What’s the T? An exploration into gender dysphoria and why it matters

I am a gay male, yet I feel I am not fully aware of the diversity under the LGBTIQ+ umbrella. The issues gay males face now has some attention of the broader community and while there is still a long way to go, there is even more work to be done to bring transgender, gender diverse and non-binary individuals to the same status.

It is appropriate timing for this Friday (May 17) to be IDAHOBIT Day – the International Day Against Homophobia, Biphobia, Interphobia and Transphobia. Sadly, these types of awareness days are still so vital as LGBTIQ+ individuals continue to be significantly over-represented in poorer mental and physical health outcomes than the general population. It starts with compassion, empathy and education – and I hope the following helps with that.

To clarify terminology, transgender is an umbrella term used to describe a person whose gender differs from that assigned to them at birth and may not fit into the binary categories of male and female (Brady & Molloy, 2018). Gender non-conformity refers to the extent to which a person’s gender identity, role, or expression differs from the cultural norms prescribed for people of a particular sex (Coleman et al., 2012). It follows then that gender dysphoria refers to the distress caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth (including the associated gender role and/or primary and secondary sex characteristics) (Coleman et al., 2012). It is important to note that not all gender non-conforming people will experience gender dysphoria, and that gender dysphoria can occur at various stages of life, although symptoms tend to heighten when secondary sexual characteristics develop during puberty (Atkinson & Russell, 2015).

Trans Flag
Above: The Transgender Flag and Symbol. Credit: WeThePeople Clothing. Below: Pride March, Melbourne, 2017.

melb pride

When this distress is significant enough to cause an impairment in functioning, and the person meets any two of six diagnostic criteria as set out in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) for at least six months, a diagnosis of gender dysphoria is made (Brady & Molloy, 2018).

Should gender dysphoria be considered a mental illness?

Consider the issue this raises – if a person’s expression of gender characteristics and identity does not match the cultural norm in a society and this causes them distress, should this be judged as a mental illness? Classing it this way attaches a pathological association (meaning that it is caused by a physical or mental disease), and this invariably leads to stigma and discrimination. Consider that homosexuality was treated in the same way and was only removed from the DSM in 1973 and the effect that this removal has had on changing social acceptance (although stigma and discrimination still exists). This stigma can result in prejudice and discrimination leading to minority stress, which is an additional stress minority groups can suffer on top of general stressors all people face, making them more vulnerable of developing mental health concerns like depression and anxiety (World Professional Association of Transgender Health (WPATH), 2010). It is important to recognise that these symptoms are generally the result of social stigma and exclusion and are not inherent to being transgender or gender non-conforming (WPATH, 2010). Please reflect on whether you think gender dysphoria should be classed as a mental illness, as it currently is in the DSM-5, as you read on.

One argument made for gender dysphoria remaining as a diagnosable condition is that it allows for access to health care and various treatment options (Coleman et al., 2012). When the DSM was updated in 2013, the term gender dysphoria replaced gender identity disorder (which was categorised as a sexual disorder), in an attempt to remove the pathological connection from being transgender (Brady & Molloy, 2018). The transgender community and their advocates remain unsatisfied with this assertion, feeling it perpetuates the implication of a mental illness and allows stigma and prejudice to continue. Furthermore, it remains necessary for transgender patients to be given a gender dysphoria diagnosis to access required health care, including hormone therapy and surgical specialists (Brady & Molloy, 2018).

Contrast this with the 2018 update to the World Health Organisation’s ICD-11 (International Statistical Classification of Diseases and Related Health Problems) – the term gender incongruence has been introduced to replace gender dysphoria, and importantly, it has been moved out of the mental disorders category, into a sexual health condition category (WHO, 2018). The WHO stated that their reason for doing so is that “while evidence is now clear that it is not a mental disorder, and indeed classifying it in this way can cause enormous stigma for people who are transgender, there remain significant health care needs that can best be met if the condition is coded under the ICD” (WHO, 2018). This change has delighted transgender advocates as it steps away from the mental illness assumption while still allowing medical and psychiatric treatment for a sexual health condition.

There are two significant factors which make clinical intervention important – the continuing over-representation of the LGBTIQ+ community in poor mental health statistics compared to the general population; as well as the positive results seen through treatment once it is commenced.

One study reported that 71 per cent of people with gender dysphoria will be diagnosed with another mental health condition during their lifetime (Buzwell, 2018). Depression (74.6 per cent) and anxiety (72.2 per cent) are most common, while post-traumatic stress disorder (23.1 per cent), personality disorder (20.1 per cent) and psychosis (16.2 per cent) are significant concerns (Buzwell, 2018). There have also been links found between gender dysphoria and autism and eating disorders, with further research being required to fully understand this (Buzwell, 2018).

Further studies show consistently high rates of mental health diagnoses in those with gender dysphoria: Telfer, Tollit, and Feldman (2015) reported that up to 50 per cent of young people with gender dysphoria have self harmed, and 28 per cent will attempt suicide. Brady and Molloy (2018) suggested even higher rates, where 84 per cent of participants had contemplated suicide and 48 per cent had attempted suicide in their lifetime. These studies showed that these alarmingly high rates of mental health issues are predominately caused by ongoing discrimination, stigma and transphobia, as opposed to being a result of being transgender (Brady & Molloy, 2018).

In relation to treatment outcomes, improvement is evident. Treatment may include a combination of psychotherapy, hormone therapy and surgery – meaning that the prognosis of gender dysphoria is generally positive (Atkinson & Russell, 2015), assuming treatment is sought and effectively managed. Successful treatment is individual – what may assist one person resolve their gender dysphoria could be very different to another person’s treatment, e.g. one person may be satisfied with a change in gender expression, while another person may wish to undergo body modifications (Coleman et al., 2012). Treatments are safe and effective in the long term and very few individuals that have chosen surgical reassignment have regretted their decision later in life (Atkinson & Russell, 2015).

Further evidence shows that the most vulnerable time for people with gender dysphoria is the time between when they decide to seek treatment to when they commence treatment. A study by Erasmus, Bagga and Harte (2015) showed that 28 per cent of gender dysphoria sufferers considering treatment had a past-year suicide attempt, compared to one per cent of those who had undertaken gender-affirmative treatment. This significantly heightened pre-treatment suicide risk was also found in another study by Telfer, Tollit & Feldman (2015), highlighting the critical need for timely access to health care support for this population.

Experiences in health care

Any meaningful therapeutic relationship will be based on openness and trust, yet, evidence shows that it is common for transgender patients to hide their gender identity from health professionals (Brady & Molloy, 2018). There remains a fear of discrimination, stigma and negativity, with various studies reinforcing this reality:

While one study stated some nurses have negative attitudes towards transgender people, another showed nurses are continuing to assume that all patients fit into a gender binary of either male or female, determined by their sex at birth. This results in transgender patients feeling invisible to nurses and less likely to garner a trusting relationship (Brady & Molloy, 2018).

This negativity and isolation extends to mental health services, where one study from Transgender Equality Network Ireland found 52 per cent of participants had a negative experience when they sought help from a mental health service, while other studies showed pronounced discrimination, blatant disgust and noticeable discomfort from mental health professionals when a patient revealed they were transgender (Brady & Molloy, 2018).

Other issues reported in studies (Puckett, Cleary, Rossman, Mustanski, & Newcomb, 2018) highlighted misgendering or being referred to as an inappropriate gender in public health care settings; unnecessary and invasive scrutiny into patient’s personal lives; denial of care; uninformed and/or intolerant medical providers; and being shamed by providers. Some patients reported bias and stigma from mental health providers, where their mental health was inappropriately used as rationale for denying care (Puckett et al., 2018).

There are also systems issues within medical and mental health settings: some patients felt that needing a letter from a therapist before treatment was unreasonable and unnecessary, while requiring a diagnosis also creates a barrier to accessing care (Puckett et al., 2018). Some patients reported feeling unsafe in a medical system that is not designed for them and that the fear of ridicule prevented them from seeking transition-related care. A lack of knowledge on gender-affirming care, including potential side effects, also causes barriers to effective support. Financial issues (cost of hormones, surgery and associated procedures), as well as insurance coverage difficulties provided yet further barriers for gender-affirming care (Puckett et al., 2018).

Stigma and bias can be explicit and implicit, where it is often unconscious and occurs despite the best of intentions. One large study of over 4,000 first-year heterosexual medical students found that almost half of the participants expressed some explicit bias while 81 per cent exhibited at least some implicit bias towards gay and lesbian individuals (Bidell & Stepleman, 2017). The experience of real or perceived stigma and discrimination in health care leads to many LGBTIQ+ individuals deciding to not disclose their true identity, or avoid accessing health care altogether. LGBTIQ+ patients report significantly lower satisfaction with their health care provider than heterosexual patients do (Bidell & Stepleman, 2017). This is one reason that I have attended an LGBTIQ+ friendly clinic for many years – I did not feel comfortable disclosing my identity or discussing my concerns in a standard clinic and I do not see myself changing that in the near future.

A critical factor of any therapeutic nursing relationship is to advocate for the patient in our care, and for that care to be person-centred. It should be a partnership that prioritises on the patient’s unique needs with compassion and dignity. There is a responsibility to care for each patient in a respectful and equitable way, regardless of their status. Mental health nurses in particular need to ensure they are providing an environment that is safe and welcoming to all, so that any person requiring care can feel comfortable to seek it. It is difficult to provide appropriate and individualised care if the patient does not feel comfortable to disclose their true identity and concerns.

The WPATH issued Standards of Care in 2011 for those seeking help with gender dysphoria, and these should be considered when we encounter a patient with this distress. The standards are:

  • Assess for a diagnosis of gender dysphoria
  • Provide information regarding options for gender identity and expression, and the possible medical interventions available
  • Assess and discuss treatment options for any co-existing mental health concerns
  • If applicable, assess eligibility for hormone therapy. Then prepare and refer the patient for treatment
  • If applicable, assess eligibility for surgery. Then prepare and refer the patient
  • If applicable, provide psychotherapy before hormone therapy or surgery (this is not a requirement). Psychotherapy can include counselling and support for changes in gender role, as well as family therapy and support for family members (WPATH, 2011)

Removing the barriers to care

A successful therapeutic relationship with a transgender patient will often mean needing to use gender neutral language. As gender identity is a spectrum, nurses cannot assume that ‘he’ or ‘she’ will be the appropriate pronoun to use. Often, transgender people do not identify as male or female, and may prefer ‘they’ – put simply though, the correct language and pronoun to use is that which is used by the person themselves, so we just need to ask them (Brady & Molloy, 2018). The use of gender inclusive forms is also imperative, especially ones that allow the person to write in their own gender identity, rather than a tick box set up. A lack of awareness of correct terminology can cause the health care experience to be negative, resulting in this population being less likely to seek help, or avoid it completely (Wilson, 2019). In a recent examination of health care organisation intake forms, 74 per cent included questions about gender and/or sex. Of these, 57 per cent were rated as using affirmative language for transgender and gender non-conforming people. Only 6 per cent of intake forms had free space for people to state their preferred pronouns and 18 per cent included an option to designate a chosen name where this differs from their legal name (Holt, Hope, Mocarski, & Woodruff, 2019).

