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Jane Fae

Feminist and writer on issues of political and sexual liberty

Why Depathologization Matters to the Trans Community

Posted: 10/19/2012 10:18 am


At last! Depathologization day is here again
<http://www.huffingtonpost.co.uk/2012/10/18/transgender_n_1982321.html?utm_hp_re\
f=uk>
- well, tomorrow, actually - and for once the world is looking in,
listening, starting to take note.

Not before time!

Because while being trans in whatever form that takes is burden
enough, it is made many times worse by the fact that those who
desperately need help must first prostrate themselves before the gods
of medicine before receiving treatment.

Not every condition is illness

"Ah, but", I hear you say. Surely "treatment" implies illness. And if
its illness, then of course you need medical people to tell you what
to do: to set boundaries; to make the diagnosis. I mean, heaven
forfend if there wasn't a textbook somewhere to tell us all what's
what. As there is in this instance: two in fact. There's the
Diagnostic Standards Manual (DSM), closely guarded by the American
Psychiatric Association, and the World Health Organisation guidelines,
which owe not a little to the DSM.

To which there is a simple answer. Think pregnancy. Think disability.
Most women don't need a GP to tell them they're pregnant. They're
pretty good at working that out for themselves, either with or without
a little over-the-counter assistance from Boots. Pregnant women aren't
ill. They may sometimes need medical help to deal with complications.

Or disability, of which there are many and varied conditions. People
have disabilities. Sometimes - not always - they need help from the
rest of us to manage those disabilities. Complications, again, may
require some medical support. But note, please, the language. This is
about giving people the tools to enable them to play a full part in
society. It's about providing a crutch - sometimes literal - on which
to lean. It's not about illness. Or "disorder". Acknowledging that,
giving respect, giving voice is perhaps the first and most important
aspect of "treating disability".

Yet this is a mountain that trans folk have still to climb. Being
trans is a condition, no more an illness than being gay (also, until
recently, classified as mental disorder).

Pathologisation means prizes

It's about being born into the wrong body, which for some is a matter
of mild inconvenience, for others, an issue of permanent debilitating
impossibility. That's a good start point, actually. Because being
trans is NOT one thing, one set of circumstances with one
all-encompassing treatment. It's about an issue that different
individuals need to deal with differently, as opposed to having a
one-size-fits-all diagnosis and treatment imposed from above.

For this is at the heart of the pathologisation process. Being
charitable, I'd call it misunderstanding. Less charitably, I'd argue
its about self-interest and career preservation by a small clique of
middle-aged, middle-class, mostly white, mostly male specialists with
an enormous self-interest in retaining their position as experts in
some trans "illness" .

Their evidence? Well, they've written a lot of papers about what trans
is and what the proper treatment of it is - often without a smidgeon
of real engagement with those they treat. Trans is "suppressed
homosexuality", despite the fact that trans men and women exhibit a
wide range of sexual orientations and none. Or, ignoring the existence
of trans men, it's about something called "autogynephilia" - an
obsession with the female form.

Of course, such evidence is all rigorously checked on the peer review
roundabout. One "expert" writes a paper which is favourably reviewed
by other "experts", who then cite the original paper in further papers
they write. It's a vicious circle of self-satisfaction and utter
unscientificness. But these guys wear the suits, so they MUST be
right!

Just as they were right about female masturbation, also, for some
while, diagnosed as disorder: and homosexuality, which they only
decided might not be disorder back in the 1980's. Though that decision
has not stopped some of the same specialists who now write
enthusiastically about "curing" trans-ness from continuing to advocate
reparative therapy, aka the "gay cure".

Abuse naturally follows

But if this means that trans folk eventually get treated, what's the issue?

How long have you got? By categorising trans-ness as a mental illness,
it opens the door to further abuse and indignity - from the street yob
who makes some oh-so-witty crack about a trans woman being mad, to the
GP whose permission is needed before any treatment is possible.
Because if its illness, there are boxes to be ticked, hurdles to be
jumped and receiving any sort of support if you are trans in the UK is
a postcode lottery.

With the right GP, at least starting the process is a doddle. Wrong
GP, and you could find yourself out in the cold for years. That
matters. You know it so matters when you've had the awful experience
of talking to trans individuals on the brink of suicide because they
cannot get anyone to take them seriously or even consider them for
treatment.

Pathologisation, medicalisation: that means, even when you're
acknowledged as suitable candidate for treatment, you must endure all
the indignities heaped upon you by pompous professionals. My one and
only experience of this, before I waved goodbye to the NHS gender
service was an uncouth consultant who, taking issue with my name,
eventually conceded that "for the purposes of this interview we shall
refer to you as Jane". I wish I'd smacked him then and there: but when
one is totally dependent on the goodwill of others for treatment, what
is one supposed to do?

Women, of course, know that there are many, many ways of "being a
woman" - and neither dress nor hairstyle defines one's femaleness. Not
so if you are trans. For then you must demonstrate to these male
professionals that you fit THEIR ideal of feminity before treatment
will follow. Stepford, anyone?

I hesitate to suggest that this imposition, this control-freakery by
"gender experts" is responsible for other forms of abuse. There are
hints that such may have taken place in the UK in the '80'sand '90's.
Definite instances of gender specialists abusing their position in the
US. But could anything of Savilian proportions ever take place now?
I'd like to think not - though the very fact that vulnerable
individuals are placed in a position where their welfare is wholly
dependent on their ability to appease those in a position of power
over them is not ideal.

But what about these operations and the like, which are dreadfully
expensive and significant in terms of consequence? No-one is asking
for all medical opinion to be excluded from the mix. Merely for it to
be toned down. Where a major procedure is proposed, it is right, as
with pregnancy, as with disability, to investigate: to ensure that the
individual requesting it understands the issues and the consequences.

It is utterly wrong to treat the individual as merely a patient, a
bystander in their own life - and in this respect, while the campaign
for depathologisation is global in scope it is good to see that in at
least one country far closer to home, the first faint stirrings of a
new and respectful trans service are taking shape. Because if you'd
like to see the direction of travel that those in the trans community
would very much appreciate, you need look no further than Scotland
<http://www.sehd.scot.nhs.uk/mels/CEL2012_26.pdf> .


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