Today on the blog, the last episode of our special Scottish Mental Health Arts and Film Festival Arts and Film Festival series, Illuminations. Please note this series contains a frank discussion of struggles with mental health and and may act as a trigger for some readers.
Today’s contribution comes from Aurelie Richards, who explores her experience encountering the medical profession and society’s pathologizing of gender.
Aurelie is a Waldorf high school physics teacher, biodynamic beekeeper, performance artist, and writer living in the Monadnock region of New Hampshire. An ordained student of Zen master Thich Nhat Hanh she has worked with the Mindful Living Initiative and Wake Up Intentional building sustainable, inclusive communities. An expression of her community building has been offering creative movement workshops in New York City and New England with victims of domestic violence through Sanctuary for Families and the Monadnock Center for Violence Prevention. Aurelie is the co-founder, with her partner, of Change Agency for Gender Awareness (chAga) producing a bi-annual, limited edition photo and essay documentation of interviews with gender variant people in the US and Canada.
Pathologizing Gender
Our modern psychological establishment suggests that queerness is a disorder, hence the diagnosis of gender dysphoria (alternately gender identity disorder) from an appropriately trained psychotherapist and an endocrinologist for gender reassignment. Furthermore, before undergoing irreversible surgery for gender realignment two letters of recommendation are required – one from the therapist and one from the endocrinologist to a surgeon. The thought of an individual requiring medical intervention for non-conformity with patriarchal standards of gender expression is considered a disease rather than what it is – the beautiful continuation and unfolding of human and world historical evolution.
The problem of gender dysphoria as a diagnosis has been well articulated. The frustrations and anxiety around navigating the maze of systemic power can be disempowering. At no point in the process is the transwoman a free, self-determining agent. Often the transwoman runs out of psychological, emotional, and financial capital due to the very practices intended for preserving psychological and emotional integrity before transition is complete. This threefold bankruptcy often results in homelessness and suicide at alarming rates.
While the hetero-masculine structures holding power over trans* medical and psychological care are problematic, the destructiveness of the diagnosis of gender dysphoria to the trans* experience is not because the experience is labeled a disease, however. The diagnosis of gender dysphoria and the labeling of gender realignment as medically necessary has led to protective legislation in select U.S. states and European countries and inclusion of gender related medical intervention in many insurance codings for schedule of benefits. These are battles hard won from decades of gender variant people and allies working diligently in the legal sector.
The pathologizing of the gender variant person speaks equally though to our spiritual-cultural relationship to disease as an unnatural phenomenon. The battles that have been fought by and on behalf of trans* people have been largely (and rightly) political and economic. Our hyper-capitalistic society responds to financial appeals before political appeals before appeals to social injustice. Were it not for the diligent legislative and economic appeals made by the trans* community for political recognition and medical inclusion, the social spaciousness and cultural legitimacy for a conversation about our relationship to the problems of pathologizing queerness would not be possible.
Turning our collective awareness toward our aversion to disease in the hopes of transforming the structures that pathologize non-normativity, we point to an imagination of the wholeness of the queer. Wellness (normative functionality in physical, psycho-spiritual composition of the human being) is regarded as natural and disease is regarded as unnatural, non-normative, undesirable. The oscillation between ease and dis-ease is the nature of being human, earthly. If our view of disease expanded to include it in the wholeness of human experience rather than having aversion to it, the diagnosis of gender dysphoria (or any of the other ways femme is pathologized – read disproportionate diagnoses of bipolar disorder in women) would not be problematic or stigmatic at all. The epistemological shift in consciousness could fundamentally change diagnosis and treatment of gender related interventions.
Overcoming the aversion to disease, it becomes possible to imagine the mental health or medical patient as co-creator in the transition process. When I began seeking a therapist for my gender transition, it was incredibly important for me that I find a therapist I resonated with but more important it was paramount that she consider me an active participant in the process. When I had my phone consultation with my therapist I was very clear that I was solid and free, that the inner work of knowing my true self had already been done over years of striving. I just needed someone to reflect the insights already there who held the systemic power of letter writing so I could start hormones. From that phone conversation on I was treated as a co-creator in the vision of my transition and not as a victim of a pathology. For example, I often gave myself cognitive behavior homework without prompting but always to the delight of my therapist. Positive psychology has been moving in this direction and it is no surprise I was able to find an affirming and empowering therapist.
What was surprising however was her invitation to co-create my letter of recommendation to an endocrinologist. When I expressed to her my doubts that gender dysphoria is something that even exists at all, her response was not that I didn’t fit the Standards of Care template but was, “How can my letter best serve your process?” We went paragraph by paragraph through the letter and collaborated on what it should say based on her professional responsibility and my own unique journey as a whole, autonomous, authentic being.
Ultimately she chose not to diagnose me with gender dysphoria in her wording and instead after describing my biography and our sessions stated that our relationship revealed to her “symptoms congruent with gender dysphoria.” I thought this was very clever. She managed to honor my wish not to be labeled but also to make the letter effective in its purpose. My endocrinologist though diagnosed me with gender dysphoria in order to prescribe hormones and an androgen blocker. It’s their rules but it’s my game so I chose to play despite the problematic diagnosis.
Every aspect of gender variance challenges norms and pushes the boundaries of political, economic, and spiritual-cultural scope. The relationship to disease and mental health is in no way exempt from the transformative force of queering. The battles that have been won have been far reaching in breadth. What my experience points to is the possibility to direct our change agency toward the depths as well and begin to unearth the roots of the systemic violence of which transwomen are an easy target but to which we are all – men, women, and trans* alike – subjected.
[Aurelie Richards]
If you are affected by any of the issues discussed in this article, please consider checking out the Mental Health Foundation who can advise you on where to seek help. To find out more about the Illuminations series, click here.