social justice

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.