In working as one of two Mental Health Commissioners at SSMU, one of the most frustrating constants I encounter is the opportunistic mobilization of mental health rhetoric. We see this in the consumerist appropriation of self-care, the disingenuous corporate “activism” which obscures the dehumanization of workers, or any other number of instances. Unfortunately, this was directly exemplified in the February 14 session of AUS Legislative Council.

With the proliferation of mental health discourses on campus, it is easy to forget about mental illness. We’ve heard it ad nauseam: one in five Canadians has a mental illness, but five in five Canadians have mental health. Yet dealing with the garden-variety ups and downs of student life is easier than addressing the traumas and struggles of the mentally ill – particularly for those of us who are racialized, who are queer, who are working-class. This truism also obscures the crucial link between marginalization and compromised mental welfare.

I do not speak on behalf of my co-Commissioner, nor do I represent the views of the VP Student Life or the SSMU as a whole. I feel strongly about the incidents and rhetoric of this session of Council because of my professional background in mental health advocacy. My positions are also informed by my own experience as a racialized person, as a Muslim, and as someone who lives and copes with severe mental illness.

Yet dealing with the garden-variety ups and downs of student life is easier than addressing the traumas and struggles of the mentally ill – particularly for those of us who are racialized, who are queer, who are working-class.

On January 30, the AUS Legislative Council voted against approving additional fees for POLI 339, a comparative politics summer course at the Hebrew University of Jerusalem. The AUS Executive Committee subsequently overturned this ruling through a secret Facebook vote, which prompted an investigation by the AUS Secretary General. During the February 14 session of Council, Arts Representative Andrew Figueiredo admitted to having pressured members of the AUS Executive Committee to vote to overturn the Legislative Council’s initial ruling. Within the scope of an apology for these actions, he also mentioned that his mental health had suffered due to recent incidents. I have no interest in undermining the legitimacy of Councillor Figueiredo’s claims; to be clear, I emphatically do not believe that he is lying about having suffered emotionally.

It is perhaps self-evident that our mental welfare is shaped by external factors. In an environment where students are expected to burn themselves out for the sake of building their credentials and succeeding academically, professional and social commitments weigh on us. When these commitments are politically loaded – as this particular issue was – this weight increases exponentially. Undoubtedly, many AUS Councillors and Executives can attest to this.

However, these external factors can transcend the petty bourgeois minutiae of student life. Experiences of marginalization, social exclusion, and political violence destabilize mental health significantly. For example, women living in poverty (who are disproportionately racialized) are far more likely to display depressive symptoms. Black women deal with extensive violence at the hands of the medical establishment, and are often limited in their access to care. Notably, Palestinians in the occupied territories face post-traumatic stress disorder and other forms of mental illness at disproportionately high rates. Indeed, mental health and illness are inextricable from the realities of racism, settler-colonialism, misogyny, and capitalist exploitation.

Elected political representatives, like the rest of us, experience mental health challenges. However, they also have responsibilities to their constituents: transparency, honesty, and a commitment to democratic process.

Elected political representatives, like the rest of us, experience mental health challenges. However, they also have responsibilities to their constituents: transparency, honesty, and a commitment to democratic process. When they are elected, they are entrusted with fulfilling these responsibilities in good faith. To fail on these fronts – and to create a hostile and coercive professional environment for your colleagues – is fair grounds for criticism (and impeachment, but let’s table that for now). Perhaps if one comes under heat for having engaged in what comes down to workplace bullying and manipulation, it is entirely justified. Student politics may impact your emotional welfare, but you still have a responsibility to both your constituents and to the individuals that you have harmed. Compromised mental health is not an excuse for coercion, manipulation, and professional dishonesty.

We should also consider how these invocations of mental health undermine the constant delegitimization and dismissal faced by marginalized Council members. Both the AUS President and VP Academic were visibly distraught during the Council meeting, particularly as they spoke about the hostility that they faced during this incident. These two individuals also formed a minority within the Executive, as they both publicly shared that they voted “no” on circumventing the AUS Council and on overturning the initial decision. It is telling that two visibly racialized women felt the weight of this mistreatment. It is telling that their emotional welfare is not being publicly prioritized in the same way as Figueiredo’s. Last year, during campaigns, Councillor Figueiredo was criticized for his tendency to “make women uncomfortable.” Isn’t that a mental health concern? Whose mental health do we value? Who can mobilize this language and be taken seriously? Isn’t the mental health of Palestinian students compromised by colonial violence? Why is their distress met with ridicule, with dismissal, with carelessness?

