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Philip A. Bialer, MD, received his BA with honors in Biology from the University of Rochester. He went on to earn his M.D. from Ohio State University where he was inducted into the Alpha Omega Alph...

Jeffrey S. Akman, MD recently completed a nine-year tenure as the Vice President for Health Affairs (VPHA), the Walter A. Bloedorn Professor of Administrative Medicine and the Dean of the School of...

Viene criticata la cornice teorica utilizzata da Griffin Hansbury (2017) nel trattamento del caso clinico da lui descritto. Nonostante la critica mossa al binarismo di genere, Hansbury di fatto amplia la teoria di Freud (1922, pp. 488-490) dell'«Io-corpo» introducendo un nuovo concetto binario, il «Vaginale con la V maiuscola» come «controparte simbolica del Fallico» [con la F maiuscola] (Hansbury, 2017 p. 20, p. 1010 ediz. orig.). Hansbury cerca di trascinare nel XXI secolo una teoria del XIX secolo radicata in presupposti antiquati riguardo alla identità di genere. Greenberg & Mitchell (1983, p. 61 trad. it.) chiamarono questo approccio teorico «strategia di accomodamento», per riferirsi ad autori che non mettono in discussione gli assunti di una determinata teoria ma la ampliano aggiungendo nuovi concetti. Viene discusso un esempio di strategia di accomodamento utilizzata nella riformulazione della teoria dell'omosessualità. A parte queste considerazioni, la capacità di Hansbury di accogliere le fantasie dei suoi pazienti su parti e funzioni sessuali del corpo crea uno spazio che permette di parlare anche di altri argomenti difficili. Facendo questo, mostra una mescolanza di tendenze sia conservatrici sia radicali nella teoria e nella clinica della psicoanalisi.

This responds to "Reconsidering Informed Consent for Trans-Identified Children, Adolescents, and Young Adults" by Levine et al., part of a small but growing, critical response to contemporary treatments of gender dysphoric/incongruent (GD/GI) children and adolescents. This author, while disagreeing with Levine et al. and other critics, hopes that with dialogue, research and engagement with the wider world, needs of all children, adolescents and young adults-those who have GD/GI and those who may not-will be best served. Critics of gender affirming treatments cite growing numbers of cases, "low level of evidence" supporting treatment, irreversible side effects and expressing regrets as reasons to oppose gender affirmative treatments. Although sharing similar concerns, the author does not conclude treatments should not be offered when appropriate. The critics' alternative reads as "just talk to the young people and find out what is really bothering them." Lacking empirical evidence for that approach does not appear to trouble them.Levine et al.'s caricature of informed consent, which this author parodies, would dissuade anyone from treatment. Their approach does not appear to be written for purposes of engaging frontline clinicians with the aim of improving treatment. Instead, they read as appeals to third parties unfamiliar with the clinical presentations of these children-parents, caretakers courts, legislatures, state health departments and national health care systems-to discourage treatments from proceeding. This impression is further buttressed by a declaration of financial support from The Society for Empirical-Based Gender Medicine, a small group of outliers from mainstream clinicians treating minors with GD/GI who present as "truth-speaking" experts regarding "facts" being ignored, elided over or perhaps even covered up by the mainstream.The author concludes by noting that clinicians who advocate for delaying treatment to GD/GI minors who need and may benefit from it to "protect" those who "aren't really" transgender is an ethically troubling issue. In other words, "first, do no harm" is a sword that cuts two ways.

Ronald E Hellman, MD is a Distinguished Life Fellow of the American Psychiatric Association. Before his formal retirement in 2017, he was Associate Professor of Psychiatry at the Mount Sinai School...

Stuart Sotsky, MD, MPH received his BA with honors in 1968 and his MD and MPH in 1971 from The Johns Hopkins University. He completed his psychiatry residency at Yale University School of Medicine ...

Harold Kooden, PhD, is a clinical psychologist, a graduate of the University of Chicago and a Fellow of the American Psychological Association (APA). He is a founder and Board Member of the Nationa...

Dr. Dan Hicks retired as Clinical Professor of Psychiatry from Medstar Georgetown University Medical Center Department of Psychiatry in 2016. He had previously taught medical students, residents, a...

SummaryThis opinion piece responds to Marcus Evans's ‘Freedom to Think’ regarding treating adolescents diagnosed with gender dysphoria (DSM)/gender incongruence (ICD). Evans notes not everything is known about GD/GI, particularly its ‘causes’. Although correct, he presents this fact as a rationale for delaying treatment for all children presenting with GD/GI symptoms. However, Marcus does not specify how long such prolonged evaluations should last nor does he have much of an evidence base to support his recommendation. This author believes delaying treatment for GD/GI adolescents who need it for the benefit of children who ‘aren’t really’ transgender is an ethically troubling issue.

