Gatekeeping

Informed consent is the only way to go with people who are legally and factually able to decide for themselves how their life, their body, their gender should be. that does not say those who are somehow not able to express themselves (in this area) should be excluded for not voicing their need. They are just mostly not understood. Each and every psycho/medical intervention needs to be for the benefit of the one who needs it. Using medicine differently equals cruel, unusual treatment or even torture. Like forced sterilisation of women because they are of the wrong class and ethnicity.

Nor do we call for the abolition of any and all social, psychological or even psychiatric involvement in the decision process towards social and physical gender transitions. However the respective professionals just not have a decisive nor obligatory and coercing role. They must be there if we need them, when we need them, as we need them.

Yes, this is a first attempt to sketch an ideal situation and it is of course a situated one, from a situation where there is in principle a well organised health care system. Without this being available and accessible other practices will develop that may be just as valid. In all cases the free will of the applicant (better than client or patient) is leading. Not a medical or state requirement.

idahot

Medical requirements are only acceptable in so far as they area a technical requirement. Like blood works before starting transitional hormone treatment. Classically called sound grounds for a certain order are not merely technical but often also moral. Like testosterone use before chest reconstruction. Professionals have to get used to a multiplicity of body images and gender identities.

Trans* and gender variant people may have mental health problems – like so many others. In that case these issues need to be attended – as with everyone – but they are not be default a game breaker for medical assistance in gender transition. Not even for scrutiny – other than with everyone. Trans* and gender variant people demand equal and just treatment to all others (ought to have). So away with required psycho screening before entering medically assisted physical gender transition.

The question that leads me to writing this article is why the hell do they (the legal and medical professionals) still wish to treat us differently? Why the hell don’t they listen to our strong wishes and our pain of living the ‘wrong’ life, our stories how our lives so often are prevented full bloom by restricting, refusing norms and values in society that we call cisgenderism and transphobia.

All over the world doctors and psychologists have learned to be the expert. But expertise does not come from applying text book knowledge but from listening to real people with an open ear and an open heart. Stand next to your “patients” instead of hovering over them with an attitude of superiority.

Politicians and lawyers need to stop legislating what does not need legislation. Only in a conservative model that refuses the basic equality of people often codified in constitutions and for sure in human rights treaties, there is a reason not to.

The world is changing, dear doctors and lawyers and politicians. And the world has always influenced lives so don’t be so surprised that we suffer from injustice. Instead become a bit more modern and realise the ivory tower is crumbling down, being permeated by the real world. You can try to contain all variation, but you can not extinguish it. Reason why legislation and practices like in Uganda, Nigeria, Russia, Lithuania, attempts by the Catholic Church and narrow-minded US religious ‘leaders’ are not only unjust, inhuman and discriminating, but in the end also futile. Just: to the cost how many lives? How many people will it take until those powers that be realise they better modernise? Or didn’t we grow over slavery and patriarchy? Don’t we have human rights discourse and legislation that all oppressed take as their tool of preference, their common discourse for change?

 

Gender dysphoria

When someone is diagnosed with gender dysphoria you are already ‘too late’. Damage is already done then, the person developed “gender stress”. Now the job is relieve the stress without imposing roles or assuming identities. This is the more true where it concerns minors.

Gender teams have a morbid focus on an imposed psychiatric disorder. Transsexuality or no transsexuality is go or no go. Unhappy but not transsexual? Sorry you are too light. All is focused towards gender reassignment.

If cisphobia was real ..

Quite some people who do not understand the concept of trans discrimination think that trans people are exaggerating when they complain how they are seen, treated in society. To counter that or at least enlighten through putting trans* experience as the norm. Then cis people (non-trans people) would be the ones being discriminated.

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Niet meer geld maar andere zorg

Daags na de aanname van de wijzigingen voor artikel 1:28 BW, de wet op de geslachtsregistratie, kwam het VUmc met de melding: “We hebben miljoenen extra nodig want we kunnen de zorg niet financieren”. En vandaag kwam de pers met een update. Het ligt uiteraard weer heel anders. Hier in het kort de problemen en de doodsimpele oplossing.
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Transzorg zonder diagnose. Wanneer?

Voorlopig niet. Want de meest nabije progressieve wijziging in classificatiesystemen – staat het er niet in, dan wordt het niet erkend – geven ons nog altijd het label “gender incongruentie” of “genderdsyforie”. En omdat het gender betreft dat met geslacht te maken heeft, krijgt het een speciale lading. Tegelijk zijn er mogelijkheden tot een andere benadering van zorg die her en der al werkelijkheid zijn. Dit artikel gaat daar nader op in.

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Mensenrechtenrapportage 2013

Er is weer een jaar voorbij en het College voor de rechten van de Mens in Nederland vraagt  weer om input voor de jaarlijkse rapportage. Hier is de onze.

