The White/Straight/Cis world of Psychiatry

I went to a conference last weekend. It was a psychopharmacology conference in New York City. I hadn’t been to a conference overnight since I was seven weeks pregnant. I have done my continuing education credits online or as one day trainings. I was excited to get away, excited to stay in Manhattan kidless and wifeless, and excited to be going to a conference. Because I can totally geek out on psychopharmacology and neurobiology.

During the introductions I looked around. It was a beautiful snooty hotel and the grand ballroom was full. There were a lot of white people. A lot of middle age and older white people. I counted. There were four people of Color out of probably four hundred. There was one person wearing a hijab.

I also distinctly felt out of place as a Queer. I didn’t get the sense there were many of me hanging out there.

I have a love/hate relationship with where I trained. It was with several middle age white  straight men. They made ignorant statements about transgender individuals and they made statements like “she just has ‘Hispanic-itis'”. Yeah. That happened. More than once. However, they were and still are, considered leaders in our field. In fact at this very conference there were at least three papers presented by the team of physicians I trained with.

I learned so much from them but I also learned about sexism hardcore in the workplace. I learned about misogyny and racism and transphobia in healthcare. I learned that these were all things that these physicians would never say they are (sexist and racist and transphobic) yet their actions spoke louder. It was just all overlooked because they were brilliant.

Well apparently that’s universal in psychiatry. Because here I was, in a room full of leaders in our field. None of the presentations mentioned minorities. In the presentation on “Treating the Medically complex with Psychiatric Medications” not once was it broken down to say that maybe treating African Americans with Lithium would be bad as they have a higher risk of kidney disease. Nor was it mentioned about treating transgender individuals and let me tell you, they are some of the most medically complex patients I treat, due to the hormonal and surgical interventions they face. Also they have the highest suicide rates and substance abuse/use of all the minorities I treat.

But yeah, it seemed like every one in the room, the leaders in my field, were focused on treating white straight cisgender middle aged individuals.

I’m not knocking white straight cisgender individuals, I mean, some one has to treat them, and it sure as hell isn’t me.

But they tend to have access to better medical treatment, to more preventative measures, and lower suicide rates and lower substance abuse percentages. Which sort of keeps them off my radar as high risk.

Anyway. So I’m at this conference. Not learning anything about the populations I treat the most. Thinking about all my clients who are people in minorities who have been put down by other psychiatrists. Told they aren’t depressed that they are “transgender which just makes you depressed” or that they weren’t necessarily raped, because “you were bigger than the person who raped you,” that they aren’t starving because “don’t you have a mother who can buy you food?”

And it just hurt me. That my field is so disgustingly and ignorantly privileged. That we as a field put off the minorities and individuals who are most vulnerable to mental illness because of our own privilege and biases.

That conference sent a survey for feedback. I politely stated that I would likely not go back due to a lack of diversity among the presenters (who were all white) and among the topics presented.

I realized that all the trainings I’ve done in the last six years have been targeted toward the Queer population or another minority. Apparently that’s how I roll. And unfortunately the world of psychiatry in general doesn’t.

The world of psychiatry needs to expand it’s boundaries and invest in educating themselves and others about minorities. Because good lord if my work experiences and this weekend with the “leaders” in my field was any indication, we have a long, long way to go.

In the meantime I’m going to keep treating my Queer folk.

I’m grateful for all the therapists I work with who also treat minorities and excel at it. And I’m grateful for my clients. Many of whom have been marginalized by other mental health providers and medical professionals and who have continued to fight and persevere and continued to engage in treatment for their own mental health.

You are the bravest people I know.

For the record individuals can be transgender and depressed- as in separate issues. Sexual assault is sexual assault. And some people have parents who have abused them, so no they can’t call them for grocery money. Ignorance is not bliss. Ignorance is ignorance. Educate yourself.

Dear White Suburbia. Stop Permitting Sexual Assaults. Thanks. Sincerely, All the girls and boys who have been victims.

