This is what I wish people who identify as ‘truscum’ would try to understand.

This is an open letter to transmedicalists.

I’m being direct this time, because I don’t want to talk about you as if you are some faraway, distant other. I don’t think that helps anything. You’re real people, and no matter where we differ, I don’t want to forget your humanity.

I’ve talked in the past about harassment that I’d experienced years ago from trans folks who identify as “truscum” (so, for outsiders, transgender people who believe gender dysphoria and medical transition are necessary to identify as trans — otherwise known as transmedicalists).

Most recently, I took to Twitter to vent about it. And, not surprisingly, a lot of you weren’t super happy with me about it.

Your responses got me wondering if I could’ve done things a little differently. Because I’ll be honest — I don’t know that it ever occurred to me before then to speak to you directly.

I’m not going to pretend that I’m not angry or hurt. But I don’t hate you, as some of you suggested. I just really, really want you to stop hurting other trans people.

Based on your responses, though, I wonder if you even realize that you’re harming anyone. I think you’re caught up in some of your own pain, too, and that doesn’t make this conversation easy for anyone.

So I’m taking a deep breath and doing what I should’ve done in the first place — unpacking, very carefully, exactly what I’m struggling with. I’m going to explain as best I can why this “truscum” thing is upsetting for me as a trans person.

And I want to give you the benefit of the doubt, because even if you don’t see me as part of your community, I still believe that you’re part of mine.

Relentless optimist that I am, I like to think that someday trans folks might join hands around a campfire singing “Landslide” by Fleetwood Mac (I swear this song is a transgender anthem — just a personal, unrelated opinion of mine).

But I’d be pleased if we were just nicer to each other as a whole.

This is the longest blog I’ve ever written by far (sorry in advance). But if you’re wondering if I’m coming from a genuine place? Rest assured, I wouldn’t expend this much energy if I didn’t care about this very deeply.

If you’re rolling your eyes about how exhaustingly long it is, you can also bookmark it at any point and come back to it. It’ll still be here. And I’m breaking it up with headers, so hopefully it’ll be easy to find your place again.

So why am I even talking to you in the first place? That’s a valid question.

To understand why, you’ll need to know a little bit of my history.

The first thing you need to know is that I work in digital media. It’s important to mention this upfront, because it’s my public work as a transgender writer that got the attention of transmedicalists in the first place.

Back in 2015, I started receiving emails and tweets from self-identified “truscum” for a blog that I wrote about how much I hated the word “transtrender.”

I didn’t believe that the stance I took was especially controversial — but it drew a lot of attention to me as a trans person, and led to some targeted harassment, which continued for a while throughout my career.

The fact that I hadn’t yet medically transitioned led these folks to start asking invasive questions about my body. They were barging into unrelated conversations on social media to tell folks I was an imposter, contacting my followers with conspiracy theories about my transition (I’d made it all up apparently), and otherwise trying to discredit my work.

And of course, I was misgendered. Just to add a little salt to the wound, I guess.

The reality is, at that point, I’d never said I didn’t want to medically transition. It was that I couldn’t.

Initially, in 2014, I’d had issues with my insurance because I’d moved across the country. After that, it was my mental health status that led clinicians to deny me access to transition-related care (if you’re curious about how this nightmare happens, I interviewed other trans folks with similar experiences, and I wrote about it here).

So while this harassment campaign was happening, I was privately struggling with dysphoria that I could do literally nothing about. You’d hope that other trans people would see this as a rallying cry to demand better access to care. But these folks didn’t.

Instead, transmedicalists told me my lack of medical interventions made me invalid.

In a word? It was traumatic. I felt betrayed by my own community; I thought if anyone was going to understand my struggle, it would be other trans people.

It didn’t stop when I finally accessed hormones, either. Instead, transmedicalists had decided I was lying about that. When I posted a photo of me holding my testosterone gel, they suggested it wasn’t my prescription, and then they decided that because I hadn’t had surgery, I still couldn’t be believed either way.

Never mind the fact that I was desperately trying to access care the entire time.

These were my very first experiences with “truscum.”

I’ll be honest — never in my wildest dreams did I think that the folks harassing me would be other transgender people.

And it wasn’t just me, either. I watched this happen many times to others as well, including some of the advocates that I deeply respect and young trans folks who had only recently come out.

So I’ll just be upfront and say… you all didn’t exactly make the best first impression.

And I know, I know. You might be thinking, “But that wasn’t ME! I didn’t harass you! What has this got to do with me?”

I understand why the generalization might bug you.

But when you tell someone that they have the ability to determine who is and isn’t transgender, some people will use that mentality to justify some really abhorrent behavior. Whether you’re passively advocating for that or actively doing so, the ultimate result is that people then feel emboldened to play “gender police.”

They feel emboldened to decide who is and isn’t “trans enough.” And that means people get hurt.

That’s the crux of the issue for me. Regardless of what you’re intending, people are getting hurt.

And I have yet to see folks who identify as transmedicalists acknowledge that this is happening, and that there are valid concerns here.

If you’re still with me here — and if you are, I appreciate it — I want to explain to you exactly why transmedicalism as a concept is so troubling to me, with the hopes you can better understand the pain that I’m talking about.

Not because I want to lecture you or that I think you’re incapable of googling this. It’s just that I recognize it’s possible that folks just didn’t take the time to unpack it in a way you could hear it, and instead they became reactive in a way that felt dehumanizing to you.

So let’s establish my starting place (or bias, whatever) here: It’s true that I don’t believe the presence of dysphoria is necessary to identify as transgender.

I understand that from the get-go, that can touch a few nerves. But I want to explain why I think that’s an important place to start from, regardless of how it makes either of us feel.

I stand by those points in part because I don’t think dysphoria is a helpful measure in the first place — which I’ll explain in a moment.

I don’t say this because I don’t understand the knee-jerk reaction that can happen when someone says they haven’t been dysphoric. Because yeah, dysphoria is painful. It sucks. When I got my first rejection while trying to access top surgery, I began abusing alcohol to cope — it was not a fun time for me. The pain nearly killed me.

I know it’s hard to imagine someone as trans when they don’t understand that kind of pain, especially when it’s a pain you’ve known acutely for a very long time. I’m with you there.

I’ve reacted that way before, too. I’m human. Sometimes my first reaction to something isn’t always my kindest one.

In a perfect world, we would have some reliable indicator or litmus test for helping folks to figure out if they were trans or not — some singular measurement that erases all doubt. As a fan of simplicity myself, I get the appeal.

But the reality isn’t so simple — many trans people suppress those feelings of dysphoria, or they misinterpret them and struggle to connect them to their gender.

This can make it impossible to discern — especially as an outsider — if dysphoria is present. Requiring dysphoria to identify as transgender, for that reason alone, has way too much room for error.

A personal example: I’ve actually experienced some level of dysphoria for my entire life… I just didn’t know initially what it was.

I don’t want to do a deep dive into my history here, but suffice to say, the background that I came from made it very difficult to question my own gender safely.

So I experienced dysphoria, instead, as feeling profoundly self-hating and “ugly” (I wrote about this previously in this article, if you’re wondering). No one else saw me as ugly or ever said I was, but it was a feeling I couldn’t shake. I felt like, no matter what I did, nothing made that feeling go away.

I just thought it was a stupid teenager thing. Except that “stupid teenager thing” didn’t go away and I became a self-hating, uncomfortable, gross-feeling adult.

If you had met me when I came out in 2012, you would’ve said that there was no freaking way I was transgender. I knew I was miserable and I knew I hated how I looked, but “dysphoria” wasn’t a part of my vocabulary yet. While it had always been there on some level, I didn’t have any way to interpret what it meant.

And this isn’t an uncommon experience, trust me. Plenty of trans people come out and are still learning how to describe their experiences. For those folks, it’s sometimes much, much later on that they realize there was some dysphoria happening for them. Sometimes the label comes first — and that’s valid.

I didn’t grasp how severe it was for me until after surgery. Only when my dysphoria was considerably diminished did I understand just how heavy it was to begin with.

It was a kind of misery I was accustomed to, to the point where I was the fish in the bowl that couldn’t really see the water. You know what I mean? But now that I’m post-op, it’s like I’ve experienced a kind of joy and ease that I didn’t know was possible.

There’s also folks for whom their feelings of dysphoria progressively appear or worsen overtime.

I think of this as a kind of “hibernation.” People suppress all kinds of emotions, and dysphoric ones aren’t some magical exception. But as they start to experiment with language, and explore their identity and expression, those feelings start to surface. As the outside world begins to reject them, that can trigger those feelings they’ve managed to push down as well.

Some people also experience dysphoria only in the form of dissociation, or a state of unreality, numbness, or disconnection. They might not connect this to their gender at all, because it’s not an emotional state they can necessarily identify so quickly in the first place.

