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by Dr. Jem Tosh (content warning: one very brief mention of s*xual assault) I was having a non-verbal morning in a meeting this week where I felt uncomfortable for many reasons, but mostly because the structure didn't work well with how I communicate (which is fairly typical of my experience in academia), and I had more of these meetings than usual so that discomfort had accumulated. I was put on the spot to speak and I struggled to do so. One participant laughed and commented on how awkward the silence was. It was only seconds of silence, but I noticed long ago that to cross social norms in academic settings takes very little (thanks to my work supporting autistic students at university). I felt embarrassed. I'm comfortable with silence and there are plenty of times where I actually prefer it. It doesn't feel awkward to me, it feels peaceful. I also appreciate that there can be many reasons why a person might take longer than others to begin speaking (such as those who stutter). I was put on the spot to speak and I struggled to do so. One participant laughed and commented on how awkward the silence was. This isn't a call-out of that individual, because it's the kind of thing that happens so frequently in these spaces and by so many that the underlying issue is rarely explicitly visible or known. Its so frequent in fact, that I've been thinking for a while that I should write this post. Rather than continue to experience that discomfort in meetings, or disengage and miss out on experiences and opportunities that I want to pursue, I'm learning to sit with the discomfort of asking for what I need instead and advocating on behalf of myself (something I'm generally very good at doing for others). The meetings this week were outside of the psygentra bubble. It's made the difference between how I run groups and sessions and those that conform to the 'norms' of academia very stark, particularly in terms of accessibility. I found some of these meetings difficult and I didn't engage like my usual very-engaging self. At its worst, I left feeling shame about who I am and how I communicate - despite being a very skilled communicator. Communicating in groups is a big part of my job and has been for sometime. I've spent over two decades developing my ability to speak in front of other people so that I could lecture and present before large audiences with confidence and participate actively in committees, departments, and organisations. I remember after my first book launch someone coming up to tell me that someday they wanted to be able to speak like I did - perhaps not realising just how much I was masking to 'fit in' with academia at the time. Putting people in a position where they have to choose between being excluded and masking isn't really much of a choice, is it? This is more than being anxious about public speaking, it's about being neurodivergent* and having to overcome or tolerate ableist norms in academic spaces (that are also often white and colonial norms too). They are structures and expectations that others may not consider or see a problem with, because it's not a problem for them personally. It can be difficult to understand or acknowledge things that are outside of our own experience and context unless we specifically seek that knowledge and understanding. So, here are some of the ways that I make my meetings more inclusive and accessible. The more of these changes you incorporate into your spaces, the more I can engage with you and the work that you do, and the less I will have to mask and recover from your meeting, workshop, conference, or seminar etc. 1. Non-verbal options I can't emphasise enough how essential this is for accessibility. Some neurodivergent folks communicate in ways that do not involve verbal language or spoken word. Others speak often but at times 'go non-verbal' or have times when they do not speak aloud. Requiring folks to speak during meetings or events and providing no alternatives, means that you're either excluding those who are non-speaking or requiring those who need non-verbal options to mask their neurodiversity to participate in your event. Putting people in a position where they have to choose between being excluded and masking isn't really much of a choice, is it? Examples of non-verbal options: (1) allow people to use online chat to contribute their thoughts, (2) encourage and support hand gestures for people to show how they feel about what is being said (as well as sign language), and (3) offer presenters the option to provide their contribution in advance such as a transcript or a pre-recorded presentation (with captions). 2. Reduce or eliminate turn-taking This one is important when working towards building a culture of consent - creating norms that have consent at the very foundation of everything that we do. Telling a person to speak or putting them on the spot, means that the individual isn't choosing to speak but is responding to a request and one that typically has some power hierarchies at play (like meeting host or chair and attendees) - and yes that's even if you don't consider yourself to be power-hungry but an anti-oppressive practitioner. It's the position you hold that has power imbalance and we can work to dismantle it, but we can't pretend that structure doesn't exist. ...allow people to not introduce themselves. Go on, add a little mystery to your meetings. The world won't end, I promise. My 'red flag' or indication that I'm going to find a meeting difficult is the dreaded phrase - 'let's go around and introduce ourselves' (as well as not being allowed to swear!). The phrase involves a number of difficulties for me, such as, I didn't offer to introduce myself and now I have to decide on the spot who this audience is and what I feel comfortable disclosing. Given that there are parts of my identity and experience that can have hostile responses depending on the audience (e.g. being queer and nonbinary) this means that within the space of a few moments (sometimes seconds) I need to evaluate the safety of the situation and come up with a verbal speech to deliver in front of a staring audience (all that eye contact can be a problem for some neurodivergent folks too). If I have to wait to speak this involves a couple more difficulties. One is needing to speak but being made to wait. For some neurodivergent people (e.g. autistics and tourettics) this can be difficult to the point of distressing, and that distress can increase the likeliness of things like tics and shutdowns. The other is that the individual now needs to process the auditory information being produced by others (something that can be difficult for those with auditory processing difficulties) while at the same time evaluating the safety of the environment and generating an introductory 'speech' to be presented verbally. That's all a bit much really. Examples of alternatives: (1) Ask participants for a bio and share it with attendees in advance, (2) introduce participants based on a bio they have given you prior to the meeting, or focus on making connections and introduce people like you would at a social gathering (e.g. 'oh hey, you and so-and-so both work on this topic'), (4) allow participants to type their introduction in the chat, and most importantly (5) allow people to not introduce themselves. Go on, add a little mystery to your meetings. The world won't end, I promise. 3. Normalise interruptions Yeah, they're not rude or disrespectful. That's just how some of us communicate and it can be an indication that (a) you're expecting that person to wait too long to contribute to the conversation and/or (b) they are super excited about what you're saying and have loads of things they want to share about it. Don't kill that passion by shutting them down over BS constructions like 'politeness'. Examples of normalising interruptions: (1) Don't require people to be on mute when one speaker is talking, and (2) don't require people to raise their hand and wait for 'permission' to contribute (see also above re: power hierarchies and a culture of consent). Think these changes will make your meetings impossible? Maybe they're too big and a smaller group size is what is needed to make the space more accessible. That won't work? Then a rethink of the structure itself is probably needed because no one said dismantling ableism would be easy. 4. Fewer faces For those who struggle with eye contact, facial recognition, and find looking into a sea of staring faces overwhelming and visually overstimulating, groups on zoom can be a nightmare. It can take so much energy just to process the visual information that it can be difficult to absorb and engage with the actual content of the meeting. Examples of alternatives: (1) smaller meeting sizes are really the main way to counter this issue, but you could also try to (2) make it an option that participants can ask other attendees to turn off their cameras while they are speaking. Another potentially obvious example (or maybe it's not) is, (3) normalise people not making eye contact - such as folks contributing to a discussion without looking at their camera or screen (this will require more auditory cues and descriptions, such as 'I've put the document on the screen and I will read the section aloud' and 'Jon has said something interesting in the chat, it reads...'). 5. Don't assume everyone has the same experience This isn't necessarily a neurodivergent thing, it's just good advice and a more trauma-centred way of working. I've sat through too many meetings where comments were made generally to the group that assumed everyone was going home to see family at the holidays (excluding and potentially upsetting folks who are estranged from family, immigrants who can't travel to see their family, those who have lost family members, or have been rejected by them) and that everyone drinks (excluding those in recovery and potentially upsetting those who have trauma regarding alcohol, such as drug-facilitated s*xual assault). There are plenty more examples I could list, but the bottom line is, don't make generalised statements. Those who have painful experiences with family are unlikely to interrupt your formal and polite meeting to disclose that - they're much more likely to leave the meeting feeling like shit. Examples of alternatives: (1) contextualise your comments, if you're looking forward to seeing your family, or you like to have a drink after work, say it in those terms, and (2) avoid making general statements (e.g. 'well women do...' 'everyone likes...' 'people are just...' and so on). 6. Reduce rigidity Yeah, lose the super rigid structure with timings. Need to cut people off because they've gone over their time? Try soft start and end times - it's more accessible and brings a fluidity to the timing that means people can choose when to arrive and when to leave. It's their choice to miss content and it's their choice if they don't want to participate for the entire event. This can also be helpful for disabled and chronically ill folks who have a flare up before or during a meeting - they can take the additional time to care for themselves before joining, or they can leave to give themselves the care they need, rather than staying until 'the end' in discomfort or pain.*** Worried that if you allow for longer discussions you will have someone who enjoys their platform and privilege just a little too much? Try discussing with them before the event about the importance of centering other voices and time boundaries (which are not the same as time limits). If they have a problem with sharing that time and space with more marginalised voices, *ahem*, uninvite them. My meetings generally last about 3 hours each and folks are typically sad to leave. Ever been sad to leave a departmental team meeting in academia? I doubt it. It doesn't have to be that way. For those who struggle knowing when to stop talking or are right in the middle of an awesome special interest info-dump during your event - consider (1) letting them share that interesting information, (2) interrupting at some point (but don't cut them off or shut them down) to thank them for the information and providing them with an additional space to share more (such as writing a blog post for your organisation, collating resources to be shared with members, doing a presentation on it, continuing the discussion in the organisation forum and so on). It can also be helpful to share in advance the general expectations and boundaries around content, or allow for meetings to be more organic and develop in the direction the conversation flows.**** If you have tried to cram too much into the time available due to an underlying fear of that dreaded silence of no-one participating, when you create smaller and more accessible spaces, you actually increase the organic engagement and deep and meaningful dialogue. My meetings generally last about 3 hours each and folks are typically sad to leave. Ever been sad to leave a departmental team meeting in academia? I doubt it. It doesn't have to be that way. A big part of this is making these spaces more flexible, because if you want a more diverse group of contributors, then why impose a 'one size fits all' structure? The greater the flexibility of the space, the more people who can access it, and the more diverse engagement you will get. Wonder why your meetings are filled with cis-het, white/settler, non-disabled, neurotypical people? It's probably the way you're running it. It can initially feel uncomfortable to have such a lack of structure because at the centre this is about giving up power and control of a meeting - and that's why it's a good thing. That's how you really begin to dismantle that power hierarchy. * I define this as having a neurological structure that differs from the constructed 'norm'. ** Others will benefit from these changes too, and some will want different types of structures to fit their needs. I recommend engaging with those who attend your meetings and learning what works best for them. *** It can also be helpful to welcome folks when they do arrive, e.g. 'Hey Krista, we just talked about [x] and [y], and we're about to talk about [z]. We're glad you're here.' **** Worried you don't have the time because you've got a deadline to meet? Consider incorporating slow scholarship and crip time into your way of working too. Also, slow down your decision making process. Try not to make decisions on the spot, or to jump ahead on a decision when not everyone has had the chance to think about the options/proposal and reflect on it. Defer it until the next meeting. Asking folks on the spot encourages people-pleasing and puts those who struggle to process information and organise their thoughts quickly at a disadvantage. It also gives you less time to consider the potential problems and pitfalls before implementing the idea.

by Dr. Jem Tosh What has hot chocolate got to do with my writing? Everything. I ate so much chocolate when writing my last book that I damn near dedicated it to Cadbury. It's a key part of my writing ritual - how I begin to create a space and mindset that ensures comfort when I'm writing about difficult or triggering topics, and one that encourages a focus on writing as a joy rather than persevering through an exhausting and miserable task. I ate so much chocolate when writing my last book that I damn near dedicated it to Cadbury. Making a hot chocolate when I'm starting to write has become a sign of the beginning of my writing time. I consider my writing time sacred - it's a time for me to create, to reflect, to bring something into existence from nothing (or from a blank page). It honours my experience as a survivor of abuse, as queer, nonbinary, and neurodivergent. It's my voice and my perspective connecting with others in a co-construction of knowledge that draws on texts and discourses that are sometimes radically innovative and others centuries old - and creating something new and unique. Isn't writing beautiful? But then, for some, writing can become a chore. In the context of academia publications are so closely confined as needing to be written in a certain way, published in a certain space, and reduced to numbers - word counts, deadlines, citations, and impact factors. This is in addition to the pressure of employment, income insecurity, and ultimately survival in a capitalist context where a job is necessary to access basic needs. Publish don't perish is perhaps a little too on the nose for those who need publications and grant proposals to keep their income. Where's the joy of writing and creating in that context? Here's how I protect my own writing time and keep it a space free from the pressures and demands of others: Put a sign on the door I got in trouble for this when I was a lecturer because it turns out that academia isn't great with boundaries. I'd do it again though - much like any boundary, sometimes it needs repetition before it takes hold. I put a sign on my office door to let people know that I am writing and not to be disturbed. The aim of this isn't really with the sign itself, so you may use something different, but it's about letting people know that you are not available at that time. That if something has come up and they need to speak to you about it, they know to talk to you about it later if it's not urgent (and so many things in academia are framed as urgent when they're really not). The university won't collapse if you take a couple of hours to write. This is also about reducing distractions - so turning off notifications, closing browser tabs, and putting the phone on silent can all help, if those are things you can do. If you have responsibilities that mean you need to be available 24/7, if it's possible to share those responsibilities with someone else, that could be one way to go. E.g. asking folks to contact someone else for that brief period of time in case of something urgent, and you'll follow up once you've finished your writing. The university won't collapse if you take a couple of hours to write. Some folks in academia aren't allowed research or writing time, which is a problem in itself, and some folks might not like that you have the time (or are making time) to write. That's the unfortunate current state of academia, where people are overworked and the context can become competitive to the point of hostility. It's also possible to create this space at home instead, asking those you share a home with to respect your writing time and space (that'll probably involve putting more boundaries in place too...). Heavy metal breaks If you're not a heavy metal fan, don't worry, you don't actually have to listen to it. When I'm writing about violence and abuse (which is most of the time) I find that after about an hour I need to listen to someone screaming and shouting about how shit everything is. After about 10 minutes or so of Slipknot's 'People = Shit' or KoRn's 'Right Now' I can usually enjoy my writing again for another hour (until my next heavy metal break). So, I recommend paying attention to how your writing is making you feel and instead of pushing through, do something to acknowledge it, release it, comfort it, rest from it - whatever you need. Then, if you feel inspired to continue you can, or if you've had enough, stop. Crip time and slow scholarship Getting some writing done and dismantling ableism in academia? That's a win-win, right? As a brief summary for those new to the concepts, crip time is about not being confined to a rigid timetable or schedule - one that prioritises non-disabled people and profits over all people. In other words, it's about putting the well-being of people before deadlines. It's about preventing burnout and making workplaces more accessible. Not being able to keep up with the relentless demands of academia is a symptom of the profession's unreasonable and unsustainable expectations - you're not the problem. So if you need to let people down, let them down. As I've said elsewhere, don't break yourself, break the deadline. Getting some writing done and dismantling ableism in academia? That's a win-win, right? Slow scholarship is one way to do this. Just slow everything down. Think it will take you a month to write a chapter? Triple that time - hell, times it by ten. Better yet, don't have a deadline at all. Take your time, don't rush it. Create something you're really proud of and that you had the time to work on until you're really happy with it - rather than rushing and submitting because you want to meet that deadline for a conference or special issue. There will always be other conferences and special issues. Enjoy it I also recommend not setting writing goals or targets for your writing time. Instead try thinking about what you would like to do - what you would enjoy writing. Adding more targets and measures has the potential to add even more pressure and reduce the joy of writing even further (unless you thrive under pressure, in which case, you do you, just watch out for burnout). The less I enjoy writing, the more I avoid it, the longer it takes to complete a piece, and the less inspired I get. This is another reason I take those heavy metal breaks, so that I'm not pushing myself to finish a piece when I'm not enjoying it. The less I enjoy writing, the more I avoid it, the longer it takes to complete a piece, and the less inspired I get. So, I centre my joy and the things I am passionate about - either because I love them (like heavy metal, sci fi, and horror) or because I'm so determined to stop them (like violence and abuse). Find supportive spaces It can be difficult to centre your enjoyment of writing and slowing down how you work when you're surrounded by others who are publishing as much as they can, as quick as they can. This can be even harder in a context where supervisors and heads of department encourage you to do the same. That's why it can be so important to protect a little bit of your time for yourself. If you have to do the kind of writing that you don't enjoy, it can help to save a little bit of time for the kind you do. Surrounding yourself with people who share that outlook, of slowing things down and doing projects that really spark your fascination and curiosity, can help you to protect that time because you're not doing it alone. I created psygentra's Writing Support Group for this reason. I wanted a space that I could keep for my writing, where I could write regularly so that I would be able to work on a project over time, but without pressure or rushing and with the support of others doing the same - people working on their own passions and at their own pace. If you want to you join us, you can learn more here.

by Dr. Jem Tosh Presentation delivered to Manchester Metropolitan University's Neurodiversity Seminar in March 2022.

