The Autonomy War

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Due to the ways in which transition is arranged, namely the forced sessions with a psychiatrist, I often feel a sense of guilt that I don´t need to feel. Namely, that all of this is my doing: if I had not been transgender (or decided not to transition), I would not have to do force myself to undergo therapy that I do not want or need. Hence, it´s on me.

Although I don´t want to be conforming to forcible therapy at all, I often wonder what I can and cannot say – as anything I say could possible be used against me and/or raise suspicions that “I might not be trans after all” because I went through dramatic childhood circumstances. The past, it seems, is always used as a means not to trust me.

The argument that this scrutiny is good really does not echo with me, not just because the chances that I am a trans man due to my childhood extremely improbable (with just one instance that I have heard of). Most of all, I find it unethical that any psychiatrist would see themselves fit to judge if I should have autonomy over my own body.

I find it reprehensible morally because in attempts to insure that I am really a man (even though my official documentation says I am a man), gender therapists and psychiatrists recreate a situation in which again the autonomy over my own body is leveled over to somebody outside of me. Just like when I faced abuse at the hands of “caregivers”.

True, I am not getting the shit beaten out of me, but the situation makes me feel the same degree of humiliation as my parents had me undergo as a child. The argument that any shrink is more suitable than me to make these decisions, makes me feel physically sick. The only reason they could ever argue so, is solely due to insurance and legal reasons.

I have been fighting to get my autonomy back from people who somehow feel entitled to make decisions for me, for an incredibly long and exhausting time. The idea that someone else than me decides about my life, and that my destiny is not mine to own, is enough to induce suicidal rage, and yet this is not taken into account at any time.

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Surgery & Stuff

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So I told you that I am trying to “beat the system”, at least where gender is concerned. I have refused, for two and a half years, to comply with regular methods of transition. That is not to say I haven´t tried. Because I have tried, really hard. I have discussed my ideals with four different gender therapists.

Nowhere lane, though. So I looked around and networked with other transmen and women who opted for unconventional ways to transition. Some of the guys had managed to get top surgery without getting an okay from a gender team. Specifically, with one surgeon who does not believe that rigid protocols are needed in order to transition.

So I wrote her. I explained my situation, and then I had my therapist write her, who has been wonderful throughout the entire process. I went for an intake, they took a look at my chest, took some pictures, I had my talk with the anesthesiologist, all my blood checks done, the stuff you need to get ready for the surgery.

So to tell you the truth, I thought I was good. Now I just needed confirmation that I would be put on the waiting list. Instead, I got a phone call from the surgeons´ assistant, telling me that a diagnosis from my therapist was not enough, because she was not a psychiatrist or a psychologist. Apparently only they know if you have dysphoria. Or not.

The phone call, for a while, had me reel on the verge of a suicide attempt. Immediately afterwards I went to my friends on Facebook, the ones who are transitioning in unconventional ways.  They told me the situation was very strange. There were a few among them who had had no diagnosis at all, and even they had had top surgery.

I wrote my therapist, who was kind of angry at the entire situation too. She did not understand why her recommendation (for me to get top surgery) was being rejected as invalid, and also why I could not get a second opinion from the psychiatrist who works at the hospital where I would be operated. Once again, I called the surgeons´ office.

The assistant said she would discuss my situation with the surgeon. See what she thought. Unfortunately, they haven´t called back yet. When I called again today, I was told that the plastic surgery department was moving to another office, so I would have to try and reach them later. So much for having an uncomplicated transition.

Life as a “Phase”

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If there´s one thing that makes me sick to my stomach, it´s the term “real life phase”. Therapists who are registered as “gender professionals”, use this term to indicate a phase in which you live as your identified gender and thus you can see if it´s a fit for you. In the past months, these therapists tell me the following.

“You need to go through a real life phase in order for us to decide that you can get surgery”. This phase, in their head, is an imaginary and random amount of time, which starts when you visit their office for the first time, and ends when they think they have observed you are male/female enough.

