Further Adventures with the NHS

I went today for a psychiatric assessment. I spend a lot of time being evaluated, alas. This one was at a Tower Hamlets Primary Care Trust medical center. It seemed like most of the other people there were for more body-focused medical stuff. It didn’t have the kind of security that Dutch mental health centers have. Indeed, the doors opened automatically as I approached.
My appointment letter was for “Ms Celeste,” which is better than Miss, at least. The receptionist looked at the letter and looked at me and asked who the appointment was for. I said my name. She looked at me a long second and then said ok and told me to sit.
The shrink was youngish. He had a student sitting in, a man about my age. I said I was ok with that. “Just ignore him” said the shrink. Right.
He had me go on and on about my childhood. Which, frankly, is not that interesting. Any fascinating memoir of my life would start later. I mean, the first time a gender shrink asks you about your childhood, you get to construct a narrative of yourself in regards to gender. Did you always know something was different? Were you blissfully unaware? Did others point out locations of difference that you didn’t see for yourself? All of this tempered by the understanding that the receiver of said narrative is a hurdle between you and hormones/surgery/whatever you’ve come for.
So I banged out a narrative for an hour about how I’m a totally reasonable sane person. He wasn’t a gender specialist, so when I said FTM, he asked what that stood for. So gender issues weren’t even that present in the conversation. He did use the phrase “Gender Identity Disorder” though, and it got my hackles up a bit.
I don’t like being called disordered. At all. The catholic church calls homosexuality “intrinsically disordered,” which is a value judgment that I’m not keen on either. Why must every location of difference be called a disorder? Could it be a condition instead? Some other medical phrase? I’m proud of who I am. Indeed, to be different means that you have to be proud or be crushed. My identity is not a disorder, it’s just atypical.
Then funding came up. He asked me when my student visa expires and started talking about “planned elective surgery.” Which, I mean, Tower Hamlets is not awash in cash. It’s one of the poorest boroughs in London. Why should they allocate their tax money to a foreign student? I don’t know how NHS funding works, but it seems to be geographically divided. Are the residents of Tower Hamlets the main funding source for their primary care trust? Or does it come out of a large pot and then is distributed by population?
In order to change my documents in California, I need to get top surgery. Also, to be able to go swimming or wear a T shirt ever again in my life. So if the NHS won’t fund it, I can . . . wait or self-fund. I don’t think it’s reasonable to try to get it too far from where I’m actually living, so surgery in California is not a good plan unless I move back there. It’s possible for people in the UK to “go private” which means pay themselves for stuff rather than wait for the NHS to decide to pay for it. I have no idea how much this would cost here, nor if it would effect them covering my T prescriptions or anything else. Aside from whether or not I could afford it, there’s issues about recovery time. It’s long. I won’t be able to lift things for weeks. This sort of situation requires close friends and I’ve only lived here since August. So even if I got NHS funding, it still might not be a reasonable plan. So maybe I’m destined to wait years no matter what.
When I do get it, if I still have savings, the first thing I’m going to do is buy the bike jersey I’ve been wanting, which I so can’t wear right now.

