Sometimes self-care is community care

I’m being admitted to a psych hospital today for the next 21 days.

Sometimes self-care means asking for help. Sometimes self-care is community care. The belief that we’re “not trying hard enough” or are “too lazy” or have to do this alone is a harmful coping mechanism which denies the fact that much of mental illness is out of our control. Getting the correct diagnosis, the right medication and the right treatment plan for therapy gives us power over the parts we can control.

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Getting real about recovery

In the spirit of “secrets make you sick”, I’m getting real with myself by getting real with you, because it’s easy to avoid stuff when I’m in my own head: For the last 6 months or more

– I have had two days of work a week and I’m really struggling financially, with my income being R5,000 short of my budget.

– I sleep 14 hours a day.

– When I’m not sleeping I’m watching series, movies or aimlessly scrolling through social media.

– I shower once a week.

– My flat is a mess and I don’t clean often enough.

– I’m not exercising or eating healthily.

– Apart from a friend once a week and my therapist every two weeks (Skype), I don’t get out of the house and have no human contact (all my own doing).

– In short, I’m wasting my life.

The frustrating thing is I’m not hectically depressed, and I know exactly what to do to get out of this slump. This leads to self-recrimination and self-flagellation, telling myself I’m lazy and that there’s something wrong with me.

I know that I’m a person who does very well with a strict routine. I flourished at school and university where guidelines were imposed. I now realise that it’s not that I’m lazy or that there’s something wrong with me. The issue is that I struggle, and have always struggled, with self-regulation. I never learnt the skill of being by myself, filling my days and life, and self-imposing routine.

These are things I need to learn. It’s that simple and that difficult. It’s a relief to realise that I’m not at war with myself, but at war with an emptiness born from skills I never learnt. It’s a relief knowing I can teach myself these skills by implementing the structure I crave.

Depo Testosterone: Nationwide shortage in South Africa

So, Pfizer, the only producer of Depo Testosterone (testosterone cypionate), the testosterone used by at least 80% of the trans, non-binary and intersex population of South Africa, has “run out” of the product. It is the most used T in South Africa because it is the cheapest.

So switching testosterone types is not an option for most of us. Switching testosterone also comes with a host of problems. The other forms of T are not comparable to Depo T in terms of chemical make up. It would be like switching from Prozac to Cipramil.

This has HUGE health implications for us. It’s a hormone, so controls a multitude of body functions. It controls moods, and with a large number of trans people struggling with depression, this has serious health implications.

Then there are the masculinising implications: we would begin to menstruate again, lose muscle, have fat redistribution occur – all things that cause us unbearable dysphoria.

Pfizer has said they will have stock end of February again. This means that we will miss 4 shots (those that tried to fill prescriptions earlier have missed up to 8 doses). 4 Shots that balance our entire bodies’ chemistry. 4 Shots that make life livable.

Testosterone is a chronic medication. The trans community is in a panic. This is completely fucking unacceptable.

Please share and tag Pfizer in Sandton. Let’s put pressure on them to remedy this national healthcare failure.

UPDATE:

Re the Depo Testosterone shortage:

So I’ve just spoken to a friend in Australia. They stopped producing Depo T early last year. He had to change testosterone types 4 times last year when the supply of Depo, Sustanon and Primoteston ceased. He is currently on Reandron.

He’s also in the medical industry and gave the perspective of the pharmaceutical company:

Bottom line is that pharma has not caught up with legal and human rights progress for trans people. They budget for the production of meds based on what Drs prescribe. This budget it drawn up 5-10 years in advance. Which means that they budgeted for HRT according to state of transgender issues 5-10 years ago and they have been caught unprepared for the suddenly increasing demand for testosterone by trans people.

Answering this demand is therefore not as simple as producing more T. They not only have budget constraints, they also place their emphasis on global crises like ARVs and insulin. Parkinson’s and Alzheimer’s are also on the rise. Also, production of more Depo T is not as easy as it sounds. They need to go through the process of testing the new batch of product and go through the red tape of ensuring that the product is up to medical standards.

So, it’s a case of supply and demand, but with processes that make supplying the demand a difficult thing.

Of course the good news, with pharma obviously being a money-making enterprise first and foremost, is that they are aware that there is a lot of money to be made off HRT and pharma giants will push to be the biggest supplier.

In the short-term, this means that we in South Africa will have to change to Nebido or Sustanon until the supply of Depo T is fast-tracked. This will, of course, be a huge finanial issue for the majority of the trans population, but we need to be aware that this kind of thing happens globally.

So, basically, pharma has to catch up with the increase in trans patients and the right to healthcare that has been granted by the World Health Organisation.

Sexuality and the trans experience

My experience with sex, sexuality and the trans experience.

I’ve only been i relationships with cis women, but have always been sexually attracted to and had sex with cis guys. When I came out I realised I was mostly attracted to trans men and non-binary people. I now identify as pansexual. To perhaps answer your next question: I believe that once we’re more secure in our gender, we’re more able to be comfortable in our sexual orientation. How do we know what our sexual orientation is until we know and live our gender?

In school I believed that I wanted to be the girls I obsessed about, and was sexually attracted to the guys I was obsessed with. When I started realising I was trans, I realised it was the other way around. And now that I present as a guy it’s made me realise that I’m not just wanting to look like guys, but have sex with them as well. Our sexual orientation, in general, changes as we get older; as we become more secure in ourselves.

