9. Superficiality: passing concerns
Assessing psychiatrists will necessarily take a sex change applicant's appearance, voice and mannerisms into account when making their decisions.
Some may believe this to be superficial and discriminatory. At worst, focusing too much on superficialities can result in "rewarding" stereotypical patient behavior - always wearing dresses and heels, obsessing over cooking and homecrafts, seeking a subservient role in relationships with men, and so on.
It is essential that sex change applicants are not encouraged to replace one "mask" with another. Ideally, this should be a journey where the applicant is seeking to be as true as possible to his/her true self - be that in the original, or opposite, gender. Nonetheless, superficial concerns are not trivial when it comes to transsexualism; they can mean the difference between contentment and disaster.
A person who looks and sounds the part will not only have an easier time of
it as a transsexual woman, but may have less to lose (at times, literally [sic])
than their less feminine peers. Changing sex may resolve some issues but it
is not a cure-all, and unresolved psychological problems may well be exacerbated
by the pressures of transition.
Bear in mind that some very attractive and "passable" transsexuals have later come to later regret their decision to change over, while some very masculine TSs have been content and productive in their new role. There is no simple formula.
Therefore all factors need to be balanced against each other. For example, a realistic and stable "masculine" autogynephilic transsexual with an established career in a tolerant workplace and reliable family or other relationships may well have a better chance of making a workable life for herself as a woman than an unstable feminine type with unresolved psychiatric issues and who lacks emotional support.
Nonetheless, an attractive and vivacious transsexual will probably have a better
chance of finding herself supportive others than a masculine transsexual with
no hope of even coming close to "passing".
"Passing" can help but it isn't the be-all and end-all
While psychiatrists logically tend to be more relaxed in other criteria with feminine TSs than masculine ones, "passing" should never be a sole criterion. Physically androgynous features do not guarantee a feminine psychology.
Male psychiatrists need to be on guard that they do not give "an easy ride" to applicants who they find sexually attractive or punish those who look like "men in dresses". By the same token, female psychiatrists need to ensure that they do not punish transsexuals who may appear to be "overdoing it" and attempting to be too stereotypically feminine.
On the other hand, not all transsexuals want to pass as genetic women. In some cases where the applicant does not want to pass, an assessing psychiatrist may need to determine whether there is an unhealthy level of narcissism, exhibitionism or masochism present that requires further exploration. However, some transsexuals hold strong political or ideological viewpoints in regard to honesty, visibility, and the need to change societal attitudes. Therefore therapists should not punish people for non-conformity to standard female roles.
It is not rare for these kinds of people to actually relish and embrace their difference to the norm; they tend to be very strong individuals, capable of giving as good as they get in the hurly burly of transsexual discrimination. So there is a danger that conservative therapists may misinterpret radicalism as psychopathology, simply because they cannot relate personally to their patients', possibly radical, viewpoints and approaches.
Therefore therapists need to ensure that they themselves do not hold any
hidden biases that could interfere with their professional objectivity.
By imposing their own morality and ideology onto what are otherwise healthy and lucid people they have the potential to inadvertently cause at the least inconvenience and, at the most, significant harm.
Proposed new categories of transsexual
As discussed in Chapter 3, Dr Blanchard's categorization of transsexuals is too simplistic to be credible or useful in itself. While his autogynephilia hypothesis is a useful contribution to the area, opening the door towards cognitive treatments which may help autogynephilic individuals achieve greater intimacy in their lives, it is of limited use as a transsexual assessment tool.
With the level of diversity within the so-called trans-community (which is generally just a disparate group of individuals), it is too simplistic to break transsexuals into two groups: homosexual/primary type" and autogynephilic/secondary type.
In order to render what is a useful addition to transgender analysis more practically
functional, the classification system should be expanded and redefined.
A proposed expansion of the theme may go as follows:
|Type 6||Masculine||Feminine||Tough Nellie|
|Type 8||Masculine||Androgynous||Soft butch|
For the above table to imbue meaning to the classification process it is necessary to define "androgynous", "feminine" and "masculine". Of course, gray areas will exist between categories. For example, "androgynous" will necessarily include both feminine-leaning and masculine-leaning androgyny. The below definitions should only be seen as a rough guide, not a definitive or black-and-white decree. After all they are only stereotypes.
The suggested colloquial names are simply a means of easy referral through evocative language that "paints the picture", and no offence is meant.
Feminine mentality (note that the stress of seeking help and the dynamics of assessment may skew the manner in which an applicant presents)
Masculine mentality (note that the stress of seeking help and the dynamics of assessment may skew the manner in which an applicant presents)
Physical feminine and masculine factors
The above table was constructed with the view that sexual orientation in the assessment context is relatively unimportant. Once severe mental illnesses and disorders have been eliminated it is more important to consider the patient's physical and mental gender and social environment with a view to the following lines of inquiry: