Worry Tree in the Bin

The Worry Tree is a complex Psychological Intervention which has led to a paradigm shift® in mental health care.

It works like this:

  1. Write down your worry.
  2. Work out if there is something you can do about your worry.
  3. If there is, then do it and LET WORRY GO, change your focus of attention.
  4. If there isn’t then… just LET WORRY GO, change your  focus of attention.

You can download a free Worry Tree over here.

(This is ACTUALLY USED in IAPT services.)

Case Example 1: Chronic pain and illness

The mindful worry tree cure for all chronic pain and illness, disability and anything non-surgical known to humankind. Basically – DON’T WORRY.

About to die or be killed – LET WORRY GO.

Case Example 2: Imminent austerity death

I am worried I will freeze to death on the street because I have nowhere to live after I was evicted due to Universal Credit… let it go you silly worry head, the nice lady from the government was on TV and said it’s all going really well, Merry Christmas!

Case Example 3: Worrying about worry

I am now worried about whether I worry too much.

Should I let this worry go and refocus my attention?

I am now going to stop worrying about worrying too much, I am going to let that worry go, and refocus my attention on the things I am legitimately worried about.

Case Example 4: Domestic violence

Nearly killed by your husband? All the refuges closing? LET WORRY GO, change your  focus of attention.

Case Example 5: The Worry Tree Worry

I am worried about this Worry Tree™. Is it a hypothetical situation or a current problem? I like that the solution in all cases is change focus of attention. This therefore requires “not thinking about The Worry Tree™”. Problem solved. QED.

Mental Health Resistance Network Protest 20th Nov #WeDemand

Screenshot 2018-11-11 21.54.56

#WeDemand
Please share far and wide
Westminster Health Forum Keynote Seminar
20th November 2018
Registration Time: 8:30 am
Start Time: 9:00 am
Venue: Royal Over-Seas League, Over-Seas House, Park Place, St James’s Street, London SW1A 1LR

Meet outside the venue at 8am. Bring whatever banners you want to bring. Be loud and be proud.

The whole thing is rotten to the core, so MHRN will be protesting this event which will bring together some of the people who have had a hand in preventing us from receiving appropriate care and a secure income.

In response to the abusive agenda of this government, MHRN has produced a document that outlines our demands. It is a living document and will be updated from time to time.

PDF MHRN

We will be launching our demands at the protest and presenting it to Claire Murdoch, National Mental Health Director, NHS England and will be sent to Cabinet and Shadow Ministers, MPs and anyone else we see fit to send it to and it will form the basis of our campaigning.

It will be an early start but it is an important protest and we want everyone who can make it to be there. And of course, it’s off to the pub/coffee shop after we have made our point.

Facebook event page

Mental Health Peer Workers: Our lived experience. Part 2

If you are a peer worker (or work in a similar role) and want to share your lived experience, please submit a blog for consideration:
recoveryinthebin@gmail.com

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Being a peer support worker is an occupational health nightmare. Luckily I tend to think of myself as a bit of a martyr, so I managed to stick it out for a couple of years. I worked in the NHS in an employability setting. The main issues I had could be categorised under the following:

  • Conflict around my identity as a mentally ill person, my diagnosis and my legitimacy as a peer to people who were accessing services I had not yet accessed

When I was a peer worker I had never been with the CMHT as a patient. I has a brief stint at CAMHS when I was 15 where I was mostly told to take baths and sing Belinda Carlisle. I had face to face CBT when I was 19, and had been on and off SSRIs for the 4 years or so since then. Despite having clear barriers to work and education, my own doctors didn’t think I needed help when things were at their worst. I was encouraged to quit jobs rather than find the right support to sustain them, which is in itself a sign of the massive gap in societal privilege between healthcare providers and those they support. That is why I was drawn to being a peer in an employment setting, as most of my barriers had been due to negative attitudes of educators and employers. 

