Health Care Redux

The more I consider the health care system "reform" currently being debated and opposed so ardently by conservatives, the more opposed I am to it – though not, I suspect, for the reasons they'd quote. In my last post, I said I was agnostic after looking at all the good things that are being proposed. Many of the things Obama and the Democrats are trying to do are not only worthwhile, but morally imperative. However, the very attractiveness of that led me to miss the key point: it addresses the symptoms of the health care malaise, without addressing the underlying problems that create the symptoms. Because of that, it is doomed to fail.

The problems of our current health care system are as follows: 1. It is an extremely complex system, in a situation where simplicity is proven, all over the world, to be more effective and far more efficient. 2. It allows outrageous rewards for malpractice suits, which drives outrageous costs for malpractice insurance. 3. It prohibits the public payer from negotiating prices with the providers. 4. The payer in most situations is motivated by profit (not need) in a system where profit is maximized by denying (not providing) the services needed – effectively rationing health care and reducing choice far more effectively than even this bill would allow.

This bill actually addresses none of these problems. Instead, it takes a quintessentially Republican approach to legislate better results out of a failing system: Government officials meet with corporate industry officials behind closed doors to craft legislation which is then crammed down the citizen's throats. Benito Mussolini would approve; he'd call it fascism – "the merging of corporate and state power." It is a mystery to me why the folks who supported Bush oppose this plan – it is exactly the kind of thing that he would support and promote.

At the risk of being boring and redundant, the solution is simple: 1. To deal with problems #1 & 4 above, expand Medicare to include everyone, and reform the paperwork process to make it simple, easy, and able to process in multiple ways (digital, hard copy, etc.). (This has the added benefit of increasing everyone's choices on doctors, providers, and so on, because every provider is a preferred provider, and there is no out-of-network unless you leave the country.) 2. To deal with problem #2 above, limit malpractice suit rewards. 3. To deal with #3 above, require Medicare to negotiate prices. 4. To additionally deal with #4 above, cover alternative health care (acupuncture, Christian Science, etc.) and preventative care.

The current reform plan on the table operates from the same assumptions and paradigm as the current system, and merely attempts to legislate better results. But without reforming the system, we won't get better results. As Einstein said, "Problems cannot be solved at the same level of awareness that created them." While doing some things to mitigate the symptoms of our current insane system, this plan will hurt vulnerable populations – small business and the middle class – while providing huge, usurious profits to huge, corrupt corporations. It will delay genuine reform. Liberals should stand side-by-side with our conservative brethren and sistren in opposition to it.

The Health Care Reform Bill

Caveat: I don't have time to research H.R. 3200, the House version of this bill, or any of the others, completely; so this analysis is based on reading the summary, scanning the text, and commentary from other sources. My analysis may have major holes in it. However, a conservative friend asked me to comment on it, so I'll give it a try.

First, this bill is almost 500 pages long. A basic principle I like to go by, articulated by Albert Einstein, is, "Everything should be made as simples as possible – but not simpler." Clearly, this bill fails that simple test.

The bill does have a lot of good points. It eliminates exclusions for pre-existing conditions. It limits out-of-pocket expenses and doesn't limit payouts. It covers preventive services. It provides health insurance for everyone. It requires the rich to pay more than the poor and middle class. It guarantees coverage for everyone. It includes mental health services. And so on.

My objections are as follows:

1. It's way more complex than it has to be. (See comment above.) It establishes a new bureaucracy, the "Health Choices Administration," with additional layers such as the "Health Insurance Exchange." It establishes a new public health insurance provider within this, I think as part of the Exchange. In addition, it seeks to fill the prescription benefit hole with this new insurance, so that people covered by Medicare then have the additional complexity of multiple payers for the same product, essentially doubling the paperwork. Every one of those is completely unnecessary and redundant. We've already got two public plans, Medicare and Medicaid, which is one more than we should have. Medicare has its problems, but it is run very efficiently. In fact, providing insurance is one of those places where government can excel, exceeding the efficiencies and effectiveness of private insurance because it is not motivated by profit, but by service.

2. The Health Insurance Exchange is supposed to compete with private insurers. Big mistake. I'd rather see something like the old-age insurance (Social Security) system: it is available for all, and if you want supplemental financial planning services, go for it.

