Opinion, by Sandy Ernest Allen<\/p>\n
A few years ago, I realized my life and work were at odds in a way that increasingly concerned me, like I was a train noticing my two tracks steadily diverging. In order to receive the life-saving healthcare I needed \u2014 like a Testosterone prescription, and top surgery, and most recently, a hysterectomy \u2014\u00a0I had to wilfully obtain a diagnosis I know to be medically \u2026 not necessarily real.<\/p>\n
As a journalist, I focus on mental health care. My first long feature about \u201cmental health care\u201d was this one<\/a> in 2015, about a woman with myriad psychiatric challenges, who\u2019d been shot in her bedroom by SFPD deputies who\u2019d been summoned there by a social worker. But for years I\u2019d already been working on what would become my first book, about our mental health care system\u2019s past and present, focused around the diagnosis \u201cschizophrenia.\u201d\u00a0<\/p>\n I sometimes say my first book was like a baton I had been handed in a relay race; My late Uncle Bob had begun the project, years back, during the decades he lived alone in his California desert home. He sent the original manuscript to me back in 2009, a project I eventually took on. During the early summer of 2015, I got a book deal, one so seemingly life-changing, I put in my notice at my job.\u00a0<\/p>\n But I gave myself a few months, not two weeks, because, first I had to wrap up editing many other stories and also writing a few, including the aforementioned, about the woman who\u2019d been shot in San Francisco,\u00a0 the case of which was then heading to the supreme court \u2026 I began wondering, more and more, what was the deal with all of psychiatry? Because back then, to my tremendous dread: I was still confused.<\/p>\n Uncle Bob had first been psychiatrically hospitalized in his hometown of Berkeley, CA when he was a teenger (this during the late sixties and early seventies). His psychiatric \u2018label\u2019 was \u201cparanoid schizophrenic,\u201d as he\u2019d spelled out across his own autobiography\u2019s cover. He\u2019d typed his life story in all caps, no paragraphs, quite misspelled, hardly punctuated except with colons. He\u2019d mailed me the sixty cigarette-stinking pages just as I\u2019d started grad school.<\/p>\n My own attitudes about Bob and \u201ccrazy\u201d people like him prior were, in hindsight, stuff I\u2019d picked up from my family and culture; it\u2019s clear now that, previously, I just wasn\u2019t very informed. (I\u2019d comment, it\u2019s pretty normal for the public without direct connections to these topics to hold such prejudiced, misinformed views as I did before.)\u00a0<\/p>\n Back when I was first writing about Uncle Bob, I was fully closeted, even to myself, and didn\u2019t think of myself as being like him; however in hindsight it\u2019s clear how much as a trans person, an outsider, I was like him. I probably resisted seeing our affinity however, resistant as I was through my teens and twenties of being seen as \u201cweird\u201d or as \u201ccrazy.\u201d\u00a0\u00a0<\/p>\n *<\/p>\n An error I often observe \u2014 amongst my fellow media professionals and in discussions of mental health: No person is actually objective (as regards \u201cmental health\u201d or \u201cgender,\u201d for example). Put simply: Cis people often think they are objective or unbiased when it comes to trans people \u2014\u00a0but they aren\u2019t. Cis people are simply, according to this repressive binary\u2019s rules, more powerful than us.\u00a0<\/p>\n Debates within mainstream psychiatry frequently focus on who gets to assign pathology-laden labels to whom. These are the same conversations that we have about trans identity, about who can correctly be called trans, and what it means to shift from centering the opinions of a therapist or doctor to affirming the ability of a trans person to know themselves.\u00a0<\/p>\n There\u2019s history to this. Before we were trans in today\u2019s parlance, trans people were trapped in psychiatry\u2019s big purple book of diagnoses, the DSM\u2014and to the extent we must obtain gender dysphoria diagnoses to obtain care, we still are. This is because we don\u2019t conform to society\u2019s norms, and mainstream psychiatry\u2019s all-powerful book defines which nonconformity is\u00a0“pathological” at a given time. <\/p>\n It\u2019s long been an \u2018open secret\u2019 that what goes in the DSM is decided not in medical laboratories but via a political consensus of American Psychiatry Association members, the professional organization that publishes the book. This became very clear to those of us observing it when, for example, Dr. Thomas Insel, then head of the NIMH, basically conceded the APA diagnoses aren\u2019t medically validated enough to base research on \u2014\u00a0a full 12 years ago<\/a>.