(Re) Making gender in the clinical context: a look at how ideologies shape the medical construction of gender dysphoria in Portugal (original) (raw)
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Pathologizing trans people: Exploring the roles of trans people and medical personnel
Theory in Action, 2018
Despite the 2013 decision to replace the diagnostic labelling of gender identity disorder with gender dysphoria, there remains wide consensus amongst scholars that transgender identities are pathologised. Yet the claim that trans identity has been pathologised has yet to be rigorously substantiated. Adapting a model for verifying the credibility of medicalisation claims, this inquiry confirms that the human phenomenon of gender-variance has underwent pathologisation to embed trans identity within a medical model by historicising how trans identity became viewed as a medical condition;
Yearbook 2014 of the Institute for Advanced Studies on Science, Technology and Society
Transsexuality has been organised within the biomedical framework since the middle of the twentieth century. The gendered body is produced through a complete set of socio-medical practices in order to regulate the human variation on gender expressions. In this binary model, there are only two sexes and two possible gender positions. People who do not fit in this very normative model have to change the body to adjust it to the normative idea on how a male or a female body should be. However, at the turn of the century, several activist movements and certain feminist-queer academic traditions have questioned this version of sexual difference. In this article, I will analyse how a particular transgender activist group is questioning the production of both sexual difference and specific models of gender identity through the medical practices on transgender bodies.
Reluctant gatekeepers: 'Trans-positive' practitioners and the social construction of sex and gender
The following study is based on 35 in-depth, qualitative interviews with licensed marriage and family therapists, counselors, clinical social workers, and professional psychologists who advertise their services as 'trans-friendly', 'trans-supportive', or 'trans-positive'. We focus on cases in which practitioners denied clients access to body modifications for reasons related to gender identity in an effort to distill how practitioners' decisions are based on their working understandings of the appropriate relationship between gendered identities and sexed bodies. In the process of determining clients' access to body modifications, practitioners speak of the importance of the level of practice, as opposed to codified texts such as the DSM, in political and ideological constructions of gender and the materialization of sexed bodies. Instead of sharing one primary configuration of these ideological components, the practitioners we interviewed differed in terms of their assumption that gender identity is a product of biological, spiritual, or social processes. We conclude by considering the possibilities for the clinical encounter to subvert dominant gender ideology by authorizing more fluid gender identities and sexed bodies.
Journal of the Sociology of Language, 2019
Can the transsexual subject speak in their own terms? This is the question this article addresses. Grounded on a Foucauldian genealogical approach to discourse analysis and on Goffmanian-inspired interactional analysis, it investigates how knowledge systems that pathologise transsexuality as a mental disorder get gradually embodied (and spoken) in consultations at a Brazilian gender identity clinic. The analysis follows the interactional history a trans woman had with the clinic’s psychologist and traces the intertextual links that connect various consultations in time. This series of encounters constitutes a socialisation trajectory during which the trans client is led to speak a language that is not hers in order to frame an identity performance within the diagnostic criteria for the identification of “true transsexuals”. The article, thus, contributes to three areas for the study of transgender and language: (1) it investigates how transsexual people are led to speak a language that is not their own (the problems of agency and trans-autonomy); (2) it points to the centrality of studying how others speak to transsexual people – a gap identified by Don Kulick but which remains underinvestigated; and (3) it highlights the importance of language use for the design of trans-positive and trans-affirmative healthcare practices.
Who watches the watchmen? A critical perspective on the theorization of trans people and clinicians
Feminism & Psychology, 2014
This paper, made from an explicitly academic-practitioner stance, aims to highlight some of the problematic ways in which academic writing on trans people, and on the clinicians working in trans healthcare, has been presented in recent years. We argue that much work theorizes trans people and clinicians whilst failing to recognise the full and complex humanity of the people concerned. Also, such work frequently universalises a small number of accounts as if they were representative of ‘the trans person’ or ‘the medical/psy profession' as a whole. We call upon future writers and researchers to pay more attention to the multiplicity and diversity of accounts, and to consider the potential damage of perpetuating certain accounts as fixed or universal.
The DSM-5 and the Politics of Diagnosing Transpeople
In the DSM-5, there has been a change in the diagnosis for transpeople of all ages from Gender Identity Disorder (GID) to Gender Dysphoria (GD), in part to better indicate the distress that transpeople may experience when their gender identity feels incongruent. The Workgroup for Sexual and Gender Identity Disorders, chaired by Kenneth J. Zucker, was employed by the American Psychiatric Association (APA) to update the DSM-5’s GID diagnosis reflecting contemporary scientific knowledge. Additionally, in a prepublication report to the APA, members of the Workgroup suggested that they would also be concerned with the destigmatization of transpeople while preserving a diagnosis that medical insurance companies would accept for issuing payments for transitioning treatments (Drescher, in: LGBT Health 1:9–13, 2013). The aims of this article are, firstly, to question whether changing the diagnosis lessens the stigmatization of transpeople. I will suggest that the semantic change from GID to GD marks “inverted” gendered expressions as pathological and, thus, continues to stigmatize transpeople. Secondly, the article explores the development of the GD diagnosis, and illustrates how the scientific data this were founded on are contentious. The article then demonstrates how the trans anti-pathologization movement has challenged the perceived pathologizing effects of the DSM-5 classification of GD. The article examines a selection of Western transgender community advocates’ websites, forums, and blogs. From these sources, the article then explores the different narratives of transpeople and political groups who offer details of their praxis, and evidences how the trans anti-pathologization advocates use the available science and human rights discourses to contest the role of psychiatry in the treatment of transpeople.
