Interventions

A long digression from a characteristically long post at Slate Star Codex, The Categories Were Made For Man, Not Man For The Categories, which I'd like to keep handy because it's just so great.

I’ve made this argument before and gotten a reply something like this:

“Transgender is a psychiatric disorder. When people have psychiatric disorders, certainly it’s right to sympathize and feel sorry for them and want to help them. But the way we try to help them is by treating their disorder, not by indulging them in their delusion.”

I think these people expect me to argue that transgender “isn’t really a psychiatric disorder” or something. But “psychiatric disorder” is just another category boundary dispute, and one that I’ve already written enough about elsewhere. At this point, I don’t care enough to say much more than “If it’s a psychiatric disorder, then attempts to help transgender people get covered by health insurance, and most of the ones I know seem to want that, so sure, gender dysphoria is a psychiatric disorder.”

And then I think of the Hair Dryer Incident.

The Hair Dryer Incident was probably the biggest dispute I’ve seen in the mental hospital where I work. Most of the time all the psychiatrists get along and have pretty much the same opinion about important things, but people were at each other’s throats about the Hair Dryer Incident.

Basically, this one obsessive compulsive woman would drive to work every morning and worry she had left the hair dryer on and it was going to burn down her house. So she’d drive back home to check that the hair dryer was off, then drive back to work, then worry that maybe she hadn’t really checked well enough, then drive back, and so on ten or twenty times a day.

It’s a pretty typical case of obsessive-compulsive disorder, but it was really interfering with her life. She worked some high-powered job – I think a lawyer – and she was constantly late to everything because of this driving back and forth, to the point where her career was in a downspin and she thought she would have to quit and go on disability. She wasn’t able to go out with friends, she wasn’t even able to go to restaurants because she would keep fretting she left the hair dryer on at home and have to rush back. She’d seen countless psychiatrists, psychologists, and counselors, she’d done all sorts of therapy, she’d taken every medication in the book, and none of them had helped.

So she came to my hospital and was seen by a colleague of mine, who told her “Hey, have you thought about just bringing the hair dryer with you?”

And it worked.

She would be driving to work in the morning, and she’d start worrying she’d left the hair dryer on and it was going to burn down her house, and so she’d look at the seat next to her, and there would be the hair dryer, right there. And she only had the one hair dryer, which was now accounted for. So she would let out a sigh of relief and keep driving to work.

And approximately half the psychiatrists at my hospital thought this was absolutely scandalous, and This Is Not How One Treats Obsessive Compulsive Disorder, and what if it got out to the broader psychiatric community that instead of giving all of these high-tech medications and sophisticated therapies we were just telling people to put their hair dryers on the front seat of their car?

I, on the other hand, thought it was the best fricking story I had ever heard and the guy deserved a medal. Here’s someone who was totally untreatable by the normal methods, with a debilitating condition, and a drop-dead simple intervention that nobody else had thought of gave her her life back. If one day I open up my own psychiatric practice, I am half-seriously considering using a picture of a hair dryer as the logo, just to let everyone know where I stand on this issue.

Miyamoto Musashi is quoted as saying:

The primary thing when you take a sword in your hands is your intention to cut the enemy, whatever the means. Whenever you parry, hit, spring, strike or touch the enemy’s cutting sword, you must cut the enemy in the same movement. It is essential to attain this. If you think only of hitting, springing, striking or touching the enemy, you will not be able actually to cut him.

Likewise, the primary thing in psychiatry is to help the patient, whatever the means. Someone can concern-troll that the hair dryer technique leaves something to be desired in that it might have prevented the patient from seeking a more thorough cure that would prevent her from having to bring the hair dryer with her. But compared to the alternative of “nothing else works” it seems clearly superior.

And that’s the position from which I think a psychiatrist should approach gender dysphoria, too.

Imagine if we could give depressed people a much higher quality of life merely by giving them cheap natural hormones. I don’t think there’s a psychiatrist in the world who wouldn’t celebrate that as one of the biggest mental health advances in a generation. Imagine if we could ameliorate schizophrenia with one safe simple surgery, just snip snip you’re not schizophrenic anymore. Pretty sure that would win all of the Nobel prizes. Imagine that we could make a serious dent in bipolar disorder just by calling people different pronouns. I’m pretty sure the entire mental health field would join together in bludgeoning anybody who refused to do that. We would bludgeon them over the head with big books about the side effects of lithium.

Really, are you sure you want your opposition to accepting transgender people to be “I think it’s a mental disorder”?