To better understand the relationship between faith and LGBTQ+ identity, we conducted a qualitative analysis of 86 respondents to a general question posed through the Dear Abby column. Responses were anonymized and analyzed using a grounded theory approach. Analysis revealed six themes, reflecting a diversity of lived experience from community rejection to acceptance, and self-rejection to feelings of acceptance by God. Despite frequent media portrayals of conflict between faith and LGBTQ+ identity, the reality is more complex, and faith and LGBTQ+ identity development can be complementary.

Religion and spirituality have been associated in many studies with an impact on mental and physical health. However, the relationship between religious faith and transgender identities is not well...

Jack Drescher, MD, is an American psychiatrist and psychoanalyst known for his work on the history of theorising about, diagnosing, treating and mistreating sexual minorities. Dr Drescher was a member of the American Psychiatric Association’s DSM-5 expert working group on Sexual and Gender Identity Disorders, which revised the DSM-IV-TR diagnosis of gender identity disorder to the DSM-5 diagnosis of ‘gender dysphoria’. He was also a member of the World Health Organization expert working group that recommended replacing ICD-10’s gender identity disorder with ‘gender incongruence’, as well as moving the diagnosis out of the mental disorders section of the latest International Classification of Diseases (ICD-11). Dr Drescher is also an expert on sexual orientation change efforts (SOCE) and served on the American Psychological Association’s Task Force on Appropriate Therapeutic Responses to Sexual Orientation. He has published a number of books in the field includingPsychoanalytic Therapy and the Gay Man(Drescher, 1998a) andSexual Conversion Therapy: Ethical, clinical and research perspectives(Shidlo et al., 2001). In February 2020, I interviewed him about his role in the recent ICD-11 revisions and his views on tackling the practice of conversion therapy. What follows is an edited version of our conversation.(Adam Jowett, Chair of the Psychology of Sexualities Section)

Marshall Forstein, MD is a psychiatrist who, most recently, was Acting Chair of the Department of Psychiatry and Adult Psychiatry Residency Director at Cambridge Health Alliance, and Associate Prof...

In the latest article of JGLMH’s Oral History Series, Emeritus Editor Dr. Jack Drescher interviews Dr. Billy E. Jones, a psychiatrist, now retired, who, among his many accomplishments, serv...

In this contribution to JGLMH’s Oral History Series, Emeritus Editor Dr. Jack Drescher interviews Dr. Kenneth Lewes, a clinical psychologist and historian, now retired, who most famously penned The...

In this continuation of JGLMH’s Oral History Series, Dr. Jack Drescher, Emeritus Editor, interviews Dr. John Sweet. Dr. Sweet is now retired from a distinguished career in psychiatry that included service as a military psychiatrist in the US Air Force, directorship of a state outpatient mental health clinic in St. Louis, Missouri, and private practice. After retirement in 2005, he has volunteered as a trustee for the William A. Kerr Foundation. In this interview, Dr. Sweet speaks with Dr. Drescher about coming to terms with his sexual orientation, in the context of both personal and professional life.

Background This study aims to understand suicidal ideation and suicide attempts among transgender individuals through an in-depth analysis of a nation-wide population general survey in China. Methods Transgender Men (TM) and Women (TW) were investigated through a cross-sectional survey. A structured questionnaire was used to investigate participants' demographic information, perceived sexuality conflicts, childhood adversity and mental health conditions. Logistic regression models were utilized to investigate risk factors associated with suicidal ideation and suicide attempts in these groups. We also conducted a quasi-meta-analysis in order to compare the prevalence of suicidal ideation and attempted suicide between general and transgender populations in China. Results A total of 1309 participants across 32 provinces and municipalities in China took part in this survey, out of 2060 valid questionnaires. In this transgender population, the lifetime prevalence of suicidal ideation and an attempt at suicide were 56.4% and 16.1%, respectively. This estimated prevalence rate is far greater than in Chinese community samples. For all transgender people, disliking birth-assigned sex, seeking sex reassignment surgery, having intense conflicts with parents, lifetime history of suffering from major depressive disorder, a recent episode of depression, self-harm, and seeking mental health services were significantly associated with increased risk of suicidal ideation. An education level of high school or equivalent, being married and/or separated/divorced, having intense conflicts with parents, or self-harm and seeking mental health services were all significantly associated with increased risk of suicide attempt. Although most risk factors for TM and TW were equivalent across groups, differences were observed in both suicidal ideation and suicide attempt models. Limitations The cross-sectional study design and lack of follow-up data are limitations of this study. Conclusions This is the first study to examine suicide within a Chinese transgender population. The clinical implications of these findings for Chinese mental health professionals are discussed. Also, the evidence from this study can be used to inform the practices of suicide prevention workers, and policy makers working with the transgender population.

