Content Warning: psychiatrists, invalidation (transgender/plurality), pathologization (transgender/plurality), gaslighting

I have been dealing with considerable sensory overload issues which are relatively severe and debilitating. Sensory overload is associated with a number of things, including sensory gating (including ability to filter out background noise), post-traumatic stress, schizophrenia, autism, and sensory processing issues. Some of these are apparently the things psychiatrists deal with, so I felt accessing that service (government-funded) would be a reasonable next step in figuring out what’s going on. My doctor and therapist agreed.

I went to the psychiatrist to talk about these issues. What I thought was a referral to someone that would listen to and help with what I was dealing with, turned out to be a more formal psychiatric assessment where I would be assessed for a small handful of conditions unrelated to my experience. Besides having many of my concerns dismissed, our plural identity and experience was also ignored and invalidated for the entire 90 minute session. I want to talk about this experience and make a comparison to gender identity invalidation.

Plurality is often associated with a diagnosis of DID (dissociative identity disorder). While I do not necessarily consider our plurality a disorder, I have found many DID resources to be very helpful in navigating our plural experiences. I’ve been working with a therapist for 10 months who has training with DID, including utilizing resources from the ISSTD (international organization which studies DID and provides treatment guidelines). My sensory overload issues and our plurality is related in that other selves do not seem to experience overload to the same degree, and more frequent self switching seems to reduce overload. Plurality and sensory overload are also both associated with psychological trauma (though not necessarily so). So I prepared myself to be open with the psychiatrist about our plural experiences as well.

At the assessment, I met the psychiatrist and a case manager. I began expressing my concerns before I was cut off and the psychiatrist began his standard line of questioning. I used “we” where it was appropriate in discussing our experiences. I mentioned that we were plural, and that many of the answers to his questions depended on who was fronting. Despite apologizing in advance for the need to interrupt with clarifying questions, he never asked for clarification around our plurality. Instead, he made notes based on what I said applied to me (except for anything to do with plurality), and completely ignored what I said about others in our system. I’m almost impressed at the mental backflips he must have had to do in order to respond and make notes as he did. Eventually he told me that my issues were caused by anxiety and I needed to learn to control that. I was sent away with no opportunity for further discussion or follow-up.

I have had a few weeks to think about things since my appointment. I have thought considerably about how to explain the invalidation that took place to those that aren’t plural. Since I have written about the similarity between trans and plural experiences, and since progressive community that generally understands gender issues is the main target audience of this blog, I want to make an analogy from my experience to gender identity invalidation.

You are now the one dealing with a debilitating issue that you are seeking help with. You are dealing with mood swings that impair your ability to work and function well in your life. You are trans and have been working with a trans health clinic (following WPATH standards) for the last year. Though you do not attribute your mood swings to being trans, you did notice that the mood swings began after you started hormones. You seek help for mood swings, and your doctor refers you to a psychiatrist.

The psychiatrist and assistant are polite and professional. You are asked about your concerns, and begin discussing mood swings before the psychiatrist interrupts with their standard line of questioning for the assessment. You bring up being trans and feel that hormones might be playing a part in your mood swings. You mention your gender identity and pronouns, but despite this you are constantly misgendered by the psychiatrist and assistant. Along with being misgendered, everything you mention about being trans including your experience with hormones is completely ignored by the psychiatrist and assistant. You are eventually told that your issues are not severe and you should learn to control them. You are sent away with no opportunity for further discussion or follow-up.

I was not seeking a diagnosis for our plurality, but it was impossible for me to separate our plural experiences from the issues I was having trouble with. Similarly, you were not seeking a diagnosis of “gender identity disorder”, but your being trans and taking hormones was relevant. We both sought help for a debilitating issue and had some hope and trust that a psychiatrist would treat us with care and respect. But instead, we were left not only feeling disappointed that the psychiatrist was unable to offer any helpful advice, but also devastated that we were not listened to and our experiences and identities had been ignored and invalidated for 90 minutes while we were in a vulnerable position.

I admit that I went into this psychiatric assessment somewhat naive. But I still think I had good reason to hope talking to this psychiatrist might be okay. I’ve heard a lot of bad experiences involving psychiatrists, but I’ve heard good ones too. There seem to be psychiatrists out there who will listen, work with you, and support the way you conceptualize your experiences. I was also told that the psychiatrist I was seeing was good around trans issues, including being non-binary (and he was). But I’ve lost hope that I’ll be able to find someone within the medical system that can help me with mental health issues. I’d need someone to listen to, validate, and ideally not pathologize our experiences around plurality which usually cannot be separated from the issues we need help with. I have even heard of psychiatrists that are good like this! But far more often it seems their awareness around DID (let alone healthy plurality) is minimal, if they believe it exists at all. And I don’t think I can handle another experience like the one I had.

The relatively controlled tone of this article does not reflect how I felt after the assessment. Trans and plural folks experience immense amounts of invalidation, often starting at a very young age. This invalidation (along with other aspects of marginalization) often contributes to significant negative mental health experiences and high rates of self-harm and suicide. To have your already marginalized identity and experiences invalidated when seeking help from a mental health professional isn’t a mere inconvenience, it’s outright dangerous.