• venusaur@lemmy.world
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    1 month ago

    According to an earlier mental health assessment, doctors said the patient didn’t have any previous psychiatric diagnoses and wasn’t suicidal.

    Sounds like a failure of the mental health system as much as the medical system. If you were seeing a mental health professional regularly and you had feelings about self harm, I would hope that this would be addressed before it happened.

    • ThatWeirdGuy1001@lemmy.world
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      1 month ago

      Except the people who have feelings like these know they can’t express them to their therapist (if they have one) without threat of being put into a hospital that’s overpopulated and under staffed to the point that people with suicidal ideations are thrown in with people who have schizophrenia or whatever other disorder to the point you can’t sleep because a guy keeps screaming about the demons in his head.

      • Gnome Kat@lemmy.blahaj.zone
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        1 month ago

        Yeah people don’t understand how bad the MH industry can be. Its why these things shouldn’t be gatekept, it should just be available under informed consent.

        • ThatWeirdGuy1001@lemmy.world
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          1 month ago

          For the people running these programs it’s a double edged sword.

          If someone expressed violent ideation and they weren’t admitted to a hospital and then they kill someone the program is seen as a failure. If someone expressed violent ideation and they were admitted and they kill themselves due to the conditions of the facility the program is seen as a failure.

          So the program receives less and less funding exacerbating all of these issues.

    • Drivebyhaiku@lemmy.world
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      1 month ago

      It’s not exactly a suicidal urge. Growing up trans before it was very commonly discussed I very nearly did this myself but ended up going the route of extreme binding, over exercising and eating disorder to avoid putting on weight that would go to places in the wrong distribution. I was in constant physical discomfort for years.

      It’s more an extreme anxiety. You don’t necessarily want to die but management of that anxiety to self soothe means physical pain is less of a problem than the anxiety. A lot of people trivialize that with trans people. They think “oh it is just looks, it is surely not that important.” but how your gender is outwardly read colors every interaction you have with strangers. Not passing means you want to go out and participate in life less. The questions they ask suicidal people won’t nessisarily catch that because you are dealing with someone who is waiting to finally break out of that place to actually live… not wanting to die. The problem with framing surgeries as self harm is not realizing that the alternative is self harm. This guy just got pushed past the breaking point waiting for someone else’s permission to live.

      • venusaur@lemmy.world
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        1 month ago

        Wanting to cut your boobs off may not come up in discussion of suicide but should come up in conversation if you’re being honest with your therapist.

        Aside from that, I’m curious how this is different than somebody who needs other forms of cosmetic surgery to feel confident with their body and the way they are perceived by society?

        Let’s say somebody is avoiding sexual relations because of the penis they were born with and tried to circumcise themselves because it’s not covered by insurance as an adult.

        Should everybody be provided care to undergo whatever surgery they need to feel comfortable in their body?

        Is anorexia not self harm if somebody does it because they can’t afford surgery and it gives them dysmorphia?

        • Drivebyhaiku@lemmy.world
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          1 month ago

          It’s a little different with gender. Like consider if I was ugly and I hate the experience of living in my body despite It’s generally considered pretty impolite to comment on that sort of thing. A barista saying “Good day ugly person, how would you like your coffee?” would probably elicit frowns and gasps from onlookers. Like it’s generally possible to go around knowing you’re not great looking because you are no surprise to yourself but it’s possible to exist in a state where you are not always conscious of the perceptions and thoughts of how other people code you because your attention can be allowed to drift. But the constant feedback snaps you back into place.

          Gender comes with a whole bunch of assumptions, way people unconsciously react, restrictions on places and events where you are considered an oddity and commentary. How often does a person refer to you in the third person where you can hear? How often are you called “sir” or “ma’am”. Every instance of that happening in society is lke that person being called ugly by the barista above. You are suddenly aware of the way your body is preceieved and all the social baggage in your life that you have to deal with. For the rest of the world being called mister, sir, miss or ma’am doesn’t strike the same cord as “ugly” does in everyone. The people who feel nothing from those gendered words don’t even notice them. But when you are trans you are reminded the same way you are if you stand naked before a mirror.

          Because when I was figuring myself out there wasn’t much information about the existence of trans people I didn’t really know surgery was an option I could pursue. There were issues with my body that puberty had already made irreversible and there’s a moment you realize no fairy godmother is going to come out of the woodwork to make things right. So I sobbed long and hard in the shower just in complete dispair that this was it. No one would ever see the real me, I would be invisible trapped my life would never be better. That this was it.

          I ended up not transitioning for reasons of love. My partner whom I love more than life has a phenotype preference. Normally I have a lot of tricks to get through my day. I distract myself, I try never to linger in front of mirrors and when I do I try to focus on the clothes I am wearing or my hair or the scraps of my physical appearance I like. I ask my friends to use names, pronouns and social aspects of gender to help me continue on crutches through my social interactions… But whenever I am misgendered in public or on the phone a part of me goes right back to that moment in the shower every single time. It can happen multiple times a day because I don’t pass. People freely remark on my biggest hatred of my physical experience on this earth directly to my face and there is not a damn thing I can do about it but take the hit most days because out there what’s happening is normal. I live in that world because the sacrifice I made ultimately brings me joy regularly…but my relationship isn’t typical. It’s not everyone who finds someone they feel is worth making daily sacrifices to be with and it requires a lot of things to be going right in my life to be okay. But I still have bad days… If I remained stuck in that moment in the shower over and over again with nothing to show for my trouble and no way out that feels like relief I would be tempted to do a lot worse than just slice off a couple of chunks of flesh.

          Being fat holds social stigma sure… But how strong could you be in the face of that if people, not just cruel ones, everyone, made oinking noises in your wake everywhere you go?

          • venusaur@lemmy.world
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            1 month ago

            That all makes sense. I’m curious then, since the gender dysphoria is exacerbated by the way society treats people based on gender, would people no longer require gender affirmation if we abolished gender and we only referred to people as they/them?

            Is being transracial different than transgender given that race and gender are social constructs?

            During segregation in the United States, would you say that black people would have benefitted from the government providing them racial affirmation surgery if they felt that they were not comfortable in their bodies, were a different skin color and had to face it constantly?

            To that point, is gender affirmation surgery a band-aid to the real problem of conformity to society’s gender construct?

            • Drivebyhaiku@lemmy.world
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              1 month ago

              I think you would probably see a massive upset in the binary trans community if there was a push to a fully “gender free” world. Consider that a lot of binary trans people don’t like the custom of introducing themselves with their pronouns. They want to allow the cultural signifiers to do the talking for them and some feel like having to constantly say their pronouns is essentially people not reading and validating their physicality. Pronoun introductions are an accommodation specifically for non-binary trans people who don’t have cultural visual signifers that allow that read. Gender presentation is a form of language. Like if you like to dress and culturally act like a woman that doesn’t nessisarily mean you are trans. Femboys might strike some as being trans people but they aren’t. Being trans ultimately comes down to a combo of how you feel about your physical body

              Also just because two things are social constructs doesn’t mean they operate on the same rules. Fat is a social construct that we are actively working as a society to deconstruct. It’s basically on a culture by culture basis but because all human populations have differently sized people that’s a universal fight. Race however isn’t like that. It is tied into long histories with complex power dynamics. People around the world do have medical procedures to lighten their skim because of beauty standards caused by occupation by European powers that treated being the lightest beige as a moral issue. We are in the midst of trying to deconstruct that narrative and divorce it from the legacy of supremacy. Maybe in the far future when we’ve put those supremacist narratives to bed and not treated different peoples like the things that they hold as culturally sacred is something we can play dress up in for giggles then we could talk about cross racial stuff… But ultimately respect comes from honoring boundaries.

              As for the question about black people in the states. I am not black. I can’t speak for that community with authority but I understand that a lot of the people I personally know would rather widen the constructs that exist around beauty to recognize what they have is also beautiful and wonderful. Like the people you love are beautiful to you. If the faces of the people who raised and loved you are a color that society values less it doesn’t mean you value it less you want other people to see them the way you naturally do.