by Dr. Jem Tosh *Content warning: discussion of s*xual abuse, coercive medical and psychiatric 'treatment', descriptions of vaginal penetration in medical and coercive contexts. Below is an analysis of genital stimulation as 'treatment' for the diagnosis of 'hysteria' that was originally intended for publication in my latest book, The Body and Consent in Psychology, Psychiatry, and Medicine: A Therapeutic Rape Culture (2020). I was really keen to include this in the chapter on sex therapy, as it illustrated the long history of psychiatric intervention that problematically focused on penetration as 'treatment', but the book was drastically over the word count and I had to make difficult editing decisions. So here it is! For the rest of the analysis of sex therapy (and 'sex' as therapy), see chapters four and five of the published book. 'Sex' as Treatment: Consent, Coercion, and Sex Therapy Different variations of genital stimulation and penetration have been a feature of medical treatments for a range of ‘pathologies’ from Ancient Greece onwards, such as stimulation of the clitoris for a ‘wandering womb’ or ‘womb sickness’ (Rivière, 1653, ‘de hyśterica passione’, p. 262; Wetzel, 1991; Tosh, 2016). This influential discourse, which positioned the womb as the basis of pathology in cisgender women and described a very broad and varied disease concept, became the foundation for the development of the later psychiatrized category of ‘hysteria’. Hysteria is a diagnosis (currently named ‘histrionic personality disorder’, APA [DSM-5], 2013) that was defined as ‘excessive’ emotion (Tosh, 2014). For example, the second edition of the Diagnostic and Statistical Manual of Mental Disorders (APA [DSM-II], 1968) described it as, “…characterized by excitability, emotional instability, over-reactivity, and self-dramatization” (p. 43), and the DSM-III-R (APA, 1987) stated, “The essential feature of this disorder is a pervasive pattern of excessive emotionality” (p. 348). It is also tied to seductiveness (APA, 2013), and ‘excessive’ and ‘perverse’ sexuality have been persistent and defining features of the diagnosis as well (Becker, 2009). This remains with the current DSM-5 (APA, 2013) listing the following criterion: “Interactions with others is often characterised by inappropriate sexually seductive or provocative behaviour” (p. 667). Cisgender women are more likely to be diagnosed with hysteria and it has been considered a ‘feminine’ disease (Arnold, 2008; Lerner, 1974; Showalter, 1987; Tosh, 2016; Ussher, 1992, 2013). This is due to the similarity between its ‘symptoms’ and stereotypes of femininity, cisnormative assumptions about gendered bodies, and the association of hysteria with the womb (Showalter, 1987; Reeds-Gibson, 2004). Cisgender men are also diagnosed with hysteria and histrionic personality disorder, albeit less frequently. This tends to happen when there is more emphasis on the ‘condition’ being a response to traumatic stimuli (Lerner, 2003; Showalter, 1987), and transgender individuals are more likely to be positioned as ‘hysterical’ in psychoanalytic discourse alongside the pathologization of their gender nonconformity (Cavanagh, 2016, 2019; Gherovici, 2010). The controversial diagnosis has garnered many feminist objections regarding its pathologization of women, sexuality, and femininity, in addition to criticisms from critical psychologists and anti-psychiatrists questioning whether it is a ‘mental illness’ or indeed a myth (Bernheimer and Kahane, 1990; Brennan, 2002; Buhle and Buhle, 2009; Gould, 2011; Hunter, 1983; Reeds-Gibson, 2004; Showalter, 1987; Szasz 1960, 1972; Tosh, 2016; Ussher, 1992). Freud and his colleagues promoted the ‘talking cure’ for hysteria, advising psychoanalysts to listen to women’s stories and find the source of the ‘condition’ in the mind (Breuer and Freud, 1895). Others recommended bed rest (Mitchell, 1875, 1904, 1908), as well as a variety of surgeries including clitoridectomies and removal of the ovaries (Briggs, 2000; Bullough, 1994; Potts, 2002; Szasz, 1980; Ussher, 1992; 1997; Wetzl, 1991). Genital massage and stimulation were also commonly used, up until the 1920s (Hunter Latham, 2015; Maine, 2001; Starr and Aron, 2011; Szasz, 1980; Warren, 2004). From the 1960s, this therapeutic focus on orgasm and genital stimulation was also evident in the defining of ‘healthy’ and normative sex in the influential works and therapy of Masters and Johnson (1966, 1970), based on their theory of the ‘human sexual response cycle’. Consequently, genital stimulation and penetration remain a focus of medical and psychological treatments for those diagnosed under the disputed and problematic label of ‘sexual dysfunction’ (see next chapter). This context, which frames penetration and orgasm as essential for psychological well-being or sexual ‘normality’, blurs the boundaries between therapy and sexual activity/abuse, between patient, therapist, and sexual partner/abuser. As a result, sexual abuse by therapists can be dismissed or psychologised as an aspect of therapy itself. In this chapter, I examine the ‘sex as treatment’ approach and the conceptual boundary between the prescription of sex within the context of diagnosis and treatment, and the sexual abuse of patients within therapeutic contexts, either under the guise of treatment or during treatment. I begin with historical examples to contextualise the longstanding issue and as a genealogical tracing of the discourse of prescribed penetrative heterosexual sex as necessary for psychological ‘health’, which includes an analysis of Masters and Johnson’s sex therapy as a telling case (Parker, 2008). I discuss how sexual abuse can be ignored or explained away as ‘lies’ or ‘delusions’, subsequently positioning rape disclosures as symptoms of a ‘mental illness’. I conclude that the dismissal of disclosures from psychiatrised and pathologised people, who are already at an increased risk of violence (Hiday et al., 1999; Hiroeh, Appleby, Mortensen, and Dunn, 2001; Kamperman et al., 2014; Short et al., 2013), can put victims in an even more precarious position as the label makes it all too easy for others to frame the voices of these individuals as ‘untrustworthy’. As a result, those meant to support survivors can be complicit in their repathologisation and retraumatisation, which requires a critical reflection on the profession as a whole and the therapies that are taken for granted as ‘treatment as usual’. Hysteria and genital stimulation In the 16th century the French physician Ambroise Paré, who was considered to have “set the stage” for modern surgery (Drucker, 2008, p. 199), theorised in De la Suffocation de la Matrice (chapter LII in Les Oeuures d’ Ambroise Paré, 1585) that a ‘wandering womb’ moved upwards in the body and was suffocated. Coughing was considered to be a sign that the uterus had made its way to the throat (Lerner, 2003). The treatment for such was: …the use of masturbation and the insertion of a pessary into the vagina. This instrument was a perforated metallic cylinder through which the fumes of various herbs would pass. The fumes were meant to attract the womb toward the lower part of the belly, thereby combating the suffocation of the womb thought to result from its ascension. (Arnaud, 2015, p. 11) This was in addition to the positioning of unpleasant smells near the nose, due to Paré’s theory that the womb would try to avoid unpleasant odours. Beyond this, however, was the particularly violent practice of grabbing and pulling the woman’s pubic hair to make sure that the pain experienced in her lower body would further ‘push’ the pleasant smells toward the womb. Physicians sometimes screamed in the ears of patients to make sure that they did not pass out during the procedure (Didi-Huberman, 2003). Pinel, the chief physician at the Salpêtrière Hospital in Paris, described genital stimulation as being used so frequently that it was “known to all matrons” (Arnaud, 2015, p. 10). The Salpêtrière was later the site of Charcot’s studies on hysteria and his case study of Marie ‘Blanche’ Wittman, who became known as the ‘Queen of the Hysterics’ (Didi-Huberman, 2003). Some physicians, however, did not use a pessary, but manually stimulated and inserted oils into the vagina instead. For example, Pieter van Foreest was described as the “Dutch Hippocrates” (Houtzager, 1997, p. 3) and wrote the influential and comprehensive Observationem et Curationemm Medicinalium ac Chirurgicarum Opera Omnia (1653), where he advised: When these symptoms indicate, we think it necessary to ask a midwife to assist, so that she can massage the genitalia with one finger inside, using oil of lilies, musk root, crocus, or [something] similar. And in this way the afflicted woman can be arouse[d] to the paroxysm. (English interpretation from Maine, 2001, p. 1) Physicians, midwives, and nurses would see women who had been diagnosed and manually stimulate their genitals on a regular basis as a part of ongoing treatment. The method was a lucrative venture due to the chronic diagnosis of women with ‘hysteria’ and the frequent treatments prescribed (Maines, 2001). Despite their invasive nature, and the potential for orgasm, the practice of medical professionals stimulating women’s genitals was desexualised and framed solely as a medical intervention. This was, in part, due to the emphasis on penile penetration as ‘real sex’, and as a result, external stimulation was more easily disregarded as sexual activity (Maines, 2001). This discourse, also known as the coital imperative (McPhillips, Braun, and Gavey, 2001), meant that any reaction to treatment (such as resistance, aggression, or orgasm) could be framed as symptoms of the ‘condition’. For example, both aggression and sexual pleasure were considered evidence of pathology, thus masking any sexual or coercive connotations. However, genital stimulation was considered to be time consuming and physicians complained of the difficulty of helping women reach paroxysm. Consequently, when Joseph Mortimer Granville (1883) invented the electromechanical vibrator, physicians were keen to use the medical device as a means of mechanically stimulating the genitals that would enable treatment of more patients and produce a quicker result, despite objections from its inventor (Maines, 2001). Vigoroux used an electromechanical vibrator as a form of medical treatment in 1878 at the Salpêtrière Hospital in Paris, on women diagnosed with hysteria, when Charcot was chief physician (Rockwell, 1903; Trower, 2012). Charcot also worked with therapeutic vibrations on a range of conditions, including hysteria, such as his use of a vibration chair and helmet (Walusinski, 2017). Electromechanical vibrations replaced other attempts at using devices for genital stimulation, such as a speculum or jets of water directed at the vulva and clitoris. The other consequence of this introduction, however, was difficulty in continuing to deny the sexual aspect of treatment, with the association of the vibrator with masturbation, which was being used in early 20th century erotic films (Maines, 2001). It also coincided with Freudian and psychoanalytic perspectives that associated masturbation with hysteria and positioned the behaviour as intrinsically sexual (Freud, 1909). The association of manual stimulation of the genitals with the sexualised concept of masturbation was a problem for physicians, as there was increasing fear and condemnation regarding masturbation and madness, or a ‘masturbation moral panic’ (Hunt, 1998; Stolberg, 2000; Tissot, 1766). It was difficult to argue that self stimulation was harmful, but that stimulation by a doctor or midwife was not. However, manual stimulation was often recommended only when sexual intercourse with a husband was not possible or likely (Maine, 2001), and at this time both intercourse and pregnancy were frequently recommended for a wide variety of women’s health issues (Bullough, 1994; Potts, 2002). As Pieter van Foreest (1653) stated, This kind of stimulation with the finger is recommended by Galen and Avicenna, among others, most especially for widows, those who live chaste lives, and female religious, as Gradus [Ferrari da Gradi] proposes; it is less often recommended for very young women, public women, or married women, for whom it is a better remedy to engage in intercourse with their spouses. (English interpretation from Maine, 2001, p. 1) Not only is this further evidence of the heteronormativity of medical discourses around hysteria, which excludes and pathologizes the experiences of lesbian, bisexual, and queer women (as well as asexual individuals), but it also represented colonial fears of a shrinking white race and what was considered to be a comparatively greater fertility of people of colour and Indigenous peoples (Briggs, 2000). For instance, hysteria was not the only diagnosis to be associated with ‘excessive’ sexuality and the treatments for some diagnoses emphasised abstinence rather than stimulation. The diagnosis of ‘nymphomania’ was also characterised as an ‘excessive’ sexuality in women that originated in the womb. Rivière (1653), Bienvile (1886), Krafft-Ebing (1892), and Thoinot (1923), all associated the disease with the uterus, using terms such as ‘de furore uterino’ and ‘uteromania’, meaning ‘madness of the womb’ (Tosh, 2013). During the 19th century this resulted in genital examinations and vaginal penetration with a speculum to ‘test’ for ‘excessive’ reactions (Groneman, 2001). Treatments for nymphomania attempted to reduce sexual desire, such as cold baths, genital surgeries, leeches, and ‘swabbing’ the vagina with a borax solution (Arnold, 2008; Groneman, 2001; Ussher, 1997). The aim was to, “…render her sexually fit to assume the duties of a wife whenever such services were needed” and to reduce the sexual pleasure of women outside of this context (Groneman, 2001, p. 18). One of the reasons for this discrepancy in treatments between hysteria and nymphomania is that hysteria was associated with the white, English (e.g. Cheyne, 1773), and colonial middle and upper classes (Briggs, 2000). Positioned in opposition to Indigenous people of colour, the ‘hysterical’ women of Europe (and later North America, e.g. Beard, 1881), were framed as not only civilized, but “overcivilized” due to an over abundance of culture and technology (Briggs, 2000, p. 246). It was not that only white or upper class women had these experiences, but that those experiences were categorised or understood within the context of white supremacy, capitalism, and colonialism. In contrast, constructions of nymphomania had stronger associations to colonial discourses regarding the ‘excessive’ sexuality of people of colour, the capitalist framing of working class individuals as sexually ‘immoral’ and conditions of poverty as giving rise to ‘vice’, and the ableist eugenic theories of (innate/hereditary) degeneracy (Chaperon, 2010; Luta, 2017; Makoni 2016; Rimke and Hunt, 2002; Ruiz, 2013; Tyler, 2008; ). For example: Catherine’s well-proportioned body and her “animal organization” - small, drooping eyes, large, broad nose and chin, thick lips - were the keys to her overdeveloped sensuality, and ultimately to her nymphomania. Reading Dr. Walton’s reading of Catherine, we can see how contemporary racial and class theories influenced him. He ‘saw’ Catherine’s face and body in the categories available to him: pseudo-scientific theories that claimed those physical features revealed her character. According to these theories, proof of the primitive races’ and the lower classes’ licentiousness could be found in the shapes of their lips, the look on their faces. (Groneman, 2001, p. 17) While the proposed causes of a sexuality deemed ‘excessive’ differed for white women and women of colour, both those diagnosed with hysteria and those with nymphomania were described as being seductive, particularly toward their doctors. Routh (1887), a British gynaecologist, was concerned about accusations of sexual assault toward physicians who treated women with hysteria or nymphomania. This was due to the supposedly seductive nature of the conditions, as well as the ‘attractiveness’ of patients. Routh (1887) repeatedly commented on the ‘beauty’ of his patients, such as a woman being “very good-looking” or “generally attractive to men” (p. 490). He also described these women as, “the most decided liars in creation” (p. 488-9), who were under the “delusion” that they had been assaulted. He stated that he came to this conclusion after hearing “terrible stories” of sexual abuse by family members and local “gentlemen” (p. 490). He believed that if women could create such terrible stories about loved ones, they could make up even worse stories about physicians. He never entertained the idea that these women had been assaulted, or that the treatments they underwent were violating or harmful (see also Money’s concept of ‘nosocomial sexual abuse’ in chapter two). He proposed a familiar solution to the problem of ‘seductive’ women and accusations of rape: include the accusations as symptomatic of the disease. By including accusations of assault, he claimed that physicians could more easily diagnose patients and “avoid any personal risk to ourselves” (p. 488-9). The pathologization of survivors of sexual abuse, of framing their accusations as further evidence of ‘mental illness’, is a well documented strategy in a wide range of diagnoses often applied to women, such as ‘borderline personality disorder’ and ‘false memory syndrome’ (Brown and Burman, 1997; Gaarder, 2000; Shaw and Proctor, 2005; Warner and Wilkins, 2003). It renders any accusation as inconceivable and unlikely to be believed due to the influence and authority of medical discourse. One example is Freud’s (1909) reversal of his ‘seduction theory’, which posited that the cause of neurosis was the prevalent sexual abuse of children. As Masson (1984), the psychoanalyst who uncovered Freud’s original theory, stated, “…these early experiences were real, not fantasies, and had a damaging and lasting effect on the later lives of the children who suffered them” (p. 3). Freud’s decision to frame such disclosures as fantasy in his later work is one of the most influential and prominent accounts of the psy disciplines silencing victims of abuse, undermining their credibility, and denying the widespread existence of sexual violence: By chance my former rather meagre material furnished me with a great number of cases in which infantile histories, sexual seduction by grown-up persons or older children, played the main role. I overestimated the frequency of these (otherwise not to be doubted) occurrences, the more so because I was then in no position to distinguish definitely the deceptive memories of hysterical patients concerning their childhood, from the traces of the real processes, whereas, I have since then learned to explain many a seduction fancy as an attempt at defense against the reminiscence of their own sexual activity (infantile masturbation)… After this correction the “infantile sexual traumas” were in a sense supplanted by the “infantilism of sexuality”. (Freud, 1909, p. 189, my emphasis) Similarly, in Krafft-Ebing’s (1892) discussions of hysteria he describes “hallucinations of coitus” and “unfounded accusations against men for immoral acts” as symptoms (p. 376). Maines (2001) states that, “It is certainly not necessary to perceive the recipients of orgasmic therapy as victims: some of them almost certainly must have known what was really going on” (p. 5), but considering the pathologization of women (Chesler, 2015; Tavris, 2017; Tosh, 2016; Ussher, 1992), perspectives like Routh’s, and dismissals like Freud’s, it is important to take a closer look at the context in which these examinations occurred. For example, when physicians found injuries from objects being inserted into the vagina, they used this as evidence of masturbation and a pathological desire for penetration, despite the fact that such marks could have resulted from abuse, treatments for hysteria and nymphomania, as well as abortions (Groneman, 2001). Moreover, Didi-Huberman (2003) observes that, “seduction was a forced tactic”, as patients at the Salpêtrière Hospital had to either display the known symptoms of hysteria or be placed with those deemed “incurable”, who were “hidden away, forever, in the dark” (p. 170). In 1867, Seymour Haden, the Secretary for the Obstetrical Society in England proclaimed, [As] a body who practise among women, we have constituted ourselves, as it were, the guardians of their interests, and in many cases… the custodians of their honour. We are, in fact, the stronger, and they the weaker. They are obliged to believe all that we tell them. They are not in a position to dispute anything we say to them, and we, therefore, may be said to have them at our mercy… (Showalter, 1987, p. 78) It is also important to remember that the body can react in a variety of ways to sexual violence and coercion, including orgasm. Biological reactions do not equal consent (Fuch, 2004; Tosh, 2016). In a context where an action is deemed fundamentally non-sexual, and a necessary part of treatment for an individual who is positioned as ‘sick’ (see chapter one for the positioning of disabled and chronically ill bodies), the concept of consent is impacted on by the power inequity and context of medical authority, ableism, and sanism (i.e. the oppression of neurodiverse people, those experiencing emotional distress, and those labeled as ‘mentally ill’, see Perlin, 1993). Can a women diagnosed with ‘hysteria’ by a medical doctor, a diagnosis supported by her socially more powerful husband, fully consent to having her genitals stimulated until orgasm, even being penetrated by objects, when it is framed as necessary ‘treatment’ for her ‘condition’? In the context of the late 19th and early 20th century, would her refusals be acknowledged, or instead be positioned as a symptom of her ‘disease’, given that it was often characterised as ‘disobedient’? To cite: Tosh, J. (2022). A Therapeutic Rape Culture: The Treatment of Hysteria. psygentra.com Further Reading Tosh, J. (2020). The Body and Consent in Psychology, Psychiatry, and Medicine: A Therapeutic Rape Culture. London: Routledge.

