Guest post: Time to break out the decoder ring
Originally a comment by Your Name’s not Bruce? on Specialists.
In the therapy room, therapist and client draw on these different vocabularies and matrices of meaning, and our task is always to resist speaking one dimensionally; this is the reflexive work of therapy. The decision to recommend physical treatment for young people is then a genuinely shared but imperfect decision, involving the client, family, other professionals in the context of a wider cultural world, in which the meaning of trans is constantly shaped and re-shaped, but which rests on no foundation of truth. The therapist is not burdened with needing to be right or certain, but to offer a reflexive and thoughtful space to help clients explore the architecture and borders of their gendered world view. [Thinking postmodern and practising in the enlightenment: Managing uncertainty in the treatment of children and adolescents, Dr Bernadette Wren]
Time to break out the decoder ring again. Here’s what I get out of this:
We really don’t know what the fuck we’re talking about, but if we notice that we’re in danger of drifting towards concepts of “truth” and “fact”, we’ll move swiftly back to confusing obscurantism that cloaks our ignorance in a smokescreen of esoteric, multisyllabic verbiage. We might be making this shit up as we go along, but at least it will look like we’re doing something.
In the meantime, we’re going to screw around with drugs and “surgery” that might not even help you feel any better about yourself, but we’ll have made you and your family complicit in your own mutilation and permanent medico-psychological dependency. We’re making sure there’s plenty of blame to go ’round, and lots of others who aren’t us to share in it.
There is no end-point or goal in this process beyond the process itself. We don’t know what “transness” is, but we’ll leave no stone unturned in our search for whatever we end up deciding it might be, for the moment. Then it might mean something else, and we’ll chase that fleeting idea too. After all, it’s the journey that counts, and who better to travel with than those of us who’ve helped shape your entire self-image and world view. But if things go south, you’re as much to blame as we are.
And aren’t “reflexive” and “thoughtful” opposites? Are they being hastily deliberative, or are they cogitating immediately? Perhaps she was reaching for “reflective”, but thought it sounded to ordinary and inactive, and so grabbed for the next word in the “matrix of meaning.” One word’s as good as another when you’re making shit up, right?
H/t Night Crow
This is such a rich mine of bullshit that a single visit fails to bring up all its riches; you can fill a wheelbarrow, your pockets, whatever vessel you have. There is still more bullshit to mine and recycle.
I’m thinking that this person shouldn’t be involved in decisions involving “recommendations for physical treatment” for anyone. You’d think a physical ailment would be a prerequisite for physical treatment. Without a chain of physiological causation, or even a definition of “transness” fer chrissake, you’d think there would not be any grounds for touching the body at all. Given the piss-poor to non-existent record of meaningfully detailed, long-term follow-up of patients, what grounds are there for recommending such “treatments” in the first place? What other branch of medicine works like this, apart from, perhaps, cosmetic procedures? “Let’s try this surgery and see what happens, and how it works out,” is not the most confidence-inspiring suggestion one could make to a person suffering from mental distress (that has been, to a great degree) implanted by the therapist.
It really is. Thanks Night Crow! I particularly dote on “The therapist is not burdened with needing to be right.” Oh GOOD, that should work out beautifully.
YNnB, before I had my shoulder replacements, there was a substantial work up. The doctor didn’t just hear that my shoulders hurt and say, okay, if you identify as having shoulder pain, we must immediately change out your shoulder joints for artificial ones. No. The work up involved multiple experts, including my GP, physical therapists, and a referral to an orthopedist, who didn’t even talk about shoulder replacements until after doing an MRI. After that, he offered me several options, and I took cortisone shots for several months before embarking on the surgery (which was actually the only option which would get back anywhere near normal use for my arms).
No one said I needed pain-affirming surgery, or suggested we should validate my pain. They looked for the root cause behind it, which may not have been something that needed surgery. It may have just required me stopping doing certain things I shouldn’t be doing to my shoulders anyway (not that I was, but the doctor must consider all options). It was only after physical therapy didn’t bring relief, and only the cortisone shots brought even short term relief, that the doctor proposed surgery.
I would hope, if I were going to have my breasts removed, they would be as cautious. I wouldn’t be less of a woman without them, but it is a major surgery and should not be undertaken lightly.
But…if I were to tell my therapist that I felt like I was a man, the immediate response would be to accept my assessment, start calling me by “preferred” pronouns, rush me to hormone treatments and surgery. Even if I were three years old!
It could be argued, I suppose, that my shoulders are not part of my identity, but how does anyone know that? How can they read my mind and know that I don’t identify as “iknklast’s shoulders”? That it is not a crucial part of my identity to be “iknklast plus metal shoulders”? Or maybe they think I identify as “pain-free iknklast” and therefore the surgery was necessary to validate my identity? (I can’t identify as that; there are other places that can develop arthritis and hurt, and I have experienced much pain in those ways, but not at a high enough level to require drastic intervention.)
Rule of thumb: removing healthy body parts from a minor on their say so is a really, really bad idea.
Your team seems to have completely skipped over considering the context of a wider cultural world, in which the meaning of shoulder pain is constantly shaped. I’ve heard that this step is particularly vital. You might have been given the opportunity to have wings or flippers* instead of arms. Or, as a start, maybe just a bit of webbing between your fingers and toes and Voila! You’re on the road to Trans Otter iknklast! Fur, and tail, and dentition, etc. are details that can be sorted out later. We’ll try this and see what happens! Isn’t this exciting?
* Or reasonable facsimiles cobbled together from various bits of extraneous tissue scraped from other parts of your body, where they weren’t really doing anything useful anyhow. probably.
Since “gender” is something which has architecture and borders to be created and explored, the term “gender medicine” is inadequate. It’s more like gender art. That puts hormones and surgery in the same category as tattoos & body modification. Those aren’t “cosmetic procedures” if they reveal the depths of your soul and express who you really, really are.
Puberty blockers and top surgery then are no different than getting a face tattoo. Maybe a cat. If the child KNOWS they need it, believe them. It’s their journey.
I am amazed anyone would write this and yet think their position is well justified. This is the smoking gun, a plainly worded admission that the concept of trans is fantasy.
Elephantoplasty anyone?
https://www.youtube.com/watch?v=SnDm3HaCQeg&t=2s