TRANSS

Mental Illness Has Impacted My Transgender Identity

Once upon a time, I wrote an article about how I wasn’t completely happy with my hormonal transition. Unsurprisingly, I got a lot of shit for it – because dog forbid I have complicated feelings about my body completely changing.

One commenter, I guess in an attempt to insult me, told me to get a therapist and that I was INSANE (emphasis theirs). What they didn’t realize was that they were correct about one thing – my feelings about my transition were absolutely informed by mental illness.

Frankly, I’m annoyed with neurotypical trans people judging my experience of transition – because comparing our experiences completely ignores the reality that I struggle in a way they never will.

What I didn’t mention in that article is that I was diagnosed with OCD after a spiral of obsession that all but drove me to the edge. And what was I obsessing about? My gender identity.

Some folks with OCD – particularly those with the pure obsessional form – find themselves obsessing about sexual orientation or gender identity. Imagine a straight person completely tormented by the idea of being gay (or a gay person obsessed with being straight), or a transgender person, like me, spending hours and hours in a panic, obsessed with the idea of being cisgender (and, yes, vice versa).

The thing about these obsessions is that there’s no concrete evidence that the obsession is grounded in reality.

I’d identified as transgender for four years, and up until the obsession started, felt secure and happy in my identity. I didn’t want to detransition – the thought of doing so horrified me. I was unbelievably opposed to living as a cis woman, which had never felt right in the first place. And my dysphoria was improving slowly but surely with my transition.

The obsession didn’t make any sense. It was just a track on loop that said, “What if, what if, what if?” But it felt like I couldn’t stop thinking about it, no matter what I did.

My therapist said that the obsession was triggered when I was supporting a friend through detransition (which I was happy to do – I love this person, and I support folks making whatever decisions they need to, including detransition!).

The fear that I might experience the despair that they were experiencing had set off an obsession – and it’s an obsession I still battle with months and months later.

When the obsession started, I was initially afraid to disclose to anyone that it was happening. I was afraid that they would invalidate my transgender identity, question the sincerity of my gender, or ostracize me from the community.

And I felt like I couldn’t tell clinicians, because I was afraid they would impede my access to top surgery, which I badly needed.

But imagine my relief when my therapist, who specialized in caring for the transgender population, recognized that my OCD was impacting my transition. I was able to access medication to help manage it – and from there, I connected with another transgender person with OCD, who had endured the same kind of obsessive spiral that I had.

Nowadays, the obsession comes and goes, and I feel more secure knowing that it isn’t a reflection of my identity but rather, an aspect of a disorder.

To be honest, when people commented on that previous article, telling me that I was less of a trans person because I had mixed feelings about my hormonal transition, I was angry. Angry because they had no idea the kind of hell that OCD put me through, making me irrationally obsess about the most fundamental part of who I am for nearly every waking hour of my day.

Lucky you, I wanted to say, that you’ve had nothing but positive transition experiences. Good for you?

The reality is that mentally ill trans people like me have a distinctly different experience of transition.

I’ve talked to trans people with generalized anxiety, who overthink and worry about every aspect of their transitions. I’ve talked to (and personally experienced) the detached, unstable sense of identity that trans people with borderline have coped with. I’ve talked to trans people with depression who, in the midst of an episode, felt too empty to connect with their transness. I’ve talked to mentally ill trans people who have had their gender identities completely written off as a delusion.

And I’ve written about survivors of trauma and mental illness who don’t even realize they are transgender until much later in life, because survival was their first priority – and because trauma can delay many aspects of self-actualization.

To be clear, being transgender is not a mental illness. But I absolutely believe that mental illness can impact our experiences of being transgender.

When neurotypical transgender people judge my experience of transition, I can only roll my eyes. What a privilege, to not live through the complexities, the complications, and the anguish of trying to manifest your truth through the trauma of mental illness, not to mention the actual barriers that prevent us from accessing care.

If we are acknowledging that things like race, class, and gender impact the oppression that transgender people have been dealt, I’m asking that neurotypical transgender people recognize that perhaps their experiences are different from mentally ill trans people – and that mental illness does not invalidate our identities, or make us less valid as transgender people.

I’m just going to say it, straight up: I think it’s ableist and fucked up to tell mentally ill transgender people like me that if they aren’t happy about transition or secure in themselves, they aren’t transgender at all.

