Gender, sexuality, and mental health.

February 17, 2013 6:09 AM

Gender, sexuality, and mental health. Help me design a workshop?

A while ago I asked this question, asking for your input about how to design a workshop about gender and sexuality for mental health professionals who didn't know a lot about queer or trans issues or identities. You guys provided some awesome ideas and resources, and that workshop was a raging success.

Now I want to design a workshop from the opposite perspective: a workshop about mental health for people who are already very well-versed in issues of gender and sexuality, who are activists and queers themselves and allies working within these communities. I'm a graduate student in a mental health field, and the workshop will be part of a multi day gathering with lots of workshops on oppression, activism, etc. I'm a lot more intimidated about giving this workshop than I was the last one, and so I really want to inform myself and make it as relevant and interesting as it can be.

So far what I've thought of doing is talking about some of the institutionalized oppression within the field of psychology: the history of homosexuality in the DSM, the current inclusion of gender identity disorder (and the necessity of getting a diagnosis of a mental disorder in order to access hormones/surgery), the phenomenon of gay conversion therapy, the history of surgically operating on the genitals of intersexed infants....that's all I've got there so far. I could also talk about how the DSM imposes this dichotomy between pathological and normal....but I'm worried about getting up as a psych grad student and giving a rant/tirade against psychology...not because I don't have a lot of problems with the DSM etc., but just because I'm going to need a job in the future, and this is a small community. I want to be able to offer critique and controversy in a calm, almost impartial way, but the truth is I'm currently kind of raging inside about some of these things, and I'm scared of broadcasting that to all of my future employers, who may not be so receptive to a scathing critique of their field and practices.

Then I was thinking of exploring mental health issues among queer and/or trans people...for this I was originally thinking of getting a loan of a bunch of clickers, so that I could poll the room anonymously about their experiences with mental illness and access to treatment, but it looks like that's not going to be a possibility, and I wasn't sure how to go about that in a really sensitive manner anyway...

I would love input from you guys about how to make this workshop a success. I'd love to be able to get the audience involved somehow, but I'm not sure how many will be there...probably somewhere between 20 and 50. As a queer person/trans person/ally, what would you want to learn about mental health, or what do you wish people knew? I feel like I'm going to learn a lot from making/presenting this workshop, and I'm really open/wanting to hear about perspectives that I've neglected or not thought about. I have about 45 minutes to give the talk/presentation/workshop, and then another 30 minutes for discussion.

Thanks guys!

posted by whalebreath to education (12 answers total)

(and the necessity of getting a diagnosis of a mental disorder in order to access hormones/surgery)

Depending on where you are it is possible to access hormones without a GID diagnosis. The ability to avoid a GID diagnosis doesn't make the DSM not problematic, but it's part of that conversation. (It's also part of the 'Are the Standards of Care optimal?' conversation.)

Can you clarify who the intended audience is? I imagine that a lot of the stuff you've mentioned is well-traveled territory for queer people working in mental health (and non-queer people with queer clients, at least those that would turn up to the sort of event you've described). Are you envisioning a discussion of how oppression and barriers to accessing mental health care can be challenged or changed?
posted by hoyland at 6:28 AM on February 17

Thanks - I'll look into that. The intended audience are not people working in mental health, they are working in things like gender advocacy centres, queer university groups, student unions, etc. So while they may have some knowledge of mental health, it's not generally their focus/area.
posted by whalebreath at 6:33 AM on February 17

To balance the criticism you might want to throw in some discussion about when and how mental health professionals might be helpful and useful and important for this community. You could talk about best practices for how to respond to various common mental health crisis situations that might come up in the context of a student group or advocacy center. You could provide handouts with information about affordable and queer-friendly mental health services in your area, suicide hotlines, etc. I attended a professional training along these lines a couple of years ago and everyone seemed to think it was useful.
posted by steinwald at 7:25 AM on February 17

What is the goal of the workshop? You mention it is for activists and allies in the queer community and I find these types of people are already pretty up on mental health issues but usually appreciate finding out about what resources they can access. Resources for their clients, but also resources for them (because activism in general is draining and being a resource for people challenged with mental illness is incredibly draining). Also a good number of them will already have/had/know someone with a mental illness. So I would talk about boundaries and self care with the group. And a large portion of time on suicide and people that discuss suicide ideation (which to me has two intertwined aspects - a genuine distress that makes someone think death is better than life but also the reward of attention from people who do not know how to professionally deal with disclosures of suicidal ideation).

