Tag Archives: medical

22 Days of Musing: 22

22. A letter to the sufferer.

So tonight is the last night of the 22-day challenge I set for myself in lieu of doing the 22 Push-Up Challenge, which asks one to record 22 push-ups a day to raise awareness of those suffering from mental health challenges, particularly combat veterans. And I thought what might be a good way to bring the challenge to a conclusion is to address the sufferers directly. To anyone who might read this who suffers some form of mental trauma or anguish – any psychological illness that in some way holds you back, that prevents you from socialising with friends, from forming romantic relationships, from even getting out of bed some mornings – I have a few things I’d like to say to you.

My dear, beloved journeyer through the valley of the shadow of death:

I feel pain like yours. No-one else feels your pain – no-one can – but I, and others, feel pain similar to yours. The pain you feel is the result of an illness, not a failing. You are wonderful. You are enough. You’re simply sick. It’s okay to be sick, and being sick is not your fault. If you can’t climb out of it alone? Still not your fault. There is help available if you can reach out for it, so please hang in there until you can summon enough strength from within yourself to make that step of reaching out. Please hang in there. You are wonderful. You are so very enough. I can’t and won’t promise that the darkness will pass; nonetheless, there are things that can help to make it more bearable. Seek counselling. Talk. Whether with a counsellor, or a psychologist, or a psychiatrist, or even the lone and last friend that you can trust, talk about your feelings, your emotions, your stresses, your worries, your fears, or your emptiness. Call one of these numbers, if you have no-one else to talk to:

Military: ADF Health (in Australia) – 1800 628 036 (24 hours, free call)
Military: ADF Health – +61 2 9425 3878 (24 hours)
Military: Walking Wounded – 1300 030 364 (24 hours)
Civilian: Beyond Blue – 1300 22 4636 (24 hours)
Civilian: Diverse Voices – 1800 184 527 (3pm-midnight, free call)
Civilian: Lifeline – 13 11 14 (24 hours)
Civilian: Suicide Callback Service – 1300 659 467 (24 hours)

Do those things that do help you to feel again. Visit a friend. Give yourself a manicure. Start a journal. Watch two hours of gambolling kittens on YouTube. Take yourself out on a date. Order your favourite delivered take-away food. Soak in a hot bath for an hour. Take pleasure in something small. Make sure to take your medication, if you’ve been prescribed it – it’s not a crutch. You’re simply sick. It is okay to be sick, and being sick is still not your fault. Your life has unfathomable value, and a value perhaps most unfathomable, right now, to yourself. Taking your life is an escape, but not a solution; you are unique and your life has value because of the unique combination of gifts that you possess. The trauma, or the genetics, or the sheer accident that visited a psychological ailment on you are not your burden to carry. They are not your fault. They do not get to define you. Your past does not define you; your present will not torture you forever; your future is, even though you may not see it from the bottom of the pit, far brighter than the despair and the terror and the agony that you’ve suffered. Even if you feel you need to tell yourself so, this is not your fault, and brighter days will lie ahead, whether they be temporary – in which case, cherish them while they last – or permanent – in which case, do the same thing. Above all, find people who can be your people. They’ll help to show you the way out of the darkness, and they’ll help to take care of you when you can’t take care of yourself. They see the good and the wonder and the positive and the immeasurable value in you, because they’re outside of your mind, not obscured by the blurred, dusty, warped filter through which you judge yourself.

I tell you all this from the darkness of my own mental illness, and I hope that some small part of what I’ve suggested, and of my reflections over the course of the last twenty-one days on my own experiences with mental illness – its causes, its triggers, its symptoms, its pain, its treatment, its passing – can help to provide even a small piece of the map that will help you to find your way out of the despair. Paradoxically, this despair, the little-death of depression, reminds me sometimes of the fiercely defiant words of House Greyjoy from the novel series A Song of Ice and Fire, which I leave you with now:

What is dead may never die,
but rises again, harder and stronger.
– George R. R. Martin, A Clash of Kings

Thank you for allowing me to share these thoughts with you over the last three weeks, and much love to you, fellow traveller. I hope your days in the dark will be short, your years in the light will be long, and that you too will rise again, harder and stronger.

