Month: November 2016

Portrait: S & R

/ TomCat / 3 Comments

shane-and-ryan-final-2

Materials: ballpoint pen + colored pencils

Time: 20 hours

Reference: photo of my friend and his husband from their 2015 holiday card. I wanted more practice drawing smiles and I loved both of their smiles in the photo. I also wanted to try drawing two faces in the same sketch.

Comments: this was the most challenging and most enjoyable portrait so far! For some reason I felt more pressure to do a good job on this drawing… maybe because they are faces of friends rather than celebrities so I thought their portrait deserved even more respect. Drawing two faces at the same time was difficult. I had originally planned to finish one face completely and then draw the other, but in order to balance the darkness of shading I had to keep switching back and forth between the two. Since finishing this portrait, I have realized that the blackness of the ink tends to fade slightly over the next couple days… I should have returned to this drawing to darken the ink and even out the shading a few days later.

shane-and-ryan-wip

“I do have my own personal convictions and values, and I live by those. But as an artist… my job is to tell the truth and to capture someone’s spirit on a certain day. And it’s never the whole truth; it’s the truth I experience in a very intense and intimate fashion.”
– Platon (New Republic, A Conversation with Platon, 2013)

Gender Dysphoria Diagnosis (Part 5): GIDYQ-AA Full Text

/ TomCat / 15 Comments

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Part 1: GIDYQ-AA Personal Reflection
Part 2: Psychological Benefits of Diagnostic Confirmation
Part 3: Childhood Gender Non-Conformity
Part 4: DSM and ICD Diagnostic Criteria
~ Part 5 in the Gender Dysphoria Diagnosis series ~
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The most commonly viewed post on this blog is Part 1 of this series: GIDYQ-AA Personal Reflection. The popularity of this post likely reflects considerable curiosity regarding the diagnostic process for gender dysphoria. Part 1 only listed a handful of questions from the questionnaire in the context of my personal reflection. It is nearly impossible to find a complete version of the GIDYQ-AA online without access to scientific journals through academic servers, so I thought it might be helpful for readers to dedicate a post to the full text of the GIDYQ-AA.

Below, I have recorded the Female Assigned at Birth and Male Assigned at Birth versions of the GIDYQ-AA in their entirety. I created my own GIDYQ-AA documents formatted for printing, including a table to record responses to questions and a section for scoring; these documents are available for download.  I also have a section describing the scoring process in detail. Finally, abstracts from the study describing initial development of the GIDYA-AA (Deogracias 2007) and from a study providing further evidence to support the validity of the GIDYQ-AA (Singh 2010) are also included.

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GIDYQ-AA Documents for Download

Female Assigned at Birth (Adult) Word
Female Assigned at Birth (Adult) PDF

Female Assigned at Birth (Adolescent) Word
Female Assigned at Birth (Adolescent) PDF

Male Assigned at Birth (Adult) Word
Male Assigned at Birth (Adult) PDF

Male Assigned at Birth (Adolescent) Word
Male Assigned at Birth (Adolescent) PDF

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GIDYQ-AA (Female Assigned at Birth) Full Text
Response options are “always,” “often,” “sometimes,” “rarely,” or “never.” Items 1, 13, and 27 were reversed scored. For adolescents < 18 years of age, the word woman was changed to girl. Items 1-2, 5-10, 16, and 24-27 were considered to be subjective indicators of gender identity/gender dysphoria. Items 3-4, 11, 13-15, and 17-19 were considered social indicators. Items 20-22 were considered somatic indicators. Items 12 and 23 were considered sociolegal indicators.

