Mental Health Therapy and Luxury

Therapy for mental health is and is not a luxury.

On the one hand, such therapy can be expensive and is often not readily available. Some therapists aren’t covered by insurances plans. Some offer sliding scale fees, and some do not (based on their needs for keeping their practices going/themselves fed/etc.). Too many people consider therapy to be something for ‘privileged’ people, something that is frou-frou or extra. Many terrible stereotypes about therapy, therapists, and those of us who avail ourselves of mental health services exist and are perpetuated. These things all work to make therapy a luxury for many people, in the sense that it is not easily affordable/accessible for these people.

Personally, this cost keeps me up at night. I guilt myself for using resources to take care of myself when I’m not financially contributing to our living situation. And yet, taking the steps to take care of my mental health has been life-saving.

On the other hand, therapy is not the same thing as a luxury good such as an expensive car, watch, set of cook ware, mansion, TV, or any other thing. While these things are also not affordable/accessible for many people, they do not provide a healing service.

I’ve heard, far too often for my liking, pairings of “I can’t afford therapy” and “I’m buying an (or more than one) expensive item,” from people who are experiencing mental health issues. People get to choose how they spend their money and manage their mental health–but those two statements don’t logically fit together.

As well, as someone for whom mental health services are a need, such statements sound to me like the speaker does not believe the issues I’m (or any one else dealing with mental illness) working with/through are real. It sounds dangerously close to saying, “Why go to therapy when you could just do XYZ other thing?” or “Oh, you should just get over it.” That may not be the intent, but it is the impact.

I cannot buy my way to mental health. I am not positive that anyone can. Even in my fundamental Christian upbringing, I got that message:

Of course, the Titanic did sink–which makes this song a bit odd once I really stop to think about it–but that repetition of not being able to buy my way to happiness? of not being able to get myself to mental wellness via money? I was gifted that even in my super-Christian, super-fundamental background, courtesy of Amy Grant.

Even though I prick myself about the costs associated with therapy, I am grateful to know that I can’t buy my way to wellness. I wish I had better words to express this, in the moment, to the people in my life who have implied that therapy and luxury goods are of a kind.

Coming Out is Forever

My wife and I had a conversation the other day revolving around her transition. She mentioned that she’d written a journal wherein she realizes she’ll be coming out forever–a feeling which I as a bi/pan person can understand, since I’m also always coming out. In our discussion, and in her journal, she brushed on the pressures of ‘fitting in,’ of ‘passing‘ as cisgender.

I paused the conversation there, because I wanted to check in with her. I wanted to make sure she wasn’t trying to conform to something that wasn’t her, that she wasn’t trying to fit into a mold with an ever-changing, ever-moving target of cisgender ‘femininity’ just because it has ‘cisgender’ attached to it. I wanted to make sure she felt free to be herself.

And I wanted to mention an article I’d read: The Null HypotheCis. This article points out that our society tends to treat ‘cisgender/cissexual’ as the null, the standard, the thing against which we test.

After all, surely if we’re going to risk so much, put so much at stake, in such a monumental “decision”, we should approach it carefully, and make sure to be certain, right? Shouldn’t we be looking for proof that we’re trans before gambling our whole lives on that being the case?

Well, maybe… if proof of being trans was even really something possible, beyond the simple proof of subjectively experiencing your identity and gender as such. But more importantly: we never ask ourselves for “proof” that we’re cis.

And yet–identifying as cisgender is (as the article points out) every bit as much of a subjective thing as is identifying as transgender. (And perhaps that’s part of the discomfort of transgender identities–that such persons make us call our cis selves into question, make us think about how subjective our identities really are.) I brought it up to her because I know how easy it is to buy into that narrative of the societally structured null hypothesis, that ‘straight’ is null and LGB is the question.

As a bisexual woman married to someone who didn’t come out of the closet as MtF until well after we were married, I lived with ‘heterosexual couple privilege’ for years. And I still do, in some ways, since we’re still in the very beginning stages of Eren coming out at work and making legal marker changes.

And yet–both Eren and I live with stigma every day. Both of us are eternally coming out. And sometimes, it’s exhausting and hard and emotionally draining. Sometimes people expect us to be the educational battering rams to knock down their uneducated peers’ views.

But worse? Bisexual people experience higher rates of depression and suicidal ideation than lesbian and gay folks, and transgender people have an even higher suicide rate. In a world where we’re constantly either erased or that it will kill you for existing, is it any wonder that our two groups experience such high rates of depression and suicide? No, it isn’t.

Eren and I worry more about her external safety and my internal safety. We worry about someone ‘finding out’ she’s transgender and deciding to hurt or kill her for that. A world that makes a punchline out of her existence means her existence is in itself dangerous and a challenge to the system. We worry about my internal safety as I am currently the one teetering most precariously on that depression slope. We worry that in 49 states (including ours), ‘trans panic’ is still a ‘defense’ for killing a transgender person.

So what can we do? We can recognize that transmisogyny hurts all of us:

Transmisogyny not only names the oppression trans women face as both trans people and as women, but it is also an enormously valuable concept for understanding what motivates violence in a patriarchal culture. It is both a specific descriptor and a larger framework for understanding much more about how gender works in our society. In fact, I would argue that the simultaneous hatred of both transness and femininity — transmisogyny — is at the root of much, perhaps even most, of the anti-queer violence in our world.

Let me be very clear: I in no way wish to take away from the specificity of the term transmisogyny and the experience of the world, unique to trans women and nonbinary transfeminine people, that it describes. I am emphatically not arguing that people who are not trans women or otherwise transfeminine directly experience transmisogyny. Rather, I believe that transmisogyny is such a strong (and often subconscious) influencer of attackers’ thoughts and actions that it underlies many of the ways in which people of all genders are disciplined and punished over perceived gender and sexual transgressions.

In other words, while transmisogyny is primarily aimed at trans women and transfeminine people, and it is experienced solely by them in ways that should be discussed without mention of other groups, its prevalence in the world is so widespread that it also happens to “spill over” into violence against others.

Combining this with The Null HypotheCis idea, we can see why so many people are threatened by transgressions against boundaries thought to be objective but actually subjective. And we can see that these shouldn’t actually be seen as threats but as freedoms for all of us, ways to break the bonds that those ‘objective’ boundaries have held us in. If we can break free from a reliance on supposedly objective understandings of gender and turn our gazes to subjective understandings, perhaps we can break free of the violence against queer people of all stripes–particularly transgender women of color–and perhaps we can begin to see visibility and a reduction in suicide rates amongst bi and trans groups.

And maybe–maybe then, coming out won’t be quite so exhausting.