I decided to dedicate myself to investigating and writing about the experience of body in transgender people. Though I am by no means an “expert” in working with this population, I have learned significantly from people I have worked with who identified themselves as transgender. I set out to organize my observations and insights by grounding them in current research, to offer something of use to the reader that is legitimized by work in the field. It struck me that in looking at body-appearance satisfaction we could learn a lot from people who experience being born with, and living with, a body that they experience as opposite of what they were suppose to have.
What is the nature of the relationship to the body for transgender people? How do they value their body? How do they take care of it, take pleasure in it? How do they deal with other people’s perceptions versus what they see or what they wish they could see? Does that change if they are able to change their body to look like what they believe they were supposed to have? What I was to discover was a dearth of research and a complete lack of theory or even sufficient conversation on the topic. There was certainly almost nothing scientific or academic of any use to working with clients. So here are my truncated thoughts combined with what I learned in my search for information on a very complicated subject.
For those new to this area, know that for transgender people, the desired body isn’t a thought, or a feeling, or even a drive. History has shown that the experience is relatively unchangeable. I would describe it as an experience of persistent identity messages incongruent with the physical body. There is a “hardwired” nature to this lived experience, though science hasn’t found the neural connections yet. Despite abusive efforts to create aversion in people who feel they are in the wrong body, to force them to stop thinking of it and stop expressing it (society can’t handle ambiguity or non-conformity, apparently), transgender people don’t stop being transgender.
Interestingly, to the transgender child, there is no incongruence or distress about the body until they are confronted with the gender that is socially assigned according to the worlds’ image of them. They are often shamed, ridiculed, and otherwise discouraged from expressing what they consider to be their true selves, from an early age. You don’t have to be a therapist to think about the impact of such conditions of worth on the development of self-esteem. Indeed, transgender people have the highest rate of suicide.
There is some published anecdotal evidence that children who are allowed to explore their gender-related interests and self-expressions without external pressure to conform are better adjusted. There is also some research that suggests that trans people who have the resources and support to transition—and who believe they will be able to “pass” as the desired, chosen gender—have better mental and physical health outcomes. Also, while trans people have been shown to be at greater risk for developing eating disorders due to body-image dissatisfaction, depressive symptoms, and low self-esteem—they have also been shown to have reduced risk of these problems after gender-confirmatory surgery.
How do we begin to support these people or even understand their struggle and offer them hope? What is our role as therapists or friends in supporting transgender people? We know that body image issues are a problem for women who feel the pressure to conform to societal ideals and this can result in negative self-perception and negative health outcomes. In clinical studies, trans people have been described as being obsessed with the aesthetics of outward appearance. It makes sense that a trans person, having to live with a body that looks nothing like what they want and one that is often in complete opposition to social ideals for the gender they feel they are, would have even worse self-perception and greater negative health outcomes. So how do we help?
I believe in the fundamental healing value of acceptance and understanding of human experience. In my role as a therapist, I must be a non-judgmental mirror for the people I work with. In asking “what” rather than “why” questions, like at the outset of this article—I can get closer to an understanding that can allow me to mirror a person’s inner view of themselves. In that way I can strengthen the sense of self and self-worth of a person. I work to emphasize the importance of the functions and joys of the body, not just its appearance.
I share the idea that self-esteem comes from dedication to loving self-care and encourage habits that lead to better relationship to the body. This can be life enhancing for a person who has had very little acceptance and hence suffers low self-worth. Indeed most trans people I have met tend to focus on the well-being of everyone other then themselves. However, to truly support trans people in healing their relationship to the body, I must also educate myself on their unique experiences and needs, whether they are in transition or not. I must also be political in joining the struggle for their rights, including educating others. I must be an advocate that supports their rights to dignity and well-being, if that involves gender-confirmatory surgery or other procedures or services. Hopefully this article is a drop in the bucket towards that monumental task.
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