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autolenaphilia · 2 years

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CW for description of massive transmisogyny and lesbophobia and almost every prejudice under the sun, including biphobia and aphobia.

Recently I wrote about trans women are dismissed as fetishists and how that worries me in connection to the kink at pride discourse. And I mentioned that there is this dichotomy in transmisogynistic thought. It is between on one side “the good transsexual” who is straight, cis-passing and gender conforming, passed rigorous medical gatekeeping and doesn’t insist too much on her rights. And on the other side of this dichotomy is the figure of the “bad trans woman”, who is fetishistic, either lesbian or bi, non-passing and the dreaded Trans Rights Activist.

This dichotomy has existed in trans medical gatekeeping since at least the 60s, and has and still often plays a role in who gets to medically transition or not. Signs of non conventionally feminine interests or sapphic inclinations can be a reason for denial of healthcare, and trans women often justifiably lie about such things to get past gatekeeping.

And one of the foremost exponents of this transmisogynistic dichotomy is of course Ray Blanchard and his “theory” of “homosexual transsexuals” (HSTS) and “autogynephiles” (AGP), which has caused its own transphobic strain of sexological research, which I will call Blanchardism for short. The dismissal of trans women as fetishists has deeper roots, but his ideology is the source of a lot of today’s transmisogyny.

One might be tempted to rephrase “HSTS” as “straight trans women” and “AGP” as “lesbian/bi trans women”. And those are the people the terms are intended to describe, but they are deeply transmisogynistic words and essentially create a kind of dream-image of the people who they purport to scientifically describe.

Basically the HSTS are “so gay they became trans”. In Blanchardism they are basically described by ultrafeminine gay men who transition because of their attraction to men and it’s often implied by transmisogynistic researchers that they do so to attract straight masculine men. They transition younger than lesbian or bi trans women, and according to Blanchard also pass better and more conventionally attractive compared to their non-straight trans sisters. Not that this keeps Blanchard from misgendering them by saying that they are “homosexual males” and the figure is essentially an extension of “the deceitful trans woman, who tricks straight men into having sex with a male”.

Blanchard however reserves the full force of real thinly-disguised transmisogyny for the autogynephiles, trans women who are attracted to women. They are described as straight men driven to transition by the fetish of autogynephilia. It’s a sexual attraction to the image of themselves as women, said to be closely related to “transvestic fetishism” (which means being turned on by wearing the opposite gender’s clothes). It’s caused by an “erotic target location error”, which causes them to misdirect their attraction to women to their own bodies, and cause their fetish. They are said to transition later, and be non-feminine and non-passing and overall described as disgusting perverted failures.

What about bisexuals, you might ask? Well, Blanchard doesn’t really believe that bisexuality exists, at least not among trans women. He argues that autogynephiles sometimes have “pseudo-bisexuality” where they are attracted to the idea of having sex with a man as a woman, but aren’t actually attracted to male physique in itself. The sex with men is just a tool to further their “being a woman fetish”. In response to that you can argue that the defining part of sexual attraction to a gender is wanting to have sex with them, not any vaguely defined attraction to their bodies in the abstract. And that what gender you are treated as in a sexual-romantic relationship is crucial to whether the person wants that relationship or not. But let’s talk more about the blanchardian ideology before we get into further.

Blanchard is also a aphobe, who doesn’t believe asexuality exists among trans women either. He came across trans women who essentially said they were asexual, but claimed they were just autogynephilic fetishists who were either lying or whose masturbation to their fetish was enough to satisfy their sexual urges (which he bizarrely claimed was a kind of “pair-bonding” to their feminine selves).

It’s all nonsense, of course. Me just writing out what Blanchard believes is so obviously nonsensical that it almost refutes itself. It’s terrible science, and you can find plenty of evidence against it. Even Blanchard’s own studies had findings that contradicted his conclusions. There are many people who don’t fit into his dichotomy, and in studies of cis women who have very similar sexual feelings to Blanchard’s concept of autogynephilia.

Smarter people than me have done these debunkings, and you can for example read Julia Serano on the subject or watch this Contrapoints’s video.

Of course, this won’t convince the believers in Blanchard’s typology, because I think it’s fundamentally unfalsifiable, just like Freud’s theories. In a manner similar to Freud, Blanchard builds up this elaborate theory of human behaviour, in which all dissent can be dismissed as repression and deceit. He is a fantasist rather than any kind of scientific researcher.

His answer to trans women saying things about themselves that contradicted his findings has always been “those bitches are lying”. They were denying their attraction to women, their masturbation and fetishism. Of course in many cases that is true, as I mentioned before, trans women have and do lie about having sapphic tendencies or even sexual feelings overall in order to get past medical gatekeeping. But for Blanchard and his followers it becomes a mantra that invalidates any evidence against their ideas. Basically anything that doesn’t fit into their transmisogynistic binary like bisexuality or asexuality is said to be essentially fake. It’s essentially like arguing with a conspiracy theorist, they can just deny any contrary evidence with the claim “it’s lies”.

It’s more interesting to look into how Blanchard’s transmisogynistic theories are not just reflections of already existing transmisogynistic ideas, but also just plain misogynistic, lesbo- and biphobic and heteronormative ones, which I haven’t seen discussed that much.

