Maddie's personal experiences in a GID clinic, both the good and the bad.

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Gender Identity Disorder (GID) Case Study: an Autobiography of a Transsexual Psychology Graduate Student

Therapy at a Gender Identity Clinic

"You're as white as a ghost! What happened?" That's what my girlfriend, Lisa, said when I came through her office door late one Tuesday night. We're both Developmental Psychology graduate students and it was almost a ritual for me to find her in her office when I drove back Tuesday nights. I wasn't full-time in my transition from male to female yet. And every Tuesday I drove a few hours to the nearest city with a gender identity clinic. Some weeks I would take this trip before dawn for a morning appointment with my therapist. But most weeks I left in the afternoon to attend an evening support group meeting for those asking for permission to take hormones. My girlfriend had no idea how much therapy had hurt me that night. And I'm lucky that I persevered long enough for therapy to help me grow.

Maybe my first visit to this clinic could have been an allusion to what was to come for me. I wasn't presenting as female all the time yet because I was still scared about what my parents or my professors might think. But in most of my time away from professors and family I would present and relate to the world as "Madeline." Even with all my experiences and my confidence that I should transition, It was still frightening for me to telephone the gender identity clinic. They made me give my legal name because the government would be paying. But even with their records saying "Mitchell" I couldn't possibly show up presenting any way but as "Madeline." Presentation wasn't a decision, it just was. So I sat in the empty clinic waiting room doing some schoolwork while I waited for my intake.

A woman walk in and looked around the room. I just looked up but she didn't say anything to me. She walked to the receptionist, spoke in whispers, turns and said, "Mitchell?" "I guess?" So I followed her, Wilma, up a winding flight of stairs. "Mitchell doesn't seem like the right name for you?" "My friends call me Madeline." "Okay, Madeline" She asked me a bunch of questions that started out addressing the criteria of "gender identity disorder" but gradually her questions felt more like she was genuinely puzzled by me and I was trying to learn something for herself. This clinic helps people with sexuality issues too so I asked, "Am I your first transsexual client?" "No, I've had a few already. But you're ... different." Calling me "different" seemed kind of weird and kind of disconcerting. But I've been called that my whole life so I forgot it about it when I left.

I was really excited to be accepted into the gender program and assigned a therapist, James. James wasn't nearly as friendly as Wilma was. Wilma and I just had this really nice conversation. But James didn't talk to me. I would come in excited to tell him about another gender accomplishment like passing in a big group. But rather than being happy for me he would just sit there and say in this monotonous voice, "uh huh." After a few meetings I had nothing to say to him. It was just awkward silence. Had he asked me a question, I would answer. But when I asked if there's anything he would like to know about me since he needed to decide if I get hormones, he would just say, "This hour is yours." It was so tense. Eventually I just asked him if he would teach me how to regulate my emotions because I was concerned about how hormones might affect me. I even gave him the name of researchers who study emotion regulation. This, I thought, would give us something to do at our meetings. He said he'd look into it and we could talk about it next time. But next time it was obvious he didn't really read any psychological research. He just read something in a basic psychology book. I couldn't tell if he was really so dumb or if he just didn't care about me. But I was thankful when I found out I would go to a support group most weeks and only have therapy with James one week a month. Finally, I would get some real emotional support from others in my situation!

But I didn't find any support at these support group meetings. In one way, I was surprised how similar we all were; every member was transitioning from male to female. But we were also very different. Almost everybody else in the group was at least twenty years older than I was. But what was even more obvious was that I was the only member presenting as female! There was a time when I would tell my life story to other transsexuals by saying, "I was once in denial and I pretend to be a guy." To me, denial meant things like folding my hands behind my back to suppress my gestures. But this room was worse than a locker-room! Group members would intimidate me as they dominated the room. During breaks I couldn't join the conversations because I don't know about guns and cars and sports. And when I looked around I saw people with short hair, mustaches, and beards! It seemed so weird to me since I would shave so incessantly in a desperate attempt to clear my face only to be left bleeding. After these meetings I realized maybe I never really "pretended to be a guy." My denial was more like minimizing my girlish personality and trying to emphasize my boyish traits. Now I just don't supress any my traits; I'm still just as analytical even though it's not always my most prominent trait.

I only felt comfortable with one group member, Jerry. Jerry was the psychologist running the group and he was a very sweet grandfatherly man. Jerry once asked us, "Why didn't you come out sooner?" One member answered with a demonstration: "Imagine Madeline is me and I'm my dad. BAM! BAM! BAM!" This person mimicked hitting me. I looked to Jerry and I didn't say anything. I was too scared. I wouldn't challenge this person after overhearing a conversation before about how "I always carry my gun around here." I guess Jerry was scared too.

