What I Needed: An Open Letter to Therapists from a Detransitioner

Detransitioner and author of this wonderful blog Maria Catt very generously agreed to write a guest post about the mental health care she wished she had received as she was going through her transition. Thank you for your brave words, Maria!

Update: Maria’s letter is getting a huge number of views. Evidently, this is striking a chord. If you are a detransitioned person and would like to submit an open letter to therapists and other professionals, please feel free to contact us. We welcome submissions.

The main thing I wish were different about the therapy I received before and during my transition is I wish my therapists had been trauma competent.

I was in therapy right after my college rape. I was in therapy for the many years I was wondering if I was some kind of trans. I was in therapy when I decided I was trans and needed to get my letters for hormones and surgery.

All three therapists knew about my college rape. All three therapists knew about my stressful childhood in a home with daily violence. The second two therapists knew about me going through an experience of being virally hated on on the internet. Looking back, knowing about dissociative states, it’s crystal clear that was a traumatic experience I had classic trauma reactions to- dissociation, depression, anxiety, avoidance. We talked over my rape. We talked over my childhood. We talked over a pack of strangers hating me on the internet. We talked and talked and talked.

Talking does exactly NOTHING to reset the human body’s stress reactions after trauma. A massage will do more than sitting in a room and talking. The first responders who were traumatized after 9/11 found massage and yoga more effective than talk therapy. I highly recommend the book “The Body Keeps the Score” by Bessel van der Kolk about the limits of talk therapy and the need for embodiment work after trauma.

So why didn’t any of these therapists teach me about cortisol and the other physiological facets of a prolonged stress reaction? Why didn’t we talk about the altered states of consciousness that are part and parcel of untreated trauma? Why didn’t anyone say anything to me about dissociation?

The first time anyone acknowledged that the circumstances I was talking about in therapy- humiliating, coerced sex (otherwise known as rape, my first therapist let me call it “coerced sex” the entire time),a stressful childhood in a violent home, the amorphous threat of a lot of men on the internet calling me terrible names and also knowing where I was performing- constituted trauma, was actually at a medical appointment. I told the doctor I couldn’t concentrate and was crying a lot. I also said I had been raped in college. I was given a prozac prescription and the doctor wrote down on my chart that I had PTSD. My therapists up to that point had not mentioned PTSD to me. Once I had what I took as permission to apply PTSD to myself, a lot of the way my brain worked made more sense. Extreme trouble concentrating. Racing, obsessive thoughts. Lots of crying. Getting triggered at comedy shows by all the rape jokes. Nightmares.

But no one said anything to me about dissociation.

No one said, hey do you ever feel like you’re an outside observer of your thoughts and actions? Do you ever feel like you’re outside your body? Do you ever feel numb for weeks at a time? Do parts of your body feel unreal to you?

This is the best link I could find describing the DSM 5 criteria for depersonalization/derealization disorder.

http://www.mayoclinic.org/diseases-conditions/depersonalization-derealization-disorder/basics/tests-diagnosis/con-20033401

I believe my experience of constructing a fantasy, non-woman persona was somewhere between a depersonalization/derealization disorder and a dissociative identity disorder. The obsessive thoughts of how my life would be different if people could see the “real,” non-woman, no boobs or butt having me, were all day, every day, for years. I’ve had obsessive thoughts about being really more like a boy since before puberty. There have been points in my life when  I would  catch myself in a window or mirror and see a boy briefly. My breasts and thighs and butt have felt unreal to me for a long time. Since long before my college rape. Pretty much as soon as they came in it’s felt to me like there has got to be a zipper for this exaggeratedly sexual body suit I’m wearing.

Now, let’s be kind to my old therapists and acknowledge differential diagnosis is a tricky skill set.

Here are the criteria for gender dysphoria in the DSM 5:

  • Noticeable incongruence between the gender that the patient sees themselves are, and what their classified gender assignment
  • An intense need to do away with his or her primary or secondary sex features (or, in the case of young teenagers, to avert the maturity of the likely secondary features)
  • An intense desire to have the primary or secondary sex features of the other gender
  • A deep desire to transform into another gender
  • A profound need for society to treat them as another gender
  • A powerful assurance of having the characteristic feelings and responses of the other gender
  • The second necessity is that the condition should be connected with clinically important distress, or affects the individual significantly socially, at work, and in other import areas of life.

