New American Psychological Assn Guidelines On Trans and Non Gender Conforming Folks

The American Psychological Association has released a 55-page document detailing guidelines for psychologists treating transgender and gender non-conforming (TGNC) individuals. 

The purpose of the Guidelines for Psychological Practice with Transgender and Gender Nonconforming People (hereafter Guidelines) is to assist psychologists in the provision of culturally competent, developmentally appropriate, and trans‐affirmative psychological practice with TGNC people. Trans‐affirmative practice is the provision of care that is respectful, aware, and supportive of the identities and life experiences of TGNC people.

Here are the new guidelines:

1. Psychologists understand that gender is a non‐binary construct that allows for a range of gender identities and that a person’s gender identity may not align with sex assigned at birth.
2. Psychologists understand that gender identity and sexual orientation are distinct but interrelated constructs.
3. Psychologists seek to understand how gender identity intersects with the other cultural identities of TGNC people.
4. Psychologists are aware of how their attitudes about and knowledge of gender identity and gender expression may affect the quality of care they provide to TGNC people and their families.
5. Psychologists recognize how stigma, prejudice, discrimination, and violence affect the health and well‐being of TGNC people.
6. Psychologists strive to recognize the influence of institutional barriers on the lives of TGNC people and to assist in developing TGNC‐affirmative environments.
7. Psychologists understand the need to promote social change that reduces the negative effects of stigma on the health and well‐being of TGNC people.
8. Psychologists working with gender questioning and TGNC youth understand the different developmental needs of children and adolescents and that not all youth will persist in a TGNC identity into adulthood.
9. Psychologists strive to understand both the particular challenges that TGNC elders experience and the resilience they can develop.
10. Psychologists strive to understand how mental health concerns may or may not be related to a TGNC person’s gender identity and the psychological effects of minority stress.
11. Psychologists recognize that TGNC people are more likely to experience positive life outcomes when they receive social support or trans‐affirmative care.
12. Psychologists strive to understand the effects that changes in gender identity and gender expression have on the romantic and sexual relationships of TGNC people.
13. Psychologists seek to understand how parenting and family formation among TGNC people take a variety of forms.
14. Psychologists recognize the potential benefits of an interdisciplinary approach when providing care to TGNC people and strive to work collaboratively with other providers.
15. Psychologists respect the welfare and rights of TGNC participants in research and strive to represent results accurately and avoid misuse or misrepresentation of findings.
16. Psychologists seek to prepare trainees in psychology to work competently with TGNC people.

In the past, some psychologists have attempted to change gender identity (as well as sexual orientation) through so-called "conversion therapy" or other coercive means. The APA’s statement, in effect, states very strongly that attempts to change gender identity should not be attempted. In this statement, the APA underscores the need for ethical treatment of transgender people and of affirming transgender and gender non-conforming people.

Thanks to Open Minded Health for blogging on the APA document.

GUEST BLOG: Non-suicidal self injury, and gender and sexual minorities

Open Minded Health discusses self-injury. In all likelihood, you know someone who does this.

Recent reports have highlighted the frequency of non-suicidal self-injury among gender and sexual minorities. 41.9% of transgender people have self-injured. I was unable to find a percentage for cis lesbian, gay and bisexual people beyond the general report that the rate was “much higher”. Gender and sexual minority (GSM) youth are at particular risk, as are cis women.

So let’s take a quick look at non-suicidal self injury this week. What is it? Why do people do it? And what should those who currently self-injure, and their loved ones, know?

Non-suicidal self injury (NSSI) is a term that refers to deliberate attempts to cause oneself injury without intending suicide. The “without intending suicide” is the important bit there. This is a separate phenomenon from suicidality, though both suicidality and NSSI can come from the same psychological source. NSSI can take many forms, but cutting and burning are the most common. People who have higher levels of stress, such as GSMs, are at higher risk for NSSI. Transgender people may have an additional risk factor because of extreme body dysphoria.

To most who have never participated in NSSI, it can seem baffling.

