Journal

Welcome to my online journal, which I started in December 2002 after several very persuasive hints from friends. Although I obviously don't write about everything that happens in my life here, I hope it'll provide an insight into who I am and what's happening in my life - whether good, bad, happy or sad.

Giving Thanks

Posted by Anna at 22:58 on Sunday, February 27, 2005
A week ago I was quite frankly a mess, and when I came to Church last Sunday it was with a heavy heart, for I knew that on Tuesday morning I faced an appointment I was really not looking forward to (I can't discuss it here as it concerns my family).

After that service I felt a strong calling to go to our sanctuary - a beautifully tranquil area in the corner of our Church set aside for members to pray by candlelight. Once Beth and I were there, I lit a candle for those I have been separated from and prayed for them. As the tears flowed, the more I felt the Love that surrounds me...the purity of Love that can only come from the Lord. By the time the tears finished, the pain I felt had been replaced by resolve and peace.

Had I written about this event last week the title would probably have been "Letting Go", "Giving the pain to God" or something similar. As it is, this post is joyful rather than sad - and that alone is something to give thanks for.

By contrast today's Service was one in which I felt pure joy, and a perfect time to say thank you for all the wonderful things that have happened this week, and the new friends I've met recently (and no, I haven't lost my old ones either!).

Was it a coincidence that two of my favourite hymns - My Jesus, My Saviour and Lord I Lift Your Name On High - were prominent in the service today? I'll leave you to decide that for yourselves...

It was during the second of those two hymns that our pastor called on God to be with us in the most eloquent and moving way imaginable. Suffice it to say that by the end of the hymn that I felt a peace and grace that had tears literally running down my face.

It was one of those moments you just can't describe. Amazing.

After the service I talked to our pastor about the events of this week. He said he'd been praying all day Monday for a good outcome for me on Tuesday, and was visibly happy that our prayers had been answered.

For me, that says everything about God's Love for us. Ask with no expectation of an answer, and you may well be pleasantly surprised at the eventual outcome.

Incidentally, I was going to light another candle in the sanctuary to say thank you tonight, but as there was someone else in more need than I, I didnt get the opportunity. That candle of thanks is now one I carry in my heart instead.

In the words of the hymn - I am a new creation.

One of the "old guard" of gender psychiatrists is under fire...

Posted by Anna at 19:35 on Saturday, February 26, 2005
There are two main paths of treatment for transpeople in the UK - NHS or private. Whilst the private route places a great deal of responsibility and flexibility in the hands of the patient, the NHS route is reputedly more rigid and inflexible.

Some (like myself) have the luxury of choosing the route that suits us best - but not everyone is so fortunate. Many have no choice but to follow the NHS route - even if their circumstances or nature do not suit the more rigid regime that entails.

Although I've never been under the care of an NHS Gender Identity Clinic, I've met many people who have, and the impression I have is that some of the senior psychiatrists - notably Richard Green, Don Montgomery and James Barrett at Charing Cross - seem to represent the sort of "old guard" style of medicine which is quite rightly virtually extinct in medicine today. My one meeting with Richard Green confirmed this - he appeared to be an academic with little or no empathy for his patients, and I felt profoundly uncomfortable talking to him.

Considered in this light, isn't it unnerving that such characters have so much say in the treatment available to transpeople in the UK? Judge for yourself...

    UK: Health Trust to Examine Comments by Psychiatrist

    The Chair of West London Mental Health Trust, Professor Louis Smidt, has confirmed that investigations will be undertaken concerning remarks made in an internal memo last summer by the next head of the Charing Cross Gender Identity Clinic, Dr James Barrett. The assurance follows a letter sent by the chair of the Parliamentary Forum on Transsexualism, Dr Lynne Jones MP, questionning whether Dr Barrett's remarks were in line with the Trust's policies within the NHS.

    The memo in question was first penned by Dr Barrett in August 2004 and was sent to the existing head of the Clinic, Professor Richard Green. Professor Green asked Dr Lynne Jones to circulate the memo to members of the Parliamentary Forum and, following the voicing of widespread concerns by Forum members, Dr Jones agreed to query some of the points made with the Chair of the Trust.

    Three weeks ago the MP wrote to Professor Smidt, with a copy also to the rust's Chief Executive and the Medical Director. Dr Barrett's August 2004 memo was apparently prompted by sight of a draft guidance document for NHS Purchasing Managers, setting out the way in which treatment for "gender dysphoria" should be commissioned. Some of the Charing Cross psychiatrist's remarks have been reported before.

    (See "Echoes of a Bygone Age").

