Mental Health Month “HIV/AIDS”

I decided to write about HIV/AIDS during Mental Health Month because whilst mental health and HIV/AIDS has a relationship, there are many other diseases and conditions with more of a relationship than HIV/AIDS and mental health. So more is talked about say, Alzheimer’s and mental health, Parkinson’s and mental health, menopause and mental health, etc.

As a neglected relationship I wanted to talk about the links with mental health and HIV/AIDS as much as anything, to be mindful of this fact; HIV/AIDS may be less of a world scourge than it was in the eighties and nineties but it has by no means gone. In fact, many who work in the field believe it is only a matter of time before the current cocktail that keeps HIV/AIDS as a manageable disease for the majority, will start to fail and require further research and medication. Additionally though we are on the cusp of a quasi-cure it would not in its current state, be do-able for the vast majority, most particularly, the poor. In addition, HIV/AIDS speaks to a larger issue, that of the continual zoonotic transmission of a disease from animals to humans (or equivalent).

Recent studies demonstrate, the rate by which potentially fatal pandemic diseases can be transferred interspecies, is far higher than previously thought. Researchers believe it is a matter of time before another HIV/AIDs style disease, will occur and spread. Whilst we may dismiss this as fear mongering, history shows us otherwise. Considering this and the history of HIV/AIDS the entire subject requires more in-depth analysis to ensure if this happens, all those infected are offered treatment rather than the select who can afford the Big Pharma monopoly prices.

If India had not stepped in, the ten million who died in Africa (and the number was in actuality far higher) would have continued to climb. If a Western country were to lose ten million to a disease, there is no way the monopoly of Big Pharma would have been permitted and as with the Anthrax scare the patent would have been lifted on the medication to ensure everyone had access to cheaper generic versions of the drug. India told this to the WHO years beforehand and offered to help those struggling countries like africa by supplying generic medication as less than one dollar a day, WHO and effectively, the Western world, ignored them and millions died.

Now the WHO and others are trying to force countries like India into not producing generic versions of existing medication in order to save lives. This at the behest of the already massively profiting pharmaceutical industries of the Western world. Profit it seems, literally comes before lives.

What does this have to do with mental health?

Having a disease like HIV/AIDS has a myriad of outcomes, not least a deleterious effect on our well-being and mental well being. Even if the disease is ‘managed’ the trauma of having a disease that is communicable, stigmatized and life-threatening, alongside the inevitable connection to sex, drugs, homosexuality and other stigmatized and judged things, causes a great deal of psychic stress.

When our bodies are unwell our minds are unwell.

Living with a disease like HIV/AIDS or hepatitis C can literally cause depression.

Surviving a disease like HIV/AIDS can cause similar issues known as ‘survivors guilt’ and the suicide rates both during the AIDS crisis AND afterward were extraordinarily high for this very reason.

Some people in power at the time felt that saving Africans was not a priority because quote; They would not know how to read the instructions on the medications, they would not take the medications properly, they would possibly cause the medication to work less effectively and even cause the virus to mutate and become resistant and put everyone else at risk’ so they chose to ignore the plight of Africa and other countries. It was essentially the worst kind of racist discrimination possible. On the other extreme, China did a disservice to their citizens by ignoring the problem saying they had no problem and thus, permitting no discussion or help.

Back to mental health. Imagine if you had HIV/AIDS today, would you feel ‘okay’ about it? Even if you had medication (with its side-effects) and you knew you may live a relatively normal life span? It would still affect you in so many ways, you would have to inform anyone you were intimate with, you would have to consider it when having children, you would have to let those you worked with and your insurance know. Even if you did not see it as a stigma, some people invariably would (because people love to judge) wouldn’t that cause at the very least, some anxiety and possibly other mental health issues?

A friend of mine contracted Hep C during college, he was deeply ashamed and despite therapy he ended up being celibate. That may be an extreme but it’s also one example of how illness, disease, viruses, and medical conditions can exacerbate mental health even when they don’t do so biologically like Parkinson’s does.

