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An Illustrated Guide to the CAMH Gender Identity Clinic Surgery Process Hi There

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An Illustrated Guide to the CAMH Gender Identity Clinic Surgery Process Hi There An Illustrated Guide to the CAMH Gender Identity Clinic Surgery Process Hi there. Welcome to my guide to navigating the sex reassignment surgery approval process in There are other important Ontario. This is a map or, institutional analysis, factors, however, that - CEO of the process. determine who gets surgery - Trustees and who doesn’t. One of There are a lot of different things that come into - Senior Management the key ones is power. - Doctors play in the process. I talk a lot about the primary There is a hierarchy at governing texts (the written stuff that dictates CAMH, like all hospitals, - Nurses the process) because, in this system, they set the and patients have - Non-Professional Staff criteria for who gets surgery. There is a lot of the least amount of overlap between them, but also some important power.2 - Patients differences. Of course, society dictates the ways that CAMH CAMH has over 3,000 staff and 25,000 patients.3 operates. In a society without as fixed or stringent gender system, the Gender Identity Clinic would look very different. Actually, there Here are some acronyms that get used (if are lots of cultures that not you forget what one is, just come back to only have space for different this page): kinds of trans people but also celebrate them.1 Because it has CAMH - Center for Addiction to do with gender, patriarchy and Mental Health and heteronormativity play DSM - Diagnostic and really key roles here but so Statistical Manual do racism, disablism and GIC - Gender Identity Clinic classism because gender GID - Gender Identity Disorder Ok, let’s go! is interpreted through FtM - Female to Male different lenses and because (transsexual or transgender) trans people are often MtF - Male to Female racialized, disabled and/or (transsexual or transgender) working class. SRS - Sex Reassignment Surgery This is CAMH (Center for Addiction and Mental Health), It was named a massive mental health facility in Toronto that some after C.K. people still call “The Clarke.” It was opened in 1966 as the Clarke, one Clarke Institute of of the most Psychiatry.4 prominent psychiatrists GID in the early Clinic 20th century5. He fought to have immigrants with psychiatric diagnoses deported.6 The GIC at CAMH follows 3 sets of rules: OHIP, WPATH & DSM.7 The GIC at CAMH The clinic will see anyone will who “wishes to also explore issues assess related to their people gender identity.” 10 for But, in order to qualify CAMH is a massive hormones but they for hormones or sur- psych institution encourage people to get those through other doc- gery, you have to meet that treats people tors and the DSM criteria. who choose to go mostly There are only two there but also assess acceptable ways to incarcerates people gender identify in people against for sur- order to access their will.8 geries.9 surgery. There’s gonna be a lot of hoops to jump through if you want provincial funding and the rules can change depending on who is in government... Dalton McGuinty was elected Premier 12 Mike Harris cut in 2003 and his funding for trans government relisted surgeries as part 13 of the neo-liberal SRS in 2008. He also policies he imple- implemented austerity mented as Pre- measures and cut social mier. Housing, 14 social assistance assistance. He and many more To get funding, you have to things were11 cut resigned in 2012, have OHIP. This means that in this era. replaced by people without immigration status can’t access SRS funded. Kathleen Wynne. OHIPs rules to get sex reassignment surgery paid for are: Generally, the surgeries are done in Montreal. And, not everything is offered, the most significant likely being the refusal to give trans women breast augmentation. Some less common procedures aren’t covered either.15 Be1 approved OHIP only 2funds 3 by the CAMH Gender surgeries, Identity Clinic not hormones The World Professional Association for Transgender Anyone can Health (WPATH) is the organization that dictates the I know it join WPATH but standards of care for trans surgeries and hormone is the dominant only “professionals use. It Issued its first version of the Standards of Care narrative and all, but working in disciplines in 1979 back when it was called the Harry Benjamin this whole wrong body shit such as medicine, 16 doesn’t work for me. I mean, psychology, law, International Gender Dysphoria Association. It was this is the only body I have. There social work, named after this guy: are parts I might want to change counseling, or that might make psychotherapy, me uncomfortable but family studies, don’t call it