For trans people with other mental health challenges, trauma and mental illness might interfere with their understanding of their gender, and dysphoria becomes attributed to other causes (I also wrote about that here).

In other words, our brains work extra hard to try to protect us, which can make self-perception as a trans person a little wonky.

That’s what brains do with any kind of trauma. And this can show up as a total break from our own sense of dysphoric feelings, or misunderstanding the source or nature of those feelings. It’s more common than you’d think.

So when a trans person says they don’t experience dysphoria? It might be their truth at that particular stage in transition. But that doesn’t mean it always will be. Those feelings could surface in the future, become better understood and recognized overtime, or progressively appear as it becomes safer to process them.

But if we accuse trans folks of being imposters from the start, we might closet them before they ever figure any of that out.

So for me? One of the big problems with transmedicalism as a concept is its potential for “friendly fire.” When you use dysphoria as this “infallible” meter stick, you actually end up excluding a lot of trans people who are traumatized or vulnerable, and arguably most in need of support, especially if they’re emerging from denial or dissociation.

Transmedicalists are more likely to harm someone who is trans than successfully cast out an “imposter.” Because in actuality, more of us are traumatized than faking it.

When I first came out, I said that I didn’t want hormones and I wasn’t sure I wanted surgery. I am definitely the kind of “transtrender” that you would’ve rallied against (and, well, you did for a while).

Looking back, I have to laugh out loud. I can’t imagine not having medically transitioned.

With proper mental health care and, yes, incredible community support, I was able to get to a place where I could identify this resistance as a fear of rejection by society and my family especially. I was in deep denial because I was afraid of what would happen if I transitioned.

I didn’t want to lose my family. So instead, I lost myself. It took a long time (and a lot of support) to really come to terms with that.

That’s the thing, though: I needed space, support, time, and compassion to be able to figure out my path.

As of 2018, I’ve been on testosterone for a few years now, which drastically improved my life and my mental health. And I’ve had top surgery, which was the single best decision I’ve ever made. I am so much healthier and happier now.

But when you use a singular measure like dysphoria to decide if someone is worthy of those things, you run the risk of doing a lot of harm to folks who aren’t “faking” anything — folks like me who needed to process things before they could make the right choice.

And there are plenty of reasons why medical transition isn’t an easy decision, too.

Some people can’t access it for financial reasons or are denied access by clinicians. Some folks have chronic illnesses that would make medical transition risky or undesirable. Some folks might consider it safer to remain closeted. Some folks are in abusive environments where they can’t even begin to contemplate something like this.

And for some folks, right here and right now? They just don’t want to or aren’t ready to.

Maybe they’re questioning, maybe they’re afraid, maybe they’re overwhelmed, or maybe they’re just fucking tired. That could change and that may not… but it’s not up to us.

It’s not our business why and it’s definitely not our place to interrogate them, especially because we run the risk of doing serious harm for folks who might be going through some shit — shit that maybe they don’t even understand yet and can’t articulate.

You just. Never. Know.

It’s kind of like that quote, about how everyone is fighting their own battle. Even if it’s a battle you can’t see — because with trans folks especially, it’s the battles we can’t see that most often define our experiences.

So listen, I’ll give you this: Some disagreement over how we define “transgender” is bound to happen. It’s not the disagreement part that I necessarily take issue with.

It’s miraculous (and incredibly rare) that anyone agrees unanimously about anything. There are some people, for example, who don’t like Nutella, and that I will literally never understand. The difference here is that when someone tells me they don’t like Nutella, no one is actually being harmed in the process.

I acknowledge that there are going to be growing pains for our community, and I think this is part of that. These aren’t the first pains, and they won’t be the last. Historically, in every community ever, there have been divisions and disputes.

What I’m questioning here isn’t the definition of transgender. It’s what actually happens in the real world when we rely on your definition specifically.

Using dysphoria or medical transition as the way to define transness results in gatekeeping — and gatekeeping doesn’t work, because it’s too easy to get it wrong. And when we get it wrong? Trans people get hurt. Period.

The people who end up hurt most often (like, overwhelmingly so) aren’t actually faking anything and just wouldn’t benefit from doing so.

I was one of those trans people when transmedicalists harassed me in 2015. I was struggling to identify and understand my own dysphoria. I was being denied access to gender-affirming care by clinicians. I was struggling with PTSD and mental illness.

It was a battle you couldn’t see, and instead of offering empathy, I was harmed by folks who should’ve stood by me.

Are there trans people who haven’t experienced dysphoria and never, ever will? There could be.

Regardless of what you think, I’m not convinced that the existence of trans folks who don’t presently experience dysphoria is justification for disbelieving people who come out of the closet.

Those folks might want to access transition-related care in the future anyway, because it could make them happier or healthier. They might uncover that they have been dysphoric as they learn more and gain more hindsight.

Which means that either way you slice it, you can’t know for sure if someone is transgender or isn’t, even by your own definition — because people change and grow all the time.

Otherwise, I apparently wasn’t transgender in 2012 but I was in 2014. I wasn’t transgender when I was too traumatized to grasp it, but I was when I was able to access and process my emotions. Which… doesn’t make any sense.

Personally? I think gender identity is a diverse and complex thing — which to me is pretty exciting — but we might never agree there, I realize.

But you don’t have to understand their experience to respect their process.

Folks need to be able to explore their gender identity without hostility, because we simply don’t know their internal reality and we never will. The paradoxical reality is that the more fiercely you try to keep “outsiders” out of the trans community, the more likely you are to hurt trans people.

It’s not effective. It’s not helpful. It serves no other purpose than to hurt people.

So if someone says they’re transgender? You should believe them (or at least leave them alone, okay?), no matter how you choose to define “transgender” at the end of the day. The risk of driving a trans person deeper into the closet is simply too great.

It’s far more important to make sure that anyone who is questioning their gender has options and support, and that those options are protected no matter what, than trying to suss out who does or doesn’t “belong.”

So the moment they say “I’m transgender,” I congratulate them and I move on. What the hell do I know? That’s between them, their support network, their therapist, and whoever else they choose to involve.

Otherwise, there’s too good a chance that a transgender person who needs support will be denied it, just because of a misguided assumption about how they’re presenting in a particular moment.

We already get that from cis people constantly. Let’s not be like them, okay?

That’s why, when I define transgender as “identifying as a gender other than the one you were assigned at birth,” I do so with very intentional openness.

I want to be inclusive of folks who are questioning, and I want to give folks permission to evolve or change their minds, because that’s the only way to ensure that trans people can make the choices that are best for them.

The reality is, very few trans people emerge from the womb with an immediate and full understanding of their identity.

But people don’t make awesome choices when they’re being shouted at or put on the defense. Or in my case, harassed. Transitioning within a community that feels like a pressure cooker, demanding a particular kind of conformity, is never going to lead to the best possible outcomes.

And honestly? Asking trans people to put the horse before the cart — to know what they need and who they are before they can entertain a label — isn’t how a lot of folks actually operate.

The label is often what connects folks to more information, support, and self-discovery. It helps them uncover what they’ve suppressed and who they might become. So being possessive over the label actually winds up failing a lot of folks in the community, because they need the language before they can find a framework to operate from.

I want to say, too, that I understand it might be hard to let go of that impulse to judge.

When we identify with our struggles, it can feel insulting when someone who hasn’t struggled in the same exact way takes on a label that has so much meaning to us — a label that you feel you’ve earned, while others seem to just be sauntering right up and grabbing it.

Even so, I think we need to all agree — at the very, very least — that this is much more complicated than simply walking up to a label and dropping it into your identity shopping cart.

We’re talking about psychology, culture, language, trauma, biology, intimacy, sexuality, even spirituality — what aspect of the human experience is gender NOT touching on? And that’s ultimately why I think reductionist definitions fail us as a community.

Gender is messy and abstract. If it weren’t, we wouldn’t be debating it literally all the damn time. The very fact that we don’t agree on this is simply proof that this is a complex thing we’re dealing with here.

And for that reason alone, I recognize that we will probably never agree 100% on what it means to be transgender. But I don’t think we have to — we just need to agree on how to treat one another.

You know, with respect.

So what do we do, then? For me, I’m just trying to do the least amount of harm. I’m asking you to consider doing the same.

There are so many different paths that people take to arrive at an understanding of themselves.

But if we close the door too swiftly on people who aren’t exactly like us, we run the risk of shutting the door on someone who needs us — someone with whom we might share a lot more in common with than we’d expect.

Personally, I don’t think people choose to be trans in a world that isn’t terribly kind towards trans people. And even if they did put on some kind of weird act, I’ve accepted that I can never know that for sure, nor can I really do anything about it.

But I can be kind and gracious with the hopes that, wherever folks end up, they find the path that’s right for them. Extending that kindness to them doesn’t harm me in any way, shape, or form.

