Susan's Place Transgender Resources

Stop Trying to "Fix" Trans People
Filed by: Guest Blogger
June 21, 2008 10:30 AM

http://www.bilerico.com/2008/06/stop_trying_to_fix_trans_people.php (http://www.bilerico.com/2008/06/stop_trying_to_fix_trans_people.php)

Editors' note: Matt Kailey is the author of Matt Kailey.jpgJust Add Hormones: An Insider's Guide the Transsexual Experience, the editor of Focus on the Fabulous: Colorado GLBT Voices, and the managing editor of Out Front Colorado, Colorado's oldest and largest GLBT publication.

Trans people aren't broken. We aren't looking to be "fixed," and we have no need of a repairman. We have spent decades trying to convince the Western world of this, and forgive us if some in our ranks were starting to feel a little optimistic about our progress - until, maybe, now.

Just when we thought that an end to the tinkering around with our brains might be in sight - at least for those who are very far sighted - along comes a repairman in the form of Dr. Kenneth Zucker, a non-transman who, like so many before him, thinks he knows what's better for us than we do. Dr. Zucker thinks he can "fix" us - whether we want him to or not.

you don't want to be "fixed"?
so, no more hormones and surgery then?

If you are a cross dresser or other non-medically treated TG then fine, but if you demand a medical solution, you can't be so offended when medical experts investigate alternatives. As a patient you can choose which way you want to be treated, but don't get angry at them for trying to help.

I disagree shoe-horning people into stereotyped gender roles based on biological sex. But i think some psychological approaches could be helpful, especially in milder or borderline cases of GID, like trying to help someone to be a happy feminine male. You shouldn't have such a knee-jerk reaction against psychology.

The difference between treating homosexuals and treating transexuals is that homosexuals don't seek other medical treatment for a perceived bodily problem.

I'm just trying to see it from the psychologists point of view here. I know this post is old, but i see a lot of excess hostility toward mental-health professionals on this site.

^{Sarcasm applied liberally. :icon_wave:}

Polarizing article.  Needs more sources and less pigeonholing such as,

"But if the American Psychiatric Association supports Zucker's views, and it must, given his appointment on the DSM task force, then it has only two choices for recourse: put homosexuality back in the DSM or take GID out."

This is flat out wrong.  If this person had read Zucker's research he'd realize that Zucker doesn't pathologize homosexuality nor try to cure it. 

I mean, I understand the push to get this out of the DSM, but using distorted information and fear-mongering will only work for so long before it inevitably backfires.

Oh, and metal angel, I love your post.

BTW, are there any researchers out there currently doing work (on the level of Zucker) with children with GID that disagree with him?  I've been looking but have been unable to find anyone comparable on the other side of the fence.

Quote from: heatherrose on August 26, 2009, 07:43:55 AM

Are you saying there is a "Cure", other than the sufferer
kowtowing to cultural normals and suffering in silence?

Nope.  I only responded after reading what I perceived to be misinformation and fear-mongering on the part of the author of the article.  Zucker might end up being a quack, but at least call him a quack for things he does, not stuff he doesn't.

Well that was my eye-catching headline.

If you read past that, you'd see that i said you shouldn't try to pidgeon-hole people into genders, but maybe a psychological approach would work to make that kid a happy boy who plays with dolls. In fact i think that sex-reassignment pidgeon-holes people into the opposite gender more brutally than even the deamonised Zucker was pidgron-holing their biological gender, and not everyone is 100% happy with the result ()

And I am not suggesting electro-shock therapy etc. Just the milder therapies like talking therapy, to be more comfortable as a feminine male/masculine woman? Some counciling to see if their is a particular need the patient feels may be met by transitioning which may be an unreasonable expectation?

Remember the solutions transexuals are seeking are very drastic. I think they should at least give psychology a chance before they make irriversable changes to their bodies. There will be some cases where the mind can not be soothed without changing the body, and they are candidates for hormones surgery etc. But i think it's wrong to see psychologists as the enemy as a lot of people around here seem to.

and you shold call Zucker a Quack for his specific tactics, forcing kids to conform to the behaviour of a given gender, not just for trying to provide a psychological cure for psychological destress.

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Post Merge: August 26, 2009, 09:48:05 AM

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a lot of kinds have transient GID, so jumping into puberty-blockers too quick is at least as damaging... i really should get to bed but i;m going to do a pubmed on this guy and see what he's really up to. My first search shows he's the leader of quite a productive research group... really should go to be though, it's 1am and i have a lab meeting tomorrow.

If they wish to 'fix' us, then just pay for the therapy, HRT and SRS.  Otherwise they can keep their homophobic/transphobic bigoted ignorant opinions to themselves.

Just because I will not conform to their narrow-minded BS views, I need to be fixed.  The only fix I need is SRS.


Janet

Quote from: Janet Lynn on August 26, 2009, 09:14:30 PM
If they wish to 'fix' us, then just pay for the therapy, HRT and SRS.

Actually that's a good point. I don't understand why so many of the people here seem so averse to seeing TS as a medical condition? As a recognised medical condition, wouldn't you have a much easier time accessing surgery for it? I don't know what the current situation is, but if the surgery is required to treat a debilitating psychological condition without an alternative treatment, then you could more easily access funding through public health services such as the UK's NHS, or from health insurance companies etc. If you are not ill then any surgery you want is just a luxury like cosmetic surgery so you are obliged to fund it yourself?

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Post Merge: August 27, 2009, 05:15:28 AM

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Yeah the people in that Dr Phil clip probably are quacks... which is about what i'd expect from Dr. Phil. I couldn't catch the name of the other one, but i can't find any legitimate research from the Glenn stanton guy. I guess if he is a cliniitian you wouldn't expect much research... but i wouldn't really judge any group by their representatives on day time TV.

i am reading some of Zucker's stuff now. The guy seems to be "Kenneth J. Zucker" correct? i am having trouble finding much that i can access because it is published in copyright journals which my uni doesn't seem to have subscriptions to, but he does seem to be publishing things with reasonable sounding titles...

I guess the thing i worry about most is the attitude which seems to be taken toward psychologists who assess patients for SRS. The general vibe i get from this community that the psychologist is some sort of gate keeper that you need to tell "the right story" to get what you want. The goal of this is to decide whether someone would benifit from SRS or hormones etc. you should take it seriously and communicate honestly.

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Post Merge: August 27, 2009, 06:25:33 AM

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a study on hormonal origin of F2M transexualism by zucker.

http://www.ncbi.nlm.nih.gov/pubmed/18585715?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum (http://www.ncbi.nlm.nih.gov/pubmed/18585715?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum)

I consider my condition medical.

here's a good one, unfortunately i think you'll only be able to get the abstract, but i'll give you a few of the more interesting quotes, i think that's ok for copyright as long as i attribute them, they are from this article:

http://www.ncbi.nlm.nih.gov/pubmed/18321016?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum (http://www.ncbi.nlm.nih.gov/pubmed/18321016?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum)

he does not support a significant connection between GID and homosexuality:

QuoteAlthough there were some modest differences in the mean scale scores (on a questionare measure of GID) between the heterosexual and nonheterosexual men and between the heterosexual and nonheterosexual women, these differences probably lack
any substantive clinical significance.

there is a lot of pretty heavy stats in it but he seems to have an interest in assessing outcomes in patients with GID, intersex people who's gender has been assigned (to see if it was assigned correctly, i.e. in a way they are now happy with), patients who have been biowomen/biomen but had some form of illness or surgery reqquiring removal of sexual organs etc.

here's the follow-up
http://www.ncbi.nlm.nih.gov/pubmed/19396705?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum (http://www.ncbi.nlm.nih.gov/pubmed/19396705?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum)

so far he doesn't seem that mad...

can't find much on proposed treatments though... he seems way more into causes if i have the right guy?

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Post Merge: August 27, 2009, 05:48:58 AM

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Quote from: Miniar on August 27, 2009, 06:36:29 AM
I consider my condition medical.

That makes sense. There seem to be a few who object to being regarded as ill, but seem to think that they have a problem which needs a radical action?

Maybe they object to being seen as mentally ill because they see it as a healthy mind in the wrong body? But the body itself is usually physically healthy in every measurable way, but the mind is destressed, so to me it seems that mind is sufferring more? But if the only way to sooth the mind is to alter the body, it seems like they should have that option. Maybe they just feel a stigma with "wrong mind"? I don't understand stigma, i get a desire for privacy (i wouldn't tell my boss about my mental health) but i also feel private about other medical stuff (i wouldn't tell him about my sexual health either).

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Post Merge: August 27, 2009, 07:01:33 AM

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http://www.ncbi.nlm.nih.gov/pubmed/17716096?ordinalpos=24&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum (http://www.ncbi.nlm.nih.gov/pubmed/17716096?ordinalpos=24&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum)

in this one he does state a correlation between non-bio-genderred behavious in childhood and future homosexuality, but he says it was less than previously stated and he doesn't seem to be trying to "cure" homosexuality.

If my memory serves me correctly, the DSM says gender reassignment surgery is an effective cure for the dysphoria many of us experience.  I agree that there's a lot of confusion out there, both with the TG and with the "experts" and there's no one stop fix all solution. 

But the main problem most of us encounter is society's attitude toward us.  And when there's a book out there that is accepted by the psychiatry and psychology community as gospel, and that book says you suffer from a "disorder" if you're TG, you can expect to be treated as if you have a mental disorder.

I think the numbers on fully transitioning speak for themselves.  The vast majority of those who transition are much happier than they were before.  I remember reading gender transition was 98% successful.  I wonder how many psychological treatments are that successful?

The facts are clear and they don't lie.  This is a medical condition, not a mental condition.  And the sooner TG is removed from the DSM and recognized as a medical condition, the sooner we can expect insurance companies to start covering our transition costs.  As long as it stays on the DSM, you should only expect your therapy to be covered.

As far as Zucker is concerned, anyone who thinks TG is a mental condition should be eliminated from having anything to do with categorizing it so and treating it as such.

