|Introduction| 

Introduction

Management of GID

Two radically different approaches are generally taken to provide patients with relief from the symptoms of gender dysphoria. One is psychotherapy, which seeks to bring the patient’s thoughts and feelings into harmony with their biological sex. The other is sex modification, which utilizes hormones and surgery to alter the patient’s physical body to match their self-perception.

The treatment approach taken depends not so much on the patient’s presenting signs and symptoms as it does on the viewpoint taken by the treating physician as to the cause of the condition in a given patient{1}. Those who take the psychotherapeutic approach view transsexualism as being a mental health issue{2} whist those who recommend physical intervention usually prefer to view the transsexual condition as either a physiological disorder or as a crystallized gender identity transposition, irrevocably fixed during a "sensitive period" in childhood{3}.

Options availaible in the management of GID

There are in fact a range of options available to persons wishing to resolve their gender conflict. They may choose to integrate cross gender feelings and attitudes into the role congruent with their natural sex, or live full or part-time in the role of the opposite sex. In this role one may choose to have no medical intervention, take hormones and/or have Sex Reassignment Surgery, which is commonly known as the ‘sex-change’.

The prefered option in the management of GID

In response to the phenomenon of Gender Identity Disorder we must argue very strongly against interventions that encourage those who suffer to embrace an identity which is in opposition to their anatomical sex. We must present the idea, based on the available research into this phenomenon, that physically living in an identity other than the ‘created’ one, will not resolve issues that are psychological, emotional, and social.

The words of Larry Crabb, a psychologist, mirror this sentiment, "A common solution to the problem of inescapable pain in our masculine and feminine souls is to anaesthetise the part of our being that has been most deeply hurt. We therefore cut from awareness what is most thoroughly male or female about us...reducing ourselves to the safer existence of neutered personhood." (Crabb, 1991:145)

Those who promote ‘medicated’ transsexuality as the answer to the agony of gender identity and role confusion, only serve to prolong the suffering, offering a ‘band-aid’ solution to the problem. In supporting those wishing change of sex we are doing an incredible dis-service to the very people who need to be given a safe place to receive healing of their developmental woundings, as well as insights and understanding of the process whereby they internalised faulty identifications. The beliefs of Sanda Davis firmly support this position, being that the nature of Gender Identity Disorders are destructive, explainable, retraceable, reversible and preventable. (Davis, 1995)

For those whose confusion centres around the fact that their physical and personality traits are ‘different’ and ‘not masculine enough’ they need to be helped to explore the possibilities of incorporating into their male identities the characteristics and potentialities which have for so long been considered ‘feminine’, whilst learning an appreciation of their maleness. Society for too long has ostracised those who do not fit the prescriptions of hegemonic masculinity calling them ‘queer,’ ‘sissy’, ‘fag’, way before the time their own stable gender identity and sexual orientation had even emerged. If society were to break down the extreme stereotypes, it may be possible to prevent one of the aetiological influences in the development of transgenderism where a male has thought. "Well if I cant live up to being a boy, I must be a girl." If a greater acceptance of the variations of behaviour for males and females was established in society, masculinity would not be considered a fearful or painful essence to embrace.

The loved ones of transgenderists, the medical and psychiatric profession, allied health professionals and counsellors, the media and society at large, if they are to be of any assistance in the life-giving process of support to individual sufferers, must recognise the complexities of the issues and dangers of Sex Reassignment Surgery. Focused sensitivity should ask the why behind the suffering and propose ways of dealing with such pain, that confront the total situation, thus affecting change on the deepest level. They must take seriously the analysis of causes of Gender Identity Disorders, with a view to affirming the ‘true’ created male self underneath the protective persona which guards the layers of damaged and underdeveloped masculinity. It is vital that we critically evaluate and attempt to change a society which so freely allows surgeons and endocrinologists to establish a lucrative business based on illusion. To uphold the myth that a ‘reasonable facsimile’ will bring forth life, health and peace of mind is to sell an individual a lie, which will in the long term, lead to the inevitable agonizing despair of disillusionment. When a person is desperately thirsty we do not lead him to a ‘mirage’ to drink.