              Your last question is difficult because it’s not the gender construct but the construct of sex… Which I know is really weird but sex is also a construct. The preservation of the idea of what is phenotypically male or female has it’s own history as being constantly proven to not be a binary. “Gender” had the original origins of existing to try and preserve the idea of a sexual binary by applying a sort of sex supremacist narrative. There is a LOT of pressure trans people face to adhere to a cultural idea of sex and a lot of gatekeeping that happen regarding treating someone’s gender as valid only if they look the part… But that’s only half the story. I know trans women who would sell their souls to have periods and get pregnant and breastfeed and experience all the messy aspects of physical femaleness that women routinely complain about. That’s not a cultural desire. Personally I don’t care so much about ever having kids. I am functionally a gay man. Do I wish I could properly be a top and have boners and ejaculate and all that stuff. Yeah sure. It’s really hard to get aroused when you are limited by hardware you don’t like interfacing with but because I care more about other functionalities of day to day of getting by in society. Even if everyone called me by the correct pronouns without fail and didn’t treat me like I was at best a preteen boy and invited me to the cookouts it wouldn’t stop me from falling into a week long depression every time I had to buy a new pair of pants. I can never look good to myself this way. People who know what I need still fuck up from time to time and I can tell their brain codes me based on my physical characteristics. As much as they try to stop it that reflex is baked in and me asking them to help me is introducing a cognitive load that they don’t have with people who have physically transitioned to the point where the switch in the veiwer’s brain actually flips. So the answer to your final question is both yes and no. Some people would be fine with using non-binary coping strategies which would cause some people to be more content without resorting to surgery but ultimately others would not because the root isn’t always strictly cultural.

              • venusaur@lemmy.world
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                1 month ago

                In a gender free world everybody would have the same pronouns. No need to introduce yourself. If society stopped reminding a trans person that they’re in the body of a specific gender, wouldn’t they then be on the same level of necessity as somebody who wants surgery because they do not like some other aspect of their body? If gender is not a thing, you only have to worry about your own perception of yourself, like how a fat person or a woman who wants a BBL does.

                Are you saying that until we abolish racism there could not exist transracial people? The history of power dynamics with race also exists with sex/gender. We would have to then abolish sexism before transgender people could exists.

                I don’t think being transracial would be based on beauty. Just like being transgender, being transracial means that you feel that you were born in the wrong body. If being transgender is dependent on beauty standards could we not expand beauty standards and widen the construct of gender to allow transgender people to feel more comfortable in their bodies? Men can feel beautiful and women can feel masculine. A penis can be beautiful and a vagina can be masculine. The question remains though. Should we provide medical care to people who are transracial?

                To your last point, it sounds like even if we abolished gender, transgender people would still suffer from dysphoria, which I then wonder how much of the dysphoria is around how you are perceived vs how you feel about your body? It might then in fact be a band-aid to another problem in the same way somebody might get a BBL to make them feel more comfortable during sex.

                • Drivebyhaiku@lemmy.world
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                  1 month ago

                  As much as you seem to want trans racial stuff to be a thing at present it’s a pretty frowned on practice. Most of the trans community look at broaching the discussions about it to be straight up transphobic because there is at present one guy out there named Oli London who currently has used his desire to look like a Korean popstar and other antics more or less as stunts for attention and has become the sort of thing transphobes point to to regularly use to discredit both trans narratives and questions around disrespectful cultural appropriatation as being crazy or to derail and discredit people of color who have been very clear that they are not a costume or an identity group that accepts new members that way. If you want to try cosmetically race swapping that’s basically up to you but at present you’d likely be pretty isolated and potentially make a lot of enemies because you’d be seen as trying to pit trans people against people of color. Beyond what is ethical or not the subject makes me personally uncomfortable not the least because it’s a narrative that often seeks to try and pin trans people into some kind of double standard. We are a group of people who feel the way we do about sex and gender. We have zero insights into people who want to change racial characteristics. If they exist at all and not just for attention seeking troublemaking then what they are doing is a conversation to have with them and whatever racial group they seek to emulate.

