Sunday, 21 April 2013

Opening our eyes (and our ears) to really think about gender

I didn't know I was an adrenaline junkie.  But it appears I am.  I think you have to be, to take to the streets of London on two wheels.  Either that, or someone who would fit somewhere on some clinical spectrum.  I could probably meet the criteria for one of two DSM diagnoses, but we needn't go there...

Some days I choose to pedal.  Others I get in my car, and drive.  More often, I take the bus.  The point is, I have choices.  I have different identities I can move between.  Without so much as batting an eyelid (or is that eyelash?)  It's a little like my clothes.  My appearance changes with my mood.  I have a degree of choice as to which version of myself I present to the world.  And I occupy a different self when I'm home alone.  

I'm not the same person at work as I am at home.  I'm not the same person around my family, as when in the company of my friends.  I may be a different person depending on my context.  And I move into and out of contexts.  Sometimes, I feel a need to escape from context altogether.  But again, that's probably another blog post.

I am fascinated by all things gender.  How do we arrive at a construction of our gender, and how do we know when we've got there?  Today was a great opportunity to explode some of my thinking around this, surrounded by fellow professionals also interested in supporting individuals for whom gender has become difficult.  

Dr. Victoria Holt is someone who knows a lot about gender, and about young people and their struggles with gender.  Gender Identity Disorder may soon become known as Gender Incongruence.  Those among us who try to keep up with the lingo are hovering somewhere around Dysphoria at present.  Sometimes it feels as though we really are in no man's land.  

But incongruent with what?  This, it seems to me, is the crucial question.  I sat in a 'goldfish bowl' discussion exercise and challenged the idea of the gender binary with every effort I could summon.  The novel idea that pre pubertal children, under 12, might be supported to explore their gender by occupying their preferred role only serves to reinforce roles, and this is surely what needs to be taken to task...

I loathe with a passion completing forms that claim to be about Equal Opportunities and Diversity Monitoring.  No problem with the goal, but the means seem inherently and repugnantly flawed.  Don't ask me whether I'm male or female.  Ask me something else.  Ask me about my gender identity.  Go on, I dare you...  So few forms I fill in, even here in the so-called modern West, offer me the opportunity to tick a box that states that I'm transgender, even fewer that I'm genderqueer, or queerying my identity.  What about 'Gender Fluid', 'Thinking about It', or 'Pangender'...  Ooooh, I can see the eyebrows twitching.    

Gender simply doesn't fit the binary.  Biology tells us this in no uncertain terms.  The only successful treatment for gender dysphoria is endocrine intervention.  And yet the gatekeepers remain psychiatrists.  Make sense of that, if you will.  

Hormone blockers are a fabulous discovery.  They've been around for a while.  It is believed that their effects are fully reversible.  So why aren't they dished out, liberally, to all of us who might want to suspend our physiological development and avoid the trauma of an unwanted puberty?  Possibly, maybe, I'd respectfully and lightly surmise, because they are expensive.

Blockers give their fortunate recipients time to think through their options, and explore their feelings in relation to their gender.  By the time they are prescribed, under the careful guidance of a multi disciplinary team, the young person has usually been aware of their dysphoria (and therefore distressed, if not disturbed by it) for at least a decade.  Some would argue that interfering with the 'natural' trajectory is tantamount abuse.  I wonder whether to withhold access in the circumstances, following thorough assessment and formulation, is ethically viable.  

And breathe...!

It's a delicate balance to strike.  As a therapist, I need to be-ware of my politics.  I am passionate about supporting young people to live more comfortably in their skin.  Adolescence is hard enough, when one is relatively stable and secure in one's gender identity.  Blockers aren't the B-all and end-all, but they are a start.  The research shows that most of the children who present as dysphoric pre pubescence do not pursue reassignment.  What it doesn't show is what happens to them...  There are inadequate follow up studies at present.  What we do know is that those who present at or after puberty more often than not do persist, and pursue transition - of whatever shade.  

A throwaway remark, an untimely intervention, forbidding a child to act in a manner that feels comfortable and true to themselves - these are the scars that young people are most harmed by.  Who's to say that girls shouldn't play football, or that boys shouldn't attend ballet classes?  Where did we get these notions from?  And why have we clung onto them?  

If I ruled the world, I'd get rid of cards that say 'It's a Boy!' and ban obstetricians from announcing a baby's gender at birth.  Gender might be best thought of as something we grow into, and might well grow out of.  It can't, I think, be happily or successfully separated from any other part of our identity and is therefore, the journey of a lifetime.  A journey that no one can take for us, and from which no one can spare us.  But, just like the roads I cycled to and from Archway, many rattling potholes to be circumnavigated along the way.  

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