Gender Dysphoria or Schizophrenia or both? How to tell, what to do?
September 16, 2014 2:39 PM Subscribe
Looking for information and support for family of a man grappling with (maybe) emerging schizophrenia and/or gender dysphoria.
I have a friend who is a 35 year old man and who has been diagnosed bipolar for some time. He has recently given up medication, begun refusing treatment, and returned to performing some very unusual behaviors which are leading his family and friends to suspect schizophrenia. He disappeared from contact with family to try on being homeless, he ran on the beach for 14 hours to answer a test from God, and most recently, he overdosed on cold medicines and left his room crowded with notes and bizarre signs. He holds very strange mystical beliefs that are out of step with rational thinking. His family is working out what to do, and how firmly to intervene. He is living presently with his parents.
When he is addressed about his erratic and self-endangering behaviors now, he claims that his gender dysphoria is the motivation for it all. However, he is not pushing for transition in any way we've recognized. The topic of the notes he littered his room with was primarily womanhood and veneration of his mother. He has "identified" with women for a long time, though we aren't exactly sure how deep that goes; he has displayed an interest in women in media, for example, and in the "feminine" qualities of empathy and kindness, in contrast to "masculine" traits. Only his past year has he come out with the news that he believes his body is wrong. The fact that this news coincides with a rise in erratic behavior is confusing.
So, the family is very mixed up about what to do, and how to perceive and proceed about this. Because the discourse about dysmorphia coming from him is mixed with other things that seem to clearly signal a big break in mental wellness terms, it's hard for them to know how to react. They are committed to being supportive, though they are coming from a conservative Christian background and are perhaps not as proactive as they might be.
As a friend, I offered that there are surely resources out there to help them feel tethered, or less alone. Since gender dysphoria and mental illness have been regarded together so long, I suspect there are tools and guidelines to help tease them apart? I'm not sure. I hope none of this reads as intolerant or insensitive, as that attitude is not the one the family nor I hold toward people battling mental illness or gender dysphoria. But they're right now in the thick of confusion on this subject, and since he's refusing treatment, this question is more about supplying the family with education and resources to put his behavior in context than supplying him with tools for healthy progress through either issue.
I have a friend who is a 35 year old man and who has been diagnosed bipolar for some time. He has recently given up medication, begun refusing treatment, and returned to performing some very unusual behaviors which are leading his family and friends to suspect schizophrenia. He disappeared from contact with family to try on being homeless, he ran on the beach for 14 hours to answer a test from God, and most recently, he overdosed on cold medicines and left his room crowded with notes and bizarre signs. He holds very strange mystical beliefs that are out of step with rational thinking. His family is working out what to do, and how firmly to intervene. He is living presently with his parents.
When he is addressed about his erratic and self-endangering behaviors now, he claims that his gender dysphoria is the motivation for it all. However, he is not pushing for transition in any way we've recognized. The topic of the notes he littered his room with was primarily womanhood and veneration of his mother. He has "identified" with women for a long time, though we aren't exactly sure how deep that goes; he has displayed an interest in women in media, for example, and in the "feminine" qualities of empathy and kindness, in contrast to "masculine" traits. Only his past year has he come out with the news that he believes his body is wrong. The fact that this news coincides with a rise in erratic behavior is confusing.
So, the family is very mixed up about what to do, and how to perceive and proceed about this. Because the discourse about dysmorphia coming from him is mixed with other things that seem to clearly signal a big break in mental wellness terms, it's hard for them to know how to react. They are committed to being supportive, though they are coming from a conservative Christian background and are perhaps not as proactive as they might be.
As a friend, I offered that there are surely resources out there to help them feel tethered, or less alone. Since gender dysphoria and mental illness have been regarded together so long, I suspect there are tools and guidelines to help tease them apart? I'm not sure. I hope none of this reads as intolerant or insensitive, as that attitude is not the one the family nor I hold toward people battling mental illness or gender dysphoria. But they're right now in the thick of confusion on this subject, and since he's refusing treatment, this question is more about supplying the family with education and resources to put his behavior in context than supplying him with tools for healthy progress through either issue.
