The Marketing of Dysphoria

I’m starting to think my struggle may be more related to my body than I wanted to believe.  My childhood is mostly a blur, but one of my earliest memories is of the relief I would feel when I tucked my penis behind my legs and imagined the image of myself in the mirror to be that of a girl.  When I was seven I performed “surgery” on my baby doll Charles Cherry Cherry Coquette by cutting out nir penis with a pair of scissors.  To this day, when my nail polish is looking good, I want to chop a finger off and put it in a jar of formaldehyde so it can be preserved in all its girlyness without the shame of being attached to me.  When I have sex sometimes having my chest touched feels wrong and awkward.  The other day I went against my own advice and wore a dress because it looked pretty good combined with pants and and a cardigan and a wide belt to give the illusion of a waist, and I definitely experienced having phantom breasts, which was strange.


If I were to drink the Trans-Aid, I would conclude that I have a female “subconscious sex.”  That my brain is wired in a “female” pattern and my suffering results from a “map” in the brain that does not match my body.  I haven’t ruled this out, but I think it’s much more likely that these bodily sensations are the result of psychogenic pain and misattribution of arousal. I propose that the indignities experienced by a gender-variant person in our society are so great that anger at society and anger at oneself is turned toward the body as a protective distraction to keep dangerous repressed emotions from being consciously experienced.  And I believe the anxiety brought on by the cognitive dissonance of gender-non-conforming presentations leads to perceptions such as phantom breasts because maintaining the conflicting beliefs “I am male” and “I am wearing women’s clothes in broad daylight” is so distressing.

I’ve definitely been convinced that there is some fundamental difference in the brains of transgender persons which manifests before birth.  But I reject the idea that the pain that results from this difference could possibly be best treated by modifying the body with surgery and hormones.

Excessive Humanity Disorder

Part of the reason I am so reluctant to try hormones is that I have an intense distrust of the medical industry.  I’m not sure how much that distrust is rational and how much is borne from being raised by an abusive psychiatrist who diagnosed me with Oppositional Defiant Disorder, physically abused me, and subjected me to cold showers and scorn to punish me every time I would engage in “anal expulsive” behavior when I failed (or refused, according to my father) to be potty trained at the age of four.  In any case I believe most doctors have their pocketbooks more than my well-being at heart.

Psychiatry especially has no idea what the fuck it is doing.  I mean, sure it has improved somewhat from last century’s shock therapies and lobotomies, but the change in its barbarism is not in quality and only in degree.

The reason psychiatry adopted a pharmaceutical model is not that it would cure mental “illness” but because of an embarrassing business problem.  Overcrowding in mental hospitals cages was reaching the proportions of an untenable crisis.  Meanwhile, Smith, Kline & French were using a shotgun approach to finding a market for the serendipitously “tranquilizing” Thorazine, which was discovered when trying to find a cure for malaria.  The pharmaceutical company marketed the powerful drug for a wide range of conditions from asthma to menopause before discovering that it was the perfect solution to the contemporary crisis in the business model of psychiatry.  Of course, the drug didn’t cure the patients.  It just disabled their brains to such an extent that they were no longer able to experience psychosis.  While the marketing said one thing, all the experts agreed it was just a “chemical lobotomy.”

The growth in the psychiatric drug industry since this watershed of deinstitutionalization is unfathomable.  The APA, FDA, and pharmaceutical companies formed an incestuous relationship with the intent of pathologizing humanity to the extent that over twenty percent of Amerikans now take psychiatric drugs.  Does one in five people really require psychiatric drugging?

Below are two advertisements for psychiatric drugs, one for Serentil from the 1960s, and one for Paxil from the 1990s.  Both of them position the drugs as solutions to wholly ordinary problems, whether “for the newcomer in town who can’t make friends,” or for the person who “would love to find someone special, only can’t.

Excessive Humanity Disorder: Then and Now

“Serene-til” was a potent “antipsychotic” with a high risk of permanent side effects such as tardive dyskenesia, cardiac arrhythmia, and sudden death.  It was finally withdrawn from the market more than forty years after release in 2004.  “Peace-il” is a supposedly safe “antidepressant” that allegedly functions by selectively inhibiting the reuptake of serotonin in the brain.  However, the evidence shows that SSRIs produce dependence and withdrawal just like an addictive drug, only the psychiatrists call this addiction “antidepressant discontinuation syndrome.” Cocaine happens to be another serotonin reuptake inhibitor.  I wonder if history’s greatest proponent Sigmund Freud had “cocaine discontinuation syndrome.”

