Thanks, David, for the details you offer about the effects of the verdict; there's definitely some protein there to discuss. Much more, I think, than in your personal differences with specific trans activists. I'd rather get into that right away than be sidelined by your proposal that trans people are not to be considered experts about being trans simply by virtue of being trans, but unfortunately I find it pretty salient.
It's been often reiterated here and elsewhere on the board that women are not necessarily experts on the oppression that faces women, and that no woman can speak for all women. Just because a woman says something is not sexist, doesn't necessarily mean it's not sexist. She may not have a solid grounding in oppression against women through which to interpret her experiences, or she may not be aware of her experiences of sexism as such for other reasons, and thus may not be as much of an expert in the matter as other women. The point is that her position should not be discounted because she is a woman, nor should she automatically be given more credence than other people because she is a woman and happens to agree with the speaker.
No blind person can speak for every blind person. Nor is there any group of people more expert on the experience of being blind than people who are blind. Doctors may be able to explain much more about what causes blindness than a blind person who does not have this background, but in understanding what accomodations are needed by blind people, a wise doctor asks and listens to her blind patients. A sighted person who has spent a few hours blindfolded still will not have direct experience of what it is like to live without sight for an indefinite period without the option of taking the blindfold off.
I would surmise that the experience of transgender people falls somewhere between. Part of our experiences are largely due to the bare fact of being transgender, which assuredly has some medical components and some identity components. Another part has to do with social aspects, in that we face real oppression that threatens us socially and physically. Incidentally, part of this oppression has to do with the assumption that being trans is a mental illness, and that our gender as we experience it is thus a product of delusion; it's this that I'm hearing echoes of in your post. Doctor knows best. Because this is a component of the oppression of trans people, it makes me angry to hear it even in people who have a real interest in protecting trans people's rights, or who have an outsider's concern for us and our well-being.
I do not have a commitment to the model that transition is the only way to treat trans people. I know of no other treatment that has even that much anecdotal evidence, little say the kind of evidence you (and I) would like to see for medical transition; if you know of one, I'd like to hear about it. I do have a commitment to the belief that it is no person's place to deny a trans person who makes an informed decision about transition the right to go ahead and do it. The important things that I would ask from doctors is to use their expertise to distinguish being transgender from organic mental illness appearing to be transness, to facilitate a decision-making process that is informed and grounded in the ultimate responsibility of the trans person, and to appropriately provide support systems for social stresses we will encounter before, during, and after transition. All this has to come from a position of awareness of trans people as people and not just sets of clinical signs and symptoms.
I don't know if this is possible under the NHS. I'm not a UK citizen and have never had to deal with the NHS. I don't know if it's possible in private practice either. But if it's not possible under either of these systems, what that tells me is not that what I want is unreasonable, but that the systems need reforming. Obviously, not today, right this minute, hold everything until these demands are met. There are people who need care in the meantime.
Now, I'd like to see a study that longitudinally tracks trans patients who choose not to transition, those who choose to transition and don't choose post-transition social support, and those who choose transition and also follow-up social support, to see which group reports the highest quality of life. This may also provide some more insight into who does better with medical transition and who does better without it, information that can be passed to trans people in a respectful way so that it can be useful to us. Because every trans person's experience is going to be different, evidence is largely going to be anecdotal. If it were a mental illness, rather than a psychosocial trait that expedience compels us to treat as mental illness because there are no systems set up to help healthy people live healthy lives, then we might have cure and remission rates--those at least would be quantifiable. You say it's too late to start such a study now; I disagree, but I also think we're unlikely to see one. If it happened, the results would then have to affect policy changes that will likely be put in place between now and then, which would be more work than if we had the results ready now to inform policy in the immediate term. A commitment to work on this research might help to slow or delay a reversal in policy that you seem to believe will necessarily occur because of this ruling; in the meantime, we need systems to support people who are transitioning and those who are not.
You're right that our community is fragmented; in part this is due to divisiveness from the medical community. From such classifications as that of "true transsexuals" and "secondary transsexuals" along lines of sexual preference, we've learned that we can get the care we need if we distinguish ourselves from those other people judged as undeserving of such care. It's a vicious, insidious lesson, and its echoes make it a real challenge to reach a consensus about what standards of care are needed for people identifying as trans-. This isn't, unfortunately, something either you or the NHS can help us with, by ripping into some segment of the trans activist community or by dismissing trans activists as a whole, or even by illuminating the deficiencies in the current evidence base. That has to be a reform movement within the community--a community that is fighting over where its boundaries are, and not building good bridges with groups that can help us. We've been, justifiably, suspicious of non-trans people trying to "help" and "inform" us while they decided for us what our lives would be like, a situation that any reasonable person is likely to respond to in unreasonable ways. |
