You still haven’t started that paper. You forgot to send that email again. What’s wrong with you? You haven’t done the dishes in a week. When are you going to write your aunt back? I can’t believe you said that stupid thing at work today. You better call the dog in. Are you ever going to start that paper?
So goes the monologue that so often takes over my mind, and that’s on the good days. I’ve posted before about my experience with anxiety and obsessive thinking. I recently stumbled upon a strange method for getting a little distance form it. I named it Simon.
I got this odd notion from an episode of On Being (one of my favorite podcasts) with pastor Nadia Bolz-Weber. She explained,
I named my depression Frances because it was like a really bad roommate who would never leave. And at the time when I really suffered from depression, it was when Kurt Cobain and Courtney Love had their child named Frances Bean, and so I named my — at the time they named their child, I named my depression Frances.
But I always pictured her more like Courtney Love, kind of emaciated in a vintage nightgown with like smeared lipstick and a gin bottle and a cigarette. Like that was Courtney. I mean, that was Frances, my depression. And like at first, she was kind of interesting to hang out with, but then she just never moved out.
Something just clicked when I heard this. Of course! All this time I’ve been observing my thoughts, knowing myself as the awareness, not the thinking/thinker. But it’s damn hard to remember when the dust-devil swirls in. What better way to disidentify from my obsessive thinking than to give it a name?
So I named it Simon. I picture him vividly: a skinny, scrawny boy of 18 or 19, with messy black hair and wire-frame glasses. I feel like he’s my younger cousin or something, and for some reason, I’m expected to live with him. Simon is the kind of roommate who leaves his dirty socks on the floor and eats the leftovers you were saving. Simon has strong opinions on matters on which he is utterly uninformed. Simon believes everything will go wrong and he wants me to know it.
Naming Simon has sparked something of a revolution in my mind. That evening, all my anxious thoughts were suddenly in sharp relief, obvious in their absurdity and complete uselessness. Shut the fuck up, Simon, I though to myself over and over. In the few weeks since this happened, my anxiety has plummeted. Best of all, whenever it rears its ugly head, it is easily shot down. I wouldn’t put up with this crap from a roommate; there’s no need to put up with it from myself, either.
No more Simon Says.
Moving forward in my counseling program, I find myself wondering what really helps people. Last night Alma asked me, “What helped you?”
How do people change? Why do some people overcome profound loss, abuse and tragedy, while other people just fade away? This is a particularly sensitive question right now as we watch a loved one struggle with serious mental illness and addiction. We both look back on our troubled younger years and see so many forks in the road where we could have taken a lethal turn–and didn’t. And so many others did. So what made the difference for me?
1. Relationships. I am blessed with an awesome family that has always supported me. I have always had good friends. Relationships are a double benefit. People were there to help me and talk to me, which was invaluable; and just knowing that they loved me was itself a powerful incentive not to hurt myself. Though I considered suicide many times, I never attempted to end my life–as soon as I thought about how I would do it, I thought about the people I would leave behind, especially my little brother.
2. Radical consciousness. I got into social justice at a young age, and it’s been endlessly valuable to me. I learned that just because you’ve been told you’re disgusting and worthless doesn’t mean you are. Society is often wrong. I learned how to see myself as in the same boat as other marginalized people. And I learned that respecting them meant respecting me, too. I could sink really low, but pretty soon I’d see the injustice of it all, and then I’d get angry–and then I didn’t want to die anymore. Radical consciousness allowed me to adopt a stance of defiance instead of defeat.
3. Religion & spirituality. When things started to get really scary for me as a teenager, I retreated into my religion. I studied Jewish philosophy and kabbalah, and I talked Torah with rabbis ranging from Reform to Hasidic. I read about other religious traditions, Buddhism, Hinduism, Christianity and Islam. I saw myself at a crossroads, and I had a choice: the path of life or the path of death. I chose life, and clung desperately to every scrap of help and meaning I could find; for me that was God, and my tribe, and my tradition, and mysticism of many varieties. Religion gave me the sense that there is meaning in the universe, the sense of being connected to a tradition across place and time, and a rich repository of narrative and poetry to draw upon in times of need. Ecstatic experiences of awe made me feel life is really worth living. I embraced life as a quest for connection and truth.
So that’s what helped me. But does that really account for it? Through these three things, there is still something unexplained, an x-factor. I always sensed the meaning and value of relationships, radical consciousness, and religion; I was able to take advantage of them. I wanted to take advantage of them. Perhaps that is the key ingredient. But what is it? Did I really just help myself? Why was I able to? Is it will to live, random chance, hope, strength, luck, faith, genetic predisposition, destiny?
I wish that I knew.
I was depressed for 15 years. Today I am thriving, and I enjoy life every single day. What happened? I transitioned.
Transition doesn’t solve all your problems, but damn, it sure does help. For me, it solved my only real problem, the disease creating all my symptoms. Turns out that my depression, deep-seated anger, social and general anxiety, problematic substance use, and self-harm were all just different faces of the same monster–gender dysphoria.