Many years ago after a sexual assault I was told my assaulter was HIV positive. I didn’t at that time have any idea of prophylactics for those exposed to HIV. Fortunately a professor of mine did and she told me where to go. I think to this day, if I had not met her, told her, and she had told me where to go, I may today be HIV positive. Maybe not a big deal if you are, but when you are not, a huge deal, which speaks to how people really feel about HIV/AIDS.

Taking the prophylactics which are basically the HIV/AIDS medication, for six weeks, demonstrated to me and gave me more empathy for, those who have to take them for the rest of their lives. They talk about how good they are at extending and maintaining life but they are rough on the body, and having to take quite a few every day, as well as the cost, is all round hard. I learned then, firstly never take your health for granted, secondly never judge someone else because you don’t know what they are going through and third, we in the Western world have an innate privilege that other countries do not have and we take it for granted.

The six-week supply of medication at the time cost around $3,000. Most of the world doesn’t earn that in a year.

This is going to happen again. And when it does, more will die and more will close their eyes to this because it’s not on their door step. We choose whom we empathize with and it’s almost a trend. If everyone else is donating we donate, if nobody cares, we don’t care, en mass this is our approach to charity and change.

HIV/AIDS hasn’t gone away. Other diseases will come that are possibly more devastating. It impacts entire generations, kills and destroys entire family trees, obliterates the ‘luxury’ of considering mental health fall out afterward because resources are so precious. Think now how many are dealing with mental health issues concerning the death of half of their families from HIV/AIDS and have no resources.

We see mental health treatment as a luxury because in many ways that’s what it is. And this is wrong. The domino effect of poor untreated mental health issues, causes loss of productivity and health, it is a vicious circle, if we ignore it, we do so with the knowledge ignoring it costs us more in the long run.

Stigma alone, social exclusion, judgement, blame, condemnation and fear, can strike illness in the heart of any sufferer. Suffering in silence, unable to share your diagnosis freely, even with the protection of the law, makes those with such diseases feel they are not the same as everyone else and in some ways that ‘secret’ they carry does set them apart. Imagine for a moment how that feels? Many of us cam emphasize somewhat, we may carry our own secrets, but that one is a pretty big secret and a heavy burden. We can help with that burden just by being good to those we meet, aware that we never know the extent of their burden.

When the next HIV/AIDS comes around, I hope everyone will stand up and demand that Big Pharma not prevent the treatment of all sufferers in all parts of the world. Your economic status or skin color do not reflect what your level of care should be. The only way this changes is if we, the people, change it by not ignoring what the inequality occurring in other parts of the world in part, due to our economic monopoly.

Mental Health Month “All queered out”

The relationship between the LGBTQ community and Mental Health has long existed. Someone who believed same-sex relationships to be a sin, may point to the mental health ‘sickness’ of those who are attracted to partners of the same gender. This goes back to the seventies where mental health and being queer or transgender, was considered a mental defect/illness. It was not until the early seventies that the bible for Psychiatrists changed this diagnosis and it no longer was considered a mental illness.

During this time of stigma, those who admitted to being queer or transgender were often subjected to camps and programs that attempted to ‘cure’ them of their ‘proclivity’ of course they were unsuccessful but they did a great job of messing up generations of queers, so much so that many stayed in the closet, marrying and having children and never ever admitting who they really were.

Someone who is anti-gay may argue, that means they have a choice because they choose to stay in the closet and marry, they can be normal after all!

There is however, nothing normal about pretending to be someone you are not, and this definitely can be one reason LGBTQ people suffer from a higher than average degree of mental illness.

If it’s an argument of which came first, the chicken and the egg, then you can cross-compare to other studies looking at marginalized and condemned groups such as racial minorities, and see that levels of mental illness rise when bigotry and condemnation in the larger society are directed toward that group. No surprise, hate begets mental illness. It’s not all in your head!

How can hate cause someone to be mentally ill if mental illness is not a mailable and ‘chosen’ ailment? Hate cannot cause someone to get cancer, so how can we argue mental illness is as serious as cancer?

