Massive wall of water, suspended. Narrow space of dry ground, an alley through the sea. I am standing on a ladder in the sand, leaning against the liquid wall. I am frantically laying tiles on the water, one little square at a time, trying to hold it up, reinforce it. I am madly laying the tiles, covering up just a few feet of this massive surface that stretches on for miles. Suddenly, I stop. There is no need for me to cover the water, to build a wall against a wall. God has already parted the sea.
This recent dream pretty much sums up the pickle I’ve been in lately. I am feeling immeasurably better since my last post. I have reoriented myself internally and, though I am just as busy, I am far less stressed out.
I realized that I have been suffering from a severe case of trying too hard. Indeed, trying too hard seems to be at the root of much of my longstanding anxiety. I have a habit of constantly trying: trying to be polite; trying to be good; trying to be perfect. I try at everything. I try hard in school, work, relationships, life. I try hard in my spiritual practice. I try hard, very hard, to relax (what an oxymoron!).
There is a hilarious irony underlying all this, in as much as trying actually undermines both being and doing. This stressed out, effortful trying is an expression of basic fear. It communicates a fundamental lack of trust in the world and in oneself. Far from improving one’s performance or helping one to meet goals, trying diverts energy, corrodes calm, and goes against the flow of life. All in all, trying makes action inferior, cramped, inhibited, uninspired, and it is incompatible with wellbeing.
So I have stopped trying. I am not trying to be a good student, counselor, partner, friend or employee; I am not trying to be healthy, happy, or perfect; I am not trying to relax, be present or meditate.
Quitting trying feels like a great big trust fall in which I am both the one falling and the one catching myself. I feel I am just sitting back and watching the actions of the mysterious intelligence I call myself. With no effort whatsoever, I do all the things I need to do, know all that I need to know, and more than that. Words just come out of my mouth spontaneously, and they’re often very appropriate words; I walk out of my house and directly to my workplace, somehow knowing the way. It’s amazing. And it really underscores just how little good trying does me. It seems I can completely stop trying and, far from my fears of my life crumbling into a twisted mess of pain, the only immediate consequence is that I feel a lot better.
I am still doing. I go about my day; I attend to the tasks that greet me. When tension and anxiety arise I remind myself: I am not trying. I am not trying to do an excellent perfect job at this or that, so if I screw up, if it doesn’t turn out right somehow, what’s the big deal? At the same time, I am not trying to be a super present spiritual person, so if I am worried and preoccupied, who cares? I’m not trying to do or be anything in particular–so whatever I’m doing and being is fine.
I am struggling right now in my other transition–adulthood. I am feeling really overwhelmed. I’ve been stressed out for a while, but I seem to have hit some kind of new threshold. The combination of grad school classes, counseling clients, intensive supervision, my job, joining the board of a professional organization, looking for an internship for next semester with time running out, and, you know, life, trying to be a good partner, son and brother, and all the little tasks that demand doing daily: dogs, chores, shopping, appointments, bills, prescriptions, phone calls… Holy shit, how the hell do people do this?!
Writing it out, at least, I can see why I feel overwhelmed. I really have a lot going on right now. The counseling & supervision is such a challenge in itself. It’s very exciting and rewarding, and I can see growth and change in myself and my clients. But wow, it pushes me so hard, I don’t have that much energy for the zillion other things going on.
I keep getting waves of anxiety, feeling like an imposter. What the hell am I doing? Who am I kidding? I’m terrified.
On the one hand, I feel like, what a joke that I am supposed to be helping others with their mental health–I’m a fucking mess! On the other hand, the nature of the work inspires me to be good to myself, to not work myself too hard, because to make myself miserable helping others be well is just absurd (not to mention impossible).
It is so damn bizarre. I’m like, ok, one minute I’m scrambling to finish a paper; then I’m in a meeting for work; then I’m coaxing someone into a signing a piece of paper promising not to kill themselves; then I’m having dinner with my partner; then I’m giving a presentation on how to help undergraduates write essays; then I’m doing dishes; then I’m listening to someone talk about being raped; then I’m watching a video of myself listening to someone talk about being raped, as another person pauses the video every few minutes to ask, “What were you feeling at this moment?”; then I’m cold-calling agencies and pleading with them to let me work for them for free; then I’m trying to get somewhere on time; then I’m sitting in tiny room with a sobbing man; then I am stopping a moment to smell the first lilacs; and a voice comes through my headphones, saying,
One generation goes, and another generation comes; but the earth remains forever. The sun also rises, and the sun goes down, and hurries to its place where it rises. The wind goes toward the south, and turns around to the north. It turns around continually as it goes, and the wind returns again to its courses. All the rivers run into the sea, yet the sea is not full. To the place where the rivers flow, there they flow again. All things are full of weariness beyond uttering. The eye is not satisfied with seeing, nor the ear filled with hearing. That which has been is that which shall be; and that which has been done is that which shall be done: and there is nothing new under the sun.
