"Gatekeeping" Semantics - Flame Free

[Beverley]

Why isn't it required of normal people undergoing "major, irrevocable life-changing surgery" and choices?

Answer:

Because a normal person is assumed to be a free rational adult capable of deciding what to do with their own bodies...... and we, are not.

I am sorry, but you are simply wrong.

I have seen plenty of other examples of people being refused things that are not in their own best interests. A very simple example would be a tattoo artist refusing to do a certain tattoo. Other more relevant examples are normal, fertile women (or men) insisting on being sterilised because they do not wish children. Many doctors simply refuse to do such operations. I have seen examples in the news of people who wish to have healthy limbs amputated. There are lots of things that apparently healthy, sane people want done to them that practitioners refuse to do.

A recent example (at least here in the UK/EU) is the situation of people with a terminal disease who wish to kill themselves (assisted suicide). These people are mentally sound, have a clear understanding of their situation and have often studied their future options in depth. Yet doctors refuse to help them. Admittedly there is a legal issue that requires some stepping round but the point is that these people believe that the medical practitioners should be helping them to have a peaceful end to their lives rather than screaming their last days in agony.

When I came out to my father... he thought I was just confused / crazy. He dismissed my feelings and figured I was just mentally unstable... said I should go see a therapist.

Whereas I did it the other way round I saw the therapist first and then told people that I had been diagnosed with a medical condition. This stopped anyone from calling me crazy and for many made it easier to accept what was happening to me because they understood that I was NOT crazy and that this was NOT a choice. It was something that I required treatment for and I was getting the correct treatment.

[Constance]

 

Okay, folks, let's keep it civil please.

[spacial]

First the differences between NHS and everything else, everywhere else are not valid, no one else has a system quite like NHS (thank god).  And at that, nothing could be further from the NHS model (be it good or bad) than the US system.  So it's absurd to compare them.

I think you'll find that most countries have very similar systems to the NHS.

But the discussion isn't about the NHS it's about gate keeping.

That Drs retain and excersize the right to decide upon decisions we have made about our bodies, based upon their own personal stance.

The system that exists now, we must each get past that first hurdle, of convincing Drs that we should be permitted to get what we seek.

I find that objectionable.

I suggest that the criteria should be based upon measurable quantities, such as, are we physically fit to survive? Are we mentally competent? So on.

How we pay for it, which is what the likes of state health services, along with private finance, is an entirely separate matter.

Most state funded health services will finance SRS if it is demonstrated to be of long term benefit to the patient.

[Stephe]

Whereas I did it the other way round I saw the therapist first and then told people that I had been diagnosed with a medical condition. This stopped anyone from calling me crazy and for many made it easier to accept what was happening to me because they understood that I was NOT crazy and that this was NOT a choice. It was something that I required treatment for and I was getting the correct treatment.

All I've ever told anyone is, I've felt this way since I was a child and I finally did something about it. No excuses, no telling them it's a "medical condition" that implies it's out of my control. If people think I am crazy, telling them it's a medical condition isn't going to change their mind. The ONLY question anyone asks after I give them my simple explaination is "Are you happy?" I reply yes and they say "Well that's all that matters."

See I don't see it as a medical condition. There isn't anything wrong with being transgendered. I think that is the problem a LOT of transgendered people have is they think they are broken and require fixing. And that this will require some serious professional help!

I transitioned with ZERO help from the medical community. I lived as a woman for several years without one minute of therapy or anything from a doctor. How can wanting to transition be a medical condition if it can be fixed without a doctor? Clearly any body mods will require a doctor and HRT should be monitored by one, but IMHO it's no different than any other cosmetic surgery.

[Sephirah]

All I've ever told anyone is, I've felt this way since I was a child and I finally did something about it. No excuses, no telling them it's a "medical condition" that implies it's out of my control. If people think I am crazy, telling them it's a medical condition isn't going to change their mind. The ONLY question anyone asks after I give them my simple explaination is "Are you happy?" I reply yes and they say "Well that's all that matters."

See I don't see it as a medical condition. There isn't anything wrong with being transgendered. I think that is the problem a LOT of transgendered people have is they think they are broken and require fixing. And that this will require some serious professional help!

