11 ms·

> But they mean it in the sense that they should be in an asylum or should not be catered to. I have often heard it in a sense of "should not be catered to but

by hh3k0 6y ago

> But they mean it in the sense that they should be in an asylum or should not be catered to. I have often heard it in a sense of "should not be catered to but rather given medical help". A fellow student once told me that he considers the current way of treating gender dysphoria irresponsible and that, if we'd treat schizophrenia the way we treat gender dysphoria, we'd all have to aknowledge the voices they hear and pretend we hear them too. I didn't know how to respond to that. I still don't, actually. My knowledge about anything mental health is quite limited.

vmception 6y ago
that response honestly sounds like he is referring to a caricature of schizophrenia as the ultimate ignorable and irreconcilable mental health disorder and doesn't actually know how we treat schizophrenia either how do we treat schizophrenia? it is something that can also be managed thats the primary limitation of the analogy. the secondary limitation of the analogy is that un-ironically accepting pronouns that otherwise bend the English language really costs us nothing, and gives us productive members of society instead of marginalized.
trans-stealth 6y ago
> if we'd treat schizophrenia the way we treat gender dysphoria, we'd all have to aknowledge the voices they hear and pretend we hear them too. Transgender people have existed in some form for a long time, the medicalization of it only started in the late 19th + early 20th century. The difference I see between the two is that there isn't a known 'fix' for gender dysphoria besides transition. I don't think any trans person would protest to never having to go through transition... but they definitely don't advocate for extermination of trans people either. There are plausible biological causes for being transgender that are parallel but not equal to intersex issues.
- deleted 6y ago
  [deleted]
zaksoup 6y ago
> "If we'd treat schizophrenia the way we treat gender dysphoria, we'd all have to acknowledge the voices they hear and pretend we hear them too." This is easy to dismiss by pointing to evidence based treatment practices. The treatment which is most effective at reducing suicide rates among people experiencing gender dysphoria is gender affirming care [0]. I doubt it is the case that the treatment that is most effective at helping folks experiencing schizophrenia is "acknowledging the voices" (not to mention as sibling commenters have that this is a gross caricature of schizophrenia in the first place). It's extremely strange to me that we pretend like gender affirming care is "everybody pretending" and not a well studied and evidence based set of treatments that has been shown to be effective. [0] https://www.thetrevorproject.org/2020/01/29/research-brief-gender-affirming-care-for-youth/ https://www.thetrevorproject.org/2020/01/29/research-brief-g...
- vmception 6y ago
  can anyone shed light on why this comment is controversial, compared to all the sibling, parent and cousin comments?
- hh3k0 6y ago
  Thank you for your reply. I have to work but will make sure to read the link you provided on my tablet before hitting the hay tonight.
jcims 6y ago
> I have often heard it in a sense of "should not be catered to but rather given medical help". The thing i worry about is that folks that go through all of the physical and emotional (and financial) stress of transitioning only to find that it doesn’t soothe the pain are likely to perceive a social pressure to keep a lid on it. The current trend of acceptance is obviously good but it seems likely our approach to treatment will evolve over time.
- trans-stealth 6y ago
  > The thing i worry about is that folks that go through all of the physical and emotional (and financial) stress of transitioning only to find that it doesn’t soothe the pain are likely to perceive a social pressure to keep a lid on it. Nope, "de-transitioners" are very welcome in the trans community, to tell their story, to hang out, to help others. There's absolutely nothing that should force them to not speak out about their experiences as long as they treat others with basic respect; there are a few that have turned religious zealot and sue people. Detransiton / desisting is relatively rare and frequently happens not because the person desisted trans identity but because they couldn't feasibly continue to transition due social or financial causes.
  - jcims 6y ago
    That’s great to hear, thank you.
  - musingsole 6y ago
    I find your broad "nope" troubling. How are you so comfortable speaking for the entirety of several others' experiences? (While problematic) the nature of the gp's claim would be impossible to prove or disprove without mind reading powers. Even if many or most trans-accepting groups make an active effort to support those with regrets...the social pressures for someone to not voice those regrets are blatantly obvious.
    - klyrs 6y ago
      I know a couple of folks who transitioned thusly, retained their trans friends and continue to hang out in the community. For one, I was present during one's "de"-transition (it's just a transition). It went fine, because the community I know is supportive of how folks identify their gender. They talked about not feeling right for a few months, later announced that their pronouns were changing, so we supported them when they felt off and changed pronouns when asked. It was a fairly simple matter, really. It's not uncommon for trans / nonbinary people to experience fluidity over short or long time periods, and "de"-transition is on that spectrum. No biggie, the world keeps turning and we're there for eachother. Notably, I've heard one such person say something along the lines of "well, no, I'm not cisgender, I transitioned twice so I'm definitely trans." Labels are pretty silly that way.
XorNot 6y ago
People making claims like that generally no nothing of the procedure by which mental health issues are diagnosed - which is to say, mental health treatment is about addressing issues which are negatively affecting someone's quality of life, until they are not. This is the same reason you can't just go through the DSM V and ascribe mental health conditions to people on TV or in the media or whatnot - it doesn't work that way. People who hear voices don't have a problem because they hear voices, they have a problem because in general schizophrenia presents those voices as hostile and aggressive towards the person. People who hear voices that are positive or helpful (which is not uncommon, though it seems to be less common in Western culture socialized people) don't have a problem, probably don't even need treatment if they do not cause any distress. That trans-people live happier lives after transitioning means that the treatment they receive (hormones,gender reassignment surgery, remembering that all of those are quite optional) is completely adequate.
- eanzenberg 6y ago
  Don’t they have much higher suicide rates? How happy can that be?
  - deleted 6y ago
    [deleted]
  - ceejayoz 6y ago
    Abused children also have high suicide rates, but that's presumably not because of some inherent internal tendency to suicide, right?
