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 Alcoholism. Show all posts
Showing posts with label Alcoholism. 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/
Subscribe to:
Posts (Atom)