Trans or just a fetish?

The question “Am I trans or is it just a fetish?” has to be one of the most common questions that is asked by people considering MTF transition. This question shows up over and over again on reddit’s r/asktransgender and other transgender forums. They almost always answer “yes, you are trans” and there is even this handy website to determine whether you are transgender or not. (Always yes!)

I think it is very important to deconstruct this question and analyze it as I think it explains some of what is going on around this issue. First, there is an implied hierarchy. One can either be trans or “just” have a fetish. The word “just” implies that this is a lesser state. Also you “are” trans but “have” a fetish. One of these things is an identity, and the other is a stigmatized mental illness. I know I would prefer to be something than to have a mental illness! There is also an implied either/or to the question. One is either trans or just has a fetish, not both. I’m not saying that having a fetish is a mental illness, just that is what is implied by the word.

People with trans identities are definitely stigmatized in many contexts, that is true. However, there are certain subcultures where being trans can be considered positively, perhaps in some queer, academic or liberal contexts. In nearly all contexts being viewed as a woman with an unfortunate issue with a wrongly sexed body, is much less stigmatizing that being viewed as a man with a fetish. This adds to the view that being trans is a more desirable state than “having a fetish”. Even in the fetish/kink community itself cross-dressing is considered one of the lower status kinks to have.

This hierarchy has existed in the trans community in a long time. Kate Bornstein wrote about it the 90s. Post-op transsexuals were at the top of the the hierarchy, followed by pre-op transsexuals, and then transgenderists (which at the time was not an umbrella category but instead was a state intermediate between transsexual and transvestite), followed by transvestites, and then fetishistic cross dressers at the bottom. This hierarchy creates a bias towards identifying as trans vs. “having a fetish”.

A larger problem is that emotionally charged words like “fetish” leads one into the realm of moral reasoning. In moral reasoning, things are good or bad, as opposed to analytical reasoning where things are true or false. Moral reasoning activates tribalism and divides us to moral tribes. When two opposing moral tribes discuss an issue it can be difficult to impossible to find compromise. The discussion of trans issues in an objective way becomes very difficult because there are factors on all sides that throw the discussion into the realm of moral reasoning. On one side there is the use of stigmatizing terms such as “autogynephilia” and “fetish” which are sometimes used by enemies of trans people to shame them. On the other side there is the use of social justice ideology which also throws things into the realm of moral reasoning. Once one side uses moral reasoning, the other side than also veers into moral reasoning and communication stops. Moral reasoning also trumps analytical reasoning which means that analytical reasoning tends to stop when moral reasoning is invoked. A good sign that you are in the realm of moral reasoning is when you believe that the “other side” is 100% wrong about everything, whether this be liberals, conservatives, men, women, trans activists, radical feminists, or who ever else. I recommend reading my favorite social psychologist,  Jonathan Haidt if you want to learn more about this issue.

My general view is that you don’t choose to have these thoughts and feelings but do have some ability to choose what to do with them. Some people have more ability to choose than others depending on their particular circumstance, this depends on the intensity of their feelings, the psychological circumstances that surround things, as well as their personal temperament. In many cases the “fetish” will be far less disruptive and be manageable. Transition creates many difficulties as well, and does not cure dysphoria, it only manages it. I think it is better thought of as a chronic condition that can be managed in a variety of ways, and the task is to figure out the best way according to your own circumstances. Also not only is term “fetish” stigmatizing it is incomplete, as there are often deeply meaningful psychological components attached as well and it is not usually just a sex thing.

This phenomena can itself be divided into several different parts some of which have the potential to cause problems others of which do not. Part of it all is simple fantasy. Fantasy itself is not harmful, and also cannot be controlled. We fantasize about what we fantasize about, and lots of people have all kinds of strange and wonderful sexual fantasies. This is just what happens when our modern brains intersect with our primitive sexual instincts. Fantasy itself is never a problem, it is only when it becomes combined with something else that it is a problem. Even for those with particularly unfortunate sexual fantasies that would cause tremendous harm to enact, the fantasy itself doesn’t harm anyone. Also, trying to prevent thoughts doesn’t usually work, and only strengthens them.

One example of when it becomes a problem is if it develops obsessive qualities or becomes compulsive. Another is if impedes the ability to form relationships. Yet another is if it causes one to violate the boundaries of others in some way.

If it is used as a coping mechanism, this can be okay in moderation. However, like most coping mechanisms there is a tendency to escalation and requiring more and more of the “drug” for the same effect.

Also, it can be tied into psychological needs. Sometimes it is tied into an experience of an “inner woman” which some people who experience this phenomena have. Jack Molay writes about this here and here.

