dysphoria

The identity trap and alt. ways to work with gender dysphoria

In this video I talk about ways to work with gender dysphoria for those that want to work with gender dysphoria in ways other than transition and medical intervention, and also for those who still have some gender dysphoria after transition and medical intervention.

Transcript:

So, hello, this is my second video and I am going to talk about ways to work on dysphoria other than medical interventions or transition. So, the reason for this is that first of all not all gender dysphoria requires transition or leads to transition. I think this idea kind of become pervasive and it’s not really true. However, there are people who do benefit from transition medical treatment. There’s evidence that shows that at least many people do experience reduction in their gender dysphoria but not everyone. Also, even among those who do undergo gender transition often still have dysphoria. I’ve known many trans people over the years and many of them may have felt like their transition was a success or beneficial but still suffer from these issues.So, the ideas that I’m going to describe here could be beneficial either if you are looking for ways to work on gender dysphoria without going through this process or maybe you might feel good about transition but want also to have better ways to work on stuff. So, we describe a number of ideas. Not all these apply to everyone. So, just sort of choose the ones that apply to you.

So, the first thing i want to talk about is the identity trap. For whatever reason in the last
20 or 50 or 30 years in Western thought we really got into this idea of identities, particularly in academic circles. This idea that we have identities and multiple identities and that identity is really important and that we need to find an identity and form an identity and discover our identity. In general, I think this is not a very good idea at all. I think it is a pretty toxic idea for several reasons. One of the first things to understand about it is that it is not a human universal.  It is a particular cultural point of view of this particular time. If you look at Western philosophy you don’t see people talking about identity very much at all. You don’t really see that until very recently that people were thinking of things in that context.

If you look at Eastern philosophy, you do sometimes see some talk about identity. In Buddhism and maybe Hinduism as well, but it is in a negative context. It is about the traps of identity and about how identification actually gets you away from your true self. We say that these identities are your true self, which is exactly backwards in my view. So, we can talk about this in a few ways.

So, one of the issues of identities is that they really connect to tribalism. Any time you have an identity which is also a group identity, such as identifying as white, or identifying as male, or female or gay or straight or black or any of these things, it creates a sense of us and them. So, there’s people that are in our identity group and people that are outside it and then this leads to tribalism. I think identities originated based in tribalism and evolution where we were part of a tribe and there was an us and a them. We kind of needed an intuition to know who were our people and who were not. So, this creates a lot of divisiveness, and makes it hard to hear things that are outside our tribal view.

Once we identify with a tribe, for example if we identify as trans we are now in that tribe, and so we take this worldview as being true, and other worldviews are rejected. This creates a lack of flexibility and a lack of ability to take in outside information. Once one identifies with something it becomes very difficult to change that. This happens in other contexts too, like in psychology and psychotherapy for things other than gender issues. For example, if you are working with someone who is depressed, sometimes they identify with their depression. They will say being depressed is who they are and that they are that kind of person. In this case it is much more difficult to work with them, and in fact they’re very unlikely to even come to therapy in the first place because they see their depression as who they are.

So, the first thing you have to do is convince them that the depression is not what they are and to try to externalize it which is very difficult. There’s a real difference between identifying a trans vs. saying “I am somebody who has gender dysphoria”.  I think it is a useful exercise to think of yourself as someone who has gender dysphoria vs. a person who is trans because that can lead to more options.

The problem is that adopting identities can increase distress and this is sort of what you see in some of the Eastern philosophy such as Buddhism.  One of the things that we want to do with mindfulness is to loosen the sense of identity – to see that for any identity we are more that that, or that we are outside of that, no matter what it is. There’s actually an exercise I think comes from Hinduism where you say “I’m not this, I’m not that” to take off these identities.  Who would I be if I was not trans? Who would I be if I was not cis? We go through the process of taking off these identities to see what’s underneath.

This idea is in some of the newer Western psychotherapies as well. For example, ACT, where we have this idea of “self as context” which is a being state, vs. “self as content” which is a concept. Identities are essentially concepts, so not authentic being. With identities we are involved with concepts, and acting from rules in our head. So, we’ve been acting from rules in our head, and this is different from acting from our authentic self, which is more like a being state. It is something that is more organic and not rule-based.  It is what we feel in the moment. Once we are in the rules, we’re dissociated from what is in the moment. The rules are a kind of shortcut, they might describe us in some way, but they aren’t what we are in each moment which is ever changing.

