On Orlando and Beyond

by Dr. Danna Bodenheimer, LCSW, author of Real World Clinical Social Work: Find Your Voice and Find Your Way  

     There isn’t much for me to say about Orlando that hasn’t already been said. Most of the debates about the underlying causes of this massacre have happened somewhere in the media or on Facebook. That said, it seems irresponsible and avoidant to write about anything else this week - because, the fact is, even with everything that has already been articulated, we need to keep talking. And talking and talking and talking. And while I have no overarching goal in talking about what happened in Orlando, there are a few points that I would like to make that feel particularly relevant to us as clinical social workers.

This is about mental health and it isn’t.

     The more wary we are about linking what happened in Orlando to mental health, the better. First, of course, the killer in Orlando had mental health problems. This is simply inarguable. But it is not fair to label him with Bipolar Disorder, which has happened many times so far. People with Bipolar Disorder don’t create mass murder. This was not the byproduct of a manic episode. Suggesting that it was puts other people with Bipolar Disorder in danger and vastly overestimates the significance of the disorder. It is certainly possible that he seemed manic during the killing, but that still doesn’t mean that we can categorize him as Bipolar. Omar Mateen was clearly a sociopath, something very different from someone with Bipolar Disorder. He completely lacked a moral compass, which is something very unusual for someone with a mental health disorder.

     The other reason why linking this to mental health is problematic is that it places some of the blame and responsibility on clinicians. The underlying message when people discuss mental health as a source of mass shootings is that mental health practitioners might have been able to stop it, or should be able to stop it. We can’t stop someone like Omar Mateen. One, we don’t have the resources. Meeting with a client once a week could never suffice. Neither would two or three sessions a week, which insurance wouldn’t cover anyway. If he had been inpatient, his stay likely could not have surpassed 30 days, let alone five. If anyone wants to discuss the issue of mental health in relationship to Orlando, then insurance companies must be considered at the front and center of that dialogue. I have to defend treatment to insurance companies almost every day. Clinically, we are simply up against a wall.

     But most importantly, Omar Mateen didn’t seek treatment. Most sociopathic people wouldn’t. We can’t fix what is not in front of us, which is why the need for better gun control is so essential.

This is about the closet and it isn’t.

     There is increased chatter about the possibility that Omar Mateen was gay, perhaps closeted. I still can’t quite piece together what is so troubling to me about this current narrative, but there are some salient points about it that I would like to make, nonetheless. First, the closet is dangerous. It is a psychologically torturous space to reside in. Often, our bodies beg for us to find release for performing an inauthentic sexuality. That said, this release rarely (if ever) takes the shape of homicide. Instead, most of the pain of a closeted sexuality is turned inward and leads to self-harming and suicidal tendencies.

     By definition, sociopathy means that someone lacks a social conscience. To remain in the closet is all about social consciousness. Someone is terrified that their sexuality will threaten their attachments to both family and community. Someone who is sociopathic is disinterested in attachment completely.

     BUT, the piece about Mateen’s sexuality that does feel worth holding onto is about the very powerful and primitive defense: projective identification. Projective identification means that there is a part of ourselves that we utterly hate, despise even. It is a part of ourselves that we feel we must rid ourselves of. Unconsciously, we identify someone who has this trait, or seems vulnerable to having this trait, or has something similar to this trait. We believe, again unconsciously, that if we destroy that person, we will be able to rid ourselves of this very real piece of our identity.

     Let’s say, for example, that there was a part of George W. Bush that hated his father. Obviously, there are a lot of reasons why this wouldn’t feel okay. It is terrifying to hate your parent, particularly when that parent is beloved and as powerful as being the actual president. One way to deal with the hate is to become president yourself, to outdo your actual father. But it is also to identify someone else who hates your father. You then would seek to hate and destroy that person yourself. Saddam Hussein wanted to kill George W. Bush’s father. Perhaps by killing Hussein, Bush could rid himself of his own familial hatred.

     I am not sure if that sums up the war in Iraq, entirely. That would be a pretty bold hypothesis. On the other hand, I do think that it is worth taking the risk of projective identification that seriously, because it is actually that destructive.

