In today's Guardian newspaper (23.5.07) (www.guardian.co.uk - under life & health, story titled, 'Mistaken Identity'); one of the leading gender psychiatrists was censured by the General Medical Council for inappropriately referring 5 patients for surgey. He didn't stick to the rules regarding referral so the censure may be appropriate, but I won't comment upon the case directly.
However, I do have a few thoughts to share. Gender Identity Disorder is like several psychological situations entirely client or patient led. It is the patient who goes to the doctor and tells them they are uncomfortable in their gender role or that they want surgery to alter their physical secondary sexual characteristics. I'm aware there may be many variations on this theme, but that will do as two of the most likely presenting situations.
The guidelines then supposedly help the professionals assist the patient in making the right choices towards surgery and in the doctor making the correct diagnosis. Obviously, surgery is not appropriate for everyone neither is the diagnosis, transsexual syndrome.
Despite the advances in medical scanning techniques and the cleverness of the doctors, no one can actually tell what you are thinking, so mind-reading is not possible (although some sharp NLP practitioners will show you it is possible to make a good guess). Therefore, the doctor is reliant on the information the patient gives them about symptoms, this applies to physical health as well as mental. So if you feed your doctor a load of lies they will mis-diagnose you, at least initially.
Quite regularly the press feature stories of people who thought they were transsexual, had surgery and regretted it. It's all very unfortunate for all concerned because the system has messed up and those persons should have been screened out. Where they are inadequate for some reason, obviously they need help in making such life changing decisions, but many of these cases don't actually seem to be mentally incompetent, just unrealistic in understanding what is possible or what it's all really about.
Don't they appreciate that once something is removed it can't be replaced. Surgeons generally don't operate on gender patients without reassuring themselves that the client/patient really wants to go ahead with it, and they have up until they are anaesthetised to change their minds.
So what are they thinking? I don't know and I'm not sure they do either, but don't we all bear some responsibility for our own lives. I'm aware of the power imbalance in the hands of the doctors, although that has changed in recent years. I'm also aware of the conveyor belt that some seem to find themselves upon heading towards surgery, when it isn't the only solution.
Because it requires medical intervention to prescribe hormones and refer for surgery, transsexualism is very medicalised. However, a recent series of guidelines published by the Royal College of Psychiatrists calls it not so much a medical condition but a variation of the human condition. So it isn't a disease (unless you go for the DSM-iv which lists it as a psychiatric condition) but it appears to have a medical and surgical treatment, which seems paradoxical to say the least.
In conclusion, I would suggest that we all bear some responsibility for our own lives and the directions they take. In the case of gender reassignment surgery, there are guidelines which need to be followed by the professionals, but they only work if the patient is honest to themselves and the doctors. We have a responsibility to ourselves to be honest to ourselves as well as those trying to help us, if we aren't then the consequences can be unfortunate and long lasting.
Comments
Responsibility
It seems the biggest problem is people who won't take responsibility for themselves. Always wanting others to make their decisions for them, and blaming others when the outcome isn't what they wanted after all.
It seems odd to read of someone complaining that her SRS was done too quickly, after the hoops I was made to go through, and perhaps the doctor in question should not have approved the surgery, but the woman in question repeatedly told the doctor she wanted it. However, I see no signs of her taking any responsibility for the "mistake". It's all about how the doctor should have not allowed it to happen. We protect children from making bad decisions and try to shield them from their mistakes; but adults are expected to be grown-up enough to think for themselves, make their own decisions, and live with the results - good or bad.
While I feel somewhat sorry for this person, in the end all I'm left with is a certain contempt for somebody who seems unable to stand on her own two feet, make her own decisions, and take responsibility for her life.
Karen J.
"A dress makes no sense unless it inspires men to want to take it off you."
Francoise Sagan
“When a clown moves into a palace, he doesn’t become a king. The palace becomes a circus.” - Turkish Proverb
Urgh.
I've heard similar stories of people not being ready when they got their change, or even changing their mind afterwards. I personally don't understand it- after all, if you were happy having the 'wrong' genitals before, you wouldn't have pursued SRS, correct? If nothing else, it doesn't seem to me that it could be any worse than the originals, but then again I'm rather biased in my opinions.
Also, how can anybody NOT take responsibility for a decision like this? I mean, even if the doctor came up and said to them "you should really get SRS, it's for the best," they still have to make the final decision and move. Surgery as major as SRS is not something you can just wake up one day and go get, or in some cases find a doctor who is nearby to do it, and even if you could the cost of it alone should make you ponder your decision. After the rigamarole to get in, you should be (expletive deleted) well sure you're doing the right thing.
Personal responsibility for your decisions is a great thing, and one far too many people nowadays don't seem to want to admit. Everybody remembers the lady who sued McDonalds over her 'too hot' coffee, and to me this is the same thing: someone didn't think through what they were doing, made a mistake, and got burned a little. Rather than admitting they did it on their own, they decide to blame someone whose only job is to do what they asked for in the first place. As a result of their stupidity, those of us who just want a cup of coffee have that much more trouble to go through before we can get our fix- and there's nothing we can do about it. I don't care if the doctor didn't go through all the normal channels, he didn't force anyone to take advantage of it, so while him getting punished is understandable from a legal viewpoint, him getting blamed for their unhappiness isn't.