To get diagnosed with gender dysphoria you need two of these criteria for at least 6 months. Absolutely I had every one of these criteria for years. I had “an intense need to do away with my primary or secondary sex features” from ages 13 to 31. I had “a noticeable incongruence between the gender that the patient sees themselves as and their classified gender assignment” from ages 13 to 31. I had a “powerful assurance of having the characteristic feelings and responses of the other gender” from 26 to 31- once I was in a queer scene and knew about non-binary identities.

And yet, my “powerful assurance of having the characteristic feelings and responses of the other gender” was an incorrect powerful assurance. I am now powerfully assured if by some medical miracle surgeons actually were able to transform a bottom heavy woman into the David Duchovny lookalike that I obsessed about being since puberty, that transformation would have ended with me profoundly unhappy. (Surgeons can’t do that by the way. I had big delusions about what surgeons would be able to transform my body into. Realizing I was deluded about that resulted in a half a year of profound, suicidal despair.) If you get triggered by rape jokes at comedy shows you will constantly be triggered by how men talk to other men about the women around them. It would cause me significant, clinically important distress, which would affect me socially, at work, and in other important areas of life, to be regarded as a man by other men. My transition was always bound to fall apart, because what I actually have is a body with a stress response that is all bent out of whack from sustained, untreated, repeated trauma.

Ok, so how are mental health providers supposed to parse out who should be labeled with “gender dysphoria” and who should be labeled with a decades long dissociative disorder that is manifesting itself with gendered fantasy?

Good luck answering that. The DSM is a frustrating document because it attempts to categorize human misery along lines of potential treatment. This means that the treatments the psychiatric community and the patient communities like to have happen end up reflexively creating the diagnostic categories. The authors of the DSM 5 acknowledged that leaving the door open for insurance companies to pay for transgender medical interventions was a major consideration in how they reworked the criteria of “gender identity disorder” into “gender dysphoria disorder.” Here’s the fact sheet the APA put out explicitly acknowledging that.

http://www.dsm5.org/documents/gender%20dysphoria%20fact%20sheet.pdf

I needed mental health care that would steer me towards constructing a daily life that works with my exaggerated cortisol responses, so that I can ease up off of the obsessive thoughts. Here are the lifestyle changes that have actually helped me with my “intense need to do away with my primary or secondary sex features” and my “profound need to have society treat me as another gender.”

1) Making reducing stress the number one goal of my life- reducing stress about money, reducing stress about bodily safety, reducing stress about accomplishments, reducing stress by separating myself from stressful people

2) Hot yoga

3) Getting enough sleep

4) Reducing use of marijuana and alcohol. Pot absolutely increases my risk of having an episode of dysphoric feelings, both while I’m high and the next day. I relied on marijuana so much while I was trans for stress reduction, and as a result felt like life was unreal, that my body was unreal, that I was living in a creepy movie, for 2 years.

If there was a pill I could take to help me with this dissociation I struggle with, I would take it in a heartbeat. My grasp on my symptoms when life gets stressful is sometimes tenuous. Getting care for dissociation is very challenging. Heck, getting care even for ADHD is really challenging- testosterone was way easier for me to get a prescription for than my ADHD meds.

I wish I had had a therapist talk to me about sustained stress. I wish I had had a therapist talk to me about cortisol. I wish I had had a therapist talk to me about embodiment work. I wish I had had a therapist who talked to me about trauma.

I also wish I had more answers for mental health providers. In the current political climate, responding to a patient who wants a letter for hormones or surgery with a line of questions about trauma symptoms is verboten. I think if MH providers felt ok about talking to each other about the traumatic histories they are seeing walk in with their trans patients, they could come up with better ways to encourage trans-identifying patients to hang out in a discernment period for awhile. Treating trauma symptoms is also something that people who should transition deserve. I believe there are people for whom living as another gender is the best outcome. I believe the people in that category also deserve education about trauma and embodiment. If only so that every decision the patient makes about the medical interventions they pursue are coming from a clear, relaxed, realistic about how their bodies can be transformed state of mind. People deserve to make life changing decisions when they are thinking clearly and are realistic about the future lives they’re constructing. People with untreated trauma are in long term altered states and should not make life changing decisions.

