7

Delusional and Disturbed

The accusation, the insinuation, that being trans is a form of madness is a hard one to hear. Answering it comes at a personal cost. To answer fully requires an admission, a detailing of my history of mental illness, and a tallying of the ways in which it and my transness can appear to cross over, but are not the same. Both of those traits are stereotyped and demonized away from their lived realities. In giving that answer, I know that it can be so easily used as a false affirmative: yes, they are mad, because they admitted they’re mad, and that means that the delusion of being trans is a form of madness, because mad people believe it. I’ve used kinder language and the correct pronouns, but you get the idea. Honesty in one area is used to discredit it in another. Being trans is often believed to cause mental illness, and mental illness to cause the belief of being trans.

The cost of this belief is twofold. It becomes a way of dismissing trans people, of labeling us “insane,” and denying our right to live honest lives. But it also prevents trans people from seeking, and acquiring, help for genuine mental health problems, out of fear that our transness will be blamed, our medical and social care withheld.

It is because of that myth, and that double stigma, that I want to be honest about my own experiences.

I had a breakdown when I was thirteen years old, and have been in and out of treatment, mostly in, ever since. After an initial, disastrous experience with a private psychoanalyst, recommended by the doctor who had dismissed my distress, I spent four years under the care of Child and Adolescent Mental Health Services at St. George’s Hospital in London. I genuinely cannot imagine being here without their help. Twice a week at the beginning, and then once a week, once a fortnight when I was doing better, my mother would pick me up from school and we would drive to the hospital for appointments with my psychological team, psychiatrist, and cognitive behavioral therapist. When one treatment failed, they tried another. When I couldn’t continue without drugs, they prescribed them, and when those drugs became too much they helped me come off them. Before I started treatment I was sleeping two, maybe three hours a night, if I was lucky, and would spend around four hours each evening locked in the bathroom, washing and rewashing my hands, my body, the floor—everything. I was in constant physical pain from depression, and the waking nightmares that are the obsessional element of OCD made me believe that I was both evil to the point of being unsavable, and dangerously close to losing all control over my own mind. After all, I had no control over the washing, checking, and counting compulsions that left my skin bleeding and my bedroom full of odd stacks of items, placed in rows and only in certain numerical combinations. I wanted to live, but I didn’t want the life I was living. The doctors who treated me gave me first the hope of something better, and then the tools with which to bring it into being.

I never told them I was trans, not even after I had come out at school and founded a national LGBT youth organization. They never asked. I told myself at the time that it was because I didn’t see my gender as an illness, something to be treated; I didn’t need their help with being trans, so why would I bring it up? There’s an element of truth in that. But what is also true is that I had no belief in their ability to acknowledge my gender while continuing my treatment, and feared that if I told them the truth they would take my treatment away. It was in the wording of the intake paperwork, an enormous form you fill in to give the team an idea of what they’re meant to be treating. There was page after page of statements—“I usually find it hard to make friends,” “I have less energy than I used to,” those kinds of things—and you have to mark your response to each, from “all the time” to “not at all.” I forget the exact wording, but I remember the placement. Around halfway through the form, after “I like to set fires” was written “I want to be the opposite sex,” or words to that effect. I remember hovering over that item, trying to marshal all of the vague questions, impulses, fantasies I’d experienced up until that point into a suitable answer, but couldn’t. I didn’t know what would happen to me if I ticked “all the time,” “most of the time,” “sometimes.” I didn’t know how to express that I didn’t want to be “the opposite sex,” but that it was likely that I was something else entirely, someone who wasn’t a girl or a boy, and who thought the whole system needed changing. I imagined that, if I replied in the affirmative, they might not be able to help me with the nightmares, the pain in my chest, the way that my own mind and body had turned against me. Without their help, I feared I wouldn’t have the strength to keep living. It felt safest all ’round to tick “not at all,” and tell myself that I could figure it out on my own time.

Maybe I misjudged my mental health team. I hope I did. I certainly presented myself in all kinds of gender-variant ways, and their compassion and care never wavered. But, even so, I listen to the horror stories of trans friends and acquaintances. I have listened to tales of doctors who insist on forcibly changing patients’ gendered behavior and presentation before providing help for PTSD, eating disorders, and schizophrenia; of doctors who have denied medication and counseling because they disapprove of their trans patients. All of this, happening as of this writing in 2016. Maybe as a teenager in 1998 it was safest to err on the side of caution and stay silent. But what a terrible choice to force a desperate person to make.

IT IS NOT only that mental health care can be cut off for being trans, but that transition-related care can be cut off for being mentally ill. Any sign that we are less than 100 percent mentally well and adjusted—as though such a person exists—and access to hormones, to surgery, can be instantly denied. There is such a strong belief that believing oneself to be any gender other than that you were assigned at birth is itself a sign of psychosis, that trans people have to prove themselves to be saner than sane in order to be believed.

