trans – Vreerwerk

Trans kids need support not diagnosis

October 19, 2013 is the international day on the depathologisation, declaring not a disorder but a positive diversity, of trans people. And because of high level developments in the World Health Organisation, that is responsible for revising the International Classification of Diseases, that is used for understanding what is a sickness, a disease, a disorder – be somatic or psychological. This is a global Classification – unlike the DSM that is still mostly US based but having a wider use. Here in NL psychologists use it, health insurers use it. For adolescents and adults there is a positive change going on, although the battle is not yet won. Because of this last issue, introducing a diagnosis for children, and 2014 being a decisive year for the new ICD, the pathologisation of trans children has been chosen as the theme for this year.

Stop Pathologizing Gender Diversity in Children

The suggestion for a theme usually comes from Spain where the campaign started in 2009. It was the time that the process to change the DSM started and they started to create global awareness for the changes. After all: the DSM still declares trans* people having a mental health problem. And when the process to change the ICD got under way, this had been taken into the campaign. Nowadays a strong focus of advocacy for trans health lies in getting a good description in the ICD-11. Since that will be decisive for how many people in the medical and political world will see us. If trans people are not (mentally) ill, but instead suffer from society, we will be taken more seriously. So that is why today and why the theme.

What is today about?

I will first define the situation: gender kids are not welcome as who they are, most learn to hide very early in life. I have recent data from the UK on that. Next I will give an overview of several developments in the social and the medical world. I will focus on how the big international classifications that are in use. By that I mean the infamous Diagnostic Statistical Manual of menatl disorders (DSM, version 5) of the American Psychiatric Association (APA) and the global, more responsible International Classiication of Diseases (ICD, version 10) of the World Health Organisation (WHO). Developments there are going in the wrong direction. And that has pretty much to do with it being children and with queerphobia.

Also I will give an update on developments in the Netherlands; what support is there, how are parents reacting? What does the clinic do? What would be good ways to advance our case for gender freedom?

Trans*

To start with trans*: this is not just transgender in the transitioning variant. It can surely mean transgressing gender norms, being and behaving gender non conforming. Because trans* is who trans* does. In a way many of you are also trans*: you do trans*, you transgress gender norms. Don’t come to me “Hey, but I’m fine with my body”. That is just one version of gender diversity, of trans*. Being trans* does not require gender dysphoria or gender incongruence or however you call it. And trans* is not just identity, it is also expression. Since so much what we all gay or lesbian or bi, is more gender expression than sexual orientation or gender identity.

So trans* can be anything non gender conforming. And acceptance for that already is quite low for kids. While the Netherlands may be relatively tolerant of it, and many young parents seem to be, recent UK data show that also the seemingly more accepted tomboy behaviour of girls and non apparent trans boys is not really accepted. Non-apparent then stands for people who later in life tell to be trans already from early on but didn’t tell anybody back then.

Kids

And by kids I mean children before puberty hits them, which roughly mean between 10 and 12 years old. Usually one says: puberty starts with Tanner stage 2. Then physical changes start appearing. In the Netherlands that gets ever earlier, and in several other countries also.

Although it is a generally accepted idea that children change, that change and development are the core phenomena of a child’s life, many implicit norms govern this period. A good example is that there is an Amsterdam kindergarten where children of many gay and lesbian parents spend their day. The personnel are very happy with the lesbian and even more with the gay parents. However all the kids are neatly divided in boys and girls and treated differently. I think this has much to do with idea that being gay and lesbian is seen as only a relationship thing, a sexuality thing, something private. Gays can be great parents also! But this goes completely beyond the point that so much is gendered behaviour, based on gender identity and/or expression.