    - bobthechef 6y ago
      Not a question of inherent tendency but cause of. Those who have elected to adapt to their convictions through surgery, hormones, etc. still have very high suicide rates. The studies (I don’t have them handy) undermine the notion that the increased risk and incidence of suicide of “pre-transition” individuals with gender dysphoria are suicidal because they’re “forced” to live in a way that seems to then to be at odds with how they feel. But we find that “post-transition” we still see high rates. Some claim that this is because of the environment, but I believe that was also addressed and found unconvincing. On the other hand, I have heard therapy for gender dysphoria (GD), such as that which addresses GD in children, can be highly effective in resolving whatever issues that are causing the confusion in the first place.
ceejayoz 6y ago
> if we'd treat schizophrenia the way we treat gender dysphoria, we'd all have to aknowledge the voices they hear and pretend we hear them too That might not be the worst idea. https://www.theatlantic.com/health/archive/2014/07/when-hearing-voices-is-a-good-thing/374863/ https://www.theatlantic.com/health/archive/2014/07/when-hear... > But a new study suggests that the way schizophrenia sufferers experience those voices depends on their cultural context. Surprisingly, schizophrenic people from certain other countries don't hear the same vicious, dark voices that Holt and other Americans do. Some of them, in fact, think their hallucinations are good—and sometimes even magical. > In an article for the American Scholar, Luhrmann describes one such patient, a 20-year-0ld Dutch man named Hans, whose inner voices were urging him to study Buddhism for hours each day. He cut a deal with his demons, telling them he'd say Buddhist prayers for one hour per day, no more, no less. And it worked—the voices subsided and he was able to taper his dose of psychosis medications.
geofft 6y ago
I'd like to argue a little bit for treating the voices in your head as real. There is a phenomenon of "plurality" where you perceive yourself as a system of multiple people/personas with unique personalities and interests and identities. Psychologists would generally classify patients who show up this way as having dissociative identity disorder - but only if they meet the criterion of the symptoms causing distress/affecting your lives, and many plural systems seem to be just fine with it. https://www.reddit.com/r/plural/wiki/faqs https://www.reddit.com/r/plural/wiki/faqs is probably a good starting point for reading about it from an inside-the-community view. (There's a plural community for essentially the same reasons that there's a transgender community.) https://smallcedarforest.org/on-transgender-and-plural-experience/ https://smallcedarforest.org/on-transgender-and-plural-exper... is an interesting post from someone who connects plural and transgender identity. (FWIW, the one person I know IRL who is out about being plural is also trans.) Going further back, we have stories across cultures of people who (either positively or negatively) claimed the ability to communicate internally with other personalities/identities, and occasionally those personalities would "front" (in the language of the contemporary plural community). And then, of course, there's the case of the woman who heard voices insisting that she get a CT scan. Her psychologist, who was giving her medication to suppress the voices, decided to do the scan just to prove she was fine - and she had cancer that required operation. When she woke up after surgery, they said, "We are pleased to have helped you. Goodbye," and they never returned. https://www.researchgate.net/publication/232271307_A_difficult_case_Diagnosis_made_by_hallucinatory_voices https://www.researchgate.net/publication/232271307_A_difficu... And while I was trying to find that story, I found this one, of an organization that helps people who hear voices in their heads by telling them the voices are real and helping them work through it: https://www.minnpost.com/mental-health-addiction/2014/04/most-helpful-thing-voice-hearer-heard-voices-are-real/ https://www.minnpost.com/mental-health-addiction/2014/04/mos...
ThrowawayR2 6y ago
While carefully not expressing an opinion one way or the other, a more clear-cut example might be body integrity dysphoria: https://en.wikipedia.org/wiki/Body_integrity_dysphoria https://en.wikipedia.org/wiki/Body_integrity_dysphoria, in which some feel that parts of their body are alien to them and should be removed. Should people support those who have this dysphoria and allow them to proceed or do the negatives outweigh the positives?
- rodgerd 6y ago
  If it reliably produces better outcomes why wouldn't you? What next, prevent women from having tubal ligation because you're offended that they don't want children?
rhinoceraptor 6y ago
> should not be catered to but rather given medical help Would they say the same for gay people? It wasn't that long ago that being gay was considered a mental disorder in need of fixing.
DanBC 6y ago
> I didn't know how to respond to that. Ask him why WHO and the UN are working on depathologization of transgender, trying to remove it from diagnostic manuals. Ask him what breakout symptoms in schizophrenia are, and why we think it's better that people continue to hear voices (so long as they're not distressing) than be medicated so heavily all voices disappear.
tchaffee 6y ago
You could try this response: treating every every mental health issue as a hallucination is similar to treating every medical issue as a heart attack. As an example, treating depression as if it were the same as hearing voices would hurt the person and be medically irresponsible. And since you wouldn't offer to do heart surgery on a friend, you should also stop trying to be people's psychologist until you are trained and qualified.
odessacubbage 6y ago
if we treated gender identity disorders the way we treated schizophrenia we would consider them to be credible & serious conditions that require medical intervention at an early age as opposed trying to pretend they'll go away if you close your eyes long enough.
- raxxorrax 6y ago
  I believe parents subjecting their children aged 5-9 to hormone treatments are abusers running after a trend. Schizophrenia usually develops after puberty, previous cases can happen but are extremely rare. The parents decision ultimately, but I don't see the advantage of medical interventions for anything related to gender "at an early age".
  - DanBC 6y ago
    You must think doctors are fucking idiots if you think they're handing out hormones to pre-pubertal children on the say so of a parent.
    - raxxorrax 6y ago
      Unfortunately there are private clinics practicing this very thing despite a majority of people growing out of their desire to transition at a later age. Medical abuse is not unprecedented. I believe it to plain child abuse and propose the the children affected get some legal support for possible recourse.
      - DanBC 6y ago
        This is nonsense.
        raxxorrax 6y ago
        Maybe, in that case giving them a possible vehicle to defend themselves shouldn't pose a problem. And that includes holding parents and practitioners accountable.

