De-pathologising LGBTQIA+ mental health & crafting better anti-carceral community spaces
To create queer spaces that centre our mental health, that are better for ourselves and our folk, we must identify the oppressive structures we dwell within and adjust our own practices accordingly.
Content Warnings: Institutional trauma, transphobia, homophobia, racism, ableism, suicide.
By Lizzie Hughes
Part of creating “happier” and “healthier” LGBTQIA+ communities should involve prioritising our collective mental health. So, here I am trying to write an opening sentence about the importance of LGBTQIA+ mental health. I’ve worked in a LGBTQIA+ specific mental health community space for some years now, and I’m thinking about the countless presentations I’ve watched that make “LGBTQIA+” and “poor mental health” synonymous, or the meetings I’ve had with mainstream projects where I’ve had to explain why our mental health is important. Where somehow, somewhere in the space between the data, what is spoken, and what is heard, a causal link is made, as if the fact that we’re statistically more likely to experience depression, self-harm, and have suicidal thoughts is our fault, because we’re queer. I always leave angry. I feel that anger right now.
It’s not surprising that I, and many others, feel this way. This is the pathologising of queerness. To pathologise something is to treat it as ‘psychologically abnormal’; it is to locate the problem as being within. Gayness, queerness, and transness has long been diagnosed and “treated” by the medico-industrial complex in alliance with the criminal punishment system, and compounded by additional factors like dis/ability and race, together contributing to a lingering idea of gayness, queerness, and transness as “wrong”. When we talk about this topic and wonder about how we can create spaces for ourselves that centre our mental health, we remember this ongoing history of punishment, shame, and blame. These difficulties and complexities don’t mean that we shouldn’t talk about “LGBTQIA+ mental health”, nor that it shouldn’t be a category at all. Certainly, talking about our mental health requires a different frame than talking about the mental health of cis straight groups, but this isn’t because there is something inherently wrong with us or with being queer – it’s because we live within heterosexual, heteronormative, cis-centric, racist, and ableist structures and our mental health is one manifestation of our response to it.
Understanding mental health as partly a response, rather than wholly innate, is a radical idea. It means de-medicalising mental health and instead recognising it as part of our response to our lived conditions. I first came across this idea in Recovery in the Bin, who provide an alternative to the problematic ‘recovery star’ used to monitor and regulate “progress”. Their critical work has taught me to reposition: instead of “I’m anxious because I’m mentally unwell” or “I’m depressed because I’m queer”, I learn “I’m depressed, I’m anxious, I’m experiencing whatever I’m experiencing in part because I live in a capitalist, oppressive, and often cruel world”. It’s hard to get this message across when up against neoliberal regimes that make the individual responsible for their own wellbeing whilst reducing opportunities for critical analysis of broader structures that remain harmful. Mental health is seen as something the individual is responsible for and that harmful systems have the right to “treat” and “solve” – whether that’s through enforced diagnosis, medication, or incarceration. Powerful work like Recovery in the Bin teaches us to refocus: to not see the individual as the problem but instead probe the relational structures around that individual, in turn helping us search for help away from these established harmful systems.
Crafting better community spaces must involve this refocusing. I’ve chosen the word “better” here because I’m cautious about “happier” and “healthier” (and community itself is a problematic term, let’s not forget). These are ideal states to be in but when in conjunction with medical institutions and the punitive state they are foreclosed to many types of bodies, like dis/abled, BIPOC, and trans people. To strive uncritically towards them feels like unchecked privilege. For example, in order to access gender-affirming and life-saving care, trans people are subjected to medical pathologisation that demands they be “unhappy” and “unhealthy” so as to deserve that care. They are invasively assessed, forced to comply with psychiatric diagnoses, and offered waiting lists so long they are killing people. Happiness and health are not impossible states of being – but some of us literally cannot surface in this world as our horizons are blunted by the pressure of “health” and “happiness”; life is, at times, unliveable.
But it is possible to produce different kinds of health and happiness. Because when we’re crafting communities we are choosing to create alternative mini-worlds. This means we can consciously select what pieces we want to keep and develop, and what we want to leave behind. We can disconnect ourselves from the structures that fail to serve us and our needs and instead turn to person-to-person care work that is relationally focused, radical resource-sharing, and mutual aid, which together will sustain us more than a pathologising mental health system ever could. This doesn’t mean we shame those of us who desire or take comfort in diagnoses or medication, but recognise that care need not be hierarchical and paternalistic, but self-generated and autonomous.
Moreover, committing ourselves to doing our own radical acts of care and compassion creates space for collective healing from institutional trauma that has perpetuated cycles of harm. We must recognise the ways in which we re-do harmful things without even meaning to, and learn that in order to shape better community spaces we have to actively resist the everyday manifestations of punishment that are connected to the pathologisation and medicalisation of queerness. Take, for instance, what feels like unhelpful or annoying behaviour in your drop-in or meet-up, or when one member of the group does harm against another. Our instinct might be to shun, shame, and ban – common tactics in our current “Cancel Culture”. But these behaviours are informal clones of the formal methods used by the prison and policing system, conditioned into us as “natural” responses to harm that in reality perpetuate harm and pathologisation. They share a logic with school exclusion, sectioning, imprisonment, and deportation. Such moments of difficulty are opportunities to recreate our responses and interrupt these techniques: grassroots transformative justice work, done predominantly by people of colour, shows how although this is never easy, it is truly possible to meet harm with care. This isn’t saying that individuals don’t have agency or that there is no need for accountability; this is about rewriting the script of what ‘accountability’ looks like and creating new futures that prioritise collective healing and leave no one behind.
To create queer spaces that centre our mental health, that are better for ourselves and our folk, we must identify the oppressive structures we dwell within and adjust our own practices accordingly. We must refuse the notion that there is something wrong with us and that in order to deserve care we must be deemed “mentally unwell”; we must refuse the solutions to being “unwell” are enforced medication, psychiatric diagnoses, and confinement; we must refuse to replicate the punitive practices of the state in our everyday lives. We must form our worlds as defiant, caring, compassionate, and as self-healing, feminist, anti-carceral, anti-ableist, and anti-racist. Further evidence revealing the appalling treatment of people confined within mental health wards makes it astoundingly clear that this resistance is urgent – we must do it now so that we move towards a radical future of care, together.
Further reading & resources:
‘Abolition Medicine: Dismantling Carceral Logics in Healthcare’, a free article by Esther Kaner
‘Practicing Everyday Abolition’, a free article by S. Lamble
The Cradle Community website
The Care We Dream Of: Liberatory and Transformative Approaches to LGBTQ+ Health, anthology edited by Zena Sharman (or a free video about the anthology)
Lizzie is a PhD student at Birkbeck researching the interface of surveillance, sensory
embodiment, and transness from the UK gender-segregated bathroom. Lizzie also runs a LGBTIQ+-only mental health project in North London for LGBTIQ+ Londoners and LGBTIQ+ asylum seekers and refugees. Lizzie’s favourite type of literature is speculative science-fiction, which they believe provides ample resources for recrafting our worlds towards better futures. They live in North London with their mum and cat. More info can be found at lizziehughes.uk and they welcome contact at email@example.com.