The ideal trans woman in blanchardism is straight, conventionally feminine and literally has her womanhood entirely defined by her attempts to please men sexually. The ideal is also that she is submissive to these men. In one of Blanchard’s questionaries (which deserves a separate post of its own because it’s bugfuck insane) to determine how straight or lesbian trans women are, you actually get less “straight points” if you prefer to “lead” in sexual encounters with men. Not that this doesn’t keep Blanchard and co. from treating her with condescension at best, misgendering her as a “homosexual male”. It’s not surprising that papers by Blanchard acolytes Ken Zucker and Yolanda Smith came to the conclusion that “HSTS” have lower IQs than lesbian trans women (which of course in reality doesn’t say anything about real intelligence). The view of straight trans women by these “scientists”, is of course extremely transmisogynistic, but it also shows transmisogyny is just misogyny applied to trans women. If these straight trans women are accorded any kind of respect from these transmisogynists, it’s because the fantasy that these studies create of them come close to fulfilling society’s misogynistic ideal of a woman. She is straight and is submissive to men, and preferably a bit dumb.

Her evil mirror image is the autogynephile, and it’s interesting how she is a specifically transmisogynistic reiteration of already existing misogynistic, lesbophobic and biphobic tropes. The idea of wanting to become a woman as a fetish builds on the sexualization of women in patriachy, so wanting to be a woman must be sexual.

Her sapphic sexuality being demonized as perverted and fetishistic is how cis lesbian sexuality is demonized too. I’m not the first to point out how the sapphic trans woman being portrayed as a predatory danger in bathrooms and changing rooms is an evolution of old homophobic/lesbophobic fearmongering. Blanchardians gleefully point out how “autogynephiles” often fail at passing as cis, and are non-feminine, and that is of course another specifically transmisogynistic reiteration of an old trope with the aim of otherize lesbians and bi women. It’s the old narrative of how they are “mannish” and fail at femininity and ultimately womanhood and are therefore disgusting to the cisheteronormative mindset.

Blanchardism as a narrative thus furthers misogyny, heteronormative and lesbophobia and biphobia. Transmisogyny is thus again revealed as misogyny applied to trans women, in concert with transphobia. And the hatred towards bi- and lesbian trans women in the concept of the “autogynephilia” is just old lesbophobic and biphobic narratives in a new form mixed with transphobia.

It’s telling how TERFs, despite their stated aims of fighting misogyny and lesbophobia have embraced Blanchard and his theories, to the point “AGP” is a fixture of the TERF vocabulary. To the extent Terfs don’t openly espouse total trans elimationism and want transness “morally mandated out of existence”, they can sometimes pretend to accept the “old-school true transsexuals”. It’s a variation of Blanchard’s HSTS stereotype who in the Terf narrative of the good submissive trans woman that went through rigorous medical gatekeeping and didn’t insist on “invading women’s spaces”. The subtext is that gatekeeping kept their numbers down to a quantity cis society could easy ignore, the cis passing requirements that existed also contributed to that, and trans people were cowed enough to not insist on their rights.

It is ultimately this that reveals the hypocrisy in the TERF accusation that trans women further misogyny, lesbophobia and in general stereotypes about womanhood. It was the cis male medical gatekeepers and “researchers” like Blanchard that actually furthered the stereotypes and literally forced them on trans women by denying them healthcare if they didn’t comply. People that are now lionized by TERFs. And in wider society, performing femininity continues to be a way of survival for trans women. All women are expected to perform femininity, but trans women due to transmisogyny especially so. We are just trying to survive. We are not transitioning to trick men into sleeping with us, we don’t transition to prey on lesbians. We just are.

#my writings #transmisogyny

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soulcxining · 11 months

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why do you call yourself an autogynephile? are you reclaiming it as a slur, or do you believe in blanchards description of autogynephilia?

hello ! for this i won't use my tq because that is a serious question,,!

i do not believe in blanchards description of autogynephilia because it do not fully fit me and i find it to be quite transphobic,, i don't use the term autogynephile in the transvestic disorder / autogynephile way. but i do fit the behavioral & physiologic autogynephilia BUT i do not overall agree w / blanchard description of autogynephilia

i am not fully reclaiming the term either,, i used to describe myself w / it when i though i was just a men which well is not the case because i'm trans-fem,,! but i feel like that my arousal that is caused by myself ( a male ) being in feminine clothes / being feminine is paraphilic - but you could say that in a way i am indeed reclaiming the term,,! for me it's just more being in feminine clothes and acting feminine causing me arousal that is autogynephilic so i call myself an autogynephile.

i'm sorry if my answer is quite confused and messy but this kind of stuff is quite hard to explain

#kanaㅤconversationㅤ🐡

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skimblyshanks · 2 years

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Being the one (1) trans person in psych class is:

Researching cited papers within cited papers abt trans identity, gender dysphoria, "transvestic disorder", and ""autogynephilia"" to dismantle the foundational issues therein, bringing out your own citations to add to the point, calling out the unreliability of citing conversion therapists. Also just completely rewriting a misinformative textbox about puberty blockers.

Only three people reading any of it

Nobody reading your puberty blocker points

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deltamusings · 1 year

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Not surprised. Instagram is very disturbing. The actual girls on the swim team are not safe.

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13ghostsustainability · 2 years

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What does "sustainability" mean to me?

I'd like to firstly state that I do not like to give out my name, furthermore, my full name out on a public domain website, especially on the current platform I am writing this on and the deranged userbase of this website. Tumblr is simply the easiest blogging platform to begin on. I will say that I am traditional academic art major and a sexology minor. Much to my dismay, we do not offer sexology in our college, but nonetheless, I am taking these classes online. Perhaps down the road, I can (with a lot more money accrued) double major. With that brief introduction out of the way, I can explain what sustainability means to me and my respective studies.

