Tag: mental health

“Tilt When You Should Withdraw”
Nursing

“Tilt When You Should Withdraw”

lesbehonest2017Leave a comment

You know you’re a millennial when…the movies of the late 90’s and early 2000’s still define who I am as a person. And they are grossly underrated by all these twats coming after us. You know I’ve met multiple people (mostly my clients in their early to mid-20’s) who have never see Lethal Weapon or Bad Boys? To be fair Lethal Weapon was 80’s but Bad Boys?! None of them! Do you know how many times I’ve referenced a line and they stare at me blankly or worse like I’m old?!

Despicable. But the worst is if they have not seen A Knight’s Tale. Not only is Heath Ledger probably one of the best actors to live (and die far too young) but it’s hilarious, sad, poignant, and action packed.

It’s also historically relevant because it’s loosely based on Chaucer’s A Knights Tale. There are many parts of this movie that speak to me, essentially the whole movie. Because it’s an underdog story of a young man being told he can’t. But then he does. I have always felt that. As a girl I was told I was too smart, too loud, too opinionated, as a woman I’ve been told the same.

All William wants to do is joust. And he’s rather good at it. He builds a team ultimately who believe in him and who stand in front of him in the stocks to block the rotten food being thrown at him. That’s when Prince Edward unveils himself and steps up to William who is dirty and weak and bent in the stocks.

Prince Edward (who is also kind of hot) leans over and says “What a pair we make huh? Both trying to hide who we are, both unable to do so. Your men love you. If I knew nothing else about you, that would be enough. But you also tilt when you should withdraw…and that is knightly, too.”

Tilting exposing a knight’s face and leaves them vulnerable to injury but it also gives them the most advantage in striking their opponent.

That scene gets me every time. I’m usually crying by the time he pulls William out of the stocks and he shakily kneels in front of the prince.

It’s quite a thing to be seen. To truly be seen. If you think about it there are very few people we come across in life who see our true selves for all that we are. Who have the patience, the insight, and the ability to see who you are.

That scene gave me hope as a teenager that I could be something more. That I could “change my stars” and along the way I would meet people who truly do see me.

I had to grow into a person I was proud to have people truly see. It was hard in nursing as a confident, smart, and direct woman. The feedback was mostly negative. And the message was to do my job and not question management even when nurses were being assaulted and abused. God forbid I ask for mental health services after a major assault or updated TdAp vaccines for the entire staff after two pertussis exposures to me personally and twenty other staff members.

It took distance and time and therapy for me to realize that what I sought was not wrong. I’m allowed to take up space and ask for reasonable accommodations, help, and support from my employer especially when working in high acuity and dangerous areas.

People seemed to listen when I spoke. I was told by a manager after I became an APRN that I was an “unofficial leader” because they knew everyone would listen to me but that I was not actually in charge. That surprised me. I didn’t realize people paid attention to me honestly.

That conversation opened the door for me to open my own practice. I was not wrong to be smart and confident and direct. I was not wrong to expect a safe work environment. And I could get that. But I’d have to do it on my own.

Five years later I am safe and I’m surrounded by people who truly see me and appreciate me personally and professionally.

It’s been validating to be in business for myself and treat employees the way I wanted to be treated and to see their appreciation and the loyalty that it builds. I’m not perfect. I’m still too direct. And I am impatient sometimes. And maybe too patient other times. I also tilt when I should withdraw- I fight the fight for clients, employees, I fight insurers, and my favorite line is “I’ve got nothing but time,” whenever I’m told that something is not possible…I make it possible. And my friends, family, and co-workers see this.

They see me and finally that what were perceived as negative traits are actually positive and have helped me grow a business and expand mental health services for the Queer community.

I’d like to think if I was in the stocks I’d have some people who would stand up to block the rotting vegetables from hitting me.

That’s a good feeling actually. Knowing I have people who see me and who think I’m worth protecting. They also would probably make very sarcastic remarks and jokes to work off their anxiety in the moment but they’d be there. (You know who you are;)

Because that is what’s important right? To have people who would block the rotten vegetables from you.

And every Gen Z-er reading this…this is why you are missing out. You don’t even know one of the life goals you are supposed to have. Lord have mercy.

My Thoughts on Treating Murderers signed: a nurse.
Mental Health Stigma Suicide · Nursing

My Thoughts on Treating Murderers signed: a nurse.

lesbehonest2017Leave a comment

Working in private practice people sometimes make the assumption I only treat the “worried well”. Every prospective employee I interview I tell them- while there are serious perks to private practice including total control of your schedule and fully remote work…we still treat sick people. You may get an easy straightforward anxiety…but you likely will have some serious cases that will push you.

For me, I’ve treated…a lot. I’ve treated sexual abuse victims, incest victims, victims of DV, and many other incredibly intense cases over the years.

What has been surprising for me, and what no one ever discussed when I attended school and training- were treating patients who committed murder. Working both inpatient and outpatient I’ve treated roughly 40-50 patients who have committed murder in some capacity.

