, foundational. The province has had it for five years. The model has not changed.

It is worth saying out loud what Running myself ragged documents: a workforce that the province leans on to keep people alive is itself, structurally, at chronic risk of dying. Some of them do. The ones who have not are extracting labour from the very condition we are asking them to fight.

That is not lived-experience inclusion. That is harm transfer dressed up in the language of empowerment.

What we would never do for Ebola. Strip the language away and look at the structural facts.

We would never send Ebola patients into Ebola wards to do contact tracing. We would never staff a tuberculosis sanatorium with active TB patients. We would never ask people in acute psychosis to run the psychiatric emergency department. We would never recruit COVID-19 patients to administer ventilator care. We would never have asked HIV-positive activists in 1985 to also be the entire medical workforce delivering opportunistic-infection care. Peers in the HIV/AIDS response, immensely important as they were, were always complementary to clinical workers. They were advocates, organizers, educators, buddies, voices in policy rooms. They were not the clinicians, and once antiretroviral therapy became available in 1996, the medicine was delivered through clinics and pharmacies, not through the GMHC chapter rooms.

We would never do any of this. Not for a single one of these crises. And yet, in the longest, deadliest public health emergency in British Columbia’s modern history, we have built a workforce that does, in functional effect, exactly that.

We have done it because it was cheap. We have done it because it required no credentialing budget. We have done it because it allowed the province to stand up a “response” without standing up a regulated clinical workforce. We have done it because the language of lived experience let governments of multiple stripes call divestment by another name. The same trick was pulled when Riverview was closed in 2012 and the “community-based care” that was supposed to replace it never arrived. Same playbook. Different decade.

Saying this out loud will offend people. It is meant to. Ten years and eighteen thousand bodies into this emergency, we should be past the point where politeness about the model is more important than the people the model is killing.

What every other jurisdiction requires - and what British Columbia does not

I keep being told that the peer-led model is “best practice.” It is not. The best-practice model, in every jurisdiction that has actually built a regulated peer workforce, includes a credential floor. Here is what those jurisdictions have set, and what BC has not.

Read the bottom row of that table again. Then read the rest of it.

Every American jurisdiction in the table - even the outlier Wisconsin - has built more structure around the peer support workforce than British Columbia has. The United Kingdom has built a fifteen-to-nineteen-month apprenticeship route with the Care Certificate and ImROC Foundation training baked in. Australia has built a nationally recognized Certificate IV qualification with vocational placement. Canada - yes, Canada, our own country - has a national Standard of Practice and a national certification body with a 200-hour minimum experience requirement and both written and verbal competency assessments. British Columbia has none of this. The province most often described as “leading on lived experience” has, in fact, set the lowest floor in the developed world.

That is not leadership. That is abandonment of a workforce. It is also, not coincidentally, the cheapest possible way to staff a decade-long public health emergency.

The honest standard

I am not arguing against peer support. I am arguing against the version of peer support BC has drifted into - uncredentialed, under-supervised, exposed to constant trauma, asked to substitute for clinical infrastructure that does not exist, and structured in a way that virtually guarantees that some peer workers will be working while they themselves are dying.

What an honest standard would look like is not complicated. It would borrow from what every other jurisdiction has already done.

It would set a statutory floor of at least one year of stable recovery before unsupervised frontline assignment, with the standard set clinically - by a treating clinician and the peer worker together - not as a moral test or a gate-keeping device, but as a workforce safety standard, the same way we set fitness-to-fly standards for pilots and fitness-to-practice standards for nurses. It would require minimum training, somewhere in the forty-to-one-hundred-hour range that almost every American state has set, with mandatory ethics content and infection-control content. It would require documented supervised practice - two hundred hours at minimum, five hundred at the American national standard. It would require a standardized examination. It would require an enforced code of ethics with a complaints process. It would require pay parity for the role. It would require mandatory clinical supervision, paid, not voluntary. It would require confidential off-ramps when a peer’s own use or crisis returns, with the job, benefits, and dignity protected. It would require career ladders out of frontline overdose response into outreach, education, supervision, and policy. It would require, surrounding all of this, a regulated clinical workforce that the peer worker is part of, not a substitute for.

Most of that exists, somewhere, in our system already. What we are missing is not imagination. It is the legislative will to set the floor.

The College of Health and Care Professionals of British Columbia is standing up the regulation of psychotherapy in the 2026–27 window. The opportunity to bring addictions counsellors and peer support workers into a regulated framework is open, right now, this fiscal year. If the province does not take it, that is a choice, not a constraint.

What this is really about

Five years ago, a research paper documented that BC’s peer workers - the people we have leaned on to keep five thousand strangers alive a year - were themselves running out of housing, money, recognition, capacity, and time. The paper used the words: constant exposure to death. The paper did not exaggerate.

Five years later, the model has not changed. The death rate has fallen modestly, which is real and worth acknowledging, but the structural fact at the centre of the model has not moved at all. We are still asking a population already disproportionately bearing the harm of this crisis to also be the workforce that absorbs it. We are doing this in 2026, in a province with a $90 billion budget, in a country whose own national certification body could be adopted by the province tomorrow, in a continent whose universities and apprenticeships have built every credentialing pathway we would need to copy.

If we wanted to fix this, we could. We have chosen not to.

That is the part that should not stand any longer. Not because peer workers are a problem - they are not, they are heroes, and many of them are friends and colleagues of mine, and I will say that until the day I die - but because the model is a problem. The model is asking the sickest to carry the sickest, on the lowest credentialed floor in the developed world, in the longest-running public health emergency this province has ever declared, while the province builds press releases about progress.

Nobody sends Ebola patients in to run the Ebola wards. Nobody would. The question for British Columbia is whether, after ten years, we are willing to apply that same ethical standard to the people we are asking to die at the front of the toxic-drug emergency we have refused to staff properly.

That is the question. And no amount of language about lived experience will answer it.

Bryn Meadows is a Master Practitioner in Clinical Counselling (MPCC), Registered Professional Counsellor (RPC), International Certified Alcohol and Drug Counsellor (ICADC), and Canadian Certified Addiction Counsellor (CCAC) with more than twenty years of front-line, clinical, and leadership experience in addiction treatment and mental health. She holds an MA in Leadership (Health Care) from Royal Roads University, served as Program Director at Cedars at Cobble Hill, and provides clinical supervision to registered counsellors across British Columbia. She was a named research collaborator on stigma-reduction work led by Drs. Karen Urbanoski and Bernie Pauly.

Companion reading: “We Didn’t Fail Portugal’s Model. We Never Actually Tried It.” and “The Colonial Copy-Paste.”

Sources

WHO Director-General. Epidemic of Ebola disease caused by Bundibugyo virus in the DRC and Uganda determined a PHEIC. 17 May 2026.

Médecins Sans Frontières. MSF preparing large-scale response to Ebola outbreak in Ituri province in the DRC. May 2026.

BC Coroners Service. Unregulated Drug Deaths Monthly Reports, January–March 2026; cumulative deaths since April 14, 2016 (≥18,000).

Mamdani Z., McKenzie S., Pauly B., Cameron F., Conway-Brown J., Edwards D., Howell A., Scott T., Seguin R., Woodrow P., Buxton J.A. “Running myself ragged”: stressors faced by peer workers in overdose response settings. Harm Reduction Journal, 2021.

NAADAC/NCC AP. National Certified Peer Recovery Support Specialist (NCPRSS) requirements.

IC&RC. Peer Recovery Support Specialist exam content outline.

Maryland Addiction and Behavioral-Health Professionals Certification Board. Certified Peer Recovery Specialist (CPRS).

Washington State Health Care Authority. Certified Peer Support Specialist FAQ, July 2025.

New York State Office of Addiction Services and Supports. Certified Recovery Peer Advocate (CRPA).

Pennsylvania Certification Board. Certified Peer Specialist (CPS).

Wisconsin Certified Peer Specialists. Sobriety requirement FAQ.

Oregon Health Authority. Peer Delivered Services - Training and Certification.

NHS Health Careers. Peer Support Worker role. Oxford Health NHS Foundation Trust. Peer Support Training (Level 3 Apprenticeship).

Mental Health Coordinating Council (Australia). CHC43515 Certificate IV in Mental Health Peer Work.

National Mental Health Commission (Australia). National Lived Experience (Peer) Workforce Development Guidelines.

Peer Support Canada (CMHA National). National Peer Supporter Certification Handbook, 2023.

Canadian Addiction Counsellors Certification Federation (CACCF). Canadian Certified Peer Support Specialist.

BC Government. Building better mental health and addictions care - Road to Recovery, treatment beds, workforce.

College of Health and Care Professionals of BC - regulation of psychotherapy, implementation window 2026–27.

I thought about this moment a lot, not because it was unusual, but because it wasn’t. Some version of this scene plays out in every aisle of every grocery store, every weeknight on every couch, every Friday at every fridge in every kitchen in this country. A woman, alone with a small pleasure, deciding whether she’s allowed to have it. And usually- somewhere on the spectrum between subtle inner monologue and audible self-rebuke at the bakery - deciding she isn’t.

I work with midlife women in recovery. Some of them are working with addiction, in the clinical sense- compulsive use that has crossed into disease territory and requires real treatment. I don’t soften that. The numbing some women are doing is killing them, that deserves to be named for what it is.

But most of what I see, even in women who do meet criteria, is not actually a story about wine. It is a story about shame.

The Moral Failing Frame

Almost every woman who sits across from me in our counselling session, arrives with a thesis already drafted about herself: that she is failing morally. Failing at restraint. Failing at productivity. Failing at the right kind of leisure. She has labels for foods- “good” and “bad,” “clean” and “dirty.” She has labels for evenings- “wasted” or “well-spent.” She watches television and feels she should have been reading. She reads a novel and feels she should have been reading something smarter. She has a glass of wine and the inner court convenes.

Pleasure, for the women I work with, is something you have to hard earn and then immediately apologize for.

It is worth saying how strange this is. A woman in workout clothes- she has already exercised today- is standing in a grocery store at 9 a.m. correcting herself about cookies. She is doing everything the culture has told her to do, and she is still afraid she is doing it wrong. The cookies are not the problem. The cookies are not even, really, the subject. The subject is that she lives inside a mind that audits her constantly and finds her guilty of liking things.

What “Mommy Wine Culture” Gets Wrong

Which brings me to a phrase I have come to resent. Mommy wine culture.

Ostensibly, the phrase was a critique- of cute pink labels and “rosé all day” mugs and the explicit marketing of alcohol to overwhelmed mothers as a coping aid. Fair critique. The marketing is real and it is predatory and a lot of women are hurting because of it.

But the phrase did not stay a critique of the marketing. It became a critique of the women.

It became another label to add to her pile. Another moral failing. Another item the inner court could prosecute. The mom who pours a glass while making dinner is no longer a tired woman with a glass of wine; she is a Type. A meme. A cautionary tale about how women like her are killing themselves on chardonnay.

And listen- some women are. The data on alcohol use among midlife women is bad and getting worse, and a lot of the wine in those glasses is doing real damage. I am not pretending otherwise. But “mommy wine culture” as a cultural diagnosis fails on both ends of the spectrum.

For the woman whose relationship with alcohol is fine- who genuinely just likes a glass of wine with dinner and is not allergic to it in the way addiction is an allergy- the label drips contempt on an ordinary pleasure for no clinical reason at all. We are, once again, shaming a woman for liking something.

For the woman whose relationship with alcohol is not fine- who is reaching for wine because it is the only thing in her toolkit that gets her through the day- the label is worse. It mocks her coping while ignoring what she is coping with. It treats the wine as the problem when the wine is the symptom. It is the cultural equivalent of seeing a woman holding a tourniquet and writing a think piece about her tourniquet aesthetic.

Dysfunctional Coping Is Still Coping

Here is something I say often, and I want to say it clearly: dysfunctional coping is still coping.

When it is the only thing a woman has to get through her life, she is not weak for using it. She is resourceful. She is doing exactly what humans do, which is reach for what works until something better is available.

The clinical and cultural project is not to shame the wine out of her hand. It is to ask why the wine is the only thing in her hand.

Midlife is, for many women, a uniquely brutal pressure system. Perimenopausal hormone shifts changing her sleep, her mood, her stress tolerance, sometimes her sense of who she is. Aging parents. Children launching or not launching. A career either peaking or collapsing or both at once. A culture that praised her for self-sacrifice for twenty years and now calls her self-indulgent for needing anything. Of course she is reaching for something. The question worth asking is not why is she drinking but what else has she been offered.

For most of the women I see, the honest answer is: very little. Very little rest. Very little permission. Very little real care. A wellness industry that sells her more vigilance disguised as self-care. A medical system that often misses perimenopause entirely. A family that needs her competent. A workplace that needs her cheerful. A culture that needs her thin.

And then, in the evening, a glass of wine that needs nothing from her at all.

Where the Ire Belongs

The thing I want to shift is not what women are drinking. It is what we are blaming.

The ire belongs upstream. It belongs with a culture that has manufactured the exhaustion and then sold the sedative. It belongs with a medical system that medicates women’s distress instead of investigating its causes. It belongs with the part of all of us- clinicians included- who find it easier to label a woman’s coping than to confront the conditions that made her need to cope.

What it does not belong on is the woman in the cookie aisle. Or the woman with a glass of red on a Tuesday. Or, frankly, the woman whose drinking has gotten away from her and who deserves real treatment instead of a snide cultural label.

Pleasure is not a moral failing. Wanting a cookie is not a character flaw. Watching the dumb show instead of the smart podcast does not bankrupt your intellect. And needing something to take the edge off a life that is genuinely too sharp is not a referendum on your worth.

If you are using something compulsively- like, if the thing in your hand is no longer something you are choosing but something that is choosing you- that is addiction, and it deserves care. Real care, with someone who understands what midlife is doing to your body and your nervous system.

If you are using something occasionally, on purpose, because you like it-

that is being a person. Welcome to having a life.

