Inkwell: Authors and Artists
Michael Bettinger (mcpsycle) Sat 30 Mar 02 09:45
Do I have anything to say about substance use/abuse and depression in the queer community? Oh, yes. Lots. Substance abuse in the queer community is rampant. But the same can be said for our society as a whole. We are a nation of people who want to feel good or avoid feeling bad and we find many ways to do that. Substance use/abuse is but one. Others include destructive sexual practices, overspending, overeating, etc. If you look at the names of 12 step programs, you will see just some of the ways we try to feel good or avoid feeling bad. As a community, we do have a problem with substance abuse. Are the figures higher in the queer community when contrasted with the non queer community? Possibly. As Mark Twain one said, There are lies, damn lies, and statistics. The figures that indicate there is more substance abuse within the queer community than within the non queer community are almost always quoted by individuals with an ax to grind. No one, seemingly, wants to look at the problem in the country as a whole or the queer community as a part of the whole. On the other side of this, the largest group that marches every year in the Queer Pride parade in San Francisco each June is a group called Living Clean and Sober. This is a queer group of people who also are members of various 12 step programs. The week following the parade each year they have a big annual three day conference in San Francisco. So, while we have a substance abuse problem (that is similar to the non queer community), we also have many in the community who are dedicated to dealing with this problem. Substance abuse patterns differ within the queer community. Gay men are more likely to be poly drug/alcohol abusers. Lesbians are more likely to get into trouble with alcohol alone, though there are enough individual cases to make such distinctions meaningless. I do not know what the same statistic for the transgender community would be. And, there is no one way to deal with substance abuse. It is estimated that half the pure alcoholics who give up alcohol do it without the help of a 12 step or other program, they just stop. The other half appear to take part in various 12 step and other programs to help them maintain their sobriety. The party drugs that so many gay men get into, especially methamphetamine (speed, crystal, Tina) are much more difficult to deal by oneself. There are only a few people I have ever met who were addicted to speed who managed to stay sober without help. As I mentioned, the same is not true for pure alcoholics. And it continues to amaze me the level of denial that exists among queer party drug users. They can be using the drugs every weekend for a couple of years, and occasionally during the week. They might have lost time at work, or have had a relationship break up over their substance use, yet they continue to deny they have a problem with it. The consequences of speed are also more catastrophic. There are many old alcoholics. There are few old speed users. Success in recovery, btw, seems to be related to the amount of time a person is willing to put in. The more a person is willing to do for themselves, more meetings, more therapy, more support groups, the more likely it is that the recovery will be successful. In my opinion, the first year of the recovery process is the most critical and I advise people to look upon that first year as a time when they are in recovery full time. All available efforts should be directed toward their recovery program. Regarding depression - yes, it appears to be higher in the queer community. There are probably many causes of depression. The drug companies would like people to believe that it is all because of a chemical imbalance and that can be cured by a pill. Antidepressants do change mood, but like everything lese, at a price. There are many nasty side effects of antidepressants. Your assumption that the increased level of depression is it probably related to the anti-queer sentiment in this country, and what queer people must endure (a lot of loss related to family and the culture as a whole), is probably right on. But depression is a major problem in this country for a lot of people, just as substance abuse is also a national problem.
C.L.Myers (clmyers) Mon 1 Apr 02 18:35
Your comments on these issues raise in my mind a more general one: health care in general. My thinking also harkens back a bit to fellow who had the strange encounter with the insurance lady. One major issue in queer communities is how well we access and utilize health care -- and for the moment I'm including psychotherapy in that. Certainly lesbians are often overlooked in terms of screening for STDs and even more general gynocological conditions on account of not being asked the right questions or being too afraid, ashamed or awkward feeling to speak up about our health concerns. As the insurance lady so poignantly illustrates, it often simply does not occur to some providers that queer folks might have special concerns and considerations. You've talked a lot about queer affirmative therapy. Building on that, perahps, what thoughts do you have about how queer persons can identify and advocate for their own unique needs when seeking psychotherapy?
Michael Bettinger (mcpsycle) Mon 1 Apr 02 20:05
Cindy - You have brought up an interesting point when you ask "how queer persons can identify and advocate for their own unique needs when seeking psychotherapy?" The irony is that the time when a person is seeking psychotherapy is often the time when that person is less likely to be able to advocate for their own needs. People often seek psychotherapy when they are in crisis, and while in a crisis clear thought is sometimes difficult. It is a lot easier to think clearly and advocate for one's needs when one is not in a crisis. If there is one thme that stands out to me in advocating for one's own unique needs, it is to request/demand that one be treated with respect. Because queer people have been taught to feel ashamed of who they are, many queer people have the notion being queer means that they have done/are doing something that is bad. This is often on a deep and suble level. And it is difficult to advocate for oneself, to demand that one be treated with respect, if one feels bad or ashamed of themself. So my message would be this. Not only is it not bad to be queer, it is not bad to have problems, even severe ones. No one asks to have problems in their lives. No one wants to live a life of unhappiness. There are many reasons why that happens, but it is not because the person in such a situation is bad. Queer people, and queer people in pain, unhappy with their life, or with severe problems deserve total respect for who they are and what they need in health care.