I think Jung’s writings on the anima are very relevant here. Jung described working with the anima as important to the psychological growth as those qualities can be integrated and produce growth. The anima can be an important guide. However, Jung simultaneously warns about the phenomena of “anima possession” where a man can become taken over by the inner woman. It was actually reading Jung and his phenomena of anima possession which first knocked loose my transgender identification.

In summary, a “fetish” or cross-dreaming are not lesser states to transgender identity. This idea can lead to preferring transgender identity which could potentially be far more disruptive to one’s life. Also, shame over sexual motivations can specifically lead to the preference for a transgender identity over other possible outcomes. This is a place where trans critics sometimes go wrong, by specifically shaming the sexual aspects of trans identity, they may be creating more of the very phenomena they oppose.

For some more related reading I recommend this essay by Ozy “Trans as Choice” and this essay by Angus Grieve-Smith “On the Slippery Slope”

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Identity is not the same as authenticity

I have been again thinking about identity, because it seems to lie at the heart of all the recent discussion of transgender issues. I have also been thinking about how the way we treat identity with respect to gender dysphoria is very different from that with other conditions. In fact, the way we treat identity with respect to gender dysphoria is the polar opposite of the way we look at most other conditions. In many different contexts, I was taught the importance of not making an identity out of someone’s condition.

For example, we try not to say “schizophrenic” instead we say “person with schizophrenia”. We try not to say “a depressive” and instead say “person with depression”. However, with gender issues it is the reverse, we are encouraged to say “trans person” rather than “person with gender dysphoria” and also to affirm those identities.

The reasons for this disidentification process are several. One is to avoid distorting our perception of the person so we do not see them as just their condition. We must remember that they are so much more than that. Another reason for this practice is to avoid stigmatizing them, so they are not seen as being just that particular condition, they are a full dynamic human being with many different parts

Another reason for this, relates to the person seeking to work with their condition themselves. When someone identifies with something it becomes frozen. It is much harder to treat someone for depression if they identify with it. If they say “being depressed is just who I am, it cannot change.” that is much harder to work with that than someone who says that they “have depression”. One technique for those who are too identified with their depression is to externalize the depression. We try to get them to see the depression as not their whole self, and to perhaps say “that is the depression talking”. This tries to bring their whole self into the picture, rather than just the depression, as the rest of the self can get lost when an identity is formed.

I have talked about identities as self-concept in the past. However, another important aspect of identity which I neglected is group identity. A lot of identities involve identification with a group. When people talk about identities they are often talking about things like race, class, national identity, political identities and certainly gender. Group identities divide us into groups. They say who is “us” and who is “not us”. The desire to be part of a group is a very basic human desire. We are tribal creatures. However, when group identities come into play, they tend to override objective reasoning. There is a sense that our group is right and the other group is wrong. Reason is no longer used to explore the truth, but is instead used to support our moral position. Arguments become moral, rather than rational, and moral reasoning trumps objective reasoning. This is part of what makes discussion of trans issues so difficult. Identity comes into play, and discussion becomes very difficult.

Another problem with group identities is that they can result in a loss of individuality. Connecting with a group and being a part of a group can be such a good feeling, especially if it is a group of people that reflects parts of oneself that have not been reflected before. A lot of my own impulse to transition 20 years ago arose in part from my encounter with the community. It felt so good to encounter people that shared the same feelings about gender that I did, as my gender feelings felt like a deep secret that I would never share with anyone and did not share with anyone “real”. Talking to people who had the same feelings and could relate to my experience was so great. I do think it played a role in my adopting the transgender identity. I am not saying that I adopted this identity due to peer pressure, as the reason I adopted this identity also related to the deeply held feelings that I had. It is rather the intersection between my deep feelings ,and the group that led to my development of this identity. I think this is true of most identities, they are the intersection between biological factors, temprament, and social identity. Cross-gender feelings exists in all cultures but how they are expressed is different depending on cultures. In one culture one might be considered a shaman, in another an abomination, in another a transsexual. Cultures and subcultures say these feelings mean certain cultural identities and the ultimate expression lies at the intersection between the cultural ideas and the internal feelings.

In a way, there is something strange about talking about people “discovering their authentic identities”, because I actually see authenticity as something that opposes identity. I see it as something that lies beyond identities. Identities freeze things into place, and are almost like heuristics. They are shortcuts for who we are, that help explain who we are to others, but are always partial. So, affirming someones identities, is in a way taking them away from authenticity. It is not surprising that many of the people who write of detransition cite mindfulness as an important factor, because mindfulness is precisely a method for loosening identities and the holds they place on us.

