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How to be a great parent or friend to trans kids
What can parents and friends of trans people do to help them beat the dismal mental health and suicide statistics? A lot, says Elijah Nealy.
Elijah Nealy, Ph.Ds, M.Div., LCSW, is Assistant Professor in the Department of SociaI Work and Latino Community Practice at University of Saint Joseph in West Hartford, CT. As an out transgender man, he has spent the past 25 years working extensively within the lesbian, gay, bisexual, transgender, and queer communities.
For 12 years, he worked at the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community Center in New York City. Initially serving as the program director for alcohol and drug counseling, then the overall director of mental health services for adolescents and adults, and finally as the Deputy Executive Director of the Center.
His book, Transgender Children and Youth: Cultivating Pride and Joy with Families in Transition, is one of the first comprehensive guides to the medical, emotional, and social issues of trans kids. To learn more about Dr. Nealy, visit elijahnealy.com.
Elijah Nealy: It is true that transgender youth, gender diverse youth, youth who don’t necessarily transition but whose gender expression is diverse or considered nonconforming or fluid are at higher risk of verbal harassment and even physical bullying within a school context. That’s been consistently demonstrated in surveys over the last 10 to 15 years.
So what I’d say to trans youth who are experiencing bullying is that it’s absolutely important that you talk to an adult in your life about what’s happening. That you don’t need to navigate harassment or bullying by yourself. In fact it’s critical to reach out and let someone safe in your life, another adult, know what’s happening, and that you can identify who that safe person is whether it’s a teacher, a school counselor, a school social worker, a parent, an extended family member. But it’s important to let someone know what’s happening because you have a right to be able to go to school and be safe and be free from the experience of bullying.
What the research is telling us in the last ten years is that family acceptance, a young person’s, a teenager’s experience of being accepted by their families is the critical mediating variable in queer young adult risk factors. So teenagers, queer teenagers, lesbian, gay, bi, trans teenagers growing up in families they experience as rejecting are eight-and-a-half times more likely to have attempted suicide by the time they’re 21 to 24. And they’re three-and-a-half times more likely to be at risk of HIV, to be using drugs and alcohol in an addictive way or problematic way, much higher rates of anxiety and depression, and that by contrast those risks are much lower for adolescents growing up in families that they experience as accepting.
The important piece about that for parents is the degree to which we can have an impact in lowering the risk factors that trans youth already face in a world that sometimes is still hostile or discriminatory, and that even in the face of external discrimination or harassment by peers or other adults or discriminatory laws family acceptance shows up as the critical mediating variable for young adult risks among trans youth.
So one best practice is to recognize that everyone of us as a human being has a right to define who we are, and that gender identity is not necessarily about our body parts but it’s about our own understanding of who we are as male or female, both or neither. It’s what’s in our brains. It’s what we know to be true about ourselves.
And so if we begin with that understanding and an acknowledgement that every human being deserves to be acknowledged and respected for who they know themselves to be that sets a real foundation in working with trans youth: That each trans young person like any other young person deserves to be acknowledge and treated with respect for who they are.
That means things like using a young person’s affirmed name and pronouns regardless of whether or not that matches your understanding or knowledge of that young person. But if I say my pronouns are male and my name is Elijah, then part of respect is respecting my understanding of myself.
From a treatment perspective that means what’s been emerging as best practices in the last ten years is an understanding of gender expression within young children and adolescents as gender diversity (and not gender variance or gender nonconformity)—And that all children experiment with gender expression, that children can have diverse and different ways of expressing their gender—young boys might like to play house, young girls might like to play with trucks—and that that’s simply gender diversity, and while it may not be “the norm” to have a boy who has feminine gender interests it is within the realm of normal; and that there’s nothing inherently abnormal or pathological. It’s simply gender diversity, and may or may not mean that that young child grows up to identify as trans.
I think part of the work for parents—many of us who are parenting today grew up in a world that did see gender and sex (or gender identity and biological sex) as synonymous. And we’ve all grown up in worlds where there are cultural norms about how men are supposed to act or look and how women are supposed to act or look. But part of what’s important is realizing that those cultural norms vary over time and they vary from one culture to another. That there’s not necessarily anything inherently right or wrong about certain ways that men might express themselves or women might express themselves in the world. One example is that, you know, in white Western culture most cisgender men are not allowed to be very physically affectionate or expressive. But if you travel in Latin countries, Mediterranean countries, cisgender straight men often much more physically expressive: greeting each other with a kiss, walking arm in arm. And that’s considered normative masculine behavior there. So part of the takeaway for parents is really questioning those norms that we’ve grown up with and recognizing that our children may land anywhere in terms of their gender expression, and that correcting that expression or enforcing strict gender norms means children grow up with an increasing sense of shame about who they are.
