There is a lot of static with the clinical community about homosexuality, transsexuality, or more specifically gender identity disorder. The classical model of therapy, and treatment of disordered, and mentally ill people is by far the most misunderstood philosophy in all of medicine I’d argue. It is often assumed that because things like personality disorders, and schizophrenia can be treated with medicines or institutionalization that transsexuality and by similar mentalities homosexuality can also be (though it has been out of the DSM for years now). It’s a profound failing in understanding to believe that Psychiatry and Psychology cures people. Rarely is a cure ever accomplished through therapy, the only thing that can be achieved, though in limited success is adaptation of behaviors to reduce the perceived illness. SO as you can see, it would be wrong to assume that the goal of therapy is to cure. Also, its important to understand that therapy is a versatile implement designed to help a therapist work through the issues to return functionality, lessen duress, and in the episode of dangerous mental illnesses to equally protect the individual and society from the individual as necessary. As I said, it’s adaptation, not medicine as is typically believed by the layman from the outside of the system.
The human psyche is a complex entity, and when it comes to disorder of this entity, conflicts, or other needs that may arise in mental health concerns. Seldom is medicine the same kind of “Fixer” you see in other forms of medicinal practice and health. Usually medicine is only as necessary, and even in medicine often times its only purpose is to treat the symptoms with no concerns for curing. The common cold must run its course, but medicine is a useful tool that can allow for a physician to make the patient comfortable, aide in recover, or negate potentially life threatening symptoms or side effects of illness. Much is similar in this regards to much if not all of psychotherapy. But if so it doesn’t address the static that comes with Gender Dysphoria as it pertains to the Psychology Community at large. It is still largely true that many conditions that would need a psychologists expertise are focused at mitigating, or functional control of the agitating mental state. I.E. A person has an unreasonable fear, the psychotherapy focuses on mitigating or eliminating the fear thus returning function. Some cases medicine is required to correct or aid in the correction of a chemical imbalance, sometimes permanently, sometimes temporarily.
Psychotherapists have many tools at their disposal to discuss the needs of the patient. This pattern that seems to be consistent across the board gets murkier when you are dealing with patients suffering with conflicts related to gender identity, or sexual identity. Unlike many other forms of disorder or illness that are responsive to cognitive approaches to eliminating the conflict both of the earlier are highly resistant to such attempts, and can be life threatening to attempt. So perceptually there is a functional misunderstanding of the commensurate process of our treatment, that it’s somehow a failure to “convert back” was a failure to try hard enough to be “cured”, or a failure on the part of the Psychotherapy Establishment to provide “adequate restorative” treatments. This is a fallacy of equivocation, and fueled by an ignorance of the methodology that has been used for well over a century in this field. The model, at least as I see it is a patient centric model, and the test of time has shown the patient centric effort is most beneficial to all parties involved. But, there is a misunderstanding of this model, because of the belief of some, that it’s designed with a “societal centric interest”. The social impact is definitely a factor in psychotherapy, but it is by far the highest priority of treatment.
Many people in the layperson society lack adequate grasp of how truly successful the patient centric model is, or that societal interests only come into play if the individual has an illness that is a threat to those around them. In the dismay of these disjunction, outsiders perceive the transition therapies of transsexuals, and the social acceptance of homosexuality as not being a mental illness as psychotherapy facilitating the delusions of the mentally ill. However, being an adjusted transsexual, or homosexual does not prevent social function or the ability to give to society effectively. The outside is unaware that such reform techniques were ineffectual, and in the societal and not patient centric model it was harmful and as a result enabling forms of therapy (patient focus) are advocated over conversion therapy (social focus). The problem is that there is still societal pressure on such establishments to “Reform” those perceived as disordered so that they match the common social order. Like I said, it’s a fundamental disconnect that the treatment for disorders is to cure the disorder as a blanket principle when it is not the case. Some are treated with psychotherapy, some people just have to learn to live with, others with medicine, and some with institutionalization. The problem is that because of cultural expectations things like homosexuality and transsexuality can be a culture shock to the uninformed.
Another fundamental misunderstanding with these conditions is that because it is at least in modality it’s mostly an internal/psychological experience, and therefore missing the physical modalities commonly associated with medical causality. Meaning it’s a ‘variance’ in thought, something ideologically or fundamentally different in a way that can’t be seen. Because of the nature of the condition, it is difficult for those who don’t have the condition to understand because within us something is different as a foundation principle to our constitution. It grants it to uncertainty, and therefore leaves it open to the unknowing to make assertions about what, why and how such conditions come about. It’s an intangible property like love, or hate, and thus between groups with these fundamental differences misunderstanding inevitably arises. It can also contribute to the fallacy that accepting it could therefore contaminate you potentially making you gay, or transsexual over ignorance of it’s immutability. Essentially, there is no amount of exposure to a homosexual, heterosexual or transsexual that will convert you because it isn’t ideological in nature, and as such not communicable through exposure. But these misunderstanding are almost always based on logical fallacies.
