Why Depathologization Matters to the Trans Community

While being trans in whatever form that takes is burden enough, it is made many times worse by the fact that those who desperately need help must first prostrate themselves before the gods of medicine before receiving treatment.
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At last! Depathologization day is here again - well, tomorrow, actually - and for once the world is looking in, listening, starting to take note.

Not before time!

Because while being trans in whatever form that takes is burden enough, it is made many times worse by the fact that those who desperately need help must first prostrate themselves before the gods of medicine before receiving treatment.

Not every condition is illness

"Ah, but", I hear you say. Surely "treatment" implies illness. And if its illness, then of course you need medical people to tell you what to do: to set boundaries; to make the diagnosis. I mean, heaven forfend if there wasn't a textbook somewhere to tell us all what's what. As there is in this instance: two in fact. There's the Diagnostic Standards Manual (DSM), closely guarded by the American Psychiatric Association, and the World Health Organisation guidelines, which owe not a little to the DSM.

To which there is a simple answer. Think pregnancy. Think disability. Most women don't need a GP to tell them they're pregnant. They're pretty good at working that out for themselves, either with or without a little over-the-counter assistance from Boots. Pregnant women aren't ill. They may sometimes need medical help to deal with complications.

Or disability, of which there are many and varied conditions. People have disabilities. Sometimes - not always - they need help from the rest of us to manage those disabilities. Complications, again, may require some medical support. But note, please, the language. This is about giving people the tools to enable them to play a full part in society. It's about providing a crutch - sometimes literal - on which to lean. It's not about illness. Or "disorder". Acknowledging that, giving respect, giving voice is perhaps the first and most important aspect of "treating disability".

Yet this is a mountain that trans folk have still to climb. Being trans is a condition, no more an illness than being gay (also, until recently, classified as mental disorder).

Pathologisation means prizes

It's about being born into the wrong body, which for some is a matter of mild inconvenience, for others, an issue of permanent debilitating impossibility. That's a good start point, actually. Because being trans is NOT one thing, one set of circumstances with one all-encompassing treatment. It's about an issue that different individuals need to deal with differently, as opposed to having a one-size-fits-all diagnosis and treatment imposed from above.

For this is at the heart of the pathologisation process. Being charitable, I'd call it misunderstanding. Less charitably, I'd argue its about self-interest and career preservation by a small clique of middle-aged, middle-class, mostly white, mostly male specialists with an enormous self-interest in retaining their position as experts in some trans "illness" .

Their evidence? Well, they've written a lot of papers about what trans is and what the proper treatment of it is - often without a smidgeon of real engagement with those they treat. Trans is "suppressed homosexuality", despite the fact that trans men and women exhibit a wide range of sexual orientations and none. Or, ignoring the existence of trans men, it's about something called "autogynephilia" - an obsession with the female form.

Of course, such evidence is all rigorously checked on the peer review roundabout. One "expert" writes a paper which is favourably reviewed by other "experts", who then cite the original paper in further papers they write. It's a vicious circle of self-satisfaction and utter unscientificness. But these guys wear the suits, so they MUST be right!

Just as they were right about female masturbation, also, for some while, diagnosed as disorder: and homosexuality, which they only decided might not be disorder back in the 1980's. Though that decision has not stopped some of the same specialists who now write enthusiastically about "curing" trans-ness from continuing to advocate reparative therapy, aka the "gay cure".

Abuse naturally follows

But if this means that trans folk eventually get treated, what's the issue?

How long have you got? By categorising trans-ness as a mental illness, it opens the door to further abuse and indignity - from the street yob who makes some oh-so-witty crack about a trans woman being mad, to the GP whose permission is needed before any treatment is possible. Because if its illness, there are boxes to be ticked, hurdles to be jumped and receiving any sort of support if you are trans in the UK is a postcode lottery.

With the right GP, at least starting the process is a doddle. Wrong GP, and you could find yourself out in the cold for years. That matters. You know it so matters when you've had the awful experience of talking to trans individuals on the brink of suicide because they cannot get anyone to take them seriously or even consider them for treatment.

Pathologisation, medicalisation: that means, even when you're acknowledged as suitable candidate for treatment, you must endure all the indignities heaped upon you by pompous professionals. My one and only experience of this, before I waved goodbye to the NHS gender service was an uncouth consultant who, taking issue with my name, eventually conceded that "for the purposes of this interview we shall refer to you as Jane". I wish I'd smacked him then and there: but when one is totally dependent on the goodwill of others for treatment, what is one supposed to do?

Women, of course, know that there are many, many ways of "being a woman" - and neither dress nor hairstyle defines one's femaleness. Not so if you are trans. For then you must demonstrate to these male professionals that you fit THEIR ideal of feminity before treatment will follow. Stepford, anyone?

I hesitate to suggest that this imposition, this control-freakery by "gender experts" is responsible for other forms of abuse. There are hints that such may have taken place in the UK in the '80'sand '90's. Definite instances of gender specialists abusing their position in the US. But could anything of Savilian proportions ever take place now? I'd like to think not - though the very fact that vulnerable individuals are placed in a position where their welfare is wholly dependent on their ability to appease those in a position of power over them is not ideal.

But what about these operations and the like, which are dreadfully expensive and significant in terms of consequence? No-one is asking for all medical opinion to be excluded from the mix. Merely for it to be toned down. Where a major procedure is proposed, it is right, as with pregnancy, as with disability, to investigate: to ensure that the individual requesting it understands the issues and the consequences.

It is utterly wrong to treat the individual as merely a patient, a bystander in their own life - and in this respect, while the campaign for depathologisation is global in scope it is good to see that in at least one country far closer to home, the first faint stirrings of a new and respectful trans service are taking shape. Because if you'd like to see the direction of travel that those in the trans community would very much appreciate, you need look no further than Scotland.

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