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The following story contains some strong language, persons bothered by such are advised to skip it. It is not, strictly speaking, a transformation story, but then little of what I write is. It does deal with T* issues, such as they are. This story didn't come out nearly as well as I'd hoped, but I'm not sure what else to do with it so I present it here. It does have the saving grace of being, as far as I know, a unique concept, for whatever that's worth. Comments and constructive criticism appreciated, flames to /dev/null - whatever in the world that is. Yours Is Not To Say By Myria People think that it's just a joke that therapists have to undergo therapy, but it isn't. I've always thought it somewhat telling that a centerpiece of my profession is that we ourselves go through much the same treatment as that which we give our own patients. In an odd sense it's almost as though we become the receptacles for the accumulated problems we help our patients overcome and then we pass those on to our therapist who then, presumably, passes them on to his or her therapist, and so on. There's something almost shamanistic in that, I think. The waiting room for my therapist was quite a lot nicer than mine. His offices were in a relatively new and quite upscale office building in Boston. My office is in an old converted three story Victorian in Brookline. Nice enough, in a rustic sort of way, but not a nice as this. Still, a waiting room is a waiting room, and I don't generally deal with waiting very well. Especially not tonight. Had there been anyone there to see me I would have contained myself. But there wasn't, I'm always the last patient of the day, so I fidgeted. I don't think I'd felt that antsy before a session since grad school. As is his wont, Dr. Lawrence was on time. Not a minute early, nor a minute late. At exactly eight hours post meridian his office door opened and he smiled at me, waving me in. Not for the first time, I wondered if that was a control issue or if he just had a phenomenal sense of time. And, again not for the first time, I wondered about his office. Had he set it up this way because he believed it helped put his patients at ease, kept them off balance, or did he just have the worst decorating sense of any man who'd ever walked the planet? The room itself was relatively large and spacious, though much of that room was unused. The carpeting was thick, lush, and... aqua. The walls were painted a bright pink. Against the far wall was the most comfortable and ugliest couch you have ever seen. Overstuffed to the point where you didn't sit in it, you sunk into it, it was so comfortable it practically begged you to take a nap. It was also the most god-awful yellow you have ever seen on any piece of furniture. To the left of the couch, against another wall, was a long coffee table with an old clock, coffee maker, and various nick-knacks on it. Things mostly, I assumed, given him by his patients. In the far corner near the door was a small desk that looked like a paperwork explosion had occurred on it. And in front of the couch, facing it, were two rocking chairs. Not exactly the kind of office you expect one of Boston's better known shrinks to have. The good doctor was not what one would expect, either. Tall and thin, he was surprisingly handsome and quite young for someone with his reputation. Always impeccably dressed, he was the visual opposite of his rather garish office and perhaps that was the point. An incredibly intelligent man, he had the kind of voice the instantly put you at ease and a manner about him that told you that when you were speaking you were the focus of his world. All the qualities one could hope for in a psychiatrist and then some. He mumbled something to me about needing to find something before we started, so while he fussed with some papers on his desk, I went to the couch and sat down. Taking off my pumps, I slid my legs beneath me and arranged my skirt, hoping I could arrange my mind as neatly. I didn't even know where to begin to try and explain what I needed to get off my chest. After a moment he apparently found whatever it was he was looking for and came over and sat down in one of the rocking chairs. "Good afternoon, Julia." "Good evening, Miles," I replied with a smile. "So it is," he said, glancing down at his watch. "How have you been? It's been a bit since we've seen each other." "I've been okay, thank you. And you?" "I've been well." He paused for a moment and then turned more serious. "I was a bit concerned when you called for this session, Julia, I don't recall you ever doing that before." "I'm generally content with our regular schedule. But something has come up, I had a case go somewhat badly and it has got me bit bothered. I guess I just needed to talk." "That's what I'm here for. What happened?" I sat