Regarding Matters Psychiatric...
So I was examining all my previous blog posts the other day, to see how often and in what detail I had blogged about the psychiatric system and being a psychiatric survivor, and found to my surprise that I haven't really covered any of that.
Which, to those who know me from the message boards I frequent, must be sort of like hearing from Al Sharpton that he blogged for two years and somehow never got around to discussing racial oppression and race relations in America. I mean, psychiatric oppression is notoriously one of my "climb up on soapbox" issues.
Maybe, possibly, I was disinclined to spoiler my own book. For those of you who read last week's blog entry about my transformative event listening to Pink Floyd? Well, the immediate fallout was that I tried to come out on campus as a different gender and sexual orientation; and the fallout from that, 3 months in, was being asked by my dormitory resident advisor to get some kind of bill of good health from the mental health clinicians across the street. And when I attempted to cooperate with that I found myself on a locked ward, treated like someone for whom a lack of coherent mind had already been established. And yes, it's an important axis around which the final section of the plot of the book revolves. But I don't have to reiterate the narrative that's in the book. I have other interests in writing about it.
When the request was made of me by the RA, I didn't find it surprising. I was a young college student who was talking to a lot of people about gender and sexuality. If I had been a person who seemed obsessed with anything that constituted a set of unusual and new ideas, there would have been the possibility that folks would think I was crazy, but ever so much more so when the obsession-topic was so directly focused on SEX, right? Thanks to Sigmund Freud, we're all very much exposed to the notion that disturbances of mind come from disturbances of a sexual nature. If we tend to think that some middle-aged guy who liquidates his retirement fund to buy an expensive red sports car is expressing some sexual insecurity, isn't that an even more likely armchair diagnosis when some college student starts risking social standing to tell people he's really a girl and that neither the assumptions normally attached to guys nor the assumptions normally attached to effeminate guys are appropriate?
Yeah, I was totally not surprised that there was a reaction basically amounting to "maybe you're not OK in the head and should talk to a shrink about this".
And reciprocally, I knew from my own firsthand experience that before I had a clear healthy understanding of my identity, I'd found the whole subject matter of sexual identity and gender to be emotionally threatening. I'd been squirmy and uncomfortable about it even while I was obsessing about it all the previous semester, trying to figure myself out. So from the outside, yeah, sure, it seemed reasonable that my current excitement and inclination to start talking with a lot of intensity about this stuff could be perceived as a kind of acting out of unresolved tensions and worried uncertainties. The fact that I now felt I was in possession of important answers rather than haunted by disturbing questions didn't change the fact that the subject matter was a sort of ground zero for emotional and cognitive stability issues.
As it turns out, approximately two years AFTER this, long after I'd successfully pried myself loose from the university's affiliated psychiatric system and gone on my way and had begun composing my first serious effort to write and publish a book about my gender identity, I found myself seriously craving something akin to a consciousness-raising group, some sort of sharing and counseling experience from which I could hone my ability to express what I was trying to express and get some feedback from other people on what I was trying to say... and let myself be talked into checking myself in to another such institution. Yeah... fool me once, shame on you, fool me twice shame on ME, highly embarrassing, but yeah...
Whereas the first institution was an old-fashioned central-casting loony bin, with us patients mostly padding around between TV sets, cafeteria, domino games, and an occasional session of "occupational therapy" doing arts and crafts stuff, interspersed with being shoved into seclusion and tied down and shot up with thorazine and all that, the second institution was new and shiny and ostensibly modern in approach and attitude. "The staff all wear street clothes and so do the patients. No bars in the windows, it's more like staying at a hotel. And they won't try to put you on medication, they don't believe in that approach, instead there will be biofeedback and dramatic role play. And the patients all participate in each other's therapy. Everyone is here to work on their own shit. Not at all like that snake pit you were in before".
Yeah. Right. Oh yes, the staff did all wear street clothes but unlike us they had keys to the locked doors. No bars on the windows, to be sure, but the screens were made of heavy metal mesh that created a barrier you weren't getting past without some industrial-strength cutting tools.