Julie

In most cases (excluding a few intersex cases) the body is perfectly healthy in it's own right? A psychological condition IS recognised as a medical condition, e.g. you can get a disability pension, you can get medicine, often there is some identifiable biological cause.

How would you diagnose GID - to determine who would benifit from hormonal and surgical treatment - if not psychologically?

There are some biological aspects of brain anatomy etc. which are different between men and women and transexuals resemble their prefferred gender in a few of these, but in all cases there is a fair bit of over-lap betwwen biomen and biowomen. It seems unlikely that they will be able to diagnose GID with a brian scan or blood test any time in the near future.

I know you feel YOU know what is right for you, but there are some people who may feel the need to transition, but who may benifit from other treatment. I'll make up an example, what about a gay male who has grown up in a very homophobic community and thinks life will be a lot easier as a woman, he may want to transition as an easy fix, but he proabbly would not benifit from transitioning. You need to diagnose it in order to give treatment to those who will most benifit and re-direct those who will not.

so, given there is no workable biological test, it seems entirely reasonable that there should be guidelines for diagnosing it psychologically.

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Post Merge: August 27, 2009, 09:24:14 AM

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A good psychologist uses the GSM as guidelines only, which is as it was intended.

I don't like that the DSM seems to include only pathological conditions and it tends to disregard normal variation. But i think the TG community has more to gain than to loose by having GID in the DSM. Effective diagnostic guidelines will help to inform studies on who can benifit form the sort of treatments you want, which may improve access to them.

I really don't understand why people are so keen to have medical problems rather than psychological ones? My ex boyfriend was bizarely pleased to find his hallucinations were caused by epilepsy rather than skitzophrenia. I can see why he was pleased in finding medications which were more effective, but i don't undertand the pride issue as such.

I guess it maybe dates from the days of huge assylums for the mad? but haven't we moved on from then?

How would you diagnose GID - to determine who would benifit from hormonal and surgical treatment - if not psychologically?

Well, to date, the only way of doing it - the diagnoses - is the word of the patient that they have it. It is - and almost unique in this - about the only thing condition that is 100% self-diagnosed. Which does lead to problems in some ways.

How would you diagnose homosexuality?  The individual says they are gay.

Now, if you want to take that further and say they engage in homosexual activities, then you need to do the same for the TG and acknowledge TGs engage in transgender activities.  It then becomes more than just taking the person's word.

How would you diagnose homosexuality?  The individual says they are gay.

No, there are certain thoughts and behaviors that pretty well mark it. And no one is really trying to fix gay people - outside of a few oddballs - so its a self defined sexual preference, not a DSM category.

Quote from: juliekins on August 27, 2009, 02:02:10 PM
How would you diagnose homosexuality?  The individual says they are gay.

There's no real medical need to diagnose homosexuality. In most medical litrature (e.g. guidelines for screaning for STDs) they tend to use terms like "men who have sex with men", the treatment is just judged be behaviour, psychology aren't really that essential for providing appropriate treatment. STD risk and any other health-relevant risks are pretty much the same for someone who displays that behavious whether they are gay, bi, or just experimenting.

But if you are going to provide drastic medical treatment (gender reassignment) you need to do a deeper exploration to determine whether they will benifit from this treatment. e.g. a lot of crossdressers would not need or benifit from gender reassignment.

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Post Merge: August 27, 2009, 05:48:15 PM

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There's no real way to "diagnose" homosexuality, if they are conducting research there are tools to define it (most often refrenced at Kinsey 1948) but there is no real need to asses a clinical patient (i.e. outside of a research project) so i guess that's why homorsexuality is not in the DSM.

I think maybe homosexuality should be described in the DSM with some kind of headder marked "normal variation", it may be useful to provide some information on normal behaviour for if someone scomes in needing treatment (e.g. for depression) but also is unusual in a non-opathological way the psychologist is unfamiliar with (e.g. homosexuality).

but i guess the cut-off is whether theree's a medical need to ever "diagnose" the condition in a patient.

e.g. a lot of crossdressers would not need or benifit from gender reassignment
Yeah, but I doubt if most of them are asking for it either.  I'm sure that many have thought about it, but backed away, and others took the hormones and let it ride at that, others who just did plastic surgery.  Most people, by they time they really get to GRS have given it a lot of thought.  And 'a lot'?  Does that mean that some crossdressers might need and benefit from GRS, 'cause I think that might be right, in some conditions.

And, There's no real way to "diagnose" homosexuality.
Oh come on now, there sure is.  Are you engaging in homosexual activity?  If yes, then you are.  Are you attracted to members of your own gender, even though you might not have ever done anything like that, except masturbate/fantasize about it?  If so, then maybe (I'm not totally sold on the idea that fantasy alone makes it so, I'm not sure that having self play sessions while thinking about some S&M deal, makes you an S&M person - not till you do it can you really own it and be it.)

Quote from: tekla on August 27, 2009, 05:51:56 PM
And, There's no real way to "diagnose" homosexuality.
Oh come on now, there sure is.  Are you engaging in homosexual activity?  If yes, then you are.  Are you attracted to members of your own gender, even though you might not have ever done anything like that, except masturbate/fantasize about it?  If so, then maybe (I'm not totally sold on the idea that fantasy alone makes it so, I'm not sure that having self play sessions while thinking about some S&M deal, makes you an S&M person - not till you do it can you really own it and be it.)

I meant there is no TOOL for diagnosing homosexuality psychologically (i.e. no diagnostic guideline, no DSM entry) because there is no NEED for it. If a person engages in seme-sex sexual activity it has some inpact on which STDs they may be at risk of and which body parts might be worth swabbing if they want a full STD screen, also if your lesbian patient only engages in sex with other women, you can rule out pregnancy. But there is not STANDARDISED clinical way to assess homosexuality psychologically because you don't need to. I most cases you just go by behaviour "have you had sex with another man in the last 12 months?". You only need to quantify the underlying psychological trait if you are doing psych research, in which context you use a zero to six scale called the kinsey scale (and there are psychometric tests to quantify this). This - i think - is why homosexuality is not in the DSM.

But if a person wants radical medical treatment (e.g. gender reassignment) there is a "duty of care" to determine whether they will benifit from this. So there needs to be a clinical guideline (including a DSM entry etc.) for assessing patients. Even if almost no patients who would not benifit demand the treatment, there is still a risk, even if we accept that 98% benifit from surgery/hormones from that stat quoted before, there's still the remaining 2% in that don't. It's worth a tiny bit of annoyance for the 98% in order to redirect the 2% into treatment which will be more suitable for their condition, given the surgical/hormonal route has quite high risks and the surgery is irreversable.

Quote from: tekla on August 27, 2009, 02:05:46 PMNo, there are certain thoughts and behaviors that pretty well mark it.

As there are with being trans.

Quote from: tekla on August 27, 2009, 02:05:46 PMAnd no one is really trying to fix gay people - outside of a few oddballs - so its a self defined sexual preference, not a DSM category.

But when it was in the DSM, most people thought gays needed fixing.  That's why removing TG from the DSM is an important step to getting people to realize we don't need fixing.

But you seem to think you think you have a problem of some sort? it seems to troubles you, and you seem to want a solution? it is a problem related to your body, so how or why is it not an illness? and untill there is some biological test (blood-test, brain-scan etc.) why is it not appropriate to descibe the illness in the only way it can be described, by psychology and behaviour?

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Post Merge: August 27, 2009, 08:40:33 PM

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You say there are thoughs and behavious which mark it, but that is exactly what they are looking for qwhen they define it in psychological guidelines. What else do you think they are doing? for example in this questionare in a paper from Zucker (i was looking into what he's been working on, there are probably heaps of others out there). It's just a way to better quantify the problem, and help to guide people towards solutions (bodily modification if that's what will make the patient happy) that will help them.

QuoteMale Version
01. In the past 12 months, have you felt satisfied
being a man?
02. In the past 12 months, have you felt uncertain
about your gender, that is, feeling somewhere in
between a man and a woman?
03. In the past 12 months, have you felt pressured by
others to be a man, although you don't really feel
like one?
04. In the past 12 months, have you felt, unlike most
men, that you have to work at being a man?
05. In the past 12 months, have you felt that you
were not a real man?
06. In the past 12 months, have you felt, given who
you really are (e.g., what you like to do, how
you act with other people), that it would be better
for you to live as a woman rather than as a man?
07. In the past 12 months, have you had dreams?
If NO, skip to Question 8.
If YES, Have you been in your dreams?
If NO, skip to Question 8.
If YES, In the past 12 months, have you had
dreams in which you were a woman?
08. In the past 12 months, have you felt unhappy
about being a man?
09. In the past 12 months, have you felt uncertain
about yourself, at times feeling more like a
woman and at times feeling more like a man?
10. In the past 12 months, have you felt more like a
woman than like a man?
11. In the past 12 months, have you felt that you did
not have anything in common with either women
or men?
12. In the past 12 months, have you been bothered
by seeing yourself identified as male or having
to check the box ''M'' for male on official forms
(e.g., employment applications, driver's license,
passport)?
13. In the past 12 months, have you felt comfortable
when using men's restrooms in public places?
14. In the past 12 months, have strangers treated you
as a woman?
15. In the past 12 months, at home, have people you
know, such as friends or relatives, treated you as
a woman?
16. In the past 12 months, have you had the wish or
desire to be a woman?
17. In the past 12 months, at home, have you dressed
and acted as a woman?
18. In the past 12 months, at parties or at other
social gatherings, have you presented yourself
as a woman?
19. In the past 12 months, at work or at school, have
you presented yourself as a woman?
20. In the past 12 months, have you disliked your
body because it is male (e.g., having a penis or
having hair on your chest, arms, and legs)?
21. In the past 12 months, have you wished to have
hormone treatment to change your body into a
woman's?
22. In the past 12 months, have you wished to have
an operation to change your body into a
woman's (e.g., to have your penis removed or
to have a vagina made)?
23. In the past 12 months, have you made an effort
to change your legal sex (e.g., on a driver's
licence or credit card)?
24. In the past 12 months, have you thought of
yourself as a ''hermaphrodite'' or an ''intersex''
rather than as a man or woman?
25. In the past 12 months, have you thought of
yourself as a ''transgendered person''?
26. In the past 12 months, have you thought of
yourself as a woman?
27. In the past 12 months, have you thought of
yourself as a man?