Alma and I keep joking that we are babies pretending to be adults. Funny cuz it’s true. I am in over my head.
[A more personal post.]
I’m in grad school studying mental health counseling. Six weeks ago I started seeing clients for the first time. The experience has been amazing, challenging, beautiful, heartbreaking, overwhelming, exhausting… Basically it’s kicking my ass.
I am confused and tired. It is strange to be suddenly doing the work for real, after a year and half of training. I feel a bit like an impostor, of course. I find myself acutely aware of my age, feeling both painfully young and oddly grown up. It’s the feeling I like to think of as “7th grade all over again.” The grade/age varies a lot by school system, but you know when you go from being the biggest kid at primary school to one of the youngest and smallest at secondary school? I feel like that, or like the first time you venture into the deep end of the pool. I’m treading water, but I can’t put my toes down anymore. Shit got real.
I absolutely love working with my clients. It’s fascinating, exciting, moving, captivating. I really enjoy it. I find myself extremely awake and present during the sessions. There have been times I was totally lost, and times when we connected and some real work got done. My biggest fear right now is, will I ever develop the endurance do this shit 40 hours a week without keeling over?
I have a wonderful, very committed supervisor who has been giving me great feedback. I am learning to breathe deeply and not rush the process. Interestingly, she pointed out that I seem more openhearted with my female than my male clients. I still carry a lot of “boys don’t cry” baggage and it gets between me and deep empathy with another man.
Sometimes I can observe myself swallowing an emotion in real time. It is so weird; the reflex to swallow, repress, so powerful, and then it’s gone. Not really gone, but no longer accessible, bound to come back later. One of the stranger times: Alma and I watched the very important and heartbreaking film Broken Rainbow. I got through the whole thing without crying, though it hurt. Then a year later, we were discussing the movie one night, and I just burst into tears, absolutely no warning. It felt like the very same tears I swallowed in the first place. I am still letting go of all my backlogged tears.
Flashes of memories of learning not to feel: my father’s exhortations of toughen up, determination, learn the difference between pain and discomfort, stop crying. I think my dad picked up on my masculinity and he trained me the best way he knew how. He taught me that you have to be tough or the world will destroy you. As a young gender-variant person, I keyed into messages of masculinity with a secret intensity, clinging to them for dear life. Onionskin heart, I dismantle one wall and I find another.
My world is changing. It essential to face the world with an open heart. Love is far more powerful than fear. The more I open to the world, the friendlier the world becomes. Strange how my family has changed. What would be dad be like if he were raising me now? Now that he seems so much less anxious and reads the Tao Te Ching?
Brick by brick, I keep dismantling. I will not compromise love.
In my circles, it’s commonplace for women to express greater comfort around other women. Is it socially acceptable for a man to say he’s more comfortable around other men?
In class recently, we watched a video of a group counseling session. At one point, a male group member said he had difficulty trusting the group. When pushed by the facilitator, he noted that he had an easier time trusting men than women. This particular group had three or four male participants and ten or so female participants. In context, he was saying he found it easier to be emotionally vulnerable with men. I have noticed that many people feel more comfortable discussing personal, upsetting matters with others of a certain gender.
During the discussion, one woman in my class made a dismissive remark about that moment in the video. Basically, she made a joke to the effect that she felt uncomfortable when he said that, that perhaps he disliked women, and that she would have wanted some distance from him. Another woman chimed in along the same lines. They shared a laugh.
These comments got under my skin. As a man, I am used to women saying they prefer the company of other women sometimes. I completely accept it. Many women have had bad experiences with men, while others just feel another woman will be more likely to understand them. At the crisis hotline where I volunteer, I don’t work a single shift without a woman calling and asking to be transferred to a female volunteer. It doesn’t offend or upset me in the least–I know it has nothing to do with me.
I acknowledge that because of the very different social positions of men and women, female-only space and male-only space are not the same. To take just one important example, women are much more likely to have experienced violence from a man than the other way around.
