Tuesday, April 2, 2013

"Schizophrenic" teens and transgendered teens: Some observations

About a Boy, by Margaret Talbot, features in the March 15 edition of the New Yorker Magazine. The author writes about the growing numbers of teenagers--increasingly female ones-- who are being surgically transgendered. The New Yorker only posts a small part of the article on the link I've provided. Do your own sleuthing to obtain this article, or, better yet, buy it in the name of sociological research. If you don't already know anyone through your network of friends and relatives who has opted to become transgendered, trust me, you will. It is likely that a friend's daughter is about to become your friend's son. Through my own network of friends and relatives, I have personally met four cases, all of them female, who have started or have completed, the transition to male.

Why am I talking about transgender themes on my schizophrenia* blog? Because, as  someone who believes in the value of psychotherapy, who is skeptical of brain and body transforming medications and surgical interventions (electroshock), there is something very alarming indeed about the acceptance by the very young (and perhaps more reluctantly by their parents), of costly and dangerous cosmetic surgical interventions that have lifelong implications. A lifetime of drugs, a body that in other contexts is considered mutilated (think of the outcry surrounding female genital circumcision) and no going back. Homosexuality doesn't call for medications or surgery, but transgender interventions do.  It is ironic that on the one hand, mental health activists are condemning the widespread medicating and over medicating of children and adults, electroshock for depression, and the dearth of access to psychotherapy, and on the other hand, under eighteens and young adults are clamoring for surgery, medications, and declaring that childhood trauma is not the issue here. I'll bet that a sound argument can be made that these teens and young adults have trauma issues and that these issues should be explored in great depth before rushing into no going back decisions. But, that argument isn't being raised.

I recently met with a MTFT transgendered person, who got her surgery done in Thailand by a Thai doctor who has done hundreds of these operations in his lengthy career. Because of this person's age (60) and the fact that she had many years to consider her choice, the surgeon waived the ten year time frame that the decision process is supposed to take.

Medical misgivings aside, it is interesting that all the parents of the teens in the article are divorced, and the small sample of people I know who have transgendered, have parents who are divorced or never married. Coincidental or not coincidental? Transgendering is like saying I am now almost physically equal to a male or female and I will become more like the absent parent.

Years ago, when the baby boomer generation started getting divorced in droves, we were fed then latest societal myth about the effect of divorce on the child. Children are enormously resilient, we were told.  And it was in our interests to believe that myth. It was, after all, tailored to us and our needs, and the last thing anyone wants to feel about divorcing when children are involved, is guilty. The resiliency myth soothed our guilt. Well, now we are beginning to see one change that can happen in this day and age when children grow up with a remote male or female presence, secure in the knowledge that genders are equal, nourished by an increasingly daring Internet pop culture, and a slavish rejection by key opinion leaders of agreed cultural norms that that were built up over centuries norms.

Back to The New Yorker article: "But Danielle, a lawyer who had studied literary theory in graduate school, told me that she found herself puzzling over Aidan's desire to transition. 'I feel like of lot of these kids, including my daughter, might be going through identity struggles, a lot of them are trying on roles.' We were having coffee at a pie shop in the Mission, at a long communal table. (At one point, the college student who'd been studying across from us politely interrupted to say that she, too, was about to transition to male.) Talking about Aidan, Danielle slipped back and forth between 'she' and 'he,' saying, 'I'm still not convinced that it's a good idea to give hormones and assume that, in most cases, it will solve all their problems. I know the clinics giving them out think they're doing something wonderful and saving lives. But a lot of these kids are sad for a variety of reasons. Maybe the gender feelings are the underlying causes, maybe not...................Danielle said that she had met many teenagers who seemed to regard their bodies as endlessly modifiable, through piercings, or tattoos, or even workout regimens. She wondered if sexual orientation was beginning to seem boring as a form of identity; gay people were getting married and perhaps seemed too settled..........'The kids who are edgy and funky and drawn to artsy things---these are conversations that are taking place in dorm rooms,' Danielle said. 'There are tides of history that wash in, and when they wash out they leave some people stranded. The drug culture of the sixties was like that and the sexual culture of the eighties, with AIDS. I think this could be the next wave like that, and I don't want my daughter to become a casualty.'

