Monday, January 10, 2011

"The Standards of Care" debate

Let's talk about Dr. Harry Benjamin a bit. When he developed the set of criteria known as the Harry Benjamin Standards of Care, (HBSOC) it was a different time. At that time homosexuality was considered a mental aberration, and gay men often tried to get SRS to get "cured" of their affliction. Of course this didn't work, and so some standards were required to determine if someone was looking for SRS for the right reasons. The standards have changed only slightly since then, and of course there are people calling for far more substantive change or even their elimination. This is complicated by the fact that it is a lot cheaper to go to another country to get the same surgery and without these hoops created by the HBSOC.

And here we get the camps again. There are a lot of "TSDIY" groups out there who call for the elimination of psychological exams and other steps before SRS. And there are the folks, mostly surgeons, therapists, and those who have already undergone the procedure, who feel that any change, much less elimination, will provide access to massive hoards of folks who are unfit to so much as don a pair of pantyhose, much less undergo SRS.

The HBSOC, often referred to as The Standards of Care, have advantages and disadvantages. For one thing, they slow the process down a lot. This is both a good thing and a bad thing. It's good because it keeps people from doing something on a whim they can't reverse, and in our litigious society chances are good that they won't take full responsibility for their actions, choosing to sue the surgeon instead. But often GID is an acute problem, at least subjectively, and there is no good reason to extend someone's suffering if they can be cured more quickly. Of course since GID carries other disorders as passengers, it is important to deal with these first to clear the patient's mind enough so they can determine what level of change they require, but any longer than that borders on harm instead of help. It's sticky, to be sure.

The big problem is that this costs money. Just with the prices in the United States for surgery, along with the side treatments of electrolysis or laser hair removal, and subsidiary surgeries that are all too common like Facial Feminization Surgery, (FFS) nose jobs, adam's apple shaves, and breast augmentation, the price is already sky high. Add in a drug or drugs not covered by any health plan, (Transsexual and Transgender drugs aren't covered on any plan I know of) and then tack on a whole new wardrobe, (Often in odd sizes) and it gets even more expensive. This explains a lot why many folks seeking SRS wind up as (often illegal) sex workers. But to add years of therapy on to it just pushes the costs higher.

So, what do I think is the answer? With the possibility that GID is about to go completely away in the DSM-V the surgeons performing this surgery will have to set their own standards. I suspect most will still require the Standards of Care as a guideline, though there is already some defection from the ranks. (One surgeon will accept a longer Real Life Experience as a replacement for the two letters from a therapist) I'd prefer one letter that basically stated that the person is healthy enough psychologically to undergo the surgery. (I'd like to see this for all elective surgeries, in fact, because people mess themselves up a lot with these surgeries) And I think the surgeon requiring some crossliving time to be a good thing.

If I had my way there'd be a measured plan for someone to work toward their goals, first starting with something like a Tri-Ess chapter or other crossdressing club, and moving toward shopping experiences, then more intense experiences, so that they can work their way into their comfort level. Then I'd suggest about a year of crossliving using a DBA or other identification that isn't permanent, (getting something to allow this passed would be a good thing) so they can find their level. Then if they're still not happy it's time to talk to a surgeon and do the final psychological workup, most likely including an MMPI for empirical results.

I'd also like to see some buy in from society and our identification resources. If I had my preference the gender marker would go away on birth certificates, school records, drivers licenses, and just about every other piece of identification, as it opens the doors to too much discrimination and serves no real good purpose. Such designations stand in the way of gender equality and a discrimination free society.

I continue to believe very strongly that dealing with the other problems will alleviate much of the pain a GID sufferer experiences, and that these should be dealt with before facing the gender issue because they influence and confound it. A person who got SRS and has Borderline Personality Disorder, for example, isn't going to be happier after the surgery, Because the BPD is still there and is a very serious problem.

This is just my view. I'm open to hearing other viewpoints, so if you have them email me and we'll talk.

Saturday, January 8, 2011

Auld Lang Sine

You know? I have yet to make the Obligatory New Year's Post. Let me get all upons.

What are my Hopes? What are my Goals? Of what do I wish to rid myself? Or, what do I wish to assimilate into my daily life?

