14 - The REAL Ways to Manage Gender Dysphoria

You're listening to Gender, a wider land. I'm Stella O'Malley, a psychotherapist in Ireland. And I'm Sasha Ayad, an adolescent therapist in the United States. Since twenty sixteen, my practice has been exclusively dedicated to I also work with gender questioning teens. And I facilitated support meetings for families and individuals who've seen the first time.

Gender issues. We're curious about the concept of gender and how it's unfolding in the wider culture. Join us as we look at gender through a wider lens. Hi Sasha. Hi, Stella. So our episode today is about how to manage gender dysphoria. And I know you really wanted to do this episode.

Yeah, I did. You know, I I facilitate m meetings at the Gender Dysphoria Support Network and we often meet. We meet on Mondays, Wednesdays, Thursdays and sometimes Saturdays too, different parents of uh Not only parents,'cause we have sibling meetings and we have other meetings as well.

But often it's an awful lot of parents who are trying to help their children who have gender dysphoria. And some of these children are adults, some of them are teenagers and some of them are quite young. And they are all coming up with different things. And they keep on asking me but. But is medicalisation the only way to manage standard dysphoria? And I look at them kind of in almost astonishment and and I kind of think Well no there's many, many ways to manage dentatus for you.

And they ask me with wide eyes, regularly in these meetings, what are they? What are these ways? As if there's these kind of almost like the Wizard of Oz behind his green curtain has all these ways to manage gender dysphoria. And I'm like Gender dysphoria is distress, it's mental distress. Deep, powerful, awful, imprisoning distress. And since time began, we humans have been managing distress in many, many different ways.

Filosofi wedi'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i Now some people grapple with their demons through religion and that's where they go and that's how they kind of kind of make sense of their distress. So this it's it's

Thousands and thousands of years old, some people become poets, some people become artists or great musicians. You know, Bob Dylan, I have no doubt, was driven to create because of his mental distress. And so it's no different than any other mental distress. There's many ways to manifest mental distress.

And some people manifest it with gender dysphoria and it's centered on gender. And it maybe it's propped up online and maybe it's exacerbated by other outside influences, but fundamentally it's it's a mental distress. And we don't need to make this more special than anybody else. Some people might grapple with their mental pain by trying to get a sense of control of the earth.

And they maybe that sense of control might turn into O C D or it might turn into anorexia. You know, there's lots of ways for our distress. Some people Grapple with the earth and they get relaxation through alcohol and to become alcoholics. There's lots of ways for us to find dysfunctional coping mechanisms. And gender dysphoria is arguably a dysfunctional coping mechanism that people set upon as this is the solution to my mental pain.

Or somebody else it's tapping, or somebody else it's restricting what they're eating because they feel powerful. And it's what you have to do is before gender dysphoria there was pain. And that's what we have to do to stress. That's what we have to at uh what's the word? Attend to. That's what we have to look at. And so what are the ways well, psychology, talk therapy, bibliotherapy, reading books?

There's lots of ways to manage gender dysphoria. You could ha lots of people talk about dialectical behaviour therapy, DBT, lots of people talk about acceptance and commitment therapy. There's lots of different therapies out there. I know you've spoken very eloquently about grounding strategies and body Body starts saw it very interested. But yeah, the big thing I wanted to kind of start this was, yep, before gender dysphoria with pain and the gender dysphoria was a solution to the pain.

And we've got to start grappling with the pain and seeing where where that came from. Yeah, I mean, what you're saying is so important. You've talked about the way transgender identities have become this exceptional thing. And we we put this kind of different type of lens on as a culture when we think about gender issues. And you're really saying this is just another way that distress can manifest in a person.

Yes, there's lots of factors that that kind of come into play as like why now? Why so many kids? Why this? Why that? But the bottom line is this is a way of dealing with distress. And I think it's just so important that that people, including people with gender dysphoria, just sit with that idea that actually this is one particular way that I could have been distressed about my identity, about my body, about where I fit in in the world.

And so we want to take a broader view today in discussing this. And we're also going to talk about some practical kind of applications. You know something that came to my mind, Stella, while you were talking is that I tend to think that i the way I might advise a family

and parents of a child is a little bit different from how of course it's different from how I would work with a young person themselves. Yeah. And when it comes to parenting, we're gonna, of course, do a whole episode about this, but I like to start with some of the basics. You know, this is very, very simple. It's almost going to sound trite. But if a person is distressed, you know, I like to start with the biology. Is this person getting an adequate amount of rest?

Are they sleeping two hours a night and up all night on their devices and therefore they have a headache and feel like crap all day? This is such a basic but very important thing. And I know I've heard you talk about this too. A lot of kids I work with have terribly dysregulated sleep cycles. So I don't know if you've had this experience, but if I don't sleep enough, I feel like crap and I'm not myself and I just don't know how to manage the ups and downs. And so that's a basic thing.

That I often listen for when working with clients or families is this young person's sleep in a good place. And all the physicals. Are they eating right? Are they getting exercise? It does sound trite and it's so important because when you get it right, you think, Oh my god. I should have been doing this so long ago. I do think about sleep problems is insomnia is a kind of manifestation of anxiety. And I don't think that's said enough.

And so that people think, Oh, I have insomnia or they're a bad sleeper and I'm like, uh that's a bit of a shallow understanding of insomnia. Th there's probably more to it than just I'm a bad sleeper. Overthinking could be an issue. Now overthinking with devices

It's just a mess. There's it's just an absolute mess for insomnia. And so like, you know, for for anybody who's trying to help somebody with gender dysphoria making sure that their their their technical hygiene or their their health around their devices is is is appropriate. Almo I would say number one. I would say number one, get at the devices and make sure that it's not kind of relentless. um technology because that doesn't seem it seems to exacerbate gender dysphoria for a raft of reasons.