Being an art major, it's tantamount that we know how to handle toxic equipment, such as turpentine and fixatives or binders that hold a pigment onto a medium, such as Masonite board or Bristol paper. Dumping your turpentine, a material used to dilute oil paints to make the painting less thick, in the sink, for example, will obliterate the clean water supply. Turpentine is awash with toxins and microfilaments of lead. Keeping our drinking water clean by taking extra and easy steps that take two seconds more of your time by transferring your turpentine into a glass bottle is far better than being lazy and ruining the ecosystem for every living organism in your general vicinity.

Sexology has been a generally uncontested, well-respected, and uncontroversial in time millennia up until early 2010 when malicious and censorious "activists" demanded anyone that speaks the truth, or does any scientific study for that matter, to have their tongue cut out and research halted. For example; sexologists have been highly against giving cross-sex hormone treatment to minors, and up until 2012, there hasn't even been sufficient trials on these dangerous hormones, notably puberty blockers. "Puberty blockers", which is a PC way of saying "chemical castration", has only ever been tested on violent and dangerous sex offenders under the brand name Lupron. There has also been an influx of young teen girls who have never showed signs of transsexualism suddenly wanting testosterone. Young men and older adult males who also show no signs of transsexualism enter these "gender clinics", who immediately affirm them without testing for autogynephilia (a term coined by Blanchard who has been studying the differences between transsexuals and transvestic fetishism since the late 70's), which in the past was known as transvestic fetishism, which is not the same as true transsexualism, obviously. There are no APA guidelines due to rabid faux-activists that have completely dismantled safeguarding vulnerable individuals, or individuals with a serious paraphilia. Instead, the Hippocratic oath has been replaced with a gun to the heads of psychiatrists and millions of dollars in the pockets of hack doctors. How is that sustainable for our future children, who follow blindly on whatever is popular or garners attention by shepherding them into a lifetime of medicalization, osteoporosis by the age of twenty, blood clots, stroke, infertility for the rest of their lives, etc.? How is this How is any of this fair to women at all? How is this fair to actual dysphoric transsexuals who now cannot get proper treatment?

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michaelbranch · 2 years

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A Brief Summary of Ideas: The End of Gender

*These summaries are kept intentionally very brief, just hitting what I consider some of the important/interesting takeaways, most word-for-word or paraphrased. My goal is also to stick to ideas/principals that might guide others (or my future self) in deciding the value of a read (or re-reading). T = takeaway, Q = Question

The End of Gender: Debunking the Myths about Sex and Identity in Our Society

Author(s): Dr. Debra Soh

Biological sex is either male or female.

Sex is defined by gametes (mature reproductive cells); sperm/by males and eggs/by females.

Gender identity is how we feel in relation to our sex.

Gender expression is the external manifestation of our gender identity.

Gender is biological; not a social construct. Hormonal exposure in the womb effects gender identity.

Whether a trait is deemed “masculine” or “feminine” is culturally defined. But whether a person gravitates towards traits that are considered masculine or feminine is driven by biology.

Everyone is a combination of male and female traits. No one is 100% gender conforming.

Gender is not synonymous with sexual orientation. But the way it expresses itself in relation to gender is influenced by social factors.

Sexual orientation is inborn and unchangeable.

Childhood gender nonconformity (CGN) is one of the strongest predictors of being gay in adulthood.

Greater exposure to prenatal testosterone is associated with male-typical interests and behaviors and sexual attraction to women, regardless of whether the individual is a male or female.

Two subtypes for male-to-female transgender typology:

Androphilic (male attracted): generally showed signs of being very effeminate from a young age.

Autogynephilic (female attracted) subtype: typically don’t experience feelings of discomfort around being male until puberty. Typically sexually attracted to women, but also experience sexual arousal to idea of becoming a woman.

Autogynephilia: sexually turned on by the idea of becoming a woman.

Cross-dresser (previously transvestites): straight man who wears women’s clothes because he finds it sexually arousing.

Transvestic disorder: desire to wear clothing associated with the opposite sex. What makes it a disorder is if the activities are excessive or troublesome.

Drag queen: gay man who dresses up in women’s clothing to emulate extreme forms of femininity. Typically not motivated by erotic desires.

Majority of gender dysphoric children desist (remit) by puberty. More likely to grow up to be gay.

Socially transitioning is associated with persistence.

T = no such thing as a transgender child. Transgender is an identity and political label . Children do not possess the emotional maturity to identify this way. They may have gender dysphoria.

Gender dysphoria: distress as the incongruence experienced between one’s experience gender identity and one’s birth sex.

Evidence that delaying puberty (via puberty blockers) leads to more benefit than harm currently does not exist.

T= many changes associated with transitioning (testosterone, surgery) have permanent effects.

Organizational vs. activational hormones:

Organizational hormones affect our development, leading to irreversible changes.

Activational hormones circulate throughout our body, and their effects are mostly reversible.

T= transitioning (particularly after puberty) still leaves you with effects of organizational hormones (ex. Greater height, strength, hand size, muscle mass, bone density in men).

Darwins theory suggests the mate preferences of one sex determine the characteristics that are passed on in the other sex.

Mens behavior is, to some extent, the result of female sexual preferences. Masculinity is the result of women’s sexual preferences over thousands of generations.