I transitioned with ZERO help from the medical community. I lived as a woman for several years without one minute of therapy or anything from a doctor. How can wanting to transition be a medical condition if it can be fixed without a doctor? Clearly any body mods will require a doctor and HRT should be monitored by one, but IMHO it's no different than any other cosmetic surgery.

It kinda is, since you don't change all your documentation, pronouns, how you want every other single person to treat you, where you go to do your ablutions and a whole lot of other aspects of your day-to-day life after having a facelift or lyposculpture etc.

However I find this response very interesting. If you don't mind, I have a few questions to try and understand better.

If you didn't see it as something about you which needed fixing... why transition at all? If it was to make you happy, that would surely imply that you were previously unhappy beforehand? If so, why was that?

[Miki]

This is exactly what I was alluding to in the OP when I hit on semantics and context. 

Mentally competent?

Who would you see for that?


A few folks seem hell bent on feeling hyper-persecuted because they're not treated like any other patient seeking run of the mill medical treatment.  I find that a bit odd and a bit surprising.

I get that the stigma of mental illness can be annoying, but at the end of the day...

So what?

How, exactly, is a GID diagnosis as a "condition" different if it is given by a medical as opposed to a mental health professional?

What, exactly, does a GID diagnosis prevent you from doing?  Your name isn't added to some national database, diagnostic information is shared only among your providers.

Does it impact your credit?  Prevent you from buying a house or car? 

I very recently received my diagnosis.  You know what changed?

Absolutely nothing.

My changes and challenges will stem from the actual process of transitioning.  Those same changes and challenges would exist no matter how the "condition of being transgendered" is defined in order to receive proper medical treatment options. 

If you're just pissed off and mortally offended that it currently falls under mental health, fair enough.  Ride that angst for all it's worth.

It seems pretty easy to get so wrapped in being bitter about it that any potential benefits that others may receive, more than a few having been demonstrated as life-saving as the result of mental health being a huge part of the current SoC, stop mattering to you.

That is just sad to me.

-Miki

[Rabbit]

Does it impact your credit?  Prevent you from buying a house or car? 

I very recently received my diagnosis.  You know what changed?

Absolutely nothing.

It gives credibility to the gross amount of discrimination we face....

The same way that when homosexuality was no longer diagnosed as a mental illness... they were able to start moving forward ...

As long as we remain considered mentally "wrong"... we will continue to be rejected by society at large... and society at large will continue to see us as nothing more than confused men who think they are women.... (because, when you label this a brain defect, that is EXACTLY what you are saying this is... instead of recognizing that people can be of varrying genders without it being a mental illness.... just like, again, the battle that different sexualities had to battle for legitimacy).

You have "Gender Identity Disorder" ...  have you stopped really reading those words? Have you stopped thinking about what that is saying?

[Miki]

It gives credibility to the gross amount of discrimination we face....

The same way that when homosexuality was no longer diagnosed as a mental illness... they were able to start moving forward ...

As long as we remain considered mentally "wrong"... we will continue to be rejected by society at large... and society at large will continue to see us as nothing more than confused men who think they are women.... (because, when you label this a brain defect, that is EXACTLY what you are saying this is... instead of recognizing that people can be of varrying genders without it being a mental illness.... just like, again, the battle that different sexualities had to battle for legitimacy).

You have "Gender Identity Disorder" ...  have you stopped really reading those words? Have you stopped thinking about what that is saying?

I appreciate what you're saying here, but on a few levels, could not disagree with you more.

Let me share some perspective around why I started this thread with the concepts of semantics, context and very specific use of language:

Professionally, I provide a significant portion of my clients with policy briefs and position papers on a wide range of issues for legislative consideration.  More than a few of those revolve around health provider policy.  So when I suggest that intentional use of language matters a great deal, it is with first-hand experience on how language evolves from policy concept to legislative proposals, and finally into legislation.


If GID is removed from the burden of any form of medical diagnosis, placing it outside the realm of a medical/mental condition that requires treatment to resolve, it becomes a purely elective endeavor.

