How do you "become" a woman?

[LeaP]

Terrific response, Frances.

Kathryn, there is no such diagnosis. Even taking a definitional (and proper) approach broader than one of the frameworks like the DSM, Benjamin's type classification (which was intended as a diagnostic AID) is far too loose and is not in itself a classification of conditions or diagnoses. Benjamin himself said almost all patients would cross categories. And it includes aspects which are quite outdated besides.

In my opinion, about the closest you can get to something like a diagnosis from Benjamin's scale are the groups. Group one is "transvestites." Group 2 is "transsexuals, nonsurgical." Group 3 is "true transsexuals." In more modern usage, I might rename group one "cross-dressers and fetishists." (Benjamin conflates these.) Group 2 would be "gender variant." And group 3 would be "transsexual." Those original groups are the primary groups we still talk about today! If you abandon the antiquated language, it rather pops into view!

[Pink Person]

I use the word transgender in its inclusive sense that describes people with transgender and/or transsex issues. I do this because sex is a subset of gender, and sex and gender issues are often interrelated even when they are not intersecting.

No one has to agree with my point of view or get hysterical about it.

I find the whole notion of men changing into women (and vice versa) to be absurd and derogatory in all its variations. If someone is a transwoman after modifications then you can be certain they weren’t all manly before them. Cismen (and ciswomen) don’t participate in these types of transformations.

For some transgender people, putting on a dress or a dress and a new body is all about communicating something to themselves and to other people that can’t otherwise be seen. The unseen you, the core beneath your shell, doesn’t transform very easily. Our shell selves are relatively mutable, but our core selves persist in comparison.

Shell transformations are important because they tell us something about a person’s core identity that doesn’t change as much. Prattle about becoming something you are not or being something you are not diminishes the core identities of transgender people of every stripe. I take it for granted that transgender people are not all the same, even though this concept seems to be incomprehensible to some of you.

[Kathryn Martin]

A diagnosis will always fall short of the real thing, that is your internal reality, which is yours and yours exclusively. And any attempts to describe it with words is going to be met with failure but we do it nonetheless because otherwise we would have no ways of interacting with the world we live in.

The question is, why do people focus so much on a "diagnostic label" despite knowing its inherent and irrepairable flaws?

I have some rough ideas why, but what do you think?

Love,
Sarah

Sarah, one of the reasons that diagnoses fall short of the real thing is because there are generalized criteria which describe the condition. If you come with a certain narrative then the diagnostician will diagnose with what this narrative describes. I could narrate a set of "facts" which would lead inevitably to a diagnosis of cancer. This would be followed up with tests which then would show that cancer is not present. The fallacy of a psychological diagnosis is that there are no tests which would rule out the condition that was tentatively diagnosed. For instance your carotype if tested will show that you have xy chromosomes (in most cases at least), which is no help in this instance.

But what is the narrative that really indicates you are transsexual? Much of what is the common narrative has little or nothing to do with the transsexual condition. Because the narrative is perpetuated over the internet, albeit increasingly refined, they jarr the listener.

But what if the observer(s) (note the switch in activity) actually witnesses you as you truly are. And all of the sudden the world actually speaks with you with all of it's wonders and terrors, not because you describe the right things but because they realize the living reality?

The reason why people find a "diagnosis" so important is because it provides a medical justification for the dissociation of the perception of the individual who is being observed. It excuses their oddness.

Kathryn, there is no such diagnosis.

Lea, with all respect to you this was exactly how I was diagnosed, with those words with the add on of meeting DSM 4 criteria for gender identity disorder (still valid in 2011) and lack of Axis 1 and 2 criteria.

To both of you: I find diagnoses important for procedural, that is gatekeeping, reasons. It opens the door for Standards of Care applications. The most detrimental effect of diagnoses however is that most people take them to absolve them from responsibility for their own self. The all so common effects of transition of loneliness, retreat, anger, sensitivity to perceived slights and micro aggressions, have much to do with last point.

I do this because sex is a subset of gender, and sex and gender issues are often interrelated even when they are not intersecting.

Wow Pink, that really is turning the world on it's head. Sex determines what gender you are, given that gender is a complete social construct created to set off the sexes. That is the only interrelation.

