Intersectionality
A nuanced approach to disparities in mental health care
 
Last year the APA commissioned a working group to prepare a report ‘that summarized critical factors contributing to health disparities in boys and men vulnerable to health disparities’.
 
A clear message from the report was that if we are to keep boys and men healthy and alive, we need to focus on the intersection of gender with other aspects of a person’s identity, including sexual identity, ‘racial identity, ethnic identity, religiosity and spirituality, and other factors’ (APA 2018). 
 
For example, the report pointed out that ‘vulnerable boys and men are in a precarious social position because they are marginalized in one social identity domain (e.g., race/ethnicity and sexual orientation) and presumed to be privileged in another (e.g., gender). Occupying discrepant social positions can lead vulnerable boys and men to respond to environmental stress, depression, and trauma by engaging in health-damaging behaviors that symbolically restore power and control’, and ‘often these behaviors are the very ones that put these males at greater risk for health disparities’ (APA 2018).
 
It feels like this report was a little neglected by the media.  It was published last year, and I have heard little commentary about it, and I wonder why.
 
You can find the full report by following the link below.  Do let me know what you think.
https://www.apa.org/pi/health-disparities/resources/race-sexuality-men-report.pdf 

Chris Warren-Dickins LLB MA LPC
Psychotherapist, (Licensed Professional Counselor), Northern New Jersey
www.exploretransform.com              
201-779-6917              
chris@exploretransform.com​
#findatherapist #northernnewjersey #beyondtheblue #mentalhealth

Earlier this year I had the honor to be the mental health expert at a panel discussion at Westside Presbyterian Church (Ridgewood, New Jersey).  We discussed the intersection of sexuality, gender and religion. 

We focused on how places of worship can become more welcoming to members of the LGBTQIA+ community, and you can watch the recording of the event here - https://youtu.be/xRrIQ7duyj0

Let me know what you think!

Chris Warren-Dickins LLB MA LPC
Psychotherapist, (Licensed Professional Counselor), Ridgewood NJ 07450
www.exploretransform.com               201-779-6917              chris@exploretransform.com

If your true identity is not the identity you were given at birth, you may identify in some other way, including transgender, gender non-confirming, gender queer, or non-binary (TGNC for ease of reference.) In all cases, you do not identify as cisgender. Cisgender means you identify as the gender identity you were given at birth.

To identify as cisgender means that you live with cisgender privilege, whether you are aware of this or not. Cisgender privilege means that you do not have to endure the overt and covert discrimination experienced by many people who are TGNC. Cisgender privilege means you can assume you will not be denied work, a home, healthcare, a place to worship, a family to love, or your personal safety, because of your gender identity. Cisgender privilege means that you don’t have to remind people (even your loved ones) of your pronouns, and/or your name (for example, you are not dead-named).

Seemingly innocuous moments in everyday life can symbolize cisgender privilege, which basically assumes a binary construct of gender identity. Examples of these everyday moments are set out below:

·        You fill out a form and it asks you to tick the box ‘male’ or ‘female’. There is no box for people who identify as TGNC
·        Your friend is pregnant and holds a gender reveal party with ‘Pink or Blue?’ on every single decoration, including the cake and balloons
·        There are only two bathrooms, one labelled ‘male’ and one labelled ‘female’
·        The same goes for other public facilities including locker rooms in gyms and changing rooms in clothes stores
·        Waiting to board a plane, the airline announces that only women and young children can board first
·        There are role models in the media and in the political arena who are cisgender
·        There are rites of passage, public ceremonies, and other traditions based around the binary concept of male and female
·        You register your child for a sports class and the instructor asks your child to get changed in the girl’s locker room, and join the girls group
·        You go to a high school graduation where everyone is told to sit in two sections: The male section and the female section

To pretend that there are only cisgender males and cis gender females in society is to pretend that parts of our population, the GNC community, do not exist. To do this is offensive, and it can leave a lasting impact on someone’s mental health.  “40% of transgender adults reported having made a suicide attempt, and 92% of these having attempted suicide before the age of 25” (Trevor Project). In addition, 86% of transgender individuals reported sexual or physical assault. Here are some accounts from a Human Rights Watch report:

“Alexander S., a 16-year-old transgender boy in Texas, said: I started getting a lot of anonymous people telling me to kill myself, that it wasn’t worth living. I called the school and told them what was going on and they didn’t do anything.”

and

“It was “like a little mental pinch” when teachers used the wrong pronouns. “It doesn’t seem like a big deal, but eventually you bruise”, 17-year-old transgender student in Utah.”