This is more designed to quantify the magnitude of GID for research, but the one in the DSM would be similar except it would be designed to characterise people in a more binary sense, "has GID" or "does not have GID". I should find the a copy of the DSM to show you. I really don't think your objection makes sense.

Quote from: metal angel on August 27, 2009, 06:53:43 PMI meant there is no TOOL for diagnosing homosexuality psychologically (i.e. no diagnostic guideline, no DSM entry) because there is no NEED for it.

Well, there used to be a tool in the DSM and you can go back to that time and use what they did then if you want to "diagnose" homosexuality.  But if I understand you correctly, since homosexual behavior is no longer in the DSM there is no need to diagnose it.  That's why TG should be removed, so people will stop diagnosing us and start giving us the medical treatment we need, covered by insurance.  Doctors will still require the two letters to cover themselves but at least our surgeries will be covered by insurance.

Quote from: metal angel on August 27, 2009, 06:53:43 PMBut if a person wants radical medical treatment (e.g. gender reassignment) there is a "duty of care" to determine whether they will benifit from this. So there needs to be a clinical guideline (including a DSM entry etc.) for assessing patients. Even if almost no patients who would not benifit demand the treatment, there is still a risk, even if we accept that 98% benifit from surgery/hormones from that stat quoted before, there's still the remaining 2% in that don't. It's worth a tiny bit of annoyance for the 98% in order to redirect the 2% into treatment which will be more suitable for their condition, given the surgical/hormonal route has quite high risks and the surgery is irreversable.

So you're saying because there's 2% of the TS population that might regret transitioning the rest of us need to endure testing, psychotherapy, years of waiting and who knows what else even though it isn't necessary for us?

While I believe it is advisable for someone to enter into therapy and give transitioning very serious consideration, if that same person wants to march into a surgeon's office, sign on the dotted line and plop down the cash to have their genitals revamped, I say let them.  What right do we have to intervene in their lives as long as what they do doesn't hurt us?  They can have FFS and BA without psychotherapy, why not GRS?

The idea we have to achieve 100% success is socialism on steroids. To say the 98% have to jump through hoops so we can weed out the 2% is simply taking things way too far.  If you're not certain you want to transition, then DON"T!  It's pretty easy.

It's a free country.  But it won't be if we keep trying to intervene in and control the lives of others who want us to mind our own business.

Julie

@ Metal Angel  Why are you asking these questions?  There are already guidelines to the treatment of Transsexual.  And it is called the Standard of Care.  And the AMA as already stated that the health care industry needs to cover all of our medical issues in the AMA Resolution 122 (http://www.thetransitionalmale.com/nctg1).

What is now needed is for the medical community and the health care industry to adopt the resolution and begin offering the needed hormonal therapy and medical surgeries.

Janet

and the sooner the better. It makes no sense to not cover something that is described as "a serious medical condition recognized as such in both the Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) and the International Classification of Diseases (10th Revision); and is characterized in  the DSM-IV as a persistent discomfort with one's assigned sex and with one's primary and secondary sex characteristics, which causes intense emotional pain and suffering;"

Some ignorant persons whom have been programmed by their culture and religion have opinions concerning gender needs. It can't be "fixed". 25  to 40 years ago a lobotomy was the option and thank God that is no longer allowed or we would be in big trouble. If an individual is told they have a disorder for long enough it becomes a disorder. Simply brainwashed by society. I agree 100% with Janet Lynn. Give me about $100,000 and I will fix it and give them change back.

Quote from: Julie Marie on August 27, 2009, 08:47:20 PM
Well, there used to be  But if I understand you correctly, since homosexual behavior is no longer in the DSM there is no need to diagnose it. 

Other way round, becuase there is no need to diagnose homosexuality they don't need it in the DSM.

QuoteThat's why TG should be removed, so people will stop diagnosing us and start giving us the medical treatment we need, covered by insurance.  Doctors will still require the two letters to cover themselves but at least our surgeries will be covered by insurance.

The problem in your argument here is that you can't claim medical treatment (especially not payed for by insurance or payed for by the governemnt) unless you have a diagnoseable illness to treat.

Untill someone comes up with a way to diagnose transexuality medically the only way to diagnose what you want to be treated for is psychologically.

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Post Merge: August 28, 2009, 02:29:31 AM

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Quote from: Janet Lynn on August 27, 2009, 10:58:41 PM
@ Metal Angel  Why are you asking these questions?
Janet

i don't see whats wrong with in being in the DSM? these days you can only be forcably committed etc. and made to endure pschological treatment if you are violent. what are you scarred of?

<sup>"* cured by materialism!" :eusa_think:

"Cure" as in relief of a medical condition or
hardening or solidification of a material?  :icon_chuckel:</sup>

Quote from: Genevieve Swann on August 28, 2009, 12:04:02 AM
I agree 100% with Janet Lynn. Give me about $100,000 and I will fix it and give them change back.

You can have that $100,000 and keep the change for a new wardrobe to fit your new body if you are treating an actual medical condition. But if you do not have an illness to treat then it's just plastic surgery, a luxury you can pay for by yourself.

If it is a matter of just wanting to be the other gender, then fair enough, it's your body, do what you like with it and pay for it yourself. But in every other context TS people insist that it's a medical condition, and insist that it's far more than meerly "wanting" to be the other gender?

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Post Merge: August 28, 2009, 12:42:52 AM

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i'm not supporting the foccus on the family types, i think they are as nutty as you think they are, i have pretty much zero tollerence for religious nutters.

i am defending the psychologists who asses people for SRS, and the researchers making a genuine scientific attampt to understand GID and improve treatment outcomes.

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Post Merge: August 28, 2009, 01:49:56 AM

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I definately DO NOT think that children should be forced into the social roles of their biological gender, but i also slightly worry that the TS community forces some people into bodies to match their behaviour, when at least a few of them may have been happier learning to love their body as it was and just being a feminine male/masculine female.

I guess on a personal level i am not totally comfortable with my gender, but i have an ideological objection to surgery and i am sure it wouldn't fix me. I think i could do with a good shrink really. I mean body modification is not right for me, other adults can choose it if they wish, and i'll happily pay the bill through my taxes if it is treating an illness. 

Maybe i'm just a bit bitter/disapointed that this comunity doesn't seem to be able to offer much advice except body modification, since i know that is not right for me.

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Post Merge: August 28, 2009, 03:26:42 AM

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Quote from: Julie Marie on August 27, 2009, 08:47:20 PM
they can have FFS and BA without psychotherapy, why not GRS?
Julie

They key difference is that FFS and BA are both entirely superficial and there is no loss of functionality, unless their are unexpected complications from the surgery but with a decent surgeon the risk is small enough to be considerred a reasonable personal choice.

With SRS (and to some extent hormonal treatments) there is a loss of functionality, mainly fertility, but also hormonal function.

Also BA and FFS would be at least partially reversable, whereas SRS removes tissues (the main one being the testicles, but also the erectile tissue of the penis) which are impossible to replicate the full function of with prostetics.

You may know it's what you want and you may have thought it through, but as responsible medical professionals they have a "duty of care" to confirm that every patient really has thought it through before they remove healthy organs.

The only thing I am afraid of is one else telling me what to do with my body and my life.  It is the same as it was with homosexuality.

There is nothing wrong with mt mind, it is the body.  And the is already a guideline for treating Transpeople, and it does not include shock therapy or being beaten down to conform.  Beat a dog enough, don't be surprised if it turns on you.  I don't need to conform to someone elses view of what I should be.  I did that and it nearly cost me my life.

Is that what I should do?  Commit suicide because they don't want me to be me?  BS.  Why must we be cured of this.  There is already a methodology in place to handle it.  And that is transition, HRT, BA, FFS, and finally SRS.

Just because you are not comfortable with you, why should that be a reflect of me or anyone else?

Get thee to a gender therapist and find your own 'cure'.  I have mine.  The only thing I ask is for the medical and heath care industry to follow the AMA resolution and cover it as they do any medically necessary procedure.

And as far as the children are concerned, they know that they a different.  Why should they be forced into a mold that they know is wrong and doing so will cause unrepairable damage to their young psyche.

Janet

your views on psychiatry are a few decasdes out of date, there are a few religious nuts trying to make people fit into moulds, but the grater majority of people working in psychology and psychiatry are trying to help them to be happy and well adjusted in whatever way seems most effective.

DSM stands for "diagnostic and statistical manual". Just think of it as a dictionary of all the medical conditions that you need to talk to the patient to diagnose, all the ones you can't detect with a blood test or scan? The entry may not even be used very much if patients can effectively self-diagnose, it's just kind of like an encyclopeadia of what's out there, all the different things that may destress a mind.

It seems to be the problem/illness is a missmatch. There is a healthy body, with an arguably healthy (but rather destressed) mind living in it. The problem is that they don't match. I can see why you want to treat the body rather than the mind, the mind is more "self", and out of psychiatric drugs VS sex hormones; genital surgery VS brain surgery; i'd probably change the body as well. But unless there is a way to diagnose it from the body's perspective, a psychological diagnostic definition seems appropriate.

Please stop accusing me of trying to make you conform to male behaviour. I think in an ideal world a feminine mind should be able to behave how comes naturally in a male body and be accepted for it. I think a healthy mind in a healthy body which are just a bit incongruous would be optimally treated by just making them get along with each other.

If the best way to makle you content is to get SRS then i think you should have that as easily as treatment for any other medical condition. But in order to provide health care in an organised and effective way, we need to define what we are trying to solve. Clear definitions of the condition being treated could help to demonstrait the success of treatment (HRT, SRS, etc.), which would help improve access to treatment.