C.L.Myers (clmyers) Tue 2 Apr 02 21:41
You've been in practice for a number of years now and I'm curious about any trends or changes you seen in your practice from the time you began until now. Are you seeing more of some kinds of problems and less of others? Mor of some types of clients than others?
bitch slapped by the universe (sd) Wed 3 Apr 02 04:29
Could you outline ways in which a queer person might request/demand that they be treated with respect? Reclaiming the word queer seems like one way. Do you advocating fighting every fight that comes along no matter when or where? Is it enough to remind ourselves that we're not bad people and are worthy of respect in some cases?
Michael Bettinger (mcpsycle) Wed 3 Apr 02 08:34
First let me address how my practice has changed over the years. I began my private practice in 1978, a very different era in San Francisco. Some issues have remained the same, others have changed. And please remember I work more with gay men and bisexuals than with lesbians. I also see some heterosexuals and occasionally someone who is transgender. Most of the basic reasons people have sought psychotherapy services have remained the same. Times change but basic personality issues do not. So people seek psychotherapy because they are feeling anxious, depressed, having relationship problems, wanting to be in a relationship, or just wanting to talk. But in other ways, the reasons people have sought psychotherapy have changed. The biggest changes relate to HIV over the past 20 year. It began with people being scared. There was a lot that was unknown and in those first few years, it was about the impact of being scared. This quickly changed to grief; the entire queer community was hit with massive unresolved grief that could not be dealt with because new grief was always being added as people continued to die. The unresolved grief continues today. And people are continuing to die from HIV. While not in the numbers that was true just a few years ago, but still enough that many of my clients are directly touched. The really new content issues, particularly for gay men relate to dating and creating multigenerational families. The dating issue is vexing to a number of gay men. Their self image and self esteem come out in dating in ways they never had to deal with in the old days. While they want to date, they find an internal resistance that they use therapy to deal wtih. Now to the other question as to how to request/demand respect. Here are some thoughts I have on the question. (I would love to hear other peoples take on this). Two issues overlap here. One is recognizing ones feelings, and the other is asserting them. And this is where I believe gender differences come into account. Men are bad at recognizing their feelings. Men are reactive, they will say or do something when they are disrespected, but it will often be an angry reaction. Women, I believe are much more aware of their feelings of being disrespected, but have been socially conditioned to not respond, particularly when the disrespect is coming from a men or a woman in authority. I would suggest men need to slow down and recognize their feelings when they are happening so they can respond in a more constructive manner, while women need to learn to respond more assertively. And one last comment. I do not believe in fighting every battle. I beleive in picking the battles that make the most sense. To fight every battle would get us sidetracked into less important issues, and cause us to burn out.
QueerMeister (maya) Wed 3 Apr 02 10:32
Michael, I'm interested in how you would define a "destructive sexual practice."
Michael Bettinger (mcpsycle) Wed 3 Apr 02 11:58
Destructive sexual practices is a hot button issue. Because queer people have been defined by the mainstream by our sexuality and condemned for it, there are many people in the queer community who are reluctant to speak to this issue. In my opinion, virtually anything can be used or abused. Sexual practices can be life affirming, or destructive. Often it is a mixture of both, which makes it difficult. What are destructive sexual practices? First the obvious ones. Non consensual sexuality. Putting aside things like rape, which is an act of violence rather than an act of sexuality, sexual practices that involve people in a non consensual way, such as exhibitionism (i.e., exposing oneself or masturbating in places designed to shock others) is clearly a destructive sexual practice. Like rape, these are actually aggressive acts that use sexuality to promote the aggression. But they are listed under sexual acts, so Ill leave that there. Perhaps more to the point is when activities that in and of themselves are not destructive, i.e, going to a sex club, but can in the context of one persons life may be destructive. Take two people. Both leave work and go to a sex club on a daily basis. For the first person, it is a healthy expression of his sexuality. He makes contact with others, enjoys his time there, gets sexual satisfaction, takes the proper health precautions given the state of his health, and is able to integrate this into his life in a way that doesnt interfere with anything else. Now for the second person. He also goes to the sex club on a daily basis. But he also tells his boyfriend that he is working late. He misses appointments because he loses track of the time and is in trouble with friends/coworkers/family members because of this. He finds himself continually picking up various sexually transmitted diseases even though he doesnt want this to happen. He tells himself he is going to change but continues with the same pattern. For this person, when his dick gets hard, his brain goes soft. His sexual practices are having a negative effect on his life. They are destroying something that he doesnt want destroyed. This could be his relationship, his job, his health, or his self esteem. When there is a pattern of sexuality that results in failure to fulfill major role obligations at work, school or home, or is physically hazardous, or is causing legal problems, then I would suggest those sexual activities are destructive.
