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.

Theory, Myth, Reality, Dancing

The Diagnostic and Statistical Manual of Mental Disorders has precise diagnostic criteria for Gender Dysphoria. The previous one had slightly different diagnostic criteria for Gender Identity Disorder. In small cell lung carcinoma, there are clear ways to diagnose the condition and a clear treatment pathway once it has been diagnosed, depending on its stage; it would be lovely to imagine that were possible for the thing some people wanted to call Harry Benjamin Syndrome; and the DSM might make it appear that it is. You visit your doctor, you say what your symptoms are, you answer questions, and get a diagnosis.

Diagnosis of GD/GID- you will transition, you will be happy and fulfilled ever after.

No diagnosis of GD/GID- you are not trans.

The DSM omits to mention many things that will affect the success of your transition- what is your family and work situation, how well do you pass, what is your personality like. Some of these are not quantifiable. People attempt transition on a wing and a prayer, and some of them succeed. “Do you want to transition?” is the main question. Some assessment of whether the desire is likely to persist, or whether you can succeed, may be useful, but that is not subject to precise scientific measurement, and may not be knowable.

There are also theories of the cause of GID, such as Autogynephilia, which is complete rubbish. There is a great deal of research about differences in trans folk’s brains, or DNA. This is reassuring. “I have a woman’s brain,” you say, because that justifies your decision to transition in your eyes, and this should be precisely measurable, ever since the BSTc was found to be female sized in a small sample of trans women.

I don’t feel scientific theories explain something this human. It is worthwhile attempting to explain scientifically, but also to recognise the limitations and incompleteness of the hypotheses.

I would rather use myth to explain my actions. “I have a woman’s brain” is refutable; “I am two-spirited” is not a statement of scientific fact but a myth, a story which justifies what I did. I transitioned. If you want a reason for that, “I got a diagnosis from a psychiatrist” would work, or “I wanted to,” but “I am two-spirited” is emotionally satisfying. Rationally, as a scientific theory, I am a materialist, but emotionally, when I consult what I feel about it, I am a theist, a believer in God. If I attempt a scientific, rigorous explanation of God or transition it is refutable and may be ridiculous, but “I am two-spirited” is not. It’s not a scientific theory, it is a story I tell. Stories guide us through life.

And then there is reality. I am faced with a choice. What do I want to do? Stories, or using pseudo science like a story, might justify my decision, or alternatively I might decide according to the story or the pseudo-science, and find my decision so unbearable that I decided the other way. Some things are irreducibly uncertain.

I can be the Rational Man, even now. I will put my feelings to one side, and work out in a rational way what is going on. I will behave sensibly. Then I cannot bear it any more, and break down in tears, unable to speak coherently, possibly curled on the floor. If I accept that state and pass through it, I become-

The Dancer

I love it. That is who I want to be. I just respond in the moment, though the crying may have exhausted me: I have clear access to my feelings and I can express my essence in words and action. I wish I could find a way to get to that state less traumatically, and earn money while in it.

Becoming trans

No-one is “born that way”. Babies have personality, recognisable in the infant and the adult by those who watch them grow up; and we grow up in families and societies which mould us. Nature and nurture intertwine. There are a group of apparent men who feel the need to “make men” of themselves, and take macho jobs- on an oil rig, in the armed forces, the police firearms unit- and then transition. I look back to my childhood and think- was there another way?

I do not “blame my parents”. I recognise that they did their best with the situations they found themselves in. They did their best for me, in love, not being inerrant. It’s not “forgiving” for there is nothing to forgive.

I am intensely controlling. That’s why I am not working: I stay in my house because I need to be safe, I am not in control outside and not safe when not in control. My mother was very controlling. Her mother was, and her mother’s father:

My grandmother had to be home by nine. One evening she did not come home until quarter past nine, and her father was very angry with her.

“But dad, I’m going to get married tomorrow!” she said. He replied,

“There’s many a slip twixt cup and lip.”