Hate can lead someone to drink too much, smoke too much, and that can cause cancer. It is called an indirect relationship. Cause and effect. The same is true of hate and the LGBTQ community, if you are condemned, judged, shamed, picked on, hated and treated badly day after day, that can literally drive you out of your mind. More commonly, a pre-existing tendency toward certain mental illnesses is exacerbated and tipped over the edge.

This does not mean, anyone ‘chooses’ to be mentally ill, but like anything in life, extreme stress CAN bring on symptoms. They have long known this with Schizophrenia, Bipolar and Borderline Personality Disorder and of course, PTSD has its roots in society as does anxiety. You cannot remove societal influence from the development of a mental illness yet it is as ‘real’ as any other disease in terms of true manifestation and side-effects.

Historically gay and minority populations experienced a high degree of stress and fear. They were having to hide who they were, meet in secret, they could be arrested because their emotions were illegal if expressed physically, and they often had other concerns such as low-income, poor access to care in the community, nobody to talk to honestly and unanswered questions about their own identity.

Our society is typically Heterosexist and Heterodominant because the vast majority of people in our society are heterosexual. It is one thing to show two women kissing, and have a bit of bisexual fun, quite another to be a committed full-time lesbian. Most people don’t relate to that, they may try to understand but that’s like a white person understanding the experiences of a black person, you can only go so far with that.

Thus, LGBTQ are misunderstood at best, and not understood at all at worst, with pastiche and parody being the status-quo. Historically this was even more so, as it was an illegal ‘act’ to be with someone of the same gender sexually (and everyone considered the deviancy of gay sex to be the key to being homosexual rather than thinking for a moment it could be about something other than sex).

Unfortunately a large portion of gay men were so promiscuous it did not help the ’cause’ because they really did live the life style that heterosexuals feared. I do condemn this in the sense that I see no good coming out of sleeping with twenty strangers a night, and whilst that may seem homophobic of me to say, having read the history of HIV and AIDS I see a causal history there as to why homosexual men became one of the earliest groups to be significantly infected by HIV/AIDS. This set the gay cause way back because straight people condemned all gays outright for the actions of the few, and believed HIV/AIDS to be a gay-plague, which of course it was not.

Reading the history of this time, I tried to better understand what would lead gay men to be that promiscuous, my first thought was, a lot of straight men would do the same thing given half the chance! My second thought was, it’s about reaction. Gays were subjected to such strict secrecy and condemnation they could not really be ‘out’ and when finally some cities were tolerant enough to be relatively out, certain populations ran with it. I understand the reaction/action/reaction cycle it exists in every subjugated population to some extent, and every new generation reacts to their parents, it’s a cycle of over-throwing the old for the new. But the level of promiscuity in cities like NYC and San Fransisco was a contributing factor as to why HIV/AIDS initially hit the homosexual male population so hard.

When we consider what a heterosexual who knows little about homosexuality must have thought upon hearing that some homosexual men with HIV/AIDS were sleeping with twenty plus partners a night, as well as doing drugs, it’s not hard to see why there was another wave of backlash against the gay community en mass.

That said, times have somewhat changed and whilst you can still find ‘bath houses’ and gay men (and some lesbians!) who wish to be as promiscuous as those early days, there is also a greater appreciation for actual relationships among the homosexual population. This should be emphasized more in our culture, as heterosexuals still believe homosexuality is about sex, and it is often a very small part of what goes into being a homosexual. The stereotypes are hurtful to the community as a whole, those include the idea that all lesbians are ugly, all queer men are paedophiles, all lesbians are men haters, all bisexuals are sex-addicts, all gay men are perverts.

Going back to mental health … when HIV/AIDS first hit, there were not enough resources to help the gay community, and there was therefore, even less help mentally. After the crisis began to die down and some treatments that worked began to help people live longer and HIV/AIDS was no longer a literal death-sentence a strange thing occurred…. there was a mass influx of extreme depression among the survivors of the ‘gay plague’ as it was known.