back on the couch and rearranged my skirt, something I do habitually when I'm tense or nervous. How to even start? "Do you remember my mentioning a somewhat unusual case of mine the last time we spoke?" "Yes," he said with a nod, " I do." "Well her name is..." Miles stopped me with an upraised hand. "You know I prefer not to get into the details of cases, Julia." One of the many reasons a therapist needs their own therapist is because of matters of therapist-patient confidentiality. The only one you can really talk to about issues involving your patients is your own therapist, but even there discussing things in any real detail is frowned upon. It's rather silly, some of the convolutions we go through in talking about things without actually mentioning any identifiable details, but it's usually justified. This time, however, I wasn't in the mood for such games. "I understand that, but in this case I think it's necessary." He watched me intently for a moment, clearly trying to gauge how serious this was, and then nodded. "Okay, I can accept that if you feel it's necessary." "I do. Her name is Lynda, she called me about making an appointment a week or so before our last session." "Did she indicate what she wanted to see you for?" "Yes, she said it had to do with GID issues. As you know, a fair amount of my practice involves transgendered and transsexual individuals." "Yes, an interesting specialization." I was in no mood to get into that one tonight so I just shrugged mentally and ignored it. "Anyway, from her voice on the phone and from the name she gave I thought she might be female to male. But before I could ask she told me that she was male to female and already in transition." "I take it this is unusual?" "Very, most patients are a long ways from transition when I first see them. They're generally only just starting to come to terms with their GID issues and there's often peripheral issues as well. Sometimes I'll have a patient that transitions after only a few months, but it isn't unusual for a patient not to fully transition until several years after starting therapy." "Transition being where they go from living in one gender role to living in the other?" He asked. "Yes, exactly." "Had you ever seen a patient who was already in transition?" "A few times. Generally someone who is switching therapists for whatever reason." "So it's not that unusual?" "Unusual, yes, but not unheard of. At least it didn't seem so then." +++ Midday sessions are by far my favorite. During the afternoon and evening things tend to be hectic. Patients are generally just coming off of work and are often tense. They'd rather be home having dinner than sitting with a therapist. I can't blame them, I'd rather be home too, but the nature of the job is you work when people have time to see you. With midday sessions it's usually different. Patients are more relaxed, I'm more relaxed, and I don't have to watch the clock as closely. In the afternoon or evenings I sometimes have to cram sessions one on top of the other to accommodate people's schedules, during the day I can space things out more and have time to do paperwork in between sessions. I was just finishing up a new file when my timer dinged to remind me that it was almost time for my next session. Walking out of my office and to the stairs, I was a bit annoyed to notice someone sitting in the love seat at the back of the third floor landing. I really need to talk to someone about removing that, I thought to myself. The walls in my building are paper-thin and anyone sitting there could hardly help but overhear anything said in my office or the office next to mine. Still, that wasn't her fault. I smiled at the woman sitting in the love seat and she smiled back shyly. I wondered for a moment who she was waiting for and then put it out of my mind, heading downstairs to get my next patient. There was no one in the waiting room, which annoyed me slightly. It wasn't quite time, but I prefer patients to be early and I hate it when they're late. I went into the common office and grabbed my mail, sitting down to sort through it while I waited. Ten minutes later, still no one in the waiting room and I was definitely annoyed. I decided to go back up to my office and give her a call. Perhaps she had simply decided not to come and hadn't let me know, hardly unheard of. When I got to the third-floor landing that woman was still sitting in the love seat and I again wondered for a moment who she was waiting for before it belatedly occurred to me that my patient might not be late at all. "Hello?' I said to her. "Hi," she said, looking up at me with that same shy smile. "Who are you waiting to see?" "You, I believe," she said, gesturing at the plaque beside my door. "Are you Julia Case?" "Yes, and you would be Lynda?" She nodded. "My apologies for my lateness, I was... tied up with some