And, yes, patients "participated in each other's therapy", all right. Here's how that worked: when you first came in you were assigned to a social status called "level 4". To eventually get out, you have to be gradually promoted to "level 1", and at each level-promoting opportunity all the patients on the ward gave feedback but the final decision-making authority lay with the psychiatrist running the place. One of the behaviors for which you would be evaluated was the kind of feedback you provided about other patients' progress. Making and expressing your own observations that coincided with the opinions of the staff would definitely work in your favor; expressing attitudes or perspectives that did not coincide with those of the treatment team, on the other hand, could work against you. In short, the psychiatrist operating the facility was manipulating the entire social environment, controlling what positive feedback and what negative feedback each patient would receive, and making it so that the institutional message was being effectively echoed by all the other patients, by penalizing them if they did not participate in that fashion.
They didn't much appreciate it when I analyzed all of the above, pointed it out and designated it as a reward-and-punishment behavior-modification tank, a Skinner box. They invented a new social status for me alone, effectively a "level 5", removing from me some of the privileges I'd originally had upon my first arrival.
Oh, and it was largely true that they did not believe in medications. They were achieving their results without them, mostly. Not so much in my case, though, so I was eventually told that I would need to start taking a drug called Navane. I took that as my cue that it was time for me to leave. Using a table knife from the cafeteria, I took out the screws attaching a retaining slide lock from one side of a set of double doors, then escaped through the gap between the doors despite the chain looped around the handles. Hitched out of the state and haven't been tempted to place myself in psychiatric custody at any time since.
Psychiatric diagnostic labeling has political significant for gender activists in particular, and I think everyone in this movement should take note of these things:
• Delegitimizing - Any time a person's behavior is attributed to their disturbed mental condition, that is code for "you can ignore what they're actually saying because it doesn't make sense and there's another, more hidden, reason for why they're saying it that's different from their stated concerns and objectives".
Usually this is couched as an act of kindness - instead of seeing yon person as a destructive maniac doing horrible things, please see that person instead as acting that way because their brain is misbehaving and don't hold it against them; and if they express hateful wrathful attitudes or creepy desires and intentions, don't take it as face value that they really feel that way and really want to do those things, there are underlying reasons causing them to "act out" like that.
But if you start with the assumption that the person in question is expressing exactly what they intend to express, it is obvious that regarding them as impaired in this fashion has the effect of discounting and disregarding them. And if you then coat that very political act in the drape of kindness, it doesn't appear to be a hostile act and those who engage in it need not feel guilt or shame for having silenced someone's voice.
• Depoliticizing - It is normal and natural that a person who has been made to feel marginalized, marked as inferior and different, oppressed, subjected to hostility and violence because of the category they are perceived by others to be in, and so on, feels painful emotions as a consequence and has a mind plagued by self-blame and self-doubts and other recurrent cognitive content of that ilk. That is the essence of what it means to be a victim of such social processes, that it gets inside your own head. Psychiatry and the surrounding penumbra of "mental health" counseling services often focus on the victim and the victim's thoughts and feelings, to attempt to provide ameliorative and supportive services. Doing so, by itself, though, identifies the problem as being located in the victim.
A political approach to marginalization and oppression and such categorical social exclusions is to identify the problem as being located NOT in the victim, at least not in the primary original-causal sense, but instead being located in SOCIETY which has done them wrong.
Even the therapeutic act of talking about what one has been through and processing one's feelings and thoughts can, and should, be political. It is important for victims to see the experiences they have been through as due to an ongoing social phenomenon in need of fixing. If this perception does not take place properly, the victim typically continues to blame themselves, for having reacted as they did emotionally.
Carol Hanisch wrote the quintessential article on the subject, "The Personal is Political", back in 1970, published in both The Radical Therapist and in Notes From the Second Year, the first being a compendium of writings about psychiatric liberation and the second being a compendium of writings about women's liberation, thus underlining the connection between gender activism and a radical questioning of psychiatric practice.
• Gatekeeping - For transgender and intersex people in particular, another issue of concern is the role of the psychiatric establishment in disbursing available medical treatment. Hormones and surgery that are desired by a person in order to allow them to perceive and to have others perceive their body as their gender identity and sense of ideal bodily integrity require are quite often restricted to those who have been deemed appropriate for those treatments by a psychiatrist.