Effective studies which examine and quantify the stress which GID causes is reduced by the treatments you seek it will help to convince health insurers and governments to help you pay for the treatment you want.

I have dealt the modern psychiatry, and none of them seem even remotely interested in helping me.  They give me anti-depressant drugs and books on everything else under the sun, but none of them have even talked about GID.  And that is why I am so against yet another document that avoids the issue.  The standard of care is the only guide that truly deals with the core issue.

The psychiatrists need to help the Trans community instead of trying to cure us.  SRS is not a 'cosmetic' surgery in the same vein as a face lift or even a BA.  Yes it is cosmetic in the fact that it improves the look of a certain part of the body. 

But if a person, who is horrible disfigured at birth, requests a facial surgery is it not to improve their outlook and life?   And it is cosmetic?  No, it is a necessary surgery and is generally covered by insurance. I was born with such a disfigurement and I am only wanting to be covered as the person in the example.

I have a diagnosis of GID, but the necessary surgery is called 'cosmetic', because the health care industry does not wish to cover it.  As I said in another thread, it is all about the bottom line and not taking care of the patient.

No one is accusing me of trying to make you conform to male behavior.  But many in the  psychiatry field do and mostly it is because of their views on Transsexuality and homosexuality.

Janet

Quote from: metal angel on August 28, 2009, 02:22:54 AM
The problem in your argument here is that you can't claim medical treatment (especially not payed for by insurance or payed for by the governemnt) unless you have a diagnoseable illness to treat.

My electrologist was hirsute.  A genetic female, she had to shave sometimes twice a day.  She had no physical problems, only the social problems with having to grow up a female with a beard.  Her insurance covered all of the electrolysis she needed to remove her facial hair.

Hirsutism was not in the DSM but she received the medical treatment she needed anyway. 

The AMA has already gone on record encouraging insurance companies to cover GRS.  That's the kind of direction we should encourage, not being in the DSM.

When your "condition" is listed in the DSM people think you have a mental problem.  I don't and I never have and I don't want some book to say I do.

Julie

<Z puts on stylish admin hat>

A reminder, expressing differing opinions and debating the issue is fine, but no personal attacks or thread will be locked!

Z

what was the personal attack exactly?

i thought i was sticking relatively well to attacking opinions rather than people, was i?

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Post Merge: August 28, 2009, 10:18:09 AM

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Quote from: Julie Marie on August 28, 2009, 11:52:54 AM
My electrologist was hirsute.  A genetic female, she had to shave sometimes twice a day.  She had no physical problems, only the social problems with having to grow up a female with a beard.  Her insurance covered all of the electrolysis she needed to remove her facial hair.
Julie

Well that's another miss-match problem, her beard did not match the rest of her body, but in that case both are easily recognised externally.

When all parts of the body that are biologically measurable match, but just don't fit the mind, it makes sense to have a psychological definition.

It may not even effect treatment on an individual basis, but it is useful to assess treatment outcomes etc. and therefor we need a definition for the condition?

And just FYI, can we lay off the stigma about mental illness please! I have quite a few friends and family who's problems are in the DSM, and they shouldn't be thought any less of than someone with a condition that isn't!

Quote from: metal angel on August 28, 2009, 12:08:29 PM
who made a personal attack?

In your above posts you say that in order for TG/TS people to claim medical insurance they have to have a diagnosable illness, and therefore it should be in the DSM.  I think you've been using the acronym too much and forgot what it stands for: Diagnostic and Statistical Manual of Mental Disorders.  "Mental Disorders" is a very stigmatized word, and I think most of us in this community would argue that TG-ness is not a mental disorder at all.

This does not mean it is not a medical condition that requires treatment, it just means its not a mental disorder.

Your specific quote was:

QuoteDSM stands for "diagnostic and statistical manual".

That's where you are making the mistake and perhaps not realizing exactly what you are implying when you say Transsexuality should be in the DSM.


edit:

Quote from: metal angel on August 28, 2009, 12:08:29 PM
And just FYI, can we lay off the stigma about mental illness please! I have quite a few friends and family who's problems are in the DSM, and they shouldn't be thought any less of than someone with a condition that isn't!

Just because something shouldn't carry stigma doesn't mean you can ignore that it does!  A Mental Disorder, stigmatized or not, is still something that needs to be *corrected*, which most Trans people do not want!  We do not want to be 'corrected' or 'fixed', just the freedom and opportunity to be who and how we want to be.

Ah well the D stands for diagnostic, the S stands for stastistical, and the M stands for manual, Sorry i left off the last two letters, but i thought that was pretty well implied. I mentioned repeatedly that it was for problems which involved the mind.

I have two problems with the vibe i am getting here:

1. What is so bad about having a mental disorder?!?!? like i just said, some of my best friends do. You complain a lot about stigma, so don't perpetute stigma for other groups!

2. You can argue that the mind is healthy but just missmatched with the body which is also healthy. But we can't have one set of books with mind problems, another with body problems, and have the missmatch in a category by itself. A comprehensive list of problems with sexual organs would include cases where they do not match the identity, a comprehensive list of problems with minds would include cases where they are in the wrong body.

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Post Merge: August 28, 2009, 12:31:40 PM

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Quote from: Ketsy on August 28, 2009, 12:19:34 PM
Just because something shouldn't carry stigma doesn't mean you can ignore that it does!

But can we at least try not to perpetuate the problem, please. This every minority for themselves thing is not going to help anyone.

Problem is, at this point in time, there's nothing we can do to prove that GID is a biological condition. It is, for all intents and purposes, the incongruence between who we are mentally and who we are physically that causes us distress. There's nothing wrong without genitals and chests other than they don't match who we mentally are.
If it can't be diagnosed physically, and we don't want it diagnosed mentally, then how are we to expect it to be considered an Actual condition for which we need medical help?

Quote from: Ketsy on August 28, 2009, 12:19:34 PM
We do not want to be 'corrected' or 'fixed', just the freedom and opportunity to be who and how we want to be.

The only place that "fixed" ever appearred was in the headline the OP wrote? this whole time i have been talking about "treatments" and "solutions"?

If the meidcal community have a propper definition of the problem they are trying to assist with, it facilitates study and discussion, and it more will likely improve the opportunities you have for accessing medical services you want than hinder them?

It is just a definition. As is stated many times on this site, cis-genderred people don't understand the needs of transexual people. Definitions are helpful for fascilitating communication.

thanks Miniar, you said it in a lot less words than i did.

Quote from: metal angel on August 28, 2009, 12:08:29 PMWell that's another miss-match problem, her beard did not match the rest of her body, but in that case both are easily recognised externally.

I think we are getting closer.  You recognize hirsutism as a mismatch because you see a woman who is happy being a woman with a condition that is typically gendered male. Women should not have beards.  This is social conditioning.  And women who do have beards should be covered under insurance to have them removed.  We seem to agree here.

But what if the "woman" is actually a transman and welcomes the onset of male facial hair growth?  And what if his parents see this as a mismatch and force him to have electrolysis? 

If society accepted a transwoman with a beard is mismatch, just like the genetic woman above, then the transwoman would also be covered by insurance for her electrolysis.  Again, social acceptance is key.

Quote from: metal angel on August 28, 2009, 12:28:24 PM
What is so bad about having a mental disorder?!?!?

Maybe you are okay walking around and telling everyone you have a mental disorder, but that's not my cup of tea, especially when it's not true.  Do that and watch the people around you walk away.  :icon_yikes:

When I went to visit a friend of mine in the hospital just after she had GRS, I was talking to a nurse.  She said GRS was new to the hospital and when the staff learned one of their doctors would be bringing in GRS patients, "We were afraid", she said.  Imagine, nurses, doctors and staff at a hospital being afraid because transsexuals were coming to their hospital.  That's the power of the stigma attached to having a mental disorder.

Meta Angel, we can agree to disagree and that's fine.  And if you want to go out on the mountain tops and scream "I have a mental disorder!", feel free to.  But please, don't try to drag the rest of us with you.  We don't want to go.

Quote from: Miniar on August 28, 2009, 12:33:13 PMIf it can't be diagnosed physically, and we don't want it diagnosed mentally, then how are we to expect it to be considered an Actual condition for which we need medical help?

For a long time fibromyalgia was considered to be a mental condition.  Doctors could find no way to diagnose it or find any physical symptoms for it.  So it became a "it's all in your head condition".  But because it was reported by so many patients and they realized there was a pattern forming here it became recognized as a medical condition.  Today they diagnose it based on the patient's description of their aliments.

Transsexuals have a long history of symptoms they have given to psychologists and doctors.  The Harry Benjamin Standards of Care addressed this and came up with a solution that works and most doctors follow to this day.  This is a tried and true treatment and it works far better than the treatment fibromyalgia suffers get.  So common sense says, accept it until you come up with something better. 

The AMA has accepted it.  We just need to get the insurance companies to do the same.  But they won't until it is removed as a mental condition.

Julie

OK gang,

I have been going over and over the original article and the posts and links here and I really wish I had something more intelligent to interject. To be more concise, I would have to do quotes and pastes of Metal Angel which would be about a yard long if printed.

First: Thank you Metal Angel for your time and patience in doing the research and footwork you have.

Second: I have to agree with nearly everything MA has said. I think there was a belief early on that MA was specifically advocating for Dr. Zucher which I have not found in re-reading the posts.

Third: I agree with the concept that until there can be found a medical/biological causation for GID, it is best left under the heading of Psychological Disorder whether specifically listed in the DSM or not. Most of our primary contacts are with the psychological community and it is their standards we first must meet.
I agree that the Benjamin Standards of Care are the preferred method of treatment and diagnosis, however, I am sure most would agree that even they should be upgraded to fit modern experience.