As a reader of my blog, you will be able to tell how ridiculous and absurd this is. I am equally male as any other – since 2015, I look male, I sound male, my passport has an M in it, my birth certificate even has an M on it. In fact, I am stealth in most situations where people have no idea of my history. And I like it that way.

There´s a couple of things wrong with this. The first one, the absurd nature of it, which I´ve just noted. The second, is the fact that these are people who deem themselves more capable than other (psycho)therapists to diagnose gender dysphoria. These are the people who should most understand the transgender case and life.

And yet they don´t. They claim they do. But if anyone – therapist or not – has the sheer audacity of telling me that I am undergoing a “phase” – which they are qualified to “diagnose” – they are just delusional. I´m very sorry, if with this term I offend anyone, but I think this must be said, I think this is true. And I intend to make this clear.

This so called phase undermines my self esteem and frequently makes me feel deeply depressive, simply because people are either unwilling to allow me to make changes to my body, or have no real understanding of what dysphoria really is, or both. This so called phase is my damn life. You want to diagnose gender dysphoria? Try respect.

Circle of No

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If you´ve been following my blog since the beginning, you´ll have read how I dumped the VUMC genderteam. VUMC was the first genderteam I went to for what they call “diagnostic phase”. It means that you wait for about six months, get assigned a shrink, and you talk to that shrink for about another six months.

The job of the shrink is to get an idea of who you are, what your life looks like, if you have any problems (mentally or otherwise). Based on that they make an assessment of you, in which you either get permission to start hormones, or they reject you and suggest more therapy. I find this entire approach asinine.

After waiting six months I had my first chat. It did not go so well. I was angry at the terrible attitude of their staff (I wrote about that here), their continuous effort to keep misgendering patients, and I had heard lousy information about the shrink that I was assigned. So I quit, and instead, I went  to the genderteam in Assen.

At first it went fine. I was much more happy about their staff, although they continuously canceled and moved around appointments. The therapist seemed a bit more open-minded and was easier to talk to. Nevertheless, it turned out that the patronizing situation in which I was held – other people deciding my future for me – was devastating me.

For a while, I tried negotiating with them. I rejected the type of treatment they were giving me and asked that a new plan of treatment be made, which took into account my situation. However, no alternatives were offered. After four very long letters, months of waiting and contacting a patient organisation, I finally got a reply.

They said that I had “closed the door on them” but that they were willing to renegotiate. Their allegations didn´t sit so well with me – I had never closed the door on them, in fact I had send them letter after letter and tried to communicate, only to get a very short reply back that basically said “your demands can´t be met” and offered no solution.

In December 2016, a bizarre misunderstanding further confirmed my feeling that De Vaart were barely invested in my situation. The whole time of ten months, the unspoken message seemed to be “figure it out”, while at the same time demanding that I completely invest myself in their techniques. I decided to quit, again. It´s the circle of no.

Being Enabled

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Few words resonate both friendliness and hostility as well as enabling does. In good circumstances, being enabled means living up to your potential, and someone who enables you is a fantastic ally to have. In bad circumstances, being enabled is a horrible state of mind which often imprisons the person within.

An enabler can be many people. It can be a partner, a family member, a professional – but most often, it´s you. You are the one deciding to quit smoking, and you are the one who is responsible for the upkeep of your body and mind. If you choose to enable your own vices, at least you will still have a degree of control over it.

If the enabler of your vices is someone else, it´s more severe. The enabler will consciously or unconsciously encourage you to be passive towards yourself, and encourage helpless thinking and behavior, so you´ll stay where you are and remain dependent on them. It´s a very creepy situation to be in and difficult to discern.

In my experience, in the field of psychiatric healthcare especially, the line between positive and negative enabling is rather thin. I have met a lot of psychiatrists that encouraged helpless behavior by approaching their patients as if the latter were less skilled and less experienced in life, even if the patients were much older.