At a time when a person is in the most intimate and personal portions of the process of defining themselves to themselves and to the world around them, they are put in a position of having to entertain and engage with someone else's notions of acceptable identities and appropriately gendered behaviors. Persons seeking surgery or hormonal intervention that would typically make it more likely that they will be perceived as female people often have to adopt the most ridiculously pink Barbie doll mannerisms and express the corresponding priorities and interests or else risk being deemed an inappropriate candidate for the medical services they seek; likewise for individuals seeking medical interventions that are socially associated with being perceived as a male person - anything deviating from the most narrowly constrained uptight masculine in activities and interests, gestures and thinking patterns, can cause a psychiatric professional to withhold access to the sought-after procedures.
• Pigeonhole-Defining - The psychiatric profession is not ignoring the phenomenon of people claiming variant gender identities. New terminologies have appeared within the psychiatric lexicon over the course of years, phrases such as "gender dysphoria" and so on. And in all fairness, not every recognition of a gender-variant identity is necessarily infused with the stigma of being considered a mental disorder, although they've certainly done their share of providing us with that kind of recognition.
They do, however, tend towards a kind of thinking in which there are a finite set of phenomena and each legitimate phenomenon is accorded an official name and often some theories about causality, even where pathology isn't being evoked. In the case of transgender people, for example, they have largely come to the point of believing that such people exist (as opposed to believing that someone who thinks of themselves in those terms has a mental disorder, which is certainly progress). Some of them believe that the phenomenon of transgender people is always caused by a biological built-in difference in the brain. Many of them harbor the expectation, consciously or not, that normal transgender people are exclusively heterosexual, do not deviate from the sex role of the gender to which they are transitioning, that they all do wish to transition, and that any ambiguity or multivariate expression of gender indicates that the person has not properly adjusted or perhaps is not genuinely a transgender person in the first place.
It's a very different mindset than one that says gender is mostly a social contrivance and that, as such, there are an infinite number of healthy ways to self-perceive and to socially present as a gendered person. The latter is about freedom and the authenticity of one's own representation of gender identity; the former is about slotting every person into a finite number of officially legitimated category-boxes.
To the extent that they've promoted this kind of thinking within the LGBTQ+ community itself, they've contributed to an environment where young people, in particular, think in terms of there being a specific and limited number of possible legitimate genders, and that it is their task to worry about which one they really are.
--------
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Which, to those who know me from the message boards I frequent, must be sort of like hearing from Al Sharpton that he blogged for two years and somehow never got around to discussing racial oppression and race relations in America. I mean, psychiatric oppression is notoriously one of my "climb up on soapbox" issues.
Maybe, possibly, I was disinclined to spoiler my own book. For those of you who read last week's blog entry about my transformative event listening to Pink Floyd? Well, the immediate fallout was that I tried to come out on campus as a different gender and sexual orientation; and the fallout from that, 3 months in, was being asked by my dormitory resident advisor to get some kind of bill of good health from the mental health clinicians across the street. And when I attempted to cooperate with that I found myself on a locked ward, treated like someone for whom a lack of coherent mind had already been established. And yes, it's an important axis around which the final section of the plot of the book revolves. But I don't have to reiterate the narrative that's in the book. I have other interests in writing about it.
When the request was made of me by the RA, I didn't find it surprising. I was a young college student who was talking to a lot of people about gender and sexuality. If I had been a person who seemed obsessed with anything that constituted a set of unusual and new ideas, there would have been the possibility that folks would think I was crazy, but ever so much more so when the obsession-topic was so directly focused on SEX, right? Thanks to Sigmund Freud, we're all very much exposed to the notion that disturbances of mind come from disturbances of a sexual nature. If we tend to think that some middle-aged guy who liquidates his retirement fund to buy an expensive red sports car is expressing some sexual insecurity, isn't that an even more likely armchair diagnosis when some college student starts risking social standing to tell people he's really a girl and that neither the assumptions normally attached to guys nor the assumptions normally attached to effeminate guys are appropriate?
Yeah, I was totally not surprised that there was a reaction basically amounting to "maybe you're not OK in the head and should talk to a shrink about this".
