Breast binding advice during COVID-19

[DJLippy]

Saw this on my Facebook today and I'm raging. The advice is one thing but all the supportive comments. This is not ok. There is never a safe way to bind it is a very harmful practice and to do so during a pandemic that attacks the lungs. It's like pro-ana sights making 'safe starvation' plans or how to purge in a safe way. We dont encourage the hatred of the body in other patient groups. Do you think that 'transphobia' and terfs will get the blame if those who bind start dying at ridiculous rates?

I think there's a subtle but significant difference between 'they're going to do it anyway' (I've not seen evidence this is specifically aimed at kids) and 'those that are going to do it anyway should be given this advice to minimise harm'.

I can't see the pic in the op clearly enough but the cartoons and colours look to me as if this is aimed to a younger audience. And as we know it seems to be mostly teenage girls and younger women who are doing this, I makes sense that they would be the target group. And I agree there's a difference between "they're going to do it anyway" and "those who do it are going to do it anyway" but it's like the pp said about self harm advice, which was actually one of the things I had in mind when I wrote my other post. That advice is generally given to people who persist in self harm, alongside help to solve the root problem and with the aim of hopefully getting all harm to stop in the long term. Breastbinders on the other hand I've seen advertised in teen Vogue and online magazines etc. I can't speak specifically about the leaflet here as I don't know where it's circulated but in general breast binding is being normalised.

The difference with the self harm patients was that the psychiatrists were also working to stop the patients from doing it at all.

I think that is a really important distinction ByGrabTharsHammerWhatASavings. Beyond highlighting the increased risk, that link is not harm minimisation. In fact I think it is subliminally implying that if you are truly trans, you will still be binding. Awful.

I can't see the pic in the op clearly enough but the cartoons and colours look to me as if this is aimed to a younger audience.

I found it fairly readable when zoomed in in a new window (ctrl & +). It seems quite neutral (perhaps more neutral than most here would like) but it's definitely not advocating their use. As before, I believe in a multi-pronged approach but I think, in this case, it's more helpful to not bash the reader with reiterations of the general harm, which I hope they'd be exposed to elsewhere and lest they completely ignore the rest of the advice and keep binding with a chest infection.

In fact I think it is subliminally implying that if you are truly trans, you will still be binding. Awful.

Might I suggest re-reading it? It opens with the title 'for trans and non binary people who bind their chest', i.e. identifying the association but not prescribing.

It seems like a sensible concession to me: clearly the sort of person this advice is aimed at is unlikely to listen to advice to 'just don't do it at all' so harm minimisation is preferable to ignoring them.

I can see your point but I disagree. It’s like telling people who cut themselves how to reduce the risk of infection. Giving the idea that it’s just a personal choice.

No! You’re self-harming, you need help to care for yourself, not advice on reducing the risk while harming yourself.

I can see your point but I disagree. It’s like telling people who cut themselves how to reduce the risk of infection. Giving the idea that it’s just a personal choice.

I suppose that it ultimately comes down to whether you prefer to 'sacrifice' what is, in my opinion, a smaller number of people who might be totally dissuaded by not offering harm reduction vs a larger number of people vs a larger number of people who might be temporarily dissuaded during a time of particular risk. It was my understanding that, in self harm, both cessation and harm minimisation attempts are employed and I certainly know that for IV and IM drug use, harm reduction doesn't significantly increase the rate of use while at the same time preventing infections but I also know people who err on the side of cessation over prevention (of harm).

For binding, I don't believe harm is the aim so I'm of the opinion that people who use binding should definitely be made aware of the risks, those who wish to stop given help and those who wish to continue given advice to minimise harm but I recognise that that's a minority opinion here.

Yes, key here is that this is not about harm minimization, this is harm normalization.

There is no attendant understanding that the women binding their breasts are taking a harmful road, full stop. In fact, much of the literature from this stable is about breast binding as a positive action to resolve psychological issues, and either dismissing the physical harm or needing to mitigate it.

There is never, to my knowledge, any attempt to actually help these women learn to love and accept their own bodies, which, for a movement so keen to talk about body positivity blah, seems incongruous.

I have quite wide hips and I used to hate them so much I would spend hours hitting them to try and encourage them to go inwards. I starved myself too and that's something I still struggle with at times. I wanted to have a straight up and down body. I didn't want to hurt myself but that's exactly what I was doing. Now I understand that what I did was a reaction to abuse and not wanting to be sexualised/not wanting to be a woman, and that's what I needed help with, I didn't need my hips to be shaved down or advice on how to safely bind my hips.