Hopes (in no particular order)
I decided that "Hopes" are too non-committal. One can hope all day long - but hope, to me, implies inaction. It belies a "bystander" mentality. So... I choose not to hope here; instead I created a few short lists of Action Plans.

Goals (in no particular order)
1) Start taking classes at the PLACE, geared towards small businesses
2) Plant (and help to flourish) a massive garden
3) Get handfasted to Nyyki
4) Make a solid Business Plan and Implement it
5) Increase physical activity, Reduce portion size
6) Take yoga classes for at least 6 months
7) Start Yoga Teacher Certification by year's end.

That of Which I Want to be Rid (in no particular order)
1) Self Loathing
2) the Persistent Anger that dogs me
3) chronic Inconsistency
4) "Destination" thinking
5) All or Nothing behavior
6) clutter
7) mistrust of Good Things

Things I Wish to Learn (and Apply) (in no particular order)
1) Yoga and Spirituality
2) Persistence
3) Inner Calm, even in the face of great strife or frustration
4) that Words have Power
5) Effortless Effort, and Removing the Weight of the World from My Shoulders
6) to Read Voraciously once more
7) organization skills

Friday, January 7, 2011

the spectrum of Gender Identity

Hi, folks, Norma here. I'm so glad Kayleigh repurposed this blog, because this is a topic I'm thinking about a lot thanks to my gender dysphoria.

This is a time were things are in flux in the Trans community. I say Trans community because I lump both the Transsexual community and Transgender community into one Meta-community. I know a lot of transsexuals don't like this, and I'll address this at a later point. But since a lot of the issues overlap, it is useful to deal with them once instead of repeating myself repeating myself over and over again. And yes, I even include the Transvestites in this category, though I don't limit it only to men in lingerie. More on why below.

The team working on the Diagnostics and Standards Manual number five have talked some about the diagnosis of GID, or Gender Identity Disorder, and there is some traction toward removing it from the sexual disorders category. This makes sense because if you accept the standard model that sexual preference, biological gender, and Gender Identity are three separate things that may or may not interrelate then focusing on it as a sexual dysfunction makes it a case of the old Sesame Street song, "Which One of These is Not Like the Other." Of course Blanchard has a differing opinion on this, but since his is mired in GID as a sexual dysfunction and flies in the face of the other model it's easy to discount it as poor theory. However, there's a possible direction this may go that has people very concerned, because instead of classing it as a form of Body Dismorphic disorder, there is talk of removing it from the manual completely.

The most common reason for this is that they feel there is no reason to pathologize what is normal behavior, and that if it isn't treated as aberrant there is a possibility that society might stop viewing it as aberrant.

The term "Transphobia" has been thrown about from time to time, and the usual definition is that it is society's fear of someone exhibiting non-standard gender roles and the same behavior by individuals. This is, of course, an inaccurate term, as phobias always impact the life of the person with them in some negative manner -- someone scared of snakes isn't phobic, they're just afraid, while someone who is so scared of snakes that they can't see an electrical cord on the ground or a picture of a snake without freaking out is phobic. Since no one is running away from transvestites or other Trans folk, it's not a phobia.

If they pull the diagnosis, there's no clear idea of where SRS (Sexual Reassignment Surgery) will end up. Some fear it will go away, while others fear it will become a "surgery on demand" model. These options scare some people and delight others. The folks for the termination of the surgery cite the number of people who get surgery without really knowing what they're doing. (This is a clear failure of the process, of course, which was developed specifically to provide time to learn what it meant to do this) On the other hand, the folks looking for Surgery on Demand cite that you don't have to go through therapy, a year long experience of wearing a padded bra, and get two letters signed off to get a breast augmentation, so this policy discriminates against transsexuals by raising the expense of the surgery exponentially. I would contend that some slow down for an augment might be a good idea, because any surgery of this type probably needs some reflection, but I'm also sure that any suggestion of this will get the Feminists all over me like political candidates on a three dollar prostitute. I also don't think this change will eliminate SRS, though other methods might be required to determine if a Doctor will perform surgery or not.