– A fellow journeyer

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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.

22 Days of Musing: 13

13. “He’s just another number, right?”

I’d like to start tonight’s reflection with some cold, hard, and objective data about mental illness in the military. They make for pretty harrowing figures. In any given year, around 5.9% of Australians suffer from depression. For serving members of the Australian Defence Force, this increases to 9.5%, an increase in prevalence of 61%. Similarly, the risk factor for post-traumatic stress disorder (PTSD) rises by 60%, from a base rate of 5.2% in the broader community to 8.3% among serving ADF personnel. For veterans the figures are less clear, but among Australian Vietnam veterans the rates of unspecified depression and PTSD are 9.5% and 17.1%, respectively, comprising a 61% and a whopping 228% increase over the background level. We live, sadly, in a world where stimuli for psychological injury are all around us. In the military in particular, people are put into situations they never should be forced to confront, ordered to do things they should never have to do, and potentially take the life of fellow human beings. Of course that’s going to fuck you up. Human minds come in all kinds – one of the great beauties of human diversity, one I’d have no other way – and the truth is that not all of those minds have the capability to witness genuinely traumatic events and just allow them to pass on by, as urged by the character Earl Coley in another of Tim Willocks’s novels, Green River Rising:

Walk on by, brother, ’cause there always a reason for it you don’ know about. An’ even if they ain’t no reason at all, it’s not your fucken bidness.
– Tim Willocks, Green River Rising

I’ve been immensely fortunate, in my third of a century up until now, to never really have witnessed a situation where I had to convince myself that it wasn’t my fucken bidness. And even so, my psyche is still one of those that doesn’t deal well even with minor confrontational scenes either. Watching two of my family members argue is about an even-money chance to make me shut all my emotions down and head into a depressive phase. But even in such circumstances I know it’s not the minor confrontation that’s really the problem, so much as it is that the minor is the last straw, the one feather-light weight that, along with the rest of the emotional load that my mind can’t stop carrying, serves to finally break the camel’s back. Learning how to put down the burden of accumulated experience and pain so that you’re no longer being squashed into the ground under its weight can be one of the great challenges of coming to deal with a mental illness. For me, I’m (slowly) starting to learn how to allow the little straws to bounce off my back, instead of continuing to accumulate in and around the crevices of the load I’m already carrying and weighing me down ever further, but even so I still feel much of the time as though I haven’t yet learned how to put down the bulk of the load. And with PTSD, the load is often unimaginably greater. Have you ever watched M*A*S*H? This is perhaps my favourite TV show of all time – not least because its mix of comedy and high drama helped to get me through the utter blackness of my own worst phase, but also because of its unflinching approach to the depiction of mental illnesses like depression, dissociative identity disorder, and indeed PTSD, illnesses often triggered by the atrocities of war at greatly increased rates I started this reflection by discussing. I can’t imagine how hard it must be to put down a psychological burden like the kinds shown in that series. As Hawkeye himself says: “Nobody forgets what happens here. The secret is learning to live with it. For all of us.” For all of us indeed.

22 Days of Musing: 12

12. The candies of fun.

The treatment options available for mental illness are rich and varied, and include not only counselling – the first place I looked to for assistance, primarily because I was not in stable employment and the counselling service they offered through the university support services was free – but also psychological and psychiatric intervention that may or may not include medication. After some time spent working with the university counsellor, I experienced a general reduction in the severity of my symptoms, but not a complete dispersal by any means, and I had a relapse after a couple of months. But as I mentioned in yesterday’s reflection, in this little while I’d come to realise that there were additional options I could seek out through the public health system, and once I did my general practitioner was my next port of call; through him I was referred to a psychologist, and subsequently started on a combination of cognitive behavioural therapy and medication, with which we were able to get my depression more or less adequately managed.

