Enjoying some debatating in my area.
theres more rumors than information how things will go and it seams it all depends if we can make a changing now, because we currently have a goverment system who is more transfriendly but probably won't last for too long.
So theres been a couple of suggestions on how to impove the threatment of transgender, they seams pretty good but one kinda bothers me.
it says:
"transpeople should give provements from a doctor that they do not suffer from serious mental illness"
May sound fair, but it dose worry me cause, when is a mental illness too serious to not getting a permission to transition?
another thing is theres also transgender like myself who have been into the current system and have been dignose with things we can't reconize ourself with because the system as it is now dont really seams to understand the concept of transgenders. Those dignose are unfortunatly very hard or imposible to get rid of and will be on your paper for the rest of our life.
the suggestion dose not say anything about us who are in that situation?
--
So im sceptical, but it said we would need this limit to be taken seriously and get the changing done who however would make the life better for alot of transgender, the problem is there may be people who get stuck in this, But if it said we should all be free the agument is we would not get the goverments accept to change the current laws?
So what do you think?
is it worth making the changing for most people knowing some will not be included?
dose it sound fair offer?
which mental illness would be included?
Is there anything ells who could be done who would be a better solution?
A diagnosis is an assessment performed at a specific time. When time passes and underlying conditions evolve and change then the original mental health diagnosis may be altered or changed.
If a person is not stable then transition may feel better in some ways but cause a significant increase in stress that may exasperate the underlying mental health condition.
Everyone is different and treatment pathways always encroach on the individual variances.
To answer your question, if a person is too mentally ill then the approach would be to address the mantel illness. It is uncomforting having others control a destiny. I believe in informed consent but the person must understand the ramifications of transition.
My understanding is that some mental illness can disguise itself as trans feelings. This needs to be addressed first. I do think many things considered mental illness should not be considered as an impediment to treatment.
I have an ex-gf who is due to have SRS next July 2014. I fear that they will grant her the approval to do so before addressing what I believe may be a borderline personality disorder. Money is no object for her so her transitioning has gone pretty quickly in comparison to other situations.
She's not addressing the fact that transitioning fully could definitely worsen her personality disorder. She may experience the intolerable body syndrome meaning that she will never be happy with the way she looks/carries herself as a woman. I wish her therapist would delay the SRS until they take good therapeutic steps to treat the personality disorder.
But what if a doctor refused you of much needed trans treatment because he said you had a condition that needed treating before you could be treated about your trans issues. Maybe your trans issues are what is causing or worsening your mental illness. I feel this may reinforce the gatekeeper attitude among medical and psychological professionals.
Quoteintolerable body syndrome
I don't know what you mean by this. I would assume your friends therapist knows of the personality issue. The therapist probably has considered it in the decision to write the letter for SRS.
LordKat, that's just the 'Catch 22'; she's manipulating her therapist in convincing her the primary issue is her gender dysphoria. This is her 3rd therapist. I don't believe she has the letter for SRS yet?
Quote from: Kaitlin4475 on December 23, 2013, 05:07:57 PM
But what if a doctor refused you of much needed trans treatment because he said you had a condition that needed treating before you could be treated about your trans issues. Maybe your trans issues are what is causing or worsening your mental illness. I feel this may reinforce the gatekeeper attitude among medical and psychological professionals.
From that perspective, perhaps you take a chance and allow SRS hoping that they stay in therapy and work on the other issues? If you are narcissistic or a sociopath, the chances of that happening are slim-to-none.
It isn't likely she made a date for SRS without at least the promise of a letter if she doesn't have one yet. It usually takes 2.
The problem is, suggestions like this are the exact reason so many transpeople feel pressured into manipulating their therapist. I mean you are there for treatment of your gender issue, yet there is an underlying fear that you may have to appear "normal" or at least a textbook case otherwise, the therapist may think you have too many other issues or your heart isn't into it, etc.
I am sure there are people out there, where refusing to treat them may well be the right course, but how could this decision possibly be made? After all how does one define how bad the other issues are, there is no defined line as far as I know. If you are not functioning well at work because you are all out of sorts from your gender issues, and it makes the therapist think your snapping at work is indicative of bipolar disorder then isn't there a serious chicken and egg issue here? Which issue is causing the other, because if the pressure from gender issues is causing the bipolar behavior then treating the bipolar behavior is never going to solve the issue.