So the biggest cisgender privilege is to live a life where you are less likely to commit suicide, and less likely to experience sexual or physical assault.

Less obvious forms of discrimination include microaggressions, which are everyday slights, snubs or insults that communicate hostility (whether or not they are intentional). GLAAD ran a photo campaign to highlight this issue. Here are some examples from that campaign –

·        Seven, a transgender man, was asked “Did you transition because you thought you were an ugly girl?”
·        Jacob, who is gender queer, was asked “When are you going to really transition?”
·        Tyler, who is agender/queer, was told “you need to shave if you’re trying to look like a girl”
·        Tiq, a trans man, was told “I would never have known you used to be a girl”
·        Shane, a trans man, was told “You understand what it’s like to be a woman”

To acknowledge all of this, and the privilege of a cisgender man, is not to deny the suffering that cis gender men may experience as a result of another aspect of their identity. For example, if a cisgender man is also a gay man, it is likely that he would have endured his own experiences of overt and covert discrimination, including microaggressions, verbal abuse, and assault. But to acknowledge the suffering of one group of people does not take anything away from the suffering of another group. 

If we are to truly understand the concept of privilege, we cannot stop at gender identity. For example, a white transgender man will experience white privilege that a black transgender man will not. As the American Psychological Association points out, each of our “social identities contributes uniquely and in intersecting ways to shape” how we experience and perform our lives (APA Guidelines, 2018). In turn, this has an impact on “relational, psychological, and behavioural health outcomes in both positive and negative ways”. In the next article in this series, we will look at other forms of privilege, including white privilege.

In the meantime, we will close with some tips on how to address cisgender privilege –
·        Raise awareness about the privilege of being cisgender
·        Stop making assumptions about people’s gender identity. If in doubt, and it seems appropriate, ask. If not, use ‘they’ rather than ‘him’ or ‘her’
·        Normalize the concept of identifying gender, including a person’s pronouns, and include your own pronouns in your email signoff
·        Gender identity is a personal matter. How you identify, and how much you share that with another person, is up to you
·        Challenge the overly simplistic division of the human race into the binary fiction of ‘men or women’. We really can do better. Gender is a spectrum as varied as any other components to a person’s identity. The binary ‘man or women’ option has never, ever reflected reality, so isn’t it high time we caught up?
​
Chris Warren-Dickins LLB MA LPC
Pronouns: (they/them/theirs)

So what about gender identity and young children? The wonderful organization Gender Spectrum suggests using 'insistence, consistence and persistence to help determine if a child is truly gender-expansive or transgender':
'If a boy likes to play with dolls or likes the color pink, this doesn’t mean they will grow up to be transgender. If a girl wants to be called “John” for a couple of weeks, this doesn’t mean she will always feel like a boy. The longer and more insistently that a child has identified as the opposite gender, a combination of genders, or neither gender, the easier it becomes for a parent to know.'

Gender Spectrum encourages parents to adopt Affirming Parenting Practices, and this includes allowing your child 'to choose, without pressure or unspoken messages, the clothes they wish to wear, how and with whom they play, their favorite toys, the accessories they favor, the manner in which they wear their hair, and the decorations and images with which they surround themselves'.
​
You also need to help your child to 'prepare for any negative reactions they may encounter outside the home by practicing their responses with them and making sure, when appropriate, that there is a safe adult for them to turn to in case they need assistance'. It also means 'discussing any negative or conflicting feelings you are struggling with over their gender with other adults, not with your child'.

No matter what, the most important point is that the 'self-esteem, mental well-being, and overall health of a child relies heavily on receiving love, support and compassion from their parents no matter where they are on their gender path.'