Lack of faith and trust in my own abilities has, in previous years, enabled professionals (notice how I am the enabler in this situation) to encourage an infantile state of mind, in which I happily surrendered my gut instinct and my ability to think for myself to them, because I expected that they would find some solution.

This never happens. It´s very simple: the only one who has the most expertise in your life, is you. But I failed to comprehend this. Back then, I failed to understand that therapists and clients are not in a skewed relationship by default – that this is a construct that exists to explain away why so many settings do function this way.

It´s hard to trust yourself when society (and possibly your parents) have taught you that a degree holds more value than gut feeling, than being experienced. It´s hard also to see yourself as a fully grown human being who does not need to hold hands with doctors and with therapists – because holding hands feels safer.

Dependency

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I often wonder why I feel like a child during a mental collapse. Part of it could be that I never grew up with any good examples. My parents were never quite parents – they were children themselves. My mom was at best, a hysterical teenager. My dad was just a confused boy with no idea what to do.

Part of it is the fact that the circumstances forced me to push forward even though what I needed was to be able to sit down and just cry hysterically. I never got past that. Not even now. I am still stuck with the need to process emotions from over twenty years ago, and the idea of this sobbing inner child leaves me bewildered.

Finally, there is the process of enabling. Lots of things enable our emotional, childish selves in the times we are living in. Things are just geared to sell you information and goods by appealing to your irrational want, such as wanting to be popular with your parents or wanting a stock of candy this freaking high.

We live in a society where every single deviation from the usual human behavior is collected in a book and given a label. They somehow become “special” and are given a treatment to match. Unlike other societies and our own past, care is now in the hands of the few.

Paternal functions have been relinquished to institutions. This is good in a way, it means we have faster and perhaps better healthcare than before. But what good does it do, when institutions label you as incapable of making your own decisions, and trust to substitute instinct completely with either medical or social sciences?

Nowadays I know very few people who feel courageous enough to tell their doctor exactly what they want – it is only through hardship that we learn we are mature enough to be knowledgeable. Sometimes having a degree is handy. But it doesn´t signify higher understanding.

We are expected to leave everything, including decisions about our own body and psyche, in the hands of people whom we have sometimes not even met before. Who know us a grand total of a few minutes, and yet expect to be allowed in the most personal of domains. This naturalization of dependency is worrisome.

Dead End (No More)

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I would love to go to sleep. I honestly would. But thoughts are roaming my brain in confusion, wandering into each other, knocking each other over. If I don´t let them out now, I will have anarchy on my hands in no time. So it´s okay, thoughts, if you´ll just behave for a second, me and my trusty IBM keyboard will set you free.

I´ve written a lot of posts about being stuck in a dead-end, particularly when I started out writing in March. The Dis-ease of Waiting, Depression, Normalized Care, Bricks in my Pants, Please Stand-By, are all examples. This feeling was mostly caused by my frustrations with transgender care in our country, where transition = psychological analysis.

Whether psychological analysis is necessary for someone to transition, or not  (I think not, depending on the manner in which such analysis is being carried out), transitioning implies moving from one place in your life to another. The old place is no longer functional. If you linger in an obsolete life for too long, it can cause you to feel stagnated.

I do not think that this is healthy. Of course, some people might need time, and I am not advocating that you should just rush your transition, and have all the changes made within a couple of months. That would be incredibly unwise. But waiting a year or more from coming out to actually going on hormones, and feeling desperate in the meantime, can have repercussions.

Admittedly I´m no scientist, it´s merely intuition, which makes me feel that stagnation induces depression, and in other cases, even suicidality. It is absolutely not inherent to being transgender, contrary to what many statistics and newspaper articles might have people believe. Changing your life for the better doesn´t induce suicidality, circumstances do.

This was my situation. From December to July (when I started testosterone on my own initiative), I frequented the emergency room due to breakdowns, anxiety, severe tension (urinary retention), and severe injuries caused by panic attacks. I still feel that transgender care on its own and its focus on analysis and examination does more harm than good.