Tuesday, August 17, 2010

MisUnderstanding Transsexuals and Transition

Every so often, I see someone start talking about transsexuals and transition. They almost always do it from an externalized perspective and inevitably make some statements that are guaranteed to make various members of the transgender community angry.

So, when Jerry Maneker wrote a post that pointed to Don Charles' post entitled "Frankengender", I got curious and went and read it.

I have to take great exception to some of the assumptions in Mr. Charles' writing, because they lead him down a path to conclusions which are just plain, outright incorrect.

... "Gender reassignment" is a cynical hoax which exploits vulnerable people and leaves them forever chasing a false legitimacy; it's so cruel, so despicable, so horribly inhumane, I can barely stand to think about it. The really tragic part is, a person's inborn Transgender status is every bit as legitimate as conventional male or female biology, but nobody will acknowledge that fact.

As I've said before, there's nothing wrong with most Transsexual patients that broader, more realistic definitions of male and female wouldn't cure.

I think this statement underscores a key assumption about transsexuals that is, to say the least, incorrect.

He's inverted things from the usual assumption that non-trans people make. Instead of claiming that it's all about the physical (surgical), he tries to make a variation on the Rad-Fem claim that gender is largely rooted in the social. (and sadly, has misconstrued it in a manner consistent with the objections that both social conservatives and radical feminists raise about transsexuals)

His misunderstanding here arises from a failure to recognize that Gender is a complex, multi-dimensional aspect of our being. At the very least it involves the intersections of the physical, social and psychological aspects of us. (and, as if we can't possibly get any more difficult to comprehend, the social and psychological aspects are likely in themselves comprised of many different threads of identity!)

The claim that "broader definitions of man and woman" would "cure" transsexuals is, highly debatable. While more flexible notions of gender would certainly help alleviate some of the stigma that transsexuals encounter in life, it cannot and will not address the cognitive dissonance that so many transsexuals experience prior to transition and (for some) surgery.

But feelings of disgust for the body you were born with is a mental health issue requiring mental health services. You don't treat mental health issues with radically invasive surgical procedures!!! That's barbaric!

I've seen this claim made before by other opponents of treatment for transsexuals. Coming from someone who apparently is connected in general with the GLBT community, I'm particularly disappointed to see it.

The problem is that it falls into the same category as so-called "reparative therapy" for homosexuals. Trying to change something as fundamental as gender or sexual identity using therapy just plain old doesn't work - at least not for those whose identity is firmly at the extreme end of things.

I can appreciate his "horror" at the nature of gender surgery - most males express that response when thinking about Male to Female GRS.

However, for transsexuals in general, GRS is an effective part of the treatment process (although a fairly late stage of the overall treatment). I would invite Mr. Charles to spend some time reading Pfaefflin et. al.'s study of post-surgical outcomes before he goes too far down the path of condemning the availability of surgery for those who need it.

I will also refer to the WPATH Standards of Care briefly to substantiate my point that there is more at play here than a single dimension of experience:

Options for Gender Adaptation. The activities and processes that are listed below have, in various combinations, helped people to find more personal comfort. These adaptations may evolve spontaneously and during psychotherapy. Finding new gender adaptations does not mean that the person may not in the future elect to pursue hormone therapy, the real-life experience, or genital surgery.

This is significant, because it underscores a clear understanding in the treatment community that surgery is but one dimension of a much broader scope of treatment.

When it comes to surgery itself, I would like to bring your attention to section X of the v6 Standards of Care:

Sex Reassignment is Effective and Medically Indicated in Severe GID. In persons diagnosed with transsexualism or profound GID, sex reassignment surgery, along with hormone therapy and real-life experience, is a treatment that has proven to be effective. Such a therapeutic regimen, when prescribed or recommended by qualified practitioners, is medically indicated and medically necessary. Sex reassignment is not "experimental," "investigational," "elective," "cosmetic," or optional in any meaningful sense. It constitutes very effective and appropriate treatment for transsexualism or profound GID.

While I would to some extent agree with Mr. Charles' assertion that GRS is not a cure per se, we can't cure a lot of conditions yet. But we have known treatments that are effective. Whether you like the SOC or not, the protocol they describe is demonstrably effective at both the individual and population levels over the long term. (Pfaefflin et. al.'s survey of post-surgery results corroborates this claim quite nicely)

It's an option for Transfolk, not a necessity!

Is GRS necessary for all transfolk? No. For some? Absolutely. The issue around surgery funding is that when you view it as "purely optional" (and therefore something the individual must pay for out of their own pocket), you create a situation where the most severely affected by their gender issues likely will never have access to the treatment they need for economic reasons. (Granted, I'm a Canadian, and I have a somewhat different perspective on funding for medical treatment than is common in many parts of the United States ... I see great value in not driving people with medical needs into bankruptcy)

I think that Mr. Charles' has grossly misunderstood that although it is a fraction of transfolk who actually have gender surgery performed, that doesn't make it less important and valid for them than any other medical intervention for a condition. Perhaps I should point out here that medical intervention for mental conditions such as schizophrenia aren't exactly ideal solutions either - at best they are marginal attempts to manage the symptoms the patient is experience ... but the patient is much better off with that imperfect treatment than with no treatment at all!

. . . they expect me to swallow this whopping big lie about "gender dysphoria", a "neurological disorder" for which no neurological therapy exists. Instead, major cosmetic surgery including breasts and reproductive organs is the only effective treatment! It's the most demented thing I've ever heard of.

For those who experience and live with whatever the causes of being trans happen to be, the consequences are very intensely real. To the point that the suicide rate (and suicide ideation rates) among transsexuals in particular are many, many times higher than the population as a whole. It's not just suffering, Mr. Charles, it can be so destructive as to be beyond debilitating. While I would agree that the clinical models used to date are imperfect, they are a damn sight better than nothing.