Let’s get this out in the open first. No high school student wants to be the victim of a sexual assault. No high school student then wants every one in their school to find out they are the victim of a sexual assault. It’s the kind of notoriety that blows.

I’ve been the person told about a sexual assault more times than I care to count. Comes with the territory of outpatient mental health. Sometimes it’s twenty years later. Some times it’s twenty days. Sometimes it’s twenty hours.

The number of teenagers and women I’ve processed sexual assaults with staggers me. Because yes. While sexual assault definitely happens to males; I have a far larger number of female victims in my practice.

The number of times the perpetrator has been prosecuted- out all of the cases I’ve had- maybe twice.

The number of times the victim reported it and the police interviewed them, the DA reviewed the case, their psychiatric and medical records were released to the DA and the police…and then nothing happened…too many times.

The really fun part is when they report it to their high school. I learned this over the last few years having moved my practice to suburbia. The high school does their own investigation. That’s right. Even when the police are involved, DCF, and every one else, the high school, under the guise of Title IX conducts its own interviews. With the victim. The witnesses. And the accused perpetrator.

In the meantime in all of my cases…the victim is expected to change their class schedule, not go to prom (because they can’t actually tell the perpetrator not to go apparently?!), and basically completely invalidate the victim at every turn. All supposedly legally under Title IX.

There is a culture of victim blaming, victim shaming, and “but he’s on the wrestling team!” shock and horror that any one could make “him” uncomfortable by bringing up the fact that he perpetrated a sexual assault.

These cases are in white suburbia. I had SIGNIFICANTLY fewer of these cases I mean significantly fewer, when I worked in a city with a very large high school and a diverse make-up. I spoke with a police officer in one of these small towns and said is it just me or is there a lot of sexual assault here? They told me it wasn’t just me. That it was a problem in their small town.

The victims first have to deal with telling their own parents. Which sucks. Every time. Then had to deal with telling me or another mental health provider. Then they told the police. Then the district attorney. Then the freaking school. Who then in multiple cases told the girls to basically change their class schedule and adjust themselves around the perpetrators schedule because they couldn’t ask the perpetrator to change anything.

I actually received calls from a nearby guidance department who were trying to elicit from me that my client’s behaviors were just that. Behaviors. They were avoiding class because they simply didn’t want to go. I just about lost my mind. I said if the perpetrator who sexually assaulted me was in my class I also would not want to go. I also would act out behaviorally. That particular guidance office doesn’t call me back anymore.

Schools are failing our children. In so many ways. Victims are  gaslighted and perpetrators are let off without even a slap on the wrist. We have created a culture of invalidating our children who are sexually assaulted because we are too scared to stand up to the wealthy white families of the perpetrators. (Eh hem. Kavanaugh. Starts at the freaking top people).

The victims are told to basically shut their mouths, sweep it under the rug, and go be a good girl now.

Fuck that nonsense.

Since I started writing my blog clients now and then will tell me they read it regularly. I don’t hide it, but I don’t promote it.

So to all of you reading. I am angry for you. I am hurt for you. I have called school administrators who left me voicemails back that their guidelines are published online and they will not discuss this further with me.

They obviously haven’t met me.

There will be discussions. If I have to plant myself in a board of education meeting until some one will listen to me every month they have them. Then I will.

I know it’s exhausting for you to constantly be fighting for your rights. I know you want to keep your head down and just make it through high school. I know you don’t want your parents to fight as hard as they want to because you just want things to go back to normal.

If that’s what you need; keep your head down. I got you.

And to anyone else reading this know that we as a society have to do better. We have to empower victims of sexual assault not demoralize them. We have to prosecute perpetrators yes even and especially when they are white and especially when they are wealthy. We can’t let this cycle continue because our children are suffering.

 

 

 

Why Parents Don’t Sleep…Wetting the Bed and Monsters in the Closets.

It was about 12:36 AM when I stood in the boys room trying not to scream. Not succeeding very well. I had tried to rationalize. I tried cuddling. I was now at the state of speaking loudly, “There are NO MONSTERS in this house! There is just me, you, Mommy, and Jackson and we are all trying to sleep and it’s not fair that you are keeping us ALL awake! I’m tired! Stop.”