NHS Mental Health Trust Shrink

In order to ration care treat trans patients, the NHS wants shrinks to be involved. Specifically, you can’t get a referral to an endocrinologist without a psychiatrist. Also, importantly, nobody wants to pay for anything unless you jump through all the proper hoops like a trained circus dog. So this morning I arose bright and early to go see a shrink.
The letter informing me of my appointment told me to go to the Queen Elizabeth Psychiatric Hospital (QEPH), which is right by school. It always struck me as highly convient, having the mental hospital right next to the Uni. I also often wonder how the queen feels about having a mental hospital named after her? There must be a great number of strange things named after her. The Queen Elizabeth Car Park. The Queen Elizabeth Strip Mall. The Queen Elizabeth Home for Rabid Puppies. Does she get any say in it? “Oh, thank you for the kind offer, but I was really holding out for a suspension bridge?” (Or can there be multiple Queen Elizabeth Bridges? Would that be too confusing? Could there be both the Queen Elizabeth Bridge and the Queen Elizabeth Suspension Bridge?) I mean, personally, I wouldn’t be picky, but I have many fewer people asking to use my name for their construction projects. Nevertheless, I think I would balk at a mental hospital. What are you trying to say?
Most Brits probably have odd ideas about America. I think they imagine the shootout at the OK Corral as being highly symbolic of the country as a whole, which is not an entirely unfair assessment. Similarly, I have various stereotypes floating around in my head about the UK, many of which come from Victorian novels. High school English classes typically spend one year on American Literature and then one year on British literature. The Victorian era seems to have been a golden age of writing in England. Or, at the very least, it’s the one most enshrined in American highschools. Costume dramas made by the BBC are also a major cultural import into the states. We all imagine a dark, smoky gray London with a polluted fog overhead, women in petticoats, Dickensonian beggars, murderers left and right (with Sherlock Holmes or Miss Marple on their tail) and hulking brick asylums, filled with suffering upperclass women who can’t accept their station in life. Women who want to read too much. Women who want to be men.
Fortunately, I have managed to avoid being committed. I woke at an extremely early hour and managed to spill every drop of my morning coffee on the floor before I left for my appointment, alas and woe. The QEPH is in a typical largish medical building. They have automatic doors, which, unlike mental health centers in the Netherlands, are actually automatic. The reception was separated only by a normal counter, again, unlike the Netherlands which was behind glass. Maybe they think I’m crazy, but at least they don’t think I’m dangerous. That was nice.
The doctor asked me when I first knew I might be trans. I should have a set answer for this by now. I should write out my official narrative and post it to my blog. Then, when somebody decides that I need to see a shrink, I can just give them the link. I don’t fucking know when I first had gender issues, ok? sheesh. I really don’t want to draw any kind of line anywhere. I don’t want to validate all the homophobic bullshit I used to be subjected to. I don’t don’t want invalidate decisions of other butch women not to transition. When did I cease just being a butch woman? When I started taking hormones and told people to call me he. Not before. It happened then.
Lack of coffee, up early in the morning, strident (formerly) lesbian feminist, so very very american. I must have seemed a bit like Hillary Clinton. But, you know, if she were a bloke. I was confused by the questions and gave confusing answers. I’m pretty sure I annoyed the doctor. Nevertheless, I have successfully jumped through this hoop.
He explained that there were evaluations and waiting lists and whatnot. We don’t just give out hormones on demand to people who ask for them, he explained. Why the hell not? What terrible harm would befall the commonwealth is trans people had easy access to transition? None!
Alas, this is just one hoop. This doctor is not a gender specialist. I’m to keep seeing him while I wait to see the one specialist for the region. Who is not in Birmingham. The second largest city in the UK has no gender clinic. The waiting list is apparently months long. In the mean time, I can keep taking T – and I can keep paying for it.
I am so very, very, very glad I started on hormones while I was back in the states. Sure, we’re all cowboys and it’s the wild west and all, but that’s not all bad. The social worker in San Francisco explained that the city had no vested interest in saying no to trans people. What purpose would it serve? The city pays for it’s residents to get this service if they want and need it, like the NHS pays for Brits (and foreign students). And San Francisco found it was coming out ahead when it got rid of all its hoops. People who come in for hormones also get the other health services that they need. Happier people tend to take better care of themselves and are healthier. Does it save tax money to say no to trans people? No, quite the opposite.
I left my heart in San Francisco. Sometimes, I think it’s the only place in the world where anything makes any sense.
I felt good about myself when I left QEPH. I got through this round. I was treated more or less like a normal person. When I got back outside to the bike parking, somebody had left a nice, new, red mountain bike leaning on my bike. With no lock on it at all. You’d have to be crazy to leave that bike out unlocked like that! . . . oh right . . . I wish my issues weren’t treated as mental health issues.