QueerMeister (maya) Wed 3 Apr 02 15:14
Which is my understanding of the legal definition of addiction.
It matters who your daddy is. (debbie) Wed 3 Apr 02 15:58
interesting topic - especially the point that the same experience can be healthy for one person and not healthy for another person. Do you think that is also true when say a teen has sex with someone much older - that sometimes for some teens that could be a healthy sexual experience and for others it may not be? do you come across that at all in yr practice?
Gail Williams (gail) Wed 3 Apr 02 16:14
Determining the definition of "destructive" on an inidividual basis is sophisticated and logical, though I'm sure some folks would find it maddeningly fuzzy to not have one rule for everyone. I'm thinking that obsessions with anything can be destructive, and threaten the ability to keep a job, maintain relationships, take care of oneself, etc. Sex is one of the areas where people can go overboard. In that way it is more like food disorders than drugs or video games. Going cold turkey is problematic. You have to have some sexuality after all, just as you have to have some caloric intake. The obsession factor may be why it is inevitable that individuals, healers and societies all have pressures to draw lines of what is OK and what is too much, too dangerous or too different. I wonder if the existence of all the dumb taboos about sex and sexuality has a certain inevitability, since culture is in part a search for simple consensus rules to make living easier. I hadn't thought of it before, but recent posts point out why sex and gender "rules" have been made in societies, and why it is now largely the work of individuals to identify where the beginnings of dangerous sexual patterns are. Except for areas of consent, of course. Interesting territory.
Gail Williams (gail) Wed 3 Apr 02 16:16
Debbie's question about teens slipped in while I was composing. there's an interesting question.
Michael Bettinger (mcpsycle) Wed 3 Apr 02 16:17
I believe one of the major problems we have as a society is wanting things to be black and white, a one size fits all mentality where things are clear and unequivocal. Rarely is that the case in my experience. Things like sexual activity must be understood in context. There are some things that seem to be black and white, but arent. Take murder. Most people would say murder is wrong, and that is a no brainer. Murder is wrong. But then there is the old response, what if a German citizen during World War II you had an opportunity to murder Hitler. Would that have been wrong? Some would argue that in that case the murder would be justified. So, if murder can sometimes be seen a justified, how can that not possibly be true for sexual activities. The example you cite, a teenager having sex with someone much older, is a hot button issue in our society. People would like to believe that it is always wrong. Period. I dont agree. I believe it is necessary to understand that sexual relationship in context. Many clients, mostly gay men, have over the years told me of sexual experiences with men much older when they were teenagers that they continue to look upon as positive experiences. And I do not believe these are cases of denial. Often the teenager was the aggressor in these situations. Sometimes that was not the case but the experience was still positive. And in other cases, it was a negative experience. Age of consent is also a legal issue but that has to be looked upon in a legal context. The legal age for giving consent differs in different states and countries. I believe it was once legal in some states for a 14 year old to be able to give consent. Most states the legal age is now between 16-18. Some European countries have a minimum age, but also have a provision that if the two people are near each others age and one is above the legal age and the other is beneath the legal age it is not against the law if they are within several years of each others age. I would also like to add a comment to mayas post concerning my comments as to when sexual activity is destructive. He states Which is my understanding of the legal definition of addiction. It is not the legal definition, but a psychological definition. It is quite close to the psychological definition of when something is an addiction or a destructive compulsion.
C.L.Myers (clmyers) Wed 3 Apr 02 16:21
I would also toss in the comment that not all "sexually destructive practices" are necessarily "addiction"-like or compulsive. Sex is one of several domains in our life that bring together different aspects of ourselves and our relationships. It's one place where we can integrate mind, body, heart and spirit in some really incredible ways. It's also a place where sometimes some pretty deep, perhaps even primitive, issues can get enacted. It's resplendent in its opportunities for incredible joy and incredible pain.