I believe that we need to hold space for mentally ill trans people to navigate their identities. To stop saying that questioning, doubting, or fearing their transness makes them inherently less than – because that experience is not only normal for any and all trans people, but especially real for many trans people with mental illness.

We need to make room for mentally ill trans people (and really, all trans people) to be stressed about transition, fed up with transition, exhausted by transition – because we don’t always have the capacity to deal with these kinds of changes when we’re just trying to survive.

We also need to recognize that mentally ill trans people are some of the most vulnerable in our community, because struggling with any kind of dysphoria (emotional, social, physical), transphobia, or erasure only jeopardizes our health even further, endangering us.

And we absolutely need to acknowledge that there are mentally ill trans people who can’t transition or don’t want to – full stop.

So yes, irritating commenter, I’m insane. Har har, you got me. Mental illness has undoubtedly shaped my sense of self and my experience of transition, as it has for many trans people.

Chances are, with the prevalence of mental health struggles in our community, if you aren’t struggling with mental illness yourself, you know and love a trans person who is.

But if we continue to marginalize mentally ill trans people, I’d venture to say that we aren’t much better than the cisgender people who marginalize us.

"To burn always with this hard, gemlike flame, to maintain this ecstasy, is success in life."
Walter Pater

BREAKING: Local Resident Comes Out as Non-Binary, World Doesn’t End

Originally published at Wear Your Voice Magazine and republished here with permission.

OAKLAND, CA – Residents are profoundly underwhelmed today after an Oakland resident, Tyler May, announced their non-binary gender identity. What was expected to be the literal end of times, residents say that they were shocked to find that the event has had little to no impact on their daily lives.

“I said over and over again that acknowledging more than two genders would signal the apocalypse,” a local cisgender man explained. “But then nothing happened. Literally. Nothing.”

“I had designed a bomb shelter and stocked it up with canned goods for the next five years,” another resident said. “Come to find out, all Tyler wants is for us to switch pronouns.”

Many locals had believed that by in any way challenging the gender binary, it would spontaneously combust, resulting in widespread fires and a complete breakdown of the social order.

But to the surprise of residents, some are beginning to speculate that someone else’s gender may actually be none of their business, and that when identities are mutually respected, the lives of residents may actually improve.

“This might sound wild,” one resident said, struggling to grasp the words coming out of his mouth. “It’s almost like… if we treat others the way we want to be treated, things are… better?”

Still, some residents are disappointed, seeming to prefer conflict.

“I’m a real transgender person, a transgender man,” one resident exclaimed proudly. “I don’t believe in this non-binary thing. I think it’s just a ploy for attention. I’ve talked about this at length on my blog, YouTube channel, Snapchat, Twitter, and Tumblr!”

Pulling the microphone closer to him and smiling, he added, “Is this being broadcast? Is this going to be online?”

Other transgender residents felt similarly. “I find it insulting that they can just identify with a gender they weren’t assigned,” a transgender woman explained. “Like, who do you think you are?”

“It’s almost like someone’s gender has no bearing on my life,” another cis resident complained.

Cisgender and transgender residents alike agreed that they had hoped for more chaos or at least something to live tweet about.

“Tyler tweeted that they were non-binary,” a cisgender resident recalled with horror. “And then everything stayed the same. No pyrotechnics, no street fighting, nothing.”

With tears streaming down his face, a cis man quietly explained, “They said who they were, and nothing happened to me.”

“Naturally, I started to wonder about their genitals, how they have sex, what bathroom they go in,” a cis woman explained. “But then my friends told me I was being inappropriate.”

Pulling a pocket mirror out of her purse and gazing into it, she whispered, “Am I… a creep?”

Perhaps the most devastating part of this experience was the introspection that transpired after Tyler May explained their identity. Many residents were visibly distressed after reconsidering the idea that two genders could really encompass the complexity of the human experience.

“It’s too much, it’s just too much,” one cisgender man explained, tearing at the hair on his head. “What’s next, telling me that I’m my own individual, not defined by the presence of a penis?”

Asked what they thought of their neighbors’ reactions, Tyler May looked bewildered. “Why do they care how I identify?” Shaking their head, they added, “People are so weird.”

transition

Am I the Only Transgender Person Sick of Transitioning?

This is not your “before and after” video that shows me ten thousand times hotter than I previously was, confirming your suspicion that transition takes you from an awkward caterpillar into a glamorous butterfly.

This is not your “I found myself” testimony, where I explain how transition fixed all of my problems and how I’m now living my best life in my best body, the life and body I was meant to have.