                  Something I also notice is that you keep saying being trans is dependant on beauty standards… Which is misguided. While there are trans people who seek to be beautiful a lot of that os more from a hunger for validation. Cis people desire beauty just as offen. But most of the trans people in my immediate circle are more… How do I say this… Aiming for personal comfort rather than beauty? Like don’t get me wrong I would like just once in my life to dress up for a wedding and not feel like a dysphoric wreck for trying to find clothing that doesn’t bring attention to the issues of being the opposite proportion from what I wish I was…but I don’t feel the need to be a handsome bloke. I just want to wear clothes to a special event that don’t need to be tailored all to fucking hell, clean up a little nicer than usual and not feel like a complete steaming pile of shit… But if my partner was properly bi and someone was like “Okay you will be instantly fully transformed into a man but you will look like you hit every branch on the ugly tree.” yeah. I wouldn’t mind that.

                  I use being ugly as a parable to cis people because generally from what I have gatherered its not like the vast majority have an intrinsic internal gender preference at all. Most of you have, as far as I can tell, never experienced anything like actual gender euphoria so I can’t use the experience of what gender incongruity feels like directly. Because of that I have to use things as analogs though they are always imperfect. Description of some of the paradoxes of gender dysphoria and euphoria are really difficult to conjure properly because it properly has to do with a sense of recognition…

                  You know that reaction you have when you see another human and you instantly recognize whether they are of a masculine or feminine body type and if you encounter someone who could be either it inspires that curiosity and attention while you try and figure it out because there’s a chunk of your brain that treats that information as vitally important? Gender Dysphoria and Euphoria works through that mechanism. Your internal sense of yourself is one thing but your external peices register to yourself as not matching so it causes this strict mental disconnect. The result is you feel very empty. Your name never feels like it belongs to you. It’s something you respond to as a function but it feels like it belongs to someone else. Your existence feels like you are performing a part in a play. Your friendships exist behind this barrier where you want desperately to feel connected but they never quite understand you or it feels like they are somehow keeping you at arms length. Nothing feels authentic to you, you might as well not even really be there because it’s all functionality happening to someone else. Then enevitably you play around with gender performance somehow. Doesn’t matter what, a short haircut, you wear a dress, someone says “oh sorry sir!” when they bump into you and you get a sudden flash of existing. For that little moment you suddenly feel real. It’s a thrilling feeling like you have been invisible all your life but suddenly someone saw you! Desire flares up to connect and ne present and exist in your own skin because for a second it feels like you are actually THERE for once. Dysphoria can feel like intense jealousy for the things that make you feel more alive but more often than not it’s this sort of numbness.

                  Cis people often don’t nessisarily understand it until they actually experience a trans person they know transition and then there’s a moment somewhere along the line where that recognition mechanism kicks in and they actually start experiencing that person as their gender… or they see the difference in how someone who used to struggle and seem sort of listless, anxious and absent suddenly is very vibrantly living in the moment and is sharp and attentive. Unless you’ve properly transgressed that boundary yourself it’s difficult to properly explain the phenomenon.

                  • venusaur@lemmy.world
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                    1 month ago

                    Appreciate the response. Did not intend to make you feel uncomfortable. Im not aware of this Oli person. Just like there are some people who may use transgender identity as a stunt, I believe there may be people who authentically may feel trans-something else. I’ll leave that convo at that.

                    I wasn’t saying being transgender is about beauty initially. You had mentioned that transracial is about beauty, and I responded saying that if this is the case then there must be some aspect of conforming to beauty standards with transgender people.

                    Cis people feel gender euphoria all the time in the context of being praised for conforming to social standards of gender. Women being praised for being beautiful. For being pregnant and raising a baby. Men for being strong. For having lots of monetary power and being sexually active. Everybody is just trying to be seen and accepted by society’s standards. When you’re a child and you grow up and are finally addressed as a man or a woman. That’s huge.