Still, in a mental health context, it is imperative that we take individuals’ unique needs seriously. The fact that men and women have different experiences on average means nothing about the needs and experiences of a specific person. Men are less likely to receive mental health treatment; I attribute this to a masculine imperative around not asking for help. If an all-male environment makes it easier for some men to do this difficult work, I think we should encourage it.
It really bothered my that my classmate inferred that the man in the video disliked or disrespected women. What he said was that he found it more difficult to trust women. Note that he didn’t say, for example, he found it difficult to trust women with important responsibilities. He said he found it difficult to trust women he’d just met with his emotions and struggles.
I can relate. When I was in counseling recently, I asked for a male counselor, because I knew I’d feel more at ease. The only time I have been in group counseling, it was a group reserved for trans men. I love women, I respect women, I have wonderful close relationships with women, and I am an ardent feminist. But when it comes to the rather odd situation of sharing my personal struggles with someone I just met, I feel more comfortable with other guys. It’s easier to speak frankly about private and difficult topics. It’s easier to share challenging emotions. I feel less need to downplay bad things, to use inoffensive language, to look like a strong, tough dude.
“Safe space” is a concept we usually reserve for an oppressed group. While the gender system does privilege men over women, it’s not a simple case of one class of people unilaterally oppressing another. The gender system does profound, specific violence to men as men. Emotions and intimacy are huge, crucial areas where gender norms harm men. This happens in ways most women probably don’t understand.
So I think that, in mental health services, men should be able to ask for safe space. Maybe, just maybe, it will make men more willing to seek help and more able to really use it when they get it. These spaces harm no one and might really help some.
The appropriate response for women who hear men express these preferences–especially women who are aspiring mental health professionals–is not derision or laughter. It’s not taking it personally or as some kind of larger comment about women. The appropriate response is compassion.
Last month, I visited my doctor and asked her for a prescription for amitriptyline. I took this medication for several years, from the time I was about 16 to age 21, to help me cope with depression, anxiety and migraines. Three years ago, delighted with the way testosterone had improved my mood, I stopped taking it.
I’m still not sure exactly why. I was doing much better–but what made me think I didn’t need it anymore? Maybe I just didn’t want to take two medications. More than that, I didn’t want to be someone who had to take two medications.
Testosterone has improved my quality of life tremendously. But after three years, I had to admit that my anxiety had reared its ugly head again. I got sick of being debilitated by spirals of worries, irrational and bottomless. I got sick of feeling like shit when nothing was wrong.
I realized I had two entirely separate conditions: I am transgender, and I am prone to depression and anxiety. To be more specific, I have obsessive compulsive disorder, in my own semi-educated opinion. These conditions certainly interact with one another, but they are basically separate. A lot of people in my family have the same depression and anxiety problems, but not a one is trans.
It’s amazing how difficult it is to admit you could benefit from mood-altering medication. I am a staunch supporter of mental health treatment–I’m becoming a counselor, for goodness sake–but I felt a major twinge of shame at asking for help.
There’s the idea that having a mental health condition makes you crazy, sick, inferior, or broken. There’s the idea that if you’re functioning and surviving, you shouldn’t seek treatment just to make your life a bit better.
Life is precious. We get one shot. There is truly no good reason not to get the most we can from it–to be our fullest and healthiest selves, to be as alive and awake as possible. For some people, medication is one important tool for making contact with reality.
I am so glad I bit the bullet and asked for the prescription. I still have obsessive thoughts, but they are fewer, and it is much easier to recognize them for what they are. My default mood, when nothing is especially right and nothing is especially wrong, has gone from agitation and uneasiness to quiet contentment. I look forward to starting the day in the morning, and I look forward to coming home at night.
At this point, I couldn’t care less about needing a couple of medications to be healthy. The thought seems preposterous now, and more than a little ungrateful, given my overall good health. I am just so glad I have them.
A wave of anxiety crashed over me. I was overcome with the sense I had made an embarrassing mistake, like walking into the wrong bathroom. Looking around, I first saw only female faces. But I wasn’t in the women’s restroom. I was in the first day of Theories of Counseling and Psychotherapy. Me, a male professor, another male student, and our ten or so classmates–all women.
I just started my second semester of grad school in mental health counseling. My program, like the field as a whole, is heavily skewed towards female. (The faculty, on the other hand, includes plenty of men–interesting bit of sexism, that.) I knew this when I applied and didn’t give it a second thought. I am comfortable around people of all genders. I reject the sexist forces that push more women and fewer men into this profession. And I think it’s important that more men get involved.