Nope. This is your “this sucks, why does this suck, why didn’t anyone tell me that this would suck?” blog entry, by a trans person who is just as confused as before, only this time with more acne.

As a genderqueer person whose desired body leans masc, desired expression leans femme, and overall identity seems to be “alien boy” but I’ll call it “well fuck, your guess is as good as mine,” trying to transition has been a puzzle at best, and a cluster fuck at worst.

About eight months ago, I threw testosterone into the mix hoping it would ease some of the social and physical dysphoria, and maybe answer some of my lingering questions (questions like, do I want to live my life being perceived as a man? how much body hair is too much body hair? can I grow a better beard than my brother? will this make my butt more compact? you know, the important shit).

Spoiler alert, on testosterone I’m totally emotionally unstable, I’m greasy and covered in acne, I have the ability to braid my leg hair, I’m building muscles in places I didn’t know I could develop muscle, and I’m growing (admittedly very cute) whiskers on my face.

So in other words, I’m a moody cat on steroids that desperately needs Proactiv. These were not my #TransitionGoals.

Everyone tells me that, having only been on testosterone for less than a year, I should be patient. But the thing that no one told me is that medical transition – and really, transition generally – can suck SO HARD.

No one tells you that not every aspect of transition will feel right or feel good. That the side effects of medical transition may make you more uncertain than ever of your choices. That sometimes it’s trial by fucking fire, learning what you want and what you don’t as you go.

That it can take a long time before you look in the mirror and say, “Aha!”

That some of us – and this is critical – don’t know what will work for us. We only know what isn’t working, and that’s valid, too.

For non-binary folks, this delicate balance is even more challenging to achieve. Some of us end up back pedaling with our dose or coming off of hormones altogether, trying not to swing too hard in one direction of the binary or the other. Some of us have to settle for something imperfect, others of us are too afraid to begin.

Pass the Tylenol, please – navigating hormones in a binary world is enough to give anyone the migraine of the century.

Truthfully, I spend most days worried about how testosterone hasn’t been this magical, life-affirming journey that has made me more certain of myself – feeling like I’ve done something wrong, or made the wrong choice if I’m not perpetually ecstatic about it. 

I’d like to think that there’s room for trans people to feel something other than endless joy – that actually, it’s an unrealistic expectation that every transgender person on hormones will have the time of their life.

I’m not unhappy, I’m just waiting for it to come together. I look at myself in the mirror nowadays and like anybody else whose body is rapidly changing, I’m just really weirded out. I haven’t had that big moment (is there even a big moment for everyone?).

I’m just sitting around like, “Whoa, bodies are totally STRANGE” and “Did my face get uglier or is it just the acne eating me alive?”

If anything, medical transition has raised more questions than it’s answered. Questions about my relationship to masculinity, what gender identity truly is, about the layers of my dysphoria, about the fluidity of my own gender (and if it’s so fluid, how do I choose a static representation?), and most importantly, what it means to transition as a trans person who is genderqueer.

I did not sign up for some philosophical obstacle course, but here we are.

Mainstream narratives convince us that transition is reserved for people who are brimming with certainty and clarity, neither of which I have. Mainstream narratives convince us that transition will be revelatory and complete us, but I have yet to feel enlightened or whole.

Is it just me?

I’d like to think that it’s okay – and that we can make room for these experiences, too. Transition is not amazing all the time. For some folks, it isn’t amazing at all, but necessary still. And if we don’t acknowledge this, we’re just being really fucking dishonest about what transition is actually like.

So y’all, I’ll just say it: I’m tired. All these bodily changes, all these lingering questions, and the work that goes into deciphering your non-binary gender in a binary world – it’s exhausting, and it sucks.

Word on the street is that it’s worth it, though. And I may not know exactly what’s in store, but there’s no way in hell I’m going back.

afraid

6 Things People With Mental Illness Might Be Scared To Admit

You know, it’s possible that everything on this list is just me. But working in mental health advocacy for some time now, I’ve learned that it’s never really “just me” or “just you” – if we’re struggling, it’s almost guaranteed that someone out there knows that struggle.

Confession: I was hospitalized four months ago and I’ve been afraid – afraid of myself, afraid of my friends, afraid for my life – almost every minute since then.

Of course, I was scared to open up about it until I realized that it’s the fear that holds us back. If we never admit that we’re hurting, we can never find the support and reassurance that we need to pull through.

