Defending Addiction and Madness: On Psychiatric Disabilities and Choice

Before I posted my newest story (What’s Left When Coping is Killing Me?), I spent days editing it. I had to vividly relive the experiences I was writing about. Also, it was extremely hard to share those parts of my life — especially my recent drug use. Until that post, that was one of the few remaining things I wasn’t “out” about. On top of stress about housing, finances, and the continued spike in violence against trans women in D.C., my anxiety was off-the-charts.

I give off confident vibes, and I share most aspects of my identity/history freely. However, being so visible and exposed is extremely draining and occasionally terrifying. People recognize me on the metro. I’ve received death threats on my cell phone. I don’t live in a protected, academic bubble — I’m a crazy, low-income tranny punk and a sex worker. Being out has serious consequences.

Recently, when I admitted to my therapist that I had lost the desire to live, I was nearly hospitalized. It was a brutal wake-up call — both to how bad off I was, and how I am not immune to the constant threat of medical surveillance and even incarceration. After sharing my story about this, I mostly received praise and support. But a few folks recommended various ways to “get rid of my anxiety” or “cure my depression/addictions/etc.” I think it’s worth unpacking their assumptions.

Most neurotypical people assume I want to or should change those aspects of myself. This ends up reinforcing much of the ableist ideologies that contributed to my being in that situation to begin with. A lot of this also had to do with judgement (outright or subtle) around the use of ‘hard’ drugs. I want to clarify/reinforce some of the things I was trying to say, and why I said them. So I decided to write about what publishing that story felt like. It evolved into a meditation about how I experience my mental illness — personally and politically — as a disability, and growing into my identity as a proudly mad, disabled person. I’m not necessarily glad to be so crazy; it makes my life very hard and has led to untold suffering. But there is a different between being glad and being proud.

I look at how ableism divides the world into “normal” and “disabled” people by making much of life inaccessible for people with physical and/or psychiatric impairments. I also explore the problem of countering false narrative of personal responsibility (“drug addiction is a choice”) with the need to value autonomous decision-making. Finally, I look at ways that being crazy can be a gift and a weapon that, when re-directed away from our selves, can destroy the social conditions which keep us from healing.

Part 1: Psychiatric Disabilities Are Real

After posting the story, my anxiety dwelt on feeling exposed and vulnerable. Slowly, I worried more and more about everything — including my anxiety itself. It becomes a spiral: The more I worry, the more I worry. After a few days, I was ready to panic about anything.

My anxiety does everything it can to focus on my insecurities and weaknesses. If there is any uncertainty about how something will end (e.g., how people might see me after finding out I am an addict, a sex worker, etc), my anxiety convinces me that the absolute worst thing it can invent is the only possible conclusion.

This time, it was a mildly upsetting e-mail. Under normal circumstances, it would have made me sad. But that day, it brought me to tears. Within minutes, my rapid-firing thoughts went from “I made a small mistake” to “I always fuck up everything” to “there’s no point in continuing to try” to “I should die.”

Once it starts, I can become convinced of lies. There is someone waiting to kill me behind every door, every shadow hides malice, and every strange sound is a nuclear bomb in the distance. I see terrible visions, sever my mind from my body, and lose myself in a psychotic detached state.

Panic is a totally normal and understandable response to the abuse and violence I’ve survived. I’ve been abused since I was a child and struggled with severe depression and addiction since I was a teenager. I’ve always been anxious and had manic episodes (misdiagnosed as ADHD). This to say nothing of the multitude of other symptoms I experience which include frequent migraines, nausea, loss of coordination/balance, prolonged periods of feeling detached from my body, impulsiveness, heightened sensitivity to lights, sounds, smells, and pain, irritability, psychosis, sleeplessness, disordered eating, nightmares, inattentiveness, racing thoughts, long periods of difficulty thinking and understanding other people, and extreme medical debt.

The problem is, before I even acquired PTSD and panic disorder, I was already bipolar amd anxious,  so when trauma was added the severity increased exponentially. There really isn’t much I can do about it anymore, besides try to manage it with behavioral changes and medication. Add to that all of my various oppressed identities (being trans, female, a sex worker, neurovariant, poor, etc) and maybe you can get an idea of how often I am placed in triggering situations.