At the end of the day, it’s more important (to me, anyway) to create a community that allows trans folks to thrive. Gatekeeping doesn’t allow for that — it makes us suspicious of each other, callous, and combative.

If we want trans people to be able to come out, we have to make our community a safe enough place for them to do so.

When I came out in 2012, I had so many incredible trans folks to look to, and I owe so much of my happiness and health to them now. If I hadn’t had their support, I would still be closeted, if I’d even be alive today.

Every person deserves the chance to question their gender and explore it freely, without pressure, harassment, or gaslighting. This isn’t just a “be nice” issue — this is about the mental health and resilience of this community.

And I so badly want to believe that the majority of transmedicalists don’t actually approve of the harassment that folks like me have experienced, and don’t want to see what happened to me happen to anyone else.

I want to believe that if they knew the full story and really thought it through, they would’ve been there for me, as a trans person who knows how hard it is to be trans.

But the only way to guarantee that we aren’t caught in the snares of gatekeeping, and harming one another, is if we end this culture of interrogation altogether.

When in doubt, we need to do the kind thing instead, and let people live. You may not understand where they are in their journey right now, but they deserve the freedom and dignity to walk that path and see where it leads them. They deserve all the time and space they need to figure it out.

They may or may not continue on that path — but it’s not for us to decide.

I’ve given you all the benefit of the doubt here, because I believe every one of us deserves it.

Will you please extend the same to other folks in this community?

signature

heart

Appreciate the blog? Please consider becoming a patron! A dollar a month might seem small, but it helps keep this labor of love going.

Need a therapist? If you follow this nifty link, you can get $50 off your first month of therapy with Talkspace. Not a bad deal! ¯\_(ツ)_/¯ Read more about online therapy with Talkspace here.

Photo by Josh Wilburne on Unsplash.

People-pleasers can be drawn to toxic relationships. It’s important to know why.

I’ve learned in life that when you observe a pattern about yourself, it might be worth examining (okay, this is an understatement — I can pretty much guarantee you that you’ll come out wiser).

One of my big “aha” moments this year was around a relationship pattern that I hadn’t noticed before. I realized that I’m a people-pleaser.

Being liked by others, especially in my personal life, came at the expense of voicing my true feelings and needs. It was more important to be liked than it was to have relationships that felt honest and nourishing.

And it’s a lonely place to be — it can feel like no one knows your true feelings or self, and that you are secondary in relationships that should feel equal. Unsurprisingly, this can lead to a hell of a lot of resentment.

And thus… a pattern emerged.

My favorite kind of person to love was someone I had to chase — the kind of emotional inaccessibility that, in my mind, was a love I had to “work for.”

I didn’t like love if it felt easy. I didn’t like love if it was readily given to me. The love and affection that I valued the most came from people who were withholding, because my self-worth was defined by “earning” love, rather than feeling inherently worthy of it from the start.

Is this sounding familiar?

The flipside of this, of course, is that I was quick to avoid people who immediately cared for me, and who offered their love freely and readily. I was more likely to run from someone genuinely caring than I was from someone who treated me poorly.

I avoided the people who gave me the kind of love I wanted, because it scared me, and I was sure that I would disappoint them with time. I thought they must be mistaken — I hadn’t yet done anything “worthwhile,” and so I was reluctant to believe them when they told me that they cared. It didn’t feel deserved.

So instead, I threw myself at the people who were inconsistent or withdrawn, because I found their distance to be safer, more believable, and in some ways, more fulfilling. Each time they finally reciprocated, it felt like a special kind of reward, reserved especially for me.

But that pursuit of approval meant a lot of the relationships I invested in were also toxic by my own design.

I was more concerned with approval than honesty. I was quick to “mirror” — saying what I believed I “should” say, deferring to someone else’s opinion even if I didn’t share it, and avoided being disliked at all costs, even if the end result was being disingenuous.

I would rearrange myself for a person if it meant these distant, withholding people might love me back. I’ve done this all of my life — and at times, it’s made me pretty miserable.

I became someone I disliked a lot of the time, but for a while, it was easy to overlook this as long as I had some special person’s approval or praise. My opinion of myself didn’t matter as much as the opinions of other people — and the more emotionally unavailable and authoritative I perceived them as being, the more their opinions seemed to matter.

For years, I didn’t even consciously realize that I was doing this.

The unnerving thing is that people-pleasers, because they so often defer and try to appease, can often attract very controlling people.

This actually makes sense if you think about it.

Someone who always wants to “win” will obviously enjoy (and even exploit) the company of someone who always lets them.

People-pleasers are more than eager to offer someone whatever it is they want — praise, attention, investment — to feel valued, while controlling folks thrive from the safety they feel from being able to offer or revoke their affection at any time.

That, in turn, creates a power dynamic. The people-pleaser is trying endlessly to earn “love” to sustain the feeling of worthiness, while the controlling person decides whether or not to offer that to them in return.

They can withdraw their approval at any time. This means they can choose when to be pursued to regain a sense of control, simply by giving or withholding love. This can be used in manipulative ways.

And often times, neither party involved actually realizes what’s happening. They’re both just pursuing what makes them feel safe. The people-pleaser is pursuing approval, and the controller is seeking, well, control.

As it turns out, this is a documented phenomenon — psychologist Shirley Vandersteen actually writes about the pleaser/controller relationship archetype at length. If you’re a people-pleaser like me, it might sound more than a little familiar.

Reading this, I was pretty convinced that Vandersteen must’ve met all of the ex-boyfriends I’ve had since age fifteen. Yikes.

The thing that’s important to remember, as Vandersteen explains, is that both people-pleasing and controlling can come from family of origin trauma.

I would take that a step further, too. I know many queer and trans people who were so fearful of rejection, they took up people-pleasing as a survival strategy, simply to cope with that fear. This is especially true of queer femmes, who are already conditioned to appease and offer emotional labor in this unreciprocal way.

If you internalized any kind of homophobic or transphobic self-concept, you might’ve found yourself overcompensating in other ways. If the world wasn’t going to accept your identity, you might’ve strived to be acceptable or even perfect in any other capacity that you could be. This offers an illusion of self-protection (the logic here being something like, “if I’m ‘good enough,’ maybe they’ll still accept me”).

The problem is, if this mentality goes unchecked, you’re likely to chase after a kind of love that just isn’t healthy or sustainable because it’s all you really know to do. You’ll be reenacting that trauma indefinitely until you learn to interrupt it.

At least, I was. The only kind of love I knew how to pursue or accept was one in which love and investment was currency — a kind of currency I had to work for, a reward for proper or desirable behavior. But this meant that I was rarely honest about my feelings, my needs, or my desires.

People-pleasers wind up giving up their autonomy in the process, too.

The pursuit of being “good enough” means that the other person holds all the cards — making your self-worth, security, and support entirely reliant on how that person feels on any given day. It’s not reciprocal. And more than likely, it doesn’t feel so great, either.

Worse yet, it opens us up for a type of abuse that is very difficult to step away from. The second a carrot of affection is dangled in front of us, the approval can be alluring enough to get us back on the hamster wheel again, and again, and again, without recognizing the true toll that it takes.

Even if that means getting hurt or never receiving the kind of love we actually want in our lives, the chase sustains the illusion that we might someday have it if we just try hard enough. It’s a comforting thought, but this is rarely (if ever) the case, because the people we’re chasing after are often the least likely to give us the love we’re actually looking for.

Here’s my advice: If any of this rings true for you, it’s time to get honest about it.

At the beginning of this year, working with a trauma-informed therapist (who is just fabulous) meant that I took a long, hard look at the ways in which I approached love and intimacy. And if you couldn’t tell from what I’ve written here… I uncovered some shit. Some really alarming, scary shit.

There’s no magical step-by-step guide that will help every individual person with these tendencies (everyone’s journey is unique — especially when it comes to trauma).

