“You’re trying to ‘squish out’ my kid”: Is it time to revise our gender boxes?

“Little boxes made of ticky tacky

And they all look just the same”

Little Boxes, by Malvina Reynolds

Humans and categories

Oh how we humans love our boxes! Black/white, good/bad, Democrat/Republican, female/male. These nice neat categories make us feel safe, like we understand the world around us!

It’s true that categories are incredibly useful. They us help quickly and efficiently (albeit not 100% accurately) deal with the massive amounts of information that bombard us every day.  However, it seems to me that categories are more like guidelines; they are the cheat sheets for how to function in the world. They are good as a starting point, but they aren’t going to give you the whole picture. Treating these categories like they are an accurate substitute for how the world really functions is sort of like relying on the Cliff Notes version of Moby Dick—you get the general picture that it’s about some guy and a whale, but you miss a lot of the important stuff that makes the book great.

When I look around the world, it seems to me that very few things in life, or at least very few of the interesting things, can be grouped into neat little checkboxes. Rather, most of the interesting things in life fall on a continuum, a diverse spectrum where the colors bleed together to create the whole. So the idea that something as rich, complex, and interesting as one’s gender identity (that is, a person’s subjective sense of being male, female, both, or neither) could be simplified down to a simple two-choice checkbox seems dubious to me. And yet, that is pretty much how the vast majority of us think about gender, male/female right?

Gender Spectrum

In recent years, more and more people have been calling for a more inclusive, more nuanced way to talk about the continuum of gender identity. And many of those calls have been coming from the parents of young children who some refer to as “gender nonconforming”, kids who identify as something other than the neat little  male or  female categories.

Several weeks ago, the New York Times Magazine ran a story called “What’s So Bad About a Boy Who Wants to Wear a Dress?”. In the article there were several stories of parents with young children who were grappling with how best to respond to their child’s nonconforming gender identity. They talked about the struggle to try to figure out what was best for their child amidst the frequently conflicting views various medical and mental health professionals, peers, educators, and family. They talked about the struggle to help their child navigate a society where, by and large, we maintain a fairly rigid concept of gender. Talking about that struggle, one mother wrote:

“It might make your world more tidy to have two neat and separate gender possibilities, but when you squish out the space between, you do not accurately represent lived reality. More than that, you’re trying to ‘squish out’ my kid.”

Should we revise our boxes?

Gender identity is a complex issue. And parenting is an even more complex and sensitive issue. And I certainly don’t purport to have the answer for how all parents should handle such complex issues with their children. And really, that isn’t my point here. Rather, what I was most struck by as I read the article in the Times was how strongly attached we humans are to our categories, how certain we are that they are “right”. And most of all, how scary it can be when those categories start to get challenged. But in clinging to those categories, maybe it’s the case that there are a bunch of kids (and adults too!) who are getting “squished out”. I don’t know what the right answer is for every parent, but I do think it would be a good beginning for our society to revisit this whole concept of gender and how we categorize it. With an open dialogue from a position of curiosity rather fear masquerading as certainty, maybe we’ll discover that there is more to this whole gender thing than we first thought. And maybe Moby Dick is about more than just some guy chasing a whale.

Why antipsychotics should not be prescribed for anxiety

The Oregonian published an Op-Ed piece that my colleague Christeine Terry and I wrote. The article addresses the growing practice of off-label use of antipsychotic medications to treat anxiety-related problems. Our aim was to bring public consciousness to this troubling trend.

We write:

Despite this lack of evidence, a 2007 study found nearly 1 in 4 (21 percent) of individuals who sought treatment for anxiety were prescribed an antipsychotic. Moreover, as Friedman points out, studies are finding that the newer “atypical” drugs have harmful side effects, such as increased cholesterol, movement disorders (e.g., Parkinson’s-like symptoms) and weight gain. Given the increasing numbers of people taking these medications, the risks associated with their use and the lack of research support for many common off-label uses, this is a huge concern.

You can read the brief (500 words) article on Oregon Live here.