It got so bad that I was in a constant state of panic and hearing voices in my head telling me to give up. I had so many delusions and psychotic episodes, I thought I was schizophrenic. I didn’t know what was going on, so I ended up in hospital a few times, where, as a trans woman, I was treated like shit. Now, I can recognize what’s happening and know what to expect. Over time, I even learned to identify patterns — like when I’m more likely to panic — that allowed me to reduce its harmful effects and make it easier to live with.

Living With Psychiatric Disabilities

When most people in the u.s. and canada hear the word disability, they tend to think of certain “physical” impairments. Historically, I didn’t want to mistakenly imply that I have had those experiences. So, in everyday life, I didn’t refer to myself as a person with a disability. However, in both a personal and political sense, I do identify as such and have become more comfortable applying that label to myself.

I will spend hours screaming and/or quivering in tears, followed by having to actively restrain the urge to hurt myself for awhile, and then a few hours of staring blankly at a wall, curling into a ball and becoming completely unresponsive, unable to speak, or start talking nonsense. Sometimes I do hurt myself. When this happens in public, it can lead to arrest or worse.

No matter what society, former employers, the unemployment office, or my internalized self-loathing say… it does not matter how much I want to, or how hard I try. I just can’t. The only way to break the cycle is intensive self-care… cuddling, exercising, movies, the right combination of medications. I have to focus intensely on removing the irrational patterns in my thoughts and getting my head back to reality. This becomes a disability because I am not allowed to do what I need to stay safe. Space is not made for me to heal; I am expected to continue being productive no matter how sick I am.

 

 

Panic is a biological response that has just as much to do with my heart rate and breathing as my thoughts. The health (and ability) of my body depends on the health (and ability) of my mind, and vice versa. In other words, when I am mentally ill, I have trouble functioning physically and it causes me physical pain. Likewise, when my body isn’t healthy, my anxiety, depression and panic are all worse.

Anyone who says that mental illnesses are not legitimate disabilities is both mistaken and reinforcing false mind/body dualism. My mind is not separate from my body, even though sometimes it feels like it is. My illness is just as physical as mental.

It’s very hard to have a disability that can cause me to become physically incapacitated for days, and even briefly endanger my life, whenever I share personal details of my life. Since being a trans/sex worker “activist” requires certain levels of personal disclosure, it makes it pretty hard to do the work of fighting for my community sometimes.

Part 2: I Don’t Need A Cure (Or, How Mental Illnesses Can Be A Force for Good)

The truth is, although it is extremely painful at times and difficult to live with, I’m glad my body and mind work the way they do under the circumstances in which I am forced to live. Madness is a healthy response to a sick world; I’m more concerned that other people don’t seem to experience crippling panic when they are confront with the violence around them. The real issue is not that I need to “fix” myself. I do my best to manage. The real problem is accessibility. Our society and culture is what needs to be fixed, not me.

The world is not structured to accommodate the way my body works. Because my impairments make me “unproductive” by capitalist standards, I am labeled weak, sick, and expendable. My health needs are ignored or even actively punished and criminalized. I live in an inaccessible world that is built to privilege certain people’s (mental & physical) abilities while excluding all of those, including mine, that are not deemed productive.

Mental Disorders and The Struggle for Accessibility

There are many things I can’t do because other people don’t take my experiences into consideration when they plan events, design pedagogy, write blogs, or build cities. So many things are at night, and my anxiety/PTSD/panic disorder often make it impossible for me to be out after dark. Before Goddard, I spent my life trying to function in schools that prioritized ways of learning that didn’t make sense to me. Without providing any warning, the media uses graphic imagery that can immediately trigger me — which usually means I can’t look at any of it for fear I’ll be triggered. During an attack, when I need to get somewhere I feel safe fast, there are few options that will get me there quickly and affordably without putting me in triggering situations.

When I couldn’t focus on memorizing numbers in school, I failed. When I’m late for work because I spent the morning trying not to kill myself, I get fired. In short, this ableist world expects me to do things that I just can’t fucking do. Period. And when I inevitably fail, I end up poor, and therefore in yet more violent and triggering situations. Again. And again.

One of the primary points of critical disability politics is that physical impairments would not be disabling in a world that prioritized an ethical responsibility for the community to collectively care for one another, and thus accommodated blindness, the use of wheelchairs, etc. Likewise, mental illnesses would not be disabling in a more compassionate, less individualistic world that respected how my body responds to trauma, how people on the autism spectrum process information, etc.