But I can share from personal experience what’s helped me. I’ll even condense it into nice bullet points, just to get you started:

  • Seek out trauma-informed care. I’m a broken record here on this blog, but therapy can be, well, therapeutic. I’ve actually found online therapy to be incredible in this regard. I am less concerned about my therapist on the other end because of the distance between us — so I’m actually more honest. I wrote about my experiences with online therapy here, if you’re interested.
  • Read up about complex trauma, especially related to families of origin. Pete Walker has written at length on this subject. His book, Complex PTSD: From Surviving To Thriving is an incredible resource, and I consider it to be one of the most important books ever written on this subject. If you’re not sure if you are “traumatized enough,” I wrote about that in this advice column. Self-knowledge really is power.
  • Approach your relationships mindfully. Sometimes we become so concerned about how others feel, we lose all awareness around how a particular relationship makes us feel. If you suspect that you struggle with people-pleasing, pay particular attention to how you feel after your interactions with the people you’re close to. Spoiler alert: You shouldn’t feel worse.
  • Look for the signs. Red flags can include feeling like a relationship is one-sided, feeling powerless, or even controlled. You might feel lonely, as if you can never say “no” or voice how you truly feel. You may notice that you’re rarely the person making decisions, that you’re a doormat, or that you cave more easily than others. You might even feel resentful, as though you aren’t getting what you want but it’s too frightening to ask. Guilt and self-blame can be really common, too, because we often attribute a relationship’s failures to our own shortcomings.
  • Take it a day at a time. Practice saying “no.” Practice vocalizing what you want or need. Validate that it’s okay to say things like, “I disagree,” “I wish I could help, but I can’t,” and “this isn’t working for me.” Take note of those moments when you say something for someone else’s benefit or happiness rather than how you truly feel. And above all else, be compassionate with yourself.
  • Stop avoiding the people who are generous with their love — even when it’s scary and even if you feel you don’t deserve it. For me personally, the biggest change I had to make was investing more in the relationships with people who didn’t hesitate to offer love and encouragement to me. I stopped avoiding their texts. I took them up on their invitations. I kept reaching out, even when it scared me. My life continues to get better and better, simply by inviting these folks into my life.
  • Take accountability. Realize that your relationships can only grow if you choose to be authentic. Recognize the ways in which you might reinforce unhealthy dynamics when you aren’t honest about your feelings. Exempting abuse, we can rob a relationship of its full potential if we aren’t being accountable for how we show up.

People-pleasing is often a survival strategy, and an understandable one at that. Thankfully, it’s one we can learn to push back on.

I genuinely believe that just recognizing these patterns in our lives can help us break out of them. And while it can be a painful process, I can honestly say it’s one of the best things I’ve ever done for myself.

Each and every one of us deserves healthy, affirming, and reciprocal love. And if you haven’t heard this recently, I’d like to remind you that you’re already worthy, exactly as you are. Don’t let anyone — past or present — convince you otherwise.

signature

heart

  • Appreciate the blog?  Please consider becoming a patron! A dollar a month might seem small, but it helps keep this labor of love going.

 

Photo by Perchek Industrie on Unsplash.

Transgender people shouldn’t have to lie about their mental health. But many do.

Until this last year, accessing top surgery was a losing battle for me. But it’s not because of where I live, my health insurance, or any of the other typical barriers you might imagine when trans people are looking for care.

It’s because I’m mentally ill.

I live with obsessive-compulsive disorder (OCD) and complex trauma; I’m also transgender. And I’ve found that, at this particular intersection, accessing the health care I need has been an uphill battle.

I’ve been denied care numerous times over the years, under the premise that I was too mentally ill to undergo a major surgery — ignoring that gender dysphoria, an acutely painful experience for many trans people, was contributing to my poor mental health.

It took two years to be placed on a waitlist for surgery, when a therapist finally decided that I was “stable” enough (without any explanation of what that actually means).

And it wasn’t just surgery that was made difficult. Psychiatrists in the past have encouraged me to stop taking testosterone, convinced it was making me “worse.” While hospitalized for depression, I had nurses trying to withhold my hormones because they didn’t feel it was “necessary.”

This last January, I finally got top surgery and I now have consistent access to hormone replacement therapy. But I still live in fear that, should my mental health decline again, I won’t have access to the gender-affirming care that has vastly improved my life and wellbeing.

Frustrated by my own experiences, I started reaching out to other trans people with mental illness to see if they’d encountered similar challenges — and I was horrified by what I found.

“A lot of doctors I saw questioned my ability to handle hormones as someone with a history of depression and self-harm,” Luke, a non-binary trans man in Ontario shared with me.

Could that history really justify someone being denied hormones altogether? I was wondering that, too. So I did a little research on the literature we have. And… it’s not exactly helpful, to say the least.

The World Professional Association for Transgender Health (WPATH) created their Standards of Care. The SOC are, more or less, the most recognized clinical guidelines for treating transgender patients. They advocate for an “informed consent” model: allowing for trans people, once fully informed of the risks and benefits of treatment, to choose for themselves the right path forward.

The standards also advocate for competent treatment of co-existing mental health conditions with the use of therapy and medications, where appropriate.

But if you look closer, you’ll find that they are limited in how they discuss treatment of mentally ill trans people. “Clients should be assessed for their ability to provide educated and informed consent for medical treatments,” it reads, without actually offering adequate guidelines for what this looks like in practice.

It also states that, before surgery is considered for someone with severe psychiatric disorders and impaired reality testing (so delusions or hallucinations, really), “an effort must be made to improve these conditions with psychotropic medications and/or psychotherapy before surgery is contemplated.”

This raises a really important question: How, exactly, do we measure “improvement” in mentally ill trans people?

And if there isn’t significant enough improvement, is a trans person simply in limbo, unable to access transition-related care?

Mentally ill trans people, then, are ultimately left to the whims of whatever mental health clinician they happen to be seeing — with very little recourse if they disagree with that clinician’s assessment of their readiness for care.

The SOC directly list conditions like psychosis, bipolar disorder, dissociative identity disorder, and borderline personality disorder as mental illnesses that could impact “readiness for surgery.”

But in a document of 120 pages, the SOC actually say very little on how, exactly, to assess at what point a mentally ill trans person might be “ready” to access surgery. Until this is made clearer, transgender people are put in an impossible position of deciding whether or not it’s safe to disclose their mental health status.

Interestingly, WPATH — and the overwhelming majority of care providers who work with transgender people — agrees that gender-affirming care is medically necessary. What’s puzzling is that, in almost any other context, mental health status would not preclude someone from medically-necessary care for any other condition.

Gender-affirming care somehow seems to be an exception, reinforcing the notion that trans-related care is “optional.”

The most direct mention of denying access to surgery in the Standards of Care reads, “No surgery should be performed while a patient is actively psychotic.”

This seems to be the only statement that a trans person can point to when they encounter obstacles, but given the other mentions of “readiness” and “improvement,” there are still too many ambiguities— and too many clinicians who aren’t at all familiar with the SOC to begin with.

Not to mention, none of this helps trans people with more severe mental health challenges who still need to access care.

It’s worth noting, too, that disorders like borderline personality disorder — which is flagged as a potential issue in the SOC — include an “unstable sense of self” as a diagnostic criteria, as well as difficulty trusting others and recurrent suicidality.

Coincidentally, these sound an awful lot like issues any trans person could struggle with simply because they are transgender.

In other words? Any trans person could  be denied care if a clinician who’s unfamiliar with this population misdiagnoses them. In fact, at the time at which I was denied surgery, I myself was misdiagnosed as borderline. When that diagnosis no longer applied, I finally found myself on the waitlist.

While some boundaries surely need to exist, the utter lack of clarity in these guidelines means that trans people with any mental health struggle are at risk.

I spoke to Traci Lowenthal, a licensed psychologist that has worked closely with the transgender community. Most of the time, she shared, “mental illness should not be a barrier to getting necessary trans health care.”

The keyword here being, of course, “should.”

When assessing the readiness of a mentally ill trans person to pursue surgery, the most important factors, she says, are safety and the ability to consent.

So long as they can provide informed consent and keep themselves safe (the example she gives is proper hygiene and medication compliance post-surgery), there should be no barrier in accessing gender-affirming care.

“If a person has delusions,” she continued, “it would be ideal if their mental health provider could help them prepare for how those delusions may impact them while they receive medical care and during recovery.”

Compare this to my two-year battle to access surgery. It wasn’t because I was delusional — I was told, in essence, that I was too depressed to undergo surgery. There was no effort made to determine if surgery might improve that depression, and if there could be ways to better prepare for surgery in that state of mind.

The end result? Transgender people are scared to be honest about their mental health. And this has serious consequences.

I spoke with Ghost (a pseudonym), a trans person in Detroit, Michigan, who experiences schizoaffective disorder, delusions, and anxiety. For them, this has meant a constant fear of interference and mistrust in clinicians. “I am absolutely terrified that my mental health status will be used against me [in transitioning],” they explained.

“I’ve already experienced ‘the look’ from a medical professional,” they went on. “The one they use when you tell them [your mental health status], and they’re suddenly very skeptical of you.”

And with disorders like schizophrenia and borderline disorder especially, all of the trans folks I spoke to said they encountered disbelief when disclosing they were transgender, simply because they had one of these illnesses.

Some trans people have resorted to hiding their mental health history, or outright lying about their mental health status to providers. Others postponed psychiatric treatment altogether to ensure they could first transition without interference, which included forgoing psychotropic medications they desperately needed.

The unfortunate reality is, clinicians can’t adequately prepare someone for the specific challenges of medical transition if they don’t know about their client’s mental health status. And of course, when trans people have greater reluctance to seek out psychiatric care during their transition, they’re unlikely to get the support they need for the best possible outcome.

The fact that trans people should have to choose between gender-affirming care OR mental health care is unjust. Access to both is critical, especially for such a vulnerable population.

