Why do we need a psychiatrist's referral for gender treatment?

Alice Purnell (Counselling Psychologist)


Issue 38
Summer 2007

The Standards of Care have placed psychiatrists as the central gatekeepers for referral for hormone or surgical treatment of trans people.

They jealously guard this money making, powerful gatekeeping role.

Once homosexuals were in the same medicalised straight jacket, seen as perverts, inverts and the walking wounded of Freud and Hirshfeld and Havelock Ellis . . . sad curiosities in a world where eugenics were in vogue.

The trans situation is an aspect of identity, not a mental illness, perversion, aberration or inversion. It can not be prevented or cured. It can be sympathetically treated . . . if only!

This involvement of the psychiatrist is as THE JUDGE AND JURY is to protect the client from her/himself and the surgeon from litigation. Now the Standards suggest that one psychiatrist is necessary ? to exclude the possibility of comorbidity ? that is to

say a mental illness, and a second equally valid referral from a psychologist, counsellor, doctor specialising in gender issues is required.

It is my belief that a client should ALWAYS receive counselling, not only to help the client clarify her/his position and situation and thinking and the consequences of these steps. A counsellor can not be a gatekeeper, but although the trans person invariably seems to go through agonies of doubt and indecision and often shame there are real issues around partners, parents, siblings and children as well as passing, employment and acceptance.

Perhaps it is time the NHS and the private sector adopted this view and approached trans in a more person centred holistic way. It is also time the trans person took personal responsibility for the actions and decisions she or he may have taken or not taken.

Informed decisions by rational people with adequate counselling might avoid the gulf in care which prevails.

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