Fourth: Getting back to the initial article; I think there is fear that the appointment of Dr. Zucher gives him fiat and steering power over the committee. Here are the words from the APA itself regarding the new DSM and how the process evolved.

http://www.psych.org/dsmv.asp (http://www.psych.org/dsmv.asp)

Fifth: I do believe we, especially those of us who seek the surgeon's knife or hormonal therapy, must admit that what we seek is medically radical. And, being that the solutions are so very radical there must be a viable diagnostic procedure and regimen. The argument that "they removed Homosexuality so us too".. is not a valid comparison. For the Doctors, Endocrinologists, Psychologists, Psychiatrists, Pharmacists, and the entire food chain of professionals, they must have the backing of their professional community and standards to ensure themselves from suit, fraud and malpractice. Without them, we have nothing but our yearnings and no avenue of relief.

And lastly: We can not just have a "come on in.. you say you're transgendered.. ok, here's your pills, surgery is a week from tomorrow" approach. Most of us go through years of struggle and turmoil before we finally have just had enough. I went under the knife. I am ever so grateful I did.  My SO, who was also MtF when we fell in love was seeing the therapists, going to the doctors, on hormones and thought that surgery was for sure in her future. Over the years she wavered. Now he is a happy, quirky, androgynous male and I have never seen him more comfortable and relaxed with himself.

Our providers need to take their time. Need to be absolutely certain.. within their own minds before giving us our papers. It is their own conscience riding with us.  If they have doubts then they are obligated to stop and hold, for our sake as well as their own.

Sometimes the fix is the knife, sometimes it is attitude, sometimes it is finding the place you are comfortable and sometimes it is just letting Johnny find out how to be a boy who likes dolls.

Just my opinion.

Quote from: Julie Marie on August 28, 2009, 03:57:35 PM
For a long time fibromyalgia was considered to be a mental condition.  Doctors could find no way to diagnose it or find any physical symptoms for it.  So it became a "it's all in your head condition".  But because it was reported by so many patients and they realized there was a pattern forming here it became recognized as a medical condition.  Today they diagnose it based on the patient's description of their aliments.

Not exactly...
They listen to your description, then run a whole set of medical tests to rule out other causes, and then they do a physical exam where they apply pressure to a set of points on your body that are tender/sore in cases of fibromyalgia.
So there is a physical diagnosis system for fibromyalgia.

If we accept the idea that all people should be able to do whatever to their bodies they want without condition so long as they have the will and the money, then there is no argument to be had.  We should remove it from the DSM.

However, if we are not willing to accept that argument and believe there is a specific obligation amongst medical professionals to decide which procedures to perform and which not to regardless of money, we must have a specific criteria to determine when those procedures are and are not advisable.  That criteria can come in many forms.

Right now, GID is not able to be determined through any medical test.  By default, fortunately or unfortunately, it is considered a condition of the mind.  A seemingly well functioning male/female for some reason believes they are actually a female/male.  The best we can go with (currently) is that there is something up with that person's mind.

So if we believe that medical professionals have an obligation to decide who to and to not treat, and we accept they must have criteria to determine this, and we accept that right now GID is only diagnosable mentally, we need a mental-based criterion by which to judge it.

So where do we find a place that will allow medical professionals to determine criteria for mental conditions?  In at least America, the DSM.  Perhaps there are other places such criteria can be found in an official, peer reviewed place, ones with less of a stigma.  But even if we cannot find one, such criteria is not out of place in the DSM.

So as for "fixing" transsexuals, we have a current method that works for many (the SOC), but for it to work the best, we need criteria for those standards to guarantee the happiest results for those seeking this treatment for this condition.  To do that we need research.  A lot of research has already gone into the SOC.  But the nature of research is one that is never ending.  Just because we have one cure doesn't mean we should stop all research.  We hardly know everything there is to know about transsexuals, gender identity, or about potential treatments.  Because of this, research must continue, and we must not resist it.  Right now one of those foremost researchers, love him or hate him, is Dr. Zucker. 

We need more researchers.  We need more actively engaged in learning all they can about us - people who won't hold to archaic ideas about what it is to be male and female and are willing to look at us with a new eye.  We also don't need people so set in their ways on how to treat transsexuals; we need people researching new ideas and thinking outside of traditional treatments in order to find better treatments. 

The very nature of research is that often findings will make people uncomfortable.  Why?  Because they change our perception of our world.  Some of us like our world, we don't want it to change, but we should not stand in the way of this progress.  The best progress will occur so long as there is something to research.  Removing the condition from the DSM might diminish research from those who are working to help us as they put their efforts toward other listed diagnosable conditions.  Perhaps you think this is a good thing.  I personally do not, but that is my opinion. 

Bottom line: I don't wish to discourage research, and I believe that we need criteria to be used by medical professionals to know who and how to treat.

Quote from: Miniar on August 28, 2009, 07:08:08 PM
Not exactly...
They listen to your description, then run a whole set of medical tests to rule out other causes, and then they do a physical exam where they apply pressure to a set of points on your body that are tender/sore in cases of fibromyalgia.
So there is a physical diagnosis system for fibromyalgia.

Today, maybe, but when one of my kids was going through being tested, they had nothing to go on but the patient's word.

The first thing they did was rule out psychological causes.  (Sound familiar?)  Then they listened to the symptoms and tried to treat it with whatever they thought would work.  The doctor said the medical community had only just begun serious analysis of the problem because it was only recently considered a medical condition.

The important point here is, until fibromyalgia was no longer seen as a psychological condition, the medical community didn't bother to take it seriously as a medical condition and therefore there was little or no studies conducted to understand the cause.

As long as TG is considered a psychological condition it will continue to be treated as such and there will be very little progress in studying and understanding it's physical origins.

Julie

Quote from: Julie Marie on August 28, 2009, 03:57:35 PM
I think we are getting closer.  You recognize hirsutism as a mismatch because you see a woman who is happy being a woman with a condition that is typically gendered male. Women should not have beards.  This is social conditioning.  And women who do have beards should be covered under insurance to have them removed.  We seem to agree here.

well actually i think women should keep their beards, the world could do with a bit of variety, but not everyone feels as comfortable being unusual as i do, so if a womaan needs her beard off to fit in that's ok, and if a guy has that condition where he's wolf-faced then i think he should keep it, but if he doesn't want to he can have insurance/gov pay for removal.

QuoteBut what if the "woman" is actually a transman and welcomes the onset of male facial hair growth?  And what if his parents see this as a mismatch and force him to have electrolysis? 

well i'd see that as wrong to force someone to change themselves, i think that would be very cruel. But no more cruel for a transman than a Frida Kahlo.

QuoteIf society accepted a transwoman with a beard is mismatch, just like the genetic woman above, then the transwoman would also be covered by insurance for her electrolysis.  Again, social acceptance is key.

Well i would happily accept someone with a beard wearing female clothing, performing a generally female social role etc. But if said transwoman needed it removed to function, then i'll pay my taxes for them to have it removed, cheaper than antidepressants.

I've said this whole time that transsexuals have every right to do whatever they want with their bodies, and that if it is a need rather than a mere want (they need GRS to function in the world) then it should even be state funded.

QuoteMaybe you are okay walking around and telling everyone you have a mental disorder, but that's not my cup of tea, especially when it's not true.  Do that and watch the people around you walk away.  :icon_yikes:

No, i don't "(walk) around and telling everyone (i) have a mental disorder" because it's private, i'll even pretend i have something more vague if i can "i don't feel well". But i'd do the same if i had a gynocological problem, i wouldn't want the doctor writing the details of my medical condition in either of those areas on the sick note for my boss. But just out of a sense of privacy about both areas.

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Post Merge: August 30, 2009, 06:10:56 AM

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Quote from: Julie Marie on August 29, 2009, 12:20:53 PM
The first thing they did was rule out psychological causes.  (Sound familiar?)  Then they listened to the symptoms and tried to treat it with whatever they thought would work.  The doctor said the medical community had only just begun serious analysis of the problem because it was only recently considered a medical condition.

The important point here is, until fibromyalgia was no longer seen as a psychological condition, the medical community didn't bother to take it seriously as a medical condition and therefore there was little or no studies conducted to understand the cause.

I think the key problem was that in the case of fibro' the lack of explanation led to a lack of cure. In the case of TS there is a physical treatment which can work, so as long as the problem can be defined (even if currently that's only possibly psychologically) the medical comunity will play along.

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Post Merge: August 30, 2009, 07:17:53 AM

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i agree with everythng Shanawolf said, very well put :)

Interalia, i agree with what you said about research. In fact research into the most unusual conditions (e.g. GID) can tell us a lot about the human body and brain work which could help far more people than expected.

I've been reading your blog too, maybe some personal perspective from you would help Julie Marie and Janet understand that their approach might not be right for everyone. I feel a bit dodgy doing a cut-and-paste job from your blog though. Care to tell us a story?

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Post Merge: August 30, 2009, 08:20:33 AM

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Post post post script, the article in my signature (which there is another thread around here somewhere about) is another well put defence of GID in the DSM. From a more TS-perspective too, rather than my perspective which is that of a gender-queer sicentist.

I have no problem with research.  Maybe we can finally get GID recognized as a medical issue, not a psychological issue.

But what I fear is the thought process that we have to be made to feel comfortable in our birth gender.  I transitioned once back 25 years ago and detransitioned after a year.  And for those 25 years I attempt suicide three times.

Transitioning isn't for everyone, but for those of us who it is right: why must we be punished or discriminated against for trying to correct a birth defect?  I have never been happier than I am now.  I am finally being myself.  The only thing that is left is SRS. 

And because it is called 'cosmetic', insurance will not pay for it, so I am stuck half way in between till I can raise the monies.  Is it right or fair for those of us stuck in this transitional phase to be refused medical treatment?  It is life saving for many of us.  what would it take to have SRS covered by insurance?  Another attempt to take my own life, because some people just don't understand?

Janet

I was thinking about this last night, given SRS is so expensive, and is not something any normal  male would want, i think it should alwayse be coverred by insurance/gov and psychological assessment be made on patient choise and "best interest" of the patient. If those who needed it got it free and those who wanted it had to pay, too many people would be trying too hard to convince the system they really "needed" it and that would get in the way of propper care.

