This is the first part of a two-part article; some names have been changed to protect people’s identities.
Chanchal, a non-binary queer individual, survived a suicide attempt. They were put on ventilation support for about a month. When they regained consciousness, they had a strong feeling of fear, loneliness and shame that clouded everything for quite some time. They felt unloved and misunderstood, the reason why they had tried to die by suicide. Moreover, the experience of bodily pain, medical emergencies, sound of intensive care machines, 24×7 observation by the doctors and nurses, and the fear-stricken faces of their parents ripped them apart.
When Chanchal came to me for therapy, they were going through frequent self-harming episodes. Using respectful, gender neutral, and open language in the sessions helped in building trust and rapport between us. Chanchal shared their preferred name and felt extremely happy when I wrote it on the payment receipt. After a few sessions, they said that they had improved a lot.
Chanchal’s self-harming pattern has been changing. They said that earlier, they tried to kill themselves, but now they only want to quell the mental agony by inflicting physical pain on themselves through cuts. Sometimes the blood oozing out of the cuts helps them to feel alive. So, now the focus is on ‘living’ instead of ‘dying’.
The more Chanchal observes their body scarred by the cuts, the more they want to heal and live. We regularly discuss the importance of being safe and responsible with their body and mind. There is depression, but they have accepted it as a part of their being. They regularly make verbal contracts during the therapy sessions, and have started focusing on their career. They have started to accept the way they are.
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Physical health and mental health are intricately inter-related (see inset above). They go hand-in-hand as far as a person’s holistic well-being is concerned. When we feel bodily discomfort, our emotional distress increases. In turn, as a result of emotional distress, we may experience somatic or physical symptoms as well.
The World Health Organization (WHO) says: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The WHO also states that there is no health without mental health. As a mental health professional, this connection is driven home to me every day by the people I work with. I often have to undertake mental health interventions that facilitate their well-being by focusing on their physical concerns in order to manage the suffering.
The connection between the physical and the mental is particularly significant for people who belong to the queer communities. I have to adopt what is called a ‘queer affirmative approach’ in working with them, as, for example, I did with Chanchal. Such an approach talks about depathologizing gender and sexuality variance, recognizing the validity of a spectrum of non-normative gender identities and sexual orientations, and supporting the individual needs of each person seeking mental health intervention.
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Arpan, a trans masculine person in his 20s, decided to undergo gender affirmative surgery. He talked about struggling to convince his mother and sister about his decision. Something happened at his workplace that, in a roundabout and painful manner, enabled him to resolve the matter.
It seems that Arpan’s supervisor was aware about transgender issues. During the COVID-19 lockdown, when work-from-home was the rule, his supervisor organized an online awareness generation for all staff members, which was well received. Arpan even shared his preferred name and pronouns with everyone. He felt that his emotions and lived reality were validated, and he experienced a safer space to express his pent up feelings.
Once the usual office operations resumed, Arpan had to shift from his home town to another metropolitan city. Sadly, people started to misgender him in the office space. He would go to the washroom discreetly so that nobody could question his intent. He started using a binder, but his colleagues continued to misgender him, often going by his office identity card. He started to communicate his concerns but this was not taken seriously. He felt helpless, clueless and out of control.
Ultimately, this situation propelled Arpan to convince his mother and sister, and they did not stop him from undergoing surgery. After the top surgery, he got his identity documents changed in terms of his desired gender and name. At last he felt confident and in control.
In our therapy sessions, Arpan shared how his sense of self shaped his body. Scholar Jay Prosser, in his book Second Skins: The Body Narratives of Transsexuality, reflecting on the work of psychoanalyst Didier Anzieu, describes the relationship between the ‘self’ and the ‘soma’. Prosser says that all forms of gender affirmative care are an effort to develop a feeling of coherence and integration between the mind and the body, between one’s sense of gender and the materiality of gender. It is nothing but achieving psychic wholeness through bodily transformation.
Arpan said that social acknowledgment was immensely important to him. He talked about the humiliating gaze of his colleagues and neighbours before he started gender affirmative therapy, how the gaze changed into one of curiosity and query once he started transitioning, and finally into surprise and bewilderment when his external appearance metamorphosed and gave him the ‘wholeness’ he dreamt of.
To be continued.
Read also article Doctor Brain’s Laboratory by Dr. Tirthankar Guha Thakurta in the November 2013 edition of Varta – Editor.
About the main graphic: A flag created for the global mental health movement by The Pete Foundation, Louisville, USA. Read more about the flag here. Image sourced from Wikimedia Commons