Changing Your Mind – Thoughts on TMS

Over the past year, and especially since the publication of Switched On by John Elder Robison, there has been a lot of attention around a therapy called TMS (or rTMS–Repetitive Transcranial Stimulation).

It’s something I have deep reservations about but others have written passionately and eloquently on the subject. What I want to consider is why somebody would choose to undergo such a therapy that literally changes their mind.

I’m no stranger to the negative feelings that arise when considering the gap between how I perceive myself and what I see when I look in the mirror: that’s a big factor in my gender dysphoria.

I also know first-hand how it feels to be teased and ridiculed for hand flapping, physical clumsiness, social awkwardness, unusual speech patterns and eclectic interests. I’ve had life-long difficulty making and maintaining interpersonal relationships, and I have times where I feel keenly the lack of people with whom I feel comfortable opening up about my problems and feelings.

I understand the drive to make physical changes to one’s body. After all, I’m in the process of seeking treatment to modify my own body, bringing it into closer alignment with what I see in my mind by erasing or concealing male characteristics and developing female ones.

There are two parts to my gender dysphoria. First there is my need to have other people respond to me as a woman, reinforcing my gender identity. Second there is my need to see my own body physically match the mental image I hold.

So as a trans woman I am actively seeking treatment to make changes to my body. This is in contrast to my feelings about my autism. Both my gender identity and my autistic identity go to the very heart of who I am.

The thing is, although I will happily modify the physical characteristics of my body I wouldn’t consider altering my mind. My neurology is inextricably tied to my identity: I feel that changing my mind would make me into a different person.

There’s a line there. I’ve put a foot over that line a few times, testing the water so to speak. I’ve experienced the effects of drugs that affect the workings of the brain: alcohol, marijuana, amphetamines, SSRIs (anti-depressant).

Some of them have positive aspects. For example, alcohol reduces my social anxiety. But there are negatives too: I make poor decisions under the influence of alcohol because it inhibits my self-control and risk-aversion: I’ve gotten myself into some dangerous situations as a result.

Speed (amphetamine) left me unable to concentrate, marijuana was relaxing but caused mild hallucinations and a degree of paranoia. The SSRIs reduced the intensity of my emotions, leaving me feeling numb: in the end I had trouble focusing and engaging with things in my life.

These were all temporary effects: my mind returned to its usual functioning state in time for which I was grateful. You see, I wasn’t myself when under the influence of any of these drugs.

I guess my point is that given the complexity of the human brain and the way its many regions interact it is not possible to adjust one aspect without affecting others. Just as a particular drug affects a small number of electro-chemical interactions in the brain with wider-reaching side-effects, so a therapy like rTMS that alters a small region must cause knock-on changes across the entire organ.

My opinion is that it is not like tuning an engine, a relatively simple system with a limited degree of interconnection and feedback between its components. It’s more like introducing a foreign species into an existing ecosystem. The effects can be slow to manifest, and predictions are error-prone due to the complexity and chaotic nature of the system.

There is no way to know what other effects rTMS would have. It might reduce my social anxiety, but even if that was all it did it would make me respond differently to people I interact with (like alcohol). And if my thoughts and behavior are changed then I’m no longer the same person.

I don’t want to change who I am: I’m comfortable with my identity as an autistic trans woman with all that entails. Changing my body doesn’t affect my personality, my thoughts: I remain me. Changing my mind makes me into somebody else. I would lose the essence of what makes me this particular unique individual, and the thought of that fills me with dread.

This leads me to suppose that for somebody to even contemplate such a thing they must not like who they are. Internalized self-hatred, blaming their neurology for what they see as their failings. It’s like body dysmorphia projected onto the ego, the sense of self. The antithesis of neurodiversity’s principles; an inability or refusal to accept one’s differences.

I see this as a result of thinking colored by the medical model of autism that sees it in terms of pathological deficits, as opposed to the social model which instead looks to society’s failures to provide suitable accommodations and acceptance as the causes of disability.

There’s nothing wrong with my mind: I have no reason to change it. I can’t say the same for the society I live in.

Rewriting History

“You were never much of a man.” Anne has said this to me several times since I transitioned; I know exactly what she means and love to hear it. From puberty onwards when I started to become aware of gender I didn’t identify with any of the male role models around me.

