A Reply to Julia Serano: Desistance, Homophobia, and the Medical Treatment of Gender Dysphoria
(This piece is based on a video that I had made, but decided to remove from public view. I have edited it and turned it into a written piece instead.)
Julia Serano wrote an article about two weeks ago called “Detransition, Desistance, and Disinformation: A Guide for Understanding Transgender Children Debates”, which is now floating around the web as expert opinion on these topics. Two detransitioned women I know have already made excellent direct responses to Serano’s article. Crash wrote a piece about her personal experiences as detransitioned and what genuine support of detransitioned women looks like, and Cari made a video going through each section of Serano’s article and responding to it. Maria Catt, another detransitioned woman, also talks about the article in this video. I wanted to say my piece as well as someone who experiences intense gender dysphoria but who has desisted from transgender identity. I also wanted to address a topic that other women have not addressed at length, and which takes up a large chunk of the article and is Serano’s motivation behind writing it: that is, the medical, psychological, and/or psychiatric treatment of gender dysphoric individuals.
In the article, Serano claims that there are basically only two options for providing care to children and adults with gender dysphoria. One approach she calls “gender-affirming”: this is the therapeutic approach where individuals are permitted to be gender non-conforming (in respect to their assigned sex at birth) and encouraged to explore their identity. In the case that this individual adopts a cross-sex-assignment gender identity they are respected and affirmed in this, and gender transition is considered as a legitimate option. The other approach Serano calls “gender reparative therapy”, and in this approach, children or adults are coercively subject to attempts to get them to conform to the gender role associated with their assigned sex at birth. Serano argues that writers who are “trans-suspicious”– critical of rises in the number of individuals undergoing gender transition or identifying as transgender– often endorse gender reparative therapy of children in particular and that they cannot see that this is motivated by pernicious and pervasive transphobia rather than genuine concern for dysphoric individuals.
As someone who Serano would likely call “trans-suspicious” given my writings, but also as a dysphoric individual and a desister, I was frankly offended that she would think that I or any other person in my position would endorse gender reparative therapy. I was never personally subject to gender reparative therapy or even sexual orientation reparative therapy, but I have been subject to homophobia by the psychiatric system. I think the idea that people like me– desisting women or detransitioned women often subject to intense homophobia– would endorse reparative therapy is ludicrous. I think that Serano herself is ignoring this key element, homophobia, that us women have experienced in service of her own agenda to increase access to transition at all costs, which I would argue does not actually constitute being fully concerned for the welfare of dysphoric individuals, either.
My personal story of homophobia is relatively short, but it is not an outlier by any means. Essentially, I was placed in the hospital because I didn’t have a boyfriend.
In January 2013, I was attending a routine appointment at my psychiatrist’s office. I had just left an intensive outpatient day hospital program the month previously. I had disclosed to my psychiatrist and the rest of my care team that I was bisexual, which was my sexual orientation identity at the time. But for some reason nonetheless my psychiatrist was obsessive over whether I had a boyfriend. She seemed to gauge the general state of my mental health by whether or not I had access to what she would call “social support”, and her single question about the social support in my life was always about whether I had managed to find a boyfriend yet. Initially, she was extremely taken aback when I had told her that at 23 years old I had never had a boyfriend and did not have one then; she seemed to think that this fact was indicative of my mental health issues over my lifespan and that fixing my poor mental health would go hand in hand with also fixing my lack of heterosexual dating. At one point, she literally tried to give me advice on how to go out and meet potential male partners. I remember telling her that I was bisexual, that I wasn’t interested in dating at the time, and that if I were to date anyone it would almost certainly be a woman. But she did not ever seem to retain this information. In any case, during this particular visit, my psychiatrist asked me at the end of the visit whether I could keep myself safe until the next one. Unfortunately, I hedged on the matter, and she became extremely concerned. She gave me two options at that point, which were not really options at all: either voluntarily sign myself into inpatient psychiatric hospital, or be subject to the legal process of involuntary psychiatric commitment. I didn’t understand what was going on, and didn’t understand fully why I even needed to go to the hospital, so I asked her why she felt this was necessary. She responded that she would feel better about my safety if I had someone to go home to– if I had “social support”– but since I had “no one in my life”, it was best for my own good that I go to the psychiatric hospital. I ended up signing the papers to commit myself to inpatient care. I was in the hospital for a week.