As for who gets the other bits and pieces and who pays... i think you'd need a health economics degree and a psych degree to work that out...

some people want all the rest but not SRS, and probably really "need" the all the rest bit, but how do you assess that, a guy who just doesn't like shaving should pay for his own electrolisis... gets real complicated...

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Post Merge: August 30, 2009, 04:09:36 PM

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I still don't get what's so bad about it being psychological?

If it is a mind-body missmatch, how is the body any more wrong than the mind? they're both wrong for each other, but each is (arguably) fully functional in it's own right. It's just a perspective issue as to which is wrong.

Would "neurological" be an improvement? My ex was bizarely proud when he found out that he had epilepsy not skitzophrenea, i don't understand why. Meant he got right meds, so i can see why he was pleassed, but not why he was proud.

It's easier to rewire the body than the brain.

Are people answering the question based on their own experience and understanding, or on simple financial considerations?

Quote from: tekla on August 30, 2009, 06:23:07 PM
Are people answering the question based on their own experience and understanding, or on simple financial considerations?

which question?

which question

Is it easier to fix the body or the brain, nether or both?

Quote from: metal angel on August 30, 2009, 05:06:28 PM
Would "neurological" be an improvement? My ex was bizarely proud when he found out that he had epilepsy not skitzophrenea, i don't understand why. Meant he got right meds, so i can see why he was pleassed, but not why he was proud.

But don't you see? Your ex did not want the Stigma of having a mental illness. Epilepsy is seen as a neurological problem and not a mental illness. This is Julie Marie's point in starting this thread.

Yes, I would like to have had my surgery paid for by my insurance company. That said, I don't think the trade off of the stigma label is worth it. Religious groups see that we are located near pedophilia and other parafilias in the DSM, and jump on the fact that we are whacked. I know of families where transpeople aren't allowed to see their nieces and nephews because we're not stable or a good influence. I once spoke to a nurse in a hospital that now treats patients having SRS. She said that until she got to know us, and got comfortable, that she was afraid of us. Haven't we seen Hollywood in the past even depict trans people as psycho killers?

I feel that being included in the DSM gives employers and others license to discriminate. That we can't be trusted with responsiblity or a security clearance. It also provides family or friends grounds for distancing themselves from us. Sure, I wish mental illness didn't have these effects, but that's reality.

Quote from: tekla on August 30, 2009, 06:23:07 PM
Are people answering the question based on their own experience and understanding, or on simple financial considerations?

For me, totally from experience.  Things I have learned in my life tell me if someone thinks you have a mental disorder, then you're nuts.  Your brain is screwed up and you're not normal.  "Get thee to a shrink!"  Nothing more can be done for you until the psychiatric experts fix your screwed up brain, if they can.  And most know if you're nuts you probably always will be.

Now, if you have a physical ailment, a birth defect, a disease, there's hope for you.  And, most importantly, it's not your fault!  So society gathers around you and cheers on your recovery.  After all, they may find themselves in your shoes some day.  But no one thinks they will end up "nuts" some day, unless it's Alzheimer's.

I grew up hearing people be considered "keep away" material because they were "mental", "screwed up", f----d up in the head".  You just didn't go near those people because you never knew what they would do next.  Even in prison, where you have the the worst of the worst, prisoners often steer clear of the mentally insane for the same reason.  People who would just as soon kill you as know you are afraid of those they think are nuts.

The stigma for being mentally "deranged" is deeply sewn into the threads of our society.  They tried to fix gays when homosexuality was listed in the DSM.  They ignored those with fibromyalgia until it was no longer considered "all in your head".  And they will continue to treat TG as a mental disorder until we get it removed from the DSM.  Don't count on it being covered by your insurance until it is.

We suffer dysphoria, the opposite of euphoria.  It is not a mental disorder.

That's my view, based on my experience, in almost 60 years of life on this earth.

Julie

Quote from: tekla on August 30, 2009, 06:23:07 PM
Are people answering the question based on their own experience and understanding, or on simple financial considerations?

Practical understanding.

I think that homosexuality, crossdressing, and TS are all traits of the mind. Difference being that CD and homosexuality are just unusual, they are not pathological because they require no treatment. In an accepting culture they cause no distress just slightly atypical behaviour. Almost like a skill, some people have minds with an unusual tallent for some particular skill, but homosexuality and CD are not a skill, just a neutral non-positive non-negative part of the normal variation.

But, correct me if i'm wrong, TS seems to cause trouble even in an accepting culture? And some people require treatment to be content, the most effecting treatment being physical transition?

If you are doing it purely as a choice then that's not a mental illness. If you COULD live as your birth gender, just you prefer not to, that's your choice, and it's certainly unusual, but not pathological. That's kind of how i used to see TS. But i keep hearing from the TS here that they NEED to transition? and i keep hearing that it's a medical condition, but there does not seem to be any identifiable symptom or functional deficit in the body? All the SYMPTIOMS are in the mind: distress, depression, anxiety etc. (as a point of interest euphoria is a symptom too, seen in bipolar for example, as part of the mania).

A lot of mental illnesses have a very organic cause, the ones we understand are often due to an excess or lack of certain chemicals in the brain. TS has some organic cause that canot yet be identified. Your theory about it being a healthy mind in a healthy miss-matched body may be right, but then there is in a weird way no illness... or you could say it's in both, the brain is wronong for the body AND the body is wrong for the brain.

I think of the DSM and similar lists as a list of all the eccentricities of the mind (not "defects" just differences) which have the potential to lead to distress.

I am really getting sick of you perpetuating the stigma of mental illness, running from the concept like the plague, i'm worried by how you'd treat a person who was associated with this concept you find so vile?

Quote from: metal angel on August 31, 2009, 06:36:10 PMBut, correct me if i'm wrong, TS seems to cause trouble even in an accepting culture? And some people require treatment to be content, the most effecting treatment being physical transition?

I see you're trying to get a grasp on something you don't understand.  And I don't want to kick a dead horse but engaging in an intelligent discussion can be beneficial.

An accepting culture would be the Native American tribes before English settlers came to this country.  In that culture they recognized transgender people as being a gift from the gods.  They saw TGs as gifted because they understood both males and females and could communicate with either.  Look up Two Spirit or Berdache and you'll find countless stories about our cultural ancestors.

You will also find none of the Two Spirit had anything physical done to them in order to conform to today's societally accepted physical gender expectations.  They didn't need to in order to lead normal lives (eg: not be discriminated against).  But they also did not have the same surgical procedures we know today.  So it's difficult to ascertain if the lack of availability of gender conforming surgery left them no option or if the way society viewed them (most were revered and given high positions in their tribes) was why they lived their entire lives with their birth genitals without any accounts of the type of dysphoria we hear about today.

Imagine you are born into royalty and seen by your society as being something special.  Why would you want to walk away from that?  Most wouldn't.

But that is not the case today.  Being TG carries a severe and horribly wrong stigma with it.  Those who are TG know this is undeserving.  So we fight it.  We also know we can't change what has taken centuries to develop.  So we take the best option and in the meantime try to chink away at the ignorance.

I can't say if I was born into a culture where being TG was honored or revered would have meant I would have not transitioned.  I'm guessing I wouldn't have.  It would have been a hell of a lot easier.  But that's not the case.  I played the hand dealt to me.  That's all you can do.  But I do know I will work, until the day I die, to make this world a better place for myself and my fellow TGs.

Julie

Ok... that makes a lot of sense, but it doesn't really fit in with the rest of your posts.

If that's the case, that it is healthy just not typical, to have a masculine mind in a female body, or visa verse, as i am inclined to believe, why are more of you not fighting for the right to live how you please in the body you were born in, rather than fighting for the right to go through the painful and generally unplesant process of physical transition?

Also, from what i read here in this forum, in severe cases of GID there is a certain deep distain for one's own body, which frankly seems kinda - for want of a better word - unhealthy? Or in the model you just presented, is that distain for "that thing between my legs" only analygous to the shame a homosexual would feel about their natural desires 50 years ago?

In which case, it seems you would be much better off fighting for a less gender-stricct world. Be a bit brave, and go out in pretty clothes with your own natural strong jaw line intact, etc. People should have the option to transition, but they should not feel that they "need" to, there shouldn't be this "transition or die" kind of mantra in the TS community.

BUT previously you and others have been adimently claiming that TS/GID is a "medical condition"? Some sort of natural defect which needs correcting? you have the "wrong" body, your entire self - with the exception of your mind and identity - is defective? Is there a contradiction here. Or do some of you feel you are ill and need correcting, while others just do not feel brave enough to live as a lady in a man's body in the current culture?

Quote from: metal angel on August 31, 2009, 10:35:13 PM
If that's the case, that it is healthy just not typical, to have a masculine mind in a female body, or visa verse, as i am inclined to believe, why are more of you not fighting for the right to live how you please in the body you were born in, rather than fighting for the right to go through the painful and generally unplesant process of physical transition?

I want to see both; we should have the right to live as any gender, at any point on the continuum, binary or non binary, with or without surgery/hrt. Without the imposed stigma of mental illness.

What feels right for me (at this time) is living somewhere in between/outside, however I defend the right of my sisters/brothers to do what is right for them.

Quote from: Julie Marie on August 31, 2009, 08:52:12 PM
I can't say if I was born into a culture where being TG was honored or revered would have meant I would have not transitioned.  I'm guessing I wouldn't have.  It would have been a hell of a lot easier.  But that's not the case.  I played the hand dealt to me.  That's all you can do.  But I do know I will work, until the day I die, to make this world a better place for myself and my fellow TGs.

I'm totally with you on this Julie!

Z

lets use th autism spectrum as an analogy?

I think being unusualy feminine or masculine for your biosex is just part of the normal variation of humanity, and largely a matter of finding a community which will accept you, or changing your own community for the better. Kind of analagous to a geek on the autism spectrum.

