Self ID

Who should have their gender recognised? The Scottish government proposes,

3.31. A requirement to submit a statutory declaration would demonstrate that applicants intend to permanently live in their acquired gender. Therefore, the Scottish Government considers that applicants under the proposed system of legal gender recognition should have to provide a statutory declaration stating that they:

  • are applying of their own free will;
  • understand the consequences of obtaining legal gender recognition; and
  • intend to live in their acquired gender until death.

3.32. The Scottish Government’s research into countries using self-declaration systems of legal gender recognition has not identified evidence of false or frivolous statements being made by applicants. However, under the proposed self-declaration system for legal gender recognition, if an applicant were to make a statement in a statutory declaration that is false in a material particular, this would be an offence.

Now, you can change your passport without a gender recognition certificate, if you provide a letter from your doctor or medical consultant confirming that your change of gender is likely to be permanent, and evidence of your change of name such as a deed poll. You need a similar letter to change the gender marker on your driving licence, which is encoded in the driver number.

I changed my bank account fairly easily, after showing my change of name document, but could not find how to do this with my bank on line even now. Googling produced a report of the bank apologising when staff demanded a GRC. Ignorant prejudice, and an unwillingness to research sometimes liberal policies, makes our lives difficult.

It is a big thing for a man to declare they are a woman. It was intensely important for me. I could not move on with my life without doing it. It was what I wanted more than anything else in the world. I do not do it frivolously. I might be able to pass as a normal man, except that I would find the attempt too distressing. We change our presentation, and make ourselves vulnerable to transphobic violence from strangers, casual prejudice on the street, and discrimination in work and all aspects of life. We do not do this flippantly. We do not do it to get access to women’s loos.

So there are sufficient safeguards in the Scottish proposal. You promise to live in your acquired gender. When I transitioned, I thought I might revert, either because I decided transition had been wrong or because I found it too difficult, but I had to try. I express myself female, and while there might be questions about someone expressing androgynously it is a question like, how many hairs make a beard. You can’t produce a number which is a beard, but one less is not a beard; but you can make a decision fairly easily in most cases that someone is presenting in the acquired gender, and take a bit more care on more difficult cases.

Perhaps someone will do this frivolously, but I hope they will be frightened off. A JP swearing a stat dec could reasonably object if they did not think a person was presenting in the allegedly acquired gender. There are taboos against cross-dressing in public, and someone who is not trans will not like to do it. In 2016/17, 318 GRCs were granted in Britain. Fifteen were refused, and two applications were withdrawn. 4506 were issued to March 2017, and a further 206 in April to September.

The change to be made is that we will not need a specialist psychiatrist’s diagnosis. Having put myself at risk in this way, I want to be able to say I am Clare without the need for a psychiatrist backing me up. In any event, a psychiatrist using DSM V would diagnose me with Gender Dysphoria if I exhibited “a strong desire to be of the other gender” and “a strong desire to be treated as the other gender”. I show that by transitioning.

Gender Incongruence of Adolescence and Adulthood

Would you rather be diagnosed with “Gender Incongruence” than “Transsexualism”? The International Classification of Diseases, which is worldwide unlike DSM which is for the USA only, is being revised. It may influence the DSM. Rather than being classified as a “psychiatric disorder” GD, or GI, might be placed in a separate chapter for “Sexual and gender related health”.

How you frame a diagnosis affects what people think of it, and what you do about it. If it is a psychiatric diagnosis, is it merely that psychiatrists are most qualified to make it, or does it stigmatise you? I believe I am a woman, or at least I want to express myself as a woman, and perhaps alter my body. The medical help I want is hormones and surgery, and counselling support to manage that change successfully and comfortably. Together, these alleviate my distress. From the point of view of fourteen years after transition, I want people to have assessment to find whether anything underlies that distress and desire, and to explore less dramatic options for alleviating distress, but from the point of view of immediately before transition I had made up my mind, and would call that assessment “gatekeeping”, which is oppressive. We know what we need. Give it to us.

Should distress (or “dysphoria”) be part of the diagnostic criteria? Well, that is a way to take away stigma from sexual fetishes. Getting aroused by high heeled shoes or whatever is perfectly healthy, and not a diagnosis for a classification of diseases. Only distress might justify medical intervention- not to make the patient normal by taking away the desire or arousal, but to alleviate the distress. That is an imperfect analogy for us. Doctor, I am not distressed at all by wanting to transition, only by society’s norms that I should not, and because of how difficult it is. I am not mentally ill. Medical intervention is justified because I am gender incongruent.

Making distress irrelevant, and focussing on the need for hormones and surgery, makes other outcomes apart from transition seem less appropriate. Then I would have found that liberating; now I find it disturbing.

Is a psychiatric or other medical diagnosis a stigma? I don’t think diagnosis is more of a stigma than being trans itself is. Cis people realise doctors are involved: if they accept me, they accept that; and if they do not accept me, that makes it no worse. The diagnosis might reduce stigma- if I transition, people might think I was being unwise, but having a doctor go along with it might reassure them.