I could never understand how these group members ever suffered because of their gender identity. One member told of an incident to illustrate gender dysphoria: clearing the kitchen table with the women once instead of watching some TV show with the guys. And that person repeated this incident every single meeting! Did something else ever happen in this person's life? Another member described a bizarre dream about being a baby girl being lowered into pink flower filled water. Jerry, being intrigued, asked if I ever had dreams like that. "Uh, no, my gender issues happen in the actual world. The only 'water' issues I have are that I haven't gone swimming since puberty because it's just too overwhelming for me to take my shirt off in public!" Okay, so I didn't really say that. By that time I was completely disillusioned. All I actually said was, "no."

Driving home I would sometimes need to stop because my eyes were too filled with tears. I felt so isolated and I never felt I was allowed to ask to be excused from the support group requirement. The idea behind the requirement makes sense. Afterall, I'm asking for medicine which changes my entire body and couldn't be comepltely undone if I changed my mind. But I couldn't see how I would grow from this experience. This wasn't my first experience of feeling trapped. I just felt like a terrible person so why should I ever assert my own needs? I remember working at a pharmacy during high school. The owner was a loud mean spirited man who always told me how stupid I was for doing this or that wrong. He told everybody that and he constantly lost employees. I somehow felt that if I quit, I would have to explain why. And I couldn't handle a confrontation. I only left that job when I was 'excused' to go to college. I wonder if I would still be working there now if I hadn't moved away?

And now I felt trapped in a gender clinic. . Jerry asked us, "What was your first sexual experience?" A group member started to say something about teenage years but then nonchalantly added having sex in second grade. This person raped a little girl, a classmate, along with several boys in the class. My mouth just fell open and my eyes swelled with tears. I cleared my eyes only to see nobody else was even fazed! I felt so powerless to get away from this creep. I needed to shout, "How could you do that to another girl?" but felt powerless to the feeling I should always show support at a support group meeting. Holding it inside must have turned my skin pale as I tried to drive home. That was the night Lisa said, "You're as white as a ghost! What happened?"

During that week I came to feel I had a right to ask to be let out of the support group requirement. Whenever I feel I deserve something I start to feel it's selfish of me to expect something. But something made this so extreme I could address it. Maybe it was feelings reached an almost moral level? I told James about the event and asked; he said he'd look into it. At the next support group meeting Jerry kindly told me to "hang in there" because I was over halfway done the required number of group meetings. The next time I saw James he made excuses for the rapist like being young and impressionable! I couldn't control my disgust. James appealed to what I "must know" from developmental psychology. So I poured out in disgust an unending stream of developmental psychology against what I "must know." But James had another flash of 'insight' and asked why took this so personally? "Because I identify with women! I hear about these jerk guys raping her and I completely feel it from her view! Isn't my gender identity the entire reason I'm this support group anyway? And no women should be forced to support some rapist!" I didn't get out of the support group requirement but in our argument I asked for a new therapist. For the rest of the support group meetings I just sat there completely despondent. I was made to go because "rules are rules" but if the rule is going and there's no rule about talking, I didn't need to talk. Fortunately they still approved me for permission to start hormones.

After everything that happened, I began my therapy with Jessie with a lot of skepticism. It was hard to trust her with anything personal and I didn't really feel any big personal problem was important to discuss. Transitioning wasn't an issue. I was already full-time and I was starting to feel a lot better about myself. Maybe it was being honest with people about who I am, maybe it was being happy when people called me "she", or maybe it was forming friendships with other women. Anyway, I decided to just fulfill the requirement with her so I could move on. She seemed nice enough. And then something I needed help with happened.

I had been doing research under a professor, Deb, who knew me first as "Mitchell." She was the first professor at my current university that I told about. Her response was, "I have no intellectual objections to it." Which kind of tells you something about her. It's so different from when I told my first mentor in Psychology, Martha, who was always an emotionally supportive person. But now I was at another university and Deb was paying my assistantship and not kicking me out of her lab. So, even though personally and professional she didn't seem like the most admirable person, I felt like I had to be thankful just to be allowed to be there. Afterall, I that weirdo transsexual.

I ran Deb's lab for her and I did that really well. Her lab was a disorganized disaster. She had no other graduate students and her undergraduates were to scared of her unapproachibility to ask questions when they didn't understanf their assignments. But I turned it around and felt a certain joy over relating to our undergraduates and organizing a dozen studies including many I came up with for Deb. In addition to giving Deb study ideas for her theory, I came to her with a study idea I wanted to pursue for my master's thesis. It was a really great idea and it combined her interests with my interests. I'm very independent as a psychologist and, even if I never liked myself very much, I still felt like a competent scientist. Deb had very little input as a designed the method, conducted an extensive literature review, designed stimuli, ran the study, designed a coding instrument with undergraduates and refined it to reliability, and analyzed the data. But during that time Deb asked me to just have the adult study portion count as my thesis. She was always in a rush to get studies done. Writing a proposal took time and we couldn't run the study until I proposed. I didn't realize what she was doing until she sat me down to tell me she was taking first authorship! That's stealing! It's actually very clever stealing because if this was still officially my master's thesis, the American Psychological Association's rules explicitly say I must get first author credit on it. I guess she must have sensed my submissive personality and just believed I would acquiesce. And I did for about a week after she sat me down to inform me of my status.