Re my trans guy attraction, I’ve realised that when I identified as a lesbian, the attraction to other lesbians was also a lot about a shared experience. It’s the same with trans guys: having a shared experience and knowing that they get the body issues, etc., makes them more attractive. Intimacy is, after all, about being seen and being able to be yourself.

Uncomfortable comfort zone: Day 41

Day 41 of forcing myself out of my uncomfortable comfort zone: stopping hermiting, getting out of the house and seeing people brings up a lot of emotions. Emotions that I’ve forgotten existed. Emotions from situations from the past that resurface in situations that are similar; sadnesses, fears, anxieties, excitement, lust, anger. All the emotions. And it’s all overwhelming and difficult to deal with. It’s no wonder that hermiting is my default; that telling myself that I don’t need these interactions is easier; that denying my need to experience intimacies and the emotions they bring is simpler. But as difficult as dealing with the prickling of coming back to life is, the positive feelings outweigh those that are difficult to sit with and I will continue to flex my limbs and get the blood flowing again. #uncomfortablecomfortzone

Day 6: Reflecting on how I am after committing to forcing myself out of my uncomfortable comfort zone #depression #anxiety

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8 Days ago I made a video (posted on this blog) about my loneliness due to isolating myself for the last two years. Despite the fear, I admitted to it as part of the process of reaching out and allowing others back into my life. 2 Days after that, I committed to forcing myself out of my uncomfortable comfort zone – the excruciating limbo between severe depression and functioning more healthily with depression and anxiety. I admitted to myself that as difficult, scary and anxiety-provoking doing the things I felt incapable of doing in my limbo are, that staying in that limbo was scarier; that I could no longer live like this. That life is hard, requires effort, is dominated by things that we do not want to do but rather have to do – adulting, in other words; and as much as I “just don’t wanna”, not doing those things fuels depression and the cycle of severe depression -> suicidality -> recovering -> living in limbo -> severe depression. And the only thing that breaks that cycle and enables healthier functioning and not just being a functional depressive, is contrary action – doing things that are the last things on earth I want to do.

These things range from “small” things like not sleeping until 12, brushing my teeth, washing the dishes more often than every 10 days and not drinking and eating from dirty dishes, messaging someone back instead of feeling too overwhelmed to even read the message, showering. Because the truth is these things are not small when you’re depressed and anxious. They’re huge. In and of themselves and because they lead to huge change.

This is, of course, in my 41 years on this earth living with chronic depression, anxiety and Complex PTSD, not the first time I’ve come to this conclusion. Because things happen in cycles. It’s a lesson I need to learn and re-learn over and over again. Because my default to the stress of life and the stress of the underlying depression and anxiety is to retreat, assume the foetal position and withdraw from as much responsibility as I’m able to without losing my job or the flat I rent or the dogs I love.

This is my default because it feels safer to withdraw from life. That in limbo depression (and I’m NOT speaking about severe depression here) is a comfort zone. An uncomfortable one, but a comfort zone nonetheless.

Elizabeth Gilbert’s words – that in the in limbo depression feel like a slap in the face, a you do not understand!, a simplification – ring so true in this commitment space to be a person who functions more healthily with depression and anxiety: “I’ve never seen any life transformation that didn’t begin with the person in question finally getting tired of their own bullshit.” And I am SO tired of my own bullshit. This bullshit that keeps resurfacing and rearing its ugly head in my life. This bullshit of the in limbo depression being a comfort zone.

So, 6 days ago I committed to taking contrary actions, feeling the fear and doing it anyway and forcing myself out of my uncomfortable comfort zone. It has not been easy. It has not been entirely pleasant. It has not felt comfortable. But each step of taking agency in my life and taking action rather than lying on that uncomfortable comfort couch that feels like bathing in my own self-loathing has made me feel better, stronger, more able. (I’ve shared about these experiences on this blog under the heading “uncomfortable comfort zone”).

I have forced myself to go out with friends twice. I have forced myself to jump into the pool and get active again. I have washed dishes three times in the last 6 days. I have interacted more on social media (in meaningful conversations) rather than just scrolling through and succumbing to the feeling that I have no energy to do more than “like”. I have showered more. I phoned my dad rather than waiting for him to phone me. I have started cooking again, eating three meals a day, bought healthy food rather than comfort food (and have lost weight and that self-loathing bath is becoming shallower).

I have been able to do this by not giving myself the option of “no”. When I’m invited out I say yes and mean yes. When I stand on the edge of the freezing pool I do not give myself the option of turning around and going back into the house to sit on that uncomfortable comfort couch.

And while it has not been easy, or comfortable, each of these actions and decisions has made me feel better. And the more I make these decisions, the more I find myself doing things with less and less conscious thought; things that would normally take me two weeks of “I have to but I don’t wanna”.

And what I’ve learnt in just the last 6 days is why I withdraw from people – it’s not just that I’m socially anxious and find social interaction draining because of the anxiety. It’s that I struggle with boundaries. As someone said to me this week: the deeply confusing thing is not being able to tell the difference between doing things despite the fear in order to feel better, and doing things despite your intuition that those things are dangerous for your own psyche and well-being. There’s so much more to say about this and I don’t know if I’m making sense, but all I know is that I now have concrete things to work on in therapy rather than the same shit different day stuff. And I’d rather be working on these things and dealing with the root causes of why I struggle with social interactions, self-care and feeling that I am enough than return to the death that is the in limbo depression; that uncomfortable comfort zone.