Jun 182018
 

Open Minded Health has been running for 7 years.

Just let that sink in. For seven years I’ve been posting about gender and sexual minority health. Sometimes I posted weekly, other times biweekly. All through medical school, personal illness and injury and tragedy. And Open Minded Health is still here. Some marriages don’t survive medical school (mine did!). But Open Minded Health did.

On March 16 I found out that I matched into my preferred specialty of Family Medicine. And I learned where I will spend the next three years of my training. On May 13 this year I graduated medical school. I am now a physician. And on the 29th of this month I will begin the next phase of medical training: Residency.

For those unused to thinking about medical education, residency is a kind of on-the-job training all physicians must go through to become licensed. Residency is so called because residents almost live at the hospital. Long gone are the days of 72 hour shifts and wheeling patients to the X-ray machines ourselves. However, residency is still a grueling time. We may now be capped at 80 hour work weeks. And I may personally only rarely need to pull a 24 hour shift. But it’s still an intense time in medical education.

For me, residency is made all the more complicated by location. I was lucky enough to get one of my top two residencies. It was one of the three closest to my home. However that means it’s only..a one hour drive away. My wife and I have made the difficult decision to continue to live at home. So I will be entering the hardest education of my life, and adding a commute on top.

All this leaves very little space for Open Minded Health. That doesn’t mean Open Minded Health will end. I firmly believe in the mission of Open Minded Health: To bring health information to all gender and sexual minorities, so that we can all make the best health care decisions for ourselves.

What this may mean is less frequent, sporadic updates. It may mean guest posts and additional authors. It may mean a formal hiatus from new posts for a while. At least, until I get settled. I’m exploring options.

What this does not mean is a complete end to Open Minded Health. This website, and Trans 101, will stay up. I will continue to do my best to check on and respond to comments and questions.

For now, please accept my gracious thanks for being an Open Minded Health reader. I will update when I can.

Take care, all. Remember to play safe, see your doctor regularly, and enjoy life!

– Dr Rose Lovell

Aug 242015
 

148px-Orange_ribbon.svgRecent reports have highlighted the frequency of non-suicidal self-injury among gender and sexual minorities. 41.9% of transgender people have self-injured. I was unable to find a percentage for cis lesbian, gay and bisexual people beyond the general report that the rate was “much higher”. Gender and sexual minority (GSM) youth are at particular risk, as are cis women.

So let’s take a quick look at non-suicidal self injury this week. What is it? Why do people do it? And what should those who currently self-injure, and their loved ones, know?

Non-suicidal self injury (NSSI) is a term that refers to deliberate attempts to cause oneself injury without intending suicide. The “without intending suicide” is the important bit there. This is a separate phenomenon from suicidality, though both suicidality and NSSI can come from the same psychological source. NSSI can take many forms, but cutting and burning are the most common. People who have higher levels of stress, such as GSMs, are at higher risk for NSSI. Transgender people may have an additional risk factor because of extreme body dysphoria.

To most who have never participated in NSSI, it can seem baffling. Why would a person do that to themselves? While everyone has different reasons, at core NSSI is about survival. Many use it to defuse overwhelming emotions. Emotional pain is just like physical pain in the brain, causing activation of the same areas. All pain causes the release of morphine-like chemicals in the brain which buffer the pain, causing the sensation of a “high”. By creating physical pain in reaction to emotional pain, the person doing the NSSI can regulate their own emotions and cope. Other people who do NSSI are attempting to focus. When the world seems far away or they feel numb, pain can help them to feel something and give something to concentrate on. Lastly, some people who do NSSI do so as a way to punish themselves, as a way of asserting control in a powerless situation, or to communicate their emotional pain….or for any number of other highly personal reasons.

NSSI is not an ideal way of coping with life’s stressors. It can be addictive. It’s easy to hurt oneself too much and accidentally attempt suicide or develop infection. Scars and NSSI behavior attract attention, limiting one’s ability to get or maintain a job. Over time it can permanently change a person’s responses to stress and pain.

NSSI is often misunderstood, even in psychology and medicine. Most psychologists and physicians have never experienced NSSI or been close to people who have, so they fail to understand the reasons for NSSI. Until the DSM-V, the only psychological diagnosis that applied was that of borderline personality disorder, which most people who do NSSI do not have.

It can be difficult for a person who self harms to get help. Psychologists and physicians are legally bound to report individuals who are at risk of harming themselves or others to the police. While necessary, it limits confidentiality and can harm trust. Some professionals require that a patient sign a “no self harm contract” before receiving any treatment. Not all patients are willing or able to sign such a contract. Physicians have a limited set of options for treatment: medications (which can take 4-6 weeks to begin to work), referral to a psychologist or psychiatrist, do some level of psychological intervention themselves, or admit the patient to the hospital. And then there’s the question of affordability, especially if you’re unable to hold a job because of the self injury.

Despite these barriers, psychological and medical professionals can be very helpful for people seeking to stop self-injuring. At bare minimum, having a psychologist or physician in the loop can help if a particular incident of self injury goes further than intended. NSSI is a coping strategy, and psychologists and physicians can be very helpful for the issues lying underneath self injury, whether that’s depression, post traumatic stress disorder, or just plain stress.

Lastly, it’s important to know that people can and do learn non-NSSI coping strategies and learn to be self-injury free.

If you want to learn more about non-suicidal self injury, I highly recommend this website. It’s old and the current version is broken, so that links off to the Wayback machine version. It’s still one of the best sites written by people who intimately understand self injury and work to provide information and help others. For a modern alternative, this website also has support forums.