A Compassionate Mind for Your Trans Body
A program outline for learning to accept what you have
6/23/2022: This was the final project for a Harvard class on the scientific applications of compassion meditation in therapeutic settings. The project was to design a program using what we learned in class. What follows is the program I designed, which earned me a high grade.
I was inspired to write on this particular topic not only by my own struggles, but by observing the stories of many other trans people across social media. I want to thank these brave people for sharing their pain and crying out for the need for this type of program, which is why I am moved to share it. It is currently in its academic form (which included things like page limits), but I will update it with more resources and detailed exercises if there is enough interest. -I.J.A.
The Problem: Gender Dysphoria, Shame, and Activism
Even if there were no obstacles to transitioning for transsexual people, gender dysphoria is a condition that fills its victims with self-hatred and shame. It is a deep body dysmorphia that is tied to sexual anatomy and self-perception, and for many people, the most obvious mode of relief is to transition using hormone therapy and confirmation surgery. These procedures, however, take time. The body has to go through the desired puberty, and a certain amount of sexual development is necessary to facilitate successful surgical results.
However, we live in a world where the finer points of transitioning are still under study. In the first half of 2022, numerous reports from Sweden, the United Kingdom, and Denmark, pioneers in transitional medicine, have warned of health risks associated with the process of transitioning, especially in youth. Around the United States, legislation is being introduced to limit medical transition, in some cases to as old as 25. This has been in response to other legal maneuvers in favor of trans advocacy that push specifically for affirming the idea that some people are “born in the wrong body” and have a desperate need to transition. The clashing of these two points of view has had a detrimental effect on both trans and non-trans alike.
The truth is probably somewhere in between, especially as trans advocates have built up the narrative that our very bodies can be “wrong,” or that gender confirmation surgery can do more than it actually does. There is nothing wrong with changing our bodies but at this point in our technology, we only get the body we have, and changes to it have limitations that don’t fulfill the expectations. Medical science may someday (and sooner than we think) progress to the point where we can alter our bodies at the cellular level or transfer our consciousness between material forms, but right now we face a reality where there are certain uncomfortable facts gender dysphorics must accept about their bodies with equanimity and find healthy ways of coping with.
Critics of exploratory therapy for trans people consider it “conversion therapy,” claiming that the intent is to deny trans people medical intervention. In reality, body acceptance is vital to both populations that choose transition and populations that do not. Body acceptance is something many people struggle with – some people might want to weightlift and build muscle because they think they’re too thin, while others might starve themselves or engage in expensive surgeries to achieve body proportions they find pleasing. Gender dysphoria adds another layer for people who suffer from it because their sexual development is of direct and persistent concern. It is far from conversion to ask a person to accept their body, even if they plan on changing it. Acceptance is not the same as resignation (Gilbert, p 219).
Target Population
There are a variety of transgender and transsexual people who could benefit from a program about body acceptance:
· To some degree, all trans people need to embrace body acceptance. We only get one body, and we need to learn to live in that body, no matter what we do to it. This includes accepting various features of our bodies, such as height and build, and how to work with them with love and acceptance.
· How to cope with the medical transition period, during which transitional secondary sexual characteristics, such as breasts or facial hair, might be slow to develop. It is also an awkward phase for many trans people as their bodies and adjust to cross-sex hormones, especially as the changes become visible.
· Trans populations for whom medical intervention is impossible, such as people with diabetes, people with congenital diseases such as muscular dystrophy, and people whose mental health is such that consent to procedures is in question.
· Youth who identify as trans. This cohort is especially controversial right now, as questions have arisen regarding the adult sexual and medical health of trans youth. This has come to light as detransitioners speak of their own experiences and reveal reasons for transitioning that have nothing to do with gender dysphoria as well as lifelong effects of transitioning young. Dr. Erika Anderson, a pioneer in trans healthcare in the United States and a trans woman herself, has spoken out against youth transition on the basis that without the natural puberty the human body must endure, children will grow into adults who cannot achieve sexual satisfaction or even become sexually aroused (Kennedy); the lack of tissue also makes confirmation surgery more difficult, as has been discussed on I Am Jazz, featuring trans youth Jazz Jennings. Given that youth medical transition is so contested, and that there are ethical questions about experimenting on minors, it will be some time before there is resolution to this part of the debate over transitional medicine. Puberty and youth is already a difficult time, making young people vulnerable already, so it is especially important to affirm youth bodies alongside their identities to prepare them for whatever future they ultimately choose.
