35 ms·

I’ll say three things: 1) Someone’s body dysmorphia is not - generally - affirmed or denied by ordinary everyday passing social interactions. In polite society

I’ll say three things: 1) Someone’s body dysmorphia is not - generally - affirmed or denied by ordinary everyday passing social interactions. In polite society, you simply don’t comment on someone’s body composition. Gender is an entirely different matter as it is a constant differentiator in day to day life. Also, in my experience, body dysmorphia has nothing to do with other people’s affirmations. We’ve all seen examples of people getting repeated surgeries to change their appearance because they simply cannot see what everyone else is seeing when they look in the mirror. 2) I think in determining “how to handle it” from the perspective of psychotherapy, we should consider what treatment is considered effective. Psychotherapy is simply not effective at changing someone’s gender identity or ameliorating gender dysphoria. The established treatment for gender dysphoria is to align the person’s gender identity and gender expression. To me, this makes sense when applied to your own life. Therapy might be able to help me realize that my perception of the size of my nose is not accurate, but therapy is not going to be effective at changing my gender identity. Do you feel that your gender identity could be changed using Cognitive Behavioural Therapy? 3) Refer back to the questions that I think should be asked if you find it too difficult to accommodate pronouns: >What do you expect someone who is gender dysphoric to do? What do you believe the appropriate course of action is for someone in that situation? What would you expect or appreciate if you were a person in that situation?

chlodwig 2y ago
Psychotherapy is simply not effective at changing someone’s gender identity or ameliorating gender dysphoria. The established treatment for gender dysphoria is to align the person’s gender identity and gender expression. Can you find a randomized controlled study where the "affirmative" approach of aligning gender expression with identity has been compared to a "reparative" approach of aligning identity with biology? I have read a lot of studies on this and what you are saying simply is not backed by the evidence. Whenever I read a study that has been referenced on NPR or such, I read the details and the details do not support what the people citing the study say it supports. In all other cases, if someone's mental conception of themselves was not aligned with the biological reality of their self, we would say the default is that the person should try to adjust their mental conception. A treatment that involved all of society changing, or even more extreme -- actual removal of body parts -- would need to pass a very high burden of experimental evidence. From what I have read, that burden of proof has not ever been close to being met. There are no studies that say that aligning gender expression works better than helping the person cope with or get over their dysphoria. If I have missed such a study, I would like to read it. Do you feel that your gender identity could be changed using Cognitive Behavioural Therapy? I do not have a gender identity and I do not have a gender. I a sex and I have an identity as a sexed being. I have a brain that has developed under the influence of testosterone, I have the knowledge of having a penis, I have the knowledge that society sees me as a male and penis-haver and all that entails. I have the knowledge that if I used a woman's locker room and exposed my penis, women would freak out, and so I do not do that. Etc. etc. I wear the clothes that I do because that is what society expects of me. There are all sorts of clothes and outfits from other cultures that I prefer aesthetically but I don't wear because they do not align with the norms of my current culture. It's actually really difficult for me to understand how a person's fundamental well-being is intrinsically and immalleably tied to names and clothing. Of all the possible forms of clothing humans have worn in the last ten-thousand years, only a tiny sliver of those clothing are socially acceptable for me to wear. And yet we all deal with that. If someone were to intentionally call me the wrong name, while everyone else gets called the name they have asked to be called, that would bother me, but only because that is a power move that singles me out. If I were to, say, join a fraternity, where everyone had to have a name assigned to them, that would not bother me, and I would be fine being called that name while hanging out in the fraternity. If someone were to call me a "woman" I would be upset because it is the reality of my biology that I am a man. Furthermore, saying you are a "woman" is usually saying, "You lack the positive qualities we usually associate with being a man -- you are weak, you are cowardly, you are whiny, etc."
- brandon272 2y ago
  The RCTs that validate your assertion (or mine) when comparing reparative therapy and affirmation do not exist. All that we have to rely on now is the overwhelming consensus among medical and mental health professionals, and that consensus appears to exist among major reputable bodies worldwide, and is based on their many decades of collective clinical experience and research. I understand your perspective - in a different world without ethical qualms or risk of harm we could conduct those studies and maybe have better, more conclusive answers. What I am suggesting is that we have the data and research that we have. While you have chosen to draw a line at requiring randomized controlled trials to convince you that a certain outcome is the right one, there is an abundance of research and clinical data that does exist endorsing affirmation of gender identity, and we can explore some of it, if you like. > In all other cases, if someone's mental conception of themselves was not aligned with the biological reality of their self, we would say the default is that the person should try to adjust their mental conception. Can you elaborate on what you mean by "other cases" that are directly comparable with gender dysphoria, and can you find some studies that support the effectiveness of this approach? Gender dysphoria seems pretty unique from a clinical perspective despite a common thread it may have with other conditions. > I do not have a gender identity and I do not have a gender. I a sex and I have an identity as a sexed being. I think it's great that you are very clear on your role in society when it comes to what side of the biological sex binary you are on. It's a luxury to not have to be concerned with it, but not everyone has that luxury. > It's actually really difficult for me to understand how a person's fundamental well-being is intrinsically and immalleably tied to names and clothing. What you are saying here is that "this is my experience and I do not understand why everyone else does not have the same experience". Do you not see a problem with that? You can have your opinion and that's fine. Other people do not have to share your opinion or approach the world in the same way. You appear to start from your biology and work backwards, as if the mind does not exist. Others would suggest that you and your biology do not even exist without the conscious mind making them real. Thus, the power of the conscious mind is actually more critical to this whole equation than whatever your biology is. Stop thinking about your own experience for 5 minutes and think about the experiences of other people and where they might be coming from based on their own perception, experience and biological realities - including the biology of what goes on in the brain!
countarthur 2y ago
These are good points and great questions! Your description of getting surgeries based on a distorted view of what they see in the mirror sounds exactly like gender dysphoria to me. I have a big nose like you and even having had romantic partners compliment me on it hasn't stopped me feeling bad about it, but I agree it's definitely more trivial than believing you ought to be the other sex, somehow. They usually say "it's handsome" rather than try to convince me it's a normal size, which is perhaps a more merciful lie! I don't know about CBT, but I know that people can be convinced by others that they should be the other sex: it happens all the time on youtube, tiktok, tumblr and across the web. That's how this became so wide spread in the first place. So I absolutely believe people can be helped to accept the truth of themselves and their real body and not require hormonal or surgical interventions. Here I'm mostly talking about insecure young people - the very different cohort of older men where there's a sexual element involved might be boned (pardon the pun!) but that's all the more reason not to have the rest of society change laws and social mores to facilitate it. If I was gender dysphoric (unable to accept the truth and be comfortable in my own body) AND believing in gender identity then I'm sure I would expect people to affirm my delusion and I'd viscerally dislike those that didn't. If I was later cured, I'd hope I'd appreciate those who stuck to their guns and didn't lie to me. Maybe it's impossible to fully accept yourself (like our big noses) and one just has to live with it and cope with it as healthily as they can. I would consider getting my nose carved down to size (regardless of how big it really is) a failure for everyone involved.
- brandon272 2y ago
  It sounds like we have established that body dysmorphia and gender dysphoria are not really the same thing? Two conditions can have a similar thread but not be the same or even related, nor require the same approach or treatment. In terms of "people being convinced by others", I think this is a relatively recent phenomenon. I think it's possible to be simultaneously concerned about social contagion and social influences, especially among young people who don't have a fully developed understanding of themselves, hasty treatments without due diligence on behalf of medical providers, commercial incentives in the medical community, etc, etc... while also acknowledging that some people simply do suffer from legitimate, intractable gender dysphoria. There is no evidence that I can find that reparative therapy is effective. A teenager being lured into something on social media for social clout is simply not the same thing as a person who genuinely, intractably believes that they were born in the wrong body. > If I was gender dysphoric (unable to accept the truth and be comfortable in my own body) One thing I find interesting about this framing ("unable to accept the truth", "affirm my delusion") is that it seems to ignore any kind of biological/chemical occurrences in the body and brain that could explain gender dysphoria and instead casts it purely in a judgemental "these trans people are just nuts" light, which seems odd given that this is a topic on which we clearly don't have all the answers.