That’s one of my myths. I come from a controlling family. That’s the proof of it. It’s the only story I have of my great-grandfather. I have few of my grandmother, and those are capable of wildly differing interpretation depending on my need. I want not to need this to be true.Ā  I want to see clearly, not to lie to myself, for I have always lied to myself, and not seen that I was lying; and then I worked out that I was lying, and worked out by analysis what sort of lie would produce this ridiculous falsehood. The first I worked out was

I lie to myself, because I want to see myself as a good person.

I don’t think I am alone in that, though definitions of “good person” differ. I lie to myself because I want to feel safe, is the underlying lie. I tell stories to understand the world, so saying how I “became trans” I link together stories which seem to fit together as an explanation which is as true as I know how.

Insofar as “truth” could have a value for me- to justify, or even explain- I will only see it partially, I will gloss over the bits which don’t contribute to my desire. But I want to be truthful, so will try not to gloss, if I see I am.

I’ve been blogging five years. My first post was 18 August 2011- here it is. I have published 1,817 posts and about nineteen pages since then, and perhaps one other person has read all of it; people stay, commenting, for years. We are where we are by accident- why, in the 1950s, would my mother take a job four hundred miles from home, in that particular town where my father was born? (I am glad she did.) A story can’t say why I am how I am, but it might come to some approximation. I intend to post that tomorrow.

William Blake, Night Thoughts 8

Culture, myth, reality

We only understand anything through language. We distinguish one thing from another through the words we use: Structuralism says that language is a system, one thing, and words relate to each other rather than to discrete things out there. Post-structuralism says I am born into a world of language, which defines what I might do or think. Orwell imagined Newspeak preventing anyone ever thinking an unorthodox thought: perhaps English does, too. Deconstructionism asserts that meanings are not fixed, but must always be ideological constructs, which attempt to make that which is the product of a particular culture or thought system seem natural, inevitable and objectively true. To destroy slavery, including slavery to concepts of masculinity, we need new language.

Back to that later, perhaps. Language comes before reality in the Bible: In the beginning was the Word; the Earth was a formless void until God speaks, and calls our world into existence. Yet in Christianity, God made revealed Truth. Human beings simply have to tune into revelation of this ready made divine order of things, and fit themselves into it.Ā 

Yet I believe in continuing revelation, human beings working things out, seeing things anew.

I have just been watching a television drama, Thirteen, in which a girl was kidnapped and imprisoned for thirteen years before she escaped. I don’t believe her post-traumatic responses, necessarily, it is a drama of events more than ideas, and one for the quotidian rather than extreme- couples split and reform, people choose between spouses and lovers; so as well as the threat of the Murderer- will he kill the ten year old he has kidnapped now?- I am offered a vision of what it means to be in a couple.

I have a choice of many such stories, in fifty-year soap operas or novellas, millions of versions, from four millennia of civilisation. They are hot, with strong threat and emotion, or cool and contemplative. There are great Myths, and English-speaking peoples are shaped by the King James Bible and Shakespeare. We have no sure way of relating the Jewish teacher, Y’shua, to the Jesus of the Gospels, but we have those stories, of being born of a virgin, changing water into wine, dying and rising again.

There are continual new interpretations of these stories. Humans use them for our own purposes. They do not trap us into one understanding but free us for greater understanding as we continually explore. Stories enable us to share glimpses of truth, as well as the clear detailed descriptions of truth in scientific papers; and to feel our way into empathy as well as thinking into understanding.

Different languages give different understandings of the world, divide it up in different ways.

I am not saying any philosopher considering language has a lesser view than this, but for me, language is a good enough tool to explore my world, and the cage is porous enough for humanity to stretch it: it is not a cage, but scaffolding, for us to create greater understanding. The stories can free us.

I started on this because I have been reading Derek Guiton who apparently fears that David Boulton will drive belief in God out of the Religious Society of Friends. Possibly no-one reading this has my precise interests, yet I hope you get something from it. Here I have looked at Boulton’s explanation of stories in The Trouble with God and found it compatible with belief in God as well as useful in understanding my world.