by hh3k0 6y ago

vmception 6y ago

that response honestly sounds like he is referring to a caricature of schizophrenia as the ultimate ignorable and irreconcilable mental health disorder and doesn't actually know how we treat schizophrenia either how do we treat schizophrenia? it is something that can also be managed thats the primary limitation of the analogy. the secondary limitation of the analogy is that un-ironically accepting pronouns that otherwise bend the English language really costs us nothing, and gives us productive members of society instead of marginalized.

trans-stealth 6y ago

> if we'd treat schizophrenia the way we treat gender dysphoria, we'd all have to aknowledge the voices they hear and pretend we hear them too. Transgender people have existed in some form for a long time, the medicalization of it only started in the late 19th + early 20th century. The difference I see between the two is that there isn't a known 'fix' for gender dysphoria besides transition. I don't think any trans person would protest to never having to go through transition... but they definitely don't advocate for extermination of trans people either. There are plausible biological causes for being transgender that are parallel but not equal to intersex issues.

deleted 6y ago
[deleted]

zaksoup 6y ago

> "If we'd treat schizophrenia the way we treat gender dysphoria, we'd all have to acknowledge the voices they hear and pretend we hear them too." This is easy to dismiss by pointing to evidence based treatment practices. The treatment which is most effective at reducing suicide rates among people experiencing gender dysphoria is gender affirming care [0]. I doubt it is the case that the treatment that is most effective at helping folks experiencing schizophrenia is "acknowledging the voices" (not to mention as sibling commenters have that this is a gross caricature of schizophrenia in the first place). It's extremely strange to me that we pretend like gender affirming care is "everybody pretending" and not a well studied and evidence based set of treatments that has been shown to be effective. [0] https://www.thetrevorproject.org/2020/01/29/research-brief-gender-affirming-care-for-youth/ https://www.thetrevorproject.org/2020/01/29/research-brief-g...

vmception 6y ago
can anyone shed light on why this comment is controversial, compared to all the sibling, parent and cousin comments?
hh3k0 6y ago
Thank you for your reply. I have to work but will make sure to read the link you provided on my tablet before hitting the hay tonight.