Gender Therapy in the Low Lands

I’ve been putting off posting about this for a long while, so I’m hazy on the details. But how many Americans can give a first hand account of gender therapy in the Netherlands? I feel a duty to post. This kind of meanders into TMI a bit, though. Be warned.

Ok, so when I last spoke of my therapy issues, I’d seen a regular shrink who wasn’t sure what to do with me and who did not speak very fluent English. (I want to clarify that I’m not criticizing anyone when I say they don’t speak English well. It’s not like I speak Dutch well, which is the language of the land. When I mention that somebody doesn’t have high English skills, it’s just to clarify that communication was not overly clear. This is a sub-optimal situation to have with a shrink.) She asked me about going to see the gender specialists at the university in Amsterdam. There was back and forth. Finally, she referred me to a center in Voorburg.
Several days later, a letter came in the mail giving me a date and time for an appointment. Fortunately, my assigned time did not conflict with my class schedule. I biked the several kilometers to the PsyQ building there. PsyQ is some sort of organization that deals with people’s mental issues. I don’t know if they’re public or private or some mixture thereof. People seem to largely have private insurance in this country. Anyway, so I showed up and walked through an automatic door to an entry alcove. There was a large glass window with a woman behind it and a microphone. There was no opening in the window at all. It was solid glass (or whatever). I had to show ID to the woman behind the glass and also present my appointment letter. She pressed a button and the automatic glass sliding door to the lobby opened.
Of course, they deal with crazy people, so they need security to protect themselves. From people like me.
The woman took my insurance card (they only reimburse and don’t cover anxiety, which is specifically mentioned on my appointment letter, but whatever) and asked me questions so she could fill out paperwork for me. Because my Dutch skills are too low to fill out any of the forms by myself. People are generally very nice about my inability to communicate in their language. Anyway.
I went to the waiting room and a woman came to meet me and explained that she was filling in for whomever I was actually supposed to meet with. She asked me all the stereotypical shrink things while taking copious notes. How did I get along with my mother? My father? What was my childhood like? I told her about coming out in Catholic school. The first girl I kissed. blah blah blah. She wanted to know about my earlier childhood. At home, I played with boys. At school, I played with girls. My parents and grandparents always got me girl toys. I had a collection of Barbies, but found them to be dull. You dress them up? Who cares? Until, one day, my friend Christy from school came over one afternoon and wanted to play with my Barbies. She pulled off their clothes and a bisexual Barbie orgy ensued. Apparently, what you do with Barbies is make them have sex with each other.
“So she taught you how to play with Barbies?” the shrink asked, very seriously. Um, yeah, am I paying for this? Because I suddenly feel like I’m stupidly wasting everyone’s time.
She changed the subject. “So what makes you think you might be -”
“I don’t know.” I cut her off. I said “I don’t know” a lot. She asked me if I would rather talk to a man or a woman. Was this a trick question? If I say woman, then I’m really a lesbian? If I say a man, then, I’m really a man? Which way should I go? Ack. I asked for a fluent English speaker. Then I started coughing and couldn’t stop. I went home and felt crappy and got a fever and was sick in bed on my birthday (I’m 31 now, btw) poor me.