Sterlisation is for cats, not for me

ICD

It is clear that the Committee that manages the chapters relevant to trans people is convinced gender identity issues must be relabeled en get a different position. The name is in the process of being changed from “Gender Identity Disorder” to “Gender Incongruence”. A mismatch between body and felt identity. That is better already, better also than Gender Dysphoria. But:

Why must there be such a diagnosis? The gender identity is not wrong, just different.
Being non trans*, the default situation of being cisgendered, still is the definition of Normal
A new diagnosis is being introduced that concerns trans* children. So a child living differently is still bad, wrong

It is the WHO that decides through scientific research what is to be considered a sickness, illness or disorder. Everything health related is in their remit. For the description of diseases etc. there is the International Classification of Diseases, ICD for its abbreviation. It is going to version 11 now, after the longest time between versions. ICD-10 is from 1990 and got in to function in 1994. Since 20 years is a long long time, the changes will be drastic, and many things will change: biomedical sciences have advanced enormously and everything may be streamlined more than before. So it will also be in things transgender related.

But the WHO is not only purely scientific and apolitically health care related. LGBTI issues face enormous contention from the usual suspects of human rights refusers for LGBTI people: the Vatican, the African group Russia and some consorts, several countries united in the Organisation for Islamic Cooperation. Recently there was to be a discussion about discussing LGBTI health issues and the issue got removed form the agenda thanks to pressure from these countries. For now the tendency within WHO is to declare it a technical issue and remove it from the agenda because of too fierce resistance.

Trans identity issues are now going from the horrible: Gender Identity Disorder” to most probably “Gender Incongruence”. The DSM 5, that American horrible psychiatric classification uses gender dysphoria. Incongruence is the least harmful term of the three, but still does not take its departure in gender diversity with all gender identities equally valid. So tis still not good. Gender dysphoria means one has lots of stress, anxiety, depression because of ones trans identity. Which is another case of wrong angle: it is not the identity in itself that causes so much trouble, it is how the world reacts and how one learns to look at it. And you know already quite young if it is OK to live like you feel. Which is why many trans people only come out later in life. Lucky the people who have enough to support to come out young. And can more or less freely develop their identities.

Gender Incongruence only means that your body and your identity do not match, are not congruent. But that still is not good enough of course. It is doable and better than dysphoria, but still.

The bad new thing for this Classification is that suddenly trans kids*, those who are not adolescents, the K-12 kids, need a separate, autonomous diagnosis of their Gender Incongruence. It will then be called, gender incongruence in children. But there are a couple of strange or incorrect things with this.

An important detail to add is that the proposal is to have the diagnosis onl apply to those children with severe complaints. Not every kid with a non traditional gender expression would fall under it. Only those whith “severe incongruence” as I imagine the wording might be. The fear for gendernon conforming behaviour seems to lessen in these circles. because they aslo say this with adults adn adolerscents, lready in the DSM-5.

First and foremost: they are sort of de-pyscho-pathologising adults. Because adults will be in a separate chapter for gender identity stuff, or in a chapter on sexual health. Not any more in the current chapter (F.64) of mental and behavioural disorders. But since children below puberty cannot get puberty blockers, there is nothing medical with them, so diagnosing them is diagnosing their – changing and developing – identity, means putting them with mental health issues.

When there is nothing medical, there is no need for diagnosing. So it is irrelevant. Surely since psychosocial support can be arranged through already existing constructions. This way a new class of experts and of treatment will be created. And once created, a specialism doesn’t want to close down.

Situation of trans kids according to research

Since this is all about trans* kids, it would be good to know a bit more about how they live, what their problems are. The problem is: there is only very little research in this. And most comes form the medical/psychiatric division of society. Not only that, it comes from researchers with a strong agenda for normalization. A name to remember in this is Kenneth Zucker from Toronto. In Berlin, Germany there is professor Klaus Beyer working with trans* kids who also has clearly non respecting ideas. Don’t get your kids to the Charité hospital in Berlin if they are queer.

The problem with Zucker and his pal Richard Green is their disrespect for the autonomy of trans people. Green is the author of “The sissy-boy syndrome”. He is Zucker’s predecessor and together they try to make a strong case for reparative therapy. This means: attempt to -de-transgender the kids, to un-gay them. Because gay and trans is Wrong. And trans is worse than gay (that is at lest within the gender binary). In the Netherlands people like these do not work at the gender clinics, but they might run loose as independent psychiatrists. Which might be even more dangerous: if the parents don’t know about the gender clinic’s youth program or better about Transvisie Zorg, the child might suffer much.