It is telling that two visibly racialized women felt the weight of this mistreatment. It is telling that their emotional welfare is not being publicly prioritized in the same way as Figueiredo’s.

To be clear: Councillor Figueiredo should resign immediately, as should any other executives who chose to both circumvent an emergency AUS Council meeting and to overturn the original vote. Failing this, impeachment is necessary. When it comes to accountability, talk is cheap. We should learn from our various representative associations’ past missteps where misogyny and racism are concerned, and move towards changing the culture which enables these abuses of power.

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It’s late spring when a friend of mine informs me that my former clinician — let’s call him Doctor X — withheld a diagnosis from her when she was his patient. She learns this during a crisis appointment with a different psychiatrist, who flippantly mentions a note on her chart which simply states: “personality disorder, not otherwise specified.” A landmine documented in med school handwriting, still active even after two years of concealment. Unsurprisingly, she responds to this information with a panic attack. She is asked to leave the office, to “return when she has calmed down.”

She submits complaints against the clinicians in question. Despite this, they both remain employed and continue to treat students.

. . . . . . . . . . . . . . . . . . . . . . . .

McGill Psychiatric Services charges a dollar per page when photocopying a patient’s chart, with a maximum charge of $25. My request takes a week to be processed. I pick up the thick white envelope at the reception desk. Debit or credit, no cash.

One of the first documents in my chart is a client evaluation form completed on February 9, 2017. Second semester of my second year. I came in for a crisis appointment. It is stated that I have “recurring nightmares about sexual violence.” It is stated that “[they] think [they were] assaulted.” One header on his page of notes is titled “PTSD(?).” His handwriting is difficult to decipher.

My wait time for a follow-up appointment with a psychiatrist is four to six weeks. Five days later, I am hospitalized for self-mutilation. The notes from my medical consultations in the Psychiatric Emergencies Unit state first that I likely have an “unspecified personality disorder with borderline elements,” and then that “BPD is a probable diagnosis.” These notes are forwarded to Psychiatric Services, and then passed onto my soon-to-be-clinician, Doctor X, for follow-up. During a second crisis appointment on February 27, a psychiatric nurse underscores this, advising my future clinician to “rule out [whether I had] BPD or bipolar-II.”

Borderline personality disorder, or BPD, is estimated to impact 1% of the general population, and 10% of those diagnosed will complete suicide. It is characterized by unstable interpersonal relationships, emotional dysregulation, and a shaky sense of self. BPD has a high rate of heritability, and is prevalent amongst individuals with traumatic childhood experiences, such as neglect, abandonment, and abuse.

I meet with Doctor X the next day. He does not inform me of this diagnosis, though he makes a small, brief note at the bottom of the page following our initial meeting: “BPD.” Antithetically, he states that my primary diagnosis is for generalized anxiety disorder. I express a desire to focus on my PTSD, which he rejects – it is the anxiety, he claims, which is impacting me most significantly. He gives me a script for escitalopram, an antidepressant. He recommends me to a cognitive behavioural therapy specialist.

The first cylindrical plastic bottle of escitalopram costs me four dollars, thanks to my Studentcare coverage. The next two months are a dissociative blur. Despite my consistent complaints vis-à-vis the negative effects of the prescribed medication, Doctor X makes no note of my declining mental state. My dose is increased at whiplash-inducing rates. I am exhausted, paranoid, and emotionally labile. I am manic, irritable, impulsive. I have delusions about the supposed risk of leaving my apartment. I don’t eat, and I relish the feeling of my ribcage under shaky hands. There is less body left for me to drag around half-heartedly. I spend hours in bed, keeping track of the wall moulding’s intricacies. I buy potted plants and let them dry out on my bookshelf. Chipped mugs accumulate on my bedside table. Water glasses. Bobby pins. At any given time, my body feels as though it is five feet away, uninhabited and superfluous. I dream about being violently assaulted and wake up in a cold sweat. The idea of pain — feeling anything again, regardless of how traumatizing — seems marvellous.