C.L.Myers (clmyers) Wed 3 Apr 02 16:21
Michael Bettinger (mcpsycle) Wed 3 Apr 02 16:23
Gails posts slipped in before my last post. And I agree with much of what Gail said. Obsessions are generally destructive, although society sometimes benefits while the person loses. The composer who is obsessed with creating beautiful music might have a miserable life as a result, but those listening to the music might simply be enjoying what they are listening to without knowing the personal cost to the composer. I do believe we all have destructive tendencies, and for a lot of reasons. Those tendencies need to be controlled for the most part. Some of those destructive tendencies can be sexual. Laws are passed to set limits. But sometimes the laws are bad laws. Laws against homosexuality are an example. Sometimes they are good laws. I believe as a civilized society we need limits; in some ways that goes to the heart of what being civilized means. But sometimes even good laws have exceptions.
Michael Bettinger (mcpsycle) Wed 3 Apr 02 16:24
It appears as if there are a bunch of us on line and posting at the same time. This is almost like a chat room!
C.L.Myers (clmyers) Wed 3 Apr 02 16:25
Kinda neat, huh!
Michael Bettinger (mcpsycle) Wed 3 Apr 02 16:28
Regarding Cindy's comments in post #64 "It's one place where we can integrate mind, body, heart and spirit in some really incredible ways. It's also a place where sometimes some pretty deep, perhaps even primitive, issues can get enacted. It's resplendent in its opportunities for incredible joy and incredible pain." I wholehearted agree! Sex is adult play. Play is important for children to be able to integrate and work through many of their issues, as well as being fun. It is no different for adults. We all need to play, and sexuality is one form of adult play. In fact, I am going to go off line now for some adult play. Cya later.
Michael Bettinger (mcpsycle) Wed 3 Apr 02 16:28
Yeah, Cindy, real neat. But not as neat as the play I am about to get to. Bye.
QueerMeister (maya) Wed 3 Apr 02 16:43
> It is not the legal definition, but a psychological definition. Perhaps both, certainly the legal I beg to differ. I was recently working on a case of a man who committed a crime while on speed. He was defending himself and protested the descriptions of himself as an addict as he felt his use of the drug was moderate and recreational, nothing more. The case interested me because I have so many gay friends questioning their practices with this party drug. They are all "negotiating" with the drug. While reading the trial transcripts on this case, there was extensive testimony by doctors on addictive behavior that was entered into the legal record to provide a legal definition of addiction. Much of it tracked with your "psychological" definition. The point being, as with the term "homosexual", the medico-legal definitions are set in place for specific reasons and I think it's important to know why they are set in place and how they are being applied. I appreciate that your standard of "normalcy" is flexible, which is the only sane response (IMHO) to such "hot button" issues. I wanted to make sure you were flexible in your approach and not judgmental.
It matters who your daddy is. (debbie) Wed 3 Apr 02 16:49
I love good play. Before I heard of yr bk I suggested people look at this website- http://www.bannon.com/kap/ Are you familiar with that website and think it is a good resource - as well as yr bk? Thanks for your answer about looking at the sex in context - it is something I feel strongly about.
Michael Bettinger (mcpsycle) Wed 3 Apr 02 20:12
Debbie - I am quite aware of the website you mention. For others, the "kap" in the url stands for Kink Aware Professionals. This is a free referral site for those who want to find doctors, lawyers, accountants, psychotherapists, etc. who are kink aware and kink affirmative. I have been listed on that web site for a number of years, almost since Race Bannon started it. In the book I also talk about finding a therapist who is kink-affirmative. For those clients who are into sexual kink, it is absolutely necessary that the therapist is both kink aware and kink affirmative. Sexual kink is still pathologized in a number of ways by the mental health profession. All this is as valid as when they pathologized homosexuality. But it is still on the books and is considered a "mental illness" by those who subscribe to a medical model of mental functioning and who also consider kink to be indicative of mental illness. maya - thanks for those insigts into how psychological diagnoses become legal definitions.
just got a fistful of pink peppercorns (jillmaxi) Thu 4 Apr 02 07:29
interesting about kink awareness. michael, where is the line drawn with kink though - or is it forever relative? when is kink just kink and when is it self-destruction -- if it is ever self-destruction? i think our kinks say a lot about us, if we look at them in a nonjudgmental way, which is what i'm guessing kink-affirmative means.
It matters who your daddy is. (debbie) Thu 4 Apr 02 08:14
that's an interesting thought - that our kink says a lot about us. like queer says a lot about us? ina way it does, but in another way it doesn't. Just because someone is gay it doesn't actually say anything about thier personality or their voting pattern or anything that you can pin down in that way. I feel like kink says something about me the way brown eyes says something about me, because for me, it is just the way I was born.
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