Can we be honest about the need for affirmation?

[FortunateCookie]

I posted some of this on the misgendering thread but it was lost in amongst everything.

I asked on that thread whether refusing to affirm someone’s gender identity was a big deal or not, and many people thought it was, and that it could lead to mental health problems and possibly suicide.

If non- affirmation is so damaging then it also follows that positive affirmation would be extremely rewarding and fulfilling.

It seems obvious that this could lead to serious conflicts of interests. For example, in the case of the woman who asked for a female nurse to carry out her smear test, and was faced with a trans nurse.

Here, when the patients needs should be paramount, she instead becomes either a cause of huge distress, or a vehicle to experience the reward of validation. Either way, it is difficult to see how her needs could be centred against the pull of such a powerful motivation. Do eg hospitals, rape crisis centres recognise this dynamic?

Either it is a big deal that a trans person has their identity affirmed, in which case it should also be recognised that this can cause conflicts of interest in situations where affirmation or not is a factor (ie performing smear tests, working in a women’s refuge)

Or it’s not that big of a deal if a trans person has their identity affirmed and therefore they won’t be offended when a patient asks for a female nurse to carry out their smear.

Which is it?

Just a minor thing (as it only covers a tiny bit of the discussion) but if there is one procedure you really don't want to be tense for it's a smear. I say bring in the candles and whale song! You really do need to be comfortable with your HCP and not just being polite.

Like telling an overweight woman that she is unsightly and has to use the disabled changing room so as not to offend the other women.

I fail to see the connection.

Female OBGYNs are imo much more sympathetic in regards to period cramps, fears when TTC (fingers crossed), didn't scoff when I told that it felt like I fainted when I got the coil...

Maybe because there are shared experiences in womanhood?

Whether a woman is overweight, has 10 kids or is desperately trying to have at least one?

Being born with a penis means that some people just can't have certain experiences... Especially when we're talking about female (=of the female sex) medical issues.

The Diagnostic and Statistical Manual of Mental Disorders
just happened to mention it incidentally in passing because reasons but it is totes not a mental disorder even though it is in the manual of mental disorders.

Not sure where I stand in the trans debate. But I feel like this is a slightly awful argument...

Homosexuality used to be a disorder.

Hysteria was once considered a genuine female health issue...

Howevet nice a transwoman is, the fact remains they do have a troubling relationship with their body. They reject their male anatomy in favour of female anatomy. Even if they don't have any surgery.

The idea, concept or fantasy of female anatomy will be present, either occasionally, or permanently.

Perhaps a transwoman cannot understand what it feels like to have a smear, for a woman. It's an unusual one, because you are incredibly vulnerable, but the situation is 'formal'.

It's just about the most exposed a woman ever is.

Knowing that a transwoman HCP has ever even given female anatomy much of a thought in that way, would make the entire situation incredibly tense, if not insupportable.

Feeling as though you have to affirm them, makes it a situation that, in my opinion, should not be considered.

If the tranwoman does not have gender dysphoria, I agree that it would be a form of assault.

I understand that, MeyYael.
What the trans umbrella and carelessly written laws have created is a conflict between those who are mentally ill and need treatment and those who have a paraphalia. Those with a paraphalia are throwing those with a mental illness in need of treatment under the bus.
One of our many concerns is that the politicians will use the adamant insistence of transgender advocates that they are in no way ill but rather "born in the wrong body with a opposite sex soul" to deny treatment to those who need it to manage their mental illness.

MeyYael

That's an interesting comment about what is and isn't a mental disorder, and a reminder that homosexuality was considered to be a mental disorder in the past.

Gender dysphoria, the feeling that one's body is wrong and needs to be changed is a mental disorder if that person is distressed by that feeling. We are repeatedly told that sufferers are often suicidal. This is clearly a mental disorder.

MeyYael

Interesting recent Twitter thread addressing the fallacious idea that transgender identities are in any way comparable with homosexuality. Author is pro-trans (as it were) but anti-self-ID.

twitter.com/SalemSpooks/status/988037179787173889

TL;DR - homosexuality does not require medical intervention to relieve distress.

homosexuality does not require medical intervention to relieve distress.

Indeed.

