Transgender patients

[Salpingo]

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Some people have made an association between body dysmorphic disorder and gender dysphoria. There is a subtype of BDD where this loss of insight that was previously seen as delusional (but is no longer conceptualized as such - it's just an obsessive compulsive spectrum disorder). However patients with BDD who have surgery are not satisfied, their distress is not abated (albeit possibly temporarily) in fact they may become worse. Conversely, those with identify as transgender who seek gender affirming surgery tend to do much better (and when they don't it is because they have other issues and may have thought everything would be miraculously better afterwards when there is no panacea).

I think the other illness that can be conflated is anorexia nervosa (which may fall into the Karl Jasper's definition of delusion). No argument will shake the conviction of someone with anorexia that they are not inhabiting a fat person's body, or even that there's something so inherently bad about being fat in the first place that its worth ruining your life.

I don't know how valid it is to use the response to surgery as a diagnostic tool -- people with body integrity identity disorder may "benefit" from surgery (http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0034702) -- the famous example is the woman who always identified as a blind person until someone finally did it, and now she's supposedly living a happy life (although that may be correlated with getting media coverage). There are a lot of drawbacks studying this -- its hard to design a study that would create a control where a person received the aid and support of a gender reassignment group (who often have excellent clinicians, social work support, support groups, etc), then somehow randomized and blinded to treatment. Maybe some would have been happy with "just" hormone therapy, or other strategies for feminization.

To answer the OP, psychiatrists will often see these patients simply because they have higher rate of psychiatric co-morbidity, but primarily as consultants to the endocrinologists and surgeons who do the work, or on the inpatient unit when they are severely disabled. For me, that led to some very skewed viewpoints, and I need to remind myself that I've only seen the worst case scenarios, disqualifying me from having any meaningful opinion (but hey, its the internet, so I can pretend).

 

[Crayola227]

http://www.ncbi.nlm.nih.gov/pubmed/7477289
Nature. 1995 Nov 2;378(6552):68-70.
A sex difference in the human brain and its relation to transsexuality.
Zhou JN1, Hofman MA, Gooren LJ, Swaab DF.

there's tons more if you want to go play on PubMed, but this was a landmark study in Nature

http://www.scientificamerican.com/article/is-there-something-unique-about-the-transgender-brain/
a good article

https://www.newscientist.com/article/dn20032-transsexual-differences-caught-on-brain-scan/

There's lots of research coming out that supports brain differences, things even going back to the womb, that supports that our sense of "gender" is hardwired in, as stated, in all cultures gender is associated with sex. That is still consistent with the fact that gender is a social construct.

 

[birchswing]

I think the social constructs make it difficult for people to be themselves as they are biologically. I am XY, for example, but there are so many naunces that go beyond male/female that are probably biologically based and we don't know about. Most people don't even know that 1/500 babies legally identified as male (XY) are XXY (there is no legal way to define this in the US). I don't really identify as being terribly gendered. But I will say this, if I had to repeat elementary school in the 1980s enough times (social construction), it would eventually drive me crazy enough that if there were an option to identify as female, I might go ahead and do it. When you're in such an environment, the incongruities grate against you. But once you're in a place where you don't have to conform, it doesn't really matter—at least to me. I could wear a dress and say I'm a lady or not say I'm a lady. I guess no one lives in social isolation, but there are certainly degrees of intensity. And yes, I do acknowledge there could be defense mechanisms against being transgendered in my amorphous view, but even if that were true in my personal case, there are pockets of the country where individual expression is still tightly controlled by gender identity. And to express oneself differently enough, I think people might feel compelled to do things they otherwise wouldn't (such as SRS). I'm all for people doing what they want, but there is something actually quite conservative about being transgender and SRS. It seems to say in a way that there is a proper place and form for certain behaviors and appearances. And you know Iran is the world leader in transgender surgeries, and they're not exactly big on the spectrum ideas.

 

[Nasrudin]

Hmmmm. Giving the body of one gender the hormones of another has huge consequences. I'm not convinced that we're not doing damage under the service of our cultural construct--Neoliberalism.

I'm sitting this one out. I'll be as sensitive to the actual patients as I'm capable of. Treat them as any other human being in need for my services. But i'm not rx'ing hormones and and i'm participating in reassignment procedures. I'll be happy to refer them out and transfer care as per there desires/needs.

I'm not convinced we know what we're doing. The issue seems too ripe for Neoliberal bias that is rife in Academic and psychological cultures.

