A Tale of Two Disorders
A week ago I received a message on Reddit from a local 9th grade school teacher asking if I would be willing to write a short paper on mental illness:
I read your post in the /r/calgary thread on mental health and I thought you spoke well about a bunch of the issues/stigma surrounding mental health. I teach high school here in calgary and am actually in the middle of a unit on mental health. My grade 9s are learning about mental illness in an attempt to increase understanding and decrease stigma. I’d love for them to have the opportunity to hear about specific mental illnesses but unfortunately there isn’t too much set up in the way of this. I was wondering if maybe you might be interested in helping out? I was sort of thinking about doing this in two parts:
- A story from the person with the mental illness - this would be up to you to write out. It could be as long or as short as you like (or are willing to write) and I could read it to the kids. It could be about anything you want - your story and your experience or your understanding of the mental illness itself.
- A Q+A. After reading out your story I would ask the kids to create questions specifically for you. If you’re willing to answer them then I can relay those answers back to them.
While time and health have not been kind this past week, I’ve finally found a moment tonight to write. The write-up follows.
I — On Stigma
The phenomenon whereby an individual with an attribute which is deeply discredited by his/her society is rejected as a result of the attribute. Stigma is a process by which the reaction of others spoils normal identity. - Erving Goffman1
I am 33 years old. It’s only in the past year that I’ve come to terms with the fact that I have suffered significantly from mental illness in my lifetime. Internalized social stigma has taken me time to overcome in arriving at this conclusion.
Stigma starts early. Ostracized as a child, bullied and unable to relate to my peers, my foremost desire was to feel and have others see me as normal. I knew I was not normal, though the secret formula to become normal eluded me, try as I might to find it. I took my inability to fit in personally, but I did understand that often I was singled-out for seeming different rather than actually being different. Kids I knew with similar interests would turn on me to avoid peers attacking them in the same way. Lacking as I thought I was in normalcy, I settled for the next best thing; doing my utmost to avoid notice. The quieter I was, the more plain and boring I seemed, perhaps the less attention my strangeness would draw.
The main problem with this approach was that regardless of how I acted, I was still the same person inside. By fighting so hard against who I was and how I felt, I began to internalize society’s stigma against that which is different, and I built a wall inside my head to hide those most worrisome parts of me from the world. I never forgot these parts of me were there and while it got easier to pretend they didn’t exist, I was always troubled about the possibility of others finding out. I didn’t always even know why I was so worried or what exactly I worried about. I thought, however, I couldn’t be accepted or appreciated if I allowed whatever it was to be seen.
The mental issues and personality quirks still existed and now I was working extra hard to not only deal with these issues, but to pretend to the world that nothing was wrong. I was diligent in this aspect of my quest for normalcy but hadn’t realized that putting on an act and mask my suffering was normal in itself. Everybody at some point in their lives will put on this act. It’s self-defence in a world we perceive as hostile. But, if so many of us are playing a part to appear normal, what is normal anyway? Does the reality where normal people are all the same and nobody is suffering really exist?
We have all probably heard “fake it ‘til you make it” in reference to depression and anxiety disorders. Shamefully, I’ve said this to others of their depression because I thought this was good advice. In hindsight, my own “faking it” was unsuccessful. On the surface it seems like good advice but what lurks beneath is disbelief in the legitimacy of people’s experiences. The problem for myself and I would venture most others is that the underlying cause doesn’t go away. Acting as though everything is alright may offer some distraction, allow one to be productive, and help one ride out the storm. But, if used as a long-term solution it can lead our minds to rely on defense mechanisms2 that can impact our mental well-being.
II — Mental Health
I never gave myself the time to think about what I might be running from or hiding from the rest of the world. I relied on my own denial, repression, rationalization, and sublimation to keep me safe. When disordered behaviour invaded my life I would write it off to identity quirks or undesirable and shameful parts of who I was. This has often led me to bouts of low self-esteem and poor decision-making.
I was never able to completely hide from those aspects of myself I boxed away. Thoughts would always surface when I least wanted or expected it. Eventually, the pressure became great enough to force me to dig deep and confront the things I had been running from.
DSM-5 aims to avoid stigma and ensure clinical care for individuals who see and feel themselves to be a different gender than their assigned gender. It replaces the diagnostic name “gender identity disorder” with “gender dysphoria,” as well as makes other important clarifications in the criteria. It is important to note that gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition.3
The doctor pronounced me male at birth. My whole childhood and adulthood I lived as male and I had little conscious awareness that I was dealing with gender dysphoria. I had never heard of gender dysphoria and only had the vaguest idea of what being transgender meant. The biggest thing I thought I had been hiding all this time was my bisexuality. Since I had become aware of my sexual orientation as a teenager I assumed all my gender-related feelings were about my sexuality. I had felt a great deal shame on account of them. I had conflated sexuality and gender in confusing ways my entire life.