I am not trying to say identities are all bad, indeed they are important. They are important because they allow us to feel a part of a group. They are important precisely because they act as heuristics. If we had to feel authentically into each moment of every day that would be a very slow, inefficient process, and probably quite difficult to pull off. Also there are problems associated with lack of stable identity, such as borderline personality disorder for example. Like Jack Engler said “you have to be someone before you can be no one”. Sometimes being authentic can be very difficult or impossible due to the pain associated with it, that can be a reason to live in identities. There is nothing wrong with that, it can be what is right for that time and it can serve an important protective function. Exploring identity is generally seen as part of normal adolescent development, because it relates to being in the world and playing roles in society. However, it seems like we have taken to reifying identities and mistaking them for the person themselves, when they can only be an approximation.

Can transition be the best solution? Yes, but I believe the answer lies under identity and not in identity, because that is where the creativity lies. So, I think it would be much better when looking at these issues to see someone as a person with gender dysphoria, rather than a trans person or a potential trans person. The same applies when exploring one’s own issues. This means the whole person doesn’t get lost and many solutions are possible. It also changes the question from “determining if someone ‘is’ transgender” to determining what the best way to move them towards wholeness.

Social Justice and Gender Therapy

This post is an expansion of this discussion I had in the comments on the 4thWaveNow blog. I am hoping to get back to focusing on working with dysphoria rather than political issues, but after spending the last three months in grad school surrounded by these ideas I thought this post was important.

A lot of what is currently going on with gender therapy is currently related to “social justice” ideology. The goal of social justice ideology is an admirable one. Its goal is to correct injustices that occur when groups are marginalized in various ways. This is a noble pursuit. Being part of a marginalized group and being subject to discrimination and prejudice is pretty awful, which is something I certainly learned after 20 years of living as a trans women.It is not the goals of social justice ideology that are problematic, but its methods. In fact, its methods sometimes cause harm to the very marginalized groups it purports to protect.

I have seen several stories from parents who take their children to see therapists for gender issues and the therapist sees the person only once and immediately recommends transition, dismissing any parental concerns as prejudice and bigotry. Likewise, people who see therapists of their own accord find their cross-gender identities are enthusiastically supported and exploration is dismissed as unnecessary. They are reassured that their gender feelings cannot relate to other causes. Some critics have suggest that therapists are just going along with trans people because they are money-grubbing and afraid of losing business if they don’t just go along with things. I don’t think this is actually true, for one I have known many therapists and none of them seem like money-grubbers, for another seeing people only once is a poor money-grubbing strategy. Rather, it is misplaced idealism that leads to this practice, which is harmful to very minorities it purports to support.

I have written in more detail about this particular ideology here. In particular there are two features that are relevant here. One is the idea of oppression. Social justice ideology sees people as members of “marginalized” or “privileged” classes. People in marginalized classes are seen as suffering from oppression and discrimination. This is true to some extent, but social justice ideology tends to see all of their problems as coming from that source.

Secondly, narratives are primary. What I mean by that is personal narratives and stories are the most important thing. The subjective triumphs over the objective. This also intersects with the idea of oppression, where members of a dominant class are seen as unable to understand the experiences of people of the marginalized class and therefore they must always take those experiences at face value.

This means that if therapist who has a strong orientation towards social justice and works with trans people they will tend to see their problems as due to oppression, and additionally feel they should not question the client’s narrative which must be taken at face value as they are oppressed people. At first I found it perplexing this practice of engaging in minimal assessment for something as serious as hormonal treatment and surgery. This seemed irresponsible especially given as I am trained as a therapist and understand how much focus is generally placed on assessment for other conditions. Now, I understand it is not so much irresponsibility, as morality. It is not that they consider it unnecessary to do assessment; it is that they actually consider it immoral to do assessment!

This is intended to help trans people and other marginalized people, but it actually can cause harm. What it means in essence is that if someone is a member of a dominant class they receive regular psychotherapy but if they aren’t they receive a special kind of social justice psychotherapy. I do think it is important that the legitimate issues that arise from social justice thinking be considered, but not at the expense of regular therapy. I feel I have been profoundly harmed by my original therapist’s failure to encourage deep exploration of my issues, versus simply “affirming my identity”.

Because of this, gender therapy is reduced to just a few steps, specifically:

1. Eliminate sources of oppression (internal and external). If the person does not accept their trans identity then that is internalized oppression, if someone else in their life questions their trans identity, than that is just due to their prejudice and privilege that makes them not understand the gender-questioning person in question.
2. Affirm and validate their identity. In particular don’t question their identity, or assume the possibility of other underlying causes, a privileged person should never question the narrative of a marginalized person.
3. Make them aware of their options and make sure they have adequate resources and support to get through transition.

