Onset

It was February 23, 2018, a Friday. I was driving alone in my truck on collections. No matter what I thought about, my thoughts kept drifting back to “What would it be like if this truck just careened off a bridge and I was no more?”

Of course, I didn’t act on it; I’m writing this. But the thought recurred throughout the day. What would it be like without Monte in the world? For me, I knew there would be rest. Rest from not being able to bring in enough income for my family. Rest from living with my in-laws. Rest from my whiny kids. Rest from alienation from my family and friends through distance. And that rest was all my mind ruminated on.

Then the tears started. It was raining that day, too. I was so alone in that truck. Cars, trucks, semis sped past me. I got to the oasis for lunch around 3:45 pm. I called 911 or some crisis line; I don’t remember. I told the woman who answered, “I feel like hurting myself.” “Do you feel like hurting anyone else?” she asked. “Yes.” I won’t say who.

Check-in

After I clocked out and drove “home” to the in-laws, I kept crying. I don’t recall if I went there or straight to the hospital. All I remember is seeing Sarah there. We cried in each others’ arms for a while. They checked me in at St. Catherine’s in Kenosha. Did all the vitals, that sort of thing. “Do you own any guns?” “Yes.” Check. This guy has the means and the mood to hurt himself. They called the ambulance to take me to St. Luke’s in Racine.

The ride was long, even though it was only about 10-15 miles. I didn’t know why my wife couldn’t take me. Anyway, we arrived at St. Luke’s. The place looked abandoned. This part actually is. Most of it is closed, except for the mental ward. There I checked in all my things: my phone, wallet, keys, clothes. They gave me scrubs, some hygiene products, and then showed me to my room. I had a room to myself for a night. My roommate slept the whole time I was there, so I never caught his name.

Names escape me now, but we were in it together. I’ll give them some names. Sue had anxiety. She had been there for about 4 days and felt the longer she was there, the more anxious she got. Tara was depressed. No affect. Sometimes she smiled, but her eyes never showed it. It was a lifeless smile. Bill was high as a kite. And fun. Man could make you laugh, but he had tried to kill himself the night before when he was on a drinking binge. He was bipolar like me. I never knew what Jess had, but probably some sort of psychosis. Schizophrenia maybe? I’m not up on my diagnoses. Grace had learning disabilities, felt like she didn’t have any friends, and was suicidal, too. One guy (who Jess yelled at a lot because she thought he was her ex), I never got his name. He just sat in a corner reading a novel.

We had breakfast together at a long table. They would give us a menu, and we got to pick what we wanted from a few options. It wasn’t terrible. The day was lightly structured. The only thing I remember was a group therapy session with…we’ll call her Joan. Joan was nice. Somehow, don’t remember how, Sue got to talking about god and assumed I believed something akin to her god. She looked at me for a connection on this, but I sheepishly said I was an atheist. Again, memories are funny things. All I remember is something like “How could you believe such a thing?” A lot of good god was doing us. We were all in this ward. Joan at least asked me if I was ok with Sue’s badgering. I thanked her for her concern but said I was alright.

I liked the occupational therapist. Still don’t know why they call them that. They seem to do something like tool you with skills. We talked about assertiveness.

I said I was here because I could barely make ends meet. My job didn’t challenge me, and my coworkers weren’t the greatest people to be around. And it was breaking my body. The one thing I could work at in this area (that wouldn’t kill me) was this job, and my body was breaking down. My neck got to where when I turned it, I felt a sharp pain into my shoulder and upper back. This made a manual job pretty damn hard. 4 Advils did nothing. Oxy helped with the symptoms but not the cause. If I was eligible for nothing else, and this job couldn’t really help my family financially, what good was I to them or to the world? I felt my worth completely tied to my ability to contribute to the family economy, and I was found lacking.

So the occupational therapist, who we’ll call Jenn, hooked me up with some job coaching and a job center. Though nothing ever came of it after my stay, it gave me some hope for the time being.

Then there was the psychiatrist, Dr. something-Armenian. He was nice, I guess, but seemed bored to be there. He put me on Latuda because he said it was an anti-depressant better suited to bipolar depression. I started taking that on the weekend stay.

I probably could have left Sunday, but Dr. so-and-so wasn’t there. Maybe Kasparian will work. Dr. Kasparian wasn’t there. So I had to call my supervisor to let him know I’d miss work on Monday. He asked if everything was ok. I told him, “No, I’m in a hospital, but I should be back tomorrow.” He was very understanding.

