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CW for dysphoria and transphobia. But if you work in OCD/ED/BDD research, please pay attention to this one. I'll elaborate a bit. https://www.lgbtqnation.com/2021/02/medical-school-suspends-study-tortured-transgender-people-science/
I'm used to stumbling on bad science done on queer people. I'm less used to it being by someone whose papers I have cited & who is featured by @IOCDF: Dr Jamie Feusner of UCLA @BDD_anorexia. From what I can tell, Dr Feusner has done a lot of good work in BDD/ED/OCD...
And that may be exactly why he should never have moved into the dysphoria field.
Because dysphoria is not dysmorphia. Because being trans is not a psychiatric condition.
Because dysphoria is not dysmorphia. Because being trans is not a psychiatric condition.
I'm going to set aside the methods (making trans people dysphoric) to focus on the premise & consequences. Consequences first: this study WILL create new, technologically advanced forms of conversion therapy.
Conversion therapy is torture and does not work. The study site includes this disclaimer, which makes clear that they are aware their results CAN be used for these purposes-- and once the work is published, WILL be. Even if not by them.
In case you're not aware, conversion therapy not only doesn't work, it double trans suicide rates. So: potential study consequences: killing trans people? https://ajph.aphapublications.org/doi/10.2105/AJPH.2020.305637
But what kind of conversion therapy comes from brain scans, you ask? We have another Feusner lab paper to answer that. fMRI neural feedback methods are proposed to fix dangerous dyspMORPHic body images in anorexia. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5752143/
(Here's a really long legal brief that I haven't read all of, outlining how high tech conversion therapy is a looming possibility we need to account for in our conversations about gender.) https://link.springer.com/chapter/10.1007/978-3-319-93907-0_41
And in anorexia, a brain scan to correct "deviant perception of the body" is a useful treatment. In gender dysphoria, that's conversion therapy.
But Sara, are you making that distinction just because you think being trans isn't a mental illness? Well, yes, but actually no.
But Sara, are you making that distinction just because you think being trans isn't a mental illness? Well, yes, but actually no.
You can read Dr Feusner here talk about treatment methods for BDD, a dysmorphic disorder: SSRIs and CBT. The long, long history of conversion therapy and trans survival has made clear that these are not treatments for gender dysphoria... https://connect.uclahealth.org/2017/08/21/disgusted-by-your-appearance-the-problem-may-reside-in-your-brain-not-your-looks/
...And if the treatments that are frontline for every mental illness in Feusner's wheelhouse (BDD, ED, OCD) do not change gender dysphoria, that again suggests that these things can't be grouped scientifically, right? The only throughline is "body image."
Body image. Huh. The best treatment for gender dysphoria is transition with social support, and regret rates on even the most invasive form of transition-- surgery-- are INCREDIBLY low. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6212091/
Not true for dysmorphic disorders. Anorexia patients continue to perceive themselves as overweight despite body changes; BDD patients often still meet BDD criteria after cosmetic surgery, sometimes switching focus to a different body part. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846290/
In more anecdotal terms: dysphoria is usually experienced as seeing your body as it IS, & feeling incongruent/unhappy with what you see. Dysmorphia is more associated with perceiving something about your body inaccurately (& obsessing on it).
Given all this: not only the study but the entire "transgender" arm of this lab's research is scientifically unsound and very unethical. Lumping dysphoria with dysmorphia has horrible consequences for trans people; it also makes bad science.
(If the argument were that because these two conditions are different, studying them in contrast could be useful-- then I ask you why, among other things, their donation link header says transgender and then only dysmorphia is discussed.)
I lied though, I do want to comment briefly on methods. This study wanted trans people w/o medical transition to reveal themselves (skintight clothing) in front of researchers to trigger dysphoria, & paid $100+ for it-- not nothing for an unemployed trans person in a pandemic--
& if you haven't been dysphoric you may not know why trans people recoil at that so much. tl;dr: imagine you needed to eat so you made $100 in exchange for being suicidal and dissociated for a week+.
(If you didn't imagine suicidal ideation as a possible risk from this kind of dysphoria trigger: again, perhaps you aren't fully prepared to study trans people.)
In summary: study risks: making trans subjects suicidal, contributing to future conversion therapy (and suicides).
Study gains: not fixing dysphoria, because we already have a lot of research on that and the answer isn't "brain feedback"--
Study gains: not fixing dysphoria, because we already have a lot of research on that and the answer isn't "brain feedback"--
So study gains: pathologizing transness, OR just answering an academic question about how trans brains work. (When that's is being done by cis people I like to call this "gawking at the transes".)
Woof, I was just going to say "hey psychiatry twitter, please look at this and think about how to improve" but as you can see I have a lot of thoughts.
Please do not research trans people if you don't actually understand trans experiences or the potential consequences!!!!!!
Please do not research trans people if you don't actually understand trans experiences or the potential consequences!!!!!!