This is one reason I so resent when someone suggests ways to “fix” my mental illnesses. The idea that I need to work harder to solve my problems is rooted in the “pull yourself up by your own bootstraps” mentality, which is the same capitalist logic that says people who are poor deserve it because they aren’t trying hard enough. Fuck that. I can’t control how my neurochemistry works. But my boss, and the whole damn capitalist order, can control whether to mercilessly fire me for it.

It is important to highlight the commonality between people with multiple kinds of disabilities. We are oppressed by some of the same or similar systems. This basic solidarity is what forms the basis of a shared community, culture, and commitment to social change. Just as disability activists have fought to ensure that public spaces are physically accessible, we must fight for a world that is equally and equitably accessible for people of all psychiatric experiences, emotional states, and mental capabilities.

Embracing My Madness

One central development in my “mad identity” as a person with psychiatric disabilities was reading a book called “Live Through This.” It is a collection of essays, stories, art, poems and photography by radical women with various mental illnesses exploring the connection between creativity and self-destruction. Among other things, that book (and plenty of conversation and introspection) introduced me to the powerful, radical idea that my mental illnesses aren’t entirely bad — and can even be useful and positive, in specific ways.

My neruovariances are part of me, for better and for worse. They make me dangerous, which is also powerful when used carefully. They make me stronger, quicker at thinking and processing information. They make me unpredictable, which can also mean innovative. My anxiety gives me a heightened awareness of my surroundings to keep me safe. My suicidal thoughts have helped me confront and come to terms with death and forced me to find my own meaning in life. My depression makes me more sensitive, compassionate, and socially-conscious. My tendency to worry and over-analyze often makes it hard for me to be productive and can lead me to panic over nothing, but it also makes me a better critical thinker. My wild, illogical emotions make me difficult to contain or control, which gives me the spirit of an idealist, an artist, and a rebel. My inability to pay attention to one thing and my manic energy can help me work on many projects at once (although finishing them is another challenge!). This all makes me a threat to capitalism (which is why they want to fix us in the first place – to reincorporate us into the productive economy), and that’s exactly what I want to be.

Sometimes I can be too hyperactive or depressed or suicidal or anxious, and then I get overwhelmed and burnt out. But when harnessed just the right way, it has helped me accomplish so many things. And they all provide me with a unique and valuable perspective on life.(3)

I appreciate the extremes. I am glad to experience the highest highs — and the lowest lows. They are what drive my passions and feed my activism. If I were happy all the time, I wouldn’t do anything. I would just be content to sit at home all the time. I do my best writing when I’m depressed, hyper, or on drugs. (Although usually I have to go back when I’m feeling more clear-headed to make sure it makes sense to other people!) The way I see it, my mental illnesses are directly tied to my intelligence, creativity, empathy, strength, and resiliency.

As long as they are kept in check and not allowed to completely take over, my depression, mania, and anxiety make me more dedicated and motivated to changing the realities under which we all live.(4)

So I’ve given up on curing my disabilities. Even PTSD. And I’m okay with that. It’s just something I have to manage, that occasionally causes me to suffer deeply, but which also make me the person I am. I’m proud and happy to be who I am. And, usually, I’m confident that even though it’s hard, I can manage, with the help of my chosen family.

And trust me … Any advice you give to me about reducing stress or lowering depression? I’ve already heard it and tried it. You aren’t being helpful, just being condescending and making yourself feel better by mistakenly thinking you’ve done a nice thing to help some unfortunate person in need.

(1) I vehemently don’t think my trans identity is or should ever be considered a mental disorder/illness. I’m just making a comparison.

(2) I don’t think my ADHD would really be a disorder either if I didn’t live in a world that marginalized my way of processing information. On it’s own, ADHD is just a natural form of neurovariance. But the combination of having both ADHD and anxiety and the social marginalization of crazy people is what gets us into trouble.

(3) The only disorders I wish I could entirely get rid of are my panic attacks and PTSD. I can’t really see anything positive about those. Notably — while there is a more-or-less proven link between certain genes and the likelihood one will develop PTSD after encountering trauma — these two are the ones that are most directly caused by social oppression and preventable violence.

(4) This is not the only reason people in general, or me in particular, would want to resist. There is also love, and hope.