The way I see it a therapist cannot read your mind, and even if they could lacking the context of your life experience wouldn't your thoughts basically be meaningless anyway? Regardless the OPs question was is it fair, and I can't see a way that it is; but it certainly would seem prudent in certain scenarios to request someone deal with certain things before gender issues, however unless you are at the point of being committed aren't you sane enough to make your own choices in the matter?
Does dealing with your TG issues allow you a better life? The oft quoted stat is that about 35% of pre op TG women attempt suicide at least once. hence it seems obvious that being 'allowed' treatment will alter that. The para-suicide rate in post op women was 32% in that study (Steve Whittle UK survey based on a cohort of 3000 European woman). The conclusion was that clients needed help to deal with issues other than their GID to live a normal life.
So the inclination is to deal with those issues first.
I'm a therapist, but not with specialisation as a transgendered issues. I'm going to comment, about times I've been used by clients as a barrow for their purpose.
There are two 'kinds' of being used, for the purposes of this topic. One is for malevolent purposes, and one for benevolent. Malevolent is the scary client who has a hidden agenda that is about being devious to strip someone else of wealth, status, privilege or power, for a self-serving agenda.
That's totally not the trans-gendered variant. That is, deceiving your therapist is not malevolent for this topic area.
To mask your true emotional experience, to get what you want from the 'system'--that's your right or choice. If you were my client, and you were transgendered seeking a rubber stamp from me for your journey, I'd know full well that there was likelihood you'd be doing your darndest to get what you wanted. I'd like to think I'd be working with you, not against you, and help you to find what it was you wanted for your, not my journey. That's what we mean by 'client-centred care'.
That would mean you wouldn't need to hide. Gender dysphoria is your tool of language and experience to communicate your needs and extract what you need from a parenting system that puts professionals as the gate keepers.
But, I've read enough at these boards and been a therapist long enough to know that what I also would *not* want for you, would be for your to *regret* your decision and experience your choice as 'a mistake' after-the-fact (post surgery).
That's the flip side of gate-keeping. There are consequences for regrets. To avoid those, again, my job is to help you define your journey and experience as being those in your keeping and power. A famous Australian psychologist's words, Dorothy Rowe, have stayed with me for over 20 years. She said "if you don't tell others the truth, at the least, make sure you tell yourself the truth" and that's good enough, I have found, for making a wonderful life. I do not always tell everyone the exact 'truth', and no one does.
I've also been around long enough to know that those who are not genuine and open with their therapists, ultimately, have that right, but that you reap what you sow, whether or not others know about what you are seeding.
Be you. You are good enough. All that you are is part of your exceptional being and be authentic to your own journey. Live long, love well, and prosper.
Quote from: stavraki on December 24, 2013, 08:24:33 AM
That's the flip side of gate-keeping. There are consequences for regrets. To avoid those, again, my job is to help you define your journey and experience as being those in your keeping and power.
OK, fair enough. But where is the line drawn, when you have a client who THINKS they have seen all the angles, have given it the requisite thought but you feel otherwise? Are you ethically bound to do what you can to protect them from an unwise choice? Or are you philosophically bound ultimately to accept their choice?
I ask this from the point of view of someone who just spent most of the past year with my therapist weighing the pros and cons of surgery and deciding that despite the difficulties I will better off getting SRS, only to have the psychologist I hired to evaluate me for the second letter, refuse to write it. Not only that but he somehow convinced my therapist to withdraw her support as well.
Mental illness happens to everyone. It stands to reason that trans people would be affected as well. To deny someone treatment because of this is something I do not agree with.
Work with the client to address issues, yes, but those issues aren't going to be addressed if the client feels they need to lie to get the treatment they need.
Also, what if someone has been diagnosed with a mental illness, but those issues have already been addressed? The label follows you for the rest of your life regardless.
Quote from: suzifrommd on December 24, 2013, 09:00:50 AM
OK, fair enough. But where is the line drawn, when you have a client who THINKS they have seen all the angles, have given it the requisite thought but you feel otherwise? Are you ethically bound to do what you can to protect them from an unwise choice? Or are you philosophically bound ultimately to accept their choice?
