Recently I was asked to speak on a panel for NSUN – the National Survivor User Network – about what mental health activism and LGBTQIA+ activism could learn from each other. NSUN is the UK’s only mental health charity to center survivor and lived experience voices, everyone involved having lived experience of mental ill-health, trauma, and/or distress. This panel was partof their 2020 AGM. You can view the full panel discussion, with the awesome Sabah Choudrey, Suriya Aisha, Kes Otter Lieffe, and Aimz Ruthron here.
In this post I want to share some thoughts about the learnings that I believe are important, in both directions, between mental health activism and sexuality/gender activism. I also want to explore the separation that we make between these two areas and whether that might be part of the problem.
Separating out mental health and gender/sexuality
The first thing we were asked to do on the panel was to introduce ourselves, including our own gender and sexuality – given the focus of the panel – and our lived experience of mental health struggles.
The answer I would usually give to this question nowadays – for example in the interview that I did for mental health podcast So Many Wings – would be something like this:
So I could be diagnosed with post traumatic stress and dissociative identity disorders if using those psychiatric categories. If you wanted to add a question in there about my spiritual/therapeutic stance then something like somatic- and social justice-informed Buddhist mindfulness might get close to that.
As I considered this answer though, I realised that a deeper truth is that it really doesn’t make much sense to me, any more, to distinguish my gender, my sexuality, my mental health status, and my spirituality in this way. The answer to all of these questions – gender, sexuality, mental health, and spirituality – could be trans, they could all be queer, they could all be plural, traumatised, and mindful. They are all of them.
So the main point I want to make in this piece is that I think we should question the very separation between mental health activism and LGBTQIA+ activism. The reasons for this is not just because – as Black feminists have rightly pointed out – we have to fight all forms of injustice – whether or not they impact us directly – in order to be truly free. It’s also not just because so many queers are also survivors due to the traumatising nature of marginalisation and stigmatisation. It’s because the very separation of these aspects of our experience may well be part of the problem which leads to both the oppression of queer people and to the distress of survivors.
I’ll return to this theme in more depth shortly. First, let’s consider what each form of activism might learn from the other, if we did regard them as separable. For each I’ll make a couple of key suggestions although there are many more we could consider.
What can mental health activism learn from LGBTQIA+ activism?
My answers to this question are both things which more radical mental health activism has already learnt from queer activism, but which could definitely do with filtering through more fully to mainstream mental health activism.
First, LGBTQIA+ activism – whether the more mainstream or radical version – has generally located the problem of queer experience out there in the heteronormative, homophobic, biphobic, transphobic, acephobic, etc. culture, rather than in queer people themselves. This is a shift that began a long time ago, in the moves towards decriminalisation and depathologisation of homosexuality. It has continued as each new addition to the LGBTQIA+ acronym has eventually argued that their experience should not be understood as a problem within the individual, but an issue with wider normative society.
Within more mainstream mental health activism there is still often a sense of mental health struggles as something which are located within the individual, which require fixing, rather than as signs of a toxic culture, unjust social structures, or systemic problems within a family or workplace, for example.
Some mental health struggles simply wouldn’t be struggles within a culture which accepted diverse experience rather than insisting that people follow certain rigid norms of behaviour and experience, and pathologised and stigmatised those who don’t. Many other struggles are the result of forms of traumatic experiences such as marginalisation and non-consensual treatment, which are individualised in the person who is struggling, rather than recognised as being structural and systemic problems.
Survivor-led and mad pride movements have moved towards a more similar understanding to queer activism: that the problem is out there rather than in here, and that one important form of resistance is that of visibly taking pride in our difference, rather than accepting the shame and stigma of the wider world. For example we might question those who can can manage to fit into the category of ‘sane’ in such an ‘insane’ world. We might celebrate the ‘creatively maladjusted misfits and changemakers’ that we are, as So Many Wings does.
What can LGBTQIA+ activism learn from mental health activism?
My answers to this question are about what LGBTQIA+ activism could learn from the more radical and critical versions of mental health activism. I wrote more about this in this paper on why bi communities, in particular, could do with a more critical understanding of mental health.
One thing that’s always surprised me in queer communities is the way people who are very critical about normative ways of understanding gender and sexuality, often seem to accept mainstream medical models of mental health. Folks who think carefully and queerly about the labels and categories that are imposed on our genders and sexualities, where those come from and who benefits from them, often seem comfortable labelling their mental health struggles with psychiatric categories, and accepting that those make them a certain kind of – disordered – person.
Also, many in the queer world challenge the binaries and hierarchies that are imposed on gender and sexuality, without applying this to mental health. So the main thing I’d like to see from a dialogue between queer and mental health activism, would be a more critical perspective on mental health among queers which questions binary divisions between normal and abnormal, mad and sane, functional and dysfunctional, healthy and unhealthy, rational and emotional, and so on. Just as with the binaries of man/woman, gay/straight, cis/trans, etc. we can ask who is served by such divisions, and whether they stand up to scrutiny. Alex Iantaffi and I explore these questions more in our book Life Isn’t Binary.
Secondly, mental health activism is – it seems to me – increasingly informed by somatic understandings of trauma and the way it operates in the body. Queer activism could certainly do with learning from such trauma-informed perspectives. My experience of LGBTQIA+ and sex positive spaces is that they are often unaware of this. For example, there’s often little awareness in party and con spaces of the potential triggers of trauma, how these show up in the body, how to know that you – or somebody else – is in a trauma response, and the implications of this in for our sexual practices and relationships.
In more conscious sexuality and kink spaces, there can often be a sense that people should be pushed to their edges, or confronted with challenging activities as a form of catharsis, without an awareness of the potentially retraumatising impact of putting somebody through a similar situation to one which was traumatising in early life. Online call-out and cancel culture, which is prevalent in some queer communities, similarly lacks an awarenes of the potentially retraumatising impact of public shaming, and the traumatised places in ourselves that such impulses can come from.
