pathologisation

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New article: Transnormativity in the psy disciplines

Today sees the publication of the first full article from the Trans Pregnancy project team, in the journal American Psychologist:

Transnormativity in the psy disciplines: Constructing pathology in the Diagnostic and Statistical Manual of Mental Disorders and Standards of Care

[click here to read in American Psychologist]

[click here to read free open access version]

In this article we provide a brief history of how certain narratives and expectations around how trans people should behave and be treated have been constructed through the disciplines of psychology, psychiatry, psychotherapy, and psychoanalysis, especially in a US context.

It is part of a great new special issue on Histories of psychology after Stonewall, edited by Peter Hegarty and Alexandra Rutherford.

We examine how the interests of cisgender clinicians and transgender patients have variously been opposed and entwined, and contextualise this in relation to wider structures of racism, sexism, colonialism, and binary thinking around sex and gender. We focus especially on how guidance for diagnosing trans people and managing trans healthcare has been contested across various versions of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (the DSM) and the International Harry Benjamin Gender Dysphoria Association (HBIGDA, later WPATH) Standards of Care.

This article does not focus specifically on questions of fertility, pregnancy and childbirth (although we briefly touch very on this topic). Rather, it provides important historical background on the evolution of certain medical services which have help to shape how trans people are treated and percieved. We are also currently writing a number of articles that will report on specific research findings from the Trans Pregnancy project, and I am really looking forward to sharing them also when they are published!

 

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Forthcoming talk: Hysterical Bodies

event posterWednesday 28 February
7pm – 9pm
Birmingham LGBT Centre
Free entry and food provided.

Bread and Roses for All, and Hormones Too!
A panel discussion with Aquila Edwards and Luke Dukinfield, facilitated by Robin Lynch and hosted by Birmingham Women’s Strike Assembly.

I will be giving a short talk about intersections between trans health and women’s health, focusing on how our bodies have historically been pathologised and disciplined in medical settings.

There will then be a facilitated discussion. I’m honoured to be sharing the panel with some fantastic speakers so it’s sure to be a really interesting event.

Register to attend for free on Eventbrite.

Facebook event page.

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WPATH 2016: the activist fringe

I’m currently in Amsterdam for the World Professional Association for Transgender Health (WPATH) biennial symposium. It’ll be the largest such conference that has ever been run, with 800 participants from across the globe. This will hopefully be the first of several posts exploring my experences at the conference (no promises, though!) – and I’m also planning to occasionally livetweet.

WPATH is an international body best known for publishing the Standards of Care, which offer guidance for practitioners supporting patients seeking to transition. The organisation has undergone a great deal of change over the years, reflecting wider shifts in understanding around trans people and our experiences. At present, the organisation’s wide scope incorporates a considerable range of views on how transition should and could be managed.

I’m here partly to present a poster detailing some of my research findings around patient experiences of waiting in the UK. However, as a sociologist with an interest in the evolution and negotiation of discourse and activism around trans health, I’ve been interested to see that at least two fringe conferences have been organised in Amsterdam to coincide with WPATH. I also thought it would be beneficial to share what’s going on with a wider audience – so, here goes!


GATE pre-conference

Global Action for Trans* Equality (GATE) is a loosely-organised international trans rights organisation: a genuinely diverse multinational network of activists with strong representation from the Global South. One of their key priorities has been to campaign for the depathologisation of trans, although members have also been involved in activism around other issues, such as access to care.

Over the past two days GATE held their own conference in Amsterdam to discuss trans health. The event both stood alone as an independent conference, and provided activists with an opportunity to discuss WPATH. I wasn’t able to attend in person, but have heard that a broad consensus was reached on a couple of issues related to the classification of trans in the World Health Organisation’s International Classification of Diseases (ICD).

The current version of the document – ICD-10, published back in 1992 – classifies ‘Gender Identity Disorder’ and ‘Gender Identity Disorder of Childhood’ as mental health issues. These diagnoses are widely used in gender clinics in countries such as the UK (note: these differ from the diagnosis of ‘Gender Dysphoria’ present in the American Psychiatric Association’s DSM). Recent statements from the World Health Organisation indicate that the long-awaited ICD-11 will replace diagnoses of ‘Gender Identity Disorder’ with ‘Gender Incongruence’, and move these to the sexual health section of the document.

Whilst GATE’s long-term goal is depathologisation, at present they have decided to focus upon pushing for this move from classifying trans diagnoses as mental health issues to regarding them as sexual health issues, as a compromise that should ensure continued funding for transition from insurance companies and public health organisations. In addition, they are arguing against the existence of the category ‘Gender Identity Disorder of Childhood’, on the grounds that this is an unnecessary medicalisation of gender diversity in young children, whilst the ‘adult’ category is sufficient to guide medical interventions for adolescents. This perspective feeds into a wider discussion around the category that is also recognised in the WPATH programme, with time set aside for a formal debate.

GATE activists will be attending WPATH to argue these points, and also to advocate more widely for trans-affirming approaches to treatment.


FREE PATHH

FREE PATHH is an event that will take place this Saturday (18th), concurrently with the first day of the WPATH symposium proper (a handful of formal pre-conferences are taking place on Friday). Hosted by Dutch trans activists, it is a free event that anyone can attend. FREE PATHH organisers argue that the high fees for the WPATH event mean that ordinary Dutch trans people are unable to attend this event held in their own country to learn more about their own health. As such, there is little interaction between WPATH and local Dutch trans communities.

