1. Traces

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My first experience in a mental health facility
was in college
not as a patient
but as a visitor
a voyeur
a participant in a medical model of disability
wherein "[a]ll of our bodyminds are judged
in one way or another,
found to be normal and abnormal,
valuable or disposable,
healthy or unhealthy" (Clare, 2017, p. 69).
No one is spared this judgment.
We do it to one another,
to ourselves,
in desperate attempts to adhere to normative notions of rationality,
acceptability,
performativity,
that govern our lives
our bodies,
our "bodyminds" (Price, 2014, p. 240),
and some,
(intentionally)
very much more so than others.
"Across the centuries, how many communities have been declared defective
by white people, rich people, nondisabled people, men backed by medical,
scientific,
academic,
and state authority?" (Clare, 2017, p. 24).
This single label
defective
is never
was never
"innocent" (Burstow, 2013, p. 81)
for, "as a species,
we live in and through words...words matter" (Burstow, 2013, p. 79).
They hold centuries of hauntings,
representing, symbolizing, epitomizing,
"symptomiz[ing]...
not the invisible or some ineffable excess" (Gordon, 2008, p. xvi)
but rather
"[t]he whole essence" (Gordon, 2008, p. xvi)
of that which has been concealed by abusive power structures
and, due to its living, breathing, animated existence within each of us,
in every space and place we occupy,
(or has been violently occupied),
"makes itself known or apparent to us" (Gordon, 2008, p. 8).
Peeling back the layers that encase
curative medical model discourse,
concealments designed to make itself stable,
indestructible, invulnerable,
whole,
we begin to illuminate the fragility,
the profundity
of the worlds
that such diagnostic expressions hold,
and come to witness the expansive reverberations of these worlds
within,
among,
and through
each and every one of us.
It is in these seemingly unassuming moments of grappling,
(the depths to which our ghosts always foretold),
"when home becomes unfamiliar,
when your bearings on the world lose direction,
when the over-and-done-with comes alive,
when what's been in your blind spot
comes into view,"
demanding "your attention,"
"demand[ing] its due" (Gordon, 2008, p. xvi).

2. Pieces

---

As I sat across the table from you
forcing small talk,
pleasantries,
scattered puzzle pieces
helped me focus my attention
and put to use my jittery, nervous hands
whose shaking physically manifested
the terror I held inside of becoming
one of you,
one of them.
You frustratingly told me how
fucked up it was that you were here.
Sitting across the desk of your
on-campus therapist one minute
then put into an ambulance the next,
whisked away to a psychiatric hospital
that I am sure you didn't have penciled in
to your agenda for today.
"What a bitch."
Rolling your eyes, like you usually do,
you warned us to never tell the actual
truth when asked, "Do you have thoughts of taking your own life?"
because, when you said, "Of course I fucking do! Who doesn't?!"
you earned yourself a two week hold in a locked facility
when all you wanted was a routine refill of your SSRIs.
Damn.
My mind flooded with every suicidal ideation I ever had
including the year, yes full year,
during high school when my parents stopped talking to me
and, to comfort myself, I would play on loop
all of the ways that I could end it all
if I didn't get a sports scholarship or academic scholarship
to anywhere but here.
Did that make me crazy?
What separated me from you?
What did I do that kept me
on the other side of the locked doors
that kept you "safe" here
and me "free"
out there?
"there is a moral to this tale, and you /
were born to tell it /
safe and free are not the same thing /
living and alive are not the same thing" (Thom, 2019, p. 153).
Since then, I bore your warning like an omen
refusing to ever, ever tell my therapist the truth
the whole truth
so help us god,
because, if anyone knew what really happened
inside my mind
I would be locked away so long that
there would be no way in hell that I would
ever get out.
"your crazy is beloved genius art when you're not standing /
on the tracks trying not to jump, and when you are...that's /
different" (Piepzna-Samarasinha, 2015, p. 42).
So, I smiled, you smiled.
I faked sanity.
I fake sanity.