FloralBunting, I don't have much experience with these groups in terms of the ratio of dissuasion:harm minimisation and, if there is a deficit of the former I would agree that there needs to be more. However I don't believe that damns the initially presented content. I would even support cigarette-style warnings on purpose-made devices if it were demonstrated that these didn't result in significantly higher rates of use of the more harmful improvised alternatives.

Neither my personal experience nor the literature I have read on the matter of harm reduction supports a purely prohibitionary approach.

Having significant experience of self harm prevention, I am 100% certain that alternatives like rubber band pinging etc. are done in a framework of leading the person away from harming and towards treating themselves with care.

Breast binding is a reality, yes; in fact so much of a reality that there are businesses capitalising on the practice to make money. There are a number of self harm methods currently accepted by our culture, this is another in a long line of physical interventions that women have been encouraged to embrace and pay for - high heeled toe pinching shoes is another that springs to mind that we don't seem to care about challenging much.

But this is a relatively new phenomenon, and I think we absolutely should be challenging it at every turn, it is not beneficial to any woman, and I make no apology, on a feminist message board, for doing so.

Thank you for taking the time to articulate your beliefs. I think that we only really disagree on which approach(es) reduce harm by the greatest factor and which forms of remaining harm are the most acceptable.

No doubt. Which is a fairly significant disagreement, really, but that's modern life, I guess.

I think I'm with Floral on this one.

The problem with this is that it seems to be a "socially acceptable" form of self-harm which really should not be promoted, in any way, at the level of healthcare professionals.
There is no mention in the images from the OP any support to help these biological females to stop doing something which actively impacts on their ability to breathe nor acknowledgment that chest binding is damaging at all times, whether or not we are in the middle of a COVID-19 pandemic.
It reads like health advice on "safer footbinding" because of the risk of bacterial infections. It's an oxymoron.
The examples of self-harm or addiction mitigation strategies are different, as societally we don't tend to say that people who cut themselves or are alcoholic are doing so as part of expressing their "true stunningly brave self;" we name those other behaviours as harmful to the individuals involved in them while doing our best to help and not stigmatise people. Yet the narrative from the healthcare profession seems almost the opposite in the case of breast binding.
If you're going to adopt any sort of strategy to assist these females-who-identify-as-men-or-nonbinary, I think you have an obligation to say outright, without all the flowery euphemisms, that the whole practice is physically damaging - especially given its potential effect on the ability of one's lungs to ventilate, which directly impacts one's capacity to supply one's body with oxygen, a necessity for survival. Natal females who are engaged in this practice ought to be reassured that it's completely okay just to STOP, every time, and to have proper measures in place to help them exit, rather than what seems like the "default" position of passivity - that the binding is going to continue. Don't judge any individuals or force them to do anything, but I'm not convinced that the message is getting across clearly enough from medical professionals that the physically safest path is to stop binding, even if people choose not to take it.

For the record, I don't think the commercial binders necessarily keep females-who-identify-as-men-or-nonbinary from having fever negative outcomes, either, if this study was correct:

"Chest binding involves the compression of chest tissue for masculine gender expression among people assigned a female sex at birth, particularly transgender and gender non-conforming individuals. There are no peer-reviewed studies that directly assess the health impacts of chest binding, yet transgender community resources commonly discuss symptoms such as pain and scarring. A cross-sectional 32-item survey was administered online to an anonymous, non-random sample of adults who were assigned a female sex at birth and had had experience of binding (n = 1800). Multivariate regression models were used to identify practices associated with self-reported health outcomes. Of participants, 51.5% reported daily binding. Over 97% reported at least one of 28 negative outcomes attributed to binding. Frequency (days/week) was consistently associated with negative outcomes (22/28 outcomes). Compression methods associated with symptoms were commercial binders (20/28), elastic bandages (14/28) and duct tape or plastic wrap (13/28). Larger chest size was primarily associated with dermatological problems. Binding is a frequent activity for many transmasculine individuals, despite associated symptoms."

www.tandfonline.com/doi/abs/10.1080/13691058.2016.1191675?journalCode=tchs20

this is not about harm minimization, this is harm normalization

Agree Floral. Health professionals should be speaking out against this normalisation. They do that with ‘pro-ana’ websites, for example.

Also the logic gap of it, as stillathing says. Binding doesn’t even work within its own genderist political framework:

We are told some women have penises, get over it, so why the fuck can't some men have breasts?

What binding does do is to reveal starkly the dangerous burden of misogyny on biological women within that political framework.

ReinstateLangCleg, I don't disagree at all that it's harmful, the thought of it makes my entire thorax twinge. Some of the co-authors of that paper also contributed to this one:
www.ncbi.nlm.nih.gov/pmc/articles/PMC6298447/

They identified that the main reason for people using binders not seeking care (the vast majority) was a perceived negative reaction from healthcare providers. Just in case I wasn't clear, I view the best possible outcome as zero natal women binding their breasts but I believe that a combined approach which includes less direct means of reaching these unfortunate individuals gets us closer to that goal.