Their best bet to start is probably to connect with a psychiatrist who can help the parents work through their reactions and offer professional advice on what to do next.
35 is, AFAIK, pretty late to be developing schizophrenia.
If he has deliberately overdosed, he is probably a danger to himself. Involuntary committment might be an avenue to explore to help him gain some rationality.
posted by feckless fecal fear mongering at 3:10 PM on September 16, 2014 [1 favorite]
35 is, AFAIK, pretty late to be developing schizophrenia.
If he has deliberately overdosed, he is probably a danger to himself. Involuntary committment might be an avenue to explore to help him gain some rationality.
posted by feckless fecal fear mongering at 3:10 PM on September 16, 2014 [1 favorite]
NAMI is probably the best place to start, they have great resources for family members of people with mental illness.
At this point I would encourage you and the family to leave aside the issue of whether or not he has schizophrenia/gender dysmorphia. Irregardless of what his diagnosis is, the most important issue here is that he appears to be at serious risk of harming himself or committing suicide. They should call 911 if he does anything like overdose or go on 14 hour runs again.
posted by fox problems at 3:42 PM on September 16, 2014 [2 favorites]
At this point I would encourage you and the family to leave aside the issue of whether or not he has schizophrenia/gender dysmorphia. Irregardless of what his diagnosis is, the most important issue here is that he appears to be at serious risk of harming himself or committing suicide. They should call 911 if he does anything like overdose or go on 14 hour runs again.
posted by fox problems at 3:42 PM on September 16, 2014 [2 favorites]
Definitely NAMI is a great resource for his family to find support from others who have been in similar situations to what they are facing and have faced. I would like to echo the point made above that what the diagnosis is doesn't matter so much in terms of what actions the family takes next. They don't need to figure out why he is doing what he is doing - they need to figure out whether he is safe without the ongoing psychiatric treatment that he is currently not compliant with. His safety determines whether they need to intervene or not.
I too would express concern about whether he is safe enough to continue in his current lifestyle based on the information you've given here. It is unclear whether he had medical treatment for his overdose or how long ago it was, but even without an overdose, a person who is so mentally ill that they are out of touch with reality enough to be a danger to themselves or others should be evaluated for inpatient psychiatric treatment. Deliberate self harm or activities that could cause serious self-harm being done without regard to one's health because of psychiatric illness/delusions are behaviors that fall within this category. It can be a very fraught decision to try to get someone who doesn't want psychiatric treatment involuntarily evaluated and possibly admitted for psychiatric treatment, but really, there seem to be limited other options here aside from disengaging (which doesn't seem appropriate given that he doesn't sound like he can take care of himself). One option would be to speak with the medical professional who was treating him up until he recently started to avoid treatment about what is going on, because they would also potentially have the power to put into motion the process to get him evaluated if he seems to be unsafe.
The family should not be trying to diagnose him at home. There are definitely guidelines and tools for psychiatric diagnosis, most notably the DSM-5 (considered the main reference for this in medicine, updates for schizophrenia and psychotic disorders criteria are linked - I can't find the specifics of DSM-5 criteria freely available, but here is the most recent DSM-IV version for comparison, and here is DSM-5's PDF on gender dysphoria updates), but these are meant to be interpreted by physicians with 4 or more years of post-medical-school training in psychiatry - that's what they are trained for, it's a challenging job, and this man's family members can't be expected to do it themselves.
