I'm sorry to have overlooked posting this sooner, but an important opportunity is at hand. The National Center For Trans Equality is seeking respondents for its second survey that is the most important study to identify transgender issues about access to health care, employment discrimination, mental health, substance abuse, public access to activities and education, to name some of the very important things that we as members under the umbrella "transgender" face.
The first survey revealed important information that was brought to public attention and made a tremendous contribution to the expansion of our freedoms and access to healthcare. It is important that no matter how you identify under the umbrella of "transgender" that you participate in the survey, even if you responded to the survey the last time it was offered. Don't believe your voice makes a difference? Maybe not in a lot of circumstances, but here it really does and it is worth the 20 to 30 minutes to take your time and respond to the survey!
A big and heartfelt THANK YOU to Mara Keisling and all the folks at the National Center For Transgender Equality.....
Here is the Link to the survey: http://www.ustranssurvey.org/
Showing posts with label Addiction. Show all posts
Showing posts with label Addiction. Show all posts
Thursday, September 10, 2015
Friday, September 20, 2013
Gender Dysphoria, Transphobia and Post Traumatic Stress Disorder
Having written on the topics of gender dysphoria, transphobia and posttraumatic stress disorder, I would like to explore how they all interact with each other to negatively impact the lives of transgender people.
I have experienced my life as a transsexual woman, observed and facilitated the process of well over 450 trans people's experience as a therapist. I have worked with individuals across the developmental life span over quite a dynamic time in the lives of trans people from the late 1950's to this time in history. I have been afforded the opportunity to experience both my private experience, echoed in my clinical work with people who have sought me out to help them find their unique path in expressing their gender identity with a sense of congruence.
Most have transitioned socially; some have completed their goal of gender reassignment surgery, while others have found a middle ground that they can be comfortable with and a few chose not to transition at all, usually because of relationships that they cherish and are not willing to lose. Despite the pain of living in a compromised manner, they have found a place where they can be their true selves to a degree that is manageable.
There have been a few who could not transition at all, instead choosing to suffer secretly or they were not candidates to transition due to medical reasons. There are also a very few who have experienced gender identity conflicts that are not clearly transsexual and come to find that hormonal reassignment is not right for them nor would transitioning to a different gender social role bring them a sense of comfort and peace or be a solution for their lives.
In almost all cases of these individuals, myself included, the forces of institutionalized transphobia, internalized transphobia and social stigmatization have played a role in the marked emotional distress they have experienced. In most cases, these social and emotional forces have resulted in various degrees of Post Traumatic Stress Disorder. Some people's experiences of being traumatized have been mild and easily resolved through treatment with the use of medications and with psychotherapy, or by simply transitioning and there are others who were severely traumatized and have been left with life long significant impairment and disability in their social functioning despite their decision to transition.
I spent some time working with Viet Nam Veterans (God Bless you and thank you for serving our country at such great personal sacrifice in so many ways), learning from more experienced therapists in that field that one common predictor of how a combat veteran would fare psychologically had a great deal to do with their pre combat adjustment.
Soldiers who grew up in stable family environments with two parent households where the children were well cared for and free of physical, emotional, and sexual abuse and did not have addictions to alcohol or drugs fared much better than those where were victimized as children, had unstable households and came from broken homes. Now this is not true of any given individual situation. Some combat veterans were also biologically more resilient to extreme distress, but these factors have had a great deal of prognostic value in predicting outcomes. I believe that the same parameters operate in the lives of people with a cross gender identity as well. These same parameters seem to have a great deal of value in determining who will experience greater trauma as a result of having a transsexual identity as opposed to those who will be able to manage the experience and have happier, better outcomes.
In Western cultures, we have seen a profound sea change in the degree that institutionalized and internalized transphobia has decreased over the past 50 years and particularly since the mid to late 1990s . In turn, I have seen better emotional and functional outcomes in young adults as opposed to people of my generation.
Indeed, the cultural changes we have experienced since then were instrumental in my own ability to come to terms with my own identity and complete my transition over the past 5 and a half years. I simply wasn't able to see a way through prior to the mid 1990's to become socially the girl and then the woman I have always experienced myself to be.
In the context of my culture's views of people like myself, which were internalized from the time of my recognition of my identity as a small child, this was simply unacceptable to myself and the culture I grew up in. Yes, there were a few people who were emotionally strong enough to do what I yearned to do from such a young age, but they were thought to be so rare that there was no way the majority of people like me could even comprehend becoming who we truly were, so I and most of my transsexual peers lived silent, tortured and desperate lives.
It is because of the process of stigmatization; the process of internalizing institutional (or cultural) transphobia that we have such high rates of suicide, addiction and alcoholism, as well as being victims of crime that we do in our community. The reason people resort to cope with drugs and alcohol place themselves in situations in which there is an increased risk of victimization and destroy themselves rather than continue to suffer in misery is because they have been traumatized and lack the coping skills to overcome their traumatization.
It is the result of internalizing societal messages that we are unacceptable as members of our society, as well as to ourselves and that we will never be able to participate in life as equals with others who have value and worth.
We come to internalize the idea that we are deviants and do not have the right to participate in life to become the best we can be and we are not worthy of loving others or being loved. As a result we become unable to love and accept ourselves and fall into a state of helplessness and hopelessness. It is a state of despair. It can become a terminal condition when a person does not see a way to integrate her cross gender identity and see herself as a whole and healthy person worthy of loving and being loved, with value as a member of our culture. It is the result of having a guilt and shame based identity, so common in people with post traumatic stress disorder.