Geacht College,

Evenals vorig jaar willen wij u deelgenoot maken van onze zorgen op het gebied van de naleving van mensenrechten in Nederland. Continue reading

Training in trans* and intersex rights

From the beginning of 2014 Vreerwerk will offer a training in human rights with a focus on transgender and intersex issues. This course aims at staff of government and inter-governmental and non-governmental organisations, students and activists interested in trans* and intersex issues that need a basis in human rights for their work, but are not looking for an expensive academic course. Continue reading

Trans in the head

Earlier I argued that trans* is not a disorder and that the problem is more likely with transphobia than with gender variation. I showed how much we are stuck in binary thinking that needs to get rid of its expectations of universality. A way out may lie in the concept of “fuzzy sets”. In the future, trans is in the head.

Who enters into combat against the idea that trans people would have a mental disorder, would best give perspectives for another way/outcome/solution. That is why we look amongst others to Ecuador.

In the end the battle for trans rights is not about identities, One should be able to freely live the gender identity one feels comfortable with. Since we have a basic right to identity, this should not lead to so many issues, we should be able to continue building a lovely en just world. Alas the struggle for identity (instead living and celebrating identity) is being used in a power struggle to privilege a particular conservative morality. The fight for identity is only a small and bloated (inflated) part of a broader struggle for justice. Though not everyone makes that step from acknowledgment to further action.

Only a small group of the trans* population enters (medical) transition. Some 12,5% in the Netherlands. Many do not because they do not want to, do not  dare or just cannot. Some love comfortably in two genders or fluctuate between two genders, others again just don’t take gender as a reference point anyway. Gender queers who throw the system over board  in that sense don’t have much with identity struggle either. Except that you must be able to be or to become whoever you feel to be. Afterwards: shall we now continue to change/improve the world?

Ec-psi-2

Some good developments in the direction of autonomy and respect come from the Spanish speaking world. More and more you encounter the term “trans en la cabeza” there, “trans in the head”. That idea leads to a totally different, not by default male or female, gender expression. oftentimes no medical intervention either which in turn has to do with archaic and arrogant treatment y psychiatrists, that mostly check if you are “trans enough”. Partially this (trans in the head) is rather sub-cultural, partially it is mainstream.

In Ecuador mostly trans people so seek medical assistance, be it official or not. Apart from the ID card that needs to be adapted to the gender one lives in. For that a campaign is waged these days, titled “Si es mi cédulo, tien que ser mi género”, “My ID must read my gender”by the organization “Cuerpos distintos, derechos iguales” (Different bodies, same rights). They warn for colonial concepts when the psychiatrist presses forward western ideas of how masculinity and femininity. In this sense the struggle for trans rights fits well in current anti colonial struggle.

This leads to a multitude of bodies and identities and thus to an explosion of what we understand by “men” and “women”. A revolutionary development: less than ever identity will relate to being born in a certain body and more to a certain conviction. Also it is a revolutionary appeal to the human right of autonomy of the body. So revolutionary alas that frequent and fierce resistance of the gender powers that be is to be expected. Nevertheless this is the way forward and we are on our way.

 

Nothing but fear

The current health care model for trans * people many times is defended as protecting the patient. Protecting them against regrets. A physician wants to be sure the patient they see, is serious, is not acting on impulse. This worry we can understand, the solution however is wrong.

A large part of the worries that physicians have regarding autonomous trans people comes from fear and ignorance. Fear of loss of work and also loss of authority.

Fear of people taking decisions they will later regret and will hold the doctor responsible for. Only to bring them before the disciplinary board. That is traumatic for the physician, when they have done their best to deliver a good job on explicit request. Incomprehension because they do not understand trans* people. They haven’t learnt a thing about them during their studies of psychology, psychiatry or medicine. And if something is taught, that is mostly rather out of date. Only this year thinking progressed slightly with the introduction of the new DSM and a new nomenclature for trans* issues.

A trans* patient does not need more or different protection than a non-trans* patient. Just as a Swedish patient needs no more or better protection than a French one. Where a doctor cares for the mental health of a patient because they do not appear to be stable, this mental stability is the problem. Not the being trans* of the person. The question should be: If I would have a patient with an appendicitis, or for cancer surgery, would I also require a psychologist’s certificate about their well-being? The fact that something is culturally loaded, is not enough reason to as for extra intervention/extra control.

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Also everyone has a right to regret. However cynical that may sound. It is very well possible a trans* person who comes out is not sure of themselves. Identity develops. The same with gay and lesbian and bisexual people. Many times they are not coming out because they feel so great with the idea. Often they only do so when a lover is in sight, although they feel their being different for a much longer time already. They don’t need to see a psychologist, they have no longer a disorder (since 1991). Not coming out, living a non-authentic life, is something you can regret also. Like you can regret marrying, or not marrying. Or having children, or deciding not to have them. No one can tell if things will work out the way it was intended. So I would almost state: also trans people have the right not to be happy with their life and their choices. It is anyway not up to the state or the medical profession to always try to prevent us from failing, from regretting. Or should we also send prospective parents first to a psychologist or sexologist? Prospective spouses to a marriage counselor to have their love tested on stability, on longevity?

