- “Brain Says You're a Girl, But I Think You're a Sissy Boy”: Cultural Origins of Transphobia
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- A Love Transcending [Trans* Transgender Transsexual Erotica] by Lula Lisbon
Some employed it to refer to those with unusual gender identities in a value-free manner, that is, without a connotation of psychopathology. Some people informally used the term to refer to any person with any type of gender identity issues. Transgender is not a formal diagnosis, but many professionals and members of the public found it easier to use informally than GIDNOS, which is a formal diagnosis. To qualify as a mental disorder, a behavioral pattern must result in a significant adaptive disadvantage to the person and cause personal mental suffering. The DSM-IV and ICD have defined hundreds of mental disorders, which vary in onset, duration, pathogenesis, functional disability and treatability.
The designation of gender identity disorders as mental disorders is not a license for stigmatization, or for the deprivation of gender patients civil rights. The use of a formal diagnosis is often important in offering relief, providing health insurance coverage and guiding research to provide more effective future treatments.
Mental Health Professionals MHPs who work with individuals with gender identity disorders may be regularly called upon to carry out many of these responsibilities: 1 To accurately diagnose the individuals gender disorder; 2 To accurately diagnose any co-morbid psychiatric conditions and see to their appropriate treatment; 3 To counsel the individual about the range of treatment options and their implications; 4 To engage in psychotherapy; 5 To ascertain eligibility and readiness for hormone and surgical therapy; 6 To make formal recommendations to medical and surgical colleagues; 7 To document their patients relevant history in a letter of recommendation; 8 To be a colleague on a team of professionals with an interest in the gender identity disorders; 9 To educate family members, employers and institutions about gender identity disorders; 10 To be available for follow-up of previously seen gender patients.
The mental health professional, who specializes in gender identity disorders should possess: a A masters degree or its equivalent in a clinical behavioral science field. This or a more advanced degree should be granted by an institution accredited by a recognized national or regional accrediting board. Mental health professionals who recommend hormonal and surgical therapy share the legal and ethical responsibility for that decision with the physician who undertakes the treatment.
The Mental Health Professionals Documentation Letters for Hormone Therapy or Surgery Should Succinctly Specify: a The patients general identifying characteristics; b The initial and evolving gender, sexual and other psychiatric diagnoses; c The duration of their professional relationship including the type of psychotherapy or evaluation that the patient underwent; d The eligibility criteria that have been met and the mental health professionals rationale for hormone therapy or surgery; e The degree to which the patient has followed the Standards of Care to date and the likelihood of future compliance; f Whether the author of the report is part of a gender team; g That the sender welcomes a phone call to verify the fact that the mental health professional actually wrote the letter as described in this document.source site
“Brain Says You're a Girl, But I Think You're a Sissy Boy”: Cultural Origins of Transphobia
A clinical threshold is passed when concerns, uncertainties and questions about gender identity persist during a persons development, become so intense as to seem to be the most important aspect of a persons life, or prevent the establishment of a relatively unconflicted gender identity. The persons struggles are then variously referred to as a gender identity problem, gender dysphoria, a gender problem, a gender concern, gender distress, gender conflict, or transsexualism.
Such struggles are known to occur from the preschool years to old age and have many alternate forms. These reflect various degrees of personal dissatisfaction with sexual identity, sex and gender demarcating body characteristics, gender roles, gender identity and the perceptions of others.
Some persons with GID exceed another threshold--they persistently possess a wish for surgical transformation of their bodies. The sex of a patient always is a significant factor in the management of GID. Clinicians need to separately consider the biologic, social, psychological and economic dilemmas of each sex. Transsexualism F Dual-role Transvestism F Treatment Goal The general goal of psychotherapeutic, endocrine, or surgical therapy for persons with gender identity disorders is lasting personal comfort with the gendered self in order to maximize overall psychological well-being and self-fulfillment.
The Standards of Care SOC are clinical guidelines intended to provide flexible directions for the treatment of persons with gender identity disorders that should be recognized as such, explained to the patient and documented both for legal protection and so that the short and long term results can be retrieved to help the field to evolve. Psychotherapy is a series of interactive communications between a therapist who is knowledgeable about how people suffer emotionally and how this may be alleviated and a patient who is experiencing distress.
Typically, psychotherapy consists of regularly held sessions. The psychotherapy sessions initiate a developmental process. They enable the patients history to be appreciated, current dilemmas to be understood and unrealistic ideas and maladaptive behaviors to be identified. Psychotherapy is not intended to cure the gender identity disorder. Its usual goal is a long-term stable life style with realistic chances for success in relationships, education, work and gender identity expression.