There are many different kinds- negligent homicide is something like a drunk driver who hits a car and some one in the other car dies- basically an unintentional homicide but caused by the person’s negligence. There are homicides that are intentional, or perhaps just witnessed but the witness is held responsible for not stopping it or for contributing to it, and the saddest are probably the murders committed by people in a psychotic state such as with postpartum psychosis- those are probably the most publicized in the media.

We learn a lot about transference and counter-transference in school- and we do talk about how it would feel to treat a perpetrator of a sex crime but for some reason we never touched on treating some one who commits a murder.

But it’s an important conversation to have.

Working in mental health has caused me to take stock of my values, ethics, and core belief systems…and made me re-evaluate all of those things repeatedly at a very visceral level.

I remember working in the pediatric emergency department. There was a certain coldness projected toward the parents that overtook all of our demeanors when we realized the child we were treating was the victim of abuse- whether sexual or physical. At some point the truth always comes out. And I did treat some children who died of their injuries. And if you could have bottled the rage in the room from the healthcare providers…well that would be some potent nuclear energy.

So I had that background going into mental healthcare.

Then I sat across from my first patient who committed a homicide. I did not have that rage encompass me though. I still do not. I think they expect it. But as the mental health provider treating the perpetrator of a crime, well they are still my patient, and I treat all my patient’s the same. With respect and I try to come from a place of empathy and understanding.

In reflecting on murderers I’ve thought of my Dad. Was he a murderer? Not by my our standards I suppose. But he did kill people when he fought in Vietnam. He was a gunner on a helicopter- one of the big ones where the sides are open…hopefully you’ve seen enough war movies you know what I mean. I asked him one day when I was old enough to realize what a “gunner” meant “Dad does that mean you killed people” and in typical Dad fashion he said, “Well I killed more cows than people hon,” and that was that. My Dad was excellent at non-answers. Especially about Vietnam.

So I suppose the first “murderer” I sat across from at a table was my Dad.

So you can see why I have a stronger response to pedophiles than to murderers? Murder I’ve had to assimilate and rationalize because I grew up the daughter of a combat veteran. There ain’t no assimilating or rationalizing pedophilia though. That’s never okay. Not even in war.

I am speaking somewhat facetiously because the double standard is absurd. Murder is never okay. Pedophilia is never okay. But we live in a society that is more okay with murder than any other type of crime. As evidenced by the lack of gun legislation in America after the first mass school shooting. We receive the message from the highest level of politicians and courts that murder is justified as long as it’s with a gun that you should be free to carry.

We also live in a society with combat veterans who have committed legal murders. And we praise them, respect them, salute them. I am not saying we shouldn’t do all of that. I am grateful for all the people who have served and continue to serve our country because I see the sacrifices they’ve made in my work every day in the veterans I treat who carry such shame, guilt, and trauma.

I used to be very black and white in my thinking. Back when I was 22 and thought I could be part of the solution in saving the world. I’m 37 now. I’ve seen children die at the hands of their parents- intentionally and unintentionally. I’ve treated men and women who have been raped and who have killed.

I also grew up with a Dad who was a Vietnam veteran and deeply committed to the love of his country.

Through all of this I’ve come to realize there cannot be a black and white version of myself or of mental health treatment. I’ve treated rapists who I did trauma work with who were deeply wounded humans perpetrating in the cycle of their own traumas. I’ve treated incredibly brave and resilient victims and supported them through court proceedings to bring their perpetrator to justice. I’ve treated murderers who carried the deep wound of taking a life. And I’ve treated murderers whose murders were legal in the face of battle but who have to make the decision to live every day because the incredible wounds they feel internally drive them so close to suicide.

There is no black and white and there is no right or wrong. What I’ve discovered in myself is that I have to present myself with empathy, understanding, and I have to listen to my gut and bodies responses. If my body is telling me that there is no remorse here, and potentially sociopathy, our consultation appointment is just that. A consult. And I will not be following up with them.

But those are rare. More common is the person who is just a person. Trying to survive. Who was thrust or who put themselves into unthinkable circumstances and who are spending the rest of their lives trying to not be defined by that one moment. There is grief for the person they once were, compassion for who they are in this moment- vulnerable and seeking a non-judgmental space- and hope for the person they can become.

Fifteen years in and I still love being a nurse. I love this field, I love that it pushes me to see beyond society’s expectations and norms. I love that it makes me examine my own weaknesses and prejudices and challenges me to do better and be better. In these cases it’s pushed me to examine my beliefs about “murderers” and what I found is they are just people with a story. Stories that deserve to be told and to be heard.

p.s. #banguns #fucktheNRA

p.p.s. For all those asshats saying you should have the choice to not treat people who are LGBTQ…you are assholes. If you continue in that vein for your “religious freedom” shouldn’t you also not treat adulterers, murderers, pedophiles…etc? How come you can decide to not treat one population of people but not all the rest? How come you are more comfortable treating a heterosexual murderer than a law abiding non-rapist and non-murdering lesbian? Y’all need to have a Come to Jesus moment. Cuz you make no sense. Just own it and say you are homophobic and transphobic.