It’s true that I don’t know your story or your struggle. But I hope that, by knowing mine, you’ll feel less alone.

Because it’s okay to be scared – and you’d be surprised at just how many of us are putting on a brave face, hoping that no one sees just how afraid we really are.

Since I got out of the hospital, I’ve been faking it with the hopes that no one sees how much pain I’m in. But today, I’m letting my guard down – I’m hurting and I’m afraid, but I know I’m not alone.

1. I’m afraid that I don’t deserve to be happy.

I recently posted on the LQTU Facebook page about how many people with mental illness tend towards self-sabotage when they’re happy.

And, no surprise, many people responded with comments and messages about how they’ve sabotaged their own recovery – and at the root of it, it seems, is a conviction that they didn’t deserve their recovery to begin with.

Been there, still there. What I’m scared to admit sometimes is that I don’t feel like I deserve to be happy – so I push my happiness away.

Happiness scares me because I feel like I’m going to let everyone down. There’s so much pressure to be “recovered,” so much pressure to be “better,” so much pressure to have your shit together.

Sometimes I try to dismantle my own happiness because I don’t feel worthy or good enough – like I can’t live up to the expectations of being healthy – and it feels easier to relapse and let things fall apart with no room to disappoint myself or anyone else.

For me, alcohol is the quickest way to sabotage myself – and damn, I am a skilled self-saboteur when I’ve got a glass or a bottle in my hand. But before I pick up the drink, I try to remind myself that instead of fearing happiness, I should give myself permission to feel it.

Happiness is not a prize that you win or a reward reserved for the best or sanest people – it’s just a feeling to be enjoyed and a feeling that everyone is entitled to.

You don’t have to be “good enough.” You just have to let it in.

2. I’m afraid that if people see my illness, they’ll think less of me.

When I had my breakdown, I was lucky enough to have friends supporting me – in ways that were often to their own detriment. Much of it is gone from my memory, but I have flashbacks, and when I do I’m always gripped with one thought: they will never see me the same way again.

I’ve always been afraid that if people saw me during a breakdown, they would realize that I’m not perfect.

I don’t have it all figured out, I don’t always have it under control, I can hurt people, I can be selfish, I can be psychotic – and everything that I was up until that point is replaced with the memory of me at my worst.

I’ve believed that if I didn’t control my mental illness and package it in a way that was acceptable or inspiring, my value to other people would be diminished. And these days, I’m constantly afraid that I’m not worth enough – even if nothing anyone has said or done indicates otherwise.

I try to remind myself that my worth can’t depend on how others perceive me or my illness. When I’m obsessing over how others see me, I ask myself, “Well, how do I see myself?”

And if how I see myself is particularly negative, or I am noticing things about myself that are harmful or not good, I know that I have some self-work to do – and that’s not the responsibility of my friends or loved ones. That’s work only I can do.

3. I’m afraid that I’ll lose control.

Happiness is not a guarantee for anyone, but when you have a mental illness, you can sometimes become hypervigilant, convinced that at any moment an episode will grab you by the ankle and pull you down.

I’m tapering off of my anti-psychotic medication right now, and it’s felt like walking on eggshells, tracking my mood every day and searching for signs that something might be wrong.

Every time I see something out of the corner of my eye, I worry I might be seeing things again; every time I’m sad, I panic that it could be the beginning of a depressive episode.

It can feel like any particular thought or feeling is a sign of impending doom if you scrutinize it too much – and it starts to feel like you can’t trust yourself or your perception of reality.

Especially when you’ve just come off of a breakdown or traumatic experience, it can feel like the ground underneath you will never be solid. The instability can make you a little crazy (literally).

But it comforts me to know that as I work at my recovery, I’ll slowly get my footing again.

4. I’m afraid that my illness makes me a bad person.

It has taken a long, long time to be okay with saying, “Sometimes I act in really shitty ways when I’m struggling with my mental health.”

I’m not going to sugarcoat it: I have hurt people. Sometimes I’m a walking stereotype of borderline and it takes a lot to deal with my shit, be accountable for my mistakes, and reel it in.

What I’ve realized overtime is that being “good” or “bad” is not the point. I think it’s really a question of being responsible or irresponsible about the impact of our behaviors.

I spent a hell of a long time being more concerned with denying that I was hurting other people because I didn’t want to think of myself as being “bad.” It was about my ego; it was about preserving this image of myself as being “good.” It was irresponsible because I opted for denial instead of ownership of my behaviors.