The result of a specialised and inclusive service can be seen in patient findings from the Gender Dysphoria Clinic in Melbourne. 88 per cent of patients were satisfied with the services they received and this significantly reduced their perceived level of distress. They felt understood in a non-judgemental way and importantly, 70 per cent of patients now felt satisfied with their ability to handle their concerns that brought them to the clinic. This survey was conducted for one month and only included those seeking treatment, yet it still highlights the positive impact of person-centred care. A lengthy waiting list for appointments was the most concerning aspect from this survey (Erasmus, Bagga and Harte, 2015).

With the evidence unsurprisingly pointing to benefits of gender-affirming care, barriers to accessing this care must be eliminated. Ways in which this can be achieved include:

  • Being a professional who is culturally competent of all populations;
  • Exploring and challenging any biases towards minority groups;
  • Training for all staff to use patient’s requested names and gender pronouns;
  • Avoiding disrespectful language such as ‘biological’ or ‘real’, instead, using terms like ‘assigned at birth’ and using the patient’s terminology when possible;
  • Providers should explain why some potentially challenging questions are necessary in an assessment; and,
  • Avoid the use of some medical terminology for the body as they may be upsetting for transgender and gender non-conforming individuals, especially in relation to primary and secondary sex characteristics (Puckett et al., 2018).

It is also important to explore the extent of support the person is having with their interpersonal relationships. If they have family, friends or partners trying to stop them pursuing gender-affirmative care, additional support may be required from health care professionals. Post-treatment support should also be established (Puckett et al., 2018).

Education in practice

Numerous studies show a knowledge gap and lack of formal education among health professionals on transgender people. One study found a large majority of nurses had no understanding of the transgender spectrum and were unable to differentiate between sexual orientation and gender identity. Nursing staff also did not consider a person’s gender identity outside of being male or female as relevant to their nursing practice. This lack of awareness leads to unsatisfactory care (Brady & Molloy, 2018).

This study also reported on the lack of transgender education for nurses, where it was found that only 10 per cent of students had a basic level of care knowledge for transgender people; almost 40 per cent of students felt unprepared to work with transgender patients; 85 per cent felt their nursing education institution did not prepare them; alarmingly, 42 per cent believed a person’s gender identity only mattered sometimes while 13 per cent felt it did not matter at all. In further research of 375 health care organisations, most did not provide their staff with appropriate policies and guidelines for nursing care of transgender people and that only 19.8 per cent of nurses had undertaken any formal training on the topic (Brady & Molloy, 2018). Even a current Google search of transgender care information on hospital websites shows a lack of visibility – other than the Royal Children’s Hospital Gender Service, only the Royal Melbourne Hospital and Mercy Health appear to have specific and easily found transgender care information on their public websites. Some educational and government resources are listed at the end of this article if you wish to explore further.

It is imperative to remember that nurses are advocates and educators. The journey of nursing is an ever-evolving process, where continual learning is required to remain current on nursing practice and hospital policy and procedures for anyone under our care. Optimal care is given when compassion and respect for diversity is upheld, improving the health care outcomes for everyone, especially those in minority groups. This does not mean that any particular group requires special treatment above others, it simply means inclusive, respectful and individualised care based on the needs of the person in our care, with their voice always being heard (Wilson, 2019).

Promoting mental health

The Royal Children’s Hospital (RCH) in Melbourne has a multidisciplinary Gender Service, providing transgender children and adolescents care since 2003. Referral numbers have increased to the extent that the service had as many requests for care (more than 200 new referrals) in 2015 than it did combined for the previous 12 years (Telfer, Tollit & Feldman, 2015). The average age when presenting is 12.3 years, but most patients report gender concerns from the age of three or four. In contrast, the Gender Dysphoria Service at the Monash Medical Centre in Melbourne reports an average presentation age of 40 years, although most patients still report gender identity concerns from an early age (Telfer et al., 2015). Increases in awareness and social change will hopefully see the average age of presentation decrease.

The Victorian Government recognised the need to support these services when they announced $6 million in funding to the RCH Gender Service over four years. This will assist the service to fund adolescent physicians, child and adolescent psychiatrists, gynaecologists, an endocrinologist (for hormone therapy), psychologists and a social worker, as well as a speech therapy service for voice training. Services are regularly evaluated to assess treatment outcomes and inform future evidence-based practice (Telfer et al., 2015).

Australia currently has a unique legal barrier to treatment. Precedent from 2004 classified stage one and stage two treatment in adolescents under 18 years of age as ‘special medical procedures’ which necessitates Family Court of Australia approval before treatment can commence (Telfer et al., 2015). Stage one treatment involves puberty-blocking medication (via gonadotrophin-releasing hormone (GnRH) analogues) and this is entirely reversible. It allows the person to develop without experiencing the associated distress that the development of secondary sex characteristics can cause when that person feels it is not their true gender. Stage two treatment generally occurs around the age of 14 to 16 years, where testosterone or oestrogen is offered. This produces partially irreversible physical changes of the affirmed gender.

A legal challenge in 2013 resulted in the Family Court removing the need for legal approval for stage one treatment (as it is reversible) and also agreed that an adolescent who is ‘Gillick’ competent (medical legal test to determine whether a child under 16 years of age can consent to their own medical treatment without the need for parental permission or knowledge) could consent to stage two treatment (Telfer et al., 2015). However, it is the Court that decides whether the young person is competent and the opinion of medical-legal reports tends to determine competency. It is potentially another form of discrimination, where the court’s involvement is an intrusion into a decision which should ultimately be between the patient, their parents (if the patient wishes) and the health care team.

A reduction in anxiety and depression has been noted after the commencement of puberty-blocking medication, followed by hormone treatment. A follow-up Dutch study 15 years post-commencement of treatment (with some also accessing surgery) determined that the young trans-adults’ quality of life, educational and vocational outcomes matched those of the general population in the Netherlands (Telfer et al., 2015).

When a young person presents with gender dysphoria, it is important that the health care provider validates their gender-related distress. Allowing the person to choose their own path without influence or pressure reinforces individualised care. An ideal situation will cater for collaborative decision-making between the young person, their family or other supports and their care providers (Bonifacio, Maser, Stadelman & Palmert, 2019).

Guidance can be found in the WPATH Standards of Care for hormone therapy, with substantially different treatment regimens for adolescents than for adults (due to the different developmental stages at adolescence). The standards also recommend assessing for both gender dysphoria and other concurrent mental health concerns due to the likelihood of co-morbidity, and advises counselling, supportive psychotherapy or appropriate medications (Bonifacio et al., 2019).

Social transitioning

Social transitioning is the process where a person changes their gender expression to better match their gender identity (Buzwell, 2018). It is an important part of the journey and has been shown to reduce depression and anxiety while improving self-worth in transgender children aged 9-14 years (Bonifacio et al., 2019). Social transitioning can include a name change, choosing a preferred pronoun, altering clothing and/or hairstyle, hair removal or growth, use of a bathroom that matches the person’s desired gender, breast-binding or genital-tucking, and adopting new activities and mannerisms. A transition can include one, a few or all of these factors, gradually or altogether – a social transition is highly individual, as is the timing of it (Buzwell, 2018; Bonifacio et al., 2019). Trans children who have socially transitioned demonstrate comparable rates of depression, anxiety and self-worth as their cisgender peers (those whose birth gender matches their assigned gender) (Buzwell, 2018).

So, what’s the T?

Consider the many issues highlighted in the literature: transgender people face stigma and discrimination in society, but also in the health care system. The majority of health care professionals lack formal training on transgender issues and this leads to substandard care for this minority group. Transgender individuals (as well as other LGBTIQ+ individuals) are vulnerable, with consistently higher rates of depression, anxiety and suicidality compared with the general population. Even a basic understanding of conducting a consultation for gender dysphoria is important, as is identifying the level of support the person has around them (Atkinson & Russell, 2015).

Although identifying as transgender is not pathological, the ongoing inclusion of gender dysphoria in the DSM-5 implies this. Other mental health concerns should be assessed, such as body dysmorphic disorder (a preoccupation with an imagined or slight defect in appearance), borderline personality disorder (a disturbance in self-identity) or Asperger’s syndrome (being prone to obsessive preoccupations that could include gender dysphoria) (Atkinson & Russell, 2015).

Individualised treatment and care is as critical here as it is with anyone else. Some transgender people will be happy to live in their desired gender role, but one large Australian study found that 86 per cent of transgender individuals were either using, or intended to use hormone therapy. 39 per cent also had some form of surgery (Atkinson & Russell, 2015). Evidence shows that hormone therapy reduces distress without adverse psychological or physical effects, but with any medication, it is important to be fully informed of reversible and permanent side effects (Atkinson & Russell, 2015). Counselling with a mental health professional proficient in transgender health is recommended, especially in assisting diagnosis of co-morbid mental health conditions.

Changing legal documents is another affirmation of gender, with Federal Government guidelines issued in 2013 stating ‘sex reassignment surgery and/or hormone therapy are not prerequisites for the recognition of a change in gender in Australian Government records’ (Atkinson & Russell, 2015). This means that a letter from a registered medical practitioner or registered psychologist is all that is required to change gender on documents such as Medicare, passport, birth certificate, Centrelink, driver’s licence and Australian Tax Office records, and the forms to change documents are available to download from government websites.

Once patients have been on hormone therapy for at least one year and living in their desired role, surgical interventions are considered. These are often referred to as ‘top’ procedures (chest reconstruction or breast augmentation) and ‘bottom’ procedures (removal and creation of new genitalia). Surgical reassignment tends to occur overseas due to greater expertise and lower cost (Atkinson & Russell, 2015).

Consider that the objective of treatment is not to change how the person feels about their gender. Instead, it is to manage or resolve the distress being caused and support should be given if the individual wishes to make changes to align their external self with their internal gendered self. Remember that there is no correct way to transition and it should be guided by the individual, both in the degree of their wishes to transition, and the timing (Buzwell, 2018).

The following recommendations suggest methods to improve the health care experience for transgender and gender non-conforming people:

  • Health care organisation websites should mention, where applicable, expertise in working with this community;
  • Include links to suitable and professional resources and support groups;
  • Detail all services offered for transgender and gender non-conforming people;
  • List any memberships to professional organisations, such as WPATH;
  • Intake forms should ask for gender or gender identity, not sex;
  • Include free space for people to write in a response for preferred pronoun and/or name;
  • Ask for “I wish to be called…” so that staff are aware of these wishes during consultations (Holt, Hope, Mocarski, & Woodruff, 2019).