Trans people face an extraordinary risk for suicide — but if they fear disclosing their mental health struggles, they are likely to suffer in silence. This puts their lives in danger.

And when a trans person with mental illness is, indeed, denied access to care, the path forward is equally unclear.

Florence Ashley, transfeminine activist and LL.M. candidate at McGill University — with a special focus on bioethics and transgender health care policy — highlights just how much of a grey area this is.

Pointing again to the WPATH Standards of Care, she notes, “The only case that WPATH describes as precluding surgery is while the patient is ‘actively psychotic.’”

The rest, she agrees, is murky at best. “As with many issues faced by trans people, the best we can do is extrapolate from sources of law that have yet to be applied to the specific issue,” Ashley said, noting that a case might be made on the grounds of medical liability and professional ethics.

However, there appears to be no legal precedent for trans people specifically to look to when making such a case.

“This really ties back to a core problem in trans law,” she continues. “At some point, policymaking bodies will have to take up responsibility and pass enforceable policies and laws on trans-specific problems in collaboration with trans communities. Otherwise, we’re always going to be left behind.”

It’s evident, then, that more research and attention is needed to properly support trans people with mental health struggles. We need clearer guidelines, direct policies, and competent clinicians who are prepared to work with trans people regardless of mental health status.

For the transgender people who fear that they will not be able to access gender-affirming care, however, this offers very little comfort.

“I’m constantly worrying that someone will look more deeply into my history and see attempts, hospitalizations, a history of self-harm, and take it all away,” Tamsin, trans woman in Vancouver confessed.

While she finally has access to hormones, she fears it isn’t guaranteed. “[It will] cause me at least some anxiety for life.”

signature

heart

Appreciate the blog? Please consider becoming a patron! A dollar a month might seem small, but it helps keep this labor of love going.

Need a therapist? If you follow this nifty link, you can get $50 off your first month of therapy with Talkspace. Not a bad deal! ¯\_(ツ)_/¯ Read more about online therapy with Talkspace here.

I’m queer and asexual. If that’s a problem, by all means, revoke my membership.

It’s Pride month. And for some, their idea of celebrating Pride is telling asexual folks that they can’t identify as queer. Nothing says “happy pride” quite like being pushed out of your own community, right?

I first came out as asexual to my close friends when I was about fifteen years old.

While friends excitedly shared their stories of making out underneath the bleachers, I had yet to feel even an iota of desire towards anyone. Everything I’d heard about “urges” in health class sounded made up to me. When I mentioned this in passing, my (very wonderful) best friend asked me if I’d read anything about asexuality.

What he told me made sense — I just didn’t want it to. I wanted to be like everyone else. What teenager doesn’t?

I felt like I was missing out on an important experience that I was supposed to be having. So I did what I figured I should do — I went out and got myself a boyfriend. I thought if I gave it a try, maybe a switch would flip in my brain. Instead, I hated kissing him so much that I started avoiding him at school. I pretended to have colds to dissuade him, but he stopped caring.

I broke up with him a few weeks later.

Maybe it was just that particular boy, though, I thought. When I found myself developing romantic feelings towards another boy in my grade, I figured this was my best shot at becoming a “normal” teenager. If nothing else, at least I’d know what everyone else was talking about.

But as that relationship went on, I again felt pressured to keep up the charade. The sexual relationship simply felt like the cost of admission — if I wanted emotional intimacy and romance, I had to offer something in return, didn’t I? I forced it. I desperately wish I hadn’t.

This is what “normal” relationships look like, I reasoned. This is what we’re supposed to do.

Like many asexual people who enter into sexual relationships this way, I lost any sense of boundaries and autonomy. I can’t articulate — maybe because it’s too painful — what it feels like to not have ownership over your body, simply because you feel it’s owed to someone else. I didn’t want to lose my partner, and I believed that as long as I kept pretending, he would stay.

I was in that relationship for three years until I finally couldn’t do it anymore. I walked away convinced something was wrong with me.

Should I be dating women? Was gender dysphoria making it too difficult to be close to people? Was I just depressed? I thought about the passion I’d seen in movies and read about in books, the fantasies and hookups my friends described over drinks, and I felt like a piece of me was missing.

When I met my partner Ray seven years ago, I was enamored. They were funny, brilliant, generous, patient, and quickly became my favorite person on the planet. I wanted to spend every waking minute with them.

They were the first person that didn’t treat physical intimacy like the “price” I had to pay to be with them, either. They supported me through my gender transition and I was there as they grappled with chronic illness. We showed up for each other time and time again.

I was never expected to be anything but myself, even if that meant that our Netflix nights only meant chilling in the literal sense. And for the first time, I had exactly what I wanted — a partner in life in the deepest emotional sense. Three years later, our queer asses got married under a rainbow flag. We drank ourselves silly and fell asleep that night, excited for the next chapter of our lives together.

Yes, a rainbow flag. The same flag that now hangs in our living room of our gay little apartment in the San Francisco Bay Area. Bite me.

If I’m not queer, tell me what I am.

When a group of homophobic teenagers in Plymouth, Michigan, tried to run Ray and me over when we crossed the street, what were we then? When bigots pulled over on the road to yell at us as we held hands, what was that? When I wasn’t allowed to see Ray in the hospital because it was illegal to get married and I wasn’t considered “family,” what did that mean?

When society told me time and time again that I was broken because my relationships didn’t look the way that they “should,” what is that called?

When my heart pounded through my chest because I was afraid my family would reject me, does that sound straight to you? When I search the history books for someone who loves like I do and struggles like I did, and I can’t find a single footnote, does that sound like a privilege to you? When I take pride in resisting notions of “normalcy” and revel in my transgressions, what would you say that is?

Are you suggesting I let go of the one word that ever encompassed all these feelings?

Lately there’s been a lot of conversation in the queer community about whether or not asexual people “belong.”

When I hear this, I feel sick to my stomach. I spent years feeling like handing over my body to someone else was simply the “cost of admission,” the natural consequence if I wanted to feel like I belonged, if I wanted to feel loved, if I wanted to be accepted.

I’m now being told that having sex and losing my autonomy are a prerequisite for being queer, too. After spending years being violated just to feel less broken, people in my own community are asking me to do the same if I want to be in good standing and be accepted.

Take my “queer membership card,” then. In fact, I’ll gladly set it on fire and watch it burn before I ever let someone tell me — or any other asexual person — that access to our bodies is the price we pay to be queer.

“Queer” has, for a long time, been a banner under which folks who have been marginalized because of their sexual, romantic, and gender identities could find a sense of community.

If asexual people can’t identify as queer, where should they go when they feel broken? When they’re told that they owe access to their bodies to someone to be “fixed”? When clinicians suggest they need to be “cured”? When they struggle to find anyone like them to assure them that they’re enough exactly as they are? When they grow up wondering if something is wrong with them, the same way that I did?

The fact that ace folks are met with gatekeepers, even in a community that advocates for inclusion, makes it clear that asexuality is just as stigmatized as we’ve been telling you for years.

If my story sounds familiar to you as a queer person, then you know damn well that I’m queer.

And in my years of blogging and publishing about my experiences, not a single one of you questioned if I was part of your community. If you’re doing so now only because I’ve come out as ace, I ask that you reflect on why.

I’m asking you to believe me now, and believe all asexual people when we tell you who we are. When we choose to identify as queer, we do so with intention and purpose. Asexual (and aromantic folks, too) are not a threat to you. If anything, denying us community is what’s most threatening here.

Gatekeepers exist only to reinforce the idea that people don’t belong — and if you find yourself gatekeeping, you should ask yourself who it serves. Because the moment you ask marginalized people to assimilate, forcing them to choose between their identity and their chosen family, I have to wonder what queerness even means to you.

signature

heart

Appreciate the blog? Please consider becoming a patron! A dollar a month might seem small, but it helps keep this labor of love going.

Need a therapist? If you follow this nifty link, you can get $50 off your first month of therapy with Talkspace. Not a bad deal! ¯\_(ツ)_/¯ Read more about online therapy with Talkspace here.

Photo by Sharon McCutcheon on Unsplash.

I didn’t know I had OCD. Here’s why the stereotypes are so harmful.

Eight years ago, I was misdiagnosed with bipolar disorder.

I didn’t completely fill those shoes, but after spending so many years struggling, I was just relieved to have a label — any label — to help me make sense of things. And when none of the medications seemed to work, they told me I was borderline. While I had a nagging feeling that wasn’t exactly right, either, I didn’t know what else it could be.

I was passed around the mental health system, with clinicians throwing their hands up, unsure of why I wasn’t responsive to any of the therapy or medication they offered me.

At one time, I was on seven different psychiatric medications, and yet I was still reporting that I felt deeply hopeless and anxious.