Natacha Kennedy

From recent UK research by Natacha Kennedy we know that of the respondents to an online survey most were ‘non apparent” trans kids. That is: they felt different already early in life but came out far later because they knew it was not considered a good thing to be trans. Already at age 8 the social radar of all children is god enough to realize this. There is no majority of one type of trans* in this research: the respondents have come out as cross dressers, transgender, genderqueer, mixed gender. The consequence of this feeling already quite young to be apart, different form the others leads to the feeling of not being able to live as one wants, to invest a lot in a gender identity that is not one’s own.

That does not have to contradict our cherished idea that gender is doing. It appears many people who live one thing, slurp, suck in what they are actually more interested in. To quote Butler in this: “Femininity is thus not the product of a choice, but the forcible citation of a norm, one whose complex historicity is indissociable from relations of discipline, regulation, punishment.” (Bodies that matter). Anyone wonder about the appearance of “gender dysphoria” then?

This nonrecognition of gender diversity is something seemingly universal. Surely here in the Netherlands the idea of gender expression is not very developed in general discourse.

transvisie zorg

Support

So what is there in support? As it is said the Netherlands is doing very well in medical support for adolescents, the question of course is: what is there for the young one? Well, there is support from Transvisie Zorg that have a social worker and a sexologist who see the parents, visit schools, talk to schools, see the kids if they want. Most of their work is with the adolescents, but a growing number of parents call for support. Their list of visited schools grows at 40 schools per annum!

The most common phenomenon roughly from 10 on, is bullying. More girlish boys than boyish girls get bullied. However every school got protocols against bullying. When talking with schools Transvisie points at bullying and the need prevent this, but it is mostly up to the kid and their parents to go to school and tell the staff they get bullied.

And then there is the gender clinic that gives “temporary” diagnoses. Precisely in the idea the ICD want s to have that diagnosis: to make it easier to enroll in the adolescent program. How good the support is, depends very much on the quality and opinions of the psychologist.

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The pain in Spain

Recently Carla Antonelli, actress, trans* activist and social-democrat politician in the regional parliament of Madrid sent in a bill to improve trans* rights in the region. It contains quite some positive elements, but on several important points like, access to health care, it is worrisome and not depathologising.

Precisely in the right wing times with a cold anti-rights wind blowing, in an autonomy and civilian-centred hating climate, it is of utmost importance to not only strive to keep what we got but to further our agenda. When playing the parliamentary game, staying is loosing.

Spain is the second country in Europe to have abolished the requirement of gender affirming surgery, in 2007 as one of the first significant civil rights acts of the Zapatero government – although it took a hungerstrike by Carla Antonelli and others to convince them of the seriousness. The results were good for the times, but not standard setting. Still psychiatric evaluation is needed with a diagnosis gender identity disorder. The clinics are called “Gender-identity-disorder units”. While requirements for medical treatment are strictly not part of the text of the law, there is a requirement to show you have (formally) undergone two years of cross sex hormone therapy.

In the 2007 law no anti-discrimination provisions has been recorded, and in a transphobic and homophobic country as Spain that is an important grief of many trans* People. Attempts to improve the current law into an “integral law” that takes care of all issues touching trans* people is stuck since there now is a conservative majority in the national parliament in Spain. In the regions, the autonomous communities (somewhere between provinces and states), alternatives are being brought to the floor of parliament with a different character, dealing with elements in the power of the region. Thus Andalusia in the South (with Seville as Capital) has a different proposal than Madrid.

The Madrid proposal is attached here as Antonelli-saenz-transexual (Spanish!). The law is meant to eliminate all kind discrimination that may be directed at trans* people. Some highlights are:

No discrimination on the basis of gender identity or sexual orientation is allowed
Reparative therapy is absolutely prohibited
The law would protect the rights for recognised trans* people to the correct gender in municipal administration
Protection in the workplace
Undertakes action against transphobia
Medical transition support for recognised trans* people, be they minors or adults
Attention or trans* people in education and to educational material

Swear dissonance

The shortest way to summarize my comments on this proposal is: anything that falls short of the Argentinian law on legal gender recognition of 2012 is not good enough. However that is very concise and I will explain this is more detail referring to the proposal at hand.