    Ironically Dr Barrett's retiring boss, Richard Green, has been closely involved in the lengthy collaborative authorship of those purchasing guidelines, along with many other leading practitioners who also attend the Forum. Many of the authors and reviewers in the project are also involved with the parallel work of a committee set up by the Royal Colleges of Medicine and Psychiatry to develop new Standards of Care for Gender Dysphoria treatment in the UK. That committee's chair, Dr Kevan Wylie (Porterbrook Clinic, Sheffield) is also a member of the Parliamentary Forum and, not surprisingly, the work of the two groups are fairly convergent .. representing the consensus viewpoint of some of the principal movers and shakers in this area of medicine and among representatives of service users.

    However, it is not the critique of individual statements or policy lines by Dr Barrett which has raised people's eyebrows. The concerns of those who've seen the angry memo are directed at what the next head of the country's biggest Gender Identity Clinic reveals about his overall attitudes and beliefs within a rapidly modernising health service.

    The NHS Improvement Plan, published by the Government in June 2004, is the latest stage in a programme of fundamental steps to modernise the country's 60-year-old health service.

    See http://www.publications.doh.gov.uk/nhsplan.

    It follows consultations, vision statements and policy documents which have been progressively published over the last eight years since the Labour Government came to power in May 1997. By now, therefore, the philosophy should come as a surprise no no-one, from board executives and clinical consultants through to receptionists and porters.

    Among the fundamental concepts running through the strategy great attention is given to remodelling services around the patient. "Patient Centred Care" is more than a buzzword. It is one of the most fundamental principles from which everythings else follows. Patient choice isn't a luxury but an essential. Likewise, attention to quality... The patient's role in measuring that quality is a principle which all departments (without exception) are expected to uphold. The vision is one of partnership between providers and consumers in achieving what the health service is there to achieve.

    These concepts also strongly reflect the ways in which trans people have traditionally criticised UK GIC's over many years. Some centres dealing with transsexual people have been anything but focussed on the needs of the individual. Choice has been practically non-existent without resort to private treatment. Quality has often been the last word which patients, their families and general practitioners would reach for to describe the process and the outcomes.

    Dr Barrett's angry memo to Richard Green reveals a very reactionary attitude towards the winds of change though .. and a thoroughly disparaging view of his patients:

    Dr Barrett writes in his memo to Richard Green that he looks upon Patient-Centred Care as a "jargonistic phrase" and adds that he has "never seen an adequate definition" of the term. Referring to the comment in the Forum's guidelines that "the terms a transsexual, transsexuals, male transsexuals and female transsexuals are now regarded as unacceptable" he sniffs disparagingly, "They are perfectly acceptableto me". The NHS plan directs that "patients and citizens will have a greater say in the NHS and the provision of services will be centred on patients needs". Yet. in contrast, Dr Barrett makes the dismissive comment: "I note that it doesn't say it should be centred on their wishes".

    The distinction between patient "needs" and "wishes" exercises Dr Barrett's mind a great deal. At one point he comments, "My concern is that patients 'wishes' are being followed in preference to their 'needs' ", leaving the reader to conclude that the good doctor thinks he has a far better idea of the latter. Later he writes, "I think that 'supervision' should be a rather active process, not that of simply agreeing with the patient's wishes".

    Overall, the impression is conveyed of someone who regards the preferences and views of patients with scepticism .. hardly a good basis on which to base any partnership approach to therapy.

    On the idea that the Charing Cross GIC and his work should be subjected to patient audits, Barrett angrily comments, "I take extreme exception to [that idea]". He adds, "I think a more independent measure of outcome than patient satisfaction audits should be applied".

    It remains to be seen how the West London Mental Health Trust will respond to Lynne Jones once it has had a chance to examine comments like these and weigh up the other expressions of concern voiced about the Clinic. A report commissioned by the Primary Care Trust serving the Brighton and Hove area of Southern England was extremely critical of Charing Cross and the Trust's sole dependency on that one Clinic when published last November (see http://www.pfc.org.uk/pfclists/news-arc/2004q4/msg00069.htm). Other PCTs are also said to be re-examining their referral and purchasing strategies in this area.

    Across the board, services for trans people also fall short in terms of many of the initial measures by which service improvement is being judged in the NHS. For instance, the NHS plan promises that: "From the end of 2005, patients will have the right to choose from at least four to five different healthcare providers. The NHS will pay for this treatment. In 2008, patients will have the right to choose from any provider, as long as they meet clear NHS standards and are able to do so within the national maximum price that the NHS will pay for the treatment that patients need."

