Tag: Support

3 Types of Trans Healthcare That Everybody Should Know About

When we hear about trans people and healthcare, we mostly hear about hormones and surgery. But trans people are way more than just hormones and surgery.

As part of my current research, I am learning about the different types of barriers that trans people experience when accessing healthcare. To my surprise, the majority of the barriers discussed were in relation to accessing transition related care – ie hormones and surgery (among other things). I had to dig significantly deeper to find anything on the barriers that trans people face in accessing regular, every day health care.

What I realized was that this was a reflection on society’s view that trans people are one-dimensional – trans. As it turns out, trans people are more than just trans. They are parents and kids and employees and students and immigrants and homeless and artists and athletes. They are just as multi-faceted as cis people – maybe more so!

This goes for their healthcare needs as well. Sure, they need access to things that are specific to medical transition, but they also need access to basic health care. They break bones, get in accidents, have chronic conditions, and get sick just like cis people.

Since this concept seems to be difficult for the medical and research communities to grasp, I thought I would break it down into three categories to make it a bit more straightforward. Here goes.

TRANS SPECIFIC CARE

This category of health care needs is specific to being transgender. These are health care protocols, medications, and surgeries that are only accessed by and applied to trans people. Some of these were created specifically for trans people. Most were designed for cis people but have been adapted in ways that are now seen as separate protocols when used for transition purposes.

  • Hormone replacement therapy (HRT) for the sake of gender transition
  • Chest masculinization surgery (top surgery)
  • Vaginoplasty
  • Orchidectomy
  • Phalloplasty
  • Metoidioplasty
  • Facial feminization surgery (a collection of many different procedures including trachial shaving)
  • Gender dysphoria diagnosis
  • Psychological assistance with gender/sex incongruity
  • Voice masculinization/feminization therapy

TRANS ASSOCIATED CARE

This category of health care needs refer to services that are used by trans people in the course of medical transition but are also used in the same form by cis people.

  • Puberty blockers
  • Electrolysis
  • Hysterectomy/Salpingo-Oophorectomy
  • Breast augmentation
  • Breast reduction
  • Liposuction/sculpting
  • Scar/Skin graft care post gender affirming surgery
  • Hair transplant
  • Hair growth treatments
  • Treatment for conditions related to bottom surgery
    • Pelvic pain
    • Incontinence
    • Urethral stricture
    • Urethral fistula
    • Post-op infection
    • Dilation

TRANS SENSITIVE CARE

This category refers to all healthcare needs that are not related to medical transition. These are basic healthcare needs that may or may not interact with an aspect of medical transition. For these aspects of healthcare, being trans is not the reason for or the focus of treatment but is still an important aspect of the whole person and their experiences.

  • Diagnosis and management of chronic conditions
  • Cancer screening, diagnosis, treatment, and follow-up
  • Mental health support and psychiatric care
  • Disability related care
  • Fertility, pregnancy, birthing, postpartum, and lactation
  • Emergency care
  • Geriatric and end of life care
  • Stroke and traumatic brain injury
  • Addiction management
  • Physical Therapy and other rehabilitation services
  • Preventative healthcare and health promotion
  • etc

If you are a cis person, think of anything you have ever needed the health care system for, or anything any of your cis family and friends have needed the health care system for. Guess what? Trans people need that care too.

It is the responsibility of the health care professional to know whether any aspect of care within their scope of practice will interact with an aspect of medical transition. For example, drug interaction with HRT medications. Even if the care is irrelevant to any aspect of medical transition or their experiences as a trans person, they still need to be treated with respect, dignitiy, and compassion in order to receive the care they need and have a positive outcome related to that care.

Check out my post about how to be a trans inclusive health care professional and find other recommendations about how to be trans affirming in the related posts below. In the coming years, I will be working on guidelines for medical researchers on how to include trans people in clinical research.

Because really, trans people may be unique in many ways but they are also people with regular, every day health care needs who deserve to have equal access to appropriate, respectful care.

Note: Trans people are by no means the only group marginalized by the health care system. People with disabilities are often reduced to their disability. People with chronic pain are often labelled as drug seekers. People who are fat/obese are reduced to a BMI category or number on a scale. None of these types of stigma are acceptable. If you are a health care professional, I challenge you to learn more about the experiences of all of these marginalized groups (and others). But if you’re overwhelmed and need a place to start, you may as well start here, with trans inclusivity.

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My Hero’s Journey, So Far

Here is how my gender journey lines up with the Hero’s Journey. Missed my previous post about Gender Transition as a Hero’s Journey? Check that out first and then come back to read my story.

ORDINARY WORLD

When my husband started being identified as a man by strangers, their ingrained heteronormative views told them that I must be a woman. I started getting treated as more feminine when we were together and this didn’t sit right with me.

I had never been comfortable with the term lesbian, and instead had always called myself gay or queer.

In grade 10 I had a gender fluid experience where I would feel like a boy named Ray for a few days every few weeks, shifting back to feeling like a girl named Meaghan in between.

I grew up in a very liberal and supportive environment but at the inception of my gender journey I had moved away and was working in a more conservative and very hetero- and cis-normative environment.

CALL TO ADVENTURE

Part way through my husband’s transition, I realized that I was definitely experiencing dysphoria as well. We had been attending local PFLaG meetings and had been listening to people describe a range of identities and experiences. Some of these, especially the more androgenous, gender neutral, gender fluid, and nonbinary ones, really resonated with me.

REFUSAL OF THE CALL

However, my husband was still in the middle of navigating how to get top surgery, how to change all his legal documentation, and what to do about continually being misgendered at work, months after coming out. From witnessing his experiences and hearing about similar experiences from the community, I knew that exploring your gender and clarifying for yourself who you are and what you need to feel authentic can make not having those things feel a whole lot worse.

Knowing that my husband still needed a lot of my support and I was not working in an environment that would be condusive to coming out as nonbinary, I decided to put off all gender related self-discovery for the time being.

MEETING THE MENTOR

As soon as my husband felt fairly stable in his transition, he encouraged me to do my own gender exploration work. As a result of his transition, he finally felt ready to be a parent (being able to picture himself as a dad instead of a mom) but also did not want to be the one to be pregnant. This meant that, if possible, I would be the carrying and birthing parent.

There is so much unknown and out of your control in the process of trying to conceive, pregnancy, and birthing. I didn’t want gender related feelings to be one more. So I started to explore what felt not so great, what felt awesome, and how my gender felt on a daily basis.

CROSSING THE THRESHOLD

Turns out I am nonbinary. I discovered that I have both female and male genders which balance out to an overall experience that is a mix of the two or ‘somewhere in the middle’. I discovered that I do have some physical dysphoria during which times I feel better if I wear a binder (if my body can tolerate it). I discovered that I have significant social dysphoria and feel much better when referred to using they/them pronouns and neutral language.

The physical dysphoria I could manage pretty well with some practice. The social dysphoria was a whole other story, especially at work.

TESTS, ALLIES, AND ENEMIES

Partly as a result of constant social dysphoria, I started expriencing periods of burnout that would last 1-2 months and re-occur every 4-6 months.

I had a few new colleagues at work that were queer and super supportive and a few others that I slowly built friendships with and eventually came out to. These allies, especially at work, were a major help on bad dysphoria days.

I had a colleague who was also a friend come out as nonbinary. Unfortunately, the support from the management team was not in place and did not appear when they needed it. There were very few allies around them and they were continually misgendered, had repeated conflicts with coworkers, and ultimately moved to a different job. As an example of what it would be like for me to come out at work, it was a pretty clear one.

Navigating the world of fertility, pregnancy, and postpartum as a nonbinary person is extremely difficult. There were times I found community and resources and felt like I could belong. There were also times that were nauseating and traumatic that I will carry with me for life.

APPROACH TO THE INNERMOST CAVE

While I was on parental leave (for a whole year – go Canada!), and in the middle of a global pandemic, I had minimal interaction with the outside world unless I reached out for it. I had significantly less dysphoria and significantly less burnout, despite being a new parent in a pandemic. This told me that my burnout was indeed primarily dysphoria related and in order to feel more comfortable in my life, and have the emotional reserve I wanted and needed to support my child, I would need to make some changes. I would need to find spaces that I was comfortable being out in. And I would need to be out in as many spaces as I could.

