(TL;DR is basically in the title.)

Hello all,

I wasn't sure where to post this, where it would resonate most or garner substantial responses, as it's sort of a complex issue that I've never heard/read anyone else express anywhere.  Given that this is a general mental illness sub, I decided to post it here first, testing the waters so to speak, so here goes.  Really need to get this off my chest as one not-insignificant issue in the maelstrom of distress I'm currently grappling with.

I'm a 26 year-old woman who lives with severe/disabling, treatment-resistant and multifaceted mental illness with several overlapping comorbidities.  In addition to bipolar depression, I've been diagnosed with Schizotypal PD, Borderline PD, and Avoidant PD.  I'm in treatment--though currently stagnating--heavily medicated, have been hospitalized inpatient several times (with long stretches in between, thankfully--last one a year ago), and survived multiple suicide attempts, at least two of which were entirely serious/committed. 

Honestly, I'm glad (albeit ambivalent) to have made it to this point, I suppose, but my life is rather 'narrow' and isolated, especially for someone my age.  I don't have a job or go to school or anything along those lines, am on SSI, have a nocturnal schedule, literally reside in a basement and generally exist outside mainstream society and its rhythms.  I'm extremely alienated from the world at large, but I've more-or-less 'settled in' to a more stable form of existence after years of perpetually turbulent hell.  I've been on the right med regimen that actually works for quite a while now, my basic needs are all met and will be for the foreseeable future, and my small support network (psychologist/therapist, psychiatrist, immediate family) seems to have accepted the reality of my limitations (I have made strides in coming to terms with that as well) without giving up on me, remaining gently supportive.

I mention all of this because it might be the reason and context why I'm feeling what I'm feeling currently, that in a sense, I finally have 'breathing room' to consider such things.

Namely, of late I've noticed that my self-esteem has been suffering (on top of how precarious it already is) from a deep-seated internal feeling of being disconnected from my gender, feeling unfeminine, like less of a woman, due to my mental illness.  I'm of transsexual history/experience, so I'm sure that factors into why this disquiets and bothers me as much as it does, but even that aside, as increasingly unpopular and 'unrelatable' as it seems in the contemporary cultural milieu, I'm a 'gender-conforming', feminine woman who strives to present myself elegantly (in an unambiguously feminine manner across all contexts), and overt femininity is important to my core sense of identity.

For years I harbored shame around and did my best to suppress and mask certain symptoms out of the perception that that would be necessary to attain conditional/contextual social acceptance in/as my actual gender.  Particularly the more flagrant schizotypal symptoms (especially the 'positive' ones, as that eccentricity, conspicuous oddness and *difference* can definitely overshadow gender presentation), the AvPD (as feminine women are expected to be socially receptive and present/engaged), and the petulant/anger/rage-based side of my BPD (for obvious reasons).  For the most part, I think that worked.  I've often been complimented by people in distinctly gendered ways indicating that I established myself in everyone's perception as I had hoped to; I've never had any problems with people questioning my gender or degendering me, what the trans subculture refers to as "passing" (hate that concept, but I digress) and so forth, and when I did socialize more regularly and when I currently do in whatever circumstances, I get the impression that I'm seen correctly, as myself, at least as far as that femininity is concerned.

But here's the thing: engendering that perception is contingent upon masking, and I'm starkly aware of that, and for various reasons I find myself less able and inclined to 'mask' my symptoms these days.  Since my StPD and AvPD diagnoses last year (I've been aware of and diagnosed with the BPD and bipolar for much longer), in many ways I've had to come to terms with the nature of those 'masking' mechanisms, that that's what I'd been doing all along, and my self-perception/sense of personal identity has had to somewhat 'reboot' as a result.  

I have some trouble reconciling those disorders, especially being on the schizo-spectrum, with my femininity.  In general I think that mental illness of the severe and more 'odd' (not just garden variety depression/anxiety/PTSD) varieties tends to have the effect of diminishing the vividity of the affected person's gender traits in the eyes of others.  An androgynizing effect, in other words, which I fear.  I really get the sense that schizos of all stripes (for instance) aren't seen as women or men who happen to be mentally ill, most of the time, but rather as "that mentally ill/crazy person...who happens to be female/male".  Because many of the complex ways that gender is conveyed and perceived, interpreted and responded to are strongly linked with conformity to social norms; it seems that the ability to blend in and be seen as a (relatively) normal human first is a prerequisite to any nuances of gender manifestation being truly seen, appreciated and understood as defining traits in one's personality.  As I *am* schizotypal and *am* avoidant and am not 'sane' by most definitions, I find it difficult to meet that prerequisite much of the time.  When I can do so, when necessary, there's this niggling awareness now in the back of my conscious mind (since being diagnosed and thus having to face the nature of my masking behaviors) that if people around me *really* knew what I was thinking and feeling, what my perceptions, fixations and priorities are in life, what my internal landscape is like, what my tendencies and coping mechanisms are, they wouldn't see me as an elegant feminine lady or a cute girl, but rather as some sort of crazy amorphous alien blob-creature, as mentally ill and socially deviant *first*, female second and feminine in the ways I like to be distantly third, if at all.  