It becomes a choice that anyone is free to engage in with no pre-requisites and no qualifiers whatsoever.

That would not break through any discrimination barriers at all.  What it would do is the opposite.

Employers, businesses and other public and private institutions would be able to enact their own standards, just as they do now, without the risk of any discrimination accusations.  Being transgender is now an individual choice, not a recognized condition. 

In the same vein that any employer in a right to work system can create dress-codes, break policies, set working hours, disallow music, smoking, what have you, the onus is on you to conform to those standards. 

There would be no legal burden for them to accept your choice, as you obviously have the freedom to choose not to transition as well. 

What a cluster->-bleeped-<- that would be.

I still think you're confusing the moral aspects of this with the logistical and practical.

Transitioning without a stipulation of necessity, recognition of a medical condition requiring treatment for resolution in the best interest of the health and well being of the patient, would be a horror show.

You would not be a patient anymore, you'd be a customer.  A customer that could be told "no" with no recourse.  Customers want things.  Patients require treatment.

To your last question, of course I've read those words.  I just don't have any problem with them in light of the alternatives available.  Which are exactly non-existent.  If that changes, that would be amazing. 

It has to change smartly, and not in a vacuum, however.  If you were to remove GID as any flavor of diagnosis, as things stand right now, you'd be removing protections against discrimination and denial of care with nothing to replace them with.

After all, if it is just a personal choice, the burden is 100% on you and no government, person, institution or entity has a legal obligation to cater to your choices.

I also have no issues with the disorder label.  If things were "in order" all of this would be moot, no?

-Miki

[Jayr]

This is one of those threads that's gonna go no where.

[spacial]

This is one of those threads that's gonna go no where.

Agreed.

[Stephe]

If you didn't see it as something about you which needed fixing... why transition at all? If it was to make you happy, that would surely imply that you were previously unhappy beforehand? If so, why was that?

What didn't HAVE to be fixed was the body mods.

What did need to change was the gender I presented to the public. I was a women presenting as a male for way too much of my life.

What was wrong was my way of thinking about my life and what I thought I was required to do. The transition was necessary, fixing my body to be more female is nice but wasn't needed to transition. I think a lot of people see being trans is they are defective/broken, they have to fix their body as best as they can before they can live as their natural gender. I found from personally experience, that isn't required.

Here is one last thought, I notice thousands of trans people who spend tens of thousands on body mods before they feel they are "good enough" to live full time, yet most of them ignore what I consider the most critical to being perceived as a woman "modification", voice therapy. I've read many say "Oh that would be fake" or "That's not my voice"... Try to figure that one out...

[Stephe]

What, exactly, does a GID diagnosis prevent you from doing? 

What it prevents me from doing is getting reasonable cost medical insurance in the USA now. It's a question on any application (have you ever been diagnosed with a mental disorder) and as someone who has to buy insurance as a single party, it has a large impact on my acceptance or the rates I am offered. I've actually been turned down twice since I tried to get insurance and the agent said this check box was the reason. They see any "mental disorder" the same, so I'm in the same boat as a paranoid schizophrenic as far as they are concerned.

Employers, businesses and other public and private institutions would be able to enact their own standards, just as they do now, without the risk of any discrimination accusations.  Being transgender is now an individual choice, not a recognized condition. 

Then explain how Gays are included in nondiscrimination clauses with no mental disorder diagnosis? Many places do protect sexual orientation but exclude gender identity still, yet we have this "official disorder".  This disorder diagnosis does not protect us from anything.

[JoanneB]

Maybe this is a cultural thing though... I'm from america... where we value personal freedom.

Ahhhh  the good old days.

The system is set up on the assumption that we are diseased (DSM) therefore we can be fixed. Insurance coverage of treatment for GID is vastly different than, let's say, typical cosmetic surgeries. Here in the US, just about all health insurance polices exclude coverage for any/all gender related treatments. A policy which makes little sense if GID is a recognized health concern.