In following the WHO’s lead, the American Psychiatric Association should remove gender dysphoria from the next update of the DSM. In doing so, the hope is to reduce or remove the stigma attached to being transgender and the associated distress caused by this stigma, in the same way that removing homosexuality from the DSM was intended to do. The reality is that there is still a long way to go for all LGBTIQ+ individuals to be free of stigma and discrimination, but if the medical field is adding to the stigma (as is the case with gender dysphoria being listed as a pathological issue), the stark over-representation of poor mental health and physical health statistics in the LGBTIQ+ community will not improve.

The WHO’s move to rename gender dysphoria to gender incongruence in the latest ICD-11, and classify it as a condition relating to sexual health is intended to remove stigma and pathological assertions. An international transgender rights organisation, Global Action for Trans*Equality (GATE), is advocating for the complete removal of this category, and instead creating a ‘Z code’ specifically for transgender adults and children. Z codes are used by the WHO to describe non-disease states that can impact health in general and mental health care. Given they are for non-disease states, they are non-pathological in nature, assisting the removal of stigma attached to this issue (Bidell & Stepleman, 2017).

It is important to note that there is currently an even division in professional opinion as to whether gender incongruence should be a diagnosis in the ICD-11 at all (or gender dysphoria in DSM-5 for that matter). Those that believe it should be included mainly cite reasons that a diagnosis enables access to health care, provides a “protected status” to the transgender child and facilitates reimbursement (although the general lack of insurance coverage in this area is yet another barrier for those seeking treatment). Those that believe it should be removed commonly cite removing the pathology, stigma and discrimination associated with a disease assumption as their reasons (Bidell & Stepleman, 2017).

The concept of minority stress is now an important context of the increased prevalence of health and psychosocial problems among the LGBTIQ+ community. This highlights that the increased incidence of poor mental health here is caused by social forces (stress, prejudice, stigma, discrimination), not a pathological (disease) state. This change could not have occurred without the removal of disease classification of homosexuality and transgenderism, so it follows that gender dysphoria or gender incongruence should follow the same path.

 

These helpful resources are available if you need more information or just want some support:

Main healthcare support is the Royal Children’s Hospital Gender Service, which has published the Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents Version 1.1 (2018):

https://www.rch.org.au/uploadedFiles/Main/Content/adolescent-medicine/australian-standards-of-care-and-treatment-guidelines-for-trans-and-gender-diverse-children-and-adolescents.pdf

(endorsed by ANZPATH, the Australian and New Zealand Professional Association for Transgender Health)

 

Gender Dysphoria Clinic – Melbourne

https://www.glhv.org.au/sites/default/files/gender_dysphoria_clinic.pdf

 

Minus18 – youth-driven support organisation, also provides training on supporting trans and gender diverse clients

https://www.minus18.org.au/index.php/workshops/adult-professional-training

 

In terms of hormone therapy medications available, NPS MedicineWise has a resource:

https://www.nps.org.au/australian-prescriber/articles/prescribing-for-transgender-patients

 

Educational resources:

For primary health care staff – ANZPATH (Australia and New Zealand Professional Association of Transgender Health) has a free 60-minute online course to promote more inclusive and responsive services for transgender, gender diverse and non-binary people in primary health care settings

https://www.anzpath.org/education

 

LGBTI National Health Alliance – includes many links to other LGBTIQ+ organisations

https://lgbtihealth.org.au/

https://lgbtihealth.org.au/trainingpackages/

 

Transgender Victoria

https://transgendervictoria.com/information/for-clinicians

 

Shine SA – Gender Wellbeing Service

https://www.shinesa.org.au/community-information/sexual-gender-diversity/gender-wellbeing/

 

Government resources:

 Victorian Government – School policy on gender identity

https://www.education.vic.gov.au/school/principals/spag/health/Pages/genderidentity.aspx

 

South Australian Government, Dept of Education – Supporting students, Gender diversity and transgender (very detailed, includes health-related support info)

https://www.education.sa.gov.au/supporting-students/health-e-safety-and-wellbeing/health-support-planning/managing-health-education-and-care/neurodiversity/gender-diversity-and-transgender

 

Victorian Government, Dept of Health – report on Transgender and gender diverse health and wellbeing (2014)

https://www2.health.vic.gov.au/Api/downloadmedia/%7B3165C620-0649-4EA1-BBA1-4CA4CEF4F58A%7D

 

Services & Support:

National – Headspacehttps://headspace.org.au/

Switchboardhttp://www.switchboard.org.au/

Q-Lifehttps://qlife.org.au/

 

Support services:

A Gender Agendahttps://genderrights.org.au/

The Gender Centrehttps://gendercentre.org.au/

Transhealth Australiahttp://www.transhealthaustralia.org/

 

VIC Services:

The Royal Childrens’ Hospital Gender Servicehttps://www.rch.org.au/adolescent-medicine/gender-service/

Monash Health Gender Clinichttp://monashhealth.org/services/services-f-n/gender-clinic/

Support:

Transgender Victoriahttps://transgendervictoria.com/

Seahorse Victoriahttp://seahorsevic.com.au/main/

ButchFemmeTrans Melbournehttps://www.facebook.com/butchfemmetrans/

Rainbow Network Victoriahttp://www.rainbownetwork.com.au/

PFLAGhttp://pflagaustralia.org.au/about

 

References

Atkinson, S. R., & Russell, D. (2015). Gender dysphoria. Australian Family Physician,      44(11), 792-796. Retrieved from             https://www.racgp.org.au/afp/2015/november/gender-dysphoria/

Bidell, M. P., & Stepleman, L. M. (2017). An Interdisciplinary Approach to Lesbian, Gay, Bisexual, and Transgender Clinical Competence, Professional Training, and Ethical       Care: Introduction to the Special Issue. Journal of Homosexuality, 64(10), 1305-1329.        doi: https://doi-org.ezproxy.lib.rmit.edu.au/10.1080/00918369.2017.1321360

Bonifacio, J. H., Maser, C., Stadelman, K., & Palmert, M. (2019). Management of gender dysphoria in adolescents in primary care. Canadian Medical Association Journal, 191(3), E69-E75. doi: http://dx.doi.org.ezproxy.lib.rmit.edu.au/10.1503/cmaj.180672

Brady, M., & Molloy, L. (2018). Mental health nursing for transgender people: Are we       caring? (2018). Mental Health Practice (2014+), 21(05), 28-33. doi:       http://dx.doi.org.ezproxy.lib.rmit.edu.au/10.7748/mhp.2018.e1223

Buzwell, S. (2018). Gender dysphoria. O&G Magazine: LGBTQIA, 20(4). Retrieved from        https://www.ogmagazine.org.au/20/4-20/gender-dysphoria/

Charter, R., Ussher, J. M., Perz, J., & Robinson, K. (2018). The transgender parent:           Experiences and constructions of pregnancy and parenthood for transgender men in      Australia. International Journal of Transgenderism, 19(1), 64-77. doi:https://doi-org.ezproxy.lib.rmit.edu.au/10.1080/15532739.2017.1399496

Cicero, E.C., & Wesp, L. M. (2017). Supporting the Health and Well-Being of Transgender Students. The Journal of School Nursing, 33(2), 95-108. doi: https://doi-           org.ezproxy.lib.rmit.edu.au/10.1177/1059840516689705

Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., … Zucker, K. (2012). Standards of care for the health of Transsexual, Transgender, and       Gender-Nonconforming People: World Professional Association for Transgender   Health (WPATH). International Journal of Transgenderism, 13(4), 165-232. doi:         10.1080/15532739.2011.700873

Erasmus, J., Bagga, H., & Harte, F. (2015). Assessing patient satisfaction with a     multidisciplinary gender dysphoria clinic in Melbourne. Australasian Psychiatry,         23(2). doi: https://doi.org/10.1177/1039856214566829

Holt, N. R., Hope, D. A., Mocarski, R., & Woodruff, N. (2019). First impressions online: The inclusion of transgender and gender nonconforming identities and services in mental healthcare providers’ online materials in the USA. International Journal of   Transgenderism, 20(1), 49-62. doi: https://doi-  org.ezproxy.lib.rmit.edu.au/10.1080/15532739.2018.1428842

Puckett, J. A., Cleary, P., Rossman, K., Mustanski, B., & Newcomb. M. E. (2018). Barriers to gender-affirming care for transgender and gender nonconforming individuals.     Sexuality Research and Social Policy, 15(1), 48-59. doi: 10.1007/s13178-017-0295-8

Telfer, M., Tollit, M., & Feldman, D. (2015). Transformation of health‐care and legal          systems for the transgender population: The need for change in Australia. Journal of Paediatrics and Child Health, 51(11), 1051-1053. doi: doi.org/10.1111/jpc.12994

Wilson, D. (2019). Inclusive healthcare for members of the sexual and gender diverse         community. Australian Nursing and Midwifery Journal, 26(5), 34. Retrieved from        https://search-proquest-com.ezproxy.lib.rmit.edu.au/docview/2161599276?accountid=13552

World Health Organisation. (2018). ICD-11: Classifying disease to map the way we live and die. Retrieved from https://www.who.int/health-topics/international-classification-of-diseases

Wylie, K., Knudson, G., Khan, S. I., Bonierbale, M., Watanyusakul, S., & Baral, S. (2016). Serving transgender people: Clinical care considerations and service delivery models     in transgender health. The Lancet, 388(10042), 401-411.             doi:http://dx.doi.org.ezproxy.lib.rmit.edu.au/10.1016/S0140-6736(16)00682-6

 

A Revolving Door

Sometimes, expectation and optimism does not match reality. That’s no reason to be pessimistic – just another opportunity to expand your viewpoint on previously held beliefs. This is how I have approached my third clinical placement, which is in a mental health facility in the suburbs of Melbourne. It is an area of nursing that holds great interest for me, hence my optimism. Halfway through this placement, the reality has been somewhat different to my expectation.

I have had to accept that, like with physical illness, not everyone recovers from mental illness. A myriad of factors may explain this – amotivated feelings about their condition (no desire to seek or engage in help), lack of participation in therapy, medication complications (this is its own set of issues, especially in relation to dependence), lack of access to programs or activities that can assist recovery, lack of a support network from family or friends, and medical personnel that are disengaged or victims of the health system, just to name a few.

What has surprised me at this early stage is the number of return patients. The overwhelming majority of patients are known to staff and are on their third, fourth, or even fifth admission. The facility does not accept high-risk patients, so I can only imagine how much worse this scenario is for facilities that do. Some patients only stay for a few weeks; others have been here close to three months. Some patients are being monitored for medication changes, while some patients are admitted for treatment that requires extended monitoring.

One of these treatment options is Transcranial Magnetic Stimulation, or TMS. I was fortunate enough to accompany a patient during one of their TMS sessions, which afforded me a fascinating insight. This patient is currently going through their third round of TMS treatment, and each round has consisted of 30 sessions. The session I attended was their 24th of this third round. The patient does not feel that the TMS is making a difference to their outlook or thought processes, but they do not want to try the alternative treatment (Electroconvulsive Therapy, or ECT, which induces seizures to alter brain activity) because of the sometimes severe side effects of memory loss.

