Theories about causality |
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At this point in time, there is no laboratory test, such as a blood test or x-ray, to diagnose transsexualism. The cause (aetiology) of this condition continues to be investigated by leading researchers around the world. Since Dr Benjamin's landmark Most of these theories have proved to be little more than moral judgements and guesswork. Some have resulted in the abuse of human rights of transsexual and transgender people. The social values of the day informed the theories and were sometimes genuine (if misguided) attempts to scientifically investigate this unusual phenomenon. 1 Lifestyle choiceIn the past and in even sometimes today, transsexualism has been thought to be a lifestyle choice. People do cross-dress and masquerade as an alternative gender as a playful form of self-exploration, performing as the opposite gender, out of curiosity or a playful form of harmless enjoyment or for the entertainment of others. This is not transsexualism. This form of fun is not motivated by an overwhelming and persistent desire for medical treatment in order to permanently change their physical body. This theory holds no relevance or relief for men and women experiencing the painful predicament of a body that has developed contrary to that of their innate-sex. 2 Environmental factorsIn recent times, environmental factors are increasingly thought to play some part in the development of transsexualism (Johnson, 2004). These factors cast a wide net over a widespread range of endocrine disrupting chemicals (EDCs) in the environment. EDCs, which mimic oestrogen and/or disrupt androgen receptors are said to interfere with hormonally sensitive tissues in mammals, including human beings. EDCs are present in the water, food and the air as detergents, plastic wrappers, cosmetics, exhaust fumes, insect repellent and herbicides, including the presence of substances in the waterways originally present in birth-control pills and antibiotics. Many of these chemicals are fat soluble, building up in fat deposits of fish and animals, with those at the top of food chain (usually human) accumulating the highest exposure to EDCs. Between 1938 and the 1980s, the best known EDC was prescribed to millions of pregnant women in many countries worldwide including Australia. DES (Diethylstilbestrol), in the form of a synthetic oestrogen, was prescribed to prevent pregnancy complications and miscarriage. By 1939, the drug was marketed under at least 400 different brand names. The wide range of prescribing and numerous forms of the drug, has made it difficult to accurately assess the numbers of women and children who have been exposed to DES. DES has been implicated in anatomic and functional abnormalities in the male and female genitourinary and reproductive tract of children exposed to the drug in utero, and also appears to be implicated in an association with disorders of sexual differentiation and even transsexualism (Dictionary of Organic Compounds, (1996, p2175), in reference to diethylstilbestrol, cites adverse human health effects include: "Causes male impotence and transsexual changes particularly in offspring exposed in utero"). There is ongoing debate about the effects of DES and the endocrine effects of other EDCs. DES could be a contributing cause just as easily as any other EDC in the environment. At best, environment factors could be a part of a complex web of causality, but there is no evidence they are a stand-alone cause for transsexualism. 3 Psychological/Psychiatric factorsPsychological and psychiatric theories focus on the 'nurture' aspects or the 'mental illness' concept of the condition. Nurture refers to all the complex interactions of family dynamics, childhood trauma or child-rearing styles. Psychological perspectives Psychological theories align into two clear divisions . Both start from the same premise: the transsexual person has failed to socialise properly into their 'correct' gender during childhood and adolescence, resulting in an adult who has a 'gender identity disorder' with an urge to 'change sex'. Either the individual has a - i) a sexual identity fixed at a young age and only treatable by assisting the individual to live as best they can within the pathology (mental illness, disturbance); The first idea offers a childhood-compliance dynamic; the second one offers a childhood-conflict dynamic. Either way, from the viewpoint of psychology, transsexualism is considered to be the result of emotional disturbance , an attempt "to ward off a paranoid psychosis" or a deviation from a 'normal healthy' sexual identity. Behavioural perspective In the 1950s, the 'theory of gender neutrality' was strongly promoted by one man - John Money, a New Zealand born psychologist who worked at the John Hopkins Hospital in Baltimore, USA. (Money presented himself as a doctor, implying he had a medical degree. He had a PhD in psychology, which enabled him to us the letters Dr in his name. He had no medical degree.) Money developed a behavioural theory that nurture was solely responsible for the formation of a person's gender identity. His theory was the basis of the wide-spread view that gender is simply a matter of childhood conditioning during a formative time period prior to 18 months of age, up until around two years after birth. In this period of time, Money theorised that a child is a blank slate on which nurture acted to create all aspects of a person including their gender. In effect, Money's theory proposed a child can be taught to be a boy or girl depending on how they are raised, what toys they are given to play with, clothes, names and pronouns and guidance received from parents. After approximately two years, the child's gender would become consolidated. It wasn't until 1997, when The behaviourist psychology of the 1950's-80's is unfortunately still evident in many tertiary textbooks and seem to still hold a good deal of influence over much of what is theorised about matters of gender and sexual behaviour. Even though the John/Joan case was not about transsexualism, the incident illustrates the harm in giving credence to the gender-identity formation theory. Psychiatric perspectives Psychiatry assumes transsexualism is a 'mental illness'. This perspective, based in mental pathology, goes back over four decades and has shaped psychological and psychiatric perceptions of transsexual people so deeply that transsexualism is listed in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, under the term 'gender identity disorder' (GID). Psychiatry believes a person's gender identity develops primarily as a result of a learning process . In the case of transsexual boys and girls their gender identity develops with incorrect 'imprinting' and 'conditioning'. Unfortunately, the treatment offered by psychiatry, has a history of treating transsexual people with a view to making them 'normal' again. Some of these strategies include 'aversion therapy' , psychotropic medication, hormone treatment consistent with the individual's birth sex and electroconvulsive therapy (As recently as the 1970's people were still being 'treated' with electro-convulsive therapy (ECT) and aversion therapy, without 'success'. Children with non-traditional gender identity presentation and behaviour were treated in psychiatric institutions with aversion therapy to reform conduct, appearance and mannerisms to be more appropriate to their apparent biological sex. See Scholinski, 1997 (now Dylan Scholinski) The last time I wore a dress: A memoir). Despite these forms of treatment costing thousands of dollars, there have never been any reports of a permanent 'cure'. There is research indicating that men and women with transsexualism experience a higher incidence of depression and suicidal ideation than the general population. When treatment is inaccessible or extremely expensive, it is not surprising that depression is evident. There is however, no evidence, that depression causes the condition. 4 Socio-cultural perspectivesWith the devastating failure of John Money's gender-identity formation theory, socio-political theorists continued to promote the belief that transsexualism was simply the result of rigid gender expectations in society. These theorists proposed, if society were more accepting of differences in social role, dress and behaviour for men and women, then the phenomenon of transsexualism would gradually fade as people would no longer feel compelled to alter themselves physically in order to live a life contrary to society's rigid gender-based expectations. Feminist theorists have employed this line of thinking to deny the existence of transsexualism. The theory is well-meaning. There is little doubt society, in general, has many unfortunate restrictions and biases. However, it is as unhelpful in offering a solution to the condition as it is in explaining the pathology of Type 1 Diabetes or asthma. Curiously enough, many of these socio-cultural theories are espoused by gender-variant individuals themselves.
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