Good questions. Personally, I hate being parented and having my autonomy stolen from me from an overly parental/parentified state. We have too many laws, too many ideas about how to limit behaviour and too many litigants. Civil action.
My view, and it's only mine on ethics, is that 'the devil's in the detail' of ethical codifications. You mention that ethics and philosophy (of morality) are not really innately aligned. People say that 'moral people are ethical people'. The answer to that is 'well, often yes, but also, no--inherently no as well'. Consider this: at the core of the client-therapist relationship are five moral principles: autonomy, fidelity, non-malefasence, beneficence and justice. Those are deeply ensconced in professional practice and laws governing regulation of the health-care industry. It's the autonomy moral fundament that is most truly violated by ethical codification. Because, the minute you 'prescribe' (parentify) a process, you are stripping a being of their auntonomy, on some level, by forcing adherence to an ethical principle. You (The State) is forcing compliance of the therapist, limiting another's autonomy. We do this, because people understand that invading autonomy sometimes saves lives because sometimes people, what? lose judgment, make bad decisions? so we parent them, like we do children, to stop them harming themselves or others. I dunno about all that. I really don't. In this topic area, the 'ethics of parenting others through gender dysphoria'. I.e. 'stripping them of some autonomy because "we" know better'. Hmm, there's an arrogance in that, I believe, perhaps in the profession as professional arrogance?
Where's the line you ask? I don't really know. But, what I do know is that were there no laws, and were the client truly empowered to define their own journey, they also have the 'right to make my own mistakes and live with the consequences'. That also includes, if you look deeply, and implies that litigation and consequences to *all* others for your own decision become irrelevant, null and void, and so *no* other then becomes the focus, either of your happiness or unhappiness about your choices in transitioning.
That second extreme has other problems. In our society--a deeply prejudiced one against trans-gendered people--I do not believe that the soul can truly be abandoned to themselves, to suffer from prejudice, without consequence to the prejudicial majority who cause harm by transphobia, etc.
QuoteI ask this from the point of view of someone who just spent most of the past year with my therapist weighing the pros and cons of surgery and deciding that despite the difficulties I will better off getting SRS, only to have the psychologist I hired to evaluate me for the second letter, refuse to write it. Not only that but he somehow convinced my therapist to withdraw her support as well.
I have great empathy for you here. "Therapist Be Gone" is what I want to scream. They probably have some diagnostic issue that they are concerned about, either of Axis I or Axis II pathology, (and our diagnostic system is deeply flawed, don't get me wrong here). Alternatively, they are the hyper-vigilant anxious therapist, afraid of post-surgery litigation in a world gone completely mental about legal consequences.
Did they explain what the blockade was?
Split personalities, delusions, schizophrenia are all very real. Combine those with varying degrees of psychopathology, and a therapist may not be keen to help a patient with TS issues first.
Quote from: LordKAT on December 21, 2013, 02:54:06 PM
My understanding is that some mental illness can disguise itself as trans feelings. This needs to be addressed first. I do think many things considered mental illness should not be considered as an impediment to treatment.
And trans feelings can disguise itself as a mental health issue.
iirc, the SOC 7 includes DID ("multiple personality") as one of the conditions that often (not always--see "underlying conditions" for further clarification) seems to lessen or resolve once HRT is begun.
I would think that every case is different, and there shouldn't be a hard-and-fast rule "If thou art Mentally Ill, Thou Shalt Not receiveth thine Hormonesth Replathment Th'rapy." Far too many variables, imho imho imho
<---shut up, me! And me too! :-X :'( ;)
Quote from: Missy~rmdlm on December 24, 2013, 06:06:13 PM
Split personalities, delusions, schizophrenia are all very real. Combine those with varying degrees of psychopathology, and a therapist may not be keen to help a patient with TS issues first.
An extreme of pathology. We say in my trade that 'certain pathologies compromise insight, and so, for those conditions, we take control of the other soul 'for their own good' we cry'. Supposed delusional disorders, psychoses, and also manias. Split personalities (dissociative identity disorder), people argue the same 'which personality wants to transition?'. Yet, even for these, evolution (or God if you want to go that way) built us with the propensity for conditions, apparently, 'without insight'. Why? We're still struggling with what a lapse in insight means for the mentally ill minority. They don't experience their universe that way. 'We the people' assume that 'you the mentally ill with psychosis' are not seeing clearly. Can we really know that?