In the taxonomy of human problems that my chosen profession addresses, we have refined the definition of the problem at hand, not as a problem with having an identity that does not match the physical body, but it is that of the distress of the recognition that the physical body habitus is not congruent with our gender identity. (Keep in mind that the diagnostic categories we have created are partly reflections of cultural norms and values.) The problem is two fold. One is the biological conflict we experience psychologically from having a gendered body that is not congruent with our gender identity. The other problem is that we recognize that this is not a state of existence that our society considers within the norm and that we have internalized that value that as a result we are not "normal" and as a result, this recognition is traumatizing.
Therefore, in reality, gender dysphoria is a symptom of having been traumatized. Gender dysphoria is not a disorder; it is a symptom of post traumatic stress disorder. In our next iteration of categorizing and diagnosing mental disorders, we need to find a way of capturing gender dysphoria as a symptom of post traumatic stress disorder and not keep it as a stand alone diagnosis, though we must preserve a way of keeping it as a legitimately recognized source of distress that is a focus of treatment and also a treatment that is reimbursed by health care insurance.
There may be those who object to this being categorized as a symptom of post traumatic stress disorder, but the only other alternative diagnostic category would be under the classification of adjustment disorders.
The migration of these diagnostic categories from a stand alone gender disorder to recognizing it as a trauma disorder or adjustment disorder will be predicated on mitigating institutionalized transphobia and the process of stigmatization that results in internalized transphobia. This will result as our evolving society becomes more and more accepting of transsexuals and other transgendered people.
We have seen this happen with increasing speed in society and as these changes in accepting trans people have come about we have witnessed the changing conceptualizations of how to identify and help people with gender dysphoria in the iterations of the DSM over the years. As society changes, we will continue to see this reflected in future DSM volumes. We will see people markedly less distressed about having a cross gender identity and they will be able to participate fully in the dominant culture without being stigmatized or internalizing a stigmatized identity in our society's future.
I have experienced my life as a transsexual woman, observed and facilitated the process of well over 450 trans people's experience as a therapist. I have worked with individuals across the developmental life span over quite a dynamic time in the lives of trans people from the late 1950's to this time in history. I have been afforded the opportunity to experience both my private experience, echoed in my clinical work with people who have sought me out to help them find their unique path in expressing their gender identity with a sense of congruence.
Most have transitioned socially; some have completed their goal of gender reassignment surgery, while others have found a middle ground that they can be comfortable with and a few chose not to transition at all, usually because of relationships that they cherish and are not willing to lose. Despite the pain of living in a compromised manner, they have found a place where they can be their true selves to a degree that is manageable.
There have been a few who could not transition at all, instead choosing to suffer secretly or they were not candidates to transition due to medical reasons. There are also a very few who have experienced gender identity conflicts that are not clearly transsexual and come to find that hormonal reassignment is not right for them nor would transitioning to a different gender social role bring them a sense of comfort and peace or be a solution for their lives.
In almost all cases of these individuals, myself included, the forces of institutionalized transphobia, internalized transphobia and social stigmatization have played a role in the marked emotional distress they have experienced. In most cases, these social and emotional forces have resulted in various degrees of Post Traumatic Stress Disorder. Some people's experiences of being traumatized have been mild and easily resolved through treatment with the use of medications and with psychotherapy, or by simply transitioning and there are others who were severely traumatized and have been left with life long significant impairment and disability in their social functioning despite their decision to transition.
I spent some time working with Viet Nam Veterans (God Bless you and thank you for serving our country at such great personal sacrifice in so many ways), learning from more experienced therapists in that field that one common predictor of how a combat veteran would fare psychologically had a great deal to do with their pre combat adjustment.
Soldiers who grew up in stable family environments with two parent households where the children were well cared for and free of physical, emotional, and sexual abuse and did not have addictions to alcohol or drugs fared much better than those where were victimized as children, had unstable households and came from broken homes. Now this is not true of any given individual situation. Some combat veterans were also biologically more resilient to extreme distress, but these factors have had a great deal of prognostic value in predicting outcomes. I believe that the same parameters operate in the lives of people with a cross gender identity as well. These same parameters seem to have a great deal of value in determining who will experience greater trauma as a result of having a transsexual identity as opposed to those who will be able to manage the experience and have happier, better outcomes.
In Western cultures, we have seen a profound sea change in the degree that institutionalized and internalized transphobia has decreased over the past 50 years and particularly since the mid to late 1990s . In turn, I have seen better emotional and functional outcomes in young adults as opposed to people of my generation.
Indeed, the cultural changes we have experienced since then were instrumental in my own ability to come to terms with my own identity and complete my transition over the past 5 and a half years. I simply wasn't able to see a way through prior to the mid 1990's to become socially the girl and then the woman I have always experienced myself to be.
In the context of my culture's views of people like myself, which were internalized from the time of my recognition of my identity as a small child, this was simply unacceptable to myself and the culture I grew up in. Yes, there were a few people who were emotionally strong enough to do what I yearned to do from such a young age, but they were thought to be so rare that there was no way the majority of people like me could even comprehend becoming who we truly were, so I and most of my transsexual peers lived silent, tortured and desperate lives.