Despite these clear barriers I was facing, I did not share the experience of those in the service I worked in as a peer. I had never come close to being admitted to an inpatient ward. At the time, I had never seen psychiatry. I had a very vague diagnosis of Generalised Anxiety Disorder, but now I am aware that I am actually autistic. There’s a lot of overlap in experiences, but looking back it was very difficult for me to relate to many of the people I was working with. I felt like a fraud, albeit a well intentioned fraud. When I went for the role I had no idea how mental health services worked. I very quickly realised that my legitimacy as a peer would be questioned, but I was always honest about my background and the fact I was still “actively unwell”.

There’s a definite resentment in the survivor movement to “entryists” or people who have had moderate mental illness. It can feel like gaslighting. I’d like people to be mindful of stories like mine when they criticise individual peer workers, because I have experienced trauma my whole life from being boxed into neurotypical expectations. Add to that the notion of “recovery”, and how unattainable that feels to an undiagnosed autistic person who has internalised guilt and mental health stigma on top of the autism. I can’t speak for the “recovery” prospects of specific mental illnesses but with autism the way you are wired will never change. 

  • Triggering myself and those I was working with, as the boundaries of peer support were (and likely still are) ill defined

The NHS love professional boundaries. They are very rigid with them. The idea is that having strict boundaries will reduce dependency from service users, and that the individual staff are protected. What then are the boundaries for someone whose very job description mandates that their lived experience be used? There are attempts to develop codes of working for peers, but at the time these were in their infancy. Also, we are all human, and those of us who have experienced trauma and exclusion have a tendency towards empathy and protectiveness of others we relate to. This is really where the idea of peer support comes from. It is this dynamic that is entirely opposed to how the NHS operates, and why it is difficult to define boundaries in peer roles. Authenticity is one of the core values of peer working, as defined by the Scottish Recovery Network. How does one be “authentic” while maintaining boundaries? 

  • Being recruited on the basis of having lived experience, but still being subject to the same HR sickness absence trigger points and inaccessible sickness absence reporting procedures

Reporting absence was always a struggle for me, because by the time I had realised I needed to be off there was no pulling myself out of the hole I was in. I’d be zoned out, realise I was late or that I couldn’t move, and then be expected to make a phone call to work. Sometimes I’d be howling my eyes out. Sometimes I was literally on the front doorstep, leaving for the train and I’d stop and go back inside. The expectation was that I would call in. I’d get round this by texting, calling and not staying on the line long enough to be picked up (so they’d at least think I tried), or I would get my husband to call as a last resort. In the case of the latter I would hide under my bedcovers with my fingers in my ears until the call was done. 

The NHS is as rigid in its HR procedures as it is of professional boundaries, if not more so. Most big employers are. When well-meaning managers and teams are bringing in peer workers, they might overlook the potential implications of this. They probably hope for the best case scenario, or feel that they can support the peer worker to stay on the right track. We all know this isn’t how mental health works, and inevitably I ended up being pulled up to HR for sickness absence. Given the nature of my meltdowns I recover very quickly, so any absences were a day long, two at the absolute most. Usually all I would need to do would be to go back to sleep for a bit and reset. The frequency of my absences meant that I hit the trigger point, I believe it was 4 episodes in 12 months. (This is kind of appalling when you think about it, even for non-disabled people).

  • Being encouraged to act as inspiration porn embodied, while still struggling to cope in work 

When I had the inevitable HR review I was referred to occupational health. I told the nurse about my role and what was triggering me. She was very understanding, and had ran a peer group for depression herself. She seemed baffled by the fact my role explicitly required me to air my trauma on a daily basis. I floated the idea that I be allowed to withhold my story in work for a while so I could patch up my mental state, or that I be put on redeployment. She said that those two options could basically result in me having no job and it would be too risky. I’ll always remember her comparing my role to Pudsey Bear.