Anxiety Treatment at Portland Psychotherapy

ACT and body image difficulties: Maybe not liking your body isn’t the problem

“Why doesn’t anyone tell us that it’s normal to feel bad about our bodies?”

What?!?  It’s “normal” to feel badly about my body? No, that can’t be right. It’s “wrong” to have a negative body image! I need to think more positively about myself and my body! Right?

Or maybe not…

Why do so many of us feel badly about our bodies?

If you grow up in American society, a society in which we are constantly bombarded with messages about one very homogenous, very unattainable image of beauty, you are likely to feel badly about your body. And yet, we’re also told we’re supposed to feel good about our bodies. Talk about a double bind! But what if this whole notion that we are supposed to feel good about our bodies, to have nothing but positive thoughts about how we look, is as unattainable the airbrushed pictures we see in magazines?

Yes, you heard correctly… I’m a psychologist who works with individuals who struggle with eating, food, and body image difficulties (meaning—I work with human beings) and I’m suggesting that maybe you “should” feel/think badly about your body. I wish it wasn’t the case, but maybe feeling badly about your body is an inevitable outcome of growing up in this society.

But what if the problem isn’t that we don’t like our body or that we have a negative body image? What if the real problem is when we let those thoughts and feelings get in the way of doing things that are important to us? Maybe what we need to focus on doing what is important to us, being active, being physically intimate, being more visible in this world, even when those activities might actually increase our negative thoughts or feelings about our bodies.

A different approach to body image struggles

This is the stance that Acceptance and Commitment Therapy (ACT) offers on the whole issue of body image. Rather than focusing on trying to think or feel more positively about our bodies, ACT suggests that what is most important is focusing on not letting those unpleasant thoughts or feelings stand in the way of doing what would be meaningful for you.

ACT psychologist and assistant professor at University of Louisiana at Lafayette Emily Sandoz, Ph.D. is one of the country’s leading experts on in the area of body image and disordered eating. She is the author of several ACT books including Acceptance and Commitment Therapy for Eating Disorders, The Mindfulness and Acceptance Workbook for Bulimia, and the upcoming Mindfulness and Acceptance Workbook for Body Image. Dr. Sandoz’s recent interview in the Huffington Post offers a great synopsis on an ACT approach to dealing with body image concerns. In her interview, Dr. Sandoz highlights that in ACT we ask our clients the following questions:

“Would you be willing to have these terrible thoughts and feelings about your body if it meant you’re able to live the life you want to live? Would you be willing to feel distress about your body image if it meant you could be more present with your children? If it meant you could be more active in your community? If it meant you could pursue companionship? Would that be worth it to you?”

We’re often taught that in order to live a good life, to treat our bodies well, to live active, passionate, vibrant lives, we first need to feel good about ourselves and our bodies. But what if it’s actually the other way around?

Things to Know Before You Say “Go”

In a previous post, I wrote a bit about the growing exploration among researchers in the use of psychotherapy-related smartphone apps for anxiety. In more local news, a Portland psychologist Elsbeth Martindale, PsyD, has developed her own smartphone app. The app is based on a collection of cards she developed called Things to Known before You SayGo.”

I had coffee with Dr. Martindale several months ago, and she talked about how the cards came out a conversation she was having with young woman about becoming involved with a man. Dr. Martindale had a moment of inspiration: she said she realized this woman had very little understanding of how to evaluate whether this guy could be a reasonable match for her or whether he was a person she should stay far, far away from! This woman simply didn’t know what to look for, and no one in her life had helped her learn how to make this kind of decision. Following this realization, Dr. Martindale began writing down questions she thought this person should consider. Her assortment of cards evolved from there.

The cards include items such as, “Is this person able and willing to listen to my feelings and desires?” (For a sample of items, click here.) They are handsomely packaged, and Dr. Martindale states they have been useful for her clients. Dr. Martindale has since developed an iPhone app version of the cards. It’s fair to note that there hasn’t been any research done on these cards, but people have had positive experiences with them.

As I’ve mentioned before, I find the potential in technology very exciting, and it’s fun to see enterprising professionals experiment with different forms of media.