Beyond The Hashtag

I woke up on Sunday June 13th with hundreds of notifications on my phone about a shooting in Orlando. My heart sank immediately into my stomach and a flood of terror, anxiety, and sadness washed over me instantly. Forty-nine LGBTQI people and allies had been murdered while celebrating life, in a place that was usually known as safe. In those moments before the shooting in Orlando, I am sure those individuals, for the most part, felt safe. They felt safe in the music, in the club, with their people.


By noon, I had been personally emailed at least 3 times requesting that I write a blog on my reaction of the shooting. Being an outspoken activist amongst the LGBTQI community, especially in the areas of addiction and mental health, people sought opinions, they wanted to know how we, as a community of activists, were we going to respond. How should we respond? What can we do to help? How can we be there for the people in Orlando, for our LGBTQI community?


I sat staring at a blank page for hours. Realizing finally that I was in the midst of having a trauma response myself. No, I did not know anyone personally involved in the Orlando shooting, however I knew people who knew them. You see, this LGBTQI community is one degree of separation. As a community we are suffering from collective trauma. The ripple effect that something as horrific as the events of June 12th has on a community will have an effect on individuals for a long time to come.


It wasn’t until Monday that I started reading the commentary, from outside sources. I started reading everything I could and I found myself deeper and deeper in an activated trauma response. I was acting out, short fused with my wife and my dogs. I was feeling frustrated and wanting to shut down completely. This was happening as I read the words:  we are a strong group, we would be resilient, and we would overcome. And I believed it, but I also needed to hold space for what was happening for me, just as I encourage those in the same emotional place to hold space for themselves. In 2016 we have already seen 14 Trans people murdered, numerous people beaten up for being their authentic selves, hundreds of bathroom bills and legislation coming up to further oppress our identities as queer people, and continued harm and discrimination from institutions especially toward LGBTQI people of color.  Orlando was not the first of the atrocities against our community, it is for sure the most publicized to date, and arguably the most intensely violent in sheer numbers.  I recognized in myself that it was not Orlando alone that was the trauma; Orlando was the activation of the collective and historical trauma the entire LGBTQI community experiences on a regular basis.


That Tuesday, NALGAP had their monthly meeting, as we were going over the events of the weekend, it was very apparent that I was not the only one who was feeling this way. As we were trying to put together lists and phone numbers for resources in Orlando, it was obvious that everyone was scattered, a normally focused motivated group of activists challenged to do what we do well. I knew in that moment what needed to happen. Before we could take care of others, we needed to take care of ourselves. Before we could come up with answers for the general public, the cisgender, straight communities, we needed to come up with some answers for ourselves, ones that addressed our collective trauma. The old adage that I hear every time I fly… “put your oxygen mask on yourself before you help someone else…” became ever so apparent.

Before I could help others, I had to check in with my support system. I had to go inside and create a space for me to heal, I had to allow others to help me sift through my own feelings and take care of me for a bit.


As therapists that are LGBTQI identified, we walk through the vulnerability that the Orlando tragedy has left in its path. We come face-to-face with the idea that we are not robots, not above the trauma, not immune to the emotional response. We have to hold space for our clients during this time, but we also need to find the space for our own selves to walk through this process.


Self-care always gets lip service, but actions of self-care rarely come to fruition. We LGBTQI people, on good days, struggle to take care of ourselves due to accessibility and self-defeating beliefs that we are not good enough. Clinicians struggle to take care of themselves because of access (many institutions in the CD and MH field do not give incentives for self-care) and because we need to be there for our clients. I mean, if we are not there for them, who is? LGBTQI clinicians are vulnerable to both sets of belief systems.


In the wake of Orlando, as a clinician who is LGBTQI identified, answer these questions. Honestly. Seek ways to get the help you need, because you need it and most importantly deserve it. You hold space for others trauma on a daily basis; it is time to hold space for yourself and your healing and allow others to support you.

1.     How do the events of Orlando, and/or the events of oppression to LGBTQI community affect me?

2.     How am I responding to the closest people in my life? Have I connected with my support system?

3.     Have I taken any ”me time” lately?

4.     What does self-care mean to me? And have I done those things?

5.     Can I ask for help from my employer? If yes, than will I? If no, then where can I seek the help I need?


If you are an employer of an LGBTQI addiction and mental health professional, answer these questions. Honestly.