When we anticipate, we’re the happiest. Unless you’re on antidepressants. The reason you take antidepressants is because you can’t anticipate. You think everything’s going to be horrible, so it usually is.
– Lewis Black

Previously I’d never thought about the idea that in my depression and anxiety a chronic illness might be affecting me, but after sitting down with the doctor and psychologist and developing a list of the episodes I’d experienced – not only since January, but since the first phase of depression I’d recognised in myself back in 2008 – it gradually dawned upon me that I was staring down the barrel of exactly that: chronic mixed depression and a social anxiety disorder (this is the precise nature of my illness as it was eventually diagnosed). Over the five years and a bit since my first diagnosis, I’ve been moved onto and off a range of medications: sertraline, desvenlafaxine, escitalopram, diazepam in a couple of instances where my anxiety has come to the fore unusually strongly, and most recently, paroxetine. Psychotropic medications of this sort can be of great assistance once the right one is found, but here also there are many challenges to confront. Starting on an antidepressant medication can disorient you, or even appear to worsen your symptoms for a short while. Missing a day of medication can unsettle you, either psychologically or physically (or both). Being on a medication too long can cause it to lose effectiveness – one of the reasons I’ve been on several different antidepressants; I was on sertraline for about three years before it lost its potency, desvenlafaxine for another year or so after that, escitalopram for just a few months (long enough to realise that it didn’t really work well for me), and paroxetine for the last few months. And changing from one medication to another, which necessitates spending a few days withdrawing slowly from the previous one to the upcoming one, can be even more disorienting than starting on antidepressants for the first time. That only happened to me once, fortunately, while coming down off desvenlafaxine; I’ve heard from other depression sufferers that this is one of the tougher therapeutic drugs to withdraw from, and the otherwise basically indescribable phenomenon some refer to as “brain zaps” were entirely alien to my experience. But they didn’t last long, thank goodness, and upon moving to the escitalopram they subsided within less than a day. I know people who are fundamentally opposed to much of psychiatric practice because of the use of psychoactive medications, but in my experience they’re a tool just like any other, to be respected but not feared; though times do occur when I feel as though the medications veil the positive and pleasant and desirable emotions nearly as much as it does the negative and painful and torturous ones, certainly I don’t think I would have made it through the last five years without their assistance.

22 Days of Musing: 11

11. Reaching out of the pit.

So last night I was finally able to outline in brief (much as it may not have seemed so to you cats, and I apologise for how maudlin yesterday’s reflection was) the circumstances surrounding my descent into the depths and my conscious recognition that I was at absolute rock bottom. It was the realisation that not only was I entirely drained psychologically, but that this loss of energy had been a fundamental impact upon my ability to muster any physical energy as well, that made me realise some two weeks into that period that I’d been thrown into a depth from which I wouldn’t be able to climb out myself. At this point I was in the middle of my Ph.D. research, but the events triggered by the fiasco with the woman I refer to now simply as “the girl from the conference” took place in mid-January, in the middle of a month of holidays I’d been taking from uni. Moreover, these events had happened in and around the devastation of the 2010-11 floods in the region (floods of such severity that they were reported around the world; I received messages from as far afield as the US and Jordan asking whether I was alright), and these floods made travel – even within the inner city – difficult and subdued the mood of the whole state for some time. Once the floods had passed and I’d realised the necessity for me to reach out for help, I started opening up to a couple of close and trusted friends, one of whom suggested that as a UQ student, I might be able to avail myself of the resources at the university, including (and especially) the counsellors provided free as part of the student pastoral support services. On one level, in retrospect I’m very disappointed that it took a friend to suggest this; certainly everyone knows that when you’re feeling unwell you should go to visit a doctor, but cultural perspectives on mental health even just five years ago were not as open as they’re becoming now; having never been spoken to about the seeking of mental healthcare services, I never put together the series of equations that would tell me depression meant mental illness, mental illness meant illness, and illness meant I should go to see a doctor. But on the other hand, I was infinitely grateful – as well as relieved – to have someone who cared suggest to me that there was something I might be able to do to seek assistance for myself. This was my first contact with mental health professionals of any stripe, and naturally there was the anxiety that went along not only with making yourself vulnerable to someone by admitting that you’re psychically disintegrating and really can’t manage even your day-to-day life on your own any more, but also the added worry of whether or not I could even be helped in this manner. But the counsellor I ended up working with, Kerryn, was absolutely wonderful; it was she who began training me to work with my depression and anxiety, and to develop psychological techniques that’d allow me to unburden myself of the worst of the acute symptoms. I worked with her weekly for about six weeks with great success. After that, internal logistics of the counselling service meant I had to switch to another counsellor, and she was nowhere near as good; in fact, I took a substantial backward step as a result of the single session I had with her. (For instance, one would think that whatever introductory psychology classes she took would have taught her that “So what is it you want me to do?” is probably not the ideal way to phrase a question to someone who’s presented in acute despair and uncertainty for your professional assistance.) It was a cold but effective lesson in mental health treatment: it’s crucial not just to obtain assistance from people who are properly trained in mental healthcare, but because of the sometimes delicate nature of the issues involved, it’s important also to have professionals on your team who can be understanding and adaptable to your particular circumstances – someone with whom you can establish a rapport, and to whom you feel comfortable revealing the wounds and scars of your psyche that you might’ve previously worked diligently to keep cloaked. So it was after having recoiled from this second counsellor that I had to find other possibilities, but at that point I’d found out enough about psychological health care options that I knew I could see a doctor to investigate the issue further, and this I did in May of 2011; it was then that a more in-depth treatment involving counselling in concert with medication was first recommended to me. I think that’s something to talk about another day.

