Psychology and Transsexuals

Le qualificatif "ordinaire" appliqué à la folie peut sembler paradoxal, eu égard à son caractère extraordinaire. L'antinomie n'est toutefois qu'apparente dans la mesure où la folie, souvent partie prenante de la vie quotidienne, peut être aussi familière que déroutante. Les auteurs de cet ouvrage, psychanalystes, psychologues et psychiatres - universitaires pour la plupart - ont fait le point, à l'occasion d'un colloque, sur les aspects familiers de la folie. La folie ordinaire peut ainsi être perçue dans son rapport à la temporalité, selon le temps qu'elle occupe, ou bien la période de la vie où elle apparaît. Elle peut être vue à travers son reflet social, restant ordinaire tant que le regard de l'autre n'a pas pris acte du désordre dont elle est porteuse. Elle peut encore être appréhendée sous d'autres prismes : celui de l'environnement immédiat, celui du rêve ou de l'acte créatif. La question en jeu demeure celle du rapport entre l'espace d'ombre dans lequel la folie ordinaire se développe et la supposée clarté de la normalité.

I present in this paper some of the ways the Acampamona, camping of "healing and
deliverance" of transvestites, organized by the evangelical mission Salvation, Love and
Deliverance (Salvação, Amor e Libertação / SAL), in conjunction with your anonymous ministry transvestites conversion, operates its religious / sexual / gendered discourse, and as such speech acts in connection with the agency itself transvestites, former transvestites and ex-extransvestites in their conceptions of the connection between body and soul.
Keywords: "Healing and deliverance" of transvestites, transsexuals and homosexuals;
gender, sexuality and religion; former transvestites and ex-ex-transvestite.

Trans Women Cannot Achieve Cis Female Breast Appearance through HRT, but the failure of the Transition Remediation is Ignored by Trans Organizations who do not Press for adequate Medical Insurance Coverage.

Researchers followed 229 people transitioning from male to female for one year after they started taking what's known as cross-sex hormones. Only 21 of the trans women attained a bra size of an "A" cup or larger after one year of hormone therapy, the study found.

Transsexuality is classified as a disorder by the Diagnostic and Statistical Manual of Mental Disorders, which shapes trans-specific healthcare policies worldwide. This paper addresses the discursive effects the imposition of a psychiatric diagnosis impinges on the daily life of Brazilian gender identity clinics. It aims to assess the epistemological and political dynamics which make the global circulation of this manual possible and to understand the socialization trajectory that leads to the materialization of diagnostically driven, rehearsed narratives in a gender clinic in the global South. I argue that the globalization of medical epistemologies and their textualities homogenizes transsexuality and impels transsexual individuals and their doctors to engage in textually constrained interactional performances which make the construction of a trusting healthcare relationship virtually impossible. The paper, thus, discusses how a sociolinguistics from the South may contribute to foster (trans)autonomy in healthcare settings where epistemological imbalances produced by ex-centric, globalized textualities constrain possibilities for agency.

Young transpersons need to be informed about sexual health. Often health care givers only focus on their identity insecurity. Adult transpersons are at en extremely high risk for STI and HIV. Our youth clinic has investigated the 31 young persons with gender dysphoria who visited us during 2015.

A meaningful human life connects with things of value outside of itself and provides fulfilment for its bearer. For humans, fulfilment depends upon self-discovery, which requires a process of conjecture and refutation, a willingness to question and criticise received views and to welcome challenges and criticism to views that one holds dear and that may seem to be part of one’s identity. I discuss some practical limitations on that self-discovery process, particularly our proneness to self-deception. I offer a personal case-study to illustrate how poor self-knowledge due in part to self-deception may bring about a descent into depression and anxiety. When one pursues an organised project of self-discovery, living one’s life is intertwined with drafting a philosophical autobiography that gives an account of one’s progress in discovering the type of life that one finds most fulfilling.

