The View From The Other Side of the Treatment Fence: My Experience as A Provider of Human Services

Originally appeared in Transgender Tapestry #98, Summer 2002.

by Dallas Denny

It was not transsexual people themselves but the system which arose for their treatment which resulted in so much human tragedy: bitter and unfulfilled transsexual men and women, disillusioned and disgusted physicians and psychologists, and a literature which unfairly stigmatizes persons with gender dysphoria. We must all of us, service providers and consumers alike, strive to understand what has happened and what continues to happen in too many instances today, for only by acknowledging the problems of the past and the present can we hope to move into the future.

It?s not unusual for professionals to seek to distance themselves from their clients. Ten years ago, I worked for the Department of Human Services in Nashville, Tennessee. I was a child protective services worker. Many of the DHS clients were disadvantaged, to be sure?but that was no excuse for the terms some of my coworkers chose to give them?the word ?Dirtleg? sticks in my mind. Unfortunately, many of my peers chose to view what was supposed to be a helping relationship as an adversarial one, and would needlessly erect barriers which, quite frankly, sometimes resulted in children going to bed hungry.

I have worked with persons with mental retardation for nearly twenty years. Most of my co-workers are sincere and caring, but even so, many of them find a need to distance themselves psychologically from their clientele. But the treatment system has been undergoing continual reform; the days of crying ?retard? are hopefully gone forever. I have seen some instances of cruel and inhumane treatment, but the system is self-correcting. Abuse and neglect are relatively rare, and punished when they can be documented.

The situation was much worse twenty years ago, but was made better by advocates and lobbyists. The formation of The Association for Retarded Citizens, The Association for Persons with Severe Handicaps, and other advocacy organizations have resulted in laws to protect persons with retardation, accrediting agencies for facilities which treat them, and quality control for all phases of their treatment. Things could be better, but I?ll have to say that I?m proud of the profession and the strides which have been made in recent decades.

Persons who live in poverty, meanwhile, who have fewer advocates, continue to be called ?Dirtlegs? with impunity.

Persons with gender dysphoria are in the same boat as poor people. Until recently, they have had no advocacy organizations, no protection under the law, and have usually been too insecure and threatened to stand up for their rights. There has been no system of checks and balances, and, until Anne Bolin, no one to point out the deadly dance played by service providers and transsexual people in the treatment setting.

The demise of the gender clinics resulted in the rise of a new wave of treatment centers which are more responsive to the needs of their clients. However, the relationship between transgendered persons and their caregivers has been and continues to be unnecessarily adversarial. This is understandable, because treatment systems are structured so game-playing is almost necessary on both sides of the treatment fence. The Standards of Care make it that way. It is time for reform, for a recentering of the locus of control. It is time for consumers and service providers to work together cooperatively, and not struggle as if they were adversaries. They are, after all, working towards the same end. The transgendered consumer wants help, and the service provider wants to give it.

I think forces are coming into play which will result in treatment reform. Although transsexualism and crossdressing continue to be stigmatizing, they are not as stigmatizing as they once were in our society. Consequently, more transgendered people are able to function in positions of responsibility, and a few are willing to take a public stance in favor of fair treatment. Transgendered people are beginning to demand their rights, and to work actively toward obtaining them. This will give rise to a new wave of consumerism, and service providers will have to be responsive, just as were the mental retardation professionals before them.

Transsexual people have been characterized in the professional literature as having a great deal of psychopathology in addition to their gender dysphoria. This is because service providers have dealt for the most part with people on the ragged edge?people who have denied themselves all their lives, and who have finally sought treatment; people who are so desperate to obtain help that they will lie and deceive in hopes of getting it; people who are bitter because of a long history of abuse and misunderstanding. They see clients who have mutilated their genitalia, who make their living by prostitution, who are suspicious of the treatment program and of their own good will and competency, and who may have chemical dependency problems. Most service providers see only this; they do not look beyond the curtain to ask why their clients are the way they are, or what it is about the treatment setting which fosters the distrust and dishonesty of their clients.

What has been lacking has been a functional analysis?that is, an inquiry into the causes of this behavior. Here, too, service providers can take a cue from the field of mental retardation.

Persons with mental retardation exhibit a range of behaviors which are highly unusual, and which at first glance appear to be aberrant: Body rocking, head-banging, pica (the eating of nonedibles?yes, I know it sounds like a malapropism), rumination (the continual regurgitation and subsequent reswallowing of food)? get the idea? For more than twenty years, applied behavior analysts concentrated on reducing the frequency and severity of these behaviors, and they were moderately successful. But in the last decade, more attention has been placed on the analysis of the functionality of these behaviors?and, surprisingly, it can often be demonstrated that these ?aberrant? behaviors effectively serve a purpose?or even more than one. Head-banging, for example, can serve the dual function of attracting the attention of caregivers and of reducing the demands caregivers make on the individual. The behavior seems less unusual when the institutional environment is considered, for it is clearly demonstrable that appropriate behavior is largely ignored.

Transgendered persons deserve this same kind of analysis.

The ways in which transgender feelings affect one?s life are global?many transsexual men and women are good liars, for instance, because until they achieve gender congruity, they are necessarily living a lie. They are often suspicious, because of a history of being betrayed and laughed at. They may turn to prostitution because of societal rejection due to their appearance. They may deal with the depression and pain caused by their gender dysphoria by turning to alcohol or other drugs, or by punishing themselves in other ways?for instance, by developing eating disorders.

It is not difficult to see how a service provider who has been burned by a number of transgendered clients might come to be wary of them, especially when the clinical literature warns of the unreliability of transgendered persons, reinforcing their personal experience. And as there are no protections for transgendered persons, it is easy to laugh at them and stereotype them. But it is not right. Department of Human Services clients are not ?dirtlegs.? And few transgendered persons fit the stereotypes, and those who do may have their reasons. The fact is that most are sane and whole persons who are trying to improve their lives.

?The Politics of Diagnosis? was not meant to slam service providers, but it was meant to illustrate what I consider the checkered past of the treatment of transgendered persons. I wrote it because I want service providers to realize that despite all the good that has been done, harm has been done, and to prepare themselves for the treatment reform which the ?90s will bring. We need the parties on both sides of the treatment fence to realize that their behavior could have been and can be better, for only then can we achieve the dialogue that will be needed in order to bring reform.

In future issues of Chrysalis, we?ll be further defining the problem and proposing a definitive solution. Our plan is to build a gate in the treatment fence.