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chelsea gibbs and dr. rachel womack standing next to each other holding hands

Navigating Identity: Chelsea Gibbs and Dr. Rachel Womack on the Intersection of Disability and Queerness

Posted on July 1, 2024 | by Glen Jennings

Chelsea Gibbs has only recently started thinking of disability as part of her identity.

“I’m a caregiver for a young lady with an intellectual disability, and she lives with us half the time, and she is struggling with the concept of her having a disability as well,” Gibbs said. “She’s afraid of the word, so we’ve been very pro disability pride, look at all these cool people who do this.”

As she considered this, Gibbs thought about her own history—her diagnoses of OCD, generalized anxiety disorder and depression, as well as a few recently diagnosed chronic illnesses. She hadn’t always considered those diagnoses as disabilities, but upon further reflection, it clicked into place in a way it hadn’t before. She and her wife, Dr. Rachel Womack, who serves as HDI’s Training Director, have had a lot of recent conversations about the intersectionality of disability and queer identities and how people process those identities.

“I’ve actually talked to a lot of people who had a similar experience to Chelsea where maybe they came out as queer in middle school or high school,” Womack said. “Then they’re 20, 30 years old and they’re getting a late-in-life autism diagnosis or a diagnosis of a chronic illness or they’ve acquired a disability… It’s important to think about how the experience of embracing one part of that identity can impact your experience of embracing the other.”

Multiple studies have shown people with disabilities are more likely to identify as queer. Little research has been done on this connection. Womack has been one of the few researchers to explore this oft-ignored intersection of identities, but she says there are still a lot of unanswered questions that Womack and Gibbs hope are one day answered or explored.

In the meantime, Gibbs notes that living with an intersectional identity can be a complicated experience.

“You have to continually do some deep self-reflection and how you identify is forever changing,” she said. “Who am I? Who are my people? Where am I safe? Am I normal? Who are my friends?”

Womack added just because two groups face marginalization, even if they’re similar forms of marginalization, that doesn’t mean those two groups will be free of negativity towards one another.

“I think some of us have an idea that, [when] going to interact with another marginalized group of people, they probably get it. But that’s not always the case,” Womack said. “There’s certainly some ableism in queer spaces and I think there’s some homophobia and compulsory heterosexuality and things like that in disabled spaces too.”

No matter how complex the identity, though, Womack said it’s simple to be supportive—not just of these particular groups, but for everyone with a marginalized identity.

“Allow them to be fully who they are, however they would like to present that to you,” she said. “That’s everything from if they would like you to use certain pronouns, if they have a chosen name that’s different from their birth name, if they prefer identity-first versus person-first language. It’s having respect for things like that and having respect for those preferences and for those needs, we’re creating safer spaces for people.”

It can also be challenging to deal with situations where people are hostile to some identities, something both Womack and Gibbs have had to deal with during their careers. Womack has a background in social work and Gibbs works as a music therapist. When they encounter hostility due to their identities in those roles, they both agree there is a time and place for advocacy. When they are at work, the client comes first.

Both also feel there are amazing things happening for both the queer community and the disability community, noting meteoric shifts in a relatively short time.

“Just look back ten years ago. [Both] the disability rights movement and the queer movement were in such different place[s]. You couldn’t even get married,” Gibbs said. With those shifts in culture, comes a younger generation that’s more open-minded and accepting.

While there are still a lot of questions about the intersectionality between the disabled and queer experiences, Womack is just one of the researchers ensuring they will have answers.

“There will be [answers],” she said. “Just give me time.”

Exploring Intersectionality: How Disabled and Queer Identity Shape Mental Health Care According to Dr. Rachel Womack

Posted on June 13, 2024 | by Glen Jennings

Research has shown a strong connection between queer identity and disability—a connection Dr. Rachel Womack is deeply familiar with.

“The research shows that folks with disabilities are significantly more likely to identify as queer, and vice versa,” Womack said. “That connection is particularly strong for individuals who are autistic, and with autistic people, we see that there is a significantly higher likelihood of identifying as trans or gender nonconforming.”

This is a fairly recent discovery that has seen little research.

“What many don’t know is that this intersection exists all across the disability and the queer spectrum,” Womack said. “We see things like lesbians being significantly more likely to identify as having a physical disability, compared to heterosexual women.”

Likewise, Womack said a lot of people studying this connection focus primarily on why the correlation exists, but Womack’s greatest curiosities lie elsewhere.

“To me, that’s not the most important question we should be asking. As a social worker, and as someone who is queer herself and also works in the disability space,” she said, “I think the better questions are, how can we support these folks and how can we change social views, social norms and perceptions to create an environment that’s safer for people who are both disabled and queer?”

