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Inspired by others, Dallas draws together psychology, philosophy, queer theory, and contemplative science. She works with gender-expansive patients providing psychiatric, gender-affirming, care. Her research includes moral psychology, trauma, and resilience. She seeks to foster empathy and prosociality while collaborating with vulnerable gender-expansive populations in community-based research and works to create a celebratory and open-hearted queer-friendly healthcare environment. Website: www.dallasducar.com
Dallas Ducar will be speaking on transgender health at the 2019 Fall Festival, happening October 1–3 in Boston’s Seaport. Learn more and register here: https://www.hubweek.org/register
Lindsay Gearheart: What is your background and how did you become interested in studying psychiatric health?
Dallas Ducar, N.P.: My background is specifically in philosophy and cognitive science. When I started my undergraduate work, I was profoundly interested in how everything worked, but more specifically, the connection between the mind and the body. The question of consciousness, which is a question that a lot of people have, was specifically one that I thought yielded some benefit with neuroscience, which is why I went into cog-neuroscience while supplementing that with philosophy of mind.
As I delved a little deeper in the academic side of things, I became more interested in the ethics of moral psychology: how what we do might affect our relationship to our identity and how we view ourselves, how very simple things like taking a shower can make us feel less guilty. Or how more complex things, like decision-making about whether to uphold our deepest virtues might affect our perception of our own identity.
This was all nice and academic, but I think it really hit home when I started to volunteer on a local rescue squad and saw mental illness for the first time in a very impoverished way. In a college setting, I had seen people who had access to quite a bit of resources receiving mental health care, namely friends, but I hadn’t seen the systemic effects of oppression and poverty as it occurred frequently within the community when I was at Charlottesville, Virginia.
I would say that responding to people suffering on the rescue squad was one of the greatest privileges that I have had in my life, being a volunteer for the community, with the community, and not really having that barrier between the work I did and the hospital. It really taught me a lot about how different life can be when you’re working with a community and the trust that can be garnered there, if you are for example not wearing a white coat, and if you are providing care on a street or you’re kneeling down next to someone who’s injured or in mental distress.
I also noticed that there were a lot of other medics on the squad that were very interested in some of the complex physical trauma, but I was really more interested in the complex psychological trauma, which was very rare. And so that really kicked off my interest in psychiatry in the clinical aspects of the academic work I was doing.
I realized it all merged together in a way where I could still ask questions like: “What does it mean to be human?” and “What does it mean to live your life?” and “What does it mean to feel your emotions?” and “Why do you get out of bed each day?” “What is it that makes life worth living?” and “How can we help co-construct better, co-create that in allowing you to narrate your own story, rather than allowing external doctors or people to have ownership over your story?”
That happened before I began my own process of really understanding my psychological suffering. While that was very deeply rooted, it also led to quite a beautiful resolution for myself, as I began to learn more about the queer and trans community. Also at the time, I was doing some minor research on gender studies, and with incredible support from my partner, I began to first identify myself as queer and then after that as a transgender female.
Needless to say, there was a lot of navigation socially about how to operate on a macho rescue squad, or how to go from being a male nurse when you walk in the room and being perceived as a physician, to a female nurse, being perceived as a nurse, and experiencing those very direct gendered assumptions.
But still, I was very lucky to have the support of my loved ones, and it was through that transition – I mean, I think we’re always transitioning, all of us – but through those initial steps, that I began to realize how important support can be. It is one of the number one defining factors in suicide rates, actually, in transgender and gender-variant individuals. And so, for myself, I saw this almost as a no brainer. Here was a group of vulnerable and marginalized people, and with almost minimal psychotherapeutic and psychopharmacological interventions, you could really save a life. And there wasn’t much education or awareness around this either.
I started as a patient in a transgender clinic, and then within that transgender clinic at the University of Virginia, I also began to practice as a nurse practitioner student in psychiatry and offer some of the very first mental health services there. I learned how important that was to individuals. And it was also really interesting being a patient and provider at the same time, having a dual-lense on how the clinic was operating, the importance of very small things, and how one person could play a role in that.
