Does Mental Health need to be higher on the agenda?

[akkakk]

@MissScarletInTheBallroom posted a great post on another thread where (and I trust it is okay to quote), she said:

Secondly, you say it's not a mental illness. Why do you think this? It's not a physical illness. Prior to receiving any kind of "treatment", trans people's bodies are perfectly ordinary and as healthy as anyone else's. Their dysphoria (if they have dysphoria) is a feeling in their head. A feeling which apparently makes them so miserable that they want to change everything about who they are, even to the point of having irreversible medical interventions which harm their physical health but may allow them to superficially resemble a member of the opposite sex. How is that not a mental illness?

I think it very much is a mental illness, and I cannot think of any other example of where we harm the physical body to try to make it "match" what is going on in the person's brain, rather than attempting to actually treat the mental illness.

Brilliantly put... the simple reality with the trans discussion is that so much of the cause / reasons / solution lies in the mental health area - but as a society we stigmatise the phrasing 'Mental Illness' to the point that even though it would be helpful to the individual, we find any alternative to avoid that categorisation...

In many ways, the actions taking place in the trans world (self-mutilation / coercive behaviour against women / denial of truth and biology) are all mental health or mental illness related...

If we were able to re-frame mental illness so that it was seen as being valuable to treat it - would that not of itself go a long way to ironing out the issues / self-deceptions / lies etc. that we are seeing...

For those with Body Dysmorphia - treat the mental illness - for those with Autogynephilia - again, there is a mental illness to deal with...

Society's current framing of mental illness as being degrading / and stigmatised is unhelpful to all - if we could find ways to reposition it so that it was seen as acceptable to have a mental health issue - and to deal with it, then we might help a number of other issues along the way.

I wish 😅I don't think normal women see their own body, internally, as a male one. Or go, "Best decision of my life!" upon waking up after a voluntary double mastectomy. Or feel like they are horrible liars when they don't pass as a man and people take them for a woman.

I can accept that I'm a sick woman, but I certainly hope that's not being a normal one. That'd be too sad!

You might enjoy the audiobook, it’s read by Hannah herself and gives quite a lot of additional context through her tone of voice, if you know what I mean.

I can see the logic of this argument.

Actually, I'm reading an extract right now, and it's way too horrible enough just reading it; I don't think I could endure listening to it 😰Those poor kids...

Most mental health treatment doesn't provide a cure. Talking therapies use various approaches, including challenging one's thinking - cognitive behavioural therapy, for example, taught me to challenge my own negative thoughts; it was much more about understanding my behaviours (that were leading to poor outcomes for me and others around me) and suggesting strategies to cope. I certainly haven't been cured of those things that were causing me problems, some of which were outside my control, but I do have more control over how I respond to them.

I have a relative who had very severe anorexia. As far as I know, she hasn't been cured of a problematic relationship with food, but she's still alive and she has had a productive life which didn't remain totally dominated by anorexia. I would be surprised if it's not possible for talking therapies to be part of helping someone to handle body dysmorphia in a more positive way.

I understand 👍 It can be tough going.

I’ve been listening to a lot of female-written non-fiction audiobooks this last year, so if you fancy some recommendations let me know.

I think the snake oil here is the very idea of a cure and this being the the magic bullet promoted, when actually you just have to come to terms with certain things and learn to live with the shite.

Instead in Insta-world we have grown used to this idea that everything has a perfect end point, everything can be fixed and we will all live happily ever after.

It's a fantasy in its own right.

@RapidOnsetGenderCritic

" I would be surprised if it's not possible for talking therapies to be part of helping someone to handle body dysmorphia in a more positive way."

It could very well be that eventually someone will find a way to achieve that, yes. I just know that for me, talking therapy with a psychiatrist and a psychologist did nothing to alter my feeling of male identity in the slightest.

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@UtopiaPlanitia

"I’ve been listening to a lot of female-written non-fiction audiobooks this last year, so if you fancy some recommendations let me know."

I admit that I prefer reading to listening, because I'm lazy: it's easier for me to read than to listen, especially in English. Buuuut it would probably be good for my spoken English... So thanks for the offer, I'll think about it :)

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@RedToothBrush

"actually you just have to come to terms with certain things and learn to live with the shite."

Indeed, and that's what transitioning was to me: deciding which shite I preferred to live with. There was never any idea of a perfect outcome for me, just a question of which type of discomfort I was more willing and felt more able to endure.

I note that transgender advocates tend to be young and still in that stage of life where they are aspiring to a goal

Most women on MN are in that next stage of life - the settlement / making the most of what life has given you stage where aspirations have largely disappeared and been replaced by responsibilities.

The concept of 'acceptance of fate' hasn't really entered the heads of the former but it pretty much defines the latter.