This was especially true around family. I wanted my kid to grow up hearing people refer to me using the correct pronouns. This meant I would first have to explain my identity to everyone my kid would be interacting with regularly (namely family) and train everyone to use my pronouns and preferred language. This would take time and my kid was growing up at a steady pace. I had to come out to family before my kid started understanding what pronouns meant and remembering and repeating phrases from those around them.

THE ORDEAL

The first step I took was to apply to a graduate school program using my preferred name, pronouns, and gender identity. I was open with my supervisor from the beginning and made it clear in my application that my identity and lived experience was a big part of why I wanted to do research work. This meant that in September, when I started school, I had the foundation and backup to expect that everyone refer to me correctly. When they don’t, I have significantly more confidence to correct them than I ever have in other environments.

When my kid was about ten months old, I bit the bullet and came out to my in-laws (who live near us) and my parents (who live across the country but were coming for a month-long visit). I did this via email with the hope of some reply, either of support or questions or concerns that I could respond to. Mostly, there was silence and confusion. I had a brief follow up conversation with my in-laws and, after a period of awkwardnes and tension, saw some awereness and progress. My sister had many follow up conversations with my parents on my behalf but I had minimal expectation that they would be able to/willing to follow through and change their use of pronouns for me during their visit.

However, their visit happened to coincide with work I was doing to develop inclusive training material for a health professions college. They were curious about my work which gave me an opening to talk about many of the issues trans people face in health care settings (mostly related to ignorance and being misgendered). The materials I was developing included a ‘bad’ version of a health care interaction and a ‘good’ version. I sent them both versions and we had a few conversations about why the ‘bad’ version was ‘bad’ and why it was important to interact in ways that were depicted in the ‘good’ version. They were able to grasp these concepts significantly better than the information my sister had attempted to explain, perhaps because it wasn’t directly about them and thus did not make them feel as defensive. They almost immediately started making an effort to use my correct pronouns. While they weren’t great at it, and they will likely back-slide between in-person visits, this was more progress than I expected and I took it as a positive sign.

REWARD

It’s an increadible feeling, being seen. It’s even better when you don’t have to fight for it first. I now have numerous allys who actively step in to do the educating and, if necessary, fighting, on my behalf. I am better at advocating for myself (or getting better at it slowly), and better at identifying situations where having an ally would be useful and then recruiting one.

Confidence, euphoria, authenticity, and visibility are pretty good rewards. Do I wish I didn’t have to fight for them? Sure. But it’s still worth the fight.

THE ROAD BACK

I now spend the majority of my time working in an inclusive environment with my name and pronouns displayed correctly on my zoom screen during ‘meetings’. I have more bandwidth to apply to my work and family. I have not had a period of burnout in over a year despite having a baby during a pandemic. I am able to exercise despite the accompanying dysphoria because, for the majority of the time, I experience more euphoria than dysphoria. I can recover easily from the few days I spend in my previous work environment where I am still not out (and likely will never be).

I am using my unique experiences and perspective to help others make their work more inclusive. I am being recognized for the value of my experiences and identity rather than ‘supported’ or ‘accommodated’.

I am thinking about the future and what I might want for myself in my transition. Are there ‘next steps’? I have a long road to recovery from pregnancy related body changes and have chosen to focus on this prior to pursuing anything further related to transition. Though, likely, at some unknown point in the future, I would like to have some form of top surgery. Will this be my ‘Ressurection’? Who knows! If you stay tuned, you’ll likely find out when I do!

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Gender Transition as a Hero’s Journey

The heroes in our favourite stories all start out as ordinary people. Their journeys often follow a similar pattern as they face trials and tribulations, discover their inner strength, and return triumphant. Joseph Campbell orginally described this story arc using 17 stages (and fairly problematic language). It has since been revised into 12 stages, most recently by Christopher Vogler.

As it turns out, these stages match the emotional stages of a gender transition pretty closely. Which means trans people are all heroes or heroes-in-training!

Here’s how it looks:

There are three parts: Departure (the beginning), Initiation (the middle), and Return (the end). These are broken down into the 12 stages.

The journey starts with the hero in the ordinary world living in a harsh and unforgiving external light in a state of unhappiness, stress, ignorance, and/or confusion.

They move to a new, extraordinary, or special world during the Initiation phase. Here they move through darkness as they struggle to discover their own internal source of light.

They then return to the ordinary world in a state of triumph and rebirth, having learned how to shine brightly from withinwith. They now have a new perspective, skill, or, in our case, identity.

As I was thinking about the steps in the Hero’s Journey and lining them up with the experience of gender transition, it was interesting how easy it was to see. Some of the original wording even makes sense without changing much except the context.

Let’s break it down and look at each of the twelve steps:

Stage 1: Ordinary World

Classic: The hero is uneasy, uncomfortable or unaware. They are living a life at the mercy of their enviornment, heredity, and personal history. The hero feels pulled in different directions and is stressed by the dilemma.

Trans: You are living with confusion and discomfort, just trying to get by with no language or understanding of why you feel different, that there is a way to relieve your distress, or what path your life is going to take.

Stage 2: Call to Adventure

Classic: Something shakes up the situation, either from external pressures or from something rising up from deep within, so the hero must face the beginnings of change.

Trans: You discover that your discomfort might be gender related by meeting a trans person, seeing a trans person represented in media, or learning about language, labels, or experiences that feel right for you.

Stage 3: Refusal of the Call

Classic: The hero feels the fear of the unknown and tries to turn away from the adventure, however briefly. This uncertainty may be voiced by someone else rather than the hero themself.

Trans: You have immense fear about the enormity of what this would mean for your life. This fear takes over and you ignore what you have just learned, bury the knowledge deep down, convince yourself that you don’t need to transition or don’t need to think about this. You try as hard as you can to fit in with what is expected of you or numb/ignore this awareness.

Stage 4: Meeting the Mentor

Classic: The hero comes across a seasoned traveler of the worlds who gives them training, equipment, or advice that will help on the journey. Or the hero reaches within to a mentor from their past or an internal source of courage and wisdom.

Trans: You meet someone who sees you for who you are and encourages you to delve into yourself. This could be a trans or queer person from the community who is living their best life and provides the experience and support you need, a therapist that starts helping you unpack your gender identity and dysphoria, or a close friend or family member who is no longer willing to let you hide from your truth.

Stage 5: Crossing the Threshold

Classic: The hero commits to leaving the ordinary world and entering a new region or condition with unfamiliar rules and values.

Trans: You come out to yourself, accepting yourself for who you are, accepting your true authentic gender identity. You are flooded by understanding, fear, excitement, confusion, discomfort, and determination.

Stage 6: Tests, Allies, Enemies

Classic: The hero is tested and sorts out allegiances in the new, special world.

Trans: You now know why you’ve felt uncomfortable your whole life and being able to point to and name dysphoria makes it so much bigger, louder, and more constant. You search the internet for trans information and find a huge community on social media platforms and many local and national organizations that offer support. At the same time, you start recognizing all the transphobic and cisnormative language around you and feel like no one in your life will accept you for who you are.

Stage 7: Approach to the Innermost Cave

Classic: The hero and newfound allies prepare for the major challenge in the special world.

Trans: You collect information from allies about coming out and navigating transition which helps you clarify for yourself what you want/need. This intensifies the dysphoria which gets harder and harder to deal with, especially when you haven’t told anyone yet. The internal pressure of knowing what you want, who you are, and how you want to be seen builds, pushing against the confines of the closet until…

Stage 8: Ordeal

Classic: The hero enters a central space in the special world and confronts death or faces their greatest fear. Out of this moment of ‘death’ comes a new life.

Trans: You decide that coming out is worth the risk, worth the loss of those that don’t support you, worth the potential harm in order to be who you are. You take the first steps to telling others who you are, breaking down that wall one brick at a time, or by driving a bulldozer straight through it and coming out to everyone at once.

Stage 9: Reward (Seizing the Sword)

Classic: The hero takes possession of the treasure they won by facing death. There may be celebration, but there is also danger of losing the treasure again.

Trans: Some people you come out to start using your correct name and pronouns and you have your first real taste of gender euphoria and what it could feel like to live as the person you are. Not everyone is supportive or consistent and dysphoria continues to fight it’s way in. You fight to hold onto your confidence in who you are and your resolve to seek what you need, using the bursts of gender euphoria as your guiding light.