Übersicht: Das Modell der Informierten Zustimmung bietet Trans*-Men-schen einen alternativen Zugang zur gegengeschlechtlichen Hormonbehandlung. Um die gegengeschlechtliche Hormonbehandlung beginnen zu können, muss nach Maßgabe dieses Modells keine Psychotherapie durchgeführt werden. In der Folge reduzieren sich – je nach Gesundheitssystem – finanzielle Belastungen sowie Verzögerungen beim Zugang zu geschlechtsangleichenden Behandlungsmaßnahmen. Statt einer Fachkraft für psychische Gesundheit ist die primäre Gesundheitsfachkraft für das erste Erfassen der psychischen Gesundheit verantwortlich, und stellt fest, ob der_die Klient_in eine informierte Zustimmung zur angestrebten Behandlung geben kann. Das Modell der Informierten Zustimmung wird im Callen-Lorde Community Health Center seit mehr als zwanzig Jahren angewandt. Das Modell integriert die Trans*-Gesundheitsversorgung in die allgemeinmedizinische Grundversorgung und betont auf diese Weise deren ganzheitlichen Charakter. Das Modell der Informierten Zustimmung steht im Einklang mit der 7. Version der Versorgungsempfehlungen der World Professional Association for Transgender Health. Eine Überprüfung der Daten von N = 1714 Patienten für einen Zeitraum von zwei Jahren ergab weder ein Bedauern der Entscheidung noch eine Umkehr geschlechtsangleichender Operationen.

Abstract
Objectives. – At the end of the French evaluations and the international revision concerning the standard
of care (SOC) for transsexual and transgender patients, the interest to propose psychotherapy as a
supplement to the sex reassignment therapy (SRT), was unanimously recognized. But, it is clear that the
works concerning this subject are rare, and that the methods of this proposal remain ill-defined. So,
many questions remain unsettled such its frame, modalities, methods, objectives and its place and
relation with or in the SRT, as well as on the theoretical models on which these psychotherapies base
themselves. The goal of this article is therefore to present the conception and the evolution of this
psychotherapy in the various versions of the standards of care, as well as the theoretical approaches on
which the current model is established, then to expose the questions which according to us, still persist
concerning this subject, as well as our remarks and proposals relating to the latter.
Materials. – At start, with the first SRT in the 1950s, this practice and his combination with
psychotherapy suffered from a strong ethical but also partially ideological, controversy. An important
number of medical practitioners met around the endocrinologist H. Benjamin to establish the first
standards of care by SRT for transsexual, and defended that this treatment was the only one that could
relieve the problem of gender identity of the transsexual patients. In the opposite, some psychiatrists and
psychologists were in strict opposition to this treatment and postulated that transsexualism was a
psychotic disorder which needed to be cured only by psychotherapy. In spite of this fist hard
confrontation, it seems accepted today that the SRT can bring beneficial effects, and that an additional
psychotherapy is maximizing the prognostic of this treatment. So, in the present, in the SOC, the goal of
psychotherapy is ‘‘to help transsexual, transgender [. . .] individuals achieve long-term comfort in their gender identity expression. . .’’. However, the question of the modalities, forms and theoretical fundaments
stay still not well defined.
Results. – Today, the SOC recommend that psychotherapist actively collaborate and participate to the
decision-making reunions of the SRT’s professional team. In the same way, the role of the
psychotherapist is described very near of a role of coaching and counseling, to optimize the SRT’s
final result. In complete consistency with these points, the theoretical models exposed are unconflict and
unpathologized models which postulate that the true gender of patients could not be expressed because
of social stigmatizations which can make them present a gender dysphoria. But, these points of view are
more controversial that it’s appearing.
Conclusions. – The more controversial point concerns the narrow collaboration and the active
participation of the psychotherapist with the SRT’s professional team and its potential consequences.
In that configuration, a collusion of the different therapeutic spaces can take place. The patients can feel
unease with this particular therapeutic relation. In the same way, on the theoretical level, the conflict is a
primary fundament in a psychodynamic perspective, but it also can be considered as a normal element of
the therapy and the SRT’s way. For all of those remarks, the question and works on the psychotherapy in
complement with the SRT have to be continued.

Résumé
À l’issue des évaluations françaises et internationales concernant la prise en charge des patients transsexuels (et transgenres), l’intérêt de proposer une psychothérapie en complément de la transformation hormonochirurgicale a été unanimement reconnu. Force est de constater que les travaux concernant ce sujet sont rares, que les modalités de cette proposition restent mal définies et que sur ce sujet des questions restent en suspens. Cet article propose donc de présenter la conception et l’évolution de cette psychothérapie dans les différentes versions des standards de soins, ainsi que les approches théoriques sur lesquelles le modèle actuel est fondé, puis d’exposer les questions qui persistent selon nous, concernant ce sujet, ainsi que nos remarques et propositions se rapportant à ces dernières.

