Can curing do more harm than good? - The danger in creating ‘normality’.
by Kirsty Kirkly

Reflection

'You treat a disease, you win, you lose. You treat a person, I guarantee you, you’ll win, no matter what the outcome'1.

This is a quote from the film Patch Adams which I think perfectly summarises the importance in medicine of looking at the bigger picture, especially at a time when we have such a vast array of ‘quick fix’ drugs at our fingertips. Whilst this has many advantages, it can mean that other, less physiologically apparent illnesses and symptoms are overlooked, as illustrated to me in a talk given by a young lady with Polycystic Ovary Syndrome.

Rachel was diagnosed with this at around 15, when her menstrual cycle stopped and she began to develop a deeper voice and chest and facial hair, associated with the excess testosterone she was producing, thus giving her both male and female characteristics. Too young to have legal consent, her parents and doctors ‘treated’ her with a cocktail of different drugs and laser hair removal, yet not once was she consulted, nor asked whether she wanted to be turned back into the female figure her body was defying. No one seemed to address the ‘elephant in the room’ in discussing the ‘difficult’ questions Rachel was facing regarding her identity, leaving her feeling isolated, dismissed and embarrassed about who she was. This, in turn, triggered years of depression, eating disorders and lack of self-worth, wherein she had been made to feel like her emotions were a side effect of the disease, and deemed not valid. She now identifies as ‘non-binary’, refusing to conform to the social construct that people must identify as one particular sex, especially in the case of the body physically acting as both.

It is often misconstrued that sex and gender are the same thing: whether someone is male or female. However, sex refers to reproductive organs and biological features, whereas gender is the social and behavioural characteristics a person encompasses, which are more fluid, overlap and are down to personal choice. With this in mind, I created a piece of artwork designed to challenge the social constructs of gender stereotypes and the idea that anatomical sex should determine gender.

Estimations suggest, whilst there is limited research, that 0.3% of adults identify as transgender2, however this could be as much as 8%3, if those with Polycystic Ovary Syndrome were included. This is before other similar diseases such as Disorder of Sex Development are even considered. Therefore combining gender and sex, treating people as either male or female is over-simplistic within medicine and consideration of the emotional contributors are as important as the biological.

Creative Piece

To illustrate this point, I chose to do a draw an image merging the male and female reproductive organs, aimed to highlight their anatomical similarities and symbolise the concept of transgenderism. Contrastingly, I also tried to incorporate the gender stereotypes associated with sex, in the use of male and female associated objects and colours. This shows the influence of health at a community and family level, wherein children are deemed masculine or feminine simply by the pitch of their cries4, at an age too young to even comprehend these social ideas.

If nothing else, Rachel’s story illustrates to me, the need for holism in medicine. For Rachel, being listened to and acknowledgment of her thoughts to gain insight into what her unwanted side effects were, would have been far more powerful than drugs. In addition, creating social awareness about transgender and including it in our ideas of ‘normal’, would help Rachel feel less isolated and promote confidence in her identity. If this had been the case initially, she may have felt more able to express her emotional challenges, coped better with the biological changes her body was undergoing, and to be more resilient, avoiding the resulting mental health issues. This point is emphasised by a study where ‘all transgender individuals expressed the importance of support groups in their healthcare journeys’, providing the opportunity to ‘build social networks’ and learn more about what their communities provided for them5.

What I learnt most about her story was the importance, both personally and professionally, of accepting differences in others and treating ‘normality’ as a spectrum. This will prove crucial in my future practice of medicine, when doctors go above and beyond to seek to resolve abnormalities and the engrained idea that differences need a cure. I admired Rachel for being brutally honest about her experiences and ashamed that I, too, would never have considered that her disease might make her question her gender. For me, this just proves how little awareness there is about transgenderism and the huge impact that the blissful ignorance of medical professionals, family and society can have on the individual. I never thought that actually treating a patient could amplify their mental health issues, but now see how this could exacerbate something which, to the patient, is part of who they are. This helped me realise the weight of the complicated interaction between physical and emotional health, which I am embarrassed to have underestimated before.

References

1 Shadyak T. Patch Adams [film]. Universal City, CA: Universal Studios; 1999

2 Gary J. Gates. ‘How many people are lesbian, gay, bisexual, and transgender?’. The William’s Institute. April 2011

3 BMJ Best Practice. Polycystic Ovary Syndrome [Internet]. 19/6/2016 [cited 19/4/17]. Available from: http://bestpractice.bmj.com/best-practice/monograph/141/basics/epidemiology.html

4 Reby D, Levréro F, Gustafsson E, Mathevon N. Sex stereotypes influence adults’ perception of babies’ cries. BMC Psychology. 2016;4(1).

5 Ross K, Law M, Bell A. Exploring Healthcare Experiences of Transgender Individuals. Transgender Health. 2016;1(1):238-249.