But in recent years, I’ve worked on accepting that instead of being “good,” I should aspire to be responsible: recognizing when I’ve done harm, being accountable for it, and helping to facilitate healing between myself and my loved ones.

Whether or not you are good or bad isn’t important. But your choices will determine the kind of impact you have in the world – so commit to making the best choices that you can.

5. I’m afraid that I won’t survive it next time.

I can’t tell you how many mentally ill folks I’ve spoken to who have all said, “I won’t make it past [insert young age].” Episode after episode, it feels like we barely scrape by, and when we get to the other side we’re certain that we could never face it again.

Sometimes when I try to imagine battling another psychotic, depressive episode, I swear up and down that I could never survive it. And when I imagine trying to live with these illnesses for much longer, I despair about how it’s almost guaranteed that I won’t live a long life.

But when I’m convinced I won’t live to see 30, I remind myself that there was a time when I thought I wouldn’t live to see 20.

I also remind myself, like I explained in this article about depression (it’s one of my favorites, you should read it), that sometimes mental illness tricks us into thinking we can see the future – the simple truth, though, is that we never could and we never will.

Back when I was attending AA meetings (which was… interesting, to say the least), the thing that stuck out to me was the idea of taking it one day at a time. Sobriety, just like mental health recovery, feels huge when we look at the long term, the big picture.

But they both can feel a little more manageable when we keep our eyes on what’s in front of us, because that’s what’s within our power to control.

This seems (1) cliche and (2) laughably simple, I know. But even so, the only way we can move forward is one step at a time – so every day I remind myself that the only moment that’s relevant right now is the one I’m living in.

Believe me, I understand the fear. I don’t know how long I’ll live, and that scares me. I don’t know if I’ll be able to manage the next episode, and that terrifies me.

But what I do know is that the choices I make today – the ways I choose to take care of myself in the now and the support I put in place – can make a difference tomorrow, and even beyond that.

And really, for better or for worse, that’s the best I can do.

6. I’m afraid that this illness is all that I am.

Everyone likes to remind me that I’m more than my illnesses. But this struggle is my every day – if I’m not drowning in a depressive episode, I’m fighting hard to keep my head above water and my life intact. There isn’t a single moment that I’m not somehow impacted by these labels.

Sometimes I fear that this struggle is so central to my existence that it overshadows everything else that I am – if I am, indeed, anything else.

And sometimes I worry that it has consumed my life to the point where it’s the only thing anyone else can see.

Every day, I’m still trying to uncover who I am apart from all of this. Trying to get in touch with the joy and passion and thrill that is buried underneath all this, the part of me that lives for something and comes alive for something.

I want to know what that part of me is like, what it takes to bring it to life.

I’m never going to pretend that these illnesses aren’t ever-present in my day-to-day.  I’m never going to pretend that my choices won’t always be informed or influenced by my struggles. And I’m never going to pretend that the impact this has had on me hasn’t touched every aspect of my life.

Just looking at this list of fears, I ask myself if mental illness will always have this kind of grip on me – if I’ll spend every day of my life afraid.

But all any of us can do, really, is try to cultivate something beautiful for ourselves. Something that makes us feel whole. Something that gives us a sense of purpose. Even if the garden is barren, even if it’s covered in snow, we find a way to make something – anything – grow.

We can have something more for ourselves, something that belongs to us. That may not define us or help us put the pieces of our identity back together – but it gives us a place to start.

Let’s Talk About The Transgender Community, Body Positivity, and Fatphobia.

Y’all, I did this super scary thing where I talked, unscripted, for half an hour about the intersections of fatphobia and transness, along with sharing SO many feelings that I have about body positivity.

I did this with the amazing Elizabeth Cooper, founder of the Queer Body Love Speaker Series! You can learn more about it by clicking this link right here.

Their introduction to my interview is super generous and makes me feel important! Check it out:
Sam Dylan Finch

More people have recommended Sam Dylan Finch as a speaker for this series than anyone else. He’s the most famous advocate for trans inclusivity within the body positive movement, and in this candid interview he shares about his own experience as a non-binary trans person who has both learned from and has critiques of the body positive movement. This topic of navigating a fatphobic, transphobic society is SO important and has something to contribute to us all.