(Reprinted with permission from the Bulletin of the World Health Organization)

This cross-sectional study uses data from questionnaires completed by adolescents in secondary schools in Suzhou city, China, to investigate the mental health challenges of youth identifying as transgender and gender nonconforming compared with cisgender adolescents., Key Points Question What factors are associated with mental health outcomes among transgender or gender nonconforming (TGNC) adolescents in China? Findings In this cross-sectional survey study of 12 108 adolescents in China, TGNC adolescents reported poorer mental health, including a higher level of anxiety, depression, and sleeping problems, compared with their cisgender counterparts. TGNC adolescents were more likely to report being bullied, experienced more suicidal thoughts and behaviors, and harmed themselves more often than cisgender adolescents. Meaning Compared with cisgender adolescents, TGNC adolescents in China appear to face a higher level of various mental health challenges., Importance Transgender or gender nonconforming (TGNC) adolescents face a wide range of physical and mental health concerns. However, there has been no school-based study to explore the prevalence and mental health status of these adolescents in mainland China. Objectives To assess the mental well-being of TGNC adolescents in China by comparing them with their cisgender peers. Design, Setting, and Participants This was a cross-sectional survey study. Of the 12 354 adolescents who completed the questionnaire, 246 did not specify to which sex they identified and were therefore excluded from further analysis. Therefore, a total of 12 108 adolescents were included from 18 secondary schools in Suzhou city, China, from June 2019 to July 2019. Participants provided consent and answered questions on sex assigned at birth and gender identity. Main Outcomes and Measures All participants completed questionnaires, including the Patient Health Questionnaire for the measurement of depressive symptoms, a generalized anxiety disorder screening, the Pittsburgh Sleep Quality Index, and a self-harm and suicide risk checklist. The frequency of being bullied at school was also measured. Participants who reported their perceived gender as the opposite of their assigned sex at birth were classified as transgender, those who identified as neither male nor female were classified as nonbinary, and those who were not sure about their perceived gender were classified as questioning. All of these participants were categorized as TGNC adolescents. Results A total of 12 108 adolescents (mean [SD] age, 15.8 [1.0] years; 6518 [53.8%] assigned male at birth [AMAB]) participated in the study. Of the 6518 participants AMAB in the sample, 5855 (89.8%) were classified as cisgender boys, 208 (3.2%) as transgender girls (transgender youth who perceive their current gender identity to be female), 138 (2.1%) as nonbinary youth AMAB, and 317 (4.9%) as questioning youth AMAB. Of the 5590 participants assigned female at birth (AFAB), 4142 (74.1%) were classified as cisgender girls, 861 (15.4%) as transgender boys (transgender youth who perceive their current gender identity to be male), 112 (2.0%) as nonbinary youth AFAB, and 475 (8.5%) as questioning youth AFAB. Compared with cisgender adolescents, TGNC adolescents reported significantly higher health concerns including lower overall health (t11 872 = –7.36; P

The American Psychiatric Association (APA) is in the process of revising its Diagnostic and Statistical Manual (DSM), with the DSM-V having an anticipated publication date of 2012. As part of that ...

In many ways, psychotherapy with lesbian, gay, bisexual, and transgender (LGBT) patients does not differ from psychotherapy for heterosexual, gender conforming, and cisgender patients. Additionally, concepts and considerations that arise in psychotherapy with LGBT patients can parallel issues that arise in psychotherapy with patients of other stigmatized minority groups. In this article, the authors discuss the concept of minority stress and its relationship with mental health conditions and review specific issues that may arise with this heterogeneous patient population, including being in the closet, coming out of the closet, the psychotherapeutic search for "causes" of sexual orientation and gender identity, and therapist self-disclosure.

The author believes there may be no way to discuss possible meanings of unwanted sexual overtures that does not arouse strong, uncomfortable feelings. Despite a sense of justice being served when victims of sexual harassment come forward and start naming names, the author asks, should we not distinguish between legitimate concern for people who have been sexually abused from the experiences of those claiming abuse but who were probably just offended or disappointed? This article discusses how interpersonal and relational analysts listen to patient accounts of sexual harassment and abuse. This is followed by a discussion of permissive sexual attitudes and mores of the 20th century. The author recounts some personal accounts of unwanted sexual advances in professional settings. A clinical vignette of a dream and its associations illustrates the psychoanalytic complexity of teasing apart problems in living from problems in survival. The author concludes with a call for increased efforts to achieve ju...

In this continuation of JGLMH’s Oral History series, Dr. Jack Drescher, Emeritus Editor, interviews Dr. Marlin Mattson. Dr. Mattson is Professor Emeritus of Clinical Psychiatry at Weill Cornell Medical College and prior to retirement, a longstanding attending psychiatrist at New York Presbyterian Hospital. He has been a highly regarded teacher and mentor throughout his career, and has served on many boards, including the New York County Medical Society and the New York County District Branch of the American Psychiatric Association of which he is a past President. In this article, Dr. Mattson speaks to Dr. Drescher about his early career and his lived experience as a gay psychiatrist.