I couldn’t put a name to how I felt; I saw part of a documentary (back in the 1980’s) which I couldn’t tell you the title of. It was about a middle-aged trans woman but her circumstances were so far removed from my own that I failed to see any connection to my own life.

So all I had were people treating me as male. My mum bought me boys’ clothes, I attended an all boys school from age 11 to 16, I played rugby. Any comments on how I looked or acted were male-oriented, either praising my conformance to the stereotypes or criticizing me when my act was unconvincing.

In my teens when I was considered old enough to be left at home alone I would decline to accompany the rest of the family to rugby matches. Instead I’d wait for them to leave and then raid my mother’s closet, dressing in her clothes for an hour or so. I’d look at myself in the mirror and feel so happy seeing a girl reflected there. I used to dream that I could travel Alice-like through the looking glass, become that mirror-girl.

I hated my male genitalia. I’d dream of cutting them off but was always too afraid of the pain and risk of death to attempt it. I always avoided showering after games at school because I couldn’t even bear the thought of anybody else seeing those parts I hated so much.

It’s easy to look back from where I am now and wish I’d said something then, started my transition before my voice dropped and my hair started to grow out on my face, recede at my forehead and become thin on top. But I didn’t have the concepts back then to even begin to explain, and I’d have been terrified at the thought of trying to explain to my parents (who probably knew even less about such things than I did).

Obviously I can’t change what happened: the events of the past are immutable. But what I can change is how I speak about my past. I’ve completely stopped using male-specific terms to refer to myself at earlier stages of my life. I was a child, not a boy; I was in my 20s, then my 30s. It’s straightforward in the present: I’m a woman and that’s that.

In my own mind I consider myself to have always been female. I don’t consider that I was socialized as male: being autistic I never felt that I fitted in anyway and didn’t form many relationships with my peers. I was always happier when left to my own devices with a stack of books, box of Lego and my computer. I didn’t participate in playground games with either boys or girls; instead I’d be reading, building trains and space ships, or writing programs.

I don’t consider my gender to be defined at all by my interests; rather it is an aspect of my identity. I simply know it as a fact of my existence, exactly the same as most other people. My mind informs my reality. That’s the reason it doesn’t feel right to talk about myself ever having been a boy or a man. I’m a woman whose body turned out wrong. One small error led to the development of male characteristics and I need medical treatment to correct it.

I tried. I tried hard for years to live up to the expectations of those around me who saw me as male. But it felt false. It was a charade, never feeling natural. I was wearing a mask, playing a part. Pretending to be what everybody else thought I was. No more. I’m through with denying who I know myself to be inside.

The new job helps a lot. Nobody there knew me pre-transition so they all just treat me as who I am. There’s no reservation in behaving the same way towards me as towards any other woman in the office: it feels very natural and comfortable. I feel accepted as myself. It might be hard for somebody who’s not trans to fully appreciate the importance of this, how validating it is to know that I’m around other people who see me as I do myself.

Who Are You?

I think a lot about identity — my identity. What terms will I use to refer to myself in my own thoughts and when I speak about myself? It’s something that has changed over my life and especially in the last few years as I’ve accepted that I’m autistic and finally come out about my gender.

Life isn’t static. We are shaped by our experiences, changing over time as we continue to grow and learn — about ourselves as much as the world around us. If we’re honest about it what others see is a reflection of our identity, multiple facets of our personality exerting their influence on everything from mannerisms to dress. But often what we present is camouflage, protective coloration to make us seem to be what we are not so that we appear to fit in with society’s expectations.

I know about this: I presented as male for most of my life, hiding who I was. But it became increasingly uncomfortable to live a lie, unable to be myself outside my own head. It caused some self-destructive behaviors and culminated in depression: it harmed me mentally and, as a consequence, physically as well. Honesty and openness have been good for me. My depression is now manageable without medication and I no longer suffer the negative impulses.

My transition has been the key to this. When I talk about gender transition what I am really describing is a change in gender presentation. My gender hasn’t changed: I’ve always been female. I just didn’t show it openly until recently. The thing about transition is that it’s not a binary switch from one state to another. It’s a process, a collection of changes that proceed at different rates.

Even changing my name is a process. Although from a legal standpoint it changed the moment I signed my declaration in the solicitor’s office, I still had to become used to it myself, to responding to “Alex” rather than “Ben”. I had to change the name in so many places, from driver’s license to medical records, from personnel record at work to email accounts. I’ve not yet completed this process: I still have a pension plan and a couple of credit cards in my old name.