business downstairs. Please, come in." "Not a problem," she replied, standing and gathering her coat and purse. She was a tall woman, perhaps five-ten or maybe a bit taller, and a bit heavy-set. Shoulder length blonde hair, expressive blue eyes, nice cheekbones, and a slightly too small mouth. Pretty enough, in an average sort of way, but certainly not beautiful. She was wearing a rather nice white sweater, red stirrups, and black flats that seemed just a tad too large for her feet. Terminally average, if you saw her on the street you'd think she was just another working woman on her way to lunch. She walked over, but stopped before walking through the door. apparently she was waiting for me, which seemed odd. "Please," I said, indicating that she should go in. She did, but reluctantly. She was obviously tense and I found that a bit off-putting. I followed her in and closed the door behind us, then grabbed a notepad and a pen. When I turned, she had already sat on the couch and was arranging herself comfortably. A good sign, I'd half expected her to be a pacer. My office is relatively small and, being on the third floor of a converted Victorian, the outside wall slopes. Against the far wall I have my own overstuffed and, if I say so myself, rather comfortable couch. Mine, however, is upholstered in a soft brown that almost exactly matches the carpeting. Facing the couch I have a high-backed swivel chair that cost me rather more than any chair should have a right to cost. I find it quite comfortable, though, and it projects the image I wish to project. I sat in it and smiled at her briefly whilst making a few notations in my notepad. I was struck by her long nails, that's gotten to be somewhat unusual today. More so because they were clearly her nails and not tips or fakes. Nicely lacquered in a pale pink, she obviously took good care of her nails and knew what she was doing. The same could be said of her make-up. Aside from the plum lipstick she wore you'd hardly know she was wearing any unless you looked very closely. Her perfume I couldn't place, a nice enough scent if a bit floral for my tastes. Her jewelry I actually envied, she apparently had very good tastes and knew how to put a "look" together. I gave her my standard spiel about how everything we talked about was completely private, how I wanted her to feel safe and be able to speak her mind, and how important it was for her to be open with me. She nodded attentively, but I didn't have the feeling that any of it meant much of anything to her. When I was done with that I paused for a moment, wondering where to go next. "Do you mind if I ask who you were seeing before, Lynda?" I asked. "Before?" "Yes, the therapist you saw for your transition." "Oh. No one." That was definitely not the answer I'd expected. "No one?" "You're the first shrinkologist... I'm sorry, you're the first therapist I've seen since," she shrugged, "since I was a kid." I made a quick note in my pad, this was getting curiouser by the moment. "Okay, so why now?" "You mean why see you now?" "Yes, exactly. You're clearly doing quite well, I'm guessing that you're well past your transition, so why now? Has some issue come up that made you decide to see me?" "Not really any particular issue, no. It's simple, really, I want to have surgery." "SRS?" "Yes. And the HBIGDA SOC requires that I have permission from two 'mental health professionals' for that, so..." If she thought I was going to rubber stamp her for SRS she was way wrong, but I didn't get the impression that that's what she expected. "I'm guessing you're on hormones?" "Yes." "How long?" "Ummm... Not quite two months now." Two months? She looked to be at least a B-cup, there was no way in hell that happened in two months. Nor did the rest of the obviously feminine characteristics of her body and face. My surprise must have been obvious in my expression. "I've had small breasts since my teenage years and I've always looked kind of, I don't know, somewhat feminine I guess," she said rather hesitatingly. Somewhat? Interesting. I scribbled "IS?" in the margin of my notepad and circled it. "Have you ever had a karotype done, Lynda?" She shook her head and from her expression I gathered that she knew what it was and didn't think much of the idea. "What drugs are you taking, Lynda?" "I don't do drugs. Or at least I haven't for a very long time." "That's good to know," I said with a bit of a grin, "but I meant what hormones?" "Oh, sorry. 