We experience discrimination. I don’t feel adjustment of the narratives we use to explain ourselves will alter that, much: I do my best. This is what I want to do. This is who I am is the necessary basic narrative- if you can’t say that, no narrative will reassure you except temporarily; if that does not let others empathise and accept you no other narrative will.

I am pleased that I suggested “incongruence” as a diagnosis in 2012, and that the ICD is now catching up. What I want for our kind is:

from society- acceptance, however we choose to dress or present
from doctors- discussion of all the options, understanding of all the pitfalls of “work male, play female” and support to do that if chosen; and making us take full responsibility for hormones and surgery so giving them to us if we ask. A Real Life Test- you can be rewarded by hormones and surgery if you express female for a year and Never Lapse- is completely the wrong answer. Instead we should be encouraged and supported to play and explore.

Medical treatment needs paid for. We need our medical treatment, including surgery, quite as much as any other person needs medical treatment. Single payers or insurers should pay for it.

marie-bracquemond-under-the-lamp

Transvestic fetishism, autogynephilia, and late onset gender dysphoria

What makes transvestic fetishism a “disorder”? Distress, or harm to others. The paraphilia subworkgroup producing DSM V explain: A paraphilia by itself would not automatically justify or require psychiatric intervention. A paraphilic disorder is a paraphilia that causes distress or impairment to the individual or harm to others…This approach leaves intact the distinction between normative and non-normative sexual behavior, which could be important to researchers, but without automatically labeling non-normative sexual behavior as psychopathological.

According to the DSM, in late onset gender dysphoria the progression is: transvestic fetishism, that is, the subject is aroused by cross-dressing; autogynephilia, arousal by fantasies of self as a woman; gender dysphoria, the desire to live continually as a woman and physically alter the body.

DSM V on transvestic disorder: The presence of autogynephilia increases the likelihood of gender dysphoria in men with transvestic disorder…Some cases of transvestic disorder progress to gender dysphoria. The males in these cases, who may be indistinguishable from others with transvestic disorder in adolescence or early childhood, gradually develop desires to remain in the female role for longer periods and to feminize their anatomy. The development of gender dysphoria is usually accompanied by a (self-reported) reduction or elimination of sexual arousal in association with cross-dressing.

DSM V on gender dysphoria: Adolescents and adults with late-onset gender dysphoria frequently engage in transvestic behavior with sexual excitement. The majority of these individuals are gynephilic or sexually attracted to other posttransition natal males with late-onset gender dysphoria. A substantial percentage of adult males with late-onset gender dysphoria cohabit with or are married to natal females. After gender transition, many self-identify as lesbian…Additional predisposing factors under consideration, [that is, theories without empirical justification] especially in individuals with late-onset gender dysphoria (adolescence, adulthood), include habitual fetishistic transvestism developing into autogynephilia (i.e., sexual arousal associated with the thought or image of oneself as a woman) and other forms of more general social, psychological, or developmental problems.

This is not on line, and I got the quotes from a comment from a trans-exclusionist, here. The DSM V definition of gender dysphoria is here.

It is a pity Ray Blanchard was involved in this part of DSM V. He claims transvestism develops into autogynephilia, then gender dysphoria, though not in all cases: there are cross-dressers who are quite happy with their gender and their hobby.

He overlooks distress and denial as a causal factor. Gender dysphoria plus denial manifests first as transvestism, then fantasising about being women, and finally gender dysphoria. We try to make men of ourselves. We cannot admit to ourselves that we are not men. But we cannot deny it completely, so first we compulsively cross-dress, with that extreme distress, repeatedly getting rid of the clothes; then we admit the desire to express female; and finally we cannot resist that desire any more, resisting is just too painful. I retain that distress. I want to be normal, and cannot be.

Which of these subjects may be observed? Only the ones who have developed gender dysphoria, generally: which of the fetishistic transvestites would you examine, as most of them will not develop GD. So my own evidence is of disproportionate value here. I self-identified as fetishistic transvestite, in 1992, when I sought aversion therapy. My psychiatrist Dr Yellowlees thought I showed transsexual tendencies, though I would have denied it, my distress (and so “disorder”) being so great. I am the example of the person who might give a history of developing female embodiment fantasies, which Blanchard calls “autogynephilia”,  after gender dysphoria was established.

Now read on: if fetishism develops into gender dysphoria, that is beautiful.

George Elgar Hicks, seated woman in white dress

Naming and Claiming

Hans Weiditz: Doctor and servantI read that psychiatrists have renamed the diagnosis, from “gender identity disorder” to “gender dysphoria”.

This is not an improvement, even if some trans folk think it is, or asked for it. Before transition, my gender identity did not fit my chromosomes or gonads. I think this is a “disorder”- it makes life and procreation significantly more difficult.