1.     Have I asked what I can do for my LGBTQI workers in the wake of Orlando?

2.     Have I given access to necessary self-care modalities to these workers?

3.     Have I walked in empathy with my LGBTQI workers with the knowledge of what collective trauma can mean for them and for my staff as a whole?


If we ignore the questions, and our answers, we continue to reinforce the trauma which goes on unacknowledged and brushed over and ultimately limits ourselves. Unresolved and unaddressed trauma is the leading cause of burnout, relapse, mental and physical illness, relationship breakdown and breakup. When we hold space for ourselves, allow others to support us in the wake of traumatic events, and take time to grieve and process all that has happened and ALL that we feel about it – unless we put on our masks first- we cannot be our best selves in the therapy rooms with our clients.


Treating Trans

Treating the Transgender population for drugs and alcohol addiction begins with understanding the humanity of Trans individuals. If we do not see someone as human, how can we treat them as such? Transgender, non-binary, and gender non-conforming individuals struggle with addiction just as any other person. Trans people struggle with higher rates of addiction than the general population. Most drug and alcohol treatment facilities are built and structured within the gender binary including gendered bathrooms, sleeping quarters, groups, policies and forms. The binary culture of treatment facilities makes it challenging for Transgender individuals to get help. Trans people are often turned away from treatment facilities because their gender expression and identities are outside the binary.


I often ask leading questions around accessibility of treatment facilities to engage a dialogue about Trans inclusion. The conversation goes as follows:


ME:  “Are you accepting of LGBTQ identified people at your facility?”

THEM:  (90% of the time) “YES!” and “OF COURSE!”

ME: “Great! So, where do you place Transgender clients?”

…. And then it comes… the dreaded silence, followed by the even more dreaded answer…

THEM:  “It depends, have they had THE surgery?”  

…“THE SURGERY” that they are talking about is most often Gender Affirming Surgery…

To which I kindly reply:  “Have you asked ALL your clients to strip down and confirm surgery or not?”


The dialogue either ends there because the clinical worker has no response. In rare cases, the clinician may engage further in conversation opening up an opportunity for education.


The only thing that Trans individuals have in common is the fact that they are Trans.  Some Trans people choose to take hormones and/ or have surgery. Some Trans people may only take hormones. Some may just have surgery. Some Trans people are perfectly accepting of the body in which they were born and assigned. Transgender is not just about fitting into one gender or another. You see, we need to start looking at gender as fluid, as changing, as socialized, as personal.


In the treatment world, especially in hospital settings and using the medical model, we conflate gender and sex assigned at birth.  It is assumed that a person that comes to treatment identifies their gender with the sex they were assigned at birth. Paperwork upon entering treatment has one of two boxes to check, male or female. There is no room for someone to define their own identity.


The question I get most often is “Well, if we don’t put that on the intake, then how do we know what unit to put them in?”  To this I say, if someone is opening up and coming out to you as Trans identified, how about letting them decide where they feel most comfortable.


Treatment is not about just getting sober. Treatment is about finding safety and being safe enough to even begin the recovery process. So my question to the treatment facilities of the world is, is your center safe and accepting for EVERYONE, including Trans people? And if you are not sure, what parts of your facility need improvement? Do you have gender-neutral bathrooms for example? Is your staff trained properly? And by staff I mean ALL staff, from facility maintenance to Nurses to Techs to CEO’s.


Trans people make up .5% of the general population. The rate of violence against Trans people is 400 times that of the general population. The rate of suicide attempts amongst Trans people is 41% compared to 1% of the general public. 60% of hate crimes toward the LGBTQ community are aimed at Trans women of color.  What is one life worth to you and your facility? When you say that you are open to treating everyone, make an effort to do so. And if you don’t know how, there are people and places to help. You may have someone who is Trans identified in your facility or on your caseload this very moment. How will you open yourself to being the first safe place someone can disclose this information? And how will you address it going forward? The ultimate decision is up to you, what is that one life worth?