Becoming whole: Could integrative medicine heal the mind-body split in gender dysphoria?

by worriedmom

Worried mom lives in the Northeast, and is the mother of several children. She works in the nonprofit area, and is a voracious reader and writer in the area of gender identity politics. She is available to interact in the comments section of this post.


Imagine this world: A child is sad, depressed, and struggling with uncomfortable, odd, or scary feelings about his or her body. Maybe a little socially awkward, maybe a lot. Worried about the fact that his or her interests don’t seem to fit in well with peers’. Maybe being mocked or bullied, because s/he doesn’t “act like” the other kids. Perhaps that child is having trouble making friends, or is even having intrusive thoughts that make it challenging to succeed at school, athletics or social life. Maybe that child has started puberty, and is concerned or ashamed about the physical changes in his or her body, and the way other people are reacting to those changes. The changes might not feel so good, even be quite unwelcome. The child’s body is perfectly healthy; the mind–not so much.

In this world, our child can go someplace where people know that there’s a solid and extensively documented connection between the mind and the body. In this place, treating the child involves taking into account the physical, social, psychological, community, environmental, and spiritual realities of the child’s life. Here:

  • The patient and practitioner are partners in the healing process.
  • All factors that influence health, wellness and disease are taken into consideration, including body, mind, spirit and community.
  • Providers use all healing sciences to facilitate the body’s innate healing response.
  • Effective interventions that are natural and less invasive are used whenever possible.
  • Good medicine is based in good science. It is inquiry-driven and open to new paradigms.
  • Alongside the concept of treatment, the broader concepts of health promotion and the prevention of illness are paramount.
  • The care is personalized to best address the individual’s unique conditions, needs and circumstances. Practitioners of integrative medicine exemplify its principles and commit themselves to self-exploration and self-development.

integrative medicine circle

Our child receives sensitive, understanding care, to help navigate through a hard time in life. His or her feelings are taken seriously (which isn’t always the same thing as literally). S/he will learn techniques such as meditation, guided imagery, and deep breathing to help cope with discomfort. Our child may have the chance to learn yoga, or T’ai Chi, qi gong, healing touch, and other movement therapies such as the Alexander technique. S/he may try out massage, biofeedback, acupuncture, or hypnotherapy. Non-western therapies, such as Chinese medicine or Ayurveda, are a possibility.

The medical care our child receives is coordinated with other therapies to help him or her feel comfortable, accepted, and confident. Perhaps our child will receive social skills training, with peers, or have the chance to interact with a specially-trained service animal. Maybe someone at this special place will work with our child using art therapy, music therapy, dance therapy or even horticultural therapy.

When all is said and done, our child is healed, calm and well, without ever breaking the skin! S/he is prepared to face the challenges of teenage and adult life, understanding that “feelings aren’t facts,” and equipped with techniques, ideas and support to help manage those unpleasant or unhelpful thoughts should they recur.

What is this place you ask? Well, it’s only the hottest trend in medicine these days. Call it integrative medicine, holistic, alternative, or complementary… whatever you call it, this approach to healing has taken the Western medical world by storm. World-renowned treatment centers have formed integrative medicine units – Memorial Sloan-Kettering, the international cancer center, is one of them. The Mayo Clinic is another. Many integrative medicine centers are affiliated with major teaching hospitals or medical schools. Over 40% of U.S. hospitals now offer at least some integrative medicine techniques to their patients.

The foundation of integrative medicine is the recognition that there is a profound, and not yet completely understood, connection between the human mind and the human body. That this connection exists is no longer open to question – otherwise, no drug trial would control for the placebo effect! Beyond this, research has shown that humans can, indeed, use their minds to control or change the way their bodies feel. These techniques provide a powerful way for people to actively participate in their own health care, and to promote recovery and healing for themselves.

not just the disease

While the jury is still out on the efficacy of some “CAM” practices (CAM being the term of art for “complementary and alternative healthcare and medical practices”), what is not in dispute is CAM’s rising popularity and acceptance among the general population. Far from being a “fringe” or counter-culture phenomenon, in certain patient populations, CAM use has been as high as 90%, and has been estimated at 38% for the United States as a whole.