In contrast, TMS reportedly has little to no side effects and is not invasive. It involves using magnetic fields to activate specific areas of the brain – generally the pre-frontal cortex, which is the area of the brain that among other things, is associated with how we see ourselves (self-consciousness) and self-related mental processes. As depression can alter these thoughts and behaviours, TMS has been shown to improve self-perception in depressed patients by progressively altering brain activity in this area with repeated treatments. No anaesthesia is required (in contrast to ECT) and a patient can resume their usual daily routine once treatment has completed for the day, and some patients can even have two treatments in one day (one session takes around 40 minutes, depending on the severity of the patient’s depressive state). TMS is not a first-line course of treatment – it is generally prescribed when a patient continues to show depressive symptoms after at least one anti-depressant medication has been attempted. Interestingly, it is not currently covered by Medicare in Australia as further research on its long-term effectiveness is still ongoing. This results in an access issue, as it requires private health insurance and an inpatient admission or self-funding.

depressed woman pic

But how effective is this treatment when numerous patients are seemingly coming back for repeated rounds of therapy? Or is it more of a case of these patients not fully understanding their triggers and therefore relapsing? It could also be medication compliance or potentially new triggers. There is no obvious or simple answer, as we are not obvious or simple beings. Our brain exerts more control over us than we may ever give it credit for (side note: I recommend Afflicted, a truly fascinating series currently on Netflix to see some real examples of this). In this case, this patient is having their third round of treatment, reports that they do not see any improvement, yet, this patient is quite engaging, warm and reactive to conversation. They have a supportive family network and cannot specify any possible triggers for their continued admissions other than the feeling of hopelessness and helplessness that engulfs them. Consequently, they continue their treatment in the hope that it may eventually have an effect.

This is another important factor to highlight: it will not necessarily make sense that someone is suffering a mental illness. I was involved in a new patient admission recently – this patient has suffered depression for nine years (from the age of 12), an eating disorder for six years and has attempted suicide twice this year. They have no history of trauma or abuse, no family history of mental illness, no obvious triggers or explanations for why they feel the way they do. There is evidence of alcohol abuse, but not drugs. They have a good social network and a job. Prescribed medications have not had an effect and something just isn’t right, so they want to give ECT a chance to help them. This patient is warm, engaging and not visually distressed. They were studying at university until it became too difficult to manage with their illness. I can only hope that we can help them and not have them become one of the “frequent flyers”.

park bench pic

Naturally, I wonder why patients are returning at the rate that they are. It is clear from speaking with the staff at this facility that the system is letting some patients down. Medications are prescribed and dispensed, mental states are constantly assessed, as are current risk statuses. What might be a confronting question is asked – have you had any suicidal ideation recently, and if so, how do you plan to go through with it? Self-harm is also assessed and is more common than I thought it would be – one patient explained that they self-harm just so they can feel something. Sadly, some patients self-harm so they can be admitted, otherwise they might be turned away for a lack of available beds. There are clear cases of dependence to medications and these are managed as much as possible, but some of the return rate of patients might just sit at the hands of the patients themselves.

Patients need to understand the role they play in their own recovery. As someone who has suffered mental illness, I experienced two critical aspects: I was going nowhere until I acknowledged my illness; the next important step was to seek help and want to work at feeling better about myself and my life, instead of feeling embarrassed and ashamed of my predicament as I initially did. This is by no means an easy or simple step – this is the most difficult thing to do. To acknowledge and accept you are struggling is tough; to seek help and open up to someone that you are struggling and need help is even tougher.

The logical thought would be that the patients in a mental health facility have accepted these two aspects about themselves. Why then are they mostly returning for repeated admissions? Are they returning to past negative behaviours or thoughts? Are they disengaged with their treatment plans (not attending therapy groups or possibly non-compliant with medication)? I believe there is no obvious or logical answer – our complex brain can lead to many variations to mood, behaviour, thought, cognition, desire, as well as many other factors. This is where the nurse must be the patient’s advocate – each patient will bring their unique set of idiosyncrasies and one care plan that has succeeded with one patient might not work with another, just as one type of medication may assist one patient but not another. It is the system that lets patients down when it is assumed one treatment option is a best-fit for all, or indeed, that all patients will fully recover from their illness. It might just mean taking that little bit of extra time to sit down and talk, to listen and to care. Rapport and trust between the patient and the nurse is vital, as is the patient’s want to recover, or at least manage their condition.

This should extend to your network of family and friends – you do not have to wait until you can see an obvious sign of a friend or loved one struggling. Take that little bit of extra time to have a genuine conversation and know that some people are doing it tough, no matter the façade they put up. Try not to judge those who have the courage to admit that they are struggling and instead find ways to understand their struggle and offer ways out of it. There is no telling when or if someone will suffer from a mental illness, but showing that person that they are not alone and that someone cares about them will make the world of difference to them – and you don’t have to be a nurse to do that.

“There is no room in my heart for hate”

“Take your broken heart, make it into art” – Meryl Streep quoting Carrie Fisher

 

It has been a rough few months again. I opened myself up and I was hurt. This time though, I did not see it coming. I was all in, but then without warning, it was all over.

Few things hurt as much as being rejected and not being told why.

Especially when it has happened more than once.

 

“The only closure you’ll get is that you won’t always get closure” 

– a trusted friend

 

So when something like this happens to me, I do wonder whether I care too much and give too much of myself. And when someone is frivolous with my heart, I can fall hard. It is so easy to fall back into a negative head space and think that I will never experience these wonderful highs of connecting with someone on a beautiful level again. Or, whether I will be able to trust someone with my heart again. Or, whether I will open myself up to hurt again. It isn’t nice and it certainly isn’t easy, but sometimes things just don’t work out the way you want them to.

I retreat to nature and try to enjoy my own company. While the great outdoors always offers a recharge, sometimes my thoughts are too much even for nature to overcome. But it is still an important part of my life and one that I need to regularly experience.

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An unforgettable sunset from near Wreck Beach, Vancouver, BC, Canada (July 2017)

Sometimes, the inevitable stage is withdrawal. It has happened before and it happened again here. I withdraw when people I really care for do me wrong. People that I trusted not to hurt me, but they did. This is when the negative thoughts can happen. And the restless nights. And I can feel very lonely when I am alone. Memories are everywhere and they remind me of the hurt. Thoughts are consumed with the confusion on not knowing what went wrong.

I sometimes think that I put too much of myself on the line, and that I am an easy target for those that don’t feel like I do. I don’t think that’s a part of one’s personality that can change though. And maybe it’s a part of one’s personality that shouldn’t change.

I know some things take time and that some people need more time than others to process difficult things. I have learned that there is no right or wrong way to process these feelings and that there is no timeline either. It isn’t helpful to expect that someone will just get over it like you might do and it definitely isn’t helpful to tell someone who is struggling to “just get over it”. There is always a time for empathy.

If you have someone special in your life, please do not take them for granted. Show them that you care, tell them that you care. You just don’t know if they’re always going to be there. Life is full of unknowns, and while that shouldn’t stop us from putting ourselves out there for both the good and the bad, the one sure thing I’ve learned is that things – and people – change.

Try to embrace the change. It is not always easy – in fact, sometimes it is the hardest thing to see – but each experience is a lesson. That’s why I will keep putting myself out there and why I will eventually feel confident about myself again. A positive mindset where you can see each experience, no matter how painful it is at the time, as a lesson, is more helpful than seeing things as a waste of time. I remember from previous struggles where I lacked a sense of purpose, it was a destructive mindset which works against any hope you have of feeling better about yourself and your life.

It is also okay to have a day here and there where you do not feel your best and when you just need to hide away. I can sense when I am feeling like this and I make sure that I acknowledge it and importantly, I try not to make myself feel bad about feeling like this. There are times when I feel like things are overwhelming and that there isn’t much to be happy about, but this is when I find it is most important to retreat and reset. It is human to feel happy and sad, and everything in between. Nothing, and no one, in this world is perfect, and it is worth remembering this when not feeling your best.

 

“There is no room in my heart for hate” – Sense8, Season 2, Episode 7

 

I think it is important to also be patient with each other. This is incredibly tough to do at times when you are hurting, as the natural reaction might be to get upset and say some things that you might later regret. I don’t see it as a weakness to be the person that understands that everyone has their struggles and sometimes, some people don’t behave the way that we think we would do in the same situation. You never really know this until you experience it for yourself. While it is easy (and tempting sometimes) to judge others for their behaviour, it is important to acknowledge that it might not be personal, so don’t take it that way.

The upshot of this is that I want to ask that we try to treat each other with a little more love and respect. I strongly believe that the increasing number of people suffering mental health deficits is related to the careless way some of us treat each other. We are unnecessarily frivolous with each other sometimes and forget that everyone has their own battles to fight. We don’t need to add to these stresses by being cruel to others. A little communication goes a long way, and sometimes it might be a difficult conversation, but just have it. So many things can be resolved by discussing the actual issues, rather than just walking away from them. I find hugs always help too.

Vale Dolores O’Riordan

The soundtrack of my teens…

It seems this is a common reaction to news of the premature passing of Dolores O’Riordan, lead singer of Irish band The Cranberries. Dolores was only 46-years-old and is survived by her ex-husband and three children. Not to mention the legacy of her stunning voice and poignant lyrics.

This reaction mimics mine completely. The Cranberries came into my life at a time when things were very confusing and often troubling – my teens. Trying to figure myself out and my place in the world (an ongoing battle).

When I first heard Dolores’ distinctive vocals, it instantly got my attention. I wanted to hear more. My first taste of what was to come was the track Dreams, released in 1993 from their debut album Everybody Else Is Doing It, So Why Can’t We? Melodic rock, matched perfectly with warbling and haunting vocals. Without the benefit of online streaming in those days, it meant heading to the music store to seek out more. I found their album and did something I didn’t do all that often in those days – I bought the album instead of just the single. Something told me this was different. It sure was – all 12 tracks on the album did what only truly great music does – it took me on a journey of emotions through very relatable experiences, even at the tender age of 14 at the time. The Cranberries‘ music absolutely moved me, as cliched as that might sound.

The follow-up album, No Need To Argue, released one year later in 1994, took this so much further. 14 songs that truly helped me through some very emotional times, both then, and even to this very day. It wasn’t uncommon for me to choke back tears while listening to No Need To Argue and I also find myself doing the same today as I give these albums another spin. Partly for the sadness of losing a gifted musician far too soon, but also partly a reminder of everything this music helped me with. Truly the soundtrack of my teens and a constant refuge in other times of need since.

In memoriam, I thought I would compile a list of The Cranberries tracks that had the most impact on me:

#20 Twenty One (No Need To Argue, 1994) – a soothing, soulful track that ends with Dolores’ signature vocals. Always a favourite to sing along to when no one was around.