01. In the past 12 months, have you felt satisfied being a woman?
02. In the past 12 months, have you felt uncertain about your gender, that is, feeling somewhere in between a woman and a man?
03. In the past 12 months, have you felt pressured by others to be a woman, although you don’t really feel like one?
04. In the past 12 months, have you felt, unlike most women, that you have to work at being a woman?
05. In the past 12 months, have you felt that you were not a real woman?
6. In the past 12 months, have you felt, given who you really are (e.g., what you like to do, how you act with other people), that it would be better for you to live as a man rather than as a woman?
07. In the past 12 months, have you had dreams? If NO, skip to Question 8. 
If YES, Have you been in your dreams?
 If NO, skip to Question 8. If YES, In the past 12 months, have you had dreams in which you were a man?
08. In the past 12 months, have you felt unhappy about being a woman?
09. In the past 12 months, have you felt uncertain about yourself, at times feeling more like a man and at times feeling more like a woman?
10. In the past 12 months, have you felt more like a man than like a woman?
11. In the past 12 months, have you felt that you did not have anything in common with either men or women?
12. In the past 12 months, have you been bothered by seeing yourself identified as female or having to check the box “F” for female on official forms (e.g., employment applications, driver’s license, passport)?
13. In the past 12 months, have you felt comfortable when using women’s restrooms in public places?
14. In the past 12 months, have strangers treated you as a man?
15. In the past 12 months, at home, have people you know, such as friends or relatives, treated you as a man?
16. In the past 12 months, have you had the wish or desire to be a man?
17. In the past 12 months, at home, have you dressed and acted as a man?
18. In the past 12 months, at parties or at other social gatherings, have you presented yourself as a man?
19. In the past 12 months, at work or at school, have you presented yourself as a man?
20. In the past 12 months, have you disliked your body because it is female (e.g., having breasts or having a vagina)?
21. In the past 12 months, have you wished to have hormone treatment to change your body into a man’s?
22. In the past 12 months, have you wished to have an operation to change your body into a man’s (e.g., to have your breasts removed or to have a penis made)?
23. In the past 12 months, have you made an effort to change your legal sex (e.g., on a driver’s licence or credit card)?
24. In the past 12 months, have you thought of yourself as a “hermaphrodite” or an “intersex” rather than as a man or woman?
25. In the past 12 months, have you thought of yourself as a “transgendered person”?
26. In the past 12 months, have you thought of yourself as a man?
27. In the past 12 months, have you thought of yourself as a woman?

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GIDYQ-AA (Male Assigned at Birth) Full Text
Response options are “always,” “often,” “sometimes,” “rarely,” or “never.” Items 1, 13, and 27 were reversed scored. For adolescents < 18 years of age, the word man was changed to boy. Items 1-2, 5-10, 16, and 24-27 were considered to be subjective indicators of gender identity/gender dysphoria. Items 3-4, 11, 13-15, and 17-19 were considered social indicators. Items 20-22 were considered somatic indicators. Items 12 and 23 were considered sociolegal indicators.