Journal of Health Services Research & Policy, 2021
Objectives This study sought to explore perspectives of trans and gender diverse (TGD) people of ways to alleviate gender dysphoria in service provision and to develop a framework for application in health and other areas that can be used by researchers and service providers to design study protocols, assess organisations and enhance everyday practice in ways that are sensitive to TGD people’s experiences. Methods Data from a national Australian survey on TGD people conducted in 2018–2019 (n = 340) were used to develop a framework for alleviating dysphoria. Participants were asked an open-ended question on ways that body discomfort could be minimised in clinical encounters. Inductive thematic analysis was used to develop themes true to participant sentiment, which formed the basis for the development of a framework. Results The sample was overall young, with 60.6% aged 18–24, and a strong representation of gender diverse people (42.6%). The most important theme for participants was the context of the experience, which included the subthemes of the interpersonal qualities of service providers, language and pronouns, and practical aspects. Aspects of systems were also important, with education and awareness being particularly emphasised, followed by inclusive environments. Access to gender affirming medical and surgical procedures was rarely mentioned (2.6%). A minority of participants indicated that there was nothing that could be done to alleviate their gender dysphoria (4.4%). Conclusions The study proposes a framework that can help facilitate assessment of a service’s current practices, inform a practitioner’s daily practice and be used by researchers to appropriately design studies. The most important areas to address centre on the context of the immediate experience, which may be influenced through systems-level characteristics.
Gender identity and the management of the transgender patient: a guide for non-specialists
Journal of the Royal Society of Medicine, 2017
In this review, we introduce the topic of transgender medicine, aimed at the non-specialist clinician working in the UK. Appropriate terminology is provided alongside practical advice on how to appropriately care for transgender people. We offer a brief theoretical discussion on transgenderism and consider how it relates to broader understandings of both gender and disease. In respect to epidemiology, while it is difficult to assess the exact size of the transgender population in the UK, population surveys suggest a prevalence of between 0.2 and 0.6% in adults, with rates of referrals to gender identity clinics in the UK increasing yearly. We outline the legal framework that protects the rights of transgender people, showing that is not legal for physicians to deny transgender people access to services based on their personal beliefs. Being transgender is often, although not always, associated with gender dysphoria, a potentially disabling condition in which the discordance between ...
Grounded in a Foucauldian genealogical approach to discourse analysis and in Goffmanian-inspired interactional analysis, this paper investigates how knowledge systems that pathologize transsexuality as a mental disorder get gradually embodied in consultations at a Brazilian gender identity clinic. It investigates the Programa de Atenção Integral à Saúde Transexual (PAIST). The research draws upon 13-month ethnographic fieldwork. It analyses how pathologizing biomedical knowledge systems make available certain semiotic resources for the identification of “true transsexuals”, solidifying, thus, a metapragmatic model of identity (Wortham 2006). The analyses focus on the micro-interactional dynamics of socialization trajectories (Wortham 2006) during which a new transsexual client of the clinic gradually learned how to entextualize (Silverstein and Urban 1996) the identity model of “true transsexual” in her identity and linguistic performances and, thus, gradually became a docile body for the purposes of the clinic. This learning dynamics took place in the sequential organization of turns-at-talk in the consultations and, above all, in the question-answer adjacency pair in which a psychologist repeatedly offered her interlocutor semiotic items for the construction of a performance that fulfills the requirements of the Brazilian trans-specific healthcare program. The research indicates that in the micro-interactional details of the consultations, clients’ local understandings of their subjectivities and bodily practices are gradually eclipsed (or in the Foucauldian jargon, are docilized) by the diagnostic construct of the “true transsexual”.
What if I'm not really trans? Gender dysphoria beyond the Imaginary
2020
The present paper delves into the predicament of gender dysphoria as it manifests beyond the Imaginary register. Devised as an autoethnography, the paper takes basis in the author's own experiences of doubt, guilt and imposter syndrome-like anxiety. It delves into a more sinister kind of gender dysphoria that do not immediately revolve around appearance or passing as a desired gender but reflects instead in a broader crisis of well-being outside a cis-gender nor-mative framework of sexual difference, that manifests in existential crisis (post-transition). Memories and personal accounts are reflected through theoretical prisms with common ground in Lacanian psychoanalysis, especially (but not limited to) as read and developed by the Ljubljana school of philosophy, (of which best known is Slavoj Žižek). It is proposed that transitioning reflects a subjectivity in becoming from an Other axis of sexual difference, that aligns with Lacanian femininity by being excessive to phallic identity. Transgender subjectivity thus highlights a common denominator of humanity: that the subject must be seen by the Other, which doesn’t exist, and that identification therefor cannot be terminated/concluded. Since the notion of (symbolically constructed) gender identity seems to fail in asserting this basic premise of uneasiness at the core of subjectivity, the psychoanalytic theory of sexuality is used to illuminate this, by discussing the notion of symbolic castration. Instead of condescending to the phallic premise of (un)Natural identity (as discerned in the medicalized dis-course of gender dysphoria) a psychoanalytic ethics of desire is discussed. The author sug-gests that transitioning can be understood as the result of a “pure,” subjectivizing (death) drive beyond the subject-Other division; thus, instead of understanding transitioning as a defensive exit, it can be conceived as radically authentic and inextricably linked to the subject’s individual mode of desire. Reflexively, such a move also designates an alienation regarding the Symbolic order as it exists. As such, it is proposed that the subsequent suffering and struggles post-transition can reflect a dire need for regaining ground in the face of the Other, that, when propagating cis-normative and naturalistic ideologies can appear unbarred and thus invasive and destructive.