#cited

[kind-of-obsesive]

The Impact of Queerphobia on the Treatment and Health outcomes of Queer Patients in Canada.

What are the impacts of queerphobia on the treatment and health outcomes of queer patients in Canada? Queerphobia, and its counterpart, heteronormativity, contribute to the poor treatment and health outcomes of queer patients in Canadas current medical system. Most medical providers are not educated on working with queer patients, despite the widespread societal acceptance of the 2SLGBTQIA+ community, leaving them floundering when queer patients come to them for help. Heteronormativity is also still very prevalent in the medical system, lowering the quality-of-care that queer patients receive, making their treatment and health outcomes poorer. Queer patients are made to feel unsafe due to the discrimination they face from healthcare providers, and this can make them less likely to seek help, lowering their health outcomes in turn. Queerphobia greatly impacts the treatment and health outcomes of queer patients in Canada.

Despite societies growing acceptance of the 2SLGBTQIA+ community, which in turn, prompts more people to share when they fall outside of the typical norm, most healthcare providers are not being formally educated on manors surrounding the queer community, nor are they studying as part of their commitment to lifelong learning. During the study Snelgrove et. al. conducted, a doctor mentioned “Formal education around trans healthcare was described as absent from medical school and residency curricula” (2012). Lee and Kanji point out in their research that “some healthcare professionals appeared unversed in queer terminology, which added to the stress of individuals who felt responsible for educating their health care provider and justifying their identity” (2017). Greta et. al. state that “Approximately 54% [of the participants] reported having to educate their providers “some” or “a lot” about trans issues” (2014). These quotes highlight that healthcare professionals are not taught how to interact with queer patients or handle the issues they might face in relation to them being queer. Lee and Kanji go on to suggest that the lack of knowledge causes discomfort for the healthcare professionals and that the “notable discomfort from health care providers made the individuals feel uncomfortable and unable to speak openly about their health concerns” (2017). When a member of the 2SLGBTQIA+ feels that they cannot speak openly to their health care provider, it makes it harder for queer patients to get the medical assistance that they need, making the outcomes worse as a result.

Heteronormativity is the belief that heterosexuality is the only normal sexuality (Merriam-Webster, 2024) and cisnormativity is the belief that cisgender people, people whose gender matches their sex assigned at birth, is the only normal gender expression.  Within the healthcare system, working under the assumption that all people fall under the umbrella of heterosexual and cisgender can negatively impact 2SLGBTQIA+ people's health outcomes. Bauer et. al. finds that “Twenty-one percent … of trans Ontarians reported ever avoiding the [Emergency Department] when emergency care was needed specifically because of concerns relating to accessing [Emergency Department] care as a trans person” (2014). This can be reasoned by Lee and Kanji’s findings: that “LGBT respondents reported that the assumption that everyone is heterosexual and cisgender was a major barrier to forming a trusting relationship with their health care provider” (2017). Trust is one of the five components of the nurse client relationship according to the College of Nurses Ontario (2006), as it allows the patient to feel comfortable being open and honest to their healthcare team; when that trust is broken, not only are the patients less likely to be honest, but also less likely to seek healthcare in the first place.

The possibility of facing discrimination can pose a significant barrier to seeking care for many queer people, as it compromises their sense of safety. Lee and Kanji found many “reactions of health care providers to an individual’s coming out ranged from embarrassment to excessive curiosity, hostile displays, direct rejection, unwarranted pity, condescension, and denial of care” (2017). Reactions like these can make it hard for people that are a part of the queer community to feel safe when seeking healthcare. Taha noted in her study that “many participants shared how lack of safety in the context of receiving healthcare services was experienced as traumatic” (2018), she then continues on saying that facing discrimination can make queer people less likely to seek care when they need it. Giblon and Bauer found “21% of trans people in Ontario had avoided going to the emergency department in a medical crisis specifically because they were trans” (2017) and lists one of the major reasons as the “high frequencies of harassment and discriminatory practices experienced by trans individuals in health care settings” (2017). Looking at the data, avoiding seeking healthcare when needed can “pose a threat to the health of LGBT individuals and result in emotional distress, inadequate care, and lack of appropriate medical attention” (Lee & Kanji, 2017)

There is little formal education on queer topics for healthcare professionals, and they aren’t often pursuing it themselves, leaving them helpless when trying to help queer patients. Most healthcare professionals work under the assumptions of heteronormativity and cisnormativity, creating a lack of trust between queer patients and their healthcare team, reducing the effectiveness of the care they provide. Most concerningly, queer people often face unsafe environments in healthcare settings due to the discrimination that is caused by them coming out as queer. In conclusion, it is clear that queer people are facing worse treatment and poorer health outcomes than their heterosexual and cisgender counterparts due to systemic and non-systemic queerphobia.