I felt awful telling service users that things would get better while I was struggling so much. Some of them knew I was struggling, given that I cancelled appointments at times. I even had a panic attack in front of one because the space we were meeting in was too noisy. She instantly turned to caregiver mode, and she did a good job of it. That said, when we are expecting to be the recipients of support, it can be quite jarring to suddenly be the provider of said support. I debriefed with my manager and she reminded me that we are all human. It was nice because in other roles I have been threatened over much less.

  • Watching individuals be encouraged to become peer workers despite the trauma it was causing me, and the lack of jobs or progression in this “profession”

People in services like the sound of peer support work. They want to give something back and help others like them. That is admirable, and no one can deny it. However, they also might long for a safe working environment with colleagues who understand their situation. When this is promoted as a benefit of peer support work, it lets society and employers off the hook. ALL workplaces should accommodate people with mental illness. People should not be encouraged to use inclusive workplaces as a crutch at the expense of their own hopes and dreams. I worked with people who were highly skilled and qualified who had somehow decided to become peers, despite peer working being capped at a band 3 salary with no progression route. 

When I did interview for a band 4 in a similar but non peer role, I was asked a very uncomfortable question at the end of my interview. “What is your own personal recovery goal?” I can assure you that no other candidate was asked that question. I fumbled through some response about how my career development was my next goal, and that was why I was sitting in front of them. No I did not get the job, and I was given no feedback despite asking several times. 

Luckily the health board I was with had really good staff development opportunities. I was able to access a bursary to do a postgraduate qualification. My manager was also really good at giving me opportunities for networking, taking ownership of developing processes around the work, some creative projects and also leading on development sessions for colleagues. Doing this enabled me to rebuild my confidence and learn more about the mental health movement. I think peers need to be given the freedom to learn from people across sectors so they can really understand the bigger picture in terms of inequalities. 

  • Witnessing the trauma people were experiencing at the hands of employers, health professionals and the welfare system, yet following a biopsychosocial approach

When people are being bullied out of their jobs and being denied the financial or social support they are entitled to, they need practical support. They either need lawyers, or the systems themselves need to change. The biopsychosocial approach waters down what makes the social model so effective and bold. Had the barriers never existed, the individual disabled people would not have the confidence issues the biopsychosocial model claims holds us back. We can do all the WRAPs and graded exposure we like, if society itself does not change then we are pushing individuals to potentially retraumatise themselves. These approaches are no doubt effective on some level, but we need professionals to advocate for us in the face of austerity and discriminatory practices. Unfortunately, professionals seem to have more clout than we do when trying to influence change, and they need to recognise this and step up. 

  • Work as a health outcome and rigidity to the IPS (Individual Placement and Support) model

One of the benefits of peer support is that it is largely born from wanting what is best for the other person. The service I worked in followed the IPS model, and sometimes this got in the way of doing the right thing for the individual. Some jobs and internships were passed over because they were not permanent, as IPS fidelity scales rate permanent employment above all else. In a precarious job market which becomes even more challenging with specialist fields, sometimes people need to take temporary work to build professional experience. This is a fact for anyone looking for work. Again, people with specific interests, experience and qualifications were somehow finding themselves down the care worker or sales assistant route. IPS is not delivered to a payment by outcome model like welfare to work programmes, but caseloads are restricted to 20-25 people per worker. This leads to a considerable waiting list, and the job retention service was in even higher demand. 

The IPS model is controversial in the survivor movement due to its focus on work as a health outcome. It is often seen as a smokescreen for DWP agendas. (The service I worked in had zero involvement with the DWP or welfare to work unless the service user asked for it). I genuinely feel that work can be a health outcome for those who want it to be, and only when the work is good for that person and what they want to achieve. Work has been a massive part of my own wellbeing, but it has also caused me heartache and stress. It is important to recognise that work itself can be the cause of mental illness. Again, any approaches to helping the individual need to be matched or outweighed by pressure to employers to make positive changes. 