But this more often constitutes the processes at work:
Quote
And trans feelings can disguise itself as a mental health issue.
iirc, the SOC 7 includes DID ("multiple personality") as one of the conditions that often (not always--see "underlying conditions" for further clarification) seems to lessen or resolve once HRT is begun.
I would think that every case is different, and there shouldn't be a hard-and-fast rule "If thou art Mentally Ill, Thou Shalt Not receiveth thine Hormonesth Replathment Th'rapy." Far too many variables, imho imho imho <---shut up, me! And me too!
Although DID is an extremely rare condition.
How do we tease apart the true 'gender dysphoria' diagnosis from more general mental-health pathology asserting itself (e.g. internalised homophobia for the person who changes sex to resolve self-disgust about same-sex attraction).
I've seen a number of post-transition-blues assert themselves for people in their new lives who now are unrequited, still on some fundamental level. There are also the group who are happy post transition.
I wonder what core features distinguish the two groups.
I'll put this the more concrete way:
1. Marcia has DID. Her three personalities are John (male), Steve (gay male) and June (lesbian female). Steve's happy to be a female cause he gets to have sex with men. June is happy for the three of them to be female because she likes women, but that puts the lesbian at odds with the gay guy, not the straight one on this occasion. John, though is antagonistic to the idea of transitioning: he's boofy and likes his penis. It's Steve who is the dominant personality, but only in therapy. Steve's the only one that knows what to say to the therapist about his feelings. John doesn't like talking about his feelings and June thinks her feelings are none of the therapist's business. The therapist is unaware of June and John. Steve deceives the therapist and gets the Green Card to get the chop, cause he likes the idea of the 'numbers' -- more men to choose from than in the gay world.
Is this the 'wrong' outcome, just because Marcia has DID, or is the 'balance of happiness' resolved because in the female body, only June is unhappy, where previously, Steven didn't want to have sex with women and June did.
2. Steve has a psychosis. He believes he is the Apostle of Christ and the Harbinger of the Antichrist. In his reality, he wants to transition so that he can please God (by being a heterosexual female, not a gay male) and please Satan (by being a deceiver of men, to trick heterosexual men into having sex with a male disguised as a man. So this 'Sin' is experienced as deeply pleasurable by Stavroula (post transition, the female) and also as Holy by Stavroula because she has pleased God by expressing her sexuality as a straight woman.
Stavroula is happy in her new body. Loves her job, still talks as 'Jesus' and also 'the Antichrist' in her nightly prayers, has a lot of friends (goes to Church on Sundays and Satanic Mass on Saturdays), doesn't break laws (the immorality/morality schism is all she needs to enjoy herself) and loves and hates everyone all at once!
Who is some Doctor whatsit to really say that either choice is 'bad' or 'should be stopped'?
and...thinking through the conventional lenses of society: therapist principles
1. Client autonomy
2. Beneficence (to good)
3. Non-maleficence (do no harm)
4. Fidelity (to *the client's needs*)
5. Justice (for whom?)
Caste those through the last post--the two 'mental illnesses'. How do they apply? Is the assumption to 'cure pathology before surgery' appropriate? DID is an extremely profound and lasting condition. Psychosis? Some cultures shaman-ise 'psychotic' people and put them at the pique of the social slag heap. It's just bossy, 'dadsy and mumsy' Western doctor-know-it-alls who think that 'those with mental illness need me', and Western socialisation that puts mental illness as stigmatising. Psychosis has positive course and outcomes in societies where the 'seeing and hearing' things are heeded as socially significant messages.
And maybe the problem is that our technology for 'shape shifting' is too young, expensive and inaccessible. If you could go into the 'morphoplasticer reconfigurer-re-isationa-ominter-machine-thing' for a hundred bucks, and change gender, boob size, penis size, skin colour, height, hair colour and eye colour, man, who the heck wouldn't do a few transition-eroonies. I'd sure as heck enjoy being black, hung and tall for a while. And I know that I'd love to be a woman as tall as a Valkyrie. I'd love to look like Belinda Carlisle in her prime, and sure as heck would be all over Bruce Lee for a while.......