References.

“Heteronormative.” Merriam-Webster.com Dictionary, Merriam-Webster,

Cisnormativity. (2024). In Cambridge Dictionary. Retrieved April 5, 2024, from https://dictionary.cambridge.org/us/dictionary/english/cisnormativity

Bauer, G. R., Scheim, A. I., Deutsch, M. B., & Massarella, C. (2014). Reported Emergency Department avoidance, use, and experiences of transgender persons in Ontario, Canada: results from a Respondent-Driven Sampling survey. Annals of Emergency Medicine, 63(6), 713-720.e1.

College of Nurses of Ontario. (2006). Therapeutic Nurse-Client Relationship, revised 2006. College of Nurses of Ontario. Retrieved April 1, 2024, from https://www.cno.org/globalassets/docs/prac/41033_therapeutic.pdf

Giblon, R. Bauer, G. (2017). Health care availability, quality, and unmet need: A comparison of transgender and cisgender residents of Ontario, Canada. Giblon and Bauer BMC Health Services Research, 17, 283. https://doi.org/10.1186/s12913-017-2226-z

Lee, A., & Kanji, Z. (2017). Queering the health care system: Experiences of the lesbian, gay, bisexual, transgender community. https://www.semanticscholar.org/paper/Queering-the-health-care-system%3A-Experiences-of-the-Lee-Kanji/4a21576b1af93507855e2d1ed887 91846bc1fcf2

Snelgrove, J. W., Jasudavisius, A. M., Rowe, B. W., Head, E. M., & Bauer, G. R. (2012).

“Completely out-at-sea” with “two-gender medicine”: A qualitative analysis of physician-side barriers to providing healthcare for transgender patients. BMC Health Services Research (Online), 12(1). https://doi.org/10.1186/1472-6963-12-110

Taha, R. (2018, November 1). “It’s hard enough for the people doing the work to access these services”: Sexual Healthcare Barriers that LGBTQ2S+ Populations Experience in a Rural Canadian Community. https://macsphere.mcmaster.ca/handle/11375/24029

[mag150cul-de-sac]

Fun fact! May is veterans appreciation month, dedicated to respecting our military

Unfun fact! Veterans are 50% more likely to become homeless than other Americans

Unfun fact! 4.9 million veterans, 27% of all veterans, have a service-related disability

Unfun fact! 7 out of 100 veterans have PTSD

Unfun fact! An average of 20 veterans commit suicide every day

Please feel free to correct any incorrect information here (with sources).

This post is not just meant to tell off all the people complaining about pride or black history month using veterans. This post is meant to be a push in the right direction for those people- if you’re going to use veterans as an excuse to badmouth marginalized groups, do something good for those people who you’re using as some kind of symbol for what’s gone wrong in America today.

I may not agree with what the military does, but it’s terrible how the people who get hurt for this country are forgotten once they’re not longer of use.

So, instead of complaining about pride month and saying that we don’t appreciate veterans, see what you can do to show your appreciation, and actually help someone.

https://www.greendoors.org/facts/veteran-homelessness.php#:~:text=What%20is%20the%20primary%20cause,in%20overcrowded%20or%20substandard%20housing.

https://www.bls.gov/news.release/pdf/vet.pdf

https://www.ptsd.va.gov/understand/common/common_veterans.asp#:~:text=PTSD%20is%20slightly%20more%20common,7%25)%20will%20have%20PTSD.

https://en.m.wikipedia.org/wiki/United_States_military_veteran_suicide#:~:text=According%20to%20a%20report%20published,die%20from%20suicide%20per%20day.

