CHAPTER 2: WHY?
Crossposting from my personal journal...
To celebrate the passing of a year of journal entries, I thought I would post the first draft completion of one of the chapters in my “Coming Out Book.” This book will essentially be a really long coming out letter that I'll give to someone after I talk to them about my transsexualism. The idea is to educate them before they type "transsexual" into Google and to cover as many questions as possible.
When we tell a friend, the first question that will most likely leave their lips is, “Why?” This chapter focuses on that question. It is a summary chapter, so it’s short (3 pages) and doesn’t get into too much science. Chapters following will go into more detail. It follows the Chapter on definitions and if followed by a chapter addressing our friends’ probable feelings.
Note that I haven’t standardized the footnotes yet, so please don’t criticize how I’m citing my sources. Once I get the bulk of the book done, I’ll go through all the footnotes at the same time and standardize them as well as gather additional information that may not be currently included.
What I would greatly appreciate is constructive comments on how I can improve the chapter, including better ways that of how I can explain why.
Chapter 2: Why is Steve Doing This?
Your first question may be “why?” Why can’t we cure this? Why can’t Steve take a pill and make it go away? Why can’t Steve get therapy and make it go away? Why does it have to involve hormones and transitioning?
It’s easy to suggest that science has a miracle pill that can make it go away, but Gender Identity Disorder has been studied for over 100 years. Transitioning has been identified as a solution for over 80 years, including the use of surgical techniques. If there were a pill to “cure” GID, then Steve and Phebe would know about it.
Some people believe that Reparative Therapy can cure transsexualism. It is usually aimed at curing homosexual populations, but has also been applied to transgender people as well. Reparative Therapy uses techniques such as behavior modification, aversion therapy, psychoanalysis, prayer, and religious counseling to prevent homosexual and transgender behaviours. Unfortunately, none of it works.(1) In fact, major medical and psychological associations such as the American Psychiatric Association, the American Counseling Association, the American Academy of Pediatrics, and the American Psychological Association, have condemned Reparative Therapy as harmful.(2)
A number of other treatments have been tried as well, including psychotherapy, aversion therapy, psychotropic medications, hormone treatments consistent with the patient's birth sex, electroconvulsive therapy, and hypnosis. In 1972, the American Medical Association Committee on Human Sexuality published an official opinion stating that these treatments have been shown to be ineffective.(3)
So there is no psychotherapeutic bullet to solve Gender Identity Disorder.
From birth, everyone is socialized according to their genitals. Naturally, Steve was socialized the exact same way: to see himself as male. As Steve grew up, this naturally caused confusion and anxiety as Steve knew his true gender - the gender his brain informs him that he is. This is detailed in Chapter 6: Steve Reyes’ Personal History & Psychology. Later in his life, cognitive dissonance progressed to actual psychological conditions that continued to increase in strength as time progressed.
You may ask, “Yes, I can see it being stressful, but why is he transitioning?” The real reason behind the transition is that it’s the only known way that consistently relieves the intense psychological symptoms of Gender Identity Disorder. Transitioning from one gender to the other is the only reliable way to relieve the psychological symptoms. This has been working well since the 1930’s.
The official listing of GID/Gender Dysphoria is in the “Diagnostic and Statistical Manual of Mental Disorders IV” (DSM IV), but, after the initial confirmation of diagnosis, the counseling focuses on managing the patient’s transition and the stress associated with it.
Some people will see that it’s in the DSM IV and believe that Gender Identity Disorder is a mental illness. While it’s in the book, it’s not really a mental illness. Nicotine dependence is also in the DSM IV, but it also is not a mental illness. The book is a reference guide to help therapists diagnose people’s conditions in order to determine the best method of helping them. In some cases it may be weekly therapy sessions, in some cases it may be medication, and in other cases, like in GID, it may require therapy, medicine, and surgical intervention.
If it helps, a valid way of thinking about Gender Identity Disorder is that it is a birth defect.
Let’s take the intersex birth defect as an example. In the case of intersex, a person is born with some combination of male and female genitalia (this type of person was previously called a hermaphrodite). It is a physical birth defect.
Transsexualism is similar, but with the brain instead of the genitals. In fact, there is some evidence that transsexualism may be reflected physically in the brain.(4) Just like someone who has an intersex condition may take steps to correct that condition, so too Steve is taking steps to correct his condition.
Some people would say that it is his choice. Being transsexual is not Steve’s choice anymore than he can choose the color of his skin. It is not ‘just’ a choice to transition. Transitioning creates huge problems. Just from a logistical perspective, let’s look at the significant obstacles Steve faces in order to become Stephanie:
- It jeopardizes his marriage with his best friend, his chances to see his children grow up, his job, and even his friends could abandon him.