jcims 6y ago

> I have often heard it in a sense of "should not be catered to but rather given medical help". The thing i worry about is that folks that go through all of the physical and emotional (and financial) stress of transitioning only to find that it doesn’t soothe the pain are likely to perceive a social pressure to keep a lid on it. The current trend of acceptance is obviously good but it seems likely our approach to treatment will evolve over time.

trans-stealth 6y ago
> The thing i worry about is that folks that go through all of the physical and emotional (and financial) stress of transitioning only to find that it doesn’t soothe the pain are likely to perceive a social pressure to keep a lid on it. Nope, "de-transitioners" are very welcome in the trans community, to tell their story, to hang out, to help others. There's absolutely nothing that should force them to not speak out about their experiences as long as they treat others with basic respect; there are a few that have turned religious zealot and sue people. Detransiton / desisting is relatively rare and frequently happens not because the person desisted trans identity but because they couldn't feasibly continue to transition due social or financial causes.
- jcims 6y ago
  That’s great to hear, thank you.
- musingsole 6y ago
  I find your broad "nope" troubling. How are you so comfortable speaking for the entirety of several others' experiences? (While problematic) the nature of the gp's claim would be impossible to prove or disprove without mind reading powers. Even if many or most trans-accepting groups make an active effort to support those with regrets...the social pressures for someone to not voice those regrets are blatantly obvious.
  - klyrs 6y ago
    I know a couple of folks who transitioned thusly, retained their trans friends and continue to hang out in the community. For one, I was present during one's "de"-transition (it's just a transition). It went fine, because the community I know is supportive of how folks identify their gender. They talked about not feeling right for a few months, later announced that their pronouns were changing, so we supported them when they felt off and changed pronouns when asked. It was a fairly simple matter, really. It's not uncommon for trans / nonbinary people to experience fluidity over short or long time periods, and "de"-transition is on that spectrum. No biggie, the world keeps turning and we're there for eachother. Notably, I've heard one such person say something along the lines of "well, no, I'm not cisgender, I transitioned twice so I'm definitely trans." Labels are pretty silly that way.

XorNot 6y ago

People making claims like that generally no nothing of the procedure by which mental health issues are diagnosed - which is to say, mental health treatment is about addressing issues which are negatively affecting someone's quality of life, until they are not. This is the same reason you can't just go through the DSM V and ascribe mental health conditions to people on TV or in the media or whatnot - it doesn't work that way. People who hear voices don't have a problem because they hear voices, they have a problem because in general schizophrenia presents those voices as hostile and aggressive towards the person. People who hear voices that are positive or helpful (which is not uncommon, though it seems to be less common in Western culture socialized people) don't have a problem, probably don't even need treatment if they do not cause any distress. That trans-people live happier lives after transitioning means that the treatment they receive (hormones,gender reassignment surgery, remembering that all of those are quite optional) is completely adequate.

eanzenberg 6y ago
Don’t they have much higher suicide rates? How happy can that be?
- deleted 6y ago
  [deleted]
- ceejayoz 6y ago
  Abused children also have high suicide rates, but that's presumably not because of some inherent internal tendency to suicide, right?
  - bobthechef 6y ago
    Not a question of inherent tendency but cause of. Those who have elected to adapt to their convictions through surgery, hormones, etc. still have very high suicide rates. The studies (I don’t have them handy) undermine the notion that the increased risk and incidence of suicide of “pre-transition” individuals with gender dysphoria are suicidal because they’re “forced” to live in a way that seems to then to be at odds with how they feel. But we find that “post-transition” we still see high rates. Some claim that this is because of the environment, but I believe that was also addressed and found unconvincing. On the other hand, I have heard therapy for gender dysphoria (GD), such as that which addresses GD in children, can be highly effective in resolving whatever issues that are causing the confusion in the first place.

ceejayoz 6y ago

> if we'd treat schizophrenia the way we treat gender dysphoria, we'd all have to aknowledge the voices they hear and pretend we hear them too That might not be the worst idea. https://www.theatlantic.com/health/archive/2014/07/when-hearing-voices-is-a-good-thing/374863/ https://www.theatlantic.com/health/archive/2014/07/when-hear... > But a new study suggests that the way schizophrenia sufferers experience those voices depends on their cultural context. Surprisingly, schizophrenic people from certain other countries don't hear the same vicious, dark voices that Holt and other Americans do. Some of them, in fact, think their hallucinations are good—and sometimes even magical. > In an article for the American Scholar, Luhrmann describes one such patient, a 20-year-0ld Dutch man named Hans, whose inner voices were urging him to study Buddhism for hours each day. He cut a deal with his demons, telling them he'd say Buddhist prayers for one hour per day, no more, no less. And it worked—the voices subsided and he was able to taper his dose of psychosis medications.

