sex transitions

Article here about individual whose ‘gender identity disorder’ specialist referred her – and a number of other patients – for surgery after inadequate consultations. Legal proceedings are apparently underway.

It reminded me of a paper presented recently by Christine Overall at a recent SWIP-UK conference. The abstract is here. These kinds of cases might be understood as supporting her proposal about how to understand transsexualism – not involving a ‘masquerade’ metaphor (taking of the mask of previous sex/ putting on a mask of assumed sex)- but rather like other important transitions; voluntarily engaged in, a significant project for the individual.

Cases where individuals regret sex changes undergone after misinformation – or insufficient information – seem to fit nicely in her model, which can presumably account for these cases in terms of taking on a (significant, life-changing) project without knowing enough about what you’re getting into. It’s harder to see what the ‘masquerade’ views would have to say – that individuals were confused about whether they were ‘wearing a mask’, say, which seems implausible.

5 thoughts on “sex transitions

  1. V. interesting. Most of the discussions I’ve seen previously of the process for sex change operations focus on the *difficulty* of the procedure, and on how humiliating it is to have to convince a doctor that you really need the operation.

  2. The problem with “gender identity disorder” specialists like this psychiatrist is that trans people generally don’t want anybody who would actually evaluate their mental state rigorously. They know what they want for the most part, and prefer “specialists” that would issue a letter of approval as quickly as possible. As a result, less rigorous “specialists” become popular within the trans community and drive out competitors who are more thorough. I’ve come across more than a few GID “specialists” who seem unprofessional and incompetent, because professionalism and competency are not what trans people look for in a GID counselor/psychiatrist. The only attributes required to succeed as a GID “specialist” are the ownership of medical (or sometimes psychotherapist) license and the ability to sign on a form letter (being disinterested in patient’s well-being is actually a plus).

    I believe that the current standards of care that requires doctors to act as “gatekeepers” to ensure that the patient is a true transsexual is fundamentally flawed, as it perverts the clinical relationship between the physician and the client. In fact, I would argue that it is in violation of basic therapeutic ethics because the role of the “gatekeeper” conflicts with the primary responsibilities of a physician or a therapist. When anything they say in a counseling session could be used to block a procedure they want badly, trans people have no incentive to speak honestly about any anxieties or confusions they might be feeling, for example.

  3. The article makes plain that C’s manager/lover was the source of most of the pressure toward gender reassignment surgery, but makes no mention of a lawsuit against that party. To bad, as that individual’s selfishness and denial is clearly central to this particular story.

    This, of course, does not exonerate the doctor. Certainly, Doctor Reid provided nothing like the kind of rigorous screening one would hope such a radical procedure requires. As a previous poster comented, many seeking such surgery gravitate toward doctors who provide a path of least resistance. This is a natural force (like water running downhill) inherant to the situation that should be checked by appropriate processes, waiting periods, and second opinions.

    Does anyone see a parallel (note, I am *not* equating the two) to the situation a woman faces when deciding to have or not have an abortion? How can a person in such a situation be assured of getting good physical and mental health medical advice?

    The problem of medical advice is the same, and I believe the choice rests with the patient in both cases. However, one key difference is that one condition is viewed as an illness and one is not, so I do concede that these are not equivalent issues in all regards.

    I suppose the underlying question I want to ask is how, socially, can we ensure that individuals facing medical choices with lasting consequences receive assessment, advice and information that is sufficient, fair, accurate, and timely?

  4. I think the abortion analogy is a useful and interesting one, but I take it in exactly the other direction. It seems to me that adult humans should be assumed to have carefully thought through the big decisions that they make, and that it is not the job of doctors to ensure this. Of course doctors need to make sure that they understand the nature of the procedure they’re having done– that’s just informed consent. But just as women seeking abortions should have their decisions respected rather than interrogated by medical providers, so too should trans people have their decisions respected rather than interrogated. Both should certainly have counselling made available to them if they want it, but this should not be required. The anology has convinced me that the lawsuit was wrongly decided– just as women who later regret abortion decisions (as some surely do) should not be allowed to sue abortion providers, nor should those who regret sex-changes be allowed to sue their surgeons. Emigrl is right: doctors should not be gate-keepers, and counselling should be a separate matter.

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