But if you are in the state of deeply needing to transition, and dispising your own body, not identifying your body as self, attempting self-mutilation (like the stories of people muutliating their gentials in their bathroom etc.)... then whatever caused that - medical quirk or sick society - that's psychologically pathological. Being feminine or masculine is not pathological, but those other symptoms are. Kind of like when you pass the threshold of geeky into full blown Asperger's syndrome and can't function in your socioty without frequent "autistic melt downs".

Another example even if you can blame culture for a lot of the motivation behind something like anorexia, it still develops into a neurological/psychological disease.

If you just want to transition but still have your free will and can function without it, that's non-pathological, but once you feel you have a medical need to transition there must be some sort of pathology going on.

Because my physical transition isn't about societies gender roles but my own comfort in my own body.

that statement is a decent description Miniar, helps me see your view a bit, but what is it a reply to exactly?

specifically it's a reply to the question

Quotewhy are more of you not fighting for the right to live how you please in the body you were born in, rather than fighting for the right to go through the painful and generally unplesant process of physical transition?

Quote from: metal angel on August 31, 2009, 10:35:13 PM
Ok... that makes a lot of sense, but it doesn't really fit in with the rest of your posts.

If that's the case, that it is healthy just not typical, to have a masculine mind in a female body, or visa verse, as i am inclined to believe, why are more of you not fighting for the right to live how you please in the body you were born in, rather than fighting for the right to go through the painful and generally unplesant process of physical transition?

We are fighting for the right to live our own lives without persecution or discrimination.  We fight for the passage of ENDA and other laws that offer protection but it takes decades to change the tide of societal thinking.  But there still exists the internal battle that can be fueled by simply looking in the mirror.  The person we see doesn't match who we are.

Quote from: metal angel on August 31, 2009, 10:35:13 PMAlso, from what i read here in this forum, in severe cases of GID there is a certain deep distain for one's own body, which frankly seems kinda - for want of a better word - unhealthy? Or in the model you just presented, is that distain for "that thing between my legs" only analygous to the shame a homosexual would feel about their natural desires 50 years ago?

In which case, it seems you would be much better off fighting for a less gender-stricct world. Be a bit brave, and go out in pretty clothes with your own natural strong jaw line intact, etc. People should have the option to transition, but they should not feel that they "need" to, there shouldn't be this "transition or die" kind of mantra in the TS community.

When you don't see the image in the mirror as being representative of the person in your heart and soul, you are at least uncomfortable with your physical self.  As we approach someone we are meeting for the first time, each of us will pass judgment, to some degree, on the person we are meeting based on their looks.  The first thing we do is gender them.  And from that we have certain expectations.  If your physical presentation is the opposite of your identified gender, you've done yourself a disservice and created a whole lot of work for yourself to undo what was just done.

To go out into public looking like half man, half woman will certainly cause most people to avoid you.  Why do that just so those who don't understand what's inside us won't feel uncomfortable about our desire to physically transition?  You say "be a bit brave".  There's a difference between that and social suicide and what you are suggesting can be social suicide.

Quote from: metal angel on August 31, 2009, 10:35:13 PMBUT previously you and others have been adimently claiming that TS/GID is a "medical condition"? Some sort of natural defect which needs correcting? you have the "wrong" body, your entire self - with the exception of your mind and identity - is defective? Is there a contradiction here. Or do some of you feel you are ill and need correcting, while others just do not feel brave enough to live as a lady in a man's body in the current culture?

I can only speak for myself here.  I can go back as far as my earliest memory and remember saying to myself, "I wish I was a girl".  That was long before I understood the social implications of being trans.  I knew I wasn't a girl and I knew that I wanted to be one.  It's pretty simple.  The mind and body were in conflict. 

You keep referring to bravery, as if that's all it takes to live the life we feel we need to live.  Would you tell someone who is afraid of a killer bee hive that all they need to do is be brave and walk up there and shake it?  No, because you know the outcome would likely be horrible.  That's not brave, it's stupid.  Suggesting a man walk around femininely attired (my mind thinks of the Redskins' hog fans) is asking for social ostracization, or worse.  You will soon find yourself totally alone.  The killer bee nest might be the better option than this.


I understand you don't understand what it's like being TS.  And it seems you are trying to understand but you are also focusing on things you believe in and not letting go of some ideas and concepts that you need to let go of in order to begin to understand the life of the TS. 

But what you are proving is this is not a condition that can be explained in psychological terms, just as a physical deformity cannot.  And that's what you have to accept in order to understand transsexualism.  It's not a psychological problem, it's a physical problem.

Once you can explain why the woman who is dysphoric, because she has a disfigured face she was born with, has a condition that can be cured through psychotherapy, then we can begin to discuss how to "fix" TSs.

Julie

I get your point from your drawing, but you can be a bit creative, you can be feminine without wearing things that don't suit you, don't wear a short skirt with hairy legs just like a woman who is over-weight should stear clear of hipster jeans.

The problem is in diagnostics, no-one - or almost no one - would want a cleft palate or missing nose. But most people who have XY chromosones want to look like a normal healthy male, there is a minority who do not, but the difference is not definable by any physical assessment.

Yes there is a solcial component, but the reason people feel the need to defy that social pressure is to do with the brain (call it "neurological" if you don't like "psychological") even if the pathology is social it is a definable trait of the individual best defined in the mind/brian?

Also there is some internal non-social component - the wrong face in the mirror effect. I guess the psychological effect of a deformity kind of makes sense, but some people would be happy with that face, or maybe just want it to be more handsome, again the difference is in the mind, and it's one that can only be detected by talking to the sufferer.

Feminine males, crossdressers, etc. are all just part of the spice of life, some of them may even decide to transition if they feel they canm better express themselves in that body and already have kids or don't want kids. But when people feel the need to transition, when they stop identifying their body as "self" that's a pathology of some sort. It could be very organic and neurological "wrong body map in the brain", but plenty of things in the DSM are very obiological (not enough of this or that neurotransmitter, or too much).

I think it's probably wrong and counter productive to have a gate keeper approach to surgery. Mainly because that leads to a patient giveing the "right answers" to get what they want, and that doesn't help anyone. It should be personal choice, people should not be excluded from transition for having different reasoning to "true" transexuals, mainly because so far the conditionis so poorly defined (exacerbated by people giving "right answers") that we can't know what on earth a "true transsexual" is.

But i think some sort of councilling is useful, to assess whether the procudure is in the patient's best interest. Just to check they are not a self-hating homosexual or totally psychotic. And to help them make an informed dicision for themselves. and to help them deal with the stress and social pressure of being mid-transition, which - as shown by your picture - must be quite stressful.

Also we need to define the phenomenon somehwere and somehow to study it. Quicker diagnosis of GID and who would benifit from transition may eliminate the stressfull step of the years of the "real life test. Better evidence for the benifits of transition may assist in arguing for better funding for it. Undertsanding unusual conditions like GID may help us understand and treat more widespread problems like the stress of having sexual organs removed because or cancer.

Also to me it seems at least a little selfish to get expensive surgery to fit in how you want to behave, rather than fighting for a better world... but if it's also organic/neuroligical it makes a bit of sense. (But hey everyone's selfish, i spend money on coffee while people around the world are starving.) I also worry that people who would be better with another approach feel a bit pressurred into full transition by the community by a narrow approach to the problem.

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Post Merge: September 01, 2009, 07:45:36 PM

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and i'd keep my beard, the neurological conddition your electorlosist sufferrs from is the opposite of mine, i am excessively autistic, she is deficiently autistic... i'll find the definition for it some time, it's partly a joke, but makes an interesting point. 

Well, from here on out it's probably just you and me, kid.  But that's okay.  You seem intelligent and really trying to get into the nitty gritty of transsexualism.  Who knows, maybe someday your work will lead to a groundbreaking discovery.  But then again, it may go the way that all the homosexual studies have.  Who knows?

Here's an exercise to stimulate your thought neurons - Let's say a person walks into a surgeon's office and says, "I hate my nose!  Everyone makes fun of me.  They look at me like I'm a freak.  I want it fixed!"

The surgeon looks at the nose and tells the patient his/her expectations can be realized.  The patient pays for the surgery, it is a success (as decided by the patient) and suddenly the patient, this person who hated his/her looks, is happy, outgoing and productive.  No more funny looks.  No more jokes behind his/her back.  Everyone raves how good he/she looks.

Would you call that a success?  Would you see that as a positive thing?  Would you be willing to say it's reasonable for medical insurance to cover such a procedure because the end result is someone who is happy and productive in today's society?

Or would you try to get that person into psychotherapy and analyze them, encourage them to see things from your perspective and ultimately try to get them to like themselves as you wish they could?

Or would you just say, "If that's what makes you happy, I see no problem with that."

Just curious.

Julie

Suggesting a man walk around femininely attired (my mind thinks of the Redskins' hog fans) is asking for social ostracization, or worse.

Unless of course you're at a Washington Redskins game, in which case you'll be one of the most popular person there.  Everything depends on situation after all, I can dress in stuff for work that few, if anyone else, could wear to work.  Girl stuff, shirts with the F word printed on them in large letters, shirts with naked women on them, it's all just rock and roll.  If I were a cubicle clown, I doubt if my boss would find it funny if I wore a shirt to work that said (as one of mine once said): "->-bleeped-<- you you ->-bleeped-<-ing ->-bleeped-<-."  But most things are situational.  What you wear to a beach in Chicago will get you arrested in Dubai.  Different strokes for different folks.

will certainly cause most people to avoid you
Get back to me on what that's a bad thing.  Most people should be avoided, and if you can get them to do that on their own, more power to you.

