Gender Dysphoria: Abnormal or Not

Another assignment in my Abnormal Psychology class was to relate three ideas between this TED Talk and the class’s textbook (Abnormal Psychology: An Integrative Approach by D. H. Barlow and V. M. Durand). Here it is.

Gender identity is a very fundamental aspect of an individual’s personality that colors nearly every social interaction and experience in their life. Gender itself is a social construct that mostly influences other people’s interactions with an individual. Gender dysphoria is when an individual’s physical/biological sex, termed their “natal sex,” matches their assigned gender but not their gender identity—these individuals are transgender. Because natal sex and gender are so often and incorrectly used synonymously, the TEDx Talk by Rikki Arundel explained the difference, as well as other issues presented with being transgender (or transsexual, as the book calls it). Some of these issues include the distinction between gender and sexual arousal patterns, gender nonconformity for men and women, and the effects of gender nonconformity in children.

One of the first items addressed in the video was the difference between gender and sexual arousal patterns (or sexual orientation). Since the concepts of gender, natal sex, and sexuality are so closely connected, it unsurprisingly confuses some people, as evidenced by Arundel’s anecdotes. There are indeed similarities between an individual behaving in ways that are more consistent with the opposite gender for sexual gratification, and doing the same to alleviate gender dysphoria. However, the former is a form of paraphilic disorder called transvestic fetishism, and the latter is no longer considered a mental illness by the mental health community. Also, a transgender individual identifying as a man, for example, would not necessarily identify as being attracted to women, the conventional sexual orientation for that gender. Sexual arousal patterns are considered independent to gender identity, and the desire of most transgender individuals is merely being able to live as the gender they feel they really are.

The book relates that there are three times as many men as women who reject their natal sex, and the video says that individuals uncomfortable with their gender assigned at birth are 80% male to female. However, this is not because gender dysphoria affects men more than it does women. It is likely because gender nonconformity is generally easier for women than for men. Women have more leeway behaving and expressing themselves in gender-nonconforming ways, such as wearing men’s clothes and young girls playing with stereotypically boys’ toys. Both men and women undergo intense social pressures to conform, but men and boys assume more risk of being cast out for expressing interest in or taking on roles traditionally reserved for women, such as something as innocuous as liking the color pink.

Children are known to develop a concrete gender identity by the age of three. Whether gender identity is innate or a result of social factors is still being researched. What we do know is, as soon as children are born and their sex is assessed, they are subjected to social pressures to fit into the gender mold they are given. Most children’s toy sections in stores capitalize on this and create a divisive line across which most kids do not dare to cross. Both boys and girls are bullied or at least encouraged by their peers and families to conform to their assigned gender, and boys especially are forced to defeminize to avoid being ostracized.

Distinguishing between gender and sexual orientation, the inherent social differences between men and women, and the influence of gender on children are not the most popular talking points with regard to transgender issues in the media. Arundel’s personal experience and study of this topic gave incredible insight into these areas. The book is also very helpful in describing the research and statistics surrounding these topics, but it does use the term “transsexual.” This seems to me that it would generate more difficulty in distinguishing between gender identity and sexual arousal patterns, since it is so similar to terms like “homosexual,” “heterosexual,” and “bisexual.” I think the book should start using the term “transgender,” which is more widely accepted today as a descriptor for people with gender dysphoria.

Electroconvulsive Therapy: Fake News?

In my Abnormal Psychology class, we had to write a paper relating three topics between a video and the material in the textbook/class. This assignment’s video was about the effectiveness of the controversial mental illness treatment: electroconvulsive therapy.  This is my take on it.

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            Electroshock therapy, or electroconvulsive therapy (ECT), has been used as a treatment since the 1930s for psychological disorders such as severe depression and schizophrenia. While there has been widespread debate since the early 20^th century about the use and value of ECT, there have also been many cases of ECT successfully improving patients’ mental health. A more modern example was presented in the TED Talk by Dr. Sherwin Nuland, from a first-person perspective. The topics discussed in this presentation included the way ECT was introduced to Dr. Nuland’s case not as a first choice by any means, other early mental health treatments, and of all things, the involvement of a certain famous figure in human history who may after all seem like the obvious individual to be involved.

            ECT has been a topic of controversy since about the 1960s. Indeed, it is generally used as a last resort for the hopelessly depressed, suicidal, or psychotic. This is demonstrated by Dr. Nuland’s personal experience with ECT and the process his doctors went through to administer this treatment in the 1970s. While at first they thought only a lobotomy would work to treat Dr. Nuland, who was going through an incredible depression, they conducted a series of ECT treatments just to humor Dr. Nuland’s highly-esteemed resident doctor who suggested it. Then to their surprise, Dr. Nuland’s psychological state improved—the ECT was a success, which happens with only 50% of patients who do not respond to psychotropic medication.