Womack has actively researched the way disability and queer identity interact in mental health services.

Womack has actively researched the intersectionality of disability and queerness in mental health services. For her dissertation, she interviewed people who identified as queer and disabled and explored how those identities affect the therapist-client relationship, something she said was a new frontier in this field of research.

“That can be a space that is, I think, particularly difficult for folks to navigate, especially when we think about providers and their knowledge of serving the queer and disabled population,” she said. “It’s something that needs a lot more attention than it gets.”

Womack’s Findings

Womack noted that understanding queer clients has come a long way in recent years, but providers’ understanding of disability has a long way to go in many cases.

“What I found a lot is that there were quite a few providers who were queer and who were pretty well versed on the culture that comes with that and some of the issues that the queer community faces, but those people had no real knowledge or understanding of disability,” she said. “There is often a misunderstanding of where is the line? What are we actually looking to treat and what do we accept as part of who this person is?”

In addition, Womack noted that some queer identities, such as asexuality, are not as well-understood among providers and their misconceptions can alienate people who are seeking help. She believes training can help address these misconceptions.

“As much as [social workers and other mental health professionals] may take a social model approach to other aspects of identity, we don’t really do that with disability a lot of the time,” she said. “I think, sometimes it gets lumped into conversations around mental illness. So maybe if there’s discussion of autism, it’s in a class on psychopathology…providers often become so deeply ingrained in this medical model of disability that it can be really hard for them to step out of that.”

She also thinks providers compartmentalize people’s identities and said, “They didn’t know how to take an intersectional perspective, where they’re looking at the experience of this person who is queer and disabled. They were only looking at these things in pieces.”

Womack discussed the impact of providers who had marginalized identities themselves on service provision. Often, providers with any marginalized identity created a more comfortable space for queer clients with disabilities, even in cases where it wasn’t an identity clients shared. It was rare for providers to disclose whether or not they had a disability. Womack suspects that this, much like other patterns her research highlighted, is due to the more medical approach in the field’s education practices.

Education is the easiest place to start fixing those problems. Womack noted that no educational program could teach providers everything, but they could still have a profound impact if they changed their approach.

“They can teach folks to look at disability in a certain way and to consider disability in a certain way,” she said. “The most important thing that we can be teaching these future mental health providers is to learn from people who identify as disabled.”

“All people offer perspective that is valuable to the rest of the world.” HDI Staff Erin Fitzgerald speaks on their experience with Neurodiversity and mental health

Posted on November 13, 2023 | by Glen Jennings

The following article discusses suicide, which some readers may find distressing.

Erin Fitzgerald could always see the signs that she was different growing up – the tools to recognize how simply didn’t exist yet.

“I grew up in an era where mental health was talked about very differently from how it is talked about today. There are some similarities and holdovers, but a lot of differences too,” Fitzgerald, who also identifies as queer and uses she/they pronouns, said. “In the 70s and 80s, I do not remember any conversation around mental health or counseling that did not feel totally pathologized. I do not remember myself or anyone else getting referred to talk with someone or getting assessed for something based on how we were doing or how we were feeling inside. I would only hear about mental health if someone were seen as causing a problem for other people, or seen as a problem themselves.”

Fitzgerald also grew up in a household with a parent who was diagnosed with a severe mental illness, who did not have the same options for support and resources that exist today. “It makes me sad to think about this, because my dad struggled quite a bit and had a hard time finding the right kind of support,” she shared. “He ultimately died by suicide, which is an all-too-common scenario when people do not have the support that they need to address their mental health issues. I cannot help but wonder if he were living in a different time, and if he could have found the kind of support that exists now, how things might have gone differently.”

Fitzgerald, who works with HDI as the CTP Coordinator with HDI’s Supported Higher Education Partnership, has had her own journey with mental health. She has had family that struggled, has worked as a support provider, and has sought support from the system as well. She was given multiple diagnoses before finally being assessed for autism and sensory processing disorder as an adult.

“It wasn’t until some years later that I even heard the term ‘Neurodiversity,’” Fitzgerald said. “That really clicked some things in place for me. It was a turning point for me to think about the way I was wired as being a neurotype and an identity, and not a problem to be solved or a thing to be fixed.”

For Fitzgerald, this was a revelation – and a total reversal of how anything related to mental health was treated in the past.

But the signs were always there, and looking back, Fitzgerald sees them clearly – both in how it’s affected her view of the world at large, and how it’s affected her view of something deeply important to her – art.