A few months ago, I attended a conference about trans health. At this conference, there was a presentation titled something like “assessments for mental health” and I was excited to attend this presentation because I thought I might finally come across some good information on this topic, which every training and conference I attend never seems to have. Unfortunately, I was rather disappointed. The presenters presented a case study of a client who had psychotic symptoms, and issues with dissociation. Surely some caution would be indicated in this case. Of course, the answer was “we found a way to get them enough resources and support to have that surgery” and there was nothing about any kind of evaluation of whether they should do this or not.

I have attended four separate trainings on working with trans clients and they all were more or less like this. Everything in the training was about cultural competency and better understanding trans people. There might also be something about the nuts and bolts of transition as well. However there was never anything about how to help people deal with their issues without transition, or how to differentiate between those who will do well with transition and those who won’t.

Here is an example of a syllabus for a class for therapists to learn about trans issues. Notice that everything in the syllabus is about learning about the experiences of trans people and how to affirm them. Again, nothing about the dynamics that might lead to transition, what factors should lead to extra caution, or how to help someone figure out if they can deal with their issues without transition.

Again, it is very appropriate to consider social justice factors when working with trans people, but it should not be considered the sole factor and overshadow regular clinical judgment. Paradoxically, serving social justice requires making sure that social justice ideas don’t result in substandard therapy for sexual minorities like trans people.

Where did I go?

Where did I go?   I fell into a grad school hole.   I started a PhD program in clinical psychology this fall, and our workload for the first quarter was very demanding. I ended up regularly working 60-70 hour weeks and the last thing I wanted to do was more writing. Now the quarter is over, and I am back.

I am questioning whether school is something I want to continue with or not.   I was hoping to get more involved in the scientific/research end of psychology in addition to the clinical end which I really can’t do with counseling degree.   However, I am wondering if this is interfering with my work rather than aiding it. This path greatly delays the amount of time it will take until I will be able to be in independent practice, something I could do in about 1.5 – 2 years at the Master’s level, but will take more like 5-6 years on this path.   Also it will be several years before I can actually do any kind of research on my own interests. I do feel it is very complimentary to my previous training, my master’s program was in holistic counseling, and this program is very much in the academic/scientific tradition which has a totally different culture to it.   So, that is something for me to figure out.

It has been good to take a break from writing the blog, I find it very difficult to avoid getting sucked into all of the toxic politics around these issues. My primary goal for this blog is to help people dealing with dysphoria, and finding better ways to deal with their dysphoria than transition.   I don’t expect those ways to work for everyone, but even if they work for some people that is a good thing.   I don’t have any moral or philosophical objection to transition, hormones or surgery. I just think they are awful experiences that people should not have to undergo unless necessary. I feel that I lost a lot of opportunities as a result of this, from not being able to have a family, to dealing with social stigma, to relationship difficulties, and various mental health issues stemming from untreated trauma and taking too high dosages of estrogen.   On the other hand I recognize that some of the challenges of transition arise directly from stigma, and I don’t want to contribute to the stigma faced by trans people either.

Although, I do have a secondary goal of bringing awareness of these issues to mental health professionals, both the issues of detransitioners, and even more importantly working to find ways to prevent unnecessary transitioning.   Increasingly, at least in the USA, there is no exploration happening at all, and some therapists even find it offensive to explore or question with their clients. I think a lot of this ties into “social justice” ideology, which I wrote about a little bit here. and guest poster Lane on the blog also wrote about.   I will write some more on this, as I am finding this ideology very prevalent in my psychology program, I don’t know if many people realize the extent to which it has taken over many parts of the field. It is important to note that one can oppose social justice ideology, without being against its goals of equality or ending oppression which are admirable.   Indeed one important reason to oppose it is the harm that it can cause to minorities and particularly vulnerable people dealing with gender issues.   Jonathan Haidt and others write about the issues of political monocultures leading to groupthink and blind spots and the people at Heterodox Academy write about these issues well.

Also, I have been taking some time to reflect upon detransition.   It has been over 2 years since my detransition, and over 3 years since I started on T. There have been things that are good about detransition, but there have been some losses as well. It is not possible to fully restore things to the way things were.   In some ways things are better. It is so great to let go of having to speak with a voice that was not my own, and to just be able to be myself without worrying about how my gender is perceived. I also find much to my surprise that I really enjoy hanging out in groups of guys as a guy, I feel like I fit in there. None of the guys I hang out with are “dudebros”, some of them are gay/bi, a lot of them are nerdy or psychology people, but it feels really good to hang out with them. Also being on testosterone has granted me more vitality and energy, greater emotional stability and generally sharper thinking.