\u00a0 However \u201cobjective\u201d such doctors might believe themselves to be,\u00a0no human is objective \u2014 as that famous instance from half a century ago of (white, male) homosexual psychiatrists removing themselves from their own big book of supposed pathologies really gave away<\/a>.\u00a0<\/p>\n *<\/p>\n I am no stranger to being on the receiving end of mental health care, to an extent that I, for practical reasons at the time, totally ellided when writing my book about Uncle Bob<\/a>. My first book was about Bob, not about me, my two editors and I reasoned.<\/p>\n My initial interest in writing Bob\u2019s story hadn\u2019t even been \u201cmental health\u201d \u2014 it had been \u201ctruth,\u201d because I was a nerdy nonfiction MFA student. My peers and I often sat around classrooms and afterwards bars, debating the limits of our own genre. I knew that in Uncle Bob\u2019s rather fantastic manuscript, I had a perplexing entry as pertained to these truth debates. I had therefore begun trying to develop Bob\u2019s materials into some form more readers might be willing to listen to. The project eventually grew a second font (what I think of as \u201cmy font\u201d; the book\u2019s literally written in two fonts). In a typewriter-y one, I \u201ccover\u201d my uncle\u2019s origins story, sometimes interrupting from him in all caps. In my own font, I added a layer of context and commentary about our family but also about psychiatry and our society itself.\u00a0<\/p>\n In America in particular, we have a bit of an upside-down situation wherein many degree-having supposed experts are largely unaware as to the broader reality. Our mental health care premise is one in which diagnostic categories are topics of great debate, and the treatments that come along with them can be even more hotly debated. According to our paternalist paradigm various professionals have often been trained to ignore their patients\u2019 reports, to whatever degree, while being faced with often fast-moving, even dangerous or potentially deadly situations in which they often must make tough calls. The overall situation, in my long observation, produces lots of hurt feelings on all sides, patients and professionals and their families; while the public otherwise remains largely oblivious about all of this.\u00a0<\/p>\n Conversely, in my long years now of studying this space, it\u2019s some activist former psychiatric patients (read: \u201ccrazy\u201d people) who tend to understand the full picture, as exemplified by the very existence of the publication Mad in America<\/a> (which was started by a pharmaceutical journalist, who wrote this now-classic muckraking work<\/a> amongst others, and is spearheaded nowadays mostly by individuals \u201cwith lived experience\u201d as one might hear it phrased, in this scene). To give another example, Uncle Bob it turned out really knew his stuff, which I learned after I fact checked all his claims to death, as I discussed at length in my book.<\/p>\n *<\/p>\n Some years ago, I might have been too timid to so clearly state the big issue regarding our psychiatric paradigm. I\u2019d have worried about offending or alienating those who take psych meds for example or who for their jobs depend upon the continuation of our current mental health norms. But Uncle Bob took psych meds until his dying day, for many nuanced reasons my book unpacks. He also spoke highly of at least one of his psychiatrists, for example. All such is not uncommon amongst even those \u201cMad Pride\u201d types I\u2019ve known and interviewed.\u00a0<\/p>\n Many Americans take psych meds \u2014\u00a0many trans and queer folk included; some of you reading might even adore your meds and\/or your psychiatrists or therapists and such. Conversely, others amongst you might find yourselves much more wary of seeking traditional such interventions\u00a0\u2014 perhaps because of previous bad experiences in such treatment settings, maybe even as kids. In general: trans people must \u201cprove\u201d our \u201csanity\u201d \u2014 to obtain the surgery and hormones we find life-saving (or insurance coverage for such). Those cis readers unfamiliar for example maybe don\u2019t realize we must get two letters of support from \u201cmental health\u201d professionals oftentimes \u2014\u00a0even trans adults like myself who\u2019ve lived openly for years in our gender. I went through just recently trying to get a hysterectomy (and my coverage was initially rejected, by United Health, in December).