Along with my name there is the important question of what words to use. Because gender affects our language so strongly it has made me think deeply about how to refer to myself, both now and when talking about myself in the past. Especially the past. It can be a little confusing, even for me, so I’ll go through it step by step.

I was born, obviously. I wasn’t “born a boy” though; I was born a girl but assigned male. Given a label, a letter “M” on my birth certificate, based on appearances. It was an educated guess by the medics and it turned out to be incorrect. Apart from my parents’ choice of name it didn’t affect me much in my early years: I wasn’t conscious of gender. I mean, I knew that there were boys and girls and that I was included with the boys, but I never thought about how they might differ. They were just labels with no more meaning than being assigned to one team or another in sports. I was definitely a late developer when it came to concepts of gender.

When referring to myself back then I have settled on avoiding gendered terms. I say “when I was a child” or “when I was growing up”. It’s more difficult when using the third person, but my preference is for something like “I went to school with Alex and was in her class for English”, using my current name and pronouns.

The other tricky area that crops up is when I describe being trans. The commonly accepted tropes, perpetuated by most media coverage, are that a trans person is “in the wrong body” or “wants” to be a different gender from that they were assigned. I see these as overly simplistic.

The way I see it is that I am not in the wrong body. I’m in my body: it’s the only one I’ve got and I’m quite used to it after more than forty years. What is wrong is that it’s a male body; its gender doesn’t match my mind. I think of myself as a woman with a hormone problem that caused me to develop male physical traits. It’s not that I want to be a woman, it’s that I am a woman who wants her body to appear female. These distinctions are very important to me.

To describe somebody as being in the wrong body is to suggest that there can be a separation between the mind and the physical body it occupies. It makes the problem sound like an ill-fitting pair of shoes, as if bodies were commodities to be exchanged at will, and trivializes the experience.

When I hear people say that I “want to be a woman” I get offended. This innocuous-looking phrase invalidates my gender identity, implying that the speaker does not view me as a woman. It suggests that it is a choice I have made rather than a core trait making me who I am. It suggests that being female is nothing more than a lifestyle, an occupation like being a scientist or a pilot. The word “want” also completely ignores the depth and strength of feeling I have about my gender.

So how would I describe myself concisely in alternative, acceptable (to me) terms? I’d say that I am a woman who was assigned male at birth, my body has male features which do not belong there, and I am compelled to change it so that it matches the image I have of myself in my mind.

Reflected in Others’ Eyes

One thing I said to people when I came out as a trans woman was that I’m still the same person. And indeed I do not feel like I’ve become somebody different at all. I do however feel less constrained, more free to express myself in a way that feels natural. I no longer feel that I’m playing a role, fitting in with what I believed people expected of me when I presented as male. It’s as if I had been confined, a square peg in society’s round hole, but by taking the step to be true to my own sense of identity I have been able to cast off the false act.

Some of the changes that Anne has noticed since I started my transition:

  • The first thing she said, which others have also remarked on, is that I appear much happier.
  • My gait has changed. I used to be heavy-footed, walking with feet splayed, and also what she described as bouncing. I now walk with my feet in line, placing them rather than “stomping”, and the weight is distributed more evenly instead of being mostly on the heel. In some respects it is similar to how I used to walk as a child, before I acquired “bad habits” (I often used to toe-walk). In fact I am now unable to reproduce my former gait as it feels too unnatural.
  • I am more expressive. She described my face as being more animated where before I had a flat affect. I also gesture more with my hands when speaking where before I would usually stick my hands in my pockets because I didn’t know what else to do with them.
  • I appear more sensitive and understanding. She told me I am more patient and responsive to her needs; I used to have a short fuse at times and would be snappy.
  • I’ve discovered color in my wardrobe. I’ve gone from wearing exactly the same black shirt and jeans every day to a variety of dresses, tops and skirts in different colors, never the same two days running.

I’ve also noticed some changes in other people’s behavior towards me since I started to present publicly as female. When I’m shopping the checkout assistants are more likely to engage in conversation. More people at work say “Good morning”, and I’m more likely to receive a smile; I’ve actually had more non work-related conversations at work in the year since transitioning than I ever did in the previous seven years! Even a few compliments on my attire, which pleased me very much since I try to make an effort.

