Susie Orbach on women’s bodies and why the panic about gender is disturbing

[busyboysmum]

Susie Orbach on women’s bodies and why the panic about gender is disturbing

www.thetimes.co.uk/article/susie-orbach-on-womens-bodies-and-why-the-panic-about-gender-is-disturbing-qrhq9nfpk?shareToken=58bd99b5f440d0ccc5be1d8fad2e1156

"It will be harder for therapists to discuss gender identity. A change to the NHS “memorandum of understanding” means that therapists are forbidden to explore underlying reasons why a patient may wish to change gender — they can only affirm the patient’s decision or face being guilty of practising “conversion therapy”, resulting in professional sanctions. Gender therapists tell me that they must adopt a questioning approach “by stealth”. Orbach says, “Obviously you can’t do therapy if you operate by stealth. That’s not therapy, it’s something else.” Maybe the memorandum doesn’t apply to all psychotherapists, she muses. I check later — it does."

This has always interested and frightened me. We are now so in thrall to psychiatry and it's power which is inextricably linked to the pharmaceutical companies which is itself a patriarchal system that I worry we do not question it enough.

Even on here (I have been lurking for some time and being informed by many brilliant posters about the GRA) i see posters say 'Oh well, we must differentiate between people with 'real' gender dysphoria and those without'. But really, what does that mean? I see the DSM referred to but without the understanding that the DSM is simply a checklist of observable behaviours put into categories. They are not defined 'illnesses' per se and it is certainly not the word of God.

More often than not there are overlaps and disagreements between clinicians about what diagnosis fits and I have had first hand experience of the vitriol and divides that exist within psychiatry over this. (See also the Rosenhan experiment for a fascinating critique of the psychiatric diagnostic process.) Psychiatry is not so objective that it is impervious to social movements and norms and as we well know, homosexuality was once included. In the 60s RD Laing wrote about the divided self and how madness was an understandable response to a mad world and Thomas Szasz wrote the 'Myth of Mental Illness'. Then there was a rejection of these views and the move to medication; mental illness was now viewed as a 'chemical imbalance'. Public moods as well as capitalist markets shift time and again and this influences psychiatry, something we want to believe is an objective science, more than may make us comfortable.

Going back to the article, I do think it crucial that therapists are able to talk about and explore the roots of our difficulties without falling into the trap of medicalising every uncomfortable or distressing feeling while acknowledging that some people are severely affected - which is a tricky balance. I personally believe that Gender Dysphoria is a response (to what is for the individual to say), just as my dissociative disorder is a response to extreme childhood abuse. What worries me as much as the GRA is the blind faith in books such as the DSM, the certainty and finality when referring to someone as 'mentally ill' which shuts down enquiry and exploration. And I believe enquiry and exploration are crucial.

Sorry if this was rambling. I would occasionally post on AIBU often in defence of people with mental health problems which often didn't go well! This is the first time I have delurked on this thread but want to say you are all amazing and have highlighted and articulated the dangers in the extreme trans movements excellently and have put into words my own uneasiness about it.

My feeling is that we should stay as close to our natural state as possible, I am shocked that the NHS treatment for what is a mental health issue is to medicalise it and surgically alter the body to endorse the delusion.

At the end of the day, if your mind doesn't accept your body as being correct, it's not your poor body's fault. It's just doing what it was made to do. We are going to be left with some really damaged people who might have just been caught up in the social contagion or going through a phase or crying out for attention due to other issues.

Your post was much better worded than mine but I think we are on the same page here

My view of how the DSM is discussed here is that most posters take a critical view, considering it to be a highly subjective text and subject to popular trends and whims. I mean you only have to look at how it's treatment and categorisation of gender dysphoria has changed in the last decade, even down to how it is named.

I get what you mean re 'real' dysphoria. I think what is alluded to here is that many young people (in particular) are led by trends, fads, some adults and the internet into thinking they are dysphoric, when in fact they are simply gender non-conforming, 'different' or possibly gay, etc. But I think you are asking more about those who are 'really' dysphoric and how we know this? That's an interesting question and I think my answer is partly about Occam's razor - firstly removing those who are led by trends, fads, some adults and the internet into thinking they are dysphoric, when in fact they are simply gender non-conforming, 'different' or possibly gay, etc. and then condidering those who are left, being clear that 'dysphoria' is a name we use to describe a condition we don't really understand and which people use because it's the best or most accepted term we have. I do often think that sometimes experiences and symptoms fit the named disease rather than vice versa - shades of Foucault maybe?

In any case, I am pleased that Susie has not drunk the cool aid. I'm a Winterson fan and I have been wondering about her. I actually thought she had drunk from the flask, but I may be wrong.

chirpyburbycheapsheep - glad you delurked because that was a useful and interesting post.

chirpyburbycheapsheep - Bravo, your post was brilliant and really got to the crux of the issue regarding therapy. I particularly enjoyed your point that: We are now so in thrall to psychiatry and it's power which is inextricably linked to the pharmaceutical companies which is itself a patriarchal system that I worry we do not question it enough.