SSRIs can also induce mania and akathisia, and have been implicated in many violent episodes including murder and suicide.  Of course, if an SSRI causes someone to have a manic episode, the psychiatrists say the “medication” “uncovered” the “patient’s” “underlying” “bipolar” “disorder.”  Not “Oops we poisoned this guy with powerfully toxic psychoactive chemicals and it caused nem to gun down forty people in a movie theater.  Sorry.”  How long will it be until Paxil is taken off the market just like Serentil?

Most psychological “disorders” and “syndromes” are just regurgitations and collations of the subjective experiences reported by patients themselves–fabricated pathologizations of natural human experience subjected to the inhumanity of modern society.  No one would prescribe Paxil for “major depressive disorder” because Prozac was generic and cost one-tenth as much.  Therefore Glaxo Smith Kline took ordinary shyness and invented a new illness “Social Anxiety Disorder” and got it into the DSM-IV.  Paxil became the only drug approved for use in this disorder, and so GSK could then market its patented drug and rake in the revenue.

Gender Dysphoria seems to be the one case where the psychiatric community has finally admitted that it is unable to diagnose someone with a disorder.  If you go to a psychiatrist and say “I think I have depression, what do you think?”the psychiatrist will conduct an interview and make an official diagnosis that you have “major depressive disorder” or not.  If you go to a psychiatrist and say “I think I have gender dysphoria, what do you think?” the psychiatrist will say no one can determine that but yourself.  So the sole diagnostic criterion for whether you have gender dysphoria is that you decide you have gender dysphoria.  I would call that simply no longer being blind to how gender is traumatizing to everyone.

The fact that transgender identities are no longer seen as pathological by psychiatry does not change the fact that the medical industry is still over-medicating the condition.  The psychiatrists are just passing on the business and referring it to more lucrative specialists in endocrinology and plastic surgery.  When all you have is a hammer, it’s irrelevant that every individual is a uniquely shaped peg and society contains only round and square holes.  You’re going to pound on the problem the only way you know how just the same.

About now is when the psychiatrists start to wonder whether I have “paranoid personality disorder.”  I guess it’s possible I am excessively distrustful.  I’ve never taken an SSRI.  If I were going to buy into the medical model of treating the individual traumas of a dysfunctional society, it would be crazy not to try an SSRI before I leaped to estrogen, don’t you think?  Unfortunately I believe an SSRI or estrogen have about as much potential to make me happy as a fuller head of hair or a new car for that matter.  My happiness is only going to come from within.

Dysphoria or Dissociation?

The author of ThirdWayTrans wrote an insightful post about how “dysphoria is very ordinary.”  On one level I agree.  The experience of a flat-chested person wanting breasts is not fundamentally different in a qualitative way from the experience of a bald-headed person wanting hair.  The problems only differ in the narratives that are used to understand the problems and the intensity with which the dissatisfaction is felt.  If society were arranged so that bald people shopped in different clothing departments, or were expected to paint their scalps to be beautiful, someone might very well feel like a full-haired person trapped in a bald-haired body.

On another level, I do think gender dysphoria is unique.  The ordinary parts of gender dysphoria discussed by ThirdWayTrans are its conscious manifestations, like the desire to wear different clothes, or be treated differently and be recognized as a different gender, or have different morphological characteristics.  To me the extraordinary parts of dysphoria are its unconscious manifestations.

It may be that, as an early transitioner, the author of ThirdWayTrans did not have the experience trans people who did not transition at an early age report, where gender dysphoria manifests as unconscious malaise, repression, and dissociation as described accurately by Anne Vitale and Jamie Veale.  I believe this experience is fundamentally different from ordinary dissatisfaction (or dukkha as the Buddha would call it).

To this day, the joy and sense of rightness that the idea of being female arouses within me occurs in fleeting moments before it is exiled from my consciousness by my psychological defenses.  It feels like a faint echo from another galaxy that somehow managed to reach me through the vacuum of space.  It feels like my life is a film in black and white, but someone who wants me to know I am more spliced in a disorienting frame of technicolor.  It feels like I’m in touch with a ghost from a past life.  It feels like I’ve yet to be born.  It feels like feeling it for more than a split second would warp the fabric of space-time and catapult me into another dimension I could never possibly have comprehended before.  It feels like everything else is just this strange nightmare that I’m too afraid to accept is not real.  I guess derealization and depersonalization such as this might be “ordinary,” and occur on a spectrum, and I’m just more dissociated than the average person, but it’s still terrifying.