It could very well be that eventually someone will find a way to achieve that, yes. I just know that for me, talking therapy with a psychiatrist and a psychologist did nothing to alter my feeling of male identity in the slightest.

I'm not sure that therapy can alter feelings; maybe it can, maybe it can't. But my experience was of understanding myself more fully, and being given some coping strategies. Some of those helped me (including ones I didn't expect to be of any use at all!), some I discarded as useless (rightly or wrongly - maybe I just didn't persevere enough for them to work).

What has helped me most has been to retire from paid work. Now that I'm out of an abusive work environment, which was stressful, exhausting and where I was expected to achieve unrealistic targets, I am doing voluntary work where no-one else can demand anything, they can only accept what I can offer. This is so much more healthy. A previous poster (thenoisiesttermagent I think) has expressed the unhelpful societal pressures very well. Of course, that doesn't mean I no longer had any problems once I left paid employment; life is often challenging and we all have to find a path through it. I am hugely saddened when that involves self harm (whether physical, or mental like some of my self-destructive tendencies). Incidentally, I have offended a trans friend by describing "gender affirming care" as self harm, but I find it hard to see it as anything else, whether or not it provides relief.

It's really sad to see that is dictating your view of yourself & your life

It's completely universal for women to have uncomfortable feelings & insecurity about their body.

I honestly don't understand what you mean? What is "that" and how is it dictating anything?

The comments you made that I quoted in my reply?!

I think this point about abusive work environments is well made. We're seeing how toxic the NHS is as a work environment - it's becoming ever clearer why there's a shortage of nurses given the public treatment of Sandie Peggie, the Darlington Nurses, Jennifer Melle and I'm sure there are far more who haven't felt able to cope with publicity and the demands of court cases. In fact I know there are.

I've been participating in the NHS audit and one trust had a whole scheme bringing nurses in from abroad and providing accommodation. It struck me how these nurses would feel even less able to speak up against safeguarding failures / an unscientific ideology / bad work practices or in the interests of their patients if their immigration status and housing is tied to their job. It seemed honestly quite a sinister set up, especially given the policies. What's the protection against being treated like dirt?

I've worked in a range of jobs from professional managerial class to working class and the difference in treatment is stark and the people who make workplace policies seemingly have no idea and no interest what it's like for the working class. Anyone working in EDI in a hospital should first have to shadow a nurse on all shifts, including overnight and A&E before they start imposing impossible policies. It seems from the evidence so far that the NHS is very classist, treating nurses poorly and doctors much better (Upton vs Peggie - not treated the same - an older woman nurse and a younger male doctor).

I think in the Equality Act the missing pc is poverty / class. Rich people shit on poor people all the time, it's probably the greatest inequality of the lot, but of course it was rich people who created and implemented EA2010 which is probably why it's missing.

So many people are treated so poorly in the workplace, and it's glossed over. The unions are more bothered about pronouns than people being fired if they speak up about bullying in the workplace or unsafe practices. Companies get away with no disabled ramps, and are awarded badges because they have rainbow lanyards.

It's not surprising facing the current school, job market and workplace environment that young people may fixate on doing something that can immediately elevate them to the most important person in the room with lots of attention. Why wouldn't you, really? In another trust one of the EDI staff was a transman whose previous experience was working at Lush - most EDI jobs are paid insanely well. Why on earth not? You don't need to have real skills like a doctor or nurse, just 'lived experience'. The NHS might as well say trans people are more important and will be treated better than everyone else - that's the effect of their policies. Trans people can choose where they are accommodated, and everyone else just has to suck it up.

The problem is, but all for the very very richest young people, the demands of trans ideology are impossible for those around them to fulfill long term. If you're some rich celebrity's child, maybe you can really surround yourself with people who never get a pronoun wrong and centre you in every single tiny thing, as if they were your parent. But in the real world, it's not going to happen. So you're setting up these young people for a lifetime of disappointment and feeling persecuted when people are in fact just behaving normally towards them. It's setting them up for mental health problems over their lifetime and I think that's tragic.

@thenoisiesttermagant You've identified of the problems with bringing in women from countries where they are socialised to defer to men and to keep quiet. Some areas are worse than others for this and of course personality plays a part.

Given the role of a nurse is to question wrong prescriptions/advocate for patients when they cannot speak for themselves, I would say this leads to a different sort of nursing.

It also means those speaking out are seen as troublemakers and treated accordingly.

The stigma seems to come from anything that associates the trans identity with a mental health problem. With anything that says "this is another mental condition, or it's an acquired solution to a different inner problem, and it is no more an expression of your true inner self than your last manic episode or your last set of obsessive thoughts". How does that go down in the trans community?