And reciprocally, I knew from my own firsthand experience that before I had a clear healthy understanding of my identity, I'd found the whole subject matter of sexual identity and gender to be emotionally threatening. I'd been squirmy and uncomfortable about it even while I was obsessing about it all the previous semester, trying to figure myself out. So from the outside, yeah, sure, it seemed reasonable that my current excitement and inclination to start talking with a lot of intensity about this stuff could be perceived as a kind of acting out of unresolved tensions and worried uncertainties. The fact that I now felt I was in possession of important answers rather than haunted by disturbing questions didn't change the fact that the subject matter was a sort of ground zero for emotional and cognitive stability issues.
As it turns out, approximately two years AFTER this, long after I'd successfully pried myself loose from the university's affiliated psychiatric system and gone on my way and had begun composing my first serious effort to write and publish a book about my gender identity, I found myself seriously craving something akin to a consciousness-raising group, some sort of sharing and counseling experience from which I could hone my ability to express what I was trying to express and get some feedback from other people on what I was trying to say... and let myself be talked into checking myself in to another such institution. Yeah... fool me once, shame on you, fool me twice shame on ME, highly embarrassing, but yeah...
Whereas the first institution was an old-fashioned central-casting loony bin, with us patients mostly padding around between TV sets, cafeteria, domino games, and an occasional session of "occupational therapy" doing arts and crafts stuff, interspersed with being shoved into seclusion and tied down and shot up with thorazine and all that, the second institution was new and shiny and ostensibly modern in approach and attitude. "The staff all wear street clothes and so do the patients. No bars in the windows, it's more like staying at a hotel. And they won't try to put you on medication, they don't believe in that approach, instead there will be biofeedback and dramatic role play. And the patients all participate in each other's therapy. Everyone is here to work on their own shit. Not at all like that snake pit you were in before".
Yeah. Right. Oh yes, the staff did all wear street clothes but unlike us they had keys to the locked doors. No bars on the windows, to be sure, but the screens were made of heavy metal mesh that created a barrier you weren't getting past without some industrial-strength cutting tools.
And, yes, patients "participated in each other's therapy", all right. Here's how that worked: when you first came in you were assigned to a social status called "level 4". To eventually get out, you have to be gradually promoted to "level 1", and at each level-promoting opportunity all the patients on the ward gave feedback but the final decision-making authority lay with the psychiatrist running the place. One of the behaviors for which you would be evaluated was the kind of feedback you provided about other patients' progress. Making and expressing your own observations that coincided with the opinions of the staff would definitely work in your favor; expressing attitudes or perspectives that did not coincide with those of the treatment team, on the other hand, could work against you. In short, the psychiatrist operating the facility was manipulating the entire social environment, controlling what positive feedback and what negative feedback each patient would receive, and making it so that the institutional message was being effectively echoed by all the other patients, by penalizing them if they did not participate in that fashion.
They didn't much appreciate it when I analyzed all of the above, pointed it out and designated it as a reward-and-punishment behavior-modification tank, a Skinner box. They invented a new social status for me alone, effectively a "level 5", removing from me some of the privileges I'd originally had upon my first arrival.
Oh, and it was largely true that they did not believe in medications. They were achieving their results without them, mostly. Not so much in my case, though, so I was eventually told that I would need to start taking a drug called Navane. I took that as my cue that it was time for me to leave. Using a table knife from the cafeteria, I took out the screws attaching a retaining slide lock from one side of a set of double doors, then escaped through the gap between the doors despite the chain looped around the handles. Hitched out of the state and haven't been tempted to place myself in psychiatric custody at any time since.
Psychiatric diagnostic labeling has political significant for gender activists in particular, and I think everyone in this movement should take note of these things:
• Delegitimizing - Any time a person's behavior is attributed to their disturbed mental condition, that is code for "you can ignore what they're actually saying because it doesn't make sense and there's another, more hidden, reason for why they're saying it that's different from their stated concerns and objectives".
Usually this is couched as an act of kindness - instead of seeing yon person as a destructive maniac doing horrible things, please see that person instead as acting that way because their brain is misbehaving and don't hold it against them; and if they express hateful wrathful attitudes or creepy desires and intentions, don't take it as face value that they really feel that way and really want to do those things, there are underlying reasons causing them to "act out" like that.
But if you start with the assumption that the person in question is expressing exactly what they intend to express, it is obvious that regarding them as impaired in this fashion has the effect of discounting and disregarding them. And if you then coat that very political act in the drape of kindness, it doesn't appear to be a hostile act and those who engage in it need not feel guilt or shame for having silenced someone's voice.