[sarahcsc]

People focus on the diagnostic label so much for the same reason they hang on to the idea of having an atypical kariotype. It has a lot to do with legitimacy in the context of repudiation from others and the lack of desire to take responsability for their lives. It's much easier say: "see, the doctors say I have a problem." Ultimately, however, transition is a decision (if transsexuality is not) and people are going to get hurt (most of the time).

Hi Frances,

Your observation is astute but the very same observation raises other important questions.

"How much responsibility should a person assume over their lives?" and "When does it become appropriate for them to relinquish responsibility or have their responsibility taken forcibly by society?"

The idea of responsibility is closely linked to the idea of freedom as the famous saying goes "with freedom comes responsibility". Therefore, if what you said was true, that if a patient's wish to hold on to a diagnosis is because of lack of desire to take responsibility for their lives, you must assume that they are also giving up their freedom to be. This certainly can't be good... or is it?

Coming from the East, I can't help but be astonished at times the amount of freedom people get in the West, yet be baffled by the lack of responsibility they assume. Why is this? There seems to be a lot of advocacy for "freedom" in the West particularly in America (please correct me if I'm wrong) but I wonder if I can say the same for "responsibility". Freedom was not given to me, I had to earn it. And even so, I had to be very careful with it because it can be taken away very easily by my parents or society. The culture of children moving out of their homes when they hit a certain age was certainly foreign to me because it is just not customary for Asians in general to move out unless they have earned their freedom (i.e. good job, stable income, getting married, wanting to build a family) and this could take many years which explains why some middle age Asian males continue to live with their parents. How much responsibility do you think these males have over the course of their lives?

I bring this up because your observation although astute, forgotten to mention the real reason why people are so reluctant to take responsibility for their lives and that is because of fear. Responsibility is the ultimate test reality throws at you. Like a bird who is about to flap its wings for the first time but at the same time daunted by the sheer cliff it was about to plunge off. A person who is refusing to take responsibility, to me, is just a person who is scared. And sometimes they are scared because of their fear of falling, but sometimes also because of how far they think they might fly (and subsequently never return).

Perhaps, just perhaps, I'm saying this with a lot of skepticism on my part as well, that for these people, a diagnosis, serves as a temporary platform in midair, kind of like a floating airstrip where the bird can first try out its wings by leaping instead of flying. The airstrip catches them, and once again gives them the option of attempting flight when they are sure their wings are functional. Its an odd analogy but its the best I can come up with, sorry... There is certainly a danger that they will remain on the airstrip forever and not wanting to attempt flight but what do you do about that? Because if you advocate for "freedom", can you not also advocate for the freedom to give up freedom? Its mind boggling...

I've seen many of my patients who appeared relieved following an initial diagnosis, only to disavow it later because they have transcended the need for that. Then there are those who know the DSM V manual better than I do but totally ignored it because none of the criterias apply to them. Or those who are hellbent on getting diagnosed. So what does a diagnostic label mean to them? The airstrip in midair that is neither helpful nor unhelpful. But to a therapist, their need for a diagnostic label informs me of the kind of person they are. And I am open minded to whoever I'm treating because I understand very well that every individual brings along their fears of taking responsibility and I recognize that my role as a therapist, is to help patients transcend their fear and most importantly, NOT judging them.

That fear is not transcultural as far as I know because in Asian cultures, children are normally very well prepared before they are allowed to take on responsibilities. Moreoever, they have to prove their ability to take on responsibilities before they are given the freedom. Hitting a certain age means little or nothing in my culture. There's no such thing as a "sweet 16" or a big "21st birthday". Freedom and responsibility doesn't come with age, it comes with acquired achievements. No achievements means no freedom. Lol. I invite other Asian forum users (or from other cultures) to critique my statements because I may be highly biased in this. I can only speak from my experience and what I understand about traditional Chinese culture.