5mg Premarin, 5 mg Provera, and 100mg generic Spiro. But I'm thinking of changing that some." I scribbled the names down, all fairly standard stuff. "Why?" "From what I'm reading it seems like Estrace and Prometrium would be better choices and my Spironolactone dosage is a little on the low side. I'd like to go to IMs, but that's a bit of a problem without a doctor." So she was self-medicating, not a big surprise there. I wrote down "Prometrium?", I'd need to look that one up later as I didn't recognize it. "You realize, I'm sure, that taking hormones without a doctor's supervision is not a very wise thing to do?" "I'm aware of the risks." Interesting response. I considered, for a moment, trying to convince her to stop self-medicating, but decided that would probably get me nowhere and forcing the issue would probably just scare her off. "Do me a favor, if you would, don't change anything until we've had a chance to discuss it?" "Okay I guess." "How long have you been in transition, Lynda?" "A couple of years, I guess. It really depends on how you count things, there wasn't any one point where I just transitioned." "It works that way for a lot of people." But generally only after some time on hormones, not years before. Another reason to suspect she was intersexed. "I'm guessing you've been seeing an electrologist?" "Yes, I'm pretty much done with zapping." "Can I ask about your family, Lynda? How have they responded to your transition?" "I don't know, really, I don't think they know. I don't have much contact with my family." "Do you have any brothers or sisters?" "One brother, but I haven't seen him for a long time." "So he doesn't know?" "I doubt it." "What about your parents?" She hesitated for a second, clearly this wasn't a subject she was comfortable discussing. "My Mom would probably have a stroke if she knew." "Why do you say that?" "My Mom always wanted a 'real' son. You know, the kind of son who plays football and dates the prom queen and grows up to be an investment broker or something. All that junk." "And you weren't that?" Talk about understatements. "No, she was always disappointed in me." "What about your father?" "I doubt he'd care one way or the other. My Dad has all the humanity of a brick, he never cared what happened to us." Lovely. "Do you know where your parents are?" "Not really. To tell you the truth I don't even know if they're still around. I guess they probably are, they're not that old." "How old are you, Lynda?" "Twenty-seven." A bit older than I'd thought. "I'm guessing that you've probably got good reasons for not being in contact with your family. Maybe that's something we could explore further at another time?" "Okay." She sounded like she'd rather have a root-canal, but that wasn't surprising under the circumstances. "Let me ask you something, Lynda. Other than getting your letters, what do you hope to get out of our sessions? What would you like to work on?" "I don't know... I, I kind of have problems with like self-esteem and stuff? I don't know, maybe you could help me with that?" "Hopefully. I know some mental exercises we can discuss that might help. Anything else?" "Well it's maybe related, but I sometimes really worry about passing and stuff, like my looks and voice and everything. Sometimes it's mega-depressing and it can kind of be a problem." Passing issues? You have to be kidding me. Clearly she wasn't. "Okay, we can try and work on that some as well." I glanced over at the clock, seriously wishing I had more time. "It's about time we start wrapping things up. I'd like to ask you, how do you feel about this session?" "It went better than I expected," she said with the first genuine smile I'd seen from her. +++ "So right from the beginning this patient seemed unusual to you?" Dr. Lawrence asked. "Yes," I replied. "I'm still unclear as to why exactly?" "Little things, mostly. Like her voice. Voice is one of the hardest things for a transsexual woman, it's a difficult thing to alter, especially without it sounding artificial." "And her's didn't?" "Her voice sounded perfectly ordinary for a natal woman." "You mentioned her appearance a couple of times, I presume that was part of it as well?" "Yes, definitely. Again, she seemed perfectly ordinary for a natal woman." He tapped his pencil for a second. "I don't know a lot about this specialization of yours, Julia, but isn't that the goal?" "Yes, but to have someone just walk through my door already there?" I took a deep breath, knowing that I was treading on thin ice here. "It's not just that, Miles. Don't get me wrong, I've known several transsexual women who were absolutely gorgeous, but most aren't. Most of my patients have some degree of problems passing even after a couple of years on hormones, let alone a couple of months. And those that don't? There are almost always things you can see if you know what to look for. A brow ridge, a hairline that isn't quite right, hands that seem proportionally too big, mannerisms that are a little off, whatever. Remnants of their past that some don't ever escape. In many cases most people probably wouldn't even notice, or if they did they wouldn't likely think anything of it, but it's there if you know how and what to look for." "And there wasn't anything like that with this