A Teen Therapist Writes About Gender Identity Issues — Sally’s Story

Sasha Ayad, M. Ed., LPC  is a therapist with extensive experience working with teens, and gender defiant teens in particular. When she started to notice her bright, creative gender defiant teen patients feel that they needed to define themselves by picking a label that then sometimes encouraged them to make permanent changes to their bodies, Sasha found herself thinking critically about this trend. She has researched gender identity issues in teens extensively, and has a private practice where she works to support gender questioning youth. In Sasha’s words

“I use non-judgmental, compassionate, dialogue that focuses on exploration rather than immediately seeking to affirm and transition your child. Together with your teen and family, we consider multiple complex factors that may contribute to their dysphoria, including social, cognitive, environmental, physical, and emotional factors. Treatments may include mindfulness, somatic, and integrative techniques as well as confidence-building, and age-appropriate sexual identity exploration. I also educate parents about the topic of gender identity, break down stereotypes, discuss risks, and encourage parents to become deeply invested in the process so they can best support their child outside of therapy sessions. While transition may be the best option for some kids, many others have had very painful and negative experiences with their transition, and I help families prevent this from happening. I believe I owe it to your child to be thorough and careful in my approach, placing safety, well-being, and happiness above all else.”

The following piece was posted originally on Sasha’s blog. While the current narrative around helping trans identified teens creates a false dichotomy between affirming a teen’s identity and being unsupportive or rejecting, Sasha’s work beautifully illustrates how one can offer unconditional support while helping a teen to navigate the confusing waters of identity.

Sasha can be reached at 888-945-8207 or  Sasha@Inspiredteentherapy.com. You can also find her on Facebook.

sally-blogI was busy working on a behavior plan for a very fidgety 6th grade boy when I heard an assertive knock on my office door. This was the third time this week Sally had left class without permission to come talk to me.

“Ms Ayad, how can I transfer schools? I really don’t think I can get a proper education here and none of the teachers know what they’re doing”, so began our 45 minute conversation. She often got fixated on one or two teachers, who despite their best efforts, could not find a good way to work with Sally. I had a very different relationship with her though, and I was able to help her work through some of her generalizations and logical leaps.

Her hair was always pulled back hastily in a low ponytail, the eczema around her mouth, though visible, wasn’t as noticeable as the smudges that covered her glasses – she pushed them up from the lenses every time. Often a curious little smirk would lift the corner of her mouth, even when she was clearly upset or discussing something serious.

She is one of those kids who teachers were often exacerbated by, but I got to see her in a different light, and I found her endearing, creative, and incredibly interesting.

Once we were able to conclude that switching schools was not the best option, and I taught her some self-regulation skill using a squeeze ball, it seemed she was much more at ease. She took a deep breath and said “Ms Ayad, can we talk about that other thing now?”

“You mean gender?” I replied. She nodded.

Sally and I had been talking for the last several months about her “gender identity”. When she first brought this up to another counselor, they referred her to me, knowing that I am experienced and confident in working with kids around this topic. However, Sally had certainly been exploring this issue online for months she brought it to the attention of her school counselors. Our first conversation on the topic made it clear that she had a broad vocabulary (straight from gender identity theory) which is not typical for most middle-school students.

My approach was patient, inquisitive, and I challenged her… just a bit. When she talked about her parents pressuring her to wear dresses and “act more like a girl”, I made a point of breaking this down, deconstructing what that means, and sharing ways that we all behave outside of gender stereotypes: and that’s a GOOD thing!

When she told me, weeks later, that she was looking for binders online and asked me to stop using the pronouns “her” and “she”, I felt deep pangs of worry, but took it slow. I asked her where some of these ideas were coming from: she was spending hours on tumblr, trans-advocacy sites for teens, and chat groups with other kids who she believed were “just like her”. I treaded very carefully, but told her about the medical dangers of binding and what the long term consequences may be. Our limitations in the school system made it hard to get too deep on these topics, but in every brief interaction with Sally, I found ways to empathize with her struggle, instilling pride in who she is, and still gently challenge her flawed ideas.

I deliberately pointed out all of the ways she doesn’t conform to gender stereotypes, without implying that she’s in the wrong body: her love of manga comics, her cargo pants, her disdain for dresses and “girly” clothes, in my eyes, made her a unique and awesome person. Hearing those compliments always brought that endearing little smile to her face.

Eventually, as her classroom behavior improved, her anxiety lessened, and she started making friends, she relied less and less on me for support that year. Several months passed and before I knew it, the school year was coming to a close. I wanted to follow up with Sally, so I pulled her from her PE class and we talked outside on a particularly nice, sunny afternoon.

I started with, “Sally, I’ve missed you, how are things going? It seems like we haven’t talked in forEVER!” A huge smile emerged on her face, and since her glasses were less smudgy than normal, I could actually see that her eyes were smiling too.

“Doing great! I’m getting along better with Ms Barnay and I haven’t been walking out of class when I feel frustrated”. We talked about the anime club, her plans for summer, and how her other classes were going. She paused, looking ready to tell me something that meant more to her than academics. “Ms Ayad, remember how we used to talk about gender a lot? Well, I’m kinda over it”.