But I couldn't do any work and my self-esteem was rising. It doesn't matter that I'm a transsexual. Maybe being a transsexual is weird? But I'm still likable and caring and thoughtful and lots of other things that should really matter! I do deserve my study and I don't deserve to be treated this way! Maybe it was first big act of self-liking. And I didn't feel selfish even though standing up to Deb would just be standing up for myself.

Deb became incensed. "How dare you say such a thing! After all I've done for you! The research is "us", not "you!" You're so selfish!" I guess I still didn't have enough self-esteem because after her scolding I fell apart and became completely apologetic even if I didn't know what for. And I started feeling like the worst, most selfish person in the entire world.

And that became the first really personal thing I spoke to Jessie about. She gave me her interpretations about it. And from those interpretations and my own introspection I started to see my low self-esteem and how I can't be assertive. That wasn't at all obvious to me even if it was changing! I mean, I did feel good about some aspects of myself. Like I feel I'm a competent scholar and I can assert myself in a classroom by raising challenging questions. But when it comes to how to relate to others as a friend or partner, I've never felt right. And maybe a lot of that stems from never being liked by boys because I was girlish and never being liked by girls because I was a boy? Regardless of what caused it, I started reading books about things like how to be assertive.

I realized how much trouble I have being assertive because it always makes me feel guilty for being selfish. Maybe that's even why I didn't ask for another therapist sooner? So Jessie and I talked about my events with Deb and lots of other smaller events soon after they happened which, somehow, always reduced to exactly the same thing. She gave a different interpretation of how to relate in each of those situations. But I didn't just passively accept her interpretation! I told her how wrong they seemed! But after talking more with Jessie and reading more I began to reflect and reexamine the events of each day differently. When I reflected about something that happened yesterday I could see how I'm allowed to have my own feelings and needs and desires. And after more talking and more reading something more profound happened. I started to actually feel differently about events while they were happening! I can see myself as likable and empowered and not selfish even when my needs conflict with others' needs.

Nothing miraculous ever happened. Therapy didn't cause this miraculous change in me; therapy was this slow process of my therapist 'recasting' interpretations of my experiences. Transitioning didn't miraculously change me. But being honest with the world and myself about my identity made me feel empowered and likable enough to face my other issues. But all together my experiences are miraculous to me. I used to consider suicide committing suicide at least once a week since third grade. But now I haven't hated myself enough to consider suicide in over a year!

I don't personally feel anybody should need permission for hormones or surgery. But, at the same time, we probably wouldn't consider transitioning is we weren't feeling a lot of distress. That's a reason to see a psychologist! I feel like we each lose an opportunity to have a psychologist, to work on the process of our life, when we become focused on their gatekeeper role, as though that's this fundamental endpoint.

But psychologists are also losing opportunities to help people when they focus on their gatekeeper role as though their goal is to make sure we appropriately reach this fundamental endpoint. Maybe someday we'll be seen for the process of growth we're going through rather than for what's supposedly a goal? Maybe someday psychologists will recognize our difficulties as self-esteem or assertiveness issues or depression or anxiety or whatever else makes us suffer in our lives. Maybe someday we'll just be diagnosed with, for example, depression. And since that depression was caused by an atypical gender identity the best long-term solution to our depression is to live true to ourselves by transitioning. Why does our gender identity need to be viewed as the bad 'pathological' thing about us?

Anyway, what I hope I can convey is that some psychologists can be very good for us even though some can also treat us very badly. And when they treat you badly, you shouldn't just suffer through them to reach your ends. You have so much to gain by finding a new therapist. If you're a transsexual, please don't assume you're therapist can only be there to block you. And if you're a therapist, I hope you'll consider your clients multi-dimensional people who deserve the right to make their own decisions and deserve to be treated as individuals with individual problems. When you make rules and "standards of care" for transitioning, you focus on an end rather than on growth. Even if two of us want the same goal, we won't grow the same way towards our goal. Please don't make 'rules' everybody has to follow because everybody is different. Was I really helped by weeks and weeks in a support group with people who scared and isolated me? Or, more importantly, can psychologists and transsexuals relate to one another as people, rather than as rules?

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