woman?" "No, nothing. Aside from her height, and she wasn't even that tall, there wasn't anything unusual about her at all." "You said that you walked right past her in your waiting room even though you were expecting a patient?" "She was upstairs, just outside my door, not in the waiting room, but yes, I did." "How did that make you feel?" "A bit dumb, I guess. It should have occurred to me that she might be my next patient when I discovered that there wasn't anyone in the waiting room." "Did that feeling colour how you handled her and the session?" "Of course it did! I'd never had something like that happen to me before. Almost all of my MtF patients, when they first come to me they're still living in a male role. They're usually confused, they don't know what to do or think, and they're usually quite a ways from transition. I've only ever had two patients come to me who were already in transition, and neither of those cases were quite like this woman." "Did you have any idea why she was so unusual?" "At the time I suspected she was probably intersexed." "Klinefelters?" Miles asked, surprising me some. I didn't know that he knew anything about the subject. "Possibly. Some sort of genetic or physiological intersexuality. Perhaps PAIS or even AIS, there were a number of possibilities." "Did that turn out to be the case?" "Not quite..." +++ Our next two sessions went fairly well. Once she opened up she turned out to be fairly personable. I never did stop worrying about her unusual condition, but my primary concern was her seeming utter lack of self-esteem. I was convinced that had to be rooted in childhood issues. Unfortunately she was reticent in the extreme about discussing her past. Not all that surprising, a lot of patients are. Especially transsexual patients, many of whom see us as 'gatekeepers' and are hesitant to discuss anything that they feel might be seen as negative. We did try some self-affirmation exercises, and though she was skeptical about them at first they did seem to be helping just a little. By the time our fourth session came around I felt we were making good progress and that it was time to deal with the medical issue. Our fourth session started as the others had. She was early, as usual, and seemed in a rather good mood. When I invited her into my office she complimented me on my dress, the first time she'd ever done anything like that. I almost said something nice about her outfit, a lovely pale pink long-sleeved silk blouse and a pleated gray skirt, but I decided not to. Generally I feel it's best if I not say anything about my patient's appearance, it's just too easy for someone to take something the wrong way. "How was the drive down?" I asked after we'd both sat down. "I took the train." For some reason I'd just assumed that she was driving into town. I only had a vague idea of where she lived, but I knew it was quite a ways north of my office. "That must take a while, wouldn't it be easier to drive in? There's parking right next to the building you know." "I don't drive, actually, don't even have a drivers license." She shrugged. "The trains aren't to bad, gives me time to read and do some thinking on the way down. It's about an hour to North Station from home, maybe thirty minutes from there to here on the Green Line." No driver's license? Interesting. "Well, as long as it works okay for you." It would drive me nuts; I don't have the patience for public transportation. "Can I ask how long it has been since you've seen a doctor, Lynda?" "It's been a while." "Like six months? A year? Longer?" "Longer, a lot longer." "Three years? Five years?" "I don't remember exactly, not since I was a kid anyway." Wow. "This concerns me, Lynda, this concerns me a lot. Especially considering that you're self-medicating. What if something happened to you? You have no medical history and no medical support to fall back on." "It's no biggie. I haven't needed a doctor, that's all." "You never get sick?" "I get the flu sometimes or maybe a cold, it's not like I need a doctor for those. I'm pretty healthy." "There are things that could happen and you wouldn't even know it until it's too late. Preventive medicine is very important, as is having someone who's aware of your situation who you could trust and go to if there was a problem." She just looked at me, no response at all. Her whole posture had changed as soon as we'd started discussing this. Her shoulders were slumped and she was sitting further back in the corner of the couch. Her eyes looked downright angry but her voice had become flat, almost emotionless. Her defensiveness on this was really starting to bother me, what was the underlying issue? "I really think we need to do something about this, Lynda. I think that as a minimum you need to see a GP and have a checkup. Do you agree?" "No." "Why not?" I asked, trying not to sigh. "Why do I need