The Spanish use of transexual is problematic because it creates a separation between those eligible for medical assistance and those not eligible. Because they don’t want the kind of treatment offered or because they cannot – for whatever reason. In the Spanish context this may make sense but still, conceptual confusion is conceptual confusion. Leaving that for what it is, I start with the basic question: who counts as a transsexual? Title 1, art. 3.2.2^o reads:

Any person that states to the Community’s authorities through a sworn declaration to experience a stable and persisting dissonance between the morphological birth sex and the felt gender identity. This declaration does in no way imply a medical, psychological or other one that pathologises transsexuality.

So, no external authority has the right to pathologise you, but a sworn declaration by yourself of dissonance/incongruence, mismatch of sex and gender is sufficient. That leaves agnostics and atheist with a huge problem: they cannot and will not swear to any deity. We need to get rid of religion on legislation (apart from legislation that safeguards the right to religion). God or which ever deity has nothing to do with state affairs.

Next there is the problem of auto-pathologisation. Doctors, nor psychologists or therapist are allowed to tell you that there is an inherent problem with your difference, that you suffer form a (mental) illness. One might say: stating your dissonance is not the same as declaring not to be an illness. But why would you have to give a reason then? This means you are not taken serious in your wish if you don’t have a Serious Reason to change. And then: why should you experience dissonance? Why not because it feels better that way? The reason you have to give is the new phrasing of the old Gender Identity Disorder paradigm. So much hasn’t changed, the book’s new edition has a different spelling, maybe a different colour. The emperor wears new clothes …This is no change at all. If you want to prevent pathologisation, you shouldn’t ask people to swear they experience a dissonance. It should be enough to give a written and signed statement, that you identify as or prefer to registered as the other acknowledged gender (since Spain like all of Europe does only recognise male and female). As Pablo Vergara says in his post on this law to be: don’t we trust ourselves then? That we ask (the proposal has been written by two trans* people! so “We” ask it) for a sworn statement?

Sex and gender

Also the law assumes there is a correct, logical, fixed combination of sex and gender. The authors are absolutely not informed by (post) modern theory that demystifies, deconstructs this sex/gender combination. For now I refer to Judith Butler’s excellent analysis in the introduction to Bodies that Matter (1999) where she explains there is no sex beyond or before gender (which as we know also is constructed, not natural or obvious). In different ways Michel Foucault already in 1976 (The will to know) explained how gender and sexuality are constructed, stimulated in a specific directions because of specific power relations, and repressed in other directions. That law doesn’t know this yet, is a juridical failure we must not go with but try to fix – or otherwise circumvent in our own proposals.

Minors

The above explained also applies to minors. If an adolescent or child comes with this wish they need a written statement by a psychologist or doctor affirming “transsexualsm in minors”. The children to who this applies to usually know very well what they feel and who they are. Having an unusual gender identitiy than society expects you may have given a certain genital layout, is only gender diversity, a natural phenomenon. Given the world’s reaction these children may need counselling, psychosocial support to further develop their gender identity and cope with a rejecting society. This also applies to adults by the way: learning how to deal with rejecting society and with internalised transphobia. But a diagnosis of gender dissonance? No.

The biggest problems reside in the paragraphs concerning definitions and access to trans* specific health care and how this is defined.

“The multidisciplinary Gender identity Unit will be led by professionals in health care in in psychological. psychotherapeutic and sexological help that will decide and give the most adequate assistance according to the personal circumstances and state of health of transsexual persons.”

Because what does title II say, on health care service for trans* people? It says all information available should be given freely to who asks for it and all interventions are made with explicit informed consent of the patient. But then: what constitutes treatment? Who decides if certain treatment is available to a patient? What is the “most adequate treatment” (Art. 11.2) and who decides this? The law does not explain how this most adequate health care should be interpreted. Meaning that they leave it to the doctors who are not used to having the expertise doubted or contested. Nor that patients decide for themselves against their professional opinion. Spanish (nor Dutch) doctors are known for their patient oriented supportive approach.