IPS guidelines state that if someone says they want to work they should be encouraged to find work in a timely fashion, no questions asked. What if people are not well enough to work, but they feel they need to because of family pressure, financial difficulty, or societal expectation? How do we know when someone is actually ready? IPS is good for countering the attitudes from professionals who tell disabled people they can’t work. Specialised job retentions support is crucial for people who are struggling, rather than letting them just walk out of their jobs. Having the correct support to help people who want to work should absolutely be part of a package of services available to those who need and want them. The survivor movement should champion approaches that work well for us, and cast a critical eye over those that do not serve us or could do so in better ways. Writing off services altogether on the basis of the wider context around welfare to work does not help the people who want this type of support, and they do exist. In any case, there needs to be more services to support mental health in work. 

  • The use of peer work to plug gaps in services which are being stripped to the bone by cuts 

While I know that my role was created out of a genuine desire to do the right thing, I can see how easily peer roles could be used to plug gaps in services. At times I was doing the work of the band 5 staff in helping people with job applications and interview preparation. I had no training in this, everything I knew I learned through my own job searches. (If that is enough to qualify someone to be an employability worker, then there is a massive talent pool of disabled people out there who could do these roles! Employability services often hire sales people because they have experience of working to targets.) 

Employability overall is a lower risk area than inpatient services. I had a degree in healthcare, but not mental health specifically. I knew confidentiality, boundaries, active listening and working with vulnerable people. I did ASIST training and mental health first aid training. I was fairly well equipped for working with the public, peer angle aside. At times I was likely seen as an infiltrator to the peer movement, because I was equally equipped with lived experience and professional training. 

When peers are being used to support inpatient services, I would be a bit more concerned about how prepared peer workers are. We know how to support each other, we have always had to. The support we give those we know as a peer is very different to how we would support someone within the confines of the NHS. 

  • Do those who recruit peers truly value their lived experience as a matter of principle? 

There is a conflict of interest between being a good peer and being an obedient employee. When I was a peer it was in my job description to challenge the status quo. I did my best to do that, aided with my brutal autistic honesty. I actually had to blow the whistle at one point, and luckily wasn’t written off by managers. I would hope that would be the case for any peer. My line manager was very encouraging of me voicing my views on behalf of service users. Not every team who has a peer worker will be this welcoming of dissenting voices. Again, the identity of the worker is in jeopardy. Do they appease, or do they fight, risking their livelihood and reputation as an employee? 

Overall, my own experience of peer work led me to where I am today. I feel that I can better advocate for people in distress and I have a much wider understanding of the barriers we face to being included in society, namely the workplace. I was very lucky in that the service I worked in was staffed by good people, there were development opportunities and I had a good deal of autonomy. However, I can’t vouch for entering peer working as I don’t feel like enough research has been put in to the potential negative impact of the role on the worker and service users. More has been done on the latter as far as I can tell, but both are equally important. Good intentions do not always result in what is best for people, and the scenarios we are talking about here are far more complex than tea and sympathy. 

Mental Health Peer Workers: Our lived experience. Part 1

This RITB blog is the first in a series of blogs about the lived experiences of being a Mental Health Peer Worker.  If you are a peer worker (or work in a similar role) and want to share your lived experience, please submit a blog for consideration: recoveryinthebin@gmail.com

peer worker part 1

Lived Experience Working in the NHS

In theory, life should be good at the moment. I’ve finished my Masters. I’ve got a wonderful hubby.  But the other day, I realised that I was taking home pretty much the same pay as I did when I left school to be a carer for my Mum at 16, and was doing a part time cleaning job.  The difference is that now I am 41, with a first class BA Hons, a couple of post graduate certificates, loads of experience working in several different disciplines and now a Masters of Science Degree.  I took the pay cut, a few bands down to my other work, roughly six years ago, with the idea that I could easily work my way up within an organisation that employs 4000 staff.  It struck my like a ton of bricks that in six years I haven’t moved, and despite my experience and specialist training, I have very little worth or value within the system I work in.  Rather than wallow in it, I decided it was the kick in the bum I needed to do something about it.