by Dr. Jem Tosh This is an English version of the chapter: 'Kritische Feministische, Queer- und Trans-Psychologie: Zur Dekonstruktion von Gender und Sexualität' that was published in Perspektiven kritischer Psychologie und qualitativer Forschung: Die Unberechenbarkeit des Subjekts (2017). Contents The Psychology of Women The Psychology Sexuality The Psychology of Trans People Feminist Psychology Queer Psychology Trans Psychology Summary Mainstream psychology and psychiatry both have a long history of defining what is ‘abnormal’ in relation to gender and sexuality. These popular definitions, and their associated theories, have often portrayed minoritised and marginalised genders and sexualities in very negative ways. Queer people, transgender and cisgender women, nonbinary folks and others who can have their gender delegitimized by others (Ansara, 2012), have often been positioned as mentally 'inferior', 'pathological' or ‘deviant’ (Foucault, 1990; Lev, 2005; Ussher, 1991). There are many psychological theories and diagnoses to illustrate this, such as ‘hysteria’ (American Psychiatric Association [APA], 1952; 1968), ‘homosexuality’ (APA, 1952; 1968) and ‘gender identity disorder’ (APA, 1980; 2000a). These will be examined as exemplar diagnoses in this chapter, which will also consider how feminist, queer, and trans psychologies have used critical perspectives and social activism to challenge such negative constructions. The Psychology of Women One of the longstanding diagnoses related to women is ‘hysteria’ (Ussher, 1991). While the definition of ‘hysteria’ has changed over time, its diagnostic criteria have centred on over-emotionality, seductiveness, and a lack of control. Defined by Hermann Oppenheim in the 19th century, as "…an exaggerated expression of emotion" (cited in Freud, 1909: 125) it remains a feature of modern psychology and psychiatry under the name ‘histrionic personality disorder’ (APA, 2000a; 2015). The diagnostic criteria reveal many similarities between ‘hysteria’ and idealized notions of femininity. For example, Reeds-Gibson (2004: 205) observes that Western magazine covers read like instruction manuals for ‘hysteria’, such as, "…how to get him to notice you, how to dress for summer [and] whether or not you should sleep with your boss", which relate to the diagnostic criteria of being "attention-seeking", "overly concerned with physical attractiveness" and "seductive" (APA, 1987: 348; 2000a: 711). She concludes that, "…our culture actually exerts pressure upon women to adopt and exhibit histrionic behavior but labels them mentally ill if they do so" (Reeds-Gibson, 2004: 201). In 1980, the American Psychiatric Association (APA) acknowledged this relationship between ‘hysteria’ and women explicitly in its description of ‘histrionic personality disorder’ as, "a caricature of femininity" (APA, 1980: 314, my emphasis). Unsurprisingly then, this diagnosis has been most often applied to women (APA [DSM-III], 1980; Arnold, 2008; Ussher, 1991). However, men also exhibit such behaviours and emotions, but ‘hysteria’ remains a predominantly "female malady" (Showalter, 1987). This is due to its historical construction as a mental disorder, which emphasized the association with women (particularly women’s bodies) and excluded experiences of men (Showalter, 1987; Didi-Huberman, 2003; Micale, 2008). For example, the word ‘hysteria’ derives from the Greek word ‘hysteron’, which means ‘womb’ (Szasz, 2007). The womb (including pregnancy, menstruation and menopause) was often linked to ‘madness’, such as the early theory that ‘mad’ women had a ‘wandering womb’ that moved around the women’s body absorbing her intellect (Ussher, 1991). This was in addition to well-known psychological case studies and photographs of ‘hysterical’ women (Breuer and Freud, 1955; Didi-Huberman, 2003; Showalter, 1987). Having constructed ‘hysteria’ as a women's mental disorder, a variety of interventions or ‘treatments’ were implemented. In the late 19th century Silas Weir Mitchell promoted the ‘rest cure’, which consisted of a period of "…seclusion, enforced bed rest, and the absence of mental activities such as reading" (Ussher, 1991: 75). This ‘treatment’, while seemingly un-invasive, has been compared to the "torture and confinement" of political prisoners due to the enforced isolation and sensory deprivation (Ussher, 1991: 76). However, the implications of this diagnostic construction and its treatment go beyond individual distress. Showalter (1987) in her classic feminist analysis of mental illness, observed how "independent", "assertive" and "rebellious" women were the most likely to be forced to adhere to such ‘treatment’. She also stated that, "hysteria was the [diagnosis] most strongly identified with the feminist movement" (p.145). Therefore, this construction of women as ‘overly emotional’, or what Foucault (1990) calls, "the hysterization of women", not only positioned women as mentally inferior and thus kept them out of work and political life, but "…diagnosis and treatment were [also] used as methods of social control, and… [hysterical] symptoms were in reality a form of protest" (Ussher, 1991: 76). Therefore, mainstream psychological definitions, diagnoses and theories have wide ranging implications for women, such as using the authority of psychological ‘science’ to justify the implementation of oppressive ‘treatments’. As the example of ‘hysteria’ has shown, psychology and psychiatry have played a key role in defining women by framing femininity and women’s bodies as pathological. It is this significant influence on how women and femininity are viewed that makes feminist psychology an important intervention within the profession, and society more generally. The Psychology of Sexuality Psychiatry also has an extensive history of framing queer people and relationships as pathological. The term ‘homosexuality’ was first used in a medical context in 1869 by Karl Friedrich Otto Westphal who suggested it meant a "contrary sexual feeling" ("conträre Sexualempfindung"), or "…a sexual drive directed toward persons of the same sex" (Halperin, 2000: 109). Queer relationships and terms used to describe them had existed long before this, but this was the first time that the phenomenon became medicalised by psychiatry (Conrad and Angell, 2004). Within Europe, this was around the time when numerous sexual behaviours were reclassified as ‘perversions’ (e.g. Krafft-Ebing, 1892) - creating categories of people and thus changing individual behaviours (i.e. 'homosexual acts') into personal identities (i.e. 'homosexuals') (Foucault, 1990). Prior to this medicalisation, 'homosexual acts' were deemed separate incidents that were enacted by criminals and subsequently required criminal punishment. This move towards psychiatry reframed queer sexualities as a mental disease that meant individuals were not (legally) responsible for their actions and needed psychiatric ‘treatment’ rather than criminal punishment (Krafft-Ebing, 1892). Subsequently, during the late 19th and early 20th centuries committed (or convicted) gay and bisexual men were the basis of most research on (the problematic topic of) ‘sexual perverts’ (Chenier, 2012). This resulted in the concept of homosexuality becoming deeply entwined with constructions of ‘madness’ and ‘perversion’. However, during the 1950s Alfred Kinsey, a sexologist who is often associated with the 1960s sexual revolution (Clarke et al. 2010), completed extensive research that began to challenge the framing of queer relationships as abnormal. Kinsey, Pomeroy and Martin’s (1948) survey on men's sexual behaviour concluded that 'homosexuality' was not a form of ‘deviance’ as a significant portion of the general population was 'homosexual'. This repositioning of queer people as mentally healthy coincided with gay rights campaigns that protested against the psychiatric diagnosis of ‘homosexuality’. This resulted in the American Psychiatric Association (APA) undertaking an internal vote, and in 1973 declaring that 'homosexuality' was not a psychiatric disorder (but refused to state that queer relationships were ‘normal’). The diagnosis of ‘ego dystonic homosexuality’ (APA, 1980) temporarily featured in psychiatric texts but was also removed by the 1987 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), although a version of it (‘ego dystonic sexual orientation disorder’) still existed in the World Health Organisation’s (WHO) International Classification of Diseases (ICD-10, 2007). Furthermore, while ‘homosexuality’ was no longer considered a mental illness, during the 1980s the assumption that heterosexuality was ‘normal’ and all other forms of (non-reproductive) sex were ‘deviant’ or ‘perverse’ was further reinforced when the APA incorporated the Human Sexual Response Cycle (Masters and Johnson, 1966) into its manual (the DSM). Despite Kinsey et al.’s (1948) earlier work highlighting the significant amount of queer people within the general population, Masters and Johnson (1966: 22) excluded them from their findings and focused solely on the (heterosexual) ‘marital unit’ (Masters and Johnson, 1970). The resulting ‘human sexual response cycle’ is framed as four universal stages of sex (excitement, plateau, orgasm and resolution), but is based on heterosexual intercourse and therefore heterosexuality remains the principal definition of ‘normal’ sexuality within psychiatry. Within the U.S., while Kinsey and others were promoting a version of 'homosexuality' that moved away from abnormality, others were framing queer people not only as pathological, but in need of ‘treatment’ or ‘cure’. This was made possible through Freud’s (1949) construction of sexuality as shaped in childhood, rather than as a biological or embodied reality. Therefore, changing people’s sexuality was deemed a possibility with the right ‘treatment’ or approach. Influential psychiatrists, such as Bergler (1956), Bieber et al. (1962), and Socarides (1968; 1995), framed ‘homosexuality’ as a result of "flawed relationships in childhood" and promoted psychoanalysis as the method to change homosexuality to heterosexuality called ‘conversion’ or ‘reparative’ therapy (Conrad and Angell, 2004). In addition to psychoanalytic and psychotherapeutic approaches, Numerous forms of behaviour therapy were also used such as aversion therapy (associating electric shocks or nausea-inducing substances with homosexual stimuli) and orgasmic reconditioning (associating heterosexual stimuli with masturbation). Other, more extreme, treatments included the use of hormones such as estrogens (to decrease ‘abnormal’ sex drive) or androgens (to increase ‘normal’ sex drive), castration and clitoridectomy, and even lobotomies. (Clarke et al. 2010: 10) Reparative therapies continue despite queer people and relationships no longer being (officially) considered by the profession as pathological. Organizations, such as the National Association for Research and Therapy of Homosexuality (NARTH) that was set up in 1992, supports therapeutic intervention for "unwanted homosexuality" (NARTH, ‘Mission Statement’, 2012) stating that such intervention, "…is aimed at decreasing unwanted homosexual attractions and increasing heterosexual responsiveness" (NARTH, ‘The Right to Treatment’, para.3). However, reparative therapy was investigated and found to be harmful in a damning report by the APA in 2000 (APA, 2000b), and this condemnation continues with moves to make such ‘treatments’ illegal (e.g. ‘California Bans Teenage Gay Conversion Therapy’, 2012). The long history of psychiatric definitions of queer people as ‘perverse’ as well as the invasive and abusive ‘treatments’ enforced on queer individuals, has resulted in much critique of psychiatry and psychology. This critique has included social action as a fundamental aspect, due to the severe consequences of such negative constructions. The Psychology of Trans People While psychiatry has applied many terms to those who do not conform to gender norms, the term transgender is used within trans communities. It is therefore in contrast to the multitude of diagnoses that have been associated with these communities. Transgender is a complex and changing concept that is predominantly used within American and European contexts to describe those who transcend or subvert the cisgender binary of man/woman in diverse ways (Lev, 2005). However, it is also used to refer to men or women who have transitioned. Sometimes when the term is used in this way, it can remove an individual’s ability to self define their gender. For example, to refer to a woman following a transition as transgender can imply that they are not a ‘real’ woman (Ansara, 2012), whereas others prefer to use the word as an adjective (e.g. trans woman). The term is also sometimes misused to refer to intersex individuals (i.e. those who are born with bodies and/or chromosomes that do not conform to the constructed medical binary of male/female). There are similarities in the constructions and experiences of transgender and intersex people (and some intersex folks define themselves as both intersex and trans), but there are also important differences (see Organisation Intersex International Australia, 2011). While transgender can be thought of as an "umbrella term" (Serano, 2007: 25), it should not be assumed that the issues and experiences of different communities are the same, or that the term applies to everyone who is not cisgender. Equally complex are the vast range of psychological diagnoses and theories applied to transgender individuals. These include, ‘transvestitism’ (APA, 1952; 2000a), ‘transsexualism’ (APA, 1980), ‘autogynephilia’ (APA, 2011a), ‘gender dysphoria’ (APA, 2011b, 2015), and many more. For the purposes of this chapter, I will discuss ‘gender identity disorder’ (APA, 1994; 2000a) as an example of the psychology of trans people. ‘Gender identity disorder’ was first introduced into the psychology and psychiatry professions during the 1980s. Following the removal of ‘homosexuality’ as a mental disorder in 1973, ‘gender identity disorder’ was introduced to address children and adults whose gender expressions did not conform to the gender assigned to them at birth. This diagnosis developed from research into ‘feminine boys’ that began during the 1960s, such as Richard Green’s influential Sissy Boy Syndrome (1987) that was the basis of the ‘gender identity disorder’ diagnosis (Bryant, 2006), as well as John Money’s (problematic) attempts to change a child’s gender identity (Money, 1975). Money’s (1975) work was extremely influential, despite being based on only a handful of case studies (Kessler, 1990) and including one case, that of David Reimer, who later described the therapy as "brainwashing" that he would have been "better off" without (Colapinto, 2000). This new diagnosis meant that children who played with toys, socialised, or dressed in ways that were culturally or socially associated with a gender other than the one assigned to them at birth were framed as ‘abnormal’. Although, to be diagnosed these children were also required to express a desire to become a different gender, the diagnosis was notably broad. Subsequently, it attracted much criticism due to the narrow view of gender typical roles, the cultural specificity of such gendered expectations (e.g. Hird, 2003; Langer and Martin, 2004; Lev, 2005), and the refusal to acknowledge the child’s self defined gender (Ansara and Hegarty, 2012). Despite these concerns, the diagnosis continued to be influential with children being referred for psychiatric treatment for their gender nonconforming behaviours. The introduction of ‘gender identity disorder’ enabled psychiatric ‘treatment’ of these transgressions against societal expectations of gender (Conrad and Angell, 2004). There are several approaches available to support children and adults who are distressed due to their gender. Recommended guidelines, (WPATH, 2011) and several therapeutic methods (e.g. Ehrensaft, 2012) advocate working with the individual's self-determined gender (i.e. affirmative approaches). However, some work to change children’s behaviour to conform to the gender that was assigned to them at birth (i.e. reparative approaches). This latter approach typically involves discouraging gender nonconforming behaviours, encouraging peers and activities that are gender typical, and for the child to spend more time with the parent of the gender that was assigned to the child at birth. This particular approach has attracted much criticism (Ansara and Hegarty, 2012; Bryant, 2008; Hegarty, 2009; Hird, 2003; Wren, 2002; Pickstone-Taylor, 2003), particularly its potential to cause further distress to the child (e.g. Burke, 1996). Individual distress is only one aspect of this problematic diagnosis. Framing certain gender expressions as mental illness reaffirms a rigid construction of gender as ‘normal’, making those who defy such roles targets for victimization and discrimination (Grant et al. 2011). It also justifies professional intervention when parents choose to support a gender nonconforming child. This can involve schools or psychologists/psychiatrists intervening (Feder, 1997) and subsequently parents following the advice of such professionals in the belief that it is in the best interests of the child’s mental wellbeing, despite contrary reports. It is this long history of psychiatric intervention and the negative construction of trans people that has inspired a counter movement of transgender psychologists, activists, and advocates who aim to produce new theories and definitions that challenge these dominant psychological constructions. Critical Feminist, Queer and Trans Psychologies Having examined the historical constructions of women as well as queer and trans people from mainstream psychiatry and psychology, and highlighting some of the negative constructions and consequences of framing femininity, queer relationships, and gender nonconformity as ‘pathological’, I will now outline the feminist, queer, and trans responses to these mainstream perspectives including examples of social activism. Feminist Psychology Up until the 1960s, psychiatry and psychology maintained the dominant role in defining women and gender ‘normality’. Prior to this, women (and femininity more generally) were seen as inferior and constructed in many ways as pathological. It wasn’t until the 1970s that feminist psychology began to form as a visible alternative (Rutherford et al. 2010; Stewart and Dottolo, 2006). Weisstein’s (1968) paper, entitled Psychology Constructs the Female; or, The Fantasy Life of the Male Psychologist (With Some Attention to the Fantasies of His Friends, the Male Biologist and the Male Anthropologist), was the first of many critiques of the sexism intrinsic to mainstream psychology (e.g. Silveira, 1973; 1974). Weissman (1968) criticized mainstream psychologists and psychiatrists’ narrowly defined roles for mentally healthy women, such as the psychologist Bettelheim who stated in the 1960s that, "we must start with the realization that, as much as women want to be good scientists or engineers, they want first and foremost to be womanly companions of men and to be mothers" (Weissman, 1968, para.2). Weissman (1968: para.43) observed that psychology and psychiatry characterized women as, …inconsistent, emotionally unstable, lacking in a strong conscience or superego, weaker, ‘nurturant’ rather than productive, ‘intuitive’ rather than intelligent, and, if they are at all ‘normal’, suited to the home and the family. In short, the list adds up to a typical minority group stereotype of inferiority. She highlighted psychology’s important role in defining women and brought the profession of psychology to the attention of the growing women’s movement (Rutherford et al. 2010). She argued that mainstream psychology failed to provide relevant theories of, or for, women due to the lack of attention paid to social context and a failure to rely on scientific methods, resulting in biased conclusions (the scientific method has since been extensively critiqued by feminists as equally problematic, e.g. Haraway, 1988). She concluded that, Psychology has nothing to say about what women are really like, what they need and what they want, especially because psychology does not know. I want to stress that this failure is not limited to women; rather, the kind of psychology which has addressed itself to how people act and who they are has failed to understand, in the first place, why people act the way they do, and certainly failed to understand what might make them act differently. (Weissman, 1968: para.6) While Weissman (1968) promoted a social agenda, such as, "…one must understand the social conditions under which women live if one is going to attempt to explain the behavior of women" (para.42, my emphasis), her paper inspired much individualistic research focused on sex differences. This research initially aimed to challenge the proposition that women were inferior and justify the inclusion of women participants in psychological research (Vaughter, 1976), but ultimately reaffirmed the authority of the scientific method and failed to replace such constructions of women (Rutherford et al. 2010). During this period, more general critiques of psychological concepts related to women also began to be published, such as Chesler’s (1972) book, Women and Madness. This critique of psychiatric and psychological discourse continued through the second wave of feminism (during the 1970s and 1980s) (e.g. Showalter, 1987) and continues still (e.g. Ussher, 2010). The more activist aspects of the women’s movement also took a critical stance on psychological interventions that failed to consider the social context of women’s experiences. For instance, the important role of consciousness-raising within feminism highlights the priority given to women’s voices and collective experiences. Bevacqua (2008) describes consciousness-raising as, "…the strategy by which women developed a political analysis of their personal lives, which would lead to the creation of a plan of action for change" (p.165). This emphasis of a political analysis on personal lives reiterates Connell and Wilson’s (1974) differentiation between consciousness-raising and therapy. As part of the New York Radical Feminists (NYRF), Connell and Wilson (1974: 5) stated that, [Consciousness-raising] is not group therapy. The basic assumption of the therapy situation is that there is an ideal feminine nature and psychology and that unhappy women are sick. We say our personal problems are political and should have political solutions. The accumulation of increasing criticism aimed at mainstream psychology and psychiatry, resulted in discussions regarding a possible feminist psychology; what would feminist psychology look like and what would its aims be? Feminist psychologists, while they come from different perspectives and use different methods (Phoenix 1990), usually share the aims of empowering and emancipating women, transforming society and challenging sexist perspectives both inside and outside of the profession (Rutherford et al. 2010). As Vaughter (1976: 120) stated, "the goal of the psychology of women is the development of a nonsexist science". The priority assigned to social and political aspects remains a key defining aspect of feminist psychology as a "socio-political perspective" (Vaughter, 1976). Furthermore, due to feminist psychology’s challenging of the psychological stance that "masculine male and feminine female are the models of “healthy” development" (Vaughter, 1976: 127), as well as the crossover between the psychology of women and the psychology of sexualities (as many positioned themselves both as feminist and lesbian/queer), the development of feminist psychology is also inextricably linked to queer and trans psychology; although this is not a straightforward history. Feminist Activism In addition to academic critiques of psychology and psychiatry, feminist psychologists participated in collective activism to change harmful diagnostic concepts, theories, and treatments. For example, during the 1980s several problematic diagnoses were put forward by the psychiatric profession; ‘self defeating personality disorder’, ‘paraphilic coercive disorder’, and ‘late lutual dysphoric disorder’. For the purposes of this chapter, I will describe the circumstances surrounding ‘paraphilic coercive disorder’ (see Caplan (1995) for a review of the events surrounding ‘self defeating personality disorder’ and ‘late lutual dysphoric disorder’). ‘Paraphilic coercive disorder’ or ‘paraphilic rapism’ was first put forward by the APA during the 1980s, but has been proposed (and rejected) five times since (Frances, 2011) most recently in 2012. This contentious diagnosis would be applied to men who had raped three or more individuals on separate occasions and who also had rape fantasies (APA, 2011c). Consequently, men could be diagnosed and ‘treated’ instead of receiving criminal punishment. As Caplan (1995: 86) cautioned, "A rapist’s tendency to think a lot about rape would be used in court by defense lawyers to argue that rapists should go not to prison but instead into psychiatric treatment… This claim was frequently made despite the fact that therapy had not been shown to stop rapists from raping again". There were great concerns that the criteria medicalised rape (Tosh, 2011a), framing it as a result of ‘uncontrollable’ sexual urges; a myth that feminists debunked in the 1980s (Brownmiller, 1971; Russell, 1975; Stanko, 1985). However, due to the actions of feminist psychologists and psychiatrists, this diagnosis was not incorporated into the authoritative Diagnostic and Statistical Manual of Mental Disorders (DSM) during the 1980s. The proposal met with protests from the DSM’s own Committee on Women, as well as the American Psychological Association’s (a separate organization) Committee for Women in Psychology. But it was Lynne Rosewater, from the Feminist Therapy Institute, and her declaration that this feminist organization would legally challenge any attempt to include the three problematic diagnoses that strongly impacted on the decision not to pursue the diagnosis (Caplan, 1995). This was in addition to overwhelming criticism from feminist psychologists and psychiatrists, protests, petitions and a wealth of media coverage about the controversy. Consequently, ‘paraphilic coercive disorder’ did not appear in the revised edition of the DSM. However, in 2010 there were new proposals for the fifth edition of the DSM, which included the controversial ‘paraphilic coercive disorder’. Similarly, the diagnosis met with criticism from feminist organizations, such as the Psychology of Women and Equalities Section of the British Psychological Society (Tosh, 2011b) as well as protests in the U.K. (Tosh, 2011c). Once again, the diagnosis was relegated for further consideration. The role of feminist psychologists in preventing the inclusion of this problematic diagnosis is evident in statements such as this quote from John Money (1999: 56), who strongly opposed the feminist view, Rape is not included in the DSM, the reason being that a delegation of women psychiatrists and psychologists engineered its exclusion. They wanted rape prosecuted and punished