· Trans people who have experienced complications with transition. Complications include infections, fistulae, rejection of surgical grafts, urinary tract infections, and a host of standard post-surgical complaints, some of which are permanent.
· Detransitioners, especially those who’ve taken surgical steps to transition. There is very little support for people who detransition, given the emphasis on affirmation. Body acceptance and compassion should be a central component of care for all trans people as it could prevent detransition, but especially for this cohort, regret and shame can be associated both with birth sex and transitional sex.
The Purpose
The central purpose of cultivating body compassion in trans people is to help them cope with their bodies through all phases of transition, from pre-transition throughout their lives. The reality is that it is unlikely that we will be able to inhabit a body other than our own without fantastic technological advancements. That means that each of us needs to accept the body we have for what it can and cannot do. A short person is unlikely to become tall, and a stocky person cannot wish themselves into a svelte body type. Even gender confirmation surgery is only cosmetic at this point in our medical history, and people who don’t have enough donor tissue don’t have that as an option.
The purpose here is not to dissuade people from making changes to their body. In fact, many body changes, such as losing weight and staying fit, are desirable. Accepting one’s body is not the same as being unwilling to change it. It simply means understanding what we have and working with it in a healthy way, including any changes we do make. If anything, acceptance is the first step toward making change, because it helps us identify the things that need to be changed rather than denying them.
The Program
The program has no timeline and can be worked either one on one or with groups comfortable enough to share. There are two primary components to it, Mindfulness and Compassion. The mindfulness practice should be worked on alongside the compassion practices, but the compassion practices should be built on one at a time based on the comfort of the patient or group.
Mindfulness
Mindfulness is like an awareness muscle. Through mindfulness meditation, we can build our awareness of our negative thoughts, stimuli that trigger our emotional reactions, and even awareness of the state of our bodies. However, mindfulness can also uncover insecurities and trauma, so it is important to work on compassion concurrent with the mindfulness practice. In the beginning, the program should engage in short breathing meditations of no longer than 15 minutes and build the practice over time as the compassion components are uncovered. At the early stages, the mindfulness component is more about engaging awareness, but over time it will become more significant as it becomes applied to compassionate views.
Compassionate Color
The first step in the compassion component is to develop a compassionate color. Each participant should pick a color or set of colors that brings up feelings of safety and unconditional love. There is no pressure to pick a color, nor does it have to be the participant’s favorite color. Participants may experiment with different colors before the settle on one that’s right for them. All that matters is that this color makes them feel safe.
This practice from Paul Gilbert gives participants a way to conceptualize these feelings in an abstract way, without assigning them to anything specific. It is meant to awaken systems in the brain that soothe when people are afraid, angry, or confused. Using a color rather than a person, place, sound, or object provides a non-threatening source of love that can be turned to in moments of fear and panic. Participants should work with their color through meditation, but also through representations they can carry with them as reminders in everyday life, such as a bracelet or swatch of decorated paper in the compassionate color.
Once participants are comfortable working with their color, it is time to expand the process.
Compassionate Place
The compassionate place, which Paul Gilbert calls the “safe space,” is a place of unconditional love that is created by the participant. It is an imaginary, ideal place that only the participant can conceive of or access. Counselors running this program might suggest participants decorate their safe space in their safe color. This is a mental space to inhabit and allow thoughts and feelings to exist without judgment. Gilbert recommends getting to know this space intimately – how it smells, how it feels, whether it is warm or cold.
He also points out how mindfulness can help participants maintain this space from intrusive thoughts (Gilbert, p 239) by making participants aware of the intrusion. Identifying intrusions weakens their power, strengthening the safety of the space. Practicing with the space and being aware of the intrusions gives participants a landscape on which to frame their thoughts and work with them non-judgmentally. To some degree, it dissociates participants from intrusive thoughts by showing them that the thoughts are only thoughts and not the entirety of their being. This prepares participants for the next step, working with the compassionate other.
Compassionate Other
There are many versions of the “compassionate other” in literature on compassion practices and psychology. Thubten Jinpa asks participants to look for a teacher, guide or mentor (Jinpa, et. al., p 248), while Kristen Neff advocates for a “compassionate friend.” Gilbert broadens it to a “compassionate image” that could be anything or anyone, even something the participant created themselves. Drawing upon the work of all three provides a long list of possible “compassionate others” for participants to imagine, such as ancestors, fictional characters, historical figures, spirits, concepts, animals, or objects.
Like the safe place, the compassionate other is a mental construct that is meant to represent our idealized compassionate self. As such, there are no limits to what this compassionate other should be like, other than unconditional compassion. The compassionate other gives participants a way to express their compassion without feeling threatened by rejection.