• Depoliticizing - It is normal and natural that a person who has been made to feel marginalized, marked as inferior and different, oppressed, subjected to hostility and violence because of the category they are perceived by others to be in, and so on, feels painful emotions as a consequence and has a mind plagued by self-blame and self-doubts and other recurrent cognitive content of that ilk. That is the essence of what it means to be a victim of such social processes, that it gets inside your own head. Psychiatry and the surrounding penumbra of "mental health" counseling services often focus on the victim and the victim's thoughts and feelings, to attempt to provide ameliorative and supportive services. Doing so, by itself, though, identifies the problem as being located in the victim.
A political approach to marginalization and oppression and such categorical social exclusions is to identify the problem as being located NOT in the victim, at least not in the primary original-causal sense, but instead being located in SOCIETY which has done them wrong.
Even the therapeutic act of talking about what one has been through and processing one's feelings and thoughts can, and should, be political. It is important for victims to see the experiences they have been through as due to an ongoing social phenomenon in need of fixing. If this perception does not take place properly, the victim typically continues to blame themselves, for having reacted as they did emotionally.
Carol Hanisch wrote the quintessential article on the subject, "The Personal is Political", back in 1970, published in both The Radical Therapist and in Notes From the Second Year, the first being a compendium of writings about psychiatric liberation and the second being a compendium of writings about women's liberation, thus underlining the connection between gender activism and a radical questioning of psychiatric practice.
• Gatekeeping - For transgender and intersex people in particular, another issue of concern is the role of the psychiatric establishment in disbursing available medical treatment. Hormones and surgery that are desired by a person in order to allow them to perceive and to have others perceive their body as their gender identity and sense of ideal bodily integrity require are quite often restricted to those who have been deemed appropriate for those treatments by a psychiatrist.
At a time when a person is in the most intimate and personal portions of the process of defining themselves to themselves and to the world around them, they are put in a position of having to entertain and engage with someone else's notions of acceptable identities and appropriately gendered behaviors. Persons seeking surgery or hormonal intervention that would typically make it more likely that they will be perceived as female people often have to adopt the most ridiculously pink Barbie doll mannerisms and express the corresponding priorities and interests or else risk being deemed an inappropriate candidate for the medical services they seek; likewise for individuals seeking medical interventions that are socially associated with being perceived as a male person - anything deviating from the most narrowly constrained uptight masculine in activities and interests, gestures and thinking patterns, can cause a psychiatric professional to withhold access to the sought-after procedures.
• Pigeonhole-Defining - The psychiatric profession is not ignoring the phenomenon of people claiming variant gender identities. New terminologies have appeared within the psychiatric lexicon over the course of years, phrases such as "gender dysphoria" and so on. And in all fairness, not every recognition of a gender-variant identity is necessarily infused with the stigma of being considered a mental disorder, although they've certainly done their share of providing us with that kind of recognition.
They do, however, tend towards a kind of thinking in which there are a finite set of phenomena and each legitimate phenomenon is accorded an official name and often some theories about causality, even where pathology isn't being evoked. In the case of transgender people, for example, they have largely come to the point of believing that such people exist (as opposed to believing that someone who thinks of themselves in those terms has a mental disorder, which is certainly progress). Some of them believe that the phenomenon of transgender people is always caused by a biological built-in difference in the brain. Many of them harbor the expectation, consciously or not, that normal transgender people are exclusively heterosexual, do not deviate from the sex role of the gender to which they are transitioning, that they all do wish to transition, and that any ambiguity or multivariate expression of gender indicates that the person has not properly adjusted or perhaps is not genuinely a transgender person in the first place.
It's a very different mindset than one that says gender is mostly a social contrivance and that, as such, there are an infinite number of healthy ways to self-perceive and to socially present as a gendered person. The latter is about freedom and the authenticity of one's own representation of gender identity; the former is about slotting every person into a finite number of officially legitimated category-boxes.
To the extent that they've promoted this kind of thinking within the LGBTQ+ community itself, they've contributed to an environment where young people, in particular, think in terms of there being a specific and limited number of possible legitimate genders, and that it is their task to worry about which one they really are.
--------
Index of all Blog Posts