Gender Identity Disorders According to Section F.64 of the ICD-10 of the WHO, the following gender identity disorders (GIDs) are classified as health problems: *Transsexualism (F.64.0 and F.64.2) *Crossdressing (F.64.1) *Transgenderism (F.64.8), which is included under gender identity disorders not otherwise specified (GIDNOS) It is important to note that gender identity disorders have nothing to do with the issue of sexual orientation, and that gender dysphoric persons may be heterosexual, homosexual, or bisexual. Although gender identity disorders are recognized as health problems, the choice of sexual orientation--whether heterosexual, homosexual or bisexualis in no way a health problem because it is simply a matter of taste. WHO-World Health Organization, from UN-United Nations. ICD-10 – 10th edition of the International Code of Desiases.
What Is Gender Therapy? *It includes the diagnosis of gender identity disorders (GID and GIDNOS) per Section F.64 of the ICD-10 of the WHO. *It includes the post-diagnosis treatment of these persons, which may involve gender transition and hormone replacement therapy (HRT). *It includes psychological counseling for these persons during the diagnosis and possible transition stages. *Transition can involve surgery to correct secondary sex characteristics, including possible sex reassignment surgery (SRS) in cases where it may be advisable. *It includes psychotherapy and sexual counseling after sexual reassignment surgery. *It is equally beneficial in male-to-female (MtF) cases as in female-to- male (FtM) ones.
Psychotherapeutic Counseling During Diagnosis and Gender Transition for Both MtF and FtM Patients
What Kind of Therapy? *Never try to make the child, adolescent or adult try to revert, or stop being someone he or she is already conscious of being. In other words, never try to make a gender dysphoric person stop being gender dysphoric. *So far, no method of therapy has been able to fundamentally undo gender identity dysphoria. *Unfortunately, there are many therapy methods-based on therapists convictions that GID is potentially reversible and that the GID patient can be molded--that have the effect of torturing children and adolescents, and that can cause neurosis in young people and adults. *We always face the temptation of imposing our vision, theories, and ideologies on the patient. With GID patients, this approach invariably results in the failure of the therapy. *The ideal GID therapist will be one who has himself or herself experienced GID. Only such a therapist will possess the understanding and respect required for the task.
In The Recent Past… *In the recent past, the psychologists Stoller and Money were considered the experts on GID (just like their followers, such as Bailey and Zucker, are many times considered today), and they tried to impose from the outside their concepts of GID etiology and therapy on their patients. *They only succeeded in oppressing their patients and causing them lasting damage. *Real tragedy resulted from these mistakes, such as the unfortunate ending of the John/Joan (David Reimer) case. *These outsider psychologists tried to exploit their patients in order to substantiate their methods and theories, rather than trying to respect and identify with their patients and trying to understand the causes and consequences of their afflictions. *A paternalistic and authoritarian attitude on the part of any psychotherapist who has not shared the reality and problems lived by GID patients is unacceptable.
Egypt and Gender Therapy *Egyptians in the time of the Pharaohs were the best psychotherapists the world has known. *The Egyptian sage always knew, by virtue of his culture, how to identify with others, with vital natural forces, and with the basic principles at work in nature and in human beings. *Thus the Egyptians developed the concepts of interpersonal identification and of rituals for identifying with the vital forces (Ntrw). *The state of consciousness gained by identifying with the vital forces of animals and other elements of the natural world gave rise to an awareness of the Ntrw (or Gods) by the Egyptians. *Religious ritual allowed them to make a linkage between the vital forces (Ntrw) and man and his humanity. *These concepts and this awareness of what is of vital importance in the reality of human life allowed them to fully develop therapeutic concepts ideal for gender therapy.
Identification With Others *In ethnology, as in ancient Egypt, the technique of identification is essential for valid and profound study of another persons reality. *Through identification, one can understand another person, along with his or her self-view and way of perceiving the world. *Psychodrama employs this same concept, as the therapist brings to life the patients own issues. *Its only possible to understand discrimination, exclusion, the feeling of being a stranger in ones own family, home, or society, and the feeling of being a stranger in ones own body-which is how many GID patients feel-by experiencing this reality personally. *This is why the ideal gender therapist is a person who has experienced GID.