3. It requires employers to provide coverage, based on payroll, not profitability. Really bad idea. We should be divorcing employers from providing coverage, not requiring more. Almost all other developed nations (those with which we trade) have single payer public health insurance; employers in those nations don't have the added cost of providing coverage. It's just one stupid way to make our own industry less competitive on the global market. Besides, it can really hit small employers hard, especially if their payroll is bigger than their profit. Expect marginal businesses to go under.

4. It doesn't mention "medically necessary." It should. Any procedure, service, or product considered medically necessary should be covered. That includes Sex Reassignment Surgery.

5. It imposes a tax on individuals without a health plan. That's okay, but I'd rather see a single-payer system that basically taxes everyone.

6. If it is true that people will be fined if they don't purchase a health care package, that is a major objection. "Nothing of benefit to the individual is obtained through coercion." (Socrates, I think?) I can think of no way to increase resistance to this bill better than this. People hate coercion, and rightfully so. I hate it. "Give me liberty, or give me death!"

7. Cost is not adequately addressed. (See update and link to Field's post below.) Without giving the public health insurance entity full ability to negotiate prices and without limiting the extent of malpractice suit penalties, cost cannot be adequately addressed. And creating redundant public bureaucracies adds a completely unnecessary level of cost, just for administration. It's stupid and counter-productive.

This health care reform bill is nowhere near as bad as some of the conservative commentary I've seen on it. For instance, one such objection is that it rations your health care. This exhibits the privileged ignorance of those who make this objection. Health care is already rationed, usually by income level. Poor people often have no coverage. Trans people can't obtain medically necessary procedures that are available to others. In fact, private insurers ration by pre-existing condition, exclusions, maximum payouts, preferred provider networks, and every other means they can legally access. This bill may well ration health care, but by eliminating maximum payouts, pre-existing conditions, and income refusals, it significantly reduces existing rationing. Another objection is that a government committee will determine your treatments and benefits. So what? Under private care, you've got an insurance executive, whose paycheck depends on reducing benefits provided to you, making those choices. And guess which one can be held accountable? (Hint: it's not the executive.) Making things better does not necessarily constitute making things perfect, but that's no reason not to do it.

Going back to Einstein's quote, the solution to the health care mess is way simpler than this bill. All we need to do is make Medicare available to everyone, with the following reforms: a) require it to negotiate prices. b) simplify the paperwork – everyone is covered, every provider a preferred provider; list the products and services provided to the patient on one sheet of paper, submit for payment, and you're done. c) limit malpractice suit payouts. d) cover alternative systems, such as acupuncture, naturopaths, homeopathy, and Christian Science treatment. Medicare is an efficiently run, existing agency; expanding it is simple, efficient, and effective. You could fit a far more complete reform package into a 25- or 50-page bill.

In sum, this bill is nowhere near as bad as the conservatives would make it out to be. It's also nowhere near as good as some liberals are making it out to be. It has some major problems, but also some really good stuff. Having looked at the actual bill, however briefly, I've modified my opposition. I'm agnostic. It will make some things better, but it will also create new problems which are obvious and predictable, and leaves other problems unaddressed. Whether there is a net social benefit to the bill is unclear to me – there may be one, and there may not. If it passes, we'll just have to wait and see.

One thing is clear, however: This health care reform bill could be a hell of a lot better.

Update: Field Negro is one smart cookie. When he posts something like this, I tend to believe it - and I agree with his commentary, especially about having each other's backs.

Party Day and Pride

I've been busy this year, building an addition on our house so that I'll have my own room. And an office, and a second bathroom, and a big-ass shop/storage room where Kristin can store her harvest – row upon row of neatly labeled ball jars filled with goodies from our garden and every stray fruit tree in a 14-block radius. This means I'm working four ten-hour days at work (I love the flexibility at my job!), and spending three-day weekends working on the house. The trusses are finally up, and the roof sheathing is going on. Needless to say, not much time for blogging, hence the erratic and rare nature of my posts. It also means that Kristin has taken over almost all domestic chores, including even doubling up on watching the kids.

Yesterday, however, two events coincided to give me a day off. A day of relaxation – what a concept!

First, it was our local PRIDE day – a party not to be missed. And, second, it was the day that one of my girlfriend's daughter had a birthday party at Skate World. I don't get to see my friend often enough because of our work schedules and the different circles our children usually travel in, so that was a must-go for me, too. Bonus – B isn't Kristin's friend, and Pride isn't Kristin's thing (though she did enjoy it later on), so she got a much-deserved day without kids.

