Timothy Kreider's responses to questions from Association of Gay and Lesbian Psychiatrists (AGLP)
1.) Joe Biden recently said that transgender discrimination is the “civil rights issue of our time.” Given that there is a serious lack of transgender-friendly providers in this country, what steps can the APA take to work on discrimination within our organization?
Psychiatry has a profound responsibility towards transgender individuals for two reasons: symbolically, for our field’s troubled legacy of defining “normal” gender and sexuality; and practically, for our effective “gatekeeper” status for the surgical and medical care often sought by transgender patients. Respect and empathy for another person begin with an earnest attempt at understanding. APA can support the training of transgender-friendly providers by encouraging residency programs to include instruction and supervision in treating transgender patients. Residents need to learn much about transgenderism that may not be covered in standard curricula: counseling patients and educating families about gender identity; handling pronouns with sensitivity; navigating the psychological, legal, and financial considerations of transition; screening for psychiatric side effects of transition treatments; and more. By setting clear expectations for training programs, APA can lead psychiatry to be continuously more inclusive and supportive of patients and colleagues alike. We psychiatrists should be the natural allies of any group that faces stigma, given the suffering from stigma we see daily in our patients of all genders and sexualities.
APA and psychiatry residency programs need not fly blind when designing standards and curricula but rather can build on existing work by other organizations. For example, The Joint Commission has published a “field guide” for how hospitals can be made more welcoming to LGBT staff and patients, World Professional Association for Transgender Health publishes standards of care for physicians with gender-nonconforming patients, and related groups like Advocates for Informed Choice can highlight how patients experience physicians who are not comfortable gender differences.
2.) What areas do you think psychiatry is deficient in regarding our basic understanding of the psychological aspects of the LGBT population? Where should current research be focused?
We need to better understand not only what factors lead to poor outcomes in LGBT persons but also what protective factors promote their healthy development. The data are clear that LGBT youth carry a dramatically increased burden of suicide, substance abuse, and other psychiatric illness. What, conversely, enables healthy LGBT persons to thrive? Broadening our focus from “increased risk” to “healthy development” will reinforce our message that non-heterosexual orientations are normal variants rather than indicators of pathology. Psychiatrists will be better able to serve LGBT patients when we have robust theoretical models for how their successful development across the lifecycle may differ from non-LGBT peers. We need a queer positive psychology.
Psychiatry has a profound responsibility towards transgender individuals for two reasons: symbolically, for our field’s troubled legacy of defining “normal” gender and sexuality; and practically, for our effective “gatekeeper” status for the surgical and medical care often sought by transgender patients. Respect and empathy for another person begin with an earnest attempt at understanding. APA can support the training of transgender-friendly providers by encouraging residency programs to include instruction and supervision in treating transgender patients. Residents need to learn much about transgenderism that may not be covered in standard curricula: counseling patients and educating families about gender identity; handling pronouns with sensitivity; navigating the psychological, legal, and financial considerations of transition; screening for psychiatric side effects of transition treatments; and more. By setting clear expectations for training programs, APA can lead psychiatry to be continuously more inclusive and supportive of patients and colleagues alike. We psychiatrists should be the natural allies of any group that faces stigma, given the suffering from stigma we see daily in our patients of all genders and sexualities.
APA and psychiatry residency programs need not fly blind when designing standards and curricula but rather can build on existing work by other organizations. For example, The Joint Commission has published a “field guide” for how hospitals can be made more welcoming to LGBT staff and patients, World Professional Association for Transgender Health publishes standards of care for physicians with gender-nonconforming patients, and related groups like Advocates for Informed Choice can highlight how patients experience physicians who are not comfortable gender differences.
2.) What areas do you think psychiatry is deficient in regarding our basic understanding of the psychological aspects of the LGBT population? Where should current research be focused?
We need to better understand not only what factors lead to poor outcomes in LGBT persons but also what protective factors promote their healthy development. The data are clear that LGBT youth carry a dramatically increased burden of suicide, substance abuse, and other psychiatric illness. What, conversely, enables healthy LGBT persons to thrive? Broadening our focus from “increased risk” to “healthy development” will reinforce our message that non-heterosexual orientations are normal variants rather than indicators of pathology. Psychiatrists will be better able to serve LGBT patients when we have robust theoretical models for how their successful development across the lifecycle may differ from non-LGBT peers. We need a queer positive psychology.