Sadly, it appears that there are no current or future plans to employ people like me – people who use lived experience of mental health conditions within their work – within specialised roles beyond the lower paid ones.  Even those of us who are more qualified, specialised or experience than our colleagues.  We will continue to be managed and led by people whose job roles do not incorporate Lived Experience.  Even if they are less qualified than we are.

I sobbed deep sobs as I realised that no matter how hard I tried, how much better I am, or how much I achieve, I am worth less than colleagues who are either not open about or do not suffer from mental health conditions.  I am worth less than my colleagues because I actively use my insight into this within my work.  I am worth less despite training for five years and taking a pay cut to do so.

We talk about challenging stigma of mental health.  We first have to do this within the mental health services who claim to support us.  If I am worth less than my colleagues because of my mental health disability, how can my colleagues treat the service users they treat as equal human beings, deserving of dignity, respect and equality?  Our gay colleagues and our black colleagues, our physically disabled colleagues are visibly able to hold positions that match the hard work, the qualifications and the merit they have have.  We want equality for the many NHS staff working in mental health services who are not facing a glass ceiling – they are facing a concrete ceiling – within the work they do.  Let us manage and develop Service User Involvement, Service User Consultancy, Service User research.  It is our discipline, one we have been developing since the 60’s, and now there are many of us who are qualified, skilled and experienced in these areas.

Stop telling us we are not worth anything, that we are worth less, whilst you promote and employ staff to manage and govern us.

This is one story, but it is the experience of many of us, actively held back and discriminated against because of our mental health disability, and our audacity to bring the insight it gives us into a space that feels shame.  We don’t want to retrain as clinicians within other disciplines, we are training in our own, and it is valid, and brings a visibility to mental health that all the other disciplines erase.  It is the missing link in our services.

Please, please start treating us as your equals.  Because we are your equals.  The barriers and discrimination you place before us mean that we will never stand anywhere near you, even if we’ve had to work twenty times harder to stand ten steps behind you.

We are worth just as much as you are.  Maybe if you let us in, the very act of seeing us as equal will improve the care that is given to all people with mental health disabilities when we access services.

Toxicity in Mental Health

DISCLAIMER: The Venn diagrams in this refer to voice hearers but the term ‘voice hearer’ here can be applied to people struggling with mental health issues in general. However this was written by a member of RitB who is a voice hearer. The preamble will make the context clear.

This morning Rita Bins was wondering to herself why she heard so many benefit bashing voices. Was this a projection of the current welfare-hostile ideological zeitgeist, as part of the neoliberal war on the welfare state? Was it a projection of how she felt the terrain of voice hearing activism stood? Or was it her background experience of telepathy, her stance as a mental health activist making her a target for other right-wing voice-hearers, struggling with their cognitive dissonance having internalised an insidious, and pernicious political subjectivity? Who knew? But she needed to work it through? What tools could she use this time? Aha! Venn diagrams!

The first Venn diagram was as so:

RITB AL

Let’s work through the overlaps. First if we look at the overlap between voice hearers and the recovery model, the most benign here. The term recovery model here refers to a particular ‘brand’ of neoliberal, individualistic, technique-driven, outcome measure focused from of ‘recovery’ (as opposed to the more polyvocal term that refers to a more diverse discourse). This group RiTB has no personal animosity to, although a part of our praxis is towards educating the limits of this model in denial of class, economic and structural aspects (the social model of mental health) that critical psychiatry does a better job of recognising.

The second group, benefit bashers overlap with voice hearers on probability are going to be of two possible groups. The first are going to be bio-medical voice hearers (hence no overlap with the medical model) who are of the (according to measures of the efficacy of medication) small group of voice hearers for whom medication works well but who either wilfully or through ignorance, cast aspersions on those who struggle to recover and for whom the medication does not work, but who have also, for whatever reason, internalised the benefit bashing propaganda against their own peers. The other subgroup of this overlap are those still on benefits whose support comes from right wingers (the equivalent of the POC whose racists peers say ‘you’re alright mate, it’s these other lot who are the problem) so to protect their social position attack other people on benefits.