When I was hospitalized a second time, included among my discharge papers was a handout about personality disorders, emphasizing that if I wanted to get better and would just work hard at it, I could “recover.” The suggestion that I was being difficult and simply not trying hard enough made me nauseous.

Through it all, not once did I consider that I might have obsessive-compulsive disorder.

Why would I? My clinicians were so focused on how moody and unhappy I was, they were totally unable to see the forest through the trees. But that’s a harsh reality for people with OCD — one study showed that half of people with obsessive-compulsive disorder cases were misdiagnosed.

Half. Imagine going to the doctor for a serious illness and the odds of your doctor diagnosing you correctly is the equivalent of flipping a coin.

I still consider myself lucky comparatively. Someone who would later become one of my closest friends stubbornly believed that my clinicians were wrong. This friend had OCD, too, and immediately noticed the similarities between us.

At their urging, I started doing research, and I realized two things: (1) Everything I thought I knew about OCD was wrong, and (2) I definitely, definitely had obsessive-compulsive disorder.

catt-liu-1624-unsplash.jpg

Photo by Catt Liu on Unsplash

This turned out to be a critical realization. Because I’d been misdiagnosed for so long, my clinicians had yet to try prescribing antidepressants for fear it would “make me manic.” The one classification of drug I needed most was denied to me for six years.

The type of therapy that was most effective, too, was the complete opposite of what I’d been receiving.

While reassuring someone with anxiety and challenging their assumptions can be helpful, reassuring someone with OCD about their obsessions can actually make them worse. Reassurance-seeking can be a compulsion for many people struggling with the disorder, and enabling those compulsions will fuel the obsession behind them.

In other words? This diagnosis was the difference between me getting better, and me getting much, much worse.

Unlike my previous misdiagnoses of bipolar and borderline, receiving my OCD diagnosis was a huge relief.

It fit in ways nothing else had before. At the same time, it was disturbing to think about how many years it took and how much emotional pain I had endured along the way.

But I don’t think it was just my clinicians’ faults, either. It’s not a disorder that’s well-understood by the vast majority of people.

I’m still amazed that I didn’t catch on sooner; it wasn’t a disorder that was completely unfamiliar to me. In fact, my paternal grandfather had struggled with OCD for most of his life. It got me thinking about how I could’ve missed something that now seems so obvious.

I’d already heard the stories — his need to have his home impeccably, impossibly, even irrationally clean; his repeated, time-consuming hand-washing; his counting every step as he paced back and forth and his insistence on walking a particular number of steps. I’d once heard that because of his extreme phobia of germs, he’d tear up and flush his junk mail down the toilet so that he didn’t have to touch the trashcan (how he preferred the toilet to the trashcan, I’ll never understand).

vadim-sherbakov-30-unsplash

Photo by Vadim Sherbakov on Unsplash

I couldn’t have OCD, I thought. I wasn’t washing my hands over and over again. My room was a mess. I didn’t count my steps. Case closed.

But what most people don’t understand is that obsessive-compulsive disorder isn’t defined by a set list of obsessions or compulsions, but rather, the mechanism that keeps people stuck in that cycle.

The simplified version is something like this: A person with OCD has a doubt that provokes anxiety (“What if I get sick from touching the trash can?” “Does having this thought mean that I’m secretly evil?” “What if I lose my mind and push this person onto the train tracks?”), and to alleviate that anxiety, they engage in a specific behavior to help alleviate the anxiety.

And it might help with the anxiety at first, which our brains really, really like. If something helps us, our brains are inclined to repeat it. But over time, for people with OCD, it takes more and more compulsive behavior to achieve the same effect, which fuels a harmful cycle.

Because we can never know anything with complete certainty, we keep returning to the compulsions to try to alleviate the anxiety.

I can’t know that I won’t get sick, for example, if I touch a trash can, but I can wash my hands to make myself feel better. I don’t know that my partner loves me right in this moment, but I can ask them.

For someone with OCD, this might result in washing their hands more and more, and asking their partner the same annoying questions time and time again to get reassurance.

Certainty is just a feeling. It requires a basic level of trust that most of us have and develop based on experience (I don’t know there isn’t a unicorn in the other room, but I’m pretty sure, based on the number of times I haven’t seen one).

But people with OCD lack that trust around certain issues (because brains are that way, sometimes), which causes us to obsess. We try to conjure up that feeling of safety and certainty with compulsions.

When someone spends a lot of time spiraling in and out of obsessions like this, that’s OCD — and often times, that person might not even realize it.

The tricky thing is that compulsions might not even be perceivable by other people. Some compulsions are entirely mental. Examples of mental compulsions can include repeatedly reassuring oneself, repeating special words or numbers, counting and re-counting, making mental lists, or reviewing thoughts or conversations.

I’ve heard OCD referred to as the “doubting disease,” and that’s really the best way I can think to describe it.

It’s the runaway train of “what if,” and then the absurd amount of time spent trying to resolve that doubt (fun fact: the doubt is never resolved). OCD just isn’t satisfied with 99.9% certainty, though, and will become consumed with the tiniest fraction of doubt, even directly in the face of logic or reason.

At times, I’d become obsessed with the idea that I might harm people, that my cat might die if I left a window open or that I might poison him by accident, that I wasn’t really transgender, that I’d made up my mental illness, that I’d fallen in love with my psychiatrist, that I might lose control and blurt out slurs or offensive statements, that I was secretly violent, that I might stab myself with a knife if I held one, and on and on and on (seriously, the list doesn’t end).

My brain would latch onto any terrible fear or anxiety I had, and then spend an inordinate amount of time obsessing about it, trying to convince or prove to myself that my doubt was or wasn’t unfounded (sometimes I imagine that my brain is like a courtroom, trying to sort out if a crime has been committed or not).

Thoughts are just thoughts, of course, but people with OCD tend to assign a lot more significance to some thoughts than most people do. It’s the way our brains are wired.

The reality is, then, that it’s not the content of the obsessions that matters. It’s the pattern of obsessing and then seeking to resolve the doubt — mentally or behaviorally — that defines OCD, and the extent to which it interferes with our lives.

Limited representation around just how many ways you can have OCD leads to a lot of confusion around what it actually looks like.

The truth is, OCD isn’t as obvious as people think it is.

There are as many obsessions and compulsions as there are people with OCD; no two people with the disorder will have it in exactly the same way. As a society, though, we’re still stuck on this idea that it’s a disorder that’s easily recognized by being quirky, frequently washing your hands, and organizing your bookshelf by color.

I had no idea I had this disorder. So when my clinicians told me I had a mood disorder, I figured it made enough sense. Not perfect sense… but enough.

While my brain ran on this hamster wheel of “what if,” my clinicians saw someone who was moody and agitated. And rather than asking about the content of my thoughts and how I was coping (or in this case, not at all coping), they focused on how those thoughts made me feel.

Of course, that exhausting mental hamster wheel made me feel like shit. Mood disorder it is! Oh, the mood stabilizers aren’t helping? Right. Personality disorder.

But underneath those moods, my brain was tormenting me. And until we addressed the obsessions, I was never going to get better.

It’s not exactly surprising, then, that clinicians are only accurately diagnosing half of us.

Because I’d heard of OCD in everyday conversation so many times, I’d just assumed it was a disorder that must be easy to understand and recognize. That couldn’t be further from the truth, though. It’s a complex, highly individual disorder, and it requires specialized care that many of us just aren’t receiving.

I was hospitalized twice, put on countless medications that would never help, misdiagnosed multiple times, and shamed by medical professionals who believed that my struggles were, in part, a lack of willpower.

And horrifyingly, I was given treatments that made me worse, and were never designed for someone with my particular struggles.

ocdcat.png

My cat, Pancake, really enjoys this book (and so do I!).

I’m extremely fortunate to now have a (totally amazing) therapist that is very familiar with my set of challenges, a psychiatrist who has prescribed medications that have made my life infinitely better, and most importantly, a framework to understand why my brain does the things that it does.

I can’t explain the level of relief that I feel now, no longer viewing my brain as an enemy but, instead, a complicated organ that’s just doing its best to handle the doubt that we all experience to an extent.

We all have obsessions and compulsions from time to time, and OCD is really a disorder of degree, not difference — and knowing this has helped me become a lot more compassionate towards myself.

In that way, I realize that OCD isn’t necessarily an “illness,” as it is a particular difference that we see in brains like mine. And we’re lucky enough to have some great tools to work with to alleviate some of the distressing stuff that comes along with it — for me, antidepressants, exposure therapy, and trauma work have helped immensely.

I had always assumed that I knew what OCD was. But I really had no idea.

It’s not just the hand-washing, stove-checking, lining-up-your-shoes disorder. It’s not quirky or fun — it’s difficult and it can be scary. The more we push this stereotypical narrative, the less likely it is that the majority of people living with OCD will get the care and support that they deserve.