wrong. sociology, anthropology, 17 speech and voice therapy and sexology” can vote.18 their minds and their souls are WPATH perpetuates a lot of ‘trapped’ in the wrong body. problematic notions about trans people. Of course, the “wrong body” hypothesis doesn’t fit everybody. They pathologize the experiences of oppression as “minority stress.”19 These are the WPATH criteria for surgeries (but it says there can sometimes be exceptions to this): “If significant medical #4 can have some “Capacity to “Age of 1 2 3 majority” 4 or mental health major implications for make a fully concerns psychiztrized people. “Persistent, well- informed are present, documented gender decision and they must be to consent for dysphoria” reasonably well Let’s go to the next treatment” controlled.”20 page to find out. I am “No a WPATH surgery should “an effort expert. Today be performed must be made to improve I will be talking while a these conditions with about how “mental patient is actively psychotropic medications and/or health concerns.... psychotic.”22 psychotherapy before surgery can complicate the is contemplated.”23 process of gender identity exploration and resolution of gender dysphoria.”21 Wrong. There is also a requirement that you get a “referral from a In order to get qualified mental health This access to professional” (1 for probably surgeries top, 2 for bottom)24 isn’t a big (or hor- and “a mental health deal... right? mones) screening and/ trans or assessment.”25 people can This requirement be coerced ensures that there into taking will be a psychiatric/ psychiatric drugs psychological or getting psychotherapy that examination at some they don’t otherwise want. point in the process. There are some surgery For phalloplasty or WPATH also says specific vaginoplasty, you have that professionals criteria as to meet all of the other can ask people to well... requirements plus “12 provide proof of continuous months of For removal of a uter- legal gender and/ living in a gender role that 28 us, ovaries or testicles: or name change. is congruent with [your] However, CAMH GIC “12 continuous months gender identity.”27 This is often of hormone therapy” called the ‘real life test.’ doesn’t require this is required.26 anymore.29 Ok, here’s the deal with the Essentially, it’s the Psy-ble (the This is Kenneth Zucker. He Psychiatric Bible). It is the big book of also works at CAMH trying Diagnostic and diagnoses that psychiatrists use. The to make trans and queer DSM 5 just came out in May, 2013.30 kids normal. He was also Statistical There were a lot of changes to on the committee for the the DSM in this issue, including DSM 5.31 This outraged a Manual... changing Gender Identity Disorder lot of trans activists.32 to Gender Dysphoria. (More on him later.) Gender Dysphoria has several components in the DSM: typical feel- A) It lasts at least 6 months characteristics;” 3. and has 2 of the following: ings and re- B) The condition is associated “strong desire for sex actions of with clinically significant 1. “marked incongruence be- characteristics of tween one’s the other distress or the other gender;” gender impairment Ok, so once all of experienced/ 4. “strong desire to expressed in social, that is done and be of the other gen- occupational, you meet all these gender and... der;” 5. “strong desire sex charac- or other criteria, have all the to be treated as the important documentation and teristics;” 2. other gender;” “strong desire areas of recommendations, 6. strong conviction functioning. etc. you can go to to be rid of that one has the one’s... sex CAMH. The application Mail in your asks why you application 1 are going to the and wait 3 clinic, where Dear Transsexual: you are in your We have been informed that you transition, what want to have surgery. your family Please come to our clinic so we can thinks, who all decide if you are a real transsexual or your doctors just a freak. You can’t go directly are and for who to contact in an CAMH: to CAMH. You have You 35 have too emergency. They also ask you much to get a referral power to supply a “written life story CAMH from a doctor; this is but OK. regarding your gender identity probably your GP but 36 could be a psychiatrist or history and goals.” another doctor.34 2 ...and wait. Eventually, you’ll get an appointment. CAMH assesses For people trying there is an additional requirement of what people to see to access bottom CAMH calls “a continuous Gender Role 4 You will have two interviews that 1. Pass Fail if they meet its surgery: Experience” which they say, most of the time are up to 90 minutes each and you criteria: a) you “will continue to be found in employment, could be asked to go for multiple follow 37 2. Pass Fail are at least school studies and voluntarism, up appointments.
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