According to the Academy of Integrative Health and Medicine:

HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores are higher when patients receive integrative services. In one study, 76.2% of patients who received integrative services for pain in the hospital felt their pain was improved as a result of the integrative therapy. [Source] Health-related quality of life was significantly improved for patients who received integrative care. Treatments were also found to reduce blood pressure, decrease anxiety and pain, and increase patient satisfaction in thoracic surgery patients. Additional studies have corroborated the observation of reduced pain and anxiety in inpatients receiving integrative care.

In addition to its use in fields such as pre- and post-surgical and cancer care, integrative medicine is increasingly used to help patients manage or cope with such chronic medical conditions as diabetes, arthritis, Crohn’s disease (and other IBDs), asthma, allergies, hypertension, headache, insomnia, and back pain, as well as psychiatric maladies such as anxiety, depression, phobias and PTSD.

People who practice in this field do not argue that integrative medicine is the cure for all ills:

Using synthetic drugs and surgery to treat health conditions was known just a few decades ago as, simply, “medicine.” Today, this system is increasingly being termed “conventional medicine.” This is the kind of medicine most Americans still encounter in hospitals and clinics. Often both expensive and invasive, it is also very good at some things; for example, handling emergency conditions such as massive injury or a life-threatening stroke. Dr. [Andrew] Weil is unstinting in his appreciation for conventional medicine’s strengths. “If I were hit by a bus,” he says, “I’d want to be taken immediately to a high-tech emergency room.” Some conventional medicine is scientifically validated, some is not.

A 2010 review of the medical, corporate and payer literature showed that:

to start, immediate and significant health benefits and cost savings could be realized throughout our healthcare system by utilizing three integrative strategies: (1) integrative lifestyle change programs for those with chronic disease, (2) integrative interventions for people experiencing depression, and (3) integrative preventive strategies to support wellness in all populations.

boy trapped in girl bodyWe’ve certainly gone quite a while in this post without mentioning the word “transgender,” but the implications for the application of integrative medicine in this area should be crystal clear. If folks are literally or even metaphysically “born in the wrong body,” or if dysphoria is primarily caused by an incongruence between one’s physical sex and one’s gender (“what’s between the ears doesn’t match what’s between the legs”), then dysphoria would appear to be a mind/body problem of the first order.

In fact, it would seem that the transgender phenomenon is the prototypical example of a mind/body disconnect – because in the case of dysphoria, all involved acknowledge that the body in question is perfectly healthy. Something seems to be amiss in the way that the body and the mind are connected, or in the way the mind thinks of or perceives the body. So, what’s the application of integrative medicine principles to the problem of dysphoria? Wouldn’t it seem like the two are a natural fit, and that dysphoria would be the perfect arena in which to use these techniques, which are now in the medical mainstream?

You would think that, but you would be wrong.

Suppose, as is all too common nowadays, that our child’s feelings of distress and discomfort are interpreted by a parent, pediatrician, teacher, or other well-meaning professional, as the harbinger of an incongruence between the child’s sexed body and his or her brain. Let’s visit a few pediatric gender clinics (there are more than 40 such clinics in the United States alone) and see what’s on offer for our confused and hurting child.

At the Boston Children’s Hospital Gender Management Service clinic (GeMS), one of the oldest pediatric gender clinics in the U.S., the course is clear. The child meets with a clinical social worker whose job it is to “make sure that you fully understand our protocol.” The child is referred to a therapist who will need to work with the child for a minimum of three months (gosh, a whole three months to decide on something that will completely dominate the rest of your life!). Next is an appointment with a GeMS psychologist for a specialized “gender-related consultation” and then… it’s off to the races with the pediatric endocrinologist.

The Seattle Children’s Hospital Gender Clinic provides pubertal blockers, cross-sex hormones and “mental health support and readiness discussion.” The shiny new gender clinic at Yale New Haven Hospital offers “puberty blockers,” “cross-hormone therapies” and “mental health services” focusing on “readiness.” Not to worry, of course, since “male to female” surgery may be obtained for those over 18 through Yale Urology. Here’s another one: the Lurie Children’s Hospital of Chicago Gender Development Services department “provides medical consultation, medical intervention (e.g., cross sex and pubertal delaying hormones) and health research with gender non-conforming youth across the developmental spectrum of pediatrics and adolescence.” Oh, and here’s another one: Cincinnati Children’s Hospital’s Adolescent and Transition Medicine Department (note “Transition” is right there in the title of the department) provides “puberty blockers, gender-affirming hormones, menstrual suppression and referrals for therapy, psychiatry, psychology, pediatric endocrinology, pediatric gynecology, nutrition and other services as needed.” The University of Florida’s Youth Gender Program provides “consultation, psychotherapy, psychiatric medication management and assessment of medical readiness for cross-sex hormone therapy.”