A week or so later, I went back to the same place, still feeling like I had a cold. I met a different woman, the head of the sexology department. She explained that the woman I had talked to previously was no longer employed by PsyQ and since they are having a staff meeting on March 5th to figure out what to do with me, somebody there should have met me in person. I was very careful the whole time not to say the word “transsexual.” (Because I am totally logical.) She asked me a few times the same question that the other woman had asked more than once. Did I have problems during sex? (Problems only in that the ladies can’t get enough of me. heh heh.) I asked her to explain herself. Well, my lack of a penis might make it difficult. (good lord) Then she asked me how I felt about my period. (um, well, questions about it make me feel uncomfortable.) I don’t think I dislike it significantly more than anybody else I know who has it. She asked me why I hadn’t stopped it with birth control. I explained that I really don’t like taking pills or whatever and don’t want to mess too much with things like that unless I have to for some reason. I’ve heard women talking about birth control side fx and stuff and always have felt glad I don’t have to mess with it. Emotional messes. Mojo killing. No thanks. “But it’s possible to stop it. Why don’t you do it?” she pushed. Yeah, but it can make your breasts bigger, I pointed out. She accepted that. She wanted to know why I hadn’t gone to Amsterdam to the university. Hey, I’ve just been going where y’all have been sending me.
I got the vibe that if I had asked for a referral for testosterone, she would have been willing to write one right then. (Actually, normally, they make you get 5 appointments in Amsterdam and then you carry forward. I don’t know if the appointments are to get a note for hormones or for surgery.) She clearly thought I was – that word that I was carefully shying away from. Which, I mean, what did I expect? A pat on the back and a “good for you being genderqueer!”? If I was fine just the way I am, why am I seeing a shrink anyway?
Then she talked to me about what she’s going to recommend they do with me. Anxiety therapy is the first priority.
god help me, I’ll get off Zoloft soon.
I’ve been off school for the last week. No classes! I didn’t go anywhere. I did an application for Birmingham (UK, not AL) and sat around. Today, I had a duo recording with a improv guy from the composition department. I took a deep breath and screamed “I don’t know who I am” as loud and as long as I could, though my tuba. (Metaphor, but not really.) Blat blat blat, I screamed, inhaled, bellowed improperly attacked breathy notes that don’t know where they’re going, what pitch they want to be, how they will resonate, where they are now, what valves are pressed or how much. Wail, blat blat blat.
Afterwards, I felt so much better. I didn’t even know I felt tense, but afterwards, I just felt so like I’d worked something out. so maybe the key to getting off Zoloft is playing loud, angsty tuba? I came home and actually mixed a piece of music. this entailed both me getting Ardour to work and having the attention span to mix something. Tuba is key.
I’m trying to be proactive. I used to tell myself to wait on things. I didn’t need to worry about my mental health problems as long as I could walk and eat and stuff. In the book Breaking Silence, I read about lesbian nuns developing stomach problems from stress and what I got form that was that I could wait until I had stomach problems. Yeah, last summer counted. I always wait like that. I went to a support group for FTMs once in San Francisco. One old guy there said that if you have to transition, eventually you’ll have to. In She’s Not There, Boylan writes of her experience at age 41, just being totally unable to carry on without taking action. I don’t want to be a mess in 10 years. I don’t want to delay and have my first stubble come in grey. I want to deal with this now and take action or put it behind me. I want to move forward from where I am now.
I know that’s it’s not a path of discovery, that it’s a path of creation. I have agency. I apply technologies of the self to create my own identity. It needs to be an identity I can make some peace with. that might require some more therapy. Or more tuba.