Counseling is a pink collar perfect storm. Caring for people–check. Low paid (relatively speaking)–check. Under appreciated–check. Warm and fuzzy–double check. I think most men just can’t picture themselves doing it. Those who are interested in mental health might opt for a different track, perhaps one more associated with authority, science, and a big paycheck.
I think that’s a loss. Men are less likely to seek counseling, but there are many who do, and some might be better served by a male clinician. Men are also much more likely than women to be in court mandated counseling. Some women and non-binary folks might prefer to work with a man. Many boys could benefit uniquely from working with a male counselor.
I’ve seen a handful of counselors myself, and the counselor’s identity has made a huge difference to me. I was in counseling as a child and adolescent, during transition to get a letter for surgery, and in the last few months as I process my grandmother’s death. My most recent counselor is a gay man of color, while all previous counselors were older white women (at least one was definitely straight, not sure about the others). I really wanted to see a male counselor when I needed my surgery letter–I had a lot of male-specific stuff on my mind at the time–but I couldn’t find one. While working with my most recent counselor, I found that I was much more comfortable speaking frankly with him. The fact that he is gay and Latino also really helped. I could see myself in him.
So both my politics and my experience tell me that pursuing counseling as a man, and particularly as a Sephardic Jewish trans man, is a great idea. But that didn’t prepare for how it actually felt to walk into a classroom that was almost all women.
I felt embarrassed, anxious and confused. I kept wondering how being transgender played a role in my decision. Would I have thought of this path I weren’t trans? Would I have entered this program? I felt like there was some unspoken guy signal I hadn’t heard, an open secret that only I missed.
Of course, there are a bunch of other men in my program, and as far as I know they are cisgender. But that didn’t stop me feeling like I’d made an unbecoming mistake.
I guess I wanted to think that being transgender didn’t have anything to do with it, with any choice I make or thing I do. Maybe part of me wants to think being transgender doesn’t have anything to do with me. It bothers me to think I might do something a cis guy wouldn’t–even though it’s a point of pride that I do certain things (being a feminist, for example) that most cis dudes don’t.
But being transgender has everything to do with it. Not because I missed some male socialization signal that would have turned me away from the helping professions. Not because I shouldn’t be there or because a cis guy wouldn’t want to be there. Being transgender has to do with it because I have years of firsthand experience with depression, anxiety, and mental health professionals. Being transgender has to do with it because I know it’s possible to make changes that make a difference in your wellbeing. Being transgender has to do with it because it’s given me more empathy for others. And being transgender has to do with it because I know I don’t need to live my life according to stereotypes. I did not transition just to trade one suffocating box for another.
I’m feeling much better about it this semester. It would be nice to see more guys around, but it does make it easy to become friends with the dudes who are there. We have a certain solidarity.
I still dread walking into a class to realize I’m the only male student. You can imagine my relief when I sat down in Human Development Across the Lifespan yesterday. I counted eighteen students, eight of them guys.
A reader asks,
As an aspiring mental health professional and a trans* person, what are your thoughts on the recent changes to the DSM-5?
Thanks for this interesting and important question. Short answer: I have a lot of thoughts! This is a complex issue. As a first-year grad student in counseling, I am just beginning to learn about mental health and the healthcare system. There is a lot to address with this topic.
First, a bit of background. Here’s a good overview of the changes to diagnoses affecting trans* people in DSM-V.
One of the biggest revisions is the move from “Gender Identity Disorder” to “Gender Dysphoria.” This change reflects that trans* gender identities and expressions are not mental disorders, while dysphoria–clinically significant distress that often goes along with being trans*–is a mental illness. This diagnosis is intended to be more respectful and less stigmatizing, while still helping to facilitate treatment for dysphoria in the form of counseling, hormone therapy, etc. Check out this fact sheet from the APA (pdf) for more on Gender Dysphoria. There are still problems here, but overall, I consider this a major improvement.
On a more negative note, DSM-V includes a diagnosis called “Transvestic Disorder” (formerly “Transvestic Fetishism”). Frankly, this is a bullshit diagnosis applied to people who are sexually aroused by cross-dressing. Here is a thorough treatment of the problems with Transvestic Disorder.
On to my thoughts on trans* folks and DSM-V–or rather, trans* folks, mental illness and diagnosis. I’m of several minds here.
First, I should say I am no fan of the DSM, period. The DSM is a culturally, historically specific document, which reflects social norms as much as anything. Psychology has frequently been used as a tool of the system to forcibly normalize and stigmatize people. I think mental health workers should focus on helping people live better lives, not on categorizing, diagnosing or describing them. I am suspicious of the validity of pretty much all diagnoses, not just those related to sexuality and gender. (This is largely why I chose to pursue the program I did, counseling, instead of another, such as clinical psychology.)