Danielle thinks that "Aidan" is going through an identity struggle. Just as many people believe that a young person presenting as "schizophrenic" is also going through an identity struggle. The acquiescence to patients groups for the two conditions by psychiatry is telling. The DSM-5 continues to cling to the stigmatizing schizophrenia diagnosis, despite the opposition of those so labelled, but it has done away with the Gender Identity Disorder diagnosis, and replaced it with the more obfuscating term "Gender Dysphoria." One group is listened to by psychiatry, the other is not.

13 comments:

  1. A most thought provoking piece about an increasingly prevalent topic. Thank you.

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    1. I would like to ask a question for those who are so sure that transgenderism has nothing at all to do with psychological issues. In my kids’ school, there has been a growing trend for alternative sexual orientation and gender with the high school girls. Like any normal teenager trend, it’s cool to be a part of it. In the period of 6 months, a total of 5 girls out of 200 decided that they were boys. Two who turned 18 are now getting hormone replacement therapy and plan on having double mastectomies whenever they are able. The hormone therapy was done WITHOUT a requirement of psychotherapy and without constant supervision of the doctor who agreed to provide the hormones for injections. The school has been supportive of these teenagers without questioning and has even required teachers to go through training to learn how to be more accepting of transgender persons. I believe that well-meaning adults are afraid to speak out for fear of being seen as intolerant. However, if there were the same number of girls who were anorexic, cutting themselves, or threatening suicide as girls have historically been known to do in clusters, there would be concern and outrage for the safety of the girls. They would enlist social workers, psychologists, and doctors to help with this epidemic. So why is this not considered an epidemic? Why would no one even CONSIDER that these girls may be following each other in making irreversible and isolating changes that will affect the rest of their lives? We restrict and counsel teenagers in other areas. You can’t drink until you’re 21. You can’t rent a car until you’re 25. Why? Because the frontal lobe of the brain is not fully formed and decision making in regard to risk taking is not completely rational. Why are professionals who know this and studied this remaining silent? Someone needs to be brave and come forward with the science that supports the need to investigate psychological factors in transgender people before they start hormonally and surgically altering themselves. It will certainly not be a popular opinion, but it might save the lives of girls like these. There are strong opinions on either end of the spectrum – transgender advocates and religious zealots. Where is the common sense opinions of the middle? Speak up! Please!

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    2. You raise lots of excellent points. Thank you for contributing them to this post.

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  2. if you've only talked to the one person you speak of above it might be a good idea to talk to other such people...especially young people before coming to conclusions...

    one hugely significant issue is that transgendered folk seek treatment and are most often coerced to NOT PURSUE SUCH CARE. They are the active drivers of anything that happens in their care.

    those labeled with schizophrenia have more often than not have "treatment" imposed.

    I think not considering that major difference is missing a huge piece that has everything to do with choice...as though we should decide who gets to have a sex change or not...

    transgender issues are very complex...I've worked with a large population of such folks in the course of my career and I have nothing but respect for the very difficult choices they make...

    virtually everyone in this culture has been traumatized one way or another...people still have the right to decide how they wish to live their lives on this planet as long as they're not hurting others...I've known some very sophisticated transgendered folks who have most certainly taken these issues into consideration.