However there are still problems that remain. For one it is impossible to get my hormone levels right. I have experimented with a wide variety of different levels and gotten it the best I can. If my levels are too low I suffer from low energy and fatigue, if they are too high I end up with too many angry thoughts and too much sex drive. I find the best middle I can but it doesn’t quite work right.   I even experimented briefly with not having it, which leads to feeling calm and peaceful but not quite alive. Also going without sex hormones is bad for long-term health. But, who knows what the long-term health consequences are. I have no idea if I am helping or harming my health by taking T, compared to nothing at all or E.

Another problem is I keenly feel a loss of community.   I was an active part of various queer communities for the past 20 years.   When I was younger I was largely focused on the bi community but also spent time in general alternative sexual minority communities.   I once co-hosted a radio show on bi issues, went to conferenes of various kinds, and worked in a queer counseling center.   The queer community was my people, and now I feel alienated from those communities due to my detransition and critical views around gender.   It is hard to go against what I considered to be my people, but I think it is very important to speak truth.

It is especially strange to be doing this right in the middle of time where there are more out trans people than ever and in many ways trans people are celebrated. I don’t at all mean to say that trans people don’t suffer a lot of stigma and problems, but there are certain subcultures where this is well accepted.   They happen to be the subcultures that I mostly live in, and I feel like I will get in far more trouble for being critical around gender issues than for being trans.   Letting go of my trans identity right at the moment when more acceptance is happening feels especially strange. I still struggle with shame around transitioning in the first place and ending up in this place. I haven’t shared about my transition/detransition with my grad school colleagues or many of my newer acquaintances/friends.

Another area that is especially challenging is dating. Even though dating as a trans woman was definitely a challenge, there were actually quite a lot of people that were attracted to me. Some of these people also didn’t have any problem with my being trans. The irony is that the real problem was me. A lot of people that were attracted to me were attracted to aspects of my androgyny or even appreciated that I was trans. However, that was unacceptable to me, as I was so wrapped up in my “gender identity” that I was very closed off about talking about being trans, and wanted to people to validate my identity, so if they were attracted to my being trans or masculine qualities that was very uncomfortable and unacceptable. I became very difficult to get close to, and that closed offness was a bigger barrier to relationships than being trans was actually.

Now, I just feel invisible. I do get read as male, but still have quite a bit of breast growth and barely grow any facial hair. I am pretty sure I will do something about my breast growth, and I think it will feel better not to feel the need to wear baggy clothes and conceal things all the time. Part of me feels good about doing that, but part of me procrastinates because it feels like it is doing the same thing again, changing my body so I can be myself.   I did briefly date a woman who was a friend that I knew before detranstion, but since then haven’t met anyone. I think I am reluctant to approach people because I don’t know how to explain my body to them, I know that is something I need to get over. I just really wanted to share the good of detransition as well as the bad, I think that is important.

That is where I am now, I am hoping to get a few more posts out over my break, and catch up with people.

Interview w/ me on Transition Radio

I did an interview with Transition Radio last night. See me talk about my journey as well as detransition and gender dysphoria.

taking dysphoria literally vs. symbolically

This article by Dr. Schwartz posted on the 4thWaveNow blog discusses the need for caution when working with transgender children. In particular, one thing he talks about is looking at the things that children are saying about their gender symbolically rather than literally. He says that differences in treatment philosophies arise from which lens the clinician views the child’s gendered self, as a literal truth or a symbolical one. In particular he says the following:

“It is possible to respond to children in a manner that is either organized around their literal narratives, or around psychological interpretations of those narratives, which themselves take into account such inner contradictions and perplexities as described above. Toward which path the clinician leans may be strongly influenced by the degree to which he or she shares the child’s apparent view of gender, that is, holds the assumptions of essential gender, or not. Simply put, if you believe gender is an internal reality, you will likely be guided or motivated to accept a literal hearing of the child’s narrative, since it matches that view. The child’s self-presentation may then seem straightforwardly comprehensible enough to guide you in clinical decision making. On the other hand, if your prejudice is to hear any claims about real, inner gender as necessarily—necessarily because you do not believe gender is real in the sense described above— composed of symbolic or metaphoric representations, then the child’s story instigates an active interpretive process, and clinical decision making proceeds differently”

Later on he goes on to say:

“There is much more to children than what they say. We owe to them a deeper listening than a literal one.”

This article is talking about children, but much of what he is saying applies to adults as well, who also have symbolic psychological processes, which just might be a little more buried. Giving this kind of deep listening and taking the time to do so is something that is not happening much with therapeutic work with gender issue currently. There is a sense of “well that is just your identity, and it shouldn’t be questioned.” This kind of deep listening also takes time, and is not something that can be done in a couple of sessions of therapy.