Interview highlights:

  • Why “every body is a bikini body” body positive beach photoshoots are exclusive (and how to reframe such projects to be trans inclusive)
  • 2 impactful lessons Sam has learned from body positivity
  • Why Sam literally sits in front of a mirror staring at his body (this is a unique exercise I haven’t heard of before)
  • How to deprogram internalized voices of oppression
  • The difference between dysphoria and dysmorphia 
  • What it means for Sam to be a non-binary trans person & how this relates to his relationship to his body

I’m not sure if I’d call myself famous (read: I would not call myself famous), BUT OKAY ELIZABETH. I am flattered!

If you sign up on the website – which just involves sharing your email address – you’ll gain access not only to my interview, but to dozens of other interviews from queer folks and queer-competent clinicians, talking about the many complexities of queer body image!

And before you tell me, “Sam! You’re only saying this because they paid you,” umm, EXCUSE ME. I did this for free!

I did this because I genuinely believe these are some of the most important conversions to be having right now, in a society which tells transgender people in particular that they are inherently broken, and as fatphobia and gendered ideals fuel disordered eating in our community.

And if you’re not interested in watching my face make weird expressions while I talk about this, or if it’s simply not an accessible format for you, there’s also a transcript available so you can simply read what I (and all the other speakers!) had to say.

It’s rare that I put myself on video without a script to talk about these things, but this was a unique occasion in which I wanted to connect directly with folks who, like me, are trying to navigate body positivity – which is a profoundly cis-centric movement – while also being transgender or non-binary.

So really, go sign up! I promise it’s not a scam (well, if it is, we can be victims together, okay, because I totally signed up too). It’s just a bunch of queer people who want to talk about our bodies in a way that we seldom have the space to do.

And be sure to spread the word! I can think of countless queer and trans people who need access to these conversations. Let’s bring everyone to the table. Let’s support and uplift one another in our journeys toward self-acceptance.

See you there!

NOS

Not Otherwise Specified: The Pain Of Hearing ‘I Don’t Know’

For the last six years, I’ve held on tight to my bipolar diagnosis – it kept me afloat in the midst of very turbulent seas. It was a framework that helped me understand my thoughts, feelings, and behaviors; it was a word that helped me find a community of people who were similarly struggling.

I remember listening to Mary Lambert’s song “Secrets” for the first time, with its opening line, “I’ve got bipolar disorder / my shit’s not in order,” and feeling the immediate connection and kinship that only comes from two people with the same endless, chaotic battle.

I felt like that song was for me.

I felt seen in that moment. I felt seen in every moment when someone I knew or someone with visibility came out and said that magic word: Bipolar, bipolar, bipolar, making me feel more and more real every time they stepped out of the shadows.

“Bipolar,” as a label, made me feel safe – like there was sense in the senseless, an anchor in an uncertain storm.

And that’s why, after a painfully long and involved evaluation, it was difficult to hear a psychiatrist say to me, “I don’t know if you have bipolar disorder.”

Mood Disorder Not Otherwise Specified, they told me, otherwise known as the grey area between depression and bipolar. Because they couldn’t just let me have depression, either – they left it ambiguous, leaving me straddling two words and two communities and two answers, pulling the ground out from underneath me.

In so many ways, this label was hollow. It was a question more than it was a statement. I couldn’t turn to the world and say, “This is what I’m going through” or “this is how much it hurts.” There’s no measure of severity, or list of symptoms, or a simple story to tell the world, tell my parents, tell my partner what’s happening to me.

Not Otherwise Specified is an empty place that tries to hold the entirety of your struggle, tries to say everything there is to say, without really holding or saying anything at all.

As if to say, “Your mind is out of bounds and we are out of words.”

My suffering has colored outside the lines like a child with no sense of where it all starts and stops.

I have no sense of where it all starts and stops.

In addition to my Mood Disorder Not Otherwise Specified, they have other things to specify: Obsessive Compulsive Disorder (OCD), which I should’ve suspected but never knew, and Borderline Personality Disorder, which they suspect is the root of my misdiagnosis.

It all feels true enough, but it also feels too new.

This, in addition to my agoraphobia, in addition to my alcohol use disorder, which both come with their own pain, a pain that I sometimes feel all over my body instead of just in my mind.

What happened to me?

There are so many names for my trauma, and so many names still missing, some more precise than others.

Just like that, I was OCD, I was borderline – two things I’d both always been and never been before – and bipolar, the very center of it all, slipped from my grasp and became an unknown, as if it were never here.

And maybe it wasn’t.

