A therapist’s understanding of gender dysphoria

The upcoming Genspect webinar on detransition will focus on how society needs to grapple with certain issues if we are to provide proper treatment to people who seek medical transition.

This webinar will be held on Saturday March 12th at 8pm GMT, so as to accommodate the majority of people from Australia, New Zealand, Europe and North America. It will explore important issues including (but not limited to) the impact of social media on vulnerable people, the difficulties for people with ASD in relation to gender politics, the challenges facing butch lesbians, and the male detransition experience.

For vulnerable people who feel lonely, lost, disconnected from themselves, and filled with self-loathing, the concept of gender identity can be enormously alluring. It opens the door to new and enticing ideas: you might in fact be another person; there might be some unfalsifiable, untouchable sense of gender identity within you that has created this disconnect from your body and your very self; with a change of identity, everything will fall into place. This is before factoring in a seemingly infinite scrollbar of YouTube videos of chatty and charming transpeople, assuring their lonely viewers that transitioning is the best thing they can ever do, that they will find their “true selves” through transition, and that everything will get easier from that now on.

I am not someone who is religious; I hold a psychological understanding of human nature. So when I first heard about the concept of “true trans” – the belief that some people have “transgendered souls” within them, that these people are thus “transgender”, and that these transgendered souls represent their “true selves” – it very nearly blew my mind. Living as we do in a post-religious age, it is notable that this concept of “true trans” appears to be rooted in a Christian belief in the soul, where it is assumed that each of us has a “true self” buried somewhere deep within us. This true self has no physical embodiment; instead, it is an unfalsifiable and mysterious sense. Some people say they have it, and others don’t.

I was brought up in an Irish Catholic home, and so I am well used to being around people who talk about their soul as if it’s an unquestionable fact. But, as with Catholicism, I’m a gender apostate. Having experienced intense disassociation from my own sex as a child, I know on an experiential level that a person can feel completely at ease with living as the opposite sex. A person can believe they know on the deepest level that, even though they were born a girl, they should really have been a boy. And yet none of us is bigger than nature. We are stuck with the body we were born into; we are stuck with the circumstances of our birth. Some of us may have to come to terms with the circumstances of our birth – potentially a painful process – and may need help to overcome the issues entailed within this. Having said that, it can also be the most rewarding process that an individual will engage in. 

Just like Lisa Simpson, I favour the Occam’s Razor school of thought: when trying to make sense of a certain phenomenon, we should shave off the flowery additions, as the simplest explanation is most likely to be the correct one. And as a psychotherapist, it seems very clear to me that gender-related distress is borne from a dissociation from oneself: the distressed mind that seeks to leave the body and become another person. This developmental understanding of gender dysphoria aligns with my understanding of many different mental health issues.

I understand alcoholism as a drive to escape the real world into a more blurred and easier existence; likewise drug addiction. I understand anorexia and OCD in a different, but similar, manner: while the disconnected mind is again seeking escape, those who are afflicted with OCD or anorexia may seek to achieve this mental escape via a false sense of control. Why some people gravitate towards an eating disorder while others move towards alcoholism is arguably as a result of our cultural context; the research suggests that there may be a heredity component as well. However, just like many therapists, I’m seldom very exercised by an inherited susceptibility for any given condition. How we nurture our nature often feels much more significant than our biological starting point.

The real question isn’t whether we can change our external identities. We can. It is whether we should. There is a further big question which far too few of us are asking: when somebody chooses to change their external identity, how should the rest of society manage this? Patrick, a detransitioned man from Germany, expressed his disappointment eloquently on YouTube when he described his heart-rending realisation, after medical transition, that he could never quite become a woman. He couldn’t change his internal body; he could only ever be a “bricolage”.

This, for me, is the game-changing information that the public needs to know. If there were public awareness campaigns that articulated how medical transition, while incredibly alluring, can never deliver on the promise of a real escape from the self, I believe that fewer people would seek these interventions. Prior to the current Zeitgeist – in which we are all supposed to agree that we have gendered souls, and might need immediate heavy medical intervention if we are to become our “true selves” – doctors required two psychiatrists to sign off on an individual’s suitability for medical transition. In this day of Dr Google, many find this an inappropriately paternalistic attitude, and believe that anybody who wishes to transition should be able to transition. Gender extremists like Dr Diane Ehrensaft believe that children as young as two years old should be supported if they declare their gender identity, ignoring the fact that adults understandably don’t take much else that two-year-olds say very seriously.

From a psychological point of view, it would be far more beneficial for factual information about gender identity, gender dysphoria and the impact of medical transition on the body to become easily available. Critically, this would help us reduce the numbers of people who transition only to end up detransitioning. Some people argue that the medical transition should be prohibited. Yet history has shown us time and time again that prohibition doesn’t work, and instead merely creates a criminal underground system. This is why we need to build the knowledge base instead of seeking prohibition: we need to work hard to prevent the silencing of mature and civil debate. All information should be accessible to adults so the majority of people can make the most-informed decisions. That’s the way a progressive society works.

Genspect’s decision to host a webinar on detransition flows from this very belief: by listening to detransitioners’ stories, we can possibly avoid future mistakes. Detransitioners have been badly treated by society, and we owe it to them to show up, lend them our ears, and make sure that others also hear about these issues. Too few people seem even to be aware that medical transition carries a very heavy medical burden on the body, and seldom lives up to the image of the promised sunlit uplands where you can apparently become a member of the opposite sex. The bitter reality is that we can’t ever become another person. We can try – but in truth, as the mindfulness guru Jon Kabat-Zinn pointed out, “wherever you go, there you are”.

Stella O’Malley is a psychotherapist and the founder and director of Genspect. The Genspect webinar on detransition will be held on Saturday March 12th, at 8pm GMT. We are charging a fee of €25 for this event: however, detransitioners, desisters and those in financial difficulty can receive a free ticket by emailing [email protected].

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