Stage 10: The Road Back

Classic: The hero is driven to complete the adventure, leaving the special world to be sure the treasure is brought home. Often a chase scene signals the urgency and danger of the mission.

Trans: You learn how to integrate your new trans identity with your life at work, home, and school, with friends and family, and in social activities, hobbies, and sports. You struggle to navigate and access the medical care and legal services you want/need in order to be safe and feel authentic in your body and identity. You are desperate for the changes and progress yet they happen at a maddeningly slow pace.

Stage 11: Resurrection

Classic: The hero is tested once more on the threshold of home. They are pruified by a last sacrifice, another moment of death and rebirth, but on a higher and more complete level. By the hero’s action, the polarities that were in conflict at the beginning are finally resolved.

Trans: You start to recognize the person in the mirror, be recognized correctly by people around you more often than not, and feel more comfortable in your body. You come up to and cross a milestone of significance for you in your transition (starting hormones, top surgery, changing your gender marker, bottom surgery, etc) with all the doubt, fear, excitement, relief, pain, re-learning, and celebrating that comes with it.

Stage 12: Return with the Elixir

Classic: The hero returns home or continues the journey, bearing some element of the treasure that has the power to transform the world as the hero has been transformed.

Trans: You reach a sense of completion related to your transition or have found confidence and peace in the sense of an ongoing and lifelong gender discovery and evolution. You are living authentically, supporting others who are questioning their gender or know someone who is, expanding your society’s view of gender and authenticity, and maybe even advocating for trans rights. Huzzah!

What an epic journey! Can you see yourself, or the trans person you love, as a hero? What stage of your Hero’s Journey are you at?

I know everyone’s transition is different. Are there stages that line up differently based on your experience?

If you add in specific details that match your own experience, what story does it tell? Who were the mentor, allies, and enemies? What tests did you face? What treasure do you carry with you to this day? What final milestone did you face and overcome during your stage of resurrection?

What was the timeline of each stage, and the journey as a whole? Did it progress in a linear fashion the way it sounds like it would here?

Share your story in the comments or send it to me in an email! If you’re willing to share it, I’ll publish it here as a post! The more stories the better. We need more variety of trans experiences and we need more trans heroes!

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Gender Inclusivity in the Workplace: What it is and How it Feels

For the last five years I have worked in the same environment. During this time, my husband came out as trans and I discovered my identity as a nonbinary person. I recently cut back on my hours at this job and started a different job. These two jobs are wildly different environments, types of work, levels of inclusion, and effects on me as a nonbinary person.

For the last few years, I assumed that any workplace connected to my chosen profession would be the same in terms of it’s effect on me with mild variability in inclusivity. But since switching to the new job, I am realizing how much of the burnout I’ve been experiencing is from inclusion related factors, or the lack of inclusivity at my previous job.

A lot of these factors are within the control of my colleagues and management staff. But some of them are simply related to the nature of the job.

WHAT A NON-INCLUSIVE WORKPLACE FEELS LIKE

When going to work at my job that has minimal inclusion, recognition, or support for my identity as a nonbinary person, I have a nebulous feeling of resistance, anxiety, apprehension, disappointment, and risk. I carry this around with me to varying degrees throughout the whole work day. It is distracting and tiring. I feel like I am hiding, shrinking, holding myself in a small tight ball inside myself for the course of the day.

Every time I have a chance to show a part of this aspect of my identity I have to make a risk vs reward calculation. Every time I encounter something that directly relates to or impacts my gender identity, even if it isn’t directed at me, I have to decide if I’m going to hide or react which is again, a risk vs reward calculation.

This isn’t to say that everything about that work environment is bad and negative. There are lots of things I like about it or else I wouldn’t still be working there. But in order to engage with the things I like about that job, I have to bring the rest of this heaviness along with me.

I am not out to the majority of people in this workplace because it doesn’t feel safe or feasible (more on this below). When I am misgendered, it is primarily out of ignorance and assumption. But, because of many factors, I expect that the majority of people would continue to misgender me even if I did come out. This means that coming out is not worth the effort or risk.

WHAT AN INCLUSIVE WORKPLACE FEELS LIKE

At my new job, I am excited to get to work every day. I can focus and do my work efficiently. At the end of the day/week I am as tired as I would expect given the amount of work I did. I still have mild reluctance to engage with people who are not necessarily trans competent but I know that, should I need to correct them on my name or pronouns, I have the support to do that.

I entered this workplace using my preferred name, pronouns, and gender identity. Not everyone I interact with knows all of that information but I feel safe in providing it openly when I need to. I can share any parts of myself that are relevant without fear and with minimal risk vs reward calculation because the risks are much lower and the reward is more likely to occur.

Colleagues recognize the types of knowledge and expertise that my nonbinary identity affords me and come to me when they have things I can help with.

Overall it feels easy, affirming, and allows me to simply focus on my work.

WORKPLACE FACTORS THAT IMPACT GENDER INCLUSIVITY

Culture

This is the factor that we think about the most in regards to inclusivity and it is definitely the most complex one. You can think of cultural factors in three groups: policies and procedures, competence, and representation.

Policies and Procedures

Is there a policy in place that protects workers based on gender identity? Do their policy documents use gender neutral language? If they have a dress code, is it gender neutral? Do their application forms and other types of documentation such as ID and health insurance forms have inclusive fields (sex, gender, legal gender marker, legal name, preferred name, pronouns, neutral labels, etc)? Is the use of homophobic and transphobic language pervasive, ignored, discouraged, or penalized in the professional work spaces as well as the social spaces in the workplace? Is it commonplace to include pronouns in introductions and email signatures?

Competence

Is the management trained in equity, diversity, and inclusion to the degree they need to be in order to put the policies and procedures into practice? Do they know what to do if an employee or colleague comes out as trans or requests they use different language or pronouns for them? Is there positive, neutral, or negative regard for differences and diversity? Are there ‘safe space’ stickers on office doors? Is the messaging around safe spaces and being inclusive accurate to the level of competence of the staff?

See the end of this post for numerous other posts on this blog related to building basic trans competence.

Representation

Is pride month celebrated? Is diversity represented in the company/business promotional materials, staff support messaging, and among the workforce?

I’m sure there are more but these are the ones that come to mind from my experiences comparing these two work environments.

Physical Environment

This factor is a bit more straightforward but often overlooked by anyone who isn’t negatively affected by it. For gender related inclusivity, some of the questions that come to mind are:

Are there gender neutral/single use bathrooms and changing spaces (if applicable)? For places like gyms, yoga studios, and rehabilitation clinics, are there spaces that aren’t surrounded by mirrors? If asking clients about their personal or health related information, are these meeting spaces private (for both sight and sound)? Is the messaging that is visible at the entrance and throughout the space inclusive and representative of diversity?

Social Demands

This is a factor that is often overlooked and took me a while to recognize as important. My experience with it is more specific to gender identity (though I’m sure it applies to many other minority groups as well).

How many social interactions with strangers or acquaintance level co-workers are required throughout a day of work? This is important because, especially for nonbinary people, strangers, and anyone who we haven’t specifically come out to, will make incorrect assumptions about our gender identity and pronouns. No matter how inclusive the workplace is and how comfortable you are being ‘out’ in that environment, every interaction with a stranger requires coming out again.

Many of the components of the other factors make this significantly less onerous. For example if the company’s messaging is clearly trans inclusive, if employees have pronouns on their ID badges, and if the culture is supportive, affirming, and protective of trans people, I would feel much more comfortable introducing myself to a stranger using my pronouns (they/them). If the other factors are poor in terms of inclusivity, this one gets exponentially worse.

But, if the type of work requires very little interaction with strangers, it is significantly easier to get through the day in a workplace that has mediocre cultural and physical inclusivity.

  • What have your experiences been with gender inclusion in your workplace?
  • Have you ever quit a job due to it’s lack of gender inclusivity? What factors affected you the most?
  • How would you rate your current workplace on it’s gender inclusivity based on the factors above (or others that you’d like to add)?

Leave me a comment below or send me an email! I’d love to hear from you.