Les techniques projectives sont en plein essor. Elles sont largement utilisées dans le travail quotidien avec les patients et diffusées dans les institutions. Mais elles sont aussi de plus en plus employées dans le cadre de la recherche en psychopathologie psychanalytique. Nombreux sont les étudiants en psychologie et les psychologues à se former à la méthode d’interprétation psychanalytique des tests, promue en France par les membres de l’Ecole de Paris (D. Anzieu, N. Raush de Traubenberg, V. Shentoub, R. Debray, C. Chabert, C. De Tychey, M. Boekholt) et leurs successeurs. Comment améliorer la compréhension des troubles ? Comment améliorer les dispositifs de prise en charge ? L’utilisation des épreuves projectives offre au chercheur une opportunité unique, celle de pouvoir mettre à l’épreuve ses hypothèses auprès d’un large échantillon de patients. Il est important de souligner que ces apports sont complémentaires, et non pas antagonistes, d’autres paradigmes conceptuels (échelles d’évaluation ou des questionnaires de personnalité établis sur la base du DSM-5). Cet ouvrage réunit une sélection de travaux. Chacun d’eux montre la façon dont les méthodes projectives s’insèrent dans la recherche actuelle : en psychosomatique, en psychopathologie, dans les domaines des agirs et des addictions. Dans chaque domaine clinique est illustrée la pertinence de l’utilisation de l’outil projectif dans le contexte de la recherche (opérationnalisation des hypothèses, dégagement d’indicateurs et des résultats cliniques). L’un des premiers livres sur le sujet.

Many comparative studies have evaluated the behavioral and functional differences between the male and female sexes. Fewer studies have evaluated the gender identity in addition to these findings. This literature review attempts to provide an outline of the most commonly referenced behavioral differences between the male and female sex as well as explain the neural mechanisms associated with the behaviors. Special attention will be allotted to studies with conflicting methodologies and results as a tool to illustrate the gaps in knowledge required for simple diagnostic methods of empirical evaluation required for concrete evidential support for transitioning transsexual patients. Furthermore, regardless of differences in participant size, or conflicting results of behavioral, and neuroimaging studies, the role of hormones in the formation and regulation of the brain does establish unchanging gender identity prevalent throughout a lifetime. The role of hormones as a prevalent factor in the establishment, maintenance, and possible modification of brain structure and corresponding behavior is imperative in the identification for the early transition of transsexual youth.

Übersicht: Das Modell der Informierten Zustimmung bietet Trans*-Men-schen einen alternativen Zugang zur gegengeschlechtlichen Hormonbehandlung. Um die gegengeschlechtliche Hormonbehandlung beginnen zu können, muss nach Maßgabe dieses Modells keine Psychotherapie durchgeführt werden. In der Folge reduzieren sich – je nach Gesundheitssystem – finanzielle Belastungen sowie Verzögerungen beim Zugang zu geschlechtsangleichenden Behandlungsmaßnahmen. Statt einer Fachkraft für psychische Gesundheit ist die primäre Gesundheitsfachkraft für das erste Erfassen der psychischen Gesundheit verantwortlich, und stellt fest, ob der_die Klient_in eine informierte Zustimmung zur angestrebten Behandlung geben kann. Das Modell der Informierten Zustimmung wird im Callen-Lorde Community Health Center seit mehr als zwanzig Jahren angewandt. Das Modell integriert die Trans*-Gesundheitsversorgung in die allgemeinmedizinische Grundversorgung und betont auf diese Weise deren ganzheitlichen Charakter. Das Modell der Informierten Zustimmung steht im Einklang mit der 7. Version der Versorgungsempfehlungen der World Professional Association for Transgender Health. Eine Überprüfung der Daten von N = 1714 Patienten für einen Zeitraum von zwei Jahren ergab weder ein Bedauern der Entscheidung noch eine Umkehr geschlechtsangleichender Operationen.

