If you are reading this and you are not trans, you have almost certainly found some of the terminology/language used in relation to trans people confusing or difficult. Having shifted towards more topical material on the blog, it has occurred to me that there’s a risk that I could add to the confusion if I’m not careful. I am consciously trying to write about stuff in an accessible way – so if you ever think I”m not doing so, tell me.
What general readers may not realize is that trans people often struggle with terms, particularly those which are used by others to define them. So I thought I would talk about one term which is widely used, and which I used to use myself and now have problems with. As of this post I’m also going to start using shorter paragraphs, having noticed looking at The Scavenger‘s articles how this improves readability. Old print habits die hard!
“Gender dysphoria” is a term used to “diagnose” trans people in order to give them “access” to support. But what does it mean? Well, have a look at the UK NHS definition and then come back here.
On a positive note, the NHS don’t call it an illness, but they do call it a condition, and trot out the old chestnut that “a person feels that they are trapped within a body of the wrong sex”. As well as not making sense to many of us trans folk, this is language geared to defining us in a particular way, because medics feel they need to define people in order to offer them medical support.
You may not think gender dysphoria is a problematic term. If you are one of the people I came out to at UEA around 18 months ago, you may think it’s an OK term not least because I used it myself as part of my coming out process. I feel very differently about the term now.
The use of the word condition still implies that there is something “wrong” with the trans person, that needs to be “corrected”. The sub-text which even this reasonably helpful NHS summary can’t quite get rid of is the notion of mental illness, which was how transness was originally regarded when medicine first had a go at definining it in the first half of the twentieth century. The attitude then was that “these quirky people strangely think they belong to another gender (mad) but if we offer treatment to help them function in that gender they appear happier and more at ease (weird)”.
The classification of trans as a mental illness has been discarded, but the standards of care, which are continually reviewed, still talk about “dysphoria” and “problems”, although this is about to change. There are lot of contributory factors why this is still the case, but perhaps the key one is the challenge of how to determine when to offer, and regulate, medical support.
So, the current situation is that we have to be classified as “ill” in order to receive “treatment”. Maybe you think that’s not a problem, but you need to consider the value judgements bound up in those words. More critically perhaps, you should consider the impact on trans individuals of medics, and society at large, seeing us as ill and treating us that way.
Trans individuals often do find themselves struggling with psychological difficulties. But, in my view, this is not about being trans, which I am now convinced is part of natural biological variation (it may or may not also be influenced by the artificial addition of hormones into the food chain, as part of treatment for pregnant mothers etc, but that’s a side issue). Not long after I realized “something” about my gender identity, at age nine, I realized that I was “unacceptable”, based on the way trans people were depicted in media and the arts, and what I heard contemporaries and adults (including my parents) say.
Having to grow up hiding myself, and in a state of self-denial, and at a time where most people around me were making sense of how they should be and live in the world as the gender in which they were identified at birth, whereas I was trying at times to make sense of my birth-identified gender and at other times my true gender, it’s little wonder that I had some psychological difficulties as a result. They weren’t about being trans, they were about having to hide being trans while also dealing with a constant internal conflict.
In 2001 my father was terminally ill, and the stress of that situation brought my trans feelings, which had been strengthening, yet further towards the surface. I went to see my GP, who referred me to a wee group of psychiatrists, who in turn referred me to Barbara Ross, Norfolk NHS’ gender counsellor.
Barbara is a wonderful woman to whom I, and many others, owe a great deal. Although she of necessity operates within the NHS system she has an understanding of trans issues which way exceeds the typical NHS perspective. I went to see her, still in difficulties, still running around in circles not resolving anything but struggling with these strengthening feelings.
As a result, I could not ask her for particular help, as I couldn’t own up to myself enough to consider what that help might be. But each time we completed what were often inconclusive meetings, she would finish by saying “Shall I just keep you on the books, so we can keep in touch?” and I would always agree. Thanks to her experience, she could see something in me that I was too scared to see in myself. It was nearly seven years after our first meeting that I was finally able to go and see her and say I intended to transition. I can never thank her enough for her steadfastness and support.
However, when I came out at work – face-to-face in some cases, by e-mail in others – I still used the term gender dysphoria. I felt I had to have some jargon to hang this big news on, as I still felt nervous about telling people. But I also
held on to the term because, even as recently as two years ago, I felt I had an “illness”. Now, thanks a lot of counselling and experience of different perspectives – from within the trans community for example and also from non-Western cultures – I can see that diagnosis as about control and external definition, even if some medical practitioners are well-meaning about it. More widely in society it’s also about “othering” though – if you can make trans people seem weird and different, you don’t have to allow us in to privileged circles, and you can mistreat us if you are able to think of us as “not proper human beings”.
In extreme cases this leads to the horrific violence we mark on Transgender Day of Remembrance (yesterday). But there are many other kinds of mistreatment or ignorance that can result from this conviction, which can often be internalized by the trans people themselves.
So medics need to recognize that we are self-determining, best placed to work out whether, and what treatment we need, and as I have written recently elsewhere many, perhaps most of us do not fit into your medical categories, however well-meaning the intention behind them.