posted by treehorn+bunny at 4:49 PM on September 16, 2014 [2 favorites]
I too would express concern about whether he is safe enough to continue in his current lifestyle based on the information you've given here. It is unclear whether he had medical treatment for his overdose or how long ago it was, but even without an overdose, a person who is so mentally ill that they are out of touch with reality enough to be a danger to themselves or others should be evaluated for inpatient psychiatric treatment. Deliberate self harm or activities that could cause serious self-harm being done without regard to one's health because of psychiatric illness/delusions are behaviors that fall within this category. It can be a very fraught decision to try to get someone who doesn't want psychiatric treatment involuntarily evaluated and possibly admitted for psychiatric treatment, but really, there seem to be limited other options here aside from disengaging (which doesn't seem appropriate given that he doesn't sound like he can take care of himself). One option would be to speak with the medical professional who was treating him up until he recently started to avoid treatment about what is going on, because they would also potentially have the power to put into motion the process to get him evaluated if he seems to be unsafe.
The family should not be trying to diagnose him at home. There are definitely guidelines and tools for psychiatric diagnosis, most notably the DSM-5 (considered the main reference for this in medicine, updates for schizophrenia and psychotic disorders criteria are linked - I can't find the specifics of DSM-5 criteria freely available, but here is the most recent DSM-IV version for comparison, and here is DSM-5's PDF on gender dysphoria updates), but these are meant to be interpreted by physicians with 4 or more years of post-medical-school training in psychiatry - that's what they are trained for, it's a challenging job, and this man's family members can't be expected to do it themselves.
posted by treehorn+bunny at 4:49 PM on September 16, 2014 [2 favorites]
It sounds more like a manic episode than anything else. They need to get him back on his meds. It's very possible that this is all just down to not being medicated.
posted by kinddieserzeit at 4:58 PM on September 16, 2014 [2 favorites]
posted by kinddieserzeit at 4:58 PM on September 16, 2014 [2 favorites]
(I am not a doctor or your doctor and can't provide a diagnosis. It's worth considering that someone can have both gender dysphoria and schizophrenia - your friend may be a trans woman or gender non-conforming in some way and also be struggling with bipolar disorder or schizophrenia and neither thing would invalidate the other or cause the other. It seems like the issue is that your friend is doing dangerous and apparently delusional stuff which is non-standard for cis people, trans people and gender non-conforming people.)
posted by Frowner at 6:36 PM on September 16, 2014 [2 favorites]
posted by Frowner at 6:36 PM on September 16, 2014 [2 favorites]
I had a family member who was bipolar and was married to a person who was bipolar. Echoing treehorn+bunny, this is not really something to mess around with. You need to get this person to a hospital for evaluation. I have done it, trickily, by saying I am going and they have to go with me, and then the social worker can evaluate them. I am not kidding: this is very serious, they can do all kinds of things, and you have to get them into a hospital for evaluation. But there are other methods, like calling the cops and telling them the person took an overdose of something or saying they indicated self-harm. I feel the gender stuff is really a reflection of the bipolar... connecting with god, or the goddess or mother figure, yes, it's way out there and you have no idea what's going on in their mind, but it's not connected with reality, it's more like... LSD for a while, and everything makes just so much sense, and you are an extension of that, not their friend.
Please get this person help ASAP, no matter what method you use: calling the cops, getting a judge to intervene, whatever. Forget the gender and religion thing, this poor person needs medical help, right way. Trust me, as a family member of someone like this, I know what it means to stand by and go wtf, but this is not the time to stand by.
posted by Marie Mon Dieu at 6:54 PM on September 16, 2014 [1 favorite]
Please get this person help ASAP, no matter what method you use: calling the cops, getting a judge to intervene, whatever. Forget the gender and religion thing, this poor person needs medical help, right way. Trust me, as a family member of someone like this, I know what it means to stand by and go wtf, but this is not the time to stand by.
posted by Marie Mon Dieu at 6:54 PM on September 16, 2014 [1 favorite]
To me it sounds like bipolar Manic state with psychotic features. However this honestly could be a stimulant addiction (meth, crack/cocaine etc). These drugs can cause all of these symptoms including the paranoia and the hallucinations.
Of course I am a person on the Internet who cannot diagnose .