RELATED POSTS

Workplace and Coming Out

Surviving in a Non-Inclusive Workplace

Trans Competency

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When You Get It Wrong: How to Correct Yourself and Others When it Comes to Trans Identities

WHEN YOU MISGENDER SOMEONE

Even I, a nonbinary person with a trans husband, sometimes get people’s pronouns or preferred language wrong. Our brains are used to holding onto stereotypes and first impressions as shortcuts. It takes conscious effort to change how we perceive people and the language we are using for them. So, when someone you know comes out as trans or nonbinary, or simply asks you not to use certain language when referring to them, you will likely get it wrong at some point.

When you get it wrong, correct yourself and move on.

Do not apologize, especially not repeatedly or profusely. By apologizing, you are putting the focus on you and the mistake you made and forcing the trans person into the socially conventional role of either thanking you for the apology or excusing the original mistake, neither of which is acceptable.

The more you apologize, the more you are emphasizing the mistake in your brain. Repeating what you said with the correct pronouns, name, or other language is necessary to cement the correct version in your brain. The more you de-emphasize the mistake and emphasize the correct version, the faster your brain will adapt and stop making mistakes in the first place.

If someone else corrects you, say ‘thank you’ (not ‘sorry’), repeat it correctly, and move on.

Sometimes we are talking without hearing what we are actually saying and someone else hears the mistake for us. If the person you misgendered doesn’t correct you, it’s not because ‘it’s fine’ or they didn’t notice. Trust me, they did. It’s more likely that they don’t want to draw attention to the mistake, to themselves, or don’t have the energy to correct you and everyone else around them every time they are misgendered.

If the trans person or someone else catches your mistake and corrects you, that’s a good thing! That means that the culture of the place you are in or the relationship you have is one of support, openness, and inclusion. Respond to the mistake in a way that upholds this culture. Thank them for making the effort to bring your mistake to your attention, even though it meant going against social convention and interrupting the conversation. Correct yourself by repeating what you said with the correct language. And then move on by continuing with the conversation.

WHEN SOMEONE ELSE MISGENDERES SOMEONE

If people around you are making mistakes, make sure to correct them if you feel it is safe to do so. It is often easier to hear when other people make mistakes than when we do it ourselves. The more you correct someone else, the more you are emphasizing the correct version to yourself and others. You can correct others by interrupting them and stating the correct pronoun/name/language, by repeating what they said but using the correct pronoun/name/language, or by continuing on with the conversation, ensuring to use the correct pronoun/name/language with added emphasis.

If you know the person they misgendered personally, and especially if that person is often present when this misgendering occurs, consider asking them how they want you to respond in these situations. Depending on the relationships involved, they may prefer you don’t correct certain people in favour of preserving a tenuous connection. Or they may not feel comfortable correcting people themself but would really appreciate if you do it on their behalf. It may depend on who else is around or what context you’re in. Sometimes they don’t know yet and it takes some trial and error. You can always check back with them later to confirm or clarify their preferences.

WHAT IF THE PERSON THEY MISGENDERED WILL NEVER KNOW?

Let’s say you’re at a business meeting where a colleague is referring to a previous client who was trans. Or you’re a health care professional at a complex case discussion and someone brings up a case with a trans patient. Or you’re at a family gathering and your uncle refers to a celebrity who is trans. Now let’s say this colleague or family member uses transphobic or ignorant language when referring to the trans person.

What do you do?

You have three options:

  1. Correct them in the moment
  2. Correct them later, in private
  3. Don’t correct them at all

How you decide is important. If you would pick option 1 if there are trans people present who would be directly affected by their comments, and option 2 or 3 if there were no trans people present at the time, I take issue with this. You are assuming that you would know or be able to tell if there are trans people present. This means you are assuming that either trans people are recognizable by how they look (false), or that, because you are an ally, anyone who is trans or questioning would have told you (also false). It also means that you are assuming that if you don’t know of any trans people in the room, everyone must be cis. You are using cisgender as the baseline until proven otherwise rather than keeping an open mind.

I would prefer if you decide based on safety and energy. If you were to correct them in the moment, would it put you at risk, create a much bigger argument that would lead to significantly more transphobia rather than less, or use more energy than you personally have at this time? If any of these are true for you, then pick option 2 or 3, using the same questions to decide. If none of these are true for you, please choose option 1. You never know who in the room needs to hear the correction, either for themself, someone they love, or someone they will interact with in the near future.

Let’s look at each of these options in more detail.

Option 1: Correct them in the moment

This takes practice. The first few times someone says something transphobic in front of you it will be gone and the conversation will have moved on before your brain clicks in and says hey, that’s not right. If you are socially confident, you might be able to interrupt the conversation to make the correction. If not, it will take some planning and repetition.

Make note of phrases that you’ve encountered and what the correct phrase would be or what assumption needs to be corrected. Plan a one sentence correction that you could say. Also plan an interjection to use to get the attention of the people in the conversation first. There’s no point in making a correction if no one hears it. Something like “Excuse me, I heard you say something that I don’t think is right” works well.

The goal isn’t to create a debate around language use and trans issues. It’s to correct how they are referring to a person or using terminology in this context and continue the conversation. So keep your corrections relevant to the topic at hand, using examples specific to the current conversation.

This option takes significant confidence and energy, even if you aren’t a trans person. But it gets easier with practice. It also takes some quick calculations about what the social environment is, how the people in the room are likely to respond to your correction, and whether you have sufficient social capital to be heard. This is a small scale example of the types of calculations that trans people make all day long. It’s part of what it means to be an ally.

Option 2: Correct them later, in private

If, for whatever reason, option 1 isn’t going to be good for you or potential trans people in the room, or the moment passed and you didn’t recognize it or decide what to do about it until later, option 2 is the next best. You have time to think about what you want to say, gather some resources that might be helpful, and pick an appropriate time when they might be more receptive and/or you feel safer or more capable of making a good impact.

This can be a face to face conversation, a text, a phone call, or an email. Sometimes it’s best to have it in writing, sometimes not. You could also consider having backup included in the conversation if necessary – either someone else who was in the room, a supervisor, or an inclusion and diversity rep if one exists in your setting. You can make sure they go with you for the conversation or add them to the email, even privately if necessary.

The important part is that you take action. If the person who made the mistake is receptive, you will be supporting them in making a positive change and providing useful resources. If they aren’t receptive, you are safer and know that you’ll have to take it to the next level should this issue come up again.

The major drawbacks of this option are that the other people in the room didn’t hear the correction so a) they may not recognize that what was said was wrong, b) they may not know what should have been said instead even if they know it was wrong, and c) any trans, nonbinary, or questioning people in the room don’t know you are an ally. So, if you choose option 2, consider other things you can do to address these aspects as well.

Option 3: Don’t correct them at all

This is the least useful option but is also the safest. Only pick this option if you have no other choice. But, if you do have to pick this option, consider other ways you can get information out to the people around you about common errors or assumptions about trans people and corrections/accurate information. Because if you didn’t correct them, and no one else did, it’s not only the person that made the mistake that needs the information but everyone else who was present and didn’t say anything either.

I hope this helps you feel more prepared and more comfortable with correcting yourself and others instead of letting mistakes slide. Leave a comment below with your experiences of correcting yourself or others and any other tips or suggestions you have.

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From Baby to Toddler: First Birthday and First Anniversary of Birthing

MILESTONES VS ANNIVERSARIES

Milestones are typically cumulative: one leads to the next and to the next, either in number (as with birthdays) or in skill level (as with motor development). Anniversaries, on the other hand, are a remembering of a singular event. Milestones feel like an accomplishment, a moving forward. Anniversaries feel like pausing and looking back, to see how far we’ve come.

The first birthday of my child was a strange mix of both. Their first birthday: a huge milestone, and hopefully the first of many birthdays to come. The one-year anniversary of their birth: this time last year I was in labour for four days, having an experience unlike any other in my life.

The birthday celebration feels very external – it’s about the baby, how much they’ve changed and grown in one year (so much!) and celebrating with family. The anniversary of birthing feels very internal and personal. It’s an experience I went through with my husband that we have only shared with a couple people.

So how are you supposed to celebrate these two highly interconnected experiences that are so wildly different?

FIRST BIRTHDAY: IS IT REALLY THAT IMPORTANT?

For most birthdays, it’s all about the person who’s birthday it is. But for a child’s first birthday, they don’t really understand what’s happening, don’t have any expectations of what a birthday is, and won’t be disappointed if it is skipped altogether. So why bother with all the fuss?