Some signals have been more mixed: a couple of times I’ve noticed men speaking to my chest rather than my face! Not sure what they’re looking at: I’ve not much development there to speak of. Perhaps it’s just habit with them? On a brighter note I had a very positive encounter with a real gentleman last summer: I was driving to work one morning along the M4 when, while overtaking a pickup, something like a string bag full of straw fell from the back of it and lodged under my car. The driver of the pickup noticed this as I pulled in front of him and he signaled for me to pull over. I pulled onto the shoulder and he pulled over behind. We both got out, and without hesitation he walked to my car and practically lay down on the asphalt, reaching far underneath to remove the debris. I was most grateful and not a little surprised since I’d never experienced anything like this before.

All this is wonderfully validating and has increased my self-confidence. Together with discarding inhibitions it all contributes to a greater sense of calm and a reduction in my general stress levels. These inhibitions were to do with my internalized view of appropriate male behavior, a collection of rules I had acquired since early childhood. How I had learned I ought to act to avoid negative reactions: certain mannerisms, displaying physical reactions to my emotional states, even the way I walked.

Some of my inhibitions were a result of as well a cause of anxiety. Being on the receiving end of teasing or bullying will affect your behavior as you work hard to suppress the things you do that seem to be the triggers. Catching yourself doing one of those things causes a huge sense of panic: you stand there waiting for the expected hurtful reactions from those around you.

Societal gender roles have a lot to do with what is seen as acceptable by people in general. Presenting as male I had the advantage of privilege and the protections deriving from that, but only as long as I conformed to the expectations of that role. For me it was uncomfortably confining because I wasn’t able to be myself, but for such a long time I was too afraid of the reaction if I didn’t “play along”: I was trapped by my fears.

Now, presenting as myself, I don’t experience those fears. I do feel more vulnerable when I’m out and about which I believe is a result of no longer hiding behind a role, a mask. I’ve written before about how I used to feel I was safely hidden inside an avatar of flesh that was all the rest of the world ever saw of me. That’s gone now: what I show is my inner self, the person that was always there behind my protective wall of conformity.

Occasionally I regret that I took so many years to build up to the point of coming out, but that’s not how my life turned out. The simple fact is that I am here now and wishing things were different can never change that; it can only make me sad. It’s true to say that I am happier now than I had been for a heck of a long time and that’s worth a lot.

Reblog: I Am A Woman from Notes On Crazy

Nattily at Notes On Crazy is hosting a collaborative blog series called Point, Counterpoint, Actual Point. This is a series of posts combating doubts about who and what we are, a set of personal accounts of accepting ourselves as we are.

My own contribution can be found here, but make sure you check out the rest of the series. There are some excellent, informative, thought-provoking entries that are well worth your time to read.

If It Looks Like A Duck…

Who am I?

That’s a question to which I struggle to find an answer that satisfies me. Oh, there are no shortage of answers: I’m Ben, I’m a husband, I’m a 40 year old, I’m a programmer, I’m an Aspie… But these are only labels. Some can conjure stereotypes: in the case of programmer that might well be of a pale-skinned, glasses-wearing, high-IQ social misfit with poor personal hygiene, no girl/boyfriend, the muscle tone of a blancmange and a diet of pizza, soda and Twinkies. As with most stereotypes there are elements that broadly fit and others that are way off. The imprecision nags at me like a label in the back of a shirt.

Tell me about yourself.

I won’t deny that I do describe myself as above — the labels, not the stereotype! But with limited time, space, or both, I can’t keep on supplying descriptive tags until I feel I’ve completed the picture. Where does that leave me? Well, people have to fill in the gaps from their own observations and that depends on how I appear to them.

I can tell you that I care very much for my wife but that obviously didn’t show to a group of doctors recently who were urgently treating her for an allergic reaction that caused her tongue and throat to swell. I think they were expecting me to appear agitated and fuss over her but I remained calm — fussing or panicking would not have helped either of us, so I sat there out of the way and let the doctors get on with treating her. That’s what I judged to be the most helpful course of action, and because I care I wanted to act in the way that I thought would benefit her the most. They asked my wife whether I cared about her because I appeared cold and unemotional.

But you don’t look <adjective>.