There's a a really interesting detransitioner named Nellie. She was actually featured in a photojournalism. Um Sunday Times Yeah, the Sunday Times. Laura Doddsworth did a brilliant piece in the Sunday Times. Yeah, it's great. We'll link to it. And um what she talked about, what Nellie said in one of her YouTube videos She she lists a whole host of things that she does to manage her gender dysphoria. And one of the things she mentioned was.

you know, that she's an artist, first of all. She's a visual artist. So again, she's like very creative and she's very into the visual aesthetic of things. And she said that following non binary models on Instagram who were very, very thin. made her hyper conscious of her own body and things she didn't like about her body. So she started following more Instagram accounts with

Different kinds of sizes of people. And she found that looking at different types of bodies made her less critical of her own body. So if you are fixated and we know that one of the traits that's tends to overlap with gender dysphoria is O C D. Mm-hmm. So if you're returning over and over and over in kind of a compulsive way To images of a body that you could never actually look like, that's gonna make your distress worse. And we know this.

We know this beyond gender. I remember Time magazine did a study of which is the most destructive to your mental well being of all the platforms Instagram. Believe it or not. Yeah. The one that is supposedly the feel-good one and that doesn't have all the dark, you know, darkness of Twitter. And yet Instagram was the one that makes us most unsettled in ourselves.

Oh wow, that's really interesting. Well, it's that visual comparison. Yeah. Yeah. So we talked about, you know, just making sure that you're kind of daily body hygiene is in a good place, getting enough rest, eating nutritious food. And I mean we glossed over that, but It is really important for people to be conscientious and thoughtful about what they eat and what they put in their body because it does impact our mood. It impacts our insulin. It impacts how well we manage distress.

So these are all things that we kind of have to experiment with. And then we talked about, you know, making sure that the visual inputs that we expose ourselves to over and over. Create kind of a healthy relationship with the self rather than one of comparison or self-criticism or scrutiny. Yeah, and there's a really important point to be made around this. They did it well in in the film The Social Dilemma, but it's called the illusory effect and it's how all propaganda is um worked.

And basically the more you see of something, the more you believe it, even if you're busy not believing it. You know what I mean? The more you see of a certain way, whatever it is, you know, women or whatever, the more you see Because of the human brain, we start to believe it even if we're telling ourselves we don't believe it. So

constantly exposing yourself, like Neely, maybe to the uh skinny, skinny girls or s whatever she was looking at, would would be kind of infiltrating her brain on a level that we don't realise. So we you have to be very careful about your content. Even if you're busy'cause some people like to go on stuff that they hate. And I'm like, Yeah, what watch that because it's it's really interacting. So it's not even just your your um how many hours are you on technology, but also what is the content.

Where are you going? And is it you know there's a great concept called slow news. And it's part of the slow food movement and sl part of the slow parenting movement. And I'm like, yeah, I really think we need to have to slow down this, this kind of constant feed of rapid emotionally driven media. could could really exacerbate ma gender dysphoria. So it's one of the many reasons that we have to be careful of of our technology.

Not only that, but you can come in now, but not only that, but there's the whole the anime world which very definitely seems to exacerbate gender display. So self awareness is needed. Mm-hmm. Mm-hmm. I I'm just thinking about this the kind of slow news movement or whatever. It's making me think of something I've discussed a little bit before that The tendency these days when a person is experiencing a distress is to reach out to outside sources to try and understand.

So they might go online and you know, we do this with all kinds of things. Like I have, you know, a pain in my stomach on the right side. I'll Google it. Is this an ulcer? What is this? So I mean we we do this with everything these days. To be self-kind of respecting and to take our time with things means we have to give ourselves a chance. To come up with our own solutions sometimes, you know, our problem-solving abilities, which are very important in managing distress.

have probably taken a huge hit. Given how quickly we can find answers to everything online. And this is really hard to do. I'm so guilty of this. I mean, if my toaster malfunctions for two seconds, I'm Googling like how to fix it. Rather than just like tinkering with the toaster or like should I look under the toaster? I mean, little things. But I wonder if you were a teenager online or a young person

Is our ability to manage our own internal world getting damaged by how quickly we seek out a label, a definition, a solution? What's the treatment? So I think to slow down and give ourselves a chance. to see if we can just sit with things or find a solution for it on our own. Yeah, I I I think our profession is very guilty of of propagating this kind of idea that you go to the professionals with your with your problems.

And up until maybe eighteen fifty, if you had a mental distress, it was your problem and you figured it out and you Maybe you turn to friendships, maybe you turn to love or whatever, or philosophy or religion, whatever you do. And then along came psychology, which is frankly very young. It's only 150 odd years old. And um it's like we're still at the point of putting leeches on people's skin, I sometimes think in in psychology, that we're we're very early in this

science and I use the word a little bit openly and loosely here, but I I think people presume we've got to kind of externalize the solution. So we have to kind of find out where is the solution to this. And it's not going to be within me. Some professional somewhere has the solution. Yeah. And what I need is a diagnosis. And when I get the diagnosis, therefore I will get the solution.

And it's like we brought that in. I would say the psychologist did rather than the psychotherapist if I could just defend psychotherapy. Blame the psychologists. But it was brought in as a framework and with implicit within a diagnosis is therefore there is a solution. And so people go running off looking for the diagnosis.

And I think it's a it's a rabbit hole really, because once you get the diagnosis you don't have the solution. The solution is actually in you. And you know, I I know there's a a beautiful book called The Time in Between by Nancy Tucker. She was um uh she had an a horrendous eating disorder. And uh she wrote about a very gifted child. She's only about twenty five. She wrote a second book which was called That Was When People Started to Worry and she's still only twenty five. She's very young.

