GID and the Debate on SRS and Hormones
By Sarah Carrier
I once said to someone that I know that the discussion raging around whether or not to remove GID as a psychiatric disorder and the discussion on SRS and hormones on demand reminded me of watching Pro-lifers and Pro-choicers discuss abortion.
Both sides talk past one another and so poison the discussion that we will never find the common ground that will help future generations of our brothers and sisters. Why must this be an "either or" discussion? The reality is that we will not wake-up tomorrow and suddenly all of this will change. Removal of GID will take time. Changes in the Standards of Care (S.O.C. will take time and like our Transition will be achieved in small steps. We must first build a foundation on which to justify these changes.
Ill Yet Not Ill?
One of the ironies of our life is that the moment we finally acknowledge our Transsexuality, we are labeled as ill. Yet, this small step is probably the first sane step that any of us have taken in our lives. There is a simple reality. Because of how society views us, we are burdened from a very early age with shame and fear. This is the "ill" part of our lives. How we have lived our lives is not healthy. Yes, we can blame society or the psychiatric community for this lack of understanding ;however, most of us, no matter how clear our understanding of who we are, will need therapy just to deal with the way we have lived our lives. Let’s face it..very few of us wake up one morning and say," Hey!,I’m a woman". We arrived at this point after a very self-destructive path in our life. We deceive ourselves, our family, our friends. So to say that we should be allowed to walk into a surgeon's office and demand SRS is ludicrous. All of us have issues and problems that we have to work through. So, while I tend to agree with the "pro-choicers", I don’t agree with SRS on demand.
Between SRS on demand and the S.O.C lies an area which can be cultivated to eliminate the extremes. While a lot of therapists are not adhering to the one year life test (and bless their hearts), the S.O.C. does codify this requirement into its standards. This area is where we can and should focus some of our energies. Whether or not a person needs a one year life test is going to vary from individual to individual. Some may only need 6 months, or 4 months, or 4 years. The harsh arbitrariness of this requirement needs to change. More flexibility needs to be given to the therapist and the Transsexual to find the life experience that is right for the client. Each of us is unique and comes from different life experiences and this is something that therapist need to understand. For example, I will probably not need one year BUT I will need at least a year to come to gripes with my past and bring about the changes needed to make it easier to go full-time. Once I reach a point of RLT, I will have already dealt with most of the issues that will come up.
Another area to focus our energies is on the issues of hormones.
Currently, S.O.C. treatment protocol states that a person must:
a) have lived for at least 3 months in the gender of choice, or,
b) the Transsexual has been in therapy for at least 12 weeks.
Most therapists interpret this to mean 12 sessions. The question arises as to the need for this. Hormonal treatment affects more than the body. This is clear from the fact that when we begin taking hormones, we begin exhibiting changes in thought and perception long before the physical changes take place. So there is more going on than just a biochemical reaction. So what is it? When we reach the point of acknowledging our Transsexualism, we will be experiencing a tremendous amount of confusion. What hormonal therapy does is give us a framework to this confusion so that we can begin to clarify our thoughts and feelings.
Hormones
I suspect that many individuals that come in for treatment get hormones then realize that this is not going to solve their problems. In a way, the hormones can help those individuals that may not end up going through with their transition.
Yes, there are issues related to continuous use of hormones but if under the care of a physician, these concerns can be minimized. The hormones for those of us that are truly transsexual gives us a sense of peace and coherency that we have not experience in our lives. They make it easier to deal with the traumatic issues that will inevitably come up in therapy. In my own case, I first started taking hormones in April of this year. I stopped in June. Why? Because I still wasn’t ready to incorporate the psychological changes taking place. I began taking the hormones again in August and have been on them since. This time the peace, the clarity, the changes in perception came without forcing and I was ready to use that strength to deal with the issues in my life. I do believe that if we allow hormones on demand we will see an increase in transsexuals using them under the care of a qualified physician.
Currently, many of us turn to overseas outlets or, even worse, to the streets to get the sense of clarity that hormonal treatment brings. This leads the individual to stay away from doctors for fear of being discovered and, at the end of the day, causes more harm to our community than hormones on demand would cause. How many of our brothers and sisters have gotten ill or died because, out of desperation, they turn to these illegal outlets. We must make hormones available on demand if one condition is met: 1) the transsexual is seeing a qualified doctor and sticks with that doctor. For many of our brother and sisters it will be the clarity that the hormones bring that gives them the courage to take that next step and see a therapist.
Finally, the DSM-4. In theory, this diagnostic tool is use to help the therapist "tree" out the client’s illness. Therapists are somewhat disingenuous in this area. They say that Transsexuals are not ill yet continue to follow a diagnostic tool that has to label us ill. Out of all the arguments that I have heard, it is interesting that none of them argue that we are ill.
We may suffer from depression (gee, I wonder why) or some paranoia (again, gee, I wonder why) but not a mental illness. We hear arguments that relate to insurance, guarding the gates of heaven (gatekeeper), making sure to weed out the ones that are really "ill" and one of my favorites," We need the DSM-4 because of the narrow-mindedness of society that sees us as ill and that if GID is not there, then therapist will not deal with the root cause but secondary issues."
Let’s stop for a moment and think about what we are saying. We are saying that we are not ill but it’s ok to label us ill since society is so narrow-minded. This is clearly a prescription for no progress being made. The reality is that society takes its cues from the "experts", the mental health professionals. I am convinced that our brothers and sisters in the gay/lesbian community did not begin to make progress until Homosexuality was removed from the DSM.
If we are not ill, then a classification of GID has no place in the DSM-4. Only when this is removed, we will begin to see the slow change in society’s attitudes towards us. The fallout will affect many;however, the fallout can be minimized if we begin now to build an alternative support structure for Transsexuals. This support can come from our community.
In conclusion, we must realize that the dismantling of the current therapeutic approach will not happen quickly nor should it. No matter how much we may get angry at how we are viewed and treated by the therapeutic community, we must first make sure that we, as a community, have put together a structure to replace the current one and this will take time. If we begin now by focusing our energies on the small steps that I have outlined here and begin to explore the concept of a community and how we can build one for our brothers and sisters, we will take the first important steps towards re-gaining a sense of control over our lives. Without a community, we will never achieve the goal of a Gender-Blind society and will never completely rid ourselves of the shame society has forced upon us. Without a sense of community, it will be impossible to build a support structure that meets our needs without having to stigmatize us as ill.
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