Cross-sex hormonal treatments play an important role in the anatomical and psychological gender transition process for properly selected adults with gender identity disorders. Hormones are often medically necessary for successful living in the new gender. They improve the quality of life and limit psychiatric co-morbidity, which often accompanies lack of treatment.
When physicians administer androgens to biologic females and estrogens, progesterone and testosterone-blocking agents to biologic males, patients feel and appear more like members of their preferred gender. However, the administration of hormones is not to be lightly undertaken because of their medical and social risks. Three criteria exist: 1 Age 18 years; 2 Demonstrable knowledge of what hormones medically can and cannot do and their social benefits and risks; 3 Either: a A documented real life experience of at least three months prior to the administration of hormones; or b A period of psychotherapy of a duration specified by the mental health professional after the initial evaluation usually a minimum of three months HBIGDA, The maximum physical effects of hormones may not be evident until two years of continuous treatment.
Heredity limits the tissue response to hormones and this cannot be overcome by increasing dosage. The degree of effects actually attained varies from patient to patient. Biologic males treated with estrogens can realistically expect treatment to result in: breast growth, some redistribution of body fat to approximate a female body habitus, decreased upper body strength, softening of skin, decrease in body hair, slowing or stopping the loss of scalp hair, decreased fertility and testicular size and less frequent, less firm erections.
Most of these changes are reversible, although breast enlargement will not completely reverse after discontinuation of treatment. Biologic females treated with testosterone can expect the following permanent changes: a deepening of the voice, clitoral enlargement, mild breast atrophy, increased facial and body hair and male pattern baldness. Reversible changes include increased upper body strength, weight gain, increased social and sexual interest and arousability and decreased hip fat. However, hormones can provide health benefits as well as risks.
Risk-benefit ratios should be considered collaboratively by the patient and prescribing physician. Furthermore, Hormonal treatment should be provided only to those who are legally able to provide informed consent. This includes persons who have been declared by a court to be emancipated minors and incarcerated persons who are considered competent to participate in their medical decisions. For adolescents, informed consent needs to include the minor patients assent and the written informed consent of a parent or legal guardian.
In persons diagnosed with transsexualism or profound GID, sex reassignment surgery, along with hormone therapy and real life experience, is a treatment that has proven to be effective. Such a therapeutic regimen, when prescribed or recommended by qualified practitioners, is medically indicated and medically necessary. Sex reassignment is not experimental, investigational, elective, cosmetic, or optional in any meaningful sense.
Prior to performing any surgical procedures, the surgeon should have all medical conditions appropriately monitored and the effects of the hormonal treatment upon the liver and other organ systems investigated. Since pre-existing conditions may complicate genital reconstructive surgeries. The medical record should contain written informed consent for the particular surgery to be performed. Genital surgery for biologic males may include orchiectomy, penectomy, clitoroplasty, labiaplasty or creation of a neovagina; for biologic females it may include hysterectomy, salpingo-oophorectomy, vaginectomy, metoidioplasty, scrotoplasty, urethroplasty, placement of testicular prostheses, or creation of a neophallus.
Minimum eligibility criteria for various genital surgeries equally apply to biologic males and females seeking genital surgery. They are: a Legal age of majority in the patients nation; b Usually 12 months of continuous hormonal therapy for those without a medical contraindication; c 12 months of successful continuous full time real-life experience; d. If required by the mental health professional, regular responsible participation in psychotherapy throughout the real life experience at a frequency determined jointly by the patient and the mental health professional; e Demonstrable knowledge of the cost, required lengths of hospitalizations, likely complications and post-surgical rehabilitation requirements of various surgical approaches; The readiness criteria include: a Demonstrable progress in consolidating ones gender identity; and b Demonstrable progress in dealing with work, family and interpersonal issues resulting in a significantly better state of mental health; this implies satisfactory control of problems such as sociopathy, substance abuse, psychosis, suicidality, for instance.
Genital surgical treatments are to be undertaken only after a comprehensive evaluation by a qualified mental health professional. Genital surgery may be performed once written documentation that a comprehensive evaluation has occurred and that the person has met the eligibility and readiness criteria. By following this procedure, the mental health professional, the surgeon and the patient share responsibility of the decision to make irreversible changes to the body.
Many persons, including some medical professionals, object on ethical grounds to surgery for GID. In ordinary surgical practice, pathological tissues are removed in order to restore disturbed functions, or alterations are made to body features to improve the patients self image. Among those who object to sex reassignment surgery, these conditions are not thought to be present when surgery is performed for persons with gender identity disorders. It is important that professionals dealing with patients with gender identity disorders feel comfortable about altering anatomically normal structures.