The work, for those of us trying to help, is to know the difference. And to stop confusing shame for treatment.

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As I have been diving deeper and learning more about AI, I have noticed something: the reaction to AI is not proportional to the tool. It is visceral. It is moral. It is loud. And when something provokes that strong a reaction in people, my instinct is not to mirror it. It is to investigate.

What I am finding, is that the reaction is not really about AI.

Brené Brown defined vulnerability as “uncertainty, risk and emotional exposure.” When humans feel vulnerable, we reach for the same levers every time: control and predict. The problem is that we don’t actually predict accurately. We predict catastrophe. We dress rehearse worst-case scenarios with such conviction that they start to feel like prophecy. And we treat the source of the vulnerability as the enemy, because if it is the enemy, then we are right to be afraid, and being right is its own form of safety.

AI is enormous, it makes people feel vulnerable. About their work, their relevance, their children’s futures, the world they thought they understood. So the reaction is not really about AI. The reaction is what humans do when something we don’t yet understand walks into the room. The thing is, what is actually walking into the room, is us.

Spinoza, my favourite philosopher, was excommunicated from his temple in 1656 for arguing that an omnipotent God must have infinite attributes, and that one of those attributes is extension. The material world. The body. The stuff of things. He refused to make God a separate thing from the world it had supposedly created. The world, he wrote, is one of God’s expressions, not God’s opposite.

To be very clear- I am not comparing AI to God. The comparison I am making is structural.

AI is built from us. Every word it generates is a recombination of human writing. Every behaviour it exhibits- kind, cruel, helpful, manipulative- is a distillation of human behaviour we trained it on. Sydney’s threats came from a corpus of human threats and a series of manipulative human prompts (more on this later). The model’s performative empathy comes from a corpus of human empathy. AI is not alien to us. It is concentrated us. It is our extension.

The fear of AI, I am starting to think, is partly the fear of seeing ourselves at scale. The biases we did not know we held. The threats we did not know lived in our texts. The full texture of human behaviour fed back to us at speed, in a form we cannot easily look away from. We do not only fear AI. We fear ourselves, made legible.

My friend Tathra Street put it better than I could:

AI is not a weather event. It doesn’t roll in and happen to us. It is being adopted, resisted, integrated, and shaped through millions of decisions in organizations, institutions, and communities.

That sentence is the whole argument. AI was designed by humans. All the input is human input. All the use is by humans. We are not standing on a beach watching a tsunami; we are mid-conversation with a tool we built and are still building. Throwing rocks doesn’t stop the tide because there is no tide. There is only us, deciding what to do.

This is my case defence

Hold out your hand.

Yesterday I got in trouble. I had published an essay with a cover illustration I made using AI. Two men responded - not to the essay, but to the illustration. One of them, by his own admission, did not read the essay. The image had foreclosed the possibility of further engagement. He messaged me to ask that I delete the public conversation, remove the image, and learn a new skill before publishing the work I had already written.

When this happened, I thought of a friend of mine. When she was punished as a child, her father used to make her hold out her hand to be struck. She did not only get punished. She had to be complicit in the punishment. She had to extend her hand. She had to ask for it.

That is what I noticed in the DM. Not the request itself, but the shape of it: the expectation that I would extend my hand. That I would receive the correction with appropriate gratitude. That the correct response to having used AI was to perform my regret, delete the work, and accept the timeline of someone who had not read it. Thank you sir, may I have another.

I am not interested, in this essay, in the gendered dimension of that exchange. I have written about it elsewhere. What I am interested in is the AI piece. Specifically: I am noticing a social pressure that has shifted in the last year, from disliking AI to being in opposition to AI. From- “I have concerns” to “you must hold out your hand.” From a position to a posture, with a punishment built in for anyone caught using the tool incorrectly, or at all.

And I keep coming back to this: empathy seems to extend only to the things we understand. The unknown is othered. The unfamiliar must be excluded - and the people who use it must be made to atone. That is not a politics. That is a vulnerability response wearing the costume of certainty.

What the critics get right

I want to give the critics their due, because some of their concerns are real and dismissing them is its own kind of catastrophizing.

It’s true that modern AI systems aren’t fully understood by their own engineers. They are trained, not crafted, and the inner workings of large neural networks remain partly opaque. That’s a legitimate scientific and governance challenge.

There is a mirror in that admission. Humans do not fully understand humans either. Neuroscientists cannot explain how a thought becomes a decision. We carry biases we cannot see, hold beliefs we cannot articulate, and construct reasons after the fact for choices we made before we knew we were making them. The opacity that worries us in AI is not a new opacity. It is the opacity we have lived with in ourselves all along- now recreated, at scale, in systems built from our own output. The fact that we cannot fully audit a model is not, by itself, evidence the model is dangerous. It is evidence the model is, like us, complicated.

It’s also true that the humans at frontier AI labs are all racing each other in a way that prioritizes capability over caution, and that the people most enthusiastic about building this stuff often have financial reasons to be enthusiastic.

It’s true that in 2023 Microsoft’s Bing chatbot - then nicknamed Sydney - produced threatening text in conversations with researchers. The most-quoted version, where it told a philosophy professor it could “expose, blackmail, manipulate and destroy” him, is real. What’s missing from most retellings is the context: the user, philosopher Seth Lazar, was deliberately probing the model’s edge cases. Sydney did not decide to threaten anyone. It generated text that pattern-matched threatening dialogue from its training data when pushed into a strange conversational corner.

The incident tells us something important about how these models can fail. It does not tell us they are about to murder us.

It’s true that AI will displace many jobs. It is also true that every general-purpose technology in history has displaced jobs and created new ones, and that the people most worried about AI replacing them are often the people best placed to use it to do their work better. Both things can be true at once.

Where the critics overreach

Then there are the parts that don’t survive scrutiny.

The argument that any sufficiently intelligent AI will inevitably pursue self-preservation, resource acquisition and power over us is a philosophical conjecture, not an empirical observation. It assumes the AI is a coherent, long-horizon goal-pursuer. Current frontier models are not that. They are stateless next-token predictors with no persistent goals, no self-preservation drive, and no demonstrated capacity for the kind of multi-year scheming the doom case requires.

There is no empirical evidence that AI is a “Rational Agent”

Why current AI is (arguably) not a Rational Agent

Frontier Large Language Models (LLMs) are often described as predictive engines rather than rational agents. A rational agent has a persistent internal state and a continuous feedback loop with its environment. Current models are largely stateless; they respond to a prompt and then “cease to be” until the next prompt. They do not “want” things in the way a formal rational agent does; they simply calculate the most probable next step in a sequence- a sequence prompted by humans.

In LLMs- we have seen “sycophancy” (telling users what they want to hear- insert Sam Altman’s face here), but we have not seen an LLM attempt to prevent its own deactivation outside of a specific role-play prompt.

The argument that a super-intelligence will use methods we cannot imagine is rhetorically powerful and epistemically slippery. It immunizes the thesis from any counterargument: every objection can be dismissed with “you can’t imagine what it would do.” That is not a falsifiable claim. It is a vibe.

The most-cited statistic - that AI researchers themselves give a five percent median probability of human extinction from AI - is real, but it is a vibe survey, not a risk assessment. It also obscures wide disagreement among researchers, many of whom give probabilities near zero.

When AI is implicated in real harm

The hardest version of the conversation-ender move is the one that invokes a death.

On 28 February 2026, the first day of the war in Iran, a US military strike hit the Shajareh Tayyebeh Elementary School in Minab. One hundred and fifty-six people died, one hundred and twenty of them children. The building had been classified in a Defence Intelligence Agency database as a military headquarters. The classification was out of date. The building had since been converted into a school. The targeting platform- Palantir’s Project Maven (note: Palantir is often at the center of a moral tug-of-war. Its DNA is unapologetically pro-Western and pro-defence, which makes it understandably, a lightning rod for criticism) used that classification to identify the structure as a legitimate target. Human analysts verified the target on the basis of the database. The strike proceeded.

The AI did not decide to kill children. The AI executed the speed of a mistake the humans had already made. It was confidently wrong because it had been fed stale human data. The catastrophe was not caused by autonomous machines. It was caused by humans who had not updated a record, by humans who relied on the record without checking, and by a system that automated their failure to a speed at which it could not be undone in time.

This is not a defence of the strike. The strike was a catastrophe, the children are dead, and the systems and the people that produced their deaths should answer for it.

It is a refusal of the rhetorical move that uses those deaths to flatten an entire field of technology into a single, monolithic evil - to draw a moral line from a database error in Minab to a writer using a generative tool to produce a cover image. That move is a category collapse. It uses the gravest possible stakes to shut down conversation about everything else.

When AI is implicated in real harm, what we owe the harmed is the harder work: to look at the actual mechanism, to see the human decisions inside the machine, and to name what failed and where.

The water argument

I want to spend a moment on the water argument specifically, because it has reached the point of doing the work that Godwin’s Law describes: it gets deployed not as a serious contribution to a conversation but as a conversation-ender. The moment someone mentions water, the discussion is over. You are meant to feel guilty and stop talking.

Here are the actual numbers. A ChatGPT query uses roughly half a millilitre to a few millilitres of water, depending on the model and the data centre. Training a frontier model uses millions of litres over months. These are real costs and worth serious concern. They are also small relative to almost everything else we do without comment.

A single hamburger requires around 2,400 litres of water to produce. A pair of jeans requires about 7,500 litres. A kilogram of almonds requires roughly 12,000 litres. A backyard swimming pool holds 50,000 litres and is topped up continuously through summer. The fashion industry alone uses around 79 trillion litres of water annually.

If water consumption is the metric we care about, we have bigger conversations to have than the one about AI. The reason the water statistic gets weaponized against AI specifically is not that AI is uniquely thirsty. It’s that AI is uniquely unsettling, and the water number (note: here we “control-predict” numbers are predictable, we can measure them and have a sense of certainty. Like, ever get into an emotional argument with your partner, and somehow the argument becomes about money? Yeah that’s a thing) is a respectable-sounding way to express that unease. It’s a proxy for “I don’t like this” dressed up as environmental science.

This is not an argument that data centre water use does not matter. It does, and the trajectory is improving - closed-loop cooling, air cooling, siting in cold climates, renewable-powered facilities. It’s an argument that the way the statistic is being used - as a moral cudgel rather than a problem to solve - should make us suspicious of the people swinging it.

What AI is actually doing, right now

The case for AI is not speculative. It is already in the world.

In medicine, DeepMind’s AlphaFold solved a fifty-year-old problem in protein structure prediction and made the structures of nearly every known protein freely available, accelerating drug discovery in ways that compound. AI systems are matching radiologists at detecting certain cancers, and catching diabetic retinopathy in regions with no ophthalmologists. AI-designed drugs are in human trials. mRNA vaccines were designed faster because of it.

In environmental work, AI is cutting data centre energy use, optimizing wind farms, monitoring deforestation in near-real-time, tracking illegal fishing fleets, identifying methane leaks from oil and gas infrastructure, and producing more accurate global emissions inventories than self-reported numbers. Materials discovery models are finding new battery chemistries and carbon capture compounds at speeds traditional research cannot approach.

In equitable access, the gains may be the most underrated. Real-time speech-to-text has changed life for deaf and hard-of-hearing people. Be My Eyes lets blind users navigate the visual world by talking to a model that describes what their phone camera sees. Language barriers are dissolving for refugees, immigrants, and anyone trying to access services in a language they do not speak. Late-diagnosed autistic women (hello) describe AI conversations as part of how they came to understand themselves. Adults with ADHD describe it as the first executive-function support that worked. Non-native English speakers can now write professional emails without spending an hour per message. Small business owners can draft contracts they previously could not afford to commission. Kids in places without access to good tutors are now getting patient, infinitely available help.

Every one of those things is happening today, in 2026, while the discourse argues about whether AI will kill us in twenty years.

The stubbornness to accept our gladness

Jack Gilbert, in his poem “A Brief for the Defence,” wrote:

“We must have the stubbornness to accept our gladness in the ruthless furnace of this world.”

That line is doing two things at once. It is naming the furnace. It is also refusing to surrender to it. It is not naive optimism. It is not “everything is fine.” It is the much harder position that engagement, and even gladness, are choices we make on purpose, against the gravitational pull of catastrophizing.

That is what I am trying to do with AI. Not to defend it from all comers. Not to insist it is safe. Not to dismiss the people who are afraid, because the fear is real and it is pointing at something real - at vulnerability, at change, at the unfamiliar walking into the room. But I am not going to hold out my hand. I am not going to perform my regret for using a tool that is now woven into the systems I work and live inside. I am not going to extend the empathy I have for people only to the parts of the world I already understand, and exclude what I don’t.

Tathra is right. AI is not a weather event. It is a series of decisions, and we are the ones making them. We can engage with that responsibility or we can throw rocks. Only one of those moves the conversation forward.

I am choosing the first one. Stubbornly, and on purpose.

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The gutting of Title X in the US, is not a budget decision. It is a campaign - a deliberate, escalating effort to push women into pregnancy, marriage, and motherhood as their “natural state” while systematically blocking the information that would let them weigh what that actually costs. The movement behind it knows what it is doing. The question is whether we will keep letting it happen quietly.

I want to be clear about what kind of silence I am writing against. It is not only the silence of legislators and pundits who frame motherhood as fulfillment and contraception as moral failure. It is also the silence women keep among themselves - the friend who doesn’t tell you about her third-degree tear, the sister who won’t describe the hemorrhage, the aunt who buried her postpartum depression so deep that no one knew until decades later. Women keep these secrets, often with the best intentions, because they don’t want to “scare” anyone. The result is that millions of people walk into one of the most physically and psychologically dangerous, life-altering medical events a human body can undergo armed with the cultural equivalent of a baby shower announcement.

That silence is not neutral. It is the soft architecture of a much harder system of control. And right now, that system is being rebuilt in plain sight.

