Psychiatric Hospitalization: Research Study

[Adam (birkin)]

I went to a psychiatric hospital yesterday to give flowers to a friend who has been hospitalized. It was a horrible, horrible place in more ways than one. As bad as GID can be when it goes untreated (i.e. not being able to transition) most trans people do NOT belong in a place like that.

[kira21 ♡♡♡]

I think that it would further stigmatise us. Plus it would force us to give up our jobs and as you know, getting a job while trans is a massive problem for people afterwards and would be even worse with a long phych stay on your CV. Plus, then, who pays for the persons house and kids, or are we forced to lose them too? Plus it would add further distance from the support network that they would need post transition - their friends.

I would really really really not like that system. Really really. 

[stephaniec]

I went to a psychiatric hospital yesterday to give flowers to a friend who has been hospitalized. It was a horrible, horrible place in more ways than one. As bad as GID can be when it goes untreated (i.e. not being able to transition) most trans people do NOT belong in a place like that.

I was in a psyche ward in a hospital . Probably a lot better than an institution. but I got out of their as soon as I could.

[summer710]

Hi.  I would reject this research proposal.  These are my reasons.

- From the listed IV (independent variables) and listed DV (dependent variables), and your stated hypothesis, it actually seems that you are comparing the current (at least in the USA) standard of WPATH vs an alternative system of consent-based GRS.  If I'm misunderstanding your study - well, then that's a problem with the proposal.  If you are, in fact, (essentially) comparing the current USA standard of WPATH vs an alternative system of consent-based GRS - it must be stated as such.  Research hypotheses must be very literal without opportunity to misconstrue their intent. 
- This will be a prospective study?  If so, you run the very real risk of not having enough GID+ individuals to tease into control vs subject groups  - you will have inadequate N.  Without adequate N - results are suggestive at best.  Would not fund.  If you were to select from a pool of GID+ individuals - you risk selection bias.  Would not fund. 
- What are the criteria to diagnose GID?  Also - will it require only one specialist, or more than one specialist?  If more than one specialist, how many?  If more than one specialist, must it be unaminous agreement or numbers weighted agreement? 
- Is the evaluation for GID a single point in time, or are there multiple evaluations?  What happens to those individuals diagnosed as GID, enrolled into the subject pool, and then at 168 hours (and for whatever reason) are no longer gender dysphoric?  How are they removed from the study?  Or are they?  I assume they are taken out of the eligible for GRS arm?  What if the subject no longer feels gender dysphoric, but the treating clinicians think otherwise (it happens...)
- With your listed DV -   patient satisfaction/if they choose or were considered eligible.  These are actually two very different elements wrapped within the same variable; indeed, you state that patient satisfaction will be measured post-op.  But how can those considered eligible but declined surgery be post-op?  If you wish to measure patient satisfaction among those considered eligible but declined surgery - what if the patient wished to proceed, but the assigned doctor declined to follow through?  Are you anticipating a negative satisfaction result?
- What is your testing scale for satisfaction?
- What are your mathematical methods?

Just a few concerns from a cursory glance.  And remember, even though just a cursory glance, I'm already questioning methodology and study objectives.  In the real world - sometimes a cursory glance is all you're given with research proposals.  Ironic, I know...

[Rena-san]

Hi.  I would reject this research proposal.  These are my reasons.

- From the listed IV (independent variables) and listed DV (dependent variables), and your stated hypothesis, it actually seems that you are comparing the current (at least in the USA) standard of WPATH vs an alternative system of consent-based GRS.  If I'm misunderstanding your study - well, then that's a problem with the proposal.  If you are, in fact, (essentially) comparing the current USA standard of WPATH vs an alternative system of consent-based GRS - it must be stated as such.  Research hypotheses must be very literal without opportunity to misconstrue their intent. 
- This will be a prospective study?  If so, you run the very real risk of not having enough GID+ individuals to tease into control vs subject groups  - you will have inadequate N.  Without adequate N - results are suggestive at best.  Would not fund.  If you were to select from a pool of GID+ individuals - you risk selection bias.  Would not fund. 
- What are the criteria to diagnose GID?  Also - will it require only one specialist, or more than one specialist?  If more than one specialist, how many?  If more than one specialist, must it be unaminous agreement or numbers weighted agreement? 
- Is the evaluation for GID a single point in time, or are there multiple evaluations?  What happens to those individuals diagnosed as GID, enrolled into the subject pool, and then at 168 hours (and for whatever reason) are no longer gender dysphoric?  How are they removed from the study?  Or are they?  I assume they are taken out of the eligible for GRS arm?  What if the subject no longer feels gender dysphoric, but the treating clinicians think otherwise (it happens...)
- With your listed DV -   patient satisfaction/if they choose or were considered eligible.  These are actually two very different elements wrapped within the same variable; indeed, you state that patient satisfaction will be measured post-op.  But how can those considered eligible but declined surgery be post-op?  If you wish to measure patient satisfaction among those considered eligible but declined surgery - what if the patient wished to proceed, but the assigned doctor declined to follow through?  Are you anticipating a negative satisfaction result?
- What is your testing scale for satisfaction?
- What are your mathematical methods?