You actually see this when people do adopt a trans identity. People read a transgender internet group, and then come to a point where they accept this identity, and the their distress actually increases. If their distress increases when they take on the identity, then the reverse of that is to disidentify and see if that lowers distress. It can be just an experiment to take on that identity and then take it off. If identifying increases your stress and disidentifying decreases your distress then maybe that is the right way to go, but it is something that you have to experiment with yourself.

The second thing that I want to talk abut is “cognitive traps”.  So there are a lot of these going on in the community where you adopt a belief system that leads you in a kind of spiral towards greater and greater identifying. This is encouraged in various ways. For example, the idea that “if you have dysphoria it means you’re trans”.  If you say you feel some discomfort about your gender and you aren’t sure; they will say that means you are trans because cis people don’t feel discomfort about their gender. So any discomfort you feel confirms the trans identity. Especially if you are someone who by the process of identifying increases your dysphoria. Then you are going to be in a spiral, so now you have more distress and confirms you are trans even more. So, these things activate a spiral.

That’s what I mean by cognitive trap, it is this feedback loop that makes things worse and worse. So then the antidote is the reverse process, like saying this story doesn’t necessarily mean that you are trans, and I am just a person with gender dysphoria. So then, you can see if maybe that will reduce your distress and you can begin to reverse the loop.

Another kind of distortion is found in one of the tests the community will frequently put out.  They ask “If you would prefer to be the other gender, then that means you are trans and must transition.”  That is not true, because that is not the actually choice you are making by transitioning. These interventions are only partial and so the real choice you are making is between having a more normative body of your natal sex, or undergoing a kind of partial gender reassignment and being in a trans body. You can make that choice, and for many people that might be right choice, but you can’t make the choice of changing your body fully and becoming fully the opposite gender because that is not possible with today’s technology. So that is one thing to really consider. You have to be in touch with the reality of the real choice you are making.

One reason to let go of the identification is that if you don’t identify with the gender dysphoria it can be placed in context with rest of your life, and you can consider whether you will cause other problems that are worse.  So then the question of the choices that you make is based on a holistic view of yourself. It is not just gender, but is based on everything.

Another trap that exists is for people who experience erotic fantasies of feminization of some kind. Not everyone with dysphoria experiences this but some people do. Then the community will say “that fantasy is proof that you have this essential identity of trans” which also leads you into the identity trap I talked about.  You don’t choose what your fantasies are like.  You have a certain sexuality generally which doesn’t change, but you do choose how you identify. For example, you can choose the meaning you place on your sexuality, but not the fantasy itself.  You can choose the meaning you place on it. You can say “well, I just have this fantasy”, and maybe you can enact that fantasy with a consenting adult or maybe you can not enact it all.  It’s a question of what choice is best for you.

The danger of these fantasies is they can lead you away from the ability to form healthy romantic relationships.There’s nothing wrong with the sexuality per say, but it is a question of whether it can lead you to connect to another person or if it leads to a kind of self-absorption. If it prevents you from connecting to others, then that is a problem.

Sometimes people have a kind of dual sexuality where they have both erotic feminization fantasies and a more heterosexual male sexuality as well. In that case it really depends. You might find somebody you can enjoy both these things with but in some cases only one of them will lead to successful relationship, so I think it is better to choose what will lead to relationships and love and all those kinds of things.  The problem is not about what is normal at all, it’s not about heterosexuality being normal, that doesn’t matter. It is about whether it is functional and can lead to connection.

Sometimes,there can be obsessions and compulsions around these things and if that is the case then the idea of obsessions and compulsions are something that is generally understood in psychology so it can be something you can work with somebody about. Seeing someone who knows about those issues could be helpful. When I talk about choice the goal is to empower you to have as much choice as you can in this process. Some things we don’t choose. We don’t choose our feelings. We don’t choose our erotic fantasies but we do choose our responses to them. This is true in theory, but in practice people don’t always have choice. Maybe because there is something really distressful interfering.