to? Look, where am I even going to find a doctor who wouldn't wig?" "You mean because you're a transsexual?" "Yes, among other things." "I'm sure there are doctors in your area who are experienced with dealing with people in transition, Lynda." "Yeah, right. There's like, what? Maybe two or three other TSs in the entirety of the city I live in?" I did sigh at that. She was probably right, but that wasn't the point. "All right, how about this? I'll write you a referral to see Dr. Spag." "The endoc?" "Yes, he's an endocrinologist. I'm sure he'll want to do a physical exam and this way we can get you off of self-medicating." I would still want her to get a GP, but at least it would be a start and I could talk to Spag about doing a complete physical rather than his usual work-up. "What do you think?" She just shrugged. "You're not interested?" "No." "Why not?" "I'm not going to see any doctors, okay? Can we please just drop this subject?" Something was way off here. "No, we can't. This is a serious issue, Lynda, why won't you do something about it? You'll have to see doctors and specifically an endocrinologist before you can have surgery you know." "I'm aware of that, I'll cross that bridge when I come to it." "That's not good enough. I need to have some level of comfort about your medical issues." "Or what?" There were tears in her eyes now and her voice wasn't much more than a whisper. "You'll stop treating me?" I don't know if I've ever had a session go from good to bad quite so quickly. "I would have to consider it, yes. I'm not going to be a party to someone's self-destructive behaviors." "Fine." She grabbed her purse and her coat and stood. "I guess that's it then." What the hell was going on here? I'd dealt with people who had a fear of doctors before, most people did to one degree or another, but this was completely out of proportion by any standard. Especially in a person who otherwise seemed completely unwilling to assert herself. "What are you afraid of, Lynda?" "I'm not afraid, I just don't like doctors dammit!" But it was clear she was afraid of something. The way this whole thing had escalated so quickly, the way her lip was trembling, the tears in her eyes. She wasn't just afraid of seeing a doctor, the idea terrified her. How did she ever think she was going to be able to see a surgeon? Or did she? What was going on here? It all came together in one of those sudden blinding flashes of intuitive logic. All of the little things, and a couple of big ones, that hadn't made any sense and hadn't even necessarily seemed related, all came together at once. "You're not a TS, are you Lynda?" "What are you talking about?" "You heard what I said." "Oh, great." She turned away from me and threw her coat back on the couch. "I don't like doctors and that makes me a transvestite? Look at me! This is who I am, this is how I look, this is how I live my life, how could I be a TV?" "I didn't say you were. I said you're not a transsexual." "Then what?" I just stared at her. "Okay, fine. If you don't think I'm a TS, fine." She picked her coat up again. "I guess we're done then." "No, we're not. Sit down, Lynda." "Fuck you." "Sit down!" She looked at me like I'd hit her, making me instantly regret my angry tone, but at least she sat. I'd been afraid she really would just leave and that would have created problems I would rather not have to deal with. "I think," I said after a long breath, "that the reason you don't want to go to a doctor is you're afraid of having a genital exam." "How am I supposed to feel? I don't even like to think about that thing down there, let alone have someone feeling me up." "I don't think that's it, Lynda, I think you don't want to go to a doctor because then they would know that you don't have a penis, you don't need surgery. You were born a woman, you were born with a vagina." "No," she said, shaking her head as she started crying, "please don't, Julia." I think that was the first time she ever called me by my name. "Why won't you believe me?" "Because I don't think that you believe you." She reached down and grabbed the hem of her skirt. "Then I'll prove it to you." I started to protest, and for a moment I wondered if my guess hadn't been way off. But she was right; it was the only way to settle this once and for all. She pulled her skirt up to her waist in the front and then pulled down her pantyhose and panties and spread her legs slightly, shyly. "See?" There was nothing to see, nothing but what appeared to be perfectly normal vaginal lips. "Now that I've humiliated myself," she said, lowering her skirt, "do you feel better? I am a TS, okay?" "No, Lynda, I don't feel better, this wasn't what I wanted. And, no, I'm sorry but you're not a TS. At least not the way you think." +++ "She didn't know?" Miles asked incredulously. "No, not consciously. Needless to say, I was at something