            Dr. Nuland relayed a brief history of mental illness and convulsions in medicine. In that brief history, he mentioned that psychiatrists in the 1930s noticed a correlation between their depressed, epileptic patients having epileptic fits and their depressions lifting afterwards. This became part of the tradition of using convulsions as a treatment, if not a cure, for mental illness. Similar correlations have been found in treating “mad” patients with malaria and with insulin. Syphilis patients would present with symptoms of psychosis, a condition termed general paresis, and before the discovery of penicillin, an effective treatment of the illness was infecting them with malaria. As a result, the high fever burned out the syphilis bacteria and many patients recovered from the syphilis and general paresis. Another treatment called insulin shock therapy became popular around the same time as ECT. High doses of insulin were found to cause convulsions and temporary comas, but afterwards, some patients’ mental health improved. Later, due to the high risk of coma and death associated with insulin shock therapy, ECT replaced it. ECT, the malaria treatment, and insulin shock therapy are all controversial for ethical reasons nowadays, but they were among the first treatments to make a connection between mental illness and physical conditions, and using a potentially harmful treatment like infections or convulsions.

            Dr. Nuland also spoke briefly of Benjamin Franklin’s famous discovery of electricity with his kite, nearly electrocuting himself in the process, and doctors after that were inspired to use electricity as a means of producing convulsions in their patients. However, what Dr. Nuland does not elaborate on, and what many people do not know, is that Franklin discovered not only how to harness electricity, but also experimented on electricity’s effects on the human body and brain as early as the 1750s. He determined that electric shocks produced bodily convulsions and memory loss but otherwise caused no harm. A doctor friend of his tried these electric shocks on himself and reportedly felt “strangely elated,” which led him to wonder whether electric shocks could be used to treat depression. In regard to the development of ECT, the rest is history.

            Because of the controversy surrounding it, and the decades-long debate about its usefulness, Dr. Nuland’s firsthand account of the effectiveness of ECT came as an interesting surprise. What was also surprising were the similarities of ECT to other early mental illness treatments, Benjamin Franklin’s contributions, and the frequency of cases in which the patient does not recover their mental health after ECT treatments. I did not expect the reaction Dr. Nuland, and so many others over the years, had after their treatments. It definitely opened my mind to new (or old, like ECT) possibilities considering mental healthcare, but also made me realize there is so much about the human body and mind we do not know and have never known in all the centuries of study, such as the reasons behind the success of electroconvulsive therapy.

Ebola and Mental Illness: Witchcraft or Something Even More Devious?

In my Abnormal Psychology class, we had to write a paper relating three topics between a video and the material in the textbook/class. This assignment’s video was about the humanitarian aid (or lack thereof) during the 2014 Ebola outbreak. This is my take on the situation.

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            The crisis surrounding the outbreak and spread of the Ebola virus in West Africa in 2014 was considered a precedent for the severity level of the epidemic and thus for the medical emergency response, or lack thereof. This incident, especially since it began in poor, densely-populated regions in a non-Western and typically overlooked part of the world, had not been properly prepared for, which was a truth medical teams and governments alike came to know very well. The people directly affected and watching firsthand as the disease spread, however, had their own perspectives. The problems Ebola presented for them also had similarities to how a very different sickness had been considered in the past. Throughout its history, mental illness had been mistaken for witchcraft, grossly misunderstood by both patients and doctors, and only when treatment and living conditions improved would patients get better, like with Ebola.

            Ebola came to be known as a deadly reality for the people of Guinea, Sierra Leone, and Liberia. The people, suddenly overwhelmed by a high death count, thought they must be cursed. They performed rituals to ward off the curses, but of course Ebola could not be prayed away, much like mental illness. Since the Middle Ages and until the 18^th century, witchcraft or demonic possession were believed to be the reasons for abnormal behavior. However, there are much more empirical reasons for both sicknesses. When field hospitals were finally opened to care for Ebola patients, the poor conditions only made healthy citizens and nurses sick. Ebola, already spreading so easily in close quarters, was being helped to spread in the very places that were supposed to reduce the number of Ebola cases. Some people would suspect the hospitals were not actually helping and that instead they were slaughterhouses designed to prey on poor Africans, leading up to instances of mass panic or mass hysteria.

            The extent of the problem was misunderstood on several levels: the West Africans themselves, doctors and nurses, the national governments in West Africa, and agencies around the world. For months, this outbreak of Ebola was mistaken for cholera and malaria, and real valuable help was not deployed until many months after that. Mental health issues also have a history of being misunderstood by both those afflicted and those trying to help. Since people who presented with psychologically abnormal behaviors were once considered to be possessed by dark forces, their bodies would be harmed in some way to make them unhospitable to demons. Torture was a form of treatment, and most patients would reportedly have a temporary reprieve but not be permanently cured. There is a rather clear parallel between mental illness patients receiving inhumane treatment, like being kept in chains and tortured to expel the demons, and people exposed to Ebola. Because of some of the cultural traditions of the people of West Africa, such as touching and washing the dead without protective gear, Ebola could spread very easily. Many people would walk barefoot and step in contaminated blood and fluids on the ground. These conditions proved to be the perfect environment for the virus to thrive, and also proved that there was no proper understanding of how to prevent infection, just as there was no proper understanding of how to treat mental illness.