T= men and women “cheat” for different reasons. Women usually cheat due to lack of emotional intimacy or because their sights have shifted to someone who is more successful. Men cheat generally for sexual novelty.

T = it isn’t necessary to redefine sex or eliminate the categories of male and female in order to facilitate acceptance for people who are different. There is no reason why someone who was born female can’t behave/present herself in a masculine way while identifying as a woman (or vice versa). It’s ok to be a different kind of man/woman.

T= the fact that transgender people identify as the opposite sex offers further evidence that sex/gender is binary. If a person says they are both genders or neither, it depends on the concept of gender being binary.

T = homophobia may be driving some amount of transition (more acceptable to be a trans woman attracted to men than a gay man).

You can’t know whether your perspective is correct without considering arguments against it.

#musings #book summary #books #transgender

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mali3101 · 1 year

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I‘m not like you and I don't feel enough for this world

#transgender #trans #autogynephilia #autogynophilia #transvestism #cross dressing #hate my life #boy in girl clothes #Suicide silence #Mitch Lucker

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purpleradfeminista · 3 years

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"Why is this kind of treatment never even CONSIDERED for a trans person?" cause dysphoria sufferers are considered non-responsive to talk therapy unlike BDD/anorexic patients who can enter remission. Maybe if you actually stepped out of the radfem bubble where y'all theorize out of your butts and did actual reading about older writings on transition you would know, duh. Read about John Money, Harry Benjamin, Magnus Hirshfield, Havelock Ellis, Virginia Prince, Lou Sullivan. If you truly care ofc

Ok sure I'll bite.

John Money: was a New Zealand psychologist, sexologist and author known for his research into sexual identity and biology of gender and his conduct towards vulnerable patients. [bolding mine] He was one of the first researchers to publish theories on the influence of societal constructs of gender on individual formation of gender identity. Money introduced the terms gender identity, gender role and sexual orientation and popularised the term paraphilia. He spent a considerable amount of his career in the USA.

Recent academic studies have criticized Money's work in many respects, particularly in regard to his involvement with the involuntary sex-reassignment of the child David Reimer, his forcing this child and his brother to simulate sex acts which Money photographed and the adult suicides of both brothers.

--I haven't read any of Money's work directly, but I have read the book that is about his patient victim David Reimer, who was surgically "turned into a girl" shortly after birth and used by Money to try and justify his opinions about gender reassignment. Reimer reports that "when living as Brenda, [he] did not identify as a girl. He was ostracized and bullied by peers (who dubbed him "cavewoman"), and neither frilly dresses nor female hormones made him feel female."

Harry Benjamin: seems to at least not have been a pedophile, and I suppose is best known for his treatment of Christine Jorgensen, but I find it significant that he only stepped in to help patients after other therapies had failed.

Magnus Hirshfield: I'm sort of puzzled as to why he's on your list, as his major body of work is about sex, and gay sex in particular, and his only contribution to what you're talking about appears to be some vague writing he did about "transvestitism".

Havelock Ellis: worth first noting that he was a eugenicist....but aside from that he appears to have been the first, or one of the first, to acknowledge that autogynephilia exists and is often a factor in the male desire to "transition".

"Aware of Hirschfeld's studies of transvestism, but disagreeing with his terminology, in 1913 Ellis proposed the term sexo-aesthetic inversion to describe the phenomenon. In 1920 he coined the term eonism, which he derived from the name of a historical figure, Chevalier d'Eon. Ellis explained:

On the psychic side, as I view it, the Eonist is embodying, in an extreme degree, the aesthetic attitude of imitation of, and identification with, the admired object. It is normal for a man to identify himself with the woman he loves. The Eonist carries that identification too far, stimulated by a sensitive and feminine element in himself which is associated with a rather defective virile sexuality on what may be a neurotic basis.

Ellis found eonism to be "a remarkably common anomaly", and "next in frequency to homosexuality among sexual deviations", and categorized it as "among the transitional or intermediate forms of sexuality". As in the Freudian tradition, Ellis postulated that a "too close attachment to the mother" may encourage eonism, but also considered that it "probably invokes some defective endocrine balance"."

Virginia Prince: I am honestly surprised that current TRAs even want to claim this person, as she seems to be like....completely saying the opposite of everything that TRAs claim to believe about their "gender identity".

"Prince helped popularize the term 'transgender', and erroneously asserted that she coined transgenderist and transgenderism, words which she meant to be understood as describing people who live as full-time women, but have no intention of having genital surgery. (bolding mine) Prince also consistently argued that transvestism is very firmly related to gender, as opposed to sex or sexuality.Her use of the term "femmiphile" related to the belief that the term "transvestite" had been corrupted, intending to underline the distinction between heterosexual crossdressers, who act because of their love of the feminine, and the homosexuals or transsexuals who may cross-dress. Although Prince identified with the concept of androgyny (stating in her autobiographical 100th issue that she could "…do [her] own thing whichever it is…"), she preferred to identify as Gynandrous. This, she explained, is because although 'Charles' still resides within her, "…the feminine is more important than the masculine." Prince's idea of a "true transvestite" was clearly distinguished from both the homosexual and the transsexual, claiming that true transvestites are "exclusively heterosexual... The transvestite values his male organs, enjoys using them and does not desire them removed." (bolding mine)

By the early 1970s, Prince and her approaches to crossdressing and transvestism were starting to gain criticism from transvestites and transsexuals, as well as sections of the gay and women's movements of the time. Controversy and criticism has arisen based on Prince's support for conventional societal norms such as marriage and the traditional family model, as well as the portrayal of traditional gender stereotypes. Her attempts to exclude transsexuals, homosexuals or fetishists from her normalization efforts of the practice of transvestism have also drawn much criticism.