#19 Not Sorry (Everybody Else Is Doing It, So Why Can’t We?, 1993) – an exercise in defiance, something that has always been a personal struggle. Not apologising for walking away from a deceitful person is something we could all benefit from.

#18 Still Can’t… (Everybody Else Is Doing It, So Why Can’t We?, 1993) – an upbeat track that hides a more sinister narrative. “Still can’t recognise the way I feel, nothing you said to me was real”. Sadly an occurrence that still happens.

#17 When You’re Gone (To The Faithful Departed, 1996) – naturally, a death-themed album was never going to be easy listening. While this album did not hold up to the incredibly lofty expectations set from the first two, some tracks still had profound effects, such as this one. “I’ll miss you when you’re gone, and it’s time to carry on”. An appropriate song to remember those that have left us.

#16 Ode To My Family (No Need To Argue, 1994) – the opening track of the album that packed a vocal punch. I never could quite understand if this was a tribute to family, or the opposite. “Do you see me? Does anyone care?” contrasted with “My mother, my mother, she’d hold me, when I was out there”. Probably a very accurate reflection of family issues while growing up and trying to find your place.

#15 I Will Always (Everybody Else Is Doing It, So Why Can’t We?, 1993) – another soothing, soulful track that tells of devotion and letting go. “I will always go beside you”.

#14 Zombie (No Need To Argue, 1994) – I’m possibly being really unfair putting this here. Zombie was the song that put The Cranberries on the global scale and contains incredibly poignant, and sadly still too real lyrics. Music has long been used to voice opposition, political or otherwise. This is no exception and while I thoroughly love this song, all the songs below had more of an impact on me, but I do wonder if the message of this song will still be so relevant in another 24 years?

#13 Put Me Down (Everybody Else Is Doing It, So Why Can’t We?, 1993) – as someone that has always struggled with compliments and confidence, this song was so raw. A haunting chorus complementing relatable lyrics. A very powerful way to end an album.

#12 I Can’t Be With You (No Need To Argue, 1994) – “It’s bad and it’s sad, because I can’t be with you”. For all of the crushes and ones that got away, intentional or not, this continues to resonate.

#11 Pretty (Everybody Else Is Doing It, So Why Can’t We?, 1993) – how two minutes and 16 seconds of music can sum up so many emotions. “You’re so pretty the way you are, and you have no reason to be so insolent to me”.

#10 Salvation (To The Faithful Departed, 1996) – probably one of The Cranberries‘ most “upbeat” songs, although it details the ongoing scourge of drug addiction. “To all the kids with heroin lines, don’t do it, it’s not what it seems”. From an album about death, it has always been a standout.

#9 The Icicle Melts (No Need To Argue, 1994) – hidden in the middle of the album is this stunning example of Dolores’ powerful vocals, mixed with tragically relevant lyrics of conflict and war. “There’s a place for the baby that died, and there’s a time for the mother who cried. She will hold him in her arms sometime, cos nine months is too long…”

#8 Linger (Everybody Else Is Doing It, So Why Can’t We?, 1993) – strings beautifully composed in the background with lyrics to match: “I’m in so deep. You know I’m such a fool for you. You got me wrapped around your finger, do you have to let it linger?” I can’t say the number of times I’ve leaned on this one.

#7 How (Everybody Else Is Doing It, So Why Can’t We?, 1993) – Dolores’ distinctive warble is all over this one, as is the usual meaningful words: “How? You said you’d never leave me alone”. Plenty of great bass guitar in this track just rounds out its edginess.

#6 Dreaming My Dreams (No Need To Argue, 1994) – an acoustic masterwork that has brought tears to my eyes countless times, including today as I listen with a heavy heart. “I’ll be dreaming my dreams with you. And there is no other place, that I’d lay down my face, I’ll be dreaming my dreams with you” – a lyric I’ve always wanted to sing to someone one day.

#5 Empty (No Need To Argue, 1994) – another masterwork accompanied by an utterly moving piano and string melody. This track always seemed to annoy my dad the most, where he’d always threaten to snap the CD if I didn’t turn it off (thankfully can’t do that with online streaming these days). I think this is possibly the best example of the power of Dolores’ voice, and as polarising as it may be, this song surely left me feeling empty after every listen. “My identity, has it been taken? Is my heart breaking? On me, oh my plans, fell through my hands. On me, all my dreams, it suddenly seems…empty”.

#4 No Need To Argue (No Need To Argue, 1994) – the title track and deservedly so. A resounding organ introduces the song, and continues throughout. “I knew, I’d lose you. You’ll always be, special to me. And I remember all the things we once shared, watching TV movies on the living room arm chair. But they say it’ll work out fine, was it all a waste of time? Cos I knew, I knew, I’d lose you. You’ll always be, special to me”. Indeed, a very special song.

#3 Ridiculous Thoughts (No Need To Argue, 1994) – “you’re going to have to hold on! Hold on! Hold on to me!” The bellowing brings further power to the line “I cried so hard, the ridiculous thoughts, oh”. Nothing like a constantly anxious mind to over-analyse every situation, over and over again to wear you out. This track seems to embody that perfectly.

#2 Daffodil Lament (No Need To Argue, 1994) – possibly a favourite for most fans of The Cranberries, and with every possible reason. It’s one of those rare, six-minute epic journeys that so few songs manage to transcend. It’s almost three songs in one – we start with a melodic relaxation, then Dolores kicks into overdrive with solid and dramatic music – “I can’t sleep, HERE!” It returns to a quiet intermission, flips into a more positive note – “…and the daffodils look lovely today, look lovely, look lovely”. And then one last haunting chant to round it out, complete with Dolores’ distinctive tones.

#1 Dreams (Everybody Else Is Doing It, So Why Can’t We?, 1993) – the song that started it all for me, and continues to be my standout. “Oh, my life, is changing every day. In every possible way. Oh, my dreams, it’s never quite as it seems. I know I’ve felt like this before, but now I’m feeling it even more, because it came from you”. Love, letting love in, being able to accept yourself, following dreams – it’s all in here and I knew from the first listen this would be a song I’d listen to for years. 25 years on, it still reminds me to dream my dreams and make them a reality. “You’re a dream to me”.

While speculation is unfortunately focussing on Dolores’ mental health battle over the last four or so years, the current information from London police is that nothing suspicious was found and the case has been referred to the coroner to determine the cause of death. I won’t add to the speculation, but I can only pass on my sincerest condolences to all of Dolores’ nearest and dearest. To Dolores herself, I can only feel eternally thankful to have had the privilege to listen to her music and know that it will live on with me, and millions of others, for a long time to come.

Vale Dolores O’Riordan. The daffodils don’t look so lovely today…

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Dolores O’Riordan (AP: Bruno Bebert, file)

A Clinical Lesson – Part I

One year of my nursing journey has somehow already passed, and unsurprisingly, the last three weeks have been the most significant thus far. My first clinical placement experience was an important milestone – I needed to test my strengths and weaknesses and bring all of the knowledge taken in throughout the year into the real world. Just how real it was is where the experience became a critical one.

There were many moments over the three weeks that will remain in my mind as I reflect on my interactions, but three moments in particular had what I feel will be a lasting impact. As in all accounts of a medical and personal nature, no real names are used in these stories that follow.

PART I

In the days leading up to the start of my clinical placement, I was thinking about the challenges that lay ahead. One challenge that I knew I would be tested on was my ability to separate the emotional attachment from the task of caring for a person in need. Little did I know that this test would present itself in the very first week.

We were each assigned one resident to assist, and it would be a “simple” resident for now – one that did not require a high level of care with their daily activities (or ADLs, Activities of Daily Living, as we like to call it). I was assigned a friendly but reserved gentleman, who just one month on from his 94th birthday, had found himself admitted into residential care due to a complication with his eye sight after suffering a three-month pneumonia battle. He was otherwise mobile and independent, even though he used a walking aide. I only needed to assist with the trickier parts of a shower, and keeping an eye on a sore he had on one of his toes. Otherwise, I found my main assistance to him was just being there for a chat and we had a rapport right from the start. He was still processing the fact that he was now a resident in a care facility, something that was both unexpected and a little uncomfortable for him. It was the little things that were making a big difference to his transition, such as the lack of honey that was available at breakfast time for his toast (and of course, I set about trying to stash some honey away for him once I learned this).

After the second day, he said we made a good team, and that gave me a sense of satisfaction I’ve rarely felt in any work I’ve ever done. I was genuinely enjoying our chats – learning about his history as a merchant shipper, and the many fascinating places he had sailed to. I learned about his wife, who had passed two years earlier, and of the way he would spend his time down at the local stores with his neighbours. He told me of his three daughters and how proud he was of them. I had the pleasure of meeting one of them and I could see why he was a proud father.

Then, on the Friday, I knocked on his door as I always did and entered his room. I saw him sitting on his bed, quietly staring out the window, with all of his belongings packed beside him. This startled me, and it was almost like he read my reaction, as he started to tell me what was happening before I even had a chance to ask. He was being transferred to another facility, as this was only supposed to be for respite care. He wasn’t sure when he was leaving, but I said I would be there to say a proper goodbye. I thanked him for the opportunity to assist him and I told him how much I enjoyed our very brief time together learning about his story. I had some other tasks to attend to and then went back to his room about an hour later.

Clinical 1

The room was empty. My heart sank. My throat felt heavy. He was gone and I wasn’t there like I said I would be. I instantly felt like I had let him down and I was so disappointed in myself.

I went back to our meeting room that we used to debrief and told my educator and fellow placement buddies what had just happened. My educator had a look on her face, almost like she knew this was coming. I had mentioned to her at the start of placement that I thought I might struggle with the emotional side of things and here we were – on day five, already facing this test. But they rallied around me (something that I hope will continue to happen throughout my nursing journey) and reminded me of the reality of the situation – yes, I said I would be there to say goodbye, but this isn’t always possible. I was there when he needed me throughout the week, and then he needed to move to his next phase. I suggested that I would go visit him in his new facility, to say a proper goodbye, but my educator stepped up again: “Are you doing this for him, or are you doing this for you?” It was a powerful question, one that instantly highlighted to me that I had become too emotionally attached to the first resident I interacted with and proved this would be a real challenge for me to work on. People in need will come and go and I won’t always be there to say goodbye – things will rarely be that perfect or organised. There is a fine line between being the empathetic, caring nurse and the nurse that doesn’t protect themselves emotionally. I was already too close to this line and I had to back away.

Parts II and III to follow.

An unequal, still

Those that know me well, know that I wear my heart on my sleeve. I find it difficult to hide my emotions, whether it is a good feeling or otherwise. This can be both a blessing and a curse.

Sleep is evading me tonight. My mind is far too active, even though my eyes are feeling as heavy as my heart. I can rarely pinpoint the cause of this, and trying to resolve that query only serves to extend the sleeplessness. Thoughts of the previous day are at the forefront, but so too are those moments from other days where unresolved matters play out in many different scenarios. It seems wearing your heart on your sleeve also means an over-active mind at the most unpredictable of times.