geofft 6y ago

I'd like to argue a little bit for treating the voices in your head as real. There is a phenomenon of "plurality" where you perceive yourself as a system of multiple people/personas with unique personalities and interests and identities. Psychologists would generally classify patients who show up this way as having dissociative identity disorder - but only if they meet the criterion of the symptoms causing distress/affecting your lives, and many plural systems seem to be just fine with it. https://www.reddit.com/r/plural/wiki/faqs https://www.reddit.com/r/plural/wiki/faqs is probably a good starting point for reading about it from an inside-the-community view. (There's a plural community for essentially the same reasons that there's a transgender community.) https://smallcedarforest.org/on-transgender-and-plural-experience/ https://smallcedarforest.org/on-transgender-and-plural-exper... is an interesting post from someone who connects plural and transgender identity. (FWIW, the one person I know IRL who is out about being plural is also trans.) Going further back, we have stories across cultures of people who (either positively or negatively) claimed the ability to communicate internally with other personalities/identities, and occasionally those personalities would "front" (in the language of the contemporary plural community). And then, of course, there's the case of the woman who heard voices insisting that she get a CT scan. Her psychologist, who was giving her medication to suppress the voices, decided to do the scan just to prove she was fine - and she had cancer that required operation. When she woke up after surgery, they said, "We are pleased to have helped you. Goodbye," and they never returned. https://www.researchgate.net/publication/232271307_A_difficult_case_Diagnosis_made_by_hallucinatory_voices https://www.researchgate.net/publication/232271307_A_difficu... And while I was trying to find that story, I found this one, of an organization that helps people who hear voices in their heads by telling them the voices are real and helping them work through it: https://www.minnpost.com/mental-health-addiction/2014/04/most-helpful-thing-voice-hearer-heard-voices-are-real/ https://www.minnpost.com/mental-health-addiction/2014/04/mos...

ThrowawayR2 6y ago

While carefully not expressing an opinion one way or the other, a more clear-cut example might be body integrity dysphoria: https://en.wikipedia.org/wiki/Body_integrity_dysphoria https://en.wikipedia.org/wiki/Body_integrity_dysphoria, in which some feel that parts of their body are alien to them and should be removed. Should people support those who have this dysphoria and allow them to proceed or do the negatives outweigh the positives?

rodgerd 6y ago
If it reliably produces better outcomes why wouldn't you? What next, prevent women from having tubal ligation because you're offended that they don't want children?

rhinoceraptor 6y ago

> should not be catered to but rather given medical help Would they say the same for gay people? It wasn't that long ago that being gay was considered a mental disorder in need of fixing.

DanBC 6y ago

> I didn't know how to respond to that. Ask him why WHO and the UN are working on depathologization of transgender, trying to remove it from diagnostic manuals. Ask him what breakout symptoms in schizophrenia are, and why we think it's better that people continue to hear voices (so long as they're not distressing) than be medicated so heavily all voices disappear.

tchaffee 6y ago

You could try this response: treating every every mental health issue as a hallucination is similar to treating every medical issue as a heart attack. As an example, treating depression as if it were the same as hearing voices would hurt the person and be medically irresponsible. And since you wouldn't offer to do heart surgery on a friend, you should also stop trying to be people's psychologist until you are trained and qualified.

odessacubbage 6y ago

if we treated gender identity disorders the way we treated schizophrenia we would consider them to be credible & serious conditions that require medical intervention at an early age as opposed trying to pretend they'll go away if you close your eyes long enough.

raxxorrax 6y ago
I believe parents subjecting their children aged 5-9 to hormone treatments are abusers running after a trend. Schizophrenia usually develops after puberty, previous cases can happen but are extremely rare. The parents decision ultimately, but I don't see the advantage of medical interventions for anything related to gender "at an early age".
- DanBC 6y ago
  You must think doctors are fucking idiots if you think they're handing out hormones to pre-pubertal children on the say so of a parent.
  - raxxorrax 6y ago
    Unfortunately there are private clinics practicing this very thing despite a majority of people growing out of their desire to transition at a later age. Medical abuse is not unprecedented. I believe it to plain child abuse and propose the the children affected get some legal support for possible recourse.
    - DanBC 6y ago
      This is nonsense.
      - raxxorrax 6y ago
        Maybe, in that case giving them a possible vehicle to defend themselves shouldn't pose a problem. And that includes holding parents and practitioners accountable.