exclusively as a nonsexual crime of violence and not subject to diagnosis and treatment as a sexological pathology. This conflict between psychiatry and feminism over the definition of rape as either a biologically based mental illness or a result of gender and social inequalities remains a key area of critical feminist psychological intervention. Queer Psychology Mainstream psychology and psychiatry posed many of the same problems to queer psychologists as it did feminist psychologists, it pathologised those who were not straight men and excluded them from mainstream research and theories. As Clarke et al. (2010: 15) state, By leaving lesbians and gay men… out of ‘everyday’ psychology of people and only including them as examples of sexual and gender deviance, mainstream psychology provided a highly distorted image of the lives and well-being of LGBT people. Similarly, prior to the 1970s, the dominant view remained that 'homosexuality' was a diagnosis of mental illness and a number of potential 'treatments' were available. This was despite earlier attempts to decriminalise and depathologise queer relationships. For example, Hirschfeld and Ulrichs were both important figures in the development of the concepts of ‘homosexuality’ and ‘transsexualism’ who campaigned for queer and trans rights from 1897 (Clarke et al. 2010). It wasn’t until later that research began to accumulate that challenged the predominant psychiatric view of queerness as 'illness' or 'perversion'. Ellis’ (1915) infamous Studies in the Psychology of Sex strongly argued against moralizing certain sexual behaviours and provided a perspective on queer relationships that wasn’t pathologising. Furthermore, Hooker’s (1957) The Adjustment of the Male Homosexual excluded convicted and committed people in their samples (countering much earlier psychological research) and concluded that 'homosexuality' did not need to be viewed as ‘pathological’. These early sexology texts played an important role in the development of queer psychology - initially called gay affirmative psychology - by challenging the predominant constructions of queer people as ‘abnormal’ and ‘deviant’. Gay affirmative psychology developed during the 1970s, alongside more general gay rights campaigns. This perspective challenged the condemnation of queer people and argued that it was possible to be both gay and mentally healthy. Initially, this approach focused on comparisons with straight people in an attempt to dissipate the association of queerness with ‘deviance’ (Clarke et al. 2010). However, this approach positioned heterosexuality as the ‘norm’ for alternatives to be compared to, and therefore replicated psychiatry’s construction of heterosexuality as ‘normal’ and all other forms of (non-reproductive) sexuality as ‘abnormal’. Affirmative psychology also tended to overemphasize the experiences of gay men, at the exclusion of lesbian and bisexual individuals (Kitzinger, 2001). It wasn’t until the publication of The Theory and Practice of Homosexuality (Hart and Richardson, 1981) that queer psychology took on a critical perspective that incorporated a social and political focus and began to critique the construction of sexuality more broadly. Kitzinger’s (1987) The Social Construction of Lesbianism continued this critique of sexuality (and incorporated both a queer and feminist analysis). Another aspect of this critique included the reconsideration of bisexuality, which early on in affirmative psychology had been dismissed as 'confusion' or a temporary stage prior to coming out (e.g. Cass, 1979). Bisexuality began to be positioned as another distinct sexual identity (Klein, 1978). Another way that queer psychology challenged the framing of queer people as mentally ill was to upturn the pathology and argue that straight people were ‘sick’ with ‘homophobia’. This term used psychiatric terminology to stigmatise those who feared queerness in the same way that ‘homosexuality’ (as a psychiatric diagnosis) had been used against gay, lesbian, and bisexual individuals. While the term ‘homophobia’ created awareness about the victimization and discrimination of queer individuals, and influenced the development of hate crime laws related to sexual orientation, Kitzinger (2001) highlights how it focused on individuals rather than the broader social issues facing these communities. Subsequently, many queer psychologists have adopted the term heteronormative to describe how mainstream approaches position heterosexuality as ‘normal’ and thus position other sexualities as ‘abnormal’ (Ansara and Hegarty, 2012). Queer psychology has several commonalities and areas of overlap with feminist (and also trans) psychologies. It aims to be inclusive and is political in its challenging of the victimization and discrimination of marginalised sexualities (Clarke et al. 2010). Rather than study 'homosexuality' or 'homosexuals', it is affirmative and positions queer people as an important aspect of ‘normal’ sexuality that should be included in mainstream psychological research. There was (and still is) a division within queer psychology regarding research aims and methods, much more so than feminist psychology. Many more queer psychologists use biological arguments, in contrast to the language-based qualitative methods of critical psychology and queer theory (Kitzinger, 2001). Nevertheless, it is critical of heterosexist perspectives and provides an alternative to such approaches, and the amalgamation of critical psychology and queer theory remains a developing field (Downing and Gillett, 2011). Queer Activism Like feminist psychology, queer psychology had close ties to broader gay rights campaigns, and the development of gay affirmative psychology was closely linked to campaigns to stop 'homosexuality' being framed as a mental illness. Drawing on the increasing research that challenged the predominant stance of queer people as 'mentally ill' (such as Ellis, 1915; Hooker, 1957; Kinsey et al. 1948), gay rights campaigns protested the diagnosis of ‘homosexuality’ from the late 1960s onwards influenced by protests in New York against police raids of gay venues (Clarke et al. 2010; Conrad and Angell, 2004). These protests led to the development of a larger campaign, spearheaded by the Gay Liberation Front (GLF) and the Gay Activist Alliance (GAA). There were also challenges within the profession with a participant of an APA debate stating that the diagnosis was "a pack of lies, concocted out of the myths of a patriarchal society for a political purpose. Psychiatry - dedicated to making sick people well - has been the cornerstone of a system of oppression that makes gay people sick" (Gold, n.d., cited in Clarke and Peel, 2005). This was in addition to gay activists disrupting professional conferences that promoted the 'homosexuality' as ‘sick’ ethos, a method known as ‘zapping’ (Conrad and Angell, 2004). However, it was the negotiation with the APA, in addition to these more public responses to the psychiatric view, that ultimately led to debate within the profession and an internal vote. In 1973, the APA voted that 'homosexuality' would no longer be considered a mental illness (and soon after the additional ‘ego dystonic homosexuality’ diagnosis was also rejected) in a huge symbolic victory for the gay rights movement (Conrad and Angell, 2004). However, the inclusion of ‘gender identity disorder’ at the same time prompted some to question whether it was the diagnosis of 'homosexuality' in a new form (Isay, 1997). This was further exacerbated by explicit assertions that rationales for childhood intervention and 'treatment' included the prevention of 'homosexuality' (e.g. Zucker & Bradley, 1995; 2004), which have since been retracted (Zucker et al. 2012). Trans Psychology While the acronym LGBT is often used and some refer to LGBT psychology, much of this work is more reflective of lesbian, gay, and bisexual psychology (Clarke and Peel, 2005; Ansara, 2010). Trans psychology (Clarke and Peel, 2007) is a recent term illustrating that while there is much crossover between lesbian, gay, and bisexual perspectives and trans psychology (much like the crossover between feminist and queer psychology), there are important differences too. Trans psychology is also the newest of the critical perspectives explored in this chapter and therefore has a shorter history, although like feminist and queer psychology, it is closely linked to the transformation of mainstream psychology and social activism. Also, while critical perspectives of ‘transsexualism’ and ‘transvestitism’ have a longer history, for the purposes of this introductory chapter, I will focus on the recent self representation of the transgender community within professional discussions of ‘gender identity disorder’ and general critiques of the diagnosis from a trans psychology perspective. The development of critical perspectives on psychiatry’s construction of transgender people has been influenced by critiques made by feminist and queer psychologists. For example, many of the initial criticisms about ‘gender identity disorder’ were made by queer psychologists arguing that the diagnosis replaced the diagnosis of 'homosexuality' (Isay, 1997) and drew on feminist critiques of gender roles more generally (e.g. Bem, 1974). However, this issue illustrates one of the tensions between the different psychologies. For example, some feminists have sided with the psychiatric perspective arguing that transgender people are 'sick' (e.g. Raymond, 1979; Jeffreys, 1997) although this is increasingly challenged by third wave feminism (from 1992 onwards) as well as the developing trans feminism field (Scott-Dixon, 2006). Similarly, "…some lesbians and gay men share straight perceptions of trans people, and subscribe to the belief that only a person born male or female is a ‘true’ lesbian or gay man" (Clarke and Peel, 2007: 24). Furthermore, while some feminists and queer psychologists advocated for the rejection of ‘gender identity disorder’, replicating the retraction of the 'homosexuality' diagnosis, trans psychologists have pointed out that the diagnosis is needed in many countries to enable transgender individuals to access medical support (Lev, 2005). Therefore, a sudden rejection of the diagnosis within the profession would have severe consequences for transgender individuals in need of body modification surgery, hormonal treatment, or potentially even emotional support in the form of therapy. Trans psychologies have therefore tended to promote reform of the diagnosis, rather than a sudden or complete retraction (GID Reform Advocates, n.d.; Winters, 2005). However, they are still critical of the diagnosis, particularly its problematic criteria and its use to enable the psychiatric intervention with gender nonconforming children (Lev, 2005; Langer and Martin, 2004; Winters, 2008), as well as the profession more generally (e.g. Parlee, 1996; Ansara and Hegarty, 2012). Challenging the reparative 'treatment' approach taken by some psychologists and psychiatrists, trans psychologists have provided information and guidance on how to support children in an environment that is often hostile to transgender people. For example, rather than change the child’s individual behaviour, some therapists promote working with the child’s "gender creativity" to "establish an authentic gender self while developing strategies for negotiating an environment resistant to that self" (Ehrensaft, 2012: 337). Also, rather than focus solely on the child, this perspective encourages working with others from the child’s social context, such as parents. For example, Lev (2004) provides a guide for supporting transgender clients in a family therapy context, arguing that coming out as trans will impact the whole family and therefore, the entire family needs ongoing support. Working with the parents is also encouraged by the work of Menville and Tuerk (2002), who work with groups of parents providing them with the skills needed to support their child manage the stigma of being transgender in an unaccepting culture. To challenge this culture, where ridiculing transgender people can be the ‘norm’, the term ‘transphobia’ was adopted to similarly deflect the stigma of ‘gender identity disorder’ onto those who feared gender nonconformists or transgender individuals (much like the queer use of ‘homophobia’). The concept of transphobia has developed to mean intentional acts of hatred, discrimination, or victimisation against transgender communities or individuals, whereas the terms cisgenderism and cissexism are used to denote instances where individuals discriminate against or offend transgender individuals due to an ignorance about the issues; it is unintentional (Kennedy, 2012). Or as Ansara (2010: 168) states, cisgenderism "…[describes] the individual, social, and institutional attitudes, policies, and practices that assume people with non-assigned gender identities are inferior, 'unnatural' or disordered". Trans psychology has only recently begun to organize against mainstream psychology that frames trans people as ‘sick’, and despite the resistance and opposition from some feminist and queer theorists, its criticisms are accumulating and having influence. The involvement of transgender individuals in professional organisations forms part of this process of clinical reform, such as the World Professional Association for Transgender Health (WPATH) that aims to "[develop] best practices and supportive policies worldwide that promote health, research, education, respect, dignity, and equality for transgender, transsexual, and gender-variant people in all cultural settings" (WPATH, ‘Mission Statement’, para.2). Although there remains a need for trans people to have more leadership positions in these developments and discussions (Tosh, 2017). Furthermore, like feminist and queer psychologies, collective social action has been at the core of much of trans psychology. However, while the aims of an inclusive, liberating, and empowering psychology may overlap with feminist and queer psychology, trans psychology is still waiting for its ‘symbolic victory’ (Conrad and Angell, 2004). Trans Activism One example of these different but overlapping psychologies working together is a campaign to challenge the psychiatric ‘treatment’ of gender nonconforming children; treatment that discourages gender creativity or transgender kids. Feminist psychologists from the Psychology of Women and Equalities Section (POWES) and queer psychologists from the Psychology of Sexualities Section (POSS) of the British Psychological Society joined with hundreds of feminist, queer, intersex, and trans academics, clinicians, and activists to protest and petition this psychiatric ‘treatment’ in 2010. Ken Zucker (the Head of a popular ‘gender identity disorder’ clinic at the time and Chair of the DSM-5 revisions for the diagnosis) was met with banners stating ‘Academic Debate or Transphobic Hate?’ and ‘Gender Is Diverse (GID)’ when he attended a conference in Manchester, U.K. He had been invited as a keynote speaker and following this invitation, feminist, queer, intersex, and trans psychologists and activists worked together to create awareness about the psychiatric 'treatment' of trans children. This campaign was not the first to target this approach, as there had been previous protests in London in 2008 (for details see http://narcissus.dyndns.org/Sarah/Zucker.pdf) and Toronto in 2009 (Wingerson, 2009). However, by working together and utilizing the authority of already set up organizations from feminist and queer psychology, trans academics and psychologists were able to intervene in the conference discussions (see Tosh, 2011c) and generate professional debate about the complexity and controversial issues surrounding the diagnosis of ‘gender identity disorder’ and its 'treatment', much like gay rights protests in the 1970s. The impact of this intervention continues, with the relationships made between feminist, queer, and trans psychologists being used to share knowledge, expertise, and support in the ongoing challenges against sexism, heterosexism, and cissexism. Summary The history of psychological theories and diagnosis related to women, as well as queer and trans people is long, complicated, and full of conflict. Similarly, while there are many areas of similarity between feminist, queer, and trans psychologists, such as the aims of inclusive and anti-oppressive work and the close relationship with social action, there have also been areas of tension and opposition. However, there is evidence of increasing collaboration both academically (such as trans feminism) and in practice (Tosh, 2011c). While trans psychology can disrupt the gender binary in a way that can feel threatening to some feminists (by opening up and redefining the categories of gender and women) and gay and lesbian individuals (as sexuality is currently defined by gender), it also provides an opportunity to develop these disciplines further, if they are willing to embrace these new perspectives and more forward together. To cite: Tosh, J. (2017). Kritische Feministische, Queer- und Trans-Psychologie: Zur Dekonstruktion von Gender und Sexualität. In R. Iltzsche (Ed.) Perspektiven kritischer Psychologie und qualitativer Forschung: Die Unberechenbarkeit des Subjekts. New York: Springer. Further Reading Tosh, J. (2017). Psychology and Gender Dysphoria: Feminist and Transgender Perspectives. London: Routledge.

by Dr. Jem Tosh Below is a sneak peek of a forthcoming book chapter, due to be published in the Palgrave Handbook of Psychology, Power, and Gender, edited by Rose Capdevila and Eileen Zurbriggen. Contents 'Gender Dysphoria': Psychiatric Discourse Violence Gender Dysphoria: Trans Perspectives In some contexts, trans folks can experience an overemphasis on their physical embodiment. This can occur when there are reductionist descriptions that focus primarily on physical sex characteristics, which tend to assume a rigid genital and gender binary. While these descriptions draw on medical discourse that is often positioned as an authoritative ‘truth’ (Foucault, 2008), it contrasts with much biological theory and research (Bagemihl, 2000; Roughgarden, 2013), as well as the existence of those who cannot be neatly categorised into groups of either ‘male’ or ‘female’. For example, intersex individuals can have diverse physical and biological presentations of gender such as having chromosomes other than XX or XY (Kessler, 2002; Roen, 2019), and Indigenous systems of multiple genders have existed long before that (colonial) medical discourse came along (Robinson, 2019). Therefore, when it comes to ideas around what is ‘normal’ in terms of gendered and sexed bodies, even disciplines like medicine that can be associated with ‘objectivity’ or considered ‘apolitical’, carry with them the assumptions and concepts that have been socially and culturally produced in ways that can perpetuate harmful and limiting discourses (Conrad and Schneider, 2010; Sayers, 1982). The narrow conceptualisation of gender in reductionist descriptions of physical embodiment neglect a vast array of physical, biological, and gender diversity in a broad range of contexts. Even in spaces where trans people are included, accepted, and welcomed, this narrow view of gender can persist. For example, problematic discourses that frame only those who have medically transitioned (i.e. have undergone body modification procedures and hormonal interventions) as ‘really’ trans, position others as not a valid or legitimate way to be trans (Vincent, 2020). In doing so, it excludes and erases the existence of those who do not want or need such interventions, as well as those who are either waiting for or cannot access them due to multiple barriers to health support - such as cost and the many gatekeepers who control that access (Pearce, 2018). Consequently, trans people can be put into a position where their embodiment of gender is inescapable as both not cisgender enough (and therefore does not fit into the binary categories created by others) and not trans enough (by not undergoing surgical interventions to fit into that binary again). This can be particularly problematic for those who are both non-cisgender and non-binary, such as genderfluid individuals where permanent changes to the body can be unhelpful if they are in a constant state of transition from one gender to another, or experience multiple (and perhaps contradictory) genders simultaneously (Galupo, Pulice-Farrow, and Parker Pehl, 2020). These examples illustrate some of the problems with reductive discourse and in failing to consider embodiment from an intersectional perspective. Focusing solely on medical discourse, that has a long history of othering those with bodies different from an idealised form of white, cisgender, non-disabled, middle class men, can result in the dehumanisation and pathologisation of any individuals, groups, and communities that exist outside of that narrow constructed ‘ideal’/‘norm’ (Tosh, 2020). In doing so, it foregrounds the narrative produced by non-trans people, one that frames trans embodiment as ‘unusual’, ‘abnormal’, or something to be ‘fixed’. This is instead of centering the voices of trans people and an emphasis on empathic and compassionate understandings of being a trans body in a cisnormative culture or context, as well as the subjective, embodied experiences of gender dysphoria and euphoria. ‘Gender dysphoria’: Psychiatric discourse In 1980 the American Psychiatric Association (APA) included a diagnosis that related to gender identity. There have been numerous changes and challenges to the concept and it remains highly contested in psychiatry, psychology, and in society more generally (see Tosh, 2017). On the one hand, it works within current medical systems and structures to enable access to medical support for some trans people, on the other hand, it pathologises many who are gender nonconforming, reaffirms problematic gender stereotypes, and excludes the experiences of nonbinary people (Bryant, 2006; Galupo et al., 2020; Langer and Martin, 2004; Lev, 2006; Ashley, 2019a). The concept was renamed ‘gender dysphoria’ in 2013 with the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a term signifying ‘abnormal’ gender distress (Winters, 2011). However, the concept and criteria showed a significant absence with regards to embodied distress (Tosh, 2014). This moved away from previous definitions that emphasised an individuals’ relationship to their own body (e.g. ‘Persistent discomfort with his or her sex…’ APA, 2000 [DSM-IV-TR], p. 581) to their position in relation to authoritative others (e.g. ‘A marked incongruence between one’s experienced/expressed gender and assigned gender’, referring to the gender assigned by medical professionals, APA, 2013 [DSM-5], p. 452). The diagnostic category has always had a strong focus on stereotypical aspects of gender, such as clothing and toys in the childhood version of the diagnosis, but there has been an increasing move away from acknowledging the embodied distress that trans people can experience, often referred to as gender dysphoria. Gender dysphoria can be a confusing term as it is used to refer to the problematic diagnostic category just described, as well as to indicate the embodied and subjective distress experienced by trans people. I use quotation marks when critiquing the former (a psychiatric diagnosis constructed by cisgender men), and no quotation marks when discussing the latter (descriptions from trans people about their own lived experience). If you have never experienced distress regarding your gender, such as (1) your gender being different from the one people thought you were when you were born, or (2) your body being incongruent with how you would expect it to be regarding your gender, then it can be difficult to imagine what gender dysphoria might be like. This is especially the case when the predominant narratives around this kind of distress come from psychiatric and psychological sources written and produced by non-trans people. In addition to psychiatric and psychological texts, media discourse often incorporates psychological concepts and narratives around gender and gender nonconformity. These media representations, then, have an equally problematic history. For example, the ‘trans people as serial killer’ trope in horror and crime fiction (such as Psycho and Silence of the Lambs) frames the ‘madness’ of mass murderers as connected to a crossdressing identity or a desire to be a different gender. Despite the critiques that outline the problems and harms of this narrative (Bermúdez de Castro, 2018; Sullivan, 2000), the trope still has traction in media spaces; J.K. Rowling’s latest book being one example of this, much to the disappointment of trans fans of the Harry Potter series (Sanders and Lang, 2020). It is one example of how transphobia can be combined with sanism: the oppression of people labeled with a psychiatric diagnosis (Perlin, 2002). Trans people being portrayed as ‘mad’ or ‘crazy’ discredits and invalidates their experiences and perspectives, which is used to justify harmful and exclusionary interventions by others (Tosh, 2020). This association of transgender people (and gender nonconformity more generally) with ‘perversion’, violence, and ‘madness’, has a long and complex history, one that originated in psychological and psychiatric discourse that conflated gender nonconformity with non-straight sexualities and pathologised both (see Tosh, 2014). It is a harmful trope that gives pride of place to a very rare occurrence (serial killing itself being relatively rare, in addition to the even rarer phenomenon of serial killers that display some sort of gender nonconformity), in place of the more frequent victimisation of transgender and gender nonconforming people. This includes the disproportionately high violence targeting black trans women (Bukowski et al., 2019; Vähäpassi, 2019) and Two Spirit individuals (Scheim et al., 2013; Ristock et al., 2017). Much like the predatory tropes regarding gay, lesbian, and queer folks (Young, 2017), psychiatric discourse is given prominence and the experiences of marginalised survivors of violence and abuse get erased. Violence One example of this pathologisation and subsequent erasure of trans survivors, is the media panic around gender neutral washrooms and the trope of the ‘predatory’ trans person (Graber, 2018; Sanders and Stryker, 2016; Schilt and Westbrook, 2015). This narrative proliferated across a wide range of media despite: a lack of violent incidents involving trans folks and public washrooms; the fact that gender neutral washrooms are not ‘new’ (such as single-use washrooms on airplanes, trains, and people’s homes); its impact on the ability of trans people to access public spaces, particularly those with a greater need of washroom access such as those with digestive and urinary health conditions (an example of the intersection between transphobia and ableism); the absence of concern regarding the harassment and assault of trans people when trying to access public washrooms; and the increased risk of sexual assault for trans people when they are made to use washrooms incongruent with their gender (Hasenbush, Flores, Herman, 