People say that we invest too much in labels, that we aren’t our diagnoses. I can’t say for sure that they’re right or wrong.

But I suspect they don’t know the loneliness of suffering something nameless. I suspect they don’t know the confusion of lacking the words to convey your pain. And I suspect they don’t know the relief when the words lead you to someone else who knows that pain, too.

When I lost “bipolar,” I lost more than just a label – I lost the story that helped me make sense of it all, the words to describe my pain, and the connection to other people who understood both.

Not Otherwise Specified is not a story, not an answer, not a connection. It’s a placeholder, a seat saved for something or someone that hasn’t yet arrived.

And what am I supposed to do with that?

tooill

When You’re Too Mentally Ill To Transition

Nearly seven months ago, I made the decision to start testosterone as a part of my gender transition.

I remember feeling so overjoyed that this part of my journey was beginning. The torment of being in a body that caused me so much distress, and being misgendered left and right adding salt to my wounds, made HRT not just a desire of mine but a real necessity.

If you’d asked me where I’d be by now, my self of seven months ago would talk about how high my dose would be, all the changes that would be happening, my desired date for top surgery (would it be September? December?), and how I’d be so much closer to the body I needed to have – closer than I’d ever been.

But none of that is true. In fact, I’m almost exactly where I started.

I’m still here because my testosterone dosage is only half of a typical starting dose – extraordinarily low and nearly ineffective, because there’s not a single doctor willing to increase it.

I’m still here because I was denied the recommendation needed to move forward with top surgery.

I’m transgender and I’m trying to transition. But the door keeps getting slammed in my face again, and again, and again.

There’s not a lot of conversation happening around the specific challenges that transgender people with mental illness are facing. I first wrote about this when I discussed my experiences in a psychiatric hospital, where I was almost denied my hormones altogether.

As someone with bipolar and a whole assortment of other diagnoses, I continually come up against obstacles in my transition that I would not otherwise face if I were neurotypical. 

I’ve been told before to stop taking hormones. I still remain on a dosage that barely alters my body – because there are concerns about how the hormonal changes will affect my sanity, despite having no evidence that it will and knowing we could lower the dosage if it did.

Most recently, I was told that I couldn’t move forward with top surgery because I was in a mild depressive episode, and that we would have to wait a few months to revisit the possibility of surgery. Seeing as the waiting period for surgery can be anywhere from six months to 2 years, it’s unclear to me why we couldn’t address my depression while I was on the waiting list for surgery.

Transition can already feel like it takes centuries just to get an inch closer to where we need to be.

So imagine, then, that you are a transgender person with mental illness, who not only has to deal with the typical challenges of gender transition, but you must also navigate the exhausting barriers that therapists, psychiatrists, and doctors place in front of you.

Imagine having no idea when you’ll be permitted to access the care that you desperately need – that you’ll remain imprisoned in a dysphoria-induced hell until you pull it together and become acceptably sane for your doctors.

It’s true that transgender people with mental illness have needs that are unique and important, due to the biochemical nature of both medical transition and mental illness. And it’s true that making life-altering changes during times of turmoil can sometimes do more harm than good.

But it’s also true that countless mentally ill transgender people have been denied hormones or surgery to their own detriment, causing real and even lasting damage.

It’s true that the woeful lack of research around mentally ill transgender people means that many medical professionals simply don’t know how to support this vulnerable population.

And it’s absolutely true that being unable to transition can worsen a transgender person’s mental health – and clinicians who do not take this into account, treating medical transition as optional rather than urgent and necessary, are contributing to the very mental health crisis they wish to avoid.

As I sit here with the inability to go further in my medical transition – stuck in a desperate situation that continues to eat me alive every day – it is obvious to me that mentally ill transgender people are being failed at every level.

If our only “solution” is to not transition, we need new and better solutions.

Assuming my bipolar stabilizes further, there will most likely be a time – I don’t know, hopefully this year? – when I can move forward, after more than half a year of being held back.

And while I’m hopeful that I’ll be able to resume my transition, I remain paranoid and fearful that it can be taken away from me at any time.

If this is what it looks like to be a mentally ill transgender person in the San Francisco Bay Area, I’m terrified to know what it looks like elsewhere in the country, where care is even less accessible and trans-competent clinicians are few and far between.

We deserve better than this. If a medical intervention is what a person needs to be well, why would we ever treat it like it’s optional? How are our gender transitions any different?