Trans people not crazy: Time to say sorry
- Published: 04 June 2010
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The World Professional Association for Transgender Health (WPATH) has released a statement on its website urging the ‘de-pathologisation of gender variance’ worldwide, writes Tracie O’Keefe.
The World Professional Association for Transgender Health (WPATH) has released a statement on its website urging the ‘de-psychopathologisation of gender variance’ worldwide.
After years of campaigning by many trans civil rights activists and members of the World Professional Association for Transgender Health (WPATH) the old psycho-pathologising guard within the organisation has been defeated.
They were a clutch of sexologists, psychiatrists, psychologists and psychotherapists who earned their living from proffering the concept the trans people were crazy.
However over the past 15 years many trans professionals have co-opted themselves onto WPATH’s board and, as I predicted years ago, the lunatics have finally taken over the asylum.
So all is well? No, not quite.
There are now many trans people throughout the world who will retain mental illness on their medical records for the rest of their lives. This will affect them when they apply for jobs, try to get a mortgage, seek medical or life insurance.
The medical records will probably not be expunged so when they fill out an application form and omit that their medical records state that they had a mental illness they will be committing fraud.
Some will never ever be able to work with children, get certain jobs, or be considered as trustworthy and reliable because of that medical record. Some medical schools are still teaching that transsexual, transgender or trans anything identities are mental illnesses.
Now that WPATH has released its statement de-pathologising trans people, will Dr Russell Reid, the consultant humanist psychiatrist and trans specialist who was harassed by a group of psycho-pathologising psychiatrists from Charing Cross Hospital in England (who were members of WPATH), be redeemed for not treating trans people as lunatics?
Russell told me he saw over 4,000 trans patients over the years and a few regretted transition – five officially. That was tragic for those patients who regretted transition but it was a clinical success rate of around 99% - not a success rate that many psychiatrists can claim.
To the remainder of his patients he was one of the kindest men they had ever met and over the years and when I practised in London I saw him save thousands of lives.
But those psychiatrists, who wanted to keep trans identities psycho-pathologised, went after him like a pack of rabid dogs, dragging him up before the General Medical Council (GMC), and tried to ruin his name. It was a witch hunt.
Russell was pounded for not maintaining the WPATH Standards of Care that now apparently don’t exist anymore in that form (namely saying trans people are nuts). Eventually the GMC found him guilty of rushing treatments and not communicating properly with patients’ GPs but as any specialist will tell you, we write thousands of letters to GPs over the years and probably only ever get a handful of responses.
Does this de-psycho-pathologising of trans people mean that doctors can now give hormones out like sweeties? I sincerely hope not because every life change deserves discussion.
Although as a therapist I do not pathologise trans people, I have required them to consider their options very carefully around medical intervention that may be irreversible.
I would take the same approach around someone considering a career change, marriage, divorce, or even committing themselves to a mortgage. Then when people have thought carefully I will support their decision. Everyone has the right to decide their own destiny.
Will surgeons now operate without referrals? I hope not. I have now seen 15 patients who have regretted their transition in other clinics and the recurring theme has always been the same: They never really talked things through before transition.
A surgeon has a clinical responsibility to ensure the patients are ready and suitable for all surgeries – especially those that are irreversible – and since they are not therapists they have to rely on mental health professionals’ referrals. When people are disappointed with reconstruction and plastic surgeries it is often because their expectations were unrealistic.
Now trans people are not crazy anymore, where will the money come from for treatment since they do not have a psycho-pathology?
The answer is simple: The money needs to come from sexual health programs, just like pregnancy, IVF, HIV treatment or menopausal services.
The dire consequences of pathologising trans people
Recently a copy of a short documentary from the UK of a homeless transsexual woman, Sheila, who lived on the streets in London in the 1960s and 70s, was released on the internet.
She is billed as transgender but I met Sheila and she did not identify as transgender but as transsexual. Please stop rewriting our history.
Sheila told me she was refused treatment by Dr John Randall in London. As was the case with many of Randall’s patients, this was because she was not his idea of what a woman should be. He just saw her as a delusional man who lived on the streets and fantasised about being a woman.
I remember she slept in derelict houses down by Shepherd’s Bush roundabout and under the Westway flyover in London. She kept all her worldly goods in a pram and pushed it up the Holland Park Road to the West End each day where she would play the violin to get enough money to eat.
On the way to college I would see her from the top of a red double-decker bus pushing her pram in the rain. Sometimes passersby would spit on her in the street, the police from Vine Street Police Station would harass and verbally abuse her in Soho for their amusement, sometimes working girls would give her money for a cup of tea, and the gangsters who ran the strip clubs would move her on so she did not frighten away the punters.
She had impeccable manners and was polite to all of them. I am not sure what happened to her but someone told me she had been found dead of pneumonia in one of those derelict houses in the early ’70s.