Participants should work with the compassionate other, inside or outside of their safe space, until they feel comfortable. This can include talking to them in visualization meditations, drawing pictures or making collages of what they might look like, writing a letter to or story about them, and getting to know them as they would a living, local person. The better they know their compassionate other, the better they will understand the next phase of the program.
Viewing Others As the Compassionate Other
Once the participants have an established relationship with their compassionate other, the next step is to put the compassionate other to work. What would the compassionate other do when they see others in distress? From the perspective of the safe space, participants should be introduced to situations that invoke the compassionate other. This can be through anecdotal examples, stories, media, or fiction, but the focus should be on how the compassionate other would help people in distress.
This is a good bridge between others and self for anyone with negative self-image, shame, or depression, but to strengthen the practice for trans people in particular, the focus of the theoretical situations should be on various types of bodies. There are a variety of stories that can be told without calling attention to participants’ dysphoria, such as:
· What would the compassionate other say to a girl with anorexia or bulimia?
· An unathletic boy?
· A congenitally disabled person?
· A person disabled or maimed through accident?
· A person with eczema or a large visible birthmark?
· A person who is overweight?
By putting the focus of compassion on other people, participants can practice what it feels like to give compassion. Using examples of other types of body dysmorphia can depersonalize the feeling, raising awareness within the participant that other people have similar experiences, including the fears and ugly thoughts that bring so much shame. The feelings become universalized (even as the situations they’re experienced in are specific), and are, hopefully, easier to work with.
Distressing emotions might arise for some of the participants as they bear witness to the distress of others, but by this time, participants are more mindful of them due to continuing mindfulness meditation. It is imperative at this stage to debrief from this distress by ending each session with a return to the safe space, perhaps with the compassionate other. Now that participants have a frame from which to build compassion for others, their own compassionate other might already help them in their safe space in small ways.
Viewing Oneself as the Compassionate Other
Once participants have had some practice at expressing compassion to other people, they will be equipped with the tools to turn that compassionate other toward themselves. Working with and getting to know the compassionate other in combination with the mindfulness meditations should by now have shown participants how the compassionate other would treat them if they were in distress, based on how the compassionate other has treated others in distress. They should be able to identify how the compassionate other manifests in their meditations, and perhaps in their lives.
This final component of the program is the most personal because it turns all the abstract concepts in on the self. No longer are participants working with theoretical and impersonal situations; now they are allowing their compassionate other to show compassion to their own distress. They are asking themselves, “what would my compassionate other say to me?” However, by demonstrating the process of compassion through the rest of the program, the answer is already apparent from the reactions of the compassionate other to other people. Once distress is reframed this way, it becomes easier to work with for oneself.
Tomorrow’s Trans
Trans people, especially youth with gender dysphoria, feel isolated in a world where they are not the norm, and this brings with it a lot of distressing feelings of unworthiness, oddness, and anxiety. However, the distress trans people feel as a result of gender dysphoria is just like every other feeling of distress and what distinguishes it is being trans, not being distressed. Working with body acceptance in dysphoric populations can only improve trans healthcare in the future, because it can give us stronger foundations on which to build trans healthcare. When people care about themselves and their bodies, they are more likely to take care of themselves in the healthiest way possible, including accepting that they might never have exactly the body they want.
Further, with more self-compassion and mindfulness, trans advocates can provide more understanding about the condition without stigmatizing transness or alienating other vulnerable populations, such as detransitioners. It is as important trans people acknowledge the negatives of gender dysphoria and transition as it is the positives so that all trans and detrans people can have an honest discussion about what is healthiest for the process of transition, but we can only do that if we are willing to be compassionate for all aspects of the process.
References
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Jinpa, T. P. (2016). Fearless heart: How the courage to be compassionate can transform our lives. Avery Pub Group.
Kennedy, Dana. “Anguished Parents of Trans Kids Fight Back Against 'Gender Cult' Trying to Silence Them.” New York Post, New York Post, 11 May 2022, https://nypost.com/2022/05/11/meet-the-parents-of-trans-kids-fighting-gender-cult/.
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Neff, K. (2015). Self-compassion the proven power of being kind to yourself. William Morrow, an imprint of HarperCollinsPublishers.
Nied, Korin Miller and Jennifer. “Jazz Jennings Just Posted a Hospital Photo after Her 3rd Gender Confirmation Surgery.” Women's Health, Women's Health, 2 Nov. 2021, https://www.womenshealthmag.com/health/a23828566/jazz-jennings-gender-confirmation-surgery-complication/.