Reading between the lines

International Day for Trans Depathologization, interview with Mauro Cabral, co-director of Global Activists for Trans* Equality

The news announces it this way: “For the first time in history, the World Health Organization (WHO) will throw out transsexuality from the chapter on ‘Mental and Behavioral Disorders’”. But (full) depathologization of gender diversity still seems a remote point on the horizon. What is good and what is better? We asked a key activist who helped create the Argentinian Gender Identity Law, a model for global policy. Mauro Cabral is co-director of Global Action for Trans* Equality (GATE), where he coordinates an international initiative to reform the Eleventh Edition of the International Classification of Diseases (ICD).

After two years of deliberation and pressure from depathologization activists, WHO recently removed the current diagnosis of “transsexualism” from the Mental and Behavioural Disorders chapter of its online [beta edition, transl.] version of the ICD-11, replacing it with a new category of “gender incongruence” in a new chapter on Sexual Health. Does this mean that trans people are not pathologized in the proposed classification? What does it mean, to “depathologize”?

For many trans advocates, depathologization is an emancipation struggle. The terminology itself also is contested. For some, it means full access to rights without any diagnostic requirement; for others, depathologization means eliminating diagnosis and medicalized control over individuals’ bodies. There are tensions among advocates around the role of medicine in defining diverse trans experiences and around ownership of the body. Does the need for surgery and hormones represent a radical prosthetic incorporation with medicine as the tool, or does it express conservative forms of technological expropriation of the body in alienating times of biocapital?1

Mauro Cabral summarizes it this way: “From one perspective, depathologization looks in a way like a Moebius band: striving for the maximal personal freedom seems to put the masking of biomedicine as regulatory principle for transition on the line; settling for less personal freedom risks perpetuation of current biomedical dogma, which diagnoses the wish to transition as personal and political pathology.”

There was a consensus in activism that transsexuality should no longer be considered as a mental illness by 2012. Now it is 2014, and this dream is still unmet. Is everything lost?

You are right. The world in which identifying as a gender different from the one assigned at birth is considered pathological did not end. However, in that time both the Diagnostic and Statistical Manual of Mental Illness (DSM) and the ICD went through an intense process of revision and reform.

What does this new version [of DSM] entail?

First, we need to clarify that, categorically, any diagnosis in the manual of mental disorders is by definition a mental disorder. Now they renamed “gender identity disorder” with an older clinical term of “gender dysphoria.” Where the previous diagnosis pathologizes trans people just for who they are, the “new” category can be seen as a step forward, because it puts the clinical focus on the trans specific experience of (the) suffering and stops when this disappears. In all the world materially or symbolically governed by the DSM and its codes, trans people stay trapped in one form or another of mental illness, and we continue to be cataloged as sufferers.

We need to remember that diagnosis in the DSM Manual is still a conditio sine qua non in many countries in the world, to access rights, like legal recognition and physical medical interventions. For example, the “treatment” for diagnosed suffering, that are still seen under this mark, and never as a biotechnologically mediated self expression.2

And in the case of the ICD reform?

The ICD Working Group called together by the World Health Organization agreed to reduce the scope of the diagnosis and proposed to scrap the current mental diagnostic categories that affect trans people, including “gender identity disorder” and “transvestic fetishism,” among others. This is fundamental: they finally recommended to remove any mention of trans issues in the chapter on mental health disorders. They also proposed new categories in a new non-psychiatric chapter on Sexual Health, including “gender incongruence of adolescents and adults,” and “gender incongruence in childhood”.

In what sense is the new category “gender incongruence” better than the previous?

Gender identity disorder” is such a damaging diagnosis that almost any replacement category would be at least a bit better. In that sense, “gender incongruence” also avoids diagnosing trans people just for who they are, paying attention to the discomfort that the incongruence could cause between the gender identity and how it is embodied. However, obviously, you can only pathologize incongruence by implicitly invoking a cissexist ideal of (bodily, identitary or expressive) congruence. Also, incongruence is taxonomically linked to suffering and congruence is linked to happiness, with medical approval enjoyed by the congruent, but missing for the others. In other words, it is proposed that identifying as a gender different from the one they gave us at birth stops being a disorder (mental or otherwise), but now the possibility of living our gender in a non stereotypical, dissident, incongruent way could be in danger3.