[perpetuallydistracting]

The Puritanical Eye: Hyper-Mediation, Sex on Film, and the Disavowal of Desire, Carlee Gomes (SOURCE).

passages that make you whisper "oh my god"

[primepaginequotidiani]

PRIMA PAGINA Financial Times di Oggi mercoledì, 04 dicembre 2024

[valtsv]

obviously people steal things from other people it's one of the oldest tricks in the book but it still always surprises me to learn that people plagiarise because my introduction to the concept was basically being told that if i ever plagiarised anything i would be executed by firing squad and my head would be removed and displayed on a spike outside the walls of the hallowed academic institution i was attending as a warning to others

[arothin]

sure thing, under the cut

Hope you don't mind me being a little lax in putting this together. Also, I have access to these through my university so they may not be available to you without a paywall, but I've noted the articles that have free versions.

To start with, Jay (2003) goes over the role of dopamine in the formation of explicit memory, and the wider hormonal pathway responsible. It is not the only step, but it is an irreplacable, i.e. there isn't an alternate pathway to the same conclusion that doesn't involve dopamine at some level. Jay also goes over the role dopamine plays in the substantia nigra in sending reward signals from there, and how those help create memories by "fixing" the plasticity of our brain (Jay, 2003, p. 385)

Smith & Graybiel (2016) analyze habit formation (also the name of the paper) and how there are multiple pathways towards developing habits. One such pathway is through stimulation-response (SR) association. This is best exemplified by pavlov's bell. whats notable about this type of habit is that it is reward independent after the habit is formed. this contrasts with action-outcome habits, which depend on whether or not rewards continue from the behaviours. (SR) behaviours are rooted in the (among other areas of the brain) substantia nigra and the dorsolateral striatum (DLS), both of which are dopaminergic (depending on dopamine). the DLS also plays a role in executive functioning (as complicated as that is) and a dopamine deficiency in the DLS would also help explain problems with executive functions.

Tripp & Wickens (2009) follows the Neurobiology of ADHD (the name of the paper) from physical differences (through genetics or brain scans) all the way through to expected behaviours of those with ADHD. Under section 4 of their paper, "proposed neural mechanisms underlying behavioural features", they describe the function of the wildtype dopamine release pathway (which as covered so far is necessary for the formation of memories and habits). Dopamine is released when unexpected rewards are produced, not predicted rewards. under normal circumstances, the repetition of behaviours that lead to the release of dopamine will cause the release to happen at "earlier and earlier predictors of reward". This means that eventually, the dopamine necessary for the executive function necessary to fulfill the behaviours of habits comes from predictors of unexpected rewards, so it does not matter if you recieve an unexpected reward or any reward at all for that matter. These predictors can go back far enough from recieving the reward all the way past behaviours, and eventually thinking about your habits can become the predictor that releases dopamine.

However, if your dopamine release does not migrate from recieving unexpected rewards onto predictors of unexpected rewards through repetition, then that means when you recieve the rewards of the behaviour you are repeating, then that reward is no longer unexpected and thus does not trigger a dopamine release. Thus there must be a continuous flow of unexpected rewards (requiring novel experiences so you cant make predictions) for there to be a continuous flow of dopamine release. This is exactly what Tripp & Wickens (2009) created a hypothesizes when they created a theoretical framework to account for the the dopamine deficiency in those with ADHD behaviours. The following is lifted directly from the paper verbstim (instead of taking a screenshot) for accessibility.

quote "Their theory makes the following assumptions:

1) in normal children, the dopamine cell response to positive reinforcement transfers to earlier cues that predict positive reinforcement.

2) this transfer provides immediate reinforcement at the cellular level when behavioural reinforcement is delayed

3) in children with ADHD, the transfer of the dopamine cell response to the cue that predicts reinforcement fails to occur

4) this dopamine transfer deficit leads to delayed reinforcement at the cellular level if behavioural reinforcement."

end quote

in "Role of Dopamine, the Frontal Cortex and Memory Circuits in Drug Addiction: Insight from Imaging Studies" by Volkow et al. (2002), they describe the effects addictive substances have chemically on those using the drugs. In summary, such substances usually either a) block dopamine transporters from reuptaking and sequestering dopamine, and therefore extending how long the signal lasts or b) increases the production of dopamine which then binds to dopamine receptors, or binds directly to those receptors instead, sometimes preferentially over dopamine.