of a loss as to what to do next." "You pink-slipped her, I hope?" "Yes, she's been in the hospital for the last five days." "Well I don't think you had much choice there. Does she still believe she's a transsexual?" "No, the entire delusion collapsed when she was forced to admit to herself that she didn't have a penis." "Fascinating. Do you have any idea what was behind it yet?" "Some, but it's a mess. I think it's going to take a while to sort it all out. I believe that its roots were in childhood sexual abuse. Lynda was an only child and she grew up in an abusive household. Extensive physical and sexual abuse from both parents. At age fourteen she ran away from home. She created a new persona for herself with a completely different background and even managed to get ID in her new name. She created a male persona named Larry." "Why male?" "A couple of reasons, from what I can gather. She felt it would be safer, she thought it would make it easier for her to get a job. I think it goes further back than that, though. I suspect she created this persona originally as a way to escape the abuse. She believed that the kinds of things that happened to her didn't happen to boys. She's wrong, of course, but it made sense from her point of view." "I can't believe she was able to pull off this deception very well?" "Better than you might expect. A short masculine haircut, loose clothes, I suspect she was binding her breasts but she won't admit to it. I would imagine that her appearance raised more than a few eyebrows, but apparently it didn't cause her any major problems or she managed to somehow avoid trouble areas. I'm guessing that most people simply thought she was an effeminate gay male. She managed to pass as male well enough to get a job and establish herself under her new identity and after that it was just a matter of keeping up the facade." "It's a wonder she didn't end up on the streets, or worse." "Yes, it is, especially given her history. But she's a very intelligent and very determined woman." "So how did transsexualism become a factor?" "Over time the Larry persona became more 'real' to her than her old self. She started to believe that she was Larry and she suppressed memories of her past." "But it would have been rather difficult to completely ignore aspects of her femaleness. Menses alone would present a problem, wouldn't it?" "She compartmentalized it off. She blacked out any time she had to deal with anything that would invalidate that Larry persona." "That way she kept the delusion internally consistent?" "Exactly. There was only one problem, she wasn't male. It apparently took a number of years to manifest itself, but in a sense she was a transsexual. Same sense of cognitive dissonance between internal and external gender, same symptoms, just a self-induced basal causality." "So she transitioned back to a female role?" "Yes, eventually. She found out that there were others who felt the way she did and, naturally enough, decided that she was one of them. She transitioned back to a female role over a period of a couple of years. Not surprisingly, her transition went quite well and eventually she decided that she wanted surgery. And that's when she came to me." "But obviously there was a defensive mechanism involved, something that kept her from situations where her secret might be discovered, thus her fear of going to a doctor." "Yes." "So how did she think she was going to get surgery? Obviously her secret would have been laid bare before she ever got on the surgeon's table." "I don't think she'd thought things out that far, to be honest. She'd gotten as far as she had rather easily, now she just wanted to complete the last step because that's what a transsexual woman is supposed to do. That's what would make her complete. At some point the emotional defenses became overwhelmed by her need to finish things and she saw surgery as the end of the ordeal." "Fascinating. I must say, Julia, this is a very interesting case and completely unique in my experience, but I don't see where the problem is or why you felt the need to go into it in such detail? You've gotten to the root of the problem, it would seem to me that she's well on her way to recovery." "Is she? I visited her this morning, Miles, and now I'm wondering if I did the right thing." +++ The psychiatric ward is in a separate building from the main hospital. We wouldn't want the crazies to mix with the normal sick folk. Or was it that we didn't want normal people to see how we treated the crazies? I could never decide which possibility was more depressing. Technically I was no longer treating Lynda, her problems being somewhat out of my league, but I was still involved both because of my knowledge of her history and my expertise with gender issues. There wasn't anything scheduled until that afternoon and I wasn't going to be able to be there