This week’s Issue Update goes a long way toward dispelling the pernicious myth that if parents and society don’t validate transgenderism and pass laws supporting “gendering affirming care” we will all be guilty of causing a “trans” person to commit suicide. Joy Godwin, who also brought us an excellent perspective through her article “My Intersex Sister,” shares her research on suicide, particularly as it related to Gender Dysphoria.
Be one of the people who knows the facts on this topic – then share what you know with others.
Toward protecting our loved ones,
Wendy Wixom, President
United Families International
Am I Contributing to Someone’s Suicide?
By Joy Godwin
We are what we think.
We are what we think. This line from a poem attributed to Buddha has been on my mind for months. Translated to English, the entire poem goes something like this:
We are what we think.
All that we are arises with our thoughts.
With our thoughts we make the world.
Speak or act with an impure mind, and trouble will follow you, as the wheel follows the ox that draws the cart.
We are what we think.
All that we are arises with our thoughts.
With our thoughts we make the world.
Speak or act with a pure mind, and happiness will follow you, as your shadow, unshakable.
How can a troubled mind understand the way?
Your worst enemy cannot harm you as much as your own thoughts, unguarded.
But once mastered, no one can help you as much, not even your father or your mother.
These powerful words haunted me every time I heard another powerful message: Kids with gender dysphoria will commit suicide if they are not given gender-affirming medical treatment. This concept is included in almost every news article and social media post written about gender dysphoria, and it is alarming.
When I first heard it, I wondered, is it true? And, if gender dysphoria (GD) is causing suicide, is the driver coming from within, or are Buddha’s words true—is the message creating harm? I believe it is the latter.
All that we are arises with our thoughts.
Suicide is tragic in every case, but there is little support to the claim that failing to provide gender-affirming care will result in a death. The UK’s largest gender clinic, the Gender Identity Development Service (GIDS), has found that “suicide is extremely rare”.
Another study, commissioned by the Swedish government, found that “suicide rates for personality disorder, schizophrenia, substance addiction, bipolar and (among males) depression and autism were all higher than suicide rates for gender dysphoric people”.
When asked by parents about the rate of suicide among children and teens with gender dysphoria, Dr. Laura Edwards-Leeper, of the World Professional Association for Transgender Health (WPATH), states that “As far as I know, there are no studies that say that if we don’t start these kids immediately on hormones when they say they want them that they are going to commit suicide. So that is misguided.”
Although there is evidence that children and teens suffering from gender dysphoria are at an increased risk of suicidal ideation (i.e., having thoughts of committing suicide), there is no credible evidence that talking about suicide will lead to dying by suicide.
With our thoughts we make the world.
Factors that do contribute to suicide are as multifaceted and unique as humans themselves. The Centers for Disease Control and Prevention (CDC) lists common factors that influence suicide rates, but they also caution readers: “Suicide is rarely caused by a single circumstance or event. Instead, a range of factors—at the individual, relationship, community, and societal levels—can increase risk”.
Learning this led me to another question: If experts caution us not to attribute suicidal ideation to a single factor, why are so many people ignoring the other issues kids and teens with GD are experiencing? A 2014 study lists some of the common comorbidities (i.e., simultaneous medical conditions) of gender dysphoria recorded by the American Psychiatric Association (APA) in the DSM-5; such as anxiety, depression, autism spectrum disorder, impulse control disorders, and history of abuse and complex trauma.
Prominent studies have also listed schizophrenia, mood and eating disorders, major depressive disorder, phobias, adjustment disorder, dissociative disorder, and substance abuse as common comorbidities of gender dysphoria. All of these can lead to higher rates of suicidality.
At the same time, mental health professionals have repeatedly warned us to be cautious when reporting suicides because there are links between the way suicides are reported and increased suicide rates.
Speak or act with an impure mind, and trouble will follow you.
If the causes of suicide are complex and rates are low among GD patients, does repeating the message my child—or my patient—will commit suicide if they do not receive gender-affirming care cause any harm? I believe it can.
Buddha’s theory, constructed nearly two millennia ago, is akin to what modern psychologists’ call cognitive distortions.
Dr. Peter Grinspoon defines cognitive distortions as “internal mental filters or biases that increase our misery, fuel our anxiety, and make us feel bad about ourselves. … In other words, your emotions and feelings about a situation become your actual view of the situation, regardless of any information to the contrary”.
Two particularly dangerous cognitive distortions are black and white thinking, and fortune telling. These can lead to hopelessness through a damaging self-image, and a false belief that the future is bleak and we have no power to make it better.
We are what we think.
Do cognitive distortions have a link to suicidal ideation, though? According to some research studies, the answer is yes. A 2014 study concluded that, “individuals who recently attempted suicide are more likely than psychiatric controls to endorse thinking styles characterized by cognitive distortions”.
In 2017, researchers designed a model to help examine how cognitive distortions and cognitive deficits interact to predict suicidal ideation. Their study concluded that, “hopelessness was found to be an important predictor of suicide ideation, as were negative evaluation of self and future. These cognitive distortions are therefore important targets for assessment of suicidality and subsequent treatment”.
Speak or act with a pure mind, and happiness will follow you.