 

[birchswing]

Hmmmm. Giving the body of one gender the hormones of another has huge consequences. I'm not convinced that we're not doing damage under the service of our cultural construct--Neoliberalism.

I'm sitting this one out. I'll be as sensitive to the actual patients as I'm capable of. Treat them as any other human being in need for my services. But i'm not rx'ing hormones and and i'm participating in reassignment procedures. I'll be happy to refer them out and transfer care as per there desires/needs.

I'm not convinced we know what we're doing. The issue seems too ripe for Neoliberal bias that is rife in Academic and psychological cultures.

I agree with you in large part (the part about the field of medicine often being unethical and leaping before knowing).

But to give you an example of a classical neoliberal: Ronald Reagan. He's kind of the definition of a neoliberal. It has nothing to do with transgenderism. If you want an example of a government system that promotes and even mandates transgenderism, look to Iran.

 

[clausewitz2]

I agree with you in large part (the part about the field of medicine often being unethical and leaping before knowing).

But to give you an example of a classical neoliberal: Ronald Reagan. He's kind of the definition of a neoliberal. It has nothing to do with transgenderism. If you want an example of a government system that promotes and even mandates transgenderism, look to Iran.

Neoliberal = thing that seems modern that I don't like.

 

[splik]

Neoliberal = thing that seems modern that I don't like.

??? I mean it's not clear what nasrudin is going on about but neoliberal most people would say refers to a particular economic approach that took hold at the end of 70s with the emergence of Reagan, thatcher and deng xioaping that saw the free market as the solution to everything and believed in the minimal state, privatization finances austerity and deregulation. although curiously wedded to social conservatism in this country in many ways markets are colorblind - if there is a market, if you can be commodified then all is equal in the eyes of the markets. you only have to go to a pride parade to see how LGBT rights are now the triumph of neoliberalism so in a sense he might be right... there is money to be had and a new market created for trans people and hormones and surgery are part of the market place. of course it's somewhat ironic too

 

[smalltownpsych]

Sometimes I wonder if the only thing that is less useful than our diagnostic labels are political labels.
😛

 

[Shikima]

We use all kinds of labels. Male, Female, Black, Asian, Depressed, Anxious, Schizophrenia, 10 calories per serving of Ketchup.....

 

[SeniorWrangler]

I'm concerned about labeling kids at an early age, since I don't see how you can tell a young gay kid from a young transvestite from a trans kid from a kid who just doesn't like the stereotypical gender role they're offered in school and the media and is trying to make sense of their experience.

 

[clausewitz2]

??? I mean it's not clear what nasrudin is going on about

I know what neoliberal used to mean, certainly, but if you are unaware that it has become the left 's favorite term of content-free abuse, I suppose you curate your reading and social media feeds better than I do. In this sense it has replaced the old favorite "fascist", previously employed for the same purpose.

Other political orientations do the same thing with different terms, not trying to pick on leftists by any means.

 

[Shikima]

I'm concerned about labeling kids at an early age, since I don't see how you can tell a young gay kid from a young transvestite from a trans kid from a kid who just doesn't like the stereotypical gender role they're offered in school and the media and is trying to make sense of their experience.

My daughter likes pink and dresses.... I'll support this label.

 

[Nasrudin]

I mean the the culture of the oppression olympics and the race for wealthy, liberal elite at universities to signify morality by speaking for oppressed classes. In one resounding, unified, and certain voice.

That makes it presupposed that we should uncritically engage in hormone therapy and surgical alteration of human beings. Because to even question the idea or suggest that extensive screening prior to these interventions should be done, is amoral. Evil.

Which is the tendency of this cultural movement--that there's the moral opinion, their's obviously, on one hand, and Evil on the other.

I'm wary of herd like behaviors is all.

 

[birchswing]

nnnn

I mean the the culture of the oppression olympics and the race for wealthy, liberal elite at universities to signify morality by speaking for oppressed classes. In one resounding, unified, and certain voice.

That makes it presupposed that we should uncritically engage in hormone therapy and surgical alteration of human beings. Because to even question the idea or suggest that extensive screening prior to these interventions should be done, is amoral. Evil.

Which is the tendency of this cultural movement--that there's the moral opinion, their's obviously, on one hand, and Evil on the other.

I'm wary of herd like behaviors is all.

