22 Days of Musing: 17

17. Division of psyche.

Today I’m continuing on from what I was writing yesterday about the rather complicated question I’ve been asked a few times: has my transition had any positive effect on rectifying, or at least helping me to manage, my mental illness? I think the simple and brief answer would be yes. As I noted yesterday before deciding that I had too much more to write on this topic and calling for an intermission of sorts (so go now and refill your popcorn), I do feel more able to push through my anxiety now to express my feelings, whether that be in expressing love and caring or in engaging in verbal self-defence, and that’s an undeniable advantage: it’s an identifiable improvement in a specific aspect of my mental illness that allows me to live my life more effectively. But although my transition has certainly done some small things to ameliorate my state of mind more generally, particularly in the area of my anxiety, both the depression and anxiety do still remain to wreak their particular brand of psychic mayhem every so often. For many trans folk, the presence of a mental illness is largely caused by their dysphoria, their feeling of alienation from the body they inhabit, or the fear of how those around them will react to their coming out, or the clash between their perception of their true gender and the perception of stigma from broader society that causes them to engage in self-doubt and autoflagellation; for such people, the process of transition is one that brings substantial and effective relief from their mental illness. If you’ll recall the statistics I cited last night, a transgender person is six times more likely to be currently suffering a depressive illness than a cisgender person. Nonetheless, that doesn’t mean that depression in trans people is always and necessarily caused by being trans and the consequences thereof. I’m reminded of the medical maxim known as Hickam’s dictum, which states: a patient can have as many diseases as they damn well please. This idea is often proposed as an intellectual counter to Occam’s razor, the better-known axiom to many students of science (even though it comes originally, much as many scientists would be loath to admit, from theology).

Numquam ponenda est pluralitas sine necessitate.
Plurality must never be posited without necessity.
– William of Ockham,
Quaestiones et decisiones in quattuor libros Sententiarum Petri Lombardi

In the medical context, the usual logical maxim of Occam’s Razor – which would counsel a doctor to seek a single underlying cause to explain the entire range of concurrent symptoms in a single patient – may end up failing (as it usually does when the hypochondriac seeks WebMD for an explanation of a range of apparent mild symptoms that would be exhibited only in, say, the early stages of kuru or pneumonic anthrax or something), because it’s statistically far more likely that a patient has two or more common diseases, rather than a single rare one. This isn’t to say, of course, that being transgender is a disease (it isn’t) or that there’s no relationship between being transgender and having depression (there is). But I suppose the point is that in my case, although my anxiety certainly stood as a grand obstacle in the way of my coming out as transgender, my mental illness is not really a secondary effect of my being trans and the social consequences of being trans, as it so clearly can be for many other trans folk; it’s more that my illness and my transness exist as two separate parts of my psyche (albeit parts that are in communication with one another, that influence and inform one another at times). Whatever it is that causes me to feel the blackness of depression, the challenges of being and coming out as transgender have only been a small contributing factor – if indeed they have contributed at all – which just means that I’ll simply have to continue to work on discovering what else the ætiology of my illness might be, what else contributes to it, what else triggers its symptoms, and what else might help to defeat it.

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