The medical protocols here are heavily influenced by the lawsuit factor. Tons of unnecessary tests are routinely ordered  just for CYA purposes. A typical court scene with the plaintiffs attorney questioning his expert witness; "Tell me Dr. Howard, If Dr Screwup had ordered the Missleburger Differential Protein test might my client ....." The answer, of course, is always yes, it could have helped, he didn't, therefore he messed up and should be punished. Totally hypothetical but juries buy it and award big paydays.

Now imagine that scene if something goes wrong with a trans person? To about everyone the T person is, and even medically recognized, as being a wacko.Many medical professionals simply refuse to deal with trans patients, no matter what approvals they have.

[Miki]

...

Then explain how Gays are included in nondiscrimination clauses with no mental disorder diagnosis? Many places do protect sexual orientation but exclude gender identity still, yet we have this "official disorder".  This disorder diagnosis does not protect us from anything.

Being homosexual requires no irreversible surgeries or medical treatment to be gay.  There is no stipulation of necessity at work, as there is no requirement for any prescriptions, surgeries or therapy.  Being gay is not a "resolvable through medical intervention" state of being.  Being gay does not require legal intervention to change official documentation and legal status. 

A diagnosis currently protects you from denial of treatment by defining a condition with a clear treatment path under an existing Standard of Care.  Remove that definition of condition and what you are left with is a personal choice governed entirely by the marketplace and not protected under any right to treatment convention that currently exists.

I'm not advocating that a mental disorder diagnosis is a good thing, or fair, or holds up to any moral argument on principle.  None of those are true.  I'm 100% with you on an informed consent model, and I would much prefer a medical diagnosis as the result of that model with referrals to mental health professionals as needed.  The rub with that is that how many GPs are qualified to identify co-morbid issues?

Would any basis for discrimination actually be reduced if it was solely identified and defined as a medical condition?  I tend to doubt it and stand by the premise that removing any form of diagnosis without a reasonable replacement that afforded protections would throw us back into the dark ages and would actually foster and support more blatant discrimination, not reduce it.


-Miki

- I also respectfully disagree that this thread is going nowhere.  It's actually going to some pretty great places by sharing perspectives and experiences around this, and I'm thankful for that.  I can absolutely disagree with Stephe and Rabbit on things and still respect their opinions and be grateful for them putting them out here.

[Rabbit]

If GID is removed from the burden of any form of medical diagnosis, placing it outside the realm of a medical/mental condition that requires treatment to resolve, it becomes a purely elective endeavor.

This is more of an issue with the way health care is handled than anything else... and I think everyone would agree the way health care is handled is a major issue.

Saying we NEED to be labeled and thought of as mentally disturbed so we can fit into a broken healthcare system is... silly.

You think this is only an issue that exists in the doctors office? That when we step outside of the house, the general population doesn't shrink away because we are "mentally ill" and "confused"? I'm sorry, but the idea that being transgendered is a mental defect is a large contributing factor to how society sees us (or perhaps, it is a reflection of the way society sees us).

I'm not sick. I'm not crazy. I simply have a gender identity which falls within the normal range for humans.

Just as homosexuals are not sick, they are not crazy... they simply have a sexual identity which falls within the normal range for humans.

How is this such a hard concept? That we are normal?

Other societies have managed to figure out that the variation of gender identity was a normal thing for people... they even believe that it wasn't a NEGATIVE, but it was a positive... because the transgendered person seemed to understand so much more than a normal person.

[Stephe]

Being homosexual requires no irreversible surgeries or medical treatment to be gay.

Neither does being transgendered. People choose to have these. As witnessed by the millions of closeted transgendered people, you can choose to do nothing. I did nothing for 45 years. I then fully transitioned into life as a woman and lived as one for several years without any irreversible surgeries or medical treatment.

There is no stipulation of necessity at work, as there is no requirement for any prescriptions, surgeries or therapy.  Being gay is not a "resolvable through medical intervention" state of being.

Neither is being transgendered. Again people choose to have these and IMHO being trans isn't "resolved through medical intervention" but that's a whole nuther can of worms I'm not opening here. I suppose you could "resolve" being gay with an orchi or meds that would kill their sex drive....

Being gay does not require legal intervention to change official documentation and legal status.