Slightly different but I have always questioned my peers as to why they were so willing to take hormones prescribed to women in the form of the pill without question. Our girls’ school hailed it as heaven sent but also made us all eat organic because of the risk of pesticides and hormones.

For me it appears we are damaging otherwise healthy bodies to conform to sexist stereotypes. The sexism in science is rife. Two books are brilliant on this subject: 1. Angela Saini, Inferior 2. Cordelia Fine, Testosterone Rex.
A third I would add to the list as an important read in the current climate is Cordelia Fine, Delusions of Gender

Gender is a mendacity, it is a man-made system designed to oppress and groom people culture wide. Society is performing amputations essentially to force people to conform to imaginary codes of practice. We are all gender-non-conforming to an extent. I hate the idea that people - be it therapists, volunteers, doctors - are telling children that something is so wrong with them that they need medical intervention throughout their lives.

That transgender ideology is almost a world-wide phenomenon from Iran, Thailand, Canada, and America to the U.K. suggests that it is not an individual ground swell movement for civil rights but has some powerful backers. How can it have made such legal inroads so quickly? Big pharma are set for big profits?

I consider gender dysphoria to be akin to Anorexia or Bulimia. These are body dysmorphic illnesses which certainly no acceptable doctor would take an affirmative approach to.

This may be a very out there idea but I am slowly beginning to believe that 'gender dysphoria' is in fact not an illness. To explain, is it not right that people feel uncomfortable (dysphoria) with a system (gender) that seeks to limit them personally, deny aspects of their individuality and oppress half the human race?

One way forward in the U.K. is to keep writing to hospitals and MPs to ask who has done risk assessment on these policies. Who will be legally and financially responsible in the future if patients question their treatment? Where are the risk-assessment results published?

ContemporaryPankhurst I agree wholeheartedly with this. I cannot believe what is happening.

busyboysmum thank you for posting in the article and starting the thread.

The good thing is I think that be it on-line or in living rooms across the country women are talking to each other about this. It is like a return to 2nd wave consciousness raising going on.

There has been a lot of discussion today on my facebook as a local girls grammar school has just gone gender neutral. Overwhelmingly people are speaking out against it. It seems to be the more intelligent and educated of my friends who seem to be questioning it. I have some lovely not as bright friends who seem to have bought into the whole transgender ideology for fear of upsetting vulnerable people. They just want to be nice and for people to live as they choose.

These posts are so interesting....

busyboysmum I do think we are absolutely on the same page and sorry if I went off track somewhat though I feel it is all linked. I absolutely agree that our natural bodies should not be tampered with as much as is possible and the power that psychiatric bodies hold must be challenged regularly....I believe that giving children hormone blockers/surgery is akin to child abuse. However I do believe that for some no amount of therapy will help and that then if surgery is the only thing that can alleviate the distress then I don't have a problem with that but only after all avenues are exhausted and it is framed as affirming something that isn't true.

Perhaps YetAnother this is what you meant by people suffering from genuine gender dysphoria and I see your point. I think my comment regarding people's belief in the DSM was due to some comments discussing diagnostic criteria on another trans thread. For me the DSM and the whole of psychiatry is a feminist issue as it has medicalised the language and distress of trauma (often abuse at the hands of men against women) which only acts to conceal it rather than understand that distress and validate the trauma that has caused it. But this is probably a discussion for another thread so will stop there!

ContemporaryPankhurst I agree with your likening Gender Dysphoria to Anorexia/Bulimia which I have also suffered from. In those times I needed people to affirm reality not sit in agreement and say 'yeah, chirpy, you really are overweight, lets get you funding for bariatric surgery.' Your post was very interesting in the political aspects of pushing the trans ideology and I will look more into that.

And LangCleg thanks.

My daughter decided she wanted to be a boy 15 years ago. She cut her hair short, decided she wanted to be called Tom (and introduced herself as Tom to her new reception class mates), and chose to wear “ boys” clothes and shoes. We just shrugged and went along with it as she had an older and younger brother (whose arrival had not gone down well with her) and assumed it was because she wanted to be like them. Our daughter had never been at ease with herself, we described her as fierce, dominating, exhausting, our challenge as parents, she was also very able and creative. She was clearly a girl who struggled with who she was, wanting to be a boy was just a part of her expression of this. Two years later she chose to become a girl again, introduced herself at her new school as (let’s call her) Amelia and for a couple of years went overly stereotypically girly. At about the age of 9 the more androgynous side of her reaaserted itself. Her friends were boys (themselves not stereotypical boys) and her choice of clothes became more functional, loose and comfortable. She continued to struggle with friendships and all the more social aspects of life and at the age of 17 the wheels came off and she had a complete mental health breakdown. She was diagnosed as being on the autistic spectrum a couple of weeks before her 18th birthday. A year on Amelia is still learning who she is, she is still at the stage of being angry and grieving and having to accept her sense of not quite fitting and being uncomfortable with herself and knowing that some of these struggles will never go away and that to thrive and move on she has to learn to manage her anxieties. She has a fantastic therapist who is helping her on this journey. I dread to think what would have happened to my daughter and the woman she is becoming if she had been born 15 years later and we had assumed her discomfort in life came from her being trapped inside the wrong body. The sex of her body wasn’t the issue, her not being neurotypical was. To assume there is no reason for a child who is presenting themselves as a different gender to their sex assigned at birth other than being transgender is completely negligent.