Why then not fight for eliminating any diagnostic mention once and for all?

The answer is both ground for pride and pain: only one country in the world, ours, Argentina, admits access to legal gender recognition and transitional health services without requiring a diagnosis, psychiatric or otherwise. Denmark recently enacted a similar policy, but only for legal recognition. This means that, in the rest of the world, people who need to have their legal registration or their bodily configuration changed will still need a DSM or ICD code to access these modifications (every time that access not only means authorization but also public or private health coverage). None of these considerations, however, justify the introduction of the category, “gender incongruence of childhood.” Resisting this classification is a focus of our efforts.

But why pathologize trans children?

The simplest explanation is that gender diversity in childhood is still culturally unacceptable, but the “rational” arguments are different. One focuses on the anxiety that daddies and mommies of children, who rebel against social expectations around their sex, may have. So children are pathologized as therapy for adults. Another argument emphasizes diagnosis to facilitate expansion, funding and publication of research on gender diverse children. This argument is both perverse and faulty. There are decades of research and publication on homosexuality, which has long been depathologized. A third argument asserts that diagnosis guarantees inclusion [of gender diversity topics] in education, in a world where sex segregation is so naturalized and depoliticized, and where, sadly, a diagnostic framework still is considered more effective than a human rights framework. Last, both the old and the new diagnoses are justified as providing an archive of clinical history.

What would the function of this archive be?

Inasmuch as the first biotechnological transitional intervention is the administration of puberty hormone blockers, there are [experts] who consider a childhood diagnosis necessary for immediate access to treatment. This position universalizes the need for diagnosis, based on a treatment that is only available in a couple of countries, and it naturalizes that need. Unsurprisingly, the “gender incongruence in childhood” diagnosis is defended precisely by those medical teams that provide the treatment. Even worse, this argument installs hormone treatment as common fate, imposing early diagnosis as a way of ensuring later transition. As medical policy experts like Sam Winter and Simon Pickstone-Taylor have stated: it is obvious that those arguments fail at the hour of tending to the two biggest necessities of the children: to grow up in a world that does not impose normative forms of masculinity or femininity on them through submitting them to a diagnosis, and the need for information, support and containment.

If they eliminate the diagnostic criteria that pathologize gender diversity in childhood, what would happen with those trans children that need special health care?

The ICD already contains and will keep, non-pathologizing codes, that permit access to assessment and professional support when needed, without any diagnosis of physical or mental disorder. In those circumstances where treatment is needed for depression or anxiety of the child (oftentimes produced by hostility and rejection around them), the ICD already contains general codes that cover the issues4.

Can intersex also be approached from a depathologization perspective?

Without a doubt, although the processes and the issues are different. Approaching intersex from a depathologization perspective affirms bodily diversity, which should never be seen as a pathology. It also means the careful work of distinguishing in every intersex body those characteristics that need medical attention from those that don’t. Depathologization activism must also articulate the irreversible consequences of pathologization, including the chronic pain, the sterility, the mutilation and the genital insensitivity, post-surgical trauma, fistulas, chronic infections, and metabolic changes caused by surgical removal of the gonads or pharmacological treatments tonormalizethe body. This is the register of how pathologization makes us ill.

What impact do terms of “disorders of Sex Development” have on the fight to depathologize intersex?

Since the mid-1990s, the intersex movement has disputed the jurisdiction of biomedicine over intersexuality. Even the medical terminology evidences bias and cruelty. At the end of the 19th Century, mythological hermaphroditism was redefined as a category for clinical use and accompanied by many pseudo-hermaphroditisms to expand diagnostic range. By the mid-1920s, a more specialized vocabulary emerged with terminology about intersex bodies, although the old terms still remained. The struggle and success of the intersex movement in the 1990s, to depathologize intersexuality and to appropriate, subvert, and transform diagnostic intersex terminology into a political identity was answered in a new pathologizing attack.