I balanced it all by taking the kids to Pride for its opening two hours, then going to the birthday party, then back to Pride where I was supposed to meet Kristin and she'd take the kids so I could help out for awhile at the Human Rights Commission table – though when I got back, the table was gone and Kristin ended up spending the rest of the time with us there.

It was a good day for the boys. They plucked free candy from nearly every bowl at the festival, and then we found the Balloon Man! An artist with balloons with a big rainbow hat made of them, he rapidly blew up and twisted long, skinny balloons into fantastic shapes. Trin got a fish on a pole, Sam a jester's hat, along with others. Other kids got an alien, or a monkey with a gun or a peeled banana. At Skate World they got to exercise their roller blades and eat a cake shaped like a hamburger; and then back to Pride where we ended up joining Kristin and going around as a family. I got to relax, chat with friends, play with my kids, and reload for another strenuous day on the roof.

Pride is an interesting event. (In the past, certain groups would come to protest – ironically, usually protesting abortion more than homosexuality. For the last two years, they didn't show up. I guess they finally put one-and-one together and got two: I can think of no female demographic less likely to have an unwanted pregnancy than lesbians. But I digress.) There are people of all ages, from tiny babies to bent old folks with walkers or wheelchairs. People of all colors – often brilliant colors dyed into hair or tattooed into skin. Camp and music and grace and vulgarity and humor and talent, and men and women holding hands and kissing their partners with freedom not found in most of society. There is a sense of freedom, joy, almost family. Here, for one day of the year, we are free to be who we are. Tomorrow, we will go back to disguising our relationships, to restraining ourselves, to modifying our behavior to deflect the sneers, the slurs, the abuse, and simply to avoid offending our neighbors, many of whom violently object to the reality of our existence – and especially to any public display of affection, no matter that they smile indulgently to see the same behavior exhibited by other-sex couples with far less monogamy and history than many of the couples at Pride share.

This is the attraction for me. It is an oasis of openness, of truth, where the stress of the need to hide is gone. Here, people do not need to indulge the social conventions that all too often oppress rather than liberate. Yet there is restraint. This is a family event. It is a chance to see that we, and our families, especially our children, are not alone, and that the people with whom we share our conditions are typically honorable, interesting, witty, fun, intelligent, often talented, and widely diverse. It is a place for peace, honesty – far more honesty than I see in most of the circles of those who condemn us – and yes, pride. We are more than okay. We are good.

Luna

When I grew up back in the '60's and '70's, I didn't know that transgenderism existed. Not only was the ranch in Wyoming isolated from that kind of information, our entire culture buried it. The media never mentioned such phenomena. No books, especially children's or young adult's, reflected it. Trans people existed neither in fact nor fiction, and that isolation shut me off from any hope of understanding why I was different from my peers, and what that difference was.

Things have changed since then. A plethora of books have emerged, explaining the phenomenon of trangenderism from a variety of viewpoints. A list of some of them adorns the bottom of this webpage. Yet as much as these informational books clarify, they do not bring my experience to the mainstream with the power of fiction. The reason they do not is this: Non-fiction reveals facts; fiction reveals truth. Non-fiction explains intellectually; fiction explains viscerally. True understanding of another human being cannot come through the intellect; it must be experienced viscerally, emotionally. And while much fiction is void of that visceral truth, much also is not.

That's a rather long lead-in to this short review, but, I think, important. Because Julie Anne Peters, a lesbian author in Colorado, has written just such a book. Titled "Luna," the story of a young trans woman coming of age, told through the eyes of her sister, illuminates the trans experience. Written for young adults and told realistically, it makes the experience of people like me accessible to all – and most especially, to young people of the age when my own confusion and isolation were more than I could bear. That confusion and isolation led directly to drug and alcohol abuse and an emotional shut-down that took many years to overcome.

Had this book been available to me, had I read it then, how many things could have been different?

It's a moot point. What's done is done, and I now have a rich, fulfilling life. Had I transitioned earlier, I would not have my two beautiful sons, nor would I have the lovely relationship I share with Kristin. I regret nothing for myself.

But I am very glad that this resource is available to young people today.

Luna. Buy it. Read it.

Hmmmm....