There's considerably less tolerance and leeway for socially-disruptive conspicuous eccentricity in young women, I believe.  I've intuited and internalized that my entire life, so I've concealed or glossed over or 'sanded off/down' the parts of myself (my personality, expression and general nature), the foibles and peculiarities that would likely come across as abrasive, "icky", flat, inappropriate or bizarre to most people and thereby detract from the characteristics associated with and that signify femininity.

So, collectively, that's certainly a major facet of this issue.  It's just hard to perceive myself as feminine or womanly when so sharply alienated from society at large and living in one's own mind as much as I do by default, as my self-perceptions rely heavily on external validation and there's less opportunity for that if and when I'm "being myself".  Knowing that makes me feel less feminine *intrinsically* even *to* myself, if that makes sense?  

To be more concrete and put it bluntly, picture a basement-dwelling recluse with a markedly flat affect that seems 'off' somehow, a rigid and apparently/superficially self-centered person exasperated with society in general, preoccupied with existential concerns and living in their own psyche, prone to escapism and regression, exhibiting odd language use/self-expression riddled with stilted formality, verbosity, convoluted syntax, vagueness and elaborate idiosyncratic metaphors, with no real friends (certainly no age-peer interpersonal relationships of any kind), unusual intense interests, and little ability, desire or motivation to participate in normative age-appropriate social contexts.  What is the gender of the person you default to visualizing from that description?  A feminine woman?  A girly-girl?  Almost certainly not.  I try, as mentioned, to tone/play these attributes down and dial them back when possible, but a lot of those characteristics are just innate to my mental disorders, just come with the territory.  It also doesn't help that StPD and AvPD are statistically more commonly diagnosed in and associated with men.

Another related aspect of it is: I already find it difficult to relate to other women on some key levels because of my transsexuality and my homosexuality/lesbianism, but my psychopathology--with its inherent degrees of self-absorbed hyper-introspective quasi-solipsism, abstract cerebral preoccupations, social withdrawal/anxiety/avoidance (I don't do group-based socialization well at all, never have), serious deficits in theory of mind and empathy in some regards, etc., etc., just takes that to a whole other level and puts it over the top.  Since homosocial bonding is such an integral defining component of what it means to be any variety of a woman or man in society, especially a feminine woman, I don't have that to reinforce my gendered sense of self either.

Yet another predominant factor that feels erosive to my internal/subjective sense of self-actualization in gender is the extent of disability that the mental illnesses entail and how that limits my life, affects my lifestyle, in two main areas.  

One has to do with the expectations that go along with womanhood in any time and place.  Any lofty aspirations I had of a career of any kind or conventional success in professional/academic/intellectual domains were totally and to a large extent permanently derailed.  Divorced, unemployed, and back living at home with my mother, I largely failed to 'launch' as an independent adult.  (The 'manchild' is a crystallized archetype in popular consciousness, however derided, but the 'womanchild' considerably less so, much trickier to conceptualize, which I think says something.)  For all the murmurings I've read/heard about how difficult it is for men in this boat to be taken seriously as men, I can't help but feel that from a certain angle it's almost harder to be taken seriously as a woman in such circumstances.  With the prevailing currents of feminism, we're expected to be and do it all, to be independent/autonomous, mature, competent and ambitiously pursuing success in work-related arenas as well as familial, self-sacrificing, nurturing and domestically capable.  I struggle immensely to even begin to be any of those things.  I don't fit the traditional ideals of femininity since I can barely care for and feel grounded in myself let alone take care of or give back to others, and even if I weren't precluded from having children and fostering a conventional nuclear family due to my medical condition (i.e., transsexual status) and sexual orientation, I would *never* be fit/suitable to be a mother, and my executive functioning is abysmal, so I'm hardly a skilled domestic, not homemaker material.  But I don't fit the modern ideals of femininity either, as I'm not a self-motivated, self-assured, 'empowered' assertive go-getter comfortable with or able to confidently wield my gendered traits differently depending upon whom I'm with (can't 'code switch', can't blend in with or socially relate to men and other women at the drop of a hat).  I don't bear any social, sexual or domestic value, but I don't have much 'professional' value either.  With femininity and womanhood in this day and age still filtered through and contingent upon those various forms of 'value', cache/'currency', where does that leave me?  For all the supposedly diversely acceptable ways to be a woman and embody femininity in this era, there's no modern equivalent of the 'eccentric spinster aunt' type of role or accepted place for that. The thought is admittedly a dispiriting one and one that contributes to my low self-esteem around my gender.