The few transgender people who can afford to be present at this important symposium, are exceptions. They can go, because they have to be present for work or because they have enough personal financial means. (FREE PATHH)

As one of those few trans people who can attend the WPATH symposium (in my case, because I was lucky enough to gain a grant in order to do so), I feel this is a really important point. WPATH undoubtedly exists to share information amongst professionals in a formal setting; at the same time, the issues at hand require input from the very people who are directly impacted. With trans people disproportionately likely to be on low incomes, even early career professionals might find themselves effectively frozen out.

The FREE PATHH programme includes talks and workshops in Dutch and English on a range of issues related to trans health, and will be filmed for later disseminaton. At the end of the day, a panel with individuals who have attended both WPATH and FREE PATHH will summarise both events. This should be a valuable opportunity to share insights from both international and Dutch work on trans health, from professional and community perspectives.

You can read the FREE PATHH programme here.

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Lyndsey Moon at TRED 2011

Lyndsey’s talk at TRED 2011, which formed the introduction to an open discussion of numerous topics including psychology, pathologisation, and the place of gender variant voices in academia.

In the talk Lyndsey explores a number of issues centring around counselling and therapy, including:

  • the (lack of) training practitioners receive on gender issues.
  • the attitudes that many trainee and practising counsellors and therapists hold regarding trans people
  • experiences of teaching PhD candidates about gender and sexuality
  • the impact of the American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM)
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Mission Statement

In the light of certain accusations that have been levelled at trans activists in the wake of the Royal College of Psychiatrists’ upcoming conference (“Transgender: Time To Change“), I feel it’s important to clarify my position on trans activism. This post relates directly to the aforementioned conference, but also more generally to the kind of activism I promote on this blog.

I believe that trans activism is for everyone. Trans activism is about promoting gender liberation for all. I feel that Leslie Feinberg sums this up particularly well in hir introduction to “Trans Liberation: beyond pink or blue”:

The sight of pink-blue gender-coded infant outfits may grate on your nerves. Or you may be a woman or a man who feels at home in these categories. Trans liberation defends you both.

Each person should have the right to choose between pink or blue tinted gender categories, as well as the other hues of the palette. At this moment in time, that right is denied to us. But together, we could make it a reality.

Trans activism therefore incorporates and complements transsexual activism, but is noteably distinct. The goals of trans activism also complement those of feminism: we fight not for gender equality, but for gender liberation.

We fight to free individuals from the constraints of necessary gender categories and gender roles with the proviso that an individual be free to define their own gendered experience. If someone wants to wear dresses, or trousers, or make-up, or grow a moustache, or armpit hair, then cool. Be free, and liberated. Express yourself.

As a trans activist, I believe that individuals have a right to transition. A transition may be social or physical. It may involve new clothes, hormones, surgery…one of these things, or none of these things. It has to be contextual and right for the individual, and move at a speed that is right for them. Transsexed people often have deep-seated reasons for feeling extremely uncomfortable with their sex characteristics, and a transition can alleviate this. A a trans woman, I have benefitted a great deal from my transition. I am fortunate enough to live a more fulfilling life.

I do not feel that my experiences in any way put me at odds with feminism. I oppose outdates stereotypes of the woman as passive and ornamental. I support my sisters’ fight for equal rights and gender liberation: for equal pay, for body sovereignty, and against sexist, patriarchial institutions. I do not dress in a particularly feminine fashion: this is what works for me. I know some trans women who are very butch, and others who are high femme. As a trans activist, I believe in their right to express themselves.

However, I feel it is important for trans activism to also recognise the right not to transition. Transition is not right for all gender variant people. The important thing is that we are all free to express ourselves, regardless. No-one deserves to be pushed onto a particular gender path by overzealous medical institutions, feminists or trans communities with a point to prove.

I oppose the ethos of “Transgender: Time To Change” because I feel that the attitude of individuals such as Az Hakeem and Julie Bindel fly in the face of trans liberation. Transition should be available to all who need it, when they need it, be this in the form of medical intervention or appropriate counselling (not pathologising “talking therapies”: the same kind of interventions that have enabled the “ex-gay” movement). It is also disappointing when such organisations fail to listen to those expressing disappointment at their actions.

I also feel that gender variant individuals – particularly children – should be free to celebrate and explore their gender variance without being treated as mentally ill “fantasists” (Hakeem’s word). Currently, gender variant individuals are either told that to buckle up and be a Real Girl or Real Boy, or otherwise pushed towards transition. This is not real choice, nor is it gender liberation.

In a gender liberated world, we would all get to decide what it means for us to be female, male, androgyne, genderqueer, polygender, genderfluid etc, without the patriarchy telling us how to control and moderate our gendered behaviour. In a gender liberated world, there would be free access to transition, but no-one would be forced into transition as the only medically sanctioned option for gender dissent.

This, to me, is what trans activism is about. The Royal College of Psychiatrists and the few radical feminists who (bewilderingly) support them are denying gender liberation and upholding outdated oppositional binaries without understanding the freedom, fluidity and thoughtfulness of the contemporary queer movement. Trans activism stands in opposition to this, and dares to imagine a world of gender freedom.