I’ve talked to therapists who specialize in trans care and I know this is already a concern for a lot of them. The political climate makes them nervous to speak openly about it. They need the voices of detransitioned people talking about trauma to create a climate where they can talk about trauma. More transitioned people being willing to speak openly about the role of trauma in their gender dysphoria would help a lot too. We are so constrained by this “brain gender” narrative. The political emphasis on sticking to that story, and editing life stories to affirm that narrative, ends up hurting trans people. At the end of the day, people get to transition because of their human right to autonomy. Part of respecting people’s autonomy is creating therapeutic contexts where they are making these big decisions with their most relaxed, calm, realistic mind. Therapists who treat trans people incorporating trauma education and treatment into their practices is a base level necessity to fulfill the ethical requirement of respecting their patients’ autonomy.

 

30 thoughts on “What I Needed: An Open Letter to Therapists from a Detransitioner

  1. Oh wow this site is pathetic. At least with the right-wingers and their ‘american college of pediatricians’ BS they rounded up a few people with degrees to put a scientific face on their hate group. This site is just a bunch of cherrypicked transbashing articles about the evil and awesomely powerful trans cabal is forcing children to transition, because you know how much every kid wants to claiom an identity that will probably result in them being hated and disowned by all their family and friends, with a ‘Ya we’re really professionals, totally serious’ disclaimer thrown on.

    You’re losing. Trans people are being accepted more and more each day. Trans kids are getting to trsansition sooner and sooner without bigots like you trying to force them to live as the wrong gender.

    Now I gotta take my hormones and head to work. Also just for the record I found this site from an article on Breitbart, a rabidly anti-lgbt site that opposes even the most basic civil rights of gay or trans people. I’m sure you totally-not-bigots- will quickly to ask them not to cite you, right?

    Liked by 1 person

    1. Hecate, would agree that a child who transitions medically who maybe would have been one of the large majority whose gender dysphoria desisted would face significant lifelong consequences as a result of the hormones and/or surgery? I’m not saying people should transition. I’m just saying we should be very, very careful and circumspect when offering these treatments to children and young adults whose identities are still often in flux. Does that really sound hateful to you?

      Liked by 3 people

    2. Hecate, another thought. I propose that “transitioning” versus “being forced to live in as the wrong gender” is a false dichotomy. Gender dysphoria is not well understood, and is likely a complicated condition with many possible causes, some of which may have a biological etiology, with others being social or intrapsychic in nature. Gender itself is a social construct.

      I posit that we should be exploring a wide range of options or supporting gender dysphoric kids and young people. Medical transition ought to be one of the solutions on offer, but I would hope we would find others as well that are less invasive.

      Liked by 3 people

    3. Why? It seems that, even for people who accept the transactivists’ narrative, there are people who turn out not to be trans. There is some growing evidence that there is a trend of people who are mentally ill or have suffered trauma or are simply very suggestible who are self-identifying with this diagnosis and because activists want zero verification or gatekeeping, well, those not-trans-people are not being treated for what actually ails them.

      Frankly, this is a problem of the transactivists’ making. Not even being able to admit that eliminating professional ability to identify people who aren’t really trans seems to be a HUGE problem which no one thought about. An unintended consequence, if you will. And, when it is happening to children and teens — humans who, because of immature and developing brains, can’t give informed consent? That’s malpractice. It’s malpractice for adults, too, but it is vital to protect children from being misdiagnosed and having irreversible hormones and surgery used upon them.

      Liked by 7 people

      1. Thank you for this thoughtful response. You have taken the words I have been trying to find, and wrote them here in a open, rational, non-judgmental manner. Your words are much appreciated. (From a mom of a daughter who is clearly NOT a trans, but thinks she is). Her life’s problems, and things that afflict her, will not magically go away if she takes T.

        Liked by 5 people

  2. “We are so constrained by this “brain gender” narrative. The political emphasis on sticking to that story, and editing life stories to affirm that narrative, ends up hurting trans people.”

