Provision of care for minority groups:
The importance of home-based support networks within the establishment
CQSW, Social Worker, Trustee Gender Trust, Oasis Group Director, GEMS Regional Contact
My involvement with gender dysphoria goes back to 1973 when I was a generic worker with a particular interest in helping minority groups. I had been involved for some time with, amongst others, homosexual people. I had contacts with FRIEND and gay rights groups.
I came across a case of cross-dressing via a colleague who assumed that I would be better able to help. They had jumped to the conclusion that cross-dressing equated with homosexuality, which of course is not necessarily true. This particular referral in 1973, was a young man called Robert and it had a profound influence on me. It brought home the realisation of how bewildered and isolated a person can feel and the inadequacies and limitations of help available.
At this time it became clear to me that more intensive care was required if gender dysphoric people were to be helped to come to terms with their situation, either by being enabled to fulfil themselves in the role they feel most comfortable in, or through self-acceptance gained by sharing their thoughts and feelings with an impartial party such as a counsellor attached to a clinic.
In Robert's case, sadly, with many factors existing making his personality very unstable, it ended in suicide, possibly unavoidably. But the tragedy of his death left me with the feeling that not everything that should be provided in the way of help, advice and support was available.
During and after my involvement with Robert, I became aware that there were many more people with gender dysphoria than I could ever have imagined. My professional training as a social worker enabled me to understand the need for obtaining knowledge of this subject from other involved professionals, so that I could help people more effectively.
My professional contacts started with the late John Randell, the consultant in charge of the Charing Cross Gender Identity Clinic at that tame and also, Marion Cochlin, a psychiatric social worker who had a special interest in gender dysphoria and was attached to the clinic. I continued with local psychiatrists, psychologists, speech therapists and some voluntary bodies, including the Beaumont Society, also concerned with transvestites and gender dysphoric people.
With the specialist knowledge I have gained over the past 21 years, I have been able to help people professionally who have been referred either at local level by psychiatrists, psychologists or GP's, or direct by gender identity clinics, Charing Cross Hospital being the clinic I have personally formed links with.
Because of my continuing concern at lack of understanding in this area, I run a self-help group for transvestites and transsexuals, Oasis. With the help of Oasis members, I have given talks to interested people and organisations such as Relate, Samaritans, social workers, GP's and nurses.
Despite growing public awareness of transvestism and transsexualism through the media, it is still seen as the stuff of tabloid headlines. Fleeting references and articles in some of the more reputable colour magazines go some way to addressing the more serious, less salacious, issues facing those designated gender dysphoric. However, I don't think I am being wholly unfair when I say that most coverage falls broadly into two categories. First are the tabloids with their typical thirst for sensationalism, reporting high profile atypical cases and expos�es, which of course does nothing to help public understanding of gender dysphoria. Secondly, technical treatise not readily accessible to the general public.
This brings me to one of my biggest concerns, the appalling lack of information and support for those gender dysphorics who fall into the `middle ground'.
Through my work I have been involved with a wide range of clients; as you are no doubt aware there is no definitive type of personality that emerges. When working in this field, although a high proportion of gender dysphoric people may be of above average intelligence, financially secure with the possibility of making the change of role less problematic, many of my clients have been less fortunate. I have encountered those not only less academically advantaged, emotionally immature, though no less adamant or eloquent on their position but, perhaps more importantly, with no familial support, let alone financial.
However, despite these two categories of those managing well with minimum intervention and those actually assigned a social worker, there are many more, perhaps the bulk, who fall into what I can only loosely term the `middle ground'.
These are gender dysphoric people, possibly in quite complex family situations, who are not in a position to only think of themselves. They need help not only with the financial, psychological and medical issues, but also with the practical and emotional problems of their everyday lives. Much of the anguish faced by my clients revolves around the pain they feel they are causing their loved ones, and then there are those loved ones who are in no less need or deserving of attention.