And when she wrote about um the time in between and her eating disorder, she came to an awful point at the very towards the end of the book where she realized If I eat a little bit more if I if I don't eat, I'll be hospitalized and they're going to drip feed me. While if I do eat, I'll be able to stay out of hospital. So no matter what I do, I I kind of have to eat.

And she kind of realized, oh my God, with horror, it's only me who can make myself better. And then she talks about the right therapist, and she said, When I found the right therapist, that was when I came to the kind of shocking realization that I had to do all the heavy work. and that nobody else could do it for me. and that the right therapist could bear witness, she could support me, she could offer strategies, but really I had to do all the heavy lifting. It was all up to me.

And it was massively up to me. And she didn't realise it until she found the right therapist, she didn't realise it. And she doesn't know whether was that the right timing for her? Or was that the right therapist who who led her to that? But if I wanted to give everybody in the world a gift, I'd give them the realisation of your problem will be best solved by yourself. Even if you're twelve.

You know what I mean? That like yeah, your parents can support it, but ultimately the heavy lifting will be done by you yourself, by your heart, by your soul, by your courage. And That's an awful realisation, but it's very empowering and liberating in itself. Yeah. Yeah. Um it It's making me think about the fact that I think it's a very human tendency to look outside of ourselves for solutions. You know, I agree with you that the field of psychology has a a role to play here.

But we've always had some kind of codified institutions to help us with things, you know, whether it is You know, you're distressed so you go to church and you pray and you confess or you're distressed so you go to a shaman, you know, who's gonna give you a certain number of herbs or something and a little ritual you do. Like I think it's really natural for human beings to look outside of ourselves for answers. But I I do feel it's a huge gift for a person to recognize that

They they are going to have to to do the majority of the work. And it's also making me think about the fact that there's a certain kind of readiness to heal, just like you mentioned with Nancy Tucker. Like was it the timing, you know? And I think there are parents who might be listening to this who are in a rush to get their kids better.

And on the other hand, there might be dysphoric people who they themselves are seeking out resources and trying to listen to our podcast. And it just really depends on the individual person and whether they're actually

interested in genuinely healing their dysphoria. And I mean I want to talk about that, but I want to just stick with the theme of the body before we move on to that. Um I really think For young people or adults whose dysphoria is very body-based, right? Like that almost sounds like it could have been an eating disorder in a different time, you know, or cutting or something very physical. I think feeling capable in the body is a really, really important antidote to wanting to change the body.

And in gender dysphoria, when you do get fixated on this idea of transformation. You're going to be very aware of how your body looks. It's completely aesthetic. And actually, Stella, when we did the episodes about the medical interventions, they're all aesthetic. They're all like, Well, if we block puberty early enough, then this child will look more like the sex they wanna be. It's so aesthetic. Yeah. And the antidote to aesthetic fixation. in my opinion, is physical capacity.

And like I never had gender dysphoria per se, but I definitely struggled with some kind of an eating disorder when I was young. And for years I was fixated visually on every little inch of my body and specific parts of my body that I was distressed by. And I easily could obsess over those things.

And for me, one of the really important things I've done to move through that was cleaning up my visual environment and making sure I wasn't constantly comparing myself to others. So I think we could apply the same thing to gender dysphoria. I focused more on physical capacity rather than aesthetics. So rather than exercise being something that was meant to make my body look a certain way, I started focusing on what is the capacity that I have with my body. How fast? Yeah, I mean lifting weight.

being able to carry heavy things, being able to push myself in a kind of self-competitive way. You know, how fast can I run? How much output can I create? How uh and of course I I have like a whole life and dance. So how How well can I express the music through my body? So being able to think about what can my body do rather than what does my body look like.

That has been probably one of the most transformative things. And of course, again, I didn't exactly have gender dysphoria, but I I know what it's like to want to get out of your own body. I think that's so wise what you're saying. I often think that

Trying to give a pride in what your body can do can lift you out of a a self loathing of your body and it can give you a deeper relationship with your body. I I I I think maybe mountain climbing, abseiling, horse riding, boating, anything that does this physical manipulation, gymnastics,

Um, and I know some some gender dysphoric children would be absolutely horrified by some of these, but I do think something like horse riding is is really interesting because there's something very soulful with a horse. and there's also physical manipulation and there's also gaining control. There's an there's an awful lot in things like that. Any of those sort of physical just to bring them in to your life.

as a way of reminding yourself that the body is there to do things with the world. The body is there to grapple with the world. That's why we have bodies. It's not to look good and it's not to look a certain way. And you know, it's not about that really. It's about something else. It's about something much more phenomenal and fabulous. Um when you were talking, it made me feel a little bit sad because I was actually a very sporty kid. And I was really into it and I was fairly good at it. And

Somewhere in the midst of it all, uh, when puberty struck, I I gave up all the sports. Haven't been good. I gave it all up and I I think I gave it all up for various different reasons and I know it's very common in children. But I remember feeling powerful. I was so powerful in my body. Running fast, swimming. um like climbing trees, being able to kind of climb trees really high, that physical ability that children have.

and they lose it around adolescence and it goes from your physical what can you do? How far can you run? How far can you kick the ball? Look at the ball going in. It moves from that to what do you look like? Yeah. And that's so narrowing and defleet, defeating for for people. And I think we've got we've got to kind of if you've got issues around your body, you've got to kind of reconnect with the power in your body and your the capacity, like you say, in your body.

Yeah. And even even being able to be still in the body, which is kind of the opposite side of this coin. I mean, we've talked about these really powerful movements or competitive, you know, timing your running or lifting weights, but The ability to actually be still with your body

is important too. And I was fortunate to have I had a job that basically I was like a professional yoga student for a long time. And I was fortunate to have a lot of really great yoga teachers which taught like a much more traditional style of yoga. What do you mean you're a professional yoga student? I got a second.

in our clothing. I'm not gonna say what the company is because it's like a whole thing. But I would go to like two yoga classes a day and just talk with yoga studio owners and create events and things like this. I did a lot of things before I

got professional with psychology. But but you know, learning from really good yoga teachers, I learned that being able to Stay present with your body even when your body is in an uncomfortable position or when you're holding a pose that feels really intense. To be able to stick with yourself and respect the fact that your body is having these sensations, it sounds subtle and it might even sound a little strange, but that's what emotional distress is. When you're feeling really sad.