    This is the huge tragedy of the cause/effect/’treatment’ dogmas pushed by trans activists and ‘gender’-blinded clinicians: that it is trans-identifying people themselves who end up being so hurt by the untruths around causes of gender identity disorder/gender dysphoria and how to ease it. Girls and young women especially, in ever increasing numbers (2 to 1 ratio now at the Tavistock under-18s, girls to boys).

    As well as trauma, there’s just not wanting to be how ‘girl’ gets defined in this culture, internalised misogyny, body hatreds, attraction to self-harm, and things like GNC girls and especially girls on the autistic spectrum being particularly vulnerable to the siren call of ‘Feel different? You must be trans like us. Follow the programme, and we’ll solve it for you.’

    Activists don’t seem to give a damn about really looking at where the well-being of kids/teens who develop GID/GD might lie, it seems more about their own retrospective self-validation, no matter the price others pay.

    Thank you so much, Maria, it is so very needed for people with first-hand knowledge to share what they know.

    Liked by 6 people

  3. In general, I agree, but I am very wary about using the Bible of Biocracy, The DSM, as authority. Biopsychiatry is not good for women. The ONLY “disorder” that makes any sense at all in this catalog of white male fantasies about human emotional suffering is the PTSD label. But even this label blames the victim’s brain instead of the trauma-inducing culture we live in. “Psychiatry: The cloak of benevolence thrown over brutal social control, with the stink of eugenics all over it.” – Amy Smith

    Liked by 5 people

  4. So let’s be clear: This person didn’t transition because of trauma. This person was prevented from transitioning because of trauma.

    This person still is experiencing an “intense need to do away with my primary or secondary sex features” and a “profound need to have society treat me as another gender.” And “If there was a pill I could take to help me with this dissociation I struggle with, I would take it in a heartbeat.”

    The person detransitioned not because they realized they were a woman or wanted female primary and secondary sex characteristics but *because they were still experiencing dysphoria because their body was still too female.* They also detransitioned because they couldn’t stand to be around men since they had unresolved trauma from being raped since they had never received proper treatment for that. Makes perfect sense.

    As a trans man who experienced the same need to get rid of primary and secondary sex characteristics and also experienced precisely zero trauma growing up, I can assure you that trans feelings are perfectly real.

    It saddens me to think that someone is unable to properly resolve their gender dysphoria due to trauma. All of the sleep and hot yoga in the world will never make those dysphoric feelings go away. I certainly tried everything I could to manage those feelings without transitioning, but I have only experienced the dissipation of those feelings through changing my hormones and secondary sex characteristics.

    Work on the trauma, yes, but be clear that that will never make the dysphoria go away. Being trans has nothing to do with trauma.

    Like

    1. Hi Adam. No, I’m not experiencing a profound need to have society treat me as another gender. I sometimes have troubles with my body map and I sometimes dissociate. Both experiences relate to the level of stress in my life. I do not like being perceived as anything other than a woman these days. I purposefully grew my hair out partly because so many people, when my transition stopped, tried to cast me as now “non-binary,” and the experience of not being able to get out of the trans paradigm and be believed about my trauma symptoms felt awful. Nowadays I would really hate to be perceived as a man or non-binary. I make a lot of effort to be read as a woman.
      I’m glad you are happy, and got the interventions that have moved you past the experience of gender dysphoria. I’m also very happy life got in the way and I didn’t get surgeries that would have locked me into being perceived as a man. Making an effort to treat my symptoms with embodiment work has resulted in this being a particularly joyful time in my life. The people around me see and know me on a deep level, and I don’t feel there are gendered assumptions that are keeping me from being deeply known, as I did while I was contemplating a trans identity and then pursuing one. People are different and need different things to be happy. Glad life is going well for us both!

      Liked by 7 people

    2. To quote even just two former transmen:

      ‘My unpopular perspective is that the adoption of trans identity is frequently a trauma response. …approximately 2/3 of my sexual abuse support group transitioned ftm [female-to-male]…’

      and

      ‘…trans identities could be a product of dissociation due to trauma, something few want to discuss. This is not just a theory, this describes my reality and that of other detransitioned women I’ve encountered. … Some people really do transition because they were raped or abused.’