Mental health activism is LGBTQIA+ activism and vice versa
When I worked as a therapist, one thing that struck me was that gender and sexuality were almost always deeply relevant to clients’ mental health struggles. This was true whether they were somebody whose gender and/or sexuality was marginalised, or somebody who was more normative in their presentation of their gender and/or sexuality.
LGBTQIA+ people’s mental health struggles are clearly related to their experiences of marginalisation, stigma, invisibility, discrimination, bullying, and so on. For more normative folks, it is often the attempt to adhere to rigid ideals of masculinity, femininity, and heteronormativity that is the problem.
For example, in relation to gender, we know that high rates of suicide and addiction in men is highly linked to toxic masculinity and rules against expressing vulnerability or emotion, and seeking help or support from others. We also know that high rates of depression, anxiety, and body shame in women is highly linked to the way femininity is defined in relation to others, and women’s worth is wrapped up in their relationships and desirability.
In relation to sexuality, many people experience distress because the very limited ideas about the kind of sex that they should have, and the relationship contexts they should be having it in, bear little relation to their internal erotic landscapes. This mismatch plays out regularly in a vulnerable and embodied way during sex, which takes a great toll on mental health. It could be seen as a form of everyday non-consent enacted against the bodies of ourselves and/or of others.
So, whether we are marginalised in relation to our gender and sexuality or not, normative understandings of gender and sexuality traumatise us. For this reason, our mental health struggles, genders, and sexualities cannot easily be disentangled, in fact should be explored together.
Bringing mental health and gender/sexuality back together
It strikes me that many cultures around the world do not separate out gender, sexuality, spirituality, and mental health at all. In many places the most spiritual people have also been those who were gender creative and erotically expansive. Language has developed in such contexts which captures that whole state rather than separating out gender, sexuality, and spirituality. In many faiths and communities, experiences which we might label mental health struggles are seen as sacred experiences, or paths to enlightenment, and people going through them are honoured and supported.
The separation of gender, sexuality, mental health, and spirituality could be seen as a toxic aspect of racial capitalism, required to ensure docile subjects who are too busy policing themselves, and each other, around their ‘normality’ or otherwise to critically consider what is being done to them, or its impact.
Certainly we can see the roots of the current form of the binary gender model and heteronormativity in forms of capitalism which required women to work unpaid in the home supporting and reproducing the workforce. In many ways this has ramped up under neoliberal capitalism with its pressure to present a successful, productive singular self who is performing gender, sex, and mental well-being perfectly, while paying little attention to spirituality beyond the individualised kind of care required to keep them functional and productive.
Perhaps one of the reasons we see such high rates of distress in neoliberal capitalist cultures is this very severing of gender, sexuality, mental health, and spirituality, within such an unjust race and class system. This could, itself, be seen as a form of historical and intergenerational trauma, as authors such as Alex Iantaffi have suggested.
The work of Audre Lorde – and many Black feminists who’ve followed her – calls into question such separation. They suggest instead that we could understand ‘the erotic’ as a powerful resource relating to how we feel when we’re most alive and mentally well which incorporates and transcends the sexual and the spiritual. If liberated such a resource would reveal and challenge all of the destructive forces we’re operating under, and require something very different.
My trans, queer, plural, traumatised, mindful self
You might find it useful – like me – to play with whether the labels you use to describe one aspect of your experience or identity are actually helpful to apply to other aspects. Perhaps this can be helpful in breaking down the divisions between gender, sexuality, mental health status, and spirituality.
I find trans a useful word to apply to all of these areas because my experience of all of them is different to what they were assumed to be when I was born, not just my gender. Also we can understand trans as signalling transition, or change over time, and I consider all these aspects of me as in a state of becoming, rather than being fixed.
The word queer can signal being outside of normativity of all kinds, and that certainly applies to gender, sexuality, mental health, and spirituality for me. Queer also involves questioning binaries, and the power structures they serve, which is something I’m keen to do, whether those binaries be man/woman or cis/trans, gay/straight or sexual/non-sexual, mad/sane or normal/abnormal, spiritual/non-spiritual or Buddhist/secular.
In addition to transition, plurality is a word which captures my experience of selfhood better than most. Again this applies across all these aspects of being. My plural parts have different genders, they have different sexualities and erotic desires, they express trauma in different ways and fall into different survival strategies, and they certainly come down in different places on a spectrum from secular to spiritual, or ‘rational’ to ‘woo’.
Finally trauma and mindful are both words which are useful across all aspects of myself. I have certainly been traumatised by normative understandings of gender, sexuality, mental health, and spirituality which have been passed down through the generations to me. These are also all sites of trauma for me as I’ve experienced gender-related bullying and discrimination; sexual assault and harrassment; gaslighting and stigma around my mental health struggles; and traumatic experiences in spiritual and conscious sexuality communities – both personally and in relation to the wider #MeToo moments that such communities have gone through.
Somatic and social justice forms of Buddhist mindfulness have been important for me, in addressing all these forms of trauma, and in coming to understand my self (or selves, or no self) better in relation to gender, sexuality, mental health, spirituality, and the ways these are all woven together.
- You can read a dialogue between me and Helen Spandler on what queer studies and mad studies can learn from each other here.
- This resource that I wrote for the BACP explains in more detail why gender and sexuality are themes that need to be explored with all clients in relation to their mental health struggles, along with race, class, disability and other key intersections.
- This article I wrote about mental health as depression and oppression in relation to bi communities also deals with these themes.
- You can find more of my resources about trauma on my trauma work page.
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