Soon after, I joined the transgender health program here at Mass General, and it’s been the perfect fit. I’ve been able to provide some of the first psychiatric services to gender minorities within the Transgender Health Program, and at the same time, help to work with the community to try and develop research and advocacy priorities, and it’s been so rewarding.
LG: On Mass General’s Transgender Health Program website, it mentions using community-based, participatory research methods to further advances in transgender health. Can you talk a bit about those methods?
DD: There’s two differences. There’s community-based participatory research, and there’s community-based participatory action research. And the action is something I like to include there. It’s not very well-known or spoken about in literature, but action research is from a form of methodologies that pursues a type of action or change and also research at the same time. So it’s somewhat novel in that it doesn’t just focus on researching with the community, which is the community-based participatory research aspect, but also defining what fundamental change we want to see in the community, which is very different and somewhat revolutionary for the scientific method. In its simplest form, action research is a way of generating research about the social system, while also trying to change that system, too. So it’s not just about producing the knowledge, I don’t see that as enough, but I also think I seek to understand and then also alter the problems that are generated by these social systems.
So the work that I have been working on right now is trying to form a community-based participatory action research group. The name is still in flux, I’ve been thinking about maybe Community Action and Advocacy Team. This would be a group of gender minorities starting within the Boston area, and then actually hopefully expanding through all of New England, connecting in person and also over the internet and fostering resilience within the community. So first starting by positioning where everyone is, locating where we’re coming from, and also giving voice to what each individual needs to protect themselves, foster their resilience, and foster something I like to call “gender euphoria.” So much of psychiatry is focused on gender dysphoria, but there needs to be a greater focus on what makes you feel right and what makes you feel whole.
So starting with that focus on resiliency and communal care together, and once we’ve fostered that voice, thinking about how we work together to amplify that voice. The hope is to develop a variety of research aims out of this group that are democratically decided with a deep understanding of equity, and trying to foster that sense of equity and inclusion within the group. And moving forward, trying to use those priorities that the community has developed to steer the research engine of Mass General.
I can’t claim to be able to steer even close to all of it, but I can say that I would hope the needs of the research aims of the Transgender Health Program are able to be steered by the community. Because even if we are a group of individuals who have good intentions and maybe even some personal experiences, to help define some of this research, we don’t know the whole story, and there are a lot of groups that are underrepresented. So the hope is to be able to take the resources and help direct those resources from the community.
LG: Speaking about the community, as you’re newer to Boston, what have you found unique about the city and its approach to transgender health?
DD: I want to acknowledge that I’ve been here for a very short time, so my perspective is myopic and constrained, but I’ve noticed that throughout my being here, I’ve been able to develop a lot of queer friends, which was something I was unable to do in Charlottesville, Virginia. I no longer feel so much like the token trans person, which is really wonderful. And just being able to have that visibility is the first step that allows for some sense of normalcy, that this is OK, this is not something that’s different in any way.
In terms of the care itself, the care I’m most familiar with is the care of the Transgender Health Program, but what has really struck me is the approach that the program has for putting the patient at the steering wheel. So much of healthcare has been in the past paternalistic, and maybe more recently, focused on, “Let’s just give the patient all the information and hope they can make the best choice.” The work of the Transgender Health Program though has been, “We’re here to be your partner on this in whatever way we can. We’re here to provide information, work with you, nurture that relationship so this feels more like a home than anything.”
We have patients showing up here all the time who just want to talk. I mean, how many times do you want to just go into your doctor’s office and talk, right? It’s a pretty novel approach, having everything in one place, and at the same time, saying “Where do you want your hormones to be, what do you feel comfortable with, what do you want to be? And we’ll help you become that.”