     Did Mateen kill 49 people to kill a part of himself? I don’t know. Clinically, it is worthy of some consideration.

Macro vs. Micro

     I feel personally drawn to understanding the events in Orlando through the lens of failed gun policy. I know that there is tremendous work to be done to heighten regulations and to create sensible legislation. But none of that helped me when sitting with clients on Monday morning, following this horrible hate crime and massacre.

     I often feel drawn to macro issues when I don’t fully know how to handle the micro experience of overwhelming pain and grief. This isn’t, of course, to say that macro issues are avoidant. In fact, they are completely essential at this moment. But I am a clinical social worker doing clinical social work. That means that even when I am in the depths of horrible psychological pain, I need to show up and sit with someone for about 45-50 minutes and hold it together. This week, that has been incredibly hard. I imagine it has been hard for many of you, too.

     This is what I have learned from it:

1. It is okay to not be great at our work every session and every day. Some days greatness is getting through the day.
2. Sometimes our clients heal us. I had a straight client ask me, her lesbian therapist, how I was doing. This felt like a gift. I said that I was okay and I thanked her for asking. It was a one- to two-minute exchange over a lengthier session. But it was just the substance I needed to really show up for her.
3. We don’t need to have the answers, and our clients don’t need us to. All our clients need, many times, is someone who DOESN’T try to make it better. Instead, they need someone to agree that right now things really suck and, hopefully, next week will feel better than this week.
4. It can disturb our clients to see that we are fine, when we shouldn’t be. We should not always suggest that we are okay in the service of our client’s needs. Sometimes they use us as a measure of how they should feel. When we perform “fine,” it can pressure them to do the same.
5. Sometimes our clients need to see our politics to feel safer. I don’t mean that we need to say who we are voting for or where we volunteer our time. That said, demonstrating our outrage about Orlando is a political act. So is the understanding of what happened as a hate crime. Saying this heals.

What happened in Orlando is partly about Orlando itself.

     Of course, I don’t blame the city of Orlando for what happened at the Pulse nightclub. However, Florida has a long-standing history of policies that have created a hostile environment for the LGBTQ population. Because, as social workers, we think holistically and systematically, this is worth noting. In Orlando, gay sex was considered a misdemeanor until 2003. It was not legal for gay families to adopt or foster children until 2015. There are no workplace protections for the LGBTQ population, meaning that being outed or out allows management to terminate someone’s employment. And perhaps, most dangerously of all, Florida allows doctors to refuse the care of the LGBTQ folks, because it is one of the states that does not protect against medical discrimination based on sexual orientation.

     It is worth completely feeling devastated about what happened in Florida. It is also worth completely feeling devastated by what has been happening in Florida for decades. There is a lot of room for activism and awareness here, and I think it is worth unveiling the many ways to consider our own country’s role in the travesty.

Finally, this was a crime about intersectionality.

     While this was an attack on the LGBTQ population, it was specifically an attack on the Latino and Latina members of this population. There are perhaps no more vulnerable members of American society than queer people of color. Queer people of color make up huge portions of homelessness in our population, are powerfully and consistently victimized by extreme violence, and often suffer from extreme levels of poverty. Many of the people who were murdered at the Pulse nightclub were working two or three jobs to put themselves through school, to support their families, or to try and create businesses. All of their stories - every single one of them - is riveting and symbolic of how marginalization creates struggle. Whether it was a first generation student entering college or a mother of 11, few of the victims of this massacre were doing anything but trying to get by while honoring the complexity and beauty of their identities.

     When mourning what happened, let’s mourn specifically and precisely. Let’s recognize the community that lost the most - a community that has fought to be out in ways that we are only beginning to truly comprehend.

Danna R. Bodenheimer, LCSW, is in private practice at Walnut Psychotherapy Center in Philadelphia, PA, and teaches at Bryn Mawr College Graduate School of Social Work and Social Research. She provides more of her clinical perspective and tips for developing clinicians in her book, Real World Clinical Social Work: Find Your Voice and Find Your Way.