October 3, 2013

Dysphoria, Crossdreaming and the Politics of Gender

In this guest blog post Joanna Santos argues that we have lost ourselves in the politics of gender. She recommends another approach to gender variance, on based on tolerance and compassion.

By Guest Writer Joanna Santos
Lili Elbe undertook sex realignment surgery in 1930.

Gender dysphoria has likely always existed as part of the human condition but much of our understanding and interpretation of what it is gets lost in the cacophony and noise coming from all directions.

In today’s society, we have lost ourselves in the politics of gender and have forgotten to go back to the source.

Fetishists and Classic Transsexuals

On the one extreme you have fetishists who argue that their activity is sourced in their own natural psychology and have no problems agreeing with Ray Blanchard that they are engaging in a paraphilia of their own choosing.

They have no issue with admitting that they are comfortable with their fetish but at the same time insist that gender dysphoria cannot be sourced in biology and is a purely psychological construct.

On the other extreme you have the older generation so called “classic” transsexuals who argue that they alone suffer from a complete psycho sexual inversion and are true women seeking a correction which will return them to a state they should be in naturally had there not been some cruel mistake made. Anyone else is an impostor or a “man in a dress” and their worst fear is that their “womanhood” will be invalidated in the eyes of society by merely being associated with the loathsome transgender umbrella.

Harry Benjamin: Between the Extremes

The problem with both of these positions is that they ignore the people who live in between both extremes; the research by people such as Harry Benjamin as well as numerous studies and interviews involving post transition transsexuals.

The early work of Benjamin alluded to a severity for gender dysphoria observed in his patients when he categorised them by type, ostensibly reflecting their affinity and desire that they should be the other sex. He never used the term dysphoria as it was not in vogue at the time but you will note, for example, that his type IV he classified as being a blend between a transvestite and a transsexual. 

Harry Benjamin
His book The Transsexual Phenomenon set the ground work for an understanding that gender dysphoria could indeed be scaled according to severity.

Notable in this work is the pure adherence to observation and complete lack of judgement or conclusions about the origins of his patient’s distress. There simply was no explanation to be found and so he did not conjecture.

Benjamin knew that there was no known explanation for the insistence of his patients that they were truly women and since its 1966 publication we have still not found a genetic marker or conclusive physical brain evidence that would allow us to find a biological explanation for this condition.

Blanchard Takes the Wrong Turn

By the late 1980’s the work of Ray Blanchard began to take us on a wrong turn.

Oddly, the focus of his findings became sexual eroticism/attraction which was notably absent from the work of Benjamin and it suddenly became, in his theory, the main motivator for the desire to switch genders; you were either in love with your own image as a woman or in love with other men and interested in attaining more lovers through transition. 

"Homosexual" and "non-homosexual"

The term "homosexual transsexual" refers to androphilic  transsexual women in Ray Blanchard's research. As androphilic women they are sexually attracted to men.

The term "non-homosexual" or "autogynephilic" refers to gynephilic and bisexual male bodied trans people.

Blanchard does not recognize transsexual women as women, and his  terminology reflects this.

The work did nothing to explain why these people felt this way in the first place but he simply categorised them into two types ("homosexual" and "non homosexual").

Blanchard also made the fatal mistake of ignoring female to male transsexualism which further eroded his already tenuous pseudo science.

47 years after the publishing of The Transsexual Phenomenon, we are still left with a vacuum which has been filled with much conjecture but very few answers.

Old and young

One thing Blanchard did observe is that the behaviour of both of his transsexual types (categorised based on sexual orientation) did typically follow a different path.

His "homosexual" patients were more likely to transition younger and find male partners while his older "non homosexual" patients were marrying women and coming to terms with their dysphoria at a later stage in their lives.

This is not a surprising observation and does nothing to deny the presence of genuine dysphoria in either type well before the age of sexualisation. That the "non homosexual" group, having the most atypical societal path to follow as well as being attracted to the opposite sex, would be far more likely to deny the presence of their gender confusion is not a great mystery to understand.

By the time all of Blanchard’s patients decided they were ready for any kind of gender treatment at his clinic, they were of course very much aware of their sexual orientation and it stands to reason that the "homosexual" group would more readily adapt to their new gender role and blend into society. Given the right circumstances, this could even involve doing so in stealth as the person’s adult life would typically just be just starting.

So while sexual orientation may be an indicator for the path a person with gender dysphoria might follow, it does nothing to explain the origins of the condition.