With tears brimming in my eyes he finally seemed to realize that I was tired and there were in fact no monsters.

The boys were never good sleepers. I got to the point where I wanted to throat punch anyone who asked me or stated to me “They still aren’t sleeping through the night?! Did you try….” because the answer was always no. They aren’t sleeping through the night. Yes I tried that. I tried every damn sleep remedy you can imagine.

Three and a half, nearly four years later, the nights are slightly improved.

There are more full night sleeps. Which almost makes the interrupted nights harder. Now it’s not that they want to nurse. It’s that they peed the bed. This week it was one night of peeing the bed and the following night of waking up screaming because there are clearly monsters in our house.

Now if I peed the bed I would want it changed silently and then I would want to immediately crawl back into bed. When one of the boys pees the bed, it’s a freaking scene. There is inevitably some piece of blanket or animal that gets wet that has to be washed which causes the epic meltdown which means we are now all fully awake.

It’s not an easy clean-up and back to sleep. It’s a clean-up of hell followed by more screaming hell. Followed by all of us eventually back in our own beds wide awake. Then the cat who is now frazzled and annoyed starts meowing and making a scene because she was disturbed.

Then the monsters. They literally watch PJMasks and Dino Dana. Nothing scary. No monsters. I mean minus the dinosaurs, but they are generally not scary.

But my son wakes up with complete confidence that there are monsters in our house and it takes me losing my damn mind to convince him otherwise. The lights are already on. The closets are checked. They sleep with the hallway light and the light in the bathroom on. Tonight I added an Elsa nightlight. It actually projects Elsa onto the ceiling. He seems obsessed with it and I told him it will keep all monsters away.

Fingers crossed.

At some point they will sleep through the night. At some point I will sleep through the night. I can’t tell you when that will be. I can tell you that if a parent tells you they were up overnight don’t ask why the kid isn’t sleeping through the night. Trust me if there was a magical cure that didn’t involve us all melting down at 1 AM about pee on the sheets or the freaking cat meowing or the monsters…I’d be all over that.

And yes. We limit fluids before bedtime for two hours. Try keeping that boy away from the faucet though. He steals cups from his toy kitchen and sneaks into the bathroom and drinks water. Then when he pees the bed and is screaming because we have to wash the towel he’s snuggling with- he wants a cup of water because the crying “makes my mouth hurt and I need water!” So yeah. The struggle is real.

I’ve had many people say, “Just enjoy being up with them at night and all the snuggles because these days pass too quickly,” or some equally quaint saying. I also want to throat punch those people. The days may pass quickly but the nights are torturously bad and long. I don’t know what kind of stuff happened with their kids at 1 AM but with mine, we are not quickly and quietly snuggling then drifting back off into a peaceful slumber.

We are more like a massive cat fight where there is chaos, screaming, urine scented, and at the end we all retreat attempting to lick out wounds before passing out.

I will never miss the chaotic middle of the night scenes. Nor will I miss the epic hangover feeling the next morning but without any fun drunken memories just a hazy recall of reasoning with a three year old about there being no monsters in the house. I won’t miss the dread with which I approach sleep the subsequent nights knowing my slumber could be interrupted at any moment by screams from pee and monsters.

Instead at some point, some night, I will realize I have slept through the night. Many nights in a row. And then I will do a fist pump and think sweet. I survived.

 

*** My business partner has twins. She told me when they were newborns that I wouldn’t get any sleep until they hit at least six or seven. She apparently wasn’t wrong. To all the twin mom’s out there. Hang in there. Six or seven years….we got this. I’m almost to year four…

 

Explaining Death to Three Year Olds.

When I called my wife around 1:30 on Tuesday she knew something was wrong. She knew I was supposed to get my first allergy shot at 1:15 and that I generally don’t call unless something is wrong.