01. In the past 12 months, have you felt satisfied being a man?
02. In the past 12 months, have you felt uncertain about your gender, that is, feeling somewhere in between a man and a woman?
03. In the past 12 months, have you felt pressured by others to be a man, although you don’t really feel like one?
04. In the past 12 months, have you felt, unlike most men, that you have to work at being a man?
05. In the past 12 months, have you felt that you were not a real man?
06. In the past 12 months, have you felt, given who you really are (e.g., what you like to do, how you act with other people), that it would be better for you to live as a woman rather than as a man?
07. In the past 12 months, have you had dreams? If NO, skip to Question 8. 
If YES, Have you been in your dreams? 
If NO, skip to Question 8.
 If YES, In the past 12 months, have you had dreams in which you were a woman?
08. In the past 12 months, have you felt unhappy about being a man?
09. In the past 12 months, have you felt uncertain about yourself, at times feeling more like a woman and at times feeling more like a man?
10. In the past 12 months, have you felt more like a woman than like a man?
11. In the past 12 months, have you felt that you did not have anything in common with either women or men?
12. In the past 12 months, have you been bothered by seeing yourself identified as male or having to check the box “M” for male on official forms (e.g., employment applications, driver’s license, passport)?
13. In the past 12 months, have you felt comfortable when using men’s restrooms in public places?
14. In the past 12 months, have strangers treated you as a woman?
15. In the past 12 months, at home, have people you know, such as friends or relatives, treated you as a woman?
16. In the past 12 months, have you had the wish or desire to be a woman?
17. In the past 12 months, at home, have you dressed and acted as a woman?
18. In the past 12 months, at parties or at other social gatherings, have you presented yourself as a woman?
19. In the past 12 months, at work or at school, have you presented yourself as a woman?
20. In the past 12 months, have you disliked your body because it is male (e.g., having a penis or having hair on your chest, arms, and legs)?
21. In the past 12 months, have you wished to have hormone treatment to change your body into a woman’s?
22. In the past 12 months, have you wished to have an operation to change your body into a woman’s (e.g., to have your penis removed or to have a vagina made)?
23. In the past 12 months, have you made an effort to change your legal sex (e.g., on a driver’s licence or credit card)?
24. In the past 12 months, have you thought of yourself as a “hermaphrodite” or an “intersex” rather than as a man or woman?
25. In the past 12 months, have you thought of yourself as a “transgendered person”?
26. In the past 12 months, have you thought of yourself as a woman
27. In the past 12 months, have you thought of yourself as a man?

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gidyqaa-full-text

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GIDYQ-AA Scoring
The table at the bottom of the photo above shows how the questionnaire is scored. The scoring process is the same for the female-assigned-at-birth and the male-assigned-at-birth versions. I have summarized the scoring process in more detail below.

  1. Participant fills out the questionnaire, indicating how often each question applies to them (“always,” “often,” “sometimes,” “rarely,” or “never”).
  2. The number of X’s in each category (“always,” “often,” “sometimes,” “rarely,” and “never”) are added up. Items 1, 13, and 27 are reversed scored, which means that for those questions, an “always” response would actually be counted as “never” and an “often” response would actually be counted as “rarely.”
  3. The total number of responses in each category (including reverse scored items) are then multiplied by weighting factors: the number of “always” responses is multiplied by 1, the number of “often” responses is multiplied by 2, the number of “sometimes” responses is multiplied by 3, the number of “rarely” responses is multiplied by 4, and the number of “never” responses is multiplied by 5.
  4. The multiplied totals for each category are then added together to give the Raw Score.
  5. The Raw Score is then divided by 27 to give the Scaled Score. (Note: if participants left any items blank, the Raw Score is divided by the total number of items completed. For example, if a participant did not respond to 2 of the items on the questionnaire, the Raw Score would be divided by 25 instead of by 27 to give the Scaled Score).

Based on published studies evaluating the GIDYQ-AA, a Scaled Score less than 3.0 is strongly suggestive of gender dysphoria, while a Scaled Score greater than 3.0 is more likely to reflect the absence of gender dysphoria. However, no single questionnaire or scoring system can perfectly capture all of the variation in gender identity and personal goals (and I have previously discussed many of the problems that I think may interfere with the utility of the questionnaire), so scores on the GIDYQ-AA are not necessarily definitive and should not replace each individual’s sense of their own identity.

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“The present study reports on the construction of a dimensional measure of gender identity (gender dysphoria) for adolescents and adults. The 27-item gender identity/gender dysphoria questionnaire for adolescents and adults (GIDYQ-AA) was administered to 389 university students (heterosexual and nonheterosexual) and 73 clinic-referred patients with gender identity disorder. Principal axis factor analysis indicated that a one-factor solution, account ing for 61.3% of the total variance, best fits the data. Factor loadings were all >.30 (median, .82; range, .34-96). A mean total score (Cronbach’s alpha, .97) was computed, which showed strong evidence for discriminant validity in that the gender identity patients had significantly more gender dysphoria than both the heterosexual and nonheterosexual university students. Using a cut-point of 3.00, we found the sensitivity was 90.4% for the gender identity patients and specificity was 99.7% for the controls. The utility of the GIDYQ-AA is discussed.” (abstract, Deogracias 2007)

