A response to the Society of Existential Analysis (SEA) conference 2022 after leading a trans-supportive forum.
Trans people have been dehumanized, reduced to a talking point or conceptual problem: an ‘issue’ to be discussed and debated endlessly. It turns out that when the media want to talk about trans issues, it means they want to talk about their issues with us, not the challenges facing us.
My intention in writing this piece is to highlight an important topic that in our existential psychotherapy community has become a source of pain and frustration since the 2022 SEA conference. This relates to diverging views around gender diversity, freedom of speech, and how an existential perspective intercepts with this.
I believe that all of us who are members of the SEA wish to live in a tolerant society, where despite differences, no group of people is marginalised, mocked or threatened. We have all had experiences of being Othered, of being judged, condemned, misunderstood and rejected. Some of us have also had experiences of being Othered by wider social messages, by political systems, and by well-established collective narratives that result in direct discrimination, oppression, danger, and invalidation.
While believing in the right to freedom of speech, I also believe in the importance of ethically considering the speech we are free with, and in creating safe ‘enough’ spaces so that controversial conversations can be engaged in respectfully. I also feel strongly that in platforming views that are divisive and have the potential to deliberately target and marginalise groups of people already facing social marginalisation, we have a responsibility to ensure this is done skilfully, with sensitivity and by inviting guidance and representation from the very people affected by the viewpoints being platformed. This is where the SEA failed at last year’s conference.
Cisgender entitlement
When I realised that the SEA was giving a platform to a trans-critical speaker at the conference, I was shocked. I have known of his stance as someone who believes in biological essentialism, objects to a total ban on conversion therapy and thinks a ‘trans lobby’ is corrupting children. My requests to the SEA conference organiser to remove a regressive speaker was rejected. My attempt to create a safe space for trans and non-binary therapists and trans-allies at the conference also failed as so many so-called gender-critical therapists insisted on being involved in this slot which had only invited trans-affirming therapists. I underestimated the sense of entitlement that so many cisgender people hold. Julia Serano explains gender entitlement in her feminist book Whipping Girl: “when a person privileges their own perceptions, interpretations, and evaluations of other people’s genders over the way those people understand themselves.”
I was left with several questions for cisgender therapists in the existential community:
What is preventing many of us from engaging with the relevant philosophical and phenomenological thought about gender diversity?
What is being experienced as so threatening about gender-expansive identities?
Are therapists who hold mainstream values and beliefs at risk of imposing normative beliefs, standards, and expectations onto their more flexible and diverse clients?
What is preventing many cis therapists from having a conversation about divergent views without hurting trans and non-binary therapists in their midst?
Can we identify the experience and impact of ‘cisgender fragility’ when we see it in ourselves or our community? (Similar to the concept of white fragility, this refers to feelings of defensiveness, discomfort or victimisation in some cisgender people when encountering gender-identity discourse.)
The gaslit feeling I was left with after hearing the trans-critical speaker was due to the cognitive dissonance and skewed statements of ‘fact’ that were being presented. So, in response to what I believe are harmful distortions, I want to offer another perspective.
Language and Labels
First, let me say something about language and labels. I am using the terms cis and trans to refer to gender differences. These terms are borrowed from chemistry with cis referring to being on the same side and trans as being on the other side. Both are umbrella terms that represent a range of gender expressions. ‘Cisgender’ refers to people who experience their sense of gender as aligned to the gender they were given at birth by parents and the medical system. ‘Transgender’ refers to people who do not identify with the gender they were assigned at birth and includes trans males, trans females, non-binary folk, some intersex people and other gender non-conforming or gender fluid people. Trans-critical perspectives object to the use of cis to describe their gender. They are not used to having to define their gender, such is the privilege afforded to cis people by a society where gender is typically only understood in a biologically essentialist and binary way.
There is always a context
The current anti-trans sentiment in the media and in our community echoes the gay moral panic of the 1980s. This right-wing moral panic was reflected in psychotherapy and psychiatry. In the 1960s and 1970s psychiatrists claimed that gay and lesbian sexuality was a curable mental illness (bisexuality and other fluid sexual orientations weren’t even considered at this point) and gay conversion therapy was promoted. Electric shock therapy was used, with painful electric shocks administered to the genitals of lesbian women and gay men whilst they were made to watch gay porn. This was termed ‘corrective therapy’ and obviously caused profound damage to hundreds of people tortured in this manner under the name of psychiatric medical science and psychotherapy.
In 1973, the DSM 2 removed homosexuality from its list of psychiatric disorders, but in 1980 the DSM 3 replaced homosexuality as a disorder with the new terms ‘sexual orientation disturbance’ and ‘ego-dystonic homosexuality’ which meant gay people were now only being pathologised if they experienced ongoing distress about their sexual identity. Internalised homophobia was seen as making gay people sick, but the cure wasn’t to change the homophobic culture in society, but in medicating and problematising the queer people affected by minority stress. This so-called disorder was, and still is, being used as an excuse for ‘reparative therapy’ or ‘conversion therapy’ to be carried out. This category was not removed from the DSM until 1987.