For the parents of course! Getting through the first year of your child’s life is a huge accomplishment. Whether it felt easy or hard, take this excuse to celebrate!

We initially didn’t really care about having a party. Everyone was busy, I was navigating the end of parental leave and returning to work, and our kid was just starting daycare and was exhausted. But we knew we would feel disappointed if we didn’t. So we made it work. We had a small family gathering outdoors and our baby got to try cake for the first time. It was nothing extravagent but it was definitely important.

Our baby is now officially a toddler (but that doesn’t mean I’m going to stop calling them my baby).

REMEMBERING THE BIRTHING PROCESS

In the days leading up to my baby’s first birthday, I was tracking what was happening the year before. A year ago at this time I was just starting labour. A year ago at this time we were talking to the midwife for the second day in a row. A year ago at this time things were getting pretty intense and I was already exhausted. A year ago at this time we were heading to the hospital. A year ago at this time we were holding our baby for the first time.

I had a long slow labour. This remembering, therefore, spans the three days prior to my baby’s birthday as well as the birthday itself. At the same time as wanting to remember these experiences, life was continuing on. I was at work one of those days. We were doing two hour daycare visits on two of those days. My husband was working for three of those days and we didn’t have much time to reminisce together. So sometimes, something important had happened the year prior, but the moment had already passed by the time I had the awareness to remember.

It felt like I was doing the experience and myself a disservice by missing these key moments. But really, no one around me knew or cared. It was just for myself and therefore I can decide how and when I remember them. Not remembering them at that exact moment a year later doesn’t mean they didn’t happen, that I’ve forgotten about them, or that I’m ignoring the impact they had. It just means that it was one experience, a moment in time, and I am continuing to live my life beyond that moment.

I definitely want to find a way to commemorate this experience more concretely next year. I want to include my husband, and potentially even my child, in my remembering process. I want to build a tradition.

BUILDING TRADITIONS

Traditions are important. They are used to mark milestones (such as having a birthday celebration) and anniversaries (such as going on a date or exchanging gifts on your wedding anniversary). Because of this, a tradition can tie these two wildly different connected experiences toogether.

For me, a tradition around my birthing experience would involve some recognition of the intensity and endurance involved in that experience. It would be a remembering and celebrating of what my body was and is capable of and the role my husband played in supporting me through that process. This year, I did this mostly on my own, internally, with a bit of sharing with my husband.

A tradition around my child’s birthday would be pretty typical – the cake and candles, the presents, and the family gathering. I also want to include a reflection on the past year – some of my child’s, and our family’s, important experiences, challenges, and achievements. This year, we had a family party with cake (no candles because fire and one-year-olds is a dangerous combination), and my husband and I did a quiet re-reading of our monthly baby journal entries and a look back through our pictures and videos.

One way we could combine these experiences in the future is with a candle. I would light the candle on the anniversary of when my labour started, each of the next few evenings we would share some memories of the labour experience and the past year of our child’s life, and on their birthday we would light the candles on their birthday cake (or cupcake if the actual party is on a different day) using the same candle. My labour candle lights my child’s birthday candles. It has the symbolism and recognition I’m looking for.

Maybe next year I’ll write another post describing what we actually end up doing. Until then, let me know what your experience of your child’s first birthday was. How do you comemorate your labour and birthing experience?

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From Baby to Toddler: Motor Milestones and Ableism

FROM BABY TO TODDLER: FIRST STEPS

Technically, a baby becomes a toddler on their first birthday. There is so much development in so many different areas around this time but the one that gets the most attention is walking. A baby’s first steps are often much celebrated and, emotionally, mark the shift into toddlerhood. The name ‘toddler’ even comes from the unsteady, wide based gait quintessential to new, young ambulators.

With walking comes more independence and the end of crawling, bum scooting, rolling, or other forms of baby locomotion. From then on into adulthood, they’ll be walking (or so we assume and hope – more on the ableism of this perspective below). Though they aren’t yet talking (for the most part), potty trained, or really all that independent, it feels like a sudden shift away from baby behaviours and into the next phase of their life.

Babies (or toddlers) learn many other motor skills before taking their first steps. There’s rolling, sitting, and crawling but even once they start working towards walking there are many skills still to learn. There’s pulling up to stand (and learning how to safely return to the ground), weight shifting, cruising, letting go in standing, taking a reaching step while cruising, and then, eventually, a free standing step. And even then, it’s a while longer before walking becomes their main mode of locomotion.

As with all types of development, babies practice each of the smaller steps constantly. They are trying new things, seeing what works, and getting excited when they figure out how to consistently replicate an action. Especially when it helps them gain access to new areas and perspectives. And we get excited right along with them. We encourage them, get excited with them, protect them, and console them.

But why focus on first steps? Why aren’t a baby’s first words or some other milestone the most celebrated aspect of becoming a toddler?

THE PROCCUPATION WITH MOTOR MILESTONES

Motor milestones and a baby’s growth are the two main indicators of whether a baby is developing as expected during their first year of life. There are standards of when babies are expected to start holding up their head, rolling, crawling, pulling up to stand, and walking. It is so easy to get hung up on these expectations, comparing your baby to others or to the ‘standard’.

This comparison can cause a ton of anxiety and pressure that we can inadvertantly pass on to our babies. We teach them that their actions and physical development will make us more excited than other areas and that is what they should focus on. We are encouraged to have our babies play on their tummies on the floor, even if they hate it (‘They’ll get used to it, you just have to keep trying!’) rather than trying alternative positions that encourage the same types of development.

Yes, motor development is an important part of a baby’s development because, as I understand it, it encourages, allows for, or results in development in many other areas such as spatial awareness, differentiation of self from others, depth perception, emotional development, etc. But what we’re not told is that there is a range of ways and timelines a baby can develop motor skills that still result in developing all these other areas, especially if the parent(s) are engaged and play with them in meaningful ways.

The most important part is that we are excited for whatever aspect of development our baby is focused on in the moment and is able to achieve. When we’re in community with others, I think it’s important to be excited and curious about all the different ways babies develop and try not to compare, shame, or judge based on differences.

MOTOR MILESTONES AND ABLEISM

The concept that there is a ‘right way’ for a baby to develop is extremely ableist. It is so easy to fall into this way of thinking when everything we are told is about when our baby ‘should’ be able to do certain things. This has become especially evident for me around the ‘first steps’ milestone.

Here are some of the thoughts that have been spinning around my head and how I’ve been trying to address them from an anti-ableism perspective:

Using ‘taking their first steps’ as the indicator for becoming a toddler

This is inherently abelist. Not all children take steps. If they do, they may take significantly longer than 12-16 months to get there. Just the idea that a human that isn’t walking is considered a baby makes me cringe. So no, a baby does not need to take their first steps to be considered a toddler. I think I’ll stick with the first birthday as the marker of that threshold.

Getting excited when my baby learns new motor skills

It’s always exciting when your child learns new things, no matter what type of skill it is. But motor skills seem easier to identify as an observer. We can see all the little progressions and attempts as they work up to being able to do something. And of course we get excited when they are able to do something new.

But does that mean we’re putting unnecessary emphasis on motor skills due to an ingrained ablist perspective? Not necessarily. If we’re excited because our baby is excited and because they learned something new, that seems fine to me. Just because we’re excited to see them roll for the first time, doesn’t mean we’d be any less excited if, at the same age, our baby had just learned how to open and close their fist. Being excited for any development at any age, whatever stage your child is at, is one of the joys of being a parent.

Using motor milestones as the main indicator of development

Again, I think this is ableist. Motor milestones should get no more weight than social development, language development, play engagement and activities, sleeping skills, eating skills, and overall growth. Sure, some of those others are harder to observe and measure and may have a wider range of ages when they appear and develop. But focusing on motor milestones simply because they are easiest to track puts undue focus on physical ability, stressing that that is somehow more important than all the other areas. This is not true and highly ableist.

Identifying motor ‘delays’ and accessing support services

As a rehab professional, this is where I get stuck. I don’t like the focus on motor skills to the exclusion of other types of development but I recognize that if there are motor delays, this can be the earliest and most easily identifiable indicator that there may be delays in other areas as well. I also know that the sooner a child, parents, and family has access to interdisciplinary support, the easier it is for the family to learn how to create a supportive environment for a child who’s needs might be different from the mainstream experience.