Cataract Journey: Interregnum

in·ter·reg·numˌin(t)ərˈreɡnəm/. noun. A period when normal government is suspended, especially between successive reigns or regimes. An interval or pause, as in, "the interregnum between the discovery of radioactivity and its detailed understanding."

After cataract surgery on my first eye, I entered a bizarre period in which that eye had excellent vision at intermediate distances (computer screen, conversation) and the other was a total blur. I’m very near-sighted (as in -15 diopters), so there was no possibility of fusing images. So the world looks blurry and sharp at the same time, and I have to use parallax (shifting my head) for any kind of depth perception. Needless to say, I do not feel safe driving. Or pouring water from a pitcher, unless I can brace the lip of the pitcher against the glass – we found this out in a somewhat spectacular fashion.

One solution might have been to wear a contact lens in the nonsurgical eye, and I had worn hard or RGP (rigid gas permeable) lenses for over 50 years. But a couple of years ago my eyes, which had become drier over the decades, flatly refused to put up with contact lenses. I tried all sorts of lubricating drops, but was never able to wear my lenses more than a few (2-4) hours a day. If I did any work on the computer, that time dropped to an hour (people blink less often while staring at a computer monitor, hence increase in scratchy, red eyes). Finally, earlier this year, I lost one of my lenses. This has happened maybe half a dozen times over  the years. I looked everywhere (if you wear contacts or are close to someone who does, you know the crawling-around-on-the-floor routine) and eventually concluded that after I had cleaned them the night before, the lens had stuck to my finger instead of sliding off into the soaking solution. Since then, I had washed my hands and tidied up the counter area. So, no hope. I’d been wrestling with spectacles ever since.

My next idea, which friends have tried, was to pop a lens out of my spectacles, so that my nonsurgical eye sees through the remaining lens. Great idea, right? And it worked – so long as I covered one eye, didn’t matter which. When I tried to fuse the equally-clear images, however, my brain went nuts. It turned out the images were of sufficiently different sizes, too disparate for my brain to turn them into one. This might not have been the case with a person less near-sighted than I am. So, rather than putting a patch over one eye – toss a coin as to which one – I’ve been wandering around in this visually bizarre state.

GUEST BLOG: Article review: Cancer and lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations

From Open Minded Health:

Gender and sexual minority health isn’t just about HIV/AIDS, sexually transmitted infections, and mental health. It’s also about cancers, and our exposures to risk factors for cancers. Why? Because everyone can get cancer, and we all need both preventative and therapeutic health care.

Cancer is not just one disease, which is why it’s been so difficult to “cure”. Cancer is when a cell mutates and grows out of control. The cells begin to invade other tissues, and can spread throughout the body. Any cell can become cancerous. And different cancers are caused by different things and have different treatments.

A recent paper, published online ahead of print, looked at the data surrounding lesbian, gay, bisexual and transgender/transsexual (LGBT) populations and cancers. They specifically looked at cancers which may be more common in LGBT communities: anal, breast, cervical, colon/rectal, endometrial, lung, and prostate cancers.

Why might these cancers be more common in LGBT communities? Perhaps because of higher levels of risk factors like obesity, smoking, and certain infections. Or perhaps because of lack of preventative health care.

But what do the data say? What data do we even have? So far it looks like we don’t have much information. Most studies about cancers don’t ask about sexual orientation or gender identity. But let’s take the data one cancer type at a time, just as the paper did…

Cataract Journey: Post-Op #1

I had my first cataract surgery a few days ago. It began, of course, with fasting and the usual pre-op check ins. I'd already begun using antibiotic and steroid eye drops.* In addition, I used an eyelid scrub, a little moist towelette with a coarse texture, the night before. I don't wear makeup, so that wasn't an issue, and my hair is dry enough so skipping a shampoo the night before (they're afraid you'll irritate your eye) wasn't a problem, either.

The surgery took place in a surgical center associated with a hospital, and clearly it was cataract surgery morning. Nonetheless, I appreciated the care everyone took with me. The nurses were great -- but I think nurses are great, anyway. It takes me a long, long time to feel clear-headed after Verced, usually used as a sedative, so the anesthesiologist and I came up with a different plan. I'm old enough to remember the days when you got what they gave you no matter what you said. How wonderful to be listened to!