In 2006, a new classification was created, that reorganized the spectrum of intersex bodies into a taxonomy of “Disorders of Sex Development.” As intersex researcher Georgiann Davis argued, this label reestablished medical authority over that jurisdiction in dispute: our bodies. A central aspect for the depathologization of intersex today is resistance to the imposition of this vocabulary and its variations. For the intersex movement, there is an intrinsic relationship between nomenclature and treatment. Mirtha Legrand notes: “As they see you, so they treat you”. Advances in genetic and in fetal monitoring technology has extended the boundaries of medicalization to reach intersex embryos. They are often de-selected in preimplantation diagnostic procedures that promote selective abortion of intersex fetuses and prenatal drug administration to “prevent” the birth of intersex children.

Which are the political consequences of intersex pathologization?

Intersex activism itself is being psychopathologized and dismissed as a political symptom of disordered bodies. Because normalizing medical interventions usually take place in early childhood, intersex genital mutilation in infancy seems to infantilize the movement. In that way they mutilate our our capacity to be seen as adult activists with more than 20 years of experience in a sustained struggle. In spite of this oppression, the strong presence of intersex activism in regional and international human right systems has decisively contributed to the recognition of these medically unnecessary and non-consentual practices as forms of torture. Like medical abuse and forced, coerced or involuntary sterilization, these medical practices are violations of human rights.

What does depathologization mean for someone who like you lives the consequences of trans and intersex pathologization?

For years there was a prayer in the Spanish speaking world that affirmed:

My body, primary territory of peace”

I would like to able to subscribe to that, one day. Today is not that day. As long as this war continues (or as I live), what remains of this body is my primary battleground.

This interview appeared first in Spanish in the Argentinian newspaper Página 12, on the occasion of the International Day for the Depathologization of Trans Identities, October 18, 2014

1Hence the question on who owns the body: if exterior criteria are to define what may happen with your your body, are you still the owner, or is it more a complex of medical and capital actors with their interests – owning shares in hormone producing companies or because of their research being paid by pharmaceutical companies? [transl.]

2 Like the remark about prosthetic use of medicine, this hints to self determination how one’s body should look and using medicine as a technical solution to get there.
[transl.]

3Not every trans/gender diverse person wants, needs or can live a “happy congruent” life. If there is a right to self determination, this extends to choosing not to submit to practices meant to become more congruent with society. The right extends to dissidence.
[transl.]

4 These existing codes may be augmented with Z-codes, to clarify special needs of trans and gender diverse children (for example, when anxiety is caused by transphobic school bullying). [transl.]

Trans*, health and human rights

Trans people are seriously disadvantaged by not having accessible trans specific health care. As by not being able to access regular health care because of transphobia and discrimination. Vreerwerk keeps writing and talking about trans health and trans* people’s access to health care. Be it general health care or trans specific. With much discrimination – whether out of ignorance or willingly – trans people are disadvantaged.

Traditionally and unjustly, legal recognition issues and health trans(ition) related health care are strongly coupled.

We can show how to argue your case using human rights always is being forgotten or submitted to extraordinary requirements to be able to access health care, Vreerwerk offers lectures and workshops – live and on te web – in gaining a human rights background to patients’ rights, to getting your collective health rights.

Vreerwerk has experience in analysing the health rights situation for trans* and intersex people and can help people to advocate for their human rights with regard to good health care that does not discriminate. We are experienced in writing alternative health care standards and have been asked more than once to look at existing practices and advise on them.

We can show how to argue your case using human rights. Central questions here are:

  • What do human rights say about health care?
  • What is there on gender identity and expression in human rights?
  • What is “good health care” from a human rights perspective?
  • What systems and recommendations are there?
  • What should be in the package and why?
  • How to build local solutions?