Some people have trauma issues. I’m not say all gender issues are caused by trauma at all. That is not what I’m saying, but if you do have trauma that can interfere with the choice process. So again, that is something to work on with someone who specializes in trauma potentially or you can read books about it. So, another thing I want to talk about is what I call gender schemas, where you have some ideas about gender that are distorted in various ways.  Distorted may not be the right word, more like rigid. The idea that one sex is good and one sex is bad. Like men are really good and women are really bad or women are really good and men are really bad.  Or maybe that it is unsafe to be a man in the world and safe to be a woman in the world or vice versa.  That is something that you might have to work though and it might not be conscious. In my case it wasn’t something conscious at al but a visceral sense that it was unsafe to be myself and man rooted in all the bullying I suffered.  It was really unsafe to be male and be myself, even though I was completely surrounded by many feminine men and never had a problem with them. It was just for myself it felt unsafe. One remedy to this kind of rigid view is to really recognize the within-group diversity of men and women. For example, to see how men and women are both very diverse groups. There are all kinds of men and all kinds of women. Maybe to look to role-models who are more atypical members of their gender and are similar to you.

Another idea to look at is the universality of suffering. One of the views of the trans community is that gender dysphoria is a very unique kind of suffering. That is an isolating view and contributes to making your world smaller and also contributes to being more attached to identity and the identity trap and increasing suffering. One thing that reduces suffering is to see the universality of it. Even though our suffering is unique in various ways it also universal. We all in some ways want to be something different than what we are. Envy or a sense that other people have the thing I need to be who I want to be in the world. In the Eastern practices, such as the Buddhist practices, we generate compassion by acknowledging the universality of suffering and we start with easier people like our friends because we want good for them because they are suffering, and then we go to neutral people, then we get to our enemies and we see they are also suffering, so they are the same as us in a way.

By seeing ourselves as being part of a universal human experience it reduces the loneliness and reduces that sort of special character of the gender dysphoria which makes it feel like no one else suffers the way I do.  So this gender dysphoria is really unfair and feels really lonely.  It reduces that.  I’ve said this once before and some people said it was trivializing gender dysphoria which is definitely not what I am trying to do, because it is not trivial. It can be very severe and intense even leading some people to suicide because it is so intense. However other kinds of suffering are like that too, they can also be so intense as well.  Seeing the universality of it can help to reduce it. We’re all humans in this boat together.

Finally, the last thing is living according to values. Really discovering what your values really are.  This is known to be helpful because if we are focused on living our values we are focused on expanding ourselves, expanding the world and expanding who we’re helping. This helps us get out of the kind of self-absorption that can be really toxic and also helps us to endure suffering.  I think one of the ideas that comes with the ideology around gender dysphoria is that we are not supposed to have pain and not suffer. This is not true, we all have pain. The question is how do we live despite that and how do we face this pain. How do we say despite our anxiety or fear or pain or anger we are going to live according to our values. This makes life more fulfilling and rewarding.

The Greeks had this distinction between hedonia and eudaemonia. Hedonia was simple pleasures such as having a drink or playing games or dancing and all of these things. They are important in moderation, but in excess can lead to this over filled feeling. There is point where they are good and then as you get more of them they become less satisfying. Then there is the idea of eudaemonia which is the meaningful kind of life. It represents living according to virtues and living according to values. It is always good and does not lead to burnout. That’s a question to ask about transition. Is it living according to your values or not. Is it creating a greater good? If it enables you to live according to your values it is a positive step. If it is shrinking your world, like a couple of other people have said then it is negative. If it shrinking your world and making it harder to live according to your values, then it might not be the best path and that is something to sort out. Again I’m not saying all these medical interventions are bad, they can be good or harmful. So, that is all I have for today and hopefully I will do more videos in the future. Thank you.

 

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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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.

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.

On AGP

So far on the blog I have not said much about autogynephilia (AGP). AGP is the idea that the root of some MTF transitions is a kind of attraction to oneself as a woman. The desire to actualize this relationship is the root cause of gender transition for those with AGP according to this theory. It is seen as a kind of erotic target location error, where the erotic target is erroneously located in the self rather than the other. It also seen as a kind of sexual orientation towards oneself instead of towards the other. It can co-exist with heterosexuality at the same time and be in competition with it.

AGP is an idea that brings up very strong emotions and is difficult to talk about for that reason. On the one hand people will say that if you talk about AGP you are reducing transsexualism to a sexual fetish, and on the other hand some people will vehemently argue that it does not exist at all. AGP is certainly a topic of great controversy, but there are clearly people who find it personally meaningful. Anne Lawrence has collected many of their narratives in her book It is also clear that not all people on the MTF spectrum experience AGP.