The roots of the myth of trans insanity go back a long way. Parmenides and Herodotus described “the Scythians’ madness” as a congenital, inheritable mental disease that caused men to speak, dress, and act like women. Cross-gendered behavior was seen as a sin, but also as a form of madness, throughout much of Western history. The originators of the modern disciplines of psychology and psychiatry as we know them today were fascinated by the idea of criminal types, moral insanity, and the hopeless degeneracy of the mind that would lead to anti-social behaviors, including those behaviors we would now describe as trans. In the popular imagination any hint of queerness—inappropriately gendered behavior—could function as a code for dangerous madness. Pulp fiction and schlock horror have had their share of proto-trans villains; cross-gendered behavior could function as a signal for martyrdom or villainy. The Rocky Horror Picture Show’s murderous Dr. Frank-N-Furter was a deliberate parody of these pop culture monsters. Trans characters make for good serial killers in the minds of cis creators, presented as men who want to wear the clothes or skins of women: Psycho, Dressed to Kill, The Silence of the Lambs. The discredited theory of autogynephilia, the idea that trans women are really men who get a sexual kick out of trying to inhabit the bodies of women, has a cultural debt to pay to these depictions.

Conversion therapy could not exist without the belief that being trans is a delusion, a sickness to be cured. It was the rationale behind the electroshock treatments, the enforced isolation, the committing to mental institutions. Trans legend April Ashley was, in her youth, hospitalized and injected with sodium pentothal and testosterone. Up until the 1980s, some clinicians still recommended the use of nausea-inducing drugs in the “aversion” treatment of trans patients.

Strangers online like to tell me that I’m deluded. I realize that this is a fairly common experience now for anyone who seeks to pursue any kind of public career. But I do find it interesting that these strangers are so invested in diagnosing my state of mind from behind their keyboards, and wonder at the disgust with which they make such pronouncements. Another popular comment is that I’ve “lost the plot,” that too much time at university has muddled my brain, as though I were some overly ambitious Edwardian bluestocking, refusing to acknowledge her feminine limits. Opponents of trans people use many a dog-whistle term to indicate that we are not in our right minds: hysterical, unstable, extreme, fanatical.

I know of many trans people who have not been able to get referrals to specialist gender clinics because their GPs still believe that being trans is a form of make-believe, a fantasy invented by disturbed and dangerous people. I know some trans people who, while institutionalized, were forced to detransition, or hide their gender variance, before they were considered well enough to be released.

MAYBE, IN THE interests of honesty, of unencumbered communication, I should try to answer that question from the inside. Is my belief that I am transgender and genderqueer—not a man and not a woman, but someone ill-suited to either descriptor, who deserves the right to shape their own sexed body—a symptom of an unwell mind?

There have been times in my life when I have felt on the edges of sanity: when I have lost control, lost perspective, been unable to do anything but travel through until I hit the other side. I believe that this aspect of my self is fundamentally different from my awareness of my gendered self, and my challenge to a gendered world. Not because my manic depression or my obsessive-compulsive disorder are not part of me, though they did not feel as though they were part of me for a great many years, but because the knowledge of how my mind knows my body to be is so… I don’t even know how to put it. How do you describe the mind and body describing the mind and body? Maybe by saying that that part is as unremarkable and basic as my brown hair and freckles. It just is.

Being trans and being mentally ill have both been hard, in their own ways. Dysphoria hurts. Smashing up against the gendered limits of our society and being smacked back hurts more. There is no doubt that dealing with transphobia and dysphoria have added to my emotional burdens. But they are not the same as the aching pain and concurrent nothingness of a low, finding oneself unable to get off the floor from an impossible mixture of emptiness and agony. Being trans is not the same as being caught in the middle of a bad OCD attack, with a mind full of horrifying images, imprinted onto the visual presence of the actual world, caught in an unstoppable bodily rhythm of impulse, release, drive, impulse, release, drive. I remember weeping, washing my hands and arms for hours, totally unable to stop—rocking backward and forward in horror as my body moved of its own volition—a machine without a pilot. I also remember weeping over the claustrophobia, the unfairness, of a body that didn’t match what I knew it should be. Those tears did not come from the same place. Being called a freak when I’m having a hard day, being told to kill myself, not getting a job I knew I was qualified for, being spat at in the street: when the hatred of others hits me, I’ve sobbed at how hard it is to be trans. When those things happen, they make my mental health worse. But I don’t think that this response is pathological, but normal, and to be expected.

I don’t want to have to cut out such an important part of my experience in order to prove that my gender and body are valid, healthy, and right. As with so much in my life, I need the ability to say, “I am all of these thing together—they do not cancel each other out, but they are not the same.”

I am not delusional for knowing myself, in all of my ill health, my uniqueness, perseverance, and hard-won clarity.