On the other hand, I sometimes feel uncomfortable when people criticize the inclusion of trans* experiences in the DSM. Sometimes, I think the cries that being trans in not a mental illness smack of ablism. I think we need to be very careful not to perpetuate bias against people who do experience mental illness. “Mentally ill” people are very stigmatized in US society. I use quotes because there is no fixed group of mentally ill people, separate from the general population. A huge fraction of people experience a mental illness, and people move in and out of this category during the course of their lives.
Of course there is nothing wrong with trans people–except insofar as dysphoria, discrimination, etc. interfere with a person’s life. In other words, there is nothing wrong with being gender variant, but people who are suffering may need some help.
At the same time, there is nothing wrong with so-called mentally ill people–except insofar as depression, anxiety, etc. interfere with a person’s life. There is nothing wrong with having gone through trauma, having atypical brain chemistry, or whatever, but people who are suffering may need some help. In many cases, people who have any form of disability suffer mainly because the majority has organized society in ways that don’t meet their needs. Sound familiar?
Personally, I think my dysphoria absolutely was and is a mental illness. For me, symptoms of dysphoria included: years of depression, panic attacks, trying to numb myself with alcohol, trouble forming relationships, trouble enjoying life, wanting to die. If that’s not mental illness, what is?
My gender identity, meanwhile, is absolutely not a disorder of any kind. Trans* people are part of the beautiful, natural variation of the human species. I don’t think being trans has to go along with experiencing mental illness–it’s just that it often does, in some societies. If I had been recognized and affirmed for my gender from an early age, if I were not considered inferior because of my trans status, etc., I doubt I would have experienced much distress at all. I think I would still have wanted to transition and change my body. I just wouldn’t have nearly died in the process.
So my mental illness was caused by the interaction of myself and my society. I think that goes for a lot of mental illness and other disabilities.
In conclusion: DSM-V is an improvement from DSM-IV, but major problems remain. I think the DSM itself is a flawed, historically specific text, and I don’t think it’s the best way for us to approach mental health. As long as it’s here, I think it’s reasonable to say that dysphoria is a mental illness, while trans* identity is not. I think folks who are quick to say that trans* people have no place in the DSM might want to take a second look at their opinion of “mentally ill” people.
Basically, it’s difficult for me to take a stance here, because I disagree with some basic premises that often frame the conversation. These include assumptions that the DSM is a good authority, that mental illness can be easily separated from social norms, and that being described as mentally ill is always bad.
I hope that answers the question. Anyone else have a take on this?
I am in my first semester of grad school, and I have struggled with how open I want to be about my trans status. On the one hand, being trans informs my perspective and is part of the reason I chose this field (mental health). Transgender issues come up from time to time in class, so there are opportunities to mention that I am trans and share my thoughts. On the other hand, I don’t want being trans to define me in the eyes of my classmates, especially because I am in a small program where I will take many courses with the same people.
I want to help educate my peers about transgender people–as future counselors, it is crucial that they are well-informed–but I don’t want to feel like I have to at any given moment. My program (and the profession) are heavily female, so I also have a some anxiety about being seen as “not really a man” if I disclose in a room that’s 75% female–like it will rub off on me or something.
The choice was sort of made for me a few weeks ago when someone outed me in class. The person responded to a comment I made with a question about how being transgender affected my experience.
I mentioned my trans status in front of this classmate and a few others during the admissions process, but had not brought it up in class. The classmate in question is supportive, but is not versed in the issues and etiquette. I suspect that almost everything this individual knows about transgender people, they know from one brief conversation with me. Apparently, they did not realize that it is not appropriate to mention that someone is trans* in front of a large group, when they have never mentioned it.
I was flat-out shocked after hearing the comment; it took me a few seconds to respond. My heart was racing, and I was not able to pay attention for the next 15 or 20 minutes of class.
On reflection, though, it was a not a bad experience. No one in the room so much as batted an eye, and everyone seemed genuinely curious, attentive, and respectful. I am not sure if someone, ahem, had previously discuss my trans status with other students, or if the group is really just as considerate and unflappable as befits future mental health professionals. Although what my classmate did was shitty and inappropriate–not to mention dangerous in many situations–it’s a relief to have gotten it over with. It’s nice to know how people will react. No one has treated me any differently. I haven’t mentioned it again, though.
Has anything like this ever happened to you? How do you navigate identity and openness in the different spheres of your life?