The term “state of health” and also personal circumstances leave open the possibility of a psychologist who because of the (supposed, interpreted) mental health state of a client thinks this person not apt for treatment because of certain aspects of their private life (e.g. they engage in BDSM with gendered roleplay and kink). Mentioned professionals are not guaranteed to be without prejudice and being dependent on a doctor or one unit introduces a bottleneck. If full, informed and prior consent is not well defined and when there is a relation of dependence (doctor-patient), it is an unequal power relation. In case of minors two doctors must be involved which makes the person’s autonomy (and that of their parents or guardians). Given the moral panic that spreads where it concerns children, and the attitude (and the – lack of – knowledge) I am not sure it is a good idea to leave this to two doctors. Normally one doctor decides what is the problem and in compel cases they consult a colleague, but it remains a one person responsibility. So an extra strong requirement is introduced here. That does not sound logical, that sounds like exertion of power, of bad ethics.

Could be worse

Not the best law, not the worst. I think by explicitly legislating against transphobia, by clearly putting in the right to no discrimination this would be very good to become a local law. It has enough merits to be accepted as a national integral law. But please chicas, your health paragraph and some of the basics are a disaster. Change that.

In Spain I now look out for the Andalusian proposal which is better, but experiences more political intrigues in getting the right version on the right tales. More on that when it gets really gets somewhere..

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Entanglements

This post highlights some nasty details hiding in the shades of the current Dutch transgender bill, as imposed upon Dutch trans people by obscure deliberations between the Justice ministry and the gender teams. Where informed consent on the one hand is the only criterion for LGR, the gender teams through a back door still have their say who is credible and who is not, who will be recognised and who will be scrutinised.

In many countries medical interventions are required in order to be able to change your gender registration on birth certificate and/or passports. Think France, Spain, US, Scandinavia, Poland, Chile, Brazil Japan, Philippines … From a human rights perspective requiring medical intervention for legal change constitutes a violation of the right to be exempt form medical maltreatment. And recently the UN Special Rapporteur in Torture classified obligatory medical interventions as such. He explicitly mentioned infant genital mutilation and forcible trans genital surgery to equal torture. And then there are countries that do not require it to be so, but do expect it. Even if they say to rely on the informed consent of the applicant. As it stands, the new Dutch law presupposes the wish to medical intervention. Also there are some countries that do not require any medical intervention. Examples are Argentina of course, the UK, Hungary, Portugal …

With the recently adapted legislation for legal gender recognition the Netherlands now opts for a strange hybrid that has some devils hiding in the details. The formal construction to be is that anyone (with a legal registration in the Netherlands) of sixteen years or older can request a confirmation letter of their long term and/or deeply seated feeling of not belonging to the sex/gender they are registered under. The only requirement is they have to understand what they are engaging upon. But as stated: the devil hides in the details. For the professionals allowed to issue such a letter of understanding, are the doctors and psychologists of the gender teams. Which is surprising. If the applicant is not by definition suffering from a mental disorder, then why have them screened by a psychologist? If going down that way, one might expect obstructive co-morbidities. These are given in the explanation of the law: the legislator fears for applications by people suffering from psychoses or other delusions. Not that there have been many reports of misuse. Most psychoses or delusions of people that apply for trans health care interventions, concern trans people with mental coping problems, trans people with co-morbidities. Not madmen playing trans. Nor villains wanting to abuse the system. And anyway, if this might be the case sometimes, the statistics are really low and the harm done is only to themselves. So the legislator is confused, fearful or influenced by the medical establishment.

The second and related problem lies in how the gender teams will react. How they will perform their task. Here word on the street is not really positive either. What is to be expected is a conflation of tasks. On the one hand psychologists still have to inform prospective patients on the medical gender reassignment protocols and procedures. On the other hand they get a new task, to screen if the applicant understands what this change of legal gender entails. When the setting is mostly assisting people with coping with their cross gender feelings, filtering out who is eligible for gender reaffirming treatment, then this is not an illogical step. But the legal requirement is different. The psychologists however – from professional pride? – insist on not just checking the measure of informed consent, but already inform and check the client’s readiness for medical treatment. This does injustice also to the current population of people that come to the gender team. Not all those rejected are not transgender (enough). Also applicants for medical assistance that are not ready for medical treatment – in the current setting or not ready at all – are being turned away.