:)
Quote from: stavraki on December 24, 2013, 05:36:19 PM
They probably have some diagnostic issue that they are concerned about, either of Axis I or Axis II pathology, (and our diagnostic system is deeply flawed, don't get me wrong here). Alternatively, they are the hyper-vigilant anxious therapist, afraid of post-surgery litigation in a world gone completely mental about legal consequences.
Did they explain what the blockade was?
I don't think they had any concern about a psych diagnosis, or if they did, they didn't share it with me. I am a well-adjusted, happy, professional person who has successfully parented two children into their teen years. I've given no one any reason to question my competence.
The evaluating psychologist told me two things. First, that it was premature to write the letter. I was only four months into RLE, (though my surgery is scheduled for the week my first year completes). He told me it was possible I would change my mind. I asked him if he was insisting that I wait until the RLE is over and then write the letter during those hectic few days before surgery. He said no, he would write a letter ahead of time, just not THIS far ahead of time. I asked him what the difference was, and he couldn't give a straight answer.
His other concern was that my wife might take me to court for "alienation". I told him that was a risk I was willing to take, but I could tell by his body language that whatever I said in response to this ridiculous statement was a waste of breath.
After my regular therapist also said she too wouldn't write a letter, I spent 40 minutes on the phone with her. She said she didn't think it would help writing the letter when I was not far enough in to my RLE (this directly contradicts an email from the surgeon, who said she would take letters whenever they come.) By the end of the phone call, I had convinced her to write me the letter (which she did), but I'm still $190 poorer for paying the second guy with no second letter.
Quote from: suzifrommd on December 25, 2013, 07:30:53 AM
I don't think they had any concern about a psych diagnosis, or if they did, they didn't share it with me. I am a well-adjusted, happy, professional person who has successfully parented two children into their teen years. I've given no one any reason to question my competence.
Right, so it's not like you haven't been thinking about this for like a thousand aeons and not like you haven't given your life decision some extremely long consideration of your innate 'wyrd' (it's a good old fashioned word. One's Wyrd is their innate reason or expression of their 'is-ness' or 'Am-ness').
QuoteThe evaluating psychologist told me two things. First, that it was premature to write the letter.
Right--pretty patronising towards you. I'd be cross/angry here if I were in your shoes. Given what I assume is your Wyrd of being (see above). He's/She's (its/they) are using the word 'premature' rather disingenuously. What I see is what I sometimes see in my therapist colleagues: the word 'premature' is actually about something about the doc that he's throwing at 'you'. And that is about our society that the doc's trying to be obedient to--the authorities of law governing his practice.
But, right there is how the ethical principle of 'client autonomy' is being invaded by a Code of Ethics. That is, morality and ethics are in contradiction here.
If I imagine myself in your shoes, some part of me is experiencing the contradiction and that's triggering my inner fighter. Which, hurled at the therapeutic community, will be interpreted by a psychiatrist through professionalised language as 'your transference--you're adolescent rebellion against me, and so dear client, of course, we know better and you're giving us exactly what we need to justify--delaying your letter. So in our care-team meetings, we're discussing you as the impulsive adolescent, whose judgment is occluded because you are rebelling and while you are rebelling, we need to contain you until things take their appropriate course. You will do what we say: you will wait'.
I will add some suggestions at the end about how to tackle this, as a client. :)
QuoteI was only four months into RLE, (though my surgery is scheduled for the week my first year completes). He told me it was possible I would change my mind. I asked him if he was insisting that I wait until the RLE is over and then write the letter during those hectic few days before surgery. He said no, he would write a letter ahead of time, just not THIS far ahead of time. I asked him what the difference was, and he couldn't give a straight answer.
Okay. Then, the 'hyper-vigilant professional psychotherapist, who is self-focussed upon his/her (the
professional's)
anxiety about
consequences caused by litigious client who changes their mind, post surgery, for premature rubber stamping of access to surgery.
QuoteHis other concern was that my wife might take me to court for "alienation". I told him that was a risk I was willing to take, but I could tell by his body language that whatever I said in response to this ridiculous statement was a waste of breath.