2019; Fogg Davis, 2017; Murchison et al., 2019). The washroom fear stems from the idea that cisgender men might dress as women to access women-only spaces with the purpose of causing harm or violence (Graber, 2018; Schilt and Westbrook, 2015), such as sexual assault (taken almost directly from that sensationalised crime fiction narrative). This framing of trans people, draws on problematic and historical discourses within psychology and psychiatry (Tosh, 2014, 2017); neglects the wealth of feminist research that shows sexual assault is much more likely to happen by people known to the individual (e.g. Russell, 1982; Stanko, 1990); erases survivors of sexual abuse of other genders (Cogan et al., 2020; Fuchs, 2004; Grant et al., 2011; Weare, 2018); masks perpetrators of sexual violence of others genders (such as cisgender women, see Anderson and Struckman-Johnson, 1998; Kramer, 2017; and Ogilvie, 2004); reduces the complexity of sexual violence as a social issue into the embodied (cis) penis (a discourse that I have critiqued elsewhere, see Tosh, 2020); and, due to this focus on gendered body parts, misconstrues cisgender men as transgender women. Ultimately, it reinforces that reductionist medical discourse outlined at the beginning of the chapter and perpetuates an equally narrow definition of sexual abuse as nonconsensual ‘penis-in-vagina’ (VIP) intercourse between a cisgender male perpetrator and cisgender female victim. In doing so, it conceptualises gender violence through the gender (binary) lens only, neglecting to consider other crucial axes of oppression such as age, race, class, disability, and sexuality. Consequently, it also erases the experiences of: men survivors who are black, working class, incarcerated, and/or disabled; boys and adolescents who have been sexually abused by adult women; queer women who have experienced domestic abuse, and more (Beck, Berzofsky, Caspar, and Krebs, 2013; Ison, 2019; Mitra, Mouradian, and Diamond, 2011; Savage, 2019). This ‘trans/predator’ narrative displaces the experiences and perspectives of trans survivors, whose abuse can also intersect with other forms of violence, oppression, and identity in complex and nuanced ways, such as racism, colonialism, and ableism. For instance, instead of fictional horror stories about crossdressing serial killers, psychological and media representations could foreground the complex intersections of survivor experiences of gender dysphoria and sexual abuse: how the sense of violation of sexual trauma can result in self-hatred and toxic shame that can combine with internalised transphobia; how narratives that pathologise gender nonconformity can contribute to victims of violence believing that they deserve the abuse (Tosh and Dempsey, 2020); how trans folks experience sexual abuse that involves nonconsensual touching or penetration of areas of the body that they experience gender dysphoria; and how body memories can complicate a relationship to the gendered body. Similarly, instead of pathologising narratives within psychology and psychiatry, given the high rates of victimisation and abuse of trans people (Cogan et al., 2020; Grant et al., 2011), there could be a predominant focus on how therapists can help trans clients process and heal these emotions and physical sensations regarding the gendered, dysphoric, and abused body. These are the narratives and discourses that are displaced by a predominant focus on problematic psychiatric perspectives that reiterate tired tropes of trans people as ‘predators’ and ‘perverse’. This is the shift needed from a cisnormative obsession with trans genitals and bodies as something to be studied, pathologised, feared, or ‘corrected’, to a empathic and compassionate understanding of the complex embodiment of being trans in a context where discrimination, rejection, and violence towards trans people remains high. Gender dysphoria: Trans perspectives Because being trans is normal, resulting distress is understood as relating to the body rather than to the mind… (Ashley, 2019a, p. 2) In contrast to pathologising perspectives on gender dysphoria, trans narratives are more likely to centre the individual, subjective, and embodied experience in relation to gender distress. Gender dysphoria can be a subjective experience of incongruence such as not recognising oneself as the body or physical presentation in a mirror because it contrasts with what they know about who they are. It can also be a constant discomfort or distress that accumulates over time in subtle ways, such as the sensation of weight in the chest area as a perpetual reminder of the ‘breasts’ that are incongruent with an individual’s gender (e.g. ‘My chest feels wrong, unnatural, like it’s not supposed to be there’ Galupo et al., 2020, p. 12), the sensations of menstruation, every time they need to urinate being confronted with a body part that causes distress, or sexual intimacy opening up painful experiences of a gendered body that is not how they want to express or experience their sexuality. These sensations can be compounded by intersecting contextual factors such as fatphobia (Koehle, 2017) and white European standards of beauty and femininity/masculinity (Armengol, 2014; Deliovsky, 2008). Another aspect of this is the transnormative representation of nonbinary identities as consisting predominantly of small/slim white androgynous bodies, and the erasure of other nonbinary presentations such as black, Indigenous, and people of colour, a range of body sizes, and disabilities. As a result, those who do not fit into that narrow definition of androgyny can feel invalid or excluded from trans and nonbinary communities. If we consider gender dysphoria to be a spectrum, or better yet a mosaic, it can range from subtle and frequent discomfort and tension, to more intense sensations. That weight on the chest can be a trigger for extreme gender dysphoria where the near constant reminder of the existence of that body part can lead to acute feelings of self hatred, and in some cases, feeling the need to self-harm or suicidal ideation/attempts (Peterson et al., 2016). This can be a particular issue during bodily changes, such as puberty and changes in body size. The development of ‘breasts’, the beginning of menstruation, the growth of facial hair, changes to the tone of voice, these kinds of bodily changes during adolescence can result in a move from that subtle but accumulating distress to more intense and debilitating emotional pain and trauma. Similarly (although discussed less often due to fatphobia), increases in body size can result in those areas of the body that are problematic for a trans or nonbinary person becoming physically bigger, more obvious, and harder to ignore, such as increases in that weight on the chest, larger hips, or a generally ‘curvier’ body that is often framed as feminine (Tischner, 2013). From the increase in movement, to the sexualisation of larger breasts/chest mass by others, a painful and distressing area of the body can become even more troublesome for a person that experiences those areas as incongruent with their gender (Galupo et al., 2020). These bodily changes illustrate that experiences of gender dysphoria can themselves be fluid. Moreover, for genderfluid people, gender distress can fluctuate alongside their changing gender(s) (Galupo et al., 2020). For some, and depending on the lived and embodied experience of the individual, one way of responding to these feelings is to redefine their body on their own terms. Rejecting the definitions assigned and created by others, they take self representation, self determination, and self definition as central and define their bodies in ways that better reflect their experience of their body. This often includes disrupting and dismantling discourse that promotes a rigid gender binary. For example, some trans and gender nonconforming people use alternatives to gendered terms like using chestfeeding to describe feeding a baby (MacDonald et al., 2016), or using gender neutral ones (e.g. internal genitalia, external genitalia) and removing the association with a particular gender, such as ‘person who menstruates’ (Spade, n.d.). This approach involves rethinking what a gendered body is and what an agender body (a body with no gender) would be. Therefore, instead of assuming that bodies with larger masses on the upper torso were ‘breasts’ only found on women’s bodies, it recognises that bodies vary on the amount and shape of mass in that area. Moreover, it acknowledges that someone’s gender cannot be determined by specific areas of the body. In addition to redefining gendered bodies, trans and gender nonconforming individuals can also use a range of technologies to adapt, modify, or transform their bodies. This relates to the work of feminists like Haraway (1999) and trans studies scholars (e.g. Sullivan and Murray, 2009) who have deconstructed the discourse of ‘biological’ bodies and the problematic separation of the organic and the technological, such as how our bodies are not single and separate entities but incorporate many kinds of technologies (from dental fillings to ileostomies), as well as microorganisms such as bacteria, ‘…making us less of an autonomous ‘self’ and more of an ecosystem’ (Tosh, 2020, p.8). Haraway (1999) concluded that the body was a cyborg that was constructed, deconstructed, and reconstructed through signs, discourse, and non-organic matter: ‘Bodies, then, are not born; they are made’ (p. 207). From this perspective, the body is not an unchanging object, but a subject in a continual process of becoming (Braidotti, 2002). This bodily fluidity concurs with the idea of trans body modification as ‘creative transfiguration’ defined by Ashley (2019b) as, ‘Foregrounding creativity and aspirational aesthetics [that] sees the body as a gendered art piece that can be made ours through transition related interventions’ (p. 2). Conceptualising the body as a canvas for self expression contrasts significantly from reductive medical discourse, that rather than limit possibilities, expands them as far as the imagination can reach. Creativity can also be a way of coping with being (mis)gendered by others and reclaiming the body, such as a participant from Galupo et al.’s (2020) research who stated, ‘If my clothes are particularly wild, and no one has dressed like that before, it's harder for people to assign a gender to them’ (p. 11), or as Ashley (2019c) describes, ‘Creativity is one of the manifold ways in which we may assert ownership over our bodies, transforming them into an art piece that is truly ours out of previously alienating flesh’ (p. 225). For trans and gender nonconforming individuals, these technologies can range from the alternative descriptors and discourses as already discussed, as well as binders to reduce the size of the chest area, to ‘top’ surgery where that mass is increased/reduced and reshaped. It can include the wearing of material to change the form and function of the genital area to ‘bottom’ surgery where a different genitalia is surgically created. However, for nonbinary individuals, especially those who experience changing genders or multiple genders at the same time, it can feel like, …there [is] no clear solution to their gender dysphoria. While the literature emphasizes that for (binary) trans individuals social and medical transition can alleviate dysphoria, the same options did not offer similar relief or present as a solution for nonbinary participants. (Galupo et al., 2020, p. 11-12) In the words of one of Galupo et al.’s nonbinary participants: ‘I get depressed because there’s no answer’ (p. 12). Perspectives that deny the existence or lived experiences of trans people can underestimate or neglect these embodied experiences of distress and how intense and debilitating they can be. Consequently, there is a paradoxical obsession with trans bodies as being reduced to genitals and sex characteristics, as an object of study, fear, dehumanisation and pathologisation, that contrasts starkly with the silence in dominant psychological and media discourses around trans embodiment as autonomous, feeling, living, subjective, human beings... Rest of the preview to be released when the book is in press. To cite: Tosh, J. (forthcoming). Trans Bodies. In R. Capdevila & E. Zurbriggen (Eds.), Palgrave Handbook of Psychology, Power and Gender. London: Palgrave.

by Bidushy Sadika Interview originally published in the Section on Women & Psychology, 48(2), 23-28 - the newsletter of the Canadian Psychological Association's Section on Women & Psychology [SWAP] (a.k.a. the feminist section). Republished with permission. Hello everyone, Happy New Year! I hope you all had restful and enjoyable holidays. Welcome to the Winter 2022 edition of the Section on Women and Psychology (SWAP) newsletter. For this edition, I have had the honour and privilege to interact with Dr. Jem Tosh. Their work exceptionally exemplifies the intersection of psychological and feminist knowledge to challenge the prevalence of violence and trauma amongst queer, trans, and nonbinary persons. To engage in this work, Dr. Tosh founded Psygentra, an organization that specializes in psychology, gender, and trauma. She has authored the following books, The Body and Consent in Psychology, Psychiatry and Medicine: A Therapeutic Rape Culture, Perverse Psychology, and Psychology and Gender Dysphoria: Feminist and Transgender Perspectives. Without further delay, let’s hear from Dr. Tosh about their journey as a psychologist with a focus on decentering dominant narratives (i.e., heteronormativity, cisgenderism, and white privilege), promoting inclusivity, and advocating education on important issues such as violence, trauma, and gender nonconformity. Their work exceptionally exemplifies the intersection of psychological and feminist knowledge to challenge the prevalence of violence and trauma amongst queer, trans, and nonbinary persons. - Bidushy Sadika, SWAP Assistant Newsletter Editor Can you tell me a bit about yourself, your training, and your background? I'm a Chartered Academic Psychologist with the British Psychological Society (BPS). So, I did a research PhD in the UK that focused on the psychology of sexual violence and gender, specifically looking at gender nonconformity. I included experiences of trans and nonbinary survivors in that. I'm also the founding director of Psygentra, an organization that specializes in critical and feminist psychologies regarding gender and trauma. That's where I do my research, my writing, consulting, and provide support - all through that space. I've published three books, all looking at issues around sexual violence or gender, gender nonconformity, and the transgender experience as well. That's because I'm a nonbinary psychologist and a survivor of abuse myself. Why did you select this area of research? Sometimes people think of me as a gender researcher, but my main focus is sexual violence and abuse. It’s just that you can't really study that topic without looking at gender. I got interested in that because growing up, I was exposed to it a lot. There were many people I could see around me who were suffering as a consequence of it. It seemed to be experienced by a lot of people and a really huge social issue that I wanted to work on and understand. Being a survivor myself, I had a personal interest and motivation to understand it – how do we work to prevent it? I also grew up during The Troubles in Northern Ireland. So, growing up in a situation of conflict, that also piqued my interest in violence in more complex ways. How does violence work in communities? How is it interpreted and understood? The focus on gender nonconformity was because I found that when I engaged with a lot of feminist work, there was the assumption that there was a gender binary of women victims and men perpetrators. But for someone like me, my abusers were both men and women, queer and straight. So, it felt like there was a lacking there. I couldn't find a space for myself within those areas of feminist psychology. So I am really trying to open up those topics and conversations so that we're including more survivors and their experiences so that they have a voice. I couldn't find a space for myself within those areas of feminist psychology. So I am really trying to open up those topics and conversations so that we're including more survivors... Can you tell me a bit more about Psygentra? What it is and what motivated you to start this organization? Psygentra stands for— psy for psychology, gen is for gender, and tra is for trauma. It's a space where I do my research, where I do my writing, it's where people can find me and the people who work with me for consulting, support, advice, mentoring, PhD supervision - just anything really. I decided to set it up because I'd been working in the UK National Health Service (NHS) and in academia and it's very difficult to work in mainstream psychology or mainstream academia as a queer, nonbinary, and neurodivergent person. I found that it can be a very hostile environment to work in. You're expected to not only work alongside, but to also collaborate with people whose work and teaching advocates for your own eradication – they’re very harmful views. And it's not just one person or a group of researchers, but because they're also teaching that, you have students who have these views as well. It creates a really hostile and toxic work environment where abuse and violence can thrive. In one of my last academic positions in a university, I was actually sexually assaulted by a student. In that kind of hostile environment, I became a target for a lot of violence and abuse. I stayed in academia for a little bit after that, but it just became more and more apparent that I was spending most of my energy trying to survive in that space and spending most of my time justifying my existence. I didn't like putting all my energy into that when I wanted to be putting my energy into research, teaching, doing more productive things around social change, and making the profession more inclusive. So, I decided to create a space that not only included people, but actually celebrated and centered diversity, and that was to include anyone who felt marginalized or excluded from mainstream academia and mainstream psychology. So that's the goal, to create a space that is safe for people who are trying to make a difference. I decided to create a space that not only included people, but actually celebrated and centered diversity, and that was to include anyone who felt marginalized or excluded from mainstream academia and mainstream psychology. What do you hope to achieve with your organization? I wanted somewhere where people could thrive instead of having to focus on survival. I wanted a space where we could make changes at different levels. So, I talk about how your research is on that bigger level. You try to influence academic discussions on what these things are, how we understand them and then training so that you're getting to individual professionals and how they practice, how they understand sexual abuse - like trying to encourage therapists to be more gender inclusive when they're working with survivors themselves or supporting them through consultations. I'm an immigrant, so I'm still getting my qualifications recognized here to be able to do therapy, but that's also a future goal. For me, it's three levels, individual support for survivors, training professionals who work with them, and then expanding and opening up the research so that we're being more inclusive. That's the goal. How does Psygentra contribute to the field of feminist psychology? I would say it contributes because sexual violence is an important theme in the organisation, and it’s an important feminist area of reducing violence against women, and violence against people of any gender. The work we do is about expanding that conversation to include more genders and more survivors. The other aspect is the gender research that we do, and we do that through a feminist lens. We use intersectionality theory drawing on black feminist work. Again, that's about expanding how we understand gender, looking at the gender binary critically, and analyzing it through an anti-colonialism lens. So, I would say that's how psygentra promotes and includes feminist psychology. We use intersectionality theory drawing on black feminist work. Again, that's about expanding how we understand gender, looking at the gender binary critically, and analyzing it through an anti-colonialism lens. Does your organization do a lot of knowledge translation that is not possible within the colonial culture of academia? Yes, having an organization that's run by a survivor and a nonbinary queer immigrant, there are a lot of things that I don't have a lot of hoops to jump through. There aren’t committees or grants that are required, that are structured around colonial and white norms of how things are ‘supposed’ to run. Designing an organization from scratch means that you get to question everything about the organization. One of the concepts we use is slow scholarship to counter ableism in academia - we don't have deadlines, we just don't! We have an online journal publication that is in a rolling format, and we publish things when they're ready, because there's such pressure in academia to publish, not perish, to publish quickly, and to write in a particular way that assumes English is everyone's first language. It assumes this very professional quantitative style of writing is the only ‘good’ one or ‘right’ one. So, we're really trying to challenge that so that more voices get heard. It means that we can open up and do things differently. We have academic papers and books, but also, I've got the blog, which describes things in a way that's more accessible, more general. I write things for people who are studying, but I also write things for survivors who are maybe just looking for information. I do that around trans topics as well. Some people just want to support a loved one or a friend and they don't really understand it. We're very careful too, for example, our social media's private, because we know that these kinds of topics can create hostility. It can attract trolls. And again, I want to make sure that it stays a safe space so that we're communicating to people who feel safe hearing about it, talking about it, and asking questions. One of the concepts we use is slow scholarship to counter ableism in academia - we don't have deadlines, we just don't! How can feminist psychologists at different levels (e.g., students, faculties, clinicians, teachers, etc.) across Canada engage or get involved with your organization? In a number of ways, one is, we have our publications that are available, and we have just set up a Psygentra Learner Subscription where you can access some of our more detailed posts. They also tend to have a little bit more personal disclosure as well. So, you have a mix of academic theory, but also making it accessible and personal with examples that people can relate to. We are in the process of developing webinars and online training. Part of our slow scholarship is we're working to make something really good, different, and unique. For example, the first webinar we are setting up is on academic activism, how to bring your activism to your academia, how to make your academic work help activism, and how to foster that relationship. So, getting involved in those, signing up for our newsletters so that you can find out about when those are released. But also, as an organization that isn't trying to replicate those rigid hierarchical structures that are out there, we are also quite fluid. So if people wanted to get involved or had ideas or wanted to share something or wanted to publish something, we encourage that and promote that! I've had people contact me because they want to publish things that have been rejected elsewhere because they were a trans author or they were rejected because their style of writing wasn't quite right. So, we definitely encourage people to get in contact and we can find ways to promote work that we find has an important message or is useful to people advocating for social change. Also, if universities or people want us to deliver a workshop or a seminar – virtually or in-person, depending on COVID and everything – we do that too. Can you tell me a bit about your book, The Body and Consent in Psychology, Psychiatry, and Medicine? What motivated you to start writing this book? The book is the result of about a decade of work in the area and noticing patterns, similarities, and things that connected from different projects I was doing. I really felt like I needed a book to be able to tell the whole story. It was one of those ideas that came to me at about three o'clock in the morning. I just woke up and had this clear idea and had to write it down. I pretty much wrote the proposal for the book for my publisher within a few hours that early morning. I just had the clearest idea of how it all fit together and that's what I did. The focus is on how sexual abuse is constructed within psychological discourse on therapy, but it also includes discussion of sexual abuse during therapy and sexual abuse that is framed as therapy. It traces the influence throughout the history of psychology from, for example, John Money's work with intersex children and the practices around gender ‘normalization’ and how that linked then to reparative approaches with queer and transgender children. One was called ‘sexual rehearsal play’ where they tried to teach children how to have heterosexual sex by getting them to mimic positions and movements. So, it's this blurring boundary between what's classed as therapy and what's classed as violence. Who gets to define which is which and the harm that it can cause? And then how those therapies go on to influence Masters and Johnson’s sex therapy. I was able to trace these harmful ideas and concepts throughout a variety of really important influential therapies and how they create an environment in psychology where rape and sexual abuse occurred and thrived and got justified. Victims got gaslit and were told that it was therapy. That's why it ends up being a therapeutic rape culture. I talk about how the kind of environment and ideas and concepts that we promote in psychology can either encourage violence or discourage it. I talk about intersectionality a lot throughout the book. I analyze the topic in relation to gender, race, disability, class, and conclude that there are 14 conditions that create this context and that we need to dismantle those. That includes things like, sexism, white supremacy, and a contractual idea of consent (people tick a box to access therapy and assume that means they consent to all kinds of possible therapies that could follow it). That's what the book is. It's pretty big, it has a lot of stuff in it! I talk about how the kind of environment and ideas and concepts that we promote in psychology can either encourage violence or discourage it. How does your book contribute to the psychological understanding from feminist perspective? Sexual violence and gender issues are key to feminist psychology but I think it expands on that by including