"Gender dysphoria, the feeling that one's body is wrong and needs to be changed is a mental disorder if that person is distressed by that feeling. We are repeatedly told that sufferers are often suicidal. This is clearly a mental disorder.". The anxiety can be a mental disorder but gender dysphoria is no longer categorised as a mental disorder

I think any TIM (what am I supposed to say now? TIXY or something?) who is a decent person, with respect for women, would avoid working in roles with vulnerable women that could cause them distress.

Just like a decent person with Tourettes wouldn't opt to work as a nurse giving smears because their condition may inadvertently cause distress to someone in a vulnerable state.

Sometimes you have to accept that your condition or illness makes you inappropriate for a particular role. Its a pisser because everyone would like to have the freedom to do and be what they want, but there are other people to consider.

Feeling as though you have to affirm them, makes it a situation that, in my opinion, should not be considered.

Exactly.

If we are being told that misgendering is a hate crime...

www.telegraph.co.uk/education/2018/02/23/teacher-accused-misgendering-child-told-police-committed-hate/

...then how can a woman reasonably refuse to affirm a male HCP when he tells her he is the female nurse she requested for her smear?

but gender dysphoria is no longer categorised as a mental disorder

DSM5 and ICD10 would both disagree with you.

Lang Cleveland

I agree. I just disagree with the "it's considered to be a mental illness" and therefore also is a mental illness...

A program on Body dismorphia was on bbc1 last night. I didn't watch it all but what I saw was fascinating. It was not gender disphoria but there was obviously a connection. The help given was CBT/Talking therapies and no question that it wasn't a mental health issue.

I really recommend watching it (I'll be finishing it later). Needless to say I have a great deal of sympathy for sufferers.

Ok i’ve been having a little think about this. I always prefer to have a woman to do a smear test, although it’s not inconceivable that I would give permission for it to be done by a man if circumstances required. I’ve been poking around in my brain to try to get to the bottom of the reason why I would feel uncomfortable with a TW, and I think it goes something like this;
A woman knows what it’s like to have a female body and has probably had a smear test herself, so will understand fully the experience I’m going through.
A man will understand that he doesn’t have a female body, and that he can never understand what it’s like to have a smear, so will not presume knowledge beyond his medical training.
TW may believe that they are actually a woman and project what they think the experience of a smeer test would be like onto their intimate care of female patients. This is not only unethical and unprofessional, it’s dangerous.
I don’t want to be treated by any HCP who assumes knowledge of something they’ve never experienced. This by nature is a prejudice and exactly the kind of thing that has no place in healthcare.

I don’t want to be treated by any HCP who assumes knowledge of something they’ve never experienced.

Brilliant point HotRocker.

Soon as I click post I always realise that I haven’t explained myself very clearly.
TW who is trained to perform smears will no doubt at some point have thought about what it would be like to have a smear done, either to their own body or the body they wish they had. Human nature and their very being a TW would make it impossible not to. It may have been a fleeting thought or it could have been hours, days of fixation, but at the point where that TW walks into the room I have no idea, but the point is, however often they have had those thoughts, and no matter how much those thoughts have informed their performance as an HCP, those thoughts will never be based on actually having a female body, and being on the other end of that speculum.
I have a very deep seated hatred of men projecting what they think my experience of being a woman should be on their treatment of me, it’s what I’ve spent my entire life railing against. The thought of having a man who thinks he is a woman projecting onto me creeps me out massively. I understand male behaviour, I’ve been dealing with it all my life, but the idea of dealing with male behaviour modified into a version of their idea of female behaviour is a layer of weird that I just can’t deal with when I‘ve got my legs wide apart and my genitals exposed.

I think you explained yourself well, hot

I always thought it was because they were male, but after this thread, I think it is more complicated than that.

I don't want to walk on eggshells while in having an intimate procedure performed on me. Any other male nurse, I can talk about my discomfort, be honest and suggest ways which make it more comfortable for me. I couldn't do that in this scenario, I dont feel I couldn't mentioned the fact that they are trans, or male. Therefore my feelings would come second.

Because if people can't cope with being referred to as male on FWR, they are not going to cope with it face to face, are they?