- His family facing the same issues with their work, the organizations they deal with, and their friends.
- Significant psychiatric assessment for diagnosis confirmation from at least one psychotherapist and one psychiatrist.
- Extremely painful procedures such as laser therapy and electrolysis for removal of the beard.
- Statutory declaration of new identity to use in obtaining new documents, as well as changing his name on all official documents.
- Dealing with legal issues regarding marriage, his will, family insurance, etc.
- Dressing a living full time as a woman, which is a mandatory precursor to surgical treatment
- Significantly increased chance of assault and murder.
- Potentially several surgeries: breast augmentation, facial feminization, and genital reconstruction surgery.
Yes, the actual transitioning from male to female is a choice, and Steve and Phebe made that choice logically. The benefits outweighed the consequences, though perhaps not by very much. That’s not to say that there wasn’t considerable emotional turmoil. In fact, they reweigh the cost-benefit equation in their minds every day.
The consequences of not transitioning can be dire. First off, it guarantees lifelong psychological pain that would have to be dealt with. The pain associated with transsexualism increases as you get older, so the chances of Steve being able to keep everything hidden from society diminish.
Also, there is a significant the chance of suicide. The attempted suicide rate among transsexuals is incredibly high. The attempted suicide rate for American society as a whole is 1 in 9,090.(5) For transsexuals the attempted suicide rate is one in five.(6)
While Steve did think of suicide, he never considered it seriously. He figured there was always something to live for, even in the worst of his situations. Then again, he had a very good childhood and was always safe: an optimal environment for mental health.
To have some understanding of what Steve is going through, Phebe came up with a metaphor that works for her. Here is part of a post from her December 24, 2007 journal entry that explains it:
…It was suggested I try to imagine myself as being suddenly perceived as male. It's impossible for me to do that. I could no more imagine myself to be male as I could to be black, Jewish, gay, etc. I'm simply not and don't have those experiences upon which to draw. It has the added distinction of cheapening the hardships and issues those people have faced/are facing/will face, since I can only apply my faulty and incomplete empathy to it. (Plus, there are people who just couldn't possibly bring themselves to try to empathize.)
Instead, I came up with the analogy of a rabbit… They're cute, innocuous, and ubiquitous.
It's like having your human brain put into a rabbit's body. Every time you twitch your nose, put a paw up, wiggle your tail, or munch on carrots, you feel/see/hear that you're not who you should be. I can imagine that it would suck for me to be trapped in a rabbit's body. I would not be able to do the things I normally do, and people would look really oddly at me and never believe a word I said if I tried to explain (assuming we can suspend disbelief enough to say that I could get the vocal cords to work well enough to communicate with human speech).
She also came up with an elegant, more scientific way of putting herself in a transgendered person’s shoes: “You get sensory reminders constantly that your external physical characteristics don't match your internal programming. Being bombarded by the incessant incorrect input, you are faced with the cognitive dissonance created by the mismatch. Since you're constantly getting sensory input, you're constantly having to think about it.”
In Steve’s opinion, this accurately describes the constancy of the psychological strain.
Given all this, Steve and Phebe decided to remove the intense psychological pressure that Steve faces every waking moment of his life. They have decided that Steve will transition to Stephanie.
Footnotes:
(1) Attempts To Change Sexual Orientation - Prof. Gregory Herek, University of California, Davis. http://psychology.ucdavis.edu/rainbow/html/facts_changing.html
(2) Commission on Psychotherapy by Psychiatrists (COPP) Position Statement on Therapies Focused on Attempts to Change Sexual Orientation - American Psychiatric Association
(3) Human Sexuality; The American Medical Association Committee on Human Sexuality; Chicago, 1972
(4) “Male-to-Female Transsexuals Have Female Neuron Numbers in a Limbic Nucleus,” Frank P. M. Kruijver, Jiang-Ning Zhou, Chris W. Pool, Michel A. Hofman, Louis J. G. Gooren and Dick F. Swaab, The Journal of Clinical Endocrinology & Metabolism, 2000. http://jcem.endojournals.org/cgi/content/full/85/5/2034
(5) World Health Organization Report on Suicide Rates, USA, http://www.who.int/entity/mental_health/media/unitstates.pdf
(6) Seattle & King County Public Health, report on Transgender Health, http://www.metrokc.gov/health/glbt/transgender.htm. Also Dixen J, Maddever H, van Maasdam J, Edwards P (1984) Psychosocial characteristics of applicants evaluated for surgical gender reassignment. Arch Sex Behav 13: 269-276.