But now I come back again to the lack of information and support for those in this `middle ground'. The medical profession have only so much responsibility within their brief to make sure, perhaps, that surgically all is done to make a transition of roles viable. Psychologically a client or patient is prepared or groomed for the impending changes, assessed throughout for psychological suitability for the procedure, but far more is involved than purely physical realignment of a person's sex. More information and more openness would be a pre-requisite of improving the situation.
In the past I have worn many hats, running a self-help group from my home, giving talks to interested bodies, as well as working one-to-one with individuals and their families.
Although I acknowledge that I am not the only one providing this type of grass-roots support, in all its divergent nature, I feel slightly despondent that on my retirement from social services, the foresight that acknowledged the need for my skills in this area should not be able to continue the service, now that I am gone.
I have decided to continue the work that I do, hard as it is to define, and hopefully may now work for GP's, psychiatrists and social services on a freelance basis. However, this does not lessen my belief that an officially recognised liaison office needs to be established at a local level to stem the panic at its source.
My work has encompassed many areas from family work, addressing the specific problems of guilt and loss, to self acceptance and the coordination between the medical, psychiatric and social bodies that become involved. When the wheels are set in motion to go along a certain path. In my official role as a coordinator the importance of my position was often acknowledged. However, it leaves me to suspect that widely differing levels of public service is offered depending on where you live in the country.
It is evident that little or no support is available in the provinces before, during and after the transition period of gender reassignment. There would appear to be no shortage of self-interested persons with biased opinions who are peddling bad advice to the unsuspecting, for personal gain. This does nothing but harm to the cause in general and the troubled individual in particular, which is why I am in no doubt regarding the urgent need for official experienced qualified support on at least a county wide basis. Even qualified general counsellors with no real experience of gender dysphoria may not offer a realistic view to the person seeking help. Within my group I have seen people offering a one-sided view to vulnerable people embarking on the same route.
I have been on the receiving end of criticism myself, accused of being unable to understand or identify with the problems that gender dysphoric people have, as I am not gender dysphoric or transvestite myself. Anyone who understands the concepts of counselling will know that being distanced from a subject is a bonus towards giving appropriate help.
Whilst I firmly believe in the importance of responsibility for one's own actions, much can be done in the form of localised support networks to decrease anxiety at this undeniably traumatic time. It should not be left to the families and friends of those involved, who are in many cases too close to be dispassionate to provide an umbrella for the gender dysphoric.
I feel strongly that, somewhere within the establishment, perhaps, as in my case, through funding at local level, a substrata of support can be offered. It is all very well to provide centres of excellence, but when a patient is isolated many miles away with no local support and after months between visits when problems and questions are allowed to fester, I feel a disservice is being done to all.
I can only hope that lack of resources is the crux of the problem and not lack of interest and that, perhaps as gender dysphoria gains a higher profile, the needs of those falling into the middle ground, who ask for so little and deserve so much more, may also be recognised.
OASIS is, as its name suggests, a haven, not just for sympathetic discussion of TV and TS issues, but also as a place to relax and unwind among friends.
Originating as a Beaumont group, Oasis was formed in the mid-1980's, but has now expanded to include GEMS, catering for a wide range of needs, both supportive and social. We also now have a magazine.
We have been meeting on the third Saturday of each month and are currently considering a second meeting every second Tuesday due to demand.
The meetings start around seven o'clock (earlier by arrangement for those that travel some distance) and include a buffet.
There is plenty of opportunity for informal chat or special events, such as makeup and wig demonstrations. Speakers are suggested and organised by mutual arrangement of the group.
Despite the informal atmosphere of the group, it is not an open house and we have a vetting process to ensure the security and confidentiality of our members. Do contact me, if you would like further details.
Citation: Ross, B., (1994), Provision of care for minority groups: The importance of home-based support networks within the establishment, GENDYS '94, The Third International Gender Dysphoria Conference, Manchester England.
Web page copyright GENDYS Network. Text copyright of the author. Last amended 24.06.06