LGBT protest 2013

In our new weekly Psychological & Spiritual Therapy column, therapist Jack Surguy is offering professional advice to The Mindful Word readers for all those questions and problems you have wanted to discuss with someone qualified and caring.

If you would like Jack to assist you in any areas of your life and relationships, fill out this form. He will respond to your questions through this column, normally published every Tuesday.


Dear Jack,

I’m hoping you can give me some advice on how to deal with things that are going on in society today.

This whole transgender “thing” has me confused about how I’m supposed to respond to people. I don’t want to offend other people, but I also feel like I’m supposed to just give up and forget about my beliefs and feelings to make others feel better about their beliefs and feelings, even though I may inwardly disagree with them.

I’m sorry, but I have problems with a guy competing in girls’ sports and beating everyone just because he feels like a girl inwardly. Science has shown us that guys are oftentimes bigger, faster, and stronger than girls. This isn’t always the case, of course, but most of the time it is. Also, just because he feels like a girl inside doesn’t mean I’m going to be mean to him or anything; I just think it’s unfair to the rest of us. It would be like me going and competing in sixth-grade sports. That would be unfair because I’m bigger, faster, and stronger than sixth-graders.

But how am I supposed to respond to all this without being called names myself? Any suggestions you have would be great. Thanks.



Thank you, Confused, for asking your question.

These issues are difficult for adults to navigate, and my guess is that our responses, at times, can be more problematic than helpful. Our society is currently engaged in significant cultural debates/wars. I wish I could simply state that we’re engaged in cultural debates, but that’s not being realistic, as people are getting nasty and sometimes physically assaultive with one another over these issues.

These are not simple questions, and there are no easy answers.

I believe that healthy debate and conversation are critical when trying to understand how we, as a society, can best respond to these issues.

America, in particular, seems to have forgotten the importance of debate, conflict, and argument.

For good ideas and true innovation, you need human interaction, conflict, argument, debate.” – Margaret Heffernan

I love argument, I love debate. I don’t expect anyone just to sit there and agree with me, that’s not their job.” – Margaret Thatcher

Alice Stewart and George Kneale

I enjoyed a recent TED Talk given by Margaret Heffernan.

The talk told the story of Dr. Alice Stewart, a physician in the 1950s who discovered that giving X-rays to pregnant women was causing childhood cancer. Even though Alice had strong research evidence to support this claim, no changes occurred for another 25 years. Alice was engaged in a pretty big fight for all of those 25 years!

Margaret asked her audience how Alice could have known her theory was correct, and to answer this, she described Alice’s “fantastic model for thinking.”

Alice worked with a statistician named George Kneale, who was described as being almost the exact opposite of Alice. While Alice was considered very social, warm, and caring, George was a recluse who preferred numbers over people. In describing their working relationship, George stated, “My job is to prove Dr. Stewart wrong.”

George’s job was active disconfirmation. He was always looking for different ways to interpret Alice’s theories, trying to find any way possible to scientifically prove Alice incorrect. He saw his job as creating conflict for Alice’s theories. It was only by not being able to prove that Alice was wrong that George could give her the confidence she needed to know she was right and to keep fighting. Alice’s daughter once stated of her mother, “My mother didn’t enjoy a fight, but she was really good at them.”

Perhaps the most troubling aspect of this story is the fact that Alice’s research was published, but no one really wanted to look at it or admit that endorsed medical treatments were resulting in the death of innocent children. Also, the X-ray machine was high-tech and considered on the cutting-edge of treatment at the time, and it wasn’t politically wise for a doctor to question treatments that generated great revenue.

Indeed, great harm rarely comes from hidden or secret information; rather, it often comes from information that is readily available, but which people are unwilling to explore or discuss for various reasons. To avoid this scenario, we must be willing to leave the “echo chamber” where reflecting voices only echo back what we say. Instead, we must be willing to develop and foster friendships with those who think differently and are willing to challenge our beliefs and opinions.

George simply disagreeing with Alice and not providing reasons and evidence to support his position would have been useless. Equally useless would have been George offering very weak or irrelevant evidence to challenge Alice’s theories. For progress to occur, both parties had to be willing to be fully and honestly engaged in debate and conflict.

This is where we in America seem to struggle: being honestly engaged in debate and conflict. Far too often deceit, misinformation, or distraction are used within our debates. Even more startling than this, however, is when those in leadership positions appear to take pride in their false allegations.

