The control freaks have taken over the asylum

So what’s my take on what just happened? I think there’s a much bigger political dimension – which I will write up later over on the political blog.

However, this feels like an obsession by some parts of the medical (psych?) profession with control and dogma: prescribing according to guidelines and not the needs of the patient. Sure: I see the need for a lead consultant, and therefore would not mind losing my private specialist.

But this prescriptive, inflexible approach to history-taking and rule-setting? Let’s NLP some of this. First off., I arrive looking good, wearing some of my nicer clothes . Hair is neat and tidy. Make-up is good. Nail polish, sadly, not quite up to scratch (sic!) – but it will do.

All this takes time and effort. Did he notice? Nope. No pleasantries. No “hair looks good”. Nothing. Would a female consultant have done better – or not? Because there is a double point to this. I’m being assessed and one of the things being thrown into the scales is one tiny trivial item legislatively – the deed poll. Whereas the fact that I took time to dress, to look good, is not commented, not recognised.

(Also unrecognised: the fact that i walk through london this way!)

Instead, its quickly on to the verbal history-taking which, let’s be honest, if I wanted to screw with their system, I could have learnt by rote.

The clothes? The look? The work that goes daily into my self-presentation? The fact that, because I am still some way from that Holy Grail of “passing”, all of the above means I walk through life now the centre of comments, sniggers, and occasionally far far worse…no comment.

But if – perish the thought – I prove “resistant” to some petty abstract little legalistic rule that they have made up for purposes of back-covering, why: that might be enough to bar me from hormones.

Well, bully for them – and I do mean bully.

I come away with my faith in the system (and my belief in all the re-assurances that the system has improved) quite shattered. I am dealing with a bunch of control freaks who either have no comprehension of what they are dealing with or…and I sincerely hpe this is not the case…know all too well.

Because if they understand what it is to be trans, then they would understand that the line is being drawn in the wrong place. Hormones should be, need to be, easy. The cost is not great. There’s a long run-in before effects become irreversible. They minimise distress.

Sure: I’ll go along with surgery being harder to access on the NHS, given the step-change in resource and consequence that it entails. But not hormones.

No. In a sane and idealised world, we would get beyond this psychiatric nonsense for the early stages. I should be assessed on basis of my understanding of the issues and ability to take responsibility for my decisions. There shouldn’t even be a question mark over hormones.

The fact that there is suggests that much of this process is about control – and little else.



5 Responses so far »

  1. 1

    You can get estrogen over-the-counter in some countries, like Spain. Everything I’ve seen says that other than messing with any remaining reproductive organs, Estradiol Valerate is only dangerous to men because they’d go nuts. You can’t even realistically overdose on it.

    Russell did try to use HRT as a diagnostic tool, (Drugs as diagnostics are common in the psych world, just not elsewhere) but was censured by the GMC for it – they’re rather fond of their “first, do no harm” maxim, even if inaction does harm. There were rumors HRT would become over-the-counter, I’ll have to chedk up on where that is. It removes a large amount of the control – both perceived and real – that doctors have over the whole process.

    (Oh, and the banket 28-day limit on prescriptions annoys the hell out of me too, that might be a PCT thing though)

  2. 2

    spirifer said,

    Jane, I so sympathise. Not because I have ever been confronted with what you are confronting, but because I deal a LOT with medical types in some areas of my work.

    Want to get an assessment of capacity done for an vulnerable elderly client who can’t manage her affairs, and who is having bailiffs turning up at her house because of all the neglected bills? GP can’t do it, as there’s a new guideline which says he can’t. Local adult mental health team won’t do it, as she’s not an “open” patient to them. Local hospital team won’t do it because she’s not quite in their area.

    Cue six months later and said assessment is still not done, and the bailiffs letters and red bills continue to pile up, whilst the lady’s £££££ sit idly in the bank, since no-one has the legal authority to take the money out and pay the bills.

    Who is looking out for the interests of the vulnerable?

  3. 3

    Phoebe said,

    Heyya Jane,


    Not a lot else to say. First hand experience of the sort of disempowerment those bastards can get up to is hard. Sorry you’ve had such a hard day.

    It would be nice if someone could get an informed-consent model through the NHS one day. It’d be so much cheaper just liberalising cheap drugs than public funding £300 every appointment for some gatekeeper to drag the assessment process out.

  4. 4

    Jenny Alto said,

    It’s funny, I’ve heard many stories about Charing Cross both good and bad. I believe Jess has a similar experience to yours. The world seems to divide abruptly into fans and detractors almost the moment the subject comes up. It’s almost as though there is a sylabus of Expected Responses to learn before going in to the system if you ask some people.

    I have been referred to Charing Cross myself, though my path is somewhat different to yours. It will be interesting to see what tack they take with someone over whom they can not hold the threat of not prescribing hormones.

    • 5

      Phoebe said,

      “Expected Responses”

      I believe this has been less viable as the shrinks have diverged down different songbooks.

      Some are Autogynephilia/HSTS theory people, my 2nd CXH shrink was a of a rare Freudian breed, and I hear tell there are some shrinks around who actually just follow the original theory (straightforward and simple as it was) that transsexual people experience great distress about living in their assigned gender, claim to be of another gender and benefit from being facilitated to transition socially into what they feel is their real gender.

      I think probably the most common thing is that as long as you’ll recognise their power and do what they say you need to in order to transition you can get through. My personal experience of this was being told that I wasn’t considered to have started “RLE” until I got a paid job, despite doing a fair deal of volunteer campaign work and being a full time carer for someone who was at risk of dying without me being around (and had no other options though we’d been hunting through social services for more support). Result: I get a job at the first opportunity, partner nearly dies several times, *everything* gets worse, I get under pressure for basically having made a decision to risk my partner’s survival in order to get approval from the lovelies CXH.

      The gatekeeping hoops sound like such a tiny thing to need to do, as long as you’re in a position of being able to satisfy them, and for some people satisfying them is trivial. But the vast majority of them are of almost no meaningful diagnostic relevance at all, and the imposition of those conditions on people who can’t or won’t satisfy a set of ridiculous and arbitrary nonsense is what’s really brutal, and this is (I think) what the side who seem to swan through CXH seem to miss because for them the experience* is relatively trivial.

      * Besides the hardships of existing as a trans person in a sometimes hostile world or recovering from the trauma of surgery

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