Before I begin, I want to clarify that the Dutch are actually pretty ok as far as restroom etiquette goes. Best are the French, then the Dutch, then a tie between Californians and Germans (I think CA might be a teeny bit better) and at the very bottom is Spain. (Also: waa, waa, waa, nobody understands me.) Ok, so on to our story.

I went to see a Dutch shrink on wednesday. Over the summer, I got a book that said that therapy can cure anxiety. Zoloft can also cure anxiety, but it stops working if I stop taking it. Also, it has not been stellar for my concentration. I haven’t written much music since being on it. So a long-term cure that leaves me able to think would be very good.
“Why do you think you are anxious?”
If I knew the answer to that question, I would have a solution already. I dunno. I think there’s something bugging me that I’m not thinking about. When I have something that is really bothering me and I try to ignore it, I tend to have panic attacks. Maybe that’s the cause of all my panic attacks. I don’t know. Lyme disease was pretty stressful. Lack of sunlight might be a problem. I dunno.
I said “I dunno” a lot. She took copious notes and asked extremely open-ended questions. One of them was “how is your identity?” Ok, this was not out of the blue, since I was sort of without one right after I got divorced, but how does one answer such a query?
“Is there anything else?” she asked.
“How do you mean?” I asked.
She noted that it was open ended.
I took a deep breath. “I have a lot of friends who are transexual. And it’s something I’ve been thinking about.”
She started a new page of notes. “You know people who have had The Operation?”
Gah!!! The Operation. What operation would that be, exactly? Would it be the operation where folks take T (or E, since I’ve known folks going both ways) until they pass? Would it be top surgery? Would it be a hysterectomy? Would that be a medioplasty? A phalloplasty?
“Um, I know a guy who had a hysto?”
Did you mother know? Did your ex-wife know? Does your girlfriend know? How long has this been going on?
no. sorta, not really. yes. I dunno, a few years. You know, I’m not at all sure about this.
So you think you are denying your real self and that’s making you anxious and maybe having The Operation would fix that?
What?!! No, I don’t know! Augh!
Would you like to speak with gender specialists in The Hague?
“I don’t know.” I’m all wary now. Outside the window, a gigantic orange cat has climbed to the very top of a barren tree. It’s among the empty branches, looking around. It’s not acting uncertain, but I wonder if it must be stuck, up so high in the tree. Why did it go up there?
“You don’t have to make any decisions. It’s your life, you know. You can just talk about it. It’s an emotionally safe place to talk.”
That’s easy for you to say. I looked at the bookshelf behind her head. It was red and in the shape of a first-aid cross. “Um.”
“They can also help you with anxiety.”
“Ok, I’ll talk to them.”
“Your friends who have had The Operation- are they happy?”
“Um, as far as I know. I dunno.”
“Well, I think we’ve probably covered enough for this session. How do you feel now? Relieved to get everything out?”
No, that’s not exactly how I would describe my mood at all. How does it make me feel to talk about anxiety? It makes me feel fucking anxious!!
I speak virtually no Dutch. Her English skills are probably not high enough to be doing therapy sessions in English. No, I was not relieved. I left and went to class where I was all jumpy.
On the way out, I tried unsuccessfully to explain to the desk person that while I was happy to provide any insurance info they wanted, my insurance specifically excluded treatment for anxiety and regardless, they just reimbursed me for things, so it would be really better if I just paid cash now. The desk person went to ask a supervisor. Out the window behind her, I saw the orange cat running along the top of the fence, like it was on a mission, had a plan, had a place to be.

Repeating Playlists

I live over a record shop. I’m lucky to have the apartment. A vocalist had first dibs, but she decided the record shop’s music would drive her nuts. I had no such qualms. They stock music I like. I don’t mind overhearing music. It’s kind of nice, actually. There’s always some background tones.

Over Christmas they started repeating the same play list over and over and it included Christmas songs and was driving me insane. I came back from break and there was something new on. Huzzah! But it’s still on. The same CD. On repeat. Every day. For five hours a day. Coming through my floor. The same seven songs. Loudly. Over and over. Every day.
So I was coming into my apartment and heard the same CD again, so I went into the shop. The shop owner was arguing with a customer over something involving receipts. She asked me what I wanted. I said, “I’m your upstairs neighbor. I don’t mind that I can hear your music through my floor. It’s kind of nice, actually. But you’ve been playing this same CD over and over again and it’s starting to drive me nuts.”
I’m happy to report that the shop owner was a total asshole. “This is what I like” she said. “In a few months, I’m gone from here. There’s absolutely nothing else I can play. All the new stuff coming in is shit.” I’m looking surprised and looking over her shoulder at the Nirvana box set, at Kraftwerk, at Ladytron, and Peaches and shelves and shelves of CDs.
“There’s nothing else?” My eyes were on the shelves and shelves of CDs. “Do you want to borrow my ipod?”
“No, there is nothing else but soon I am gone. I’m with a customer.” she gestured at the man with the receipts and her angry eyes dismissed me.
Well, in a few months I’m gone too. She acted like I was being totally unreasonable. She’s been listening to the same CD for over a week. I’ve been listening to her same CD for a week. I could try to drown her out, but I know from experience she would just turn up louder. (I asked her once if my music was bleeding through and bothering her. She said it was not. (This was not snarky on my part, sound design is very important for a record store.))
In other news about me going crazy, I have an appointment with a shrink scheduled. Yay me. All the shrinks in the Netherlands that deal with gender issues are at a university hospital in Amsterdam. I do not have an appointment with such a shrink.
Finally, while I tag my old posts, some RSS readers like bloglines and livejournal are publishing old posts as if they are new. This is a bug, because they are ignoring the post date in the feed. (Safari does not have this bug.) Those of you being annoyed by this should consider filing bug reports.


