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 And if something is taught, that is mostly rather out of date.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.
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)
I wouldn’t be surprised if many diagnostic-psychologists have fear-diseases themselves. What happens when you have a fear-disease? One has strong believes what will go wrong and very little ability to listen to other peoples views. This is what happens with psychologists in genderteams: they fear for very many people in their own environment: the CvZ (health insurance institute), politics, psychologist-colleagues with different opinions, board of directors of the hospital and guess what: all those fears lead to the same conclusion: the whole procedure as it is now has to stay strictly as it is, because if anything changes the whole genderteam will have to close…
No-one wants them to close. We do want them to implement the 100% informed consent, where individuals can decide for themselves if someone needs a diagnostic-psychologist. A diagnostic-psychologist who thinks (s)he is unmissable is like a butcher who thinks that no-one can do without meat. Times change, not in favour of the butchers.
Great essay, thank you!
excellently written! I’ll translated into the GruppoLuna website (with the appropriate credits and link to the original article, of course). well done!