Part 3: Drugs, Choice, & Mad Liberation

Many people who experience what the mainstream currently labels “mental illness” do not relate to their experiences as disorders at all. Instead, they view them as “dangerous gifts” (to use a term borrowed from The Icarus Project). Many writers in the radical mental health movement have reframed how we define what types of bodies, behaviors, and experiences are healthy and questioned the ways in which society defines some people as normal and others as crazy or sick.

Health and illness are not diametrically opposed states. Everybody experiences a little of both. This post explores how our culture shapes notions of what it means to be healthy, and defines specific people as ill — and what it might look like if we allowed crazy people to self-determine our own definitions of health. (Hint: It would mean looking at sickness as more than an individual problem or deficiency, and locating our health as collective problem.)

Specifically, I’m interested in how this intersects with drug use. It’s interesting, though not surprising, that many people who wrote me focused on the fact I admitted to using drugs during the story. In reality, that was just one of the problems I was facing during the narrative. What about the fact I was financially broke, feeling hopeless after the death of my friend, or internalizing whorephobic messages? Even though those things were honestly more of a threat to my health than the drugs, no one wrote to lecture me about them.

Regardless of the mostly good intentions of the individuals who wrote to me, their focus on the relatively short passage about drugs mirrors our culture’s tendency to blame all of poor/marginalized people’s problems on drugs. We are all taught to believe that drug users (especially addicts) are at fault for their own problems. In reality, drugs are merely a scapegoat used to obscure the real blame for our woes: economic and social inequality.

 

This attitude can also be found within some anti-psychiatry activists who oppose any attempt to “cure” madness but also completely reject all medication. Sadly, this tends to be disempowering for people who do experience their particular madness as a disorder and who also have both the desire and the means to treat it. A truly socially-just approach to mad liberation must recognize that everyone’s experiences are unique, and must be rooted in harm reduction and self-determination. This would mean meeting people where they’re at and not judging them for their decisions. People know their own situation the best, and for some, that means medicating (whether through doctors or not).

The arguments against medicating are similar to the argument some people make against transsexuality. In both cases, we are told to embrace our natural body by rejecting chemicals and other technologies. Well, there is no such thing as a purely “natural” body. All bodies exist in a social context and all bodies have been modified in some way by technology. Life is made from chemicals, and we’re all cyborgs connected to ecological systems anyway. The ability to access desired technologies that will improve our quality of life — hormone replacement therapy, anti-depressants, whatever —  should be considered a human right. Period.

 

 

Besides, just about everyone is on some kind of drugs. It’s just that some of them (alcohol, caffeine) are normalized and others (prescription medications) are considered acceptable. People — and often only certain types of people e.g. queers, people of color, poor people — who self-medicate “illegally” (without the State’s permission) are the only ones who are subject to criminalization and scorn.

***

While I appreciate that people are concerned, I don’t need or want to hear advice about how much or what types of drugs I should or shouldn’t do. Whether intentionally or not (it’s usually unintentional), it comes off as judgmental and condescending. If you aren’t one of the people I’ve specifically designated to keep me in check, what I do to my body is none of your business.

I was pretty clear in the story that, while drugs weren’t the healthiest temporary solution, they were enough to keep me going — and sometimes that’s all I need. I made an intentional analogy between drugs and falling in love — both are risky and scary and might end in tremendous pain. But we still do it, and that’s okay. And yes, they sometimes cause harm. But, as I said, “sometimes healing looks like hurting.” I also said that I should never feel judged for what I do to survive — whether it’s sex work, drugs, or reckless romance.

Drug users and marginalized folks get enough shit as it is. The twin criminalization of drugs and the social stigma against those who use them are regularly used to police poor folks, communities of color, queers, people with mental illnesses, etc. Don’t believe all of the sensationalized propaganda you read. Like everyone, sometimes we need help or even medical attention. If anything, seriously life-threatening drug addiction is a health issue and an illness that needs to be treated — not demonized, put in jail, moralized at, or subjected to paternalistic advice.

The best way to help someone you think might need it is merely offering: “Hey, if you need/want help, call.” I appreciate when people let me know they’re there for me. But most of all, if you want to help crazy people, start changing the world. Seriously. Most of the bad shit that I described in the story was not due to drugs or mental illness. It was oppression, violence, poverty, and inaccessibility.

If you want to help me get better, don’t offer me suggestions for lowering my anxiety or lecture me about the dangers of speed. Start helping me prevent more senseless deaths in my community, for starters. Okay?

 

 

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