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  3. Hi, Monica,
    As I understand it, in the past and in certain countries, anyone wanting to transgender could not do it right away, the idea being that this decision should not be taken lightly. The waiting period has largely been dropped. This has its pros and cons. An MTF I spoke with said that the longer one waits, the worse it can be psychologically. Makes sense for some people, but a waiting period may also cause other people to re-examine what they orginally felt was true about themselves. Who we think we are at 18 is usually not who we think we are in mid-life. I don't see sexual orientation as static, but I do think a lot of people at 18 are very unsure of who they are, and that can manifest as sexual confusion, schizophrenia, bipolar, depression. Erring on the side of caution by waiting period seems a prudent strategy, IMO.
    Thanks for your thoughts. They always bring a new perpsective to the post.
    ...Rossa

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  4. Not so long ago there were no sex-change operations and no hormone therapies. People accepted their lot and made the most of it: quirks and all. Were they more unhappy because of it? I doubt it. Nothing is perfect in this world, nothing ever will be.
    Anon2

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    1. Jessica Britton, co-founder, Phoenix Transgender SupportMay 18, 2014 at 9:59 AM

      Actually, what many of those people did was cross over and live full time without surgery or therapy. Transgender people have always been with us and always will be.

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  5. Rossa,

    Careful.

    Once you're seen as anything other than "progressive," the very groups that *scream* for diversity will want to make sure you're kept nice and quiet...

    I find this *fact* to be pretty fascinating.

    I think you made some great points in this post.
    Good luck with the fallout.

    Duane

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    1. And if it's seen as a legitimate choice, the taxpayer should always be *forced* to pay for it...

      Hardly the political thought of the late Dr. Thomas Szasz... who was a libertarian, *not* a "progressive"!

      I'm growing awfully tired of the *one-size-fits-all* diversity of thought with all of this stuff... It so predictable, boring.

      Duane

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  6. I can only tell from my personal experience: I'm 15 and I know that I'm neither male nor female. I'm going to wait until I'm 18 at least for any surgery or other treatment (but I'm visiting a gender psychotherapist). However, I think you can't criticise someone who knows at age 13 that they're of a certain gender and wants to transition. Being trans* isn't a trend, it's not a choice or lifestyle. It means feeling wrong in your own body, day after day, and believe me, you don't want to wait ten years with a body that doesn't belong to you. Binding every day is not really healthy (I'll take this as an example), but not binding inflicts even worse psychological damage. How can you expect someone who is SURE they're doing the right thing to suffer for years on end when a solution is finally available? I think we should be grateful that sex reassignment surgery exists.

    Also, why do you keep comparing trans* to homosexuality? "Homosexuality doesn't call for medications or surgery, but transgender interventions do." "She wondered if sexual orientation was beginning to seem boring as a form of identity..." Gender identity is about who you are. Who you want to be, where you want to fit in, which category fits for you or whether you're outside of all the categories. Sexual orientation is who you want to be romantic/intimate with, and that has nothing to do with your gender. A transwoman (meaning: her birth sex is male, her gender is female, call her "she", etc.) can be gay or bi or straight or asexual, it doesn't make a difference. (Everyone else as well, of course.) You could also say that taller people are more likely to be trans*, it would be no more nonsense than this comparison.

    Also, this quote is notable: "...it is interesting that all the parents of the teens in the article are divorced, and the small sample of people I know who have transgendered, have parents who are divorced or never married. Coincidental or not coincidental? Transgendering is like saying I am now almost physically equal to a male or female and I will become more like the absent parent."
    That's a nice theory, but nothing more than amateur psychology. Who knows, it may even be like this for some people. But those have to be a minority within the trans* spectrum. My parents aren't divorced, and I know many other trans* people with "traditional" families. Also, for example, a transgirl wouldn't say "I am physically equal to a male". Maybe her body would even look like a guy's body, but she would never fit the role of a lost father because she's a GIRL.

    About the DSM-5: "Gender dysphoria" is a term used for the idea of "feeling wrong in your own body". It is a nicer term than "Gender Identity Disorder", as you will see when looking at the meaning.
    Gender Dysphoria: The problem here is the bad feeling caused by the wrong body.
    Gender Identity Disorder: The problem here is the gender identity of the diagnosed person. This formulation says "They shouldn't feel like this" and implies that the gender identity - what they feel like - is a disorder.