I think it becomes ableist when motor delays (or other delays) and accessing support services comes with negative judgement. Anything along the lines of ‘your child isn’t normal’, ‘you have failed as a parent’, ‘you did this to your child’, ‘you should be able to support your child on your own’, or ‘you are weak for needing help’ is pure ableism. Even the more subtle aspects of needing to prevent as much future disability as possible so they can have a good life is ableist. Preventing disability for the sake of enduring less pain, stigma, or struggle is one thing. Assuming that they won’t have a good life if they are born with or develop a disability or delay is a whole other and very ableist thing.

FINAL THOUGHTS

  • First steps are very exciting and are a culmination of many smaller skills and hours of practice.
  • First steps and the beginning of walking (or being fitted for and learning to use their first wheelchair) marks the end of ‘baby’ locomotion skills and can trigger a grieving process around the end of the ‘baby phase’.
  • Babies become toddlers on their first birthday, not when they take their first steps.
  • Focusing on motor milestones to the exclusion of other areas of development is ableist.
  • Stressing about and pressuring your child to perform motor skills they are not yet ready for is unnecessary and comes from internalized ableism.
  • Comparing to others or the ‘standardized norm’ can cause unnecessary stress and focus on motor development.
  • Following your child’s lead and being excited for whatever skill they are working on is one of the joys of parenting and not inherently ableist.
  • Accessing support for yourself and your child should you feel you need to help provide a positive and supportive environment for your child is important.
  • Negative judgement around motor delays (or any type of delay or disability), accessing supports, or perceived future quality of life is extremely ableist.

Have you had similar thoughts and experiences? Do you agree or disagree with what I said here? Leave a comment below with your thoughts or share your story!

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How to Manage Stress and Prevent Burnout Part 2

If you started with Part 1, you’ll already be familiar with my blue-yellow-green-yellow-red stress state system, what each state feels like to you, and have a variety of factors you can use to identify your stress state. If you’ve been tracking your state since last week, you may have already noticed some patterns in how your stress state fluctuates over the course of a day or week.

The next step is to identify what is making your stress state move away from the green zone (triggers) and what you can do to bring it back towards the green zone (relievers). Then we’ll put everything together to build a routine where you manage the stress you accumulate as it happens and keep yourself in the green zone as much as possible.

TRIGGERS

Triggers are anything we find stressful. Anything that changes our stress state in a direction away from the green zone.

Some are obvious – the ones that have already come to mind as you read this. Others you’ll have to discover by observing fluctuations in your stress state and looking for the cause.

Some are predictable and consistent – these are the easier ones to manage. Others are spontaneous or fluctuating in intensity and will take extra time, awareness, or effort to manage.

Types

There are lots of different types of triggers. The things that trigger a stress response in you is completely individual and valid. Here are some examples (but this is by no means an exhaustive list):

  • Personal
    • Health fluctuations, physiological stresses, pain
    • Security (income, house, car, work, finances)
    • Dysphoria
    • Addiction
    • Reminder of past trauma or loss
  • Interpersonal
    • Abuse, threats, violence
    • Discrimination
    • Worry or care for a loved one
    • Expectations
    • Deadlines
    • Tension in a relationship, broken trust
    • Loss
  • Societal
    • Political unrest or discrimination
    • Systemic discrimination
    • Sensationalist news cycle
    • Pandemics/natural disasters

This list is just to get you started and give you some ideas of where to look. Not all of these will be sources of stress for you and there are likely other things that are triggers for you that are not on this list. You can keep adding and removing triggers from this list as things change in your life. For now, let’s take the list you have and fill in some practical details for each one.

Effects

Some triggers have a consistent and specific effect on your stress state. For example, some triggers will always push you towards the red zone while others will always push you towards the blue zone. If you notice any triggers like this in your list, make a note of it.

Most of your triggers will have a more general effect of moving you away from the green zone in either direction. Which direction your stress state moves is not always predictable since we are complex organisms living in a complex societal system. We are not trying to create an equation or predictive model, simply look for patterns.

Intensity

Different triggers will have different magnitude of effect. Some cause a small amount of stress and might move you from green to yellow or yellow to red/blue (one step). Some cause a moderate amount of stress and could move you from green straight to red/blue or from yellow straight to black (two steps). Some may cause so much stress that you would immediately shut down or dissociate i.e. move from green straight to black (three steps).

Consider each trigger on your list and assign it a number value from 1 to 3. You can add a 0.5 value if there are some low level triggers that wouldn’t even move you a whole stress level. Or you can use whatever number system works for you (1-5, 1-10). Try to keep it as simple as possible. We want to be able to easily relate it to the fluctuations in our stress state and, as you’ll see in the next section, use the same system for our stress relievers.

Let’s take a look at those now.

RELIEVERS

Relievers are anything that decreases your stress level or shifts your stress state towards the green zone. These are not things that get rid of the cause of the stress (the trigger or stressor). They are activities that reduce the stress load on our system by helping us process or decrease the effects of the stress.

Types

As with triggers, there are lots of different types of relievers. I have grouped them into categories that I find practical.

  • Positive Interaction
    • A long hug
    • Intimate time with my partner
    • Positive social time with a small group
    • Exercising compassion by doing something nice for someone
  • Moving Your Body
    • Running or other cardiovascular exercise
    • Hiking or fast paced walking
    • Dance
    • Strength training
  • System Regulation
    • Deep breathing
    • Meditation
    • Yoga, stretching, Tai Chi, Qigong
    • Relaxation
    • Reading
  • Creative Expression
    • Creative writing
    • Art
    • Crocheting, sewing, or other fiber crafts
    • Singing or playing music
  • Productive Processing Time
    • Journaling
    • Therapy
    • Letting my mind puzzle through things, find connections, or clean up the mental clutter while doing housework, having a shower, or other mundane task
    • Doing a mundane task while staying focused on the positive effect I am having or the gratitude I have towards that aspect of my life

Some of these will occur over the natural course of your day. Some you will have to find time to engage in.

Effects

Some relievers will have a stronger effect towards relieving stress from specific sources. For example, I find exercise to be particularly helpful for acute triggers like an interpersonal interaction where I experienced discrimination and creative expression to be particularly helpful for chronic low level triggers like dysphoria, systemic discrimination, and typical daily stress.

Some relievers will have a stronger effect when you are in a specific stress state. For example, I find system regulation relievers to be more helpful when I am in the yellow to red zones and positive interactions when I am in the yellow to blue zones.

Some relievers will be effective no matter what stress state you’re in or what the trigger was. For me, this is productive processing time.

If you notice any of these specific effects, make note of them next to the relievers in your list.

Intensity

As with triggers, each reliever will have a stronger or lesser effect. Some will bring you one level closer to green, some will move you two levels closer to green. However, in my experience, triggers tend to be better at moving us away from the green zone than relievers are at restoring us to our green zone. So if you used the 1-3 scoring system for triggers, it’s likely that you’ll be using 0.5 or even 0.25 for some of your relievers. Even though it seems like an activity that relieves so little stress wouldn’t even be worth doing, it is important to have these relievers in your list. You’ll see why in a second.

Energy Cost

This is a really important aspect of relievers to consider. How much energy does it take for you to initiate or complete each relieving activity? You can use a number system again (1-3, 1-5, or 1-10) or a traffic light system (red for hard, yellow for moderate, green for easy), or any other system that makes sense to you.

The important thing is to know which activities you can do with little to no energy reserve, which ones will take a bit more energy, and which ones will take considerable energy. This shows you which ones to engage in when you’re in an extremely burnt out state (black), which ones you can manage in a moderately stressed state (red/blue) or slightly stressed state (yellow), and which ones you’ll only be able to engage in when you’re at your best (green).

For the most part, I have found that the higher the energy cost, the greater the intensity of the effect on my stress level. This means that the low cost relievers have the smallest effects. But sometimes, if that’s all I can manage, that is where I have to start. Don’t forget these effects are cumulative. Four easy stress relieving activities can bring me out of the black zone and back into blue/red. I then have enough energy to engage in slightly higher cost activities that have a stronger effect.

Now that you know all about your triggers and relievers, let’s design a practical strategy for managing your stress level and keeping you in the green zone.