You're best bet is to get him back on medication in whatever way possible. Until his thoughts are organized and he can sit still nothing can be worked on. He may have some dismorphia. He also may have a non mainstream religious belief system that is okay to have normally but becomes problematic when not being able to differentiate reality from hallicinations.
(Note I am pagan and work in the mental health field. I have a very very large opinion on non mainstream religious beliefs that can be construed into mental illness when it is a widely held belief of the subculture. That doesn't sound like that's going on here but if you want me to chat to you about that soapbox just me mail me. )
posted by AlexiaSky at 6:55 PM on September 16, 2014 [3 favorites]
Of course I am a person on the Internet who cannot diagnose .
You're best bet is to get him back on medication in whatever way possible. Until his thoughts are organized and he can sit still nothing can be worked on. He may have some dismorphia. He also may have a non mainstream religious belief system that is okay to have normally but becomes problematic when not being able to differentiate reality from hallicinations.
(Note I am pagan and work in the mental health field. I have a very very large opinion on non mainstream religious beliefs that can be construed into mental illness when it is a widely held belief of the subculture. That doesn't sound like that's going on here but if you want me to chat to you about that soapbox just me mail me. )
posted by AlexiaSky at 6:55 PM on September 16, 2014 [3 favorites]
I absolutely agree that the most helpful thing for everyone will be to try to get this person in front of a psychiatrist. I would want everyone to be aware, however, that having a patient involuntarily committed to an inpatient psychiatric hospitalization is actually very hard, and "being actively psychotic and not taking medication" is not usually enough to do it. (The person usually needs to be actively suicidal -- as in, going to hurt themselves right then -- or so disabled by their mental illness that they are unable to provide for their basic needs like shelter, food, or physical safety.)
So I wouldn't assume that putting your friend in front of a doctor will automatically lead to a hospitalization. Which can be good, actually, in terms of talking people into going to see the doctor.
posted by jaguar at 8:23 PM on September 16, 2014 [1 favorite]
So I wouldn't assume that putting your friend in front of a doctor will automatically lead to a hospitalization. Which can be good, actually, in terms of talking people into going to see the doctor.
posted by jaguar at 8:23 PM on September 16, 2014 [1 favorite]
I have zero experience with schizophrenia, but I am trans so at least I have maybe half a clue instead of no clue at all.
I don't think there's anything wrong with acknowledging that his feelings about gender may be connected to his mental problems, as long as you're not pathologizing being trans. You're not saying it's wrong to be a jogger when you say its scary as hell that he's running on the beach for 14 hours because God told him to. He's doing all kinds of new, surprising stuff right now, and coming out as trans is one of those things. Just as he may run until his toenails fall off, he may do harmful things related to gender. You're full entitled to worry about anything new he's obsessively pursuing right now. Don't feel guilty about that.
If he venerates his mother that much, hopefully he'll listen to her when she tells him he needs to stay on his meds and stay in therapy. (Assuming she's still around.) I'd suggest trying to get him into a transgender support group ASAP. For various reasons that could be very problematic for him and other other members of the group, but I think it's important to try. Depending on where you are in the country, there may be a LGBT group in the area that could hook him up with trans people who have been homeless and/or had mental health issues. Definitely give that a try. If he meets people he can look up to, who have been through some of what he's going through, hopefully he'll listen to their advice.
Finally, should we be referring to him as she?
posted by Ursula Hitler at 9:55 PM on September 16, 2014 [4 favorites]
I don't think there's anything wrong with acknowledging that his feelings about gender may be connected to his mental problems, as long as you're not pathologizing being trans. You're not saying it's wrong to be a jogger when you say its scary as hell that he's running on the beach for 14 hours because God told him to. He's doing all kinds of new, surprising stuff right now, and coming out as trans is one of those things. Just as he may run until his toenails fall off, he may do harmful things related to gender. You're full entitled to worry about anything new he's obsessively pursuing right now. Don't feel guilty about that.