And as with the other question I asked "When does it become appropriate for them to relinquish responsibility or have their responsibility taken forcibly by society?", I thought about people who are either so destructive to themselves or to others that freedom is simply something that society cannot afford to give. Depressed people who are acutely suicidal, the psychotic person who lost contact with reality, the psychopathic murderer, or the genocidal dictator. But what about the compulsive cheater who go around breaking hearts with little remorse? Or the narcissistic person at work who puts people down in order to elevate their own status? The backstabbing friend at school? Society as a whole decides when to take a person's responsibility/freedom depending on the severity of their actions.

Remember Alan Turing? Hailed as a hero of WWII for decoding Nazi secret messages, he was also chemically castrated because he was homosexual. That is how far society will go to take away a person's freedom back in the days. I'm glad things are changing albeit too slow for my liking! Lol..

So coming back to the original topic: To me, a person's who rely on a diagnostic label to conduct their lives is probably too afraid to fly, but not too afraid to leap. Some people continue to live productive lives bearing a diagnostic label while some are totally disabled by it either by true or imagined disability. It is not up to me to judge if what they are doing is right or wrong because I sincerely believe that everybody should be allowed the freedom to live lives however they want to as long as they are not causing harm to themselves or others. I also believe that with time and opportunity, they will eventually transcend the need for a diagnosis and learn to live a truly authentic life. I'm still learning in many ways to do that myself and I am humbled by how convinced some people are of their identities.

The reason why people find a "diagnosis" so important is because it provides a medical justification for the dissociation of the perception of the individual who is being observed. It excuses their oddness.

...I find diagnoses important for procedural, that is gatekeeping, reasons. It opens the door for Standards of Care applications. The most detrimental effect of diagnoses however is that most people take them to absolve them from responsibility for their own self. The all so common effects of transition of loneliness, retreat, anger, sensitivity to perceived slights and micro aggressions, have much to do with last point.

I've mentioned my take on the psychological implications of a "diagnosis" but also mentioned earlier in post #79 about the practical implications as well, which you have touched on here as well. In the real world, you can't get help unless you are given a diagnostic label and that must be accepted. Like me, you are also aware of the potential detrimental effect of a diagnostic label but again, that risk is inevitable therefore it is better to learn to accept and manage it rather than trying to avoid it altogether.

As to what you said about it being a "medical justification for the dissociation of the perception of the individual who is being observed. It excuses their oddness.", I think I may have to disagree with that one. Because what is more attention drawing than to have a big diagnostic label attached to you? Odd people, although less accepted, are nonetheless tolerated. However, attach a diagnostic label to them like "Gender Dysphoria" or "schizophrenia" will result in downright abhorrence and rejection. It probably draws more attention to the oddness than anything else! And worse, it opens up the oddness to more negative interpretation. Don't you agree?

Another problem I see sometimes in my practice, is the lack of continuity of care. I imagine a good therapist is one who takes into consideration the practical and psychological implications of a diagnostic label before dishing it out to their patients. Also, a good therapist tries their best to help their patients make well informed decisions, which includes telling them that things aren't necessarily going to get better following the diagnosis or even after transitioning. But most importantly, when it comes to continuity of care, the therapist has a role and responsibility to help their patients manage their mental health prior and after transition as part of the transitioning process. To simply apply a diagnostic label and then leave them is in a way, very irresponsible. But that's just me being idealistic perhaps.

Love,
Sarah

[Frances]

My response was not that philosphical. It was more an obersavation on the "my wife won't let me" comments that I hear all the time on this forum. It's easier to say that than acknowledging fear and guilt. There is no blood test and lots of people will not believe the transitioner, especially relatives and close friends. A diagnosis makes it easier to sell it. Incidently, I went through a very rigourous gatekeeping style of program. I was never given a diagnosis.

[Marleena]

It was more an obersavation on the "my wife won't let me" comments that I hear all the time on this forum. It's easier to say that than acknowledging fear and guilt. There is no blood test and lots of people will not believe the transitioner, especially relatives and close friends. A diagnosis makes it easier to sell it.

This sounds an awful lot like me. When I first started in this section I used my diagnosis to try and show I belonged here. That diagnosis was reached by my support group leader who I turned to for help. She had all the health care connections that could help me with the GD. I remember her saying "you appear to be transsexual" and that scared me. I remember telling her I didn't want to be transsexual! I wanted a different answer. I was looking for somebody to tell me it wasn't true and that never happened. I began to realize it's the only thing that makes sense for me though. Some of you had absolute clarity while I just couldn't understand what was going on with me. I just knew it was gender issues.