So if a ten-year-old boy, 12-year-old boy is frequently told, “Don’t throw like that, that’s how girls throw. Don’t be a sissy. Don’t walk like that, only girls walk like that,” that 10 to 12-year-old boy begins to move into adolescence and adulthood feeling like there’s something wrong with who he is. And having a sense of internalized shame about himself that puts him at risk in terms of mental health and substance use.
So historically the understanding of gender nonconformity or gender expression that’s outside the bounds of what we consider stereotypically acceptable for a man or a woman within the culture has been defined in the Western world largely by the psychiatry profession. And any kind of gender expression that was not normatively masculine for men or normatively feminine for women was considered abnormal and pathologized, historically. So from that model, children—a young five-year-old boy who has feminine gender interest, like to play with dolls, likes the color pink—would have been treated historically in a manner that was designed to shut down those feminine gender interests and redirect him into solely what are considered socially acceptable “masculine” interests like trucks and cars and blue. So historically gender diversity, gender expression outside the norm is considered nonconforming and abnormal.
So if we think about that shifting, in some ways we can think about homosexuality being removed from the DSM in 1973, and ironically enough in 1980 gender identity disorder went into the DSM. And, from many perspectives, there’s some thought that gender identity disorder went into the DSM in 1980 as a way to continue to monitor particularly what might be emerging gay male identity or men with feminine gender interests from growing up to become gay men. So young boys with feminine gender interests now diagnosed with gender identity disorder. Still considered an abnormality, the result of “inappropriate parenting,” the result of “incomplete gender development” from a Freudian perspective—but now gender identity as a psychiatric diagnosis that any trans person has to receive in order to be allowed to medically transition.
As we move from 1980 on, part of what we see is transgender people in the society becoming more and more visible, more and more vocal about their stories, their narratives, their life experiences. And with that comes a greater understanding that gender and sex are not nearly as binary as we thought they were. That in addition to the biological sex of male and female one in 2,000 infants are born with what’s called an intersex condition, which means the doctor can’t easily assign them in one of those two boxes at birth based on genitalia or chromosomal makeup. And so even biological sex, which we think of as those two boxes, male or female, is more diverse.
And certainly our understandings of gender identity and gender expression shifting to be much more of a continuum, from very, very masculine or male-identified all the way across that continuum to more traditionally feminine in gender expression or female-identified and every point in between.
Suicide, substance abuse, mental illness, and harassment affect LGBTQ kids at highly disproportional rates—but there is a single mediating factor that can lower those risks dramatically: family acceptance. LGBTQ teens who experience rejection at home are 8.4 times more likely to have attempted suicide by their early twenties. As the visibility of trans people increases, raising and supporting trans kids is emerging as critical. How can we help them beat the dismal stats? Elijah Nealy shares a few best practices for parents and friends, from understanding gender fluidity and questioning gender norms to respecting pronouns and recognizing that being trans isn't necessarily about body parts—it's about what's going on in someone's mind. These tips may help save a life, and better yet, it can help a trans kid become a confident, healthy, and loved young adult. Elijah Nealy is the author of Transgender Children and Youth: Cultivating Pride and Joy with Families in Transition.
Vaccines find more success in development than any other kind of drug, but have been relatively neglected in recent decades.
Vaccines are more likely to get through clinical trials than any other type of drug — but have been given relatively little pharmaceutical industry support during the last two decades, according to a new study by MIT scholars.
Sallie Krawcheck and Bob Kulhan will be talking money, jobs, and how the pandemic will disproportionally affect women's finances.
What would it be like to experience the 4th dimension?
Physicists have understood at least theoretically, that there may be higher dimensions, besides our normal three. The first clue came in 1905 when Einstein developed his theory of special relativity. Of course, by dimensions we’re talking about length, width, and height. Generally speaking, when we talk about a fourth dimension, it’s considered space-time. But here, physicists mean a spatial dimension beyond the normal three, not a parallel universe, as such dimensions are mistaken for in popular sci-fi shows.
An article in Journal of Bioethical Inquiry raises questions about the goal of these advocacy groups.
- Two-thirds of American consumer advocacy groups are funded by pharmaceutical companies.
- The authors of an article in Journal of Bioethical Inquiry say this compromises their advocacy.
- Groups like the National Alliance on Mental Illness act more like lobbyists than patient advocates.