She’s been playing this same CD from before. This is the one that was driving me crazy before Christmas. It’s been a month. jldgsfljgsdfgSLJDF

Edit 2

The record shop owner just knocked on my door and explained that she was pissed off at the customer, not me and that she has a cold and can’t hear and she switched the CD and turned it down and explained their marketting policy about their playlists. So it’s all ok now.

New Cell Phone

So apparently, it was not beating my cellphone against a pillar in Oakland that temporarily cured it of it’s antenna woes (although that seemed to help). My pld phone existed on a different frequency than the new system in Connecticut. this explains why my reception was steadily degrading (as they changed the system) and why it would spring back to life in NYC and CA.

I have a new phone as of today that works on both the NY/CA frequency and the new CT frequency and it didn’t cost me anything. The guy at the phone store assured me that my old phone would be sent to CA and sold as refurbished and not go into a landfill. He also gave me the name and phone number of a recording studio in Hartford that often needs bassists to sit in on pop/punk recording sessions. I also learned that the fancy new cell phone rings are actually mp3s. so my dream of composing cell phone rings is a bit odd then, since any song can already be a ring. I’m going to double check this last fact. But maybe I can play in a poppy punk band at least.
My personal ad is liove, but doesn’t yet have a picture. So far, no replies. I’m feeling far less certain about things than I did earlier. My confusion and unhappiness is great. My tears flow freely. I went to the school shrink and cried a lot. She wants to see me for the next two weeks. she does a great concerned expression. It must be hard to listen to woes all day. I had dinner with some undergrads and said i had seen one of the shrinks and they all knew her. Everyone in Middletown is insane. The people in the mental hospital are insane. The people in the halfway houses are insane. the people in the grocery stores are insane. everyone connected to the university is insane. we’re all damn crazy around around here. I want to go home. I kind of wish that I had never come.

couples therapy is a lot like that Simpsons episode where they go in for family cousilling and the shrink gives them foam covered bats to hit each other with. then bart realized that you can take the foam off and promptly breaks Homer’s leg. If you didn’t need help before, boy, you sure will afterwards. How this is suppossed to do anybody any good, is beyond me. In times of stress, the guru to turn to is not any shrink you can think of or anyone that advocated airing all of your dirty laundry all at once in an attack-like barrage. no the voice to listen to, the voice of reason is Miss Manners. Clearly what is required in times of stress that people make an extra effort to be polite, not let everything negative out in a vian quest for catharthis.I would rather grow back my wisdom teeth every week and have them removed every week over and over again like that mythical guy whose spleen grew back every night, than go to couples therapy. The wisdom teeth thing is much nicer. Everyone had your best interest in mind and people are nice to you afterwards. Your spouse doesn’t start crying and avoid you. she brings you ice cream instead. Isn’t it better to get ice cream?When I was a kid, my mom dragged me off to family cousilling along with the rest of my family (but i was the primary target). that was pretty miserable. it gave me a terrible opion of shrinks. i decided they were all bad people who tried to sow discord in order to keep themselves employed longer or maybe because they really hate people. I could never tell which. Everyone assured me that going as an adult (even if pretty much against my will) would be very different. Nope. It’s exactly the same. No, it’s worse, becuase I end up paying cash for it at the end. Before it was miserable, but at least it was my parents money.And then I went out to the car afterwards, and there was a parking ticket. Yes, it just gets better and better. No-one will ever get me into a shrink’s office again. I’m going with the they-all-hate-people theory.