Psychological Development Beyond Sex and Gender Realignment

Dr. Tracie O'Keefe, DCH

Gendys Conference, 1998

Nearly all the emphasis of gender and sex realignment treatment, in the past, has been placed upon the physical changing process. This is often seen by many professionals and patients as reaching its ultimate conclusion with genital surgery. For others, however, post-transition may not include genital surgery but a point at which they have reached a certain partial physical transformation and social change that is comfortable for them. Any psychological or psychiatric interviews that may have been carried out during this process are often seen by many professionals and patients as test procedures which the patient will either pass or fail.

If the patient passes the test mentality of the interview then the clinician may recommend the patient to undergo the physical changes they seek through hormone therapy and surgery. A great number of patients feel they are in danger of not passing such interviews and therefore may be hostile to the clinicians and withhold information, edit the truth and even tell a complete lie. Some of the responsibility for this must be with the clinicians involved, because in the first part of the clinician and patient contract there should be an agreement with the patient that they can be safe in telling the clinician absolutely anything. However, because patients are in a high state of anxiety when they arrive, apprehensive, and afraid of the test mentality patients themselves often seek to tell the clinicians what they think they want to hear.

The danger with patients' truths not being discussed is that the patient can then begin to start what it called "doing the rounds," where the patient goes to several doctors, not listening to what they are saying for fear of failure.

Just recently I found myself in a room with six other post-transition transsexuals and transgendered people at a party. Into the room came a biological male who knew us all and he asked how come everyone in the room had got their treatment. One person looked at all the others asked if she should tell him and then casually replied, "Oh! That easy, eventually we all read the same book so we knew what to say."

Post-psychological development is generally the farthest thing from the sex and gender patient's mind when they are in the process of transition, which can be a very "now" orientated experience that demands all their attention in coping with the present. One might call it the emergency of the moment because transpeople are generally so unhappy about their physical selves that the drive to remedy the situation takes over their lives.

It would be foolhardy to pretend that life as a transsexual or transgendered person is anything less than extremely difficult as well as glorious both pre- and post-transition. After having gone through what may be tantamount to a total physical refit then one has to deal, from time to time, with what can be devastating prejudice, ignorance, injustice, abuse, violent attacks upon both the person and their right to live as they wish. And that's only to get your tailor to button the blazer on the other side.

Some transpeople choose to be open and public about what they are and others only feel safe enough to live their lives secretly, telling no one of their personal history. Either way can, at times, be precarious and stressful and despite all the successes achieved by a post-transition individual, the lack of humanity displayed by some people can be deeply distressing. Fortunately the majority of people in life are kind, but the transfluid person also needs to be psychologically and philosophically equipped to deal with the drivers that drive on the wrong side of life's road.

Of the six people that had been in the room at the party with me, two had been alcoholics, one a heroin addict and spent several years in a monastery, one suffered from chronic depression, one had had three children taken away by the previous partner, and one had a heart attack through high anxiety, having been shunned by their entire family. Although these people had survived their experiences and triumphed over life's adversities they all agree that with the right guidance their lives could have been much easier.

April Ashley spoke of how she felt she was driven to alcoholism by continual harassment by the press and the injustices of the British legal system. Renee Richards suffered from dreadful attacks from the press, simply because she wanted to play tennis. Stephen Whittle told me how he woke up to find himself in the Sunday newspapers without him even having been contacted by them to ask for a comment, something I have experienced myself. Dana International, after winning the 1998 Eurovison Song Contest, received death threats from extreme right-wing Jewish groups. Brandon Teena, like many others, was killed, simply for what he was - a sex, gender and sexuality fluent individual.

The catalogue of unnatural pressures that can be brought to bear upon the psychological health of the transsexual, transgendered, or sex and gender fluent person of any kind need not unnecessarily effect them severely or long term. For the first generation of high-profile sex, gender and sexuality fluent people who arose internationally in the 1960s there was less specific help available than there is today. Many of these people had to learn their survival and prosper lessons through the 'hard knocks' school of life and have come through to achieve excellence in their personal life, careers, and intellectual actualisation, in spite of or because of the obstacles placed in their path. Some never made it as the pressures of society's rejection were too much for them and they committed suicide, had short lifespans due to stress-induced illnesses, low quality of life or were hounded and frightened into a reclusive lifestyle.