Can't resist posting this quote that showed up on a friend's signature line:

"The Bible contains six admonishments to homosexuals and 362 to heterosexuals.
This doesn't mean God doesn't love heterosexuals. Only that they seem to require much more supervision."
-Lynn Lavner, comedian, musician

Beauty

One of the things I appreciate about being raised by a Christian Scientist is learning their definition of God. In the CS worldview, there are seven synonyms for a universal, single deity: Life, Truth, Love, Mind, Spirit, Soul, Principle. It offers a different, meaningful, and far more accurate understanding of God than the traditional Christian trinity of Father, Jesus, and the Spook (the three of which, somehow, are just one god. Wrap your head around that one!) Some of the things I love about it include the following:

It removes gender from the concept of the godhead completely. What gender is Life? Could be any – and, in fact, includes every. If mankind really is made in the image of God, then, truly, either man is genderless, or God includes all genders. This concept of God really does equalize the sexes, and by changing it from an anthropomorphic entity, makes the genders equal – all of them.

It removes the patriarchy from any sense of sacredness or higher meaning, and renders it what it is: politics.

It makes God accessible not as a distant, judgmental entity, but as ever-present – here, now, universal, and complete.

However, if it were me, I'd add one more to the list: Beauty. Everywhere, everything that is created in nature is beautiful in its own way. I am surrounded by beauty; I have been, everywhere I've gone, from the deserts of Arizona to the forests of Europe to the lush jungles of Hawaii to the stark Aleutians, and even far out in the middle of the Bering Sea. I was born in the beauty of sugar maples in their fall plumage, raised in the beauty of the Rocky Mountains. Everywhere I look I see beauty: the face of a child, the expression on a mother's face as she nurses her baby, puppies and kittens, even a vulture soaring on the wind. I hear it in a meadowlark's clear notes, the chuckle of water over rocks, Jerry Garcia's fantastical guitar solos blending in harmony with the band. I feel it in the warm sun on a cool fall morning, and the fall of cool water on a hot day. I smell it. I taste it. It fills me with joy, and brings tears of gratitude to my eyes.

God is Beauty. How could She not be?

Self-Preservation: Why I’m a Liberal #2

I'm a trans woman, a full-blown member of the LGBT community. By default, my choice of primary political party affiliation must be Democrat. The GOP has established itself in opposition – even violent animosity – against me and every other gay, lesbian, bisexual, and trans person in the country. I can't understand the Log Cabin Republicans, gay members of the party that desires to oppress them. They're like the gay versions of House Negroes.

Regardless of what conservatism may have meant in the past, it currently stands against equal rights and justice, firmly on the side of oppression and judgment. Conservatives have placed themselves in opposition to Thomas Jefferson's defining statement of American values: "We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are Life, Liberty, and the Pursuit of Happiness." Every effort of LGBT people to indulge in these rights, which conservatives take for granted in regards to themselves, is met with determined resistance by them. The oppression – frequently but not always unintended – is often invisible for these conservatives. In the same way, many white people have no understanding of how our culture oppresses black people, and many men are clueless about how it oppresses women. Those individuals who do not take this stand are drowned out and neutralized by those that do. Votes count for something, and actions speak louder than words.

This is not to say that conservatives have bad intentions. Often, their intent is only to support the institutions that have supported them, in our culture, for decades or centuries – religion, law, tradition, marriage, family, and so on. I have no trouble with that; in fact, I support them, too. The difference lies in that I believe there is room for all of us. I support those institutions not just for the majority, but for all of us.

When it comes to LGBT issues – to allowing gays to marry, to antidiscrimination laws, to universal health care, to fair taxation, etc. – I believe that we create a better society when all are welcome within it. I have experienced the social pressure to conform to a norm that is unnatural to me. I know the isolation and desolation of the closet. As a compassionate human being, I want to do all I can to relieve that pain for all. I also believe that the society we will create from granting gays, lesbians, and trans people an equal place at the table, will not be an immoral hell, but a healthier, happier, and more peaceful society. I believe that everyone should have the right to express themselves, not only within the parameters of this nation's First Amendment, but also in respect to the way they present their own gender. I believe that everyone has a right to safety within their own community, and given the bullying and abuse of gender variant children on schoolyards, and the frequency of gay- and trans-bashing incidents, we must counter the demonization of LGBT people wherever we find it. In fact, as a trans woman, I'm an activist just by showing up.