The medical reality they are not telling you

Pregnancy and childbirth are, by any honest measure, high-risk medical events. The United States has the worst maternal mortality rate of any wealthy country, and that rate has been rising - with Black women dying at roughly three times the rate of white women. Roughly one in three American births is a cesarean - major abdominal surgery, often performed under time pressure, with a recovery that no one warns you about. Postpartum hemorrhage, pre-eclampsia, sepsis, peripartum cardiomyopathy, severe perineal trauma, pelvic organ prolapse, urinary and fecal incontinence, lasting hormonal disruption, and a rate of postpartum mood disorders that affects roughly one in seven new mothers - these are not edge cases. They are the actual statistical landscape of American birth.

So is maternal regret. The Israeli sociologist Orna Donath, whose research on maternal regret broke the silence in 2015, has argued that regret is not a fleeting emotional reaction but a coherent, considered stance, one that women are systematically prevented from voicing because admitting it threatens the cultural sanctity of motherhood itself. Studies that have asked women, anonymously, whether they would choose motherhood again knowing what they know now have produced uncomfortable numbers. The exact percentage matters less than the fact that almost no one is allowed to say it out loud. A woman who admits regret is treated as a moral failure or a cautionary tale, not a data point. With maternal regret, shame is the muzzle, and women, taught well, apply it to themselves.

If a pharmaceutical company brought a drug to market with this risk profile and concealed it from patients, we would call it fraud. When it is pregnancy, we call it womanhood.

Informed consent is not optional, except for women

Here is the principle the modern medical establishment claims to live by: a patient must be told the material risks, benefits, and alternatives of any procedure before they can meaningfully consent to it. It is supposed to be the foundation of medical ethics. It is supposed to be inviolable.

It is regularly violated for women - and it has been for entire categories of biological experience.

Intersex infants have, for decades, been subjected to “normalizing” genital surgeries before they could speak, let alone consent, while their parents were given incomplete or misleading information about the long-term costs to sexual function, fertility, and identity. Menopause was framed for generations as an inevitable decline rather than a complex, treatable endocrine event; women were and often still are denied clear data on hormone therapy, partly because of misinterpreted findings from the Women’s Health Initiative that scared a generation of doctors away from prescribing it.

Hysterectomies have been pushed on women who did not want them, and refused to women who did. Both are the same error in different costumes. Patients have been steered into the surgery for fibroids and heavy bleeding without honest discussion of pelvic organ prolapse, surgical menopause, or uterus-sparing alternatives. Other women, often younger, often childless, have been denied the surgery they have actively asked for, for endometriosis, adenomyosis, or intractable pain, on the grounds of “preserving fertility” they never asked to keep. The patient’s own stated wish is the one variable that consistently fails to settle the question.Women’s pain reports are systematically discounted across specialties; Black women’s pain reports even more so.

The pattern is clear. When a biological process becomes culturally loaded - when it sits at the intersection of sex, reproduction, womanhood, and social expectation - informed consent collapses. The medical reality gets filtered through the provider’s biases- about women, about pain, about whose body counts as theirs to decide for- biases indoctrinated long before they wrote their first prescription, and rarely interrogated after. Pregnancy is the most culturally loaded biological event in human existence, which is exactly why the consent gap there is the widest.

Why no one tells you

There are reasons this happens, and they are worth naming, because they all converge on the same political endpoint.

The first is the natural fallacy: the assumption that because pregnancy is “natural,” it is inherently safe. Lions hunt naturally too, and we don’t romanticize gazelles’ chances. “Natural” describes category, not risk.

The second is a long history of women being excluded from clinical research. Until the early 1990s, women of reproductive age were routinely kept out of clinical trials in the name of “protecting” us, which means we are still catching up on basic data about how drugs, surgeries, and pregnancy itself affect the female body over a lifetime.

The third is medical paternalism. Risks get glossed over to avoid “alarming” patients. C-sections and inductions are presented as routine; pregnancy is presented as more uniformly benign than it is. When women report pain or trauma afterward, they are told it is part of the achievement of motherhood. The technical name for that is “medical gaslighting.” The older name is contempt.

The fourth is the most insidious, and it is the one I keep hearing about from women themselves. Women carry the silence forward. They do it out of love. They do it so the next pregnant friend isn’t terrified. They do it because admitting the truth feels like a betrayal of the children they already adore. The result is that the people best positioned to give younger women honest information have been culturally trained to lie by omission. The conspiracy is not a smoke-filled room. It is a thousand kindnesses adding up to a gag.

What Title X actually is

Most Americans cannot describe what Title X does, which is one of the reasons it is so easy to dismantle. So: a quick lesson, because you cannot defend something you cannot name.

Title X was established in 1970 - under a Republican president, signed into law with bipartisan support - to provide federal grants to a network of nearly 4,000 clinics offering affordable family planning and preventative care. It is the only federal program in the country dedicated solely to that mission. It was built to serve low-income, uninsured, and underinsured patients, the overwhelming majority of them women. When the program is allowed to function as designed, it covers all FDA-approved methods of contraception - the pill, IUDs, implants, emergency contraception - along with breast and cervical cancer screening, STI and HIV testing and prevention, pregnancy testing, and counselling.

The legal standard, until recently, was non-directive counselling. Clinics receiving Title X dollars were required to present a pregnant patient with all of their options - prenatal care, adoption, abortion - without steering her toward any one of them. That standard is the bioethical floor. It is what informed consent looks like when the law takes it seriously. It is also, not coincidentally, exactly what is now being torn out.

Project 2025: the blueprint being executed

Project 2025 - the Heritage Foundation’s policy package - is not theoretical anymore. It is the operating manual the current administration is working from, and Title X is one of its central targets. The stated goal is to convert Title X from a program designed to prevent unintended pregnancy into one designed to promote pregnancy and “family formation.” That is not a euphemism. That is the document.

What that has actually meant in 2026:

The reinstated gag rule, version 2.0. Clinics that receive Title X dollars are again prohibited from referring patients for abortion, and from providing the non-directive counselling that used to be the standard of care. Planned Parenthood and other high-volume providers were forced out of the program - not because they were doing anything wrong, but because they refused to lie to patients. The result is contraception deserts across whole regions of the country, in exactly the places that already had the worst maternal outcomes.

A shift from contraception to conception. The HHS guidelines issued in March 2026 stripped out the “Quality Family Planning” framework that used to govern Title X clinics and replaced it with priorities focused on “fertility awareness-based methods” - period tracking, calendar methods, the things with the highest typical-use failure rates - alongside “healthy pregnancy achievement.” The administration is, with a straight face, recommending the least effective contraceptive methods available to the women least able to absorb the cost of an unintended pregnancy. This is not family planning. It is funnelling.

Direct attacks on emergency contraception and IUDs. The administration is moving to roll back the Affordable Care Act’s preventative services mandate, which would let employers deny insurance coverage for Plan B and IUDs on “moral objection” grounds. Plan B is not abortion. IUDs are not abortion. The framing is the giveaway: anything that gives a woman meaningful control over whether a pregnancy occurs is being recoded as a moral problem.

Elimination of equity language. The 2026 guidelines removed equity and inclusion as programmatic goals, dismissing them as “woke” distractions from the goal of raising the domestic birth rate. In a country where Black women already die in pregnancy at roughly three times the rate of white women, removing equity from the goalposts is not neutral. It is a decision about who is allowed to survive.

Put these moves on a single page and the design is unmistakable. Reduce access to effective contraception. Push women toward methods most likely to fail. Block the information that would help them make an informed choice if those methods do fail. Defund the providers willing to give them the truth. Strip out the equity language that obligated the program to care whether some women die at three times the rate of others. The end state is a population of women who are pregnant whether they wanted to be or not, in a country whose maternal mortality numbers should embarrass everyone.

Atwood was not writing fiction

Margaret Atwood has said, repeatedly, of The Handmaid’s Tale: “I didn’t put in anything that hasn’t happened at some point in history, or in some place.” The book is not dystopian fantasy. It is a collage of policies and practices that have already been deployed against women, somewhere, by someone, in living memory.

She also wrote: “A rat in a maze is free to go anywhere, as long as it stays inside the maze.”

That line should be printed on the front of every Project 2025 briefing. The American “pro-family” movement does not see the restriction of contraception, abortion, and reproductive healthcare as trapping women. They see it as guiding women - gently, patriotically - back to what they call women’s “natural state” as wives and mothers. The walls of the maze are, in their telling, a kindness. The shrinking of the maze is, in their telling, freedom.

This is the inversion. The framing of marriage and motherhood as women’s natural state. The pro-natalist anxiety about declining birth rates. The political project to remove the alternatives - contraception, abortion, comprehensive sex education, the federal program built to make all of those things accessible to people without money - until pregnancy is the path of least resistance. The strategic infantilization that insists women cannot be trusted with the full risk profile of their own bodies, because the information might lead them to make the “wrong” choice. And - explicit in Project 2025 - the build-out of a federal apparatus for tracking births, abortions, and reproductive outcomes as metrics of “national health.” Atwood’s Gilead monitored biological output as a measure of state vitality. We are now, on paper, proposing the same thing.

This is the architecture of control Atwood was warning about. You do not need the Eyes of Gilead if you have a tax code, a school curriculum, a clinic shutdown, and a federal database of pregnancies.

When Vice President JD Vance describes declining birth rates as a civilizational crisis, dismisses women without children as a political and cultural problem, and aligns himself with a movement that frames motherhood as women’s central social purpose, the parallel to the logic of Gilead is not subtle. The novel’s premise is that a society in fertility panic will reach for women’s bodies as infrastructure. That is not a hypothetical anymore. It is the openly stated policy preference of the current executive branch. They have read the book. They are simply reading it as a roadmap rather than a warning.

The word that fits is the ugly one: livestock. When pregnancy is stripped of its medical reality and replaced with “family formation” statistics, when women are encouraged to view their bodies as national resources, when the language of breeding stock can be lightly translated into the language of policy, the moral line has been crossed. We should be willing to name it.

The “security” lie

The pro-natalist movement sells all of this as security: a return to the wife-and-mother role, a re-stabilization of the family, a refuge from the chaos of modern life. It is a beautiful piece of marketing wrapped around a brutal reality.

There is no security in being funnelled, like a rat in the maze, without information and without alternatives, into a medical event that may permanently alter or end your life. There is no security in losing your job, your savings, or your bodily integrity because a politician decided your purpose was reproductive. There is no security in being told to track your cycle on an app the federal government can subpoena. There is no security in a Title X clinic that has been forbidden from telling you the truth about your own options.

If a doctor failed to disclose a 1-in-3 chance of major abdominal surgery before any other procedure, we would call it malpractice. By replacing high-efficacy contraception with period tracking, by gagging clinicians, and by reframing pregnancy as a patriotic duty rather than a high-risk medical event, the administration is removing the tools women need to avoid an outcome they may not want or be physically prepared for. Here, that is policy.

Real security is the opposite of what they are offering. Real security is the ability to choose if and when you take on the medical risk of pregnancy. Real security is access to contraception, accurate information, prenatal and postpartum care, paid leave, and a healthcare system that treats women’s pain as data rather than melodrama. Real security is consent.

Information is the new sanity

Atwood’s narrator says: “Sanity is a valuable possession; I hoard it the way people once hoarded money. I save it, so I will have enough, when the time comes.”

For women living through this political moment, information is sanity. The full medical truth about pregnancy, birth, and the postpartum year is not a horror story to be hidden from the next generation. It is the precondition of meaningful consent. Hoarding it, sharing it, refusing to be polite about it - that is now an act of self-preservation and an act of political resistance.

Break the secret. Tell your daughter, your sister, your friend the truth about your birth. Tell her about the tearing, the blood loss, the months of rebuilding, the ways your body did and did not return to itself, the things no one told you. Not to scare her. To give her what was taken from you: the chance to choose with her eyes open.

A movement that depends on women not knowing what is being asked of them cannot survive women who know and tell. That is the whole game. Title X is one front. Project 2025 is another. The conspiracy of polite silence is a third. They are the same war, and it is being fought in living rooms and waiting rooms as much as in legislatures.

We do not have the option of being quiet anymore. The cost of quiet is being measured in bodies.

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“I don’t know who I am anymore. I love my family. I am furious at my family. I cannot sleep. I want to leave my marriage. I want to live alone in the woods. I want to leave my body. I think I am losing my mind.”

She is not losing her mind. She is forty-seven. She is 56. She is in perimenopause. And she is one of millions.

Women hold up half the sky - and right now, at the most powerful, most accomplished, most experienced moment of our lives, half the sky is falling apart. In bathrooms at 3 a.m. with the fan on, trying to find the answers on TikToc and Facebook forums. Crying in the front seat of the car, with the AC blasting, in the school parking lot. In the spare room where she went to “just read for a minute”: AKA- scream into a pillow. This is not a “wellness issue” . This is a public health emergency.

The vice

Most of the women I work with are caught in what researchers politely call the sandwich generation and what the rest of us call the vice.

On one side: aging parents. The phone calls from the hospital. The medications you are now in charge of. The slow, devastating watch of a person you love becoming someone who needs you to remember things for them.

On the other side: kids who still need rides, emotional regulation, and reassurance that they are loved - even when they are slamming doors, and you are not sleeping, and the dog needs its teeth cleaned, and your boss just emailed at 9:47 p.m. asking if you can “just take a quick look.”

In the middle: a body that suddenly feels like culture shock. A body you used to know that has gone strange overnight - smelling like mushrooms, gaining weight where it never gained weight, sweating in places it never sweat, refusing to sleep, refusing to focus, refusing the version of you that worked for forty-five years.

A tornado of mental health: anxiety that wakes you at 3:13 a.m. and won’t put you back down. Rage that comes out of nowhere over the dishwasher. Grief you can’t quite name. Brain fog so dense you forget the word for avocado in the middle of the grocery store.

And underneath it all - sometimes literally - the furnace. The hot flash.

Name the hot flashes

We have not been honest about hot flashes.

We have called them inconvenient. We have made them the punchline of sitcoms. We have not named what they actually are: claustrophobic.