Later generations do not now have to work out their paths with such confusion and disadvantages, as modern cognitive behavioural techniques and the learnings of our sisters, brothers and others can help everyone cope with life situations more easily.

Where many people who are post-transition get into trouble is when they adopt the mindset of "I am finished now . . . and I can live my life just as every one else and I can stop thinking about what I am and remain where I am." Therein lies the trap of complacency, lack of evolvement and road to psychological decline. A person is what they are and to be in denial about that can rob them of valuable resources that they needs to survive as a personality.

Men and women think quite differently - that is not segregation or prejudice, it is nature. Men are more small-chunk thinkers, analytical, narrow focused, goal orientated, more aggressive than women, fraternity based, and literal. Women tend to look at the big picture, are more nurturing, long-term thinkers, time givers, more patient, less aggressive and are involved in the fight to define their own status in a post-industrial society. If a person changes their body to match an internal set of feelings about their core identity, then there is also a need to change their psychology to match life expectancy, aspirations, dreams, achievements, social behaviour and mental development. Not to do so can arrest personal development, happiness, contentment and withhold sex, gender and sexuality resolution.

There are only two motions in the physics of nature: one is growth and the other depletion. Maintenance at the status quo is an illusion. Physical, psychological, social and spiritual growth is the road to being a healthy and happy post-transition sex, gender and sexuality fluent person. If the environment, family, work and society does not allow that to happen, then they must be changed.

Each of us as individuals must hold ourselves responsible for contributing towards an ever better self and world. No matter how small that contribution may be, it is our key to self-empowerment, and a guarantee against suffering the slings and arrows of outrageous fortune. Whatever the drawback the post-transition person encounters they must continue to develop the kind of mindsets that equip them to deal with that situation and move on to a greater and more satisfying sense of self.

There is also the personal journey of discovering what makes a man a man or a woman or woman and everything in-between, and how that relates to the post-transition person. Learning to accommodate and negotiate the differences, which can be seen as blessings or curses, according to perspective. How to survive in a man's world and to deal with the 'wimmin born as wimmin' brigade who choose to exclude anyone who even vaguely threatens their separatism. How to live your life as a sex and gender you were not trained for as a child and discovering a sexuality that transcends the "what bunny rabbits do" biology lessons of early school years.

Altering the body to the mind is not the solution for the sex, gender and sexuality dysphoric, but for some people altering the body and the mind can be a way forward that will give maximum pleasure and satisfaction in life. Too many people have come out of gender realignment programmes punch drunk by the process itself and unsure quite what they are supposed to do next. This reminds me of a philosophy adopted by the charity Oxfam, "Give a starving person food and you will feed them for the moment . . . teach them to farm in a better way and they will feed themselves".

For the vast majority of people who undergo some form of realignment treatment, through choice as well as compulsion, it transforms and changes their lives to such an extent that they achieve a higher quality of life. Those patients can also ask for even more than a vial of hormones and the cut of the surgeon's knife both during and after that treatment, so that they may achieve their own sense of excellence.

Dr Tracie O'Keefe DCH is a clinical hypnotherapist, psychotherapist, and counsellor formerly practising at The London Medical Centre, Harley Street in the UK. Now the Director of the Sex, Gender, and Sexuality Identity Clinic, at The O'Keefe Institute, Sydney, Australia.
In asociation with Katrina Fox, she is the author of a number of books, details of which may be found on her website:
Their latest publication is Finding the Real Me: True Tales of Sex & Gender Diversity, published by Jossey Bass Wiley

Citation: O'Keefe, T., (1998), Psychological Development Beyond Sex and Gender Realignment, GENDYS '98, The Fifth International Gender Dysphoria Conference, Manchester, England.
Web page copyright GENDYS Network. Text copyright of the author. 15.03.02 Last amended 28.01.04