Doctor X’s notes of our appointments rarely exceed five two-word-long lines, and tend towards illegibility. The tight, orderly structure of his writing is somewhat pleasing when it doesn’t sting. Briefly, he mentions the “question of bipolarity,” with no further details. He refers to me as “giggly.” He decreases my dose. On April 13, 2017, he quotes me as saying: “my brain is trying to kill me.” This is all that he writes. He increases my dose. Five days later, he reports that I am “fine now.”

I remember that appointment clearly. I don’t remember much of that year, but I remember that appointment, because I cried for ten minutes straight while telling Doctor X about how much I wanted to kill myself. He seemed at a loss, unmoving in the face of my sadness. Our appointments – booked for an hour-long time slot, as they always are at Psychiatric Services — never exceeded ten minutes. I would always cry. He would usher me out at the ten-minute mark. I was not fine.

Less than a week later, I am hospitalized for the second time.

One assessment documents the following: “patient sitting on bed. Appears well groomed, wearing appropriate clothing. Short hair, large glasses. Thin. Multiple fresh cuts on forearms (~30 on left, ~3 on right). Facing window. Increased level of psychomotor activity (running hands through hair, moving fingers). No eye contact. Cooperative but seemed frustrated at having to repeat [their] story… Anxious, labile… Depersonalization: ‘does not know how to make [their] body feel real.’ Good insight.”

And then another: “self-harm with strong BPD traits.” I am described as “help-rejecting,” likely for having stated that I am uncomfortable speaking to a male doctor. “Keep overnight for safety (voluntary).” Nobody offers to clean off my forearms.

The next morning, I wake up to flakes of dried blood on my standard issue sheets. “I believe the main diagnosis is BPD, along with PTSD. Affect is fully reactive. Smiles. Has sense of humour, engages well. Copy of chart to be faxed to McGill.” At this point, they inform me of my personality disorder diagnosis.

I eat breakfast with a plastic fork and knife. Too volatile for real cutlery. A slice of bacon stares at me, dripping grease onto Styrofoam. I don’t eat meat. A med student enters the room as I am changing out of my hospital robe, breasts exposed. “Did the seroquel help you sleep?” he asks.

Given my friend’s experience with Doctor X, I consider receiving my diagnosis during this sojourn at Montreal General to be a godsend. He withheld it from me for two months, but what if I hadn’t been hospitalized a second time? Would I have waited two years? Would I have never been informed of my diagnosis, never been referred to the life-saving practitioners that I’ve been lucky enough, insured enough, unthreatening enough to patronize? The reality of my situation is that suicide was a real possibility, as it is for countless individuals with BPD, especially in the absence of appropriate psychiatric treatment. How do you make sense of personhood after suicidality? I have never known how to picture myself in five years, but I know that I will carry that feeling of constant precarity forever. I was nineteen and I was ready to die. I could have been getting better. I should have been getting better. I repeatedly told Doctor X that his treatment plan was failing me, was hurting me. He didn’t listen. That a clinician could have denied me a chance at recovery should be seen as nothing less than a slap in the face to my autonomy and agency — as a patient, as a person.

I begin to see a new clinician at Psychiatric Services. I am weaned off escitalopram. The withdrawal period is like pulling teeth. I am tired. I am irritable. I look up dialectical behavioural therapy practitioners. I am referred to the Personality Disorders Program at the Allan Memorial Institute. A week and a half passes, and my body has adjusted to life without SSRIs. Doctor X avoids eye contact with me in the lobby of the Brown Building. Sometimes I pass by his office and feel a swelling tide of dread, a visceral urge to vomit.

In September of 2017, I meet with the coordinator of the Personality Disorders Program, let’s call him Doctor Y.

He asks me about my eating habits, and I describe a consistent pattern of restricting my caloric intake. “I am unsure,” I say, “whether this actually counts as anorexia.”

He writes: “never had full anorexia, but keeps [them]self very slim.” My ribcage braces itself against taut skin, jutting through my T-shirt. His office is too cold.

He does not document my disclosures of sexual violence.