It is clear that this form of transsexualism is not identical to a sexual fetish. It behaves differently than a sexual fetish in several ways. One is that fetishes tend to diminish with age, this form of transsexualism tends to increase in intensity with age. Another is that reducing/eliminating testosterone is one of key treatments for disruptive fetishes. This is something that happens when people transition MTF and it doesn’t usually cause their gender feelings to halt.

In order to help gain insight into this issue it is helpful to look at how sexual attraction and romantic love work in general. It is the product of two distinct brain systems, the lust system and the attachment system. The lust system governs sexual arousal and desire. The attachment system governs the emotional bond that exists with the object of attachment. It is possible to have one system activated and not the other. It is possible to have lust without attachment and attachment without lust. In long-term relationships the attachment may persist even if there aren’t any sexual feelings. Finally it is possible for attachment to exist without there ever being lust involved such as in familial relationships.

This is important because both systems are involved in AGP. This is necessary to explain the phenomena. It is not just a fetish, which would be purely a product of the lust system, but there is an attachment component as well. This is important because the attachment is what explains the ways in which it does not behave like a sexual fetish. The lust component is what I have referred to as erotic imprinting elsewhere. I have not spoken much about the attachment component.

Also, arguing against AGP because it reduces transsexualism to a sexual fetish is arguing against a straw man version of AGP. The proponents of the AGP theory acknowledge the role of a romantic/attachment component as well. Here is an essay from Anne Lawrence that discusses this. Blanchard discusses this in his writing as well.

There are people who just have the lust component with no attachment component. Again, this lives on a spectrum from a mild optional kink to the exclusive way in which someone can get turned on. This is true of all kinks and fetishes. This in and of itself can range from an enjoyable activity to a harmful obsession. In my eyes a kink or fetish is unhealthy if it harms others, prevents healthy relationships, or otherwise interferes with life. It is also important to note that fantasies of becoming a woman are only a subset of the erotic imprinting involved. For example, sissification fantasies are common and people with those fantasies also sometimes develop transgender identities.

One thing that is significant about the attachment system being involved is the attachment system behaves differently than the lust system. Fixed erotic imprinting, particularly in MAAB folks is generally for life, and is triggered by anything that fits its profile. Attachment is to a very small number of specific objects. Most significantly, the attachment system has mechanisms for both creating new attachment relationships and ending attachment relationships. People find new partners and break up with old partners. This means it should be possible to break this attachment to self, even though the erotic imprinting is unchangeable. It is also possible for this attachment to develop over time, which is something we sometimes see when people develop a transgender identity late in life. The problem with attachment to self is that it can interfere with attachment to others and compete with attachment to others. Attachment relationships are among the strongest predictors of health and well-being and are very important. Prioritizing attachment to others over attachment to self is healthy choice, a choice against narcissism.

So, how does this tie into the other concepts I have described. The first is this AGP mechanism only exists in a subset of MTF gender dysphorics and transitioners. It is not required to develop a transgender identity, nor does it automatically lead to a transgender identity. The narrative serves as an explanation for these feelings that avoids shame as sexual motivations are stigmatized. This is part of why some of these erotic imprints lead to a greater possibility of developing a transgender identity, but not a certainty.

Also, if a person develops the kind of attachment to self found in AGP, it is probably serving an important psychological function. That is where other elements such as trauma and gender schemas come into play. It will not be possible to break this attachment relationship as long as the psychological conditions that require it exist. Also genetic or biological factors can come into play as influencing the creation of erotic imprinting, possibly a person’s reaction to sex hormones and ultimately identity as well.

One thing that is clear is that these issues are complex, and go beyond a simple construct of “gender identity”. It is also important to note that the presence or absence of AGP doesn’t make a transgender identity less real Part of the reason that the idea of AGP draws such intense emotional reactions is the idea that transgenderism is somehow fake if AGP is involved, or the false dichotomy that one “has a fetish” or “is really trans”.