“Ok, tell me what you mean by ‘over it’, Sally”.

“Well before, when I didn’t have any friends at school, I was meeting a lot of people online and I thought they were my friends. Then when I actually started hanging out with people in real life, things felt different. Before, I really wasn’t comfortable with myself so I felt like I needed to change. But now, I’m ok with myself”.

I nearly fell off the bench. This was one of the most profound realizations a therapy client can make – and she, even in her young 13 year-old body and mind, came to this conclusion by herself: “I really wasn’t comfortable with myself, so I felt like I needed to change. But now I’m ok with myself”.

I was grinning from ear to ear by this point. I told her how incredibly proud I was, that I was so happy she was feeling good about herself.

Over the summer I thought often about Sally’s story. While she turned things around largely on her own, I can’t help but wonder how things might have unfolded had I followed the prescribed gender identity model.

What if I had asked about using male pronouns?
What if I had been very supportive of her desire to bind her chest?
What if I had affirmed the idea that because she doesn’t like dresses and feels like she identifies with trans kids online, that she too may be a boy stuck in a girl’s body?

And what if I hadn’t directly (though gently) challenged some of her flawed beliefs – that stereotypes and clothing styles are a good foundation on which to question your biology, to modify your body parts, and to change your entire identity.

These are questions gender therapists HAVE to ask themselves, and it frightens me that most aren’t. Our kids are dynamic, different, and unique. But they also have insecurities, self-doubt, and are vulnerable to finding “solutions” in the wrong places. When a teenager feels isolated and misunderstood, trans-advocacy sites can convince them that hope lies in changing who they are. And isn’t this the opposite of what we’ve always tried to instill in kids: self-love, confidence, and embracing their uniqueness?

Regardless of the misinformation and wayward perspectives currently taking over the mental health field, I will continue to focus on self-acceptance for my clients. Sally’s story, and many others like it, will be our reminder that in counseling, self-loathing should never be promoted over self-love.

*The names in this story have been changed to protect the identities of the people involved.

“Four Words Sheryl Never Said”

Cari is a 22 year old detransitioning woman wrote this earlier post for this blog. She recently created these powerful posters, which she has been kind enough to allow me to post here. Cari blogs about her experience at guideonragingstars.tumblr.com, where these posters first appeared. 

“These posters are in reference to my therapist at TransActive Gender Center, Sheryl Rindel, who I saw for 3 months before being referred for hormone therapy at 17. She did not address my trauma history or other stressors in my life which contributed to the depression I blamed on being dysphoric and pre-transition, or present me with alternative ways to deal with dysphoria.”

4words14words2

4words34words4

 

Doomed to Repeat

Doomed to Repeat

A scant 25 ago, therapists with (mostly) the best of intentions managed to ruin many people’s lives. Through the use of recovered memory therapy, clinicians unwittingly participated in creating false memories of horrific abuse that in some cases permanently sundered relationships between parents and adult children, cast a life-long pall of suspicion on parents, and sent innocent people to jail for decades.

In the late 1990’s there were numerous lawsuits in which therapists or psychiatrists were successfully sued or settled on charges of having propagated false memories of childhood sexual abuse, incest, and satanic ritual abuse. Fran and Dan Keller served 21 years in prison after young children who attended their daycare began making wild allegations after having been coaxed by a therapist. According to one child witness, the Kellers “had everyone take off their clothes and had a parrot that pecked them in the pee-pee,” and “came to her house with a chainsaw and cut her dog Buffy in the vagina until it bled.” The therapist construed these childish imaginings as literally true, and concluded her small patient was a victim of ritual abuse. The Kellers were finally freed in November of 2014 after the only witness who provided any physical evidence of abuse – a doctor – recanted.

The false memory and ritual abuse scares of the ‘80s and ‘90s now seem bizarre almost beyond imagining. Therapists, psychiatrists, government agencies, congressional committees, and the media bought into the belief that worldwide satanic cults had infiltrated society and were ritually abusing children on a significant scale.

Tragically, history is in the process of repeating itself. Something strikingly similar is happening. The current trend to diagnose children as transgender bears an eerie similarity to this previous social panic. This matters because as with the previous panic of the ’80 and ‘90s, the current trend is harming people who will have to live with the consequences for the rest of their lives. Below, I outline the similarities – and differences.

1.) Victims of false memory syndrome and many transgender kids are orienting their identity and relationships to a false belief. Wikipedia defines false memory syndrome as “a condition in which a person’s identity and relationships are affected by memories that are factually incorrect but that they strongly believe.” Research has confirmed the suggestibility of the memory making process, making it clear that false memories can be created through cultural transmission, peer influence, and the techniques described as a recovered memory therapy.

The Wikipedia article goes on to state that false memories per se are not the problem. “Note that the syndrome is not characterized by false memories as such. We all have inaccurate memories. Rather, the syndrome is diagnosed when the memory is so deeply ingrained that it orients the individual’s entire personality and lifestyle—disrupting other adaptive behavior.” (Emphasis mine.) The false memory becomes a central point of the person’s identity and determines his or her interpersonal relationships.