The Corruption That Brought Prozac to Market — Robert Whitaker, Journalist<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="bea9cff2b25efc18b663a011a679ba16"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/UyaJExxFPAE?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>Consumer-oriented groups gained steam over the ensuing decades. Their efforts helped inspire the 1938 Food, Drug, and Cosmetic Act after over 100 people (mostly children) died from a sanctioned drug, Sulfanilamide. If not for the hard work of these advocates, this case might have been overlooked.</p><p>Early efforts also focused on the food industry, which was increasingly using chemical preservatives. The origin of Consumer Reports can be found in the consumer advocacy movement. Both the food and drug industries were getting a free pass to experiment on citizens with few repercussions.</p><p>These movements provided a social foundation for important advocacy work in the second half of the century. Female-led groups evolved to focus on women's reproductive rights, AIDS, and mental health. As the authors write, these groups struck a balance between working <em>with</em> and <em>against</em> current trends. Sometimes you need to craft legislation with officials; at other times, you have to rage against the machine with everything you've got. </p><p>Advocacy marked an important turning point in public health (and culture in general). These groups were tired of placating to a medical model that treated the male body as the standard. This wasn't limited to anatomy. As I <a href="https://bigthink.com/coronavirus/pandemic-warnings-rp-eddy" target="_self">wrote about last week</a>, a high-profile 1970s-era conference about the role of women on Wall St featured no women on stage. You can imagine what reproductive health looked like during that time. </p><p>Advocacy groups made real impact in public health. Then the money began pouring in. </p><p style="margin-left: 20px;">"These groups were funded largely by individual donations with some foundation support, but in the late 1980s, newer women's health groups moved to professionalize, effectively splitting the women's health movement."</p><p>A number of groups resist corporate ties to this day, such as the National Women's Heath Network and Breast Cancer Action. Too often, however, groups argue that their existence depends on corporate funding. This can lead to uncomfortable compromises. </p><p>An estimated two-thirds of patient advocacy groups in America accept funds from the pharmaceutical industry. Pharma companies gave <a href="https://link.springer.com/content/pdf/10.1007/s11673-019-09956-8.pdf" target="_blank">at least $116 million</a> to such groups in 2015 alone.</p><p>For example, over a three-year period, the National Alliance on Mental Illness (NAMI), which was founded by two mothers whose sons suffered from schizophrenia, received nearly $12 million from 18 pharmaceutical companies. The largest donor was Prozac manufacturer, Eli Lilly. By 2008, three-quarters of NAMI's budget was funded by the pharmaceutical industry. It gets worse:</p><p style="margin-left: 20px;">"An Eli Lilly executive was even 'on loan' to NAMI, paid by Eli Lilly, while he worked out of the NAMI office on 'strategic planning.'"</p>
A customer waiting for his medication at the Headache Bar in a pharmacy in Sydney, Australia. Among the items on sale are 'Paigees with Chlorophyll' and Alka Seltzer on tap.
Photo by Dennis Rowe/BIPs/Getty Images<p>This influx of cash skews public understanding of drugs. It also influences advocates to overlook real problems caused by pharmaceutical interventions, especially when it comes to mental health.<br></p><p>For a real-world example, consider how Xanax came to market. As journalist Robert Whitaker <a href="https://www.youtube.com/watch?v=2e829xdb4AA" target="_blank">explains</a>, an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1463502/?page=1" target="_blank">initial study</a> was conducted to determine efficacy in treating panic attacks. After four weeks, Xanax was outperforming placebo, which is common with benzodiazepines over short-term usage. But it wasn't a four-week study; it was a 14-week study.</p><p>At the end of eight weeks, there was no difference in efficacy between Xanax and placebo.</p><p>At the conclusion of the study after 14 weeks, the placebo outperformed Xanax. By a lot.</p><p>Why is Xanax still prescribed for panic attacks? Because the pharmaceutical company, Upjohn, only published the four-week data. The 14-week data was not in its favor. Nearly forty years later, over <a href="https://www.statista.com/statistics/781816/alprazolam-sodium-prescriptions-number-in-the-us/" target="_blank">25 million</a> Americans receive a prescription despite its <a href="https://drugabuse.com/xanax/effects-use/" target="_blank">long list</a> of side effects and addictive profile. </p><p>As the authors note, many consumers are not aware of how advocacy groups are funded.</p><p style="margin-left: 20px;">"An international study of groups in the United States, United Kingdom, Australia, Canada, and South Africa found that the extent of relationships with industry was inadequately disclosed in websites that addressed ten health conditions: cancer, heart disease, diabetes, asthma, cystic fibrosis, epilepsy, depression, Parkinson's disease, osteoporosis, and rheumatoid arthritis."</p><p>That's a tangled web of relationships. Pharmaceutical industry funding negatively impacts the work advocacy groups should be focused on: protecting us. NAMI, for example, claims that as a "natural ally" to the pharmaceutical industry, it helps consumers access "all scientifically proven treatments." When the industry ignores evidence of long-term damage caused by its treatments, you have to wonder what's being advocated. </p><p>Although, as the authors conclude, that question is easy to answer. </p><p style="margin-left: 20px;">"Instead of drawing insights from patient experience to set organizational agendas and challenge industry agendas, today's groups are silent on high prices and drug harms, oppose efforts to regulate these basic rights, and demand access to drugs that challenge the safety and effectiveness."</p><p><span></span>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a>, <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank">Facebook</a> and <a href="https://derekberes.substack.com/" target="_blank">Substack</a>. His next book is</em> "<em>Hero's Dose: The Case For Psychedelics in Ritual and Therapy."</em></p>