Link between gender dysphoria and dissociation found

Here is an interesting study I just ran across from Collizi, Costa, and Toldarello, entitled “Dissociative symptoms in individuals with gender dysphoria: Is the elevated prevalence real?”, abstract pasted below:

This study evaluated dissociative symptomatology, childhood trauma and body uneasiness in 118 individuals with gender dysphoria, also evaluating dissociative symptoms in follow-up assessments after sex reassignment procedures were performed. We used both clinical interviews (Dissociative Disorders Interview Schedule) and self-reported scales (Dissociative Experiences Scale). A dissociative disorder of any kind seemed to be greatly prevalent (29.6%). Moreover, individuals with gender dysphoria had a high prevalence of lifetime major depressive episode (45.8%), suicide attempts (21.2%) and childhood trauma (45.8%), and all these conditions were more frequent in patients who fulfilled diagnostic criteria for any kind of dissociative disorder. Finally, when treated, patients reported lower dissociative symptoms. Results confirmed previous research about distress in gender dysphoria and improved mental health due to sex reassignment procedures. However, it resulted to be difficult to ascertain dissociation in the context of gender dysphoria, because of the similarities between the two conditions and the possible limited application of clinical instruments which do not provide an adequate differential diagnosis. Therefore, because the body uneasiness is common to dissociative experiences and gender dysphoria, the question is whether dissociation is to be seen not as an expression of pathological dissociative experiences but as a genuine feature of gender dysphoria.

Disclaimer: I have only read the abstract for this article and abstracts can be misleading sometimes, this is actually a problem with a lot of blog posts around these issues. I have since read the article

This article is interesting because it shows a link between dissociation and gender dysphoria and notes a link between the two. Further people with dissociative symptoms show more distress than those that do not. There is also a high rate of childhood abuse which is also seen in a few other studies. I consider my own dysphoria to be essentially dissociation and I wasn’t able to become truly embodied until I accepted my body as it is and let go of my cross-gender identity. Here is an article by twentythreetimes from the female detransitioner perspective.

This study showed a high amount of trauma, and even more so for the people with dissociative symptoms. Also this article showed that after treatment for gender dysphoria these patients showed lower levels of dissociation. This makes a lot of sense based on what I know about trauma.

Basically, in order to reduce the distress and symptoms caused by trauma is there are three things you can do, often in combination.

1) You can learn to cope with the symptoms and how to tolerate them better. You can learn mindfulness, and distress tolerance skills. You can learn to come back to your body quicker. You can learn not to panic about your symptoms causing distress on top of distress. This can help reduce the severity and intensity of the symptoms but will not eliminate them.

2) You can work on reducing / eliminating triggers. There are various ways to do this. There are behavioral techniques such as Exposure therapy and newer techniques like EMDR These are ways to alter or even eliminate the traumatic imprints make triggers effect one less or even not at all this. This can be a quick or lengthy process depending on the type and severity of the trauma.

3) You can avoid the triggers. Trauma is contextual. A person with trauma is usually not continuously in a traumatized state. They enter into the traumatized state in response to a trigger, which is a sight, sound or other environmental cue that holds an association to the original traumas then placing the person back in the place and time where it happened as if it is happening right now. If you can identify these triggers you might be able to avoid situations where they happen, however there is a significant cost for that in diminished aliveness.

In particular if the trauma is gendered, you might be able to avoid the context of trauma and the triggers by not seeing yourself or having others see you in that gender. In my own case my trauma was around it being unsafe to be a soft sensitive man, so I felt like I couldn’t be myself and be a man. I was perceived as an atypical woman when I was perceived as a woman too, but that was no problem because it didn’t trigger the context of the trauma. Of course I instantly felt unsafe if I was perceived as a man by others or even if I knew that people knew I was trans because that meant that I could really be a feminine man and hence in potential great danger. So transition did help me be more myself in that sense, however it came with significant costs as I was disconnected from my body and constantly stressed about people knowing if I was trans.

So it doesn’t surprise me at all that we see relief after transition. It is also important to note that 70% of the subjects studied did not have a dissociative condition and 55% did not have a childhood trauma history. Trauma is only part of the etiology of gender dysphoria, but I definitely think it is a large part for some.

This doesn’t mean that people with trauma shouldn’t transition, this doesn’t mean that those whose gender issues arise partially from trauma are somehow “less real” We should appreciate multiple factors of causality as is typical for most things in psychology.

Again, transition and gender dysphoria treatment are helpful that seems pretty clear from the evidence. I just think that gender should not be treated as its own special box and should be viewed holistically and connected to other parts of the psyche. I am also not saying that those with trauma should not transition, but ideally it would be best to work through as much of that as possible before making permanent changes. Sometimes this is not possible, and people may need to ease some of their gender distress in order to even begin working on trauma. That is part of why these issues can be so complicated.

