Trans and body dysmorphia

Most of the questions at Greenbelt were friendly, but the last woman to speak compared us to people with body dysmorphia or BIID. I wonder why- to engender disgust with us, perhaps. We should not be indulged, because what we want is repulsive- to save us from ourselves or to save others from going the same way. Tina found the comparison repellent.

Anyone who likes the world nice and neat, with simple comprehensive categories, may need me to “be a woman” before they can tolerate me. The first response, never having come across us before, might be Yuck. Oh, says a wise friend, that’s a trans woman. She’s a woman born in a man’s body. Or, she’s born that way. She is mostly harmless. And the person who likes the world to be explicable accepts the explanation. Or the friend says, he’s like body dysmorphics, one of the bad people. Yuck is appropriate.

I can tolerate a certain amount of disapproval. I just have to. Some people think my way of being ridiculous or disgusting, and as long as enough people accept me I sort of rub along. My view is that body dysmorphic people are doing their best under difficult circumstances. I hold the liberal view that they should be allowed to do what they want if it does not harm others, because they should be trusted to make their own decisions for their own flourishing.

I feel I benefit from an atmosphere of general tolerance more than a categorisation as among the Acceptable kinds of weirdo. Body dysmorphics bad. “Trans women- women, really- and therefore acceptable” is subject to argument. “Person who is in part inexplicable, just like every single other human being” is not. Let us rub along as best we may.

After, we were surrounded by people wanting further encouragement; then we went for a drink, and to The Canopy to hear Lorraine Bowen. Her songs should not work, being not sophisticated at all, but they are joyous. Much of the crowd danced the actions to the Crumble Song:

Everybody’s good at cooking something- mime stirring pots
I’m good at cooking- both hands to chest indicating self
Crumble!- Hands in the air like a gymnast at the end of their routine
In fact, I’ve got one in the oven- bending down miming taking it out
Would you like some?- Mime offering it.

I think it’s intended as a double meaning for a bun in the oven, or pregnancy. It seems innocent and ridiculous to me. We liked it, a joyous crowd not concerned with how we appear. The freedom of silliness. How we appear is a terrible tyrant.

-Any requests?
-Dill Pickle!
-Oh, I’m not sure I could do that one at Greenbelt.
-Dill Pickle! Dill Pickle!

Amputees by choice

Should people who have a desire for the amputation of a healthy limb receive that treatment? In this paper Tim Bayne argues yes.

What causes the desire? Bayne distinguishes Body Dysmorphic Disorder from Bodily Integrity Identity Disorder: in BDD, the “wannabe” believes the limb is diseased or ugly, and in BIID the person’s identity does not include the limb. In both the wannabe knows the limb is part of their body, unlike in deafferentation, where people rationally recognise the limb is theirs but only know where it is from visual clues, so that learning to walk again is difficult. Some amputees have phantom limbs, even trying to use those limbs eg to answer the telephone.

A wannabe might have apotemnophilia or acrotomophilia, the sexual desire to have an amputation or attraction to amputees. The attraction may be a projection: few apotemnophiles form permanent relationships with amputees, as it is never the right amputation. There is overlap between devotees, those who pretend to have an amputation, and wannabes. In a survey of only 52 subjects, 87% admitted sexual arousal. Bayne suggests that some wannabes might have BIID, some BDD, even some both, and if there was a sexual component this does not invalidate the desire: Perhaps the sexual element is better conceived of as common, though not inevitable. Sexuality is an essential ingredient in most people’s sense of identity. Like Gender Identity Disorder, BIID might be importantly sexual without ceasing to be essentially concerned with identity.

What could justify a surgeon amputating? Harm minimisation: many will damage their limbs in a dangerous way. Autonomy: an individual’s conception of their good should be respected. Jehovah’s Witnesses are not forced to have blood transfusions. Whether it is morally relevant is that amputation is an act rather than an omission is questionable, especially where doctors have an obligation to promote health. Arguably wannabes are not competent to give informed consent, as they are deluded; but it is a specific individual delusion, they are otherwise rational, and given the delusion amputation is a rational response.

