Trans medicine and storytelling

Transition is a process of self-discovery, self acceptance and self-expression. How should society react to that? By celebrating and facilitating it.

Doctors should consider gender dysphoria, the discomfort arising from not fitting the assigned gender. They should treat any underlying psychological conditions, any resultant anxiety and depression, and help the patient consider all options for gender expression. Gender dysphoria- that feeling of extreme discomfort and alienation- exists.

Medicine proceeds, perhaps especially in this case, on stories. Until 1912 doctors did more harm than good to their patients: natural healing processes and placebo accounted for most of the cures. The doctor sees a distressed patient who wants a solution to their problems, which has sufficient scientific rigour to convince them. Once a solution is proposed, other patients are aware of it, and consider whether it might apply to them. A cold can be cured, by waiting, but epilepsy or arthritis can only be managed. Perhaps no-one has good mental health, but most people can function reasonably well.

People have been expressing themselves as the opposite sex for centuries, part time and full time. The chance of getting that accepted by society through medical confirmation was blissful, and scientific stories of brain difference grew up with mythic stories of being a “woman trapped in a man’s body”. Stories grew to counter the narrative, which people share to enjoy a communal sense of disgust against the Other: stories of mutilation and falsehood- yet still we transition.

David Brooks writes of two kinds of stories- myths, from Athens, of solitary heroes overcoming challenges, showing competitive virtues of strength, toughness and prowess; parables, from Jerusalem, of ordinary people together, showing co-operative virtues of charity, faithfulness, forgiveness and commitment. The two cultures are not so rigorously divided, but the point stands. To some feminists those co-operative virtues can seem too much to fit the “feminine” stereotype used by the Patriarchy to hold women down. Then trans women are the enemy, enforcing feminine subjugation. No group of people can exist without co-operative virtues, not a city, company or family. All human beings have co-operative and competitive virtues, and in maturity learn to balance both. More competitive societies, failing to value co-operation, increase stress and depression.

The story of the “true transsexual”, who transitioned gender roles with hormones and surgery, enabled me to accept being myself. I could shed the poisonous male act. But that male act was also a story, about how men should be, not fitting real people in the real world, and the “true transsexual” story was too restrictive, demanding too high a cost. Now we have stories of “non-binary” people, who do not fit either gender stereotype and play between.

Trans men are confronted with the story of the butch lesbian, fearlessly being herself without the need to pretend to be a man. And some women present as butch lesbians, but carry regret and a sense of incompleteness: does that arise because they are really trans, or because men are treated with greater respect than butch lesbians?

The way we present to other people is a story we tell about ourselves to others. We judge others constantly, and try to be seen in particular ways. Do you dress casually, fashionably, stylishly, scruffily? How do you hold yourself? Do you look others in the eye? Jewellery sends signals.

Transition is hard to stop once you start. I went to work presenting male, but went out at the weekend expressing myself female. I found I could do that in straight spaces as well as queer spaces, in the concert hall then the supermarket as well as the gay village, and the male act at work seemed more and more stifling and unbearable. Transition was a story, a solution which took hard work and determination but would complete my liberation. It would take time, but I knew the solution, I was clear about where I was going. How could I resist? The doctors I chose went along with that story. Protests from outside, particularly cries of disgust and derision, only strengthened my resolve- of course, when seeking to realise my true self, there would be carpers and mockers: think the chromatic woodwind “critics” in Strauss, Ein Heldenleben.

After transition, I embarked on a yet more perilous quest, to find who I am, as a human being. From a point of not knowing, I find what motivates me, what repulses me, what gives me joy. I come to trust my humanity, my gifts and qualities, as good in themselves. Why would I be so hard on myself? I am still escaping that oppression.

The story of transition, the person liberating their true self, is not countered by attempts to undermine it. The carpers and critics may attack its scientific rigour, but it retains enough to convince us. It has too much staying power to be blown away. It works. It liberates us, and insofar as more work of liberation remains to be done after, we only see that after completing transition.

A woman told of years with the psychiatrists demanding whether she was sure she wanted a vaginoplasty. Are you sure you will not regret losing your penis? Of course she was. It was not the right question. I want to produce, here on my blog, a more satisfying story which will supersede the other, the difference between solid gold and gilded lead clear to all, and now I am groping. Unknowing has something to do with it, the way the person is crushed into the male box. Who are you, really? What stops you knowing yourself?

Transition works. Give us something better, and we will choose it. Non-binary identity works for people who identify as non-binary. Making transition easier, stopping the carping, might reduce our desperation to prove ourselves. Transition would be less of a big deal. It would be recognised as one way people can be. That would reduce its emotional heat.

All comments welcome.

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.