Addressing dysphoria not only led me out of the misery of mental illness. It also led me into feminism, social justice politics, and radical consciousness. It led me into community with badass human beings who live authentically and strive to help others. It led me into my chosen field, mental health. It led me to God.
Gender dysphoria is a good problem to have. Gender dysphoria is a problem that, at least potentially, ends. It’s a problem with a solution. It’s a problem with a path to recovery, crooked though that road may be.
As I watch friends and family members struggle with depression and addiction, as I get the news of more and more classmates dead before 30 by suicide or overdose–goddamn am I glad to have been given gender dysphoria and the ability to address it. These people I knew, may they rest in peace, by and large had access to treatment… just not treatment that worked fast enough.
My problem was simpler than that. Sometimes I see a friend dealing with depression, and I honestly hope the real issue is that they are a gender or sexual minority. At least then I’d know how to help.
Gender dysphoria is a problem that creates friendships and community, artwork and poetry, awareness and solidarity. It’s a problem that can lead you down an incredible road of growth and self-discovery, maybe even to your destiny.
Perhaps gender dysphoria isn’t really a problem at all.
Bzzz. There’s that sound again. Bzzz. Bzzz. You shake your head, like you could shake the sound out of your ears. Bzzz. That sound, a harsh, metallic buzz that makes your teeth tingle and your stomach turn. Bzzz. It comes from everywhere and nowhere, out of the air, out of your own ears. Bzzz. When did you first hear it? Hard to remember now, it was so long ago. Did you notice it at first? Bzzz. Some vague memory of trying to take a spelling test in elementary school, distracted by the noise. Bzzz. Was it new then? You can’t remember. Bzzz. Bzzz. One thing’s for sure, it’s been with you a long time now. Bzzz. You used to try to describe it. One night asked your mother if she heard it. Bzzz. “What do you mean, sweetie?” she’d said, with the strangest look of sad, puzzled panic barely concealed on her face. “Nothing!” you yelled, in a voice too loud, too cheerful. “Never mind!” Already running away. Bzzz. Bzzz. It didn’t take long to figure out no one else heard it. Later, as a young adult, you worked up the nerve to ask a doctor about it, when you were at an appointment for something else. Bzzz. “I did want to ask you one thing,” you managed, just before the doctor left the tiny room. Bzzz. Bzzz. “I have this sound–this buzzing–I hear it sometimes.” That same look of confusion, worry, and something else. What was that other emotion, half-visible on his face? Disgust, maybe. Bzzz. He’s all business, peers into your ears with his little flashlight. Bzzz. “Everything looks healthy,” he declares with satisfaction. “I could refer you to a specialist if you’re worried about it.” Bzzz. Bzzz. “No, that’s okay,” you tell him. You just want to go home.
Thanks to captainglittertoes for this post, which inspired me to experiment with new ways to narrate the trans experience.
As a kid, I obsessively repeated number sequences in my mind. 1-2-3, 1-2-3, 1-2. 1-2-3, 1-2-3, 1-2… If I failed to repeat the pattern–the right numbers, in the right order, at the right time–my mother would die.
At 5, I knew she would die in a fire; at 6, I knew she would be shot. At 8, I knew she would be killed be a drunk driver, and at 9, I knew she would get cancer. I became especially consumed by this terrible false foresight when she went out at night. I begged her to take me along to meetings and choir practice, convinced that if I were there, she wouldn’t die. Or at least you would die too, a part of me whispered.
I have struggled with anxiety for as long as I remember. I now recognize it as OCD, which runs in my family. I am worming my way out from under the thumb of these fevered preoccupations.
The same pattern has followed me in a dizzying variety of forms, both subtle and overt. In the most obvious and painful form, I believe that my mind can cause or prevent a loved one’s death. I recognize the pattern by two telltale signs:
- The thought states or implies that my mind can somehow influence external events and/or predict the future. If I think about something bad, it will happen; or else, just as often, if I don’t worry, it will happen.
- I am fixated on an imagined disaster . There is little evidence that this event will actually occur.
The delusion is so obviously false, and the fixation so clearly misguided, it is hard to believe I fall for it over and over again. But mine is a clever and persistent monster. I talk myself out of wild improbabilities, only to talk myself into new fears, ever so slightly more plausible. The shape-shifting apparitions of my mother’s death–fire, gun, car accident, cancer–chronicle the obsession’s development over time.
I want to be free of my father’s disease. I have loosened and loosened its grip; I have reach levels of calm I never thought possible. Transition, medication, and meditation have done me worlds and worlds of good. These days, my moods are upbeat and steady. People remark on my peaceful demeanor, a compliment that always surprises me. Still, again and again, I get caught in its cold fingers, and I find myself with a knot in my stomach, gasping for air, when absolutely nothing is wrong. I never want to feel that melancholy panic again.