Celeb ftmsA short note on the term “readiness.” It’s interesting and perhaps unintentionally revealing that this word shows up on so many pediatric gender clinics’ websites in connection with gender counseling, rather than other terms that could be used such as “suitability,” or even “screening.” “Readiness” connotes a certain inevitability about the transition process – for instance, an educational psychologist assesses a child’s “readiness” for school. The question is not if a child will go to school, of course, but when.

Although I’ll admit I haven’t reviewed the websites of every single one of the 40 U.S. pediatric gender clinics, so far I haven’t seen any that are incorporating integrative medicine techniques and principles. What seems clear is that pediatric gender clinics do not view their mission, in any sense, to include assisting their patients in resolving dysphoric feelings short of medical intervention, much less engaging in discernment or decision-making as to whether medical transition is appropriate in any given case. In fact, as we know, the primary approach to the treatment of dysphoria in the United States has shifted away from the much-maligned “gatekeeping” of the past, to an “affirmative” model. What this means in practice is that the patient (or the patient’s parents) dictate the terms of engagement; if you’re going to a “transition” clinic, guess what you’re going to get?

And although much lip service is given to the idea that a child is on a “gender journey,” it’s pretty clear from the gender clinics’ websites that this journey has only one expected destination. Most of the gender clinics’ websites contain cheerful, if not glowing, testimonials to the happiness that lies ahead for their successfully transitioned patients (“Never a Prince, Always a Princess” “Becoming Lucy,” and of course, “Born in the Wrong Body”).

The Gender and Sex Development Program, housed at the Lurie Children’s Hospital of Chicago, is especially upbeat about the amazing future in store for their pediatric transition patients, with links to a documentary entitled “Growing Up Trans,” testimonials from grateful parents and thankful teens, and multiple links to news stories with titles like “Trans Teen in Chicago: From Surviving to Thriving,” and “When Boys Wear Dresses: What Does it Mean?” (hint: the correct answer isn’t “nothing”).

gender spectrumIn fairness, it’s possible that the mental health assistance pediatric gender clinics promise their young patients could include helping children and families decide whether medical transition is the optimal outcome. It’s impossible to know whether psychiatric care given by a therapist who is professionally affiliated with a transition clinic would still be unbiased about the subject. But anecdotal evidence certainly suggests that “gender therapists” are personally and professionally invested in the transition narrative to the exclusion of all other therapeutic approaches.

Moreover, one of the primary activist goals of the transgender lobby is insuring that young patients do not have access to integrative medicine, CAMS, or to any other treatment modality, besides “gender affirmation” (i.e. medical transition for all who seek it). “Conversion therapy” bills, which prohibit therapists and other professionals from adopting any other treatment approach for pediatric gender dysphoria other than gender affirmation, have already been passed in seven states and many cities, and federal legislation that arguably would enshrine “gender affirmation” as the sole acceptable treatment has been proposed in the current Congress. (Even legislation which confuses the issue would also confuse would-be caregivers and create a chilling effect.) A new lobbying group, 50 Bills 50 States, has been formed to push for anti-conversion therapy laws to be passed in all states that do not currently have them.

One point on which all sides in this debate can agree is that gender dysphoria represents a radical “disconnect” between the mind and the body. But there is another, fundamental, “disconnect” at work here, too. We know, and have known for millennia, that there are many ways to address mind/body dysfunction that do not entail wholesale alteration of the body, which can succeed in healing and strengthening the mind. Integrative medicine blends the best of these techniques with Western medicine to obtain the healthiest outcome for the patient, yet those involved with pediatric transition appear resolutely blinded–if not hostile–to any potential application in their own field… willfully “disconnected” from current medical thinking and practice.

In fact, if the activists get their way, the “healing place” envisioned for our child at the beginning of this article will not only remain imaginary, but will be outlawed throughout the United States. Parents–indeed, all people who care about children–should be very, very worried.