Up to now everyone passes through a psychological diagnosis of gender dysphoria. If you just want acknowledgement of your identity, partial treatment, the whole package or maybe counselling. No discrimination this way. That starts behind the first gate. It very much looks like the amount of people requesting a consult will grow, potentially a lot, and next there will be quick and a slow path/trajectory. The fast route is for who only wants legal gender recognition. They get in principle one talk and are free to go then. Until they want medical treatment. Group two wants immediately medical assistance. It is not clear now if they will get the offer to first change their gender marker. Or will be side lined with longer waiting times until there is more capacity. Or the other way round: if you only need a certificate, you can wait. This approach is plain wrong. Not from a medical/psychological point of view. Then it is logical to first do a thorough anamnesis. But these people do not come for a medical anamnesis, they want their gender marker changed in order to easier decide how to continue with life. In order to find out how to make sense of their gender difference. Now the processes of gender change have the chance to be more separated, it also could become more clear that there is a need for more counselling. The psychologists at the gender teams only check if you conform enough to the diagnostic criteria for (full) medical treatment. And then they only take your pulse during transition. Which leaves trans people in limbo again for the most important element of health care: support.

So, the applicant for legal gender change who does not want or need (any more) medical assistance inquires at the civil registry for the conditions to change their gender marker and then hears they have to go and see a psychologist or psychiatrist from the gender team. That means the state considers the requester to be mentally incapacitated for an autonomous decision regarding their gender.

Transgender Network Netherlands asked the secretary of Justice for clarification, since he is making a mess of it. I am very curious what he will come up with, but something tells me we still have to wait some years before we will get real informed consent.

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Legal gender recognition in the Netherlands – an update

As you may have seen on the social media already, or on trans mailing-lists: change in Dutch gender recognition legislation just took a big leap this afternoon of 9 April 2013.

Already five years ago Dutch trans people contacted the minister for Emancipation (and Education, Science and Culture) complaining about the ridiculous and human rights violating legislation that goes back to 1985. The minister then promised to get it changed fast.

Fast forward to 2011. Human Rights Watch presents a report on the situation of trans people in the Netherlands and precisely then a watered down proposal is presented. National and international trans organizations complain heavily, only being happy with the removal of the requirement for medical (physical) interventions. After discussions and comments in the first (written) lecture in parliament some improvements are made.

Last week the debate took place and today the change proposal has been voted to continue to the next round, the Senate. After that only a signature of the head of state is needed for the law to come in to force.

What does the law entail when accepted?

Every person with a Dutch birth certificate or residence can amend it without medical intervention. If at least 16 years old.
Provided with an expert letter confirming the applicant’s durable conviction being of the other gender. The expert is to be a doctor or psychologist of the gender teams. Others are to be cleared by the gender teams.
Go to the civil registry and it will be adapted.
Evaluation of the law after five years

Amendments have been brought to the floor to change some important aspects:

LGBT organisations (incl. the trans organisation) want a wider group of experts to be authorized to write an expert opinion, like social workers, reverends, sexologists, gender experts, trans organisations … Alas: rejected
It has been requested to bring the evaluation term of the law back to three years because of the rapid developments in the field. Alas: rejected
Lower the age limit to 12 years. Alas. Also rejected
Also it has been requested to investigate the possibility for a third gender marker or nothing at all. This motion has been accepted. Results are to be in within two years (to prevent the ongoing UK “investigations”). The precise order has not yet been commissioned.

All in all a good result, but it leaves still room for improvement on essential points. Life for trans people will be enormously improved, probably per Jan 1, 2014 as hope is the changes will then have effect.

As a note: this has no implications for the availability of trans specific health care. These issues are not legally coupled.

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Fucked up lip service

The proposal for change of the existing gender recognition legislation in the Netherlands is out. This proposal will be debated on the floor. It is – as the previous version – not good enough. Actually it hardly changed since last time we saw it.