Indeed, I think this focus on taking gender thoughts literally is precisely what makes cross-gender roles in modern Western culture different from those of other cultures. Lots of cultures have cross-gender roles of some kind, but only in the West do we have the idea that one literally becomes the other sex, and that indeed the whole point of transition is to do just that. This also brings with it the idea of “passing”, proving your membership in the identified sex by becoming indistinguishable from natal members of that sex. This is also something that is not considered part of the gender-variant roles of other cultures.

If taking gender dysphoric thoughts and feelings symbolically, seems strange or a form of denial, it is helpful to see that this is something that we do all the time, and in fact it is quite important that we do so.

Consider being angry at someone for wronging you in some way. You might feel anger, and have the associated thought “I am going to kill that person”. Taking that thought literally would cause a great deal of trouble. There are lots of responses that you can have to the feeling of anger, and the thought “I am going to kill that person”, some of them healthy and some of them are not.

One possible response to the anger is to feel shame, that you are a “bad person” for having such angry thoughts, and a good person wouldn’t be angry and have the thought about killing someone. This would just add to the emotional pain and would not do anything to assuage the anger.

Another possible response is distraction, to pretend that it isn’t happening and distract yourself. This sometimes is a healthy response, as the emotion might be too overwhelming to deal with right now, or be related to some temporary chemical issue like meds or hormone levels. However, it does nothing to meet the underlying need of the anger, and even if something is heightened by brain chemistry issues, there still might be a real need underneath that. Anger is an important signal and shouldn’t be ignored. Distraction shouldn’t be an always thing, and many mechanisms of distracting from feelings escalate over time, such as numbing behaviors like drug use.

Another possible response is to try to repress it, saying “I’m not really angry”. This tends to only strengthen it.

It is also possible to construct an identity around it. “I’m an angry person, that is just how I am” This will make it a lot harder to work with as you take it as an essential part of your identity rather than as an emotion. This will also strengthen it.

Another response is to accept it, this doesn’t mean you literally do what it says, but that you acknowledge and accept it. The function of anger is to provide energy to deal with an obstacle. There is likely a real obstacle that needs to be dealt with in some way. Once you have acknowledged and accepted the anger you might get some insight into what that is, and sometimes it is obvious. Once you know you can act appropriately to meet that need, perhaps there is different way to meet the need, or perhaps you have to negotiate with that person, or perhaps you do need to engage in appropriate consequences for them. This can be hard in the moment of course. The important thing is that the anger is a real signal of your real needs and is not always unhealthy.

To take dysphoria symbolically is similar. There is a feeling of dysphoria, which is distress and dissatisfaction combined with thoughts such as “I should be a woman”, or “I am a woman” or “I hate being a man” “Being a man is disgusting”, etc. Like anger, this distress is on a spectrum and can go from mild to quite overwhelming. To take it literally, is to go through transition / hormones / surgery. This may be the right thing, but it is not the only thing. There are other responses besides taking it literally.

Shame and repression have similar effects here that they do with anger, and denying it by saying “I’m really a manly man” or something like that and attempting to live that will also make things worse. Dyphoria points to the fact that something is wrong and needs to change, it is an emotional response that says something is wrong. The associated thoughts give a proposed solution, but like the “I want to kill this person” thought, it is not necessarily the case that they be taken literally. Constructing an identity around it also strengthens it like with the anger.

The question is what are the underlying needs? They may be sexual, but they may not be, and I think it is ultimately the psychological needs that drive one to transition (vs. just having a fetish) Ironically, one of those needs might be to avoid the shame of having a fetish. In any case, there are real and valid needs that are underneath the dysphoria and it is important to meet them. It is only important that they be met somewhere in your life, it is impossible to meet all of our needs in all aspects of our lives, and indeed we must make compromises in order to have relationships and connection with people, and that is the single largest determiner of happiness.

Sorting this stuff out is something that can take time, and indeed something I think there needs to be more of. Yes, adults at least should have the right to transition, and transitioning does improve some people’s lives. However I think there is the need for more exploration, I sure wish I had that. I was approved for hormones after just 2 sessions of therapy, working out everything took 150 sessions.

Here is a story of someone who worked through things symbolically. Here is a
story
from a man who work on integrating his own feminine side but wasn’t transgender. I also recommend the site Transcend Movement in which he talks about a similar process of working through things symbolically. I am not saying that everyone can deal with their gender issues through such a process, but I am saying that more people can than currently are.

The obstacles presented by ideology in discussing trans issues

One thing that makes discussion of trans issues very difficult is that it that it lies at the intersection of ideology and truth. Science strives to seek truth and to be ideology-free. It can never meet this goal because it is done by humans who are incapable of being ideology-free. Still, it is the best method we have for minimizing the effects of bias and trying to get at an accurate picture of the world.