In this continuation of JGLMH's Oral History Series, Dr. Jack Drescher, editor emeritus, interviews E. Gerald Dabbs, MD. Dr. Dabbs was in private practice of psychiatry and child and adolescent psy...

Aujourd’hui, l’Academy of Psychoanalysis and Dynamic Psychiatry2 est ouverte aux membres gays et lesbiens. Pourtant, quand elle fut fondee en 1956 la position du mouvement psychanalytique sur l’homosexualite etait pour le moins hostile. Longtemps, ce fut la theorie elaboree par Freud au debut de sa carriere – assimilant homosexualite a immaturite – qui prima. Celle-ci ceda le pas a des theories neofreudiennes qui pathologisaient l’attirance pour une personne de meme sexe – ainsi que les comportements qui y afferent. Suite a la decision, en 1973, par l’American Psychiatric Association3 de retirer l’homosexualite du dsm, l’homosexualite commenca – et continue – a etre plus communement consideree comme une variante normale de la sexualite humaine. L’histoire des prises de position successives de la psychanalyse sur l’homosexualite n’a fait que renforcer l’idee qu’on ne peut separer les theories psychanalytiques du contexte politique, culturel, et personnel dans lequel elles ont ete formulees. Lorsque l’on retrace l’evolution des mentalites, l’on se rend compte du niveau d’influence qu’on pu et que peuvent avoir les analystes, autant pour faciliter que pour freiner la tolerance et la reconnaissance.

Background This study investigated the prevalence and factors associated with counselling and psychotherapy service use among Chinese sexual minority populations. Methods A nationwide cross-sectional study was performed using snowball sampling method, which led to the inclusion of 18,193 participants. Participants’ sociodemographic background, clinical, and psychological data were gathered. Multivariate logistic regression analysis was performed to explore any associated factors. Results There were 2007 participants who had used counselling and psychotherapy service out of the total population. Among those who had used psychotherapy services, 80.2% participants perceived discrimination, 1.1% reported that they had been refused treatment by a counsellor and/or psychotherapist, 1.6% had experienced verbal harassment, and 8.4% reported that their counsellor and/or psychotherapist lacked knowledge and experience in treating sexual minorities. In addition, regression analyses indicated that those who were divorced/widowed, had religious beliefs, and those who had experienced discrimination, verbal harassment, and rejection for treatment by health professionals all had an increased likelihood of utilising counselling and psychotherapy service. Conclusions Service providers and policy makers in China should improve the quality and availability of counselling and psychotherapy services to address the mental health needs of sexual minority populations.

Aims Compared to their heterosexual peers, youth who identify as lesbian, gay or bisexual (LGB) tend to suffer higher rates of peer victimisation from bullying. However, studies of LGB adolescents' participation as bullies are scarce. We aimed to examine the possible association of sexual minority identity and the heightened risk of not only being bullied but bullying others as well. We also explored the effect of one's sexual identity on their involvement in bullying through the mediation of coping strategies and mood states. Methods A total of 12 218 students were recruited from 18 secondary schools in China. The demographic information, positive and negative coping strategies, mood state (anxiety, depression and hypomania) and information related to bullying and being bullied were collected. Multinomial regression was used to assess the heightened risk of sexual minority groups in comparison to their heterosexual adolescents' counterparts. A structural equation model (SEM) was used to test the mediating role of coping strategy and mood state between one's sex, sexual identity and bullying experience. Results Two trends could be observed: (1) LGB groups reported heightened risks of being bullied and bullying others at school than heterosexual peers. However, being a sexual-undeveloped girl seemed to have a protective effect on bullying-related problems. (2) Birth-assigned males were more likely to be bullied as well as bullying others at school when compared to birth-assigned females. SEM analysis revealed that being a sexual minority was directly associated with a higher frequency of being bullied (B = 0.16, 95% CI [0.10, 0.22], p < 0.001) but not bullying others (B = 0.02, 95% CI [−0.02, 0.06], p = 0.398) when compared to the heterosexual group. Negative coping, hypomania, anxiety and depression were associated with a higher frequency of being bullied, while positive coping was associated with a lower frequency of being bullied. Moreover, negative coping, hypomania and depression were associated with a higher frequency of bullying others, while positive coping was associated with a reduced likelihood of bullying others. In addition, being bullied and bullying others were significantly correlated in the SEM model. Conclusions This novel research investigated the dynamic nature of the interaction between victim and bullying of LGB school adolescents in China, with a specific exploration of the psychological mechanism behind the pattern of being bullied and bullying others. School-level interventions aimed at teaching positive coping strategies to lower psychological distress are recommended to support sexual minority students.