The news came in the mail. An update of the website of the Justice and Security ministry. The proposal for change of gender recognition legislation is ready for second reading. Written comments have been worked through and answered. The secretary of state for Justice and Security apparently was not impressed by the questions and by the comments of the trans-movement. We are not impressed by him. Never were. Some refreshers:

It took a Human Rights Watch report for government to come up (immediately!) with a proposal for change.
This after some three years of talking and checking back with the legal advisor of government and of several ministers speaking of their worry for the current situation.
Extensive comments for all national (TNN, COC, ..) and international (TGEU, HRW, GATE) stakeholders have been given.
Then again the government needed reminding not to stall. Promise is debt.
Comments again from national actors went to all political parties that took up several important questions but – of course not required – government took up maybe one point
The trans movement is only taken seriously where it is advantageous for government

So what does the proposal of Dutch neoliberal cum ex-social ex-democrats comprise?

An expert in gender dysphoria must check if you are sincere and that you have an enduring conviction. If you are not deluded or doing it out of delusion. If it is not done out of criminal intent
Appointed gatekeepers consist of current doctors and psychologists gender teams, and others accorded by the ministry. They proposed a nice package deal.
“Real Life Experience” or long time living in the role of preference has no influence on the legal part of the process. But gatekeepers may take that more serious than other expressions of trans-gender
You must be at least 16 years of age
After giving birth as a (legal) man you will still be the mother. Mater semper certa est. No wishes to make pedigree law gender neutral. Tendency is more re-biologising
Good thing: no need for hormonal or surgical treatment
Good thing 2: no court procedure necessary anymore
The law will be evaluated after five years

So, two or three important good changes, and lots of lost opportunities in this proposal. Where good thing 3 may be that the expert opinion may not be a diagnosis. But how will this go if the applicant later goes on to medical procedures? Will it then be taken as a (psycho) medical diagnosis? So you must be gender dysphoric to get help?

Government gave in on the easy part: the world moves to outlaw coerced medical treatment (actually already for some time). Lately by UN Special Rappporteur Juan Méndez who now moves required and coerced medical interventions for trans people and infant genital mutilation as with intersex children explicitly into the Convention against Torture (absolute, never relative, always enforceable human rights law).

Yogyakarta Principle 18 is about this issue: medical maltreatment, unnecessary medical interventions. The Yogyakarta Principles on human rights regarding sex, gender and sexuality, that Dutch government says to wholly support.
Principle 3 however is about recognition before the law. Apart from making change easier than before, government still requires trans people to see an expert in effing gender dysphoria. who must check if we feel to belong to The Other Sex. We are never the experts on us. The trans movement has not been consulted on the issue of the expert, the medical experts have.

It is a long way to Tipperary. And an even longer one to gender justice.

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Trans in je hoofd

Eerder is geargumenteerd dat trans geen ziekte is en dat transfobie eerder het probleem is dan gendervariatie zelf. We hebben laten zien hoezeer we vastzitten in binair denken dat z’n globale pretenties moet opgeven. Een uitweg kan liggen in perspectief dat fuzzy sets bieden. In de toekomst ben je ‘trans in je hoofd’.

Een boekje dat de strijd aanbindt met het idee dat transgenders een geestesstoornis zouden hebben, doet er goed aan met perspectieven te komen. We kijken hiervoor onder andere naar Ecuador. Continue reading

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Transgender – wat is daar nou ziek aan

Mooie brochure, geeft heel gefundeerd aan wat er mis is aan gepathologiseer en wat er mis is met binair denken in gender/holebi-land…!” (Frederique Retsema, voorzitter Transgender Vereniging Nederland)

Recent is de Vreerwerk-brochure Transgender – wat is daar nou ziek aan uitgekomen. De eerste uitgebreide Nederlandstalige productie die gaat over pathologisering van transgender. Zo kun je hem op papier bestellen. En hier kun je hem downloaden

Waarom zijn trans*mensen nou afhankelijk van een medische behandeling om hun genderregistratie te mogen wijzigen? En wat is daar goed of fout aan? Zoeken alle transgenders medische hulp? Hoe zit het met trans*: is dat een derde gender? Hoe zit het elders in de wereld? Hoe zal trans er in de toekomst uitzien? Op deze vragen gaat het boekje Transgender: wat is daar nou ziek aan, in.