But, one event from yesterday is clearly troubling me. Yet another opportunity presented itself for Australia to join the many other developed nations of the world in treating a minority with respect and dignity. Once again, a fearful and ignorant few stood in the way of any progress.

Fairness, equality and compassion stand at the very centre of my being, and the continued toxic nature of the marriage equality debacle is taking a toll. I have previously written of the shockingly disproportionate mental health statistics of the LGBTIQ community, yet is it at all surprising when we continue to be told that we are not equal? Why is our love subject to an often hateful discourse, when heterosexual couples can merely go about their daily lives unquestioned, both in marriage and divorce? What impact does our love even have on anyone else’s? The world hasn’t imploded in any of the countries that have moved to protect the rights of all of its citizens, as opposed to just those that meet a religious criteria.

Some of these aforementioned statistics bear repeating:

  • Same-sex attracted Australians have up to 14 times higher rates of suicide attempts than their heterosexual peers
  • Up to 50% of trans people have actually attempted suicide at least once in their lives
  • LGBTIQ people have the highest rates of suicidality of any population in Australia – 20% of trans Australians and 15.7% of lesbian, gay and bisexual Australians report current suicidal ideation (thoughts)
  • Lesbian, gay and bisexual Australians are twice as likely to have a high/very high level of psychological distress as their heterosexual peers (18.2% v. 9.2%). This makes them particularly vulnerable to mental health problems
  • The average age of a first suicide attempt is 16 years – often before ‘coming out’

Source: Rosenstreich, G. (2013) LGBTI People Mental Health and Suicide. Revised 2nd Edition. National LGBTI Health Alliance. Sydney, p 5.

Are we so short-sighted now that we can’t see the impact that this toxic discourse is having on the LGBTIQ community? Particularly those that are younger and still trying to figure out how to make their way through an already difficult time. The last thing any of us need is yet more ill-informed people preaching on a topic they know nothing about. How powerful a statement would it be to those who are currently unequal in the eyes of the government, to finally be treated as equal?

Humans are social creatures. Most of us crave love – some of us spend an awful lot of time thinking about love, both in its positive and not-so-positive forms. Marriage is one way that we express our love for another, and when a segment of the population continually get excluded from this, for no good reason other than tradition or religion, it really is no surprise that mental health issues swing wildly towards the LGBTIQ community. I am sick of having to justify my right to equality and I am sick of having to listen to hate and ignorance as an excuse for it. How dare some people think they have a right to vote on who I can choose to spend the rest of my life with! Did I get a vote on their choice?! The world needs so much more love, and yet, too many people are focussed on anything but love.

As tends to happen with these kind of things, important facts are ignored when they don’t suit the argument. When the Marriage Act was changed in 2004 by the then Prime Minister (to the current day definition of marriage being between a man and a woman only), it was simply done by an act of parliament – no plebiscite, no vicious hate campaigns, no fuss. It just happened. Apparently the same course of action to change it back simply cannot be done the same way, for the opponents are crying foul play, and that only a public vote should decide this – not an act of parliament. Trying to have it both ways without reference to facts that are inconvenient to their flaky argument.

In the meantime, I’ll just prepare myself for another round of bemusing (and probably hateful) commentary around why I’m not worthy of equality. I started wearing the “Live Proud” rainbow band on my wrist many years ago as a reminder to myself that I am equal, and I promised myself that I would wear it every day until I am an equal under the law. It appears we still have a very long way to go…

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In the Wrong Place

As I grow older, one thing is becoming more clear – I need to travel. The benefits of travel are too numerous to mention, but the happiness I feel while abroad is unmatched in my current home life. That might sound really obvious – something that isn’t routine is more enjoyable than something that is. But there’s more to it than that.

Travel has allowed me to grow as a person. I’ve had to fend for myself in unfamiliar situations, sometimes in foreign languages. I’ve met wonderful people by chance and had very memorable experiences listening to their stories. There’s been the odd scare or two as well, but that is part of the journey and it’s also something that my own city provides every now and then too.

There is one thing that my recent travel has shown me though – that I am in the wrong place. There has been an uneasy feeling over me for some years and my time in Canada has highlighted this further. I don’t feel I belong in Melbourne anymore, and if I’m brutally honest with myself, I’ve probably been feeling this for at least the last six years. Not previously having the courage to act on it meant that I festered away and went through the motions. Something inside me is not allowing this to happen anymore, and so I went exploring.

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Toronto Pride, June 2017

Canada has always been a country of interest for me. I was offered an exchange when I was 20 to do one semester of university at McGill in Montréal. I didn’t take it, as I didn’t want to leave my Mum here on her own (she was going through some rough times, and my brother was also away travelling). Oh how I would do things differently now! Maybe it’s missed moments like these that fuel my desires to explore and not think of the reasons why I can’t do something. It’s more about why would I not do it?

So it comes as no surprise to me that my last two trips to Canada (luckily for me, these two trips have been in the last eight months) have had a profound effect. My time there has been overwhelmingly positive – stunning landscapes and cities, genuinely friendly people, a relaxed but proud attitude, a strong belief in diversity and acceptance – these are among the reasons that I feel I am in the wrong place.

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Credit: Zack Singer. Stunning sunset at Wreck Beach, Vancouver, BC, Canada. July 2017

It’s also why it was so difficult to leave Canada on both of these occasions. As my first time in Canada was ending, I cried uncontrollably as I approached the airport. I tried to wipe away my tears before they were visible, but the sadness washing over me could not be contained. I was genuinely upset that I had to leave and make the long trek back “home”. I did not know when I would be able to return, and the prospect of returning to my lonely existence back in Melbourne was something I was not ready for. There were other issues at play at this time, only serving to compound my sadness about having to leave. These inevitably made the transition back to routine a very difficult one – in fact, the few months after returning to Melbourne have been the most challenging of my life thus far. I was lost and feeling hopeless about all of the major aspects of my life, so it should not come as a surprise that I found myself at the dreaded door of depression and anxiety. I would not wish these few months of my life on anyone – there are few feelings worse than feeling like there is no hope. Every day. Every night. It all becomes too hard and it is so much better to hide away, rather than risk someone you know or love seeing you like this. Then the worst part happens – all this alone time compounds all of the negativity. The voices in your head take over every moment, always reminding you of the failures and never letting up. Sleep becomes more difficult each night – the mind does not rest, forcing the body into this same restlessness. A tired mind only conjures further negative thought, adding more turbulence to an already bumpy ride. All of this makes it even more difficult to see a way out. To ask for help, or to feel comfortable enough to open up to someone seems far too risky. What will they think? Will they laugh at me and tell me to suck it up? Will they not even care? Will they use this information to their advantage somehow? All irrational thoughts find their way to become rational when your mind is so clouded by overwhelming hopelessness.

I got lucky. A few friends noticed my changed demeanour and offered their support. I cannot underestimate the importance of being present for someone suffering through their own mental demons. For me, being able to talk about it without fear of ridicule made an enormous difference. I also sought professional help – something not everyone is either able to do, or feel comfortable to do. But I knew I needed help to get through this. It had become too big for me to handle on my own. Each time I would start to rise back up, the slightest setback would send me straight back to bed. There were days when I just could not face the prospect of getting up. I knew I was bad company, so what was the point in going outside and participating in the world around me? Spontaneous bursts of tears further added to the risk of going outside – what if I just started bawling at the supermarket checkout? I could not risk it, so I stayed indoors most days.

Then, I got lucky again. The opportunity to study in a field that I’ve long admired presented itself and after speaking with some friends, I took this opportunity. I had something to be hopeful for, something to show me that I had a purpose. All did not feel lost now. It may have been a distraction to everything else, but it felt like things were changing. I wasn’t feeling sad all the time anymore. There were still ups and downs, but the ups seemed to be outweighing the downs now. Having a sense of purpose again was a fundamental shift in attitude and it was helping me recover.

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Vieux Montreal (Old Montreal) – 375 years old this year. Montreal, Quebec, Canada, June 2017

 

The opportunity to travel back to Canada appeared and I seized it. It would be my reward of sorts for making it through my first challenging semester of nursing. And what a reward it was – my second visit to this beautiful country could not have been a more positive experience. Each city I visited had compelling reasons for me to stay, helped by the fact that I now have friends in these cities. But this has also led to the inevitable fall that I am currently feeling. I have been back “home” for three days and I am feeling more alone than ever. I was again very sad to leave Canada (no uncontrollable tears this time, but I got close while sitting at the airport) – partly because I am unsure when I will be able to go back for another visit, but more so, because I feel like I need to be there. I felt so happy, comfortable and so welcome in Canada, and I do not feel that here in Melbourne. It’s hard to explain the exact reasons, but it feels like I’m in the wrong place. And that is a strange feeling, especially when the prospect of being able to leave is years away. I am too old to move on a working holiday visa, and studying abroad is too cost-prohibitive, so my only option appears to be completing my studies in Melbourne and relocating with my new qualification. That is a three-year prospect. I don’t want to wish time away, but three years seems a long time to live somewhere when you don’t feel you belong. I know I need to find a way to make this work, but those voices of hopelessness are starting to nudge their way back in.

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The Inukshak at another golden sunset, Vancouver, July 2017

I write this both as a coping mechanism and as a call out – life is feeling complicated and challenging again and I need to find a way to rise above it. For three years. If any of this is resonating with you, I hope these words can give you the strength to speak up, but more importantly, know that you are not alone. You might feel alone, like I do at times, but there are many others fighting these same battles. Some have been fighting them for a very long time, others are relatively new to the fight, but the more we talk about these issues, the more we can support each other through them. We are social beings and we are so much stronger when we are together. We are also better when we know we are valued, when we are seen, when we are heard. When we are relevant. When we are loved.

Selfless – A Story of Giving

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My Nonno Michele, or “Mick” as his Australian friends called him. Yes, that’s me on the right looking pretty excited to get into that cake (clearly the sugar obsession started at a young age), and yes, my Mum loved indoor plants and making big cakes.

Today would have been my Nonno’s 90th birthday. He wasn’t a perfect man – none of us are. He was a selfless man and he’s the reason I’m here today. He’s also the reason many Italian migrants to northern suburbs Melbourne found their way in their distant new home.

Post-World War II Italy was not a prosperous place. Particularly in southern Italy, opportunity did not appear to be on the horizon. In much the same manner that I imagine current day asylum seekers make the impossibly tough decision to leave the relative surety of their homeland, my Nonno Michele Pizzichetta made that impossibly tough decision to get on a boat headed for a little-known country on the opposite side of the world. He left a small town, San Severo, in the Puglia region, for a 2-month boat trip. He did this on his own, leaving behind his wife and two very young children (my Mother being one of them). He arrived in Melbourne, Australia on 26 November 1952. Imagine that for a moment – a 25-year-old man, leaving behind his young family, to see if a better life existed in a mystery land so far away it took nearly two months to get there. It’s so difficult to comprehend as it’s so far away from the world in which I find myself in – a world that was made possible by his selfless move in 1952.