“This study aimed to provide further validity evidence for the dimensional measurement of gender identity and gender dysphoria in both adolescents and adults. Adolescents and adults with gender identity disorder (GID) were compared to clinical control (CC) adolescents and adults on the Gender Identity=Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ–AA), a 27-item scale originally developed by Deogracias et al. (2007). In Study 1, adolescents with GID (n1⁄444) were compared to CC adolescents (n1⁄498); and in Study 2, adults with GID (n1⁄441) were compared to CC adults (n1⁄494). In both studies, clients with GID self-reported significantly more gender dysphoria than did the CCs, with excellent sensitivity and specificity rates. In both studies, degree of self-reported gender dysphoria was significantly correlated with recall of cross-gender behavior in childhood—a test of convergent validity. The research and clinical utility of the GIDYQ–AA is discussed, including directions for further research in distinct clinical populations.” (abstract, Singh 2010)

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References

Deogracias JJ, Johnson LL, Meyer-Bahlburg HFL, et al. The Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults. 2007. The Journal of Sex Research 44(4):370-79. 

Singh D, Deogracias J, Johnson LL, et al. The Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults: further validity evidence. 2010. The Journal of Sex Research 47(1): 49-58. 

Self Portrait #1

/ TomCat / Leave a comment

self-portrait-1-final

Drawing this self portrait was a fascinating experience.

Before I ever start a drawing, I spend a lot of time analyzing the face in the reference photo, observing the technical aspects of facial proportions and composition and contrast, and figuring out how to capture the emotion in their expression. It’s an intellectual and artistic analysis done from a detached, non-judgmental, keenly observant, and empathetic perspective. This process has completely changed the way I see my own face in the mirror. Now I see my face with so much more interest – what’s unique about her face? how would I capture her expression there? – now I see my face with so much more compassion.

Drawing my self portrait (titled #1 because I think there will be more!) was very strange at first, like an out-of-body experience, similar to my mirror experiments but more prolonged and more precise. I deliberately drew all the facial imperfections that have long been a source of self-consciousness for me: acne scars on my left cheek, the vein that so prominently traverses my left temple, right iris heterochromia.

After I finished the sketch, I realized that I actually like my eyes – they are very big, very expressive, and asymmetrically colourful. I also like my collarbones and the upper pectoral definition on my chest, the hard-earned result of thousands of pushups. And I’ve always loved my short, messy hair.

I never thought I would be capable of drawing my own face. My self portrait took six hours to complete… six hours staring at my face, after six years of showering in the dark and avoiding mirrors with pathological self-loathing.

self-portrait-1-laptop

Materials: ballpoint pen (black) + black fine-point Sharpie marker + Staedtler colored pencils

Time: 6  hours

Reference: photo of myself taken July 16, 2016 on the stairs at a city train station. I chose that photo because the lighting provided good contrast and the cautious, wary facial expression is characteristic of my chronic skepticism.

Comments: I sign most of my drawings as TM. But I have as many names as I do clothes, so when I started drawing again, I was initially unsure what my signature should be. Most commonly I go by Thomas or by my given name (which starts with J), so I decided to sign with a provisional TM. I can turn the T into a capital J with a single curved stroke of the pen if I want. I signed this self portrait with JM because my given name and the face I drew have been mine my whole life. Thomas is a newer addition.

self-portrait-1-wip

Irene Adler: Do you know the big problem with a disguise, Mr. Holmes? However hard you try, it’s always a self-portrait.
Sherlock Holmes: You think I’m a vicar with a bleeding face?
Irene Adler: No, I think you’re damaged, delusional and believe in a higher power. In your case, it’s yourself. And somebody loves you.
– BBC Sherlock (S02, E01 – A Scandal in Belgravia)

Portrait: P!nk

/ TomCat / Leave a comment

pink-final

Materials: ballpoint pen (black, green) + black fine-point Sharpie marker + Staedtler colored pencils

Time: 5 hours

Reference: P!nk, pop/R&B singer, songwriter, actress. I love her androgynous appearance. I also wanted to try another smile (first smile Tom Hardy).