3. Diagnosis

---

I came to your office after weeks of reaching out to
therapist after therapist who took sliding scale
payments
and stated having some competency around trans issues
and trans people
like me.
I, honestly, just wanted you to sign my letter
that proved, according to the WPATH 4 Standards of Care,
that I was sane, competent, and capable
of making the decision all by myself
to chop off parts of my chest that
were undesired "freebies"
on an AFAB body that desperately wanted to be cut loose
of excess baggage.
You told me that it would take at least 3 sessions (300 bucks!)
to get my letter.
I told myself, that's 3 fucking weeks where I better not
sound crazy
say anything crazy
or tell the truth.
It was pretty clear from the start
that the truth would not set me free
but rather would keep me locked in a cage
for which, unfortunately, only you
held the key.
After two years of working together,
gender affirmation surgery and countless bottles
of hormone gel later,
I finally opened the door to my mind
ever so slightly
to let you peak as a guest
yet perpetually, diagnostically
as a voyeur,
peering, leering,
from the pathologizing realm of the medical industrial complex
into the inner workings of, what I would consider,
a "Mad Mad Mad Mad Mad Mad world" (Smith, 2020, p. 377).
Ironically, I have to pause here
because it's time for our weekly phone session
where I still pick and choose how much to say,
how much to let on to.
Never, ever, ever will
I tell you about the intrusive thoughts,
those intrusive thoughts that
(as I learned while being a call operator
for a crisis lifeline)
are a normal, reasonable, and understandable
form of harm reduction
used to cope
with a society that never envisioned me part of it.
Those thoughts,

I'd rather keep them to myself…

"if your bones should start to murmur and hiss /
in a language that is not safe to know, then leave…/
if you should start to think forbidden thoughts /
then come for me //
the end of ever after is the beginning of the truth" (Thom, 2019, p. 40-41).

4. Access

---

Standing outside of the LGBTQIA+ mental health facility
in the outskirts of Boston,
a few minutes before I was due for my intake appointment,
I couldn't help but stop and stare
at the juxtaposition of the rather quaint,
New England-style house
turned facility for the crazy and queer
situated next to the gray warehouse-looking,
locked-down institution for those who,
unlike me, would not be allowed out each night.
I had spent years avoiding this exact place,
this exact situation,
this exact mind.
But for all of my running,
what was it? 6 marathons now?
and all of my numbing,
the ghosts kept surfacing
and could be pushed down no longer.
It's wild to me that the very thing that I feared for so long
became the only thing that I felt could save me
hold me
protect me
in the midst of this darkness.
"I claim brokenness to make this irrevocable shattering visible" (Clare, 2017, p. 160).
The "twisted genius" (Dyson, 2018, p. ix)
of the medical industrial complex is that
that which we need
so often perpetuates our dependency,
harming and haunting
with remarkable intentionality and precision:

The Medical Industrial Complex is an enormous system with tentacles that reach beyond simply doctors, nurses, clinics, and hospitals. It is a system about profit, first and foremost, rather than "health," wellbeing and care. Its roots run deep and its history and present are connected to everything including eugenics, capitalism, colonization, slavery, immigration, war, prisons, and reproductive oppression. It is not just a major piece of the history of ableism, but all systems of oppression. (Mingus, 2015)

To walk through the doors of this facility,
to receive care,
and walk back out,
day in and day out,
was a privilege reflective of my whiteness,
my class, my citizenship status,
my job, my access to health care...
"...as a widespread ideology centered on eradication, cure always operates in relationship to violence" (Clare, 2017, p. 28).
It is my privilege that opens the doors to 'treatment'
from a "debilitating" (Puar, 2017, p. 16) system
that constructs and reconstructs
ableist notions of normativity and
curative ideology that ensures that "access to
the identity of disability" remains
"a function, result, and reclamation of
white privilege" (Puar, 2017, p. 15).
My longing for the exact space
that haunted me for so long
was, thus, saturated with linguistic and systemic structures
designed to further the lives of some
and enact a "slow death" (Puar, 2017, p. 12)
on those bodyminds for whom survival
remains contingent upon the denial of
debility (Puar, 2017, p. 15).
In the fine print, just below the line
where I signed my name
that first day
on the facility's intake form,
it read…

There is always a cost to getting better (Puar, 2017, p. 1).