These beliefs are born in the conviction that people do not choose to be gay, or trans. I know I didn't choose to be trans; it was something I fought hard against for 40 years. It's born in an intimate knowledge of my own morality and genuine family values, and in the proximate knowledge I have of the values and morality of the gays, lesbians, and trans people of my acquaintance. It's also born in my own religious conviction, in the words of Jesus: "Judge not, lest ye be judged." "Do unto others as ye would have them do unto you." "Why beholdest thou the mote that is in thy brother's eye, but considerest not the beam that is in thine own eye?" "God is love."

Ultimately, it comes down to two worldviews. One values unity of culture, the comfort and ease of living in a world where every interaction with another human is predictable – it orients around a status quo; the other values the variety of diversity, enjoys engaging with and is curious about people one doesn't understand, and orients around openness, love, and acceptance. I embrace the second. I also recognize the need for balance. Without some unity of culture, it's hard to find our place in the world, but without diversity, culture is boring and oppressive.

In sum, my liberal views on LGBT issues come from both prior conviction and resistance to discrimination. They come from native belief and self-preservation. But even if native belief weren't there, the needs for safety and self-determination trumps all; even if my beliefs were conservative, I would still ally with liberals in my own defense, and in the defense of those who share my condition.

* Standard note: I value dissenting opinions as crucial to the maintenance of freedom and democracy. While I would like to write convincingly, to influence opinion and sway the balance of power my way, I also consider the conservative viewpoint to be important and meaningful. I do, however, believe that political discourse does not have to be nasty and vicious. I prefer to listen to and respect my political opponents. I ask the same from them.

NARTH and BS

A conservative blogger recently posted information that a "scientific" study had found that gays and lesbians don't suffer harm from reparative therapy. (Worth noting here this the article regarding the ICD-10: "It lists ego-dystonic sexual orientation as a disorder instead, which it defines as occurring where "the gender identity or sexual preference (heterosexual, homosexual, bisexual, or prepubertal) is not in doubt, but the individual wishes it were different because of associated psychological and behavioural disorders, and may seek treatment in order to change it.") Having never heard of NARTH, I followed the link. Being a straight trans woman, I didn't look into the writings on homosexuality much, but instead focused on their entries on GID - and found a web(page) of misinformation. I hate to give a group like this even this much of attention, but some of the stuff written there really needs to be refuted. (For more on reparative therapty, try this, or this, or this.)

From "Transsexuality Explained," by Sander Breiner, M.D. (Note – in this article, the writer hardly mentions trans men, who compose about half the population of trans people – no doubt because "they're women" and so have no importance nor reflection on the human experience, which is white and male):

• "There are a significant number of male homosexuals who would like to be a female with a penis. There are others who would like to be completely transformed into a female, but can't arrange to have such a complex surgical procedure. Both groups will obtain hormones from various sources; often it will be illegally from a pharmacy."
  

The assumption here, of course, is that trans women are gay men. But what about all those trans women who are attracted to women? And trans people who can't afford or obtain prescriptions for hormones (typically due to a lack of adequate health care) obtain illegal hormones online or on the black market – not from pharmacies, which actually have pretty stringent control mechanisms for disseminating controlled drugs. I'm rather surprised this "M.D." doesn't realize this.

• "The transsexual male who was not part of a university/medical school treatment program, will often take hormone treatment (self-prescribed and administered), and play a feminine role with unsuspecting heterosexual males (often as a prostitute). … Their thinking about how they are tricking, fooling and using others has a clearly sadistic dynamic as well."
  

There are few if any current (2008, when this article was updated/published) university/medical school programs, and people who did go through these regularly told the gatekeepers, such as McHugh, what they thought the gatekeeper would want to hear to help them transition. Hormones are commonly and typically prescribed by doctors, and it would be silly to go to the doctor every day to take a little green pill. And many trans women are kicked out of their homes or fired because of discrimination, and end up on the street. They are forced into sex work to survive. They are not using, so much as being used; and they are not partnering with "unsuspecting" men so much as men who seek them out (tranny chasers). Most trans women, however, are employed, and reveal their status to prospective sexual partners if they are not asexual. In other words, this statement is patently false.

• "Their histories almost invariably demonstrate a mother figure who is at least domineering, manipulative and controlling."
  

That sounds almost exactly the opposite of my mom, who left us free to make our own choices about most things, who never tried to manipulate us that I can remember, and who was definitely not domineering. Nor do I recognize this as a pattern in my trans women friends, whose families run the gamut.