    .. Yet this seems an unlikely prospect for trans people so long as many Strategic Health Authorities carry on relying upon Charing Cross as their sole provider for services in this field. To achieve choice, regions will have to start building alternative services to service local need and provide real choice in methods and approaches. They will also need to fund the kind of patient-friendly private services which UK trans people so obviously seem to prefer, judging by the ways in which so many have obviously voted with their wallets in the past. In a small field, patients may need to be able to go elsewhere within the European Community to access specialist talents in short supply. The standards of care currently being drafted under the Royal Colleges of Medicine and Psychiatry will also need to ensure that the ability to mix and match services is preserved too, in the face of some practitioners who would rather write the rules to favour "one stop shop" centres, which Charing Cross would presumably like to remain.

    Similarly, according to the Government's plan:

    "In 1997 patients waited up to 18 months for treatment - after seeing a GP, after seeing a consultant, and after diagnostic tests. Those times have fallen and now the maximum wait for an operation is nine months and the maximum wait for an outpatient appointment is 17 weeks. When this programme has been delivered in four years time, the 1997 maximum wait of 18 months for only part of the patient journey will have been reduced to 18 weeks for the whole journey. The previous long waits for GP referral, outpatient consultations and tests are included in that pledge."

    .. Clearly those statistics don't apply to the real experiences of trans people yet .. and there is no excuse whatsoever why someone seeking help with the distress of Gender Dysphoria should find themselves subjected to a second or third class standard of care compared to any other need.

    Undue reliance on a single centre by many health areas has created unacceptable waits for people to obtain a consultation in the first place. It has also fostered a service which has become arrogant as the result of holding an officially encouraged monopoly position. Now, in a post-gender recognition climate, Britain's trans people need to be asking increasingly tough questions within their local NHS ... just as those down in Brighton and Hove have already done.

    In many parts of the world trans people's calls for service improvement are that much more of an uphill battle because the things we so often complain about are things which medical establishments have a vested interest to maintain. They even write so-called "Standards of Care" in ways that cement the status quo and "control" or "manage" the client.

    In Britain we are luckier. The things we call for as the result of bitter experience are uncannily aligned with the principles which the Government espouses as a goal for all NHS care in the 21st Century. To use a colourful but evocative expression, trans people aren't pissing into a force nine gale with these ideas. Anyone who thinks we don't deserve more say in treatment; in real choice; in shorter waits; and in better quality; needs to justify why those things don't apply to our care when the Government sets them as measurable goals across the board for every other sphere of treatment.

    The emphasis shifts from us needing to justify why these principles should apply, to the providers needing to explain why they don't yet do so.

    For consultants brought up in the halcyon days of unbridled power this must all be rather upsetting. Dr James Barrett will not be the first or the last practitioner to find their attitudes questionned against the Government policy and performance yardstick. Trans people must now be increasingly prepared to use such national standards as tools .. because everything that has come before has served to emphasise that we belong on an equal footing with everyone else.

    The Government's health service strategy transforms the things we seek from a risible-sounding plea into mainstream rights. But nobody will simply grant those advances unless people using services are show they are prepared to couch their expectations and questions in those terms.

    All in all it will therefore be extremely interesting to see how the West London Mental Health Trust responds.

    - Christine Burns



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It's going to be interesting to see how this develops. The fact that the Parliamentary Forum is involved suggests that this issue is not going to go away quietly this time.

All we can hope is that ultimately the provision of treatment improves - and by that I don't just mean its availability (that's another story of course...as anyone who is on the waiting list for Leeds GIC can testify).

Had I been an NHS patient, I honestly don't think I'd have coped nearly as well in such an environment (or even made it through treatment) as I did privately. That's not to say that Dr. Russell Reid (my consultant) is perfect of course, but at least he was willing to empathise with me and give me control of the pace and details of my treatment.

To wonderful friends, good food and good music

Posted by Anna at 23:45 on Tuesday, February 22, 2005
Today is one happy day. Not only did an appointment this morning (which I expected to be painful and difficult) go far, far better than I anticipated, but we spent the remainder of the day in the company of friends, and tonight we were invited to meet some new friends for dinner.

First things first. After my appointment we dropped in on our friends Mark and Debs. It was good to see them, and just for once Mark wasn't wearing one of his many costumes (the last time I turned up there he was regaled in a Town Cryer outfit, ready to exercise his not inconsiderable voice on the streets of Basingstoke. The time before that I seem to remember he was dressed as a pirate...).

As usual we stayed there chatting for several fun hours catching up on everything.

Although I've not been active on the re-enactment circuit for several years, I still know lots of people and apparently the scene hasn't changed much. More interestingly, they still know me.

Those I've encountered (and all of my old friends in Berkshire) have all been fantastic - my transition was a complete non-issue. Among those who didn't know me quite as well I get the impression that there's still significant curiousity....they're intrigued.