Unfortunately, it seems that people are much more invested in causes than truth. In fact, there have been incidents of people manipulating research and evidence simply because they were afraid it would prove their opponent correct.

The DSM (Diagnostic Statistical Manual) 

Even though transgenderism is hotly disputed, we must try and stay focused on what science and research say about the issue. More importantly, we must be willing to allow research and science to shape our political outlook, not vice versa. Before venturing into what research is saying, however, I’d like to share some general practice guidelines from the American Psychological Association.

The DSM (Diagnostic Statistical Manual) is the book used to make mental health diagnoses. Some people are diagnosed with “personality disorders,” which are deeply ingrained patterns of maladaptive behaviour that are viewed as part of a person’s personality.

Personality disorders are considered some of the most difficult disorders to treat. However, the general guideline is that someone won’t be diagnosed with a personality disorder until the age of 18. This guideline is in place due to how much a teenager’s personality can change throughout adolescence. Issues a teenager may have significant struggles with at 14 years of age may not affect them at all when they’re 16. Therefore, mental health professionals are urged to avoid diagnoses that can have long-lasting effects.

With this in mind, I don’t believe it’s a wise practice to try and insist on or advocate for any procedures that may have lifelong consequences. The brain of a child or adolescent isn’t fully formed and their decision-making capabilities aren’t at full capacity. As adults, our job is to be a mental “braking” system for them by getting them to slow down, take their time, and not make decisions based solely on how they may feel in the moment.

Transgender suicide statistics

Studies suggest that 41 percent of transgender people try to commit suicide at some point in their lifetime, while just 4.6 percent of the rest of the population does. This tells me that no matter what the current opinion is on transgenderism, these people are suffering to the point at which they want to end their lives. With a 41 percent suicide attempt rate, our responses should be 100 percent focused on how to help these individuals.

Now, some would argue that the suicide rate is so high due to transgender people being bullied and ridiculed by society. However, 46 percent of those who stated that they tried to commit suicide deny ever making their feelings public, so these attempts can’t have been due to being bullied and ridiculed.

Nonetheless, feelings of isolation, fear, and being misunderstood could very well have contributed to the mental state of the 41 percent who attempted suicide.

Hormone therapy and attempted suicide

Forty-five percent of the people who undergo transgender treatment or hormone therapy attempt suicide—a percentage higher than the general transgender suicide rate.

This strongly suggests that these therapies should only be used after a long period of consideration, and rarely, if ever, used with someone who may be unstable at the time of treatment. It further suggests that individuals who undergo these procedures should be supervised and strongly encouraged to continue therapeutic services both during and after treatment.

Again, suicidal feelings may arise due to the social reaction these people receive. However, my theory is that many of these individuals are hoping that the treatments are going to “fix” how they feel on the inside. When this doesn’t occur, and a person finds that they’re still dealing with the same feelings after the treatment is over, they may feel like nothing will ever help and it’s just easier to try and end their life.

In other words, unrealistic expectations of what these treatments can do may be contributing to the high number of suicide attempts.

Haphazardly applying the “transgender” label 

For me, the following is an extremely important statistic. According to Dr. Paul McHugh, former head of psychiatry at Johns Hopkins University, 70 to 80 percent of all children with transgender feelings grow out of it. These are very significant percentage rates that may suggest a couple of things.

  • First, given that 70 to 80 percent of children and adolescents grow out of these feelings, treatments that have significant effects on physical and hormonal development should, again, rarely be considered.
  • Second, just because a child or adolescent may question their gender doesn’t mean we should encourage or apply the label “transgender” to them haphazardly. Doing so may result in some individuals feeling locked into that label. In fact, a person questioning their gender in relation to some aspects of life may be a normal part of development.

Gender Dysphoria

The DSM-5 currently considers transgenderism a disorder if it causes significant disruption within a person’s life. However, it’s known as Gender Dysphoria within the manual, instead of transgenderism.

With Gender Dysphoria, a person is often distraught by the feeling that their perceived sex or gender, as seen by society, isn’t congruent with their inner perception of their sex or gender. For example, a male may present feelings that he’s a female, or a female may present feelings that she’s a male. This is where things can become tricky—let me give you an example.