It is because of the process of stigmatization; the process of internalizing institutional (or cultural) transphobia that we have such high rates of suicide, addiction and alcoholism, as well as being victims of crime that we do in our community. The reason people resort to cope with drugs and alcohol place themselves in situations in which there is an increased risk of victimization and destroy themselves rather than continue to suffer in misery is because they have been traumatized and lack the coping skills to overcome their traumatization.
It is the result of internalizing societal messages that we are unacceptable as members of our society, as well as to ourselves and that we will never be able to participate in life as equals with others who have value and worth.
We come to internalize the idea that we are deviants and do not have the right to participate in life to become the best we can be and we are not worthy of loving others or being loved. As a result we become unable to love and accept ourselves and fall into a state of helplessness and hopelessness. It is a state of despair. It can become a terminal condition when a person does not see a way to integrate her cross gender identity and see herself as a whole and healthy person worthy of loving and being loved, with value as a member of our culture. It is the result of having a guilt and shame based identity, so common in people with post traumatic stress disorder.
In the taxonomy of human problems that my chosen profession addresses, we have refined the definition of the problem at hand, not as a problem with having an identity that does not match the physical body, but it is that of the distress of the recognition that the physical body habitus is not congruent with our gender identity. (Keep in mind that the diagnostic categories we have created are partly reflections of cultural norms and values.) The problem is two fold. One is the biological conflict we experience psychologically from having a gendered body that is not congruent with our gender identity. The other problem is that we recognize that this is not a state of existence that our society considers within the norm and that we have internalized that value that as a result we are not "normal" and as a result, this recognition is traumatizing.
Therefore, in reality, gender dysphoria is a symptom of having been traumatized. Gender dysphoria is not a disorder; it is a symptom of post traumatic stress disorder. In our next iteration of categorizing and diagnosing mental disorders, we need to find a way of capturing gender dysphoria as a symptom of post traumatic stress disorder and not keep it as a stand alone diagnosis, though we must preserve a way of keeping it as a legitimately recognized source of distress that is a focus of treatment and also a treatment that is reimbursed by health care insurance.
There may be those who object to this being categorized as a symptom of post traumatic stress disorder, but the only other alternative diagnostic category would be under the classification of adjustment disorders.
The migration of these diagnostic categories from a stand alone gender disorder to recognizing it as a trauma disorder or adjustment disorder will be predicated on mitigating institutionalized transphobia and the process of stigmatization that results in internalized transphobia. This will result as our evolving society becomes more and more accepting of transsexuals and other transgendered people.
We have seen this happen with increasing speed in society and as these changes in accepting trans people have come about we have witnessed the changing conceptualizations of how to identify and help people with gender dysphoria in the iterations of the DSM over the years. As society changes, we will continue to see this reflected in future DSM volumes. We will see people markedly less distressed about having a cross gender identity and they will be able to participate fully in the dominant culture without being stigmatized or internalizing a stigmatized identity in our society's future.
Thursday, November 1, 2012
Alcoholism and Addiction
It's the same thing, alcoholism and addiction,
really. Same illness, just a different substance. Then add on to this category
the process addictions: gambling, spending, sex, porn, eating disorders like
bulimia and anorexia. Let’s also recognize the binge- purge cycle associated
with gender dysphoria where one acquires a wardrobe appropriate to our true
gender identity and then in a fit of guilt and shame throws it all away, only
to repeat the cycle by acquiring another wardrobe.
“The National Institutes of Health (NIH) estimate
that 7.3% of the general public abuses or is dependent on alcohol, while 1.7%
abusesor is dependent on non-prescription drugs. Eight percent (8%) of study
participants reported currently using alcohol or drugs specifically to cope
with the mistreatment that they received as a result of being transgender or
gender non-conforming, while 18% said they had done so in the past...” (transequality.org
:2011).
How is addiction defined? Essentially, an addict
continues in the behavior involving a substance or process even when it creates painful consequences for
an individual and the individual continues to engage in the use of the substance
or behavior despite those consequences. What are the life domains involved
where one experiences negative consequences that indicate an abuse or
addiction?
1. Legal:
This could be a result of illegal behavior such as driving under the influence,
possession of a substance, or other illegal acts that bring law enforcement
attention.
2. Emotional:
Depression, anxiety, obsessive compulsive disorders, and Post Traumatic Stress
Disorder. Many of these are a result not just because a person’s physical body
does not match the person’s gender identity, but because of emotional, physical
and sexual abuse the individual may experience simply because they are
transgendered.
3. Financial:
Money spent on substances or process addictions, divorce, custody battles,
clothes that can’t be afforded, or to replace what was purged, as well as so
many other issues.
4. Spiritual:
the sense that we are alone, isolated and having no connection to others. It
may be a result of being rejected by our faith if we are raised in the church.
5. Health:
These are consequences of illness or accidents that are a direct result of
abusing substances or engaging in compulsive actions without regard for their
consequences.
6. Social:
Broken relationships with friends and loved ones as a consequence of behavior
under the influence that is painful or otherwise hurtful to others.
In the past 11 years, working with
substance abuse patients, I have known well over 100 people who have died due to overdose, accidents, illnesses
contracted as a result of drug use, and suicide. Most of them were very
nice people and their loss of life is tragic. The collateral emotional damage
to their loved ones cannot be underestimated.