Now, the word “dysphoria” is in the diagnosis, as if the discomfort were the thing which was sick. Generally, a diagnosis names an illness, kidney disease is a problem with the kidneys, the new name “disruptive mood dysregulation disorder” states that a person’s inability to control his temper is the Problem. We M-Fs experience ourselves as female, and our experience is not deluded, or psychotic, or sick: the problem is being thought to be male, and what follows from that.

The problem is not the word “disorder”, but the inclusion in the Diagnostic Statistical Manual of Mental Disorders. Being trans is not a mental illness. I recognise, however, that a surgeon will need confirmation from a psychiatrist that she should do a vaginaplasty and orchiectomy.

So there should be two possible diagnoses: “Gender identity incongruence”, which is a physical health problem, requiring physical intervention, and “Psychotic delusion of gender identity incongruence”, a mental health problem, where the belief that one is really of the opposite sex arises from mental illness. I don’t know whether anyone actually suffers from the latter, but the concept allows the psychiatrist, physician and surgeon to work together: the psychiatrist says No, I am certain your patient does not suffer from psychotic delusion, so the appropriate treatment is hormones and surgery.

Gender identity incongruence would continue to be self-diagnosed, as now. “Yes, I know I have testicles, but I also know that I am a woman, and want hormones. Therefore I have GII.”

Self-diagnosis is important. Someone else, who an outsider might think to be very similar to a person with GII, might say, “I am a man. I have testicles, and I want to retain them. However sexually I am a femme lesbian, and I want to express myself in ways which my culture considers feminine.” Or whatever. Only those of us who want surgery or hormones need come into contact with scientists or doctors at all.

And each individual is the one to classify themself. If anyone else does it, that is oppression.

While on classification, there is no word I hate more than “non-homosexual”. The scientists refer to the “homosexual transsexual”, a M-F attracted to men. That is, they call her a man. So what do they call us gynephiles? Heterosexual would be the obvious word, we are attracted to women- though, under the pressure of being forced to jump through hoops, some of us claim to be Bi or asexual. But “Heterosexual” would make us appear almost normal, and that would never do. “Non-homosexual” it is, not even homosexual, not even as normal as that. Rational scientists, with their Objective terms! Using the word “gynephile” would have just a tincture of kindness, and that would never do.

More detail on DSM5 than even some trans women will want, here.

Orthorexia

A woman in her late teens shuttled between two hospitals, being treated for anorexia. When she was brought physically in shape, she would be sent back to the mental hospital on the other side of the city. As there was no coordination of treatment between the two, her condition was managed rather than treated, until she died of it. Perhaps with my life and eating being controlled by doctors, I would lose the will to live.

Anorexia is a coping strategy. Often, people with anorexia will have other strategies, such as cutting- “cutting” is the word used by many who have that coping strategy, “self-harm” is the word imposed by outsiders classifying them. If their cutting is treated too intrusively, they may reduce it, and turn to eating control instead. Anything for a quiet life. It is necessary to deal with the underlying issues, rather than the coping strategies which are symptoms of them.

If I want to avoid certain foods because of ethical concerns, or for my own ideas about my own health, that is my concern. “Orthorexia” is a word coined by doctors to describe such behaviour, implying that it is an eating disorder characterised by a harmfully rigid adherence to particular dietary rules. It may be linked to obsessive compulsive disorder, they say.

Honestly, doctors butting in all the time. These are ordinary coping strategies. Everyone is a little nuts, and it is as if these busybody doctors think alcohol was created for making sterilising wipes.

Synaesthesia is a condition where the senses affect each other. So particular sounds may cause someone to see colours, or words may appear coloured. Olivier Messiaen had the condition, and used it in his music, such as Colours of the Celestial City. While it is not “normal” in the sense that only a small proportion of the population have it, and arguably it is slightly maladaptive, as it is an additional way of perceiving the World as other than it is, people with the condition generally are quite happy with it, so doctors can back off. No cure needed here, thank you.

Transsexuality is a natural variation of the child in the womb, through which girls are born with testicles, and boys with ovaries. While it might please certain people with overly tidy minds to convince those boys that they really were girls, and their ovaries were the most important thing for deciding that, from the inside it feels like who I really am, my identity, is the most important thing. I am female. I would be less “cured” if I was made happy presenting male, because then I would not be me.

So again, I think that the American Psychiatric Association, about to publish its fifth edition Diagnostic and Statistical Manual of Mental Disorders, can butt out. I am not mentally ill. Perhaps DSM 5 could include a diagnosis of psychotic pseudo-transsexuality, where there was a psychosis producing a delusion of transsexuality- but I am female, and my disorder was entirely physical. It was alleviated by genital correction surgery. I am not sure I particularly want screened against mental illness: I think the strain of transsexuality on a child might cause mental illness, rather than the other way round. I resent gender dysphoria being included in a manual of mental disorders, where it has no place.