Here’s a thing about me: My mental health is fucking shite. Depression underscores everything that goes on in my life. It got particularly bad in the last 24 hours. For certain reasons, I became consumed with regret and associated self-hatred, something I have a tendency to do. I spent much of that time crying. I wanted to do things to hurt myself, and I just about managed to avoid that. Just about.
This reminded me of my need to have some kind of serious help from people that are trained professionals in mental health. I’m woefully ill-equipped to deal with things myself. The lack of that support impacts upon me, and it leads to things spilling out over my friends. They see my tweets and facebook updates that desperately cry for attention, they get my texts and calls. One of my housemates found herself sitting with me as I cried when she should have been getting her sleep before work a couple of times recently.
Those able to handle this stuff are wonderful, and their talking to me helps things a great deal. But it can only help so much when they don’t necessarily know how best to deal with my mental health as it manifests itself at that particular time. Certainly, neither the strategy of being pragmatic and positive, nor vague attempts at comforting, make things very much better. What tends to happen is I keep moaning until I feel I’ve moaned too much and little has changed.
And I’m probably never going to access what support is available from the NHS. Why? Because the NHS are also handling my transition, which is the most important thing to me, more important than mere matters of being horribly depressed.
Are the two things mutually exclusive? The problem is that I don’t know. We that are transitioning on the NHS know well that any excuse will be used to delay or stop the transition related care we’re getting or we’re going to get. In discussions of NHS trans support, there’s always a notion that we must have mental health problems only such as we can persuade medical practitioners is directly related to dysphoria – anything else can demonstrate that we’re not capable of being certain about transitioning (for we must be certain). We hear horror stories demonstrating that issues of mental health appearing on one’s medical records can be a really bad idea.
Would that happen to me for pretty routine mental health support? The problem is that I don’t know. Like so many people transitioning on the NHS, I want to take no risks whatsoever. There are prescribed hormones taken safely under medical supervision at stake. There is a cunt at stake. Both of those things are important to me.
We suffer a complete lack of clarity in what should and shouldn’t affect one’s ability to transition. Everything comes down to the judgment of clinical staff. That is, the gatekeepers; the same gatekeepers to whom we must appear perfectly gender-normative, question nothing, not be at all queer, just in case they decide we’re not trans enough. I find myself not accessing mental health support I need, just in case the gatekeepers think it looks bad on my medical records. Perhaps I’m wrong and it would be just fine. The problem is that I don’t know.
These gatekeepers are in place to restrict transition to only the most worthy. Some trans people have reported doctors openly saying that it’s to be sure their budget is spent well. We must be worthy, and just about anything can render us unworthy. Fuck that. Trans people have pretty universally struggled long and hard to get to a point of accepting the need to transition; when we seek support for our transition it’s because we need to get on with it. Instead we spend years proving ourselves worthy as we jump through the hoops. Our freedom to keep living our lives during transition requires a system that seeks not to define worthiness, but to collaboratively seek the best outcome with each trans patient. No Gatekeepers, No Masters.