Our
community has a suicide attempt rate of 41%.
Those who abuse substances have higher suicide rates than the general
population. It isn’t a surprise that substance abuse plays a large role in
depression and suicide. Those of us who are of transgender experience most
often are no strangers to depression, myself included, though my depression
stems from other issues in addition to having lived years in varying degrees of
denial about my own identity. I thank my God and my wife and friends who love
me that I have never been to the point where I considered suicide, but I, like
many have had bleak dark days when I wished I had never been born or were dead.
Now that I have accepted myself and am transitioning those dark days are fewer
and fewer.
When I worked at Bryce Hospital in
Tuscaloosa, Alabama (my spiritual home!) I worked with the forensic unit that
housed people found Not Guilty by Reason of
Insanity by the courts for varying offenses, some serious, some not of
such consequence, but all the crimes were felonious. When I got there and was
assigned to the unit, I was told essentially “Here is your unit. Do what you
want with the programming”. It had the longest length of stay of the chronic
units for several reasons. Some of them were because of the heinousness of the
offense, other reasons included they had not had a unit director to provide
structured therapeutic treatment for that patient population. Other patients’
offenses were not that severe and were candidates to be returned to the
community.
To cut to the chase, I developed
programming that allowed many of these patients to progress to the point that
they could be placed back in the community and I did indeed start placing them
back in to structured living placements or returned to live with their
families. Unfortunately, they would stop taking their prescribed medications
and abuse drugs and alcohol. Then they would be recommitted to the hospital,
most often in a psychotic state or severely depressed, or manic. Typically,
they were only out of the hospital for 30 to 90 days before they were returned.
My graduate program did not include
any classes on substance abuse treatment. That was not unusual for that time.
So I had to educate myself about substance abuse treatment. In the course of
this self-education process, I learned for the first time about 12 step
programs. Alcoholics Anonymous was the original 12 step self-help program and
was founded by Bill Wilson and Dr. Bob Silkworth. I also studied materials from
the Hazelden Foundation, our nation’s premier institute of treating addiction
and educating professionals such as myself on how to treat alcoholism and
addictions. I also attended 4 days of training at the Alabama School of Alcohol
and Drug Studies. I developed the first dual diagnosis (mental illness and
chemical dependency) in a state hospital in Alabama and was also the first to
bring AA and NA into a state hospital in Alabama.
People on my unit began to recover
from alcoholism and addiction and began to successfully be placed back into the
community without returning to life in an institution. It is one of the
accomplishments in my life that I am most proud of.
What I have taken from this is the
importance of 12 step programs. The 12 step self-help program has saved the
lives of more people and can be applied not only to alcohol and drug
dependencies, but to the process addictions. In fact, it is my belief that
anyone can benefit from practicing principles of the 12 step program whether
you have an addiction or not. They teach you to rely on a higher power; however
you may define that to be. They teach you to take stock of yourself, recognize
the problem areas of your life and how to address them. They teach you to make
a list of those you have hurt in one way or another and to make amends to them
when it does not hurt the person you make amends to further. They teach you how
to not harbor anger and resentment and how to resolve these issues. They teach
you how to improve your relationship with others and your higher power and how
to learn to become serene by accepting things you can’t change, changing what
you can and recognizing what can be accomplished and what cannot.
Are the 12 step programs for
everyone? No. There is no one size fits all solution to our problems. Not everyone
can benefit from the 12 steps, but by and large, the 12 steps help more people
than anything else in overcoming addictions and compulsions.
I have said this for years: Psychotherapy
and medications treat depression and anxiety more effectively than either
alone, borne out by study after study to the point it is irrefutable. If someone came to me and said “Sherri, I can
either pay you $100.00 (USD) for each hour of therapy or I can go to AA, (NA,
or whatever 12 step program addresses the issue at hand) which is free, but I
can’t do both, I would send them to the 12 step program to try first. That
means its money out of my own pocket, which is a very high endorsement. It’s
not about my self-interest, it’s about getting people help so they can be who
they are authentically and be happy and healthy.
I personally estimate that12 step
recovery programs can be of benefit to 85 to 90% of people who participate in
them. There are 10 to 15% of people who for whatever reason do not find them
helpful. Whatever you decide to do if you have an addiction or a dependency of
some sort, never give up in your struggle to overcome it. You deserve so much
more than having to live with the despair of chemical dependency or with a
process addiction.
To find a local meeting here are some links:
Alcoholics Anonymous: www.aa.org
Narcotics Anonymous: na.org
Sexaholics Anonymous: http://sa.org/
Gambler's Anonymous: http://www.gamblersanonymous.org/ga/
Sex and Love Addicts Anonymous: http://www.slaafws.org/
Al Anon: http://al-anon.alateen.org/home
Overeaters Anonymous: http://www.overeatersanonymous.org/
or: www.OA.org
Codependens Anonymous: http://www.coda.org/
A Christian oriented 12 step program: http://overcomersoutreach.org/
To find a local meeting here are some links:
Alcoholics Anonymous: www.aa.org
Narcotics Anonymous: na.org
Sexaholics Anonymous: http://sa.org/
Gambler's Anonymous: http://www.gamblersanonymous.org/ga/
Sex and Love Addicts Anonymous: http://www.slaafws.org/
Al Anon: http://al-anon.alateen.org/home
Overeaters Anonymous: http://www.overeatersanonymous.org/
or: www.OA.org
Codependens Anonymous: http://www.coda.org/
A Christian oriented 12 step program: http://overcomersoutreach.org/
Wednesday, May 30, 2012
Meditations While Mowing- On Low Self Esteem
Today, once again, I contemplated playing golf. I have taken it up again a year and a few months since my cervical spinal fusion. I feel so much better and hadn't been able to do outside yard work for the last three years either. My friend "Janet" from college is an excellent golfer and on the state ladies' golf association board. She plays in tournaments around the state and I admire that she has continued to play at a competitive level after having become a recent survivor from breast cancer.