The false memory may be bizarre and become obsessional. The McMartin pre-school trial was the longest and most expensive trial in American history. Those that testified claimed they saw witches flying in the air, traveled in hot air balloons, and were taken into an elaborate system of tunnels underneath the daycare.

In an account of the FMSF website, one patient recounts the bizarre things that she eventually came to believe:

“I recalled various fragments of movies, books, talk shows, and nightly news, and soon I had plenty of child abuse memories. But, it didn’t stop there. Eventually, I said I had taken part in Satanic Rituals, been buried alive, drank blood, and helped to kill a baby. With every new memory, my therapist was intrigued and building a case to prove he was right about me all along.”

And these bizarre beliefs can become one’s central point of reference, eclipsing critical thought, leading the person to surrender his or her rational faculties in service of the belief. This is described by a victim of false memory syndrome on the website of the False Memory Syndrome Foundation.

“Twice a week, I would go to therapy and be told the only way to feel better was to relive these memories. He would sit next to me on his couch covering me with a blanket while I, in a regressed, hypnotic state would start to have these “body memories.” This therapy continued and I had to be hospitalized six or seven weeks at a time. I’m now convinced that my depression and suicidality were mainly caused by the incredible conflict between wanting to be with my parents and pleasing my therapist.”

Through buying into the false belief, the person’s historical biography is re-written. Old events are re-imagined in light of the new “information,” radically altering the person’s sense of identity and sundering connections to family and friends.

As a victim of FMS describes on the FMSF website:

“I’ve lost six and a half years of my life, a chance to have an intimate relationship with my mother, time with my three young children, and my marriage of 21 years.”

Transgender children fall prey to the bizarre belief that they are born in the wrong body. There is no scientific validity to the idea that someone can be born a “man in a woman’s body” or the other way around. In fact, there is a great deal of research that indicates that there is no such thing as a male brain or a female brain. Taken away from the clamor and din of politics, the assertion that one is chromosomally and biologically one sex, but of a different “gender” in some mysterious way makes absolutely no sense and is every bit as strange as asserting that daycare workers sacrificed babies and fed them to children. Those who define their inner sense of being misaligned with their anatomy often cannot describe this experience without reference to sex role stereotypes, and an appeal to notions that seem much more metaphysical or subjective rather than empirical.

Please note that I am not denying the existence of gender dysphoria. Gender dysphoria is real and often causes significant distress. It ought not to be stigmatized, discounted, or minimized. Those who suffer from gender dysphoria deserve to have their pain taken seriously and to be offered appropriate help and support by both their families and society at large. In some cases, transitioning may be the treatment required to alleviate the gender dysphoria, though like all invasive medical procedures, it ought not to be the first line of treatment if a less drastic intervention can do the trick. It does not follow, however, that we must accept the groundless and bizarre explanation that someone is born in the wrong body. The feelings of gender dysphoria are undeniable. How we explain those feelings matters a great deal if one of those explanations leads to a young person undergoing serious medical intervention with lifelong consequences that may or may not adequately address the presenting problem. In some of the FMS cases, patients presented to a therapist with distress over a marriage, for example. The therapist wrongly attributed their pain to repressed incidences of horrific abuse, which made the patient worse, not better. Attributing a young person’s pain to being born in the wrong body is no less strange, and is just as likely to lead to an inappropriate intervention.

And as with the false beliefs present in many cases of FMS, the belief of gender noncomforming youth that they are actually the opposite gender disrupts other adaptive behavior, severs important relationships, and can become obsessional. Consider this story about a 16-year-old natal female who came out as transgender at age 14 or 15. The child, referred to only as PD, was adopted at age 6. The parents understandably had a hard time coming to terms with their child’s assertion of being a different gender, and they refused to call their child by the new name. This caused the child “very great annoyance and distress,” according to the courts. As a result of feeling misunderstood because the parents refused to use the new name, PD cut off all contact with them, refusing even to allow them to have any information going forward.

While the transgender teen story is usually portrayed in the media in celebratory terms, my contact with parents living through this indicates that at least some of the time, the tale is a darker one. Even supportive parents report that their teens become increasingly isolated and distressed after coming out. They withdraw from friends who aren’t trans. They cease their involvement in extracurricular activities. Their academics suffer. They stop talking to parents. They become obsessed with their appearance and with “passing.” They suffer outsized distress over the indignity of being “misgendered.” Their ambit of concern shrinks to encompass only the paranoid echo chamber of illusory oppression.

As is the case with FMS, the “discovery” on the part of a young person that they are trans brings about a reevaluation of their prior life that validates their diagnosis, altering their sense of identity and personal biography.

Following is a comment posted by a reader of this article. Note that the commentator reports on fairly common childhood experiences of gender nonconforming behavior that now take on momentous significance as evidence of being trans.

“I didn’t know since I was two. I knew I was different but I didn’t know how. Like I always envied the boys but never understood why. I wanted the boy toys, and never thought about why. I wanted to be in boy clothes cause I never felt comfortable in girly stuff, and never thought about why that was either. But I knew something was different.”