Just a few concerns from a cursory glance.  And remember, even though just a cursory glance, I'm already questioning methodology and study objectives.  In the real world - sometimes a cursory glance is all you're given with research proposals.  Ironic, I know...

Awesome! Awesome! Awesome! Thank you, I was hoping for ideas like these. Believe it or not, I've actually answered most of these questions in my actual proposal. I just copied and pasted the variables and hypothesis to keep things simple--but I actually do have a methodology to my madness . . . um, no, like I said this study is hypothetical. And at the beginning of the paper I actually have a preface/disclaimer that takes the proposal out of this world and places it into a completely different world where services are more abundant as are people suffering from GID--so population/sample size and quality becomes irrelevant.

But yes, you did read my idea correctly. I'm suggesting an alternative to WPATH. I want to know if WPATH is actually hindering people/negatively impacting people's mental health. I feel that people suffering from GID would benefit greatly from group work with both others suffering from GID and other mental illnesses and constant evaluation in a safe and secure place. Other treatment could be offered first before hormonal or surgical intervention. But once both doctor and patient conclude that a diagnosis of GID is accurate and establish a short and long term plan for stabilization, hormonal or surgical treatment can proceed.

I know that such an idea is horribly unpopular among this community. But it's what I think I would have wanted myself. For people who might read this and become hateful or judgmental, remember it's just pretend and ultimately, it's just a signifier of my own mental health issues—not yours. Keep an open mind.

[kira21 ♡♡♡]

I know that such an idea is horribly unpopular among this community. But it's what I think I would have wanted myself. For people who might read this and become hateful or judgmental, remember it's just pretend and ultimately, it's just a signifier of my own mental health issues—not yours. Keep an open mind.

You asked for judgement though! :-)

I want opinions based on what I've provided. Would you participate in such a program? What are the pros? The cons? Can you identify any possible flaws or problems with this idea?

If your sample group was a group of people who were effectively hospitalised against their will how would that affect the results? It is not clear whether this was optional, with WPATH provision alongside for those who elect not to be hospitalised, or a replacement system. I think if you had suggested that this is an elected option, then you may not have received so much resistance from those for whom such a system would not work and would not have chosen that pathway.

It might be what you would have wanted, but you are one person and would it be a one size fits all, like the current system? If so it would have to consider how it would affect others who are not in the same position as you. My judgement was based on the position of people like me and the effects that I listed would be massively negative for me and people like me. It might also have negatively affected you too in that, if you had experienced such a system, you might find, though there were aspects that you felt you needed at the time, the ongoing issues caused by it would still leave you wanting something different.

I realise it is just a proposal, but at the same time, it is just a proposal which you asked for feedback on, and we provided you feedback. When you are providing a system for everyone, it is you who should listen to how it affects them and keep an open mind, not the other way round! :-) If you received very negative feedback, that should mean something to you.

As an option for those who feel that they are not able to function in society already, it could be an option, otherwise, I think it would be a terrible idea for those reasons which I have already stated.

[aleon515]

" I know that such an idea is horribly unpopular among this community. But it's what I think I would have wanted myself. For people who might read this and become hateful or judgmental, remember it's just pretend and ultimately, it's just a signifier of my own mental health issues—not yours. Keep an open mind. "

I couldn't disagree more that anybody has been hateful! I don't think there have been any personal attacks on the OP! The comments have been on what we would think of psychiatric hospitalization as a alternative to some other kinds of systems. I don't think it's popular here for a few reasons (none of which are "hateful"): 1. Psychiatric hospitalization is, in itself, not benign, but many of us found it harmful and stigma producing. 2. It continues the harmful conception of trans as being a psychiatric illness. 3. It is not really a good model (and there are other possible models that reduce the problems the OP sees in WPATH--these problems do exist, in many cases). It's possible that there are some other concerns as well that I missed.

I think some people might benefit from a more in depth kind of situation, say if they had concurrent mental illness or substance abuse (though whether you still want to hospitalize them is dubious). It is possible to intervene in community based situations which are more normalized. (Think Chicago House.) I feel very strongly that being transgender is normal (maybe not convenient!!). (I'm not opposed to Maui or the Florida Keys either. )

I got the idea that you see this as a diagnosis and evaluation to HRT and SRS kind of as a one stop thing. (I dont' actually agree with the concept of a "diagnosis" of being transgender. But that's perhaps another issue.) Maybe I got this wrong, but I think that sometimes a few years isn't a horrible idea for all that, as long as it is payed for and not out of pocket. Also people's desire for such things can actually change over time.