more genders. I have a whole chapter about intersex folks, a whole chapter for trans people, a whole chapter on cisgender men survivors and several chapters on cisgender women survivors. So, there are lots of examples of how sexual violence impacts on different genders, but how gender is still really important in how that is experienced. I think it also forms that part of feminist psychology that critiques the profession, looks at it and thinks, what can we do better? What is oppressive either intentionally or unintentionally? What are we doing that's harmful that we don't realize or don't mean to? For me, it's a key part of that aspect of feminism, of constantly critiquing things, analyzing things and thinking, how can we do better? Do you have any more comments about your other books? Like Psychology and Gender Dysphoria? That book is probably the only book that doesn't focus on sexual violence. It was requested by an editor. An editor got in touch and they were aware of all the controversies around gender dysphoria and transgender people, all the different debates and disagreements, and they didn't understand them. So, they wanted a book that outlined and explained all the controversies, e.g. here’s why they exist, here’s what they're saying, here are the problems with them and so on. So, I wrote a book in two parts. The first part goes through how gender nonconformity and femininity have been framed very negatively in psychology and psychiatry for a long time. I go through all the different diagnoses and the debates within the profession about them - and the problems. The second half of the book looks at how feminism has addressed gender nonconformity, both from a positive part of feminism – those challenging gender norms – but also how trans exclusionary feminism has drawn on some of those pathologizing narratives from psychiatry and psychology to continue to harm and exclude trans people. At the end of the book, I flip the switch a bit and show how trans people have framed psychiatry and feminism. So, it's this discussion between these three areas that I've had quite a lot of feedback from parents and trans youth who've read the book, who aren't the target audience at all. It's an academic book. They said that they found it so helpful to understand why you see what you do in the media and the news, or from politicians and celebrities, and going, “oh, that's why they're saying that because it comes from that thread of argument or they are thinking in this way”. Perverse Psychology was based on part of my PhD thesis. It was me analyzing sexual violence and gender nonconformity against these parallels. I'd say very briefly, what I noticed was how very often psychology would frame sexual violence as ‘normal’, as a part of ‘aggressive male behavior’. Like in developmental psychology aggression would be a part of ‘normal’ development for boys, or in evolutionary psychology sexual violence would have ‘reproductive value’ - all these really problematic, harmful, horrible kind of discourses. Then on the other side, they were saying that trans people and gender nonconformity are ‘dangerous’ and ‘perverse' and really ‘bad’. To me, that was really backward thinking. Actually, rape is really bad and trans and gender nonconforming people are just trying to exist. So, I argued that it was the profession that was perverse, not the people they were diagnosing. It was the profession that was perverse, not the [gender nonconforming] people they were diagnosing. What led you to write your book and what do you hope to achieve by writing books on these topics? The main reason I wrote them was because I couldn't find anything else saying what I was saying, or talking about the issues that I was seeing at that time. Initially when I started writing and tried to get published in feminist journals the feedback was, “can you remove the part about transgender people?" I was saying, “no, that's key to what I'm trying to talk about”. So, books were a really good way for me to have enough space to explain everything and explain why it was important. That was definitely one big part of it. I think what else I was trying to achieve was about opening up the conversation and bringing awareness to it and giving voice to those who can't find themselves represented in other spaces. Like I said, there are books on sexual violence in therapy that focus on women, but those trans youth were the focus of that horrible ‘sexual rehearsal play’. They need a place to be able to see their stories, be validated, and recognized and outraged. I often give warning when people read my books that it's not an easy read and you will likely be outraged at some of the talk about things like the electric shock treatments that they used to give to gay and trans people. It is really horrific when you look at how marginalized groups have been treated in psychology. So, it's raising awareness and opening discussions, but the main goal is always about how to improve. I always think of it in that positive way. I describe myself as a critical psychologist and a feminist psychologist, and I think some people can be scared of both of those terms because they think they're very negative but for me it's a very positive thing to look at something and think, “okay, where has it gone wrong?” so that we can make it into a better thing. I think that's a positive goal in the future instead of thinking, “well, this is how things are and we're stuck with it”. I think that's a more negative thing. ...when I started writing and tried to get published in feminist journals the feedback was, “can you remove the part about transgender people?" I was saying, “no, that's key to what I'm trying to talk about.” Part Two to be released in May 2022... Connect with SWAP: Twitter Facebook Canadian Psychological Association Website - SWAP Check out the SWAP Newsletter for the Emerging Canadian Feminist Scholars Profile Series, recent member publications, awards, job postings, book reviews, and more. To contribute to the SWAP Newsletter, contact the editors: Jenna Cripps, Newsletter Editor jenna.cripps@mail.utoronto.ca Bidushy Sadika, Assistant Newsletter Editor bsadika@uwo.ca

by Dr. Jem Tosh (Content warning: discussion of s*xual abuse, gaslighting, and abuse by women) This week I had the unfortunate experience where my history of abuse was not believed. It’s certainly not the first time that I’ve disclosed and had my trauma dismissed, but it was the first time that I wasn't believed in a therapeutic context.* Not being believed can exacerbate existing trauma by increasing shame, preventing further disclosure, and it can lead to an avoidance of support services. It can result in a survivor feeling like the abuser's perspective is valued more than theirs, that their pain is considered irrelevant or invalid, and like they have to suffer in silence. ...betrayal trauma can mean that no answer ever seems sufficient to the question: how could they do this to me? Not being believed during therapy can be even more harmful because (1) the therapist is in a position of authority and the survivor is typically in a position of emotional vulnerability and (2) it replicates the harmful actions of abusers, bystanders, and others who have failed to protect the victim/survivor. Denying the abuse occurred can be a common aspect of gaslighting that abusers use to silence victims. They can deny it so often and lie so well, often acting like nothing happened, that survivors begin to question and doubt their own experiences and memories (institutions can do this too - see also Dr. Lucy Thompson's work on institutional trauma). This manipulative denial can coincide with a survivor's own difficulty with accepting that something awful has happened to them, particularly if it involved someone close to them who they trusted. The resulting betrayal trauma can mean that no answer ever seems sufficient to the question: how could they do this to me? Struggling to understand and accept past abuse can become even more difficult and complicated if the individual experienced trauma related amnesia or betrayal blindness** (i.e. "the dual state of simultaneously knowing and not knowing something important") - which can particularly be the case with childhood sexual abuse. My experience of not being believed (particularly in spaces that should know better - e.g. therapeutic and feminist) has most often coincided with my disclosing of abuse by women. Bystanders who witness abuse can do all kinds of mental gymnastics to rationalize and trivialize abuse, because that’s easier than acknowledging the harm that’s been done by someone they know, respect, admire, or even love. It’s even easier to deny it when abusers are notoriously charismatic (especially if they engage in lovebombing), groom those around the victim to make sure they have continued access to them, or act like Dr. Jekyll and Mr. Hyde - where only their victims witness their abusive and violent side. These latter aspects, of being able to manipulate the perception of the people around themselves and around a victim, can result in survivors being disbelieved by the very people and institutions meant to protect them. The fact that the constructed idea of an abuser is typically a (cisgender and heterosexual) man,*** often portrayed as being ‘mentally ill’, ‘disturbed’, or uncontrollably violent, makes it easier for abusers who don’t fit that (narrow and problematic) stereotype to access victims and continue to cause harm. It also makes it more difficult for men survivors to be believed and to find support. If the idea of women being sexually violent makes you uncomfortable because it challenges your understanding of abuse, then I'd argue that your understanding of abuse is either inaccurate, incomplete, or both. In some ways, then, my experience of not being believed is unsurprising (particularly in spaces that should know better - e.g. therapeutic**** and/or feminist) because it has most often coincided with my disclosing of abuse by women. Abuse by women goes against the vast majority of research, writing, and understanding of abuse (especially sexual abuse) in these contexts. But it does happen - women do abuse and they do sexually abuse others. I know this is true because I've lived it, researched it, and I've listened to other survivors who have been abused by women too. If you're not supporting all survivors, then you're oppressing and silencing some survivors - and that's not okay. If the idea of women being sexually violent makes you uncomfortable because it challenges your understanding of abuse, then I'd argue that your understanding of abuse is either inaccurate, incomplete, or both. If you're not supporting all survivors, then you're oppressing and silencing some survivors - and that's not okay. It can result in harmful situations like survivors feeling excluded and unable to disclose, or survivors seeking understanding in a therapy room only to be told that their experience is unbelievable. In a society that likes to ignore or deny the horrific and epidemic extent of sexual abuse, to a feminism***** that grounds its theories of violence in a rigid gender binary, there is little space for those of us with devastatingly violent and damaging experiences of sexual abuse perpetrated by women. Experiences that are not antithetical to feminism: "...a close look at sexual victimization perpetrated by women is consistent with feminist imperatives to undertake intersectional analyses, to take into account power relations, and to question gender-based stereotypes..." (Stemple, Flores, and Meyer, 2016). ...there is little space for those of us with devastatingly violent and damaging experiences of sexual abuse perpetrated by women. This context, where a hard 'norm' has been constructed and repeated so frequently, makes it all the more difficult for those with experiences outside of it to be believed and to find support. This includes queer survivors of domestic abuse, men survivors, nonbinary survivors, and more. So while my being disbelieved involved one person, its hurt was connected to many more experiences of silencing, exclusion, and erasure. I'm a person who exists outside of the gender binary and my experiences of rape do too. To those who work with survivors of abuse: do better. About the Author I am a Doctor of Psychology and an EMDR and OEI Trained Trauma Therapist. I offer trauma counselling in-person in downtown Langley, BC, Canada or online for residents of BC. I specialize in working with survivors of violence and abuse, and those struggling with the impacts of complex trauma. Notes: * I’ve had a few problematic therapists in my time, but I’m lucky to have had a few great ones too. Those positive experiences, where I was validated and believed, helped to counter gaslighting significantly. ** While a useful concept in trauma work, it draws on harmful ableist discourse. *** In addition to harmful and problematic discourses that frame marginalised folks as predatory to justify violence and victimization, such as queer people and racialised folks. **** And therapy is not immune from sexual abuse, as my last book showed. See a summary of my findings here. ***** A feminism because #notallfeminisms - those that promote this rigid gender binary perspective are much more likely to represent white feminism (as in feminism that engages with or fails to dismantle white supremacy) with a predominant focus on cisgender, heterosexual, non-disabled, and middle-class women. Resources: Betrayal Trauma Theory by Dr. Jennifer J. Freyd (and see also her more recent work on Institutional Betrayal) Sexual Victimization Perpetrated by Women: Federal Data Reveal Surprising Prevalence by Stemple et al. (2016) The Proportion of Sexual Offenders Who Are Female Is Higher Than Thought: A Meta-Analysis by Cortoni et al. (2016) Understanding the Prevalence of Female-Perpetrated Sexual Abuse and the Impact of That on Victims by Jacqui Saradjian (2010) The False Memory Syndrome at 30: How Flawed Science Turned into Conventional Wisdom by Joshua Kendall (2021)

by Dr. Jem Tosh (Content warning: discussion of s*xual violence and the pathologization of trans people) As I write a proposal for the second edition of my first book, Perverse Psychology, I thought it might be useful to outline exactly what I mean by that term and the theory behind it. Perverse Psychology per-verse adj. Directed away from what is right or good; perverted Obstinately persisting in an error or fault; wrongly self-willed or stubborn* My analysis of psychological and psychiatric constructions of sexual abuse started with the 'paraphilias' - sexual activities and behaviours that psychiatry and psychology (controversially) deem to be 'abnormal'. My work started with the 'paraphilias' because the proposals for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) were released shortly after I started my PhD. They included the troubling concept of 'paraphilic coercive disorder', despite it being rejected several times before. 'Paraphilic coercive disorder' referred to rape in the main criteria and I argued that the proposed diagnosis medicalised sexual violence. It was a focus of the protest and academic activist intervention I co-organised in 2010, which also addressed problems with the psychiatric treatment and diagnosis of 'gender identity disorder' (now called 'gender dysphoria'**). One thing that struck me in the critiques of 'paraphilic coercive disorder' was how often it was framed as new - both in terms of those who did not mention the feminist protests and critiques from the 1980s, but also how sexual abuse has been pathologized in psychology and psychiatry throughout the DSM's history and long before it. Whether a part of the (also problematic) 'sexual sadism disorder' or the pre-DSM 'satyriasis', sexual violence has been included as a 'symptom' of mental 'illness' for well over a century. Instead of challenging abuse and those who enact it, psychiatry and psychology pathologize the victims and subject them to invasive therapies and pathologizing theories that result in discrimination and stigma. This most certainly could be considered an example of being 'directed away from what is right and good' - (Tosh, 2015, p.115) What I noticed about this construction, which troubled me even more, was the boundary that was put around it. What gets categorised as 'abnormal' sexual violence and what is 'normal' sexual violence? Is there really a concept of 'normal' sexual violence - is it 'normal' at all? What are the implications of framing certain kinds of sexual violence in this way? I was troubled by this paradox, on the one hand sexual violence was positioned as symptomatic of disorder, and on the other hand it was framed as 'normal' in some situations. That latter group coincided with the normalisation of masculine violence - harmful theories and narratives that centred 'rough and tumble play' as key to boys' development but not girls.*** It framed sex and sexuality in (heteronormative and) oppositional terms, with men being described as active (and 'aggressive') participants with a high sex drive and women framed as the passive and asexual complement that required pursuing and even coercion to 'awaken' a sexual interest.**** Gender Nonconformity To understand this dichotomy, I needed to examine psychological and psychiatric constructions of gender. What I noticed was, when the violence fit into psychological narratives about masculinity (the 'norm' constructed by psy disciplines) it was most often positioned in that 'normal' violence category. Those instances that were positioned in the other category, the 'abnormal' rape concept, tended to represent gender nonconformity; a combination of 'masculine' violence with (what psychiatry constructed as) a 'feminine' 'over-emotionality'. Like discourses about 'hysteria' (and the present-day version, 'histrionic personality disorder'), it was not the 'masculine' violence that was framed as 'abnormal', but the overly emotional display or expression of it in certain contexts that would result in its pathologisation. I looked again and again and found repeatedly that distinction - 'normal' violence was controlled, functional, necessary, and 'abnormal' violence was emotional, uncontrollable, irrational. The latter replicated psychology and psychiatry's constructions of pathologized femininity (not only through hysteria discourse, but others too, like 'borderline personality disorder'). The persistence of psychiatric interventions with children who defy gender norms continues the profession's stubbornness to acknowledge wrongdoing... - (Tosh, 2015, p. 115) The other parallel I noticed, was the similarities in the pathologization of gender nonconformity in these psychological and psychiatric texts. From 'transsexualism' and 'transvestic disorder', to 'gender identity disorder' and 'gender dysphoria' (which have a history as long as psychiatric constructions of rape), it was not just femininity being pathologised but also the gender nonconformity - in other words, psychiatry had a problem with the existence of trans women and girls*****. For the constructions of 'abnormal rape', they pathologised the problematic construct of 'feminine' 'over emotionality' as well as (what psychiatry considered to be) the gender nonconformity of it existing or being expressed by a (cisgender) masculine body. I found this conceptualisation deeply problematic and harmful - to frame gender nonconformity (and transgender and nonbinary people) as 'abnormal' but 'masculine' violence as 'normal'. This is because I don't think we should consider any kind of violence as 'normal', regardless of the gender of the perpetrator.****** Nor do I think that gender nonconformity should be pathologised. So, based on the definition of perversion given at the beginning of this blog post (and the final chapter of the book), I conclude that because of this backward understanding of violence, abnormality, and gender, it is psychology and psychiatry that are perverse: If psychology considers transgender people to be 'abnormal' and rape to be 'normal', or argues that certain genders should be prevented but masculine violence should be encouraged, then it sounds to me like psychology is the one that is perverse and in need of an intervention. - (Tosh, 2015, p. 116) Reviews for the First Edition: "Highly original, closely argued, and ingenious analysis" Professor Erica Burman, University of Manchester "A captivating critique of the disciplines of psychology and psychiatry" Shari Fitzgerald, Memorial University "At last a book that speaks about the unspoken. Well written, well referenced, a highly stimulating read" Kirsten Nokling, The Psychologist "Well written, insightful, interesting, informative, and an excellent resource" Joan Strutton, PsycCRITIQUES "Invigorating and provocative" Pierre Brouard, University of Pretoria "A very important book about how modern psychology has been used to invalidate and suppress sex and gender diversity" Jack Molay, Crossdreamers Nominations Shortlisted for The British Psychological Society Book Awards, 2016 Preface by Professor Ian Parker: "Instead of subjecting those labelled as 'abnormal' to the gaze of psychology, [Jem] Tosh invites us to turn around and look carefully at that gaze. How is it structured, and how is it linked to power? What are the consequences of the proliferating categorisation of sexual disorders, and what does that tell us about knowledge production in psychology? And how are the borders between masculine and feminine policed, and the many different attempts to cross those borders treated by psychology as 'perverse'?" Perverse Psychology is part of Professor Ian Parker's Concepts for Critical Psychology: Disciplinary Boundaries Re-Thought book series with Routledge. Check out the full range here. Contents of the First Edition 1. Introduction Anti-psychiatry Critical psychology Discourse Analysis Feminism [Trans psychology] PART 1 - SEXUAL VIOLENCE 2. Psychology and sexual violence: A historical review Rapere Rape as perversion The DSM Online research Psychiatric Discourses Reverse Discourses Conclusions 3. Remedicalizing rape Forensic Psychology Feminism Sexology Remedicalizing psychiatry Paraphilic Coercive Disorder Paraphilia NOS DSM-5 Conclusions PART 2 - [GENDER NONCONFORMITY] 4. Psychology, homosexuality, and 'feminine boys' 'Sodomy' Perversion Psychoanalysis The DSM 'Feminine boys' Conclusions 5. [Gender Nonconformity] and psychology: Transforming gender identity (into) a disorder Gender nonconformity Perversion Gender identity The DSM-5 Gender dysphoria Conclusions PART 3 - PERVERSE PSYCHOLOGY 6. Rape: A perversion of gender Stranger rape, strangely fascinating Psychiatrization Normalizing rape Pathologizing gender nonconforming victims Paraphilic rape The 'unreasonable' rapist Feminization Conclusions 7. Conclusions: Perverse psychology 'Directed away from what is right and good' 'Obstinately persisting in an error or fault' Perverse psychology A note on 'transgenderism' I also thought that it would be a good idea to explain the context around the problematic word 'transgenderism', how it ended up being in the book title, and what it could be replaced with in the second edition. The word 'transgenderism' is currently considered an offensive term and its use is discouraged. This is because it has become associated with those who invalidate trans people and can be used in discussions and analyses to dehumanise transgender people. When I was writing the book (between 2010 and 2013) the word didn't have the same association, being used often in texts that discussed transgender people from a clinical and non-transphobic context. But language changes, particularly in discourses where there is so much hostility, stigma, and growth. I wasn't 100% comfortable with the word 'transgenderism' then but I couldn't yet put into words why. I argued that it wasn't quite the word I was looking for and that it didn't actually describe what I was talking about, but I was advised to use the word because otherwise no one would discover my book. I walked away from many publishing opportunities that requested I remove the 'transgender piece' entirely from my work, so compromising on language in some ways seemed like the best I could ask for at that time. I don't compromise anymore. I wanted to use the term 'gender nonconformity' because my analysis was about how psychiatry framed gender, created gender norms, and then pathologised nonconformity to those norms. That includes the pathologisation of transgender and nonbinary people, but my analysis was on how psychology and psychiatry constructed the expressions and behaviours of gender nonconformity, as it is this observable behaviour that tends to be the main focus of psychiatric texts and perspectives in this area. That was the problem when I started writing about these topics over a decade ago - these terms weren't as well known, understood, or critiqued. Every paper I submitted and every chapter I wrote, the feedback from editors and reviewers alike requested that I define all the terms I was using because they (and they expected the readers too) were not familiar with them. I was asked for detailed backgrounds of each diagnosis I mentioned regarding gender dysphoria based on the assumption that it would be new information to most readers. That's not the case now. Everyone and their granny seems to have an opinion on transgender people. Even if they don't know the details of the gender dysphoria diagnosis, these concepts are more recognisable and familiar than they were then. I wish I had stood my ground more. I walked away from many publishing opportunities that requested I remove the 'transgender piece' entirely from my work, so compromising on language in some ways seemed like the best I could ask for at that time. I don't compromise anymore. Notes * From www.thefreedictionary.com ** I use quotation marks to highlight that I am talking about a psychiatric concept, not to undermine or invalidate people's lived experiences of gender distress or gender dysphoria. *** They did not consider nonbinary children and when they did consider transgender youth, they were most often misgendered and pathologized as having a 'disorder'. **** These perspectives rarely considered queer relationships or asexuality, tending most often to pathologize them if they were mentioned. ***** While there is work on trans men and gender nonconforming and 'masculine' girls (e.g. cisgender tomboys) psychiatry and psychology have a well-documented disproportionate interest in trans women and femininity. To read about constructions of sexual abuse in psychology and psychiatry and experiences of cisgender and transgender men, see my latest book The Body And Consent in Psychology, Psychiatry, and Medicine: A Therapeutic Rape Culture (Tosh, 2020). ****** Not to be conflated with aggression. I have discussed my conceptualisation and differentiation between consensual aggression and (nonconsensual) violence elsewhere. Use promo code IRK70 for 20% discount when purchasing my book from routledge.com Please note that the first edition (like most of my publications) uses my deadname. Please use Jem Tosh when writing about or citing my work. I'm genderfluid/nonbinary and my pronouns are they/she.

