Quote from: Keroppi on November 08, 2010, 04:13:41 PMI understand the opinion that since people are going to self med anyway, then let's provide the information for them to do it more safely. However, since most posters are not actual experts, anything they state are at best hearsay.
No, actually some of us do provide well-referenced documents. You don't have to be an expert yourself to be able to share expert references.
Quote from: pebbles on November 08, 2010, 12:40:57 PM
Of course it can be, So we have to provide accurate and non-misleading information about those hazards and allow an individuals at the end of the day to make an informed choice and respect that they made that choice with all the facts for themselves regardless of whether we would have picked that path or not.
Yup, gatekeeping is entirely bad because of how it affects our honesty and personal development. We certainly shouldn't be the ones acting as gatekeepers in front of fellow transsexuals. For a few references on how this affects people here are some quotes from a paper I'm preparing for the Danish National Board of Health...
From Standards of Care for Gender Identity Disorders:
"Belief in the true transsexual concept for males dissipated when it was realized that such patients were rarely encountered, and thatsome of the original true transsexuals had falsified their histories to make their stories match the earliest theories about the disorder." (5, s. 3).
further
"Ideally, psychotherapy is a collaborative effort. The therapist must be certain that the patient understands the concepts of eligibility and readiness, because the therapist and patient must cooperate in defining the patient's problems, and in assessing progress in dealing with them. Collaboration can prevent a stalemate between a therapist who seems needlessly withholding of a recommendation, and a patient who seems too profoundly distrusting to freely share thoughts, feelings, events, and relationships." (5, s. 12).
From Counselling and Mental Health Care for Transgender Adults and Loved Ones:
"Clinicians conducting assessment prior to initiation of hormones or surgery are in a "gatekeeper" role that involves a power dynamic which can significantly affect therapeutic rapport (Rachlin, 2002). The client often perceives the evaluation not as a desired tool to help them therapeutically determine a plan of action, but rather as a hoop that must be jumped through to reach desired goals, a frightening loss of physical and psychological autonomy, or a type of institutionalized transphobic discrimination – as psychological evaluation is not required for non-transgender individuals requesting hormones, breast augmentation, or hysterectomy (Brown & Rounsley, 1996). In BC, surgery assessors are appointed by the BC Medical Services Plan, further reducing clients' sense of choice about the assessment process.
(...)
Normalizing emotional reactions clients commonly have (e.g., anger, anxiety, fear) and also the common behaviours (e.g., trying to tell the assessor what the client thinks they want to hear, being belligerent/uncooperative, being manipulative) helps frame this as a systems issue rather than a personal power struggle. Discussion about what the assessment process involves (discussed in the next section) is imperative as client anxiety or anger is often heightened by inaccurate understanding of the process." (7, s. 19).
Madeline H. Wyndzen, Ph. D. writes:
"At one time you couldn't transition if you weren't completely 'homosexual' because *obviously* a 'real' female is completely heterosexual. As transsexuals discovered this bias, they lied in order to get surgery. Fortunately today most gender clinics accept sexual orientation and gender identity are distinct." (32).
Yolanda LS Smith, Ph. D. states:
"In most SR applicants the motivation for engaging in psychotherapy is very low. For some because they expect that all their problems will disappear after obtaining SR. Others do not confide in the therapist because they, sometimes correctly, expect to be denied SR, when they are open about their problems."
[Smith, YLS. Sex Reassignment: Predictors and Outcomes of Treatment for Transsexuals. Universiteit Utrecht, 2002. s. 23. URL: :
http://igitur-archive.library.uu.nl/dissertations/2002-0808-103443/inhoud.htm]
Anne Lawrence, Ph. D. declares:
"postoperatively collected data may be more accurate in some ways than data collected preoperatively, because it is less likely to be distorted by selective reporting or deliberate dissimulation, which transsexuals sometimes believe are required in order to obtain surgery (Lawrence, 1997; Walworth, 1997)" [Lawrence, AA. Factors associated with satisfaction or regret following male-to-female sex reassignment surgery. Archives of Sexual Behavior, Vol 32, 2003. pp. 299–315.] (s. 312).
Johnsson and Wasserzug writes in a study:
"Cohen-Kettenis and Pfafflin noted that such individuals ''seek contact with medical professionals to have surgical or chemical castration only.'' What Cohen-Kettenis and Pfafflin did not emphasize was the difficulty that these men face given the available diagnoses in the DSM-IV. Many fit the GID-Not Otherwise Specified (GID-NOS) diagnosis in the DSM. However, it is our experience that an ''NOS'' GID is sufficiently vague that it is more of an obstacle than an aid in obtaining a referral for an orchiectomy in most parts of the Western world. In many places, it will not get them access to hormones either. This leaves the individuals two options: they can lie about the nature of their GID and claim that they are male-to-female (MtF) transsexuals in order to obtain hormones or an orchiectomy, or they can go outside of the established medical system for treatment." (30).
Jay Prosser writes in an antology of transsexuals:
"In effect, to be transsexual, the subject must be a skilled narrator of his or her own life. Tell the story persuasively, and you're likely to get your hormones and surgery" [Prosser, Jay. Scond Skins: The Body Narratives of Transsexuality, 1998.].
Judith Butler writes:
"one has to be gauged against measures of normalcy; and one has to pass the test. (...) The price of using the diagnosis to get what one wants is that one cannot use the language to say what one really thinks is true. One pays for one's freedom" [Butler, J. Undoing Gender, Routledge, New York and London, 2004. s. 91].
From a wikipedia-article:
"Legal needs such as a change of sex on legal documents, and medical needs, such as sex reassignment surgery, are usually impossible to obtain without a doctor and/or therapist's approval. Due to this, many transsexual people feel coerced into affirming pre-ordained symptoms of self-loathing, impotence, and sexual-preference, in order to overcome simple legal and medical hurdles. (Brown 107) Transsexual people who do not submit to this medical hierarchy typically face the option of remaining invisible, with limited legal options and, possibly, with identification documents incongruent with gender presentation."
[Sex reassignment therapy I: Wikipedia, 27. maj 2010. URL:
http://en.wikipedia.org/wiki/Gender_reassignment_therapy]
Marissa Dainton was quoted in The Guardian:
"Dainton says patients encourage each other purposely to avoid discussing issues that might hold up their treatment. "Most people who go to psychiatrists with a view to changing gender have actually researched and know a lot of the things they should say - and some of the things they should stay clear of."
[Batty D. Mistaken identity. The Guardian, Saturday 31 July 2004. URL:
http://www.guardian.co.uk/society/2004/jul/31/health.socialcare]
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