An Honest Discussion of The Underlying Issue Behind the Fallon Fox Controversy

Disclaimer: This post is intended to be a jumping off point for a conversation about a side of SRS that has not yet been discussed. I am far from an authority on SRS and transexuality, so if I have stated an incorrect fact, please edify me. If you disagree with an opinion, let's discuss it. This isn't a place to venomously attack others views and defend your own- it's a place to respectfully exchange ideas to increase our understanding of a nascent topic extremely relevant to MMA at this time. Perhaps this can be a place to shift our perspective of a subject that too often causes us to become deeper entrenched in our views due to extremee dialectical, emotionally charged differences of opinion. Let's not do that here, ok?

I've largely stayed away from the Fallon Fox threads due to the devolution of the comments sections I've looked in on into bigotry and intolerance of views that aren't in full support of Fallon Fox and the transgendered community. First off, I want to give some context for my viewpoint- I'm a licensed clinical social worker (LCSW-R) who works full time in a large NYC hospital's adult inpatient psychiatric unit and currently have 6 patients that I provide psychotherapy to in a private office. My second job in the field was from 2002-2006 as a case manager in an outpatient mental health clinic for LGBTQ adults.

1) I think that it's asinine for Fallon Fox to be allowed to fight women in MMA. The field of transgendered research is simply too young to provide useful conclusions on this topic. My personal opinion is that transgendered females are not women- they are transgendered women. I am happy to refer to transgendered men or women by the nomenclature that they prefer (i.e. he or she) out of tolerance and compassion, but I don't KNOW that it is correct, and they will never be able to fully undo what nature has done. All medical treatment before and after sexual reassignment surgery is performed with the goal of making the patient as female and un-male as possible and no matter how effective this treatment is it will simply never be able to make one 100%, natural woman. We may never know which elements of gender remain untouched or intact from before the surgery, and these unknowns may have profound physical corollaries which can greatly affect one's ability to perpetrate sporting violence.

While one can question just how much a transgendered fighter's opponent's safety and ability to compete is jeopardized by these physical differences, there is an immutable fact at the foundation of this issue: men have extreme physical advantages over women- it is not safe for a woman to fight a man. A transgendered female used to be a man, and still has male attributes.There must be enough mitigating evidence, obtained through research, in order to form a medical (biology and sports physiology) consensus showing that there is not enough competitive advantage retained from the pre-op gender to make it an uneven competitive environment. In other words, the burden of proof falls on those seeking to allow transgendered women to fight natural born women. One thing that I hope that we can all agree on is that if she is allowed to be licensed, then her opponents need to be informed so that they can make an educated decision.

2) At the core of this issue is the fact that not everyone is comfortable with the idea of transgendered individuals in the first place- and this is where things get sticky. First of all, one who is not comfortable with this population is not necessarily bigoted or ignorant- it's 100% ok to be unsure of the medical, social and psychological appropriateness of being pro-sexual reassignment surgery (SRS). I'm going to come out and say it- I'm not entirely comfortable with the pro-SRS approach to transexuality- please hear me out as to why I feel this way before coming to the conclusion that I'm a horrible person.

Like I said, I am a mental health professional. I have had extensive and intensive experience with an incredibly wide array of populations and pathologies, so I am far from a layman when making the following comment: nowhere else in mental health do you address a feeling or behavior that is ego dystonic by performing a surgery to accomodate the dystonia. Typically, the source of the dystonia is addressed and modified with the goal of having the individual acknowledge and accept the quality of themselves that is so unacceptable to them. To actually change the characteristic to become syntonic instead of addressing the underlying dystonia is highly irregular. If the technology existed, would it be appropriate to: provide a sufferer of Obsessive Compulsive Disorder with synthetic skin, so as to eliminate the damage of constant washing? Do hoarders get prescribed a larger house so as to accommodate their ever-growing hoard? These interventions grossly perform the same service as sexual reassignment surgery for one who feels as though they were born in the wrong body. Instead, the prevailing wisdom of best practice is to work to develop skills to allow the patient to "sit with" the anxiety produced by the dystonia without engaging in the behavior that gratifies it, which if engaged in, of course ends up intensifying the extreme feelings of dystonia anyway.