Lou Sullivan: was an American author and activist known for his work on behalf of trans men. He was perhaps the first transgender man to publicly identify as gay, and is largely responsible for the modern understanding of sexual orientation and gender identity as distinct, unrelated concepts.

Sullivan was a pioneer of the grassroots female-to-male (FTM) movement and was instrumental in helping individuals obtain peer-support, counselling, endocrinological services and reconstructive surgery outside of gender dysphoria clinics. (bolding mine) He founded FTM International, one of the first organizations specifically for FTM individuals, and his activism and community work was a significant contributor to the rapid growth of the FTM community during the late 1980s.

From what I've read I don't know, it kind of sounds like Lou might have agreed with me that counselling should be a first step before handing out hormones like M&Ms. But unfortunately I can't ask him since he had the misfortune to decide to live as a gay man at the height of the AIDS epidemic.

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Ok I spent some time researching all those folks you mentioned. None of them seem to say, or have the opinion, that counselling is useless for people with gender dysphoria. So my question remains......why is it not considered as an option? You are telling me that it "doesn't work", but not one piece of the "research" you told me to do bears that out, and there is actually quite a LOT of research showing the reverse, that many folks who identify as transgender, especially young children, will eventually desist if supported with counselling but not given a social or physical transition. So. My question is still hanging out there. Thanks for providing me some interesting reading, however!

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star-anise · 4 years

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An ask I got recently:

hi so i’m a transmed and i’m not sure if you’ll answer this because of that but i saw your post about transmedicalism and was wondering if you could expand on that? you seem like a genuinely kind and judgement-free person, thank you darling x

My response:

Heh, you call me “judgement-free” and ask for my opinion on a topic I’ve formed a lot of judgments about… I get it though, I’m not into attacking people for what they believe so much as providing FACTS. As a cis queer, my insight into transmedicalism isn’t really about the innate experience of trans-ness so much as using my education and professional experience to talk about social science research, diagnostic systems, and public health policy.

This ended up really long, so the tl;dr is, I think transmedicalism as I understand it:

Misunderstands why and how the DSM’s Gender Dysphoria diagnosis was written,

Treats the medical establishment with a level of trust and credibility it doesn’t deserve, at a time when LGBT+ people, especially trans people, need to be informed and vigilant critics of it, and

Approaches the problem of limited resources in an ass-backwards way that I think will end up hurting the trans community in the long run.

TW: Transphobia; homophobia; suicide; institutionalization; torture; electroshock therapy; child abuse; incidental mentions of pedophilia.

So first off I’m guessing you mean this post, about not trusting the medical establishment to tell you who you are? That’s what I’m trying to elaborate on here.

I have to admit, when you say “I’m a transmedicalist” that tells me very little about you, because on Tumblr the term seems to encompass a dizzying array of perspectives. Some transmedicalists believe in what seems to me the oldschool version of “The only TRUE trans people suffer agonizing dysphoria that can only be fixed with surgery and hormones, everyone else is an evil pretender stealing resources and can FUCK RIGHT OFF” and others are like, um… “I have total love and respect for nonbinary and nondysphoric trans people! I qualify for a DSM diagnosis of dysphoria but that doesn’t make me inherently better or more trans than anyone else.”

Which is very confusing to me because according to everything I’ve learned, the latter opinion is not transmedicalism. It’s just… a view of transness that acknowledges current diagnostic labels and scientific research. It’s what most people who support trans rights and do not identify as transmedicalists believe. But I kind of get the impression that Tumblr transmedicalism has expanded well past its original mandate, to the point that if a lot of “transmedicalists” saw the movement’s original positions they’d go “Whoa that’s way too strict and doesn’t help our community, I want nothing to do with it.”.

Okay so. Elaborating on the stuff I can comment on.

1. DSM what?

The American Psychiatric Association publishes a big thick book called The Diagnostic and Statistical Manual of Mental Disorders, called the DSM for short. This is the “Bible of psychiatry”, North America’s definitive listing of mental disorders and conditions. It receives significant revision and updates roughly every 10-15 years; it was last updated in 2013, meaning it will likely get updated sometime between 2023 and 2028.

The DSM lists hundreds of “codes”, each of which indicates a specific kind of mental disorder. For example, 296.23 is “Major depressive disorder, Single episode, Severe,” and 300.02 is “Generalized anxiety disorder.” These codes have information on how common the condition is, how it’s diagnosed, and what kind of treatment is appropriate for it.

Diagnostic codes are the key to health professionals getting paid. If there isn’t a code for it, we can’t get paid for it, and therefore we have very few resources to treat it with. The people who actually pay for healthcare–usually insurance companies or government agencies–decide how much they will pay for each code item to be treated. They’ll pay for, say, three sessions of group therapy for mild depression (296.21), or they’ll pay for more expensive private therapy if it’s moderate (296.22); they’ll pay for the cheap kind of drug if you have severe depression (296.23), but to get the more expensive drug, you need to have depression with psychotic features (296.24).

