Reckoning With the Medical Oppression of Trans Bodies: Deconstructing the Clinical Space

• In Event: Centering Trans Studies in Educational Research and Practice

Abstract

Gender nonconformity goes back to the earliest human records with gender nonconforming people often playing very important roles in their societies (Roscoe, 1998). It is within the context of European colonialism that gender nonconformity became pathologized and eventually medicalized (Gill-Peterson, 2018). As a result of this colonial history, a primary challenge currently confronting trans individuals is getting access to gender affirmative care, a challenge that has increased with the recent rightwing assault on trans communities (HRC, 2022). Yet, even when they can get access to care they often confront mental health professionals who have been trained in approaches that stem from a long history of pathological clinical frames (Nystrom, 1997; Drescher, 2015; Conrad, 2007). We can see this in historical efforts of the field to engage in conversion therapy (Gershman, 1968) as well as the more recent Diagnostic and Statistical Manual of Mental disorders (DSM) framing of trans people as having “gender dysphoria.” (APA, 2013) As a result, to get access to gender affirming care trans individuals along with the mental health professionals they work with must rely on the pathological framing of the gender dysphoria diagnosis to get access to gender affirmative care (Borba, 2015). Ironically, this pathological frame is the same underlying logic that shapes rightwing assaults that suggest that trans people are grooming youth (HRC, 2022).

After providing an overview of this history of pathology, this presentation will describe a qualitative study that examines counternarratives that centers the knowledge and expertise of trans and queer clinicians who are responsive to and affirming of the variety, fluidity, and intersectional experiences of their trans clients. Snowball sampling was used to recruit 8 trans and queer-identified clinicians who provide psychotherapy services to trans and queer people. The data was collected through semi-structured interview of approximately 60 minutes each that focused on the procedures they undertook related to collecting demographic information, diagnosis, and procedures for exploring gender identity with clients. After transcribing the interviews, I used Grounded Theory to identify emergent themes across the approaches of the 8 individuals (Padgett, 2016). The data analysis revealed that the participants all sought to center trans experiences by (1) accounting for the history of pathology of the mental health field, (2) avoiding heteronormative and cisnormative assumptions, (3) facilitating conversation about privilege and oppression and (4) advocating for broader institutional and social transformation.
I conclude by exploring the ways that each of these principles while emerging from centering the needs of trans clients opens new directions for creating a relational space to practice health care that is inclusive, resists oppression, disrupts pathology and is willing to embrace the transformation, growing and health of all human beings. I focus particular attention on how creating clinical approaches that are inclusive of trans people and challenge pathologizing frames in the intake process, clinical diagnoses and the clinical relationship offer liberatory approaches to mental health support for all individuals regardless of their gender identity.

Author

• Luis Ramirez, Ramirez Psychotherapy