    Other groups of people (for example, members of a multiple personality system) often feel discriminated by the use of the word "disorder", because they claim the problem doesn't lie within the situation, but in the feelings/ traumata/ situations/ ... created by the situation. This holds truth for most trans* people, too. You can't help someone by saying "bend over 180 degrees and live like that" because that's no life. They will be unhappy and there are lots of people who killed themselves because of this. You can help, however, by telling them that it's okay. They don't hurt anyone by being trans*!

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  7. Robin,
    You are obviously very articulate for someone so young, but how is it that you are so confident that you've actually figured out WHO you in a gender and sexual orientation sense when so many others struggle with uncertainty for years? Maybe you are right about who you are, but maybe you are also heavily influenced by popular culture, your school environment and your perceptions of your parents. I may have got this wrong, but you also seem to think that what the DSM says is accurate. There is no scientific validity to it. It is well known that psychiatrists "vote" on new diagnostic labels, ie. it is there opinion of who you are, and the DSM has managed to pathologize just about every aspect of human behavior. You wouldn't be the first teen to be so influenced. The search for identity goes on firmly into one's twenties (an often traumatic decade) and beyond. Today, Katie Perry may sing about kissing a girl but in twenty years she'll have moved on and so will culture. Surgical interventions are for life. People your age don't think twice about them, nor about drugs that in many cases have to be taken daily for life. According to the Associated Press, Adverse drug events are routinely accepted and heroically endured, even though, reports the Associated Press, “More than 1.5 million Americans are injured every year by drug errors in hospitals, nursing homes and doctor's offices, a count that doesn't even estimate patients' own medication mix-ups. . . (O)n average, a hospitalized patient is subject to at least one medication error per day.” (4) More than 100,000 patients annually die, just in the USA, from drugs properly prescribed and taken as directed. (5)
    http://www.nbcnews.com/id/13954142 You are too you to think that your body is anything but resilient. Your mind is changeable, society will change, but your body, once changed, opens up a host of other complexities that you may wish one day you hadn't had to deal with. There is also no harm in being cautious and skeptical, even if there are others around you blindly rushing in, or encouraging you to do so. Thanks for your heartfelt thoughts, and please check back here from time to time if you are so inclined to tell me how you are doing.
    Best regards,
    Rossa

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  8. "People your age don't think twice" yeah ok im done. Its been hard reading all of these posts; i was trying to find some angle where they all didnt seem to be drawing complete assumptions about people, but now i know for sure that this simply is the case. None of you know how fucking hard it is to get past the most dogmatic scientific community there is, to finally get the pills theyve had loaded up and waiting. To convince people who arent interested in making any meaningful attempt at having a two-sided conversation that you're sane is damned hard. You're even more crazy if you're afraid of the people accusing you to be, as why would one fear people who tell them they're crazy? I didnt want to kill myself until the pills i told them i didnt want. I didnt stop eating until the fourth round of new anti depressants. Everyone with any sort of grounded real perception of how pharma works understands that like all other empirical business, the bottom line is money and nobody gives a fuck. Turns out after a dna test theyd never suggested, that all of the pills perscribed have negative impacts on my system. It doesnt matter though, HES gumming the pills IT must be a nut. Yeah... please.

    Do you lot really have nothing better to do than log on and bicker about the nutty trans kids? Then somehow taxes come into the discussion like federal/state policy somehow have anything to do with the most persecuted minority in the us. Phone your fucking congressman. You think your "bah bah sheep" comment is in any way relevant to the world at all? The only relevance it carries is in my mentioning it as the most overused slander that every fedora wearing reddit wannabe politician has spit time and time again, and as the closer that holds together your fragile ego. Is that not almost sickeningly ironic?

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I am no longer approving comments. All I ask is that you be respectful of others and refrain from using profanity.