The Question of Transitioning

Treating gender dysphoria with physical transition is a relatively modern invention. Before the advent of the 20th century no such knowledge existed to try and surgically correct an individual to reflect the mental image they had of themselves as their target gender. Indeed, Lily Elbe, one of the early pioneering patients of the procedure, died during surgery which would have fashioned for her a man made womb.

Today, the most curent thinking at gender clinics and hospitals now focuses exclusively on the concept of gender dysphoria. The idea is to aid the patient find a workable solution to either live within the confines of their existing gender or find an alternate solution (either through HRT and or GRS) in order to increase their quality of life and lessen the gender incongruence they feel.

Deliberately and noticeably absent from the current language are the terms "transsexual" or "transvestite" because their intent is not to forge a path for the patient based on labelling which might negatively impact their course of action.

What we know is that, for many, transition works because we have the proof. For the record, I am completely in favour of something that returns a person to a state of normality so that is not in question in this essay.

Choosing not to Transition

When I was undergoing therapy myself, it was explained to me that the gender clinic at the Montreal General hospital treats patients who may or may not transition fully or not at all. The aim is to reduce their level of discomfort with their birth gender and not to encourage GRS.

Based on my readings, my life experience and the therapy I underwent, I consider myself a disphoric which fits an HB type III or IV categorisation. It unfortunately places me in an in between stage where choosing to adhere perfectly to either gender does not fit my natural sensibilities and consequently, I have found my own solution rather than subscribe to hormone therapy or surgical intervention.

For those who are more greatly afflicted (such as types V and VI) the only answer appears to be surgery and in fact my province fully funds the operation once you pass the required treatment cycle of the hospital.

So I don’t believe that one can reduce gender dysphoria to a simple matter of sexual orientation or attraction; these are just peripheral issues which have done more to obfuscate than to elucidate. In fact, crossdreaming (or the eroticism at the idea of being the other gender) has been shown to occur in both types of transsexuals so this is not even a key issue.

The main issue really should be: why are some individuals attracted to the idea of becoming or behaving like a gender they were not born as? This question has never been answered adequately and certainly not from a truly scientific perspective.

The Variance of Gender Variance

It must be noted that not all gender variance causes distress and indeed it could be said that, for many, a great deal of the turmoil they face due to their not fitting comfortably into the binary is due to societal disapproval. For those who would otherwise feel perfectly at ease existing between genders the pressure to conform makes it that they need to meet expectation in order to meet general approval of their families, colleagues and friends.

It has been shown that in societies (such as Samoa, India, Thailand and native cultures) where there is a higher degree of acceptance of gender variance you often find less distress among gender variant people. My own early exhibiting of gender variance was met with strong disapproval which then caused me to try and suppress it as much as I could only to have it resurface with renewed vigour in my forties.

So what causes people to feel they are between genders, genderless or feeling strongly like the other gender? We don’t know. There could be a myriad of reasons but nature produces so many variations that much of this can be attributed to the randomness inherent in this process. We see irregularities at all levels in nature and it makes sense that gender would not be excluded.

In recent years, science has noted pesticides and EDCs as potential sources of unwanted estrogens which end up in our lakes and rivers as well as the predominant use of plastics in our manufacturing of products. These sources are lending a hand in increasing the likelihood of producing more gender conflicted children. There are also sociological factors at play which, no doubt, contribute towards creating a gender conflicted individual.

The challenge we have as a society is that in the absence of a clear answer, we fashion a degree of tolerance and understanding for this condition which, in the end, only affects a tiny sliver of the general population and is in no danger of being contagious. If we can remove the caustic gender politics inherent in all human affairs, often borne out of fear and ignorance, we would all be better off.

Let’s instead focus on the science and the treatment to alleviate any suffering or stigma that this condition may bring with the goal of helping gender variant people integrate comfortably into their respective societies.

Joanna Santos
To quote Harry Benjamin:

“Too many individuals are that way; what they do not like must be forbidden and punished. Then they are satisfied. I have even met transvestites who dislike (or pretend to dislike) transsexualism so much that they are against estrogen treatment and operation (for reasons of self protection?). There are also transsexuals who dislike transvestites as well as homosexuals. Intolerance can be found in strange quarters.”

You can read more by Joanna over at her blog.

See also the blog post What Harry Benjamin Really Meant.

Discuss crossdreamer and transgender issues!