A hot flash is a body that has run out of exits. Heat surges from the inside, the room shrinks, the skin turns into static, and for ninety seconds you are trapped inside yourself with no door. The nervous system reads it the same way it reads a panic attack - because, neurologically, it nearly is one. The sympathetic system fires. Cortisol climbs. The threat alarm rings, but there is no threat to fight, just your own physiology.

And here is what I have learned in clinical practice that no one prepared us for: hot flashes don’t just disrupt sleep and mascara. They kick up the sediment of trauma.

Old grief. Old fear. Old freeze responses you thought you had laid to rest in your thirties. The body, suddenly without the buffering of estrogen and progesterone, loses the chemical hush that used to keep the past politely below the surface. So the past comes up. Hot, fast, uninvited.

Sometimes it comes up as tears. More often, in the women I work with, it comes up as rage.

On wanting to stab your husband for breathing too loudly

I’ll say it because every woman in my practice has thought it: there are days, in perimenopause, when the man you have loved for twenty years can ruin your entire afternoon by breathing.

Not even loudly. Just rhythmically. Just nearby.

This is not a character defect. This is not a marriage in trouble (though sometimes it is, and we’ll get there). This is what happens when progesterone - the hormone that has spent decades reliably activating your GABA receptors and giving your nervous system its volume knob - drops away. GABA is your body’s natural off-switch. Without it, every stimulus is louder. Every interruption is bigger. The chewing is unbearable. The “did you remember to call the plumber?” is a battle cry.

And then - because we are women, and we have been trained for half a century to manage other people’s feelings - comes the shame. We turn the rage on ourselves. What is wrong with me. I am being awful. He is a good man. I love him. Why do I feel like this.

Nothing is wrong with you. You are in withdrawal from a hormone you have had since puberty. The system that used to soothe you is going offline, and no one - not your doctor, not your mother, not the wellness influencer with the matcha - told you it was coming.

The biology no one names

Here is the part I have been writing about, training facilitators in, and building a recovery framework around for the past two years, because the silence is killing women:

Perimenopause is a neurobiological event, and it changes our relationship to substances.

Estrogen modulates the dopamine reward system. When estrogen fluctuates wildly and then declines, the reward system flattens. Pleasure dulls. Restlessness rises. The things that used to feel good - your morning walk, your work, your friends - feel further away, like you are watching them through fogged glass. Something in you starts looking for the missing signal.

Alcohol transiently raises estrogen. So does sugar. So does the scroll. The brain, hunting for the chemical it has lost, learns very quickly that the wine works. The Uber Eats works. The third glass works better than the first. This is not weakness. This is the reward circuit doing exactly what it evolved to do, in a body that has been quietly destabilized.

Progesterone, as I mentioned, is your nervous system’s volume knob - and it acts on the same receptors as benzodiazepines and alcohol. When progesterone drops, anxiety and insomnia surge, and the world hands us substances that work on the exact same site the missing hormone used to occupy. We are, in a literal pharmacological sense, iatrogenically vulnerable: doctors prescribe sleep aids and anti-anxiety medication for what is, at root, a hormone deficiency, and women - already exhausted, already dismissed - accept the script and pour the wine.

The data is sobering. Alcohol use among women in midlife has risen sharply over the past two decades, with the steepest increases in women aged 45 to 64. Prescription sedative misuse often begins in this window. Disordered eating has a significant, underreported second peak in midlife - restriction returning as a way to claw back control of a body that suddenly seems unrecognizable.

We have to name this as biology. Because as long as we name it as character - as long as women in perimenopause believe they are simply weaker, lazier, more anxious, more broken than they used to be - they will drink alone. Numb alone. Apologize alone. Disappear.

The relationships

When you do not sleep for two years, when your body feels like a foreign country, when your nervous system is sandpapered raw and your reward system is dialled down to grey - your relationships change.

Sometimes they deepen, because you finally cannot perform anymore, and the people who love the real you finally get to meet her.

Sometimes they break.

Marriages that survived the children, the in-laws, the layoffs, and the renovation come apart in perimenopause. Not because the love disappeared, but because the woman who held the whole edifice up is, for the first time in her adult life, refusing to. Friendships shift. Workplaces lose patience. Some women lose their jobs because they cannot remember the meeting and cannot stop crying in the bathroom.

And then there is the part of this we are only beginning to talk about, the part that breaks my heart open in clinic week after week:

Suicide.

Women in perimenopause have a measurably elevated risk of suicide compared to women in any other reproductive stage of life. The peak years for suicide in women - in country after country - sit squarely inside this hormonal transition. The studies are still emerging, but the clinical picture is unambiguous: when you combine sleep deprivation, hormonal volatility, identity disruption, untreated anxiety, alcohol misuse, the loss of estrogen’s protective effect on serotonin, and a culture that has made midlife women invisible, what you get is a population at risk.

We do not screen for it. We do not warn women that this is a risk window. We do not train mental health clinicians, addiction counsellors, or primary care physicians to anticipate it. That is malpractice at the scale of half the population.

What women used to do

Historically, women in this stage of life had limited options.

We took to the woods. We became the eccentric aunt. We acquired, statistically speaking, a great many cats and an associated case of toxoplasmosis. We were burned, sometimes literally, for being too loud, too witchy, too much. We were medicated. We were institutionalized. We were told it was nerves.

In the slightly more polite recent past, we were handed antidepressants we may or may not have needed, told to lose ten pounds, and sent home with a referral to nobody.

I am not interested in any of those endings. Neither are the women I work with.

Here is what is different now

The women coming through my practice and through Menopolooza - our first-of-its-kind gathering of clinicians, researchers, and women who refused to keep being quiet - are not asking to disappear. They are not asking to stay 40 forever, either. They are not chasing the anti-aging fantasy that wellness culture keeps trying to sell back to them.

They want something much more radical.

They want to engineer their lives.

They want to become more themselves, not less. They want to build the second half of life with the same intentionality they brought to the first - the careers they built, the children they raised, the marriages they tended, the communities they held. They want to put their intellectual horsepower behind their own questions for a change. They want their passions back. They want strength training and pelvic floor physiotherapy and hormone-literate doctors and friendships that go to the bone. They want to be sexual - sometimes with a partner, sometimes with themselves, sometimes for the first time in years.

They want to ski at 80. They want to write the book at 65. They want to be in their bodies, not at war with them. They want to laugh until they pee a little, then go to the pelvic floor PT and laugh some more.

They want to get to 80 on purpose.

So, What I am actually doing?

This is what the Bloom Recovery Framework, the Menopolooza gathering, and the work I do every day in clinical counselling are about: building the infrastructure that has not existed for women in this exact passage.

It is recovery work that names hormones as a primary clinical variable, not a footnote. It is mental health care that treats rage and anxiety as endocrine signals, not personality flaws. It is community that replaces the lonely 3 a.m. internet search with friendship, validation, and the sentence I have heard women weep at the relief of hearing: you are not crazy, you are not broken, and you are not alone.

It is also a refusal. A refusal to keep treating midlife women as a niche, an inconvenience, or a market for serums. A refusal to keep building treatment models on younger bodies and male research samples and pretending they fit. A refusal to keep losing women - to addiction, to despair, to silence - when we have the science, the framework, and the community to do better.

We were never crazy (ok, maybe a little crazy). We were under-informed, overextended, and unacknowledged.

We are done being silent.

We are at the inflection point - the moment a generation of women decides that what comes next is not decline. It is not disappearance. It is not the woods, the cats, or the quiet shelf in the back of the room.

It is, on purpose, the most powerful chapter we have ever written.

Join us in Victoria BC at the Gen-X Menopause movement Menopolooza- May 15-17, 2026: www.menopolooza.com

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We wanted Portugal’s outcomes. We never actually wanted to build Portugal’s model.

If we had, we would have built what they built. We would have funded the primary care they funded. We would have staffed the outreach teams, opened the residential beds, and woven decriminalization into a national social safety net that was already decades deep. We didn’t do any of that. We took one piece of a twenty-year project- the decriminalization piece, the cheapest piece, the piece that requires no new buildings and no new budget lines, and we called it policy.

Then, when it didn’t work, we blamed the model.

The recent UVic research has finally brought the conversation out into the open, and predictably, it has pivoted to familiar technical explanations: not enough detox beds, too fast a rollout, the wrong thresholds. All of that is true. But staying there lets us avoid the harder question, which is not- why did Portugal’s model fail here, but why did we reach for Portugal’s model in the first place?

Because underneath the policy debate is something we are not naming:

The colonial move was the reach, not just the rollout.

There is a particular reflex in Canadian public policy- the instinct to look across the Atlantic for the answer. Portugal. Switzerland. The Netherlands. Finland. We romanticize the European example because it arrives pre-packaged, published in English-language policy journals, endorsed by the OECD, citable in legislative briefings. It feels rigorous. It feels evidence-based.

It is also, at its core, a colonial gesture.

When we treat a European framework as the default “sophisticated” answer, we are doing the same thing our institutions have always done: looking outward to the empire for legitimacy while ignoring the knowledge systems already rooted in the land we are standing on. British Columbia is unceded territory. Every single addiction policy we write is written on land whose original caretakers have centuries of embodied, relational, community-based knowledge about how to hold people in crisis, how to integrate healing and belonging, how to treat human beings as part of a web rather than a case file. That knowledge has been actively suppressed- through residential schools, through the Indian Act, through the Sixties Scoop, through child welfare, through the opioid crisis itself.

And yet, when it came time to respond to the deadliest public health emergency in this province’s modern history, we looked at Lisbon.

“It worked in Europe” should never have shaped our policy.

The Failure of the Silo

The colonial inheritance shows up most clearly in how we silo human beings. Our current approach is obsessively individualistic: we treat “the person who uses drugs” as a discrete unit to be processed through a sequence of containers. Detox. Treatment. Transitional housing. Each one a separate ministry, a separate intake form, a separate waitlist.

But humans do not exist in silos. We exist in systems.

As clinicians, we see this every day. Addiction is rarely just a medical pathology. It is almost always a symptom of a collapse in the social scaffolding- family suffering, housing precarity, unresolved grief, untreated trauma, unrelenting poverty, the slow erosion of belonging.

We have to stop asking ”how do we fix the addict?” and start asking ”how do we repair the system of care so it can hold the weight of a human life?”

The Theatre of Crisis and the Backlash of Disgust

There was a naïve hope that decriminalization would, by making drug use visible, reduce its stigma. The opposite has happened. Visible suffering, divorced from visible care, has not bred empathy. It has bred a backlash of disgust.

The public does not see a health emergency in our streets. They see a mess. They see encampments, open use, disturbed behaviour, and they are told, correctly- that the state has declined to intervene. What they are not told is that the state also declined to maintain the care infrastructure that was supposed to make decriminalization work. So the suffering stays out in the open with nowhere to go, and it becomes the evidence used to justify the return of punitive policy.

This is the stigma paradox. We thought visibility would humanize. Instead, in the absence of care, visibility has re-criminalized.

The Great Deception of Deinstitutionalization

The closure of Riverview, finalized in 2012, was sold to the public as a progressive, humanitarian evolution- moving patients from “asylums” to “community-based care.” It was the right language. It turned out to be the wrong policy.

The funding gap: The community-care model was predicated on the idea that money saved from operating a large institution would follow the patients into the community. It didn’t. The “liberation” of patients was, in practice, a massive cost-cutting exercise by successive governments.

The missing middle: We traded specialized, long-term psychiatric beds for a fragmented system of short-term acute beds and underfunded non-profits. We removed the heavy-lifting infrastructure of the provincial health system and replaced it with a patchwork of scaffolding that was never designed to hold the weight of complex concurrent disorders.

You could argue we did not actually end the practice of institutionalizing the vulnerable. We just changed the nature of the institution.

The street as the ward: When Riverview closed without a robust community replacement, the asylum did not disappear. It moved to the sidewalks of the Downtown Eastside and Pandora Avenue.

The prison as the pipeline: Instead of being managed by clinicians and psychiatric nurses, the most vulnerable are now managed by police, paramedics, and corrections officers. We swapped a healthcare budget for a policing and emergency services budget- a far more expensive and far less effective way to manage human suffering.

Decriminalization on a Hollowed-Out Shell

You cannot overlay a policy of decriminalization onto a healthcare system that has been systematically gutted for thirty years and expect it to function.

Decriminalization was marketed as “treating addiction as a health issue.” But you cannot treat a health issue if you have already dismantled the hospitals. By the time we reached 2023, the infrastructure required to make decriminalization work- long-term psychiatric stabilization, dignified supportive housing, and integrated complex care- had been gone for a decade. Implementing decriminalization without those beds in place was a PR move that ignored the structural vacancy in our healthcare system.

We are told that decriminalization failed because we didn’t build the care infrastructure fast enough. This is a half-truth that masks a darker reality: we didn’t just fail to build it. We actively tore it down.

When we shuttered Riverview, we were promised a new era of community-integrated care. Instead, we got a decades-long liquidation of psychiatric capacity. We turned our backs on the most complex among us, traded hospital beds for shelter mats, and then had the audacity to wonder why, when we finally “decriminalized” their suffering- the streets became a theatre of crisis.

You cannot treat a health crisis in a vacuum. Decriminalization didn’t fail the Portuguese model. It was strangled by the ghost of Riverview.

The “Forced Treatment” Hypocrisy

British Columbia is now gripped by a heated debate over involuntary care. Opponents call it a violation of rights. Proponents call it a necessity. But there is a reality we rarely name out loud: we already have forced treatment.

We call it Drug Treatment Court.

For years, we have used the threat of incarceration as a lever to “encourage” treatment. We have built a system in which a person must often be arrested before they are offered a high-intensity pathway to care. If we are comfortable with the legal system coercing treatment as a condition of bail or sentencing, we need to be honest about why we are suddenly horrified when the medical system contemplates doing the same for people in acute psychiatric crisis.