The third overlap is those who support the Recovery Model but who benefit bash, presumably with no lived experience themselves, so on probability mental health professionals. Who have service users and survivors in their charge, but have internalised the anti-benefit media hate-campaigns so much that they are willing to override their own professional knowledge of their clients’ personal circumstances and take a hostile position on their clients’ actual lives and rights. Or they have internalised the individualist aspects of Recovery Model propaganda and blame their clients for not trying ‘hard enough’, no matter how ill their clients may be, treating them as malingerers because of the failure of the techniques of the Recovery Model that they have invested their careers in.

But the most odious and pernicious is the triple overlap, peers willing to sell out their compatriots, internalising their own ‘successful’ recovery as ‘hard work’ and a ‘meritocracy’ in denial of the differences between mental health lived experience, the structural disadvantages the unrecovered struggle with, and the personal advantages the ‘recovered’ have benefited from, that are now ‘all their own work’. The ideology of ‘choice’ over the ‘reality principle’ and its relation austerity that affects and blights so many of the unrecovereds’ lives. These truly are the people Recovery In the Bin are most critical of.

One last Venn diagram though, just in case you were unaware, as there is no excuse, no exception. Venn Diagrams don’t just show ‘overlaps’, some show ‘subsets’.

RITB AL2 (2)

Recovery In The Bin Statement Against Racism

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Recovery In The Bin stand against racism and acknowledge it is pervasive throughout culture and the systems we are subject to. We acknowledge white privilege and the duty for those with it to recognise and strive to remove it and to challenge the culture of Whiteness. We support an intersectional understanding of how each of us may have privileges and oppressions. We oppose anti-Semitism, Islamophobia, and the State-led policies of hostility toward migrants and asylum seekers. Learning to negotiate with each other respectfully and with humanity is an ongoing process that at times is difficult but to which we should all be committed. We also demand professionals acknowledge the presence of institutional racism and workers who collude with this at an individual and/or collective level are contributing negatively to the mental health of Black, Asian, and Minority Ethnic (BAME) service users. Professionals should join us in learning and changing – to listen to and to give platforms to BAME Service Users, and marginalised groups who are not even visible to services or excluded by hostile environments. We draw particular attention to the appalling higher risk of violent and abusive treatment faced by people of African-Caribbean and African heritage. It is massively under-acknowledged that racism contributes to mental distress and illness; we must recognise and work to change that.

RITB With The T

We wanted to add some specific detail to our previous Statement of Support in respect of the intense activity around the Gender Recognition Act Consultation that is creating upsetting misinformation. You can fill in the consultation with advice here. We oppose Transphobia (definition on wiki) which can be described as ‘any oppression that arises from people being trans, or perceived as trans or as not conforming to gender norms. And the structural oppression of transgender people by cispatriarchal society, and prejudicial and/or ignorant attitudes, narratives and actions which contribute to those structures of oppression’.

Screenshot 2018-10-14 23.22.12

We recommend this great post by Rosie Swayne. And we thank activists for their permission to print here the text of a leaflet which was handed out at an ‘L with the T’ solidarity demonstration recently that deals with common misperceptions. A PDF can be downloaded here > TERF rhetoric vs reality

TERF Rhetoric vs Reality
Content warnings: transphobia, mention of sexual assault, rape, suicide, mental health problems, conversion therapy, medical gatekeeping.

TERF rhetoric
Children are being given irreversible medical transition before they are old enough to know that they’re really trans.

Reality
Research confirms that children who assert a transgender identity know their gender as reliably as their cisgender peers of the same age. The effect of hormone blockers is reversible, while the effects of unchecked puberty are much harder to reverse if necessary. Transition-related surgeries are not performed on children.