                    I appreciate taking the time to help me understand your feelings and your perspective on how the rest of the transgender community feels. I have no doubts about how you feel about yourself and I don’t question the validity. I have difficulty understanding the boundaries of being trans and the thresholds for what should be provided medically to people as a human right vs what should be treated as a mental health issue.

                    I’ll continue to do research and talk to people about it.

    • AnarchistArtificer@slrpnk.net
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      1 month ago

      Mental health systems are so overburdened that it’s not uncommon for someone assessing a trans person’s poor mental health to go “well, you’re experiencing [wide array of concerning mental health symptoms], but it’s my opinion that these symptoms are almost entirely attributable to gender dysphoria, and you’re already on the waitlist for the gender identity clinic, so there’s nothing more I can do.” and then they discharge them.

      With such huge wait lists, it would make sense to keep someone on your books to keep an eye on them at least, if they’ve expressed feelings about self harm, but that doesn’t happen because the system hasn’t sufficiently acknowledged just how fucked the trans healthcare wait times are. Like, in the UK, there’s a statutory maximum of 18 weeks wait from when the referral was made until your first appointment, but the standard wait for an adult to have a first appointment at a gender identity clinic (which doesn’t involve any treatment, that comes months later) is literally years. But officially, you should be seen within 18 weeks, and under those circumstances, well the mental health people discharging you is reasonable if there’s little they can do to support you

      • venusaur@lemmy.world
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        1 month ago

        Imagine mental health professionals should address this situation with gender dysmorphia in the same way their might address somebody who wants to get a BBL.

        Let’s say the person has dysmorphia about their body and they are willing to undergo one of the most dangerous cosmetic procedures available (1 in 3000 mortality) in order to feel good about themselves. A good therapist/psychologist, and maybe in conjunction with a psychiatrist, should try to get them to a place where they are comfortable with their body and do not have feelings of self harm because of it.

        • kase@lemmy.world
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          1 month ago

          I just want to point out, gender dysphoria is different from body dysmorphia, though the words look very similar. A person with dysphoria (eg, a trans person) sees their body the way it really is, but is uncomfortable with it. A person with dysmorphia (eg, someone with an eating disorder) sees their body as different than it actually is, and is uncomfortable with that perception.

          That said, you can’t effectively treat someone experiencing body dysmorphia the same way you’d treat someone experiencing gender dysphoria, and vice versa.

            • kase@lemmy.world
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              1 month ago

              Do they? I guess they’d have to figure out why they’re so set on getting that surgery, if it isn’t a matter of skewed body image. Any treatment is going to have to depend on that, I’d imagine. Has there been research on this subject?

              I sincerely doubt a doctor’s first response would be to encourage the patient to get a BBL. Gender-affirming care (specifically here, hrt and surgery) has been extensively scrutinized and researched and has been proven effective for treating gender dysphoria, and other treatments (like conversion therapy) have proven ineffective. As far as I’m aware, the same isn’t true of BBLs and (is there a name for this phenomenon?). From what you said, it sounds like BBLs aren’t nearly as safe as gender-affirming care, so that might make it more difficult to justify. It’s also worth mentioning that gender-affirming care is justified by just how bad the outcomes are without it (e.g. suicide rates, persistent mental health struggles, quality of life). Afaik, similarly negative outcomes haven’t been observed in this case, but please correct me if I’m wrong.

              *I’m typing this on my phone, but if you do want sources on the effectiveness and safety of gender-affirming care, effects of conversion therapy, etc., I’d be happy to provide them once I get home.

              • venusaur@lemmy.world
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                1 month ago

                Idk that they’ve done a lot of research on BBL’s specifically, but people who I know have had cosmetic surgery did so because they were unhappy with how their body was, not because they saw it as something else.

                I don’t doubt that gender affirming surgery can help people. I’m just wondering why one type of mental abnormality should be treated with surgery over another.

                I’m curious, if society abolished gender, would people still feel the need to have gender affirming surgery? They would only ever be perceived as they them.