I HAVE AIDS

I had felt uncomfortable immediately on walking into the room for the counselling session. Besides the two chairs there were mattresses and lengths of rubber tubing and battered telephone directories. What concerned me, though, was the pot plant, which was having a difficult time staying alive. I remembered a Woody Allen quip: ‘Never trust a doctor with dying pot plants in his consultation rooms’. Did that apply to counsellors I wondered.

The counsellor was obviously uncomfortable with my feelings of exultation. To have accepted them he would have had to redefine his understanding of the initial emotional response to a positive HIV diagnosis. This, he was unprepared or unable to do. The non-verbal and not so non verbal expectation was that if only I could experience anger, we could start at a point in the emotional landscape that to him was intelligible and non-threatening.

‘I see from your notes that you had two periods of depression in your twenties, once requiring admission to hospital’ said the psychiatrist. That was true. The first had occurred in my mid-twenties, when I began the process of coming to terms with my sexuality. It had been a difficult time. The guilt and the shame provoked by my realisation that I was a homosexual were probably due in great part to my earlier involvement in Catholicism. While struggling to accept my sexuality I did go into a very deep depression and was treated with Parnate, a mono-ammine oxidase inhibitor. It had a miraculous effect. Within six months I had a job, a flat and I had successfully come out. But the depression returned in my late twenties. At this time I was medicating the depression with alcohol and illegal drugs. I was admitted to hospital and given anti-depressant therapy. Anafronil was put into an intravenous infusion and over a period of two hours it was administered directly into the bloodstream. I remember we had to go to the basement of the hospital into a tiny room, which only reinforced my feelings of powerlessness and shame around the depression. The treatment didn’t work. I left as depressed as when I had been admitted. Drinking and drugging still helped to medicate the depression, while sexual addiction, to which I was sailing perilously close, began to provide another elixir. ‘I think we’ll deal with the depression first , so lets try you on Prozac.’ He wrote a prescription, gave it to me and stood up rather purposefully. I realised the session was over. ‘I’ll see you in a month’, he said.

As I walked along the corridor, following the exit signs, I knew this was not the answer, not this time. I could accept I was in a crisis, certainly at some sort of turning point. But I felt I wasn’t getting the understanding to negotiate this difficult terrain.

Depression is a major factor living with a positive diagnosis. I suspect that a large proportion of the gay men have a tendency towards depression prior to an HIV diagnosis, though I would not take quite the gloomy view of researchers at Johns Hopkins hospital, Baltimore, in 1993, published in a paper called, ‘Depressive symptoms as predictors of medical outcome in HIV infection’, which states confidently that a lifetime history of depression is common in all patients afflicted with HIV.

I began to wonder why I had such a resistance to being helped. In accepting care I would have had a clearly defined role, imposed from without, maybe, but still a role.. However, the role available to me was one in which I was denied a self-determining future. It was this I now know I was rejecting.

As the initial phases of exaltation and then helplessness passed, I began to see my life as a journey. And so I looked at various maps that might help me to understand the terrain In which I found myself. Looking at psychological maps of change I found them complex and detailed, though they tended to agree on two points. First change is a process, and it is possible to define the stages or phases within it. Second, the experience of change is both potentially creative and destructive. The major problem I found, was this distinction between creative and destructive, that one moved through a period of rocky territory and eventually arrived at a point of integration, of creativity or reorientation and acceptance. I found that both psychological and spiritual maps tended to point in the same direction, after traversing dark nights of soul and sense, one moves into a unitive state. Or, after a process of purgation, one moves into a state of illumination. It was this expectation of final freedom from conflict that I found disturbing.

There had always been a degree of marginalisation within my life. Born into a fairly arid, Protestant family, I flamboyantly converted to Catholicism in my late teens. This effectively marginalised me within the family structure. In keeping with the co-dependency implicit in much of what passes as Christianity, I then made a decision that my life from then on would consist of helping others. So with a degree of self-regarding drama, I launched into situations where I was the helper, whether with the homeless, the mentally ill the alcoholic, or the sick, tending always to those on the margins of society. This same paternalistic philosophy of care I took with me into my training as a nurse, I maintained a rigid distinction, there were the sick and there were the well. Across the divide, I was in the well.

There is a great deal of talk today about margins and fringes. The margins are said to be the place of the prophet, the victim, the oppressed, the creative and the eccentric. Being on the margins, has for some, become a vocation. The language of marginality has provided a meaningful way of seeing and talking about the experience of not fitting in. There is, however, a negative side to this language and imagery. To define oneself as marginalised is to define oneself in relation to another’s definition of the centre. And as mentioned, it is to have a future defined by others. To be marginalised is also to be the recipient of projections from the centre. These three points I realise were powerfully at work within the psychiatric and psychotherapeutic professions. To keep one safely on the margins is effectively to disempower and violate the capacity for growth. The capacity of the client to initiate and follow through his own healing, in whatever form that may take, is discouraged. The abusive potential of therapy, particularly cognitive therapy, in this respect is great, in so far as the prospective client is encouraged to adopt another’s definition of his experience. In doing so, the interests of the carer and society at large are served. Those in the centre will continue to marginalise and keep marginalised those perceived as a threat. This process was demonstrated recently in a well known HIV centre, when one afternoon a group of lads were happily watching television only to be disturbed by a troop of volunteers, who had returned from a rather grand funeral, laden with flowers. With suitable solemnity and to the disbelief of the residents, they decorated the sitting room with the funeral flowers, modifying the atmosphere from that of an enjoyable social space to that of a chapel of rest. Pedestrians four floors below were no doubt mystified a little while later to find themselves showered with carnations, lilies and chrysanthemums.

. Material Copyright © 1997 THOMAS (Those on the Margins of a Society)
THOMAS is an integral part of Catholic Welfare Societies, Registered Charity number 503102