This commentator reaches the rather spurious conclusion that not being comfortable in “girly” stuff as child can now with hindsight be seen as early evidence and “proof” that she was trans. Of course girly stuff is rarely comfortable for little girls. And many little girls prefer “boy” toys, just as many boys prefer “girl” toys. Our refusal to accept narrow sex role stereotypes should not be evidence that we ought to reject our bodies. It ought to be evidence that we should reject sex role stereotypes.

2.) False memory syndrome and the transgender child trend involve highly sensational subjects that involve children and sexuality.

Children and sex are perennially two of the chief lightning rods around which mass hysterias often take form. The false memory and satanic ritual abuse panics of the ‘80’s and ‘90’s occurred in conjunction with a significant cultural shift, as women left home to go to work in huge numbers, leaving their children in daycare. The allegations of ritual abuse that swirled around daycares in the panic may have served as an expression of anxiety and ambivalence about this societal transformation.

Now, the popular imagination has been caught by transgender children. We celebrate the “courage” of these children and their families and rush to endorse hormonal treatment to forestall the “trauma” of puberty. What cultural current might this be in reaction to?

3.) In both FMS and the transgender child trend, the media played a key role.

Both of these trends have been presented in an uncritical way in the media. In the case of false memory syndrome, high profile media attention presented without critical dialogue fanned the flames of hysteria.

In 1983, Geraldo Rivera aired “Satanic Cults and Children.” In 1988, he did another episode mcmartinentitled “Devil Worship: Exploring Satan’s Underground.” In 1995, Rivera apologized for his role in spreading the hysteria with the following words:

“I want to announce publicly that as a firm believer of the ‘Believe The Children’ movement of the 1980’s, that started with the McMartin trials in CA, but NOW I am convinced that I was terribly wrong… and many innocent people were convicted and went to prison as a result….AND I am equally positive [that the] ‘Repressed Memory Therapy Movement’ is also a bunch of CRAP…”

In 1989, Oprah Winfrey hosted a show on “Child Sacrifice,” and Sally Jesse Raphael did a segment called “Baby Breeders.” In 1991, Raphael covered the story again with a show called “Devil Babies.”

20/20 and HBO both did special stories on the subject. HBO’s special was entitled “Search for Deadly Memories.” This documentary shows techniques for recovering “repressed” memories, and featured many doctors and other “experts,” lending credibility to the claims. Eventually, 20/20, 60 Minutes, and HBO would all produce shows that were skeptical of the panic.

I need hardly offer evidence for the media contribution to the current transgender child trend. It is difficult to go through a day without hearing reference to a transgender child on some mainstream media outlet. Nearly all of the coverage is uncritical if not celebratory.

4.) Both movements created high profile “stars.”

In 1980, the book Michelle Remembers by Lawrence Padzer and Michelle Smith was Michelle_Rememberspublished. It was the first book on ritual abuse, and is largely responsible for setting the SRA panic in motion. Though it has since been entirely discredited, it was reported on and taken as fact by journalists and talk show hosts including Oprah, who interviewed Smith on her television show. The book was a bestseller and a tremendous commercial success, and Padzer and Smith earned an estimated $350,000 from its publication.

Jazz Jennings is a 16 year old transgender girl noted for being one of the youngest publicly documented people to be identified as gender dysphoric. She received national attention at the age of six when Barbara Walters interviewed her on 20/20. Other high profile interviews followed. Jazz has her own company (Purple Rainbow Tails, founded when she was 13), her own YouTube channel, a children’s book, and her own reality TV show on TLC. In 2014, she was named one of “The Most Influential Teens” of the year by Time. She has modeled and appeared in television commercials for acne treatments.

5.) Both movements have been fueled by hysteria over immediate peril of children

In both cases, the narrative is driven by powerful fears over the welfare of children. In the case of SRA and FMS, anyone who expressed doubt over the veracity of the claims was subject to intense vitriol and claims that they were harming children by not believing them without question. An advocacy organization was formed by the parents of the children involved in the McMartin preschool trial called “Believe the Children.” It became a clearinghouse for information on SRA.

Regarding the transgender child trend, those who express doubt about a child’s claim that he or she is “born in the wrong body” are often accused of “killing” transgender children. The fact that there are very high rates of suicide attempts among those who are transgender is repeatedly cited as a reason why transgender children must be immediately affirmed and transitioned. (This is an uncritical use of the statistic. A study found that 41% of those who are transgender had attempted suicide. However, the study did not differentiate between whether the attempt came before or after transition. A study from Sweden indicates that suicidality among those who have medically transitioned is significantly higher than in the general population. It would appear that those who suffer from gender dysphoria do indeed have a high rate of suicidality. However, there is no robust evidence that transition reduces suicidality.)

 6.) Therapists played a significant role in the promulgation of both movements.

Protecting the innocent, advocating for those who are at risk and vulnerable – these are appealing roles for therapists to take on. Therapists in both movements have appeared to have the moral high ground. Many have been quick to jump on board to be sure to be on the right side of history.