Your eyes are filling up with tears, there's a lump in your throat. It comes through us as physical sensations. Or if you're anxious, you know, your heart's pounding, you're clammy. If we if we are afraid of the physical sensations of emotion. We try to run away from it and we can't actually process it and we can't figure out what our bodies need or what we need or so I just feel like there's so much that our body can teach us if we learn how to.

kind of engage it in dynamic ways. Like, yeah, sometimes we have to push our bodies and be strong. Sometimes we have to be quiet and just be in our bodies in a peaceful way. So I mean, these are just some things that are very, very important parts of managing the physical experience because none of us exist without a body. Anybody listening to this, you have a body. So you better figure out how to deal with it.

Yeah, and if our if our if our body is distressing us, I would like to say, well what's behind that? Wha what what is behind that? What is driving the fact that your body is distressing you? And um it it could be emotional needs aren't being met. And William Glasser, lots of different psychologists had different kind of um we all have physical needs and if I don't get enough sleep I get weepy, if I don't get enough food I get hungry, etcetera, etc.

Equally psychologists have identified emotional needs, but that doesn't get lifted enough. William Glass at probably because the psychologists argued among themselves about what exactly are the words to describe our emotional needs. Um but Willem Glasses I like'cause they're quite simple. He said we have five he's an American psychologist.

he kind of developed choice theory in in around the sixties. Very interesting. But anyway, he said we had five emotional needs, which were we have a need for some we have to meet the we have to meet them all or mental distress will manifest. And so we have a need for safety and security, a feeling of being safe in the world, a feeling that we we kind of are not threatened.

We also have to have a need for love and belonging is in you know, we belong somewhere, somewhere that that everybody understands us and knows us. We have a need for fun and challenge. That means our brains been stretched, a bit of a laugh. A need for power, need for feeling of com competency in the world, and lastly a need for freedom and autonomy to do your own thing.

Yeah, if one of those needs aren't being met, and I would say regularly many of them aren't being met, just like many of us aren't eating the right food and many of us aren't even having enough sleep. We end up weaker as a result. And so if you have gender dysphoria, I would say, well, where's your emotional needs? Are they being met?

Are are are you meeting all your needs? Where's your physical needs? Are they being met? Let's get back to basics here. Just make sure your needs are being met before we go any further. I look back on my teenage years and I think, well, I was underslept, I was sleeping. 'cause of a whole weird scenario is in I was sleeping three or four hours a day a night. And uh'cause I was having two lives. I had a kind of one life with one friend and I had, you know, my ordinary school life.

And I was so depressed, but what was the impact of that lack of sleep? I just laugh because I'm so weepy if I don't get enough sleep. So I there I was, a desolate, isolated teenager who was completely dismissing the fact that she wasn't getting enough sleep because that was boring. That was a boring kind of trite. analysis of the deep existential trauma I was undergoing. And I look back and

I wonder would I have had a very different life if I had just had sleep? I know that sounds silly, but I heard you say something I wanted to ask you about. You were saying there's kind of two groups when you talk about gender dysphoria. One is people with gender dysphoria, which is the incongruent, the the kind of deep feeling of dissatisfaction between the body and the gender roles that are maybe imposed upon us.

And then there's people who are meeting kind of the adolescent tasks, the tasks of adolescents. And you see these as two groups. Yeah. Am I right in the thinking that I'm Well I think about it more like there are some and this is just based on my clinical experience, you know, over the last few years. There are some people who are really dealing with an existential body distress.

So these are people who have a lot of overlap with eating disorders, a little bit of O C D, maybe like compulsive picking or like just kind of things that are showing up in the body. These might have been your kind of bulimics from a few decades ago. These are maybe c could have been cutters, you know. And these are people who are really, really struggling with the body in a very specific way.

Then there's another cohort, and I even hear young, you know, LGBTQ people talking about this. There's this thing now called social dysphoria. So they say, well, I don't really have sex dysphoria. I don't really have a lot of body dysphoria, but I have social dysphoria, which is I would like to be perceived a certain way socially, but they're fine with their body. So I think this kind of hints at a totally different cohort of young people.

And I think some young people are attempting to meet the demands of adolescent development through the identity. So if there's a young person who feels Like mom and dad have always had too big of a a say in their life, and they've never had any autonomy, and they feel really afraid to disappoint or go against their parents. The gender dysphoria and the identity of trans might be attempting to meet that need for separation or that need for autonomy.

And in that case, like in my experience, it's really not fruitful to work with this person on their body distress because they're not really experiencing that much body distress. What they're experiencing is kind of a tug of war.

with mom and dad over allowing me to be my true self and mom and dad trying to make me not be trans. I th I mean that can show up in other ways too, but I do think that there's there's just lots of different ways that a gender a transgender identity actually manifests and it might be indicating totally different kind of reasons or causes behind it.

And so for some people with enter dysphoria, it might give them a nice sense of control. And that's why they're gravitating towards it because that feeling of I'm going to control my body and then I will be able to feel in control in an out of control, chaotic world. And that's how their mental distress is alleviated because they feel I gotta control this. I'm gonna control how people see me, I'm gonna control how they speak about me with my pronouns and my name.

how they perceive me and how they talk about me with with with uh my identification. Somebody else might get a sense of belonging. You're going to be part of this huge community, and it's really, really warm, and it's actually very interesting because there's an awful lot of um concept.

rattling around, there's an awful lot of social network going on and I'm I'm really part of a movement here and it's a big new innovative movement uh global that I'm part of. And then some people get a feeling of power. And they feel I'm I'm empowered for the first time in my life. I I didn't feel powerful, but now I feel powerful.