This Traumatized Nurse
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This Traumatized Nurse

lesbehonest2017Leave a comment

Part of my practice that I never planned on but am incredibly grateful for are the nurses. Nurses sticks with nurses. So it makes sense that many seek treatment with nurse practitioners.

Nurses are a crazy bunch but we wear our crazy on our sleeve. I’ve said to nurse clients many many many times…”You have a high tolerance for crazy because of your work, so I’m telling you, what’s happening in your life- insert something crazy here- is not okay, and you are tolerating it because your ‘crazy’ tolerance is way too high.” This is actually generally well received and then we process how to address whatever issue they are dealing with.

So here I am in my therapy session today. I said, listen, there’s been a lot of crazy in the last couple weeks, but I need to focus on these panic attacks I’ve been having. I’ve never had panic attacks before, and I kept forgetting I was having them because they were so infrequent.

The first one was two years ago. I was working inpatient and a patient became agitated and stood over me and threatened me. My heart raced, I completely froze, then when I finally left the room I couldn’t calm down. I had to go outside to my car, not speak to anyone, and just sit there and let myself freak out.

When I tell you this is not me…this is not me. I was an ED nurse, I’ve worked inpatient psych, and I’ve had a lot worse situations come at me. Like actually come at me. I went home that day and forgot all about it. Thought it must have been a fluke. Then I worked inpatient again. Similar situation except this time a patient told me he was picturing shoving a knife in my throat while standing over me. Again- this was not out of the ordinary for inpatient work.

Then recently I had music playing and at the end of the song there are two men who become agitated and start fighting. I forgot the song was playing and all I heard was two men yelling at each other, and I freaked out. I looked all over the house and out in the driveway thinking there were actually people getting agitated. Heart pounding. Etc. So I tell all this to my therapist and I say, we gotta do something about this. Because I’ve never had this happen before and it keeps catching me off guard.

She asked me to describe what happened. I did. Then she said, “You know those experiences where you have people physically and verbally threatening you- it’s normal for a person to have their heart race, it’s normal to feel threatened because you were being threatened. Those are not typical panic attacks, they are normal reactions to a stressor.”

Dude. I actually argued with her. I was like, uh no, those are normal occurrences when I work in the hospital. Then she argued back, and then we literally argued about me being threatened. And of course I was threatened. Of course those are normal bodily responses to feeling threatened. What’s messed up is that I literally never thought that.

I thought there was something wrong with me for reacting to people threatening me.

Sit with that for a moment.

That’s what happens to nurses who work in high acuity settings. We are led to believe that there is something wrong with us for expecting to feel safe. I argued with my therapist about my reacting to being threatened. I tried to rationalize that being threatened is normal and there’s a problem with me- not the setting.

Is it any wonder that nurses are fleeing the profession? Why do I feel weak for having a normal physical and emotional response to being threatened? Why do I feel less than and ashamed? Because I have been trained to feel that way. I have been trained to see the problem within me instead of in the messed up hospital systems who do not protect us.

I have been- kicked in the ribs, bitten, spit on, rushed at multiple times, had a chair and a laundry basket thrown at and over my head, had a knife pulled in my office (twice), been verbally threatened countless times including outpatient “I will drop your ass” “I will fuck you up” and so much more. I have witnessed horrific assaults. I have witnessed horrible takedowns. I had a patient, most memorably, leap across a table and land on his knees nose to nose with me, hands fisted on either side of my head and say, “All it takes is a punch. And poof. You’re fucked.” I sat there and stared back at him, and as the entire staff gathered outside the door because the whole unit saw what was happening I calmly leaned in closer and said, “You done yet? Take a fucking seat.” Without blinking. When the laundry basket got tossed, I said, “Dude you are not,” He said, “Ma’am, you better put that pretty head down.” I ducked. He threw it. Not aimed at me.

So many more stories. So many more memories. So you see, when a patient stood up agitated, and I epically panicked, I thought there must be something wrong with me. Because I’ve been through so much worse so many times. I never got time off after any of those events. Except the kick in the ribs. And literally only because there was some minor damage to my liver and a visible large bruise over my right ribs. I never got debriefed after most of these events. I certainly never got a raise or hazard pay.

And in fact when I got time off for the rib kicking- my manager and co-workers made negative comments about it. As if I was weak for being told to take time off by occupational health.

It was all a day in the life.

But now that I do mostly outpatient, and I’ve had space and distance and time to heal. My body and my brain are telling me this is fucked up. When I go back to inpatient and am threatened I apparently react appropriately now. I’m not in survival mode, so I can’t just compartmentalize it out.

I am not sure what the answer is. I do not want to give up inpatient. But my therapist seems to think it’s kind of a messed up place to work. And after much reflection I don’t disagree. It makes me sad to realize that this work I used to love is actually totally ass backward and so detrimental to people’s mental health. Nurses. To nurses mental health.