PUTTING IT ALL TOGETHER

So far, you have:

  • Identified your stress states and described them using physical, mental, and emotional cues
  • Identified patterns in how your stress state fluctuates throughout the day or week
  • Identified your triggers, how they affect your stress state, and how intense that effect is
  • Identified your relievers, what types of triggers or stress states they are useful for, how intense the effect is, and how much energy they cost

Now you will learn how to use this information on a daily basis to manage your stress as you accumulate it. The goal is to develop a routine that is sustainable and helps keep you in the green zone. That way, when you encounter unexpected triggers or routine triggers are suddenly more intense, you have a buffer before you end up in the black zone and you have the energy reserve to engage in the most effective relievers.

Here is one example of a daily practice you can follow:

  1. Monitor your stress state (as discussed in Part 1)
  2. Make note of the triggers you encounter – type, effect, intensity
  3. Make note of the relievers you engage in – type, intensity
  4. Determine amount and type of unresolved stress
  5. Engage in appropriate and manageable relieving activities

You will see a pattern of typical triggers you encounter and typical relievers you engage in. If your day to day activities are sustainable and allow you to stay in the green zone, you will find you are engaging in enough relievers to match or outweigh the amount of stress generated by the triggers.

If your day to day activities are slowly leading you towards burnout (or other black zone state), you will find that your typical daily relievers are not sufficient to counteract the stress generated by your triggers. Are there triggers you can do a better job of avoiding or resolve altogether? Are there relievers that would be more effective that can replace the ones you are currently using? Are there relievers you can add to your routine that would be low cost or ones you can do while doing other things?

After a few weeks of assessing your stress state and the balance of triggers and relievers, you will figure out which relievers work easily into your schedule to most effectively balance the majority of the stress from your triggers. But at some point, you will encounter one of those spontaneous triggers, one that was suddenly at a much higher intensity, or a seemingly unending stream of small triggers that add stress faster than you can deal with it. This is when you’ll need to add something to your routine.

Determine which relievers you have the energy to engage in and of those, which would be the most effective based on the type of trigger or the stress state you are in. If you’ve been doing a good job of relieving your daily stress as it happens, you will be starting from a fairly stable place and it will not take nearly as much work to return to your green zone.

You can add extra relieving activities to your schedule a couple times a week to process any extra stress beyond your typical that you accumulate from those unpredictable triggers. If your stress is well managed on those days, these become bonus green-zone-reinforcing activities!

I hope this set of emotional processing and stress management posts has helped you! If you have questions, need clarification, or simply need a sounding board to work through some of these steps, don’t hesitate to reach out. You can send me an email or comment on a post.

If you have a different way to process big emotions or manage ongoing stress, I’d love to hear it! Please send me an email or comment below! My strategies won’t work for everyone. Maybe yours will be the strategy someone is looking for!

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Trans Wisdom: The Power of Community

COMMUNITY HAS EXPERIENCIAL KNOWLEDGE

Many things in life, including transitioning, are difficult, complex, and not well understood by the general public. Navigating these experiences is difficult in part because there is so little information available about what to expect, what to avoid, and what resources are available and helpful.

Communities are full of people who have gone there before you. They have way more knowledge and information that is tried, tested, and true than any professional or google search can provide. The bigger the community, the wider the range of experiences and suggestions you will find and the more likely you will find something that works for you.

Without the local trans community, we would not have known that ‘the proper referral process’ that our family doctor was following was outdated and incorrect. We would not have found a doctor willing to follow the current referral process to prescribe my husband Testosterone. We would not have had personal recommendations for where to go for surgery. We would not have had scripts to use when encountering resistance at various governmental and private institutions when trying to change his name and gender marker on documentation. We would not have had scripts to use when acquaintances, friends, and family asked inappropriate, invasive, or poorly worded questions. We would not have been prepared for how long the waitlist was for specialist referrals needed to complete paperwork.

So much of what we learned about how to navigate my husband’s transition came from our community. Without the community, we would have struggled significantly more, waited for specialists that were not required, and felt incredibly alone.

COMMUNITY PROVIDES SUPPORT

We need support from a variety of sources when we are going through something difficult and big. Support from a broader community is one of those sources. Being part of a community of people that are all experiencing something similar normalizes the experience and provides validation.

Often, when our experiences are rarely or poorly represented in mainstream media, we are left feeling like we are the only ones going through this. This can lead to questioning whether your experience is legitimate, whether your reactions to this experience are valid, whether you should be dealing with it differently or better, or whether you’re doing the right thing. We can feel lost, isolated, confused, self-conscious, fearful, anxious, and angry. We can internalize the judgements and negative responses from those around us, including what is represented in mainstream media.

While having a community won’t automatically make the experience an easy, positive one, it will show us that there are others out there struggling and thriving in similar circumstances to our own. Seeing someone else describe their own experience in the same way we would, navigating the same barriers and systems, struggling with similar emotions, tells us that our experience is shared, normal, and valid. We find voices other than our own to counteract the negativity and judgement that we have internalized.

Normalization and validation of our experiences doesn’t take away the difficult aspects, but it helps fortify us against the toll that those parts of our experience can take on us. It helps us weather them. Community gives us someone to talk to who will respond with positivity, understanding, and support without us having to first explain our experience to them from the beginning.

COMMUNITY MEMBERS HAVE IMPLICIT UNDERSTANDING

People who share our experiences will automatically understand our struggles, milestones, and achievements. This is huge. If you need support, even just an ‘aw that sucks’ or ‘I hear you’, and you share your point of struggle with someone outside your community, instead of support you might get a blank stare, a confused look, a platitude, or an inappropriate question. In order to get the response you’re looking for you would have to explain your situation from the beginning, often sharing a lot of personal information in order to bring them up to speed, and may not ever get them to the point of understanding enough to provide the support you need.

I repeated this process many, many times over the course of my husband’s transition. I spent more energy in the explanation than I received in whatever support I got back. The more marginalized your experience is, the less likely it will be that you will automatically get the response you’re looking for. I found a huge difference between the support I got when I had a miscarriage vs the support I got when my husband was transitioning (and we were struggling against systemic barriers).

It was always such a relief when we could tell a group of trans people about something that had happened and immediately get the response we were hoping for, be it support, commiseration, information, or celebration, without having to provide any explanation or background. I learned through trial and error when it was worth explaining my situation to non-community members and when to keep my struggles and triumphs to myself until I had community to share it with.

COMMUNITY HELPS US CELEBRATE

I didn’t realize how important this function of community was until I had something to celebrate and got a response from non-community members that was sympathetic or blank instead of excited. It really takes away from the positive experience when someone assumes it’s negative and you have to explain the whole backstory before they conceptually get it. Even then, they don’t really feel excited for you.

But members of your community do. They have celebrated the same things or are looking forward to the moment when they can. They understand how hard it was to get there. They understand why that milestone is worth celebrating. Without community, the milestone passes you by with a small blip of excitement, self-satisfaction, accomplishment, pride, relief, and perhaps some apprehension about what comes next. But when you get to celebrate with community, your milestone is celebrated by so many others that it is magnified. It becomes a bright moment in a timeline of struggle that you can look back on to give you strength when you need it.

Being able to celebrate the high moments with people that understand can shift our perspective of the entire experience. It can shift the focus from the struggle and loss to the achievement, hope, and success. The story of our experience, when we look back on it, is now characterized by the moments we celebrated with the community. They shine so brightly that they overpower the dark parts between them. They don’t erase the struggle but when the experience if viewed from farther away, they stand out as the most important parts. They make the rest of the experience worth it.

COMMUNITIES HAVE LOUDER VOICES

The voice of the many is often louder than the voice of the few. The more marginalized your experience is, the more powerful the effect of the community. These are also the experiences that get the least attention from media, politicians, health care, and research. Community is necessary to amplify our voices to share our experiences and gain access to the resources and services we need.

The members of a community often have a wide range of outside expertise, connections, and influence. So not only do they have a louder voice, but they can often find a way to get their message heard by the right people with a lot less effort than a single person might.

Communities can form organizations, develop a funding base, and develop their own resources. They can hold fundraisers that are coordinated across an entire country. They can pool their resources from multiple sites and put them towards something that no one person from the community would be able to change.