I feel between the SOC and the fear of gay marriage is why in the US most states require surgery. That's a failure of the law and GID diagnosis doesn't make this better or worse. If I could get the sex marker changed after I was diagnosed with GID I might feel slightly differently about it.  Also notice being Gay means you can never get married in the present state of thing in the US.

A diagnosis currently protects you from denial of treatment by defining a condition with a clear treatment path under an existing Standard of Care.  Remove that definition of condition and what you are left with is a personal choice governed entirely by the marketplace and not protected under any right to treatment convention that currently exists.

I have zero fear of doctors getting out of this marketplace. Witness all the FFS doctors who are not being mandated to provide these services.

I'm not advocating that a mental disorder diagnosis is a good thing, or fair, or holds up to any moral argument on principle.  None of those are true.  I'm 100% with you on an informed consent model, and I would much prefer a medical diagnosis as the result of that model with referrals to mental health professionals as needed.  The rub with that is that how many GPs are qualified to identify co-morbid issues?

Would any basis for discrimination actually be reduced if it was solely identified and defined as a medical condition?  I tend to doubt it and stand by the premise that removing any form of diagnosis without a reasonable replacement that afforded protections would throw us back into the dark ages and would actually foster and support more blatant discrimination, not reduce it.

I don't see any "reduction in discrimination" that has this mental disorder thing as a basis right now. There is nothing in any law that says you can't discriminate against someone because they have a mental disorder. I fail to see what protection we get from this.

[MacKenzie]

This is one of those threads that's gonna go no where.

  Yeah i've found trying to get your point across over the internet is in fact kind of pointless. You can't post anything without hurting or offending someone no matter how well you word it. It's just like an endless cycle of "i'm right your wrong" attitudes. I try to stay out of these sort of threads when ever possible, it's a waste of time.

  I have a headache from reading the walls upon walls of text.   

[Miki]

Stephe, Rabbit, I think we've gotten to that place where the whole "respectfully agree to disagree" thing comes into play.

Thanks for the civil back and forth, and thank you both for for sharing your honest take and your personal experiences around this issue. 

There's a lot of nuance involved and I honestly respect and appreciate the perspectives you've both shared.




As for causing other folks headaches, my sincere apologies if this somewhat complex issue not being watered down into lowest common denominator platitudes and politically correct TG talking points has been problematic reading. 

I honestly think, "I'm right, you're wrong" has been deftly avoided in this thread in favor of the clarification of passionate viewpoints and opinions while not being offensive.

I think that is never a bad thing on a forum dedicated to that exact purpose.

Thanks

-Miki

[MrTesto]

What it prevents me from doing is getting reasonable cost medical insurance in the USA now....

It is my understanding that one of the real benefits of the upcoming health care reform in the US (a.k.a. 'obamacare') for trans people is that we can no longer be refused care under pre-existing condition exclusions.

Things are going to be changing drastically over the next few years, I think. The new WPATH SOC include and encourage informed consent for hormone access. The US govt has said that gender markers on passports can be changed without a specific requirement for medical transition, either hormones or surgery. More US states are changing driver's licenses to be updated based on primary care dr (or other providers) attestation of lived gender consistency. The next DSM has some significant changes removing binary identity requirements for trans people. More insurance companies are covering trans care, including SRS. And the ICD-10, the international healthcare coding structure, is itself being revised. Not all of these documents and policies agree, by any means. But the stranglehold that the DSM has had is loosening, and a new generation of medical and mental health providers is coming on the scene.

[Alainaluvsu]

It is my understanding that one of the real benefits of the upcoming health care reform in the US (a.k.a. 'obamacare') for trans people is that we can no longer be refused care under pre-existing condition exclusions.

Unfortunately, this doesn't mean that we can get insurance at affordable rates on individual plans.

For example, I applied for an individual plan hoping to pay in the range of 100 - 150 a month. I was rejected because "current medications, and planned or expected surgery". Insurance is a business looking to turn a profit after all. They're going to have to charge you more than what they expect to pay out in order to accept you. And currently, with tests, doctors visits, and HRT, I'm paying roughly 200 a month.

If you get lucky and get an employer that offers a health plan that covers transsexualism, that's a different story I guess...