In this case, the pit in question is a "civilization" that seethes with entrenched transphobia. That's the abnormality that needs to be corrected . . . and it's still there! Quackery like "gender dysphoria" and Frankengender "sex change" operations keep it there.

I will agree that there is an entrenched degree of transphobia in society, and that it deserves to be expunged from society. One of the things Mr. Charles' has misunderstood, and misrepresents through his entire argument is the role of the therapist (at least the good ones).

A good therapist will help their client work through and beyond the transphobia in society and themselves. Guess what? - even after that process has worked its way through in a reasonable fashion, we still find that there are transsexuals who are not willing to live with the incongruity of feeling and living as female in our society without the gender surgery to align body and soul.

The point, Mr. Charles, is that for a fair number of transfolk surgical intervention is part of the solution. The rest of the solution comes from within - an inner journey that is at least as moving and powerful to those who undertake it as your own journey into faith no doubt was.

As for changing society's paranoia about transgender people as a whole, the only way that's going to happen is for those who are trans to live well and be positive examples within our circles. Sadly, when the most generous of estimates place the rate of transgender identity at somewhere in the 1 in 3000 range(and personally, I think that's very optimistic), the odds of there ever being enough transsexuals to influence the greater mass of society into a more engaged, thoughtful place are tiny indeed.

It is one thing to argue for excising transphobia from society, but it is quite another to do so without acknowledging the very real need for transsexuals to change their bodies.

If you get angry e-mails about your posts on the subject, it is no doubt because so many would read what you are advocating as an attempt to erase their own narratives. Generally speaking, erasure tends to result in cranky people. Not everyone who is transgender is content to live in the nether world betwixt and between.

Personally, Mr. Charles, I would strongly suggest spending some time talking with therapists and other treatment professionals who are part of WPATH, and a little more time in the clinical literature about transsexualism before you go making proposals like "fixing the mind". It seems to me that your own thinking is filled with as much subjective nonsense on the topic as comes from the likes of Peter LaBarbera and Julie Bindle.

[Update 19/08/10]
Reductio ad Absurdum

In the comments over at Jerry Maneker's blog, the conversation took a turn for the surreal and outright ridiculous when Jerry writes the following in reply to one of my comments:

If there were no transphobia in society, it is unlikely that there would be many transexuals who would feel "like they were born into the wrong body."

Ummm...right. So eliminating transphobia will reduce the number of transsexuals - I can't even begin to express how ridiculous that kind of reasoning is. The degree and extent of transphobia in society today is enormously lower than it was thirty years ago; and the numbers of transsexuals hasn't exactly dropped off, has it?

As for the argument that eliminating transphobia would allow more transfolk to live comfortably without pursuing surgery, that's at best a bald assertion with no evidence to back it up.

I'm sorry to say it, but even within the broad GLBT community, there's an immense amount of misunderstanding of transgender folk as whole, and transsexuals in particular. It's truly sad when people opine about how to deal with the plight of others without bothering to inform themselves in a meaningful way about those people.


fq said...

(I wrote this comment at Jerry's blog. Thank you)

Rev. Jerry, thank you for posthing this. While I disagree with your and Don Charles's opinions, I appreciate the space you have provided.

Why is Don Charles suddenly an expert on Transgender and transition? Is he Trans? If he's not Transgender, why are his opinions superior to the Transgender community?

And I find the title "Frankender" quite offensive, like Trans people are monsters. And the illustration of the soccer (?) playing with his bare buttocks is offensive because it shows Don Charles is trivializing Trans concerns and using sports photos to "sex up" what should be a serious discussion.

I will never take Don Charles seriously. I left several comments on this topic at his old blog and they were never posted. And I resent the fact I cannot leave comments at his new blog unless I get a Google email. Jerry your system is much more user friendly. Since you and he have comment moderation, why does Don make it so difficult to comment at his site? What is he afraid of? And how ironic that he rails against other blogs and comments but he is the worse (sp?) offender.

I love my sexuality and my identity. It is a gift from God.

Aerin said...

Aaaahhh... the meta-penis rears its head again. (Pun probably intended.)

Changing society's reactions to transgender people goes hand-in-hand with changing society's reactions to a whole lot of other things. In my younger days, I thought of this project as ridiculously difficult, but possible. Nowadays, I just wish for SRS (species reassignment surgery.)

Seriously, I suppose it's both good to see someone recognize the need for attitude changes and sad to see him work from such a good start to an end that totally misses the point.

MgS said...

Erasing people's narratives and experiences to support a position is always a bad choice of platform to argue from.

Mercedes said...

Thank you. I've been debating about whether to even dignify the article with a response in case the link would give it publicity / traffic, -- it's so blundered and blindly written from someone who clearly has no idea about the transsexual experience. You handled it very well here.

I will actually give the author credit for correctly identifying societal transphobia as the primary "mental illness" instead of transsexuality itself. But then his dismissal of transsexual experience and the medical evidence is just as horrifically transphobic.

Again, thanks.

Anonymous said...

I'd actually quibble with the 1 in 3000 number.

American Insurers, with their strong incentive to minimize numbers and treatment, have pegged the incidence at 1 in 867. Or 6 in 5000. Lynn Conway's estimates put transitioners at 1 in 250, and those who express consistent transsexual desire at 1 in 50.

There are more of us than you think. Too many of us hide, however, on one side of transition or the other, for our visibility to match our numbers.

MgS said...

Valerie -

I tend to be cautious about those statistics - the fact is that there are far too many people who are invisible to them.

Further, I worry that estimates such as Lynn Conway's are using very broad or very ambiguous nomenclature.

We have a long ways to go before population frequency statistics for transsexualism / transgenderism will be truly useful measures of actual incidence rates.