\u00a0<\/p>\n Meaning trans people, regardless of our other psychiatric experiences, however positive or negative or mixed bag, we must interface with \u201cmental health\u201d professionals in order to obtain the life-saving trans healthcare we need\u00a0\u2014\u00a0gatekeeping that harms many wary of psychiatry itself. I also work with two talented \u201cmental health\u201d type professionals myself these days. In general: I respect all individuals\u2019 choices. These days, I also understand, and fully respect \u2014 as someone who\u2019s now reliant on Testosterone nowadays\u2014\u00a0the feeling of fearing some bullshit eugenicists in power taking away my life-saving pharmaceutical.<\/p>\n Underscoring: I am not arguing we should take away anyone\u2019s life-saving medications or other treatments \u2014 ever. No radical mental health activist I\u2019ve known is arguing to take away anyone\u2019s meds, nor even ECT\/shock \u2014\u00a0arguably the most controversial psychiatric treatment<\/a> still in use. Radical psychiatric patient\u00a0 activists (and their professional allies like me) are typically just concerned with whose decision it is when it comes to which chemicals and such go into our bodies and minds. Nonetheless, American psychiatry\u2019s book remains very powerful, authoritative in our country especially, in our schools, in our doctors\u2019 offices and our therapists\u2019 ones \u2014 and in our courtrooms.\u00a0<\/p>\n *<\/p>\n I have long been diagnosed with anxiety and CPTSD, amongst other mental health-influenced conditions. Which is unsurprising given my being a survivor of childhood domestic abuse, for example. Also worth disclosing to you all here: In 2021, some three years after AKOMP first published, I had my own severe, life-altering psychiatric emergency \u2014 one I will be discussing in my in-progress sequel to the first book.\u00a0<\/p>\n In brief, this crisis and its aftermath cemented my already strongly held beliefs that these are universal considerations. By which I mean, in practical terms: The form our mental health care takes matters \u2014 especially for those experiencing severe totally disabling emergencies.<\/p>\n What sorts of options does the supposedly \u201csane\u201d tax-paying public fund for such emergencies? Bullets and jails? ERs? Or something better, something more humane? Something more science-backed and also commonsense? To echo a rhetorical question a Voice Hearer activist I greatly admire often asks:\u00a0\u201dWhat would you want, if you were having the worst day of your life?\u201d\u00a0<\/p>\n I\u2019m a proud trans, queer, Mad reporter who covers \u201cmental health care.\u201d I try to do so in a way that\u2019s science-backed and also humane. I try to admit my own biases\u00a0\u2014 including to myself. I hope my (in some cases literal former) colleagues in the mainstream press, those cis folks stubbornly focused on writing on trans children in particular<\/a>, can learn to do the same. Because their delusion, however self-protective, is killing my community \u2014 especially vulnerable kids.<\/p>\n Trans rights are human rights. Mad Pride is another way of saying the same thing. These are conversions about the unchecked rot that is eugenics. These are conversations about bodily autonomy. These are conversations about the great diversity of humanity itself, including within. And yes, we\u2019re talking about \u201ctruth\u201d itself. These conversations do matter given for example the Supreme Court hinging their entire ruinous decision in Skrmetti<\/a> to the psychiatric diagnosis of \u201cgender dysphoria \u2014\u00a0again prerequisite for us trans folks to access care. Hence me, those years ago, I went and I willingly got one, in order to get top surgery and then T and then, most recently, a long-delayed hysterectomy.\u00a0<\/p>\n But really we\u2019re talking about power: Who gets to define you? Doctors? Governments? Industry-funded lobbying groups? Or do you as an individual get listened to, regarding your own truths? Do you get to follow that inner light, the one only you have experienced and feel inside? As for that truth, I often don\u2019t know what to call that, other than \u201cdivine.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"Opinion, by Sandy Ernest Allen A few years ago, I realized my life and work were at odds…\n","protected":false},"author":2,"featured_media":2563,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[60],"tags":[97,259,260],"class_list":{"0":"post-2562","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-mental-health","8":"tag-health","9":"tag-mental-health","10":"tag-mentalhealth"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/2562","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/comments?post=2562"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/2562\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media\/2563"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media?parent=2562"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/categories?post=2562"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/tags?post=2562"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}