It took me eight years to get the answers I needed. And too many of us are out there, still waiting.

signature

heart

Appreciate the blog? Please consider becoming a patron! A dollar a month might seem small, but it helps keep this labor of love going.

Need a therapist? If you follow this nifty link, you can get $50 off your first month of therapy with Talkspace. Not a bad deal! ¯\_(ツ)_/¯ Read more about online therapy with Talkspace here.

 

Header photo by Hai Phung on Unsplash

10 Ways to ‘Reach Out’ When You’re Struggling With Your Mental Health

I’m a mental health writer and advocate, and a suicide attempt survivor. I’ve told people on this blog many times, “Keep reaching out.” I’ve written multiple articles preaching the importance of vulnerability, defying stigma, and owning your struggles.

This is my whole thing, okay? This is what I do.

So when one of my closest friends died by suicide a few weeks ago, I wasn’t just shocked — I was completely gutted.

I thought there was never a question of whether or not my loved ones could reach out to me. But the very person who I’d talked to so often about mental health… didn’t call me.

Not even to say goodbye.

Screenshot 2018-03-03 at 10.30.59 AM

The last night I spent with them.

In the weeks following their suicide, my grief took me to dark places. I soon began having my own suicidal thoughts. And even then, when it was my turn to “reach out”? Even after losing my friend? I began to withdraw, too.

I watched, with painful awareness, as I did much of what my friend seemed to do leading up to their suicide. I wrote myself off as a burden. I isolated myself. I got lost in my own head. And despite knowing the danger of where I found myself, I said nothing.

After an especially scary night, I realized something: No one ever explained to me how to ask for help. No one told me what “reaching out” even meant.

As my grief began to snowball, I hesitated to tell anyone I was struggling, largely because I didn’t know how. I didn’t know what to ask for, and without knowing what to ask for, it felt too complicated and futile to ask.

“Why didn’t they tell me?” is such a common refrain when we talk about suicide or mental health challenges in general. It’s easy to make this remark, because “tell someone” seems like a simple request. But in truth, it’s vague at best.

“Reaching out” is this skill we’re somehow expected to know, yet it’s never taught and rarely modeled for us.

It’s this vague, hopeful sentiment that people throw around, without ever really defining it. What are we asking people to do or say? It’s not exactly clear.

So I want to get more specific. We need to be more specific.

I don’t know if an article like this could’ve saved my friend. But what I do know is that we need to normalize asking for help and talk about what that might look like, rather than pretending it’s a simple and intuitive thing to do.

Maybe then, we can reach people sooner. We can meet them more compassionately. And we can find better ways to support them.

So if you’re struggling but you don’t know what to say? I get it.

Let’s talk about it.

1. “I’m (depressed/anxious/suicidal). I’m not sure what to ask for, but I don’t want to be alone right now.”

Sometimes we don’t know exactly what we need, or we’re unsure of what someone can offer. That’s okay; that shouldn’t discourage us from reaching out. It’s perfectly fine if you have no idea what you need or want — especially when all you can think about is how much you’re hurting.

Let someone know how you’re feeling. You might be surprised by the ways they offer to support you. And if they aren’t helpful? Keep asking until you find someone who is, or seek out a hotline (I know it can be weird to talk to a stranger, but there are some awesome hotlines out there).

2. “I’m struggling with my mental health and what I’ve been trying isn’t working. Can we (meet up/Skype/etc) on (date) and come up with a better plan?”

Feeling helpless or exhausted is part and parcel for dealing with a broken mental health system. But a team approach can make it a little more manageable. Sometimes we need a cheerleader/researcher that helps us explore our options, especially when we’re having trouble believing that we have any.

One thing you’ll also notice is that, for almost everything on this list, I suggest setting a time.

This is important for a couple reasons. The first being that it helps the person you’re talking to understand the urgency behind your ask. It can also be helpful to know that there’s an event in the near future when you can expect to receive some support. This can help us hang in there when things get bleak.

3. “I don’t feel safe by myself right now. Can you stay on the phone with me/come over until I calm down?”

I know this is a hard one to say. Because we often fear telling someone just how much we’re struggling, and admitting that we don’t feel safe? That’s a biggie. Obviously you can replace the word “safe” if it’s not working for you, but I always encourage people to be direct, because it’s the surest route to getting exactly what we need.

Asking someone to be present might feel especially vulnerable. It might not even feel like, in the moment, it’ll make that much of a difference. But you’re more likely to feel better with support than without any.

And remember, from everything we know about mental illness, depression is more likely to be a liar than a truth-teller (I talk about that a bunch in this blog post).

4. “I’m in a bad place, but I’m not ready to talk about it. Can you help me distract myself?”

You do not have to talk about what’s bothering you if you’re not ready.

Opening up a whole can of worms might not be the safest or best thing for you in that particular moment. And guess what? You can still reach out for help.

Sometimes we just need someone to shoot the shit with, so we aren’t stuck in our heads, making ourselves a little crazy. This is a valid and healthy thing to ask for! And it’s a subtle way of making folks aware that you’re having a rough time, without needing to go into detail.

The sooner the folks around you are aware that you’re having a hard time, the quicker they can show up to help you through it.

Early interventions are so critical for our mental health. In other words: Don’t wait for your whole basement to flood before you fix a leaky pipe — fix the pipe when you notice the problem has started.

5. “Can you check in with me (on date/every day), just to make sure I’m alright?”

I cannot say it enough — do not underestimate the value of asking for a check-in. I am such a huge fan of this as a coping skill, especially because it can be super helpful for everyone involved.

If you take nothing else away from this article, it should be this: Please ask people to check in with you. It’s such a small thing to ask for in the age of texting, but it can help us stay connected, which is freaking critical for our mental health.

(If you’ve played The Sims before, remember the social bar? That’s you. You need to fill it. Humans need to connect with other humans. It’s not just about wanting to, it’s that we actually require it to survive.)

And this can happen in so many smart ways. A few of my favorites:

  • “I haven’t been doing well. Can you text me every morning to make sure I’m okay? It would really help me.”
  • “Hey friend. I’ve been kind of sad lately — do you maybe want to Snapchat/send selfies to each other before bed every night, just to check in? It’d be nice to see your face.”
  • “I’m in a funk right now. Do you want to be self-care buddies? Like text each other once a day something that we did to care for ourselves?”
  • “I’ve been isolating myself a little lately. Can you check in with me every so often, just to make sure I didn’t fall off the face of the earth?”

Add emojis wherever fitting if you want it to feel more casual (but really, you don’t need to, there’s nothing wrong with asking for what you need!).

Asking for people to check in with you when you’re struggling is just like buckling your seatbelt when you get in a car. It’s just one extra safety measure in case things get rough.

Both can actually save lives, too. Consider this a PSA.

6. “I’m having a hard time taking care of myself. I need extra support right now around (task). Can you help?”

Maybe you need help getting to an appointment or the grocery store. Maybe you need a cheerleader to make sure you took your meds, or someone to send a selfie to to prove you got out of bed that morning. Are your dishes piling up in the sink? Do you need a study buddy? It doesn’t hurt to ask for support around tasks like these.

Sometimes these things add up when we’re struggling with our mental health. But we forget that it’s okay to ask for a hand, especially at those times when it could really make a difference.

Being an adult is already challenging. If you’re going through a rough time? It’s even harder. We all hit a point when we need some extra support. Don’t be afraid to let folks know directly how they could support you.

7. “I’ve been feeling so low. Can you remind me about what I mean to you or share a favorite memory? It would really help me.”

I used to think that asking for something like this meant I was “fishing for compliments.” And what a lousy way of looking at it…

Sometimes we need reminders that we matter! Sometimes we can’t recall the good times, and need someone to help us remember them. This is true of every single human being on the planet.

It’s such a simple request, too. If you’re the kind of person that feels nervous about making a big ask (again, I’d encourage you to challenge that assumption — it’s okay to ask for help!), this can be a small step in the right direction.

8. “I’m struggling right now and I’m afraid I’m reaching my limit. Can I give you a call tonight?”

To be honest, it wasn’t until my friend died that I finally found these words in particular.

Up until that point, I’d never been sure exactly how to raise the alarm. You know, that moment when you’re not at the end of your rope, but you’re getting there? It’s a crucial moment.

Yes, you can and you absolutely should reach out then, even if you aren’t sure if it might make a difference (spoiler alert, people might actually surprise you). I think about how much pain I could’ve avoided if I’d saw that moment for the opportunity it really was.

Listen to that little voice in the back of your mind, the one that’s trying to tell you that you’re a little too close to the edge for comfort. Listen to that nagging feeling that tells you you’re in over your head. That’s your survival instinct — and it’s an instinct you should trust.

9. “I know we don’t talk much, but I’m going through a tough time and I feel like you’re someone I can trust. Are you free to talk (day/time)?”