chlodwig 2y ago

Psychotherapy is simply not effective at changing someone’s gender identity or ameliorating gender dysphoria. The established treatment for gender dysphoria is to align the person’s gender identity and gender expression. Can you find a randomized controlled study where the "affirmative" approach of aligning gender expression with identity has been compared to a "reparative" approach of aligning identity with biology? I have read a lot of studies on this and what you are saying simply is not backed by the evidence. Whenever I read a study that has been referenced on NPR or such, I read the details and the details do not support what the people citing the study say it supports. In all other cases, if someone's mental conception of themselves was not aligned with the biological reality of their self, we would say the default is that the person should try to adjust their mental conception. A treatment that involved all of society changing, or even more extreme -- actual removal of body parts -- would need to pass a very high burden of experimental evidence. From what I have read, that burden of proof has not ever been close to being met. There are no studies that say that aligning gender expression works better than helping the person cope with or get over their dysphoria. If I have missed such a study, I would like to read it. Do you feel that your gender identity could be changed using Cognitive Behavioural Therapy? I do not have a gender identity and I do not have a gender. I a sex and I have an identity as a sexed being. I have a brain that has developed under the influence of testosterone, I have the knowledge of having a penis, I have the knowledge that society sees me as a male and penis-haver and all that entails. I have the knowledge that if I used a woman's locker room and exposed my penis, women would freak out, and so I do not do that. Etc. etc. I wear the clothes that I do because that is what society expects of me. There are all sorts of clothes and outfits from other cultures that I prefer aesthetically but I don't wear because they do not align with the norms of my current culture. It's actually really difficult for me to understand how a person's fundamental well-being is intrinsically and immalleably tied to names and clothing. Of all the possible forms of clothing humans have worn in the last ten-thousand years, only a tiny sliver of those clothing are socially acceptable for me to wear. And yet we all deal with that. If someone were to intentionally call me the wrong name, while everyone else gets called the name they have asked to be called, that would bother me, but only because that is a power move that singles me out. If I were to, say, join a fraternity, where everyone had to have a name assigned to them, that would not bother me, and I would be fine being called that name while hanging out in the fraternity. If someone were to call me a "woman" I would be upset because it is the reality of my biology that I am a man. Furthermore, saying you are a "woman" is usually saying, "You lack the positive qualities we usually associate with being a man -- you are weak, you are cowardly, you are whiny, etc."

