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Sometimes the symptoms of trauma can mimic the symptoms of illness.
As the therapist at an LGBTQ+ centered treatment center, Jaki Neering often sees people come in with a myriad of mental health diagnoses that just don’t match the person that Neering sees.
“I get this person in front of me and I’m not seeing any of these diagnoses,” said Neering, who works at Inspire Recovery, a treatment center in West Palm Beach, Florida that serves LGBTQ+ folks. “I’m hearing their story and their trauma history, and the diagnosis doesn’t appear to fit.”
People who are LGBTQ+ are diagnosed with mental illnesses at a higher rate than the general population, but Neering and others who work closely with the community believe that members are often misdiagnosed. That’s because the symptoms of the trauma from living a life filled with discrimination, prejudice and rejection can mimic the symptoms of mental illnesses.
“I see them as being normal symptoms to an abnormal experience,” Neering said. “From childhood, we have told this person that they can’t be themselves.”
LGBTQ+ folks are often told that they cannot act in a way that aligns with who they really are. As a survival mechanism, they often adopt a persona that is more socially acceptable. But maintaining that persona can be exhausting, which means people may isolate, withdraw or have other behaviors that are often misinterpreted as the symptoms of a mental illness.
“If the client is coming in and saying ‘I isolate’ or ‘I’m hopeless,’ these symptoms may indicate major depression or bipolar disorder,” Neering said.
When people are able to drop their personas and be accepted as they truly are, the symptoms of the misdiagnosed mental illness are often alleviated. That can have lifesaving implications.
“Suicidal ideation will decrease by 56 percent just by using that person’s correct name and pronoun.”
Inspire Recovery intentionally creates an LGBTQ+ centered treatment facility where people can connect with their true selves, sometimes for the first time. However, for people getting treatment in a more traditional setting, micro-aggressions can further compound the trauma of growing up LGBTQ+. For example, many inpatient units are divided into male and female floors, so a person may be placed based on their sex assignment at birth, rather than their authentic gender identity.
“That’s retraumatizing,” Neering said. “The professionals are trying to help, but they’re using the wrong name, pronoun and room assignments. The client can’t even begin to receive any help because the setting is perpetuating the problem.”
It is often hard for professionals to make a proper diagnosis, because the persona that an individual has adopted is so deeply entrenched.
“It’s like the persona is receiving treatment,” Neering said. “They can’t treat the person because the persona is in front of the professionals.”
In addition, “the current definition of gender dysphoria doesn’t include symptoms like withdrawal, self-harm or isolation. Having an improved diagnosis that reflects the lived experiences of many transgender, non-binary and queer people would help more individuals get an accurate diagnosis and more effective treatment,” Neering said.
At Inspire Recovery, Neering and the rest of the staff focus on allowing people to get comfortable living their true identity. Even simple changes can make a big difference. One client who had a history of chronic self-harm stopped hurting herself when she began wearing nail polish and dresses at Inspire, physical changes that aligned with her gender identity and gender expression.
“I’m able to do therapy with their authentic identification, rather than this persona that they’ve been living in and presenting to the outside world,” Neering said.
Sometimes, however, clients are not ready to let go of a mental health diagnosis that they have been labeled with for years.
“It is a safety net to hold onto the diagnosis,” Neering said. Sometimes, that’s because people are hoping that a medication can help them overcome their issues without doing the hard work of emotional regulation.
“We’re in a society where we want a quick fix,” Neering said. Learning to regulate emotional responses takes time, effort, and therapy, which some people are reluctant to delve into. When they do, however, it can be beautiful.
“It’s empowering,” she said. “They realize, ‘I have control or power over these things. I can choose to do the coping skills, to practice, to show up in group, rather than the powerless feeling of being victim to the diagnosis.”