Even writing this feels bad. I feel shame? for having such a perceived weakness. Then I think this is soooo messed up that I think a weakness is having a normal physical reaction to being threatened. I’ve been told it’s not a panic attack when it’s a normal stress response to being threatened. So my not-panic attacks suck. Being threatened sucks. Being a nurse who thought there was something wrong with me for having an emotional and physical response to being threatened…is just tragically sad.

To all my nurses. It’s not you. It’s them. You are not wrong or bad for demanding safety in your workplace. You are not wrong or bad for having feelings in whatever capacity about being unsafe in your workplace.

The White/Straight/Cis world of Psychiatry
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The White/Straight/Cis world of Psychiatry

lesbehonest20173 Comments

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.

Working in Mental Health Must be Crazy.
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Working in Mental Health Must be Crazy.

lesbehonest2017Leave a comment

I generally don’t tell people my profession right away. If they ask what I do I say “I’m a nurse,” that’s usually enough. If they ask further I say I work in mental health. If they ask further I say “I own my own practice.” I try to keep it short and simple.

People’s general response is “Wow that must be crazy,” or they ask what kind of people I treat, like the people I treat are some sort of sideshow freak. I always respond that I treat many different people. Again to just close the subject.

A couple reasons: I don’t think discussing my work is appropriate in most situations. All of what I am told is confidential and protected. I work hard to protect my client’s privacy. Basically any discussion about them could be perceived as disclosing too much.

I don’t know what everyone’s story is. I could say that I treat a lot of sexual assault victims, and trigger the person I’m talking to who may be a survivor of sexual assault.

I don’t want to hear about everyone’s story. If I’m at the grocery store or at the gym I don’t want to know your mental health history. I just want to exist in the world in that moment without bearing other people’s shit.

So yes. I can be rather closed off about my profession. Not because I’m not proud of it and the work I do. Because I am. I love my work. I love that it’s unpredictable. I love that my long term clients trust me and look forward to seeing me. I love getting referrals from my clients because I know they trust me to see their friends and family.

It’s like parenting. The days are long but the years are short. I have some long ass days. Days I want to cry, scream, and everything else. I hate insurance companies. I hate that they dictate care and reimburse crap. I hate chasing people for money and/or getting screwed and never paid. Because it is my livelihood and it pays my mortgage.

I started keeping a video diary at the end of my days.

Yeah as soon as I figure out how to upgrade my plan that’s happening. I was watching some of them tonight and it’s hilarious. Also sad.

Here’s my point to this rambling blog post. I love working in mental health. It is fucking nuts some days. I’ve had knives drawn in my office. I’ve held people as they cried. I’ve been screamed at, sworn at, quietly glared down, and mildly stalked (yes there are levels). I’ve also been the first one to know about a pregnancy. The first one to know about a marriage proposal. The first one who a person comes out to about their sexuality or gender identity. I’ve watched people literally transition from one gender to another and everywhere in between. I’ve forged relationships with clients who have a deep mistrust of mental health practitioners and I’ve discharged clients and been fired by clients.

I’ve seen people through marriages, divorces, children, high school, college, and first jobs. What’s crazy is not my work. It’s not my clients. What’s crazy is the stigma that still exists around mental healthcare.

What’s crazy is not my clients. 

My clients constantly amaze me. People who make generalizations about mental healthcare do not understand that nothing separates them from my clients. Nothing. I’ve treated the poor, the rich, the middle class, white, Black, gay, straight, old, young, and everything in between.

The need for therapy or psychiatric medication doesn’t make some one crazy.

Denial that one is in need of therapy and/or psychiatric medication defines crazy.

To all my clients and everyone courageous enough to seek mental health treatment for yourselves I see you. I admire you. I don’t think you are crazy. I think you are some of the bravest people I know.

 

 

 

 

Vagina, Penis, and Poop Problems in Psychiatry
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Vagina, Penis, and Poop Problems in Psychiatry

lesbehonest20171 Comment

Let’s set this straight. I work in mental health. Psychiatry. I am a psychiatric mental health nurse practitioner. Technically.

Yet when I go to my “open recent” tab in Word I find “Bowel Regimens” as a commonly and recently opened file. I prescribe many medications that cause constipation. So we talk a lot about poop in my office.

Diarrhea is often also a symptoms of anxiety so yeah, poop comes with the territory of mental health.

Nothing surprised me more though than the first time someone told me about their vagina problems. Or their penis problems. I have made the following statements in my office:

“You can use plain yogurt as lubricant because it doesn’t affect your ph so it shouldn’t cause a yeast infection, just make sure it’s plain. No sugar added.”

“Is the rash on the shaft of the penis or are you talking upper thighs?”

“‘Down there’ doesn’t cut it my friend, and remember I’m married to a woman, so you’re gonna have to be wicked specific.” 

“An odor can be caused by many things. Don’t douche that’s so bad for your ph. Stop using all the wipes and scented crap. Let your body regulate itself. I promise your vagina will thank you for it.” 

“That sounds like Herpes. Get that shit tested.” 

“Pull your damn pants up, NO I don’t want to see your rash! Go see your gyno!!”

“So are you able to ejaculate or no?” 

“You understand this means that your testicles will be removed permanently from your body?” 