Some say an attempt to change the belief is an attempt to change their identity, who they are. Perhaps they have tried and failed: there is little evidence, but it is unclear another cure would work. There are feminist arguments against cosmetic surgery, that the desire for a different body is false consciousness, but people are allowed to seek it.

Incidentally Bayne argues that transsexual surgery is less acceptable, because trans women conform to stereotypes- weak, helpless and obsessed by appearance. Here I wonder if he is motivated by empathy or perceived kudos for putting an unattractive argument convincingly.

The operation will have a therapeutic effect if (i) wannabes endure serious suffering as a result of their condition; (ii) amputation will ‚Äď or is likely to ‚Äď secure relief from this suffering; (iii) this relief cannot be secured by less drastic means; (iv) securing relief from this suffering is worth the cost of amputation.

One writer claimed the desire for amputation has its origins in attention seeking sparked by the deprivation of parental love. I find I am able to appear needy, and attract those who like helping, by less drastic means; and this disbelieves the subject. Why do you want the amputation? Simply for itself. “It is who I am.”

Many will feel repugnance, as shown by my initial choice of title, a poor joke to cover my embarrassment- “Off with their Legs!” That is not a ground for refusing the operation. Disgust is no reliable indicator of moral objectionability.

Monet three trees in grey weather

James Cantor

Last post on paraphilia for a while, I hope. The reason I bang on about it is that I have suffered from crippling shame, and I seek all ways: cognitive-behavioural, psychological, emotional, rational- to overcome it, without denying truth. 

I sought help from James Cantor, and am grateful for his generous and detailed response. He referred me to his article “Is homosexuality a paraphilia?” This title seems to¬†assume that it is helpful to lump together shoe fetishism and lesbian transsexuality as a single phenomenon, paraphilia, from which homosexuality, a characteristic of Dr. Cantor, may be distinguished, but the article includes this passage, which helps me in my task:

Other than by being sexual, the most salient feature on which male homosexuality and the paraphilias resemble each other is their lifelong nature‚ÄĒstarting in childhood and being immutable despite all efforts to convert them to conventional sexual interests. There have periodically been claims of successful conversion of homosexuality to heterosexuality or of paraphilia to euphilia, but such observations are perhaps better attributed to more mundane reasons, such as demand characteristics, suppression of only the overt expression of the undesired behavior(s), or a reduction of sexual desire in general, rather than in any change in actual focus of whichever sexual interest. Similarly, reports of adult-onset paraphilias might instead be attributed to (typically neuropathological or drug-induced) loss of the ability to suppress already-existing interests.

Unfortunately for me, academics usually have to charge for their work, but a search on that site for paraphilia produced this. Click on “Show summary” to see the abstract. It says that¬† researchers looking at Body integrity identity disorder (BIID) first classified it as a paraphilia. Rather than being impartial investigators assessing evidence, they reacted out of emotional revulsion, and linked BIID to things also conventionally found revolting.

I wondered if lesbian transsexuality may also be distinguished from paraphilias. A shoe fetishist will agree that there is no point in licking and kissing a Jimmy Choo apart from arousal, and if he ceased to be aroused, he would cease the fetishistic act. Whereas, there may be a reason for imagining myself expressing myself female separately from being aroused: gender dysphoria. The gender dysphoria may arise prior to the sexual arousal. There is no reason to assume otherwise. This is true whether or not gender dysphoria in people with testicles who are attracted to women, and those who are attracted to men, is more than one phenomenon. Indeed, I was more committed to transition after taking testosterone suppressants.

In his article in The Oxford Textbook of Psychopathology on “sexual disorders”¬†Dr Cantor¬†is careful to distinguish autogynephilia from gender identity disorder. They may co-exist, but he does not posit a causal link either way.

That is the crux for me. I am quite happy to admit that I was aroused by fantasies of me as female and pictures of me dressed female. I have no wish to distance myself from the shoe fetishist, who gets aroused by one thing other than a human partner, I by another. What hurts and shames me is the idea that that is all it is, that I am recognised as different by everyone I speak to and all it is is a sexual fantasy, rather than the Real Me.

