Opinion: The Majority Speaks

Tanya and Robin are our dynamic writing duo and in every issue of Homotropolis they will zoom in on current trans issues in Denmark.

Opinion: Denmark through the eyes of a transgender couple

SK (sexological clinic) claims to be the “best” qualified team of physicians to treat trans people in Denmark. They are so adamant in this belief that they insist they should, in fact, be the only doctors legally allowed to treat us, and currently they are. Let’s examine their claims. Like anyone seeking medical intervention for a health-related concern, we do, in fact, desire access to the finest treatment available, by the finest physicians available. If SK could prove they are the absolute best at what they do, and that any treatment option which does not include them would, in fact, be deleterious to our treatment outcomes, that might go a long way toward convincing many of us that we are in the best hands with them. We do not, however, believe that to be the case. Let’s examine their claims closely, and see if they are, in fact, what they purport to be.

Two kinds of mental illness
They have years of experience treating trans people thought to be mentally ill. They have, in fact, treated a whopping 104 such trans persons between 1978-2010. We are willing to concede that they are the resident experts on treating the unfortunates who suffer from the “disease” of trans. But since, as it turns out, there is no such disease, they really no longer have a patient base, do they? We must remember that there are two kinds of mental illness which one may associate with being transgender. One derives from calling the condition itself a mental illness. It is not. We settled that argument when the condition was recently changed in the Danish National Health Classification System (SKS) to reflect this new way of thinking. We’re not alone. The Americans also settled the issue for themselves in 2016 when the APA released the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V), removing the word “disorder” from trans nomenclature. The WHO is in the process of trying to make a similar change. They are, in fact, caught up in a nasty argument with opponents of the move like the Saudis and the Russians, who also, by the way, are proponents of imprisoning or executing us, hardly the kind of thinking with which we should ally ourselves, no matter how much SK seems to wish us living in the dark ages. The matter is settled. Let’s move on.

Fighting a war
The other type(s) of mental illness are those which arise from living a trans existence in a world that treats us like pariahs. For instance, being a soldier is not a mental illness, but expose that same soldier to the insanity of war and mental illness (usually PTSD) often does ensue. Trans persons also fight a war with hatred, transphobia and prejudice every time they venture outside their door. They fight these battles with everyone from their families to complete strangers, and often the very medical professionals charged with their treatment. It’s little wonder that these conditions can lead to concurrent instances of mental illness. It’s amazing it does not happen more, but make no mistake, it doesn’t. While it’s true that the obstacles we face as trans persons can lead to battles with mental illness (most often depression and anxiety), it’s just as often true that we find immense strength in our experiences. Many of us go on, at least in other countries, to become therapists ourselves. Professor of Communications Studies at Roskilde University, Dr. Tobias Raun, noted in a recent paper that, “The higher prevalence of psychiatric problems among trans people might not be strange at all considering the amount of social, cultural and work exclusion and discrimination” (our trans. from Danish). And when we do choose to seek psychiatric help with our transitions, we are perfectly capable of making that decision and choosing a therapist for ourselves.

Further, Sexological Clinic (SK) is the supposedly “foremost” publisher of transgender research in Denmark, a lofty claim indeed. Well, actually, one of their doctoral candidates, Rikke Kildevæld Simonsen, published a paper on the subject of “Long-term follow-up of individuals undergoing sex reassignment surgery: Psychiatric morbidity and mortality.” The paper materialized after a number of Danish politicians questioned the fact that these “experts” in trans health care hadn’t published anything in 30 years. The paper, which relies on a problematically small study sample, drawn from SK’s own patient base (remember those 104 trans persons?), and without any control group, calls into question the efficacy of treating trans persons without once questioning SK’s own treatment practices. Simonsen was awarded her doctorate at a dissertation defense trans activist Laura Mølgaard Tams labelled an “academic coffee club chat about dead trans people.”

Don’t we deserve the best care?
As long as no one else can treat us, SK are the only ones who can. Imagine the public outcry if such a legal arrangement were imposed upon Danish cardiologists or oncologists? Imagine a woman with stage IV liver cancer being told that there is one small group of physicians from which she is legally allowed to choose, that in fact they have already been chosen for her with no other options legally available. And we cannot afford to be naïve here, for while it is true that transgender persons do not suffer from an illness, it is also true that serious medical interventions (SK labels them “cosmetic” surgeries, as if these procedures are no more critical than the average tummy tuck) are sometimes required to bring a trans person’s body and mind into balance with their perceived gender. Don’t we deserve the best medical care available and to make those choices for ourselves, like those who seek any other type of medical help?

Them versus us
Recently a conference was held in which SK invited the most conservative doctors from other countries they could find to convince the most conservative Danish politicians that one, trans persons are still mentally ill (haven’t we been down this road, though?), and, two, they know the best ways to treat a bunch of mentally ill trans folk. Few there would question such tactics from a progressive standpoint since they didn’t invite any progressive medical professionals or politicians to their little get together. They could have invited a few progressive Danish physicians at the suggestion of Transpolitical Forum, but apparently, all those doctors are currently under investigation for treatment of trans persons outside the purview of SK. Of course, SK are not only the instigators of those investigations, but they are considered the foremost experts in gender- and sexuality-related matters when the Danish Health Department seeks to make rulings in such matters. It seems a series of rather disingenuous moves for professionals so “confident” in their superiority. We called to ask them if they have thoughts on this, and were assured they had “no comment” about, well, anything. The woman who answered the phone assured me that she wasn’t allowed to comment, and refused to connect me to anyone who was.

The progressive-minded trans persons from the local activist communities they did invite are understood (at least by SK) to be in the minority and, therefore, unqualified to have their opinion taken seriously.

One of those local activists was well-known vlogger, Niels Jansen, who noted with a nod to one supposed “expert’s” ineptitude,

“It was hard to attend emotionally. The invited doctors were all speaking from their prepared slides; one of them started by defining that a trans woman was a person identified as woman by birth and transitioning into becoming a man (our emphasis) while the others were using a lot of their time arguing against [on-demand] legal gender change.”

He continues,

“There was this odd feeling of them vs. us throughout the conference. The doctors who were invited by SK were speaking first and were given ample time to speak, while there was no time for questions. The trans organizations were then given the little remainder of time divvied up between their speakers and the question and answers section. So, when it came to questioning the SK argument, the time was spent and they closed the conference without having had to defend their arguments.”

Amnesty International (AI) was invited as well, though under protest by SK. SK Chief Psychiatrist, Dr. Birthe Smidt, noted that the invitation was due to pressure from AI’s 2014 report on “human rights violations against trans people in the Danish health system.” Tams called it “a shocking but at least honest assessment from a clinic that should have done much more to cooperate with the Danish trans community long before [AI] became involved” (our trans. from Danish).

A recent landmark U.S. survey of the trans population reports that around 1.5% of the population is transgender. That means there are around 82,500 trans persons in Denmark. SK treats, on average, 3.5 per year. When legal, on-demand gender change took effect September 1, 2014, 350 applicants showed up on the first day. That’s 100 times more of this at-risk population than SK is equipped to treat, even if they are the best equipped to treat them, and they simply aren’t. What happens to everyone else? Does SK care, and how does that sit with their claims that they “speak for the silent majority?”

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