Therapists used a variety of techniques that have come to be called “recovered memory therapy” to search for “forgotten” or “repressed” memories of trauma. Such practices spread quickly and were fueled by materials developed by those without clinical expertise such as the book The Courage to Heal, which was written by a poet and creative writing teacher and one of her students.

Of course, a darker side to the well-meaning impulse to help those who had been victimized is that the movement to recover repressed memories created lucrative earning opportunities for some therapists.

In recent years, there has been a growth in the number of therapists who identify as “gender therapists.” To my knowledge, this is not a protected title in any jurisdiction. Anyone can call themselves a gender therapist. At most, a gender therapist may have received training from a transgender advocacy organization. Most transgender advocacy organizations have few members with any clinical or mental health background. Online research indicates that a gender therapist is “someone who helps a transgender person with their transition.” This gender therapist, for example, has a video blog where she answers questions. To the question “how do I know if I am transgender?” she answers that “if you are asking that question, you probably are not cisgender.”

Gender therapy is a lucrative and in demand specialty at this point in time. The gender therapist noted above, for example, has recently released a book about discovering one’s gender identity.

7.) Governmental and professional organizations have bought into the movement’s narrative.

No less an organization than the US Congress held hearings on daycare abuse. Recent policies put forward by the International Olympic Committee, the National Education Association, and the Obama administration show that many of our most important institutions have bought into the gender identity narrative.

8.) The concept has penetrated deeply into popular culture, including children’s picture books

dont make me go backA 1990 children’s book entitled Don’t Make Me Go Back Mommy (Hurts of Childhood Series). The description of the book on Amazon reads as if it is a humor piece.

“Five-year-old Allison’s behavior indicates to her concerned parents that something is wrong at her day care center. In unseen action, they discover that the center practices sexual, physical, and psychological abuse in the guise of religious ritual. Through dialogue, Allison and her parents reveal their feelings and the beginnings of the healing process to counselors and legal personnel. Some details of abuse are familiar from the lengthy McMartin trial, such as the “movie star room” in which naked children are photographed. The appendix lists 10 guidelines for parents on how to handle their own feelings during this family crisis.”

There are a number of books for children about being transgender. I Am Jazz is just one i am jazzexample. It is recommended for children ages four to eight. Following is its Amazon description:

“From the time she was two years old, Jazz knew that she had a girl’s brain in a boy’s body. She loved pink and dressing up as a mermaid and didn’t feel like herself in boys’ clothing. This confused her family, until they took her to a doctor who said that Jazz was transgender and that she was born that way.”

9.) Because the false belief relies on self-diagnosis, it is impervious to contradictory evidence.

In the FMS and in the transgender child trend, someone’s subjective experience of him or herself trumps other claims, even without evidence. According to this paradigm, anyone who is not in the special class (abuse victim or transgender person) cannot speak about that phenomenon with any authority. The premise that the oppressed are infallible gets one way into the weeds fairly quickly. Something becomes true and unable to be questioned simply because a member of a certain special class says it is so.

10.) Both movements were spread by social contagion which relies on the very human trait of suggestibility.

The FMS episode gave rise to a great deal of research about how suggestible we all can be, how easy it is for well-meaning therapists to suggest things that didn’t really happen and in this way, create “memories.” A good overview of this research can be found here.

Many teens coming out suddenly as transgender without a history of prior gender dysphoria or even gender nonconforming behavior say they “knew” they were transgender after they read something online. The language that they use to describe their experience is quite consistent, likely an indication that they picked up the ideas from similar sources on the internet. For example, many parents report that their child said “Would you rather have a dead daughter or a live son?” or something similar. Many teens also talk about the “button” thought experiment – if you had a button that could make you into the opposite sex like that, would you push it?

In both cases, the indicators used to diagnose are vague. Neither SRA nor transgenderism are well-defined phenomenon. The definitions shift and alter as convenient. For example, some transgender advocates do not believe that someone should need a diagnosis of dysphoria in order to transition. Simply saying one is trans ought to be enough without any dysphoria.

In both cases, conclusions with far reaching implications are arrived at using suggestive techniques. Transcripts of therapy sessions in which highly suggestive techniques were used can be found here. The contagion was also spread in both cases by peer groups. Many teens coming out as transgender are doing so in the context of peer groups who are also coming out. I am aware of one school where nine natal girls all announced that they were trans within a short space of time. In regards to FMS, there were documented cases where some people “found” repressed memories after spending time in a peer group for survivors. (See “Therapist Not Needed to Recover Memories.”)

11.) Interestingly, in both cases feminists were the some of the first and most outspoken skeptics

The panic over SRA was problematic not just because it ripped families apart, but also because it diverted attention and resources from real child abuse issues. Some feminists voiced concerns about this. Today, feminists such as Elizabeth Hungerford, the blogger 4thWaveNow, Germaine Greer, and Rebecca Reilly Cooper are drawing attention to the inconsistencies in the transgender narrative and expressing concern about how this trend is distracting attention from issues of sexism and gay and lesbian issues. Of particular concern to feminists is the fact that many young lesbians are identifying as trans and going on to take hormones and have surgery. In this sense, transition acts like medical gay conversion therapy, changing lesbian girls into straight boys. Some suggest that many young lesbians are identifying as trans due to internalized misogyny and homophobia.