The intellectual basis for freedom from shame is established.

Today, Gauguin, to cheer us all up:

The blue pill

Using male pronouns to refer to me is as disrespectful, uncivilised, and wrong, as calling a black person a N*****.

This is who I am. To express myself female is what I wanted, against all common sense or rationality, against the evidence of my own senses, looking at my own body. Plunging into the nature of my being, that I am female is deeper than anything else, utterly impervious to change. Actually, the pill question: “If you could take a pill and be a normal male without these feelings, would you?”- well, I come out with the “right” answer, “No, because then I would not be me”, but sometimes it is a close run thing. Being transsexual has given me such intense pain that sometimes I do not know how I have borne it. I have been suicidal, just wanting to die, for months at a time, and twice I have undertaken preparatory acts, though not any actual self-harming physical act- I have formed the decision, then backed off.

To refer to me as “she” rather than “he” is a basic level of courtesy which I am entitled to, and fortunately receive from most people I meet. However, where I do not, I will not be sympathetic or understanding, and nor should you be, whoever you are. I so resent still having to work through these issues aged 45, ten years after getting the courage to express myself female at work.

It is the same for people with body integrity identity disorder. If someone is complaining about how difficult it is to get a wheelchair on a bus, “Well you could walk” is an answer just as disrespectful as using male pronouns for me.

It seems to me that humanity, now, is working through issues of otherness and respect, issues of living together, issues of accepting the full range of human diversity and the discomfort that currently engenders. I think we can get these things right, and that free, diverse humanity has far more access to blessing and gift than regulated, regimented humanity. For my own self-respect, I will assert my right to respect from others. I have been at the fulcrum of this issue, and have survived.

If I can assert my right without anger or fear, then I am giving an invitation, though one some people will be unable to hear: an invitation to see humanity in the full beauty and richness of our diversity, and to accept all those bits of yourself which you have falsely been told are unacceptable.

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It really matters to me to see humanity as progressing. Things are not as I might wish, but I do think they are getting better. A little group of Quakers, frightened of Peak Oil, climate change, and the Global Financial Crisis had a conversation where I asserted this, and people brought forward the Bosnian war and the Rwandan genocide, child labour in India, even female genital mutilation, forsooth, as evidence against. I could play the game: I have a good level of articulacy and rhetorical skills. I am interested in current affairs and history- and Life, in all its fulness and variety, even if more as an observer than a participant, so far- so I can come up with apposite examples and elegant argument. Instead, I disengaged.

Heaven is Here. I see it. That anyone does not see it is not evidence against its existence. So, I do not need to win the argument and convince anyone, I am satisfied in my own mind.

I can say to anyone, look around yourself. See the abundance and the beauty and the wonder and the Blessing. Look, at this, or this, or this. And if they cannot take this in, I may give up on them.

Gosh, that is pretty mature of me. Saintly, even. Or, since I am doing teenage at the moment: the argument going against me, I went into a sulk. Words….

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Am I boring you? Am I just repeating myself? I have been¬†thinking about¬†that last Pronouns conversation, three weeks ago. There are times when it is the other’s own stuff coming out, or they are just ignorant, and there are times when they¬†want to push¬†my buttons. Those two, they know, they have the intelligence, maturity and experience¬†to understand completely. That particular time, it was deliberate. As if I have a big, red button, as big as my torso, and all you have to do is tap it gently and watch me implode.

I HAVE NOTHING TO BE ASHAMED OF.

Ah. Breathe it in. I am getting there.

I have nothing to be ashamed of.

You will not hurt me with this.

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I visited Belfast in 1988. There were soldiers with guns, and armoured vans with low skirts on, so no-one could roll a grenade underneath, and barbed wire protecting the pubs. I was pushing my bicycle through the station. That army officer will not walk in front of me- so I hurried, walking in front of him, making him pause. And- I felt his Love reach out and envelop me. That is the only way I can put it.

Rather than suppressing it, I am feeling the intense pain of decades of feeling that I am an outsider, that I am less, and I see a way through this.

TED, in praise of vulnerability.