Once I was hooked up to an IV and my eye was dilated, it was time to begin. The first step was a femtosecond laser to break up the cataract and make an incision for its removal, at the same time correcting my astigmatism. This was not only painless, but an amazing light show. Gorgeous colors, flashing lights, snowflake mandala patterns...and the laser makes funny noises as if it's singing to itself.

Phase two was the removal of my lens and implantation of the artificial corrective lens. After talking with my surgeon (and my financial advisers!) I opted for accommodative lenses, which should give me great distance and intermediate (computer, piano, social) correction. I'll still need reading glasses, which is okay.

This is the phase that disturbs most folks. They envision (excuse the pun!) pointy metal instruments coming at their eyes. I saw nothing but lights! The lights were not as entertaining as those produced by the laser, but they were quite benign. Before I knew it, my doc was saying it was over and was placing a clear, perforated plastic shield over my eye.

I spent a little while in recovery, not so much from the surgery as the anesthetic, and then my husband drove me home. The surgical center folks were adamant (a) that I not drive; (b) that I have someone at home in case of need. "Need" amounted to eating a light lunch and sleeping most of the afternoon. The next day I had a follow-up exam with the surgeon, who was very pleased by how everything is healing, and was allowed to take off the shield except for sleeping. Oh joy, I get even more eye drops four times a day!

I had thought that I'd be able to pop a lens out of my spectacles to correct the nonsurgical eye, but alas that didn't work. So I toddle around with one still-dilated eye that can see intermediate distances just fine -- far distance will come as everything settles and my eye muscles learn how to flex the lens -- and one utterly myopic eye. Needless to say, I can hardly wait for the 2 weeks to fly past so I can get my second eye done!

It is amazing to open my eyes in the morning and have (one of them) see clearly. Also, the brilliance of the colors astonishes me. I had no idea how much my cataracts "grayed out" colors. I feel like Dorothy, stepping from black and white Kansas into Technicolor Oz.


*My doctor's protocol; yours may have a different one.

Eye image licensed under Creative Commons.

Cataract Journey: Countdown

As part of my preparation for cataract surgery, I’ve begun talking with my eyes. Or rather, talking to them. I say, “Eyes, something exciting and perhaps a bit perplexing is going to happen to you. But don’t worry, it’s like a hip replacement. It’ll help you see even better than before. I’m going to make sure you are safe (antibiotic eyedrops) and comfortable (steroid and anti-inflammatory drops). And we will have such fun seeing bright colors and sharp detail for many years to come.”

They don’t have a lot to say in response. But…

A week or so ago, I started dreaming about the surgery. It was the usual showing up without clothes or without having attended class or without having memorized your lines. In this case, I arrived at the surgery center, having forgotten I was supposed to fast. There was much hoo-ha and calculation of what I had eaten how long ago.

This last weekend, I drove our van down to LA to help my older daughter move in with us. The drive down was in daylight and the only visual problem I had was seeing the street signs while looking for hotel and then her apartment. But (for various reasons, you know the drill) we did not get started back until 7 pm. I am normally an early-to-bed person and ended up consuming as much caffeine as I usually do in a year, I’m sure. I was painfully aware of how stressful and difficult night driving has gotten to be. Almost all the freeway driving was in darkness. I have never appreciated trucks so much – all those lights made them easy to discern, much more so than the lane markers. Daughter and I took turns leading as we caravaned along, too.

I could imagine my poor eyes saying, “We’re trying, mom! This is the best we can do!”

“I can’t ask for more, eyes. I’m going to get you some help real soon now.”

So now I am taking my pre-op eyedrops four times a day. Fortunately, I’ve been using lubricating drops for so long, I’m used to putting drops in my eyes. After surgery, I’ll add two more. I have to wait two minutes in between each medication so it doesn’t wash out the one before. Other surgeons may have different protocols. I’m observing this one meticulously. I’ll be taking these for a while, because I’ll still be on some of them when it will be time to start full doses prior to the second surgery. 

I am considering dubbing this season The Summer Of The Eye Drops.