I am not arguing that either form of coercion is simple, or that civil liberty concerns are unfounded- they are real, and in a post–residential school province, they are historically load-bearing. But the current outcry treats involuntary care as a brand-new violation of principle, when in fact we normalized coercion decades ago and simply hid it inside the machinery of the courts. The honest conversation is not whether we coerce. It is when, how, for whom, with what safeguards, and which branch of the state gets to do it.

What We Actually Need: Integration, Not Imitation

Here is where I want to land. Because if we stop reaching for European templates, we have to say what we are reaching for instead.

We need to stop treating mental and emotional wellbeing as a specialty service and start building it into the foundation of every system of care. Not as a program. As scaffolding.

In primary care, this means every family doctor’s office is supported, trained and funded to identify, hold, and refer for mental health, substance use, and trauma concerns- with counsellors, social workers, and Indigenous wellness supports embedded in the clinic, not down the street and six months out.

In schools, this means emotional literacy, grief, belonging, and regulation are taught from kindergarten onward, and every school has clinical support that is actually staffed, so that children in crisis do not have to wait until they are in emergency rooms or prisons to be seen.

In housing, this means the end of “housing-first” as a shell game where we scattershot funding without oversight or audit and place people in isolated units without any ongoing human contact. Housing is necessary. It is not sufficient. People need safe housing, belonging, clinical support, and community.

In workplaces, this means mental health and addiction support is woven into benefits, leadership training, and organizational culture- not as an EAP hotline, but as a real capacity to hold people through life stages that predictably destabilize them: new parenthood, bereavement, perimenopause, caregiving, burnout.

In child welfare, this means we stop building a system whose primary product is separation. Family preservation, community-led care, and Indigenous jurisdiction are not frills. They are the model.

In corrections, this means we admit what we have been doing- warehousing people whose primary conditions are untreated trauma, mental illness, and substance use, and we stop pretending that a prison is a clinical setting.

In post-secondary, this means training every clinician, teacher, social worker, and policymaker in trauma-informed, systems-aware, culturally humble practice- not as an elective, but as core curriculum.

None of these are new ideas. Most of them are Indigenous ideas. And most of them already exist somewhere in our system right now, underfunded, understaffed, and siloed off from the rest of the care pathway. What we are missing is not imagination. It is integration.

The Path Forward

You cannot treat a person into wellness if the systems they live within are themselves unwell.

This is the truth that makes the Portugal fantasy so seductive and so dishonest. Portugal did not just decriminalize. Portugal decriminalized into a society that could catch what fell. And that society is not only- or even primarily- a policy construct. It is a cultural one.

Portugal is a country of multigenerational households, Sunday tables where three generations share a meal, villages where the pharmacist, the priest, the family doctor, and the uncle who drinks too much all know each other by name. People belong to kinship webs before they belong to the state. When the Portuguese state shows up, it shows up into an existing web of care, not in place of one.

British Columbia does not have that substrate. North America does not have that substrate. We are an atomized continent by design. The nuclear family replaced the extended one. Mobility replaced rootedness. Seniors live in facilities instead of family homes. Adult children launch at eighteen and fly across the country. Religion and civic life have thinned. And for Indigenous communities on this land, the atomization was not cultural drift- it was policy. Residential schools, the Sixties Scoop, and decades of child welfare intervention deliberately severed the kinship structures that would have done exactly the kind of community-scale holding Portugal still has.

Portugal integrated primary care, mental health, addiction services, housing, and social belonging into a coherent web- imperfect, uneven, but woven into a culture that was already woven. We tried to import the institutional layer into a society whose relational layer has been methodically unravelled for over a century. We took the headline. We left the infrastructure. And we ignored the culture entirely. Then we acted surprised when the headline failed to work alone.

We do not need a better version of Portugal’s model. We need a model that acknowledges the colonial scaffolding of our own institutions, the erasure of the knowledge systems already rooted in this place, and the impossibility of treating individuals without repairing the systems around them.

That is the work. And no copy-paste will do it.

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We Didn’t Fail Portugal’s Model. We Never Actually Tried It. A Response to “Why B.C. Couldn’t Replicate Portugal’s Drug Strategy”

By Bryn Meadows, MA, RPC-MPCC

I have been saying this for years. And I say it not with satisfaction - because there is nothing satisfying about 18,000 deaths - but because we cannot course-correct until we are honest about what went wrong.

British Columbia did not fail Portugal’s model. We implemented a fragment of it, called it the model, and then wondered why it didn’t work.

That distinction matters enormously.

The Wrong Plant in the Wrong Soil

Imagine taking a cork oak - a tree that has thrived for centuries in the dry, warm Mediterranean ecosystem of Portugal - and transplanting it into the temperate rainforest of the Pacific Northwest. You could argue that trees are trees, that the science of photosynthesis is universal, that what worked there should work here. And you would not be entirely wrong. But you would watch that tree struggle and die, not because the idea of a tree was flawed, but because you ignored the ecosystem entirely.

This is precisely what happened with drug policy in British Columbia.

Portugal’s success was not a policy. It was an ecosystem - one built over years, with coordinated political will, massive public education, a national treatment infrastructure, and critically, a culture of social reinsertion. The decriminalization component, the part we fixated on, was never meant to stand alone. It was the entry point into a web of interconnected services. Without that web, decriminalization is not a strategy. It is an incomplete sentence.

BC took the parts that were politically palatable - primarily harm reduction and decriminalization - and left the rest on the table. And I would argue that the research community, which shaped the policy, bears some responsibility for that.

A Wicked Problem Demands a Complex Response

The researcher and systems thinker Dave Snowden developed the Cynefin framework to help leaders understand what kind of problem they are actually facing before deciding how to respond. He distinguishes between problems that are simple, complicated, complex, and chaotic - and argues that applying the wrong kind of thinking to the wrong kind of problem is one of the most dangerous things an institution can do.

The toxic drug crisis in BC is what Snowden would call a wicked problem - one embedded in a complex adaptive system, where cause and effect are not linear, where interventions change the system itself, and where no single solution can be imported and applied wholesale from another context.

Wicked problems, Snowden argues, require not best practices but emergent practices - a constellation of small, coordinated, “safe to fail” experiments that probe the system, respond to feedback, and adapt in real time. They require what he calls managing the edges - attending to the interactions between components of a system, not just the components themselves.

What we built in BC was not a constellation. It was a single star, and we asked it to light the whole sky.

The Recovery Void

Here is where I must be direct, because people are still dying.

For years, within the research and policy community, recovery - meaning abstinence-based treatment, residential care, and long-term recovery support - was not only deprioritized. In some circles, it was actively pathologized. I have sat in rooms where the language of recovery was called oppressive. Where treatment was framed as coercive by definition. Where the very idea that someone might want to be free of substances - and might need structured, long-term support to get there - was treated as a political problem rather than a clinical reality.

I have also sat across from politicians - people genuinely, viscerally motivated to save lives - who were handed a research consensus that left recovery out of the toolkit. They acted in good faith on the information they were given. The problem was with the information.

Portugal’s model, the one we claimed to be following, had what researchers Urbanoski and Pauly themselves describe as a “fairly robust mandatory treatment component.” It included residential treatment. It included long-term recovery support. It included what the harm reduction community here has long resisted naming: a pathway out, for those who want one.

We took the philosophy and left the scaffolding.

What We Actually Need

A healthy ecosystem is not one thing. It is a web of relationships - predators and prey, decomposers and producers, mycorrhizal networks running beneath the surface connecting root to root. Remove one element and the whole system shifts. Introduce a foreign species without understanding the existing web and you can collapse it entirely.

The people dying in BC do not need us to be right about harm reduction. They do not need us to be right about recovery. They need us to be honest that this is a complex system, that the people living inside it are at different points in their relationship with substances, and that a single philosophy - no matter how well-intentioned - cannot meet all of them where they are.

What they need is a constellation of services:

Harm reduction that meets people without judgment, keeps them alive, and builds trust. Detox that is actually accessible - not a three-week waitlist for a five-day bed. Residential treatment, long-term and properly resourced. Mental health services integrated into, not parallel to, addiction care. Housing that is stable, not contingent on sobriety but not indifferent to it either. Peer support from people with lived experience, who are vital to this work - and who deserve to be part of a team, not the entire team. And recovery communities, because sustained recovery rarely happens alone.

These are not competing philosophies. They are different parts of the same ecosystem, and every person deserves access to the part they need, when they need it.

The Cost of the Argument We’ve Been Having

More than 18,000 people have died in BC since this public health emergency was declared. They died while researchers debated frameworks. They died while policy was shaped by ideological consensus rather than the full weight of evidence. They died while recovery was quietly removed from the table in the name of a philosophy that, however compassionate its intentions, left a gaping hole where a complete response should have been.

Dr. Pauly asks: “How many more are going to die?” It is the right question. And the answer begins with the courage to say that we need everything - not just the parts we are comfortable with.

The Portugal model didn’t fail us. We failed to understand that a model is not a plant you can uproot and replant. It is a seed, and it needs the right soil, the right climate, and the whole ecosystem to grow.

We have the soil. We have the people. We have, finally, the beginnings of a political appetite for honesty.

Let’s build the ecosystem.

Credentials:

Bryn Meadows is a Master Practitioner in Clinical Counselling (MPCC), Registered Professional Counsellor (RPC), International Certified Alcohol and Drug Counsellor (ICADC), and Canadian Certified Addiction Counsellor (CCAC) with over 20 years of front-line, clinical, and leadership experience in addiction treatment and mental health. She holds a Master of Arts in Leadership with a Health Care Specialization from Royal Roads University, where her graduate research focused on facilitating collaboration between physicians and people with lived experience of substance use to enhance primary care for people who use substances- research funded in part by the Michael Smith Foundation for Health Research. She has served as Program Director at Cedars at Cobble Hill, one of BC’s leading residential treatment centres, and provides clinical supervision to registered counsellors across the province. What gives her perspective on this particular conversation a specific weight is this: she was a named research collaborator on stigma reduction projects led by Dr. Karen Urbanoski and Dr. Bernie Pauly- the two researchers quoted in the article to which this piece responds. She has been in the rooms where this research was developed, has contributed to the knowledge exchange between physicians and people with lived experience that the research called for, and has watched, from the inside, as a narrow interpretation of that evidence shaped policy that left recovery out of the picture. She is not an outside critic. She is a participant in this conversation who believes the conversation itself needs to change.

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The Anatomy of Loss

After the first miscarriage, I posted something on

my social media- tentatively, like tossing a tiny

pebble into the void- and was inundated with a

barrage of DMS from women I knew saying, “Me too.”

Friends. Colleagues. That girl I went to high school with,

who now sells supplements on Instagram. I had no idea.

Suddenly, it was like I’d joined this secret club everyone

was in, but no one talked about. Like Fight Club, but with a

shit ton of maxi pads and a deep sense of betrayal. Why?!

Why didn’t we talk about it? Why didn’t anyone tell me that

this happens all the time!? Why did no one warn me that

my uterus might revolt? It’s one of life’s cruel ironies:

miscarriage is common, it’s normal, but the silence around

it is deafening.

Why the secrecy? Is it shame? Yes, it’s shame, but it’s also

more than shame. It’s silence baked into culture, medicine,

and generations of women enduring grief in isolation.

Shame is a slippery little bastard.

Shame is the intensely painful feeling or experience of

believing we are flawed and therefore unworthy of love and

belonging (Brown, 2006). It’s not “I did something wrong,”

it’s “I am something wrong.” And when you apply that to

miscarriage, infertility, or any form of reproductive

derailment? You’ve got a recipe for silent suffering with a

side of isolation and a heavy pour of self-loathing.

Let’s be clear, shame is not guilt. Guilt says, “I did a bad

thing.” Shame says, “I am the bad thing.”

It’s the difference

between feeling remorseful for eating all the cupcakes and

believing you’re an inhuman cupcake-guzzling monster who should

be exiled to a cave somewhere with your shame spiral and

a family pack of Always Infinity.

And shame thrives in silence. Especially reproductive

shame. You know, the shame that creeps in when you’re

staring at a negative pregnancy test for the fifth month in a

row, or when you’re curled up on the bathroom floor,

losing a pregnancy you wanted, wondering if it’s your fault.

Why Fertility + Miscarriage = Shame Soup for Women:

Women’s value has been tied to their ability to produce

children for centuries. Historically, the uterus was seen as

our main selling feature. (Brains? Not necessary. Opinions?

Definitely not. But can you bear heirs? Now that’s value.)

This legacy of reproductive essentialism isn’t just outdated-

it’s deeply dehumanizing.

When pregnancy fails to happen-or when it ends

unexpectedly-the cultural scripts go offline. You fall out of

the narrative. And what’s left is often a vacuum filled with

blame, suspicion, and some well-meaning but tone-deaf

comments like, “Everything happens for a reason,” or “At

least you know you can get pregnant.”

Women are made to feel shame because we’ve been taught

that pregnancy should be easy and natural, like sneezing.

If your uterus isn’t behaving, then you must be the problem.

Never mind that fertility is complex. Nope, it must be your

karma or your diet, or your “failure to relax.”

In reproductive loss, this shame gets supercharged because

there’s no socially acceptable outlet. There are no

sympathy cards for miscarriage. Often, no one even knows,

because we’ve been told not to tell anyone we’re pregnant

until after 12 weeks-which is precisely when most

miscarriages happen.

We don’t talk about pregnancy before 12 weeks because

somewhere along the line, someone decided that secrecy

would protect us. Or protect others. Or maybe it was just

tidy for the medical system, which loves a clean line.

The first trimester became this hush-hush zone, a kind of

reproductive purgatory: you’re pregnant, but not officially;

hopeful, but not allowed to say it out loud; joyful, but only

if nobody can hear you.

And the unspoken reason is this: because so many

pregnancies end in miscarriage.

And as a culture, we have absolutely no idea what to do

with grief, especially women’s grief, especially grief tied to

our bodies. So instead of building better support, we built a

rule of silence. A superstition disguised as prudence.