Feeling like your voice is being heard and that you helped to change the system so that the next person to go through a similar experience will have a slightly easier time of it than you did is huge.

What experience have you had where being a member of a community made a big impact on you or the wider world? What other ways did being a member of a community impact you? Leave a comment below or send me an email!

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How Dysphoria Contributes to Burnout and What You Can Do About It

WHAT IS BURNOUT?

I have struggled with cycles of burnout for many years now. For a long time I felt like I was making it up, or being lazy, or finding an excuse to avoid the mundane but challenging parts of everyday life. Very little of what I was feeling matched the symptoms of depression but that was the closest I felt like I could come. Until I heard about burnout.

When I’m in a state of burnout, the thought that keeps going through my mind is ‘I just don’t care’. I know I should, and usually do, but I can’t muster up the emotional energy to engage with almost all aspects of life. This is not me. In this state, I don’t feel like myself. And because I don’t have the energy to care, it is very hard to make myself do the things that will help me get out of the state of burnout.

I feel numb, heavy, and drawn to escapism. It feels like the world is happening around me and I’m just going through the motions. I don’t keep up with house chores, I eat less and more poorly, I socialize less, I exercise less (usually not at all), I am often late, and my productivity at work decreases.

If this sounds like you or someone you know, I highly recommend the book ‘Burnout’ by Emily and Amelia Nagoski. Not all of it resonated with me but the parts that did have been very helpful by giving me language to discuss my experiences of burnout with others, different ways of thinking about and noticing how I’m functioning, and practical strategies to prevent and recover from burnout.

HOW DYSPHORIA CONTRIBUTES TO BURNOUT

I have found that dysphoria is a large contributor to my burnout. There are three reasons for this:

  1. It takes a lot of mental effort to ignore the buzz of dysphoria in order to focus on what I’m supposed to be doing. It takes mental effort to check in with myself, identify what aspects of dysphoria I’m feeling, and use appropriate management strategies. It takes mental effort to identify and avoid situations that trigger my dysphoria (as much as possible). And it takes mental effort to reframe the dysphoria or fight it’s effects by using positive self talk and affirmation. So yah, lots of mental effort.
  2. Dysphoria is constant. It goes up and down depending on the day, my emotional state, my physical state, who I’m around, and what situation I’m in, but even at it’s lowest it’s still there. So lots of constant mental effort.
  3. Generally, there is a lack of understanding from others about what dysphoria is and how it affects me (or how it can affect people). The situations where my dysphoria is triggered the most and which are unavoidable are also the situations where I’m surrounded by and interacting with people who do not understand dysphoria. So lots of constant mental effort that is invisible to or misunderstood by the people around me.

WHAT BURNOUT FROM DYSPHORIA FEELS LIKE

For me, certain symptoms of burnout are specific to dysphoria. Three main ones are:

  1. Decreased attention/focus. So much of my attention is taken up by ignoring, managing, avoiding, and fighting the effects of dysphoria that I have less mental space to spend on other things. It is harder to stay on task, perform multiple step activities without getting derailed, maintain momentum on a task, block out distractions, and remember details.
  2. Irritability/easily frustrated. Dysphoria is an internal irritant that is constant and unavoidable. No matter how good I am at managing it, it will never be zero. So I already have a baseline irritation that I am working to ignore. That means that I have less patience for other sources of irritation. Less patience leads to more frustration. The more dysphoria I have, the more easily frustrated and irritable I am.
  3. Physical, mental, and emotional fatigue. The constant mental effort I talked about above is exhausting. The feeling of being misunderstood and invisible and at odds with myself or how people see me is emotionally exhausting. We feel our emotions in our bodies so I end up with a feeling of heaviness and lethargy that means I don’t feel like I have the physical energy to exercise or do any extra tasks (even though that is what would often help me the most).

WHAT YOU CAN DO ABOUT IT

Over the last few years I have developed a number of different strategies to help manage my burnout. After reading the book I recommended above, I have some more language to explain it and some practical strategies to suggest.

Prevention

Identify the sources of dysphoria for you. Develop strategies to decrease as much of the dysphoria as you can (more posts on this in the Related Posts list below). Where possible, avoid situations that trigger high amounts of dysphoria or repetitive situations that trigger even small amounts of dysphoria (such as getting dressed in a room that doesn’t have a mirror).

As much as possible, make these dysphoria prevention, management, and avoidance strategies automatic. Restructure your environment, schedule, or routine so that you don’t have to spend mental energy on remembering to do things in a different way. The goal is to decrease your baseline mental workload, not increase it.

Protection

In psychology they talk about protective experiences that may be completely unrelated to the harmful experience but help build resilience and emotional capacity or offset or heal some of the negative effects. There are a few protective experiences that I have found to be important in decreasing the burnout caused by dysphoria.

  1. Euphoria. Notice moments of gender euphoria and seek them out. Avoiding dysphoria is helpful to tell you what doesn’t work for you but moving towards euphoria tells you what you should do. Moments of euphoria can pass us by or be overshadowed by dysphoria unless we notice them, focus on them, and celebrate them. In this way, they can be a beacon of light to look forward to and to remember when we feel overwhelmed by dysphoria.
  2. Support. Whether through therapy, social support groups, online groups, friends, or family, support from people who understand what you are experiencing and can give you a sounding board to process and strategize with is important. Your support person/people can also help bring your attention to the symptoms of burnout you are experiencing and provide some external motivation to socialize, exercise, or engage in whatever other activities are necessary for you to recover.
  3. Affirmation. Dysphoria is constantly telling us that something is wrong, that we don’t fit in our body or in society, that we don’t look the way we should, and that maybe we’re making this whole gender identity thing up. Finding sources of affirmation, whether from your support network, from positive social media influences, or a personal journaling, self-talk, or meditation practice can be extremely helpful in offsetting the negative thoughts and feelings associated with dysphoria. The more the affirmation comes from an outside source, the less mental work we have to do to provide the same level of protection and, often, the more likely we are to believe it.
  4. Activities and Interests. Part of burnout, for me anyway, is a lack of interest in things that I would usually enjoy. The frustrating thing is that engaging in things I enjoy makes me feel better. The trick is to find activities and interests that do not trigger any dysphoria. This allows you to engage in your activity or interest with less mental effort so that it doesn’t make the burnout worse which results in a net gain of positive emotion and energy.

Process the Stress

This concept is directly from the book I recommended earlier. The gist is that we experience our emotions in our bodies as a chemical and neurological process. When we are under constant stress (as with dysphoria), our bodies are constantly in ‘fight, flight, or freeze’ mode. Even if we get a burst of euphoria or a period of relief from dysphoria, our bodies still have to complete the chemical reaction or neurological pattern that was triggered by the stress. If we don’t engage in activities that encourage this completion to happen, our bodies remain in the stress state which only gets stronger the next time we experience stress (five minutes later).

So while we can’t necessarily get rid of the stressor (dysphoria) and stop it from triggering a stress response in our bodies, we can do various things to move through the stress response in our bodies, complete it, hit the reset button, so that the responses to this continual stress don’t compound as much. For me, the most useful activities are physical activity of any kind, breathing, affection, positive social engagement, and creativity (writing, painting, and crocheting). With so many options, it is easy to engage in at least one per day, usually more.

One of the tricks to making this as effective as possible for me is to do these activities mindfully. To focus on the calming effect it is having on my body, mind, and emotions. Or, if there was a specific situation that was stressful that I am ruminating on (because my body is still stuck in that stress cycle), I focus on that situation at the beginning of the activity, think through it, feel the emotions that I felt at the time (or didn’t allow myself to feel at the time), and continue the activity until the emotions and the associated physiological response dissipate. The amount of relief this brings in a very short span of time is pretty incredible.

Tl;dr

Burnout sucks and makes us feel numb, exhausted, and irritable. Dysphoria can lead to burnout due to the constant mental effort that is invisible to or misunderstood by the people around us. You can help yourself avoid repeated cycles of burnout by preventing as much dysphoria as possible, protecting yourself against the negative effects of dysphoria, and processing the physiological stress triggered by dysphoria (and any other sources of stress).

I hope this helps you. It is what I needed to hear five years ago. Leave a comment below or send me an email with your thoughts and experiences of burnout. Maybe your experiences are similar to mine and maybe they are very different. Either way, your experiences have value and I would love to hear about them.

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