I relate this story not just to show you that homophobia is still out there in psychiatry, but also to lay bare my motivations. I am not motivated to trust the psychiatric system in general, although I still interact with it regularly. I do not think “more gatekeeping”, i.e. more psychiatric control, over dysphoric individuals is appropriate. I do not think at all that proper treatment of gender dysphoria in children or adults involves subjecting them to anything resembling what I went through; I don’t think anyone should be pushed towards gender conformity or acting in “accordance” with their gender role in any way. Not being gender conforming– primarily not being appropriately heterosexual and endorsing heterosexual norms– got me sent to the fucking hospital. So I do not believe anyone who is gender non-conforming should be subject to coercive or punitive treatments whatsoever.
What treatments should gender dysphoric individuals have access to? I’ll admit I don’t really have a systematic answer to this. But I do have many, many questions about the current system of treatment, and I know what gender non-conforming individuals should not be subjected to as a matter of our right to be free from coercion and medical abuse.
Something I think Julia Serano would agree with, and most transgender people would generally agree with, is that children or anyone else who expresses something other than conformity to the gender role associated with their sex at birth do not have a medical condition based on this fact. And neither is being gender non-conforming a symptom of anything, just as my not having a boyfriend was not a symptom that justified me being sent to the psychiatric hospital. If an individual is in severe psychological distress that interferes with their functioning in life or their general well-being, then this is the reason that they need psychological care. It’s not the bare fact that they’re displaying traits typically associated with another gender role.
However, we do need to be brutally honest about the motivations of any authority figure within our patriarchal and homophobic society. Parents of children with gender dysphoria and psychiatric or psychological professionals who treat gender dysphoria are not just concerned with the distress that dysphoric individuals are undergoing, just as my psychiatrist was not just concerned with my psychological distress or immediate bodily safety. Parents and psychological professionals do often want to see a “normal” patient as the end result of treatment. And a gay child who ends up a gay adult is neither considered a normal result nor an optimal one, even among those who pay lip service to being progressive or supportive of LGB issues. Parents and professionals are often extremely afraid– and not irrationally so– of the discrimination, harassment, ostracism, and perhaps even violence that an openly gender non-conforming child will face. So it’s not just in virtue of children or any gender dysphoric individual showing distress or hurting that parents and professionals care about what happens to them. These authority figures care what the child or adult’s future will look like insofar as they care about what treatments ought to be given to them so that they have a certain kind of future. And there is a lot of bullshit invested in that.
Parents and professionals do care to some extent about our distress as persons with gender dysphoria. I don’t want to deny that. But when we unpack the bullshit, we see that it’s not just because we’re in distress that we get picked out for treatment. It’s also because we are gender non-conforming. It’s in virtue of being gender non-conforming that transition– either social transition when an individual is very young, or undergoing medical interventions at puberty or older– makes sense as a treatment to be offered to us.
Let’s think about social transition specifically. For an AFAB child who is distressed at the characteristics on their body that are designated to be female characteristics, it makes sense to offer a treatment to this child that involves them being seen as a boy and living in the social role of a boy insofar as this child is already deemed as having a resemblance to being a boy in some way, that this child is seen as being “boy-like”. Of course, the neutral way of referring to this is calling this child gender non-conforming, rather than saying this child is “like a boy”. The fact that the child is gender non-conforming and the fact that people in this child’s life will attribute an internal gender identity of “boy” to the child or say that the child has some essential boy quality are not separable facts. This partnership of facts is why psychological professionals recommend social transition for this child as a treatment for their distress.
One might think that we offer the child social transition to the boy role because the child asserts things like “I am a boy” or “I want to be a boy”. This isn’t the entire picture. Parents and other authority figures in charge of a child’s care very clearly don’t offer kids everything they want, and they don’t validate or affirm every thing a child says about themselves. There is a reason why these gender statements are taken to be legitimate in certain cases. There has to be something behind the child’s statement that justifies what they say and makes it reasonable for parents, schools, legal entities, and entire medical systems to devote resources to them. There has to be something reasonable that justifies the child seeing a gender therapist, or seeing a therapist who then diagnoses the child’s issues as specifically gender issues, and then for social transition to be proposed instead of some other intervention. And this thing that makes it reasonable is that the child is “boy-like”, that the child is not conforming to gendered expecations for female individuals.
This is how being gender non-conforming becomes a symptom of a medical condition. Think about the implications of this.