Once, twice, six months a lady

On Sunday of this week, the 11th of September, I realised that I had passed six months of being publicly out as a trans woman. My post to Facebook on the 11th of March was not the first time I’d told somebody I was transgender, of course; by that time I’d already been undergoing hormonal therapy for about ten months, and had told perhaps thirty or thirty-five people in total. Basically my close friends first, then my family, after having worked on the issue for some time with my psychologist and two doctors. (It goes beyond having “a doctor” these days for me; I seem to have accumulated a medical team instead. A GP who specialises in treating gender-variant people, an ordinary GP who I see for other issues, a psychologist, a psychiatrist, a laser technician. Coo.) Six months is not very long, to be fair – I know trans people who have been out forty years or more – but still, this forms a milestone in my own journey, and a milestone that this time last year I was still terrified by and thought I would never have the courage to achieve.

On the whole, I’ve been far more lucky than most in my transition. Focused as my life is upon the academy, and of a fairly large city to boot, the people around me tend to have a fairly broad perspective, and are generally much more liberal (in the small-ell sense; my friends overseas no doubt find it a peculiar irony that the major Australian politically-conservative party are named the Liberals) than might be expected from the members of an “average” community. Moreover, we as anthropologists and archæologists spend our lives investigating the structures of and systems of interaction within societies, and when social roles differ from supposed norms, we tend to be curious and interested rather than horrified and disgusted by variations from those norms: we seek to be descriptive and talk about what is, rather than prescriptive and talk about what should be. For these reasons, I’m infinitely grateful to have happened to exist within the milieu I have when I finally realised that transitioning was something I wished to pursue. Though my transition has easily been one of the hardest things I’ve ever done and continues in a variety of ways to be challenging and difficult (the breakup of my last relationship resulted from my partner’s inability to come to terms with my being transgender, despite the fact that I’d told her this fact and about my desire to transition less than a week after we started dating; I won’t lie, I’m still a little bitter), the friends, colleagues, and family around me have inundated me with nothing but support, love, endearment, and admiration. From some people it’s even reached the level of clear excitement, which is a little discombobulating, but equally lovely to experience! No doubt it’s a combination of being happy for me on the one hand, and being touched that I trusted them enough to tell them on the other. I’ve felt similar rushes of what I could only call excited love when my friends have entrusted me with their own stories, their own secrets. It’s an immense honour and a great gift when someone trusts me sufficiently to reveal their hearts to me, a gift far beyond any material object, and if that’s an honour and a gift that others have perceived when I’ve likewise shared with them, then they can rest safely assured that their feeling of being honoured and trusted is equalled only by my gratitude for their trustworthiness.