--Jay

(BTW, someone suggested what I said was favorable to ECT. I feel the treatment for even depression is highly questionable. If was very mild in my criticism, it wasn't the point of what I was writing about.)

[Rena-san]

I don't think anyone's been hateful yet. That's why I said "might be hateful." I was more qualifying the response I wrote that basically reverted Gender dysphoria back to GID. (I myself believe I have a mental illness and would prefer to say it as such) 

But anyway,  I've actually really enjoyed the input and feel like I've gotten the type of feedback I wanted...and I'm not really sure what I expected. But anyway, I'm glad people are opinionated about this topic! It means it's a good topic to raise.

 Also, if I didn't make it clear...and this is pry my own fault...but consent and confidentially would be of utmost importance in this study. I know practically it may be difficult to ensure that, but again...it's all hypothetical. 

[aleon515]

I don't think anyone's been hateful yet. That's why I said "might be hateful." I was more qualifying the response I wrote that basically reverted Gender dysphoria back to GID. (I myself believe I have a mental illness and would prefer to say it as such)

You may feel that way but it something because it has been drilled into you or you had an unfortunate lack of acceptance. Other cultures in the world view being trans as something completely normal and have adapted ways of dealing with it. Being gay was once viewed as a mental illness but this view is such a minority opinion now that I think it is considered unusual to think that. I think transgender experience will at some point be viewed the same way. I mean I hope so!
I know someone who thinks we are about 30 years behind gays and lesbians in terms of social acceptance. Kind of outside your OP but I think it is interesting what your "model" is here.

--Jay

[Colleen♡Callie]

I feel that people suffering from GID would benefit greatly from group work with both others suffering from GID and other mental illnesses and constant evaluation in a safe and secure place.

Too bad there is no such thing as GID anymore.  The psychiatric community no longer acknowledges this as a disorder.  Which is the entire point of the change in terminology from Gender Identity Disorder to Gender Dysphoria (GD).  It is no longer considered, deemed or treated as a mental illness.  It is still handled by the psychiatric community, yes, not because it is still deemed a mental illness, but because there are other illnesses that can occasionally present like Gender Dysphoria while not being GD, in which transitioning and not treating the actual issue can be more harmful than not for the person.  It is done to rule out other possibilities.

The idea you present here, to me would be more harmful to the mental well being of most trans* people than WPATH, by claiming and convincing through action that being trans* is a mental illness both to the person suffering from GD and to society at large.  What do you think telling people that who they are is nothing but a mental illness would do to the psyche of that person?  You can state as loudly as you wish that "No, 'GID' isn't a mental illness" in your study and to your subjects, but by hospitalizing them with people suffering from other mental illnesses, and treating them as such, negates that statement to such a degree it firmly states the opposite.  That you and your study have deemed GD a mental illness to be treated as such.  That, my friend, is more damaging and harmful to a trans* person's identity and mental state than the WPATH could ever be.

Just because you are more comfortable with considering it a mental illness doesn't mean it won't be harmful to many others to classify it as such.  Not to mention, the whole point of considering it a mental illness is and was an attempt to discredit the use of hormones and transitioning as treatment.  That the problem lies in the mind not the body and thus the mind must be fixed, not the body.  However, all attempts to fix the mind have failed, where as fixing the body (through transitioning) has succeeded.  This is the number one reason it has been disqualified from being deemed a mental illness.  As treating the mind has failed entirely.

[Suziack]

...(I myself believe I have a mental illness and would prefer to say it as such).

Rena-san,  Could you elaborate with why you consider it a mental illness? I find that surprising, especially coming from someone who is post-op.

[Ms Grace]

When I detransitioned twenty years ago I then spent a long time believing I had a "mental illness" at the time I was going through transition. Not true of course I now realise, it was just how I tried to rationalise my feelings and actions.

[stephaniec]

Too bad there is no such thing as GID anymore.  The psychiatric community no longer acknowledges this as a disorder.  Which is the entire point of the change in terminology from Gender Identity Disorder to Gender Dysphoria (GD).  It is no longer considered, deemed or treated as a mental illness.  It is still handled by the psychiatric community, yes, not because it is still deemed a mental illness, but because there are other illnesses that can occasionally present like Gender Dysphoria while not being GD, in which transitioning and not treating the actual issue can be more harmful than not for the person.  It is done to rule out other possibilities.

The idea you present here, to me would be more harmful to the mental well being of most trans* people than WPATH, by claiming and convincing through action that being trans* is a mental illness both to the person suffering from GD and to society at large.  What do you think telling people that who they are is nothing but a mental illness would do to the psyche of that person?  You can state as loudly as you wish that "No, 'GID' isn't a mental illness" in your study and to your subjects, but by hospitalizing them with people suffering from other mental illnesses, and treating them as such, negates that statement to such a degree it firmly states the opposite.  That you and your study have deemed GD a mental illness to be treated as such.  That, my friend, is more damaging and harmful to a trans* person's identity and mental state than the WPATH could ever be.

