Comments for The Know-it-all Men Of The APA: Ray Blanchard at http://ts-si.org , comment 0 to 2 out of 2 comments http://ts-si.org Thu, 28 Aug 2008 20:36:35 +0100 FeedCreator 1.7.2 http://ts-si.org/content/view/3206/995/#pc_758 Very well put Holly, though I would add one caveat for clarification regarding your statement: So when a patient presents WANTING medical sex reassignment it should be done immediately 'Wanting' and 'needing' are two very different things; each is distinct and seperable from the other. The HBS patient, through need, develops want (a strong, overwhelming desire to be corrected and made whole). Both are present. Autogynephiliacs, as another example (if we are to believe the theory) develop need through want. Given the urgency and impact of one, the other usually will follow. Want and need become indistinguishable to the ordinary discerning eye which is one huge reason why there is, and must remain, an HBS diagnostic process. As an HBS born woman myself, I understand the nature of HBS. I would have loved nothing more than to have been given a hormone prescription on my first visit and scheduled my surgery at the same time. But how responsible would that have been of my doctor? Without benefit of ascertaining my need, and based wholly on my expressed want, he could have been making a HUGE mistake. It has been my own personal experience to witness, on one very vivid occasion, a person who was compelled through 'want' to have SRS. From my perspective, as witness and participant in the event, this person exhibited not a single sign or symptom or need to have the surgery, though he displayed an energetic and compelling desire. I asked him why he felt so strongly about changing his sex and he responded, "Because I want to a woman." This response (which was soooooo wrong), and whatever condition drove it, is the reason there is (and should always remain) a vigorous attempt during every HBS diagnostic endeavor to include both medical and psychiatric evalutations to rule out other non-HBS causes, of which there can be many. The 'want' of the HBS patient must be driven by 'need', and it becomes the task of the diagnostician to rule out all but HBS-derived causes. In cases of early detection and treatment, i.e. children or pre-teens, this task may be compounded by atypical behavioral development, making professional assessment particularly challenging and necessary. That said, I cringe when I hear DSM-IV and GID discussed in the same sentence with HBS diagnosis. I wholeheartedly endorse the removal of GID from the DSM, it is a failed concept...'scaremongering' as you point out...that has lingered long past its perceived usefulness as a diagnostic tool. As we are all only too well aware, we are not crazy between our ears, we are crazy between our legs. (Sorry, crude analogy.) While I consider the DSM a discredited source for HBS diagnosis and treatment, what replaces it? Well, common sense immediately comes to mind. Competent psychiatric evaluations do not require the guiding light of a Freudian-esque liturgical text that misconstrues the nature of the very 'disorder' it describes. I think there are practices within the mind/brain sciences that are sufficient for ruling out psychoses. And isn't this all we need? We don't need to be told our minds are 'disordered', we need to confirm that they are not. The two concepts are totally different and we don't need the DSM to discern the truth of our condition. When other biological or psycho-social conflicts are systematically eliminated, only HBS remains. Regardless of future HBS diagnostic parameters, we need to get GID out of the DSM now so we can move into the 21st century where supportive biological/medical evidence of HBS exists. - Kelly Mon, 19 May 2008 13:04:48 +0100 http://ts-si.org/content/view/3206/995/#pc_739 Autogynephilia sounds to me like just another term for effeminate bisexual man. An attempt by the ex-gay movement to get in by the back door. HBS does seem plausible, but there's a simpler way (below). Two criticisms leveled at those who seek change are (1) If GID is depathologized there will be no treatment for transfolk and (2) No alternative is proposed. Firstly, it is mere scaremongering and blackmail to suggest GID must be kept -- medicine is evidence-based. Treatments proven to be highly successful in an overwhelming majority of cases are not going to go way merely because we don't understand WHY they work and some psychiatrist's theory is debunked. As Harry Benjamin himself said "Psychiatry is a discipline that lacks common sense". ---------------- Secondly there really is a practical alternative - consider this: ------------ (a) Since sex reassignment is PROVEN beneficial in people who WANT it, then the original (at birth) sex assignment must have been iatrogenic (sex assignment at birth is a medical thing and damaging medical things are called iatrogenic). ------------- (b)Iatrogenic damage should always be corrected when it can be and at the earliest opportunity. So when a patient presents WANTING medical sex reassignment it should be done immediately in medical records since it is PROVEN beneficial to reassign those who WANT reassignment. At that point there is no Transsexualism, GID or whatever since there is no cross-gender identification in the new gender. Treatment on a same-sex basis follows the same as for "non-trans" people with gynecomastia, vaginal agenesis, estrogen or testosterone hormone deficiency etc. Equality, not special treatment is all transfolk want, for example transmen get breast reduction on the same terms as non-trans men who need breast reduction. ----------- The emphasis of the words PROVEN and WANT reflects the fact that medicine for transfolk should be, but presently is not, EVIDENCE-BASED and PATIENT-SATISFACTION driven. ----------- Respectfully, there is a better way forward beyond either GID or HBS, it requires removing transgenderism from the DSM as was done with homosexuality a generation before. And not letting it back in by the back door. Gay men have a lot to fear from these DSM committees wo are out to "cure" them even though they publicly say the contrary. - Holly Sat, 17 May 2008 11:10:11 +0100