Creating body dysphoria

Some people believe that there are two kinds of dysphoria: social dysphoria, meaning a discomfort with the social expectations associated with a gender role, and body dysphoria, meaning a discomfort with the awareness of physical sex characteristics.

In this worldview (sometimes called “truscum”; the word is adopted as a badge of pride by many people who espouse it), the feeling of body dysphoria separates the true transsexuals from the wannabe “transtrenders.” It is a “medical condition,” resulting from a mismatch between brain sex and the shape of the body, and the only cure is full hormonal and surgical transition. Social dysphoria, by contrast, is a malaise resulting from society’s restrictive gender roles, and affects everyone who’s paying attention. The only cure for this is reforming society to equalize the sexes, and any other response is a waste of time.

In the truscum worldview, resources available for trans people are scarce, and the true transsexuals with their medical condition deserve priority over the transtrenders who only experience social dysphoria. Transtrenders also monopolize media time and attention, and trivialize transgender problems in people’s minds.

This argument rests on two claims: (a) that body dysphoria is qualitatively different from other kinds of gender dysphoria and much more intense, and (b) that body dysphoria is innate – either you have it or you don’t.

When I first heard this argument I was skeptical of the first claim. Does body dysphoria even exist, I wondered? I couldn’t think of a way it could arise psychologically, so I didn’t really think too much about the claim that it was innate. Now I’ve not only seen that body dysphoria does exist, but I’ve also seen how it can develop, in fully grown adults who never experienced it before.

My friend Claire said she had never felt any dissatisfaction with her body until she transitioned. But after a significant period of being accepted as a woman, and then a single incident focused on her genitals, she began to experience intense, traumatic body dysphoria. And she’s not the only one.

I’ve heard similar stories from other trans women, and they all have the same pattern: feeling accepted as a woman, thinking of themselves as a woman (with no “trans” qualifier), and having to confront the fact of having male anatomy at a time when it was inconvenient (or worse) to have it.

The fact that all of these women were fully grown adults when they first experienced body dysphoria means that there is no way to neatly divide the world into “true transsexuals” and “wannabe transtrenders.” It doesn’t show that body dysphoria is never innate, but it does prove that it isn’t always innate. We’re not all born this way.

Unethical therapy

When 17-year-old Leelah Alcorn committed suicide on December 27, she left a note on Tumblr urging action to help trans people like herself:

The only way I will rest in peace is if one day transgender people aren’t treated the way I was, they’re treated like humans, with valid feelings and human rights. Gender needs to be taught about in schools, the earlier the better. My death needs to mean something. My death needs to be counted in the number of transgender people who commit suicide this year. I want someone to look at that number and say “that’s fucked up” and fix it. Fix society.

Some trans people have responded to Alcorn’s call for action with a petition to ban “the practice known as ‘transgender conversion therapy.'” Here’s how Alcorn described her therapy experience in an October posting to Reddit found by Cristan Williams:

I wanted to see a gender therapist but they wouldn’t let me, they thought it would corrupt my mind. The would only let me see biased Christian therapists, who instead of listening to my feelings would try to change me into a straight male who loved God, and I would cry after every session because I felt like it was hopeless and there was no way I would ever become a girl.

I wholeheartedly agree that what Alcorn describes is a disgrace to the therapeutic profession, and that it should be stopped. The goal of any therapy should be to give the client a place to be heard and respected, to free them from repression, and to help them find the path that works for them. Biased, faith-based sessions where the only acceptable outcome is determined in advance is inhumane brainwashing, not therapy. If it takes a law to stop it, I’m in favor.

This image is not an endorsement
Photo: Barbara B. Shostak, Ph.D. / Flickr. This image is not an endorsement

That said, I have concerns about this drive to outlaw all “conversion” and “reparative” therapies. I want to make sure there is room for the kind of therapy that I want and need: therapy that helps me to live in the gender that I was assigned at birth.

As I’ve written before, I feel many of the same feelings that other trans people feel, but believing in a gender identity goes against my skepticism, and many years ago I chose not to transition. Over the years, with the help of several therapists and the support of friends and family, I have succeeded in losing a lot of my repression, but I still have to deal with those transgender feelings, and I will probably need to see therapists, at least occasionally, for the rest of my life.

My therapists have been supportive of my decision not to transition, and I am confident that if someone came to them wanting to transition, they would be similarly supportive of their decisions. Unlike the therapists hired by Alcorn’s parents, my therapists listen to me, and respect me.

I’ve never been to a gender therapist. From what I’ve seen and heard – from the therapists themselves as well as from other trans people – there are very few who have any idea how to help someone like me who’s decided not to transition. While they may pay lip service to the idea of not transitioning, they seem to see their job as helping trans people jump through the hoops necessary for transition. What happens if a trans person changes their mind about transition – or decides to detransition? Are they simply declared to be “not really trans after all,” and left to fend for themselves?

Gender therapy is better than “conversion” therapy, because it doesn’t impose anything that the client doesn’t want, and it’s better than the “gatekeeping” practices that were prevalent for the late twentieth century, but it is still a biased situation where the only acceptable outcome is determined in advance.

We trans people need therapy, and we deserve a range of options where we can find support for the path we choose. We do not need therapy that is just another way for parents to repress us, as Leelah Alcorn described her “Christian” therapy. But we do need support for those of us who have chosen to live without transitioning.