I have covered some of the ways in which I see the transgender child trend is similar to the phenomenon of false memory syndrome and satanic ritual abuse. How are they different?

The internet.

Information and ideas travel faster and further now, making it easier to spread social contagion.

In the case of FMS, most of the victims were adults. Now the victims are children.

If there is even a small chance that significant numbers of young people are permanently altering their bodies on the basis of beliefs about themselves that may change, shouldn’t we all be trying to slow this train down?

If we do not wish to repeat the mistakes of history, we are well advised to study and learn from them.

Another Open Letter to Therapists: “I needed someone to to help me unwind the internalized homophobia and misogyny keeping me always repressed and compromised.”

A lesbian coming to terms with her sexuality in her 30’s, thissoftspace considered transition as a solution to her discomfort with her body and feelings of alienation, but found another way.  She writes about her reconciliation with womanhood and acceptance of her sexuality on her blog thissoftspace.wordpress.com and her tumblr thissoftspace.tumblr.com While she did not engage in psychotherapy during the period in which she was transitioning, she does have some thoughts on the kind of process that would have been helpful to her. I am grateful to her for sharing her thoughts.

While thinking about writing this post, I found myself getting my old High School yearbook out of my closet. After all, our concern here is youth, and I was curious about a nagging memory from my own teenage years. I remember well my senior photo, taken when I was seventeen. I remember wearing beige pants, a white oxford shirt buttoned to the top, and a light blue vest under a dark blue blazer. I remember being very uncomfortable as the photographer tried his best to pose me, and intent on looking confident and powerful. In the waist­-up shot I selected for the yearbook I appear a bit like, perhaps, the classy lesbian CEO of a powerful company. The kind of woman who might not only own her own yacht but sail it herself.

Not a bad look, in my opinion. What I remained curious about was whether any of the other girls looked anything like me. Granted, this was the mid­-90’s, so girls wore collared shirts in all styles and colors, but no other girl had hers buttoned up to the top. No other girl wore a vest and a blazer like a three ­piece suit. No other girl faced the camera with a closed­-lip smile, natural, combed­-through hair simply hanging about her shoulders, and a square­-shouldered, slightly intimidating pose.

Out of the hundred or so in my graduating class, no other girl looked anything like me.

I was born into a middle­-class white family in the northeastern United States, both of my parents working professionals. My brother ­ four years older ­ and I went to a well­ regarded school district, and we all attended church every Sunday. Although our family had some ups ­and­ downs, including my parents’ divorce when I was a teen, I grew up more or less free from financial stress, drug or alcohol addiction, or any outright abuse. To most other families who knew us we appeared more or less the American ideal, including the green grassy lawn and a dog.

The surrounding area was a mixture of rural farmland and suburban small towns, still 95% white and predominantly Christian to this day. I thought nothing of the white, American, Christian standard that pervaded my everyday life. I only knew I had to take off my jeans and sweatshirt to pull on tights and a dress for church on Sundays, and there were disparate male and female dress codes at school. I constantly found myself torn between the freedom I enjoyed at home, where my brother and I roamed our grandparents’ acres of overgrown fields and woodlands, and what was expected of me any time other people were present. The girl running barefoot and topless around the backyard with a water­ gun was never acceptable. I learned very early to be quiet, to cover myself, to not speak of my boyish interests, and to do my best to blend in with other young girls ­ at least whenever they or their parents were around.

When I was in high school I existed in two worlds. At school, I had friends and did well in classes, participated in a handful of activities like the Latin club and band and orchestra. I loved marching band and wearing a uniform that blended the differences between the girls and the boys. For our formal concerts, however, the rule was girls had to wear a skirt or dress in order to be allowed to perform, so twice a year my mother and I went on long, stressful shopping trips trying to find something I could bear to wear. (The last year, she kindly made me a black split­ skirt that went under the radar.) I never wore makeup, not even to cover acne. I only grew my hair long so I could have a braid or ponytail “queue” like my male heroes from the 1790’s ­ and also because the short, spiked hair I had wanted in 8th grade had been subtly discouraged.

Away from church and school I lived a very separate existence. While my classmates were listening to Nirvana and Boyz II Men, I was listening the the traditional Irish group The Chieftains and walking through the woods and fields, seeking to find peace in nature. One of my favorite tunes was “The Strayaway Child” ­ a haunting melody with an old rhythmic heartbeat beneath ­ which seemed to capture my sense of otherness, of separation from the rest of society. I am still moved by this song whenever I hear it, still speaking to me of being out of step, perhaps lost, perhaps simply strayed too far from what everyone else considered normal.