After about sixty seconds from the time of the allergy shots- there were three- my throat started to close. It’s an odd feeling, not totally like my throat was closing, more like it gets tight and so itchy that I want to stick a coat hanger down it.

The nurse was pretty calm, though she later told me I gave her some gray hairs, as she told me I was having an anaphylactic reaction and they needed to give me epinephrine. The allergist came in, he’s also one of my favorite doctor’s, and also calmly explained what was happening as I was injected with epinephrine. My throat opened up, and then they gave me benardryl and told me to call some one.

I had to get a second shot of epinephrine about thirty minutes later because the whole throat closing thing started again. In the middle of it I was surprised and at first, not anxious. But then as I realized what happened and remembered all of the cases of anaphylaxis in the emergency department I took care of, I started picturing the worst.

Three days earlier I threw out my back. So I was also uncomfortable.

The next day I went to work. My arms hurt from the shots, and I had started wheezing the previous night leading us to wake up at 2 AM to make sure I didn’t miss a Benadryl dose and albuterol. Then I went to work. Being my own boss, knowing I’m taking three days off next week, I don’t get PTO. I saw patients with a sore back and sore arms, wheezing, and hoping the anaphylaxis was going away.

That was last night. I stayed at the office until after seven, catching up on paperwork and billing after seeing thirteen clients.

I came home but eight, to my wife saying the boys wanted to say goodnight. I dragged myself upstairs, and fell into bed with my Jackson. He told me all about his day. Declan chiming in at times from his bed. Then Declan asked about going away on Sunday. “We goin to Hampshire?” “Yes baby, we are going to New Hampshire,” “With Gramma?” “yes baby with Gramma,” “Mama!” “What baby?” “We forgot Poppy!”

I was half asleep, feeling like I got hit by a truck, and my son chooses to bring up my Dad. He died in April. We went to New Hampshire together as a family every year. This will be the first time for us up there without him.

“What do you mean?” I asked.

“Poppy going to come down from the sky to Hampshire?”

At this point I had tears in my eyes, “No baby, he’s not,”

“Aww, Mama, then he won’t give me a hug and a kiss. I wanna hug Poppy,” he said “I want him to meet Hediz and give him a hug too,” (a friend at daycare).

Now I’m openly crying, and I choke out, “I miss his hugs too baby. I wish I could hug him too. But it doesn’t work that way. He’s never coming back from the sky, he’s an angel up there now baby.” He looked disappointed but accepted this. Jackson sat up and gave me a hug. Then I kissed them both goodnight and walked out of their room.

I walked downstairs sobbing and tried to explain to my wife what just happened.

The thing about parenting is that I am never prepared for those moments. I had a shitty week. It was only Wednesday! I was ready to fall into my bed and sleep. Instead I was caught off guard by a random thought from my son about my Dad. They go weeks without mentioning Poppy. Then the night that I am feeling physically and emotionally beat is the night I have to further explain that he is actually permanently gone. It’s the night I have to think about his hugs, and how much I miss them.

It’s been six months since he died. I dread each day because I think about him every day. But I look forward to each day because it’s one more day we make it through since he died. I keep waiting for the day it gets easier. So far it’s not here yet.

Within a twenty four hour period I was recovering with my back, I had an anaphylaxis reaction so bad I required two epi-pen’s, I saw thirteen clients at my practice and saw six patient’s inpatient at the hospital, I fought with Anthem, shocker, and I explained death to my three year old twins. Again.

The whole adulting thing is overrated.

Parenting makes me appreciate and admire all parents. We all have these moments. These five second moments that make up our day that bend us, touch us, torture us, because our kids are innocently enquiring about something that can be incredibly triggering for us.

I don’t get days off or time outs as much as I crave them.

Tonight we made cookies and doughnuts (I bake them) and butternut squash Chile. I did three loads of laundry, and I tried not to think about the packing I haven’t done for New Hampshire yet. But we didn’t talk about my dead Dad and they fell asleep without screaming. I’ve had about an hour to watch The Office, write a blog post, and fold all three loads of laundry.