Just because you are more comfortable with considering it a mental illness doesn't mean it won't be harmful to many others to classify it as such.  Not to mention, the whole point of considering it a mental illness is and was an attempt to discredit the use of hormones and transitioning as treatment.  That the problem lies in the mind not the body and thus the mind must be fixed, not the body.  However, all attempts to fix the mind have failed, where as fixing the body (through transitioning) has succeeded.  This is the number one reason it has been disqualified from being deemed a mental illness.  As treating the mind has failed entirely.

I think the better solution is better funding for outpatient care and group therapy if desired. Institutionalization seems to be  pretty backward and drastic. It was my understanding people are institutionalized because they can't care for them selves or they harm others or themselves. I keep thinking of the movie "one flew over the cuckoo's nest"

[aleon515]

True that there are a lot of people suffering who are transgender, but there are still very many people who are employed, happy, in relationships, etc. and do continue to be transgender, which doesn't seem consistent with any sort of mental illness. I'm not in a relationship, but I am happy and feel comfortable in my own skin for the first time. I believe suffering comes from self-hate, lack of acceptance, and those kinds of factors. If you come to terms with those factors you can be happy. This is not at all what happens in a mental illness.

--Jay

[Colleen♡Callie]

I think the better solution is better funding for outpatient care and group therapy if desired. Institutionalization seems to be  pretty backward and drastic. It was my understanding people are institutionalized because they can't care for them selves or they harm others or themselves. I keep thinking of the movie "one flew over the cuckoo's nest"

Yep. Exactly what institutionalization is about.  Which is why I previously pointed that out as a flaw in this proposal and again consider it harmful to most trans*people's mental health being institutionalized with "other" mentally ill people.  Regardless of whether the study states people with GD aren't mentally ill, the practice of institutionalizing them with mentally ill people will overwhelmingly state otherwise, and be more harmful, not "more helpful their mental health than WPATH" as OP seems to believe.

This study if it were ever actually done would send trans* rights and wellbeing back to the beginning in the worst way possible.

[aleon515]

Yep. Exactly what institutionalization is about.  Which is why I previously pointed that out as a flaw in this proposal and again consider it harmful to most trans*people's mental health being institutionalized with "other" mentally ill people.  Regardless of whether the study states people with GD aren't mentally ill, the practice of institutionalizing them with mentally ill people will overwhelmingly state otherwise, and be more harmful, not "more helpful their mental health than WPATH" as OP seems to believe.

This study if it were ever actually done would send trans* rights and wellbeing back to the beginning in the worst way possible.

I think it could be argued that institutionalization is harmful for everybody regardless. The whole topic of what institutionalization does to people is very well documented elsewhere. But in short the effects are lowered autonomy, self-confidence, etc. Sometimes there are no other good answers, but at in this case we know of various other kinds of ways of delivering services to trans* people without it. In the case of trans people with drug addiction and so on, I believe community type services are a good option and are also MUCH cheaper than institutionalization which all by itself is very expensive ,without the side effects. There are actually programs designed to prevent institutionalization in people with mental illness, intellectual disability and other groups who have been historically institutionalized (group homes, community based drop in centers, free/low cost counseling, etc.).


--Jay

[Allyda]

Yep. Exactly what institutionalization is about.  Which is why I previously pointed that out as a flaw in this proposal and again consider it harmful to most trans*people's mental health being institutionalized with "other" mentally ill people.  Regardless of whether the study states people with GD aren't mentally ill, the practice of institutionalizing them with mentally ill people will overwhelmingly state otherwise, and be more harmful, not "more helpful their mental health than WPATH" as OP seems to believe.

This study if it were ever actually done would send trans* rights and wellbeing back to the beginning in the worst way possible.

I agree with this and what Colleen said in her prior post above. And I too beleive a proposal such as this if implemented would send the trans rights we've gained, right back to the stone age.

I have never considered or viewed myself as having a mental illness. Instead, I feel I have a birth defect that is now being medically corrected through transition.

Ally

[Miss_Bungle1991]

I have never considered or viewed myself as having a mental illness. Instead, I feel I have a birth defect that is now being medically corrected through transition.

I agree. 

[calico]

I have never considered or viewed myself as having a mental illness. Instead, I feel I have a birth defect that is now being medically corrected through transition.

Ally [/font][/size][/color]

+2 for here as well,  I'm still curious about why the OP views being trans as a mental illness

[intergrated_dispose]

Im going to reply to the original poster.

I've always felt ugly as a male (not cause of my looks or anything but because I have male features) so going through hrt and everything, would make me feel better as I'd feel beautiful as a woman.