Sexually diverse people are finally socially acceptable (with significant exceptions) and not considered mentally ill, but the focus, in exactly the same way, is now with gender-diverse folk.
In 1980, the DSM 3 added ‘Gender Identity Disorder’ to its new psychiatric categories. By 2018 the DSM 5 removed this invented pathology stating, “it is important to note that gender nonconformity is not in itself a mental disorder.” It introduced instead the term ‘Gender Dysphoria’ when distress is associated with the person’s gender experience. The medical profession framed the distress commonly associated with gender variance as an individual problem rather than a social problem, just as it did with gay and lesbian sexuality previously.
The SEA conference played right into this stance by platforming a trans-critical speaker in an insensitive and ill-considered way. I doubt they would have platformed a speaker who held racist or homophobic views, so why is cisnormativity and trans hostility seen as acceptable to promote?
Gender is a verb not a noun
Nature is diversity. Humans are diverse. Our world wouldn’t survive unless it was varied. Gender is one aspect of such variety. Gender is understood as a biopsychosocial construct which includes aspects of identity, expression, experience, and roles. It is different to biological sex.
Our current understanding of gender is deeply influenced by patriarchal colonial practices. Controlling bodies, gender, relationships, language, culture and spirituality was and is an aspect of colonialism. Historically, many indigenous cultures regarded gender as connected more with identity, expression and role than simply biology and there are many examples of cultures where gender difference was/is celebrated rather than being problematised.
Travis Alabanza writes in None of the Above: “When the gender binary is created so harshly, all it forces from us are strong reactions – because it eradicates any chance of a calm self-discovery. Transness is held to a higher scrutiny, so we are seen as the performative choice or reaction, rather than that we are living proof of the reactionary ways the gender binary makes us live. We, rather than the gender binary itself, are seen as unnatural.”
Existence proceeds essence. We all know this existential truth. Our bodies come into being with the potential for sexual expression along an often-fluid spectrum of homosexual, bisexuality, heterosexuality and asexuality. So too with our gender. Just as a baby isn’t born with a sexuality, neither is a baby born with a gender. Rather there is a potential for gender expressions along a spectrum of femininity, androgyny and masculinity as the baby becomes a child, a teen, a young then older adult.
Gender is also never really our own. It is intersubjective. Our notion of gender is affected by other people responding to us in certain ways and policing us when we move outside of the gender norm.
Many of us experience gender as something we are instructed in, corrected about, or mocked if straying from the norm. Yet there are multiple ways of being, of experiencing and of expressing femininity, masculinity, and androgyny. I believe that cisgender identities and expression are just as diverse as transgendered ones. We are all choosing our gender not once, but repeatedly. When applying the existential notions of facticity to gender, we can understand that our biological body has genitals, reproductive organs and hormonal and chromosomal factors that bring about certain human possibilities and limitations. However, we do not have a fixed relationship to this given of embodiment. We have bodies that, due to sex characteristics, are described as male, female or intersex by our cisnormative society, but we still get to choose our own relationship to our sex characteristics and the gender that we didn’t get to choose from birth.
More and more therapists have clients who experience their gender identity as beyond the norm of binary notions of cisgender male and female. As existential therapists we are strongly positioned to embrace the notion of fluidity. To be willing and able to work from a framework of a flexible self-construct. For if our own self-constructs are sedimented there is no way we can enter our client’s experiential world. Our psychotherapy training ideally encourages us to notice and shake up our sedimented perspectives in order that our way of being in our encounters with clients is as fluid and open as possible. How else can we understand our clients’ worlds? As Emmy van Deurzen and Martin Adams write in Skills in Existential Psychotherapy and Counselling: “How can we understand anything without first understanding that which does the understanding?”
Gender affirming surgery
Survival for most trans people is about shrinking, becoming invisible, so the streets are safer to walk on, the schools and workplaces safer to exist in…. Surgery and hormones are not the ‘cure’ to a gender binary problem. They do not solve the ‘problem’ of the dysphoria which a cisnormative society created.
One of the main errors in the argument made by trans-critical people is the skewed overfocus on trans people’s gender-affirmative surgery. Yet, the majority of plastic surgery carried out in the UK is breast augmentation. Most people having this surgery are cis women. Breast implants are their gender-affirming surgery. Why are cisgender women enlarging their breasts with medical implants if not to get closer to their perception of being female in a sexist world where the objectification of the human body markets a very particular gendered ‘look’? Buttock implants and liposuction, labiaplasty (removing part of the labia for a ‘neater look’) and rhinoplasty are also gender-affirming surgery for cis women.
Cis male gender-affirming surgery includes gynecomastia (male breast reduction), penile augmentation to create a bigger penis, chin augmentation to enhance a more ‘masculine’ jaw, liposuction to remove fat from parts of their body to sculpt a more ‘masculine athletic look’ and implants under the chest muscle, stomach, and calves.
Yet the moral outrage of transphobic and trans-critical voices conveniently ignores this type of gender-affirming surgery, even when the number of teenage cisgender girls getting plastic surgery on their breasts and vulvas is dramatically escalating. When one group of people is treated differently from another – as in this example between cis and trans people’s gender-affirming surgery – it leads to outright discrimination and prejudice.