Girls, get your mammogram. Do it for the people you love even if you don't want to do it for yourself. It might be embarrasing the first time, but you will be treated respectfully and while it is uncomfortable, I can think of other medical tests that are less pleasant. If you are without insurance or have low income, your local health department and community hospital can help! For many, there are no costs involved.
One of the benefits of feeling better is being able to mow again. Mowing is something I have enjoyed in my adult life. Plenty of sunshine makes me feel wonderful! I also have time to think about a lot of things and it is a wonderful time to nourish my spiritual condition. This is a very important thing to do at this time in my life with many major changes in process. Being able to mow gives me time to be reflective and mindful of what needs to be done, not only for myself, but for others as well.
I am trying to be a good daughter as we go through my father's final illness. I'm learning many lessons about myself and about taking care of myself. One of the things I have been learning is to take much better care of myself. Today I was sore, decided I shouldn't play golf because of being sore, and I still had a lot of mowing to do. I have a lot to mow to begin with, and I have begun doing Mother and Dad's home so there is one less thing my mama has to worry about.
While I was out there mowing my Mother's huge yard, once again I had my "fingers forcibly pressed upon that firey braile alphabet (Tennessee Williams, Glass Menagarie)" and experienced a uniquely female experience that is uncomfortable. Too much bounce to the ounce. I wasn't wearing a bra and I need to when I mow. I had my diamond ring on as I usually do but neglected to put it away because of being in a hurry to get their place done and finish up mine. It takes almost five and half hours to do it all.
As I mentioned this gives me plenty of time to meditate and contemplate things that I often don't have the time to think about otherwise. I'm soaking up the sunshine and thinking about things personal and things impersonal.
Sometimes it is a spiritual discipline and I think of the matters that are greater than myself. I spent some time on this today. I thought about those who need help and asked for help for them. I think about the many things I'm grateful for. I think about what I need to do and take responsibility for in order to improve my overall wellbeing.I spent some time thinking about why so many of us in our community experience low self esteem. I think it develops as a result of our realization that we are different from others, even before we know what that difference is. So we are speaking of people at a very young age when this begins. We know we are different from other boys and girls and we intuitively recognize that most often being different equals bad, especially when the differences are pointed out frequently in something said by the ones important in our lives such as "Why can't you be more like.....??" If you hear that a lot, especially the younger you are, it's going to create feelings that you aren't ok to begin with and then soon after you discover what that difference is. You aren't like the other boys who you are supposed to be like, and you aren't like the other girls who you feel you are like. Quite the internal conflict for a very young person, isn't it?
After a while, it becomes more and more apparent to others and is pointed out to the young person. "You need to act like this because boys...... or don't do that, you are acting like a girl...." Generally, people in this situation are often physically and emotionally abused and sometimes even sexually abused. It creates very low self esteem if it is allowed to go on. It will have life long consequences for that person if it is not prevented from happening or stopped as soon as it becomes known.
We know that people with low self esteem are much more likely to suffer from depression and anxiety, substance abuse, poor academic and career performance, problems with forming positive and healthy relationships with others, poor self care and increased mortality rates due to suicide and accidents (because people who don't care about themselves aren't careful about their activities). Even when these people are relatively successful in various areas of their life such as career or a sport or with a good relationship, they often have difficulty in seeing themselves as being successful in these endeavors.
Low self esteem is often difficult to treat because it presents in so many different ways as I have pointed out. We professionals tend to treat the symptoms and often don't address the low self esteem that creates the problems. That happens because individuals with low self esteem frequently are unable to identify why they have low self esteem. They know they have it, they need help identifying the lies that were told to them about themselves as well as the ones they told themselves and bought in to so much that it has become their reality and their "truth" about themselves.
The hard part is being vigilent in identifying these negative beliefs and especially being comitted to replace the self deception with more objective and healthy beliefs about oneself. Yes, we all have things we do poorly, never did well at, and most likely never will. And, that's ok. We have to be objective enough to be ok with that. For example, I will never get to be a medical doctor because of my inability to be able to perform math well enough to have that career, but I have a wonderful career as a therapist, I have been able to help untold numbers of people directly and indirectly. I know I have saved peoples' lives. It's been a very satisfying career for me. I don't dwell on the failure of not becoming a doctor. I am also a very caring person and I go out of my way to help others if at all possible.
The failure is in not also recognizing that we are amazing women in other ways than what we are not good at and being able to celebrate ourselves for those wonderful things that make us good people. Its our responsibility to recognize these wonderful things and to take joy in these qualities. We need to recognize there is nothing wrong with being a transsexual. That took me awhile until I took the responsibility to change how I felt about myself. How about you?
Saturday, December 24, 2011
To Your Health!