The psychomedical literature of transsexualism, which began after Hamburger et al.'s announcement of Christine Jorgensen's sex reassignment some 52 years ago, consists chiefly of clinical reports and studies written by presumably nontranssexual individuals. It is a literature which has been historically based on a number of unfounded assumptions: that those with gender identity disorder (as it is now called) are mentally disturbed; that their destinies are best determined by mental health professionals; that only those who are profoundly unhappy in their birth gender should be allowed access to body-changing medical technologies, and then only after passing various tests required by psychotherapists; and that body-changing medical technologies should be used only in the service of altering bodies to resemble as closely as possible those of the "other" sex, with no intermediate states allowed or even conceivable. Only in the last few years have new writings begun to challenge these assumptions.
The assumptions which have driven the literature arose from the often sexist and homophobic attitudes of researchers and clinicians [Kessler & McKenna, p. 118] and have colored both public and private perceptions of transsexuals and transsexualism and set the course for the literature itself by determining not only the research questions asked, but the ways in which the resulting data have been interpreted. The biases of researchers are often kept overtly out of their papers, but are made clear in their conversations with other professionals. [Raymond, 1979] Cautionary voices of anthropologists, feminists, occasional clinicians, and transsexual people themselves have been virtually ignored. Bolin, p. 63] Questions of experimenter bias, subject selection, and the power dynamics of the client-caregiver relationship have not been addressed. Until recently, the voices of transsexual and transgendered scholars were entirely absent from the discourse [Denny, 1993]. Consequently, the psychomedical literature of transsexualism is largely pejorative, tending to blame and otherwise stigmatize transsexuals not only for their very transsexualism, but for shortcomings in research design and treatment. When the assumptions underlying this literature are understood, the literature's failing can be seen to lie not so much in the inadequacies of transsexuals themselves as in the shortcomings of the system which arose to treat and study them, and in the disenfranchisement of transsexuals themselves, who have been considered unworthy of contributing to the literature. [Green, 1997]
Much of the existing literature, although technically accurate, addresses in detail questions which no longer seem relevant. For instance, there have been any number of studies designed to determine the ways in which transsexuals vary from controls (i.e., "normal" individuals). A great deal of effort has been expended in attempts to "manage" transsexualism and transsexuals themselves. Meanwhile, other, more important, questions remain unaddressed. We do not particularly need further studies about the relative performance of transsexuals vs. control groups on the scales of the MMPI; we need studies which will define a new literature which is less bound to the notion of the inevitability of genital surgery and Ken and Barbie stereotypes of masculinity and femininity, which empowers transsexual people rather than degrading or stigmatizing them, and which asks new questions relevant to a new century.

Purpose
The purpose of this research project was to obtain a global picture of osteopathic dysfunctions found in transmen who have undergone surgical gender reassignment, by studying more specifically the repercussions of mastectomy, genital reconstruction and testosterone.

Methodology
Thirty-seven participants were recruited, aged 21 to 54 years old, then divided in three groups of 12 transgender men, 12 cisgender women and 13 cisgender men. Data collection was done through a one-on-one interview with each participant, using a general health survey, as well as questions regarding the medical aspects of transition for the trans* participants. A series of 43 osteopathic tests and evaluations were performed on each of the 37 participants.

Results
Our study shows a significant number of repercussions on the superior cervical spine, cervicothoracic area, soft tissue of the neck and thorax. The pelvic mobility is also affected, whether through the bone structure or musculotendinuous elements. Visceral testing revealed changes in the mobility and motility of organs, and cranial tests showed a disturbance felt throughout the entire craniosacral axis.

Conclusion
Mastectomy, hysterectomy, testosterone and high levels of stress bring a tremendous amount of disruption in trans* subject’s homeostasis. With its holistic approach, osteopathy allows the practitioner to bring harmony between the body and soul, to care for the person while respecting their authenticity, and accompany them toward global wellness, and is therefore a treatment of choice to support trans* folks in their transition process.

Some authors in disability studies have identified limits of both the medical and social models of disability. They have developped an alternative model, which I call the ‘composite model of disability’, to theorise societies’ ableist norms and structures along with the subjective/phenomenological experience of disability. This model maintains that ableist oppression is not the only source of suffering for disabled people: impairment can be as well. From a feminist, queer, trans activist, anti-ableist perspective and using an intersectional, autoethnographic methodology, I apply this composite model of disability to trans identities to consider the potentially ‘debilitating’ aspects of transness. I argue that transness, like disability, has too often been perceived from two perspectives, medical or social, without the benefit of a third option. From a medical perspective, transness is reduced to an individual pathology curable with hormonal/surgical treatments, a conceptualisation that erases structural oppression. From a social point of view, transness is conceptualised as a neutral condition and variation in sex/gender identity. In this model, structural oppression (transphobia/cisgenderism) is seen as the only cause of ‘trans suffering’. I argue that, just as the medical and social models of disability provide limited opportunities for reflection on the complex experience of disability, medical and social understandings of transness, respectively, are insufficient to describe the complexity of trans experience. I explore the possibilities presented by the application of a composite model of disability in trans studies. By problematising both cisgenderist oppression and acknowledging trans people’s subjective experiences of suffering through some of the debilitating aspects of transness, this composite model avoids the pitfalls of the medical and social models. The application of tools from disability studies to trans issues uncovers cisnormativity in disability movements and denounces ableism in trans movements. This will, I hope, solidify alliances between these communities and fields of study.

Link: http://link.springer.com/article/10.1057%2Ffr.2015.21