Want to know more? Want to hire us? Mail vreerwerk@xs4all.nl

Bijdrage aan ronde tafel LHBT emancipatiebeleid Nederland

Onze bijdrage aan de recente Ronde Tafel LHBT emancipatie draait om cisheteronormativiteit en andere, betere zorg als middelen voor een beter transleven. De minister van OCW – verantwoordelijk voor (LHBT)-emancipatie vroeg om input voor de komende periode, een halverwege evaluatie dus. Dit is wat wij schreven.

VREERWERK OVER (LHB)T EMANCIPATIE

De hoofdlijnenbrief OCW Emancipatie meldt vier punten:

  • participatie in het licht van de gevolgen van de economische crisis,
  • sociale veiligheid van vrouwen, meisjes en LHBT’s
  • verschillen tussen jongens en meisjes in het onderwijs
  • internationale polarisatie.

Onze opmerkingen vallen sterk onder de punten “b) sociale veiligheid van vrouwen, meisjes en LHBT’s”, en “c) verschillen tussen jongens en meisjes in het onderwijs”. Een geheel ander punt waar we uw aandacht voor vragen heeft een sterke connectie met het thema. Over de participatie van i.c. transmensen hebben wij weinig toe te voegen – TNN gaat daar mooie dingen mee doen die overigens bij lange na niet voldoende zijn – en reacties op internationale ontwikkelingen zijn bij het COC in goede handen.

De vraag in de uitnodiging “Moet er na 2014 worden ingezoomd op bepaalde, nieuwe, thema’s? Zo ja, welke en waarom?” wordt door ons volmondig met “ja” beantwoord. Onzes inziens dienen de volgende punten per 2015 aan de orde te komen:

  • Bestrijding cisheteronorm
  • Betere transitiezorg en zorgtoegang voor transgenders

BESTRIJDEN CISHETERONORM

De Cisheteronorm gaat er van uit dat iedereen een niet-trans lichaam heeft en hetero is. Tenzij het tegendeel is aangetoond. Consequentie daarvan is de strijd om niet-heterorelaties gelijke rechten te geven als niet-homoseksuele. En dat het een hele klus is om je genderregistratie aan te passen. Want normale mensen (cisgenders) doen dat niet. Dit type samenleving is bijna per definitie ook vrouwonvriendelijk. Heterosamenlevingen met vrouwen die echte gelijke mogelijkheden hebben zijn zeldzaam, ook een geëmancipeerd land als Cuba voldoet er niet aan.

Problemen jegens LHBTI personen vooral te maken hebben met geïnternaliseerde beelden over genderexpressie, hoe een man/vrouw zich hoort te gedragen. Dat wordt duidelijk uit hoe trans- en homofobie werken. En hoe de vooroordelen werken. Ondervraagden over holebifobie melden stelselmatig dat ze problemen hebben met het veronderstelde onmannelijke gedrag van (homo)mannen en het onvrouwelijke (butch)gedrag van (lesbische) vrouwen. De problemen zijn voor transpersonen in Nederland het grootst in de periode van gendertransitie van een herkenbaar gender naar een ander herkenbaar en erkend gender. Overigens gaat het om de perceptie dat iemand holebi, trans of intersekse is. Gender(expressie) normen zijn het grootste probleem hier. Die moeten veranderen. Und zwar schnell.

Wij adviseren de overheid vanaf 2015 hard in te zetten op het bestrijding van gendervooroordelen.

Dat komt holebi’s, trans* en interseksepersonen, maar ook ‘gewone’, cisgender mannen en vrouwen ten goede.. dat gaat niet alleen over rollen maar ook over identiteiten. Nadruk leggen op het bestrijden van gendervooroordelen en het stimuleren van vrije genderkeuze (qua identiteit en qua expressie, voor iedereen – ongeacht cis- of trans/intersex). De koplopers-constructie kan hierbij misschien nuttig zijn. Maak werk van de CEDAW-verplichtingen (art. 5a) in deze.