If he venerates his mother that much, hopefully he'll listen to her when she tells him he needs to stay on his meds and stay in therapy. (Assuming she's still around.) I'd suggest trying to get him into a transgender support group ASAP. For various reasons that could be very problematic for him and other other members of the group, but I think it's important to try. Depending on where you are in the country, there may be a LGBT group in the area that could hook him up with trans people who have been homeless and/or had mental health issues. Definitely give that a try. If he meets people he can look up to, who have been through some of what he's going through, hopefully he'll listen to their advice.
Finally, should we be referring to him as she?
posted by Ursula Hitler at 9:55 PM on September 16, 2014 [4 favorites]
She may well be trans. A lot of trans people are also mentally ill. A lot of trans people come out during mental health crises — when all your other shit is falling apart on you, keeping your gender a secret is a lot harder.
But like everyone else is saying, if she is trans, then she is a trans woman who is in the middle of a psychiatric emergency. She will still be a trans woman when she's out the other end of this emergency. This is like if someone came out to you while you were in the middle of rescuing them from a burning building. "Oh my god, thank you. I'm so glad you told me. Now let's get you the fuck out of here."
Unfortunately, being a schizophrenic trans person is not easy. Many doctors will be unwilling to even consider giving her any sort of transition-related care, even once her symptoms are under control. That sucks really hard, but it's the truth. From the linked article: “You can’t prove a negative,” he said. “I’m not saying you’re not transgendered, but I can never be sure that this transgendered thing is legitimate.” And that's someone whose schizophrenic symptoms didn't include any gender-related obsessions or delusions. So your friend is going to have an uphill battle to get her gender identity recognized — and to transition, if she ultimately decides she wants to — even once she's out of this immediate crisis.
The way I see it, what her family can do to help here is to be an advocate for her on both fronts — help push her to get the mental health care she needs, and help her push her doctors to recognize her gender and give her transition-related care as needed. At the moment the first of those is much more urgent. In the long run, assuming she is indeed trans, they will both be deeply necessary.
posted by nebulawindphone at 10:35 AM on September 20, 2014 [1 favorite]
But like everyone else is saying, if she is trans, then she is a trans woman who is in the middle of a psychiatric emergency. She will still be a trans woman when she's out the other end of this emergency. This is like if someone came out to you while you were in the middle of rescuing them from a burning building. "Oh my god, thank you. I'm so glad you told me. Now let's get you the fuck out of here."
Unfortunately, being a schizophrenic trans person is not easy. Many doctors will be unwilling to even consider giving her any sort of transition-related care, even once her symptoms are under control. That sucks really hard, but it's the truth. From the linked article: “You can’t prove a negative,” he said. “I’m not saying you’re not transgendered, but I can never be sure that this transgendered thing is legitimate.” And that's someone whose schizophrenic symptoms didn't include any gender-related obsessions or delusions. So your friend is going to have an uphill battle to get her gender identity recognized — and to transition, if she ultimately decides she wants to — even once she's out of this immediate crisis.
The way I see it, what her family can do to help here is to be an advocate for her on both fronts — help push her to get the mental health care she needs, and help her push her doctors to recognize her gender and give her transition-related care as needed. At the moment the first of those is much more urgent. In the long run, assuming she is indeed trans, they will both be deeply necessary.
posted by nebulawindphone at 10:35 AM on September 20, 2014 [1 favorite]
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I have a friend who is a 35 year old man and who has been diagnosed bipolar for some time. He has recently given up medication, begun refusing treatment, and returned to performing some very unusual behaviors which are leading his family and friends to suspect schizophrenia.
Bipolar disorder with psychotic features is a thing. See this link for a start. Especially if this individual has recently given up meds and other forms of treatment. Schizophrenia would seem to be less likely than this.
posted by RainyJay at 2:56 PM on September 16, 2014 [4 favorites]