One of the more important things that I am both personally and professionally concerned with is the status of our overall well being. It worries me that we don't pay enough attention to our general health and worry most about getting HRT and the surgeries that we want to feel complete. Many of us ignore our health towards this goal by obtaining black market hormones off the street or from pharmacies that sell on line that don't even require a prescription. We don't really know what we are getting from these sources, but the imperative to move our bodies towards a better fit with our minds allows us to take risks risks with our health we would never consider doing otherwise regarding the rest of our health care. It is not entirely our fault, but we share some of the responsibility for this conundrum. 
It has been notoriously difficult to find therapists, physicians and other health care providers to provide the care we need, yet more and more health care professionals are willing to treat us and more and more insurance companies are willing to pay for some, if not all of our health care needs on a parity to that comparable with other diagnoses. Many health care systems offer financial assistance based on income. There are also free clinics in many communities that offer health care to those who work, have no insurance and are of limited income.
When I began working with transsexuals, way before I ever considered that it would be possible for me to transition, I was the only therapist who provided transgender care for the greater part of Virginia. I had one resource for a physician who provided HRT for my male to female patients. I had no resources for my female to male patients, but I had never encountered one until the last 4 years and I was able to find a doctor willing to provide his care.
Today I have developed resources for my patients that include the psychotherapy I provide, substance abuse treatment, treatment for co occurring mental health problems and second letter evaluations (psychiatry), primary care, endocrinology, aesthetic dermatology and voice therapy. Generally, we think of male to female people benefiting from voice therapy, but female to male people can benefit from this service as well. That is because communication within our gender identity does not only include the pitch, tone and inflection, of our voices, but it also includes non verbal communication such as gestures and body movement.
For whatever reason, even if you decide to go the DIYS (do it yourself) HRT route, there are some things that are absolutely necessary and should not be neglected.Please do these to maintain your good health!
1. Blood work: We need to have some blood work done twice a year when first beginning hormone reassignment therapy and after full induction, at least once a year. These tests include a metabolic panel to check the functioning of your organs. The liver and kidneys are particularly stressed by hormone therapy. Having a lipid panel is important as well because hormones can elevate cholesterol and raise the risk of coronary artery disease.
2. Depression, anxiety and substance abuse: These problems are epidemic in our community and we have an overall suicide rate of 41% of those who have attempted suicide at least once. People of color have a much higher rate of attempted suicide than that reported overall.
3. Substance abuse is a particularly severe problem for us and exacerbates depression and anxiety and is often a huge factor in attempted suicides. It has been difficult for us to find substance abuse treatment that is sensitive to us as individuals, but this has been an emphasised area for improvement among substance abuse treatment professionals. This problem is taking too many good brothers and sisters away from us. It is so unnecessary too. There are 12 step programs available. They work for more people than anything else. Check out Alcoholics Anonymous
or Narcotics Anonymous
. Click on these links to find a meeting near you! http://aa.org/ or http://na.org/ . Some of the groups in some localities are for GLBT people specifically, if you don't feel comfortable with another type of meeting, but if there aren't any of those type meetings available in your area, please don't make that the excuse to not get the help you need. It is truly a matter of life and death.
4. Don't forget your annual mammography! While we generally have a lower rate of breast cancer than genetic women, we are at higher risk with family histories of our moms, sisters and aunts having had breast cancer, especially if they had one of the mutations that cause the more aggressive breast cancers. It is really a painless procedure and will be a life saver. Then there are a couple of tests that we hate as a reminder of having a body we felt was wrong for us. We still have to have the digital examination of our prostate glands. While the risk is reduced, we still are at risk for prostate cancer as we age, even though estrogen and progesterone are treatments used to slow the growth of prostate cancer. We also need to have the PSA blood test done on a yearly basis.
For the guys, it is important to continue to get that pelvic regularly along with a pap smear, and even if you have had a hysterectomy and oopherectomy, you will still need that done periodically, perhaps not as often.
5. See your dermatologist once a year, especially if you have had heavy sun exposure or have a history of skin cancer in your family. It is imperative that you do this yearly if you have has any relatives who had malignant melanoma. This is an extremely dangerous skin cancer and it is too often the case that when it is finally found, it is often too advanced to be successfully treated.
6. See your dentist twice a year! People who are able to keep their own teeth are healthier and live longer. Poor dental health can often lead to heart disease.
7. Don't smoke! It is the most difficult of all addictions to overcome, but it can be done! Smoking is a deceptive addiction, because it doesn't kill you as quickly as some other addictions, but the long term health consequences are devastating and are well known.
8. If you use alcohol, please use it in moderation. Alcohol in any quantity has negative effects on every tissue and organ in the body and is one of the more deadly addictions. Alcohol causes many ruined relationships and injuries due to accidents as well as fatalities. Know when you have had too much and don't be too proud to ask for someone else to drive or take you home. There is no shame in that and it may save some one's life if not your very own life.
9. Get some exercise daily! Even if you can just take 30 minutes and go for a brisk walk, it will improve your overall health as well as cardiac health. It will help you with weight control as well.
10. Be sure to laugh every day! Enjoying humor has been known to benefit general health and one's outlook. Cultivate a positive attitude. It is part of being healthy and attracting positive people. It will be part of being successful and happy in your own life. Smile! positive people are attracted to people who smile and are interested in their well being too.