Anyway, yours sounds like some of it might be trauma. People manage trauma long term rather than cure it. Therapy might not be a cure but with insight therapy you'd know how being "the man of the house" fitted in and how much effect it really had, directly or indirectly, along with other stuff, and maybe find some alternative ways to frame the problem that might make the discomfort more manageable.

And by the way, have you listened to any of the Transparency podcast? Two middle aged US transmen talking it all through, with guests. They talk about how they came to be as they are, and how they deal with it now about managing dysphoria, transition helped but didn't totally fix it. The episodes are still around though they stopped making new ones a year or so ago.

(Sorry - one US, one Canadian, I think! It's all across the pond.)

@AmaryllisNightAndDay

"With anything that says "this is another mental condition, or it's an acquired solution to a different inner problem, and it is no more an expression of your true inner self than your last manic episode or your last set of obsessive thoughts". How does that go down in the trans community?"

Well, you would probably get as far as "another mental condition" before you got shouted down? And the whole "acquired solution to a different inner problem" would probably get you either irate or completely baffled reactions? I've certainly never heard it mentioned, and even less so discussed.

"Anyway, yours sounds like some of it might be trauma."

What isn't trauma-based in my life 😂? I totally wouldn't be surprised if this turned out to be linked as well, yes.

"And by the way, have you listened to any of the Transparency podcast?"

No, but it sounds very RTMI. Thank you for the rec!

I've never heard of anyone managing to cure body dysphoria with talk or medicine therapy.

Talking therapies - sometimes alongside psychotheraputics - are used with reasonable levels of success to treat non-gender-related forms of body dysphoria and dysmorphia. No reason why they shouldn't also be useful for gender dysphoria - especially with extra research to refine them for the specific problem. They shouldn't be ruled out for all simply because there's a possibility they might not work for some.

On a related point, a PP gave the 80-odd percent resolution rate by simply waiting for puberty to run its course. IIRC, those figures are pretty old - before social contagion, before rapid-onset was a thing - so relate mostly to male children with longstanding feelings from early childhood. I suspect the rate would be considerably higher now.

@NoBinturongsHereMate
Talking therapies - sometimes alongside psychotheraputics - are used with reasonable levels of success to treat non-gender-related forms of body dysphoria and dysmorphia. No reason why they shouldn't also be useful for gender dysphoria
Absolutely, and I certainly agree talking therapies are a good thing to try in the first instance. However, I guess if we're considering putting a person on psychotheraputics, from my perspective the relative cost/benefits/side-effects of those against cross-sex hormones is something that can be more directly compared. No drug is perfect.

There are plenty of examples of gender dysmorphic people who feel positively about gender-affirming treatment over all, myself and Seethlaw included. I certainly wouldn't ignore or diminish the experiences of those that it doesn't help, and it clearly needs to be approached with caution, but I do think gender-affirming treatment is the "treatment to beat" for severe gender dysmorphia. There is a reason I opted for transition as treatment, and that's because it's truly the only thing I believed would actually help. If there had been a better option, I'd gladly have taken it, but as it stands I honestly don't feel there is.

@Serencwtch
It's really sad to see that is dictating your view of yourself & your life
I think if I'm understanding what Serencwtch is saying correctly, she is reacting to you saying "feeling they are horrible liars when they don't pass as a man and people take them for a woman" is dictating your life @Seethlaw.

From my perspective, I feel absolutely the same (in reverse!) as to what Seethlaw said; genuinely it feels like 'lying' or being deceitful to be read as a man. I wouldn't say that feeling has "dictated" my life; I've made a conscious proactive choice to transition. I really did weigh up the merits of attempting to repress/cope, or transitioning. Yes I suppose the presence of those feelings "dictated" I'd have to make that choice, but I do feel it was a choice I made. You have to play the hand you're dealt in life! I couldn't see a path to real happiness with trying to repress the feeling.

@TroubledWatersTW

"I think if I'm understanding what Serencwtch is saying correctly, she is reacting to you saying "feeling they are horrible liars when they don't pass as a man and people take them for a woman" is dictating your life."

I'm honestly trying to understand, but I'm still baffled. Like, I had a problem which bothered me a lot. I implemented a solution, and now the problem almost doesn't bother me any more. How on Earth is that "letting anything dictate my life"? It's the opposite, isn't it? I didn't let the problem darken my life permanently.

" Yes I suppose the presence of those feelings "dictated" I'd have to make that choice, but I do feel it was a choice I made. You have to play the hand you're dealt in life!"

Exactly. What was I supposed to do? Pretend I didn't feel what I was feeling? I've actually done that before, in other matters, so I know only too well how destructive it is. I wasn't going to do it again.