Informed Choice
Finding Help in the Professional Jungle
by Carl W. Bushong, PhD, LMFT
Reprinted from TV/TS Tapestry Journal, renamed Transgender
Today there is a growing spirit of inclusion and cooperation within the gender community, along with those of differing sexual orientation. Transgendered people are no longer confined to narrow "lose-lose" solutions, but have a large number of choices. The general public has become aware of the gender community's existence, if only being partially accepting, through tuning into television talk shows, through the general media and entertainment. But, the gender community is still in its adolescence and is faced with a new set of problems. These are problems of understanding, communication, and choice; the latter being what should be considered "informed decision making."
Being a psychotherapist practicing in Tampa, Florida, and working with the gender community, I have made some interesting observations. I believe conditions in Florida can be used to reflect conditions in the USA as a whole. The first and most major issue is a general lack of understanding within the professional community. There is still too much ignorance and misinformation present in the professional community of psychotherapists, psychiatrists, endocrinologists, general medical practitioners, and even with hospitals, and general health and mental health help lines and organizations. But thanks to the excellent work being done by the gender information organizations, this wall of ignorance is slowly beginning to crumble. The confusion between gender identity and sexual orientation is still there, and a large percentage of professionals still feel gender differences (referred to clinically as dysphoria) can be "cured or fixed." The typical viewpoint is to become normal; the "therapeutic" goal is to learn to be like most other individuals no matter what harm or burden is imposed. While gender dysphoria is not normal (something most people do or have), IT IS NATURAL and not learned or "chosen."
But, as harmful as these misunderstandings may be, I believe a far greater danger may come from practitioners who present themselves as caring and helping by way of dispensing hormones and surgical intervention without any guidelines. The proper sequence of procedures or access to information and choices available which make for the many adjustments and changes (physical, psychological, emotional, social, and legal) to become a whole "new woman (or man)" ARE NOT made available to their clients. All too often individuals in transition, or for that matter who feel they "have arrived," become a collection of disparate traits and cosmetic changes instead of a complete package. Naturally, some individuals are stubborn and refuse to accept any guidance and support. But the real culprits that hold many from achieving their best are the treating professionals themselves. At first glance one may feel that this client awareness should be brought about from the mental health provider, and the specialty providers should only do what they do best. But unfortunately there are primary care physicians working in the gender community who are content to dispense hormones without any care about the consequences to their patient clientele, and surgeons who also intervene without care of the consequences.
Many times providers remain ill informed outside of their specialty, or worse, remain uncaring and expect the transgendered client to fend for oneself. They never aid or foster an informed consumer's mind-set. Who's best interest is served when a specialty provider is often unprepared to provide the client with the broad based understanding needed to make the proper choice? If an individual happens upon "professionals" who offer no guidance or sense of priority while dispensing hormones, or SRS with little or no life-style preparation - a disaster may be in store. The individual's future happiness is threatened when the outcome of such "professional" intervention may be a bearded, baritone post-op lady with large breast implants but little or no training or understanding of how to walk, talk, or sit, let alone a strong sense of "female-self."
As the gender community grows, many function fully within this microcosm. While a sense of community is important, being part of mainstream society is also important. Too often the quick-fix mentality can be contagious, pushing others toward medical, surgical and life-style changes that would not be considered appropriate - at least in the particular sequence suggested, leaving individuals to stick together in a small world of their own - and influence others along the same path. In an area such as gender shifting, where myth and ignorance often exceed knowledge, it is only expected that the lay persons in need should be confused, frustrated, angry and uninformed. The transgendered often begin life feeling as if they are the only person in the world to have such a problem; that something is wrong with them - and not just in society's view. When at last they try to be themselves, to throw off sometimes decades of deception, frustration and denial, they are often angry and resentful. So much of their life is felt to be "lost," and naturally there is an eagerness to get on with their "new self," right now! Unfortunately, many in the gender community have collected a lot of "excess baggage" in the form of a marriage, family, children, and educational/professional development that doesn't properly translate to one's desired gender role. And just like society as a whole, the transgendered individual may focus far too much on the physical aspects of gender, down-playing or even missing the mental, behavioral, social and emotional aspects.
When it comes to gender, our culture is genitally obsessed. What's between your legs and on your chest determines one's gender (sex). Body form and plumbing are all our society sees and therefore all the transgendered person may be aware. The most important service a professional can provide for transgendered person is to instill the knowledge, support and resources needed for a series of "informed choices" as to what, how and where their transformation will take them. We in the mental health profession are so comfortable with figuratively placing people in little boxes with neat labels on top such as "primary transsexual, secondary transsexual, crossdresser," etc. The truth is we are all in a classification of one: OURSELVES. In my opinion, a psychotherapist's role is to be a helper, a teacher, and a guide. To help the transgendered with those areas and conflicts resulting from a lifetime of living a double life, one inside or hidden from others, one out in public. The therapist needs to be a teacher in making available all the accumulated knowledge, skills and choices one has as well as clearing away the myths, lies and misinformation. And as a guide, the therapist aids the client through the social, legal, medical and emotional mine fields toward one's "new self."
Today quality gender based services are becoming increasingly available, although they are still geographically spotty. While some regions of the country are very "gender knowledgeable," others are not so gifted. Even in areas with minimal professional services available, the dynamism that a conscientious and self-aware gender support group can provide is tremendous. But sometimes self-help groups can be counter-productive, if the blind are leading the blind. Group knowledge, resources, and a desire for personal growth are essential.
The rigid, arrogant, we-know-what's-best-for-you gender clinics and hospitals of the past are obviously not the way, and individuals need to be more in control of their lives and bodies. And while the transgendered now can take a long overdue control of their destiny, one should keep in mind that success is heightened by "informed choice," not just choice.
© 1994 Tampa Stress Center, Inc. / Tampa Gender Identity Program (tm)
Dr. Bushong can be contacted at the Tampa Gender Identity Program, PO Box 273107, Tampa, FL 33688-3107, Telephone: (813) 884-7835, and online at: www.nu-woman.com