Survivor guilt and the depression that comes from severe illness and PTSD (seeing all your friends die) are HUGE factors in the development of mental illness. Some survivors actually deliberately stopped taking their HIV/AIDS medication and let themselves sicken and die because of not being able to stand surviving. They felt they didn’t deserve it. Why me and not my friends?

This was exacerbated by virtually NO resources for gay individuals who needed to talk about what they experienced, witnessed and felt. This still stands, in most cities throughout the US there are no specific mental health services for the homosexual and bisexual and transgender populations.

During my studies as a psychotherapist I sat in a large room with over a 1000 counselors on a briefing about ‘homosexuality and mental health’ during which everyone was told that to be homophobic or intolerant of homosexuality, was incompatible with being a mental health professional. Sounds good huh? Not so good. Of the 1000 there I would easily hazard a guess and say that a third, possibly half, were somewhat prejudiced, very ignorant and possibly homophobic. I say this after hearing them speak, the questions they asked, the people they were.

This is not condemning someone who is homophobic, any more than I would someone who is racist. It is your right. But it’s not legal and it’s not moral. So given this, those people have the difficulty of being legally required NOT to be what they actually privately are. Do you think many of them would admit this? Do you think they would stand up and say ‘I am against homosexual relationships’ and possibly lose their license? For those who are homophobic or anti-gay, you may be shaking your heads and saying ‘this is why it should not be legalized, you are forcing people to feel what they do not’ and I agree with the latter statement.

If you are homophobic you probably shouldn’t be a therapist with the exception of working in a religious community for like-minded people.

If that sounds extreme, well it is. Just as I would say if you are racist you should not work in a public setting but you would be fine in say, a community that supported your views and this cuts both ways (white and black).

LIkewise, if you are sexist, don’t work with the opposite gender.

I’ve been told that when you are a ‘ist’ you should work through your feelings and you should take clients who push your buttons. I don’t agree. Therapy is a fragile experience, and people pick up on intolerance. When I was training I saw and heard enough people to see, they KNOW when you are not comfortable with them. The same goes for ignorance, there is no place for ignorance and therapy when it comes to treatment. If you don’t understand it, refer, refer, refer. To someone who does.

The problem is funding, there are no funds for the queer community because it’s seen like Planned Parenthood as a problem more than anything else.

So if gays don’t have access to good mental health services (and other services) is it any wonder they have higher percentages of certain diseases and mental health issues?

The bottom line is; LGBTQ populations exhibit higher levels of anxiety, depression and alcohol/drug abuse than the standard population. This is not because they are all sex-addicted club fiends who pour drugs down their throats whilst sleeping with twenty partners a night. But the reality of this does lead ignorant people to label mental health as a weakness and point to this as an example. Some even go back to the idea that mental health is a perversion of nature, just as the pilgrims did when they put mentally ill people to death or locked them up.

It doesn’t take long to learn about a group of people you have nothing in common with and it can go a long way. Typically Native Americans ask that therapists working on reservations be of Native American heritage. Some say it should not matter who the helper is, it is more about their willingness to help.

I disagree. It does matter. Just as if you are black and you have been subject to racism you may wish to see another person of color, there’s nothing wrong with that, just as there is nothing wrong with being female and wanting a female gynecologist or therapist.

More gay people need to educate the majority about the specific issues relating to their population so those heterosexual therapists can actually be of some help to queer populations. Even more than that, those therapists who are anti-gay or prejudiced should recuse themselves. Yes – step away – don’t see homosexual patients – do them a favor!

Currently the accepted protocol is to be objective and even if ‘you are personally anti-gay’ you can be objectively helpful to a gay client. That’s ridiculous, no you cannot. I have a friend who is fairly anti-gay and works as a therapist and he is not ever going to be helpful to a gay client and can do more damage than good. Period. I have told him this but until the system changes, his boss and other leaders will insist that anyone, irrespective of their personal beliefs, treat gay clients.

Let’s change this…. and some other things and maybe the rates of mental illness will begin to decline in the LGBTQ population and with it, the high rates of suicide.