brandon272 2y ago
The RCTs that validate your assertion (or mine) when comparing reparative therapy and affirmation do not exist. All that we have to rely on now is the overwhelming consensus among medical and mental health professionals, and that consensus appears to exist among major reputable bodies worldwide, and is based on their many decades of collective clinical experience and research. I understand your perspective - in a different world without ethical qualms or risk of harm we could conduct those studies and maybe have better, more conclusive answers. What I am suggesting is that we have the data and research that we have. While you have chosen to draw a line at requiring randomized controlled trials to convince you that a certain outcome is the right one, there is an abundance of research and clinical data that does exist endorsing affirmation of gender identity, and we can explore some of it, if you like. > In all other cases, if someone's mental conception of themselves was not aligned with the biological reality of their self, we would say the default is that the person should try to adjust their mental conception. Can you elaborate on what you mean by "other cases" that are directly comparable with gender dysphoria, and can you find some studies that support the effectiveness of this approach? Gender dysphoria seems pretty unique from a clinical perspective despite a common thread it may have with other conditions. > I do not have a gender identity and I do not have a gender. I a sex and I have an identity as a sexed being. I think it's great that you are very clear on your role in society when it comes to what side of the biological sex binary you are on. It's a luxury to not have to be concerned with it, but not everyone has that luxury. > It's actually really difficult for me to understand how a person's fundamental well-being is intrinsically and immalleably tied to names and clothing. What you are saying here is that "this is my experience and I do not understand why everyone else does not have the same experience". Do you not see a problem with that? You can have your opinion and that's fine. Other people do not have to share your opinion or approach the world in the same way. You appear to start from your biology and work backwards, as if the mind does not exist. Others would suggest that you and your biology do not even exist without the conscious mind making them real. Thus, the power of the conscious mind is actually more critical to this whole equation than whatever your biology is. Stop thinking about your own experience for 5 minutes and think about the experiences of other people and where they might be coming from based on their own perception, experience and biological realities - including the biology of what goes on in the brain!

countarthur 2y ago

These are good points and great questions! Your description of getting surgeries based on a distorted view of what they see in the mirror sounds exactly like gender dysphoria to me. I have a big nose like you and even having had romantic partners compliment me on it hasn't stopped me feeling bad about it, but I agree it's definitely more trivial than believing you ought to be the other sex, somehow. They usually say "it's handsome" rather than try to convince me it's a normal size, which is perhaps a more merciful lie! I don't know about CBT, but I know that people can be convinced by others that they should be the other sex: it happens all the time on youtube, tiktok, tumblr and across the web. That's how this became so wide spread in the first place. So I absolutely believe people can be helped to accept the truth of themselves and their real body and not require hormonal or surgical interventions. Here I'm mostly talking about insecure young people - the very different cohort of older men where there's a sexual element involved might be boned (pardon the pun!) but that's all the more reason not to have the rest of society change laws and social mores to facilitate it. If I was gender dysphoric (unable to accept the truth and be comfortable in my own body) AND believing in gender identity then I'm sure I would expect people to affirm my delusion and I'd viscerally dislike those that didn't. If I was later cured, I'd hope I'd appreciate those who stuck to their guns and didn't lie to me. Maybe it's impossible to fully accept yourself (like our big noses) and one just has to live with it and cope with it as healthily as they can. I would consider getting my nose carved down to size (regardless of how big it really is) a failure for everyone involved.

brandon272 2y ago
It sounds like we have established that body dysmorphia and gender dysphoria are not really the same thing? Two conditions can have a similar thread but not be the same or even related, nor require the same approach or treatment. In terms of "people being convinced by others", I think this is a relatively recent phenomenon. I think it's possible to be simultaneously concerned about social contagion and social influences, especially among young people who don't have a fully developed understanding of themselves, hasty treatments without due diligence on behalf of medical providers, commercial incentives in the medical community, etc, etc... while also acknowledging that some people simply do suffer from legitimate, intractable gender dysphoria. There is no evidence that I can find that reparative therapy is effective. A teenager being lured into something on social media for social clout is simply not the same thing as a person who genuinely, intractably believes that they were born in the wrong body. > If I was gender dysphoric (unable to accept the truth and be comfortable in my own body) One thing I find interesting about this framing ("unable to accept the truth", "affirm my delusion") is that it seems to ignore any kind of biological/chemical occurrences in the body and brain that could explain gender dysphoria and instead casts it purely in a judgemental "these trans people are just nuts" light, which seems odd given that this is a topic on which we clearly don't have all the answers.