Comments: I was very upset about external circumstances while completing this drawing, so I did not enjoy the process but I forced myself to continue drawing anyway. I am not happy with this sketch – her hairline is too low on her forehead, and the shading is poorly done. But I do like her smile, and I’m glad I was able to finish the drawing.

pink-wip

So raise your glass if you are wrong
In all the right ways, all my underdogs
We will never be, never be anything but loud
And nitty gritty, dirty little freaks
Won’t you come on and come on and raise your glass!
Just come on and come on and raise your glass!
– P!nk (Raise Your Glass, 2010)

He Who Fights With Monsters

/ TomCat / 2 Comments

falling-man

I have not been posting much writing lately.

I was hospitalized (for the second time) on a psychiatric unit from May 9 to August 12, 2016. As I alluded to in previous posts, my time on the psychiatric unit was incredibly valuable with so many radical improvements physically and psychologically. I was allowed to use my laptop during off-unit privileges and I wrote extensively – in notes to myself and messages to friends – about the changes and insights that developed during my hospitalization. I occasionally posted on this blog during that time, but most of my writing remained unposted because there was simply too much to process so quickly. I had expected to maintain my positive trajectory following discharge so I had planned to revise and post my writing here shortly after leaving the hospital.

But now, trying to retrospectively capture the enthusiasm and excitement in my old writing feels forced and hollow. Over the past few months, most of the major improvements have deteriorated as rapidly and radically as they arose, and I have been left to watch my mind disintegrate once again. As this decline has progressed, my despair has been considerably amplified by the knife-sharp awareness of just how much I had gained in hospital and how much I am in the process of losing.

So I have avoided writing altogether, instead posting my drawings and my poems and my photos which have taken on much darker undertones in recent weeks. It would, perhaps, be something of a delusion to think that anyone has noticed the change in the nature of my posts. Very few people visit this blog, and of those that do, I doubt that most of them have the patience or interest to read my writing in its entirety. My closest friends have often criticized my writing in my correspondence to them as being too lengthy, too distressing, or too rigorously academic. I have no reason to believe that my writing here would be perceived any differently by an online audience.

Is sharing these thoughts a desperate self-pitying bid for attention? No. Because any attention granted in response to such a plea would be quite superficial and quite meaningless, so it would be illogical to seek that kind of attention. No. This is simply an honest account of my current experience. I value authenticity above most other personal attributes. To me, authenticity – and her sister trait, vulnerability – represent extraordinary courage: the courage to “endure the sharp pains of self-discovery” in the process of understanding one’s own experience, and the courage to share this experience with others despite the risk of invalidation and rejection that plague every potential human interaction.

One of the most confusing patterns that I’ve noticed as my depression has worsened during recent months has been the withdrawal of many of my closest friends. Formerly close relationships have become strained, distant, and detached. I have been trying very hard to understand what has contributed to this widespread withdrawal. At first I believed that I was the common denominator, and I spent many sleepless nights trying to figure out what is so wrong with me that my friends are no longer willing to engage with me in ways that feel genuine. But now I wonder if it is less a problem with me, and more a problem with them. Perhaps the common denominator is their inability or unwillingness to tolerate the excruciating intensity of the sadness, loneliness, hopelessness, and meaninglessness that dominate my psychological landscape.