Swanson et al. (2000) did a meta analysis of previous papers that looked into the correlation of alleles of the DAT1 gene that are over efficient in the reuptake of dopamine, reducing its signalling length and efficacy, and of the DRD4 gene which created a "subsensitive" dopamine 4 receptor. Their meta analysis concluded that the DAT1 allele that created over efficient dopamine transporters was more present in the ADHD test populations than the control group, and the DRD4 allele that created the subsensitive receptor was also more present in the ADHD population than the control group. They concluded that while the evidence in any one study in the meta analysis was either weak or not significant, there was evidence enough to support a dopamine deficiency theory of ADHD.

Fourteen years later Kollins & Adcock (2014) published another meta analysis of ADHD research and concluded that not only was there strong and statistically significant evidence of the mutant alleles of dopamine related genes in ADHD populations from Swanson et al.'s meta analysis (with more papers and studies this time), but also more evidence for half a dozen other mutant alleles for other dopamine related genes, and further explored the roles of dopamine in memory formation and addiction.

Tripp & Wickens also specified the mutant alleles from Swanson et al's meta analysis by name as culprits for their theory of dopamine deficiency induced behaviours.

However Tripp & Wickens, Swanson et al., and Kollins & Adcock also specified that the effects of no one mutant allele is enough to cause the physiological or behavioural differences we see in people with ADHD. Kollins & Adcock explained further that while no one gene was respsonsible for ADHD, taken together, all of the mutations in the dopamine pathways go along way to explaining the physiological effects of ADHD, and the behaviours those changes give rise to, even after accounting for the effects of nuture in the nature vs nuture debate. The multitude of genetic sources for ADHD also explains why it is a spectrum, and why not everyone shares the same symptoms.

Another aspect of support for the dopamine deficiency theory of ADHD that is a common throughline from these papers is that Dopamine agonists (i had to look this up, a substance that causes a physiological response when paired with receptors) are the best treatment of ADHD available, which is what current ADHD medication does.

Ultimately I believe just this small slice of research supports my conclusion that people with ADHD are vulnerable to addictions because it supplies dopamine when we cant get it elsewhere, and we are unable* to form competing or new habits to break us out of habits formed by addiction.

*I understand that there is the constant caveat that not everyone experiences ADHD the same way or to the same degree. However, I am writing this from my perspective, where I have ADHD so severe that I have a special prescription that exceeds the medically advised maximum and i STILL struggle. when changing meds to find something strong enough to work, I ended up taking a different drug that even at low doses was supposed to give people without ADHD hallucinations, paranoia (specifically of bugs under your skin) and heart attacks. again when I had a prescription higher than the recommended maximum, all it did was give me mild insomnia.

References

Jay, T. M. (2003). Dopamine: a potential substrate for synaptic plasticity and memory mechanisms. Progress in Neurobiology, 69(6), 375–390. https://doi.org/10.1016/s0301-0082(03)00085-6

Kollins, S. H., & Adcock, R. A. (2014). ADHD, altered dopamine neurotransmission, and disrupted reinforcement processes: Implications for smoking and nicotine dependence. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 52, 70–78. https://doi.org/10.1016/j.pnpbp.2014.02.002

Smith, K., & Graybiel, A. (2016). Habit formation. Dialogues in Clinical Neuroscience, 18(1), 33–43. https://doi.org/10.31887/dcns.2016.18.1/ksmith. free article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4826769/.

Swanson, J. M., Flodman, P., Kennedy, J., Spence, M. Anne., Moyzis, R., Schuck, S., Murias, M., Moriarity, J., Barr, C., Smith, M., & Posner, M. (2000). Dopamine genes and ADHD. Neuroscience & Biobehavioral Reviews, 24(1), 21–25. https://doi.org/10.1016/s0149-7634(99)00062-7. free article: https://pubmed.ncbi.nlm.nih.gov/10654656/.

Tripp, G., & Wickens, J. R. (2009). Neurobiology of ADHD. Neuropharmacology, 57(7-8), 579–589. https://doi.org/10.1016/j.neuropharm.2009.07.026

Volkow, N. D., Fowler, J. S., Wang, G.-J., & Goldstein, R. Z. (2002). Role of Dopamine, the Frontal Cortex and Memory Circuits in Drug Addiction: Insight from Imaging Studies. Neurobiology of Learning and Memory, 78(3), 610–624. https://doi.org/10.1006/nlme.2002.4099

yep.