And that's very kind of so If you were trying to help yourself if you had gender dysphoria or if you're trying to help somebody who you love who has gender dysphoria, I'd really strongly recommend, rather than dashing off looking for a therapist, I'd really strongly recommend what is the driving need that's being met here. What is what is this what is at root of this? What is it? Is it a need for power? Is it a need for belonging? Is it a need for

control. What is it? And then when you have that, then you know there's lots of ways to meet that need. Now for some people it might be a need for power and therefore I'm gonna go towards the masculine power. That's where I get it. Some people it might be a need for softness and gentleness. And so I will go towards softness and I will identify as female.

Yeah, I mean it means though, like again, talking to parents and talking to dysphoric people is just really different. But let's say we're talking to a dysphoric person. Maybe they're trying to identify as trans, but their dysphoria actually seems to be getting worse, which can certainly happen, you know? Or they've identified as trans and they've started a medical procedure and for whatever reasons of their own have decided to detransition.

I think that the important thing is there has to be a radical amount of curiosity and openness as you ask yourself, you know, for me, what were some of the factors that maybe contributed to this distress in the first place? And you know, I think the reason for me that it felt important to start with some of these body based things is because Lots of people I know who have gender dysphoria tend to be overthinkers.

So they probably already have spent years and years sitting around thinking about why, why, why, why. And so, you know, I I usually will say, well, if that hasn't worked out great, let's try a different approach. Maybe let's forget the thinking, let's work on these other things.

But you know, once the person is in this place of curiosity or trying to understand, there's a way in which they have to be radically open to whatever comes up and being able to examine our own. kind of coping strategies and what we're really bothered by means we have to address the pain that was there first. I mean, you talked about that at the beginning. Yeah. The before the gender dysphoria there was usually pain.

And if this is a way of avoiding it, then it's gonna be really challenging to move the gender aside and say, well what else was really causing me to feel so alienated from others or out of touch with myself or whatever the case is. And for me, for my own mental pain, just for my tuppets worth, what freed me more than anything was self awareness.

You know, if you can have self awareness and insight about what distresses you and what is the cause of your But if you're disconnected from that and you don't know why you're upset, and you've got an rage that's driving you, and you don't even know why, but you're just furious. then there's a suggestion to me that self awareness would really help. And I I often feel when I work with clients and when I work in the the gender dysphoria support network

Which I often call the GDSL, which is easier for me. Um, I I find that we have to build our self-awareness, not externalize that. Don't throw that out to the therapist. If we can build our inner self-awareness, We're free to do everything. I do think And it does get lifted a lot at the meetings at the G D S N is that it seems to me

A lot of children are trying to individuate from parents and that's the cost-benefit analysis. They're trying to reject their parents and become a person and they don't quite know how to do it, so they kind of in a way I I'm not only the person you think I am. I'm completely somebody different. I'm this person over here and I'm identifying and you don't know anything about you. In a way it's it's a it's a rejection of the parents and it can feel devastating for the parents.

But I think it's often as you've called them before and I think it's a great phrase, the compulsively compliant child. And when you're compulsively compliant, you're you're so used to saying yeah. that you've never got to y shout your your no. Do you remember that great? Do you remember the Dead Poet Society? And he got them all to shout their yup. Yeah. Yeah. These kids need that.

Yes. And this is their yup. You know what I mean? They need to kind of they're trying to roar and they're trying to go, This is me, this is my roar. And um it it it's coming out, I believe now this is just a theory and it's a fairly highfalutin one, but I think I think there's something in it. I really do. So you're recommending scream therapy then?

Well, I mean no, I uh in all seriousness I I do want to say I'm recommending they learn to say no. They learn to find their strong voice, they learn to look at something and say not for me. Don't want to do it. They learn to say, Yeah, I know you want me to to unload the dishwasher, but I won't. And the parents don't like this because they're saying, if I could only keep every one of their traits except this one, I'll I'll be happy. And I'm like, Yeah, no, no, no, no, no.

Not gonna happen. Yeah. I mean I I think even beyond that, I find a really common issue with these kids is that they're terrified of being angry. Yeah. And that's an issue in this society. It's compulsively positive. She's positive. And you know, we've got to be aligned with our dark side. You know, Carl Jung wrote about this very eloquently about, you know, our shadow side. But we have it. And you've got to kind of bring it in or it's going to be driving you.

And and the shadow in Carl Jung's conception of it is anything that we have disallowed in ourself consciously. And it will show up in some other way. It's like playing whack a mole. You know, you you bang it down and then it comes up some other way. And so the shadow includes also Traits that are not necessarily considered like negative traits, but anything that we do not allow in ourselves, which can include things like.

self indulgence or pleasure, you know, if you come from a family where everything has to be in moderation all the time, you know, that might be your shadow is something in there about unabandon, you know, and just uh complete like freedom. So shadow is really important and and to think about these kids with their anger issues. I am struck by how unwilling sometimes young people are to even just

say something not nice about another person. Yeah. There's this I feel like we needed toxic empathy. I saw a psychologist talk about this. I thought it was brilliant. But Uh we a as a whole human being, we have a whole host of emotions and they're in us for a reason. We have to be able to be angry. We have to be able to be You know, aggressive in moments, not necessarily physically aggressive with our parents or something, but these kids are terrified.

of any impulse inside of themselves that i it comes from a place of anger. I'm really interested in this and I know about that concept called toxic empathy, but I'd move it forward to is there a concept and I think there is of toxic positivity? Yeah. It's this blank, yes, good. Everything's good. You do you. I'm gonna be positive about everything. I do not let in the darkness or the the shadow side.