Jonathan Hadit, who is one of my favorite psychological writers, studies moral reasoning. He wrote an excellent book about it called The Righteous Mind. One of the things he talks about is that people have certain values that they hold sacred. He talks about the ideological differences between liberals and conservatives as being largely due to the fact that they hold different values sacred. When the tribal values are threatened people are far more concerned with neutralizing the threat then what is true or not. These sacred beliefs essentially become religious beliefs and anything that challenges them feels like heresy.

This is just part of the natural condition of humanity, and the same people that can be very capable of reason and nuance about questions that do not concern their sacred values suddenly become incapable of it when they do. I remember having a co-worker who was a decent programmer. He was also a Scientologist, and would occasionally talk about how “L. Ron Hubbard was an incarnation of the Buddha, and a messiah” or other Scientology related topics. I found it perplexing that he could have the logical chops necessary to be a good programmer and simultaneously be a Scientologist, but once beliefs acquire a religious character they are immune to logic. It is much the same with political ideologies.

One of the other things Hadit talks about is the importance of diversity of ideologies in creating good science. Scientists, like all people have ideologies and sacred beliefs. Scientists are often quite passionate about their theories. They are far from neutral, disinterested observers. So, any one scientist runs the risk of having their bias interfere with their observations. Science has tools for neutralizing bias from double-blind studies to peer review. Peer review relies on other scientists looking over the science, but they too have biases. If you have an ideologically diverse set of scientists then the effect of their biases are minimized. However, to the degree that they are not ideological diverse, groupthink and other phenomena can prevail. This effect is increased if the scientific study in question contradicts the sacred tribal values of that particular group of scientists.

In the therapy world we are also concerned with the biases of therapist interfering with the therapy and making it hard to see the client clearly. This phenomenon is called countertransference, which is where the therapist projects their own stuff onto the client and does not see the client clearly. Being aware of this is a start, but therapists are people too and are often blind to their own biases and personal hooks. One way to counteract this is through consultation groups, to get the opinions of others who do not have the same biases that you do, and therefore can see things clearly that you can’t see. However, if the therapists in the group share the same ideological beliefs and biases, then this does not help, and can even make things worse as phenomena such as groupthink take over.

Having a strong conviction that the “other side” is absolutely wrong about everything is a sure sign of being engaged in tribal thinking. The truth is messy and cuts across ideologies. It can be very difficult to let go of tribal thinking as it gives a sense of belonging, which is a primal need. If one does commit to the truth wherever it leads you, you are likely to be denounced by all ideological tribes. That can be a very lonely path. Speaking out for truth that goes against your tribal values is very difficult. I recently read Alice Dreger’s excellent book Galileo’s Middle Finger where she talks about the conflict between truth and activism. Indeed, Dreger, as someone committed to truth over ideology, is often denounced for both being a “crazy liberal” and “neo-reactionary conservative”. I once read two articles denouncing her in these opposite ways within 10 minutes of each other.

The community of psychologists and therapists is far from ideologically diverse. Hadit, who is a social psychologist, gave a talk to a group of around one thousand social psychologists and asked them how many identified themselves as conservative or moderate. As described in this article in the New Yorker,
only 20 or so identified as centrist and only 3 identified as conservative. There might have been more conservatives that feared the career ramifications of openly identifying themselves as conservative. Further research in the article confirms that 37.5% of those social psychologists surveyed would be less likely to hire a conservative colleague, so their feelings would be entirely justified. This article describes social psychologists specifically, but similar phenomena exist with clinical psychologists, social workers and other mental health professionals.

I have come to the reluctant conclusion that it is progressive ideology itself that is the one of the things that gets makes it difficult to work on these issues. As a life-long liberal, and former card-carrying member of the ACLU back when that was a thing, it has been tough to come to that realization. I have long considered liberals to be my tribe and to see this ideology as itself being a problem makes me feel like I am without a tribe. However, since tribalism itself is the issue, perhaps that is a good thing. I want to emphasize that all ideologies get in the way of seeing the world clearly, it is just that the particular ideology that dominates the psychological profession is on the left. In particular, the following aspects of progressive ideology, particularly the specific progressive ideology of the psychological profession come in to play:

Privilege / Power Dynamics

Progressive ideology views the world in terms of privilege and power dynamics. People are divided into privileged and marginalized people across various axes. Why this is relevant is that is trans people are seen as a marginalized class while cis people are seen as a privileged class. This brings in to play various aspects of progressive ideology which is concerned with equalizing power dynamics. Indeed, helping marginalized people have a voice is a noble goal, however sometimes this ideology can cause harm to the very people it is trying to support.

One for the related ideas is that a marginalized class has been silenced and it is important that their voices be heard, particularly about their own experience. The privileged class is deemed to not understand the experience of the marginalized class and should listen to them. This is indeed true, and there is a long history of medicine centering men and treating women as afterthoughts and other examples of only paying attention to the dominant class. So it is indeed good and important for trans voices to be heard about their own experience.