“It is interesting – I think that way my brain is wired has always affected my view on the world as well as my art. But I have not always been in good touch with what that wiring was,” Fitzgerald said. “So only in recent years do I feel that I am able to understand the degree to which that affects my view of the world, and how that is portrayed in art.”

comic from spectrum with four squares. the top left has a person wearing a hospital gown holding their head with text reading, "Sometimes it takes a crash..." the next square show a person laying face down with text that says, “…to find a landing…” the next shows that person crouching on the ground with one foot on the floor, with text that says “…to find your footing…” the final square shows that person wearing a grey t-shirt and pants standing an a podium with a rainbow flag behind them with text reading, “…find your place.”

That’s a big part of how Fitzgerald relates to the world. Art, she said, is an essential part of her life.

“When it comes down to it, art is the primary way that I process information and emotions. This has always been true, and not just with visual art. Music, writing, theater, any kind of creative expression – it all helps me to process things,” Fitzgerald said. “Consuming it, creating it, engaging with it, talking about it – all of these actions are extremely important to me. I can’t imagine life without being swirled up in the arts on a regular basis.”

Today, Fitzgerald creates a cartoon called SPECTRUM that explores the multiple aspects of her journey and identity. She started the project after attending a class with Lynda Barry – somewhat accidentally, she noted.

“I did not go there to learn cartooning specifically, but after the workshop I started drawing cartoons every day. I did not set out to draw a cartoon called SPECTRUM, or to cover specific topics such as Neurodivergence and Queerness. But that is what kept coming out on the page, so that is what I went with,” Fitzgerald said. “I have been drawing SPECTRUM cartoons ever since, and it has been a great tool for me to further process the world around me and to think more deeply about my interactions within it. It has also turned out to be a good tool for having conversations with other people around those subjects.”

Cartoons like SPECTRUM are relevant to an emerging field known as Graphic Medicine, one that Fitzgerald says is still finding its identity. But it’s one she finds exciting for its diversity in application and accessibility. Graphic Medicine is, explained simply, the intersection between the realms of graphic arts (such as illustration and comics) and health and medicine. This can take many different forms, which is part of the appeal. It also does something that is central to a lot of work that Fitzgerald does – gives a voice to more people to share their experiences.

“I was drawn to this field for many reasons,” Fitzgerald said. “The part of this field that is most appealing to me is the fact that engaging with and creating graphic works can increase understanding of topics such as overall health, medicine, mental health, identity, and community engagement. It can intersect and therefore help connect people and ideas from all different disciplines and perspectives.”

Fitzgerald also notes that the principles of graphic medicine are in line with those of Universal Design and Universal Design for Learning in a few key ways – in giving people additional tools to communicate and understand concepts related to health and medicine, and in giving a voice to people receiving supports – allowing everyone the chance to learn together. In addition, graphic formats provide context and color to raw data, adding images and stories to the numbers.

Fitzgerald is also working on a wordless graphic memoir called InQuest, which documents her perspective about the mental health system. She hopes the project will help increase understanding of that system from the perspective of people who have navigated it from the other side. “The message I find most important from that project is this: the perspective of a person experiencing a mental health crisis is valid and meaningful, and should not be dismissed,” she said. More information about that project can be found here.

A spectrum comic that has someone not in frame ask, “So…can you tell me about your strengths?” A person that looks nervous responds, “Well I don’t mean to brag…but my amygdala is huge.”

Today, Fitzgerald works with people with intellectual and developmental disabilities (IDD) as they attend college – something that has only recently become an option for many. That, Fitzgerald says, is because people have historically not included the voices of people with IDD in conversations about higher education.

“I think this is partly because of that tendency in our society to separate people into categories based on what we are told they do or don’t know, or can or can’t do,” she said. “If we want to be truly inclusive, we need to see everyone else as a partner in this journey, and not only in a specific role of expert or learner. That is how we got here, so we need to expand our own perceptions as we continue to build the way forward.”

In general, that is a uniting factor in a lot of what Fitzgerald does – working to ensure that voices of all people are heard and valued in the process.

“One of the main things I want people to understand about mental health and IDD is that all people offer perspective that is valuable to the rest of the world. In our society, we tend to put certain perspectives up on a pedestal as being more important, and putting other perspectives in a category as being less valued,” she said. “We tend to separate people into categories of those with expertise to share, and those who need that expertise. That is oversimplified and can be quite dangerous. It is important for us to recognize the value in all human perspective, and to stop pathologizing everything that is outside of the norm. I think we have come a long way in this, but we still have a long way to go.”

Read Fitzgerald’s ongoing comic, SPECTRUM, here.