11. Do something for someone else. It is good for one's outlook and overall attitude to do something nice for someone else. It doesn't have to be anything big, just look for that little opportunity to do something special to help someone else. The return will be ten times what it took to do that little helpful or kind thing!
I hope that you all have a happy and healthy 2012!
It has been notoriously difficult to find therapists, physicians and other health care providers to provide the care we need, yet more and more health care professionals are willing to treat us and more and more insurance companies are willing to pay for some, if not all of our health care needs on a parity to that comparable with other diagnoses. Many health care systems offer financial assistance based on income. There are also free clinics in many communities that offer health care to those who work, have no insurance and are of limited income.
When I began working with transsexuals, way before I ever considered that it would be possible for me to transition, I was the only therapist who provided transgender care for the greater part of Virginia. I had one resource for a physician who provided HRT for my male to female patients. I had no resources for my female to male patients, but I had never encountered one until the last 4 years and I was able to find a doctor willing to provide his care.
Today I have developed resources for my patients that include the psychotherapy I provide, substance abuse treatment, treatment for co occurring mental health problems and second letter evaluations (psychiatry), primary care, endocrinology, aesthetic dermatology and voice therapy. Generally, we think of male to female people benefiting from voice therapy, but female to male people can benefit from this service as well. That is because communication within our gender identity does not only include the pitch, tone and inflection, of our voices, but it also includes non verbal communication such as gestures and body movement.
For whatever reason, even if you decide to go the DIYS (do it yourself) HRT route, there are some things that are absolutely necessary and should not be neglected.Please do these to maintain your good health!
1. Blood work: We need to have some blood work done twice a year when first beginning hormone reassignment therapy and after full induction, at least once a year. These tests include a metabolic panel to check the functioning of your organs. The liver and kidneys are particularly stressed by hormone therapy. Having a lipid panel is important as well because hormones can elevate cholesterol and raise the risk of coronary artery disease.
2. Depression, anxiety and substance abuse: These problems are epidemic in our community and we have an overall suicide rate of 41% of those who have attempted suicide at least once. People of color have a much higher rate of attempted suicide than that reported overall.
3. Substance abuse is a particularly severe problem for us and exacerbates depression and anxiety and is often a huge factor in attempted suicides. It has been difficult for us to find substance abuse treatment that is sensitive to us as individuals, but this has been an emphasised area for improvement among substance abuse treatment professionals. This problem is taking too many good brothers and sisters away from us. It is so unnecessary too. There are 12 step programs available. They work for more people than anything else. Check out Alcoholics Anonymous
. Click on these links to find a meeting near you! http://aa.org/ or http://na.org/ . Some of the groups in some localities are for GLBT people specifically, if you don't feel comfortable with another type of meeting, but if there aren't any of those type meetings available in your area, please don't make that the excuse to not get the help you need. It is truly a matter of life and death.
4. Don't forget your annual mammography! While we generally have a lower rate of breast cancer than genetic women, we are at higher risk with family histories of our moms, sisters and aunts having had breast cancer, especially if they had one of the mutations that cause the more aggressive breast cancers. It is really a painless procedure and will be a life saver. Then there are a couple of tests that we hate as a reminder of having a body we felt was wrong for us. We still have to have the digital examination of our prostate glands. While the risk is reduced, we still are at risk for prostate cancer as we age, even though estrogen and progesterone are treatments used to slow the growth of prostate cancer. We also need to have the PSA blood test done on a yearly basis.
For the guys, it is important to continue to get that pelvic regularly along with a pap smear, and even if you have had a hysterectomy and oopherectomy, you will still need that done periodically, perhaps not as often.
5. See your dermatologist once a year, especially if you have had heavy sun exposure or have a history of skin cancer in your family. It is imperative that you do this yearly if you have has any relatives who had malignant melanoma. This is an extremely dangerous skin cancer and it is too often the case that when it is finally found, it is often too advanced to be successfully treated.
6. See your dentist twice a year! People who are able to keep their own teeth are healthier and live longer. Poor dental health can often lead to heart disease.
7. Don't smoke! It is the most difficult of all addictions to overcome, but it can be done! Smoking is a deceptive addiction, because it doesn't kill you as quickly as some other addictions, but the long term health consequences are devastating and are well known.
8. If you use alcohol, please use it in moderation. Alcohol in any quantity has negative effects on every tissue and organ in the body and is one of the more deadly addictions. Alcohol causes many ruined relationships and injuries due to accidents as well as fatalities. Know when you have had too much and don't be too proud to ask for someone else to drive or take you home. There is no shame in that and it may save some one's life if not your very own life.
9. Get some exercise daily! Even if you can just take 30 minutes and go for a brisk walk, it will improve your overall health as well as cardiac health. It will help you with weight control as well.
10. Be sure to laugh every day! Enjoying humor has been known to benefit general health and one's outlook. Cultivate a positive attitude. It is part of being healthy and attracting positive people. It will be part of being successful and happy in your own life. Smile! positive people are attracted to people who smile and are interested in their well being too.
11. Do something for someone else. It is good for one's outlook and overall attitude to do something nice for someone else. It doesn't have to be anything big, just look for that little opportunity to do something special to help someone else. The return will be ten times what it took to do that little helpful or kind thing!
I hope that you all have a happy and healthy 2012!