I grew up, after all, not knowing anyone like me ­ and I don’t mean that in the superficial sense, as though I knew no one who shared my interests or no one I could be friends with. I had friends, but I knew no one like me ­ no other girl who wouldn’t wear dresses and makeup, no other girl who didn’t want to date boys, no other girl more interested in computer games and building models than she was in preparing for the spring prom. No other girls or even women like that ­ though there were rumors of that one gym teacher. Lesbianism was at best left unspoken and at worst whispered of as a sin, a dirty practice. There simply was no option of being gay in my immediate community, and no example of living as a gender non­-conforming woman. I had to just keep muddling through the best I could, with prescriptions for Xanax and an SSRI for my anxiety, depression and panic attacks. No one ever looked further for the source of my constant distress about who I was and where I fit in.

For young women struggling with their identity today, there is a visible option, a hopeful solution to their own distress. Online, it isn’t difficult to come across young women with short hair and men’s clothing, apparently breaking through our culture’s strict gender norms. Almost always, however, they will describe themselves as queer, genderqueer, or non-­binary, sometimes as trans­-masculine, sometimes as trans men. Sometimes they are visibly transitioning through their tumblr blogs and their Youtube videos. Years ago when I was still struggling to accept myself as a lesbian, I came across an article titled “Where have all the Butches Gone?” supporting the transition of gender non­conforming lesbians to trans men. Chaz Bono, originally Cher’s daughter and a butch lesbian, transitioned years ago and was welcomed as a male dance partner on Dancing with the Stars. The most visible and socially­ acceptable option for a young female exploring gender expression these days is to abandon her womanhood and transition to something ­– anything — else.

Where have all the butches gone? Rachel Maddow, a proud butch lesbian, is seen on television in feminine makeup and scoop-­neck collars. Ellen Degeneres, possibly the most famous lesbian in America and at least grounded in more gender-­neutral clothing, nevertheless is a spokeswoman for Cover Girl. To be a woman in our society who rejects makeup and feminine dress is to step into a world where you are never seen. Our culture either demands us take on some kind of feminine practice in order to be accepted as female, or pushes us towards transitioning away from womanhood.

This may not be the root of every young woman’s interest in the transgender narrative, as trauma and mental illnesses factor in as well, but for me, after seven years of trying to be a gender non-­conforming lesbian, I found myself seeking a solution in another identity. At very least when I looked at and listened to gender-queer, non-­binary and male-­identified females, I found a reflection of myself at last; I heard someone else saying, “I hated wearing dresses. I hated playing with dolls. I hated how others viewed my body. I hated being a girl.”

What was not revealed to me until later ­ because the voices of gender non­conforming and butch women are stifled, twisted and suppressed by overwhelming trans activism and homophobia ­ was that women, natural, mentally healthy women, can hate wearing dresses, can hate playing with dolls, can hate how society views their bodies and can hate “being a girl.” I finally learned that we all deserve to live our lives free of those stereotypes and oppressions, and I finally began to live as myself.

When I found out the Michigan Womyn’s Music Festival existed, when I watched video and saw photos and read stories of that event, I found myself in tears. When I watch the women of the Wanted Podcast, I find myself in tears. When I read the experiences of detransitioned women, of women who lived as men for years or months only to return to womanhood, I find myself in tears. Because all of them speak the truth of a shared experience, of walking away from society’s expectations, so often alone, in an effort to find some kind of space and freedom for ourselves. In speaking, we reach out to each other, and at last see ourselves and this alternate path. It is so often hidden, but it exists as surely as gender­-defying women have existed throughout human history.

Finding that hidden path lead me home, for the first time in my life. I find myself echoing what other women have said when they testify “Michfest saved me” ­ finding these women and this path certainly saved me. Once, there were places where this alternative way of being a woman could be welcomed, seen, and celebrated. Now, more and more, all traces of this path are being obscured. Butch lesbians are being asked their “preferred pronouns,” if not immediately assumed to be a “he” or a “they”. Huffington Post embraces “Queer Voices” instead of gay or lesbian voices. Trans­activism has pushed gay men and lesbians from traditionally supportive organizations such as GSA’s. I read all the time of young lesbians, trying to find their way as young women, finding their only support groups full of “genderqueers and trans women.” And with the strident voices of the trans-­equality movement constantly gaining ground through far-­reaching validation such as the recent order from the Department of Justice, identifying as trans is looking more socially acceptable, and perhaps even more socially empowering, than being a gender non-­conforming woman ever has.

If the young women of today who are considering transition or identifying as other than female are going to be reached with an alternate path for their lives, they need to be shown that option in a positive, inspiring, realistic way. Whether they are gay, bisexual, or straight, whether they are exploring gender expression or abandoning it altogether, they need examples of women, role models from history and fellow travelers on the path, who can empathize with the experience, clarify the source of the hardships, and provide guidance and support. In order for this to occur, a bridge must be built between the often straight and gender­-conforming families of these young people and the often marginalized and ostracized gender­-defying women who have made this journey their lives.

Sometimes it seems like a problem that will remain circular: because potential role models never fit in as young women and so are made invisible, the young women of today, seeing no future version of themselves, begin to believe they will never fit in, either. And so they are erased by alternate gender identities, and the cycle continues. My hope is that because this issue has come to a point of crisis ­ an exodus of teen girls dis-identifying as female ­ society as a whole will have to confront the pervasive oppression of modern femininity. When women who exist outside of the conventional female gender role are finally embraced as whole and natural role models for young women, so many possibilities will be opened up, so many paths revealed, so much space will be made for everyone to live and express themselves just as they are.