TERF rhetoric
[Cisgender] women are at danger of being harassed or assaulted in bathrooms if trans women are allowed to use them.

Reality
Trans people just want to be able to use the bathroom in safety, like anyone else. There are no documented cases of this having led to harassment or assault of cis women. On the other hand, trans people frequently feel, and are, unsafe in the bathroom of their birth assignment.

TERF rhetoric
Trans women uphold stereotyped notions of femininity defined by patriarchy.

Reality
Trans women’s style of presentation is as diverse as that of cis women, if not moreso. This is despite the fact that they face even more pressure to conform to stereotypes, in particular by doctors who often continue to enforce discredited gatekeeping standards requiring such conformity before allowing access to medical care.

TERF rhetoric
[Cisgender] female biological reality is a defining aspect of women’s experience of oppression.

Reality
Women’s oppression takes many different forms for different groups of women. For example, lesbian and bisexual women face particular forms of misogyny, flavoured by homophobia, that straight women may not, while lesbians may be less likely to encounter other manifestations which usually take place in the context of relationships with men. In the same way, trans women’s experience of misogynistic oppression is different in some ways to that of cis women, but those experiences are no less oppressive and no less female.

TERF rhetoric
People who claim to be trans should instead be encouraged to accept their birth gender.

Reality
“Conversion therapy” on trans people is as abusive and ineffective as it is on LGB people.

TERF rhetoric
Trans women are men who are “trying to infiltrate women’s spaces”.

Reality
Trans women are women.

TERF rhetoric
[Cisgender] lesbians are being pressured to sleep with trans women, or shamed if they do not.

Reality
The vast majority of trans women want nothing to do with people who don’t consider them women; so the idea that they would want to pressure anti-trans cisgender lesbians to sleep with them is somewhat absurd. There is some discourse around the implications of cisgender people excluding transgender people of their preferred genders from their potential dating pools on the grounds of their transness, but this does not amount to anyone being pressured to sleep with people they don’t want to.

TERF rhetoric
Emphasis on detransition.

Reality
Less than 1% of people who have undergone transition choose to “detransition”. Often, those who do are responding to societal prejudice rather than rejecting their transitioned gender. Statistics about “surgical regrets” are also frequently cited in bad faith in this context. Many of these statistics include people who express dismay relating to complications or poor outcomes, as well as post-surgical depression – both of which are common problems following procedures of all kinds – and may or may not have any second thoughts at all about having undergone surgery. Likewise, even in rare cases where a patient might regret having opted for a procedure, this should not be taken to imply regret for having transitioned or a desire to detransition.

TERF rhetoric
Transition does not improve mental health or rates of suicide and self-harm.

Reality
Untreated gender dysphoria (due to delays or refusals of treatment), unnecessary and intrusive questioning/tests, prejudicial attitudes by service providers, and restrictive treatment pathways, all contribute to minority stress which is detrimental to the mental health and wellbeing of trans people. [shura.shu.ac.uk/8957/1/Ellis_Trans_people%27s_experiences_of_mental_health.pdf]
An article published in the July 2016 edition of The Lancet offers significant evidence that the “distress and impairment, considered essential characteristics of mental disorders” among trans people primarily arises in response to the discrimination, stigma, lack of acceptance, and abuse they face on a regular basis. [thelancet.com/journals/lanpsy/article/PIIS2215-0366(16)30165-1/abstract]

TERF rhetoric
Transition surgeries are “mutilation”.

Reality
This is a transphobic insult masquerading as an argument.
“Mutilation” is used here merely as a way to express disgust about trans people’s bodies; it is irrelevant to the actual purpose and merits of surgeries, which are effective and often lifesaving treatments.

TERF rhetoric
Gender is purely a social construct. Or Gender is defined by genitals.

Reality
Traditionally feminism understands both that biology does not determine how we experience the world AND that our biology does contribute to our shared experiences as women. There is no contradiction here for transgender women.