            While the governments of Guinea, Sierra Leone, and Liberia tried to cover up the magnitude of the Ebola crisis, a small medical company called Metabiota was simultaneously downplaying the problem. No one expected or was prepared for the ferocity of this outbreak. As a result, the authorities who could help stop the continual, lethal spread did not deem it the catastrophe it really was, and the appropriate level of humanitarian aid came too late. Meanwhile, the citizens of these countries were dying, so they learned to take matters into their own hands. When they began changing the way they live—such as properly burying their dead and learning about preventing the spread of disease—the death count declined. Similarly, in the 18^th and 19^th centuries, there was a reform movement to improve the quality of care inside asylums. Instead of giving inhumane treatment to the mentally ill, there was a rise in moral therapy. The mental hygiene movement worked to create more individualized care with a focus on rest. There was a resoundingly positive effect on patients’ health because the way of thinking about mental illness changed. Those most directly affected by Ebola started a movement of their own to deal with the new reality of the disease, changing the way they thought and acted, which saved lives.

            The similarities between the errors in handling the Ebola outbreak and the history of psychopathology were not immediately easy to observe. In the end, mental illness and Ebola are similar not in terms of causation, but in terms of effect. The way in which the Ebola crisis was managed, as described in the video, was even more frustrating than the way in which mental illness was managed in the past, because the Ebola outbreak happened in the 21^st century, not the Middle Ages. I thought it was unfortunate that the comparisons were between pre-18^th century cases of mental illness and modern cases of Ebola, as both should be handled with better care by now.

Catharsis and Anger: A Summary

In my class Research Methods in Psychological Science, I wrote a summary of a research article on the effect of venting when angry. The findings were very interesting to me, so I decided to share my summary here.

Article: Bushman, B. J. (2002). Does venting anger feed or extinguish the flame? Catharsis, rumination, distraction, anger, and aggressive responding. Personality and Social Psychology Bulletin, 28, 724-731. doi:10.1177/0146167202289002.

The common idea that venting anger through physical aggression decreases anger, catharsis theory, was tested in this study by Bushman (2002). Cognitive neoassociation theory, an exact opposite theory which states that venting anger through physical aggression increases angry feelings, was also tested. Bushman predicted that following catharsis theory would make participants less angry, and following cognitive neoassociation theory would make participants angrier by not allowing them to vent their frustrations. Catharsis theory consists of two forms of venting: rumination, in which participants are told to think about the cause of their anger while being physically aggressive, and distraction, in which participants are distracted from their anger but still are physically aggressive. The questions posed by this study included whether or not catharsis theory would make participants less angry, and whether rumination would make participants less angry than distraction.

The results of 300 undergraduate men and 300 undergraduate women were recorded during this single-blind study, with 100 participants of each gender distributed into each of the experimental groups: rumination, distraction, and control. All 600 of the participants underwent the same treatment in the beginning, but the way they were told to deal with their anger afterwards changed between the three different groups. Each of the participants wrote an essay on a personal opinion, then a fellow participant, who was not actually real, gave them very bad evaluations on their essay, which angered them. The participants then rated their anger, and the rumination and distraction groups were given the chance to act on it with a punching bag. Participants in the rumination group hit the punching bag with the thought of the fellow (nonexistent) participant in mind. Participants in the distraction group hit the punching bag as a form of exercise, focusing them away from their anger. Participants in the control group merely sat quietly for several minutes. Then every group completed a form to determine their mood. The next part of the study involved a competition between each of the participants and the nonexistent participant who had wronged them. Whoever was quicker to press a button would avoid getting a blast of noise, and the participants could control the decibels and duration of the blast given to the slower contestant. This showed the researcher how the participants would choose to be aggressive towards the person who angered them.

The results from these exercises posed a direct contradiction to the hypotheses and previous popular thoughts about venting anger. Any of the participants who engaged in rumination and even distraction with physical aggression showed more anger and aggression than the control group that did not participate in hitting the punching bag. There was also no significant increase in positive mood for any of the groups. The anger levels for the distraction group were less than for the rumination group, but the two groups did not show much difference in levels of aggressive behavior, which suggests that physical aggression, like hitting a punching bag, can still increase aggression.

By the end of this study, the data supported cognitive neoassociation theory in that venting increases anger and aggression. The study included any possible confounding variables with the differences in gender and desire to hit the punching bag. Even though I personally have never felt much calmer after venting my anger, I (as well as some punching bag manufacturers, I’m sure) would prefer a direct course of action to make myself feel better, so the evidence surrounding venting anger is difficult to accept. However, further studies may need to be done to completely disregard catharsis theory, due to the long-term effects of anger. The original reasoning behind catharsis theory was that if people do not release their anger, eventually they will explode. Therefore, the question remains: will people who do not vent now be angrier later?