Healthcare companies, especially in the USA where the system is very very broken and the DSM is written, are cheap bastards. If they can find an excuse not to fund some treatment, they’ll use it. “We think this person who lost their job and can’t get off the couch should pay this $1000 bill for therapy,” they’ll say. “After all, they were diagnosed as code 296.21, and then saw a private therapist for five sessions, when we only allow three sessions of group therapy, and you’re saying they haven’t had enough treatment yet?”

A lot of the advocacy work mental health professionals do is trying to get the big funding bodies to pay us adequately for the work we do. (This is a much easier process in countries with single-payer healthcare, where this negotiation only needs to be done with a single entity. In the USA, it needs to be done with every single health insurance company in existence, as well as the government, sometimes differently in every single state, and then again on a case-by-case basis as well.) Healthcare providers have to argue that three sessions of group therapy isn’t enough, that Medicaid needs to pay therapists more per hour than it costs those therapists to rent a room to practice in, or else therapists would lose money by seeing Medicaid clients. DSM codes exist a tiny bit to let us communicate with each other about the people we treat, and a huge amount to let us get paid. The fact that their existence lets people make sense of their own experiences and find a community with people who share common experiences and interests with them is a very minor side benefit the DSM’s authors really don’t keep in mind when they update and revise different diagnoses.

So when it comes to convincing insurance companies to pay for treatment, humanitarian reasons like “they’ll be very unhappy without it” tend not to work. The best argument we have for them paying for psychological treatment is that it’s economical: that if they don’t pay for it now, they’ll have to pay even more later. If they refuse to pay, let’s say, $2000 to treat mild depression when someone loses their job, and either refuse treatment or stick the person with the bill, then that person’s life might spiral out of control–they might, let’s say, run low on money, get evicted from their apartment, develop severe depression, attempt suicide, and end up in hospital needing to be medically resuscitated and then put in an inpatient psych ward for a month. The insurance company then faces the prospect of having to pay, let’s say, $100,000 for all that treatment. At which point somebody clever goes, “Huh, so it would have been cheaper to just… pay the original $2000 instead so they could bounce back, get a new job, and not need any of this treatment later.”

Trans healthcare can be kind of expensive, since it often involves counselling, years of hormone therapy, medical garments, and multiple surgeries. Health insurance companies hate paying for anything, and have traditionally wanted not to cover any of this. “This is ridiculous!” they said. “These are elective cosmetic treatments, it’s not like they’re dying of cancer, these people can pay the same rate for breast enhancements or testosterone injections as anyone else.”

So when the APA Task Force on Gender Identity Disorder (a task force comprised, as far as I can tell, entirely of cis people) sat down to plan for the 2013 update of the DSM, one of their biggest goals was: Treatment recommendations. Create a diagnosis which they could effectively use to advocate that insurance companies fund gender transition. Like when you go back and read the documents from their meetings in 2008 and 2011, their big thing is “create a diagnosis that can be used to form treatment recommendations.” So that’s what they did; in 2013 they made the GD diagnosis, and in 2014 the Affordable Care Act required insurers to provide treatment for it.

A lot of trans people weren’t happy with the DSM task force’s decisions, such as the choice to keep “Transvestic Fetishism,” which is basically the autogynephilia theory, and just rename it “Transvestic Disorder”. The creation of the Gender Dysphoria diagnosis, basically, was designed to force the preventive care argument. They didn’t think they could win on trans healthcare being a necessity because healthcare is a human right, so they went with: Trans people have a very high suicide rate, and one way to bring it down is to help them transition. One of the major predictors of suicidality is dysphoria. The more dysphoric someone is, the more likely they are to attempt suicide (source). Therefore, health insurers should fund treatment for gender dysphoria because it was cheaper than paying for emergency room admissions and inpatient psychiatric hospitalizations.

I have spoken to trans scientists about what research exists, and my understanding is: The dysphoria/no dysphoria split is not actually validated in the science. That is, when you research trans people, there is not some huge gaping difference between the experiences, or brains, of people With Dysphoria, and people Without Dysphoria. Mostly, scientists haven’t even thought it was an important distinction to study. The diagnosis wasn’t reflecting a strong theme in the research about trans experiences; that research showed that trans people with all levels of dysphoria were helped with medical transition. The biggest difference is just that dysphoria is a stronger risk factor for suicide. Experiencing transphobia is another strong risk factor, but that’s harder to measure in a doctor’s office, so dysphoria it was.

(I’ve seen some transmedicalists claim that dysphoria’s major feature is incongruence, not distress. And I’ll just say, uh… in psychology, “dysphoria” is the opposite of of “euphoria”, literally means “excessive pain”, and is used in many disorders to describe a deep-seated sense of distress and wrongness. As a mental health professional, I just can’t imagine most of my colleagues agreeing that something can be called “dysphoria” if the person doesn’t feel real distress about it. If you want a diagnosis that doesn’t demand dysphoria, you’d need Gender Incongruence in the upcoming version of the ICD-11, which is the primary diagnostic system used in Europe, published by the World Health Organization.)

2. Doctors are not magic

Medicine is a science, and science is a system of knowledge based on having an idea, testing it against reality, and revising that knowledge in light of what you learned. We’re learning and growing all the time.