Now, now- I can hear the argument: those conditions are all pathologies and those behaviors are all harmful, sexuality is not a pathology and [safe] sex is not harmful; therefore, clinically adjusting for the pathology is not a cogent comparison. Yes, that's true, but again, I go back to ego-dystonia vs. ego-syntonia, which is the crux of analyzing just about any psychic characteristics. When presented with a case, us as clinicians must first ask: is this behavior/characteristic/quality/identity in harmony with one's self-concept or does it run counter? That will largely inform the treatment. Now, if that still rings false to you, how about internalized oppression amongst minorities, which I believe to be an extremely apt comparison? Black folks who are in treatment for internalized oppression (of which there are MANY) aren't advised to lighten their skin- Asians aren't introduced to plastic surgeons to discuss eye widening- the focus of the treatment is on embracing the identity unique to them, empowerment and identifying through the generation of insight the external sources of their internalization of oppression.

Perhaps the most similar population is the transabled community-able bodied individuals who feel as though they were physically disabled people born in the wrong body and yearn to have physical impairments, including paraplegia. The transabled movement is advocating for legalization of doctor-assisted paralysis, in which the spinal chord would be severed surgically so as to induce the desired condition. To me, as a mental health practitioner, this is the same issue as that which faces transgenger adults- that is, they both suffer from identity disorders which lie on a spectrum. Whether that identity disorder results in someone feeling as though they're born the wrong gender, race, nationality, species, etc.- it is a dystonic reaction by the ego. Why then is SRS seen as a viable treatment for identity confusion when every other example of such is treated differently? It's not because there is a medical consensus, which there is not- even in the LGBTQ clinic that I worked in, some of the most outspoken advocates for the social cause were staunch opponents of SRS and individuals suffering form gender identity disorder were actively advised against SRS- getting the surgery was seen as therapeutically inappropriate- it was enabling the pathology instead of empowering the individual. SRS was supported in a handful of cases, after the patient demonstrated therapeutic progress with the underlying psychologiocal issues and still wanted the treatment. Now, we know that before a reputable SRS center will provide the surgery, the patient must go through a minimum amount of time (I believe it's 2 years- am I right) of psychiatric/psychotherapeutic treatment (does anyone know which one it is?)- my question is what is the goal of that period of treatment? My understanding is that it's to rule out any severe psychiatric illness, as sufferers of severe and persistent mental illness (SPMI; i.e. schizophrenia, schizoaffective disorder, bipolar, etc.) are not approved for the surgery. Are the patients treated for their gender identity disorder and any other psychiatric diagnoses that they may have, or is this merely a period of assessment? I have ethical concerns about this, as the treating clinician likely works for the surgical provider or markets themselves particularly for this niche and is selected and hired by the patient, thus creating conflicts of interest. Ideally, there would be a third party, independent organization that could provide objective assessment in order to approve the patient for the surgery; a la the doctors which provide assessments for Supplemental Security Disability determinations. Going back to my disclaimer; if anyone knows this info, please let me know.

Today, there remain many psychiatrists who are very much against SRS as a viable treatment for gender identity disorder, a few of them are here and here. Their concerns are supported by research, as there is a lot of research suggesting that SRS does not cure the fallout from the dissonance of one who feels as though they were born in the wrong body, in fact, it can exacerbate it, likely due to the fact that the underlying causes of those feelings of "wrongness," "being out of place," or born in the wrong body are symptoms of a larger underlying psychiatric condition instead of the cause of it.

It's not cool to be hateful, close-minded and willfully ignorant, but much more needs to be learned about the interplay between gender and sexuality in general; individuals who feel trapped in the wrong gender's body in particular; and post-op fighters competing in the physically weaker gender's division specifically- to the point where endorsing feelings of being fluctuant, irresolute and uncertain should be accepted as it breeds discussion, research and education. If someone doesn't feel comfortable referring to a trans as the post-op gender, they don't deserve to get flamed and ostracized. I think that it's clear that it's far from a clear cut issue- so long as that confusion is expressed respectfully, it shouldn't be discouraged by the morality police (a culture of which can get a little out of hand on here sometimes- something that I both love and loathe about this community). It's such an emerging social and scientific issue that ambivalence is to be expected and addressed through an exchange of ideas.

\The FanPosts are solely the subjective opinions of Bloody Elbow readers and do not necessarily reflect the views of Bloody Elbow editors or staff.

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