He writes: “considers [them]self a Muslim, and carries a bag with a statement against Islamophobia.” He writes: “mental status: tattoos, rings on the nose,” as though these could be meaningful markers of traumatic life experiences or neuroses.

I do not discuss my sex life at length. I mention my bisexuality. I mention being in an open relationship. I mention my minor in gender studies, of all things.

He writes: “very intellectual, justifying problems on ideological basis (e.g. [their] promiscuity, which is somewhat impulsive and desperate, is framed as polyamory).”

I meet seven out of nine criteria for BPD. He tells me that my values and intellect will be the primary barrier to effective treatment. I wonder if he has ever said this to a man.

Borderline personality disorder is stringently gendered. This is, in part, because of differential rates of accessing care — men, on average, seek psychiatric help more infrequently.

However, there are other factors at play. Due to misogynistic perceptions of women’s symptomology, they are three times more likely than men to receive borderline diagnoses. Similarly, many psychiatrists have assumed the existence of a link between gender dysphoria and BPD. Additionally, childhood sexual abuse and violence — both of which are disproportionately experienced by girls and young queer and trans youth — are considered to be potential causal elements in the development of BPD.

Misogyny is the thread which ties together this labyrinthine mess of psychiatric malpractice. I think of Doctor X suggesting that we focus on my anxiety, rather than my PTSD. Did he justify this, perhaps, with the assumption that my rape was neither traumatizing nor serious? I think of every note from a consultation or appointment where my survivorhood is not mentioned. What does it mean that Doctor Y saw a facial piercing, or the shape of my body, or a patch on my backpack as more noteworthy than rape? In “Cartographies of Silence,” the feminist poet Adrienne Rich writes:

[Silence] is a presence

it has a history a form

do not confuse it

with any kind of absence.

Omission is telling. It may let us understand what an author has taken for granted in their creation of a source. Why do we allow practitioners to dismiss rape as a reality in their patient’s lives? Where does that leave survivors?

I ask my new therapist about the rationale behind withholding a BPD diagnosis.

“The only real reason would be the risk of further destabilizing a patient who was already volatile.”Bee Khaleeli

I was asking for help, wasn’t I? I was asking in all of the ways that I could. I wanted medication that worked. I wanted therapy that worked. I wanted a psychiatrist to see my hurt, to say “you have been hurt,” and to act accordingly. In what world could that be read as volatility? I was asking as clearly and loudly as possible, but I was received by clinicians as a dumb, petulant little girl. A hysteric.

“For what it’s worth,” he assures me, “that coordinator at the Allan has terrible reviews on RateMDs.”

This is comforting for a split second, before I remember that McGill is probably still paying Doctor Y six figures a year.

My therapist thinks that writing this article will be a good outlet. We switch topics.

It is late summer now. I refill my prescriptions for sertraline and clonazepam at Jean Coutu. Little yellow capsules, flat white tablets. The pharmacist asks if I am pregnant or breastfeeding. “God, I hope not!” A joke.

Affect is fully reactive. Smiles. Has sense of humour.

My new psychiatrist says that I no longer meet enough diagnostic criteria to qualify for a BPD diagnosis — just “traits.” She weighed me at our first appointment, and immediately referred me to a dietitian for follow-up. I had a BMI of 16.2.

Keeps [them]self very slim.

My psychiatrist assigns me readings. I complete them without fail.

Help-rejecting

. . . . . . . . . . . . . . . . . . . . . . . .

Months later, in the lobby of Psychiatric Services, I ask Doctor X why he withheld my BPD diagnosis.
“I don’t recall doing that.”
I tell him that I saw my chart.
“I don’t recall you ever asking if you had this diagnosis.”

The post “MY BRAIN IS TRYING TO KILL ME” appeared first on The McGill Daily.

Judging by the mood of the audience, the latter composed of an eclectic mix of young queers, local literati, and a scattered handful of elderly folks packed into a second-floor space in the Atwater Library with nary an empty chair in sight, nobody regrets showing up. The Atwater Poetry Project has featured a smattering of queer writers since its inception in 2010, such as Zoe Whittall and Gwen Benaway, but tonight’s feature undoubtedly stands out. Self-described “writer, spoken word artist, therapist, and wicked witch” Kai Cheng Thom was joined by the inimitable Trish Salah in presenting selections of poetry, new and old. Together, Thom and Salah explore mythology, identity, violence, and trans experiences through their work.