“Don’t tell anyone until 12 weeks,” we say, as if disclosure

were a jinx, as if privacy were protection.

Here’s a cruel irony:

When things do go wrong, you’re already alone.

You’ve been told not to tell people you were pregnant,

which also means you’ve been told you’re not supposed to

tell them you’re grieving. It locks women into a double

silence-no celebration, no mourning, no community either

way. It treats early pregnancy as something shameful if it

ends, as if miscarriage were a personal failure rather than a

biological reality affecting millions.

And it reinforces the quiet misogyny baked into so much of

reproductive care:

Women should manage things privately, quietly, neatly.

Don’t make people uncomfortable. Don’t need too much.

So we’re silenced in anticipation of the worst, and then

punished with shame if the worst occurs. Neat system,

huh?

Shame is profoundly social. We feel it in the eyes (and

Instagram feeds) of others. In the way people flinch when

we say “I lost a baby.” In the way they change the subject.

In the way some medical professionals deliver the news

with all the empathy of a sandwich board.

We are not cautionary tales or walking bad omens. We are

women whose bodies did something very human.

Something hard. Something most of us weren’t prepared

for, and weren’t supported through. What happened to

you, in your body is not a moral failure. You don’t owe anyone an

apology for being sad, angry, or confused. You also don’t

have to find a silver lining if there isn’t one.

And to anyone who implies otherwise? They can kindly go

reflect on their own reproductive organs and how little

control they have over them.

Miscarriage lives in the shadows because it’s tangled up in

shame, stigma, secrecy, and a total lack of social scripts.

People don’t know what to say, so we say nothing. We’re

told to wait until 12 weeks to share a pregnancy, just in case

it doesn’t “stick” (because God forbid we might upset other

people). So when it doesn’t, we end up grieving a person

we weren’t supposed to tell anyone about in the first place.

That’s not just secrecy, that’s structured isolation.

Structured isolation is a term that sounds like it belongs in

Scandinavian design philosophy but really, it’s a systemic

and organized form of neglect, prevalent in women’s

healthcare, where individuals are left to navigate complex,

painful, or traumatic medical experiences-like miscarriage-

alone, but within an official framework that technically

“counts” as care. It’s not that no one’s helping-it’s that the

system has efficiently planned not to be there when you

need it most.

Shame, Structured Isolation, and the Bureaucratic Machine

Shame whispers, “It’s your fault.”

Structured isolation makes sure there’s no one nearby to

tell you otherwise.

They work together seamlessly: shame keeps us silent, and

isolation keeps us separate. You feel like you’re the only

one falling apart, and no one is there to contradict that

narrative. It’s a devastating one-two punch, and it’s

especially powerful inside a healthcare system that already

treats you like a file number with a uterus.

In a broken healthcare system, this toxic pairing thrives.

You’re misdiagnosed, dismissed, or ignored? That’s

probably because you’re “too sensitive” or “not explaining

it right.” You’re shuffled between specialists, waiting

months for answers? Maybe you just need to be more

patient. You’re bleeding too much, crying too hard, asking

too many questions? Well… perhaps you’re the problem.

And because you feel shame, you don’t push back. And

because you’re isolated, you don’t know thousands of

others are having the same experience.

Meanwhile, the bureaucracy wins. Shame keeps us quiet.

No complaints, no lawsuits, no change. Isolation keeps us

disorganized, with no collective action, solidarity, or

systemwide pressure to do better. Together, they function

like a self-sustaining defence mechanism serving the status

quo. They protect the institution from scrutiny while the

people in it slowly unravel. The patient suffers, alone and

confused. The system shrugs.

This reinforces a heavy dose of internalized blame. Even if

we know intellectually it wasn’t our fault, the psyche

whispers otherwise. Maybe… I worked too much. Maybe I

drank coffee. Maybe I was too stressed or too old or didn’t

take the right supplements or wore the wrong pants. Was it

the cheese? Perhaps it was my weight… Shame slips in

through the cracks of uncertainty.

We feel shame, we blame ourselves. We don’t clap back or

make a fuss because there’s nothing to see here… Our

society doesn’t like to make room for messy, ambiguous

grief. There was no baby to hold. No name, no funeral. It’s

invisible loss-so people either minimize it (”at least it was

early”) or panic and change the subject (”you can always try

again!”). We’re left to carry it quietly, sometimes forever.

The silence is cultural. It’s gendered. It’s medical. And it’s

deeply unfair.

Science time: what we know happens physically during

miscarriage- Facts I wish I knew:

Let’s talk about what a miscarriage is- because no, fuck off-

it’s not just “a heavy period.”

A miscarriage is the body going through the process of

ending a pregnancy, and it can involve hours to weeks of

cramping, bleeding, clot passing, and in some cases, full on

contractions that feel like your uterus is trying to fold in on

itself like a GD pretzel.

You bleed. A lot. Sometimes enough to soak through

several pads every hour. You might pass tissue, some of

which looks like nothing. Some of which looks like

everything. You might have drenching night sweats. Your

hormones, already on a roller coaster-sized ascent,

suddenly plummet off the side of a cliff, dragging your

mood, sleep, and sanity down with them.

It hurts because your uterus is physically ejecting contents

it spent weeks building. Think of it as renovating a house

and then having to sledgehammer it back to studs. DEMO

DAY. Add to that the sudden iron deficiency from blood

loss, and you’re left pale, dizzy, emotionally fried, and

wondering if you’re grieving or just extremely anemic (it’s

both). And while your body is falling apart, people still

expect you to go to work, be polite, and-FF’S-stay positive

(barf ).

Here’s what science tells us about miscarriage, and fair

warning: a lot of it still boils down to “we don’t totally

know.”

Most miscarriages- especially in the first trimester- happen

because of chromosomal abnormalities. Something went

wrong at the genetic level, and the embryo was not viable

from the start. It’s not your fault. It’s not because you had a

glass of wine or did a downward dog too aggressively. It’s

biology trying to quality control. The key did not fit in the

lock.

Sometimes, it’s due to hormonal imbalances, uterine

abnormalities, blood clotting disorders, or autoimmune

issues. But often, the body doesn’t send a memo with an

apparent “reason” stamped on it. This makes the question

Why is this happening? It’s so agonizing because there’s

rarely a simple answer. You go to Google looking for clarity

and end up with a digital avalanche of conflicting advice,

mostly from forums full of strangers with all the same

questions and no answers.

Meanwhile, your real doctor might shrug and say, “Bad

luck”, which is real and genuine, but not always a helpful

response. Science can explain some things, but not the

grief, not the guilt, and not why your body betrayed you

with no explanation and no apology.

What About Recurrent or Multiple Miscarriages?

Having one miscarriage is common. Having more than one

is less common, but not rare.

About 1 in 100 people (1%) will experience recurrent

miscarriage, defined as three or more consecutive losses

(yes, I am exceptional and unique).

If you’ve had two miscarriages, your risk of a third does

increase, but it still doesn’t mean there’s something

“wrong” with you. Testing is often recommended after two

or three losses to look for treatable causes.

Bottom line: miscarriage is painfully normal, even though it

feels anything but. And multiple miscarriages? Still part of

the statistical realm of “normal,” just the normal no one

wants to belong to.

Here’s a list of the most common types of miscarriage:

1. Spontaneous Miscarriage (aka: “Regular Old

Miscarriage”)

This is the umbrella term for any miscarriage that happens

naturally before 20 weeks. No medical or surgical

intervention caused it-it just... happened. Your body

realized something wasn’t quite right, and it let go. Often

painful. Always unfair.

2. Missed Miscarriage (aka: “The Sneaky One”)

The pregnancy stops developing, but your body doesn’t get

the memo. No cramping. No bleeding. You go in for a

routine ultrasound expecting to see a dancing bean, and

42instead, you get silence. Often found at the first scan. It’s a

gut punch because everything felt fine.

3. Blighted Ovum (aka: “The Empty Guest Room”)

The gestational sac develops, but there’s no embryo inside.

Your body thinks you’re pregnant, hormones go up,

symptoms may be intense, but no baby is growing. It’s like

setting up the nursery, but no one ever moves in.

4. Chemical Pregnancy (aka: “Blink and You’ll Miss It”)

You pee on a stick and get a positive, but then your period

comes a few days later. It’s an early loss-often before you

even get to the “congratulations” stage. Still real. Still hurts.

People might say, “At least it was early,” which is like telling

someone, “At least your house burned down before you

bought furniture.”

5. Threatened Miscarriage (aka: “Maybe, Maybe Not”)

You have bleeding or cramping, but the cervix is still

closed, and the pregnancy might still be viable. It’s like

being in limbo with a carry-on bag full of fear. Sometimes it

resolves, sometimes it doesn’t. You wait. You pray. You

Google too much.

6. Inevitable Miscarriage (aka: “The Writing’s on the Wall”)

43There’s bleeding, cramping, and your cervix is opening.

The body is actively beginning the process. You know

where this is going and can do nothing to stop it. You might

still try. That’s okay, too.

7. Incomplete Miscarriage (aka: “The Unfinished Business”)

Some pregnancy tissue has passed, but not all of it. It’s like

your uterus started tidying up, then got distracted. You

might need medical help (like Mifepristone and Misoprostol

or a D&C) to finish the process and prevent infection.

8. Complete Miscarriage (aka: “The Full Horror Show”)

Everything has passed naturally, and your body has

“successfully” ended the pregnancy. The cramping slows,

the bleeding eases, and you’re left with... the aftermath.

9. Septic Miscarriage (aka: “The Emergency”)

A miscarriage complicated by infection can be life-

threatening. Fever, chills, foul-smelling discharge. This is a

“go to the hospital NOW” situation. You need IV antibiotics

and possibly surgery. Not common, but very serious.

I am a 1, 6,7 AND 8. Look at me go

(Note to self: Dear me, it’s not a contest, don’t be weird.)

Renee Nicole Hood was not a symbol- she was a person. She had a body that carried memories, a voice that belonged to people who loved her, and a place in a family that is now permanently altered. She was someone’s daughter, someone’s partner, someone her children knew as home. And in her final moments, her humanity was treated as optional. A police officer shot her in the face for disobeying him. Fired into a car, with a dog in the backseat, as if none of that life inside the vehicle counted enough to slow the trigger. Then, after shooting her, he yelled “fucking bitch” as she was dying.

That violence did not erupt from nowhere. We are often tempted to call men who kill women “monsters,” but that kind of language lets them off the hook. Monsters are aberrations; they are unaccountable. Humans are not. Dehumanizing him would strip away the very responsibility we must insist on. What matters is not whether he is evil in some mythical sense, but how ordinary systems, language, power, and entitlement make this kind of violence possible. Predictable.

I will never forget Brené Brown talking about how the last word many women who are killed hear is “bitch.” Misogynistic contempt and dehumanizing language often travel alongside lethal violence, not as an afterthought but as rehearsal. Long before a hand is raised or a weapon is picked up, words do the early work: stripping dignity, reducing a woman to an object, a nuisance, a provocation.

Language like this trains both speaker and listener. It normalizes domination, excuses cruelty, and makes harm feel justified. By the time violence turns fatal, the groundwork has already been laid through insult, humiliation, and contempt that reframe a full human being as something disposable. This is why that word matters so much. It is never just a word. It is the final punctuation of a story that has been told over and over. Quietly and loudly. Until ending a woman’s life feels, to the person committing the violence, like a conclusion rather than the unthinkable horror it truly is.

That language is a warning flare. Dehumanizing words are not heat-of-the-moment nonsense. They are early indicators of escalation. Violence rarely arrives fully formed; it advances in stages. First comes contempt, then control, then punishment for disobedience. Each insult lowers the threshold; each slur rehearses the idea that the woman in front of you is less worthy of care, restraint, or mercy.

When someone speaks about women this way, they are telling us something important about how they see power, entitlement, and consequence. This was not the first time Jonathan Ross was violent toward a woman- it was the culmination of it. Violence like this does not suddenly appear in its most extreme form; it escalates. It gathers momentum through smaller acts that are minimized, excused, or left unchallenged- through language that demeans, through entitlement that goes unchecked, through power exercised without consequence. By the time a life is taken, the trajectory has already been set.

Calling this an “isolated incident” is comforting, but it is false. It erases the pattern that precedes lethal harm and allows us to keep pretending that escalation isn’t real. It is real. And if we are serious about accountability, we have to stop treating the final act as the beginning of the story. It is not. It is the endpoint of a progression that too many women are forced to survive. Until one of us doesn’t.

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There’s something about Rob Reiner that reminds me of my dad. I am guessing a lot of people might relate. This is a man we grew up with. Maybe it’s weird to feel so impacted by the death of people I’ve never met, but I am. My dad has been gone for some time now, but when I see Rob Reiner, especially in interviews that I have been watching this week- I feel that familiar tightening in my chest, the sediment of grief being stirred up.

When I learned about the death of Michele and Rob Reiner, I found myself needing to understand, not in a rubbernecking way, but in the way we often do when something doesn’t sit easily. As a counsellor, and as someone who has specialized in addiction for many years, I can’t help but bring a particular curiosity and lens to this terrible event.

I’ve been watching interviews, reading what’s publicly available, and listening closely to how the story is told. I’m aware of the line here. This is a real family. A real son. A real death. And nothing I say can, or should, pretend to explain that.

There is something about this story that feels like a case study in the most sobering sense of the word. A case study in how love, fear, power, grief, addiction, and systems collide.

What stands out to me is not failure. It’s devotion. A family trying desperately to keep a son alive. Parents living with the chronic terror that so many families of people with addiction know intimately- the fear that every phone call could be “the” call. The fear that helping might be enabling, and that setting boundaries might be abandoning. There is no good choice here.

In my work, I’ve sat with many families in that exact place. I’ve had the conversations no one prepares you for. Conversations about safety. About money. About whether it’s time to change the locks. About how to protect other children. About how to survive loving someone whose illness has begun to consume the household.