by Dr. Jem Tosh It happened again. As I was researching a new book chapter I was recommended an article written by someone I had met at a conference, whose work I had found useful and cited fairly frequently. They had decided to wander into the polarised and hostile territory of studying trans folks in psychology, and unfortunately, they hadn't done it very well. Only covering debates and discussions from the last five years, the conclusions were based on very partial and incomplete information. It would be like me writing a piece assuming that sexual violence had only existed for five years and that rape crisis centres and other interventions were 'new'. If an undergraduate student had submitted it as an essay, I would have failed them outright. But there it was, published in an academic journal, and peer reviewed to boot. If an undergraduate student had submitted it as an essay, I would have failed them outright. Mistakes are a part of life and they're certainly a part of academia. Mistakes are key to learning and research, like refining a hypothesis after not getting the significant result you expected, or updating a theory when a relevant theme you hadn't considered comes up in an interview. It's also a key part of anti-oppressive practice, of unlearning the harmful and problematic defaults that we are taught living in a racist, sexist, transphobic, homophobic context. It's acknowledging that we know more now than we did before, but that our learning isn't over yet and maybe it never will be. That's just how deeply ingrained these harmful ideas are. Reading a single book about racism won't end white supremacy, for example. If you have made mistakes, rather than beat yourself up about it, reflect on it, learn from it, apologise if it caused harm, address it if it needs corrected, and then continue on your unlearning and anti-oppressive journey. With that in mind, I offer some advice on the mistakes I see circulating in academic spaces when folks write about trans people and how to avoid doing them. 1. Assuming that trans people are 'new' Read up on trans histories and avoid making this crucial mistake. This will also help fix the error where medical treatments are framed as 'new' too - such as reading up on gender affirmative surgeries and hormonal treatments that have taken place for decades. Make sure to include or acknowledge that many genders, outside of the narrow gender binary that was enforced during colonisation, existed in many cultures across the globe for a very long time. They can even be older than the country you're living in. For instance, Two Spirit folks have existed for much longer than the country I live in - Canada. Writing as if genders other than (cis) men and women are 'new' or 'controversial' erases this Indigenous history. This is a big error for several reasons, (1) you're leaving out relevant research and information, as well as key texts, theories, and prior discussions, and (2) it skews your conclusions. If you're only looking at one small section of the research, then your results or perspective is only going to reflect those views. It also continues the centering of white European and North American conceptualisations. So, make sure to include these crucial perspectives, otherwise that black square you shared and your commitment to learning more about white supremacy was performative activism at best. Speaking of activism, let's talk about using that term in academic writing on trans topics. 2. Dismissing 'trans activists' Do you dismiss the gay activists or queer activists who protested and challenged the profession to remove 'homosexuality' as a mental disorder in the 1970s? Were their arguments that conversion therapy was harmful not valid? Was the fact that they were activists erase their expertise, as psychologists and psychiatrists? It can be common for marginalised and oppressed folks to become involved in protests and challenge oppressive structures because they have no real choice not to - because those structures impact on their life. This doesn't make their voices less relevant than other academics, it makes their lived experience and their academic work worth listening to. Was the fact that they were activists erase their expertise, as psychologists and psychiatrists? What about feminist academics? Those who protested and challenged the profession over its sexist portrayals of women and femininity, its misrepresentation of sexual violence as typically committed by strangers, and the cruel treatments women were made to undergo for problematic diagnoses such as 'hysteria'? Do we dismiss their arguments because they were activists? Did their PhDs and community work evaporate the minute they began to call out the profession? They faced a similar choice to either work in a profession that belittled them, pathologised them, and caused harm to women, or work to make it better. Is their work not valid? Is their lived experience a reason to dismiss their work and their concerns? The term 'trans activists' is often used in texts to discredit the perspectives of trans academics and clinicians, and the valid concerns and criticisms made by trans people.* It positions cisgender (i.e. non trans people) as the experts on being trans. We see people infuriated when committees that decide policy on women's health are filled by men,** when governments working on austerity measures are over-representative of millionaires and billionaires, but somehow people think it's acceptable to sideline trans voices when discussing trans people. It's not. This is why it's problematic when work on trans issues is so often led by non-trans academics. 3. Cisgender academics leading research projects on trans topics Things change. We might feel comfortable with how things are, or how we've always done them, but what was acceptable once, might not be acceptable now. Historically, it's been common for research regarding trans folks to be conducted and interpreted by cisgender people. This has resulted in much of the harmful and pathologising discourse around gender nonconformity in psychology. This centering of cis academics was for many reasons, one being that there are so many barriers to academia, education, and employment for trans people that accessing academic spaces can be difficult at best and impossible at worst. Things are a little different now, those barriers are still there, but some of us are getting through (with a lot of effort, persistence, and the resulting trauma). As others have said in other contexts, don't speak for us, pass the mic. But we're the 'token' trans or nonbinary person on the project. We're the 'consultant' or 'advisor' on the committee, not the head of it. We're reimbursed with $100 for participation, but not a liveable income or reliable salary with benefits. We are listed as an author, but not the lead author. We collect and analyse the data but the Principal Investigator gets the promotion. To counter the long and pathologising history, that has caused so much harm, it is important to invert the current power structure of academia - the hierarchy that places cisgender researchers above trans academics. This can be a difficult reflection for allies who make space for trans folks where there once was silence, but it can be a delicate balance to create space for us without taking up our space. As others have said in other contexts, don't speak for us, pass the mic. 4. Excluding trans folks from research on other topics This one is subtle, because you don't know what you don't know. One of the hardest parts I find of doing a discourse analysis is looking for the absences - what's missing? If you are used to something not being there, if the silence is 'normal', then it can be difficult to recognise it as a problem. Just like leaving out the history or the context can skew your work on trans topics, it can also skew your work on other topics too. Trans people are more than their gender - they are academics, teachers, partners, parents, neighbours, politicians, trauma survivors, and more. The mistake of treating trans folks like a 'special interest group' who are only worth discussing or considering when talking about gender, is exclusionary. This can be another difficult issue for allies - for those who include pronouns in their profiles, make effort to get names and terminology right, and educate themselves on the issues relevant to trans people. To realise that you are trans inclusive in some respects (e.g. including them in some of your work and your daily life as you consider pronouns and gender transitions of friends, family, or colleagues) but not others (e.g. excluding them from your work on gender violence, research on parenting, work regarding bullying in schools and so on). Trans people are a part of the population - like queer folks, like black folks and people of colour, like disabled folks. They are not a separate group living on their own trans island only to be considered when the word trans comes up. They are not a separate group living on their own trans island only to be considered when the word trans comes up. If you're researching violence (a topic I have spent my entire academic career researching) and you're not including trans folks - why? They are now a well-documented group in terms of the high rates of marginalisation and abuse. This includes the Trans Day of Remembrance for trans people killed for being who they are, which disproportionately impacts on black trans women. This is in addition to the high rates of sexual violence experienced by trans and nonbinary folks and domestic abuse. To exclude trans people (and other genders, such as cis men survivors of violence and abuse) provides a partial perspective on gender violence. This highlights, like black feminists have been saying for decades, the importance of intersectionality when analysing violence, abuse, and oppression. Excluding trans folks from this research area ignores the experiences of black trans women, and it shouldn't. 5. Using outdated terminology This is a tough one because language changes frequently here, and there are so many terms related to gender that it can be a huge contrast to what many of us were taught growing up (e.g. that there were only a few words and they were all pretty simple and clear-cut). I've made this mistake myself and I wish I could go back in time and fix it, but I can't. It's a good example of how everyone makes mistakes and it shouldn't stop you from trying to get better at it. My first book Perverse Psychology, includes the word 'transgenderism' in the title and in several places in the main text. The word, at the time didn't have the same negative connotations as it does now, but I wasn't comfortable with it. I wanted to use the term 'gender nonconforming' because that was what my analysis was about - about those who do not conform to the gender norms produced by psychology. As it was my first book, I took the advice of others who were in a position of authority, who were cisgender and who did not research these issues, and I agreed to compromise on the language. I shouldn't have. I should have been firmer and given them the reasons why that term was not advisable based on my research and personal experience. I've made this mistake myself and I wish I could go back in time and fix it, but I can't. So, here's the lesson, when using language around transgender and nonbinary people, don't go looking for official guidelines from your university or the standard grammar rules the journal uses, or what the copy editor thinks - follow the lead of trans folks. Worst comes to worst, yes, withdraw the publication if they won't accept gender inclusive language. This has been my stance ever since. I've withdrawn accepted papers from journals and special issues, walked away from research projects and job positions, because I won't promote harmful or exclusionary language. That's more important to me than a publication on my CV. 6. Not including trans or nonbinary authors If you're writing about trans people but your reference list looks like a cisgender pride parade, then it's likely that your analysis and conclusions are going to exclude important perspectives and critiques from the very people you are writing about. There are plenty of trans and nonbinary academics to draw on in your work. If you're struggling to find them, then it might be an indication that you need to diversify and broaden the sources you use for information gathering and your networks. Nothing stifles innovation more than an insular echo chamber. The other side of this can be including trans and nonbinary authors tokenistically. I came across this recently while reviewing a book chapter. The entire text relied on the gender binary (and some trans-exclusionary work) but crossed over into trans-exclusive research with a brief mention of trans and nonbinary people - thrown on to the end of a sentence like an awkward afterthought. Including only one or a few references without really considering trans people in relation to the topic can come across as contradictory and confusing. It can also make it seem like trans people only have one perspective because it's difficult to convey the diversity of trans communities in a short comment tagged on to the end of a single sentence. If you're writing about trans people but your reference list looks like a cisgender pride parade, then it's likely that your analysis and conclusions are going to exclude important perspectives and critiques from the very people you are writing about. Tokenistically citing trans and nonbinary people can also mean that work is 'cherry picked' to support a theory that is unrepresentative, like including a trans author who supports your view that many or most other trans folks do not (e.g. because they consider it to be inaccurate, harmful, or transphobic). Deflecting or dismissing criticism or concerns from trans communities because there is a minority who agree with you can result in your writing being too narrow and unrepresentative. This doesn't mean that you need to exclude that minority, or that you only include information that represents the majority opinion, but that it's important to include and contextualise sufficient content to reflect the diverse perspectives within trans and nonbinary communities more generally. Otherwise you risk a partial perspective being conveyed as a universal 'truth'. Concluding thoughts Trans people have been existing, learning, creating awareness and educating for many years but there has been a renewed interest in trans people in the media, politics, and academia. For some, when they're writing they only consider this latest development. They are not yet aware that many of these arguments and debates have already occurred and we are just repeating them (like if we don't know our history we are doomed to repeat it, and for those of us who do know the history, we are doomed to repeat it anyway because no one else bothered to do the reading. It's like when a teacher gives the whole class detention because one student didn't do the homework). So, rather than dismissing trans people, or speaking for them, the number one way that you can easily improve your writing on trans topics is to listen to trans people. So, rather than dismissing trans people, or speaking for them, the number one way that you can easily improve your writing on trans topics is to listen to trans people. Notes * This doesn't mean avoiding the term or not mentioning the important activist work being done, but that it shouldn't be framed as 'extreme' or 'uninformed'. Nor should it be assumed that it's an academic vs activist 'debate'. It's entirely possible to be both an academic and an activist. This binary categorisation positions activism as antithetical to academia, which is problematic and inaccurate. ** Health issues that also impact on trans and nonbinary people but who are often left out of such discussions. To cite Tosh, J. (2021). 6 Mistakes Academics Make When Writing About Trans People. psygentra.com Resources Glossary of Terms - GLAAD APA Style - Gender - American Psychological Association Guidelines for Psychologists Working with Gender, Sexuality and Relationship Diversity - British Psychological Society Guidelines for Psychological Practice With Transgender and Gender Nonconforming People - American Psychological Association Gender Identity in Adolescents and Adults - Policy & Position Statement - Canadian Psychological Association A Call to Action: The Urgent Need for Trans Inclusive Measures in Mental Health Research - Abramovich & Cleverley Gender (Mis)Measurement: Guidelines for Respecting Gender Diversity in Psychological Research - Cameron & Stinson Black on Both Sides: A Racial History of Trans Identity - C. Riley Snorton Histories of the Transgender Child - Julian Gill-Peterson Transgender History: The Roots of Today's Revolution - Susan Stryker Asegi Stories: Cherokee Queer and Two-Spirit Memory - Qwo-Li Driskill Queer Indigenous Studies: Critical Interventions in Theory, Politics, and Literature - Ed. by Qwo-Li Driskill et al. Outspoken: A Decade of Transgender Activism and Trans Feminism - Julia Serano Trans Activism in Canada: A Reader - Ed. by Dan Irving & Rupert Raj

by Dr. Jem Tosh (Content warning: Discussion of s*xual abuse in therapeutic and medical contexts, non-consensual surgeries, conversion therapies) In my latest book I theorise that therapeutic and treatment contexts in psychology, psychiatry, and medicine have a deeply problematic foundation in relation to how the body is conceptualised, how consent is considered, and the role of sexual abuse in (and as) therapy. I draw on examples from conversion therapy and sex therapy, treatments for sexual 'dysfunction', methods for evaluating sexuality and more. I analyse telling cases from over a century ago to the present day. I describe sexually abusive therapeutic contexts for transgender and cisgender women and men, nonbinary people, and intersex folks. Through a critical and intersectional discursive analysis, I show how marginalised groups are pathologised in a way that is used to normalise and justify troubling treatments - treatments that potentially cross the line from therapy to violence. "Rather than using 'therapeutic culture' to refer to the 'therapisation', 'emotionalism', or the pervasiveness of psy discourse in everyday life... I add 'therapeutic' to the concept of rape culture, which argues that rape is a result of complex and interrelated social and cultural factors. This moves the concept of rape away from the individualistic theories of psychology and psychiatry that construct the problem as an internal and uncontrollable 'lust'. 'Therapeutic culture' in this context, then, refers to the complex and interrelated social and cultural 'norms' that produce a particular version of therapy and therapeutic practice within a broader psy complex... " - J. Tosh, 2020, p. 102 Below is a short slideshow outlining the 14 conditions of a therapeutic rape culture, with examples for each. I consider these conditions central to the creation of a context where the abuse of marginalised groups can thrive. Preventing violence and abuse in therapeutic contexts, then, requires addressing and dismantling these conditions. Chapter Abstracts Each chapter of the book (other than the introduction and conclusions chapters) focuses on a particular telling case. The book links those cases through a genealogical discursive analysis that illustrates the interconnectedness of research, theories, and practice regarding gender and sexuality in psychology, psychiatry, and medicine. This tracing of harmful narratives regarding consent, the body, therapy, and sexual violence concludes with the theorisation of a therapeutic rape culture in the final chapter. 1 - Introduction In this chapter I introduce the theoretical underpinnings of the book and define key concepts, such as intersectionality theory, critical discursive psychology, and the medical gaze. Through a range of examples of medical coercion and violence, I conduct an analysis of the concept of ‘the body’ in medical discourse with a focus on the intersections of race, class, gender, sexuality, and disability. The chapter concludes with an overview of the book, as well as a reflection on my own positioning in relation to the topic under analysis. ...where does the 'self' end and the Other begin? Who decides what bacteria is 'good' and 'normal' and part of the constructed bodily boundary of the biological self, and what is constructed as 'bad' and 'pathological' like an invading and colonising Other? 2 - Intersex youth: Non-consensual surgeries and nosocomial sexual abuse This chapter describes and critiques the concept of ‘nosocomial sexual abuse’ that was coined by John Money in his work with intersex youth. Defined as sexual abuse that occurs within medical settings, the concept was often used in discussions of ‘false’ accusations against professionals. I examine the experiences of intersex people in medical and psychological therapies designed to encourage gender conformity and ‘normalisation’. I challenge the dismissal of disclosures of abuse in this context as ‘false’ and interrogate the boundary between ‘therapy’ and violence. I argue that in defining an intervention as harmful or helpful, centering the perspectives of those experiencing the treatment and a more complex and relational concept of consent is imperative. 3 - Queer and trans youth: ‘Sexual rehearsal play’ and reparative therapies Continuing my analysis of therapies that promote gender conformity and the work of John Money, I analyse Money’s conceptualisation of gender development in childhood particularly in relation to sexuality. I critique and problematise his theory of ‘sexual rehearsal play’, that frames sexual orientation as malleable in childhood, and his attempts to manipulate children’s sexuality for a heterosexual outcome. I examine this (hetero)sexualisation of childhood through the lens of consent and sexual abuse, troubling Money’s controversial normalisation of adult-child sexual relationships and his contested concept of ‘heterophobia’. I conclude that sanitising sexual manipulation via therapy destigmatises and trivialises the actions of abusers and the discourse of ‘sexual rehearsal play’ silences survivors of childhood sexual abuse. Queer and trans children who are survivors of sexual abuse must navigate this concept of 'childhood' where they are Othered for their experiences of abuse as well as their gender and sexuality. 4 - ‘Sex’ as treatment: Consent, coercion, and sex therapy This chapter continues to trace the influence of Money’s work, by proceeding with Masters and Johnson’s uptake of his conceptualisation of sexuality as malleable and their therapeutic approach to ‘sexual dysfunction’. I analyse Masters and Johnson’s sex therapy as outlined in their classic text Human Sexual Inadequacy (1970), focusing on constructions of consent and coercion. I examine how this foundational approach to sex therapy shaped broader therapeutic understandings and approaches to sexual difficulties, which created a therapeutic culture where sexual abuse by therapists proliferated. ...what would consent look like in the sex therapy context, where academics removed stimulatory techniques from sex worker communities and implanted them into a pathologizing and oppressive medical system? 5 - Penetration as ‘treatment’: Pathologizing sexual avoidance and pain I further my analysis of the concept of ‘sexual dysfunction’ and the boundary between therapy and violence through an examination of the DSM-5 (APA, 2013) diagnosis of ‘penetration disorder’. I critique its pathologization of non-penetrative sexual activity, sexual avoidance, and vaginal penetrative pain in the context of a longstanding construction of (particularly women’s) sexual ‘frigidity’ as problematic for therapists and heterosexual men alike. I analyse therapies that focus on penetration as ‘treatment’ and their implications for consent and coercion within therapeutic contexts. In addition, then, to analyses of sexual abuse within therapy, I argue that we must also consider how therapy itself can promote and produce further sexual coercion. 6 - Phallometrics: Quantifying sexual violence and sexuality Continuing on from the analysis in the previous chapter of the problematic construction of vaginal penetration as central to sexual ‘normality’ and ‘health’, this chapter examines how the focus on penetration, and particularly the penis, is central to rape discourses within psychology and psychiatry. I analyse the use of phallometrics in research, forensic, and therapeutic settings; that is, the measurement of changes in the penis to assess for sexual arousal. I trace its history from harmful behaviourist reparative therapies with gay men and gender nonconforming people, to its current use to assess for coercive and marginalised sexualities in sexual research and forensic contexts. I analyse phallometric discourse in relation to the construction of sexuality and rape, as well as how the procedure of measuring penile responses is troubling when issues of consent and sexual abuse are considered. I conclude that framing sexuality and rape as solely embodied in the human penis, not only reifies problematic gender binaries of embodiment, but also silences cisgender men survivors of sexual violence. 7 - Conclusions: A therapeutic rape culture Drawing on my analyses throughout the book, in this chapter I outline the process of pathologization, victimisation, and normalisation evident in psychology, psychiatry, and medicine. I describe how the psy-complex first frames particular groups of people as ‘abnormal’ to justify harmful intervention; interventions that are then normalised and sanitised as ‘treatment’. This process occurs within a broader therapeutic rape culture that draws on and contributes to multiple intersecting axes of oppression. Finally, I discuss the need for a culture of consent in therapy to counter the normalisation of abuse in psychology, psychiatry, and medicine, and the importance of believing survivors. To cite: Tosh, J. (2020). The body and consent in psychology, psychiatry, and medicine: A therapeutic rape culture. London: Routledge. About the Author: Dr. Jem Tosh is a Chartered Member of the British Psychological Society and a Full Member of the Canadian Psychological Association. They are the Director of Psygentra, an organisation that specialises in the psychology of gender and trauma. Jem is also the author of Perverse Psychology (2014) and Psychology and Gender Dysphoria: Feminist and Transgender Perspectives (2016). Want slides for your lecture or to give to your students? Download a PDF of the slideshow presentation below: Use promo code FLY21 for 20% discount when purchasing my book from routledge.com