In his own words (intentionally left in his broken English), from an interview with the City of Whittlesea in 2001:

“I was in the army and I was look for the go out of Italy because in Italy not many jobs and I want to make some future to my family. Matter of fact I did my ideas come to, I did I come to Australia I like, I been a like it first since I come here. Another thing too I remember very well when I buy this block of land in Thomastown in the Poplar Street, corner Poplar Street and Boronia Street when I buy that I was a feel to be really own something in Australia in Thomastown and then I bring my wife and the children and look forward to build the house, I did build the house through the Building Society and I been paying the bank 1971. I work very hard because I used to work Saturday and Sunday one hour every change they do work and I saved a bit of money to pay the house off. When I pay the house off I went and see my Mother that’s after 18 years I been in Australia I went and seen my Mother because my Father died two years after I been in Australia, the first time I come. After I went seen my Mother I left money for the house I leave my wife money for food and children and went and seen my Mother. I take the time off from the job a bit of a holiday and went and seen my Mother. I stay in Italy the first time nine weeks it is a part of my holiday I been keeping that holiday for a few years they grow. Then when I come back I see everything the right way. I was worried my Mother not was well because was very old. Three years after my Mother died and I was happy I been to see. I been carry on some things you know I come back to Australia and work again and that’s my life I keep a go like that”.

It would be two long years before my Nonna, Mother and Uncle could make the journey to Melbourne to join him. He spent those two years doing whatever work he could to get by, while also buying a block of land with a bungalow in the developing northern suburbs of Melbourne and eventually building a house on it for the family to live in. They arrived on 11 November 1954. He learned enough English to get by from attending night school and from his various jobs – making materials for suits, and utilising the skills he learned in the Italian Army to work in maintenance and the metal trades.

In 1956, he began what would become a lifetime of community action. I am emotional to learn that he even helped raise funds for the construction of the hospital I was born in: “I been really myself live in my own country I was like you know I cared somebody else, some Italian anybody because in my own country I used to do the same you know, help the people how much I cared and that’s what I did here when I be in Australia. In fact, 1956 I was living in Thomastown I been collected some money to build the Preston Hospital, no can do because not enough money, that’s what you call Community Hospital. I been for years you know collecting big money from the trains, Thomastown and also raffle tickets through the Preston Council and sell that ticket in Cup Day and the profit it went to the hospital. I collect a bit of money door to door around Thomastown that time it used to be two shillings”. Sadly, that hospital is no longer there – it’s been turned into apartments. Another hospital was built further north which would become my birthplace’s replacement. My Nonno also played a role in the new Northern Hospital development and was on the Steering Committee that got it built. On this he said: “I be very happy I did that because I feel I believe that’s why you can help people. I been helping people for the pension for anything they come and ask for me. I used to do this sort of thing in my own country and I now a do here. All my difficulty to me the language that why I be doing a lot more than I doing I still feel happy I did and people all around this area respect me and they do the right thing. I never stop, I still do help them when I can”.

For these numerous selfless acts, my Nonno Michele was awarded the Citizen of the Year. But in his typical benevolent way, he said “I not ask, they give it to me. Yes, I did a lot of things. Many time I try to push the Council at Whittlesea to get road built. Because the children used to go on the school in the winter you have no roads to the children not to the school to go along water and mud. I was feeling very sorry for the children, and I did push the Council that time. I not afraid to knock on the door and ask for the benefit to the people, benefit to the area, benefit I see to this area, no discrimination. I like to see that why because this very good area, you see the people come from different countries I seen never been discrimination for long time. I like to see that way because that’s what should be in every area, every place in Australia”. Wise words from a man lacking a formal education but absolutely not lacking compassion. Although these words were spoken in 2001, they could not be more relevant to the society we find ourselves in now, 16 years later.

He was also actively involved in social groups and events. A member of one of the very few Italian/Australian clubs at the time (meeting in Lygon Street, Carlton, which is still the main Italian area of Melbourne). “I was the Treasurer. You see, around this area, I build two pensioner clubs, the Bocci (an Italian lawn bowls game) club. 22 years ago, City of Whittlesea give a piece of land to make the Bocci club they give all the land and the fence around it – it still there. Us build the row for playing Bocci and it built 22 years ago and now I look after the welfare, Italian welfare in Whittlesea, I look after, I am the President. Before that I build Eastern Thomastown Bocci. Before this, I build the others and the Councillors helped me a lot for build all these citizen clubs in Thomastown. They said 12 years ago start Italian Women Groups. Why I started that Women Groups because I see the woman by themselves. They have nowhere to go, nobody to talk to and my idea, I got the Pensioner Club, I got the Bocci Club, now I gonna start something for the woman, that’s what I did. When I started there were five to six women now there be 200-300, maybe more. They have good fun, they play together, the Bingo, have a talk, have a dance. Many times I go there myself and you have a good time, food together, very good. I like it because I see I do something good for them and now there are too many people there and the place where they are not big enough – I tell them I gonna ask Council to build a bigger place for you”.

My Nonno Michele was the one other migrants to the area would go see when they needed help. He was referred to as the “Welfare Italian” and he said “the Council give me one place where I can meet the people with the problem every Friday from 10 o’clock in the morning to 4 o’clock in the afternoon. And they are very good and happy for that and the fact that people come there for ask for help, they come to pass the time too, play cards, or have lunch together, or some bit of music and play Bingo like that for the Italians. No obligation – the only fee for one year $3 for membership and that’s very good because I want to keep as low as possible, because all that come there are pensioners and the ladies and not rich people, that’s a working class people. Sorry I say that, because in this area they are all a working class, because I remember the rich people never come to this area because the rich people go to Toorak or South Yarra, but here all the friends all working, all get on well together”.

His community action also extended to political activism – he was a member of FILEF, or the Federazione Italiana Lavoratori Emigrati e Famiglie (Italian Federation of Migrant Workers and Their Families), a group that existed from the 1970s in Melbourne. It is said that “not only has FILEF been the launching pad for the professional careers of some of its members, but at a smaller scale it forged the political consciousness of rank-and-file activists and ordinary members who through their activism or presence in FILEF were able to retain, express and foster their political culture, whether communist, Labor or broadly left-wing” (pg xiii, http://www.academia.edu/11331631/Immigrants_turned_Activists_Italians_in_1970s_Melbourne). He is pictured below at some of their meetings (pictures courtesy of the article linked above).

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Even my Nonna (Pina Pizzichetta, 2nd from the left below) got involved in the political action, pictured here at a PCI meeting, which was the Partito Comunista Italiano (Italian Communist Party), later renamed the Partito Democratico della Sinistra (Democratic Party of the Left) in 1991 and Democratici di Sinistra (Democrats of the Left) in 1998.

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When asked what Italian people hope for, he replied “Italian people not only here but everywhere, they are very good for the family. They look after family and in fact the ladies, the Italian ladies, the grandmother, always look after the grandchildren, they do everything for them, cooking, buy them some suit, shoes or some socks, they grow the grandchildren more than they grow their own children”.

It’s really no wonder that I continue to develop a strong desire to be socially minded and to be actively involved with social programs that assist those less fortunate than myself. I have it in my blood, and I owe it to both of my grandparents who fought for equality and access to basic rights for all, regardless of position or background. They did this with very little wealth of their own, but did it anyway. I’m so incredibly sad that I did not know this story when my grandparents were still here, but maybe I was too young to understand it anyway. So many things I need to say thanks for, but I know that the best way I can say thanks is to continue their legacy. Happy 90th birthday Nonno, I miss you so much (and you too Nonna). I hope I can make you proud one day as I try to contribute to the world around me, much in the way you did.

The Pursuit of Happiness Isn’t For Sale

“Love people and use things. Cos the opposite never works” – Joshua Fields Millburn, The Minimalists

 

I’ve been searching for a fulfilling career path from my first day working as an accountant. I knew through University that this wasn’t going to be for me, but for some reason, I persisted with it. I also gave it a good 12 years professionally in five different organisations, but each time, the initial challenge of learning new processes and meeting new people would fade after six months and the mundane routine would set in.

I decided to pursue a career change – one that many advised me against. The health and fitness industry seemed a perfect fit and I was passionately immersed in it for 18 months. Until the lack of financial stability finally took its toll. So I went back to a career that I knew I had no passion for, yet, felt the need to return to so I could get some financial freedom back.

Money is an interesting concept – I can say with total confidence that it simply does not make you happy, but not having enough to sustain a life you want is a recipe for unhappiness too. So, where’s the line between living for a bank balance and living for a passion?

This question has been in my head for years and I’m not sure I have the answer yet. Through these 12 years working in accounting and finance-related jobs, I pretty much hated them all, but persisted with them for various reasons – lack of acceptable or viable options, money (or so I thought), lifestyle (or so I thought), it came easy to me and people told me I was good at it. I worked with people that enjoyed what they did, and good on them. I worked with people that admitted they just did it for the money, or for their family, or for the mortgage. I worked with people that hated what they did, but didn’t see a way out, so they just kept grinding away. I saw myself slipping into that latter group and it was a scary prospect. There’s few feelings that I’ve encountered in my time that scare me more than the feeling of being trapped.

My first career change almost came about by accident, but it taught me many lessons. I discovered that I had other talents and that I did have the confidence to get in front of large groups and lead others. It also started to highlight to me the true value of stuff. I’m using this non-descript word purposely – “stuff”. The more I earned in accounting jobs, it seemed the more I spent. And I can’t say I have much to show for that spending either. I just accumulated stuff, and got into substantial debt at the same time. Maybe I was constantly buying things to make me feel better about being in a profession I had no connection with, or maybe I just liked having things.

When the income was substantially reduced with my move to health and fitness work, my lifestyle had to adjust. I simply couldn’t afford the same luxuries and certainly didn’t have the means to pay the credit card debt either. But this wasn’t just a job – this was a privilege where I got to help people improve their fitness and their life, while having some fun at the same time. I can’t adequately describe the feeling of having someone approach you and tell you that you made a positive difference to their day, to their outlook on life. Sadly, as a society, we don’t reward these types of jobs with appropriate pay, and after 18 months in this uplifting world of group fitness, I had to make the brutal decision to go back to accounting. I just couldn’t pay my bills and I was too embarrassed to ask another person for some money. Surprisingly, it was really tough to get back into accounting after a break – apparently it’s frowned upon to step away from your career to see what else is out there. Your commitment to the cause is questioned and you need someone to give you a chance. What a load of bullshit! Someone did eventually give me that chance, but it’s ridiculous that it is this way.