That fear we would decide for ourselves, for prosecution because they helped the ‘wrong’ trans person also stems from fear and ignorance. First of all, informed consent should be a requirement. With or without a psychologist, if the patient doesn’t understand what is involved, at is where it ends. Secondly, it won’t be the first time a medical psychologist would be involved when a patient has to undergo invasive treatment. But not all patients that undergo say oncological treatment will have to see a psychologist.

When society stops freaking out about trans* people, the suffering will decline enormously. After all, it is the outside world that gives us a lot of our trouble. And we as a part of that world got the message that it is not good to behave as we do, to feel like we do. So, stop freaking out and join the revolution. We are nothing more than a threat to your mental status quo. So what.

(Translation of “allemaal angst”, that appeared here on 21-12-2013)

Allemaal angst

Ik hoor het huidige zorgmodel voor transmensen nogal eens verdedigd worden met het argument dat men de patiënt wil beschermen. Behoeden voor fouten. En ook dat een arts zeker wil kunnen zijn dat de persoon in kwestie het meent en niet in een opwelling besluit. Nou is die angst begrijpelijk, maar de oplossing is dat niet.

Eigenlijk komt een groot deel van de zorgen van de medici voor autonome transen voort uit angst en onbegrip. Angst voor verlies aan werk en autoriteit ook. En zeker ook angst voor mensen die besluiten nemen waar ze later op terug komen en waarvoor ze dan vervolgens de arts voor de tuchtraad slepen. Dat is traumatisch voor de arts, wanneer deze zhaar best heeft gedaan goed werk te leveren op expliciet verzoek.
En onbegrip omdat men transmensen niet begrijpt. Men heeft er niets over geleerd tijdens de studie pyschologie/psychiatrie/geneeskunde. En meestal is dat wat men eventueel leert erg achterhaald: pas dit jaar is het denken officieel wat opgeschoven met de nieuwe DSM.

 

056Een trans* patiënt hoeft niet beter beschermd te worden dan een niet-trans* patiënt. Zoals een Franse patiënt niet beter beschermd hoeft te worden dan een Nederlandse. Wanneer een arts zorgen heeft omtrent de geestelijke gezondheid van de patiënt omdat deze niet stabiel overkomt, is die geestelijke stabiliteit het probleem. NIet dat die persoon trans* is. En dan dient men zich af te vragen: als ik een zwaar bezorgde patiënt voor een blindedarm ingreep, of een kankeroperatie binnenkrijg, zou ik daarbij ook eerst van een psycholoog een verklaring omtrent zhaar welzijn willen? Dat iets cultureel beladen is, is nog geen reden om extra controle te vragen.

Verder heeft iedereen het recht op fouten. Hoe cynisch dat ook moge klinken. Maar het is goed mogelijk dat de trans* persoon die uit de kast komt niet zeker is. Identiteit ontwikkelt zich ook. Holebi’s zijn ook vaak helemaal niet zeker als ze uit de kast komen, en doen dat vaak pas als ze een vriend/in/g krijgen, terwijl ze hun anders-zijn al veel langer voelen. ZIj hoeven niet langs de psycholoog, zijn niet meer ‘ziek’. En van niet uit de kast komen, niet waarachtig leven, kun je ook spijt krijgen. Zoals van trouwen, of juist niet trouwen. Van kinderen krijgen, of juist niet aan kinderen beginnen. Wie zal zeggen dat het altijd goed gaat? Ik zou bijna zeggen: ook transen hebben recht op ongelukkig zijn, op fouten maken. En het is zeker niet aan de staat of de medische wereld ons daar per definitie voor te proberen te behoeden. Of moeten mensen die kinderen willen ook eerst langs de psycholoog of de seksuoloog? Wie gaat trouwen langs iemand die hun liefde test?

Wat betreft die angst voor zelf besluiten, voor vervolging omdat men ‘de verkeerde’ heeft geholpen: daar zitten een paar rare dingen aan. Ten eerste, is  informed consent dringend gewenst, een voorwaarde zelfs. met of zonder psycholoog, als degene om wie het gaat niet snapt waar zhe mee bezig is, houdt het verhaal überhaupt op. En ten tweede, voor ingrijpende medische behandelingen wordt een patiënt wel vaker langs een medisch psycholoog gestuurd.

Wanneer de samenleving ophoudt spastisch te doen over trans*mensen zal het lijden ook sterk afnemen. Tenslotte wordt het lijden voor een groot deel veroorzaakt door hoe de wereld tegen ons aankijkt. En wij als deel van die wereld hebben opgepikt dat het niet goed is om zo te zijn. Stopt met spastisch doen en join the revolution. Wij zijn hooguit een bedreiging voor je mentale status quo. Zut alors.