by Dr. Jem Tosh [Content warning for s*xual violence, r*pe, including personal disclosures. Please note that some of the links contain detailed descriptions of r*pe] I recently watched the HBO documentary, Woodstock 1999: Peace, Love, and Rage (2021) - both for my interest in rock music but also because it was known for widespread misogyny and sexual violence. For those unfamiliar, Woodstock '99 was meant to replicate the (nostalgic) celebration of music from the original music festival in 1969 that featured artists like Jimi Hendrix, The Grateful Dead, The Who, and Jefferson Airplane. This time, however, the organisers were worried about losing potential income and ended up fencing in attendees - literally. The documentary shows thousands and thousands of people confined to, what was originally a military base, with a lack of necessary resources (think water, toilets...). This was in addition to just about everything being overpriced and in a heatwave no less. So, at the very least, we can say that the three day event was uncomfortable. ...their biggest hit being the very obviously named 'Break Stuff'. If you thought this was going to be a chilled acoustic song or a romantic duet, I've got some bad news for you. Add to the mix that the organisers didn't really seem in touch with the music at the time. In the documentary one of the organisers still blames Fred Durst (from Limp Bizkit) for the resulting violence and riots that occurred, outraged that he encouraged fans to destroy things - despite Limp Bizkit's biggest hit being the very obviously named 'Break Stuff'. If you thought this was going to be a chilled acoustic song or a romantic duet, I've got some bad news for you. So while big name rock and metal stars like Metallica, Red Hot Chili Peppers, Megadeth, and KoRn played on stage, the crowd got rowdier and by the end, the festival was set on fire. Fires burned, fences were ripped down, mud (mixed with water from the toilets) was leaking just about everywhere. Reports of sexual violence occurred with some sexual assaults being so blatant that performers even commented on them. In the documentary Dextor Holland, lead singer of The Offspring, is shown chastising attendees for groping women who were crowd surfing. Victim-blaming isn't very rock and roll, y'all. As expected of organisers who didn't really understand their target audience, as well as the general sexualization of women and femme folks in rock and metal, they condemned the women for exposing their breasts and the way they dressed. This was despite the original Woodstock's promotion of 'free love' (itself, not as free of misogyny or sexual violence as folks might like to think), and the right for anyone to dress how they like and be free from the threat of violence. Not to mention that it was a heatwave and mud-covered clothing isn't the breathable, moisture-wicking fabric you'd want it to be. Victim-blaming isn't very rock and roll, y'all. Although, some of these moments were described as being more coercive than they were carefree. For example, there were reports that some women showed their breasts out of fear as they were often surrounded by groups of men insisting that they 'show [their] tits'. They feared retaliation or escalation if they refused. Given that men were observed ripping the clothes off women who crowd surfed, it would make sense that some women removed their tops in this situation because they feared that if they did not, the group of men would do it for them - and perhaps more. As one attendee stated: "If you were a girl, and you were topless, you were going to get groped. If you were a girl, and you weren’t topless, you were going to get yelled at for not being topless". This is an important contextual factor as women and girls who attended the event also witnessed sexual violence targeting others. Therefore this implicit threat of further violence for not complying with initial sexual coercion was described by some as the reason for not resisting, reporting, or calling for help - because of a fear of attracting the attention of more potential attackers. As there were reports of multiple gang rapes (e.g. during KoRn's set), as well as observers cheering perpetrators on during the violence, this was not an unreasonable or irrational fear. ...they simply had nowhere to go and no one to turn to. That's what happens when sexual abuse occurs in plain sight and no one gives a damn The documentary does touch on the fact that the crowd was predominately young, white, men and that making necessary items (like food, water, somewhere to sleep and shower) inaccessible or of such poor quality as to be practically redundant, as well as a lack of organisation and security, was a context for violence to thrive. While (white) men can be, and are, victims of violence (including sexual violence), they are also shown to be the perpetrators in the majority of cases of interpersonal and mass violence. So, while there were plenty of violent men who assaulted women at the event, there were also plenty who didn't, as well as plenty of folks who witnessed violence and did nothing. For the victims, they simply had nowhere to go and no one to turn to. That's what happens when sexual abuse occurs in plain sight and no one gives a damn (and that's as true for families as it is for festivals).* Blaming the Music It's easy in these cases to blame the music. Marilyn Mason had his fair share of being blamed for violence committed by fans. He was initially outspoken about this oversimplification in such a way that often surprised his accusers - he was more articulate and knowledgeable than they expected of someone who looked and sounded like him. He highlighted how his work was a critique of the violent norms of America, from 'Portrait of an American Family' to 'Disposable Teens' - it was an (anarchist) outrage against systems and structures that normalise harm and oppression. As Manson said in response to his music being associated with the Columbine School Shooting, "A lot of people forget or never realize that I started my band as a criticism of these very issues of despair and hypocrisy." These arguments perhaps carry less weight now that he is currently being investigated for multiple counts of r*pe and abuse. For survivors of sexual violence who sought comfort in his music, this can be a devastating revelation. It's easy to look at the aggressive sounds and lyrics of the music and say, 'Well, what did you expect?' but then why is this question not asked when the same accusations are made against musicians in other (more socially accepted) genres, like pop music? Artists that have long histories of abuse allegations (e.g. Micheal Jackson), as well as song lyrics that promote violence (e.g. 'Blurred Lines'), show that sexual abuse by musicians (or fans) and violent themes are not limited to rock and metal music. For example, there were rapes reported and witnessed in the 'Rave Hangar' during Moby's set and at Alanis Morrisette's performance at Woodstock '99. The latter had a predominantly female audience and men still (violently) sexually assaulted women crowd surfers. This was in addition to the assaults that occurred nowhere near the music - in tents and towards food vendors. Music concerts and festivals in a rape culture carry the same threats of violence as other social spaces in that culture. If rock or metal music caused violence (including sexual violence) then we wouldn't see it occurring within other genres or other fandoms - but it does. Fans of jazz, hip-hop (both more scrutinised than others due to anti-black racism), pop, dance, and more, sexually abuse other people. No genre is immune because sexual abuse and consent are far more complex, contextual, and personal than listening to a song and being indoctrinated by it to commit a violent act. The other side of this, is that if rock and metal music caused violence, then everyone who listened to it would be violent. If they're not (and they're not, because that would be a whole lot of people) then it shows that there are other pertinent factors. For those fans who are violent, the violence has another cause. It doesn't exist in a vacuum, although heavy metal does make for an easy scapegoat. Something often missing from the analysis of Woodstock '99 and the violence that ensued, was that these bands often play large festivals that don't spiral into bonfire-fuelled destruction - such as the annual Download Festival in the UK. Sexual violence can be a common experience at music events though - as can any space where groups gather, because they reflect the greater power structures and inequalities of that society. Music concerts and festivals in a rape culture carry the same threats of violence as other social spaces in that culture. Surviving with(in) metal music Something else that often gets missed by those who blame the music, is just how varied that music genre is. On the one hand, you have Limp Bizkit singing about the 'he says, she says bullshit', a phrase often used to discredit r*pe and abuse accusations. On the other hand you have KoRn, with lead singer Jonathan Davis who has publicly talked about being a survivor of childhood sexual abuse and the trauma of living in an abusive home**. KoRn's very beginning centred Jonathan's experience of abuse with the devastating and infamous 17-minute song 'Daddy' from their debut album: You raped! I feel dirty It hurt! As a child Tied down! That's a good boy And fucked! Your own child I scream! No one hears me It hurt! I'm not a liar My God! Saw you watching Mommy why?! Your own child Jonathan breaks down sobbing in this song and it's utterly heartbreaking to hear. Listening to 'Daddy' as a teenager was probably the first time I tapped into my own memories of childhood sexual abuse in a way that I couldn't verbalise to anyone. I cried alongside the song, when Jonathan did, and sobbed for many hours (and days) afterwards in a cathartic release of grief and validation. In a way, it feels like he is the first person I disclosed to, the first person who 'got it', and someone who would finally believe me. As many other KoRn fans have said, that album made them feel less alone. This is particularly true due to the representation of gender in the song. The title of 'Daddy' and the chorus referencing 'Mommy' meant that incest survivors could relate to the lyrics regardless of the gender of their abuser. For example, it could be a cry to a father declaring that their mother abused them, but simultaneously an anger at a mother for letting a father abuse them. Also, given that Jonathan's abuse was not incestuous but involved a female family friend who babysat him, his expressions and experiences can reach a broader group of survivors of childhood sexual abuse too. The parental themes in the song were a result of Jonathan telling his parents and not being believed (e.g. "No one hears me/I'm not a liar"). So, while Jonathan has later stated that his biggest regret is the name of the song because people assumed he was abused by his father, the name gives voice to those who have been sexually abused by their parents. Perhaps even rarer still, Jonathan's experience gives voice to those who have been sexually abused by women (not necessarily a rare event, but something that rarely gets discussed or acknowledged). In a way, it feels like he is the first person I disclosed to, the first person who 'got it', and someone who would finally believe me. As many other KoRn fans have said, that album made them feel less alone. The theme of childhood abuse (and sexual abuse) filters throughout KoRn's discography - from high school experiences of homophobic bullying in 'f*get' (based on Jonathan's way of dressing during his teens - "Here I am different in this normal world/Why did you tease me, made me feel upset?/Walking stereotypes feeding their heads")*** to the images on album covers (i.e. their debut album, the Issues' fan cover) and music videos (e.g. 'Falling Away From Me'). Even in their groundbreaking 'Freak on a Leash' video, where the main theme is following a bullet as it passes through a range of items - it is a bullet directed at the band, not one they have fired. They play the heaviest part of the song in a dome filled with bullet holes. This positions the band as the target (or the victim) not the oppressor. Like Jonathan has described, it was 'a band of outcasts'. The therapeutic side of live (metal) music There were times when I felt safer in a mosh pit than in my own bed. When I was being sexually assaulted as a child (and as a teen, and later again as an adult), I froze. When I was in the mosh pit, I fought back. There's an important bodily experience there - from learning from a young age (especially as someone read as femme) not to fight back and not to answer back, to physically defending yourself when surrounded by aggressive men who are bigger and older than you and in an environment where you are heavily outnumbered. Learning that I could fight back and survive was important, and it occurred at a time and in space where when people fell over in the mosh pit, people stopped and helped them up. It was consensual, in that those who wanted to be there gravitated towards the pit, and those who didn't want to be a part of it stood back and watched. It felt then how my boxing classes feel now. The gigs and venues were smaller, the bands less well known, the crowds made up of the freaks, geeks, and outcasts. It was a space where those who felt (and/or were) excluded everywhere else could feel at 'home', where they could be pissed off at a cruel and unfair world without judgement. There were times when I felt safer in a mosh pit than in my own bed. Even the movements of jumping, shaking, and head banging can be a therapeutic release - like shaking can be recommended for abuse survivors to release tension in the body, free body memories, or to complete a frozen fight or flight cycle. This is a noted feature of Jonathan Davis' live performances: "It’s no wonder his trademark stage move is a full-body convulsion that suggests he needs to shake off his own skin." This nuance can get lost in an oversimplification of aggression - one that conflates consensual aggression with (nonconsensual) violence. What those who like to blame heavy metal miss, is that anger can be a constructive, functional, and 'healthy' response to abuse. For those who have been sexually abused in childhood, that portrayal of traditional or nuclear families as 'good' and heavy metal music as 'bad' can be alienating. For an incest survivor, that constructed ideal of the 'family' can be nothing but a myth - and they might want a space where they can call it out, or even scream about it. That 'nice', polite exterior of a family can hide so much cruelty and harm, just as much as heavy metal can hide empathy and compassion (e.g. KoRn's 'Somebody, Someone' might sound aggressive unless you pay attention to the lyrics - 'I need somebody, someone/Can't somebody help me?/All I need is to be/loved just for me'). Heavy metal isn't afraid to scream about injustice and abuse as loud as it can, and that can be soothing and feel safer than the secrecy of an abusive home. So, not all metal is the same, and not all anger is the same. As Beverly Engel writes in her book on healing from sexual abuse - there are many constructive ways that survivors can release their anger as a part of their healing, such as physically (e.g. boxing), verbally (e.g. screaming into a pillow), through the written word (e.g. write a letter you never intend to post), or with your imagination (e.g. visualise releasing your anger). Heavy metal isn't afraid to scream about injustice and abuse as loud as it can, and that can be soothing and feel safer than the secrecy of an abusive home. In a way, the anger of KoRn's music, the loud highly distorted guitars, and the screaming, kept me alive. It can be easy to fall into the depression and hopelessness of childhood sexual abuse - the feelings of powerless can consume you, along with believing that you (and your body) are worthless. Getting pissed off instead (recognising that you didn't deserve the abuse and it shouldn't have happened) and putting the blame where it belongs (with the abuser), can be a path to healing. So whether you want to punch a punchbag, write a letter that you'll never post, or scream 'I fucking hate you!' repeatedly along with Jonathan Davis (on 'Right Now') - constructive anger directed in a healing way can be helpful. Conclusions Being a survivor and a metal fan can be complicated, like dealing with the misogyny and sexual violence from other fans. As Jonathan Davis stated, "Nu-metal was full of misogynistic dickhead jocks... The sort of people who'd be bullying me at school if they weren't supporting my band at shows." One of the last gigs I went to I was sexually assaulted by a group of young men who followed me around the venue wherever I went, and no one intervened or helped so I had no choice but to leave. The gigs had changed - they were bigger with a more diverse group of people, some fellow survivors, some who thrived on violence. So not all gigs are the same and that's the difficult part for survivors who are fans of heavy metal. Sometimes those spaces will be healing, sometimes they will be harmful. But that's art - it's open to interpretation beyond the artist's original intentions, much like any text. As the music became more popular, survivors like Jonathan Davis had to contend with the spaces they first went to escape victimisation being filled with those who aligned with the ideas and concepts that were central to it. From 'f*get' being an anthem against homophobic bullying and a personal account of the suffering it causes, to 'jocks' 'gleefully' chanting the homophobic slur completely disconnected from the original meaning of the song - or survivors of sexual abuse feeling empowered and inspired by someone not afraid to speak their truth at a live concert, to the fear of being sexually assaulted at that gig by fans who seem to have missed the point by a mile: "Judging by the Woodstock ’99 rapes that reportedly began with Korn’s set, Davis’s embattled conscience is lost on the same lugheads who flocked to Nirvana’s noise without reaching its tender center... Korn are far more complicated than the scene they’ve engendered". To cite: Tosh, J. (2021). Heavy metal and healing trauma \m/. psygentra.com Footnotes: * Thats not to say that it is never taken seriously or that things haven't changed at all since 1999. For example, a sexual assault was reported and investigated at a recent KoRn concert and the perpetrator handed himself in to authorities. ** However, Limp Bizkit and KoRn did collaborate on the highly criticised 'All in the Family' song - that used problematic language regarding homophobia and sexual abuse. Jonathan Davis has subsequently apologised for the song and said that everyone who was involved is embarrassed that they did it. He also attributed the atypical themes being a result of excessive alcohol, and Jonathan started his sobriety shortly after the album ('Follow the Leader') was released. He stated that at this time in his career, when KoRn quickly grew in popularity, he felt that he was performing a 'role' that was expected of him. He has also apologised for the other problematic (and misogynistic song) 'Cameltosis': "What the fuck was I fucking thinking? I was 27. I was still really immature." *** Jonathan questioned his sexuality as a result of this homophobic bullying but he is straight. He maintains that labelling someone else's sexuality or making assumptions about it is harmful, and has been unwavering in his support for queer people: "No-one is born racist or homophobic – that behaviour is taught" and, "To me love is love, and if two people love each other they should have the right to be wed." He has also shown his support for transgender folks: "I think it’s cool. If you feel inside you are a woman, be a woman – no one can take that away from you... No one can make that feeling go away. If that’s what you need to do to be complete, then no one has the right to tell you you can’t do that" - as have other band members, like guitarist Head. On Black Labyrinth (Jonathan's solo project released in 2018) was a song entitled gender that covered themes many gender nonconformists can relate to: "I know my gender but still I demand (To be you)/Turn my gender down/I'm sick of this situation/I've outgrown what I'm made of." Resources The Legacy of Woodstock '99 is Sexual Assault - Steven Hyden (2019) Two Woodstock Fans Allegedly Raped in Mosh Pits - MTV (1999) Don't Drink the Brown Water: Our Live Report from Woodstock '99 - SPIN The Art vs. The Artist: Reckoning with My Favourite Musicians' #MeToo Allegations - USA Today (2019) Heavy Metal Youth Identities: Researching the Musical Empowerment of Youth Transitions and Psychosocial Wellbeing - P. Rowe Mining the Motherload: Mastodon's #twerkgate and Sexual Objectification in Metal - K. Sollee, Metal Music Studies (2015) Black Metal, Trauma, Subjectivity and Sound: Screaming the Abyss - J. Shadrack Scene Witch - "Scene Witch exists because survivors of sexual violence in our music communities are not being heard or believed."