If you know someone who is suffering from suicidal ideation, there are reliable sources you can turn to for help. Decades of research, and experiential knowledge gained through mental health counseling, have given us a good picture of what we can do to support someone who is suffering from thoughts of suicide.
A Google search for “suicide treatment” garnered more than 300 million websites run by organizations offering information; including the International Association for Suicide Prevention, National Institute of Mental Health, CDC, and The Jed Foundation—which focuses on young adult resources.
The nonprofit organization, Boys Town, maintains a website with resources for teens who are, or know someone, experiencing thoughts of self harm and suicide. They offer a template and instructions for creating a personal safety plan; an important step for helping someone who is experiencing recurring thoughts of suicide or self harm.
One remarkably effective treatment for healing mental health conditions fueled by cognitive distortions is cognitive behavioral therapy (CBT). Developed nearly 50 years ago by Dr. Aaron T. Beck, CBT “helps people identify their distressing thoughts and evaluate how realistic the thoughts are” and then trains patients in how to change their distorted thinking.
But once mastered, no one can help you as much [as your thoughts].
There is no question that every human life is valuable, and every death is tragic, because what we each add to the planet is inimitable. Each of us can comfort people who are experiencing suicidal ideation by remaining with them in their darkest moments, and helping them see their incomparable beauty through clear, undistorted thoughts.
There is hope. Suicide is preventable, and it is not the only alternative to any of life’s complex problems; even the often distressing and complicated problem of gender dysphoria.
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Joy Godwin is a veteran adapted needs teacher working towards earning her CFLE. Her and her husband of 34 years have five children, four in-law children, and two grandchildren. Her greatest joys are spending time with her children and grandchildren, being in a quiet place alone with her husband, gardening, teaching, and learning about how to build happy families.
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References
Boys Town. (n.d.-a). Creating a safety plan. Your Life Your Voice.
https://www.yourlifeyourvoice.org/Pages/tip-creating-a-safety-plan.aspx?psafe_param=1&s_src=google_ads&s_subsrc=cpc&gad=1&gclid=Cj0KCQjwsp6pBhCfARIsAD3GZubuYdUsNlWHSlKNqIlv5hvlSqiVpwbZuZznIUDXP-6Z-M2LEZ8shFoaAp9lEALw_wcB
Boys Town. (n.d.-b). Topic: Suicidal thoughts. Your Life Your Voice. https://www.yourlifeyourvoice.org/Pages/suicidal-thoughts.aspx
Centers for Disease Control and Prevention. (2022, November 2). Risk and protective factors. Centers for Disease Control and Prevention. https://www.cdc.gov/suicide/factors/index.html#:~:text=Individual%20Protective%20Factors,Strong%20sense%20of%20cultural%20identity
Deutsch, M. B. (2016, June 17). Overview of gender-affirming treatments and procedures. UCSF Transgender Care. https://transcare.ucsf.edu/guidelines/overview
Edwards-Leeper: Support doesn’t always mean medical interventions. Genspect. (2021, October 7). https://genspect.org/leeper-edwards-support-doesnt-always-mean-medical-interventions/
Fazakas-DeHoog, L. L., Rnic, K., & Dozois, D. J. A. (2017, May 31). A cognitive distortions and deficits model of suicide ideation. Europe’s journal of psychology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5450979/
Frew, T., Watsford, C., & Walker, I. (2021, May 5). Gender dysphoria and psychiatric comorbidities in childhood: A systematic review. Taylor & Francis Online. https://www.tandfonline.com/doi/pdf/10.1080/00049530.2021.1900747
Gender Identity Developmental Service. (n.d.). Evidence Base. https://gids.nhs.uk/professionals/evidence-base/
Grinspoon, P. (2022, May 4). How to recognize and Tame your cognitive distortions. Harvard Health Publishing. https://www.health.harvard.edu/blog/how-to-recognize-and-tame-your-cognitive-distortions-202205042738#:~:text=Cognitive%20distortions%20are%20internal%20mental,cut%20down%20our%20mental%20burden.
How to help a friend who may be suicidal. The Jed Foundation. (2023, March 9). https://jedfoundation.org/resource/how-to-help-a-friend-who-is-suicidal/
Jager-Hyman, S., Cunningham, A., Wenzel, A., Mattei, S., Brown, G. K., & Beck, A. T. (2014, August 1). Cognitive distortions and suicide attempts. Cognitive therapy and research. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4185206/
Mazaheri Meybodi, A., Hajebi, A., & Ghanbari Jolfaei, A. (2014, August 11). Psychiatric axis I comorbidities among patients with gender dysphoria. Psychiatry journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4142737/
Myers, S. A. (2022, October 17). When gender dysphoria and schizophrenia overlap. Psychology Today. https://www.psychologytoday.com/us/blog/living-outlier/202210/when-gender-dysphoria-and-schizophrenia-overlap
Suicidal crisis support. International Association for Suicide Prevention. (2023, August 18). https://www.iasp.info/suicidalthoughts/
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Wanta, J. W., Niforatos, J. D., Durbak, E., Viguera, A., & Altinay, M. (2019, November 1). Mental health diagnoses among transgender patients in the clinical setting: An all-payer electronic health record study. Mary Ann Liebert, Inc. https://www.liebertpub.com/doi/10.1089/trgh.2019.0029