Bronzino, fresco from the chapel of the old palace in Florence, 2

The Descent of Inanna

Inanna, the Queen of Heaven, wants Gilgamesh, King of the city of Uruk, as her lover, but he spurns her. Your lovers have found you like a brazier which smoulders in the cold, a backdoor which keeps out neither squall of wind nor storm. In a rage, she calls on her father god Anu to give her Gugulanna the Bull of Heaven to take revenge on Gilgamesh. He refuses, but when she threatens to break open the doors of the Underworld so that the dead shall eat food like the living, he relents. The bull snorts and the Earth opens, and the warriors of Uruk are killed; but Gilgamesh and Enkidu kill the bull. Inanna curses Enkidu, who throws the bull’s right thigh at her. For this, the Gods kill Enkidu.

Inanna arrays herself as the Goddess, in royal robe and crown, and the breastplate called “Come, man, come”, thenĀ descends into the underworld to attend the funeral of Gugulanna, whose husband is her sister Ereshkigal, Queen of the Dead. She leaves behind Ninshubur, her servant, with instructions if she does not return. She pushes aggressively at the door of the Underworld, and Ereshkigal commands the doorman to open the seven doors a crack, letting her through but removing her royal garments. “Let the holy priestess of heaven enter bowed low.” When her garments are removed, Inanna protests: “What is this?”

“Be satisfied, Inana, a divine power of the underworld has been fulfilled. Inana, you must not open your mouth against the rites of the underworld.” Or,
“Quiet, Inanna, the ways of the underworld are perfect,
They may not be questioned.”
(The first comes from this prose translation, the second from this verse translation.) Inanna makes Ereshkigal stand, and takes her throne, but the seven judges shout her guilt, and she is turned to a corpse, hung on a hook.

When she does not return, as instructed Ninshubur petitions Inanna’s father-Gods Enlil, Nanna and Enki to rescue her. Enlil and Nanna refuse, saying “Inana craved the great heaven and she craved the great below as well. The divine powers of the underworld are divine powers which should not be craved, for whoever gets them must remain in the underworld. Who, having got to that place, could then expect to come up again?”

Enki creates two demons to rescue Inanna. He gives them the life-giving water. They go to the underworld and find Ereshkigal sick and in mourning, her unwashed hair “bunched up as if it were leeks”. They sympathise, and she offers them a river of water. They demand the corpse, sprinkle the life-giving water on it, and bring Inanna to life.

When Inanna returns, she is escorted by demons who will accept no sacrifice, but afflict humanity- “tear the wife from a man’s embrace”- without pity. She must bring back a substitute, for no-one has ascended unscathed from the Underworld. She finds Ninshubur in mourning, and will not send her, but her husband Dumuzid is dressed magnificently and seated on a throne, so she chooses him. The demons seize him. He escapes briefly, and his sister asks to share his fate: each will spend six months each year in the Underworld.

Stone bowl offered to Inanna


What does the story of Inanna mean?

It is incantatory and repetitive. You would hear it as a story, and the repetitions would please you like the returning themes of a symphony.

The Jungian interpretation is clear. Jesus said, When you strip naked without being ashamed, you will become children of God and have no more fear. Inanna’s finery is mere pretence, masks so she might look good- though Isaiah 64:6 sees them differently: we are all as an unclean thing, and all our righteousnesses are as filthy rags. Our pretences are stripped away, and we are free.

The individual garments may have individual interpretations:

With the me in her possession, she has prepared herself:
On her head she wears the shugurra, the crown of the steppe.
Across her forehead her dark locks of hair are carefully arranged.
Around her neck she wears the small lapis beads.
At her breast she wears the double strand of beads.
Her body is wrapped with the royal robe. [or, She covered her body with a pala dress, the garment of ladyship.]
Her eyes are dabbed with the ointment called, “let him come, let him come.”
Around her chest she wears the breastplate called “come, man, come.”
On her wrist she wears the gold ring.
In her hand she carries the lapis measuring rod and line.

What could each mean? Comment! Knock yourself out!

Joshua J Mark, in the Ancient History Encyclopaedia, eschews the Jungian interpretation: the tale shows how self-centred and unfair a Goddess may be, and humanity suffers. Also the change of Dumuzid and his sister explains the seasons. Though myths may pass through many hands, and have meanings added. He thinks Ereshkigal is praised at the end of the poem-

Holy Ereshkigal! Great is your renown!
Holy Ereshkigal! I sing your praises!