So, how do I see it? I see Gender Identity Disorder as a spectrum, starting with transvestites and other crossdressers and ranging all the way to transsexuals. And I feel that someone should find the level they're comfortable with in a rational and slow process. Start out crossdressing, then if you feel it's not enough, look at some of the further options like aramization or hormones, progressing to reversible surgeries, and finally if that isn't enough go to SRS.

I'm not getting SRS. That's because Kayleigh enjoys that little piece of anatomy too much, and it's not all about me -- I'm not a narcissist. I was headed for SRS before we got involved but I now choose not to out of love for her. Fortunately my aramization didn't go far enough that I lost potency, either, because we would like to have a child together. But of course as soon as we do manage to conceive I'll start the process up again. How do I feel about the proposed changes to the DSM and the whole debate? If they're right and de-pathologizing GID makes it more socially acceptable, that's great. I'd love to live in a world where one's own gender expression was their personal choice. But I feel it's a long hard road coming. I doubt SRS will disappear, and I don't see Surgery on Demand becoming the norm either. Even in the most permissive situations the foreign clinics require a talk with their therapist to determine how the person will handle what they're asking for. I also think that seeing a therapist is a good idea even if it's not required for SRS. Living as an outcast in our society, especially one that many people would consider a freak, causes psychological problems. Depression, Obsessive/Compulsive disorder, narcissistic Personality Disorder, Borderline Personality Disorder, and of course Body Dysmorphic Disorder are common passengers with GID. I strongly feel that dealing with these problems first will provide much greater success for the Trans person when they find their comfort level.

At this point some of the Transsexuals are reading and saying, "Another damned Transgenderist who doesn't know what HE is talking about." (There is a disturbing tendency among the transsexual crowd to claim that anyone who doesn't agree with their personal view is a man who is either pushing an agenda or is grossly misinformed and clueless, and calling someone a man and using male pronouns in this crowd is often the worst insult they can lob, hence the male pronoun there -- I don't identify that way, but I understand the dysfunction behind it well enough to shrug their attempt at an insult off as proof that they're not open minded) You're entitled to your opinion, and I honestly don't have a feeling about it -- my identity isn't up to a group vote. But I'm sure if you're in the community you know a "fasttracker" who went from a male shaped person to a female shaped person in a year and a half, and who acts like, as the old moniker goes, "A man with breasts."

Slowing down is good. Very Good. And I'd also like to point out that I'm no novice to the fields of psychology and neuroscience, so perhaps an open mind is in order, as I very well might know something you don't.

I think this is enough for now. I have a lot more to say about a lot of things -- family, parenting, gender identity, and even mythological creatures. If you want to discuss any of this calmly and rationally, feel free to email or IM me.

Who is Norma?

Well, first off, that's not my real name, of course. Posting one's real name on a blog is risky, especially for T-folks.

I've made more than forty but less than fifty passes around the sun. I have a degree in music from one of the schools in the University of Texas system. I also hold a Wiccan initiation, the equivalent of the third degree, though I don't practice Wicca per se anymore, and also have founded a northern Heathen Kindred.

My spiritual beliefs fall somewhere between a three poled arrangement between Neo-paganism, Norse Traditionalism, and New Age Metaphysics. I'm not bound to one philosophy, instead looking for answers from as many sources as possible. Taoism also plays a strong part in my faith.

I compose songs and musical works. I also write fiction and non-fiction. My fiction tends to science fiction oriented works, with some limited fantasy stuff. I also write some erotic fiction, some of which will appear soon on a few sites on the web. I am published, though of course I won't reveal when and where to preserve anonymity.

I have a strong interest in psychology. In fact I was looking at a career in it until recently. I'm working on establishing a recording studio that produces audio books soon.

Notice a strong lack of "I am" statements above? That's because I don't like them -- my identity is more than a label. The only thing I am is me.

Oh, one more thing -- I lost my vision in the summer of 2003. That's not a figurative statement -- I've been declared legally blind, and it's total, not partial blindness. And though I need a little assistance, I do alright. I have good orientation and mobility skills, a good sturdy cane, and a very good guide dog.

That's enough for now. Expect more thoughts from me here, and less sharing of my feelings. (I have other outlets for those) And of course, feel free to email me if you have questions or want to chat.