I didn’t have a gender­-defying woman as a role model when I was growing up, and neither did I have access to a good therapist. I would have benefited beyond words to have had an alliance between the two: a gender-­defying woman to show me who I could become, and a therapist to help me unwind the internalized homophobia and misogyny keeping me always repressed and compromised. I needed ­ desperately ­ to be shown that the barefoot girl running around outside was perfectly acceptable just as she was, and in her essence, without ornamentation or alteration, was worthwhile and lovable. Now in my late 30’s, I’m finally beginning to understand the consequences of being that strayaway child ­ the cycles of anxiety and depression, the obsessive fears about my body being unhealthy and wrong, the strangling social anxiety and crippling lack of self­-confidence. I am just beginning to become whole, thanks in part to the sisters young and old who have shown me the way. If I can show the way to others, I will do so, if only in living as my most authentic self. Let no other young girl stray away on her own, seeking escape from the world and some space to be herself.

Let no other girl become lost with no one to guide her. There is a way home. I hope beyond hope we can reveal that alternative together.

“I Was Not Given Options Other Than Transition:” Another Open Letter to Therapists from a Detransitioning Woman

This post is from Cari, who is 22. She began transitioning at 15 and began medically transitioning with testosterone at 17. She eventually had a mastectomy before deciding to begin detransitioning earlier this year. You can read more about her experience on her blog  guideonragingstars.tumblr.com as well as here. Thank you so much for your contribution!

 

When I try to think about the care I wish I had when I was transitioning, a few different things come to mind, but the single biggest one is the fact that I was simply not given options other than transition.

When it comes to picking apart the reasons for my dysphoria itself, it’s easy to point to something in hindsight, but the truth is I was a stubborn child and am now a stubborn adult, and it’s possible I wouldn’t have been receptive to treatment for these issues anyway, once I had set my mind on transition.

However, why did I think that transition was the solution in the first place? Largely, because I bought into the idea that it is the only cure for dysphoria. This idea seems to be ubiquitous in trans spaces. It’s meant to illustrate why transition care should be prioritized and covered by insurance, but it also has the effect of invalidating any kind of alternative treatments. Suicide is considered a direct outcome of dysphoria by many, as simply what happens when the proper treatment (transition) isn’t given, the same kind of causal relationship as death by diabetic coma might be for untreated hypoglycemia. The application of this idea to a diagnosis that has no objective test, that has many differential diagnoses that can be difficult to pinpoint or treat, that is infrequently questioned or scrutinized in any meaningful way by gender therapists, is very dangerous.

Very soon after coming out as trans, the “reality” that I would have to transition in order to be happy hit me, and I became deeply depressed. Transition became a huge focus of my life, because I believed it needed to be, that I needed to devote my energy to it in order to alleviate my dysphoria, in order to live my life, really. I’ve seen a lot of therapists, including three who specialized in gender therapy. Yet it wasn’t until I began reading the writings of detransitioned women that I had any clue there were other viable ways of dealing with dysphoria.

Another really important thing to me is the need for trauma-informed care. Therapists need to be looking at the histories of people who are seeking transition, to be working through their trauma with them in more ways than just talking about it briefly. When I was in therapy and soon to start hormones, I told my therapist about my trauma history, which seemed to do little more to affect my treatment than having a session or two devoted to talking about it, and then pressing forward with the idea of transition. The idea that trauma could have caused body image issues, dissociation, reality distortions, not wanting to be a woman because of the “target” status it conferred, was never brought up. Nor was there much of an attempt at treating my mental health symptoms other than through transition. This needs to be part of the conversation—even if there are so-called “true transsexuals” whose issues are caused by some kind of neurological difference, (controversial, completely unproven, and supported by highly flawed studies) there are also plenty of people who can recognize their dysphoria as being based in trauma or mental illness, at least once they know where to look.

The third thing I can identify as a cause is the lack of representation of adult women who were gender nonconforming or butch, and the narrowing of “acceptable” gender expression as girls grow up. It’s one thing to be a tomboy, but tomboys are expected to “grow up” (become feminine) eventually. For me, this realization came around the same time as puberty started to make itself known, and the associations I began to make between my female body and the constriction of gender roles I felt was powerful. It does no good to ask a child “could you be happy living as a butch woman?” if she has no idea what that could possibly mean for her as an adult. One of the ways you’re supposed to be able to tell if someone is “really trans” is for them to think about how they can see themselves living in 10, 20, 30 years—as a man, or as a woman? This is a flawed diagnostic for many reasons—how many people, trans or not, can picture their future in a positive light while dealing with depression or trauma? But when there are no models for the type of woman you want to grow up to be, it becomes even more skewed.

Link between gender dysphoria and dissociation found

Since Maria Catt discussed the role of trauma and dissociation in her own experience of dysphoria, I thought I would reblog (with kind permission) this thoughtful post from thirdwaytrans that looks at some research linking trauma, dissociation, and gender dysphoria.

Third Way Trans

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…

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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.