You might think, reading this: aren’t children and other individuals in distress precisely because of their body characteristics associated with their sex assigned at birth? Isn’t that what gender dysphoria is, and doesn’t that warrant some sort of treatment based on those facts? And I would agree in some respects. This is why the gender-affirming approach has real benefits and why people like Julia Serano claim that it works. Gender dysphoric individuals are in distress about what their sexed characteristics indicate; they are in distress because these characteristics are meaningful. To children, what this means is that they have to do certain activities, act a certain way, and be treated a certain way based on these sexed characteristics. So, of course children will feel better when they undergo social transition: when they are permitted to do the activities they want to, appear they way they want, and act the way they want. And it’s not just that they’re allowed to do these things when they socially transition, because many parents do attempt to allow their children to be gender non-conforming prior to transition, but it’s also that they’re treated with respect by their parents and others around them for being the way they are. They are treated as if they are making sense for being this way rather than being anomalies or aberrations that are just being allowed to get away with their gender non-conformity. They are now being allowed to have some level of autonomy over their lives as if they’re reasonable agents, rather than facing derision and punishment.
So this is where I start asking questions.
Do we need psychiatry to be involved to believe these children (or anyone) and to give them autonomy over their lives and to respect them for who they are? Do we need a whole medical, educational, social, and legal system based on the idea that these children are “actually” a different sex in some sense, and that they’ll eventually likely need surgical and hormonal interventions later, in order to take these children’s distress seriously and to let them be who they are as gender non-conforming people? I want you as the reader to remember that the psychiatric system is the same system that subjected me to medical abuse based on homophobia. Do we need that system to be giving us the official narrative on these children? The narrative does say that gender non-conforming children make sense, that their distress and needs are legitimate, and that they’re worthy of devoting resources to and worthy of our care and attention. But it also says that they’re only worthy of these things insofar as we can think of them as transgender, with all of the implications that entails. I want to ask: can we view these kids as worthy of resources and give them care and attention without this narrative?
Did you know the American Psychological Association (APA) only issued a statement saying that reparative therapy for homosexuality was ethically questionable in 1997? I can remember 1997; I was a child then. The official condemnation of what the APA calls “sexual orientation change therapies” did not come until 2008. Nearly all of you reading will remember 2008. It was two years after I started thinking of myself as transgender, and coincidentally, that was the same year I realized I was attracted to women.
This is not old history.
If we consider the psychiatric system to be homophobic– a system also infested with patriarchy, one that doesn’t care about trauma done to AFAB people and will assign us pathological labels based on being traumatized– do we want this inherently homophobic and misogynistic system to be in charge of deciding whose distress is worthy of any systematic care, attention, or resources? And do we trust that system when it then says of the people whose distress is worthy that they’re really another gender inside and that that will then require hormonal and surgical intervention, otherwise the distress, the dysphoria, will never ever resolve?
Serano herself says in her original article that “transness is not something that can be easily or objectively measured, it is inherently subjective and experiential.” Do we think that we can trust something like this, something that is a highly personal journey, to a psychiatric system with the attributes that I just described? Serano also says that transition is a “matter of personal exploration”. Do we trust that to a system that doesn’t care about personal exploration, and in fact wants to stomp out the personality and personhood of certain classes of people altogether in the name of “treatment”?“
Serano suggests that "trans-suspicious” individuals are making “the argument that some people are easily swayed or misled into transitioning ” and that one can only make this argument “if one intentionally denies, discounts, or downplays the existence of societal transphobia, gender dysphoria, and the legitimacy of trans people’s gender identities. In other words, this line of reasoning is condescending and steeped in transphobia.”
I don’t deny, discount, or downplay that our condition as dysphoric individuals is awful, whether we transition or not. I don’t think that transitioning is something that anyone takes lightly: the prospect of transitioning and exposing myself to all its risks was for me like jumping to save myself from a burning building. I don’t think this is a matter of persons who don’t have very serious distress over their bodies and lives, who don’t have serious issues around gender, being “tricked” into transitioning. Serano has a section in her article about the trope of cis people being tricked into becoming transgender. I don’t think of things this way at all. I think people with gender dysphoria need to have their distress be seen as legitimate, and I think they need it to be resolved.
Unfortunately, the only way to do this right now is to turn to the psychiatric system.
I don’t think the best answer to getting dysphoria resolved and for our issues to be taken seriously is for the psychiatric system to exert the effort to “gatekeep” by picking out which people’s distress is serious–meaning it justifies medically endorsed body modification– and which people’s distress is not serious enough for “real” treatment. I don’t think that is a good model at all. Actually, I think this model is the one that is “condescending”.
It says to us: “what you are feeling isn’t real, it’s not a thing, unless you believe a narrative about your soul, or your brain, or whatever we’re calling it this week, being a different gender”. It says: “what you are feeling isn’t important unless we can find a way to also conveniently erase how weird and different you look and act as a gender non-conforming person”. It says: “we don’t care about your distress unless we can justify treating it, and the way we justify treating it is using misogynistic and homophobic concepts”.
I do not buy that this is the absolute best we have got to give to children or any other individual who is facing gender dysphoria. Do you?
