Quote from: tekla on June 08, 2008, 02:46:15 PM
With relationship to other mental problems, there are lot of people with GID who have substance abuse problems that ought to be dealt with before anything else.  Informed consent depends on being rational in the first place.

Definitely!

Quote from: tekla on June 08, 2008, 02:46:15 PM
With relationship to other mental problems, there are lot of people with GID who have substance abuse problems that ought to be dealt with before anything else.  Informed consent depends on being rational in the first place.

Actually, you can and DO work with dual-diagosed people on their psychiatric issues while they are still using.  In fact, harm reduction is the official policy of the San Francisco Dept. of Public Health.  As abstinence programs continue to show poor performance, AA for example has a 10% success rate at the 5 year mark,  more localities are likely to move in that direction.  It already is the policy throughout many EU countries.  Can you name any instances where someone in the midst of a severe substance use problem had the surgery?  You'll find very few addicts have the financial resources for gender related surgeries.

harm reduction is the official policy of the San Francisco Dept. of Public Health

Which of course is such a huge success, after all, few places are as drug free as SF.

Quote from: tekla on June 08, 2008, 04:49:31 PM
harm reduction is the official policy of the San Francisco Dept. of Public Health

Which of course is such a huge success, after all, few places are as drug free as SF.

Be that as it may, tekla. Again, what appears to work best for the most is what often becomes best-evidence-based practice. Drug addictions may be cause, effect or symbiotic with mental disorders. I'd personally plunk for problems arising pretty much simultaneously.

Treatment of the two in conjunction with one another tends to work quite well. Your problem of being oriented enough to give one's informed consent is certainly mandatory. But, Claire is right at base that co-morbid disorders seem to best be treated both at once.

Harm reduction is another best-evidence practice as is a technique called motivational-interviewing.

As Liz pointed out above, with some disorders it is 1) hard to diagnose consistently the disorder and 2) have methods of treatment that qualify as best-evidence.

BPD, for instance, is often attributed to people who simply piss-off the clinician. It, like the over-used and under-defined 'passive-aggressive' can be euphemisms for 'that person pushes all of my buttons' to an actual difficult personality disorder.

One does the best one can and tries to admit when she's taken a wrong turn or is misinformed, ignorant of or inexperienced in particular modalities and mental difficulties. Team-work tends to be efficacious as then a number of people are able to bring experience and thoughts together.

Psychoanalysts, who created many of the terms we use, seldom did or do that.

N~   

All that stuff I don't know about, but I do know the history of The City, and going back to the days when it was called Yerba Buena (Good Herb in Spanish, perfect eh?) when the first opium dens were set up, through the 49ers whiskey soaked vacations, the Barbary Coast (in its day, proudly called "the wickedest place on earth" and many here miss it, a bunch of antique stores is not a substitute for open and wanton debaucheries) to the Roaring Twenties when it was known as "the wettest of the wets" for its open violation of Prohibition, to the War Years, the Sixties - when the Ellis D. Sox (yes, LSD) was Director of the Department of Public Health of the City and County of San Francisco tried to stop the use of acid (today we celebrate Jerry Garcia, Ellis D. Sox is all but unknown), to the present day when marijuana is openly sold in stores that advertise and openly smoked -- trying to control drugs here (and alcohol is just the most popular drug, not something in a different class, as in "drugs and alcohol") is just peeing in the ocean trying to stop the tide.  After all, if all the tourists left The City, there are enough seats and stools at the bars so that all the adults in the entire City can go out for a drink at the same time.

I'm not going to join the fray on co-occurring BPD but based on my own experience as a mental health professional I haven't really seen it.  Working at a clinic that did treatment programs for both GID and BPD I saw maybe 1 TG client that was a participant in a Dialectic Behavioral Therapy (DBT) group, the level of care treatment for BPD.

I think a better candidate for co-occurring psychiatric disorders is Post Traumatic Stress Disorder, PTSD.  That was what I saw at my previous job.  A friend who did her MSW thesis project on violence in the transgender community found that of 300 TGs she surveyed "one in four participants in this study met criteria for posttraumatic stress disorder (PTSD)."  Many PTSD symptoms are similar to those of BPD.

A friend who did her MSW thesis project on violence in the transgender community found that of 300 TGs she surveyed "one in four participants in this study met criteria for posttraumatic stress disorder (PTSD)."

That, sadly, sounds close to the truth, and close the the stats that CUAV uses too.

Quote from: Claire de Lune on June 08, 2008, 04:42:08 PM

Quote from: tekla on June 08, 2008, 02:46:15 PM
With relationship to other mental problems, there are lot of people with GID who have substance abuse problems that ought to be dealt with before anything else.  Informed consent depends on being rational in the first place.

Actually, you can and DO work with dual-diagosed people on their psychiatric issues while they are still using.  In fact, harm reduction is the official policy of the San Francisco Dept. of Public Health.  As abstinence programs continue to show poor performance, AA for example has a 10% success rate at the 5 year mark,  more localities are likely to move in that direction.  It already is the policy throughout many EU countries.  Can you name any instances where someone in the midst of a severe substance use problem had the surgery?  You'll find very few addicts have the financial resources for gender related surgeries.

Groups like AA want you to believe that Abstinance Only is the only treatment method that works.  It's not.  It's not even the best.  The goal of most treatment programs is to help the client manage their substance use so that it does not cause personal and social problems at which point it's no longer a substance abuse problem.  Of course with illegal substances abstinance is the only legal outcome.

Quote from: Claire de Lune on June 08, 2008, 05:50:50 PM
I'm not going to join the fray on co-occurring BPD but based on my own experience as a mental health professional I haven't really seen it.  Working at a clinic that did treatment programs for both GID and BPD I saw maybe 1 TG client that was a participant in a Dialectic Behavioral Therapy (DBT) group, the level of care treatment for BPD.

I think a better candidate for co-occurring psychiatric disorders is Post Traumatic Stress Disorder, PTSD.  That was what I saw at my previous job.  A friend who did her MSW thesis project on violence in the transgender community found that of 300 TGs she surveyed "one in four participants in this study met criteria for posttraumatic stress disorder (PTSD)."  Many PTSD symptoms are similar to those of BPD.

Yes, and is consistent with the high incidence of physical and sexual abuse of transgendered children and youth.

Quote from: Always Amanda on June 06, 2008, 12:04:24 PM
But why... why do these issues that are so far in the past become SO important?

That's an important question.  I used to think that the past didn't matter and could go on without ever confronting it.  Sadly, it doesn't work that way.  (ticked me off to no end, let me tell you)

I'd say the shortest answer is that a lot of who we are is a reaction to our environments when we are young.  For example, if a child is told to 'shut up' a lot as a child, that person may grow up to be a very quiet person who can't say what they think or feel (wonder how I know that ).  That's just one example.  But as a child who was forced to be extremely quiet and stay out of the way, the only way I got over that at all (certainly not completely) was to go back and deal with it.  I had to let myself feel the emotions that it caused and the hardest thing I had to do was to put myself out there and start saying what I wanted and making people notice me...not always with great outcomes.  But I did it and I'm a much more assertive and self assured person than I was.

So maybe it wasn't the short answer...