-because she sought justice against Inanna; but the Goddess of the Dead should be propitiated, especially after portraying her as outsmarted by her sister.

For me, a myth speaks to the unconscious. I can explain the meaning that we lose our pretences, our identities, when we find our unconscious, because I have become conscious of that. There may be other meanings in the story.

I have been at thirdwaytrans again. He finds the identity “a trans woman” a prison, because it means we can no longer present male. A commenter brought up Inanna. First I tried to please the World with my hyper-manly persona (from Greek for mask) then, more truly me, with “Clare”. After descending into Hell, or reaching rock bottom, I learn how valueless the masks are. Before I transitioned, I thought that in five years’ time I might be trying to present male, but transitioning was the only way to get to that place. My identity as trans liberated aspects of myself I could not express otherwise.

Unilantern, commenting, claims masculine and feminine are patriarchal oppression. She produces a great long screed arguing masculinity is seen as instrumental, femininity as expressive. If a man is expressive he is seen as feminine. But composers, painters, poets, philosophers, even writers, were until recently overwhelmingly male.

Healing-stars Goddessastrology compares the removal of the seven garments to the purification of the seven chakras, though chakras are understandings from a different culture. Hooray for eclecticism!


Of myth

Paul Mu’ad Dib walked into the desert, where he must surely die. Why would he do that? I can think of reasons, from his character, experiences and desires, and possibly he is giving his life for his people. Rational and emotional explanations meld into myth. I swill that metaphor round my mouth like a fine single malt, and appreciate the different notes of its lingering aftertaste. More possibilities emerge from consciousness. Perhaps I will dream of it.

Dune is all about myth and religion. There are the created and merged religions of the Zensunni and the Orange Catholic Bible, and the myths spread by the “Missionaria protectiva” so that any Bene Gesserit witch can tap into them, and pretend to be an apostle or a God. Knowing of their origin, Jessica does not appreciate that on Dune, the myths have become true. In Dune, the rationality of the “Mentat”, a human computer, is kept separate from the spirituality of the Reverend Mother, but in the first sequel Dune Messiah they are united.

Wisdom-sayings litter the book:
The most persistent principles of the universe were accident and error.
The clear safe course that leads downward into stagnation.
I told him that to endure oneself may be the hardest task in the universe.
Do not be trapped by the need to achieve anything. This way, you achieve everything.

Does the prophet see the future or does he see a line of weakness, a fault or cleavage that he may shatter with words or decisions as a diamond-cutter shatters his gem with a blow of a knife?

Atmosphere is more important than action for the second novel. Dune has battles and knife-fights, Dune Messiah has one exercise with a fighting-machine more to show the character’s mood than be “exciting”, and has council meetings and conspiracies. What would knowing the future, and the horror of the best path through it, mean? The deliberately created religion has meaning for the pilgrims: perhaps, for some of them, it even has value.

Doctor Who has been playing with myth, during the Eleventh doctor. There is the Last Centurion, guarding the Pandorica for two millennia, and Clara jumping into the Doctor’s time-line, to merge with his life. The Doctor spends six hundred years in a town called Christmas, where the day is only minutes long, and the night hours, saving it from attack. Then there is the Ultimate Question- “Doctor-Who?” on which the Universe depends. For the plot, that question and its significance needed to be explained, and having one explanation it lost all its power.

Old wine in new wineskins it. Don’t classify it then reason from it. This is not always advice I take.

I want to know where the feeling comes from. Is it from current experience (good) or a reaction because of past experience (bad)? My thoughts and feelings really are my enemy, they constrain me. If I could even now “make a man of myself” life would be so much easier, I catch myself thinking. What would that even mean? Kelley tells me how his class of 14 year olds resonate with the idea of not fitting the “Man-box”, the constrained ways of being a Man in this culture. In the story of Theseus, Procrustes forced people onto his bed, and if they were too small he stretched them, if too big he cut bits off. That myth’s meaning is so clear to me, though what the Greeks thought of it I do not know. Robert Graves links it to the Isthmian Games.