Twee praktische uitwerkingen:

* Op overheidsgebied alle communicatie zo wijzigen dat nergens om geslacht maar om aanhef wordt gevraagd en laat dit een open (tekst)veld zijn. Behalve in (sommige) medische zaken en voor de persoonsregistratie is het is absoluut onnodig te weten wat de persoon die de medewerker voor zich heeft in zhaar ondergoed heeft. De nieuwe Europese data Protection Directive (art. 20) is ook heel duidelijk over de noodzaak van privacy bescherming.

* Voer overal bij de overheid genderneutrale toiletten in. Geen toegang hebben tot geëigende sanitaire voorzieningen is een ernstige mensenrechtenschending waarvoor een Speciale Rapporteur in aangesteld in de Verenigde Naties. Doorgaans leidt de ‘toiletkwestie’ hier niet tot zulke taferelen als in de VS, maar dat het hier niet extreem is, staat niet gelijk aan geen probleem. Niet alleen non-binair identificerende personen hebben baat bij deze toiletten. Ook transpersonen in transitie en überhaupt eenieder die een toilet nodig heeft. Gehandicaptentoiletten zijn al gendervrij en uw thuistoilet doorgaans ook.

GOEDE TRANS/GENDERZORG

Als tweede en laatste hoofdpunt willen wij uw aandacht richten op een thema dat vooral bij het departement van VWS hoort, de zorg. We brengen het evenwel hier in vanwege de coördinerende rol die OCW hier speelt.

We sommen kort een aantal belangrijke problemen op en geven uitwegen.

  • Voor transgenders werkt het recht op gezondheid zachtst gezegd niet optimaal.

  • De bestaande transgenderzorg is niet respectvol naar de zorgzoekende burger die medische ondersteuning zoekt want benadert de hulpvrager als iemand met een psychische stoornis. De beschikbare zorg sluit niet aan op de wensen.

  • De zorgvrager wordt bestraft voor het kiezen voor “gedeeltelijke” behandeling middels vertragende extra gesprekken met de psycholoog of arts. Behandelteam ontkent wat de zorgvragers zeer regelmatig aangeven.
  • Transgenders worden gescreend op lijden en krijgen daarvoor een psychiatrische diagnose. Deze lijkt nog zeer veel op de oude (DSM-IV, ICD-10) genderidentiteitsstoornis en erkent de autonomie van de zorgvrager noch dat genderdiversiteit an sich geen behandeling behoeft.

Natuurlijk moet de patiëntenstop van het VUmc worden opgelost, bij voorkeur door op meer plaatsen zorg in te kopen. De VUmc poli kan fors afgeslankt worden als er niet meer standaard een psychiatrische diagnose nodig is. Dr. T’Sjoen van genderteam Gent stelde recentelijk al dat slechts een heel kleine groep misschien risico loopt (Zizo, 31-3-14, http://www.zizo-online.be/interview-professor-tsjoen-over-de-rechten-van-transgenders). Dat filter je er bij informed consent ook wel uit. Onderzoek van het in New York gevestigde Callen Lorde centre for LGBT Health onder ruim 1100 zorgvragenden toont 0% “spijtoptanten” zonder diagnose (Eisfeld & Radix in Informierte Zustimung in der Trans* Gesundheitsversorgung. Zeitschrift für Sexualforschung, 2014:1, pp.31-43)… )

De financiële bottleneck in Nederland zit bij de psychologen, want de GD diagnose wordt niet vergoed wegens ontbreken DBC/DOT1. – Middelen zie nu gaan naar een absurde verplichte diagnose van Genderdysforie, kunnen beter worden ingezet door hulpverleners in te zetten om de bestaande klachten (depressie, angststoornis, suicidaliteit, ..) aan te pakken en de transpersoon met moeilijkheden te empoweren.