“You can still orgasm, you just need a partner who’s committed to getting you there. You are familiar with your clitoris yes?…NO!? okay. Here’s a drawing for you. Start externally. Move internally. Use a vibrator at the same time as internal stimulation. From the expression on your face you’ve never used a vibrator. Okay you ever heard of one?” 

“Very rarely this medication can cause a sustained erection. Take sudafed. It works.” 

“Have you ever heard of the jade egg? Well you can pop it in before you start making dinner, by the time you’re done with dinner you will definitely be ready to have sex.”

“Yes there are some that are made with a stringy thing attached so you can pull it out.”

“Your how old? Ugh…okay….let me take a breath here….okay yes we can talk about sex but just know that I think you’re not old enough and the only reason I’m entertaining this conversation is because if you’re going to have intercourse anyway I’d rather you do it safely, but good lord please God wait!”

“To clarify condoms protect against STDs and birth control only protects against getting pregnant and only if you take your pill every day.” 

“And you’re sure there’s no possible way you are pregnant?…..I think you’re pregnant.” (I have said this on multiple occasions and have yet to be wrong. Four times I told the patient before they knew and they later called me to confirm and ask how the hell I knew.)

“Well your partner is stating that douching before anal sex is important to them. How do you feel about that?”

“I’m not the person to tell if you should or shouldn’t have an abortion. I’m just here to support you. I see you. I am here for you no matter what you decide. Let’s keep talking.” 

“You’ve decided to keep it. Okay. Let’s talk about how you’ll finish high school and the stigma of being a young mom. There are people who will want you to fail. But I know you won’t. I know you have what it takes to do this. You’re going to be a great Mom.” 

“The abortion was when? Okay, so let’s talk about how you’ve been feeling since.” *

There are a couple reasons I end up talking about vaginas and penises. Medications I prescribe have sexual side effects. Depression causes a decrease in sex drive. Bipolar mania can cause an increase in sex drive. So people’s sex lives can directly correlate with their mood.

But also, what I’ve discovered, is people want a safe space to talk about sex and sexual organs.

MD’s in their white coats draping patients in awkward paper create a sterile environment. One in which patients don’t feel like people. They feel like specimens. Whereas in my office we may never have touched physically but I know intimate secrets about them and their mental health.

I also treat them like humans. Not specimens.

I also ask. Not about their actual parts. But about their sex lives. Do they have one? Are they satisfied with it? Do they use protection? What kind? I ask these questions and then they know it’s okay to talk about that stuff here.

No I was not expecting the questions about vaginal odors and rashes that accompanied the safe space sex talk. But after it started happening and my initial shock and horror subsided I realized that it was actually complementary. I made them feel comfortable. When I asked why they didn’t ask their medical doctor these questions they often shift in their chair and look down, “Well, I dunno, it always feels like she’s in a rush,” or “I dunno I mean I’m naked and they are in and out, and it’s embarrassing talking about this.”

They are less embarrassed asking me whose never seen their vagina, then asking the doctor who is up their elbows in their vagina.

I also treat a lot of transgender and non-binary individuals who are pursuing surgical intervention for their gender journey. If I’m writing the letter of mental health clearance I have to bluntly say what exactly will happen and what the consequences are so I can write they have a true understanding and can consent to the surgery.

It’s not that I’m uncomfortable talking about sex and sexual parts. It’s that it shocked me at first because I went to school to treat the brain. I felt like I was at the wrong end.

Disclaimer: I have never diagnosed or treated with medicine or assessed visually any of the issues that are brought to me by my clients when it comes to anything below the brain. I listen and provide feedback and refer them to a specialist. I am obviously very careful about not practicing outside of my scope.

I think it’s wonderful that clients feel safe with me. I think it’s disheartening that so many don’t feel safe enough to say these things without my support to their primary OB/GYN or urologist or primary. Modern medicine has become so forced, quick, and detached that patients are missing a connection with their providers. They are missing the opportunity to feel safe and supported by all their healthcare providers. Not just in mental health.

It used to bother me. The vagina and penis questions. But now I take it as an opportunity to try and understand what’s missing from their relationship with their medical provider. Why don’t they feel safe saying this to the people who can actually assess, diagnose, and treat it?

I’ve learned a lot about sexual health and sexual dysfunction. I’m proud to say I could likely help any one with difficulty orgasming. I also know more than I ever imagined one could possibly know about anal and vaginal intercourse. I can say the words: penis, vagina, anus, ejacualation, masturbation etc. without blinking an eye or making faces and changing my body language. I mean that’s a score one for me. Try it. Try saying any of the phrases I quoted above to anyone and try keeping a poker face.

My point to all of this: If you are a healthcare provider: people WANT to talk about sex. They need to. They need guidance and help and they have questions. Be open to it. Welcome it. Create a safe space.

If you are not a healthcare provider: ask the questions. You deserve the answers. There is nothing wrong with you for asking.

To all the Mental Health Practitioners: God bless. Find a quality picture of the anatomy of a vagina and a penis. Trust me. You’ll use it.