You never know what you got until you read about it in the DSM

Het boekje bevat de volgende artikelen:

Meer dan twee (J Vreer Verkerke)

Vrijwel iedereen heeft een genderidentiteit, een diep gevoelde overtuiging in hoeverre ze zich man of vrouw (of anders) voelen. Een aanzienlijke groep mensen heeft hun eigen variant, plaatst zich ergens tussen of buiten man of vrouw. En dat komt overal voor.

Wat is normaal? (Thijs Witty)

Het onderscheid tussen het normale en het pathologische wordt direct verbonden aan hoe dit binaire paar geconceptualiseerd is in diverse wetenschappen. Welke waarden worden toegekend aan een normale toestand en een pathologische toestand? En met welke methodes wordt dit onderscheid in de eerste plaats mogelijk gemaakt?

Gendererkenning in Nederland (J Vreer Verkerke)

Niet dat het onverwacht is, maar de regering neemt transgenders niet serieus genoeg. Zoals het er nu uit ziet, krijgen we redelijk wat taart, maar we mogen niet zelf het recept van de taart bepalen. En daar verzet de transbeweging zich tegen. Zonder autonomie is de wet niet compleet.

Gendererkenning wereldwijd (J Vreer Verkerke)

Toen Nederland in 1982 het proces begon naar een wet die het wijzigen van geslachtsregistratie mogelijk maakte voor transseksuelen, was het een van de eerste landen die dat deed. Alleen Zweden en Duitsland hadden eerder een wet. Nu komen wenkende perspectieven komen nu uit Latijns-Amerika.

Aantekeningen vanuit een diffuse logica (Trinidad Bergero et al. )

De Wereldgezondheidsorganisatie en de American Psychiatric Association beschouwen transseksualiteit als een geestelijke stoornis. In dit artikel zetten de auteurs kritisch een aantal aspecten uiteen die betrekking hebben op die conceptualisering als mentale stoornis. Zij denken dat het belangrijk is rekening te houden met de ideologische basis en de impliciete waarden in de classificaties.

Trans in je hoofd (J Vreer Verkerke)

Eerder is geargumenteerd dat trans geen ziekte is en dat transfobie eerder het probleem is dan gendervariatie zelf. We hebben laten zien hoezeer we vastzitten in binair denken dat z’n globale pretenties moet opgeven. Een uitweg kan liggen in perspectief dat fuzzy sets bieden. In de toekomst ben je ‘trans in je hoofd’, met een veelheid aan genderexpressies en geslachten.

Downloaden

De brochure valt hier te downloaden voor wie genoegen neemt met digitaal: Brochure Definitief. Wil je liever papier, dan kun je dat bestellen: voor €7,50 plus porto is “Transgender: wat is daar nou ziek aan” te bestellen door het sturen van dit formulier.

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Wegen voor transformatie

De transformatie van het zorgmodel vereist een her-denken van de erkenning van transseksualiteit en transgender als element van diversiteit. De gang door het gezondheidssysteem kan niet gebaseerd blijven op een scenario dat historisch een veelheid aan identiteiten heeft uitgesloten, waarvoor gezondheid en recht tegenstellingen zijn gebleven. Continue reading

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“Wat diagnostiseren, waarvoor zorg verlenen”: basisproblemen in de diagnostische fase

“Op geestelijk terrein is degene die vraagt, zich beroept, smeekt, abnormaal”
Franz Fanon, Piel negra, mascaras blancas 2008:134)

De diagnostische fase vormt een punt van controverse in de medische praktijk rond transseksuelen. De functie van de diagnostiek zelf staat ter discussie, als we accepteren dat er geen enkele reden is om vol te houden dat de rol van de gezondheidsprofessional moet zijn te evalueren of een patiënt wel of niet echt transseksueel is. (Garaizabal, 2003). Continue reading

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Geen transformatie van het zorgmodel zonder ander paradigma: van transseksualiteit naar transfobie

Het is 2008. Onder de titel Answers to your Questions about Transgender Indivduals and Gender Identitiy toont de werkgroep over genderidentiteit van de American Psychological Association (APA) een stap voorwaarts in het debat over geestesziekte: ze verklaart zonder voorbehoud dat de transgender conditie geen geestesziekte per se is. Continue reading

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