I don’t know if this sounds painfully obvious or totally groundbreaking, but: Basically all medical research is done by people who don’t have the condition they’re writing about. Psychology has a strong historical bias against believing the personal testimonies of people with conditions that have been deemed mental disorders, so researchers who have experienced the disorder they’re writing about have often had to hide that fact, like Kay Redfield Jamison hiding that she had bipolar disorder until she became a world-renowned expert on it, or Marsha Linehan hiding that she had borderline personality disorder until she pioneered the treatment that could effectively cure it. Often, having a condition was seen as proof you couldn’t actually have a truthful and objective experience of it.

So what I’m trying to say is: The “gender dysphoria” diagnosis was written and debated, so far as I can tell, by entirely cis committee members. The vast majority of psychological and psychiatric research about LGBT+ people is written by cisgender heterosexual scientists. Most clinical and scientific writing has been outsider scientists looking at people they have enormous power over and making decisions about their basic existence with very little accountability.

And to show you how far we’ve come, I want to show you part of the DSM as it was from 1952 to 1973. It shows you just why so many older LGBT+ people find it deeply ironic that now the DSM is being held up as definitive of trans experience:

302 Sexual Deviation This category is for individuals whose sexual interests are directed primarily toward objects other than people of the opposite sex, toward sexual acts not usually associated with coitus, or towards coitus performed under bizarre circumstances as in necrophilia, pedophilia, sexual sadism, and fetishism. Even though many find their practices distasteful, they remain unable to substitute normal sexual behavior for them. This diagnosis is not appropriate for individuals who perform deviant sexual acts because normal sexual objects are not available to them.

302.0 Homosexuality 302.1 Fetishism 302.2 Pedophilia 302.2 Transvestitism […]

Yes, really. That is how psychiatry viewed us. At a time when research from other fields, like psychology and sociology, were showing that this view was completely unsupported by evidence, psychiatry thought LGBT+ people were fundamentally disordered, criminal, and incapable of prosocial behaviour.

My favourite retelling of the decades of activism it took LGBT+ people and allies to get the DSM to change is from a friend who did her master’s thesis on the topic, because she leaves in the clown suits and gay bars, which really shows how scientific and dignified the process was. The long story short is: It took over 20 years of lobbying by LGBT+ people who were sick and tired of being locked up in mental institutions and subjected to treatments like electroshock training, as well as by LGBT+ social scientists, clinicians, and psychiatrists, to get homosexuality declassified as a mental illness. And that was homosexuality; the push to change how trans people were listed in the DSM is very recent, as seen in the latest version listing “Transvestic Disorder”, a description very few trans people ever use for themselves.

Here are a few more examples of how people with a condition have had to take an active part in the science about them:

When HIV/AIDS appeared in the USA, the government didn’t care why drug addicts and gay people were dying mysteriously. Hospitals refused to treat people with this mysterious new disease. AIDS patients had to fight to get any funding put into what AIDS is, how it spreads, or how it could be treated; they also had to campaign to change the massive public prejudice against them, so they could be treated, housed, and allowed to live. Here’s an article on the activist tactics they used. If you want an intro to the fight (or at least, white peoples’ experience of it), you could look into the movies How to Survive a Plague, And the Band Played On, and The Normal Heart.

Chronic Fatigue Syndrome (CFS) is a little-understood disease that causes debilitating exhaustion. It’s found twice as often in women as men. Doctors understand very little about what it is or why it happens, and patients with CFS are often written off a lazy hypochondriacs who just don’t want to try hard. There are basically no known treatments. In 2011, a British study said that an effective treatment for CFS was “graded exercise”, a program where people did slowly increasing levels of physical activity. This flew in the face of what people with CFS knew to be true: That their disease caused them to get much worse after they exercised. That for them, being forced to do ever-increasing exercise was basically tantamount to torture, so it was very concerning that health authorities and insurance companies began requiring that they undergo graded exercise treatment (and parents with children with CFS had to put their children through this treatment, or lose custody for “medical neglect”). So they investigated the study, found that it was seriously flawed, got many health authorities to reverse their position on graded exercise, and have made strides into pointing researchers to looking into biological causes of their illness.

Amyotrophic lateral sclerosis (ALS) is a rare but debilitating disease that isn’t researched much, because it affects such a small portion of the population. The ALS community realized that if they wanted better treatment, they would need to raise the money for research themselves. In 2014 they organized a viral “ice bucket challenge” to get people to donate to their cause, and raised $115 million, enough to make significant advances in understanding ALS and getting closer to a cure.

A common treatment for Autism is Applied Behaviour Analysis (ABA), which is designed to encourage “desired” behaviours and discourage “undesired” ones. The problem is, the treatment targets behaviour an Autistic person’s parents and teachers consider desirable or undesirable, without consideration that some “undesired” behaviours (like stimming) are fundamental and necessary to the wellbeing of Autistic people. Furthermore, the treatment involves punishing Autistic children for failure to behave as expected–in traditional ABA, by witholding rewards or praise until they stop, or in more extreme cases, by subjecting them to literal electric shocks to punish them. (In that last case, they’ve been ordered to stop using the shock devices by August 31, 2020. That only took YEARS.) Autistic people have had to campaign loud and long to say that different treatment strategies should be researched and used, especially on Autistic children.

So I mean… I get that the medical model can provide an element of validation and social acceptance. It can feel really good to have people in white coats back you up and say you’re the real deal. But if you get in touch with most LGBT+ and transgender groups, they’d say that there’s still a lot of work to be done when it comes to researching trans issues and getting scientific and governmental authorities to recognize your rights to social acceptance and medical treatment.