Unlike previous episodes of depression, my current experience is also dominated by anger, a towering and terrifying RAGE. Often this rage is directed at myself, rage like drops of blood attracting a predatory frenzy of depressive sharks. Sometimes this rage is directed at the world, rage like hand grenades exploding in the face of societal adherence to oppressive conventions that marginalize so many broken people. And sometimes this rage has no target, rage like a forest fire burning at the whim of wind and weather, the crackling searing heat omnivorous and destructive. But fires are essential for regeneration of forest vegetation. Maybe my rage is the first step towards some kind of psychological reintegration.

Direct feedback from my friends and my own observations during interactions with them suggests that humans are fundamentally distressed by intense emotions, especially anger, in themselves or in others. I am not sure why emotional intensity is so uncomfortable for them, and they have all been unable to coherently articulate the reasons behind their discomfort. But I wonder about several possible contributing factors.

1. I think many people retain a false and judgmental belief that intense emotion is necessarily the result of some kind of distortion or magnification on the part of the person expressing it. This belief may be the internalized result of an affect-phobic culture. This belief may also reflect the fragility of human egos finding comfort in a comparative notion that the absence of such painful intensity in themselves represents their own superior emotional regulation.

2. I think many people also believe that the expression of intense emotion necessarily implies a desire or expectation to reduce that intensity. Almost without exception, people automatically respond to someone else’s pain with advice and suggestions intended to help fix the problem or suppress the emotional intensity. I think this tendency reflects an unwillingness to accept their own powerlesssness. People seem largely unable to understand how their aggressive attempts to be helpful actually eclipse their capacity to empathize.

3. And I think that most people are afraid of truly empathizing with intense pain because doing so would require acknowledging their own innate potential to experience pain beyond their control. Such an acknowledgment would shatter illusions of personal agency. When somebody like me calmly and rationally outlines the meaninglessness and futility of life when all sense of purpose, satisfaction, and self-worth have been stripped away, people are forced to re-evaluate the framework they use to justify their own worth and purpose – they must then confront the threatening truth that these ideas are often built around tenuous and artificial self-delusions.

I have always tried very hard to avoid overwhelming my friends with the negative aspects of my experience. I have shared the fact of my depression with them, but I have intentionally minimized the severity of it, I have openly and deliberately invalidated myself in conversation with them, and I have often completely avoided mentioning my most distressing experiences. These behaviors represent my conflicted and evidently unsuccessful attempts to be authentic yet avoid provoking their discomfort. But as my depression becomes more debilitating and more painful, it becomes increasingly difficult for me to hide it. And as the intensity of my pain becomes more evident to them, the more uncomfortable they become and the more they withdraw from me. I have seen their faces fall, I have felt the cooling of the air between us, I have heard their static silence oozing through the speaker on my phone whenever I allow them to see a fraction of my truth. They cannot face my reality, so they retreat and withdraw. Their silence becomes deafening, and their absence suffocating.

“Wer mit Ungeheuern kämpft, mag zusehn, dass er nicht dabei zum Ungeheuer wird. Und wenn du lange in einen Abgrund blickst, blickt der Abgrund auch in dich hinein.”
– Friedrich Nietzsche (Aphorism 146, Beyond Good and Evil, 1886)

[Translation: He who fights with monsters should look to it that he himself does not become a monster.
And if you gaze long into an abyss, the abyss also gazes into you].

Depression is a monster. And I feel like an abyss. My existence is intensely painful. This pain is all-consuming, inescapable, and terrifyingly rational. I move from day to day accompanied by more distress than most people have ever known or even have the capacity to imagine. When I stop protecting them from me and allow them to glimpse the true extent of my hopelessness, they are horrified to find themselves gazing into the abyss. And they are even more horrified to find the abyss gazing back at them with a familiar face.

I never knew
I never knew that everything was falling through
That everyone I knew was waiting on a cue
To turn and run when all I needed was the truth
But that’s how it’s got to be
It’s coming down to nothing more than apathy
I’d rather run the other way than stay and see
The smoke and who’s still standing when it clears
Everyone knows I’m in
Over my head
Over my head
– Over My Head (Cable Car) (The Fray, 2005)