The problem of real vs. fake

The distinction between “real” and “fake” comes up a lot when discussing transgender issues. This is also sometimes framed as “valid” vs. “invalid”. I think this distinction is a false one in most cases, and serves to obscure thinking on these issues. People are very invested in whether their identities or conditions are “real” or“fake” and therefore have a strong stake in proving points that makes their identities “more real’. Likewise, opponents of transgenderism attempt to prove (or just assert) that transgender identities are “really fake”.

This whole discussion is a category error. Identities are not real or fake, because they are narratives. Narratives are stories and are constructed and culturally-specific. This does not make them “fake” though. It is an unfortunate assumption of Western culture that things that have material existences such as rocks or hormones, or body parts are “more real” than things that are concepts or narratives or stories. When it comes to the question of how to be more happy or how to best live our lives, this is not true. Concepts and narratives have as much, or even more to do with this question. They are very powerful. Dark thoughts can lead to suicide itself. People live and die by the millions over narratives. Would you say that religion has had less impact on human action and happiness than the spleen? or molybdenum? Constructed things are neither less real nor less powerful than physical things.

It is important to note that I am definitely not saying that everything is constructed. The postmodernists, having discovered that narratives are constructed sometimes go too far when they decide that everything is constructed. Bodies are not constructed (though the meanings placed on them sometimes are). Instincts aren’t constructed,impulses aren’t constructed, hormones aren’t constructed, chairs aren’t constructed. This does not make them “more real” though, and certainly doesn’t make them “more important” which the next leap in the chainfrom “more real”.

Another error that the postmodernists make is taking the idea that narratives are constructed and neither true nor false to mean that they are all equal. They are not equal. Narratives can be more useful than others, narratives can be more healthy than others. Some narratives are life-affirming and lead to flourishing, and others lead to destruction. An extreme case of a destructive narrative can be found in something like the “Jim Jones cult” which led to mass suicide. This also illustrates just how powerful narratives are, as they can override even survival instincts.

There may be low-level biological instincts and imprinting that lead people to develop transgender identities. However, the story that arises to explain these instincts is distinct from the instincts themselves. Neither is more real than the other, but it might be possible to decouple them.

Certain conditions like PCOS and autism correlate with transgender identity, both of which are known to not be caused by childhood experience. (That doesn’t make them more real than things that caused by childhood experience though!) It very well might be the case that some people benefit from cross-gender hormone therapy. Many trans people report the find hormone therapy improves their mood and functioning and they should be allowed to make that choice. However, this question is distinct from the narrative that is told to explain it. People with thyroid hormone deficiency function better when given thyroid hormone, but do not have a story that their “true thyroid is functional and they must take thyroid hormone to affirm their healthy thyroid identity.” This is partially because they don’t need to construct such a story, because thyroid deficiency is not stigmatized. Gender is such a polarizing topic that people who want hormones because they feel it makes them function better is seen as not a sufficient reason. They somehow have to prove that they are really a member of the other gender in order to get that medicine.

This distinction between “real” and fake” leads to endless discussion on whether trans women have “female brains”,which contain the assumption that if this question is true transgender identities are “real” and if this question is false transgender identities are “false”. There are several studies which show brain differences between trans folk and controls. In some cases these studies are confounded for the effects of cross-gender hormones in other cases not. A few of them do show a couple of brain structures that look similar between trans women and cis women This study is often quoted.

However, other show intermediate structures and others show trans women having structures in common with cis men. Here is a great article about a study showing that trans women’s brains show differences from controls, but not that they are like cis women’s brains.

There is a related idea that if there are such brain structures, then the condition is physical and therefore real. However, nearly all mental health conditions show up in the brain. Autism, schizophrenia, bipolar, and depression all show up in the brain. The real truth is that mental health conditions are no less real than physical health conditions and should not be stigmatized. People who suffer from things like depression or bipolar are stigmatized while those that suffer from heart disease or cancer usually aren’t. This whole discussion is a red herring really, but becomes important when we decide physical conditions are “more real’ than mental conditions. This distinction is doubly false because mental conditions are physical conditions also.

In summary I recommend experimenting with banishing the idea of “real vs. fake” from thinking about gender issues, it might reduce the emotional charge and help to promote clear thinking, and answer the real question which is what response to gender dysphoria will lead to the most happiness and well-being.