[etirabys]

can anyone find me that mesopotamian clay tablet telling you to marry a party girl because she'll bring you joy

[charmee-silly]

“studies have shown”

WHAT STUDIES, WHO CONDUCTED THEM, WHERE ARE THEIR RESULTS, CITE YOUR SOURCES

[myfootyrthroat]

School: Teaches you something for a week with historical background, context, effects, and outcomes.

One TikToker: Tells you it's fake while doing a bad contour.

Some of y'all: SCHOOL LIED?!

[robinsversion]

How I sleep knowing I always cite my sources:

(First image from the film Drip Dippy Donald (1948); second image from season 4, episode 3 of the Simpsons, “Homer the Heretic” (1992).)

[metamatar]

Zionists love to ask me, "How would you fare in Gaza?" to which I love to respond, "How would I get to Gaza?" This first question, like many transphobic heckles that I have received from Zionists, is an Althusserian hail. According to Althusser (1971), the hail serves to interpolate the individual into the subject, to bring the individual into ideology. The noble identification of "gay friendly" Tel Aviv's gift to all queers is a hail—an interpolation of the transgender body into an always already indebted subject position, one enmeshed in a "cycle of debt." Under the Zionist economy of gratitude, the transgender subject is perpetually indebted to capitalism and the West for allowing her to exist. The properly delimited space for the transgender subject within this ideology is essentially one confined to an apoliticized space of pride parades and gay bars, but never the front lines of an anti-imperial or anticolonial project. It is a queer/transphobic assault against those visibly queer bodies who refuse to be properly disciplined neoliberal queer consumers—and transgender bodies are often the most visibly queer bodies and hence the ones singled out for attack. As one cannot return the gift to the one who gave it (in this case because the Zionist disidentified from his own queerphobia), the transgender subject is forced to pass it along—to Palestinians. Hence, the queerphobic Zionist can pass the gift of his racist colonial phobia as well as his queerphobia on to the transgender subject. The projection allows the Zionist to disidentify from the transphobia inherent in his hail. This is particularly important, since it is precisely the violent transphobia—"what are you?"—that is an incitement to vulnerability. I am supposed to feel vulnerable, afraid, attacked by this hail, in order that I may pass on that gift of death to the supposedly transphobic Palestinian.

Papantonopoulou, Saffo. “‘Even a Freak Like You Would Be Safe in Tel Aviv’: Transgender Subjects, Wounded Attachments, and the Zionist Economy of Gratitude.” Women’s Studies Quarterly 42, no. 1/2 (2014): 278–93. http://www.jstor.org/stable/24364930.

[theoptia]

Clementine von Radics, from “Letter from Anaïs Nin to Clementine von Radics”

Text ID: For women who are tied to the moon, love alone is not enough.

[primepaginequotidiani]

PRIMA PAGINA Financial Times di Oggi venerdì, 13 settembre 2024

[rpfofficial]

but if i gave up on being silly i wouldn't know how to be alive

[kings-highway]

absolutely obsessed with the fact that tsukki works in a museum + is still in university post timeskip because it highly indicates that he absolutely will end up living a double life. personally I am of the persuasian that tsukki goes on to get a masters / eventual doctorate in history (and/or an adjacent field, like archeology, paleontology, anthropology, you get the vibes)

but like I imagine the fucking Sendai Frogs (or any of his volleyball friends) dont exactly enjoy chatting about 9th century kings or 12th century architecture so it just never comes up. except for when tsukki tells them he's going to be missing practice because he's flying to China to a few small villages with local churches and temples to study old medical records and put together a timeline of the opiod wars in less documented places and the rest of the Frogs are just like !!!!!!!!!!! you're doing what now????? and he's just like yeah its a government grant :/ but it'll be nice to get published in this journal and then all of his teammates go home and google him and find the half dozen articles he's published that high school students are citing in their research papers

but then when he's working in the archives and reading through old newspapers a coworker of his comes down and is like "hey kei would you be able to fill in for a docent that called in sick tomorrow? we just need someone to lead a few tours" and tsukki is like "sorry, I booked that time off. the d2 volleyball league starts tomorrow." and the coworker is just like. what?