****To any one who thinks any woman makes the choice to have an abortion lightly: they don’t. We don’t. I have held clients as they wept over the loss. I have treated teenage moms in the thick of it. Society doesn’t like teenage mom’s yet we also judge those who have abortions or who become pregnant. The young women I’ve treated who have faced abortion versus becoming a teenage mom have continuously impressed me with their grace, their strength, and their pain no matter what path they choose.

SCOTUS and LGBT Allies Walking the Walk
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SCOTUS and LGBT Allies Walking the Walk

lesbehonest2017Leave a comment

I was all set to write this really cute blog post about how my two year olds think I’m their pet. (“Come Mama”, “Sit Mama”, they expect me to eat whatever they put in front of me, and sometimes they make me beg after yelling and asking nicely don’t do it.) It was going to be really funny. Then I saw the headlines. SCOTUS sided with the damn baker. If you don’t know what that means Google it. Educate yourself.

Now what it does not mean is that people can discriminate against LGBT individuals nationally. HOWEVER, seeing as over half the country voted for #45 I know that unfortunately half or more of the country is not very intelligent and they will not read the actual SCOTUS ruling they will just see this as their rightful opportunity to be louder and more discriminatory toward LGBT individuals and families and they will feel justified in doing so because the SCOTUS said it’s okay…(which they didn’t. Again read the ruling and educate yourself.)

What I’ve been saying since I started writing this though is that people who identify themselves as allies of the LGBT community need to walk the walk. I’m going to explain what that means in case you don’t know.

It means more than just putting a rainbow flag over your profile pic for Pride month. It means more than commenting on FB posts that are homophobic.

Let me teach by example. I own my own mental health practice. I have let it be known to my clients and colleagues that I am an out provider and that I’ve got the backs of all LGBT individuals. That means when I get a call from a transgender identifying individual I stay late, I come in early, I work on my day off, in order to expedite their intake. Will I do this for a heterosexual individual? No. Because they have heterosexual privilege. They didn’t have to wait weeks, months, or years to find a transgender friendly provider. They didn’t have to call a dozen places and be asked what transgender means or what their “real name” is. I’ve seen transgender clients for almost pennies because they didn’t have insurance. And in doing so I’ve built a reputation among the trans community as being a trans-competent and trans-friendly provider. Same for gay men, lesbians, drag queens and Queer identifying individuals. I’ve walked the walk. I’ve gone to bat for my people and they know it. I’ve also seen such interesting characters and the secretary in my building has mastered a deadpan expression no matter who walks in.

I do this because I’ve always been a fan of the underdog. I worked in the two most hated areas of hospitals. Emergency department and psychiatry. Those people who have been opposite me in an argument or in seeing my advocate for patients know that I am loud but that I have strong silences. I also tend to get my way. So trust me, you want me advocating for the most unprotected and vulnerable population in our country right now. But I can’t do it alone.

By walk the walk I mean if you know the corner store is owned by a homophobic family or person but you buy your coffee there every morning anyway because the closest coffee shop beyond that is 30 minutes….buy a freaking keurig or drive thirty minutes. Know who is homophobic (ah hem Home Depot and Chick Filet and Barilla past) and stop frequenting their businesses and stop buying their products. Living without Home Depot has been rough at times but we survive. Don’t just talk the talk with your “love is love” crap. Put your money where your mouth is.

And stand up to your family and friends in person NOT just on social media. If you hear them use dyke and fag terminology: speak up. Don’t remain quiet because it’s easier because you are complicit. It’s hard. Been there. I was recently at a picnic and some one started talking about transgender people and how they just didn’t get why “they need to do that, why can’t they just be happy with what God gave them?” I could have shut up and turned away and started a new conversation with some one else. But that would make me complicit. And if I could just educate one person and change one person’s views it can make a difference. So I didn’t turn away. I took a deep breath and did a down and dirty transgender education session in less than five minutes. It went fine. There were no punches thrown and we both felt safe expressing our viewpoint and experiences. I could see movement toward understanding and while I didn’t want to talk work at a picnic how could I not address that?

Don’t call yourself an ally unless you are ready to walk the walk.

When you do, don’t expect thanks or praise- I sure as hell didn’t. I mean I’ve been thanked and stuff and that’s great but at the end of the day it’s the right thing to do and actions speak. I didn’t get my education to take care of rich white heterosexual entitlement. I got my education and my license to help those in need. The LGBT community is sorely in need right now.

I personally will not turn down friends, but at the same time only put out your hand if you know what you are truly offering.

13 Reasons Why it Still F*&%$ With My Head…
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13 Reasons Why it Still F*&%$ With My Head…

lesbehonest20171 Comment

Hey it’s me. The blogger. Season 1 of 13 Reasons Why (On Netflix) was horrendous for me to watch. I had to because all my freaking clients were triggered by it. And I then had to tell their parents to watch it. Then I had to meet with their parents about it and explain that yes shit like this does actually happen. Yes there is this secret teenager world and yes bad shit happens in it.