At some point this week will be over. I likely won’t remember that my back was thrown out or the emotional toll of my clients this week.

But I will remember my son asking me if Poppy can come down from the sky to hug and kiss him. Because it’s something I wish with all my being could be a reality.

 

Transphobia and Homophobia and Excuses.

Recently a client told me a story of them walking in a grocery store and being approached by a random woman who simply stated, “Why don’t you just be the (gender) you were born to be?” My client is trans.

My client is good natured and did not respond, just smiled and wished them a nice day and walked away. They relayed it to me with good humor and no malice. “They were older, they were of a different generation,” all the excuses they could give for that woman they did.

But it rubbed me wrong. I am very protective of my Queer clients and frankly it pissed me off. I’m sick of the excuses allowed for people who are homophobic and transphobic. Just because you are of a “different generation” does not provide allowances for being hateful and discriminatory.

I come back to my Nana. She was 90! She accepted her two gay granddaughters and our kids. She accepted her Queer niece without question. She was born in the 1920’s and she was clearly of a different generation. But she loved her family and would not do anything to hurt us.

“Yes but she was so lovely and kind,” I can hear it now…the excuses. Why my Nana could be accepting and tolerant and others can’t be. I don’t want to hear it. I’m sick of hearing it. I’m sick of the hate being excusable based on your age, religion, or ethnicity.

There are no acceptable excuses for homophobia and transphobia. None. Not one.

I’m part of a lesbian moms group and a frequent topic of conversation is “What do you say when some one asks you about how you had your kids?” or “How do you respond when some one asks ‘who is the real mom'”? People generally are kind in these responses. I am less so. I am sick of being kind in the face of ignorance and malice.

As a minority do you have any idea how exhausting it is to be the one to take the high road? But then if we respond with any type of anger or sarcasm we are “bitchy or PMS-ing or giving lesbians a bad name” or whatever.

I’m tired. I’m tired of hearing story after story of people being fired from their jobs for being Queer (YES it happens and is legal in most states). I’m tired of feeling like I should be kind when people ask me intimate questions about how my kids were conceived. Because honestly what happened with my vagina, cervix and uterus is none of your business.

I’m tired of trying to engage conservative websites and pages by asking questions in a non-confrontational and non-insulting way (but bringing to the surface hatred and discrimination) and instead of having a dialogue with me being blocked. How can we create change if the conservative right won’t even have a dialogue with an individual on the left? I don’t understand! They call us snowflakes yet they cannot even bother to answer my questions. They just block me. To date roughly ten facebook pages and blog pages have blocked me. After not once answering my questions. But I’m the snowflake. Eyeroll.

I’m tired of hearing about the homophobic administration and all their bullshit.

What keeps me going? The Queer youth. The trans kids I meet who are brave enough to transition in this awful climate of transphobia where WE are DYING. Suicide and Homicide are taking us. Yet my trans clients persist. They wake up and face each day with an inner strength and fortitude that I am consistently awed by.

The Queer youth who are gay and lesbians and bisexual who fear coming out to their parents and friends but who do it anyway because they are not snowflakes. They are the strongest people I know.

I’m tired yet I persist because the Queer community persists. Because even in the darkest of times all you need to do is turn on the light. (Albus Dumbledore)

If you are old it’s not an excuse. If you are young it’s not an excuse. If you are religious it’s not an excuse. There is no excuse for discrimination, intolerance, and hatred. Cowards hide behind age and religion. True strength lies in every Queer youth waking up to live another day in this state of adversity. Rock on. 

And to the old lady in the grocery store. Come see me. I’m happy to explain why they are not the gender they were “born” to be with a full bibliography of references. Also: stop going up to random people you don’t know and feel it’s okay to make statements and judgments to them about their gender identity or sexual orientation. It’s not nice, it’s wrong on many levels, and could be considered harassment which is illegal. Just stop.

Otherwise I feel it may be my duty to start going up to random old women making transphobic statements asking “Why are you not being the kind loving person you were born to be?”