“I hate being treated like an emergency waiting to happen.” UK student Bailey Patterson speaks on her experience with suicide and wanting to help others

Posted on September 28, 2023 | by Glen Jennings

The following article discusses suicide, suicidal ideation, miscarriage, and sexual abuse, which some readers may find distressing.

Bailey Patterson was 4 or 5 when she began struggling with suicidal thoughts.

“Things like ‘I wish I’d never been born,’ ‘I don’t want to be here,’ ‘I wish I would die,’” Patterson, a senior Interdisciplinary Disability Studies major at UK who identifies as multiply disabled, said. “Those thoughts progressed as life threw me more curveballs, where I was pretty actively having suicidal thoughts probably every day of my life when I was in middle school and high school. Still, I would never have a plan, it was just pretty aggressive thoughts.”

That lasted until she was 16, when a friend had experienced a traumatic event for which Patterson felt responsible. Her mother interrupted her first suicide attempt shortly after that.

Patterson is not alone in struggling with suicidal thoughts. According to the American Foundation for Suicide Prevention, suicide is the 11th leading cause of death in the US. The World Health Organization reports that it is the fourth leading cause of death among 15 to 29-year-olds. The CDC reports that 12.3 million American adults have serious suicidal thoughts and 1.7 million attempt suicide. In 2022, 49,449 people died by suicide.

Patterson considers herself chronically suicidal, but stresses that suicide is a complex issue. Mental illness is often a component of it – according to the National Alliance on Mental Illness, 46 percent of people who die by suicide have a known mental health condition – but Patterson stresses that there are other extenuating circumstances. She remembers her first stay as an inpatient in a mental health facility. The only other patients in her ward were girls, ages 12 to 17.

“There was a really common thread about gender-based violence,” she said. “Several of the girls on the ward had been sexually abused by older men.”

Patterson noted that she thinks this ties into a major factor in suicide that is commonly overlooked.

“There’s this narrative in popular culture that if someone is suicidal, it’s because they don’t see the value in their lives or they’re depressed, and you can do this that and the other to make it go away. You can take long walks and you can eat healthier and you’ll feel less depressed,” she said. “For many people, the cause of the suicidal thoughts or the depression is the situation they’re living in. There are people living in current abusive situations that they feel they have no way of escaping from, there are people who are dealing with interpersonal violence or abuse, there are people who are homeless, there are people who are in poverty, there are people who are experiencing systemic interpersonal racism and sexism and bigotry. Those things are not things that you can walk and eat better to get rid of.”

That means that addressing those issues will help also help address the risk of suicide among marginalized populations. Patterson believes that addressing those issues while promoting mental health will do a lot to solve the problem.

“I feel like if we understood that and worked towards those goals while also keeping in mind personal wellness and self-care and things like that, that would be a big help,” she said. “A lot of people are overlooking some of the greatest causes of distress that are leading people to be suicidal.”

She also remembers difficult times and experiences for both her and the others she met during her two inpatient stays. Among them, she particularly recalls a patient with a fear of needles being given medication by injection against her wishes when that patient felt there were other ways to administer similar medication and another woman on her second trip to inpatient services who had been pregnant when she was checked in and miscarried after being given a medication early in her stay.

That experience awakened in Patterson a desire to help others with the same struggles. Now, she channels that into standing against abuse and the loss of autonomy in psychiatric settings. Currently, Bailey is a Student Informatician with SPHERE at HDI, Officer of the Disabled and Ill Student Coalition, and an activism and research advocate in the Mad Pride and Psychiatric Survivors movements.

“The feeling of solidarity with these other with these other people who were also experiencing something similar to what I was in the moment, being there, hearing their stories changed my life,” she said. “That was the first moment where I thought ‘this is important and I want to do something about this for the rest of my life.’”

Helping others is one of the ways in which she deals with the frequent thoughts of suicide that she still experiences – and feels like she will always experience.

“I manage, like a lot of us do,” she said. “Take it one day at a time and try to take care of myself as best I can, but I do not foresee a life for myself where I do not feel suicidal in some degree most days of my life. That’s probably just the way it is for me. That’s something that I’m going to have to continue to manage for the rest of my life, and I think that’s ok.”

She’s found a few coping mechanisms that can help when the thoughts get particularly bad.

“One of the things that I do is I try to imagine a time in the future where I am happy,” she said. “That can be really hard, especially when you’re very depressed, but I have a couple of things in my mind, scenarios where I could be doing this thing that would be a happy moment for me. I try to really picture it and stay in that moment…then I try with all my might to believe that could happen for me one day. That’s my best coping mechanism thus far.”