  1. Most disturbing scenario for parents…my kid is being bullied or my kid was brutally assaulted and they were told by the school their kid would NOT have to see the perpetrator. But guess what they do. They end up in the same classes. They end up on the same freaking stage at graduation. ALL the time. I see it every day. It sucks. It feels so wrong and it feels like the anger of the victim and the shame of the victim is forgotten or invalidated or both.
  2. Sexual assault and date rape happens. Then these girls have to go to school and see the guy that did it. For maybe another four years. They may never tell me the name of the perpetrator. They may be telling me for the first time ever. They tell me quietly, with shame, with tears, and there’s nothing I can do. It’s the most powerless feeling in the world and when I tell the parents they feel that times a thousand.
  3. School systems are systems. They want kids to come and learn and behave and leave. They don’t want to have to pay for anything extra. They will not assume responsibility for the bullying in the halls, bathrooms, lorckerrooms. They will turn a blind eye as a child is punched in the head repeatedly in front of them.
  4. Guidance counselors are human. They don’t always provide guidance in the best interest of the student but rather in the best interest of the school. I’ve experienced this as a student, as a provider, and now as a viewer.
  5. Teenagers have this completely insane superpower that no matter what crazy shit is happening they can still compartmentalize, put it aside, and go have fun and make out at a movie theatre. Let them. They need it.
  6. Teenagers literally think no one else has ever felt the way they are feeling. No matter what you or I say nothing will change their mind. So just let them feel it.
  7. We all knew the kids in my school who had abusive parents or whose parents get high. Teenagers now know the same shit. But there’s that whole code of silence. So don’t ask them, because they likely won’t tell you a damn thing. But just know that they know.
  8. Social media bullying happens every second of every minute of every hour of every day. The shit kids today, starting as young as they can hold an iPhone and download snapchat, have to cope with and defend themselves against is incomprehensible to all of us who grew up with flip phones. When I tell parents to look through their kids insta, finsta’s, snapchats, kik’s, WhatsApp, and to look for apps that are blockers to parental controls, they generally stare at me like I have three heads. If you have a child with a smartphone you need to know what these things are. You need to go through your kids phone. And it terrifies the shit out of me that NO ONE does this. Also, take it out of their room starting at 6 pm or 8 pm. Jesus grow a pair and give them a break because they won’t give themselves one. They need you to parent their phone use. I am so careful about not judging parental decisions but this is the one space I do. Take their damn phone. They need you to.
  9. Teenagers don’t use condoms as much as they should. It’s terrifying. I’ve had so many teenage clients have abortions and have babies. Buy them the freaking condoms instead of putting your head in the sand.
  10. Athletes are prized and placed on a pedestal. Every other child in school who is good at drawing, writing, singing, acting, dancing, etc. They are all made to feel less than. Even though they are the ones that go on to become politicians, teachers, nurses, doctors. They are the kids that become something. Yet they are defined as being less than for the first eighteen years of their lives because they can’t kick a freaking soccer ball. Athletes get away with shit other kids don’t. I know, I was one.
  11. Guys are allowed to fuck a lot of girls and not be called whores. They are allowed to sleep around and still shoulder up to high school administrators and parents and get scholarships. Girls who have sex with even one person can be labeled as sluts, whores, and are treated essentially in the opposite fashion.
  12. One of the top two reasons this show fucks with my head is because it is so true to life. And because so many people watching it like to believe it’s not true to life. I’ve seen literally every single one of these scenarios play out in reality whether in my own life or in my career with my clients. If I could have chosen to not watch this damn show and to not have it come out with two seasons I would have. But I don’t like looking away from shit, and so many of my clients were talking about it, I had to watch it. The guidance counselor takes the blame for every adult who missed that girl’s cry for help. Yes I’ve been an adult in a kid’s life listening to their cry for help and telling them not to kill themselves. I’ve also been the kid, struggling to help myself and help my friends questioning if I had any friends at various times, and questioning whether we should all live another day.
  13. The top reason this show fucks with my head is because I have two toddlers. They will one day be teenagers. They will see abuses, drunk people, high people, bullying, they will potentially be bullied or God forbid bully some one else. They will have smartphones that I will spend my life monitoring the shit out of. They will be these vulnerable beings who think they are adults but are still kids and they will cause me to battle parenting them, loving them, and falling asleep every night praying they choose to live no matter what they face.
When therapists “don’t want to get involved”.
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When therapists “don’t want to get involved”.

lesbehonest2017Leave a comment

I’ve seen enough LGBT youth now in my private practice to unfortunately have heard many times, “Yeah my last therapist just didn’t want to get involved.”

Here’s the story.

I see people for therapy and/or medication management. When I see clients for medication management I still do a thorough assessment. I ask all the tough questions and find out why someone is really depressed or anxious or whatever. I poke and pry because I don’t want to prescribe medication if there is actually a deeper issue that just won’t respond to medication.

Case in point- every LGBT youth whose family is not accepting of their sexuality. That would make me depressed too. And anxious. Because they fear that if they are “out” their parents will kick them out, stop supporting them financially, but most of all they fear their parents will stop loving them.