What price are you willing to pay?

5. Release

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To kick off group therapy,
we were asked to draw our
dysphoria.
Scanning a table full of
miscellaneous art supplies,
I couldn't help but chuckle to myself
at the absurdity of constructing
a thing that has caused me
so much pain,
so much suffering,
so much confusion,
out of pipe cleaners, markers, glitter, and glue.
You gotta be fucking kidding me.
Sitting there in frustration, silence, and bemusement,
I began to realize that this task was so hard
so difficult
so damn unfathomable to me
because my dysphoria has always remained
illusive, slippery, slimy,
perpetually just out of reach.
As I picked up my pen and began to draw,
I looked at my arm
and remembered the satisfaction,
the relief,
the release,
of getting two dark, solid bands of ink
etched deep, deep under my skin.
The pain was beautiful
because, for the first time,
I felt like I could tap into you,
know you, even briefly,
by inviting you up to the surface,
to my level, to live, breathe, and manifest
in a way that bore some semblance of reality,
rationality,
truth.
You were never something that I could describe
easily,
but your name, the ability to be named,
granted to us by the indefatigable medical industrial complex,
remarkably and hauntingly,
offered a small, illuminated pathway
through years and years of darkness.
It's so fucked to think of you as
both an identity and a diagnosis,
a "trans diagnosis" imbued with "standards
that are embedded with racist, ableist, classist, and heterosexist
expectations" (Lair, 2016, p. 171),
hinged on our experience of "distress" and
"impairment" (American Psychiatric Association, 2013),
and fully couched within the Diagnostic and Statistical Manual
of Mental Disorders - 5th Edition.
Progress has attempted to be made
to distance our "treatment" today
from the medicalized horrors of the past
(a distancing that tries to erase culpability, forgetting transness'
"transitive" quality to always refer back to an action
"that requires a direct object to complete its sense of meaning"
(Snorton, 2017, p. 6)).
This past (and present), based on the principles of eugenics and
the "perpetuation of white racial superiority",
sought out the complete and utter "elimination of those
deemed 'unfit'" based on labels,
diagnoses,
"notions of degeneracy, criminality, perversion,
and disability" (Lair, 2016, p. 20):

Simply put, diagnosis wields immense power. It can provide us access to vital medical technology or shame us, reveal a path toward less pain or get us locked up. It opens doors and slams them shut. (Clare, 2017, p. 41)

The thing though about the past is that it haunts,
it demands to be known, and refuses to be ignored.
And when you say that you're doing better
by establishing a "current term [that] is more descriptive
than the previous DSM-IV term gender identity disorder"
because this term "focuses on dysphoria as the clinical problem,
not identity per se" (American Psychiatric Association, 2013),
you fail to recognize that you still label us as problems
to be fixed,
to be healed,
to be cured,
forced to meet the expectations of a "white, able-minded,
and heterosexual definition for
… 'normality'" (Lair, 2016, p. 23).
So, as I draw you, dysphoria,
I cannot separate you from the past, from the present,
from the future,
from the systems that are purportedly designed to
"cure":

Cure promises wholeness even as the world pokes and prods, reverberating beneath our skin, a broken world giving rise to broken selves….The ideology of cure would have us believe that whole and broken are opposites and that the latter has no value. (Clare, 2017, p. 158-159)

Is my testosterone a cure, a tool to force my bodymind
into the rigid, binary definitions of cisnormativity?
As I rub gel into my skin each morning, I hold these questions,
these notions,
these hauntings,
in the same hand that grips a bottle of $300 medicine
that quiets my dysphoria,
my distress,
my impairment,
lulling it back to sleep deep within the recesses
of an embodied sense of self
that I desperately want to
call home.

"how can i feel homesick /
if i've never been home?" (Thom, 2019, p. 100)