Read more here https://www.genderspectrum.org/explore-topics/parenting-and-family/?fbclid=IwAR1BGGmBZcem7SxSQ60ch7yHyJO8eCfQdXI6c9W1IhDD9-yhfqt1s2ru5Bo#more-340

Chris Warren-Dickins LLB MA LPC
Psychotherapist, (Licensed Professional Counselor), Ridgewood NJ 07450
www.exploretransform.com               201-779-6917              chris@exploretransform.com

So what exactly is Gender Identity? 

In the words of Gender Spectrum, gender identity is 'our internal experience and naming of our gender. It can correspond to or differ from the sex we were assigned at birth'.

Gender identity is not a binary concept, this is simply how we have understood (or oversimplified) gender. The reality is that gender identity exists on a spectrum, and this can include people who are transgender, cis gender, non-binary, gender queer, and other gender identities. 'Because we are provided with limited language for gender, it may take a person quite some time to discover, or create, the language that best communicates their internal experience. Likewise, as language evolves, a person’s name for their gender may also evolve. This does not mean their gender has changed, but rather that the words for it are shifting.'

'Each dimension of gender is informed by our unique intersection of identities, experiences, and personal characteristics. We are more than our body, gender identity and gender expression: we are also our race, ethnicity, class, faith, sense of geographic place, family history, and more.

​Our gender is personal because, while we share some of these aspects of self with others, the way that all of these identities, influences and characteristics come together is unique to each of us'. Read more here https://www.genderspectrum.org/quick-…/understanding-gender/

Chris Warren-Dickins LLB MA LPC
Psychotherapist, (Licensed Professional Counselor), Ridgewood NJ 07450
www.exploretransform.com               201-779-6917              chris@exploretransform.com

For some, it is easier to believe there is not a problem, than to have to face the full onslaught of someone else’s distress.  If someone believes they are not directly impacted by an issue, they choose to close their eyes and ears.  The trouble is, one person’s distress is rarely relevant to just that one person.  We need to take responsibility for every person in society, because their distress could be caused by us, and their distress could, eventually, become our problem.
 
“I go to a Catholic school, where I’ve heard that my counselor has made some racist comments in class. Unless I 110 percent trusted and were close to my counselor, I wouldn’t feel comfortable confiding in them.”
 
This is just one account in the ‘LGBTQ Youth Report’, published last year by the Human Rights Campaign.  The report highlighted the multi-layered difficulties experienced by LGBTQ youth.  I have set out just some of these findings, and if you are at all concerned about living in a healthy society, you will find these disturbing –
 
‘Only 25% of LGBTQ youth have families who show support
for them by getting involved in the larger LGBTQ and ally community.’
 
‘Trans youth are over 2x more likely to be taunted or mocked by family for their
LGBTQ identity than cisgender LGBQ youth.’
 
‘LGBTQ youth of color report hearing family express negativity about
LGBTQ people more frequently than their white peers.’
 
‘Only 27% of LGBTQ youth can “definitely” be themselves in school as an LGBTQ person.’
 
Only 26% of LGBTQ youth report that they always feel safe in the classroom.’
 
‘Seventy-seven percent of LGBTQ youth surveyed report that on average they had felt down or depressed in the past week. Alarmingly, only 41 percent had received psychological or emotional counseling to address these issues in the past 12 months. LGBTQ youth of color
face even greater challenges in accessing counseling services, with large disparities and an average of 37 percent of respondents having received psychological or emotional counseling in the past 12 months.Importantly, youth who had received counseling reported better mental health outcomes.’
 
