INTERSEX : a view from both sides of the fence

1. INTERSEX: a view from both sides of the fence mani mitchell counsellor change agent intersexual p.t.s.d. queer kiwi

2. INTERSEX: a view from both sides of the fence In memory Keith Taylor Sydney (Gosford) Psychotherapist

3. INTERSEX: a view from both sides of the fence Clarification: In this presentation I am using the term intersex as a reclaimed word. I am also using DSD not because I like it or agree with it – it is sadly the ‘new’ medical term I acknowledge that many intersex people do not see themselves as queer or queer (glbt*i) identified, I am in this presentation talking only about people who do. I am NOT seeing intersex as a reality, something that is in itself pathology In this presentation I am taking about intersex identified people who are experiencing and or seeking help with mental health issues.

4. INTERSEX: a view from both sides of the fence One side: Educator - disaster/mental health professional Other: Intersex/DSD I live with the long term consequences of childhood trauma - sexual abuse (PTSD)

5. INTERSEX: a view from both sides of the fence Intersex:a medical umbrella term used since the 1950”s Definition A body that someone has decided is not standard male or female. Incidence: Visible during a persons childhood 1-2000 live births. Actual*, as high as 1-100 live births. (invisible – not diagnosed) * Work of Professor Milton Diamond Hawaii

6. INTERSEX: a view from both sides of the fence The ‘modern’ (1950’s) treatment paradigm. Still very much anchored in the thinking of sexologist Dr John Money. Focus psycho/social (emergency) – need for clear agreed gender (Gender seen as a binary) Congruent body Child rearing Secrecy Hetro-normative – binary (male, female) eurocentric – trans/homophobic response to difference

7. INTERSEX: a view from both sides of the fence Very few intersex conditions that are truly life threatening and needing surgery or treatment. • Salt wasting CAH • Urinary tract issues. • “the existence of intersexed bodies threatens to disrupt the Western notion that there are only two sexes that are quite distinct from one another, scientists and medical practitioners have used their cultural authority to affirm sexual boundaries and to secure their own place as the legitimate arbiters of sex and gender.”

8. INTERSEX: a view from both sides of the fence Treatment Typically Aggressive: gendering the child – following it up with ‘normalising’ surgery and or hormones

9. INTERSEX: a view from both sides of the fence Surgery not always confined to genitals

10. INTERSEX: a view from both sides of the fence

11. INTERSEX: a view from both sides of the fence The trans/homophobic ‘shadow’… Every intersex (DSD) persons story/journey will be different. My contention: you can not do this work with clients if you have not done your own – AND that your comfortable being outside your comfort zone and working with an reality (story) that may well be poorly (sometimes impossibly) languaged.

12. INTERSEX: a view from both sides of the fence Intersex DSD knowledge/information • Its your responsibility to learn, its not your clients job to teach you • Unless you are considering paying them to do so! Warning: Doing work in this area has the potential to challenge and change much of what you know, have assumed and think about the human world.

13. INTERSEX: a view from both sides of the fence The mythical ‘hermaphrodite’

14. INTERSEX: a view from both sides of the fence Impact: (potential) as a clinician be aware the client may know their story or they may know very little! Your client might be comfortable talking – unable to – or not consider any of the following relevant Have you and your client agreed what it is you want to do in counselling? When was the intersex reality identified (birth/later) • Was the difference significant or not • What was the difference (there are over 30 diagnosable intersex conditions) • Was there an issue around gender? • Did the assignment change?

15. INTERSEX: a view from both sides of the fence • Was your client abused by family as a result of their being different – physical – emotional – handed over for adoption – family break up – • Was your client abused: bullying /teasing/violence/sexual abuse (home – school – community) • or an ‘abuser’ during their childhood (acting out) • During the clients teen years what went on – how was it going through puberty -

16. INTERSEX: a view from both sides of the fence • Was being a teenager a positive experience • Were there issues with relationships – family – school – peers – intimate. • Alcohol • Drugs • Violence • Depression – anxiety – self harm – suicidal – (attempts) hospitalization • Interpersonal skills – okay - problematic

17. INTERSEX: a view from both sides of the fence • How does your client feel about their intersex/DSD status/identity now – is it a problem? • Does your client have a stable gender identity that they are comfortable with it • Does your client have a stable sexual orientation – how has sexual experiences been for them, are there intimacy difficulties • Is there a fertility issue and is it a strength/a problem or neither for your client • Is there anything they want to change

18. INTERSEX: a view from both sides of the fence Image shown with awareness to the owner of this body I show it with respect only so you may understand a little more..

19. INTERSEX: a view from both sides of the fence Other things to consider: Impacts of • Shame - fear - secrecy - lies - silence - • Rejection - discrimination - trust violation - isolation • A missing/lost personal narrative • Being born different • the hospital ‘freak’ - teaching opportunity • Trauma • To be queer is to be the person that was supposed to ‘die’

20. INTERSEX: a view from both sides of the fence Other things to consider: • Revenge (desire) • Anger • Trust - repair issues (physical and or psychological) • Dissociation • Absence of self care • Poor sense of self • Grief/loss • Culture (does your client come from a culture where intersex is treated differently)

21. INTERSEX: a view from both sides of the fence Moving forward: • Educate yourself…. • Work with respect • Assume nothing • Work alongside your client • Listen (exquisitely) • Expect to be ‘checked out’. (many times) • If you get it wrong - apologise • Be alert to transference - counter transference ! • Typically this is not fast work!

22. INTERSEX: a view from both sides of the fence Moving forward: • Gender identity issues (if your client does not identify or is exploring issues related to their assigned birth gender) • Then you both have some potentially complicated work ahead. • Your role may well be critical helping your client move forward - points to consider • your client may or may not identify in the binary • if your client sees themselves outside the binary can you support them? • If the person had genital surgery as a child this process will not be straightforward.

23. INTERSEX: a view from both sides of the fence Moving forward: Remember • Your client is the expert - not you. Beyond Blue p3 • “60% of intersex people reported having experienced depression, and over 70% had seen a counsellor or a psychiatrist during the previous five years.”

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28. INTERSEX: a view from both sides of the fence thank you

29. INTERSEX: a view from both sides of the fence References: Kennedy, K. Psychological Distress in people with intersex conditions. Leeds, 2006. Mental health promotion and prevention services to gay, lesbian, bisexual, transgender and intersex Populations in New Zealand. Te Po ISBN 978-1-877537-77-6 Depression and anxiety in gay, lesbian, bisexual, trans and intersex populations. Beyond Blue. 2012. Berkley Journal of Law and Justice.Exceptions to the rule: 2006 Volume 21. Davies, D. (2000) Therapeutic perspectives on working with lesbian, gay and bisexual clients. Open University Press. Dreger, A. (1999) Intersex in the age of Ethics. University Publishing Group.

30. INTERSEX: a view from both sides of the fence References: Preves, S.E. (2003) Intersex and Identify. London. Rutgers University Press. Reis, E. (2009) Bodies in Doubt an American History of Intersex. Baltimore. Johns Hopkins University Press. Karkazis, K (2008) Fixing Sex Intersex, Medical Authority and Lived Experience. London, Duke University May, L (2005) transgenders and intersexuals . East street publications.