• "Such men have little to no relationship with their family. Unfortunately, their lifestyle has a clearly self-destructive quality."
  

First, a trans woman is not a man. Second, as mentioned, many trans women, especially youth, have been kicked out of their families for being trans. Most, however, have some relationship. In my case, I'm quite close to my former wife (I share a household with her) and kids; I'm close to the surviving members of my immediate family; I have good relations with my cousins, nephews, and nieces. And most of my transwomen friends also have supportive families.

• "Their lifestyle has a clearly self-destructive quality."
  

Yeah. Like mine. Lots of healthy, nutritious, natural food in the diet, close connections with family and friends, spirituality, purpose and meaning, a good, middle class job. Actually, just like (surprise!) "normal" people, we run the gamut, from health nut to addict.

• "These individuals usually do not stay in any adequate psychotherapy program (i.e., once per week for at least three months). They also have significant problems in certain areas of reality perception; therefore, long-term intensive therapy is the best choice, and long-term supportive therapy with medication is the bare minimum required to prevent them from destroying themselves."
  

If we don't stay long enough in a therapy program, it's most likely because the therapist doesn't know jack about gender dissonance. Paying $80/hour to educate someone who is supposed to be educated is not cost effective; the trans person involved will most likely stop sending good money after bad when she's got her letter authorizing hormones – and who could blame her? The "reality perception" is conveniently left vague. What areas? What medication is prescribed? The implication is some kind of anti-depressant; the reality is hormones and androgen blockers, which are not psycho-active. And the self-destruction comes almost completely prior to transition, when virtually all trans people have suicidal ideation, and many attempt it. Post-transition, such becomes much less common.

• "There is a smaller group of transsexuals that includes those individuals who have been involved with a university-sponsored, medical-school treatment program."
  

He goes on to mention Wayne State University and Johns Hopkins University programs, both of which, I believe, are now defunct. The problems with these programs were legion. The gatekeepers turned away multitudes because they didn't fit the profile they were looking for (described by the author in the next section of his article). Trans people with same-sex attraction (trans women attracted to women, for instance) were turned away. Etc., etc. Those that did get in typically learned to deceive skillfully, giving the stereotypical answers the gatekeepers were looking for in their efforts to get hormone therapy and surgery.

Breiner goes on to describe a caricature of transsexualism who is completely unrecognizable when compared to real trans women, like Lynn Conway, Jennifer Boylan, Kate Bornstein, Calpernia Addams, Dr. Sara Becker, Anna Moore, Tobi, Julia Serrano, Hangar Queen, Andrea James, Dr. Becky Allison, etc., those represented here on Lynn Conway's website, and me. He then sums up thus:

• "At this point in the process, I … must tell the surgeons that the disturbed body image was not an organic at all, but was strictly a psychological problem. … The more pervasive and extensive is this misperception of oneself [as defined by Mr. Breiner et al], the more significant is the psychological problem. The more the patient is willing to do extensive surgical intervention (especially when it is destructive), the more serious is the psychological problem. … This principle of isolated significant psychopathology indicating serious psychological problems (despite their ability to function in all other areas of life) is well known psychiatrically, historically, and by the judiciary."
  

So well known, in fact, that almost no one knows about the many people who have violated gender boundaries throughout history and in almost all cultures. So well known that psychologists who specialize in GID regularly authorize hormone therapy and surgery, and the AMA has determined that surgery is "medically necessary" and is often necessary for positive outcomes, and that it limits health risks from other sources. So well known that the judiciary regularly allows name changes and sex marker changes on documents.

I've written on this issue before. By the American Psychiatric Association's definition of a mental disorder, trans people are mentally disordered when they try to live as the sex they were assigned at birth – not when they transition. It's notable that the ISD-10 lists the denial of being homosexual as a mental disorder; the same should apply to denial of gender dissonance. Indeed, it almost killed me, and it did make me almost completely dysfunctional in my social and practical life. NARTH does a grave disservice to the people who go to them for help, supporting the mental disorders that affect them, rather than the patients themselves.

I wanted to correct a second article, too, but have run out of space and time. This is too long anyway. And still, I wonder: where are the trans men? Breiner and others go to some length to describe and define transsexuality, and yet never even mention, or at best only in passing, half the transsexual population. Perhaps, in their phallo-centric world, the desire for a penis is perfectly sane.