I tell my patients that no amount of medication I prescribe will take that fear away. Then I ask how we can address this issue with their family. They usually look at me through tears and tell me no previous therapist wanted to insert themselves into this issue in the family.

For a little bit I started questioning if I was doing the right thing. But then I saw their relief, and I’ve met with parents and processed their fears and feelings around their children’s sexuality. I’ve never met with parents without extensive processing with the kids first, and I’ve never done it in a way that would out my client if they do not want me to do that. I am extremely respectful of their boundaries and where they are at in their own journeys.

But I can’t ignore the elephant in the room. I can’t continue to increase an anti-depressant dosage knowing the depression comes from feeling rejected and not address that in some way.

As a therapist and as a nurse I feel it is my duty to provide support not only to my client but to the family system. And my teens and young adults are grateful to have someone speak up for them and be heard in ways by their parents that maybe as “the kid” they cannot be. It’s a fine dance to be sure though. Balancing where my client is at and where their family is at and what each needs from the other in the moment.

Therapists are in a position to be incredible advocates for LGBT youths. Why would we not seize the opportunity? And if you are not comfortable for whatever reason to do the family work then refer them to someone who is.

Many clients come to me feeling stuck. The best part of the work is helping to unstick them from the fear and secrecy and move their whole family forward into the light.

It’s incredibly difficult and requires good supervision as a clinician and continuing education specific to the LGBT community. But it’s doable and as difficult as it is it’s the most rewarding aspect of my work. Too many LGBT youth face high rates of depression and higher rates of suicide to ignore this issue and to not insert ourselves.

 

 

Stuff on my desk.
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Stuff on my desk.

lesbehonest2017Leave a comment

That book in the picture is an amazing reference guide for any one who is transgender or who treats transgender clients or who knows some one who is transgender.

Background. I’m a big fan of books. Paper books- not the shit on kindle. First order of business in our new house was not the potentially leaking roof but the built-in’s I want built in our new living room. Irrational…yes. I’m okay with it.

Back to Trans Bodies Trans Selves. I wrote a blog post about coming out as a provider. Putting pictures up of my family in my office was a big deal for me. Then I started treating transgender clients and I realized me being a lesbian was not enough. Because there are plenty of lesbians who unfortunately may discriminate against those who identify as transgender. I also felt like some families were okay with me being a lesbian but maybe not accepting of transgender individuals. And not for nothing but they could potentially be in the waiting room at the same time and I don’t want my transgender folks feeling anything but acceptance.

Hence the big green book on my desk. It sits right on the edge facing out towards all my clients. You literally can’t miss it. I have a few other books about transgender clients scattered around my office too. I’m anything but subtle.

But my ploy worked. One of my clients made a lot of “should” statements about transgender individuals and then said, “But I wanted to ask you about it, because I know you see a lot of them or something, and one of my friends thinks he might be transgender,” and gestured toward the books.

It’s not my job to educate others about being transgender or agender or non-binary. But it’s a role I fully embrace. Because my clients who are not transgender may have no understanding of it, and they have a safe nonjudgmental space to now ask about it. We can explore their biases around it and they can ask questions in a judgement-free zone that may be inappropriate to ask a transgender individual. I’ve pulled out the Trans Bodies book and we’ve looked at pictures and read parts of it.

It is not my intention to make clients be pro-transgender people. But it is my intention to provide education when it is asked for in an objective manner. It’s a hard line to walk, because I don’t want to impose my beliefs on others. But at the same time I’m making it known that I am a lesbian provider who is accepting of all people who enter my office. I think providing a space to air beliefs wether I agree with them or not is important. Open dialogues are necessary in order for people to grow and learn and really feel another person’s perspective.

I had never mentioned to that particular client anything about my work with LGBT individuals prior to them raising that question. But because they saw my books laying around, and my other LGBT welcoming signs and posters they knew that they could ask a question.

I’ve had other clients bring up their transgender family members or friends. I’ve gotten referrals from people based only on these books laying around my office.

Non-verbal messages are incredibly powerful.

If you own a business or you are in healthcare or have the ability to create a safe space for LGBT individuals just do it. You may think it’s a small thing to put a rainbow flag or the transgender flag on your bulletin board or the human rights equality sticker on your car, but it’s not. We take notice. We feel safer and we are more likely to open up to you. We are more likely to come back to your place of business and to refer our friends there.

Instead of our country focusing on how to shut out people from business perhaps we should talk about how to bring our business in.

There are people who probably disagree with me for utilizing my office space to put a controversial issue out there. I respect your opinions and we have to agree to disagree. If #45 can use his office to trample on transgender rights in a loud/abuse of power type of way then I’m going to use mine to provide safety to a marginalized population in our society who are dying by murder and by suicide.

My books provide an opening to a dialogue. The dialogue can be uncomfortable and eye-opening, and painful. But those are the only dialogues worth having…no?

“Words are, in my not so humble opinion, our most inexhaustible source of magic, capable of both inflicting injury and remedying it.”

Albus Dumbledore