And if someone close to you is struggling with suicidal thoughts, Patterson stressed that one of the best ways to help is to keep treating them like a human being.

“Anyone who hears that their loved one is going to have emotions that come up for them, but I think the number one thing you can do is not freak out,” she said. “You should be there, and you should attend to the problems…I sometimes get the feeling that we are treated like a danger. I hate being treated like an emergency waiting to happen. I think the best thing you can do is just be calm and present for that person and realize that the person speaking to you is the person you’ve known.”

Warning signs of suicide may include:

No longer participating in things they enjoy
Feeling sad all or most of the time
Talking about dying or wishing not to be alive
Feeling hopeless or feeling like one has no purpose
Withdrawing from social groups or saying goodbye
Giving away important items

If you are struggling with suicidal thoughts, help is available. You can call the suicide and crisis lifeline at 988 or text SAVE to the Crisis Text Line at 741741. Both services are free and available 24/7. If someone is in immediate danger call 911 or go to your local Emergency Room.

This article represents the opinions of the author and interviewee, not that of the University of Kentucky.

“Mental health isn’t a one-size fits all.” Austin Nugent speaks on her experience with OCD and how it may look different from what you think.

Posted on May 31, 2023 | by Glen Jennings

What do you think of when you think about OCD, or obsessive-compulsive disorder?

Is it someone who has to obsessively organize their whole book collection by author? Or someone washing their hands, over and over and over for fear of catching an unknown disease?

According to Austin Nugent, a Disability Program Administrator at HDI, even if you’re not completely wrong, you only have a small piece of the puzzle.

“I think the most common misunderstanding is that mental health is one-size fits all, so if you have obsessive compulsive disorder, it’s going to look a certain way, like you see in the movies,” she said.

For Austin, OCD doesn’t look like washing hands over and over again, or counting the number of times she closes the door or quadruple checking that the stove is off. It is intrusive thoughts caused by a sensation, image, or idea. These triggers are often perceived as insignificant by others, but for Nugent, her OCD attaches meaning to her intrusive thoughts leading to a great deal of distress. She gets stuck on things needing to be ‘just right’ like a conversation, the organization of a closet, the texture of food, or the formatting of a document.

If things don’t meet the expectations of her OCD, she will seek reassurance, avoid particular situations, or perform mental rituals like ruminating for hours or days, or over explaining and correcting to alleviate her anxiety or discomfort. To most people, it may not even be noticeable that she is caught in an ‘OCD cycle.’ But for Nugent, it’s very real.

“People often think I appear to be fine, so therefore I must be fine,” she said. “No. My brain is on a constant loop. My heart is racing, and I am super clammy and sweaty because I am on the verge of a full-fledged panic attack about something that happened two hours ago that most people would probably find very insignificant, like a typo in an email or a twitch in my eye.”

A fear of what has happened is just one of the ways her anxiety manifests. It can also present as a fear of what-ifs.

“I also get uneasy about things that don’t happen, like someone saying something one way instead of another, convinced that I must be a ‘bad person,’” she said. “I know the twitch in my eye is probably because I’m tired, and someone not responding in a certain way is not indicative of my worth, but OCD will do all that it can to convince me otherwise.”

But it’s not all a challenge, she noted.

“Although OCD can cause me a lot of anxiety and be very time-consuming, I have learned to be proud of my journey, as I also find benefits and strengths in having OCD,” she said. “For example, it makes me incredibly detailed-orientated and very organized.”

For Nugent, Mental Health Awareness Month is a reminder for others that for her, it isn’t confined to just a month. She is always aware of mental health, and the need to prioritize her mental health care.

“Mental health awareness is a daily occurrence for me,” she said. “I need to pay very close attention and be very aware of my mental health needs constantly…if not, my OCD will rear its head and intensify, and then that ends up affecting every area of my life. Once I get in an OCD cycle, it can be very difficult for me to disrupt the cycle and move on with my day .”

But Mental Health Awareness Month is also an opportunity. People who don’t have mental health conditions can get great benefits out of being mindful of their mental health and wellness.

“Therapy is valuable for everybody,” she said. “It does not matter if you have a mental health condition or not, we all can benefit from having a toolkit of strategies when we’re in a rut.”

She also encouraged people to learn more about mental health and challenge stereotypes.

“There is so much misunderstanding around mental health,” she said, adding that just because it doesn’t look like it does in the movies doesn’t mean it isn’t real. “Don’t discredit anyone because they don’t fit the mold that you have in your mind of what OCD or anxiety or schizophrenia is supposed to be.”

This article represents the opinions of the author and interviewee, not that of the University of Kentucky.