Something is not working here. I feel upset and find myself wishing for something impossible which I would hate if I could get it, or I would be completely different as a person.

I have been reading Hilary Mantel, and history books on the Tudors. A Catholic friend said with no hint of irony that Edward murdered martyrs, and Mary executed heretics. I like to think that now I have a more nuanced view, that I can see different aspects and issues, though I still think Elizabeth’s settlement best. Her Church of England accepted a wide range of Catholic and Reformed views, and had no allegiance to a weak politician at the mercy of foreign kings and armies, though it might have been better with less state control. Possibly this view is affected by 35 years as an Anglican. And- I can be open to new understandings, and so gain understanding. Brilliant. And- I need to understand my current situation.

It seems that I can say sensible things, that this job was a good place for me to be, or that defeat was no judgment on me but showed my integrity- and I do not feel that way. The world is not that hostile, I say, there are always positive things to see, the negative has no value, the acceptance is so much more important than the rejection- and something inside me does not believe it. So I break down in tears rather than do a job application, and cannot go out after a failed job interview. I like to think that is not merely my inner critic, as I hope it does not have so much control over me. So I imagine my rational self at war with my emotional being.

I could see it differently: I have managed to convince my rational self that I may survive in the World, and this is a good start, now I haveĀ  to persuade my emotional being. Even, finish persuading her, I have made a start.

Lao Tzu allegedly agrees- the internet never gives sources.

Thinking and feeling

File:Loke og Sigyn by Eckersberg.jpg

Seeing the gender psychiatrist was one of the most painful things ever to happen to me, and perhaps my greatest moment of growth.

Before I saw my GP in November 2000, I was concerned how I would persuade her to make the referral, and I phoned the Beaumont Trust helpline to discuss it. “Tell her how you feel” said the volunteer, and in the end I told her how unhappy I was. But when I saw Dr Dalrymple, I was concerned to persuade him intellectually. It appeared to me that I was TS, for particular reasons. So I made my arguments, and he dismissed each one. All he left was that I feel happy female. He took away all my myths. I woke in the night weeping, and the next day I could not go to the office, because I was crying, and so I visitedĀ Margaret, my best friend,Ā and cried and she sympathised.

I lay in my bath and thought I feel happy- the more I remove my body hair, my voice working towards alto from baritone. I like my nails long and varnished. I express myself how I want to express myself, and called that “feminine”. It did not seem the hot panting joy of a pervert or the fanatic enthusiasm of a Convert, it felt quiet and peaceful and harmonious. It was my feeling, from my heart. So I did not need my myths. However, seeing Dr Dalrymple had been so painful that I could not see him again, and I went private.

Ever since, I have thought of this incident as putting me in touch with my feelings more than ever before. I have thought I am naturally more disposed to Feeling, but grew up in a milieu where feeling was devalued in favour of thinking. Only thinking was useful. This now seems impossible: how may I decide what to do, other than by what I Want, by feeling?

So Jung as explained by Robin RobertsonĀ makes senseĀ to me. If Thinking rather than Sensation or Intuition is my “Primary Function” then Feeling isĀ  my “Inferior function”, the “Royal Road to the unconscious”. I would agree with him that balancing these two, using each for its proper purpose, is best, and I suppressed feeling, driving it into unconsciousness. This is common- consider the man shouting “I am Perfectly Calm!!” And- I remain primary Thinker: I still am perplexed that I cannot explain intellectually, why I want to express myself female. Feeling happier is not enough for me. My whole search for the “Real me”, trying to think it through, is Thinking rather than feeling. Feeling might have me there already.

Since reading that book, I have been remembering my dreams. I dreamt of David Mitchell last night, specifically of performing comedy with him- not remembering my lines, not having rehearsed enough, you know the type. Wish fulfilment, and Robertson explains this as dreaming of a God- celebrities are the closest thing we have to Gods these days. Perhaps a comedian represents clever and mischievous trickery, as Loki would have done at one time.

When we need to relate to the world in a new or different manner, writes Robertson, our dreams produce a God or Goddess who possesses the abilities we need. The Animus figure evolves into someone we can be comfortable with in a human way.