I knew I wouldn’t last in accounting when I went back. Particularly my last role, which I won’t name here, where I was absolutely overpaid and underworked, was a time where things got really bleak. But I can see now that it was a blessing. It was what I needed to know again – that money truly is not the catalyst for happiness, and that this industry simply wasn’t for me. Most people I spoke to said to stick it out, take the cash and start studying in your spare time, then quit. But I couldn’t do that. I couldn’t continue taking that salary that I didn’t deserve, all while working in a job that I truly hated. So, I quit and took the chance of going back to study while working part-time at a gym again to help ends meet. I started a Writing and Publishing Masters and was absolutely loving it, before another job opportunity presented itself. This time, it wasn’t accounting, but my knowledge from those roles would come in handy. The part-time work was becoming a factor too, as my hours were inconsistent and budgeting for things was proving difficult. There were also other factors to taking this new opportunity, so I jumped in with both feet.

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When I’m absolutely honest with myself, I know that I will need to leave this role too. Simply, I’m most content when I am giving back, when I am contributing to society in a positive and meaningful way. I know this now, but putting it into action is proving to be the hurdle. When I was helping others improve their fitness and outlook on life, I was truly happy and satisfied with work. When I write, I am happy, as expressing myself in this form is a release. It doesn’t always carry the same notion of giving back, but it does allow me the opportunity to communicate thoughts such as these, which may give at least one other person the confidence to interrupt their status quo and seek what truly makes them shine. I’m probably a socialist and I am completely comfortable with that. I see no issue with wanting everyone to have equality in all forms and with helping those that haven’t had the same opportunities to succeed that I have. So it follows that I don’t believe in capitalism, and most things that it stands for. The pursuit of money does not bring the best out of people and it certainly doesn’t allocate it fairly.

This finally brings me to an inspiring documentary movie I recently watched on Netflix, Minimalism – “a documentary about the important things”. It speaks of everything I have discussed here, as well as detailing a movement of de-cluttering your life of worthless possessions and simply taking what you need. They explain that although we have more things at our disposal now than we could possibly have imagined (or ever needed), we are also suffering more unhappiness and depression. We think that adding more material possessions will make us happy – that latest phone, or the newest trend in fashion. Even that bigger house that we can’t afford, or don’t actually need. Yet, it traps people into a routine of Monday to Friday melancholy and programs them into thinking they’ll be OK once (or if) that pay rise comes in.

I know that some of you reading this are probably thinking I’m overstating the impact of putting up with a meaningless career, but if you’re truly happy with your career, or the job you just happen to be in right now, then this isn’t aimed at you. This is for people that used to think like I did while wasting away in a career path that I had no passion for. Don’t think that you have no choice, or that you’re trapped. You may need to alter a few things about your lifestyle, but if it means you can be passionate about something again, then it’s surely worth it. I’m still searching for that elusive career path that will make me happy with myself again – it’ll look something like a social or community-based organisation, a not-for-profit or even a health-oriented role. I’m lucky – I know I have options, and although most future paths for me will inevitably mean returning to study, I just know I have to do it. And by getting rid of all the unnecessary stuff around me, I’ll be freer to continue exploring my options, and the world around me.

Born This Way

It was just an ordinary day, which meant that one of Australia’s mainstream newspapers was due for some good old-fashioned hysteria, scare-mongering and lies. It’s usually an attempt to demonise a minority or just have some fun at the expense of those that cannot defend themselves. A few days ago, this unashamedly unethical ragtag decided it was time to attack the LGBTI community again. However, this time, they went for the lowest of lows – they went for the youth.

An article at the top of the front page of Wednesday’s edition – an exclusive by the way – was so ineloquently titled “Activists push taxpayer-funded gay manual in schools”. Presumably being in this prominent position meant that it was the most important story of the day, but I’ll leave you to decide whether there were more pressing issues on this Wednesday (I can think of at least one more important issue that involves 267 people about to be sent back to a life of abuse and mental torment, but maybe I just have a different perspective of the world). I’ve actively decided not to link the article here (nor name this shameful excuse of journalism) for two reasons – it’s behind a pay-wall and I really don’t want you to give them any money to read it. It’s also just so farcical from top to bottom, so I don’t want to waste your time. I do however want to draw attention to how damaging this kind of “reporting” is, and will continue to be, if it is left unchecked and unquestioned. Though the “taxpayer-funded” part is quite hilarious – I’m not sure what their point is, but is this a good time to remind them that their beloved church that they so vehemently defend at all times does not pay any tax, while also receiving large sums of funding from the government?

To be clear, there is no “gay manual”. What would a “gay manual” even do, or attempt to do? This strikes at one of the most hurtful aspects of what homophobes believe – that being gay is a choice. Who would choose this? Why would you bring all of this unwanted attention and subsequent disadvantage to yourself if you didn’t have to? I’ll never forget one of the first things my Mum said to me when I finally had the nerve to come out to her (at age 28 by the way) – she was really concerned that I was going to miss out on opportunities, or be treated differently, simply because of my sexuality. And here I was worried about her getting upset at not getting any grandchildren from me. The fact that it took me so long to officially come out to my Mother is a direct statement of the way I felt scared and anxious for the real me to be out there. The prime of my life was spent hiding away for the fear of being found out. I had no boyfriends and I didn’t go out much all those years, simply because I was so scared of being found out. Why did I feel like this? Well, that’s what twelve years of Catholic education will do to you. I’m not upset that my parents felt it necessary for me to go to a religious school, but I do greatly resent the education I received of a narrative of the world in which I was a freak while growing up and discovering myself, while they go through scandal after scandal of sexual abuse of children in their care without any attempts to correct the many wrongs they have committed.

It was during my high school years that I first began to feel attracted to another guy. To say that was a terrifying and utterly confusing experience would be one of the greatest understatements I’ve ever made. I only wish there was something reassuring available to me at the time that explained some of the possibilities of what I was thinking and experiencing. This is no “gay manual”. Labelling it this way implies that you can teach someone to be gay. That would be as effective as gay conversion therapy, which is hopefully and finally about to be made illegal in Victoria. This is a teaching aide that forms part of the Safe Schools Coalition. It is an anti-bullying document designed to help children – all children – understand the differences that make us our own unique individual, and that there’s simply no reason to pick on someone, or exclude someone who might not fit into some main category. I don’t see anything wrong with that, especially as 80 per cent of homophobic bullying involving LGBTI young people occurs at school and has a profound impact on their well-being and education (Australian Research Centre in Sex, Health and Society, La Trobe University, Private Lives 2: The second national survey of the health and wellbeing of GLBT Australians (2012) p 39). I like to be positive though and it gives me hope that LGBTI young people at schools where protective policies are in place are more likely to feel safe compared with those in schools without similar policies (75 per cent compared with 45 per cent). They are almost 50 per cent less likely to be physically abused at school, less likely to suffer other forms of homophobic abuse, less likely to self-harm and less likely to attempt suicide (T Jones and Western Australian Equal Opportunity Commission, A report about discrimination and bullying on the grounds of sexual orientation and gender identity in Western Australian education (2012), p 11). I would think that having this resource available in schools can only have a positive impact, as it appears to be doing, and it certainly isn’t doing what this article is trying to suggest.

With the lack of such a resource in those times, I sought the advice of a teacher (who was also presumably gay, but I’ll never know for sure) who I felt comfortable enough with to share the thoughts I was having. He did help me understand that while I was probably having different thoughts to most of the other boys at school, there was nothing wrong with the thoughts I was having. I am very lucky to have had someone give me this reassurance at a time of need so I didn’t go down the path that sadly too many LGBTI youth go down.

The statistics glaringly show the disparity of mental health, self-harm and suicide in the LGBTI community to that of heterosexuals:

  • Lesbian, gay and bisexual Australians are twice as likely to have a high/very high level of psychological distress as their heterosexual peers (18.2% v. 9.2%). This makes them particularly vulnerable to mental health problems
  • The younger the age group, the starker the differences: 55% of LGBT women aged between 16 and 24 compared with 18% in the nation as a whole and 40% of LGBT men aged 16-24 compared with 7%
  • LGBTI people have the highest rates of suicidality of any population in Australia – 20% of trans Australians and 15.7% of lesbian, gay and bisexual Australians report current suicidal ideation (thoughts)
  • A UK study reported 84% of trans participants having thought about ending their lives at some point
  • Up to 50% of trans people have actually attempted suicide at least once in their lives
  • Same-sex attracted Australians have up to 14 times higher rates of suicide attempts than their heterosexual peers
  • Rates are 6 times higher for same-sex attracted young people (20-42% cf. 7-13%)
  • The average age of a first suicide attempt is 16 years – often before ‘coming out’ Source: Rosenstreich, G. (2013) LGBTI People Mental Health and Suicide. Revised 2nd Edition. National LGBTI Health Alliance. Sydney, p 5.

That all makes for very sobering reading. It also highlights just how critical it is for young people to be supported throughout their journey into adulthood, not to have some elitist set blast false headlines and news stories across their front pages suggesting otherwise. It’s because of continued homophobic examples like this that almost half of all gay, lesbian, bisexual and transgender people hide their sexual orientation or gender identity in public for fear of violence or discrimination (Australian Research Centre in Sex, Health and Society, La Trobe University, note 7, p 46). It’s also why a large number of LGBTI people hide their sexuality or gender identity when accessing services (34 per cent), at social and community events (42 per cent) and at work (39 per cent). Young people aged 16 to 24 years are most likely to hide their sexuality or gender identity (Australian Research Centre in Sex, Health and Society, La Trobe University, Private Lives 2: The second national survey of the health and wellbeing of GLBT Australians (2012) pp 45-46). I wonder why that is.

I am a part of those statistics. Countless times, I have hidden my sexuality from friends, work colleagues, family, Barry next door – you name it. I have encountered discrimination based on my sexuality. A previous boss of mine commented to someone else at this workplace (after I had left that workplace) that he would not have hired me had he known I was gay. I am scared to hold the hand of another man in public for fear of being abused – something I have seen happen in Melbourne before. The number of conversations I have had where I actively used words to avoid questions of why I did not have a girlfriend all those years, or where I faked an interest in “blokey” conversations to keep the charade going. This was all due to the world around me – a world that still tells me I’m not equal. That my love for another man is not the same as the love between a man and a woman. Yes, it’s 2016 and we’re supposedly advancing, but the simple fact is that I am still discriminated against, simply for the love I have for someone of the same sex. So, if there is a teaching aide in our schools reaffirming that we are all the same even though we have our unique identifiers, and that those differences are to be embraced rather than shamed, I am all for that. I am hopeful that the youth of today have more confidence to be themselves and not hide their true identity for as many years as I felt I had to. But as long as mainstream media continues to peddle this hysterical and utterly damaging sensationalism, we still have a long way to go. LGBTI young people report experiencing verbal homophobic abuse (61 per cent), physical homophobic abuse (18 per cent) and other types of homophobia (9 per cent), including cyberbullying, graffiti, social exclusion and humiliation (Australian Research Centre in Sex, Health and Society, La Trobe University, Private Lives 2: The second national survey of the health and wellbeing of GLBT Australians (2012) pp 45-46). These headlines just perpetuate these experiences and the people that write them ought to be held accountable for these actions.

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