In order to understand how surgery can alleviate the psychological discomfort of patients diagnosed with gender identity disorders, professionals need to listen to these patients, discuss their life histories and dilemmas. The resistance against performing surgery on the ethical basis of above all do no harm should be respected, discussed and met with the opportunity to learn from patients themselves about the psychological distress of having profound gender identity disorder.
A variety of explanations have been suggested for the etiology of emotional difficulties in this population. One view sees the mental health problems of transgender persons and perhaps this condition itself, as bound up with early family difficulties and trauma.
An absent or abusive father, or an overindulgent or abusive mother and other aspects of family conflict during early development, may impede identification with a same-gender parenting figure Stoller, From a somewhat different perspective Kohut, the mirroring of the self in relationship to significant others may be distorted among some transgender persons. This may be manifested as narcissistic pathology or some other form of personality disorder Hartmann, Others have viewed transgender identification of children as a maladaptive defense mechanism in the context of a threatening environment Ovesey and Person, ; Devor, Another view traces emotional distress among transgender persons, more specifically, to a negative body image.
A sense of awkwardness or discomfort about ones anatomical sex is often linked to negative affect associated with these ideas Steiner et al. Transgender persons have long been described as fundamentally disliking their biological sexual characteristics Hoenig, According to Benjamin , transgender persons exhibit intensely negative attitudes toward their genitalia, in particular. For trans women, the penis supposedly becomes an organ of hate and disgust Benjamin, From this perspective, negative attitudes toward ones self one dimension of depression are epiphenomenal to underlying negative attitudes toward ones body.
Others have pointed to perceptions of stigma and experiences with discrimination associated with gender variant living in an often hostile environment Cole, Because they transgress fundamental norms of the binary gender system, transgender persons are thought to be at the low end of the hierarchy of acceptability in American society Herek, Recent studies indicate that these individuals experience stigma and discrimination in seeking housing, employment and social services and are not infrequently verbally and physically abused. There is some evidence that these perceptions and experiences take a toll on mental health functioning in this population Jones, But in addition to the above factors, most investigators would probably agree that the mental state and perhaps mental health of transgender persons is affected by the extent to which transgender identity is incorporated in social relationships and supported or not supported by relationship partners.
The interpersonal relationships of transgender persons have been described in a number of qualitative and small-scale studies. Informing a long-term sexual partner or spouse about ones trans identity is often associated with interpersonal turmoil, especially if the relationship was formed on the basis of a non-transgender identity Brown, Some relationships with existing sexual partners are re-negotiated in which a transgender identity is accepted and reciprocated Higgins, Informing parents about transgender identity is described as critically important Parker and Barr, The failure of parents to acknowledge the legitimacy of this identity is viewed as an obstacle to achieving a sense of self-acceptance among transgender persons Bolin, ; Sapora and Brzek, Identity-affirming relationships with parents, when they occur, are described as a type of symbolic rebirth.
Among trans woman, parents were the source of their birth and nurturance as males and symbolically can be the source of their rebirth and nurturance as females Bolin, Some siblings, caught between their beliefs about proper gender roles and their personal loyalties to a brother or sister, have been described as dismissive and hostile to transgender persons Sapora and Brzek, When it occurs, acceptance by siblings is described as vitally important; it may represent a type of retroactive credibility for a trans identity Bolin, Changing genders in the context of relationships with children may be charged with emotion and confusion.
Despite these difficulties, relationships of transgender persons with their children have been formed in which finding novel ways of dealing with gender-variant living are a source of pride and distinction Boszormenyi-Nagy and Spark, In the process of transitioning, transgender persons typically sift through their friendship network, largely avoiding those individuals anticipated to be critical toward their newly celebrated core gender.
Some friendships may be re-established, based on ones new gender and new friendships may be developed. Whether old or new, celebrations of identity with friends provide much-needed emotional support and generally legitimate a gender-variant lifestyle Blumenstein, Changing ones gender presentation in the workplace is a unique challenge. Turning over changing genders in the context of existing employment is not infrequently associated with strained relationships with co-workers and supervisors, which frequently results in loss of employment Bolin, In sum, the social relationships of transgender persons appear to be a complex array of both negative and positive experiences, in the context of different relationships, which frequently change over time.
The complex array of experiences in social relationships and their affects on mental health, can be conceptually understood in terms of four general processes:. Here and there, so-called cases of surgical sex transmutation have been reported. However, in order to understand the many faceted questions involving sex transmutation, we need to understand sex in its genital meaning as well as in its physical and psychological manifestation as a passion.