And I I go back to and I know we've mentioned it before, but you know, that whole kind of positive psychology, that positive movement. That kind of was brought in With books like The Secret and you know Oprah Wimpy and stuff and I know Oprah could be brilliant, but there was a real kind of let

Let's just do positivity here. And it's like, I don't know, because if you know your history, you ca you cannot we come there's a great phrase, you know, not a phrase, a great quote from Robert Ardry, who I believe is problematic for some reason, but sure everybody in history is at this stage. And he says he says we are born of risen apes, not fallen angels. And the apes were armed killers besides.

And then he says, So what should we wonder at? Should we wonder at all the terrible things that happened in in the world? Or should we wonder at our ability to produce art and poetry and all the beautiful things? We're coming from April. But we have a dark side, and that dark side, we were killers in our ancestry. And you know, that dark side isn't given enough room. And with that is the designification of childhood, where children these days have been brought up in this compulsively positive.

Kind of background where it's all about being positive and all negativity, everything has been kind of regulated out.

And it's frightening because they're frightened of the dark thoughts that are in their head and they suppress them. And when you suppress thoughts, they come out in mangled, warped ways. And they can come out in lots of different ways. Yeah, I I mean it's interesting because on one hand, I think young people these days are much more attuned to like destigmatizing mental health and like you know, talking about your depression. And so in some ways it seems like on the surface they're actually

able to, but it's all up here. It's all cerebral, it's all talking. And it seems like there's a lot more space in our culture for talking about sadness or depression than there is about anger. So I mean, there's just something maybe because we come from a line of chimpanzee killers or whatever it may be, maybe there's a part of our instinct that knows anger can be so dangerous, right? So maybe we have a natural aversion to it or а like a societal pressure to

kind of keep the lid on anger. There might be something evolutionary about our fear of it. But I think if anybody is listening talking about gender dysphoria, it might seem a little bit disconnected. But Being able to own and experience all of your own emotions, including anger, feels like an important thing to do. I feel that there's a real link with rage.

and gender dysphoria. And I I really think People with dentos for you are very uneasy when I I might lift that up and point out that there's often unattended rage. We could focus more on our rage than on the gender dysphoria. And for those of who those of listeners who do have gender dysphoria who are listening, I do want to say focusing on your gender dysphoria is not the way out of gender dysphoria. Just like focusing on your depression is not the way out of your depression.

Focusing on your anorexia is not the way out of your anorexia. You're trying to expand your brain, expand your life to all the other things, anything else. You sit around focusing on your genitys for you. That's exactly how you'll get work. And uh i it's a real crucial point. For people to realize, and if you want to focus on something dark, focus on your rage as you expand.

If you uh as you expand everything else in your life. So you expand your ability to kind of be part of art and culture and maybe it's books, maybe it's video gaming, I don't know what it is, music. You also expand your c social connections, you s you you deepen your relationship with other people, you deepen your self awareness, and you might lift yourself out. Well if you instead choose to go on devices and explore every inner corner of the dentist, that will be how you feel better.

Yeah, I think you're right, Stella that's not a good thing. the focusing on the thing that is causing the distress can often actually just make it bigger. I think you talked about the illusory truth effect where the more you think about something or focus on something, the more real it starts to feel. So That's the kind of ironic thing about psychology and mental health is like

you know, there's this push in our culture, like let's put more emphasis on mental health, let's talk about mental health more. And you know what? I mean, that sounds really great from a bureaucratic standpoint, but in practice actually we do want to expand to bigger things and You know, I I often will talk with parents who I consult with about, you know, is is the person's life enriching in other ways?

And if it's not, then this can become the one thing that a young person focuses on because it gives them a sense of hope. If you believe that changing your body will make you happy, you're gonna spend a lot of energy in that fantasy. So if you can develop hopeful, enriching, valuable experiences in other ways, that can be a really nice counterpoint. I do think um, you know, you've lifted it before and it was really good around the kind of the very gifted children, the exceptional children.

They are looking for they're looking to really get into a subject. They're looking to get into it and really explore it on any any level. And maybe gender is the one they've they've lit upon. And I would say, yeah, expand it beyond that and expand it to anything else that you could really, really, really explore. And then you're kind of you're expanding your mind. And uh it's it's unfortunate if what you've decided to kind of focus on is bringing you down. And I do think kind of

measuring your mood before you go online and then measuring it after. Just tracing and tracking your self awareness around is this making me feel better or is this making me feel worse? It can be a very helpful just fairly kind of you're you're you're kind of doing the heavy lifting yourself of realizing what's working here, what's making me feel worse. I I do think a lot of the slogans around mental health have have

led us into a really um simplistic view of mental health where we think if we can get rid of the stigma, we're gonna get rid rid of mental distress. And I think uh uh that's wrong.

That's wrong. We every single like in six thousand years from now and if the humans are still alive, there will be massive mental distress. We can sophisticate ourselves out of everything except mental distress because the existential kind of angst of we don't know where we came from, we don't know where we're going and life is phenomenally unfair. Is is irretrievable. We can't get over that. These are awful truths.

And I guess what this is making me think, Stella, that expecting a distress-free life is unrealistic. And this is also true for gender dysphoria. You know, if gender dysphoria just happens to be the way you get hung up on things. Don't expect that you can just make it all go away. We are all in a process of grappling with our own demons. A and might we in in fifty or a hundred years, might we come to a point where adolescence is

almost developmentally distressing that it's it's just that is something that we just have to kind of get through to harden our shells for adult life. I'm I'm not sure about that, but can we get through adolescence without distress? And are we I consider myself along it. I'm horrified by my child's distress and she's entered sh adolescence and my little boy is entering it too.