Some people set great store by their belief in their powers of observation: seeing is believing. And when they’re told something that is at odds with what their own eyes have seen they are inclined to disbelieve it. In this case of the doctors — maxilla-facial surgeons and registrars — even with a passing knowledge of autistic behavior they didn’t believe my wife when she told them I do care about her but I’m not expressive: I didn’t look like I cared. You just can’t win sometimes.

It quacks like a duck, therefore…

If I tell you that I’m 5’11” and 210 lbs, stockily built, physically strong and bearded you will have a particular image of me. You might expect certain traits that correspond to that image: stereotypical masculine traits such as:

  • self-confident
  • independent
  • hard
  • thick-skinned
  • aggressive

You’d be in for a surprise: I’m none of those. So I present as male which matches my biological sex but I don’t necessarily think or behave in the corresponding way. Told you I was weird! 😉

It’s a platypus?

Conan-Doyle wrote  in Sherlock Holmes “when you have eliminated the impossible, whatever remains, however improbable, must be the truth”. And the truth here will have to wait until I have eliminated the impossible. You see, I can’t accurately answer the question with which I opened this essay. I don’t know how to describe who I really am: I’m as reliant on labels as everybody else. To myself I am just me — I know what that means but the collection of thoughts, feelings, behaviors and physical matter doesn’t have a name. Any words I or others use are an approximation, a simple sketch of the reality.

René Magritte in his famous painting La Trahison des Images (The Treachery of Images) captured this perfectly. As the caption on the picture states, “Ceci n’est pas une pipe” — “This is not a pipe”. The realization for me of the literal truth of that statement was profound.

And finally…

I hope I’ve not left you disappointed that I didn’t answer my own question. Instead I wanted to explore what identity means and how my perspective cannot be translated to anybody else without losing fidelity. All anybody else will ever see is an imperfect reflection through my words and their eyes.

Identity

We all go through life acquiring labels: abstract, shorthand descriptions of how others see us. Some are positive: intelligent, caring; while others are negative: weird, rude, crazy. I’ve picked up several over the years. But how do these labels relate to my self-image, my identity?

The short answer is that they don’t. I see myself as an individual, unique, with a set of behaviors and thoughts that is mine and mine alone. Yes, I share certain traits with others to varying degrees and this induces people to file me under certain categories in their minds. To put me into particular boxes bearing little hand-written labels, identifying me as a set of characteristics.

When I think of these labels I picture a dark, dusty, wooden cabinet, perhaps in a Victorian museum, with row after row of small drawers. Each has a tarnished brass handle and above the handle is affixed a small, age-yellowed paper label with one or two words written in a neat copperplate hand; the black ink has faded to gray. Inside each drawer, in perfect alphabetical order, is a stack of plain cards and upon each is written a person’s name in the same hand as the drawer’s label.

This view of a person as a collection of basic, orthogonal characteristics has its uses. It provides a point of reference, a sketched outline upon which to build a more detailed representation. But the picture must not be confused with the subject it represents – a portrait of somebody, whether painted or written, cannot describe them fully. The picture is not the object. That is the message in René Magritte’s La Trahison des Images (The Treachery of Images) with its caption, “Ceci n’est pas une pipe” (“This is not a pipe”).

As in mathematics, membership of any number of sets does not predicate that those attributes are the sum total of being, of identity. It’s just like saying that a particular number is prime and odd, and attempting to infer its other attributes from that incomplete description. Can you guess what number I was thinking of? The number of possible answers is literally infinite.

When I consider myself reduced to a meager collection of adjectives my hackles rise and it brings to mind the rebellious outburst of Number 6 in The Prisoner, “I am not a number, I am a free man!” By simplifying me, painting me with a palette restricted to primary colors, you deny my complexity and individuality. To understand a person in any depth it is necessary to consider the subtleties, the fine nuances of their character. To be aware of those aspects that set them apart from others who appear superficially similar. To understand that your labels are no more than a frame that limns the gross outline within which lies the colorful richness of detail.

I reflect upon my own identity and I can recognize traits, but they are not me – they do not define me. They are the bold strokes from a broad brush upon the canvas – no fine detail is possible. I am a complex system emerging from the unique combination of more factors than I can name, each contributing to the whole and generating new additional behaviors through their interactions. In this whole world of some six billion people there is not one other who is the same as me. I am me, no more and no less. My being is my identity in toto.