Two minds
It seems to me that the rules are in place to cover the psychiatrists and surgeons liability, and to make as sure as possible, even at the very real risk of putting off hormones and surgery until puberty has passed, that the patient doesn't have some other issue. Which half of that is more important to the average psych, I don't know.
In a perfect world, everyone would be perfectly diagnosed by the age of twelve. My stepfather is a psychiatrist. He knows very well that it's very much a "soft science." Heck, half of them are nuts. A few years ago I heard that, of all the professions, psychiatrists have the second highest rate of suicide.
P.S. I detect the beginnings of a story coming on....
Aardvark
"Happiness is when what you think, what you say, and what you do are in harmony."
Mahatma Gandhi
"Happiness is when what you think, what you say, and what you do are in harmony."
Mahatma Gandhi
Responsibility and freedom
I agree with Aardvark here (hey, it's not the first time.) Psychology is a soft science and that makes it very hard to practice. With all the hoops that Transgenders must jump through it is hard to believe that something like this could happen. But we don't all live the same life, and there are other reasons people may want to escape the gender limits they are forced into, and people are not always able to see their own situation. I know a sixteen year old girl that cuts her arm with nail clippers, just little scratches, just little pains, only a few scars so far. She will argue: They make her feel better; it is her body,isn't it? (No please don't think I'm comparing her to transgender people - I'm just showing what conclusions people can reach with the right kind of stress and anxiety.)
The coffee story fits the situation to a certain extent. It is ridiculous to blame the vendor because you spill your coffee and get burned, but what if the vendor has been cited for keeping it at 200 degrees before and continues to do so? (Yes, some people are buying for later, but not everyone.) What if the foreseeable accident of spilling the coffee causes the unforeseen result of third degree burns over a large area resulting in very painful long term treatment. Who has the responsibility then? Every situation, as is every person, is different.
So we are left with only imperfect possibilities: an absurdly paternalistic system which frustrates the people that know what they are and seek what is truly best for them. Or a system that allows some people to seek unreasoned long term changes due to what are(fairly) short term problems. And if Claudia is to be believed, she- he never said he wanted the change but was talked into it by his friend and the doctor at a time of stress and dependence. And the doctor says he knows what is right. That coffee is very, very hot.
I don't have any answers to any thing ever any more, but I think Claudia hit on the problem at the end; it is the rigidity of the gender roles that leads those that fit neither role to get lost and hurt a lot. Perhaps there is a small joy in certainty even when it brings nothing but anguish and grief.
For what it is worth;
Hugs, Jan
Liberty is more than the freedom to be just like you.
Will I Be happy
Years ago while waiting in the grain truck while my father ran the combine, I read and reread old Reader's Digests -- which come to think of it was probably the genesis of my minmalist writing style.
A short story in the magazine spoke of a man who had just arrived in a new town and was having a cup of coffee at a restuarant before going to his new house.
"I wish there was a way to know if I'm going to be happy here," he lamented to the waitress who had just welcomed him to her hometown.
"There is," she answered. "Just answer one question for me and I'll tell you with 90% certainty whether or not you'll be happy here."
The man looked at her skeptically. "Okay, you ask your one question and if I agree that question might give you a solid indication of my future I'll give you a five dollar tip, if not -- no tip. Fair?"
The waitress nodded and wiped the counter-top as she spoke. "All you have to do is tell me -- Were you happy in the town you came from?"
The man grinned and dropped a five dollar bill on the counter.
Some people are miserable and think changing their sex will make them happy. Some of those are right. Some are wrong. For some of them their misery stems from a much different source.
Angela Rasch (Jill M I)
Angela Rasch (Jill M I)
Life in These United States
Jeez, I remember that one. I read them at my aunt's house and when I was in the hospital. And back then, a five-dollar tip would be like dropping a fifty today. But the lesson was worth it.
Roger Miller said, "You can't roller skate in a buffalo herd but you can be happy if you've a mind to." It's true. Which doesn't mean that there aren't intolerable situations for which one shouldn't seek a remedy.
People often confuse being bold (taking risks) with being brave (facing fear). The moral difference is enormous.
I knew a homosexual TV once who loved being "wife" to his lover. So he decided on a sex change. But six months of living female day after day convinced him; he was male and preferred being male with occasional "vacations". Another similar case I knew chose to live as female for forty years (last I saw of her) without getting or seeking surgery.
People can't be accurately sorted into a set number of boxes for an arbitrary purpose by any objective rules-based process. In mathematical terms, the equation has an undeterminable number of dimensions.
- Erin
= Give everyone the benefit of the doubt because certainty is a fragile thing that can be shattered by one overlooked fact.
Laughter Is the Best RX
Although I've ripped psychiatrists and psychologists (and psychology teachers) in my stories, I have great respect for what they try to do.
When we say we know someone, I think that means we feel comfortable when can predict their behavior under certain circumstances.
How often do we find we don't know that person at all -- one whom we had considered a friend?
In a world that is constantly re-defining roles who can say with any degree of certainty what will make someone else happy for any longer length of time.
Angela Rasch (Jill M I)
Angela Rasch (Jill M I)