The other way that mental illness-related disability detrimentally affects my ability to feel connected to my femininity is a more direct one, in that with limited 'spoons'/energy and poor executive functioning, it can be oftentimes tough to consistently perform the routines and upkeep that goes into a burnished feminine presentation.  When it comes to physical beauty/appearance: I don't have the focus, time-management skills or patience for involved full-face makeup techniques--most days it's all I can do to cover blemishes with basic slapped-on foundation, powder my nose a little and apply lipstick, and only for appointments and on relatively 'good' days when I'll be in public--and that's not to mention that I can't afford 'quality' makeup anyway (first-world problems, I know).  My eyebrows often go to pot  due to forgetfulness and make my face look weird.  I had very long, beautiful curly hair (not trying to sound narcissistic or vain, but it was one feature I was proud of--I'd wake up with spiral columns!) that is now severely, probably irreparably damaged because when bedridden with severe depression and negative symptoms I couldn't keep up with the high maintenance of it and didn't get split ends trimmed when I should've because of the social anxiety going to the hairdresser invokes for me, and going gray at an alarming rate due to what I assume is meds, traumatic experiences in the past few years and constantly high baseline stress levels.  Skincare is something I similarly neglected for far too long and struggle to do well, and the chemicals I rely upon to barely function on a daily basis interfere with my hormone levels and are now causing acne and oiliness to my chagrin.  But when it comes down to situational sanity or superficial beauty, I have to sacrifice the latter for the former.  The harsh truth is that severe mental illness ages a person rapidly.  Between the continual duress one's under, the medications and the unhealthy habits and propensities that accompany life with 'low-functioning' MI, with psychotic-spectrum, affective *and* personality disorders all at once--and are more challenging to simply relinquish and 'shake off' (diet can't always be optimal when dealing with executive functioning issues, nicotine use--at least for me--is simply necessary to function even if not addicted, personal hygiene can go by the wayside when embroiled in an earth-shattering emotional crisis or lost in obsessive existential ruminations and frantically trying to interpret and make sense of ideas of reference I'm bombarded with all day), looks go, and they go downhill *fast*.  Validation and confidence as a feminine woman is a lot more elusive when that outward presentation is less than attractive, and with severe mental illness, suddenly needing to put in a great deal of effort to ensure it stays sufficiently winsome to garner that validation and feel confident happens sooner and is simultaneously less feasible.

All of the above cumulatively builds up into that sense of gendered self-alienation, a dulled ability to perceive myself as the highly feminine young woman that is so thoroughly central to my core identity/sense of self (which is especially important for me to feel grounded in, given the identity instability symptomatic of my conditions) which in turn is frankly important to my quality of life.  I don't mean to sound unduly trite or vain in this, but, I mean...it feels like it's been forever since I've just felt pretty, cute, or elegant--*feminine*, you know?--to/for myself, even though the few people who I interact with regularly still sometimes tell me that I project those qualities.  

It really has me disheartened, and I feel very alone in it, as if nobody else understands this.  Other women with this level and these types of psychological/psychiatric disability (particularly other schizotypals and generally outsider/eccentric types) by and large don't seem to care about gender, being feminine or how they're perceived as much AFAIK, and many from what I've seen express how they're gender-nonconforming and comfortable with that, find such matters beneath their concern or attention, and/or deconstruct the entire concept into meaninglessness (e.g., "gender is all a construct, the hell with societal standards and traditionally feminine traits...").  Treatment providers and mental health professionals don't seem IME to grasp why this matters either, that self-actualization with and feeling confident in gender expression can be necessary and significant to the overall self-esteem they're attempting to help one build, repair and bolster.  The default response from everybody seems to be along the lines of "be unabashedly yourself!" but it's not understood or empathized with when what one feels to be one's "self" is distinctly gendered--feminine femaleness, in my case--and with that part undermined by mental illness.

So...I've wondered, do any other women living with severe/disabling MI experience this sense of being less-than-feminine, of disconnection with/unwanted dissociation from internal perceptions of and confidence in their femininity and womanhood (where it's frustrating, hurts self-esteem)?  I would love to hear your experiences.  If so, what has helped you work through this and feel...well, feminine, pretty/cute/elegant (whichever apply to you in whichever ways), like a woman again?  I intuit that I can't be the only one contending with these issues and nuances, but it often feels that way.  More broadly, from anyone with input on this overarching subject, any thoughts?