for the session, I still had my own office to run. Still, I wanted to check in on her, let her know I was still there for her, and see how things were going. The wardroom is rather large, as such things go, and set up to be as homey as possible. A TV at one end with several recliners facing it, a couple of couches, and several tables where someone could sit and play a game or whatever. There were only a couple of patients there this time of morning, all under the watchful eye of an orderly. Lynda was sitting at a table at the far end of the room, as I walked up I could see she was assembling a puzzle. She didn't even glance up at me as I sat down. "Go away," she said. "I just wanted to see how you were doing, Lynda." "I'm miserable, okay? Does that make you feel any better?" "No, it doesn't. I'm not trying to hurt you, I just want to help." She looked up at me, a fire in her eyes that truly scared me. For a moment I thought she was going to attack me, and then it was gone and she looked back down at the puzzle pieces. "Don't you think you've 'helped' me enough?" "I'm sorry," I said as I stood, best that I just leave. "I know how hard this must be for you." "You don't have the first fucking clue how hard this is for me!" She yelled. The orderly looked up, but I waved him away. "You don't have any idea what you've done to me, do you?" "Tell me," I said as I sat back down. For a moment I thought she would just ignore me, but she looked up again and there were tears streaming from her eyes. "I used to think there weren't any possible hells that could be worse than being a transsexual." She shook her head. "Boy was I wrong there. You've taken my fondest dreams and turned them into a nightmare. I used to imagine what it would be like to just wake up one day and be complete or what it would have been like to have been born physically female instead of just mentally. I used to fantasize about it, dream about it, imagine it. And now it's true, it's happened, and it's a nightmare." "Why do you say that?" "Because I'm not me, goddam it! My whole life has been nothing but one big lie. I'm not real, Larry wasn't real, it's all been a lie. Who am I, Julia? Can you tell me? The rest of these bozos around here sure the hell can't." "You'll have to discover that for yourself, Lynda, it's not something anyone else can do for you." "I was discovering it for myself! I was happy with myself for the first time in my life. I was even starting to like myself a little. Then you had to go and pop my bubble and now I'm miserable. I hate myself worse than I ever have and I don't even know who I am anymore. And I hate you for doing it to me. Why? Why couldn't you have just left me alone?" "You were delusional, Lynda, something had to be done." "Why? Why did something have to be done? Was it so bad for me to think I was a TS and to get through things? Is that so much worse than this? At least I knew who I was, at least I had some hope." "Then why did you come to me?" It was a stupid question and I regretted it as soon as the words were out of my mouth. "Because of the goddamn system set up by a bunch of anal-retentive control freaks who think they have they right to say 'yea' or 'nay' over someone's life. They want to be able to say who gets to be normal and who isn't, who is normal and who isn't. That's why you're in this business, isn't it? You like having that power over the poor slobs who come to you." "I do what I do to try and help people." "Yeah, right. Like you helped me?" "I'm sorry, but I did the right thing Lynda." "It's not your life, it's not up to you. Yours is not to say." She turned away from me rather deliberately and her body shook with her tears. I tried to think of something to say. Some way to comfort her, some way to tell her that it would all be better, and, yes, some way to defend what I had done. But nothing came, no words that would mean anything. There was only a hollow feeling in the pit of my stomach as I rose and left the hospital. +++ "So what you're saying is that you're having a crisis of faith?" Miles asked, rather a bit too sardonically. "I wouldn't have put it that way, but yes, basically." "You want to know if you did that right thing with that girl?" "No, I want to know if we're, any of us, doing the right thing. I've been thinking about this a lot, Miles, and it's really bothering me. Is all of this about helping people? Because if it is it sure doesn't seem like I helped Lynda much. Sure, she'll recover and eventually she'll hopefully be fine. But there's so many other ways I could have handled this. It makes me wonder if what all of this is about isn't helping people, it's just another way of enforcing society's concepts of what's 'normal' at any cost, no matter if it's what's best for the individual." "I think you know the answer to that question, Julia." "Do I, Miles? Do I really? Do you?" Fin