There are some people like that, who try to squash free speech on campuses. But it's not everyone. The current civil rights movement is different than anything I've seen before. I find its tenor to be clinical and often tedious, sometimes to the point of sounding somewhat disordered and trapped in a type of scrupulosity OCD:

http://everydayfeminism.com/2016/02...&utm_medium=social&utm_campaign=SocialWarfare

(as an example)

I consider myself someone who wants to learn a lot, and I also tend to be on the "progressive" side of politics (although progressive itself is a tricky word, often bringing up images of prohibition). But I am also very happy to try to be intellectually honest and to try to divest my interests from a topic I'm learning about. I'm not saying it's easy to challenge ideas on a college campus. You always have to be aware of which ideas have the most power, especially when grades are involved. But it's a good exercise in learning the art of persuasion.

 

[clausewitz2]

I mean the the culture of the oppression olympics and the race for wealthy, liberal elite at universities to signify morality by speaking for oppressed classes. In one resounding, unified, and certain voice.

That makes it presupposed that we should uncritically engage in hormone therapy and surgical alteration of human beings. Because to even question the idea or suggest that extensive screening prior to these interventions should be done, is amoral. Evil.

Which is the tendency of this cultural movement--that there's the moral opinion, their's obviously, on one hand, and Evil on the other.

I'm wary of herd like behaviors is all.

Ah, you seem to be using neoliberal to actually refer to people who we would call liberal in the United States. I suspect that if you used the term to describe anyone engaging in the oppression Olympics to their face, they would have an immediate and highly negative reaction.

 

[birchswing]

Ah, you seem to be using neoliberal to actually refer to people who we would call liberal in the United States. I suspect that if you used the term to describe anyone engaging in the oppression Oly mpics to their face, they would have an immediate and highly negative reaction.

It's even more confusing really. We have neoliberals in both economics and IR (not the same thing) and liberals in IR (but IR neoliberals are actually closer to IR realists than they are IR liberals), in addition to the US domestic sense of liberal, which doesn't have much to do with IR liberals (in fact the US domestic sense of conservative is probably more closely associated with both the economic and IR sense of neoliberalism).

 

[smalltownpsych]

It's even more confusing really. We have neoliberals in both economics and IR (not the same thing) and liberals in IR (but IR neoliberals are actually closer to IR realists than they are IR liberals), in addition to the US domestic sense of liberal, which doesn't have much to do with IR liberals (in fact the US domestic sense of conservative is probably more closely associated with both the economic and IR sense of neoliberalism).

Like I said, political labels are even more confusing than diagnostic labels. In addition, both types of labels only work when applied to groups because the indidividual never quite fits the definition, but a group is made up of individuals and the label applies to an amalgamation of traits and or beliefs that doesn't really exist except in the abstract.

Another point about the topic of gender is that many people and most of my patients are confusing gender roles with gender identity and thereby operating out of the same mindset of categories that they believe are trying to eliminate. Sometimes my patients with 70 to 80 IQ make more sense because they can't overthink this kind of stuff. "He might be wearing a dress, but he ain't no girl."

 

[Nasrudin]

edit.

 

[birchswing]

Like I said, political labels are even more confusing than diagnostic labels. In addition, both types of labels only work when applied to groups because the indidividual never quite fits the definition, but a group is made up of individuals and the label applies to an amalgamation of traits and or beliefs that doesn't really exist except in the abstract.

Another point about the topic of gender is that many people and most of my patients are confusing gender roles with gender identity and thereby operating out of the same mindset of categories that they believe are trying to eliminate. Sometimes my patients with 70 to 80 IQ make more sense because they can't overthink this kind of stuff. "He might be wearing a dress, but he ain't no girl."

Reading old IR pieces is infuriating. The "big" thinkers in IR from what I can gather would be like the modern-day equivalent of a person with a blog, except that their thoughts were exalted for reasons I can't quite determine. The only useful contributions are the most obvious conclusions most people would already hold. There's no real science there, or even any great philosophy. Somebody more motivated than me should write something up comparing the history of IR to the DSM. I guess they're more related than we would typically think. One deals with the human mind, and one deals with a collection of human minds relating to each other. With both, I think there is a case for science, meaning I believe you can make more than just an idiographic evaluation of 7 billion minds or an idiographic history of world events, but in each we're still scratching the surface, and I guess that results in each having somewhat arbitrary, overlapping, unhelpful labels.

 

[benlinus]

American Hero