Aftermath

So Monday afternoon, they let me out. Sarah picked me up. I forgot what we talked about or where we went. One of the things, though, was we sold my shotgun, and I forfeited my rifle to the Pleasant Prairie Police Department. Some Lieutenant or Sergeant whatever looked at me dumbfounded. “Is this some kind of Russian rifle or something?” “Yah, a Mosin-Nagant.” They drew up some sort of legal thing for me to sign, so I signed away my ownership of the weapon to them. I now had no easy means to harm myself.

After Dr. Kasparian put my order into Walgreens, I went to pick up the Latuda. “That will be $500.” Shit. Well, I have insurance. “But I have insurance. Does it not cover it?” “Well, that’s what it is with insurance.” Double shit. I looked at what insurance had covered. It had covered $1300. So a one-month supply of this drug cost $1800 without insurance. No wonder people commit suicide. They can’t afford treatment.

Anyway, I call my psychiatrist. Dr. Chandragupta is a funny man because he is so direct, almost aggressive. “Why didn’t you call me? You don’t need Latuda. We’ll just add some Zoloft to your Wellbutrin, change your Risperdal to Abilify, and that will be that.” He, of course, doesn’t speak like this. For that matter, all these quotes are me paraphrasing people with some of the still-vivid memories. And this med change was over several months after that episode.

Postlude?

Now, I’m dealing with extremely low energy, fatigue, long sleep (but never feeling rested, no matter how much rest I get), and loss of interest in things that usually jazz me up. But I think I’m coming out of this round of depression. I was just thinking today, I have a wife who loves me, a family who calls me once a week, friends I game and chat with around once a week, coworkers who seem to think I’m cool, and I’m making progress on my goals. I may have a drinking problem, but I’m working on that, too. One day at a time. Reading is becoming fun again. My kids don’t set me on edge. I’m good at my job. I’m making a bucket list. I am valuable; don’t need you to tell me that. I just am. And that assurance feels nice for a change.

If you struggle with mental illness, don’t hesitate to reach out to someone. I’m a pretty good listener, even though I’m no professional. Maybe comment. Maybe dm me. Maybe bypass me altogether and get with the pros. Hang tight to your kin. It gets better.

(~1350 words: analyzing Paul McHugh’s dealing with transgender issues)

Caitlyn Jenner’s last interview as Bruce Jenner occurred a little over a month ago. Then on June 1, 2015, she announced herself to the world with her new name and a cover shot. This prompted comments ranging from support to denigration.

So this link Wednesday has to do with one psychiatrist in particular who holds a lot of clout with conservatives who oppose to transgender persons (or what transgender people do, not their persons, according to the rhetoric).

1. “Surgical Sex” by Paul McHugh

Paul McHugh hopkinsmedicine.org — Paul McHugh
hopkinsmedicine.org

Paul McHugh was the longtime chief psychiatrist, professor of psychiatry, and department head at Johns Hopkins University and Johns Hopkins Hospital. He has gained much publicity for his position against SRS. In this article published on First Things (see their About page here), he discusses why he opposes it. He primarily found the desire for SRS solely in men who could not deal with their own homosexual attraction and sexual experience. He wished to test his unease with these men by testing 1) if an operation resolved other “psychosocial issues” (“relationships, work, and emotions”) in them and 2) if operations performed on boys with abnormal genitals combined with raising the them as girls allowed them to be gender-adjusted in adult life as women.

Concerning his first inquiry, McHugh followed Jon Meyer’s research. Meyer had spoken with SRS patients years after their surgeries, finding that they were largely satisfied with their choice. McHugh inferred, though, that the surgery did not resolve other psychological issues present in them.

Concerning his second inquiry, he followed the research of William G. Reiner. First, Reiner used comparative anatomy to conclude that even if boys were surgically altered postpartum, they had still been exposed to testosterone in utero. These young children, though raised as girls, preferred “boy” play: “enjoying rough-and-tumble games but not dolls and ‘playing house.’” Reiner’s case study on 16 “genetic males with cloacal exstrophy” found that once the youths had learned about their birth sex:

8 boys declared themselves male
5 continued to live as females
1 lived in sexual ambiguity
(2 had parents who had elected not to have the surgery performed on their children)

McHugh then concluded that gender identity flows not from socialization, but from genetics and intrauterine encounters with testosterone. I have two issues with McHugh’s inferences from the data and studies. The first has to do with the propriety of his first inquiry: is it appropriate to ask if SRS solves other psychological problems in a person? I’ll propose something and let you think about it: does gall bladder surgery have benefits for asthma sufferers? McHugh admitted that men who underwent SRS were satisfied with the results in the majority of cases. His contention is that it did not solve attendant psychological issues. Should that be expected? If I suffer from bipolar disorder, schizophrenia, and obsessive-compulsive personality disorder, will treatment for one diagnosis work for the other two? Some medications help multiple things. For example, Depakote can be used as a treatment for seizures, migraines, or the manic phase of bipolar disorder. But this isn’t always the case, and to expect one treatment to affect multiple issues doesn’t seem reasonable to me.