I.E. For a heterosexual male they may think, “I am a man, and being with women feels good and makes babies to continue the race. So I’d assume heterosexuality must be good. Therefore, homosexuality must be bad.” As I stated before I find many of the fallacies about homosexuality and transsexuality are fallacies of equivocation or of false dilemma/dichotomy (or at least I think it is) and are sometimes comparing things that are not comparable. It would be similar if you replaced man with human, and being with a woman having babies with eating sugar and cake. It would still be a fallacy because some people have problems metabolizing sugar and could die from consuming it without medical intervention. Being with a woman doesn’t feel good for all men, therefore you can’t inference that one is good or bad verses the other. If you do it’s black or white thinking therefore creating a false dichotomy. The number of homosexuals and transsexual per capita isn’t changing or growing with time, though the increased awareness and visibility can give that appearance (much like the apocalyptic doomsayers when it comes to Earth-wide seismic activity as a sign of the end times). It’s not growth in prevalence, it increased awareness, and accessibility of information on the phenomenon. Once social acceptance is achieved I am sure the statistics will become fairly static, not fluctuating much if at all. However, the mysteriousness of it does facilitate a lot of the fear-mongering that revolves around the issues at hand. How can you fight or understand something you can’t see.
This is a bridge that we will all one day have to overcome to really and truly find equality. Understanding the variation of human experience is important to our future. As a race we need to learn to acknowledge all things that define us, not just those things that culturally accepted. When society accepts homosexuals, it’s not because of erosion of some bronze age morality, it’s because we have morally evolved to know that it is natural, harmful to repress, and of no hindrance to social function, integration and contribution.
When Psychotherapists provide hormone therapy approval, and letters for SRS (Sex Reassignment Surgery) they aren’t facilitating the delusions of the delusional, they are recognizing the decades of study on it, the needs of the patients, and honoring the validity of that individual’s immutable gender identity as displayed by such clinical research, trials, peer-review, and stringent scientific methodology. This is our lives, our bodies, and our sanity we are talking about, and it’s in our best interests that people use sound science, and conscious effort to do what is morally sound as well. Allowing the beliefs of the majority to override our needs is hardly in the spirit of equity, anymore than the reverse.
The psychologists of the world don’t take homosexuality or transsexuality (or its treatment) lightly or liberally as the conservative and religiously motivated would so have you believe, and have published their professional and educated consensus on the matter for all to see. This isn’t some liberal conspiracy against the conservatives, or some attempt to fight against God, undermine morality, or attack the religious ideologies of the world, it’s just reality. If you are homosexual, that is what you have and will always be; if you are transsexual, that is what you have and will always be. We have evidence of this, while all the opponent has is baseless and contradictory assertions driven by prejudice, superstition, and bias that is evidence free or fabricated.
Related articles
- Ex-Gay Therapy: NPR Forgets Infomercials Are Not Science (psychologytoday.com)
- “Curing” Homosexuality (psychologytoday.com)
- When boys would rather not be boys (macleans.ca)
- What Psychotherapy Means Today (bigthink.com)
- i’m a conversation-crashing alien with rad eyestalks! (rainbowgenderpunk.wordpress.com)
Involvement of “Psychotherapists provide hormone therapy approval, and letters for SRS” is beneficial in many ways.
But doing so, by means of a mental health DIAGNOSIS of psychopatholgy is plainly a dishonest lie, there is no mental illness for the problem lies with society and not the individual. Should psychotherapists act unethically in order to promote the health of their patients? Do the ends justify the means even if they involve abdication of morality? Apparently psychotherapists do not regard ethics as disposable.
I agree, psychopathology is a problem, but until a better method of service can be hammered out I’d say I prefer having some sort of structure enabling me to get the services I need. Pathology is a significant snare across the board with other issues aside from gender identity for sure. I think a paradigm shift in mentalities about psychotherapy could go a long way with this issue. Meaning that the patient centric model still needs a little be more patient centered tweaking, because there is still stigma and social focused normalization. Some therapists understand this, while others are largely oblivious; however, I feel social normalization is unethical even in mild to moderate doses because gender variant behavior is not an issue of social order/safety any more than homosexuality. Social focus normalization should be eliminated except where public safety is concerned, but in many areas it is not and there is still a tendency to stigmatize gender variances as “failure to conform/reform.” This, of coarse, was only part of the focus of my blog.
As for the ethical ambiguity of psychotherapists within the current model, I’d argue that many of them at least operate with in the confines of the standards of care; therefore, the standards of care should be the target of scrutiny. I think the biggest problem with this particular change is the chance of a significant vacuum of necessity if it were depathologized, thus many cling to it out of fear. However, many medical providers, including the VA have standards on file for administration of HRT and psychotherapy outside of the Harry Benjamin Standards of Care, as such there would be no vacuum in care for those areas already covered by such policy. However, infrastructurally, and socially there is still inadequate “good faith” support agreements for the treatment of transgender people, so some areas would experience a vacuum, while others would be largely unchanged. It should be without stating that our support net should stand on it’s own without there needing to be some sort of crutch to treatment.
As I said this change needs a shift in thinking from social normalization prioritization (Zucker et al) to a personalized need approach as an “overwhelming consensus” not the “fault-line” split we currently see in psychopathology. Such a shift, in my opinion would open the door for depathologization, and allow for more people to be able to seek transition services without pathology based hoops to jump through. I still think the therapist is necessary in the process more for some and less for others in a personally tailored approach, but only as an informed consent process, not as a “gatekeeper” unless other mental illness is a contraindication with such consent much as trans support organizations in Canada, and some more progressive areas of the US have adopted. That as long as you understand the risk, and don’t display other “risk factors” you don’t need therapist approval for hormones. That being said, there is a already a wind of change blowing through this very concept. Hopefully, providing such a break down will help those who don’t understand the seemingly “reverse psychology” nature of the methods for these topics will open up the minds of more to the greater understanding of these psychopathologies.