We verwachten van de overheid dat zij op de juiste niveaus belissingen neemt die tot de volgende gewenste resultaten leiden.

  • Een einde aan het diagnostiseren van transgenders met een psychiatrische diagnose. Gendervariante personen zijn niet gek. Handhaving van deze diagnose is handhaven van mensenrechtenschendende procedure.
  • Snelle spreiding van chirurgische en endocrinologische zorg over het land. Overal zijn endocrinologen en chirurgen met ervaring op dit gebied. Wouter Bos stelde recent in Nieuwsuur dat VUmc niet wil monopoliseren dus dit moet niet op onwil stuiten.
  • Snelle – vooroordeelvrije – oplossing van het enorme tekort aan kennis jegens de problemen waar gendervariante mensen (onder wie transgenders) tegen aan lopen. Einde aan het one size fits all beleid. “Volledige behandeling” is niet voor iedereen gelijk.
  • Sterke diplomatieke steun vanuit Nederland binnen de WHO voor depathologisering van transidentiteit en steunen of formuleren de progressiefste voorstellen van de ICD.

Voor ons hangt het punt van een andere zorg ook samen met het eerst punt van het bestrijden van holebi- en transfobie. Naast dat goede zorg een basisrecht is dat verankerd is in diverse mensenrechtenverdragen, heeft het een positief effect op de suicidaliteit die zoals bekend zeer hoog is onder transgenders.
Het erkennen dat mensen heel verschillende genderidentiteiten en expressies kunnen hebben en dat ze daarbij soms medische ondersteuning nodig hebben, zou moeten leiden tot een meer faciliterende zorg. Niet meer op een one size fits no-one georiënteerd model.

Wij spreken veelvuldig van burgers en zo min mogelijk van cliënten of patiënten om ook een impliciete medicalisering zoveel mogelijk te voorkomen. Transgenders zijn net als andere burgers individuen in een sociale leefwereld. Het grootste verschil met veel andere groepen burgers is hun achterstand, de discriminatie en achterstelling waar ze mee te maken hebben.

Samenvattend: Bestrijd genderstereotypen door onderwijs en voorlichting, beschermende maatregelen wegens kwetsbaarheid en achterstelling. Neem transgenders serieus, ook in de zorg.

1 Naschrift: Inmiddels is duidelijk dat de DBCs er zijn en er vermoedelijk sprake is van mismanagement en onverantwoord lage zorginkoop. Tot dit is opgelost, blijven de problemen bestaan.

Hoe “nodig” is transchirurgie?

Vertaling van Pablo Vergara Perez’ “Que tratamientos necesitamos las personas trans y por que? Eerder verschenen op la Transtienda.

krammetjes

Er is een eeuwig debat over de vraag of de trangenderzorg nou wel of niet gefinancierd moet worden. Is deze echt nodig? Als transgender geen ziekte is, hoe rechtvaardig je de speciale zorg dan? Kun je de zorg voor transgenders vergelijken met de zorg voor anderen?

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Chitrangada

On April 4 I had the honour to introduce the Indian movie “Chitrangada” by Rituparna Ghosh to the cinema visitors at Cinemasia film festival in Amsterdam. This is what I told them.

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Zorg is van belang, niet “gender dysforie”

Genderzorg hoeft niet gebonden te zijn aan ontrechte psychiatrische diagnoses. De meeste mensen hebben die ook niet nodig. Daarin lopenmedische processen en de WPATH Standards of Carre 7 achter. Dat blijkt ook uit een inteview dat Mare Van Hove had in het Belgische holebitijdschrift Zizo met de Gentse endocrinoloog Guy T’Sjoen. Continue reading

Praktische oplossingen voor patiëntenstop VUmc

Sinds januari neemt het VUmc geen nieuwe trans*-patiënten meer aan, want daar hebben ze geen geld voor. De regering heeft de Nederlandse Zorgautoriteit (NZa) ingeschakeld voor een analyse van de situatie. Continue reading

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?

 

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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