My second issue has to do with McHugh’s use of Reiner: “sexual identity is mostly built into our constitution by the genes we inherit and the embryogenesis we undergo. Male hormones sexualize the brain and the mind.” If effects in the uterus are primarily what account for sexual identity, why did nearly 43% of the boys operated on live as females—i.e., according to socialization—or ambiguously? Wouldn’t his claim call for a much higher ratio of “boyness” trying to overcome female socialization? Can a claim for naturalness/normalcy hold if it only accounts for roughly 57% of the sample?

2. “Transgender Surgery Isn’t the Solution”

(Google the title; if you click on this link, you have to subscribe in order to read the full article)

I came across this article when another article referenced it. That article had the catchy snippets in its title: “Johns Hopkins Psychiatrist: Transgender is ‘Mental Disorder;’ [sic] Sex Change ‘Biologically Impossible.’” (check out what the DSM-V says about it being a mental disorder; thanks to Brynn Tannehill; In the upcoming weeks, when I discuss the “institution” aspect of religion, I will discuss the politics of classification) While I read that article, I wanted to read the original. It is imperative in research to see what writers/speakers do with their sources in order to see if there are unstated motivations beneath their stated intentions.

I want to draw attention to one statistic provided by McHugh:

When children who reported transgender feelings were tracked without medical or surgical treatment at both Vanderbilt University and London’s Portman Clinic, 70%-80% of them spontaneously lost those feelings. Some 25% did have persisting feelings; what differentiates those individuals remains to be discerned.(Monte’s emphasis)

He also refers again to his reason for stopping sex surgery at Johns Hopkins: “surgically treated patients” were satisfied with the surgery, but didn’t experience relief from other “psychosocial” issues which he doesn’t detail here.

In this article, he produces a much more relevant study to his aims. The Karolinska Institute in Sweden conducted a 30+ year longitudinal study on over 300 people who had undergone SRS. He highlights two things. One, 10 years following the surgery brought about mental health issues, and two, the patients had a 20-fold suicide mortality rate when compared with the general population.

Concerning the Vanderbilt/Portman study, McHugh admits that no one knows for sure why gender dysphoria continues in 25% of individuals who experience it as children. With him, I don’t know what to do with this. It could have genetic or social contributors, or a combination of the two. We just don’t know. However, he’s the psychiatrist, and he doesn’t offer any alternatives to SRS (besides “devoted parenting” for children and adolescents) or help. If you’re a public intellectual offering your two cents, provide some solutions.

The second study concerns me. That suicide statistic is astounding. An article by Mari Brighe (about The Transadvocate here) critiquing McHugh’s op-ed detailed many of his misuses of data, including the following quote from the Karolinska study:

It is therefore important to note that the current study is only informative with respect to transsexuals persons health after sex reassignment; no inferences can be drawn as to the effectiveness of sex reassignment as a treatment for transsexualism. In other words, the results should not be interpreted such as sex reassignment per se increases morbidity and mortality. Things might have been even worse without sex reassignment. As an analogy, similar studies have found increased somatic morbidity, suicide rate, and overall mortality for patients treated for bipolar disorder and schizophrenia. This is important information, but it does not follow that mood stabilizing treatment or antipsychotic treatment is the culprit. (Monte’s emphasis)

Further links in the article cite differences in androgen receptors between transgender and cisgender men and a difference in brain anatomy between transgender women who haven’t yet undergone hormonal treatment (the article calls them “male-to-female (MTF) transsexuals”) and cisgender men.

What I take from this is that transgender persons need more access to mental health resources, but that a ban on SRS in itself would not “fix” them. With high suicide rates, abuse from families of origin, mistreatment by police and hospitals, and homelessness, exclusionary tactics like negative labels are not helpful. Labels more often than not serve to categorize a group as “Not us,” that can then serve as a shield of indifference to real complaints, issues, and needs.

So is Caitlyn Jenner mentally ill on account of being transgender? The DSM says no. I think the question might be missing an issue, though. My question is, do Jenner and people like her have access to mental health, relational, financial, occupational, housing, and other resources that I enjoy because no one is obstructing my access according to my appearance? I guess a person could say, “Stop trying to be something you’re not. Make your appearance more normal and you won’t have these problems.” To me that’s like saying, “Stop practicing Christianity, because it’s against your nature. You won’t have relational problems associated with being resisted because of your religious observance.”

Tag: suicide

My Stay in the Mental Ward