I wasn't there to hear the other side of the conversation. My first point.
But--at face value, given what you are saying, this feature is only his/her concern,
to the extent that he/her (your therapist's responsibility is to)
bring it up in therapy. But here's the clincher, so that
you can decide whether or not and when that ('that' being 'your wife's alienation') matters. Beyond that point,
not the therapist's role--ie not right to
use that (
that being
'I'm your wife's defender') as justification to obstruct you.
QuoteAfter my regular therapist also said she too wouldn't write a letter, I spent 40 minutes on the phone with her. She said she didn't think it would help writing the letter when I was not far enough in to my RLE (this directly contradicts an email from the surgeon, who said she would take letters whenever they come.) By the end of the phone call, I had convinced her to write me the letter (which she did), but I'm still $190 poorer for paying the second guy with no second letter.
Smells of cat poo dressed up in cellophane paper. I see what you mean.
I'll put the suggestions/ideas for you in my next post.
thank you for being patient with me to bring me up to speed. It can be very frustrating to get a whole, multi-month process summarised, in text, to educate the reader. I'm appreciative of your patience.
Here's some tools to tackle this:
1.
The Analysis: Is your therapist having a counter-transference that is contaminating their decision making. In this case, my tool for you to use as you would, were the words 'the hyper-vigilant therapist', who is 'anxious about civil consequences' and whose 'anxiety is self-focussed, not client focussed' and so is using the word 'premature' to
'protect themselves, not you'.
2.
Things to Be Wary of: 'the psychotherapist ready to pounce' on you and attribute your pressure to rush this forwards as about 'the pathological you': dear client, you're being delinquent. You are battling your parents, coming out in this battle against me, your therapist. Your pressure to proceed quickly is pathological and you're being impatient. We have laws to delay this for a reason.
So, be aware of this and actually use it to your purposes:
*Another way* to put people's obstructions as the food and vehicle for your progression:
3.
Self-protectively: to your therapist: therapist, I am feeling infantilised by the parental process involved in transitioning. I have teased apart, from my transference, which part is about the teenage rebellion in me, and which part is about the invasion of my autonomy by the process of therapy, misused. I'm wondering if the process is becoming
iatrogenic for the client. (Look up the word - it means 'the therapeutic process as causative of illness, not healing' - entre here
core therapeutic principles:
Non-malfeasance.
Beneficence (see earlier post).
Stated in plain language: make the therapist self-reflective. Get his monkey off your back, so that you can deal with and understand your own process.
4. I have some questions for you, dear therapist :)
- Are you having an anxiety-counter transference as my therapist, worrying about what's going to happen to you, if you release the letter and I transition and then change my mind?
- I'm wondering how my wife's potential alienation is your responsibility. Can you clarify that please. I can assure you, I have spent a lot of time on this one. I may lose my wife, and I am aware of that, but how have you formed the conclusion that I am not aware of that?
- When a client is being directive of the process, and not a passive recipient, are you (dear therapist) experiencing that as a counter-transference. Are you, not me being the rebelling adolescent because I am being directive?
5. Have yourself truly in a position where you will take responsibility for post-operative feelings. All that means is - ask the question 'if I wasn't at odds with my therapeutic team, how would I truly feel at this point'. Make this
entirely about you and your Wyrd.
summed up:
Psychiatry might be 'clever' but not always 'smart'. When you say to a psychiatrist "I am feeling infantilised by being parented" some will grin in that ghoulish way, as their eyes tell you 'got you now'.
When the rhetoric starts, ask them questions.
"are you suggesting that invading client autonomy, by imposed delays, is not potentially iatrogenic, for that group of clients, who have the sense of self to know what's best for them. (that is how to ask a psychiatrist the question 'you don't always know what's best for me, you just think you do', by making them responsible for their own profession--power has responsibilities). And the question is also 'or are you suggesting that the therapist is always right?"
And one for your own community:
It's the two groups of trans-gendered at opposition. On the one hand, those who are being pushed by the gatekeepers to 'wait'. On the other, those post-op/transition attacking psychiatry because 'you got it wrong, my transition was a mistake, and you didn't realise it doc. I'm coming to get you'.
what should we do about this?