My familiarity with Thom’s work and my familiarity with Montreal are very closely tied — I first saw her perform in my first year at McGill, at Gender Blender, a monthly queer performance event. I was struck by her dynamic and emotive stage presence, along with her capacity to sidestep all the clichés of spoken word poetry. This capacity for performance has certainly not dulled over the past two and a half years. As Thom herself tells us during a question-and-answer session following the reading, she “writes for both the page and the stage.” Her language is complemented and punctuated by affected tones of voice (from evocative sung stanzas to raw almost-screams) and a full-body commitment to the words she speaks.

Thom’s work is characterized by fluctuations between sincerity and snark, between novelty and tradition. Reading from her latest collection of poetry, a place called No Homeland, she offers a scathing indictment of “white Montreal hipster queers” (admittedly a sizeable portion of the audience) with their “tattoos of odd things like cats and vegetables.” This same piece ends with a billet-doux, a love letter, to a white trans femme lover, somehow quelling (or perhaps harmonizing with?) the frustrations produced by exclusion. Here, the whiteness of the queer community does not (and cannot) exist independently from the author’s experiences of tenderness and intimacy. The two realities are inextricable, and ultimately inform one another.

[Kai Cheng Thom] offers a scathing indictment of “white Montreal hipster queers” (admittedly a sizeable portion of the audience) with their “tattoos of odd things like cats and vegetables.”

Salah’s performance follows; she reads from her collection Lyric Sexology, which was re-published by Montreal-based Metonymy Press last year. She describes Lyric Sexology as a “series of archives” in which trans, non-binary, and gender-nonconforming subjects encounter various gendered realities within existing historical narratives. Within this text, an ancestry of sorts can be constructed. Salah’s first example of one of these “forefathers” is Greek mythology’s blind seer Tiresias; with just a trace of wry humour, she notes that “Tiresias would undoubtedly contest this status.”

Nevertheless, Salah reminds us that Tiresias was “a boy before he was a man, a man before he was a woman.” By selectively adopting components of an existing myth, Salah refashions it into an undeniably queer narrative.

The notion that we lack a coherent queer and/or trans history is certainly not unique. This is not the outcome of community disinterest or disengagement — rather, this absence of queer ancestry is produced by the absence of historical sources which we would otherwise rely on to produce our stories. Documentation of our predecessors is often found in medical, legal, and legislative texts, which are more often than not skewed by homophobic and transphobic prejudices. Furthermore, queer people lack access to direct intergenerational transmission of information, a central component to the preservation of history in communities tied by ‘blood’ and biological family.

Salah offers the queer reader and listener a type of appropriation — a solution to our absence from history. This coveted ancestry is created by writing the queer and trans subject into a pre-recorded past. Some of this ancestry is particularly fraught, such as Salah’s queer rendering of American suffragette and eugenicist Charlotte Perkins Gilman. Salah pauses to mention that these queer re-imaginings of history inevitably implicate race and nationhood. These realities complicate the production of queer ancestry. Where and how do we find traces of queer experience in stories that are often oppressive and violent? How do we address this violence?

Documentation of our [queer and trans] predecessors is often found in medical, legal, and legislative texts, which are more often than not skewed by homophobic and transphobic prejudices.

Salah’s work also calls to mind ancestors of ours who are written into in history, and those who are not memorialized on their own terms. An account of Daniel Paul Schreber — a German judge who propounded that God was turning him into a woman and was subsequently diagnosed with psychosis and institutionalized — reminds us that “Lili Elbe would be saved by her doctor/Herr Doktor,” but Schreber and many of our queer ancestors were not so lucky. Unlike Elbe, who was immortalized in film as one of the first recipients of genital reconstruction surgery in The Danish Girl, Schreber’s queer experience was preserved in the writings of Freud, who linked his supposed psychosis to repressed homosexual desire.

Salah offers the queer reader and listener […] a solution to our absence from history.

Salah’s work ultimately reminds us that our queer and trans histories are neither static nor concrete. It offers readers and listeners the agency to construct our own lineages and mythologies, ultimately functioning as a remedy to the grim realities of queer loneliness and futility.

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