[LeaP]

Kathryn, I know that is how you were diagnosed. My comment was that it was not really a proper diagnosis. The DSM portion of the diagnosis was perfectly appropriate. And it, of course, was important most of all because it provided access to care, not because it defines the condition… Which it does not, as you know. The "type five" add on, however, does not describe the condition at all. It is a loose collection of behavioral, physical, intensity, sexual, and other such things lumped into observational categories. The only condition – actual condition – that you have, especially with the lack of comorbid issues (which are really a separate set of considerations anyway) is that you are transsexed. Intensity itself is not a condition so much as it is a treatment consideration. As with many other medical conditions, many manifest over a range of intensity. Same condition and sometimes requiring treatment, sometimes not.

The most important part of the Benjamin scale is the groups. One is transvestites, two is nonsurgical transsexuals, three is true transsexuals. If you bring the terminology up-to-date, it basically boils down to cross-dressers and fetishists (Benjamin conflates these), gender variant, and transsexual. I.e. the same things we are still talking about today, and which Benjamin separates along treatment lines, supporting a point you often make.

[Rianna Humble]

This thread is so far from its origins, I'm not sure if you could get back even with a Sat Nav. Time to close it.

If you want to continue discussing the philosophy of diagnosis in relation to TS folk, please start a thread about that. Equally if someone wants to discuss the doctrine of personal responsibility, they can start another separate thread about that insofar as it relates to transsexuality.

[Kaitlyn Michele]

I was never given a diagnosis (what I mean to say is that my path was chosen BY ME..at which point I got a letter that technically would be the diagnosis)

In psychiatry is it "anxiety" or "depression" or both? I realize there are standards that are usually followed, but they are different by country, and there is a lot of leeway in how doctors apply them.. then there is the issue of what to do about it....for depression and anxiety there is a laundry list of medicines and therapies that work for each, and many doctors use their experience to decide how to advise their patients, and will use medicines that are not prescribed for the official diagnosis...

unfortunately my family has a history of dealing with this and after 4 medicines and 3 psychiatrists I found a cocktail of meds that improved my quality of life, and the cocktail included one medicine that is totally off label for my situation but has been shown to help and it hugely improved my quality of life!!!

I think this is applicable to this discussion the idea of a purely medical diagnosis for transsexuality.
I believe transsexuality is a medical condition...but there is no more magic to it than being diagnosed with depression or anxiety disorder...
and its not always easy to diagnose, and then the whole what to do about it part can be very easy or very hard depending on the person.... that's why personal responsibility is so hugely important..

for me to take paxil or Prozac or abilify of Ativan are all things that I can test by just taking a pill... whether I do cognitive, ACT or mindfulness therapy are things that are easy to try on for size and see if I progress.... but its still my responsibility to report back to my doctor how I felt on the paxil... its my responsibility to apply the therapies suggested by my doctors, and the doctor still has to make judgments on the veracity of my statements and decisions about proper dosages....I think its all applicable to what goes on with us...

I never even thought of the idea of a diagnosis....maybe that's because throughout my therapy I kept trying to poke holes in the idea I was transsexual....my own nature is pragmatic and an intuitive decision maker....I do not like being told what to do....I had a good therapist and she "learned me" she never said to me "you are a...." ....she didn't lead me to water, but she kept it close enough for me to find the water and in my own specific case, my therapy simply helped me take responsibility for my own life... my therapist says today, "oh for sure I diagnosed you as transsexual"...but her feeling is never to say that to the patient...its too powerful...its her belief the person has to get there themselves because if they cant, then they are not ready to deal with it...

if you can't take personal responsibility for simply naming what it is that you are , then you are not ready to own it, and you are not ready for the responsibility of dealing with it...especially if its transition..

in the end, that is what this is all about... taking responsibility for your own life... its sooo hard to get there...read the posts... we are all over the map with how we get there!!!

that's a testament to the difficulties of getting well if you have this fricking problem many of us share, and its why I tend to have huge respect for transsexuals that are able to live a great quality of life ..

.