If You Havent Lived It… *If you havent lived it…you can, at least partially…as a training and therapy exercise. *Becoming a transgender or transsexual is clearly impossible, but living as a crossdresser is certainly possible for anyone. In that way you can at least partly experience the social reality of the GID person. *And so, its essential for the prospective gender therapist to spend between six months and a year living socially and publicly as a crossdresser in order to be qualified to counsel and evaluate GID individuals. *Only through this process of identification can a therapist be of any real assistance to a GID patient.
Learning with Ethnology *Consider the writing of Juana Elbein dos Santos, Ph.D., from her doctoral dissertation in ethnology at the Sorbonne in the 1970s: *The ethnologist, with rare exceptions, lacks background experience and does not live sufficient time within the group, and so the majority of the time his or her observations are imposed from without and are colored by his or her own frame of reference; its rare that the ethnologist speaks the language of the study subjects, and he or she often relies on information from study participants who in turn speak the language of ethnology poorly. *In her dissertation, she goes on to say: To be initiated, to learn the features and values of a culture from the inside through a dynamic relationship within the heart of the group, and at the same time to be able to derive from that empirical reality a groups organizing principles, dynamic meanings and their symbolic relationships, in a conscious effort of abstraction as an outsiderthis is a highly ambitious undertaking against which the odds of success are stacked.
Initiatory Experience *Individuals with GID always live in a social and cultural existential ghetto that results from the ignorance of society about who they are and why they are like they are. Many are prostitutes who lead a sub-human existence. Trauma abounds in their lives, beginning in their infancy, permeating their adolescence and culminating in their adulthood. *What psychotherapeutic approach can best help alleviate such debilitating stresses? *Regardless of the psychotherapists background, as an outsider its necessary that he or she have initiatory experience, that is, have the radical and prolonged experience of being at minimum a crossdresser, openly and publicly, for a period of months or even years in his or her customary social environment. This is the initiation we propose in order to meet Elbein dos Santoss requirements to establish the credentials of a psychotherapist coming from the outside.
The Language *After the initiatory experience we are proposing, it will be easy for the therapist to understand the language of GID. *Only after experiencing a profound real-life initiatory experience can a psychotherapist from the outside understand the violence resulting from post-traumatic stress disorder (PTSD), spontaneous weeping, loss of hope and attempts at suicide. *In this way it will be possible through the language of GID to establish a therapy regime based on identification with the patient, engaging in social and psychological interchange, rather than employing pre-conceived theories from the outside and analyzing patients as if they were laboratory animals. *The language of GID is the language of empathizing with another in his or her desperation. It is also the language of identification with natures vital forces, which the Egyptians in the time of the Pharaohs knew well how to tap. *Still, the best solution will always come from the inside toward the outside, even though the opposite approach is not, strictly speaking, impossible.
Conclusion *To the psychologist or psychiatrist, the sexologist or other analyst of GID cases: do you want to learn how to deal with these cases, but you are not personally gender dysphoric? *1. Make yourself gender dysphoricexperience a real-life initiatory experience as a crossdresser, publicly exposing yourself to the hostility of society for six months or a full year. *2. Learn the language of gender dysphoric suffering by suffering as a gender dysphoric person does. *3. Identify with your GID patients, using techniques of psychological identification. *4. Learn how to work with them, and to make contact with their inner reality that you have already personally experienced (even if to a lesser degree). *Then, using a good life history and Gendercares MFX and FMX tests of unexpected gender identity/ expression, a diagnosis will be easy and the treatment will be simple, and it will be possible to anticipate a cure or at minimum a significant alleviation of the problem. *But always remember: Transsexual GID generally has a biological etiology and involves a discordance between the patients mental gender and his or her sexual organs, caused by genetic and hormonal factors aggravated by the mothers emotional state during pregnancy. However, transgenderism and crossdressing almost always are the consequence of trauma. And only the patient himself or herself knows the deepest truth about the possible roots of the problem. *Identify with the patient…help him or her to self-diagnose. *Then, you will have made yourself a real gender therapist!
Bibliography Colapinto, J.As Nature Made HimHarper Collins, 2000 ; Elbein dos Santos, J --- Os Nagô e a Morte --- Editora Vozes, 1975; Freitas, M.C. --- Meu Sexo Real --- Editora Vozes, 1998.