I wanted to include this because I realize that not all of us have people we’re close to that we confide in.

When I was a teenager, everything changed for me when I reached out to a teacher at my high school that I barely knew. She had always been incredibly kind to me, and I had a gut feeling that she would “get it.” And she did!

To this day, I still believe that she saved my life at a time when I had no one else to turn to. She connected me with a social worker, who was then able to help me access the resources I needed to recover.

While it’s important to be respectful of people’s capacities and boundaries (and be prepared, of course, if someone can’t be there for you or isn’t helpful — it’s not personal!), you might be surprised by the responses that you get.

10. “I’m suicidal. I need help right now.”

Raise the alarm.

Raise the damn alarm, friends, and be as direct as you need to be. An emergency is an emergency, whether it’s a heart attack or a self-harm risk. Harm to you in any form is reason enough to ask for help.

I promise you, there’s someone in this world — an old friend or a future one, a family member, a therapist, even a volunteer on a hotline — who wants you to stay.

Find that person (or people), even if it takes time. Even if you have to keep asking.

Give people the chance to help you. It’s a chance that my friend deserved, and it’s a chance that you deserve.

(And if all else fails, I have this resource about going to the emergency room when you’re suicidal. I’ve personally been hospitalized twice, and while it’s not a ritzy vacation, it’s the reason I’m here today.)

Pick something from this list. Write it down, even if it’s on your hand or a sticky note. Reach out — because now you know how.

Hell, bookmark this article while you’re at it. I know I’m going to, because there are times when I need this advice, too.

If you’re struggling with your mental health, let me remind you that it’s never too soon or too late to let someone know.

And it’s never, ever too heavy, too messy, or too much to ask — even if you asked fifty times the day before.

I’d have rather had my friend “bother me” every day for the rest of my life than have to lose them forever. Their life was that precious.

And yes, so is yours.

signature

heart

 

Hey there, friend. Before you go, I want to share some resources with you.

If you’re suicidal, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386, or reach the Crisis Text Line by texting “START” to 741741.

You can also go to the emergency room. If you’re not sure if you should or how to prepare for something like that, I’ve got an article for that, too.

This isn’t just a generic “here are some numbers” plug, this is a “I want you to stay, we need you here, please don’t go just yet” plea.

 

Screenshot 2018-03-03 at 10.35.49 AMAnd lastly…

There’s a memorial fundraiser in honor of my dear friend, Cris Alvaro. The funds raised will go to organizations that support trans mental health and racial justice.

This article is, of course, dedicated to them.

Topher, you’re still the brightest star in my galaxy. We couldn’t keep you safe. But I will never stop fighting for a world that could have.

 

Feature photo by Matthew Henry on Unsplash.

I’m Transgender. But Trust Me, I’m Just As Surprised As You Are.

I’m glad that there are transgender people who knew who they were from the time they were very young. I’m just… not one of them.

As a kid, I honestly didn’t give much thought to gender. I did find myself confused from time to time as to why gender roles existed — in my mind, I didn’t perceive myself as being any different from my older brother, so there were moments when imposed expectations felt grating.

But gender wasn’t something I gave a lot of thought to. It didn’t feel especially present in my early life.

As someone who struggles with mental illness, my teen years were largely defined by my difficulties with complex trauma and obsessive-compulsive disorder. I didn’t have the luxury of contemplating who I really was. Gender seemed to be an avenue to desirability and outside approval. It was a role that I was cast for, rather than an identity I could consider. So I played the part, reluctantly. What else was I supposed to do?

My first conscious questioning of gender was when I was watching television as a freshman in college. I saw an androgynous person on television, and I remember thinking to myself, “That seems like it would be so much better… no expectations, just being.” It planted a seed for me. I didn’t know what “transgender” meant at that time. I just knew that I was drawn to this idea of gender ambiguity, for reasons I couldn’t quite place.

I remember going to my boyfriend at the time, telling him that I was thinking about cutting my hair off and maybe changing up the clothes I wore. This possibility excited me, but it repulsed him. “I don’t think I’d be attracted to you anymore,” he explained. “I think your femininity is what makes you attractive.” Fearful that I would be rejected by those close to me, I pushed my gender questioning to the very darkest corner of my mind.

I grew up very sheltered. My world was tiny, all things considered. And while some transgender folks know immediately and intuitively who they are, I spent many years living the life I was told I should be living. My way of coping with trauma and mental illness was to mirror the expectations people had of me, with the hopes of avoiding further harm. The more I could blend in, the more protected I felt.

In a world that deliberately pushes us into very restrictive gender roles, questioning those roles can feel deeply unsafe. A delayed timeline doesn’t make us impostors; it’s an expected consequence of living in such a cisnormative world.

It shouldn’t surprise us that so many people more readily repress their gender questioning before embracing it. For trans folks who already feel unsafe, we often can’t access the questions we need to in order to become who we’re meant to be. Many of us still lack possibility models, information, and safety, all of which can delay those important realizations that push us forward.

Repressing the desire to question or explore gender can be a very important and valid form of self-protection. That was definitely true for me.

My life ultimately changed when I met another transgender person in university. They were living the life that I had imagined when I first saw that androgynous character on television — they were completely gender-ambiguous, occupying an in-between space that I’d only pictured in my mind. I immediately felt drawn to them, and as I got to know them, I found the courage to begin exploring my own gender, too.

Family and friends that had known me for a long time were shocked. I didn’t really know what to say, other than to reply, “Hey, I’m surprised, too.”

Because in many ways, I was. With every step of my transition, I worried that I was making some kind of mistake. Shouldn’t I have realized this sooner? Could this really be a weird phase? Why now? Why this?

But with each change — clothes, pronouns, hormones, and most recently, surgery — I became a happier, more confident and self-assured person. The knots that had been in my stomach for as long as I could remember came undone; my social anxiety and agoraphobia started to melt away. I found an inner peace that I never knew was possible for myself.

I came alive. And… well, it really did surprise me.

And while I can look back at my history and see how this path makes sense (the video game characters I identified most strongly with are… pretty telling, honestly), that realization only comes in hindsight. While I never enthusiastically or even explicitly identified as a girl or woman, I didn’t exactly imagine an alternative until I was much older.

I’m not alone. In my time as a public figure in the community, I’ve found this to be a totally normal experience for many of the transgender folks that I’ve talked with.

I know plenty of trans people who are similarly surprised to be transgender. And why shouldn’t we be? Society tells us in a thousand different ways that trans people are rare oddities, terrible mistakes, or worse, simply don’t exist at all.

When I got surgery a couple weeks ago, I remember being wheeled into the operating room and thinking, “Am I seriously doing this?” I knew that this was what I needed, and yet I was still floored that this was something I had to endure. Yet when I woke up, the relief I felt was immediate and palpable. My first thought was, “Why didn’t I do this ten years ago?”

Being a particularly effeminate trans man, I think my process took much longer because society is so limited still in its understanding of gender. It took a lot to reconcile the fact that I could be especially feminine but still need transition and move through the world being perceived as a man.

Being seen as a feminine woman made me profoundly uncomfortable, and yet somehow, being seen as a queer, feminine man feels authentic and empowering. This is something I’ve simply learned about myself with time, kind of in the same way I’ve learned anything else about who I am. Trying new things, seeing what feels right, and going with my gut.

One thing I continually hear from loved ones of trans people is some iteration of, “I had no idea. Why didn’t I see it?” What these folks fail to realize is that, chances are, their transgender loved one didn’t necessarily see it right away, either.

Some of us take years, even decades to arrive at a safe place to explore our gender. I try to imagine telling teenage Sam that he was, in fact, a boy — and that he’d eventually transition medically to live his most authentic life — and it’s laughable to me. It would’ve been as foreign to me then as it was to most of my loved ones when I came out.

“Trans… gender?” I likely would’ve asked. “What the heck do you mean?”

I do wonder what my process would’ve looked like in a society that is more encouraging of questioning and exploring gender. I like to think that the realization would’ve happened for me much sooner, though I can’t know for sure.

For now, though, I find some comfort in creating space for trans people to be surprised. We absolutely deserve the space to be shocked, particularly in a society that often interrogates trans people’s identities before accepting them. Of course we’re surprised. When cis is presented as the only option, it can be shocking to realize we could be anything else.

Our genders are valid, even if our process has shocked us, confused us, or evaded us.

I’m transgender, and most days, it still surprises me. But being surprised doesn’t change who I am. In fact, it’s one of the best surprises my life has given me.

signature

heart

Appreciate the blog? Please consider becoming a patron! A dollar a month might seem small, but it helps keep this labor of love going.

Need a therapist? If you follow this nifty link, you can get $50 off your first month of therapy with Talkspace. Not a bad deal! ¯\_(ツ)_/¯ Read more about online therapy with Talkspace here.

Photo by Angello Lopez on Unsplash