Sheila is one of hundreds of trans people I have seen die through rejection. Either they died in poverty when no one would give them a home or work, turned to drugs, were murdered by real lunatics, arrested time and time again in the sex industry or just ended it all by committing suicide.
Big Pearl grew breasts, then had them cut off, then tried to grow them again and eventually expired on the end of needle full of heroin. Her clinician was a person with no empathy.
Queenie, a trans woman so traumatised by being molested as a child, felt so judged by her psychiatrist that she never trusted a health professional again and also died from one fix too many, as did Stacy and many others.
Tom jumped under a train because his psychiatrist said he was too short to be a man and would not prescribe him testosterone.
I was locked in a mental asylum, strapped to a bed and pumped full of psychedelic drugs at the age of 11 for three years, often in a cell six feet by eight. From the window I could see the strait jacket cells and hear the patients screaming as I wondered if I would ever get out.
“You’re not a girl,” I was told. “Just disturbed.” But when I failed to masculinise in the way the psychiatrists thought I should, they still stuck to their guns and only released me at 15 when my GP threatened to expose them.
It was Maureen, a local drag queen who worked the streets behind a pub in the north of England, who fed me Sunday lunch when I struggled to make ends meet at college. Maureen had an occasional job but it was never long before she was fired again when staff complained about her identity and she went back to street-based sex work.
It was my friend Big Dyke Jamie with one eye who let me sleep on her floor when in the second half of my teens the psychiatrist with his cruel harassment drove me yet again to attempt suicide.
He denied me hormones and insisted I tried to live as a male, so I obtained them behind his back and told him what he wanted to hear, which seemed to change from month to month. Later we buried many of his patients in Earl’s Court cemetery as living on the margins drove them over the edge.
I remember the April Ashley, a former British model, telling me she was strapped to a hospital trolley and given Electro Convulsive Therapy (ECT) at 15 to convince her she was male. Then in the middle of her divorce case in the early 70s medics – including psycho-pathologising psychiatrist Dr John Randall from Charing Cross Hospital – declared her male even though it was clear she lived and identified as female.
The history of how intersex, sex and/or gender diverse people have been treated by the medical profession and society is littered with daily abuse.
This, however, is the history that WPATH wants to keep hidden as it magnanimously exhibits is benevolent charity. It is the history that it refuses to post on its notice board every time I draw it to their attention.
Time to say ‘sorry’?
The Harry Benjamin International Gender Dysphoria Association (HIBIGDA) – as WPATH was previously known – was the major body responsible for the official psycho-pathologising of trans people in the first place.
It was also WPATH (of which I am a self-confessed long-term professional member) that continued the illusion that trans people were crazy and howling at the moon.
Perhaps now might be the time for WPATH to make a public statement saying ‘sorry’.
After all isn’t the new nice association now full of very nice professional trans people themselves who don’t think all trans people are crazy?
Well, not quite.
It seems that WPATH is now dominated by the transgender fascista who believe only people who agree to call themselves transgender are the real sane ones.
All other trans people such as the transexed or transsexuals – like yours truly – are still as nutty as a fruit cake. In fact we are not only non-compliant, difficult, refuse to accept our ‘transgenderness’, we should also be excluded from the proper workings of that association.
Does anyone smell prejudice?
So, will ‘sorry’ do?
Not really. It will just be a hollow holler. To say sorry for past oppression while still being engaged with your present subjugation of people who are not exactly like you is not really sorry at all is it? It is just another game of tribalism and people making careers out of labels of a different kind.
Even if we are not mad as hatters anymore there is still so much work to be done in giving all intersex, sex and/or gender diverse (ISGD) people an equal playing field with the average Joe or Josephine.
Some people are intersex, some have issues about their physiological bodies and others about their gender performance.
Each person is an entity to themselves, so never assume you know exactly what people are. At my clinic we start with using the ‘Ask Etiquette’. You ask someone how they might like to be addressed and how they might identify. It is polite, after all, and very rude to call them transgender when they tell you they are not.
At the moment my friend Norrie is fighting to get back the world’s first ‘Sex Not Specified’ identity documents the New South Wales government in Australia cancelled when they realised how popular it might be.
There are always new frontiers to be forged and those on the edge who breach the barriers of ignorance to teach us, rather than those who set up barriers for their own gain.
As for WPATH and saying ‘sorry’, its board members developing an even bigger conscience, and changing the association’s name once again to a much less offensive one and to be much more inclusive?
We will see. Every dog has its day. Many of us survived and prospered, outliving the last lot of oppressors, and maybe we will survive the transgender fascista too. I’ve seen bigger miracles come to pass.
Dr Tracie O’Keefe ND, DCH is a sexologist practising at the Australian Health and Education Centre in Sydney, Australia. She is the author and/or editor of several books on sex and gender diversity, the latest being Trans People in Love.