It’s not being Male per se for me either. I’ve had Male gynaes and been ok with it. I’ve also refused Male practitioners who made me feel unpleasant- one came out with the ‘if you can have sex you can have a smear’ with a leer and that was my cue to tell him that yes I could have a smear but he wouldn’t be doing it - the conflation of a speculum with sex in his mind was disquieting to say the least. No you aren’t going to fuck me with a speculum, you can fuck off, pal.

With a transwoman I feel the issue of coercion into consent is troublesome, and I feel the relationship with the female body is troublesome as well. I have no way of knowing if the person is a genuinely dysphoric decent person or someone with AGP. If the latter, I’m then participating in a sexual act against my will with them. Just as I felt with Mr. ‘If you can have sex..’

I think it’s because the line between sex and identity is so blurred. Sexual feelings have absolutely no place in healthcare, where as issues of identity for a tW are being pulled into healthcare, and I don’t see how the TWs feelings about female genitalia don’t cross over into the sexual. If you’ve spent your entire life wishing you had a vagina, I expect the vast vast majority of those thoughts have been centred on sex, not gynaecological health checks. 99.9% of the time men view, and are taught to view vaginas as fuck holes, because that is the only experience most of them will ever have related to one. Women experience the messy, painful, problematic business of actually having a vagina without being allowed to talk about it, because men don’t want to know about our dirty fuck holes unless they are fucking them. In that case how can TWs thoughts and feelings about female genitalia be informed by anything other than sex?
Like I stated above, I wouldn’t rule out allowing a man to perform a smear. I recognise that men view vaginas as fuck holes and I also recognise creepy behaviour so it would immediately be kicked out of the park if I suspected it. It’s the disingenuousness of somebody telling me they’re a woman, and that they empathise, and that they understand me that I find irreconcilably uncomfortable, because I know they aren’t, and they can’t, and that it’s utterly arrogant and deluded of them to think that and expect me to accept it.

Anyway I’m going to shut up now. I think you get the drift.

I think you’ve explained really well HotRocker, thank you.

I understand male behaviour, I’ve been dealing with it all my life, but the idea of dealing with male behaviour modified into a version of their idea of female behaviour is a layer of weird that I just can’t deal with when I‘ve got my legs wide apart and my genitals exposed.

I think this pretty much sums it up for me.

Yep. Not doing it. If refusal causes someone to file a complaint against me or threaten to do so? Bring it on, the answer is still no.

As we have got on to trans nurses yet again, and you have all again decided that even toughyou have never meet a trans nurse or talked to one. That we have certain motivations for doing what we do. So as a trans nurse I thought I might enlighten you all as to the reality of being a trans nurse yet again.

Quick side note on dsm5 dysphoria as been changed from a mental disorder but is still in there just not a disorder.

Right first off having worked on wards and in the community do you know how many times in the last 10 years that this as come up as an actual issue once. And that was at the point I transisioned and it was the organisation who highlighted it and used the positive discrimination in the equality act to limit areas of my practice this was done in consultation with me and while it is hard to hear that you can not do aspects of a role you are trained to do and as a professional want to carry out. We put them in place and there was no issue around that. This was done as I did not have a GRC at the time. So for everyone who thinks the equality act is not used in this way it is all the time and it is done in agreement with people I was offered an alternative role if I did not wish to remain in my post.

Right patent interaction you know how many times people have asked if I'm trans none, I tend to put this down to people having more. Pressing matters when they are in hospital and wanting someone who knows what they are doing looking after them.

The smear issue which I have never done and would not choose to do as its not my area of nursing. If I was in that area I would not do them as the potential for issues would be high and I no one comes to work to cause people issues.

The point I always make is that BAME nursing face people bit wanting them to care for them every day in this country and what usually happens when they do is that they get someone else if they can or with current shortages more often now explain that they are the only. Person available at that time and if the person would like the care now then they will have to have them Or some one can come later. Most people choose to have there care done all patents have a right to decline care and to say that we do not put them first is a misrepresentation of our profession.

If you still feel that we should not be in nursing then by all means come and join the profession God knows we could do with the people right now and then see for yourself the real issues that we face and not the made up ones you all keep talking about.

Bespin but no one has said no to trans nurses wholesale.

The only issue being discussed is that, for some procedures, patients might prefer a same sex HCP and that, if one is requested, then a same sex HCP should be provided because the comfort and dignity of the patient is more important than the feelings of the HCP.