Friday, November 4, 2011
Practicing What I Preach: My Life With the WPATH SOC
I'm sure that some people must imagine that because I am a therapist that I can scoot around the Standards of Care and get what I want using my professional connections with other professionals who work with trans people, but I don't believe that would be in my best interest for my own health care. So I abide with the Standards of Care in my own life. Would you want to have open heart surgery by a doctor who didn't have a standard of care for that procedure?
I have been an advocate for the Standards of Care long before I became a member of WPATH. I know that some people deeply resent the existence of a standard of care and being required to follow a process. Consider this though; The National Center For Transgender Equality (Transequality.org) and The National Gay and Lesbian Task Force commissioned a survey that reported a number of terribly sad statistics of what many of us have experienced, some things I have personally experienced over the years. 41% of trans people who were surveyed had attempted suicide at least once as opposed to the general public whose rate of attempted suicide is only 1.6%. For those of us who are unemployed, lost a job due to discrimination, or have been forced into sex work, the rates are much higher and for people of color the attempted suicide is 49%. I find these rates appalling and unacceptable.
Addiction and substance abuse are also terrible problems for us. 70% of the survey reported current problems with substances overall. 3% have been denied access to substance abuse treatment programs and 4% have experienced mistreatment while participating in substance abuse treatment programs. As a professional who also has spent a significant part of my practice in substance abuse treatment, I recognize that it can be absolutely crucial to catch a person at the moment they are willing to get into treatment or that moment will be lost and not come around for quite a long time, if ever. If you miss that opportunity, it could literally be fatal. 25% experienced either denial of care or being treated poorly by doctors' offices or hospitals and 16% were denied help or were mistreated in emergency rooms. 12% reported denial of help or were mistreated in mental health clinics. Simply unacceptable.
Another reason to seek out healthcare professionals who use the framework of the Standards of Care is because of the discrimination we face from healthcare professionals which bothers me quite a bit both personally and especially as a health care professional. Professionals who use the standards to guide practice will likely have a network of local health care providers who can be sure that you have equal access and are treated with the dignity any person is due.
Half of us report we have had to educate health care professionals on our needs and how to treat us. Fortunately, there is a national effort directed by the National Institutes of care to educate the health care community to provide us with competent care. Having WPATH's Standard of Care, provides health care professionals a quick way to get up to speed on how to work with trans people.
One of the pitfalls that some health care professionals fall into is solely relying on the standards and not tailoring them to the needs of the individual. The SOC clearly state that they are not to be rigidly used and state they are a guide to practice. They were not meant to be followed by rote with each patient. Often in the beginning of the learning curve, a professional will tend to rely on them more often ver batim, but as experience is gained the professional often feels more comfortable in relying on their own clinical judgement. I think that I would prefer a practioner who followed them as written rather than practicing in ignorance and possibly making a serious mistake in my own care.
SO all in all, I think having the WPATH SOC benefits us and that is why I use them personally and professionally.
I have been an advocate for the Standards of Care long before I became a member of WPATH. I know that some people deeply resent the existence of a standard of care and being required to follow a process. Consider this though; The National Center For Transgender Equality (Transequality.org) and The National Gay and Lesbian Task Force commissioned a survey that reported a number of terribly sad statistics of what many of us have experienced, some things I have personally experienced over the years. 41% of trans people who were surveyed had attempted suicide at least once as opposed to the general public whose rate of attempted suicide is only 1.6%. For those of us who are unemployed, lost a job due to discrimination, or have been forced into sex work, the rates are much higher and for people of color the attempted suicide is 49%. I find these rates appalling and unacceptable.
Addiction and substance abuse are also terrible problems for us. 70% of the survey reported current problems with substances overall. 3% have been denied access to substance abuse treatment programs and 4% have experienced mistreatment while participating in substance abuse treatment programs. As a professional who also has spent a significant part of my practice in substance abuse treatment, I recognize that it can be absolutely crucial to catch a person at the moment they are willing to get into treatment or that moment will be lost and not come around for quite a long time, if ever. If you miss that opportunity, it could literally be fatal. 25% experienced either denial of care or being treated poorly by doctors' offices or hospitals and 16% were denied help or were mistreated in emergency rooms. 12% reported denial of help or were mistreated in mental health clinics. Simply unacceptable.
Another reason to seek out healthcare professionals who use the framework of the Standards of Care is because of the discrimination we face from healthcare professionals which bothers me quite a bit both personally and especially as a health care professional. Professionals who use the standards to guide practice will likely have a network of local health care providers who can be sure that you have equal access and are treated with the dignity any person is due.
Half of us report we have had to educate health care professionals on our needs and how to treat us. Fortunately, there is a national effort directed by the National Institutes of care to educate the health care community to provide us with competent care. Having WPATH's Standard of Care, provides health care professionals a quick way to get up to speed on how to work with trans people.
One of the pitfalls that some health care professionals fall into is solely relying on the standards and not tailoring them to the needs of the individual. The SOC clearly state that they are not to be rigidly used and state they are a guide to practice. They were not meant to be followed by rote with each patient. Often in the beginning of the learning curve, a professional will tend to rely on them more often ver batim, but as experience is gained the professional often feels more comfortable in relying on their own clinical judgement. I think that I would prefer a practioner who followed them as written rather than practicing in ignorance and possibly making a serious mistake in my own care.
SO all in all, I think having the WPATH SOC benefits us and that is why I use them personally and professionally.
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