This rich support surprises me anew every day, and every time that I think about that support is another little nudge forward, another shot of gratitude that helps me moving myself forward even through rough times. (And lately these rough times have comprised the bulk of my waking life. While my gender transition is only relatively tangentially related to them, I also suffer from clinical depression and a social anxiety disorder that currently aren’t stable. Nonetheless, the support that my loved ones are giving to both my gender situation and my mental health struggles is in large part the engine that propels me through each new day. I’ll talk more about those anon as well.) And to be completely fair, apart from a snide comment I overheard on the train last week – in which one numb young shit asked her friend how to spell the derogatory word tranny so she could send it in a text making fun of me to a third and presumably equally small-minded friend; a request that, from my perspective, dripped with the richest of irony by exposing the same lack of education that probably yielded the bigotry it contained – I’ve largely been treated with respect and honour by the people I interact with. There have been issues of misgendering, of course, and standing at a broad-shouldered and fairly barrel-chested 6’1″ I’m not really surprised, even though disappointed and a little hurt every time. Even there, though, it’s usually from people who don’t know me and consequently are much easier to ignore or just get past, and from those who do know me, I never have any issue so long as I can see that an effort is genuinely being made. (Self-recognition and self-correction of a name or pronoun slip go a long way in that regard, though it really doesn’t have to be a big deal. In all honesty, a simple apology, a quick “sorry” with a correction of the slip-up and then just returning to conversation as normal is absolutely fine with me. I don’t want for you to have to be overtaken with embarrassment any more than you want to. We all fuck up from time to time, and Christ knows I’m still very much coming to terms with the change myself!)

And it does help me to think that when I attract stares and odd looks from strangers, even though I feel I’m now living as my most authentic self and portraying to the world the person that I feel I truly am and want to be, they’re staring because of my being transgender. I feel much pride in being a trans woman, and although I do wish often that I wasn’t so stereotypically masculine in my build, it does please me to think that when I attract stares from people, I may be one of the first trans people that they’ve seen “in the wild” (as it were) and can thereby show them that I’m just a person, just another human being with my own interests and desires and hopes and character. Another aspect of dealing with the stares and strange glances is that, in part because of the anxiety disorder I mentioned earlier, I always used to feel that people were staring at me anyway, was always afraid that people were silently standing in judgment of me. Even before I realised I was transgender, even before my transition began, I felt this was the case. It’s one of the reasons I got my first piercings – my left brow and ear, which I got at the same time at least two years before I ever began undergoing hormonal therapy (indeed, before I even came to the realisation I was transgender). And the strange thing is that, paradoxical though it may be in that I feel I truly am what many trans people phrase as living my truth, I weirdly feel better about being stared at now than I used to pre-transition. There’s a line that I think parallels this sense nicely, a line from the epilogue of what for many years has been one of my favourite novels – Tim Willocks’s Bloodstained Kings – in which the main character, Cicero Grimes, finally comes to terms with the deaths of his father and brother and leaves his city home for good:

He packed his Olds 88 with the things he needed, and a few of the things he wanted, and drove south, deep into Mexico, where the air was dry and the days were long and where he could speak Spanish and be thought of as strange because he was a gringo, and not because strange was how he was.
—Tim Willocks, Bloodstained Kings

I suppose I view myself in a similar light to Cicero Grimes: I’m quite comfortable now, after my transition, with being the target of stares; with being thought of as strange because I’m a “tranny”, and not because strange is how I am. (And believe me, I really am strange.) It lets me say to myself, “Well, if they’re judging you for being transgender, then they’re just bigoted and they are therefore unimportant.” It allows me in my turn to brush off stares as being the superficial responses they are; as the Klingon proverb says, ghIlab ghewmey tIbuSQo’ pay no attention to glob flies. And who knows? Perhaps those stares will encourage people to learn, to grow, to understand and come to an acceptance of not only me and other transgender people, but everyone in the queer community. These days – particularly with the heated argument across society about the Federal Government’s rotten-to-the-core proposal for a plebiscite on the topic of marriage equality, a plebiscite that I vented my spleen about just a couple of weeks ago – I feel more of that kind of understanding and acceptance can only be a good thing, and if my existence in the community as a trans woman can serve as a means by which to accelerate that acceptance for me and all like me, then let them stare.