Which leads me onto an amusing incident which happened while we were there. Purely by coincidence, one of the guys who trained me back at the start turned up at their house while we were there. At the time I was talking to Mark in the lounge and Beth went downstairs to ask Debs if she needed any help in the kitchen.

If you know re-enactors you can probably hazzard a guess at what happened next. When Mark and Debs' visitor enquired who Beth was, Debs' son Shane replied "That's Beth -Anna's bird".

After leaving Mark and Debs we headed off to meet some new friends (always a favourite pastime of mine!) at an informal vegetarian (and very tasty) dinner party.

As it turned out, most of those there were musicians so by 9pm we were being entertained by an impromptu jam session! Not just any jam session though - instead of the usual guitars and keyboards this one mainly featured congo drums and diggery-doos.

The atmosphere was absolutely incredible, and very, very infectious. It's almost enough to rekindle my long dormant ambition to learn to play an instrument or three. Now if only there were more hours in the day...

"There must be a full moon out there tonight"

Posted by Anna at 20:47 on Monday, February 21, 2005
I've never really been one to fit in with others' expectations. Even if you disregard the gender issues I used to have, I was always different in one respect or another.

As a case in point: by the time I transitioned at the end of 2002 I'd already had long hair for something like 12 years (throughout most of which time I had to put up with regular digs from my mother who hated it. Then again she's one of those people who worries about "what people think"). At the time I also had a bikers leather jacket, which was according to friends nowhere near scruffy enough (one even advocated running over it in my car to give it that "run in" look!). Although that alone made me stand out a little in most crowds (well, except the annual one at Castle Donnington!) I just felt I'd found an image which suited me...almost.

Of course I had issues I was only dimly aware of then...I was extremely deep in denial at the time. Aware or not, those issues were nevertheless very real, and with them came the deep emotional scars they had caused throughout my life. For one thing, I was socially awkward, and although most people seemed to like me (maybe they sensed I was empathic...something I didn't even realise then) few came anywhere close to figuring me out.

Getting involved in the medieval/dark age/renaissance re-enactment circuit from October 1993 onwards helped me a great deal with that reticence, as it gave me access to a subculture (for want of a better word) with a completely different view of life than that in mainstream society. Looking back, the sheer flamboyance of some of the people (not to mention the costumes - if you know anything about 16th century European history you'll know what I mean!) also probably appealed to me on a level I wasn't even aware of. In that environment I could be different and distinctive, while still being part of something unique.

Skip forward a few years.

When I was transitioning I really had no idea what my new "look" would be....my mind was really just focused on surviving then. It was an agonisingly painful time, and looking back I find it amazing that I made it through, let alone that I managed to put my life back together as successfully as I have.

However, one thing I did discover during the latter stages of transition was that black really suited me. That's a look I've gradually built upon, to the point where I now have a reputation as "a bit of a goth". In a way that's misleading - I'm not really a goth...I just like the look...so much so that I brought it with me to Thailand when I returned there for my FFS last year...

And so (finally) to the present. Last night Beth and I were in town and had some time to kill before the Church service at 6:45pm. I was dressed casually in a pair of black jeans, ankle boots (with 3" heals, of course!) and a closely fitted black top with lace on the lower arms. It's a look which I really like, and which many people have said suits me perfectly.

To pass the time we wandered into the Branksome, a friendly and often quite lively place which is fun to visit occasionally. They often have some form of entertainment there - for example, the last time we were in there there was a singer entertaining the crowd, and tonight was no exception. There was a "comedian" on the stage, and although he seemed to be going down well enough, I didn't really pay much attention as we walked past the tiny stage (you have to walk past it to get to the bar).

Of course, many comedians love to crack jokes about those who stand out from the crowd in one way or another, so it didn't come as a huge surprise to me when this loud voice boomed out over the PA...

"There must be a full moon out there tonight".

I just smiled enigmatically, and carried on walking towards the bar...

What an amazing picture!

Posted by Anna at 22:43 on Wednesday, February 09, 2005
Every so often in our lives a picture is taken which says so much about who we are, and how we feel. We think it's time we shared one such picture - one which we feel shows our love better than any other we have. It was taken by one of our friends in the Church at the Church's 25th Birthday Bash in November, and at the time we didn't even know he was pointing a camera at us!


Now isn't that an absolutely stunning picture? I've a feeling that when we eventually have our own place (we can dream, can't we?) a framed print of it will have pride of place on the wall in our living room...

Finding Nemo

Posted by Anna at 23:26 on Friday, February 04, 2005
We watched Finding Nemo tonight. It was absolutely hillarious, but I found parts of it profoundly upsetting, as the theme - a father searching for his child - tugged at a wound I carry with me in my heart.

Once you become a parent, it's not something you can (or should) put behind you.