I said on another thread recently that I see the transactivist movement partly as a men's sexual rights movement (with no care for women casualties along the way) but also partly as a radical body hacking movement. It seems hyper-individualist and hyper-capitalist to me - pathologising and medicalising perfectly healthy bodies for two ends: the creation of new profit markets; the belief that there is no society and an individual sense of self is the only thing that matters.

Tripilates to you and your DD. Thank you for sharing this. I think the comorbidity of gender dysphoria with autism particularly is a huge concern where as you say, no one is looking further than the dysphoria and encouraging children to transition.

We're reaching a dangerous point now of the word 'trans' trumps everything. All carefully constructed, evolved guidelines, principles of good practice, ethics, increasingly even legislation, are put aside as soon as the word 'trans' gets involved. The government are involved in making an unholy mess with all this, and its going to end in disaster for some very vulnerable people and some really awful legal cases.

a radical body hacking movement. It seems hyper-individualist and hyper-capitalist to me

This

Identity is reified and enshrined in objects (clothing, possessions) and now bodies are being treated as though they are in that category of objects too.

Thank you for some great posts - plenty of scope for some PhD theses there! I am going through this with my 19 yr old DD, recently diagnosed with ASD, who announced that she is "actually a guy" not long after her 18th birthday. I am petrified that she is going to turn up at a GID clinic and for there to be no exploration of why she feels this way, and whether there are any alternatives to hormones and surgery. That would not be conversion therapy, surely?

The optimistic side of me is hoping that clinicians do actually explore more robustly than they advertise, for fear of being shut down (or sacked as has happened in Canada). First do no harm., etc.

2 recent interesting blog posts here - in both cases the comments afterwards are as illuminating as the main post:

4thwavenow.com/2017/12/07/gender-dysphoria-is-not-one-thing/comment-page-1/

and another one here, which goes to the points about medicalisation, trends and the psychiatric "industry" etc:
4thwavenow.com/2017/12/29/not-plural-phobic-uspath-psychiatrist-promotes-transition-for-multiple-personalities/

The recent NHS consultation on Gender services included the NHS assessment of the evidence base which concluded:

"Overall, there is only limited evidence to demonstrate the efficacy of hormonal therapy or gender reassignment surgery with regard to long-term complications or physical functional status. There is no available evidence regarding cost-effectiveness of the treatment"

The research on favourable outcomes are all from around 2005 ish - with none reflecting the recent uptick in female to male young adults.
In fact the only research quoted about FtM says: "One troubling report (Newfield et al., 2006) documented lower scores on quality of life (measured with the SF-36) for FtM patients than for the general population" - but again 11 years ago is a very long time.

The full document is here:
www.engage.england.nhs.uk/consultation/specialised-services-consultation/user_uploads/gendr-ident-policy.pdf

I can't see any evaluation of the use of therapies, other than hormones or surgery on its own (because presumably it is now banned under the Conversion Therapy ban).

I also wonder if any other irreversible and costly interventions are offered on the NHS with such a poor evidence base. If there are any medics/academics out there?

Final thought - Gender Dysphoria is possibly being replaced by "Gender Incongruence", removing the need to feel any distress.

I have spoken before about a difference between actual dysmorphia and whatever it is that genderists think is happening.

This isn't based on the DSM rationale for diagnostics at all, but rather on an observable hatred of some part of the person's body to the extent that they attempt self-surgery on it.

What the new memorandum is saying is that we're no longer allowed to explore different avenues before consigning people to a lifetime of drugs and surgery which actually don't have the desired effect (even in people with 'real' dysmorphia long term, sadly), but that pharmaceuticals are to be a first port of call.

We're not even allowed to research different avenues either.

I can't think of anything that would also warrant costly and invasive treatment on such subjective criteria within the NHS.

Thank you for this thread. I am new to finding out about this issue and really shocked at what seems to have suddenly become a new and largely unchallenged orthodoxy, with frightening implications for women and chikdren.

YY LangCleg, I too think that it is shaped by a sense of the plasticity of the body, a logical outcome of the way cosmetic surgery has become increasingly more accepted and lucrative during the last few decades. When almost everyone on TV or media has has some kind of "work" done - whether teeth whitening, Botox, facelifts, lipo - from Kim Kardashian to Jennifer Saunders - surely the next logical step is believing that the body can just be remade exactly how you like. And if you don't believe that body modification is widespread, just look at the number of young people who have tattoos, the number of celebrities who have had major work done, the ideal of looking like the Kardashians when the bodies they have could not be achieved through any combination of just diet and exercise.