Who is going to be ‘family’ to the 75% of LGBTQ youth who have no support from their own family, or the ‘trans youth’ who are being ‘taunted or mocked by family for their LGBTQ identity’?  You?  If you are willing to open your eyes and ears, and to help with this societal issue, here are the Human Rights Campaign’s suggestions -
 
‘School Administrators & Teachers

• Establish clear and inclusive policies to support LGBTQ youth
• Provide annual LGBTQ-inclusive training for all school staff
• Be intentional about creating safe spaces for LGBTQ youth
• Be a visible advocate for LGBTQ inclusion and equality
• Provide educational resources for teachers, parents and students’

 
‘Mental Health & Medical Professionals

• Be open to discussing sexual orientation and gender identity
• Seek additional training to increase proficiency in LGBTQ issues
• Be an advocate for LGBTQ youth at all levels of health care
• Provide educational resources for teachers, parents and students’

 
‘Parents & Family Members

• Learn the facts and be informed about issues that impact LGBTQ youth
• Be aware of the LGBTQ inclusion policies that impact LGBTQ youth — in your state,
• city and local school district
• Advocate for LGBTQ inclusive curriculums, programming and clubs
• Watch for signs of bullying
• Get involved with local
• LGBTQ organizations
• Make your home a safe and affirming space for LGBTQ youth — whether or not you
• have openly LGBTQ children’

​Full report available here -  
https://www.hrc.org/resources/2018-lgbtq-youth-report
 
Chris Warren-Dickins LLB MA LPC
Psychotherapist, (Licensed Professional Counselor), Ridgewood NJ 07450
www.exploretransform.com               201-779-6917              chris@exploretransform.com

As a member of the healthcare profession, I have a duty to ensure that my services are available for all members of society. 
Dr Wizdom Powell, lead author of a study in the journal Behavioral Medicine, points out that “medical mistrust is significantly contributing to delays in African American men utilizing the health care system”. 
​
The study refers to the need for ‘patient-centered interactions’ which are characterised by ‘mutually as well as supportive and responsive communication’. This ensures a higher likelihood of ‘patient to trust’.  As the study points out:

“For African-American men, who are disproportionately exposed to daily, racialized slights against their humanity, a little patient-centeredness could go a long way in restoring their medical organization trust, as well as improving timely detection and screening.”

In addition, the study points out that I, as a clinician, need to remain aware of the “the more pernicious role of structural racism in policies, practices, and procedures impacting medically vulnerable and underserved populations”.  

https://www.tandfonline.com/doi/full/10.1080/08964289.2019.1585327

Chris Warren-Dickins LLB MA LPC
Psychotherapist, (Licensed Professional Counselor), Ridgewood NJ 07450
www.exploretransform.com               201-779-6917              chris@exploretransform.com

The American Counseling Association (ACA) has issued a statement regarding gun violence.  A link to the full statement can be found below.

It is important to highlight that the ACA "strongly discourages attributing these atrocities to mental illness—rather than considering the complex interplay of the misuse of guns and targeted acts of gun violence".

Included in the ACA statement are links to useful resources, should you need these.  I have attached one of those useful documents, a factsheet on 'Helping Survivors with Stress Management Skills'.

Chris Warren-Dickins LLB MA LPC
Psychotherapist, (Licensed Professional Counselor), Ridgewood NJ 07450
www.exploretransform.com               201-779-6917              chris@exploretransform.com

The label ‘toxic masculinity’ is unhelpful for the whole of society, no matter the gender identity.  In this fascinating interview with Dr Wizdom Powell and Dr Ronald Levant (from minute mark 25:13 onwards) Dr Powell makes the important point that “we are complicit in maintaining this idea of masculinities that is mythic and difficult to achieve”, and “these messages start very early in the life course”.

Dr Powell also makes the important point that, in order for boys and men to get the help they need, we “need to think about structural arrangements for particular racial and ethnic minority males like black men and boys that actually make it even more likely that men will push back from seeking the help they need, and these arrangements include structural disadvantages like racism that can interact with men’s beliefs about what it means to be a man to negatively impact their health.

So we need systems change…to make it possible for boys and men to enact masculinities that really convey the dynamic broad range of emotions they are capable of displaying.’

Full interview (from minute mark 25:13 onwards) available from this link - 

https://www.kcur.org/post/seg-1-human-cost-reassessment-seg-2-toxic-humanity#stream/0

Chris Warren-Dickins LLB MA LPC
Psychotherapist, (Licensed Professional Counselor), Ridgewood NJ 07450
www.exploretransform.com               201-779-6917              chris@exploretransform.com
​