Furthermore, we also need to look into social attitudes. There are different issues for people who are going to live full time in the opposite gender role versus people who are balancing two gender images. With the transsexual, once the gender shift occurs, most of the work is done and one can get on and live ones life. However, if one is a cross-dresser, its an ongoing issue.
Ones whole life he is dealing with balancing the two and thats a big challenge. If your whole life is a secret, it affects who you are and your relationship with other people, particularly with people whom you love. Who do you tell, how do you tell, what is the effect of having a secret, of feeling not completely known, feeling of being rejected?
Of course, there are issues of depression, isolation, loneliness, feeling different, issues of self-esteem and a lot of guilt over who you are. As such additional research is needed to further elucidate the social psychological processes involved in the association between identity affirmation and mental health among transgender persons. Subscribe Today. Science Alert. All Rights Reserved.
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- Les Chênes dor (Litt.Generale) (French Edition);
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- Light on the Road.
- Managing Your Career (Lessons Learned).
- Adolescents qui dérangent: Entre différenciation et provocation (Crise et anthropologie de la relation) (French Edition).
- A Love Transcending (Trans* Transman Transgender Erotic Romance).
Research Article. A Forensic Consideration. Sharma and Manisha Gupta. Similar Articles in this Journal. Search in Google Scholar. How to cite this article: B. Sharma and Manisha Gupta , Trends in Medical Research, 2: DOI: CLINICAL THRESHOLD A clinical threshold is passed when concerns, uncertainties and questions about gender identity persist during a persons development, become so intense as to seem to be the most important aspect of a persons life, or prevent the establishment of a relatively unconflicted gender identity.
Gender Identity Disorder of Childhood The individual shows persistent and intense distress about being a girl and has a stated desire to be a boy not merely a desire for any perceived cultural advantages to being a boy or insists that she is a boy. Either of the following must be present: a Persistent marked aversion to normative feminine clothing and insistence on wearing stereotypical masculine clothing; b Persistent repudiation of female anatomical structures, as evidenced by at least one of the following: An assertion that she has, or will grow, a penis; Rejection of urination in a sitting position; Assertion that she does not want to grow breasts or menstruate.
The individual shows persistent and intense distress about being a boy and has a desire to be a girl, or, more rarely, insists that he is a girl. Either of the following must be present: a Preoccupation with stereotypic female activities, as shown by a preference for either cross-dressing or simulating female attire, or by an intense desire to participate in the games and pastimes of girls and rejection of stereotypical male toys, games and activities; b Persistent repudiation of male anatomical structures, as evidenced by at least one of the following repeated assertions: That he will grow up to become a woman not merely in the role ; That his penis or testes are disgusting or will disappear; That it would be better not to have a penis or testes.
Identity awareness: Keeping the secret about ones transgender identity from others may, in itself, contribute to emotional distress Cole, On the other hand, disclosing emotionally significant aspects of ones self-concept to others has long been suggested as contributing to mental health Jourard, Identity performance: Even if a transgender identity is revealed to others, a failure to act upon it in the context of the relationship may negatively affect mental health.
Behavioral expressions of transgender identity, such as cross dressing, may produce a sense of well-being Steiner et al. In a sample of 55 trans women, a scale of social reorientation, based on reported cross-dressing and role-playing in four role contexts, was strongly associated with fewer depressive symptoms.
A Love Transcending [Trans* Transgender Transsexual Erotica] by Lula Lisbon
Identity congruence: Even if others are aware of transgender identity identity awareness and this identity is acted upon in the context of the relationship identity performance , a failure of relationship partners to respond in terms of this identity may be disconcerting. A reciprocation of transgender identity identity congruence may contribute to mental health Stets, Identity support: It may vary from ridicule and devaluation identity rejection to acceptance, positive reinforcement and behavioral reciprocation identity support.
The type of behavioral response rejection versus support is seen as critically significant for the well being of transgender persons Boswell, American Psychiatric Association, Benjamin, H. The Transsexual Phenomenon. Julian Press, New York. Bentler, R. Prince, Ekins, R. Transcending stories. In The transgender phenomenon pp. Ekins, Richard and Dave King. SAGE Knowledge. Have you created a personal profile? Login or create a profile so that you can create alerts and save clips, playlists, and searches.
Please log in from an authenticated institution or log into your member profile to access the email feature. While transcending may take place by means of erasing, substituting, concealing, and implying, as in the other modes, the meaning of the transgendering and its attendant sub-processes is fundamentally redefined in the transcending mode. Redefining is the major sub-process.
In the process of this redefining, selves, bodies, body parts, sexualities, and gender, within the redefined system of classification, will take on CQ Press Your definitive resource for politics, policy and people. Remember me? Back Institutional Login Please choose from an option shown below. Need help logging in?