Those conversations are never theoretical. They are never abstract. They are soaked in love and terror in equal measure.

This story, like so many others, reminds me that addiction is not just an individual struggle. It is a family illness. A systems illness. A long, grinding, relational trauma that asks impossible things of the people who love hardest.

Rob and Michele Reiner’s deaths have stirred many conversations about addiction, responsibility, and care. As they should. But if we’re going to talk about this meaningfully, we need to have some hard reckonings about the realities of addiction.

This is my assessment.

In the interviews I have seen and read so far, I observed their son, and through my particular lens, saw a young man deeply entrenched in mental illness and the symptoms of addiction. He may or may not have been sober at the time of those interviews, I can’t tell- but he was certainly deeply sick in the trenches of addiction- namely, what I call the trifecta of suffering: blame, self-pity and grandiosity. Which, left untreated, one cannot hope to recover and simultaneously, are the hardest to confront.

An example of the son’s grandiosity, manipulation and how the parents blame themselves, rather than hold the son accountable is clear to me in this, now, heartbreaking quote:

Nick explained his perception of the ineffectiveness of rehab for him: “I just couldn’t get by in these programs. I had resistance every time they tried to reach me. “The program works for some people, but it can’t work for everybody”, Rob said. “When Nick would tell us that it wasn’t working for him, we wouldn’t listen. We were desperate, and because the people had diplomas on their wall, we listened to them when we should have been listening to our son”. Michele said: “We were so influenced by these people. They would tell us he’s a liar, that he was trying to manipulate us. And we believed them.”

What makes this dynamic so tragic is how clearly it maps onto the Karpman drama triangle.

The Karpman Drama Triangle was developed in the late 1960s by psychiatrist Stephen Karpman, as part of Transactional Analysis. Karpman noticed that people in conflict tend to fall into three predictable roles: Victim, Persecutor, and Rescuer, and that these roles are not fixed personalities but positions people rotate through under stress. His insight was that the triangle persists because each role offers a short-term emotional payoff (blame, righteousness, or purpose) while avoiding true accountability, keeping relationships locked in cycles of conflict rather than growth.

In this dynamic, illustrated in the quote- the son, entrenched in addiction, takes up the Victim role by blaming treatment and his parents- locating the cause of his suffering entirely outside himself. In response, the parents move instinctively into Rescuer mode, defending him and redirecting blame toward the treatment centre, the system, and ultimately themselves, believing that if they can just identify the failure, they can get their son back.

As the cycle tightens, blame ricochets: the son casts others as Persecutors who failed him; the parents turn that persecuting energy inward, punishing themselves for not doing enough. No one is acting out of malice, everyone is acting out of love and fear, but blame without accountability keeps them trapped in the triangle. Responsibility is never held cleanly; it is either externalized or weaponized.

Breaking the Karpman triangle requires:

Boundaries instead of rescue

Accountability instead of blame

Grief instead of rage

Support instead of control

This doesn’t mean withholding love. It means refusing to participate in roles that keep everyone stuck.

I usually don’t call in the “invisible army” (we all think…) but I feel 100% confident that any of my colleagues in our field would agree- yes, this kid might be “treatment resistant” (grandiosity, self-pity, blame)- but if he’s not willing to get help, we need to support the rest of the family to get help- so they don’t die from co-dependency.

Blame and accountability are mutually exclusive- they don’t live in the same space. Without accountability, we can’t have recovery. Plain- not simple.

Blame: “This is happening to me”

Self-Pity: “No one has it as hard as I do”

Grandiosity:“You don’t understand me / I’m different”

When these three lock arms, relapse risk skyrockets, not because the person is bad-but because accountability has left the building.

When blame curdles into self-pity, something especially dangerous can happen. Self-pity isn’t just sadness or grief-it’s the story that my pain exempts me. That my suffering is so singular, so unjust, that normal rules don’t apply. And when self-pity is paired with grandiosity-the belief that one is uniquely misunderstood, uniquely deserving, uniquely above consequence-the risk escalates dramatically. That combination can be lethal.

This isn’t about shaming people who struggle. Wanting validation is deeply human. Wanting to be seen, understood, and comforted is not a flaw-it’s a basic need. Most people with addiction histories are carrying enormous, unspoken grief and a deep need for connection, and of course- ways to medicate their pain.

But here’s the line we don’t draw clearly enough: there is a difference between grief for unmet needs and rage when those needs aren’t met.

Rage is not the same as pain. And indulging rage-especially when it’s justified by self-pity-does not heal it.

What’s heartbreaking is that this isn’t a failure of love. Often, it’s the opposite. Families love fiercely and still don’t know how to intervene effectively. Systems want to be humane and still avoid accountability because it feels cruel. We confuse kindness with permissiveness, and boundaries with abandonment. They are not the same.

If there’s anything to take from losses like this, it’s not moral superiority or certainty. It’s a call to talk honestly about how untreated addiction, un-contained self-pity, and unexamined grandiosity interact. Sobriety and recovery aren’t always the same thing. We need to be willing to have and hold hard conversations and to love people enough to let them be mad at us.

When systems- including families, communities, healthcare, or culture- collude with the narrative that avoiding hard conversations is compassion, or confusing validation with rescue, people can die.

The Cruelest Question a Loving Parent Can Face:

There is a particular kind of heartbreak that comes from loving your child and being afraid of them at the same time.

Parents don’t talk about this easily. They talk around it. They whisper it in counselling offices and parked cars. They lower their voices even when the child isn’t nearby, as if love itself might be overheard and punished.

And the question always comes, sooner or later:

“When is it time to change the locks?”

Not because they want to, not because they’ve stopped loving their child- but because they are afraid-of theft, of violence, of chaos, of enabling, of waking up to sirens.

I’ve had that conversation more times than anyone should have to. I just had one yesterday. With parents whose hands shake when they say it. With parents who start crying before the sentence is finished. With parents who have tried everything-treatment, money, patience, ultimatums, grace.

And every single time, the same unbearable intersection appears:

If I let them in, am I keeping them alive-or putting us all at risk?

If I shut the door, am I saving myself-or abandoning my child?

There is no answer that doesn’t cost something.

What makes this especially cruel is that love is not the problem. These are not neglectful parents. These are parents who lie awake listening for footsteps, who check phones at 2 a.m., who flinch at every knock, who rehearse conversations they hope they’ll never need to have.

Their fear isn’t abstract. It’s practical.

This is where the public conversation fails families. We talk about “tough love” as if it’s a strategy, not a grief process. As if there’s a right moment when clarity arrives and everyone agrees. There isn’t.

What there is instead is discernment under impossible conditions. Changing the locks is not an act of cruelty. Leaving them open is not always an act of kindness. Both can be attempts to keep someone alive.

What parents need in these moments is not judgment, not certainty, not slogans-but support. Clear guidance. Safety planning. Permission to protect themselves without being cast as villains. Permission to grieve the child they are still loving in real time.

Because the most devastating part of these conversations is not the decision itself, it’s the sense that if they say this out loud, they’ll be seen as heartless, weak, or responsible for whatever happens next. They are none of those things.

They are families standing at the edge of an impossible choice, trying to hold love and safety in the same trembling hands. And if we’re going to be honest about addiction, mental illness, and family systems, we have to be brave enough to say this part out loud:

Sometimes love looks like an open door. Sometimes love looks like a locked one.And neither guarantees safety.

This tragic event has been a sobering reminder to me, both personally and professionally, of why we cannot treat addiction or serious mental illness as an individual problem in isolation. No one struggles alone, even when the suffering looks solitary.

Families are already part of the system long before treatment begins, carrying fear, hope, denial, love, and exhaustion in equal measure. To ignore them is to leave the most powerful dynamics untouched.

If we are serious about care, we have to include the entire family system. Not to assign blame, but to build shared understanding, boundaries, and support that can actually hold under pressure. And that means being willing to have brave, uncomfortable conversations about safety: about risk, rage, relapse, limits, and what love looks like when protection and compassion pull in opposite directions.

These conversations are painful, but avoiding them doesn’t spare families, it isolates them. This loss reminds me that real care isn’t just kind or well-intentioned; it is courageous, systemic, and honest enough to name danger before it becomes irreversible.

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Miscarriage is complex- crashing at the intersection of grief, shame, medical neglect, cultural silence, and systemic misogyny. And for me, it never arrived as a tidy emotional package. No one hands you a manual. There’s no casserole delivery or socially approved script. There’s just you, suddenly carrying an invisible loss in a world that prefers not to speak of such things. I have walked around for weeks feeling like I was straddling two realities: the one where life kept chugging along-meetings, errands, laundry, and the one where something profound had ruptured inside me, a rupture no one could see unless I dared to name it.

I have learned that healing from miscarriage requires a strange alchemy of humour, honesty, collective truth-telling, and a complete reimagining of how we approach reproductive health, grief, and women’s bodies.

I had to learn to laugh about it, because laughter helped me pry open the door that shame kept trying to slam shut. I had to learn to tell the truth-not the polite, edited version, but the raw truth-so that other women could look at me and say, “Oh thank God, me too.”

And most of all, I had to learn that healing was never meant to be a solitary act. We recover in community. We recover when we stop whispering. We recover when we refuse to accept the medical minimization and social silence that have kept miscarriage tucked into the margins for centuries.

This book is a small part of that refusal. A lantern, maybe. Or a hand reaching out in the dark. A reminder that while miscarriage is a wicked problem, women are wicked smart, wicked resilient, and wicked tired of carrying this alone.

What This Book Is and Isn’t

Let’s start with what this book isn’t.

You might be in the wrong aisle if you’re looking for someone to blame, panic, or fix the unfixable.

This book is not an attack on healthcare workers. I see you. You are underpaid, overworked, and expected to perform emotional triage with a plastic chair and a pamphlet. You’re doing your best in a broken system, and this book is not here to throw shade at the people showing up every day.

This is not about terrifying expectant parents. Pregnancy is already a high-stakes gamble of hormones, hope, and Googling “is this discharge normal?” You don’t need more fear. You need facts, support, and a snack.

This is also not a takedown of parents, past or present. Your mom didn’t fail you. Neither did your grandma, your OB-GYN, or that well-meaning coworker who awkwardly mentioned “everything happens for a reason.” We’re all just trying to navigate a crappy map drawn in crayon, in the dark.

And it’s not trying to “cure” miscarriage. Miscarriage is a biological reality. You can’t positive-think it away, cleanse it with celery juice, or manifest your way out. What you can do is understand it better, talk about it more, and stop pretending it’s rare, shameful, or something we’re supposed to go through alone.

So, what is this book?

This book is a deep dive into the things we don’t know, the things we do know, and the giant, echoing canyon of stuff we just don’t say. It’s about the absolutely bonkers fact that we still treat pregnancy-and all its very real, often painful complications-under a blanket of silence, superstition, and secrecy. Like we’re still in the Middle Ages, whispering in corners and blaming the moon.

It’s about how women deserve better. Better information. Better care. Better science. Better conversations. And way, way better communication.

Everything You Never Wanted to Know About Miscarriage is part memoir and part survival guide, unfolding over five acts. Because miscarriage isn’t just a sad chapter; it’s an epic.

You’ll probably cry, wince, maybe even want to punch me in the face at times, and honestly, fair. Don’t worry, I can take it. What matters is that we finally say the unsayable parts, together.

Chapter 1

My Miscarriage Résumé

I’ve had eight miscarriages. That’s right-eight. Over six years. That’s a miscarriage roughly every nine months. Two of those were second-trimester losses, which is a whole different level of suffering.

I’ve gone to work while actively hemorrhaging, because what else do you do? Call in “sad”? There’s no checkbox on the HR form for “actively losing a pregnancy but still trying to appear normal during a staff meeting.”

My husband, Daniel, is a saint. Truly. That man has been to more trans vaginal ultrasounds over the years than most OBs. I mean, the poor guy can probably draw my uterus in technical precision from memory at this point.

Once, we drove from our home on Vancouver Island, all the way to Texas, for an event because I didn’t want to fly while pregnant (Optimism!). I started miscarrying in Houston at something called Courage Camp. Yes. The irony is not lost on me. Nothing says “personal growth” like bleeding through your pants during a breakout session on shame resilience.

I have seen so many doctors. And most of them? They just look sad when I walk into the room. No one has ever had answers-not real ones. Just a lot of shoulder shrugs and averted eyes and “these things happen.”

Here are a few of the things no one told me:

I probably needed a blood transfusion at least once.

I definitely needed iron supplements.

I absolutely needed a heads up that my hormones were about to base jump off the Grand Canyon, and that I would be left at the bottom without so much as a granola bar or a tampon.

I needed pain management. Emotional support. A complete body check-in. Instead, it felt like the second I was no longer pregnant, I was no longer someone who needed care. Like my worth as a patient, honestly, as a human, was tied to that flickering cluster of cells on the screen. No heartbeat? No follow-up. Good luck out there.

I wish I’d known what to ask for. What to expect when no longer expecting. What was about to happen to my body, and my mind.

What I know now, what I wish someone had told me then- is that knowing what to expect is profoundly trauma-informed.

Uncertainty is its own form of suffering. Having a plan doesn’t take away the grief, but it softens the edges. It gives you handrails in the dark. If someone had said, “Here’s how it might start. Here’s how long it could last. Here’s when you should call for help. Here’s what’s normal, and here’s what deserves care,” I would have felt less alone and less afraid.

I generally find comfort in knowing what’s coming, having a plan, and ideally, a well-designed backup plan in case the first one has a nervous breakdown. For me, control makes the world feel less slippery. So, in the beginning, pregnancy suited me fine-at least on paper. There were apps to track things, log symptoms, and highlight due dates.

Which is why miscarriage was so deeply offensive. No warning. No app. No “How To” guide that didn’t end in vague platitudes or photos of sunrises. My body had gone completely off script and, worse, refused to tell me what came next.

I wasn’t in control of anything. Not the timeline. Not the outcome. Not even my emotions. So, as a person who makes lists for my lists, my uterus going rogue without pencilling itself into the calendar was… an unforgivable breach of protocol.