Post-operative regret
Another skewed view put forward is about so-called ‘gender regretters’. Post-surgery regret is a factor that plastic surgeons and medical insurers collect data on and find that there are always people who regret having plastic surgery for whatever reason they undertake it. A 2021 report by the American Society of Plastic Surgeons concluded that gender-related regret was very rare at under 1%, with a slightly higher figure for regret due to medical complications. All surgery can lead to regret; all decisions for that matter. Singling out the small numbers of trans people who regret having gender-affirmative surgery demonstrates the ways prejudice works, a distortion of facts, a manipulation of information, and a moral panic based on fears that are inflamed rather than addressed and reassured.
Children and hormone use
Another argument the presenter put forward was that the ‘trans lobby’ was putting children at risk by Gender Identity Services (GIDS) rushing to put children on puberty blockers causing irreversible harm to them. Yet the medical information from GIDS clinics and doctors state that hormone blockers are reversible. Most trans and gender-distressed children have to wait years for medical interventions like this. Cisgender children who start puberty early are given hormone blockers and these children do not have to go through the same obstacles to access hormone blockers that gender-distressed children do. It is actually cross-sex hormones that are irreversible (creating breast development and vocal changes) and these are not used before 16 years. Additionally, there is no gender-affirmative surgery given to trans children at all in the UK. This surgery only happens to adults.
Trans-critical messages often cite their concern for children ‘forced’ to adopt a gender identity without any exploration and at a cost to their mental health. I assume that they do not consider any research that challenges this. For example, The Trevor Project 2019 National Survey in North America found that gender-affirming care has been shown to reduce suicide ideation and suicide attempts in transgender youth, along with social support, familial support, and reduction of discrimination. Gender-affirming care includes using the pronoun and name chosen by the young person.
Ideology
The speaker referred to ‘trans ideology’ repeatedly during his presentation. Seemingly without any irony that he was presenting us with his own ideology – a mainstream cisnormative ideology powerfully supported by the media, politicians, educators, religious leaders and others. In Existential Perspective on Relationship Therapy, Darren Langdridge & Meg-John Barker argue that “all therapists operate within an ideological position and communicate these to their clients within their work even when engaged phenomenologically, whether knowingly or not”. What is seen as trans ideology could also be understood as trans visibility. Previously it was far too dangerous for gender-diverse people to speak out.
Of course, this doesn’t mean that all that is written about and vocalised by trans and non-binary people is palatable and productive. Many are raging and social media allows hostility and aggression to be expressed more easily now, without consequences. However, there are many more hostile transphobic cis people raging on social media with far more political clout and without the fear of violence that trans and gender-nonconforming people live with. A further contradiction is how gender education and therapist exploration is seen as impartial and objective when a trans-critical therapist is offering this to a client, but indoctrination when a trans-affirming therapist is.
Existential therapy
As existentially informed therapists we facilitate our client’s exploration of their own relational, subjective truths as they make sense of experiences and existence. We refer to a fluid self and we work with paradoxes and polarities. We do not attempt to fix, correct, or change the client’s self-construct. We are taught not to pathologise nor steer our clients towards a normative idea of what it is to be human. Surely it fits for us to show curiosity about how we and our clients experience our embodied and social and interpersonal experiences of ‘being’ gendered?
I am interested in Rosi Braidotti’s idea of ‘affirmative ethics’ and I hold that it is our responsibility to be aware and knowledgeable about cultural narratives and political conflicts around gender, to notice and understand our own biases and assumptions, to identify gaps in our learning and remedy this. We require an informed mind and also a beginner’s mind to phenomenologically suspend our judgements and get as close to our client’s experience of themselves as possible.
Discussions around gender diversity are often polarising. The media stirs up divisive rhetoric and the ‘powers that be’ benefit from a split and angry population who can focus their frustrations on the way in which ‘one side’ impose views and opinions on the ‘other side’. We require resilience to lean into uncomfortable conversations and risk being vulnerable or offended. We require an overview of what is happening politically when we adopt a particular stance. Who really benefits from these fractures that result from hostile disagreements in small communities like ours? Inflamed rhetoric distorts the facts and realities and presents conflicted messages that we are all affected by to varying degrees. Media and consumer capitalism have a powerful influence on the global delivery of mainstream oppressive and rigid messages.
Our community needs to be careful that transphobia is not legitimised under the language of ‘viewpoint diversity’ and that we make use of the positive potential of existential and phenomenological perspectives to embrace diversity and protect and support our members and clients who are already marginalised by society. To end with the words of Audre Lorde:
If I didn’t define myself for myself, I would be crunched into other people’s fantasies for me and eaten alive.
Niki D
A version of this article was published in the April 2023 edition of the Hermeneutic Circular.
Full references available from the author. Since the 2022 SEA conference, a Trans and Trans-allies Network for existentially informed therapists was started. If you are interested in being a part of this network, please email Niki D at info@nikidtherapy.co.uk .
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