Quote from: tekla on September 01, 2009, 08:30:36 PM
Unless of course you're at a Washington Redskins game, in which case you'll be one of the most popular person there.  Everything depends on situation after all, I can dress in stuff for work that few, if anyone else, could wear to work.  Girl stuff, shirts with the F word printed on them in large letters, shirts with naked women on them, it's all just rock and roll.  If I were a cubicle clown, I doubt if my boss would find it funny if I wore a shirt to work that said (as one of mine once said): "->-bleeped-<- you you ->-bleeped-<-ing ->-bleeped-<-."  But most things are situational.  What you wear to a beach in Chicago will get you arrested in Dubai.  Different strokes for different folks.

Actually that's kind of what i've been suggesting a bit round here. People who can live with their body themselves but feel they can't play the role they want to in it need a new culture moore than a new body. Get a job in a reserach lab, or some other part of a university, or in rock music, find some new friends you can be yourself around, pleanty of places in the world where no one gives a hoot if you're a man dressing or acting like a woman.

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Post Merge: September 02, 2009, 12:30:01 AM

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Quote from: Julie Marie on September 01, 2009, 08:19:42 PM
Well, from here on out it's probably just you and Here's an exercise to stimulate your thought neurons - Let's say a person walks into a surgeon's office and says, "I hate my nose!  Everyone makes fun of me.  They look at me like I'm a freak.  I want it fixed!"

The surgeon looks at the nose and tells the patient his/her expectations can be realized.  The patient pays for the surgery, it is a success (as decided by the patient) and suddenly the patient, this person who hated his/her looks, is happy, outgoing and productive.  No more funny looks.  No more jokes behind his/her back.  Everyone raves how good he/she looks.

Would you call that a success? Would you see that as a positive thing?

I guess so, for that individual, it's a reasonable course of action if they can afford it. It's not the way i'd do it for sure, but if the patient is genuinely improved in outlook/productivity it may be good for them and those around them.

Personally the i like the world's natural variety (my partner has a slightly crooked nose and i think his nose is just perfect, it is unique, i think it is one of his most attractive features), but it effects the patient more than me so it's their choice.

QuoteWould you be willing to say it's reasonable for medical insurance to cover such a procedure because the end result is someone who is happy and productive in today's society?

I guess for privbate insurance there should be consumer choice, some policies which fund cosmetic procedures and some which don't, with the difference in cost reflected in the premiums. But i'll take about a public health system perspective because that's what i'm familiar with. There are many reasons why public health systems should not fund plastic surgery. A few of these reasons kind of inter-relate but i'll try to break it up.

It is too expensive, and there are higher priorities. It may help the patient but i don't think any genuine improvement has been sufficiently demonstraited to justify the expense at a population level (see below re psychology). But if the patient is willing to pay for it they should be able to obtain it privately under safe conditions which are monitorred by public health autorities.

It is not correcting a functional deficit, the purpose of healthcare is to treat disease, not to beautify and normalise. If they had trouble breathing, eating, or speaking it is a pathology to treat, if not, it's just aestetic and kind of a lusxury/low priority.

There is a bit of a grey area here of social exclusion, facial deformities can cause people a lot of trouble. If they lacked a nose entirely or it hung down past their chin etc. it may be justifyable to fix it at public expense. I guess the cut off i'd place on it would be whether the nose is one that someone else would possibly be happy with. But i think even if they have a very unsual facial feature, care should be taken not to make them feel compeled to change it.

The compulsion to change it is abnother reason i would be reluctant to publically fund plastic surgery. If the health system deems having a nose with a bit of personality sufficiently pathological that they willing pay to change it, that puts undue pressue on people to look "normal" and idealised. It puts more psychological pressure on those who would not otherwise want to change. I get this kind of worrying vission of going outside and everyone looks like barbie... very expsensive, and probably not a healthy culture.

If they have a "normal" functional nose but it causes a functioal deficit psychologically to the degree where they cannot get on with life, I confess i am not a psychologist, but i would say that this is a psychological illness. It is actually a sign of what my foggy memory tells me is called "body dismorphia", and to the best of my memory this is a sign that the patient will not benifit from surgery. I would actually consider this sort of symptom possible grounds for not allowing that patient go through with surgery even at their own expense untill they have tried psychological cures. a body-dismorphic patient usually isn't happy with fixing just one part and will often get so much surgery that they end up with actual deficits in physical function. (I'm pretty sure that's in the DSM, but i forget where to find the on-line copy of it on my uni website...)

Actually to me transsexualism seems slightly similar to body dismorphia? Except transsexuals more often benifit from surgery than body dismorphics do. I think this would be due to the different goals. Transsexuals feel the need to be the other gender, their goal is usually to look like a "passable" member of the opposite sex, so there is kind of an end in sight for their surgery, they have a somewhat acheivable goal. Whereas a body dismorphic patient seeks to look "perfect", they have a less acheivable goal, and will likely not be satisfied by any amount of surgery.

QuoteOr would you try to get that person into psychotherapy and analyze them, encourage them to see things from your perspective and ultimately try to get them to like themselves as you wish they could?

I think that should be an option for them, but i don't think they should be compelled to go for councilling if they don't want it.

I don't think it's worthwhile doing any extensive patient screening councilling for a minor procedure like a nose job (except possibly in the case of suspected dismorpihia where some councilling may be required before surgery is offerred as an option), but i think they should (and do?) have a discussion with the patient about any risks of surgery, their reaons for wanting it, and whether the results are likely meet their expectations.

I would also think that councilling - if they were willing to co-operate - may be more worthwhile on a public health level on a cost/benifit basis. I don't know what a new nose costs but a psychologist costs about $100 to $150 (Australian) per session. So 10 sessions at $100 each ($1000) may be worth a shot if they can show the same effect as nose job because they are probably more affordable (I assume a nose job is more than $1000), and there is pretty much no risk to the patient whereas surgery carries some health risks, and psychology may treat any underlying self-exteem issues etc. which the nose job would not.

QuoteOr would you just say, "If that's what makes you happy, I see no problem with that."

Up to personal choice. If it genuinely makes them happy it's up to them.

But, like i said above, i think they should pay for it out of their own pocket, because it's not a high priority, it's not correcting an actual defect, and the benifit per expence has not been adequately demonstraited on a population level.

QuoteJust curious.
Julie

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Post Merge: September 02, 2009, 01:32:05 AM

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Actually distinguishing transsexuals (who often benifit from surgery) from body dismorphics (who generally do not) is one of the reasons to keep both in the DSM.

Actually i reckon they should put homosexuality back in, just with a big headding saying "normal variation: no treatments required or available".

Quote from: metal angel on September 02, 2009, 02:47:40 AMActually i reckon they should put homosexuality back in, just with a big headding saying "normal variation: no treatments required or available".

Be careful where you say that.  You could get your head taken off.   :icon_chainsaw:

Read the wole sentence.

I think the DSM should be expanded to include normal variations, not just pathology, i can't think of any other examples though except vague personality types. My main point of having some of the normal variation in there is that it may reduce the stigma of GID and other things being "in the DSM".

The sub pathological range of a lot of conditions is in there implicitly, maybe make that a bit more explicit, it would help to better define the pathology. Like separating healthy perfectionism from OCD.

I really can't think of any healthy variation in humans which is as distinct as homosexuality which isn't in the DSM though. Can you? (Genuine question i'm stumped and curious)

GID probably belongs in there so it can be distinguished from conditions like body-dismorphia and psychotic delusions. A way to define those who may benifit from medical treatment (because no biological tests exist). Being free socioty etc. patient chooses treatment, but medical professionals should advise and guide.

Unless there is an imminent risk of death, the way to define a disease as opposed to normal variation is just whether it bothers the individual and interfears with them getting on with life.

Separating off a portion of the human race as defective is just fascist. That was my point. Having a book of pathologies in something as foggy as the mind is maybe a bit of a flawed mission from the start, why not turn it into a book of variations. With notes on how to deal with the dificulties some of them may cause in extreme cases.

I have a bi-polar friend who has a mild case and doesn't medicate it because she thinks the manic phases are better than being normal at times. She tends to just monitor it to know how to live with it, and control her intake of recreational drugs to keep it in control (e.g. no coffee when manic). So lets take bipolar out of the DSM...

I have Asperger's syndrome, but i don't need meds (i don't even think there are any) and i get on in life a lot more successfully than a lot of "normal people" (higher grades at school, pretty easy time finding jobs etc.), i just need a few extra/different skills for coping with day to day stress... OK Asperger's is out of the DSM...

I show some OCD symptoms but my constant checking means i never loose my wallet... OCD goes out of the DSM...

Being depressed after a death in the family is perfectly normal... so that goes out of the DSM... continued or unprovoked depression is a medical condition caused by a chemical imbalance in the brain... depression goes out of the DSM... (and someone had better work out quick a biological test for that biological problem to keep the suicide rate down...)

Some people hear voices but can learn to live with it and even find it helpful and comforting. There is a group called "hearing voices" who support this ... audable delusions and skitzophrenea go out of the DSM....

getting to be a rather skinny book isn't it?

Homosexuality almost never causes any problems in it's own right without the help of an intollerant culture, so it's ambiguous as to whether there's a point having it in there at all. There is not really such thing as "extreem" homosexuality when it turns pathological. It might be useful to have it in there with "normal variation: no treatments required or available" to emphisisse that it is perfectly healthy and distinguish it clearly from things which can casue more problems, and it can be a distinct trigger of distress e.g. if the person also suffers from the delusion of there being a supreem being who hates them. Just a thought.

GID does seem to belong in there though. Though some people are happy to cross-dress etc. and some people pragmatically take extreem measures (surgery etc.) to fit into an unaccepting gender binary world. Some people seem to have distress caused just by the GID itself ,without much in the way of obvious social pressuere. Those who define it as a "medical condition" and feel they require corrective treatment. Untill someone finds a way to see this elusive "wrong body map" or whatever the cause might be, the only way to diagnose this medical condition is psychologically.

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Post Merge: September 02, 2009, 10:46:49 PM

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homosexuality and asperger's do seem kind of analagous actually... there is no extreme homosexuality which is equivilent to autism so the similarity is not total, but to me there seem like a lot of similarities in that it's a normal variation which can cause trouble in an unaccepting society.