Within a few years, the definition you’re resting on will turn to sand beneath your feet. The Great DSM Machine will begin whirring into life pretty soon and considering what revisions it has to make. You’ll have an opportunity to make your voice heard and to push for real change. So… do you want to be part of that process of pushing trans rights forward, or do you just want to feel loss because they’re changing your strict definition of who’s valid and who’s not?

3. Scarcity is not a law of physics

One of the major arguments I see transmedicalists push is that there’s only a limited number of surgeries or hormone prescriptions available, so it’s not okay for a non-dysphoric person to “steal” the resources that another trans person might need more. This makes sense in a limited kind of way; it’s a good way to operate if, say, you’re sharing a pizza for lunch and deciding whether to give the last slice to someone who’s hungry and hasn’t eaten, or someone who’s already full.

When you start to back up and look at really big and complex systems–basically anything as big, or bigger, than a school board or a hospital or a municipal government–it’s not a helpful lens anymore. Because the most important thing about social institutions is that they can change. We can make them change. And the most important factor in how much the world changes is how many people demand that it change.

I’ve talked about this before when it comes to homeless shelters, and how the absolute worst thing they can have are empty beds. I used to work in women’s shelters, which came about when second-wave feminists started seriously looking at the problem of domestic violence in the 1960s and 70s, It was an issue male-dominated governments and healthcare systems hadn’t taken seriously before, but feminists started heck and did research and staged demonstrations and basically demanded that organizations that worked for the “public benefit” reduce the number of women being killed by their husbands. Their research showed that the leading cause of death in those cases were when women tried to leave and their partners tried to kill them, so the most obvious solution was to give them someplace safe to go where their partners couldn’t find them. Therefore the solution became: Women’s shelters. When feminists committed to founding and running these shelters, local governments could be talked into giving them money to keep them running.

(Men’s rights activists, the misogynist kind, like to whine about “why aren’t there men’s shelters?” and the very simple answer is: Because you didn’t fight for them, you teatowels. Whether a movement gets resources and funding is hugely a reflection of how many people have said, “This needs resources and funding! Look, I’m writing a cheque! Everyone, throw money at this!” In other news, The BC Society for Male Survivors of Sexual Abuse does great work. People should throw money at them.)

When the system in power knows there are resources it wants and doesn’t have, it finds a way to make them appear. For example, in Canada, the government knows that it doesn’t have enough trained professionals living in its far North, where the population is scarce and not very many people want to live. Doctors and teachers would prefer to live in the southern cities. But because it’s committed to Northern schools and hospitals, they create incentives. For example, the government offers to pay off the student loans of teachers or health professionals who agree to work for a few years in Northern communities.

Part of why trans healthcare resources are so scarce is that for a long time, trans people were considered too small a part of the population to care about. Like, “Trans people exist, but we won’t have to deal with them.” Older estimates said 0.4% of the population was trans, which meant a city of 100,000 people would have 400 trans people. A single family doctor can have 2000 or 3000 clients, so the city could have maybe 1 or 2 doctors who really “got” trans issues, and all the trans people would tell each other to only go see those doctors because all the rest were assholes. And the cracks in the system didn’t really seem serious. A couple hundred dissatisfied people not getting the healthcare they needed? Meh! Hospital administrators had more to worry about!

But the trans population is growing. A recent poll of Generation Z said 2.6% of middle schoolers in Minnesota were some kind of trans. which is 2,600 per 100,000. That’s enough to make hospitals think that maybe the next endocrinologist or OB/GYN they hire should have some training in treating trans people. That’s enough to make a health authority think that maybe the state should open up a new gender confirmation surgery clinic, since demand is rising so much.

Or well, I mean. Hospitals have a lot on their minds. This might not occur to them as their top priority. They’d probably think of it a lot sooner if a bunch of those trans people sent them letters or took out a billboard or showed up by the dozens at a public meeting to say, “Hello, there are a fuckload of us. Budget accordingly. We want to see your projected numbers for the next five years.”

When you’re doing that kind of work, suddenly it hurts your cause to limit your number of concerned parties. Sure, limited focus groups or steering committees can have limited membership, but when you put their ideas into action, to protest something or lobby for political change, you need numbers. If you want to show that you’re a big and important group that systems should definitely pay attention to, you don’t just need every trans or GNC or NB person who’s got free time to devote to your campaign, you also need every cis ally who can pad out numbers or lick envelopes or hand out water bottles or slip you insider information about the agenda at the next board meeting. You need bodies, time, and money, and you get them best by being inclusive about who’s in your party. Heck, if it would benefit your cause to team up with the local breast cancer group because trans women and cis women who have had mastectomies both have an interest in asking a hospital to have a doctor on staff who knows how to put a set of tits together, then there are strong reasons to do it.

Basically: All the time any marginalized group spends fighting over scraps is generally time we could spend demanding that the people handing out the food give us another plate. If you don’t think you’re getting enough, the best answer isn’t to knock it out of somebody’s hands, but to get together to say, “HEY! WE’RE NOT GETTING ENOUGH!”

That kind of work is complicated and difficult! It’s definitely much harder than yelling at someone on Tumblr for not being trans enough. But if you do any level of getting involved with activist groups that fight for real systemic change, whether that’s following your local Pride Centre on Twitter or throwing $5 at a trans advocacy group or writing your elected representative about the need for more trans health resources, you’re pushing forward lasting change that will help everyone.

#staranise original #transmedicalism tw #transphobia tw #homophobia tw #my problems with sj let me show you them

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