How can Trans folx get non-judgemental treatment ?
Trans people have been the subject of discriminatory treatment for a long time. So much so that some of us are scared to venture out and ask for help in fear but Dr S Mohan Raj and doctors like him are trying their best to provide a safe space.
What resources did Dr. Mohan have to guide him through his practice?
Dr Mohan’s training at NIMHANS gave him outstanding exposure to all things including sexual orientation and gender dysphoria. He talks about how his training at NIMHANS made it possible for the psychiatric training to be fairly open and completely non-judgemental. In addition to that, Dr Mohan Raj says that the Indian Psychiatric Association as a whole has taken a stance that is very non-judgemental. The Association does not see sexual orientation or gender dysphoria as illnesses. Rather Gender Dysphoria is seen as a condition that can be supported if the patient needs any help dealing with their identity. Sexual orientation isn’t treated either.
In Gender Dysphoria if the patient wants to transition then the psychiatrists help facilitate it. Even the law helps facilitate the patient. It is also a requirement by law for the psychiatrist to give a certificate.
Why the need for a certificate?
The certificate is needed to say that after talking to the patient, the psychiatrist can determine that it is Gender Dysphoria and nothing else. This happens because the person has to go through hormone therapy and surgery which are irreversible. Additionally, if this is related to plastic surgery where a patient wants to change their appearance by changing their nose, eyes or ears etc then the plastic surgeon will want an opinion because there are a few conditions that have similar symptoms and they need to be ruled out.
One of these conditions is called Body Dysmorphophobia.
What is body dysmorphophobia?
In it the patient feels like there is something wrong with their body, say their hands are too big or their nose is too small. And so they will end up going to a plastic surgeon to have repeated surgeries. And sometimes what it leads to is that they will get unhappy with the treatment and ask for their old body part- reverse the surgery. So to avoid these eventualities they will ask for a psychiatric consultation. This is for routine plastic surgery.
In the case of gender dysphoria, it is the irreversible nature of the surgery and the hormonal treatment. It is a safeguard, as they want to make sure that it is not the Body Dysmorphophobia that is guiding this decision. Body Dysmorphophobia is a Psychotic condition where a person has a false fixed belief that there is something different about the way that they look. This is something that needs to be ruled out.
What is OCD?
Then, there is a condition called Obsessive Compulsive Disorder, or OCD for short. In it, a person has recurring thoughts about something. It can be a line from a song, or an image or can be a doubt, “Am I really a man/ a woman?” So, this is another thing that needs to be ruled out.
So after all of that, the certificate will say that they do not have these other psychological issues, they are just gender dysphoric. So other things are ruled out.
How does one start the process of getting a GD Certificate?
The certificate states that the patient here is fully aware of the procedure and its irreversible nature. And they were in the right mind when they sought this advice. This is something that most surgeons or physicians would like to know before they start their procedure. This is when the person is fully aware of whatever is going on and they understand the consequences of the treatment as well.
The psychiatrist is like a screen.
In essence, is it merely ruling out other conditions than diagnosing gender dysphoria?
No, it is both. It is the diagnosis of gender dysphoria by ruling out other causes. It is not a psychotic disorder and it is not OCD.