Whilst healthcare professionals could undoubtedly be more sensitive to these patients and more inviting for them to speak about their issues (as they could in many other areas, including mental health in general, frankly), I think it risks painting an overly simplistic view of the picture (a bit like saying if we can just get the whole world to parrot "transmen are men" then all the mental health issues for trans people would cease -when the reality seems FAR more complex than that, given the frequent concurrent histories of sexual abuse, PTSD, autism, etc that many of these individuals if presenting as youths).

In their discussion, the authors in that second study also don't seem to have in their imagination that perhaps just stopping altogether is something to consider. Instead, they seem to want to be thinking about how binding affects double-mastectomy outcomes?

"Although evidence-based clinical guidelines for minimizing binding-related risks do not exist, a previous analysis of these same cross-sectional data demonstrated that taking days off from binding and specific methods of binding were associated with a reduced risk of negative health outcomes.More research, especially prospective data on mitigating binding-related risks and how binding may impact top surgery outcomes, is needed for robust, evidence-based clinical recommendations."

www.ncbi.nlm.nih.gov/pmc/articles/PMC6298447/

Instead, they seem to want to be thinking about how binding affects double-mastectomy outcomes?

I don't think that undermines the validity of their data regarding avoidance of healthcare any more than it undermines their data in the other paper about the harm caused by binders. If someone is binding, it seems like the best approach is to get them in front a healthcare professional who will be accepting, tolerant but also honest about the damage they're causing. From that point, they can hopefully be persuaded to stop.

I think it risks painting an overly simplistic view of the picture

I think that any one approach in isolation is oversimplification and, while there is a fine line between harmful normalisation and pragmatic harm reduction, I believe it's a challenge that can be met by the healthcare community.

Undoubtedly. No one is disputing that it's perfectly possible for healthcare professionals to take the approach they do with other self harms, like cutting or pro ana stuff.

But they are not. That's the crux here, it really is. There is a marked difference in approach in attitude and advice around binding compared to other self harming activities. Because the prevailing, ideologically motivated view is that it's not self harm. Therefore, the healthcare system does not put out this information on 'safe binding' in a wider setting of discouraging binding and dealing with causes etc. That's the problem here.

Not to be antagonistic, at all, but genuinely curious as to how you would practically counsel these patients, Gronky?

The reason I pointed out that line is not to undermine the study, but to highlight my suspicions as to how the authors are approaching this question - my feeling is that these "gender identity professionals" aren't actually presenting/imagining the alternative of stopping, at all, but may in subtle ways simply end up encouraging more patients to think of/take "next stage" of intervention - double mastectomy.

Which, as you know, is a serious surgical undertaking that carries its own risks, so I would see it as a more drastic form of self-harm.

All of this medicalisation, of course, benefits any professionals who are practicing privately or proclaiming their "expertise." So I am dubious of the notion that putting more trans patients in front of "affirmative" doctors will do any good - there are too many competing interests at play.

You really think someone who gets super sick is going to rather dying than taking their binder off?

You lot barely speak to trans people at all, do you. Apart from the 4-5 GC trans women you love so much (until they try to use the loos at a women’s place meeting).

What a mature and helpful contribution to a calm discussion about young women harming themselves and what is the best way to prevent that. Your focus is noted.

Because the prevailing, ideologically motivated view is that it's not self harm.

That may be because there's a certain stigma attached to that label.

Therefore, the healthcare system does not put out this information on 'safe binding' in a wider setting of discouraging binding and dealing with causes etc. That's the problem here.

I agree that should be a focus. I just think that the initial post was also helpful as part of this.

Not to be antagonistic, at all, but genuinely curious as to how you would practically counsel these patients, Gronky?

I don't find that antagonistic at all but I'm not qualified. What I would like to see happen is a suitably qualified person address the reasons they feel the need to bind in the first place and hopefully work towards them overcoming those feelings or channel them in a less harmful direction (e.g. clothing which doesn't require a binder but presents an image which they feel comfortable with).

Gronky, then honestly, I don't think we disagree at all, tbh.

@FloralBunting Maybe try you listening to the people that do it. You lot deciding what is best for a whole batch of people without listening to how they feel about things (and seemingly having none of you as any kind of expert in therapy or psychology) is pretty bizarre. Why not ask why they do this thing you don’t understand and listen to their answer? Would buy your faux concern if you showed any sign that you care about what they think or even why they do it.

Trans, you're very rude. And particularly ignorant. I have plenty of relevant experience and connection to women in this situation, and you have no relevant experience at all, so I will take your contributions with as much authority as they deserve.