Given the views I grew up around, this isn’t surprising. Even on TV when I was growing up, gay characters were a rarity and still portrayed as effeminate stereotypes. “Gay” was the same as “flamboyant” in mainstream culture, and bisexuality was invisible. I was only aware of bisexuality due to my early access to bulletin boards and the internet. I did the only thing that seemed reasonable at the time: I locked that part of me away and hoped I could live a good life as a heterosexual man.
I internalized a lot of transphobic stigma over my life without really realizing it. Movies like Ace Ventura: Pet Detective and comedies where “that woman is really a man” served as the punch-line reinforced the status of trans people as a target. Growing up I didn’t understand being transgender as a distinct concept from crossdressing/transvestitism, and I never viewed myself as a crossdresser. As far as I was from realizing I was transgender, all this stigma would also have to be overcome.
After coming out as bisexual at age 30, I started to peel back the layers of my self-denial. I explored expression in ways that seem silly to me now but I hadn’t previously allowed myself to explore (simple things like wearing the colour purple). Still, something wasn’t making sense and I began to be more troubled by the lack of answers. I kept at it, slowly peeling back the layers, immersing myself more in LGBTQ community and culture, reading more about the history of the LGBT movement, and becoming more adventurous in my self-expression.
The turning point for me came when I decided to attend the local halfway-to-Pride-party dressed in women’s clothing. I sported a dress, a wig, makeup, accessories, and a coat of nail polish. This was the first time I had ever fully dressed in women’s clothing and it ended up being the first time I felt the full, unimpeded force of my gender dysphoria.
The feeling of gender dysphoria is not quite the same for everyone, and is not necessarily triggered by the exact same things. For me I had managed to spend most of my life in denial with gender dysphoria maintaining a low background hum. It caused me general discomfort with masculinity and maleness. The hypothetical question of what it would have been like to have been “born a woman” always intrigued me. But, to date, gender dysphoria hadn’t yet caused me significant distress. Now, for the first time indulging in what I truly wanted my gender dysphoria made itself clear that it would no longer let me fight it.
I still didn’t know what gender dysphoria was and I didn’t realize at the time that’s what I had felt. I only knew I was in distress and taking steps toward feminine gender expression felt like a positive direction. I learned a great deal about being transgender and transitioned over that year. I tried on various identities: “genderqueer”, “androgyne”, “trans feminine”, and “woman”. Over this duration I changed my expression in small increments. In order, I experimented with nail polish, daily makeup, ear piercing, and buying women’s clothing. By the end of the year I was living outside of work as a woman.
At age 32, at the beginning of 2014, I changed my legal name, and changed gender at my workplace. I started hormone therapy shortly after. Gender dysphoria has been minimal after breaking my denial, realizing myself to be a woman, and coming out. In fact, I now feel a euphoria about myself that I have never felt before.
Everything isn’t perfect, and life can be hard as a transgender woman, but I can’t now imagine being anyone but me.
The second of my disorders to be diagnosed was ADHD-PI4, also known as as ADD (Attention Deficit Disorder).
Ever since I first heard about ADD in my junior high or high school years, the thought had occurred that I might have it. Unfortunately, such a suggestion was never taken seriously either by me or the adults in my life, and I was never diagnosed or treated. As a disorder ADHD has been considered a joke by many and even today ADHD is commonly thought to be over-diagnosed in children and adolescents. Doctors have been accused of over-prescribing ADHD medication and claims have been made that some teachers are using ADHD as a way to sedate unruly children.
I can’t account for all these claims, but I do know that I am one of many adults who slipped through the cracks for diagnosis in both childhood and adolescence. This left me with extreme difficulty functioning normally at home, in society, in post-secondary school, and in the working world. Only in recent years has adult ADHD been investigated seriously[^adult adhd]. It turns out that many children with ADHD do not simply grow out of it, but as adults continue to experience symptoms. If not diagnosed in childhood this can leave adults like myself struggling for answers.
A combination of social stigma and a lack of awareness were contributing factors preventing me from being diagnosed at an earlier age. I often wonder if my life would have gone differently if I’d been diagnosed and treated in my childhood or teen years. In adulthood I’ve had constant issues with disorganization, inability to maintain interest, lack of motivation (executive function), inability to multitask, and poor follow-through.
That last point touches on a particularly sore point in my history: I’m a University drop-out, not for lack of skill or intelligence (I received a 3.92 GPA in my first year), but an undiagnosed disability that prevented me from being able to maintain focus on a long term goal. Throughout my school years and adulthood, I frequently felt like I was letting myself down. I would commit to something, fail to deliver, feel guilty about failing to deliver, and things would continue in that pattern without me being able to correct it.
I have now been formally diagnosed and am on ADHD medication. With treatment I am now able to work far more effectively than ever before.
Goffman, E. (1963). Stigma: Notes on the Management of Spoiled Identity. Prentice-Hall. ISBN 0-671-62244-7. ↩