I don’t know of any other healthcare system that focuses on that, at the same time while also priding itself on equity. So many different quality measures focus on very specific indicators that can be captured predicting important health outcomes, but one thing we don’t have a measure for is equity. What we know more than anything is that LGBTQ individuals aren’t going to their providers. Why? It’s usually because they might not feel comfortable there. So how can we pay attention to people’s unique identities and foster a sense of feeling welcomed and knowing that there’s autonomy so that going to any provider’s office can be not only an OK experience, but an experience that’s affirming, that is a lovely experience, that you want to show up for even when you don’t have that appointment, and that’s a pretty amazing transformation in healthcare delivery.
LG: I saw that you recently authored a paper on mindfulness for healthcare providers — could you tell me a little about that research?
DD: I have been involved in what’s called contemplative science for quite some time — it’s also called complementary alternative medicine, too — and what my work seeks to do at a very fundamental level is help teach people the tools that they already have in their own toolbox to be able to relax and to be able to feel safe. What we know from anyone who’s suffered any type of trauma, whether it’s an LGBTQ individual, a healthcare worker, someone on the front lines, is that that fight, flight or freeze system can be on constant overdrive and really lead to negative effects on their own health outcomes.
When working on the rescue squad in my own experience, I saw some amazing dedicated individuals who would volunteer their time again and again up to the age of 75 because they really wanted to be a part of their community and help their community. But what some of these individuals were not doing was taking care of themselves. So what we piloted and had wide-ranging success with was the first mindfulness-based stress reduction intervention for emergency medical technicians. This includes EMTs for basic life support and intermediate life support, medics and paramedics.
That space to be able to calm oneself really showed strong improvements in professional quality of life, while also being able to show consistent improvement in compassion and being able to be aware — mindfulness, the act of being aware — and when we’re more aware of the decisions we make, the words we choose, the virtues we commit ourselves to, I believe, the better provider, employee, spouse, family member or whomever we’ll be. And specifically in the healthcare setting, a lot of my work has been toward healthcare providers, and it’s a ripple effect. You change the life of one healthcare provider or healthcare worker, and you see a ripple of less medical errors, more attention to detail, more ability to be compassionate with the patient and oneself. That can result in less burnout too, which we know has been a huge problem in healthcare.
This initial step toward paying attention to oneself, taking a moment to breathe, being able to settle one’s own internal state, and then maybe go deeper too, and be able to let go of that suffering that you don’t need to hold on to, is pretty ancient in its practice, but also seems to continually be revolutionary for many people. We found that amongst the EMTs, and that’s also something I would love to be able to work with alongside the queer community in Boston and New England, in regards to being able to help foster the many different senses of resiliency. And that may be mindfulness, but also may be many other things too.
Some of the other work I’ve done has been with lupus patients, and specifically lupus affects women of color. In the study, we did heart rate variability measures, FMRIs, various brain scans, bloodwork, and what we found were that people had some dramatic improvements in their physiological health outcomes from a psychosocial mindfulness yoga-based approach. But what a lot of these women of color really believed in and benefitted from the most was interpersonal communication, which is something we didn’t really think that much about, but did include. Specifically, it was how to speak to your loved ones about pain and suffering, especially when the pain and suffering can be invisible. All that’s to say is that the initial investigation into what makes someone be resilient is so important, because you may be trying one thing when it’s not a one-size-fits-all endeavor or intervention.
LG: Was there anything else you wanted to share, any final thoughts?
DD: I would like to say for any transgender or LGBTQ individual who is suffering, there are places to go to seek care. The Trans Health Program is one of them, Fenway, BMC. There’s a lot of different places, and this is a field where there’s a lot of dedicated individuals who really want the care that’s being provided to be expansive, to grow, and to be affirming. So there are people who want to help.
Speaking from personal experience, there can be hope, too. For anyone who is suffering, there are people that want to help. For anyone who knows someone who is suffering, the importance of support is one of the biggest predictors in any LGBTQ individual’s health outcomes, specifically psychological health outcomes. I would strongly encourage anyone reading this to not hesitate to lend that support.
This Change Maker interview was originally published August 2019 on the HubWeek blog.
The HubWeek Change Maker series showcases the most innovative minds in art, science, and technology making an impact in Boston and around the world. Know a change maker you think should be interviewed for this series? Nominate them here.