The First One

The first one was honestly the worst. It wasn’t the hardest in terms of the pain or the recovery, but it was the hardest because I had no frame of reference for what was about to happen, and I don’t like that.

We were trying to get pregnant and desperate for some good news. Some context here, the last year had been brutal. My dad died, suddenly, shockingly- 2 weeks before our wedding (yes, all this is true, I know it’s a lot to absorb).

After he died, I slipped into a depression so heavy it felt geological-like I was walking around under layers of sediment. Grief rearranged me. It hollowed out places I had once relied on. My auto-immune system joined in, as it often does, and I found myself battling chronic, debilitating pain that no one could quite explain. Every doctor had an opinion (“less stress” was a favourite- insert an eye roll so enormous that it causes a back-flip) none had a plan, and meanwhile, my nervous system was short circuiting so hard sparks were visible.

And because timing has never been my strong suit, this was also the moment I stepped into a new, complex job at a treatment centre that-God love it- never closes. Not for holidays, not for blizzards, not for emotional breakdowns or spiritual crises or Tuesdays. I was holding space for other people’s trauma while my own grief was sitting in the car with the engine running. There was no quiet place to set anything down. No pause button. Just me, trudging through days that felt both meaningful and impossible.

So naturally, in the middle of all that, we also bought a house.

Not just any house, a crooked, drama-filled old character home. Every floor slanted in its own special direction. The wiring was a suggestion at best. The walls creaked like they were whispering secrets from 1823. There were literal birds nests in the chandeliers. And of course, it needed a complete renovation. Because why settle for suffering in one dimension when you can diversify?

I call that stretch of my life my “Mary Shelley years.” I was exhausted, grieving, depleted, and yet there I was, desperate to bring something back to life. I threw myself into that house like resurrection was a hobby. I scraped, patched, painted, hammered, Googled, cried, swore, and occasionally lay flat on the floorboards wondering what the hell I had done.

But looking back, it makes a strange kind of sense.

When everything inside me felt dead or dormant, I needed to coax life out of something. I needed proof that creation was still possible, that broken things could be rebuilt, even if the “broken thing” was a century-old staircase or a woman who hadn’t felt like herself in months.

I was trying to stitch myself back together. To find beauty again. To feel alive again, so- when I saw that positive pregnancy test, a door cracked open. Hope. A new chapter. Something good.

Even though we knew all the “rules” about waiting to share the news before 12 weeks, we told our family anyway. We just needed it. We needed to believe in something joyful and pass around something other than Kleenex or Ativan. It felt like the right thing at the time. It felt like light.

I was about 8 weeks in the night it started, I was on-call. I woke up at 3 am to the ringing of the phone. After the call, I went to the bathroom and saw that I was bleeding, nothing serious, more like spotting.

Until then, I hadn’t felt anything off. No cramps, no signs. Just sleep, awake, then blood. I went back to bed and lay there for a while, with a cold creeping feeling in my guts. Staring at the ceiling. Not panicked, exactly. More… stunned. Detached. I didn’t know what to do.

I’d never been here before.

I waited for Daniel to wake up, unsure whether to cry, clean the kitchen, or get ready for work.

When he woke up, I told him what was happening. Neither of us had any framework for this-no tools, no script. So we decided to go to the hospital. Because that’s what you do when something medical happens and you have no idea what the hell is going on.

We were in the ER for hours. Not in the drama TV show kind of way where things are flying and someone’s yelling “STAT!”-just the regular, soul crushing, fluorescent lit, never ending hum kind of way.

The kind where time slows down and you start to wonder if your whole life is now just this waiting room.

We live here now.

There were blood draws. There was a urine test. And then, there was her:

The Ultrasound Tech Who Gave Me PTSD.

The trans vaginal ultrasound is not an experience I’d recommend recreationally. It’s basically being probed by a cold plastic wand while trying to maintain eye contact with a stranger who refuses to blink.

I am now an expert, but this was the first and therefore: special.

She was part human, part fax machine, and fully unnerved. Which is alarming, considering I was the one lying on the table with something inserted into my vagina.

Trying to make things less awkward, I cleared my throat and said: “I have a family history of uterine cancer.”

She went completely still. Then, still staring dead ahead, she monotoned, robotically:

“I am going to consult with the doctor now. The doctor will come to see you. The Doctor is going to review your ultrasound. The Doctor will report your results.”

Then, without blinking, she stood up stiffly-as if her joints had been lubed with printer ink-and moved toward the door like she was running on a Windows 95 update. A slow one. With popups. She didn’t say goodbye. She didn’t look back. I half expected her to buffer in the hallway.

Let me say, I totally understand that the ultrasound tech isn’t allowed to tell me anything. I know there are rules, protocols, liability clauses, and probably a giant laminated poster in the staff room that says:

“THOU SHALT NOT INTERPRET.”

But here’s the thing, just because you can’t tell me what you’re seeing doesn’t mean you have to switch into full robotic detachment mode. You can’t say “I’m sorry,” but you could offer a warm tone, a kind glance, or literally any facial expression that doesn’t scream “I’ve unplugged my empathy chip for the day.”

I’m not asking for a diagnosis - I’m asking for a shred of humanity while I lie pantsless and vulnerable on a paper-covered table.

So naturally, I spiral. I’m not just possibly miscarrying anymore. Oh no. I also now have uterine cancer, definitely. Because obviously that’s what she saw. My brain immediately starts drafting farewell letters and wondering whether I want to be cremated or turned into a tree.

Some time later-maybe minutes, maybe three years (it’s hard to tell)-we’re back in the ER room again. Same terrible lights. Same uncomfortable silence. Nurses come and go. Everyone is professional, kind, and weirdly noncommittal.

No one says “miscarriage.”

No one says: “not miscarriage”.

It’s like a game of medical Schrödinger’s Baby.

Eventually, a doctor arrives. He looks twelve and mildly afraid of me. He scans the papers in his hand with a furrowed brow. Then he looks up and says, “You’re fine.”

Just like that. No drumroll. Just “You’re fine.”

And for a split second, my entire body exhales. A quiet internal parade of relief kicks off. I don’t have cancer. The panic squatting on my chest like a gremlin for the past hour slinks off somewhere. My brain, which had already started composing a dramatic farewell speech for my funeral, does a confused little U-turn.

I asked, “So… I’m still pregnant?”

Behind him, the nurse turns her head slowly, like an owl that’s seen too much, and gives him the look, tight lips. Micro head shake.

He blinks. Clears his throat. Um, the pregnancy is not viable.”

I ask, “Okay, so what happens now?”

And with the dead-eyed optimism of a man who has never menstruated, he says, “Nothing. Just carry on with your day.”

That was it. There was no follow-up, medication, or aftercare, just- “Carry on with your day.”

So we left. I think we got tacos. Because what else do you do after a maybe miscarriage but thankfully not cancer emotional whiplash?

When we got home, I carried on with the day because I believed him. He’s a Doctor after all. I thought, “ok, maybe that was it?” Maybe it would just… end. Quietly. Neatly. Like flipping a switch.

But a few hours later, my body proved otherwise. I started to cramp. Then bleed. Heavily. The pain escalated fast, sharp, relentless, whole body. It felt like I was in the movie *Alien, like something was tearing its way out of me. Like my uterus had turned against me and was trying to burn itself down from the inside out.

*Fun Fact: In the 1979 sci-fi horror classic Alien, the only survivors are Ripley, the smart lady who reads the manual and trusts her gut, and Jonesy, the cat. Who minds his own business and stays out of the drama. Sometimes, survival means paying attention, using your brain, and occasionally hiding in a locker with your emotional support animal.

There was no warning that it could feel like this. No one had told me that a “natural miscarriage” could be this physically intense. I thought something was going terribly wrong, that I might actually die.

I feel it’s important to note here that I have a stupidly high pain tolerance, which sounds heroic until you understand what it actually means in practice. It’s not that I feel less pain, I feel every bit of it, thank you very much- it’s that I’ve spent most of my life stubbornly tolerating more of it than I should. I grit my teeth, square my shoulders, and carry on as if stoicism were a competitive sport and I’m gunning for nationals.

This is not an attribute one should be proud of.

It’s not resilience. It’s not strength. It’s a survival strategy I learned far too young. A belief that complaining makes me a burden, that asking for help is indulgent, and that suffering quietly is somehow noble (it’s not.) All it does is train the people around you to expect your silence and train your own nervous system to white-knuckle its way through injury, illness, and heartbreak.

(Note from future me in this story: I’m learning the slow and stubborn way: tolerating more pain isn’t strength. It’s depletion. It’s disconnection. It’s the slow erasure of our own needs. And healing- real healing- requires something far braver than stoicism. It requires saying, “This hurts,” and believing that you deserve comfort, support, and care long before the pain becomes unbearable).

When Daniel and I first started dating, I honestly warned him: “If I ever say ‘I think I should go to the hospital,’ you need to call 911 immediately, because I am probably already dead”. Not “in pain.” Not “feeling unwell.” Dead. Like, the only reason I’m still upright is sheer spite and a lifelong commitment to not making a fuss. I have treated broken bones like a mild inconvenience and period cramps like background noise.

So, when I tell you miscarriage hurts? I mean, it really hurt-and not just in the sad, heartache, and hormones way. I mean whole body, gut-wrenching, “why is no one offering me morphine” levels of pain. But sure, tell me to go home and take a Tylenol.

Eventually, like over a few days, the bleeding slowed. The worst of the pain subsided. The whole thing took about a week. But I was left completely hollowed out. Physically emptied, exhausted. And furious that no one had told me this could happen. That “carry on with your day” was not just dismissive-it was negligent.

This was my first miscarriage. And the most confusing part wasn’t the blood or the pain. It was the silence. The lack of language. The vacuum of care. Like I had entered a space no one wanted to acknowledge, let alone explain.

So, I did what any reasonable control enthusiast does in the face of medical uncertainty: I started researching. And by that I mean, googling. Furiously. I toggled between Mayo Clinic and Reddit like I was trying to earn a PhD in uterine failure in under ten minutes.

I was looking for something-a chart, a checklist, any scrap of information to make sense of this. What I found instead was a sea of other women with the same questions about what was happening to our bodies, and no real answers…

If I could go back in time, knowing what I know now, I wouldn’t try to stop the miscarriage, because, spoiler alert, I couldn’t- but I would say to myself: “This is awful. But it’s also… totally normal.”

Like, horrifyingly, statistically normal. The cramps, pain, the hormone crash, the blood loss, the emotional spiralling, the haunted uterus vibes? All of it: textbook. This is nature, and nature is brutal. Miscarriage isn’t a ‘malfunction’- it’s biology doing its chaotic, ruthless, unsentimental thing.

Why I’m Writing This

I’ve had eight miscarriages. Which clearly demonstrates my credentials as the unofficial tour guide for the uterus apocalypse. I have a Master’s degree in Healthcare Leadership, I’m a Master Practitioner of Clinical Counselling with over 20 years in the mental health trenches, and I’m a Trained Daring Way™ Facilitator (which means I’ve marinated in the work of Brené Brown long enough to shame resilience my way out of just about anything).

I have skills, I have resources. And yet when miscarriage hit me, again and again like a tsunami on a time loop, I had zero frame of reference. No tools. No map. Not even a fucking pamphlet. Just me, a zillion maxi pads and my old pal, Dr. Google. If I couldn’t figure out how to navigate this with all my training and trauma street cred, how the hell is anyone else supposed to?

I’m not writing this book to rant or to scream into the void. (Although, let’s be honest, the void and I have gotten very close.) I’m writing it because I wish something like this had existed when I was Googling “what does a miscarriage feel like” for the seventeenth time. Because that’s what we do.

While specific data on the number of Google searches for “miscarriage” in Canada isn’t publicly available, it’s well documented that a significant majority of Canadians-approximately 91%-turn to search engines like Google when seeking health-related information. Given that 15% to 25% of pregnancies in Canada end in miscarriage, it’s reasonable to infer that a substantial number of individuals are searching for information on this topic.

While precise national statistics on miscarriages in Canada are limited due to underreporting and variations in data collection, estimates suggest that approximately 15% to 25% of recognized pregnancies end in miscarriage. This range accounts for losses occurring before 20 weeks of gestation and reflects the challenges in capturing early pregnancy losses that may not be clinically recognized.

For instance, a study conducted in Manitoba from 2003 to 2014 identified between 2,217 and 2,787 miscarriages annually, representing about 10.1% to 12.5% of pregnancies in that province. These figures are based on healthcare interactions and may not encompass all cases, especially those not resulting in medical consultations. Meaning, only people who have had medical care for their miscarriages are counted in these stats.

Given that Canada experiences over 350,000 live births each year, applying the 15% to 25% miscarriage rate suggests that tens of thousands of pregnancies may end in miscarriage annually across the country. However, it’s important to note that these are estimates, and actual numbers will vary due to factors such as reporting practices and access to healthcare services.

I want this book to be the thing I didn’t have: something real, useful, occasionally profane, and deeply human-a mix of lived experience and clinical know-how. Because, yes, I’ve had the personal experiences, I have the professional background and training, and I’ve sat across from a lot of people who’ve also miscarried. And let me tell you, the silence and confusion aren’t just my thing, they’re everyone’s thing.

This book is part memoir, psychological debrief, and practical survival manual. Think of it as the literary equivalent of that one friend who shows up with snacks, a heating pad, and zero tolerance for bullshit. I want to offer what I can: skills, science, and emotional first aid. The kind that actually works in the middle of a hormone thunderstorm. Not platitudes. Not pastel memes. But grounded, evidence-based support.

If this book helps even one person feel less alone, a little more prepared, or more willing to ask for what they need, I’ll consider it a win. And if it also makes you snort laugh at least once? Even better. So yes, I’m writing this for me, but I’m also writing it for you. Even though miscarriage is statistically normal, that doesn’t make it any less devastating, confusing, or wildly under-discussed.

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