Its disguises are manifold, but the root is the same. My mind ceaselessly sets about attacking problems, always making plans and calculations, hedging bets, setting goals. Like a loyal dog, my mind sniffs out possible problems and goes about solving them. There is nothing wrong with this–it’s useful. But my poor little mind, always wandering through worries, returns again and again to one problem, the Problem of Problems, a nauseating truth it cannot solve.
My mind has been trying to outsmart death. Temporariness is the wall I’ve been banging my head against. My mind hits it and gets stuck in an endless loop of magical thinking, like a scratched CD stuttering, like a crashing computer.
When I can observe this, a warm glow overflows from my heart. It is the light of love for myself, for the good old dog that is my mind, bound to try, doomed to fail.
It’s okay, boy. You just can’t solve this one.
הֲבֵל הֲבָלִים אָמַר קֹהֶלֶת הֲבֵל הֲבָלִים הַכֹּל הָבֶל
Mist of mists, said Kohelet. Mist of mists, all is mist.
Once each week, I spend four hours in a tiny office on campus. All the windows are covered; the door is made of metal and requires a code to open. I sit at a station with a computer and a phone. My job is simple. The phone rings. I answer it.
At the suicide hotline, I have two tools: voice and silence. I have learned when to speak and when to be quiet. I echo emotions, diction, volume, pitch. The technical term is tone-matching; I prefer to think of it as harmony. People call for every reason you could imagine and many you couldn’t.
During my first shift, two years ago now, I dreaded the shrill alarm of the telephone. My hand trembled as I lifted the receiver. Who was on the other side, waiting for me? Now I love the surprise. I welcome the blinking red light, the ring, pleading and insistent. I sit quietly in that strange place. Secret windows on other lives open before me, then vanish. I will never know their names or see their faces. I have only a voice that comes to me riddled with static, beaten by wind, drowned by traffic. Sometimes I hear the croak of a television or the chirps of children playing.
Each call is a dance with a stranger. Sometimes it’s tender, sometimes it’s funny. Sometimes I cry. Sometimes I feel like I’m going to vomit. Sometimes I just sip on weak coffee and share in the sounds of two human beings breathing, not saying a word. Sometimes I struggle to understand somebody. Sometimes I feel like I’m talking to someone I’ve known my whole life.
The service I provide is both infinitesimally small and unfathomably large. Sometimes I feel like I helped somebody, sometimes I don’t. I rarely know for certain. I can’t fix desperate poverty, crumbling marriages, or intractable addictions. I can’t cure illnesses or mend hearts. I can’t fix anything.
I can only do one thing, faithfully, over and over. I can listen. I can echo. I can be there, a companion, a witness, for a few minutes of existence. The phone rings. I answer it.
My mother taught me the names of flowers. Wandering through her garden, they come unbidden, like fragments of songs I’ve almost forgotten. Crocus, iris, hyacinth. I say the words and then second-guess them, I think that’s what it’s called. I look them up; they’re never wrong.
On the radio I heard about a man who taught his young daughter the names of all the colors, but never mentioned the color of the sky. When he asked her what color the sky is, she wasn’t sure how to answer. White? Blue? She settled on blue, but it took awhile.
Language shapes reality, mediating not only what is know, but what can be known. Closer to us than skin, language is a lens, directing our focus.
Nobody taught me the words for myself. I learned them, a second language. They will never be self-evident like the words I learned in childhood. A hyacinth just is a hyacinth, the distance between name and named minute. I can go years without saying the word, yet it is always there, ready. But the words for myself, for my body, I struggle to pronounce like contorted transliterations. They don’t roll off my tongue.
After dinner this weekend, my mother laughingly mentioned my first therapist, who I saw when I was five or six, who we haven’t talked about in years. I feel we share an awareness of the obvious cause of my childhood troubles, but I can’t be sure–it’s unspoken.
There is no love in my heart! My mother crooned in a singsong whimper, imitating things I told the therapist. I winced and tried to laugh, unsure if she noticed my discomfort. I think she wanted us to laugh about it together, to make it funny, to make it okay–absolution. I was taught to think of my childhood depression as humorous, slightly ridiculous. These days I can’t remember what was so goddamn funny about a five-year old who says “There is no love in my heart” and “I wish I had never been born.”
Recently I told my fiancee the story of the ugly duckling. She said she didn’t know it. My voice trembled as I told her of the awkward baby duck who looked like no one else and had no friends. I couldn’t keep from crying when the ugly duckling at last transformed into a beautiful swan.
I suddenly perceived the desperate hope I’d hung on that cygnet in a picture book. A saltwater mixture of hope and despair had pooled in my heart and stayed there. I carried those tears for twenty years, until I could no longer carry them. I was that hideous duckling–but in real life, I thought then, no one ever turns into a swan. It was a mute grief, failure a foregone conclusion. I had a double secret: I was destined to be someone, and I would never be him.
On the last point, of course, I was wrong.
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 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?