You also need to discuss how the mental health field is funded and which services can be accessed for free/sliding scale and what the costs of other services are. I would also talk about their specific rights under the Charter and their provincial human rights code and how to exercise their entitlement to those rights through the courts and tribunals including the appropriate legal langague to use ("disability, "duty to accommidate", "undue hardhip") and their definations.

Soooo, personally, I would do a bit about the intersection of mental health and queerness with just a light touch on the history of it (yes, I am very aware of the history, including the recent history like the Clark Institute and some of the arcane rules around provincial funding for gender reassignment), but if you are dealing with a young crowd the fact that homosexuality was taken from the DSM 40 years ago is literally a lifetime ago and although interesting may not be what they are looking for exactly.

Do you know the spoon story? Although it was intended for invisible chronic physical illness in general (which mental illness is...) I find it really works well as an anecdote for the extra burden mental illness puts on the people challenged with it. As is the Bridge story as an explanation of why boundaries are important. If you were going to do handouts/slideshow Hyperbole and a half has a good webcomic and Chester Brown's Louis Riel has an excellent depiction of delusions. If you were showing film clips Margaret's Museum has a few great scenes (although it works better seen in its entirety). As they are already activists they would probably appreciate hearing about the mad pride movement. It think you should also talk about some of the positives of mental illness, including the freedom to be transgressive and accepting two-spirit people in the First Nations

You can discuss the very important pyschosocial aspect of mental health, how to build those networks both formally and informally and the importance of inclusive language. I would touch on the biophysical aspects of mental illness, including the controversy over medication. In my talks (which focus heavily on educating non-professionals about mental health) I often liken mental health to diabetes - it is disease people understand and has some similar appropriate treatments: lifestyle choices, support networks and medication. THe three need to be balanced, someone who consistently makes healthy lifestyle choices and has a strong support network may not need the medication if they have type 2, but people with type 1 need the medication even if they are doing everything else "right". And like diabetes, mental illness can be sometimes prevented by proactively taking care of your health, but sometimes it hits for no apparent reason.

If you have time to touch on comorbid disorders, the link between mental health and physical health, and the risk of non-professionals "diagnosing" mental illnesses that are actually manifestations of physical disorders like thyroid, low blood sugar, dehydration etc and that myth of "pull yourself up by your bootstraps" is so destructive you are golden.

You also should at some point touch on addiction; the connection between mental health, self-medication and addiction is so strong and equally stigmatised by our society.

Good luck with the workshop!
posted by saucysault at 7:30 AM on February 17 [6 favorites]

As a queer person, I would be most interested in discussion of internalized homophobia/transphobia and the impact of minority stress. I always wish that there was more public discussion of how it can (sometimes) be hard just going through normal life when you often feel "other." When my friends and I have talked about it, it's often been with a sense of relief at finally acknowledging it and knowing we're not alone. I'd personally find that kind of discussion of the specific challenges and strategies needed to maintain "normal" mental health as an LGBTQ person in our society more interesting than a discussion that focused more on mental illness per se. I think that would also dovetail well with the suggestions above to talk about self-care and boundaries.
posted by zahava at 7:48 AM on February 17

I was kind of surprised by the topics you mentioned. They seem to be a brief history of ways psych has fucked queer people over, when I expected a brief overview of how mental health is understood (and perhaps some big current questions) and resources that are available. So maybe I am not clear on your audience.

It's not clear to me if you brought up those topics because they're your motivation for studying this intersection, or if you are aware that these are the questions your audience will have. Successful workshops usually lean on the latter strategy. I have worked a bit in a related field and I have been in workshops about mental health there, and they stuck to answering concerns that we would have as service providers and clients: what's going on in my head? How do I get help? How will that affect my other stuff?

I would probably spend some time defining some often misunderstood terms (e.g. Bipolar) and talking about how mental health is similar to the Kinsey scale. What I mean by that is that few people are 100% gay or straight, and it can change over your lifetime, and mental health is similarly variable. Symptoms of depression, OCD, mania, etc, are all on scales and change over time. Trans people are all different, and bipolar people are all different. (This in itself is a critique of the DSM, but does not need to be directly pointed at it. You will be preaching to a choir who is used to being stereotyped while being aware of a huge rainbow of variation. They will hear you!)

You could also bring mental health into the intersectionality discussion. As zahava mentioned, being othered is stressful whether that's due to gender performance, sexuality, race/ethnicity, disability, or mental health status.