Recently, in session, a teenage girl stated that she was transgender. I replied by asking her what she meant by that. The young lady stated that she felt more like a boy than a girl on the inside. Intrigued, I asked her what aspects of being a boy she felt. She stated that she didn’t like to wear dresses, she didn’t like makeup, and didn’t like how girls judged each other on these things. I could understand that.

This young lady hadn’t been raised in an environment where those things weren’t highly regarded, but she didn’t care for them. I responded by telling her that most of those things were considered more gender-based traits (“masculine” or “feminine”) and that being a girl didn’t mean she had to like them. I told her that many girls throughout history and the world have felt no need to conform to societal norms of what’s “feminine,” yet have felt no need to question whether they were female or not.

The young lady looked at me and said, “I’m confused, then.” And she was! The message she’s received, so far, suggests that if she questions or doesn’t like certain feminine traits, then she’s transgender and instead feels like a boy inside.

Putting myself in someone else’s shoes

No matter how hard I try, and no matter how much effort I put into it, I can’t know what it’s like to experience life as a female. I only know life from a male perspective. I can do my best to try and put myself into someone’s shoes, as they say, but in the end, my ability to do this is limited by my experience and perspective.

This is part of what intrigued me when the young lady stated that she felt more like a boy. What aspects of being a boy did she feel more like? All she was able to do was describe “masculine” activities and her aversion for more “feminine” activities. But these preferences don’t determine whether someone is male or female. A very “feminine” male may still very much consider himself a male, and a very “masculine” female may consider herself very much a female.

Therefore, for someone to declare that they have an inner experience of being something, and yet have no way of actually knowing what that thing experiences, suggests that they may not be perceiving things accurately.

I realize this may not be the approved answer or the popular answer at this time in society. However, when you seek truth, popular vote or approval don’t matter. And as I stated before, with an attempted suicide rate of 41 percent, I don’t believe we have the luxury of weighing what’s popular against what’s unpopular when helping these people.

Furthermore, allowing these individuals to believe that hormone treatment or surgical procedures are going to make a large percentage of them feel better is reckless and potentially lethal.

The push to change our perception of reality

We’re currently experiencing a push from some in society to do away with all objective means of perceiving reality. We’re often told that what matters most is how we perceive ourselves from within.

While this may sound like wise advice, I often find myself working with those who have taken this adage to the extreme. For example, when I ask “normal” high school teenagers to rank how they feel about themselves on a scale of 1 to 10, with “1” meaning they can’t stand themselves, “10” meaning they couldn’t feel any better about themselves, and “5” meaning halfway in between, the vast majority of answers I receive range from 6.5 to 8.5 or so.

However, when I ask criminalistic teenagers with no remorse for their behaviours to rate themselves, without hesitation they respond with a 10. These people love themselves. If I focused treatment on their inner experiences alone, no treatment would even be necessary.

Again, these individuals love themselves and don’t see any problem with their behaviours, so part of therapy with them involves helping them gain a more realistic view of themselves.

I believe much of the same principles apply when working with transgender individuals. My goal in treatment isn’t to challenge their inner experiences, but to help them deal with those inner experiences in light of objective reality. If they happen to be a male who believes they feel like a female inwardly, then therapy needs to focus on how they, as a male, can deal with having an inner experience that they believe is female. In doing this, I believe that I’m helping that person prepare for extremely stressful times when suicide may be considered an option.

Responding with kindness and compassion

So, how should you respond to these situations? I have a couple of suggestions. First and foremost, do your best to respond to transgender people with kindness and compassion. They’re truly suffering, and adding to that suffering may have lethal consequences. Try to be as understanding as possible and perhaps even ask them to help you better understand. This can open up lines of communication, and more importantly may help a person feel more understood, which could realistically save their life.

At the same time, I don’t suggest that you or anyone else abandon your perception and experience of reality, either. In other words, just because a male may feel like a female inwardly, that doesn’t mean they don’t possess all the biological advantages a typical male has over a female. I don’t believe allowing a male to compete against females is fair or healthy for anyone involved.

I ask for your patience, Confused, as we adults try to come up with acceptable solutions to these issues. I urge you to not abandon your views or values just because of societal pressures. At the same time, I urge you to respond with kindness and compassion to those who are suffering, but also realize that responding with compassion doesn’t mean necessarily agreeing with anything you believe to be inaccurate. I hope these guidelines can help you try to continue to deal with these gender-based issues in a loving, compassionate, and responsible way.

image: Ted Eytan (Creative Commons BY-SA)