And I'm kind of thinking we I think we've been brought up that we've we've we've made life so lovely for ourselves in so many ways, we kind of panic in the face of mental distress. Mm-hmm. And we're we're fearful of it. And I think we kind of We're going to have to realize well it's it's if you if you're not going a bit mad in this world, you're asleep.

Yeah. And that's that the the the burden of the involved engaged person is mental distress. Yeah. Oh that's so important. I mean this is also about You know, we we c we live in a world in which we have a lot of control over our environment. in our internal and external experience un unfortunately gets lumped in with that.

You know, we're recording this February of twenty twenty one. I I live in Texas at the time. We just had this massive freeze. I had no power for four days. It was seventeen degrees out. Did you have a bike to I almost did, Stella. But you know, I I kept thinking, god damn, we are so spoiled. And I I heard you talk about inside a house. I s I still had shelter, but I was cold. I was cold for four days and I wanted to die.

So I mean I just I want to say that We are so lucky to be able to control our environment most of the time, really in the in the In the long scheme of things, we are a blip in time where we have this level of control over everything. I mean, if my browser loads slow, I roll my eyes and I like throw my hands up, you know? So we're just we have to keep it in perspective and You know, I I think this ability and desire to control everything, um

Uh I just wanna talk about how that might also show up. Do you have a thought? Yeah, I do. Uh'cause I I I just want'cause it occurred to me as you were going through your breakdown over the weather over the last week. We we we we have become so sophisticated in our culture and we're talking about language and we're talking about theories and we're online and we're full of this and we forget actually nature is so much bigger than us.

And we can kind of think, ooh, we're so clever. And then suddenly a storm blows us out, and suddenly we're like cavemen. And it it's a it's a really interesting and good lesson to learn that actually nature is massive and we have not got a hold of it. But it reminds me of the beautiful uh poem by Adrienne Rich.

And she has a beautiful poem called Storm Warnings. And it's about it's about the melancholy that can come across people. And it's a lovely poem for those of us who do suffer kind of mental distress. She basically says when she feels you know, if you read the poem it's really lovely, but when she feels the the distress, the melancholia, the vulnerability coming.

She's she's battening down the hatches, she's kind of preparing her house, she's putting on the you know, the storm candle, she's closing the curtains, she's kind of softening herself, ready for the storm that's coming. And if we could be a little bit more tender to ourselves, that storms of deep distress is going to hit every one of us.

And be ready for them because they're gonna hit you and they're gonna hit you like nature whacked you over the head in the last week. And be gentle with yourself in those times because you can go to really dark places. In those times. And that's when we have to be softest and gentlest to ourselves. And self-compassion, build our self-compassion so that we can really be able for these storms that hit.

And if you're a deep-thinking person, they're bound to hit you hard and fast. And that's okay, because that's being involved in life.

And there are also times for dysphoric females who have where the storms can also be something as w what we might think of mundane as getting your monthly cycle. Oh yeah. If you have told yourself that you're a male or a guy for years on end and your period comes, that in and of itself can feel like a storm.

Can I just say you know, the way we talk about physical, we forgot and both of us seeing as we're talking about menstrual calendars to each other, we forgot to say major issue for girls is to think about your your calendar, your menstrual calendar. Are you aware where you are and your cycle?

'Cause it gets missed in the midst of all the distress and it can be a huge factor that can get completely dismissed. Well, I think there's a I would love to do an episode on this, but I just think there's an absolute disrespect for our cycle. It's treated either as a disgusting inconvenience that everybody hates anyway. Or, you know, trans guys just choose to ignore it and pretend it's not there or they get on T so that it stops. I mean I I just think that um

It's not just a matter of know when your period's coming so that you anticipate being grumpy. Like we have these in c entire fluctuations of energy, mood, abilities, creativity. um sociability, like there are so many things that change for us in a given month. And again, you know, back to that self-compassion. If we can have a little compassion for the fact that our body is in a process.

And be a little curious about it rather than treating it with such disdain. I mean, I am so curious about how that might change things. Now again, if somebody's identity is serving something else, good luck trying to get them to be interested in their monthly cycle. But, you know, I I think it's it's really you you can't have

Acceptance for yourself if you siphon off certain aspects of the self and say, well, I'm gonna accept myself except for that. You know, I'm gonna accept myself except for this thing, is the hard stuff that we actually have to accept. Yeah, boys as well can be get very f fixated on their bodily hair and uh you know, you y they talk about the gender dysphoria and sometimes I think it could be bodily hair phobia.

And for girls it could be menstrual phobia. N I'm just s not saying all of them, but it's it's kind of interesting how much it gets focused on breast hair, menstruation. And I think building self awareness about it and getting quite specific about what is your thing, what is really hitting you. But for some people I think, and you spoke about it at the beginning of this episode, and I think it's important that we

we raise it up that for some people it could be a capacity around their body and, you know, some sort of kind of realizing of what their body can do. For some people it could be an exploration of their sexuality and an exploration of the kind of maybe their uh internalized homophobe hopophob homophobia that they might have, that that could be the self-awareness that sets them free.

And it it's it's definitely for me that the self awareness around whether it's your bodily cycle or your bodily moods or your internalized mental manif manifestations, th it it all helps if you can just start to get to know your Yeah, I think you're saying that we need to be willing to accept that there could be complicated reasons. There are lots of moving parts here.

And it's never just going to be one thing. I think there are some people with gender dysphoria who really like concrete black and white answers and step by step processes. And I would say Good luck because this is really messy and it's not that simple.

Th there's one more thing I wanna just lift up before we before we Before you do, I just wanna jump in with one thing. It reminds me this kind of focus on medicalizing my mental stress reminds me of the massive push in the early nineties for Prozac. And it was going to just kind of fix us all. That that's how it was brought in, certainly in Ireland, like woohoo, we've got Prozac. All problems are over. And then uh no, that's not how it turned out.