There is also often a cultural push in activist/social justice/common cause realms to be Strong and not be the person needing services, while doing the type of work that often leads to burn-out. This undermines mental health.

What kinds of strategies are effective in recognizing when to get help, or easing the pressure off when you see your mental health starting to suffer whether it's due to workload or Othering?

Are there particular psych meds that might be problematic if you are (eg) FTM trans and on hormones?

Are there local centres or doctors who are particularly queer-friendly when dealing with mental health?

It might also be nice to talk about neuroplasticity, as it is a big incentive to actually meditate and engage in training your brain to heal itself. Always nice to include some hope!
posted by heatherann at 8:43 AM on February 17

For the audience you describe - non mental health specialists in contact with a range of people, some of whom may be seeking help - I think the most useful sort of mental health workshop is not theoretical. A practical skills based approach is often really appreciated. An example of this is Mental Health First Aid or ASIST.

Practical ways to respond to people who are distressed and suicidal, depressed or anxious, or psychotic, are useful skills for anyone to have. This sort of practical information tends to be particularly appreciated by people working in people supporting contexts, as they are often under prepared practically for mental health support.

Skills based exercises (role play etc) can be very effective. There's a range of evidence based approaches to supporting people that should be the basis of any workshop (e.g. Ask about suicide, don't use guilt, watchful waiting for mild depression, etc) that are easy to access.

The only cautionary note is that exercises can be triggering for some people and if you are planning any sort of mental health workshop in a non mental health context you should have a support plan for participants, and ideally a prepare person to act as a supporter if anyone becomes distressed.
posted by Gilgongo at 10:27 AM on February 17

Another thing to consider offering is not just reactive actions the participants can do when dealing with their clients that may be challenged with mental illness, but specifically being proactive and what they can change about their organisation to prevent/mitigate mental illness in their client base. Have examples of successful policies and procedures.
posted by saucysault at 10:58 AM on February 17

Yeah, I was just coming back to say that talking about minority stress would definitely be a good place to bring in intersectionality in terms of race, gender, disability, etc. Even having a mental illness often puts that sort of "othering" stress on people. I have friends who struggle with whether to disclose their mental illness, worrying about what stereotypes other people have about it and whether they will face rejection. What are ways that our communities can support everyone, whoever they are?

I also love the idea of talking about neuroplasticity and offering resources where participants can learn about supportive practices like meditation, yoga, discussion groups, sports, etc.
posted by zahava at 11:08 AM on February 17

As a queer person with mental health problems, if I went to a seminar on 'Gender, sexuality and mental health' and was presented with the content you described in your question, I would feel very stigmatised and ashamed. I don't think that's the effect you would want to give, so I don't think that's the talk you should give. People with mental health problems are used to getting the message that psychology and psychiatry are so flawed we're better off not seeking treatment, and if we seek treatment we can be criticised for doing so: "Why are you taking those drugs? Aren't they too strong/addictive/numbing/placebos/just a crutch?" "Why are you getting therapy? Isn't it self-indulgent/brainwashing/unscientific/a waste of resources/just a crutch?" I think it's important that you ground your workshop in people's actual experiences, and while I wouldn't want you not to acknowledge the flaws and problems in various approaches, the fact is that teaching people to avoid mental health treatment costs lives. If you're going to talk about gender, you need to talk about the damaging effects of cis masculinity on mental health, and the fact that men are dying every day because of their beliefs about gender. You need to talk about the higher rates of addiction and suicide in queer and trans people. You need to talk about lesbian/bi women and self-harm.

I think it's useful to talk about the institutional problems with psychiatry and psychology, but that is relatively high-level, graduate-studies type material, and you need to bear in mind that there will be people in your audience who haven't yet grasped elementary-level stuff about mental health, eg that they should seek medical help if they are suicidal, or that drinking is not a good way to deal with feeling bad, or not to look down on people who have a mental illness. Teach them to count first, then teach them calculus.
posted by Acheman at 11:41 AM on February 17 [1 favorite]

Thanks everyone, this has given me loads to think about so far! Keep it coming :)
posted by whalebreath at 12:00 PM on February 17

Really thanks a million. I wanted to best every answer. I was feeling pretty unqualified and knew that there was a lot I wasn't considering - I love having you guys around to clue me in and set me 'straight' (ha). I think giving this my best shot will be a really great way to teach myself and get educated about things I want to know about and want to be able to share with people. You guys rock.
posted by whalebreath at 3:58 PM on February 17 [1 favorite]