Understanding the past, seizing the moment, shaping the future
Reflections by Lynn
Conway
Professor of Electrical Engineering and Computer Science, Emerita,
University of Michigan, Ann Arbor
September 11, 2013
“Numbers count, even if psychiatrists can’t.” – L.C.
During the past two years, a wave of change has swept through the University of Michigan Health System’s Comprehensive Gender Services Program. Under the leadership of its new director, Nancy Quay, the program has broken with its infamous past, and moved to the front of the emerging transgender-healthcare movement. We can learn much by reflecting on CGSP’s past, on its reshaping via new leadership, and by envisioning the impact it could have in the future.
I first encountered CGSP
as I tentatively
began coming out in 1999:
I’d gone there with the idea of volunteering to help, but was
rudely awakened on encountering a clone-like echo of the notorious gender clinic
at “The Clarke
Institute”
(now CAMH), in Toronto.
Back then, psychiatrically-dominated thought in university-based
gender clinics saw transgender people as suffering severe mental illness. As a
result
supportive
treatments were oft considered complicity in madness and most efforts
were devoted to delaying and discouraging physical/social transitions, except in
cases of ‘confirmed’ madness.
As part of their gate-keeping, the clinics did ‘research’ on this
‘rare disease’, in hopes of preventing or reversing it. That research led to the
emergence of
Zuckerian trans-reparatism as a primary
‘curative’ treatment,
especially
among trans-children, and to the
pathologization of all socially
transitioned people
as being de-facto mentally ill.
The gate-keeping at CGSP during the 2000’s was particularly
brutal: many unsuspecting already-transitioned patients who sought CGSP’s help
were told
they had to
de-transition, stop taking hormones, and start all over again in order be
accepted into the program (a practice
I exposed via the
internet
in 2002). Needless to say, only a few desperate indigent folks did so.
The trickle of occasional indigent patients at such clinics
maintained psychiatrists’ group-illusion that the condition was extremely rare
and limited to the ‘underclass’. Meanwhile, invisible numbers of desperate
trans
people from all walks of life traveled along covert ‘underground railroads’ to
freedom in stealth, as they’d done for decades.
However, as the new decade began in 2000, the internet spawned a
burst of trans-visibility:
Huge numbers of transgender people discovered each other,
networked together,
wrote about their
lives,
blogged-and-exposed their
psychiatric profilers, and
vibrantly began seeking their full
human rights. It also became
clear that the
psychiatrists’
estimates of the numbers of trans-people were at least two orders-of-magnitude
too small.
By the end of the decade, the transgender-rights movement had
made huge advances all around the country, in
legal rights,
employment
opportunities,
anti-discrimination codes, anti-bullying advances, access to
health insurance
and healthcare
in many areas – and the beginnings of major advances in
social
support for transgender children and their families and
advanced
puberty-delaying medical care for transgender teens.
Furthermore, as awareness of the plight of trans-people began to
rise among the general public, national media began shifting from
exploitation-coverage to supportive-coverage of transgender stories. Meanwhile,
UMHS CGSP kept on chugging along under its old paradigm of trans-pathologization.
And then
Nancy Quay became director of
CGSP:
With Nancy came a fresh viewpoint towards social support and
medical care for gender-variant people at UMHS, based upon her experiences in
social work. I witnessed for myself what happened when she went into action.
Nancy focused on ‘breaking down barriers’, listening to patients,
building trust, creating an environment where everyone ‘expects respect’,
continually streamlining program-logistics, exploring ‘what really works’ to
make lives fuller and richer – and working to lead rather than distantly follow
the social wave of change in trans healthcare.
Nancy has been especially active in expanding support groups for
parents and partners. After all they’re often the ones, rather than the
transchild
or transperson, who suddenly needs group-support.
Turning feelings of fear and social embarrassment into heartfelt expressions of
support for child or partner is just the kind of magic that social-support
groups can work – bringing together groups of people who’re going through the
same thing, and enabling them to constructively build upon their shared
experiences.
It is this social dimension of gender-exploring/transitioning
that is so profound, and is where social support is most needed. Transgender
medical care is just that – medical care – when put into that social context.
Though often quite vital, as is any medical care, it involves merely the
mechanics of physical-gendering, and pales by comparison with the complexities
of the social dynamics of transition.
On August 13, 2013, I participated as a guest-speaker at a CGSP
support group for parents of transgender children (of all ages), and thus
immersed myself into the new CGSP culture. While exchanging stories with
parents, I witnessed newly formed group-understandings emerging in real time –
understandings that would deepen those parents’ love and support for their
trans-children and strengthen their family ties for the duration. It was a
profoundly moving experience.
Not that all’s totally cool at CGSP. The conservative UMHS
medical establishment retains pockets of transphobia,
as in the medical center where transgender medical treatments are sometime
sought. However, even that will change as staff members there are increasingly
confronted by social reality.
Envisioning the impact CGSP
could have in the future:
We know from recent national media coverage that public awareness
and support for gender-variant people is rapidly growing – especially awareness
of the many difficulties transpeople face when negotiating medical services.
Furthermore, large numbers of transgender children, teens and adults live in
southeast Michigan (0.3% to 1% of the
population,
as opposed to the
0.003% to 0.01%
myth of old-time psychiatry).
Thus as news of CGSP’s newly-enhanced reputation spreads, UMHS
will experience rapidly escalating appeals for help from this historically
pathologized, socially marginalized and medically underserved population.
Numbers count: the time to act is now, or else they’ll all go elsewhere.
Given additional support and a sanction to act, CGSP is
well-positioned to shape and evolve social support infrastructure for this
population, and to collaborate regarding national-level provision of such
support infrastructure. By doing so, CGSP could provide an exemplar UMHS
‘laboratory’ for exploring, by analogy, all sorts of new methods for supporting
other arising sub-communities.
CGSP
could also advise regarding the cohering of information about the seeking,
evaluating and following-up on help from the many emerging centers for trans
medical, legal and support around the country – including the UMHS medical
center (if over time it scales-up its trans medical-care capabilities). Such
activities could also trigger forward-looking collaborations regarding
human-empowerment among, for example, those at the UM School of Social Work,
School of Information, School of Law and the Medical School.
By visualizing this opportunity-space, by enhancing the scope and
reach of CGSP, and by seizing the moment – UM could move to the forefront in the
exploration of social/medical/legal/educational/human-rights empowerment.
Along the way, our academic community could learn much about what it means to be human.
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