      Other detransitioned women also write of trauma having been key in their arriving at a trans identity.

      I have not identified the above women here because some detransitioners have expressed discomfort with their blogged experiences being quoted out of context. Anyone who might wish to know more about their experiences in context can google quotes from above and find their blogs.

      ‘My unpopular perspective…’ and ‘…something few want to discuss.’ Yeah, that they tell us this – and that Adam feels able to make the blanket declaration that ‘Being trans has nothing to do with trauma’, to deny that anyone can have arrived at a trans identity through trauma – shows how censoring the dominant trans dogma is about the realities of what can cause trans identities to take root. Such censoring denial is harmful to people. And outright denying the realities of others doesn’t seem good practice. (Though thinking about it, you could say that denying the realities of others is a big part of trans ideology.)

      Adam, I can understand that it wasn’t your experience, and that you might want to detach yourself from the idea of trans identities sometimes being caused by trauma, but maybe the people who told you it never has to do with trauma didn’t themselves want to admit it.

      And in case anyone wants to come back against the two detransitioners above with the old, “Well they must not have been ‘REAL’ trans”, then here’s more from the first one, in response to an ‘anon’ commenter accusing her of having “f*cked up and mistakenly thought you were trans lol”:

      “I’m sorry, anon, but we were real transmen. Hell, a bunch of us still kind of *are* transmen against our will at this point, because the world at large reads us as male no matter what we do now. We were real, as real as anyone, which is to say, not at all – because there is no “real” when it comes to this.

      “If how you’re living works for you, then I’m glad to hear it. But I’ll warn you not to build your house on the foundation of “realness” because there is no there there.”

      Liked by 4 people

      1. When I said that being trans has nothing to do with trauma, I was saying that trans people exist. That people who experience gender dysphoria cannot make it go away through hot yoga.

        I don’t really care how Maria identifies or tries to manage the discomfort she feels with her body. The only thing I take exception to is people misinterpreting or implying that there’s no such thing as transsexualism.

        There are people born whose internal and external sex do not match. People who’ve known they were the other sex since as early as they can remember–people with no history of trauma. So hopefully we can all agree that transsexual people exist and have existed across cultures and throughout history because there’s a natural, biological variation that causes it.

        I know my reality better than anyone else knows my reality, and I would advise others not to build houses on any premise that does not acknowledge the existence of trans people.

        Yes, there are people who appropriate being trans and adopt a trans identity. You and I are ultimately on the same page. I don’t want people to misunderstand what being trans is. Being trans isn’t about gender and it’s not about smashing the gender binary and it’s not about escaping being a woman. It’s about addressing a neurological quirk in which the brain expects to have a male body, that is, the brain is male–whatever that means–and the body is typically female (and vice versa).

        If someone only starts expressing discomfort with their body after trauma, I doubt that person is trans.

        Like

  5. A clear, brave and thoughtful response Maria. Thank you. Thanks especially for your links on bodywork for trauma response – CBT I have found, can sometimes re-traumatise. This has given me a lot of food for thought.

    Liked by 2 people

  6. For a long time, this issue has been distressing me. The total subservience of medial ethics to political ideas it truly horrifying, as are the silencing tactics used in the name of tolerance. I’m always careful about who I reveal my opinion to out of fear of being considered bigoted. I feel like as someone who has never experienced dysphoria or transition, I don’t have a lot of authority in most people’s eyes. But the fact that this website exists, and that more detransitioners are speaking out is comforting to me. Good luck with your long journey a head.

    Liked by 3 people

  7. More comments about this post can be read here:

    https://www.reddit.com/r/Gender_Critical/comments/4kdgr8/what_i_needed_an_open_letter_to_therapists_from_a/

    Many are about the need for better gatekeeping from transition not only because of trauma but also autism, dissociation, dyspraxia, and simply being a teen – partly that teens experience ‘an entirely normal absence of control over their new big dumb sexy bits even grown ups can’t really control’, and being told that that normal discomfort in your own teenage body is something called ‘dysphoria’, which means that maybe your body is ‘wrong’.

    Liked by 2 people

  8. Thank you so much for this post, especially the part about body treatments… I’ve never heard that before, but I will try massage and maybe some of the others. I actually did find talk therapy helpful, inasmuch as it gave me someone to listen, which I simply have not had in my personal life. I’m hoping to continue that somehow, but I may now have to switch to CBT, since that’s what most therapists in this area who take my insurance practice. Very nervous to hear that it can re-traumatize, but forewarned is forearmed. I will also address my stress levels. It gives me a lot of (hopefully) useful ideas to bring to therapy, anyway. Again, thank you so much.

    Liked by 1 person

  9. Thank you, Maria, for sharing your experiences in a thoughtful and non-judgmental way. You are courageous to do so and I am thankful to find you and your voice, over the other “noise” out there. Anne’s response above could be my words too, as a very concerned mother of a very misled daughter.

    Liked by 1 person

  10. Hi, again. I’ve started reading “The Body Keeps the Score,” and I’d really like to try some of the stuff Van der Folk recommends, especially Sensorimotor Psychotherapy. Do you have any suggestions on how to get started (without going too far too fast, for example)? Or even just how to get in touch with some good body therapists? He mentions some of them are flakes or charlatans.

    Once again, thank you so much!

    Liked by 1 person

    1. Good question. I will see if Maria Catt has specific suggestions. In terms of finding someone, I would ask someone you trust to make a recommendation. I realize this isn’t very specific. If you like, you can drop me an email and let me know where you are located. Perhaps I will have some suggestions.

      Liked by 2 people

      1. Thank you. Unfortunately, I’ve never been able to tell many people about this. I have asked old therapists, but they’re not familiar with this approach. I’ll try emailing you if I can find your email address…thank you again!

        Like

    2. This is the million dollar question! I actually still have not found a therapist who 1)addresses PTSD through a somatic lens and 2) that I can afford. The Sensorimotor Pyschotherapy website has a Find a Therapist feature.

      https://www.sensorimotorpsychotherapy.org/referral.html

      I have been just going to lots and lots of yoga on my own, and from what I understand about Trauma Sensitive Yoga, my studio actually incorporates a lot of practices to make their classes safe and helpful for traumatized people.

      http://www.traumacenter.org/clients/yoga_svcs.php

      I spoke to a trauma therapist recently who pointed out that a lot of trauma work is relational- having a long term relationship with your therapist can be vital because many of us experienced trauma at the hands of caregivers growing up, and ideally you try out healthier approaches to bonding in the safety of the therapeutic relationship. The problem is most insurance companies will only pay for short term therapy- 20 sessions or less. The trauma therapist I spoke with was of the opinion that wasn’t enough time to enact change.

      We do not have a mental health care system that is responsive to trauma in the US, so those of us who have the insight that we need to address the ways trauma has shaped our lives are in a tough spot.

      Sending you good vibes to find your therapist, and also sending myself those good vibes too! I wish I had real help to offer you!

      Liked by 2 people

      1. Thank you! Your insights are helpful in themselves, and so is your advice. Yes, the US system is really messed up, especially considering how much violent crime we have – and therefore, people suffering from trauma. I will try both of those links, thank you. Fortunately, I’ve been told we may soon get a trauma-informed yoga instructor at my campus. Praying so! And prayers for all of us in recovery! God bless!

        Liked by 1 person

    3. “Somatic Experiencing” is an excellent form of treatment for trauma that is very gentle, body centered, and NOT retraumatizing.

      An excellent first book to read by the developer of SE is “Waking the Tiger” by Peter Levine. If you’ve experienced trauma, you will see yourself again and again in these pages, and for me it was such a relief to know that I wasn’t crazy or just making things up. You will also find hope that the trauma reactions your body experiences (and your mind interprets often in unhelpful ways) can be resolved for good.

      Here’s a website about SE by Peter Levine: http://somaticexperiencing.com/ There is a link at the bottom right of the Home page for help finding an SE practitioner.

      In order to not be retraumatizing, the process is very slow, which presents a problem if you don’t have a lot of money. If you can afford it, though, SE is one of the best treatments I know of for trauma.

      Liked by 2 people

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