You know what I mean? If you read like anatomy of an epidemic and things like that, you really like, oh God, there's so many other complex issues. So medicalizing our mental stress. hasn't got a very good history.

No. There's probably more richer ways. But sorry, I jumped it on you. Yeah, no, that's okay. I mean, I'm thinking about this issue of control that we touched on earlier. You know, you said that sometimes this is a way to try and gain control. And one thing that I find that comes up a lot for young people, especially during adolescence, is that sometimes identifying as trans is a way of to try to signal something to others about them.

So rather than just being a boring old cis girl, being trans is a way to say, actually no, you can't put me in that box or you can't make this assumption about me. And particularly for kids who do feel kind of different. Or kids who have a lot of internalized Whatever. Internalized misogyny, where actually they kind of judge women harshly and therefore they don't want to be a woman. Or internalized homophobia, where

even though they're really accepting of gay rights, like they think it would be quote, creepy to be a lesbian. Like anything like that, I think a very important thing to do is be willing to be misunderstood. Because if you're really gonna accept yourself, you have to accept the fact that, you know what, if I am just a boring old cis girl, some people are gonna assume things about me that aren't true. Or if I'm a lesbian and that's hard for me to deal with.

You know, why? Why is that hard for me to deal with? And can I accept that people are gonna judge me incorrectly? And I I really think it gets dismissed and it gets derided and mocked, and I don't think it's fair. I think, and I know I'm going into funny territory here, but I think the burden of privilege is difficult to grapple with.

And I think feeling much luckier than other people because you've got cis white privilege or because you're upper middle class and you realise I've got all the luck in the world and I'm still really unsettled and unhappy in myself. Where am I going? And I I think for the average adolescent, that's a really big concept, especially if you're a deep-thinking adolescent. And so you have to find a way.

To understand that there are millions of people who are so much unluckier than me. They didn't get the education that I got, they didn't get the the looks, the intelligence, the the class that I got. And I've got this kind of golden card and I'm unhappy and I'm so I need a problem to focus on because I can't quite handle my privilege because I I don't know what to do with it, because it's a weight around my neck here. And I don't know what to do with it. I don't think we've really given enough

Compassion and understanding to well what do you do if you're privileged and you're fourteen and you feel lucky but you feel really unhappy? That's a funny place to be. Yeah, I mean there there's a whole narrative right now around what does that mean? What is privilege? What is oppression? What is it to have certain opportunities that other people didn't have? What is it to have certain skin tones that other people are different? I mean, there's a lot here.

And again, I mean, any anybody who is a deep thinker and who is a sensitive person They don't want to be seen as the bad guy. Yeah. And so I I think identifying into a queer identity might be a way to signal like You know, I'm one of the good guys. I'm not here to step on anybody's toes. I'm not arrogant. I'm not

you know, snobby or whatever. It's more than that. It's identifying with the good guys. That's one reason. And it's also identifying because you're deeply distressed, you're identifying out of privilege because you think I can't be privileged and have this much mental distress. And I'm like, you can you can you can have deep, awful, heart wrenching, imprisoning emotional. a deep distress and still be very privileged.

And they think they can't so they identify out of it because they're like, Well, I couldn't be these this distressed and be privileged, so I must be something else. Well, because they're told that privileged people have it easy. And they they feel bad about that. But actually the the problem is that I mean, I absolutely know and I do believe.

that not having our basic needs met. So people who are in really dire straits financially, of course they have a totally different set of stressors. And that's very taxing on their development. But it's not true that people who have money can't have problems. I mean that's just patently ridiculous. And I think that's the idea that a lot of teenagers are growing up with today. So this is just kind of another

you know, thing to think about if a person's asking themselves, why am I dysphoric? Why am I distressed? We talked about a lot of things. I mean, do I have some anger that I can't access? Do I feel kind of guilty because of my position of privilege relative to other people? Like these are all important things that might have caused somebody to feel alienated or wanting out of their body or wanting out of their identity.

Yeah. And I think this episode we're coming to the end of it, I think more than anything What we try to lift here is there's many, many reasons for distress. There's generally something driving behind gender dysphoria that you would have to get to the root of before you could really lift yourself out of it. Yeah. And it's not all about the diagnosis and uh waving kind of surgical wands.

that will get you out of it because as many, many, many trans people have said, I transitioned and the gender dysphoria remains very high. So it's it's not necessarily resolved with surgical intervention or hormonal intervention. It m I would say the best way to resolve mental distress in whatever form it takes is self-awareness. that would be for me the the most liberating path. Whatever way you get it. It really just struck me that we have not talked at all about

gender nonconformity. Like the the resolutions in our mind has nothing to do with oh yeah wearing pants or skirts. I mean, we really I don't think we believe that gender control really that much about gender. I mean And and I I really try to emphasize that, that of course it's taking that form on the surface, but it may not really be exactly about that. And it makes me think that when we look at binders and things like that, like removing body hair for maybe male

I think those external solutions, they give a short term satisfaction that you think are reducing your gender dysphoria. And I'd say, yeah, I'm sure it does in the moment. Um, but it probably emphasizes your thoughts around gender and uh m myself and yourself have really come to the conclusion you expand your mind beyond the gender dysphoria rather than reducing it to focusing.

Thanks for joining us this week on Gender, a wider lens. This podcast is partially sponsored by Rhyme. Rethink Identity Medicine Ethics. Rhyme is a nonprofit organization dedicated to improving the long term care for gender variant individuals. Visit rethinkime.org to learn more. If you found value in our show, please review us on iTunes and subscribe so you never miss an episode. And you can follow us on Twitter, Facebook or Instagram.

Just go to our link tree. That's linktr.ee slash wider lens pod. Our discussions are for educational purposes only and are not intended as a substitute for mental health services.