However, this ideology leads to trans narratives being taken at face value by clinicians, and digging underneath them to be seen as being against the tribal values of the clinicians working on these issues. This is a well-meaning attempt to bring social justice to the marginalized people.

However, digging underneath things can be very important. Psychology is full of ideas about how people have defenses, self-serving rationalizations and all kinds of ways in which they don’t necessarily understand their own motivations. This is just as true whether someone is privileged or marginalized, and to ignore this when working with marginalized people is to do them a disservice. Indeed it is giving them lesser care, than you give to privileged people.

Primacy of narrative / lived experience

Another part of this ideology is the primacy of narrative and lived experience. This means the subjective is more important than the objective, and that lived experience trumps scientific research. This goes triple when it intersects with the ideas of privilege/oppresion referenced above. This is another idea that has good roots but can be taken too far. Narratives and lived experience are indeed important. As a therapist it is important to bracket aside theory and make sure that you are not treating a client as an object, or a theoretical construct and seeing the person as an individual. People are messy and do not fit cleanly into boxes.

However, the theoretical constructs and scientific research matter also. There is a vast deal of difference in degree of scientific orientation among psychologists and therapists. One problem in psychology is that the academic community of research psychologists and the community of clinicians and therapists often don’t talk to each other. Some sections of the the clinical community are even actively anti-science. Some professors in my master’s program would use the term “evidence-based practice” almost as a swear word, like it meant un-evolved. The narrative is not the only thing that matters.

Nothing is pathological

Progressives are absolutely allergic to the idea of pathology and tend towards the idea that calling anything pathology is “stigmatizing”. So there are movements to talk about how everything from bipolar to schizophrenia is a healthy variation of human experience. Many even question the very idea of mental illness. They are quite correct that stigmazing causes harm. I think it is harmful to stigmatize people based on their conditions, however we should never lose track that some things are healthier than others. For me the question of whether something is healthy is not whether it is normal but rather whether it is functional. Even being functional in some environments is sufficient, that is just a matter of getting to the right environment.

I recently read the excellent book Buddha and the Borderline by Kiera Van Gelder. This book tells of a woman’s journey in healing from borderline personality disorder. She describes how much of her community as well as many of those therapists and psychologists that treated her did not want to give her the borderline label for the reason that it would be stigmatizing. She acknowledges that it can indeed be stigmatizing when she is labeled borderline by others, but it it is also helpful to acknowledge it as an illness and that helps her in working with it.

I think refusing to understand that there is a such thing as health and a such thing as pathology causes problems, especially if you are in a profession where you are supposed to be an agent of health. Pathology should not be mistaken for diversity.

The insider experience is the only one that matters

Progressive ideology centers the insider experience, and holds that the words of a member of a group are those that are valid about a group. For example, only trans people should speak about trans experience, only women should speak about women’s experience, only black people should speak about black experience etc. It is indeed quite true that people that don’t have a certain experience are likely to get things wrong about that experience. Women are likely to see things about their experience that men don’t see, etc. Problems arise when the people studying something are all of one group and they are studying a different group. This idea also intersects with the idea of priviledge/power, and so applies in a much larger way when it is a privileged class studying a marginalized class.

This is an important idea, and tremendous harm has been caused by the lack of representation of minority groups in health. It is a very good thing that their voices are being heard in respect to their own health. However, while it is true that the insider can see what the outsider cannot see, it is also true that the outsider can see what the insider cannot see. Fish can’t see water. How many times have you encountered someone who had some false idea about themselves that everyone but they could see? This is precisely why the outsider perspective is important also. It is best to see something from as many perspectives as possible. All groups whether marginalized or privileged are prone to cultural blind spots and groupthink. Particularly in the case of groupthink, an outsider perspective is precisely what is needed.

Identitarianism

I have written quite a bit about my views on identity here, and here The identity politics wing of progressivism strongly encourages a focus on identity, both the importance of personal identity and an identification with particular groups and classes. In addition to the critiques I made earlier, one problem with identiarianism is that it exacerbates the kind of tribal thinking that clouds truth. Once people feel their group is threatened they focus on defending their group rather than truth. This is just hard-wired into human psychology.

Conclusion

The nature of tribalism, identity and ideology increase the difficultly of find scientific truth on trans issues. The tense nature of these discussions drive away many people who might be interested in working on these issues, and also causes harm to trans people, as they are deprived of scientific advances and the best possible care. Understanding these effects and working towards minimizing them can help to reduce the tension in the ongoing discussion and help us work towards a future where all those who are dealign with these issues receive the best possible care.