Medical model

I was styled by SophieWhat do doctors do, exactly? They cure physical illness, but with disability it is more complex- they help patients conform to an ideal as well as possible. Synaesthesia seems at best a distraction, but many synaesthetes like their peculiarity and seek no cure. Messiaen used it in his music, producing colours only he could see but sounds many enjoy. Mental illness is cultural with medical responses: what level of boisterousness is classed as manic? Plastic surgery is given for preference, even where there is no physical or mental need of it.

Trans women could fit three separate categories here. I am a woman, so my deformed, enlarged clitoris is reduced, to look like any other woman’s. I am mentally ill, with the chronic delusion that I am female, so unusually the doctors help me conform to my delusion in the hope it will make me function better. Or I am well, but want to alter my body so should have plastic surgery if I want it.

I was styled by Sophie 1I say the sickness is in society and not in me. I am effeminate and unmasculine, and this is a bad thing- or at least I hear enough messages that it is bad, for me to be distressed at how feminine I am. You might think society is more accepting than that, but a friend recently expressed to me his distress at being thought unmanly. He thought the solution was to become more manly, rather than to find people who would accept him as he is- like the two of us who heard him, at that moment. Perhaps he will change, and see the solution as self-acceptance; and perhaps he will veer between these two paths, uncomfortable on both.

Whether I am a man or not, I am more comfortable dressed feminine calling myself Clare. If others were completely happy with feminine men, I would not need to, and perhaps never would have. I might have retained my gonads. This fashion blog, where I got the pictures, thinks that is OK now. I notice evidence otherwise.

We don’t fit in, so get sent to Doctors, who have to do something. How to alleviate distress? “Therapy” to make me more Manly does not exist, though some treatments might get me suppressing my nature, to my harm. I don’t think I am mentally ill, but within the normal range of feminine to masculine. Are there ways to thicken my skin, get me able to tolerate messages I should be more masculine, that I am wrong in some way? What we have in Britain is a path where those who persist in expressing ourselves female are allowed to have hormones and plastic surgery to help us better approximate a female appearance; or deal with the issues in our own way, without the treatments. In Iran, where homosexuality is seen as wicked but transition permitted, some people who would function as gay men here get gender reassignment.

I needed to accept my femininity. Without the cultural judgment that such femininity is womanly, a psychiatrist might have seen that self-acceptance was the way to alleviate my distress, without the need for transition.

But transition is the path the doctors prescribe. They like to do what all the other doctors do. That is the Hunter v Hanley test of medical negligence- did s/he do something different?

9 thoughts on “Medical model

  1. One of my heroes since boyhood was a woman named Madeleine Castaing. If I had to credit a single person for me becoming me and doing what I do, it would be her. She wore wigs and had an elastic band under her neck to keep her facial skin taut. People loved to ridicule her for the quirks. She always answered, “I do what I do, and I like what I do.” – she also said, “When I look in the mirror what I see is taut skin, not an elastic band, so it’s not my problem.”

    What we really need to accept is our own essence, desires, soul. No excuses, no explanations. This Is What There Is.

    et donc, Madeleine


    • I have spent my life, fighting my essence, desires, soul. I still have a chaotic/ nurturing/ controlling Parent inside, criticising all my responses, and now I have to accept my actions, both what one might call “authentic” and those constrained by the inner parent- see response to Rimonim.

      This blog is about accepting, and seeing the contradictions. Odi et amo.


  2. I really hear you about how the medical establishment violently normalizes trans and disabled bodies. Self-acceptance is so important, and transition is no substitute for that. I am sorry that doctors pushed you down a path that might not have been the best for you, just because it made them more comfortable.

    The weird thing is, the medical model can push transition on people when self-acceptance/social acceptance of gender variance would be better…and it can also block trans people from accessing medical transition! My main experience of the medical establishment was having to jump thru a bunch of bullshit hoops to get simple medical treatments that I knew were right for me. In a society where male femininity and female masculinity were accepted and valued, I think I’d have a lot less baggage, and I also think I’d still have wanted surgery and hormones. In that society, I figure, all people would have open access to medical treatments as needed, without coercion or gatekeeping.


    • I wanted my operation very much, and after my thought experiment was, what if my little toe was crushed, and had to be amputated? I would have to live with it, but would find it horrible. The cut I wanted had been so much more.

      At the time I thought myself completely asexual, and when I find myself so attracted to certain women, I find my passive, vulnerable, surrendering sexuality painful. Casting about for a way of accepting my own being, I wonder if it would have been in some way authentic to retain my penis.

      And yet vaginaplasty was what I wanted, and I went to the psychiatrist who was most open to saying, “If that is what you want, what almost no-one would want, have it”. The more responsibility we force on doctors, saying any mistake is their fault, the harder it is to get treatment. Mastectomy when it was not indicated is a blameworthy mistake for the doctor, refusing it when it is indicated seems not to be. I am in favour of the trans person taking responsibility, and the doctor being blamed only if there is a particular extreme case which I cannot imagine.


      • Thank you for sharing your experience with me. I hear you, and I’m trying to understand. It sounds like you had only one way to imagine yourself as acceptable–as a woman, with all that supposedly entails–and that this vision was right and liberating in some ways, and not right and painful in others. In a binary world, we often have to pick the “least wrong” option between 2 extremes, and that just doesn’t reflect our real diversity as human beings.

        I’m cool with more responsibility being on trans people for our transitions. I think it would be best if everybody–us, doctors, wider community–saw things that way.

        On the other hand, doctors are bound by some version of the Hippocratic Oath, and I think that’s appropriate. Both performing unnecessary treatment and withholding needed treatment can be violations of a doctor’s duties. People unwilling to perform the duties of a doctor should choose a different profession.


        • I am not sure I understand myself. I know how much I wanted that operation, and how taboo removal of parts of the body is. I have never felt happier than sitting in Russell Reid’s office, hearing him dictate a letter recommending it. I have no desire to revert.

          Around desire and relating, I feel extremely vulnerable. That fear and vulnerability makes me cast around for other ways of seeing. I get hugged, and I stiffen up.

          On doctors withholding necessary treatment, I find it inconceivable that a panel would find a doctor failing to provide hormones or surgery in the wrong. They would find s/he had reasonable grounds for thinking it not indicated, even if the treatment was later provided by other professionals.


        • This is the question, and not just for me. If women could be as manly as a Harlan Coben hero or John Wayne character, without everyday sexism and micro-aggressions claiming she is “bossy and aggressive” rather than “commanding and assertive”; and if men could be as feminine as Marianne Dashwood- if you have not read Jane Austen, pick another character, you know what I mean; would any of us need physically to transition?


          • It’s a valid question, and since we don’t live in that world, we can’t know for sure. My strong intuition is that some people would still need to physically transition. And in such a world, one hopes, that wouldn’t be such a big deal. The freedom to be fully masculine or feminine is only one part of this equation. There’s also the freedom to live as a man or a woman, and the need to alleviate dysphoria caused by mismatch of subconscious sex and apparent physical sex. It’s impossible to disentangle all these threads, of course. I just come back to my hunch that, in any society with the medical technology, I would wish to medically transition. The difference for me, in a society that honored gender variance, is that I’d have no desire to be stealth and would celebrate being trans (as it is now, I share this information with only a few trusted people in my life).

            However, I certainly think it’s the case that some people would not need to transition if they could be honored as their authentic selves without altering their bodies. And who knows–maybe some people who choose not to transition in our society would transition in a gender utopia.

            Liked by 1 person

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