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.

 

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Mental Health Month “the invisible mentally ill”

Most people when faced with the knowledge someone is mentally ill says

why don’t you just get some help?

therein lies the rub

this writer can attest, ‘getting help’ isn’t as easy as clicking your red shoes together

In the US today there are large portions of what I term ‘shut-in depressives’ those people who are under-or-un diagnosed as suffering from Major Depressive Disorder. They are typically under-employed/unemployed/self-employed or on a pension. They do not factor into many of our statistics in this country. If we added them, imagine how much the landscape of mental health in this country would change? IE; More sick people than we realized.

Why aren’t they counted?

Many times if you aren’t insured by your full-time job you don’t have access to mental health resources. Even with insurance you are severely restricted to how much you can obtain. Individuals with this coverage often fear being discovered and do not use it, or fear the stigma from doctors who if they see ‘anxiety’ on your medical chart, will literally see any illness you have as being psychosomatic (in your head) so … chest pain? Anxiety. Headaches? Anxiety.

My friend who had headaches and was mentally ill was told, it’s anxiety.

It was a brain tumor.

Secondly; Those who are not full-time employees of a company who still insures their workers (and this is growing daily) has to purchase their own insurance. If you consider the cost of say, one of the lowest plans, at $450 a month, a car payment, plus a $8k deductible that has to be paid out of your pocket before you can begin being covered, how many people working say, part-time or a low to medium wage job can afford that? May as well not have insurance!

Of course if you want to pay out $900 a month like a friend of mine, you get great insurance. $900 will also pay for a rented apartment per month.

Thirdly; Those who choose not to go with the self-pay medical insurance are not irresponsible they are normal working folk who cannot afford to pay that much per month. They rely upon pay-as-you-go services like walk-in-clinics. Such clinics cannot refer you up the chain, so they’re great for a sprain or ant bites, not so good if there’s something seriously wrong.

Forth; The ER. The USA has seen huge numbers of people coming into local ER’s with mental health problems, they are second to major car accidents seen at ER’s and typically include the homeless, the low-income, the undocumented, and students. This is a short-term solution. If you are having a manic episode they will pump you full of pills, give you a script, a few lists of people you can follow-up with and send you on your way after a 3 day hold. Given that most state-run hospitals for mental illness were closed in favor of ‘care in the community’ more mentally ill people can be found in jail and prison than anywhere else. Second to that, the streets.

But what we do not consider, are the numbers of invisible mentally ill who fall through the cracks and defy the stereotypes. I will call those people high-functioning mentally ill, by this I do not mean they are ‘better’ than the mentally ill man on the street, but they are able to cover their mental illness a little more, and ‘act’ more functioning. This is the same as a high-functioning alcoholic, and it does in no way suggest those who are not, are weaker.

The high-functioning depressive is typically older. We hear a lot about teen depression because of the higher rates of suicide upon early diagnosis among teens. There are more resources for teens and young people than middle-aged brackets because the two age groups highest for suicide are the very young and the very old.

Where does that leave the 30-year-old mother suffering from postpartum depression or the 35-year-old man who is living in the back of his parents garden in a trailer or the 45-year-old wife who drinks during the day to cope?

The invisible and the high-functioning (because both are not mutually exclusive) walk among us. Typically if you ask them how they are doing they will say ‘fine’ and you will know they do not mean it but you will not ask them more and they will know they do not mean it and will not offer more. Why? Because unlike at 16 when you trust the world to want to listen, a few years down the road you get it, nobody wants to know.

And it’s not just that nobody wants to know about depression it’s that nobody wants to know a depressive, or be friends with a depressive, or be married to a depressive, or date a depressive, or hang out with a depressive.

Does that sound harsh? Do you feel the need to defend?

It’s a harsh truth because if you asked anyone, yourself included, would you rather be friends with someone who is depressive or not, most people statistically check the ‘not’ box. Does that mean if you are dating someone who reveals they are depressed you will automatically dump them? No because you are invested and loyal. But if you went on a dating site, would you choose the profile of someone who says they are depressed most of the time? A few will say yes, and mean it, but the majority, will not.

And that’s the crux of it. It’s a circular self-fulfilling prophecy.

The depressed person – puts off the non-depressed – by their sense of isolation and loneliness – and becomes more lonely and isolated because their depression causes others to avoid them.

So feeling isolated breeds more isolation in effect.

And they still say … snap out of it (like anyone who feels this way, is choosing that for a fun buzz)

Now, to be fair, isn’t it understandable and isn’t it unfair to expect people who are not depressed to ‘friend a depressive’ and be responsible for cheering them up? Sure. But that’s not what a depressed person needs. They know their partner, sister, mom, aunt cannot ‘cheer them up’ because it doesn’t work like that, and neither do magic wands.

What a depressed person wants is the same as what everyone else wants. They want to be accepted for who they are, they want to be respected, they want to be liked, they want to be loved.

But on the other hand they are battling feelings of isolation, alienation, despair, panic, anxiety, fear, nightmares, terror, self-hate, phobias, sensitivity and paranoia.

You may say, well if someone is paranoid then how am I supposed to help them?

Again, it’s not your job to ‘help’ it’s your role if you choose, to be in their life, just like you would anyone else.

For most this is a difficult chore. They find it hard when the depressed person bails on them because they cannot get out of bed, when they have a melt down for no apparent reason, when they are quiet and not talkative, when nothing they do seems to make them happy.

Oh happiness, the illusive demon for the depressed, always out of reach.

Or in the case of the bipolar, there, gone, there, gone, there, gone.

No depressed person or mentally ill person chooses their burden, and yet, the world is intolerant of their disease in a way that is unique to mental illness.

The next question has to be … why? We’ll deal with that in a future post.

So the bottom line is – among us today are many who are invisible to mental health services (of which there are precious few). They are not poor enough for the very lowest income options, they are not well off enough to realistically afford their own insurance, coverage or get a job that will provide that, and as America was founded on the work ethic and our health care was tied to our ability to work this was a problem that bore the need for alternatives, which we now have, but they are so expensive it defeats the point.

Where does the stay at home mom or stay at home wife, or part-time-worker with depression go to get help and treatment that is reliable, cost-effect, consistent and long enough in duration to have any effect?

Having lived in several countries I am in a position to attest, it’s not that much better in other countries. There are more services literally speaking in countries with socialized healthcare but they are so full as to be practically redundant for the complex needs of their societies. I have yet to find a model I would use to base future health care ideals upon.

Then of course you have countries like India, China, Russia, that have a mixed-bag in terms of their approaches to the issue of mental health. For some, it’s almost akin to a crime, for others, admitting it will effectively condemn you to forced inadequate treatments and large-scale stigmatization (more on stigma and shame in future posts) and others socially encourage the condemnation of the mentally ill so that it’s not even discussed and acknowledged.

So as a whole, when we look at all the countries that make up our planet, we are failing to help those who have mental illness, really, really failing. And worst still, there are those among us, who we don’t even know are suffering, who have nowhere to turn, and effectively subsist rather than exist.

You can see them if you look close enough. But most of us don’t want to, or are too ‘busy’ to care. With everything in our ever-busy lives, when do we have time? The only ones who may really try to do something, are going to be our nearest and dearest and for many depressed people there are no nearest and dearest.

What if you are alone more or less and you are mentally ill and you don’t have money, where do you go?

Posing this question to a mentally ill person in the midst of a crisis they are likely as not to say, I’d just give up and take my own life.

Next time you judge someone for being suicidal, consider, have we left many other options for them?