The psychotherapist Daniel Mackler produced a film called the Four Stages of Emotional Healing where ne outlines a path of 1) dissociation, 2) depression, 3) grieving, and 4) enlightenment.  In the film, ne astutely identifies that the modus operandi of most psychological practitioners is to bring clients backward from depression into the inferior state of dissociation.  It’s pretty obvious that the function of “transition” is to bring clients back from suffering into a dissociated state.  Anyone with a penis who says ne is a woman is in pretty much the epitome of a dissociated, or perhaps even delusional state.

As ThirdWayTrans wrote in October, “I think people really are letting go of a false self in the process of transition, the trick is not to just adopt a second one.”  I hope to master this trick.  However, if I know one thing it’s that I have to reunite myself with that fleeting joy.  I hope that reunion does not require me to pretend to be a woman, but if it does, so be it.  I can no longer stand feeling so utterly disconnected from myself.

Not to be Reproduced (La reproduction interdite), René Magritte, oil on canvas, 1937.

Perceptual Narrowing and Culturally Mandated Emotional Crippling of Children


During early childhood, our brains are sensitive to a broad array of stimuli and amenable to adopting a wide variety of cognitions and beliefs. As children develop, these perceptual abilities are narrowed through a neurological process called synaptic pruning. Infants’ neurons are all wired together in a redundant manner, but as a child matures many of these connections are abandoned. The initial redundancy in the brain allows the infant to respond to any environment, while the subsequent specificity allows the child to respond best to the particular environment into which it was born. While aiding learning, this process also results in the loss of ability to make certain observations that would have been possible in another environment.

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Introducing Pas un Homme

In nir 1929 painting The Treachery of Images (La Trahison des Images) René Magritte invites us to fundamentally question the reliability of our understanding of reality. The painting features an archetypal depiction of a smoking pipe. However, directly below the pipe appears text which, in French, disclaims “This is not a pipe.”

The Treachery of Images, René Magritte, Oil on Canvas, 1929
The Treachery of Images, René Magritte, Oil on Canvas, 1929

Clearly the depiction of the pipe is not a pipe. But the contradiction implores us to consider how we are betrayed not only by the image, but also by our mental models of reality.

By what means do we arrive at the calculation which awards truth to the verbal statement rather than the image? We compare the painting of the pipe to our memories of experienced pipes, to thoughts about pipes, to Sherlock Holmes, to the mental schema of a pipe. This schema is no more real than the painting. In fact, even when smoking a pipe, one never fully grasps its reality directly. Only our ideas about reality can be known. And our ideas about reality are inevitably wrong.

Gender is such an idea about reality—an especially pernicious idea about reality. Gender betrays us far more than the image of the pipe because, unlike the painting, gender is deliberately misleading. To fail our trust as much as gender, the image of the pipe would need to be painted hot pink and doused with a heavy layer of glitter and feminine deodorant spray. For example, the following image might depict the treachery of gender.


That’s right. This is not a shoe. Moreover it’s not even an image of a shoe. Wikipedia defines a shoe as “an item of footwear intended to protect and comfort the human foot while doing various activities.” The image may be of an ornament, a sex toy, a torture implement, or a glass cutting device intended for use on ceilings, but certainly not a shoe.

Similarly, I am not a man.

About the Author

My name is Nickie McKinley. I’m a thirty-one year old person with XY chromosomes (I assume), an elongated genital tubercle, and a predominantly androgenic hormonal mix, but also a strongly repressed self-identification with the social categorization of people commonly known as females. Many people in a similar situation these days would take estrogen and start living “as a woman.” The idea of doing that feels even more inauthentic than presenting myself as a man. Instead, I’m trying to socially transition to a liminal gender status—that is occupying a position at the (illusory) boundary between the sexes.  Some would call that “genderqueer” but calling it liminality more specifically describes what I want to achieve, and highlights gender as a caste system and the difficulty encountered by anyone attempting to question the cultural hegemony and the legitimacy of the castes.  This blog is partly an account of and aid to my social transition, and partly a discussion of relevant issues in feminist, queer, and transgender theory and activism.

I separated from my wife last year and live in Portland, Oregon with my six-year old child, and when I’m not biting the polish off my nails fretting over gender, I enjoy playing music and the ancient Chinese game of go (围棋). Unfortunately my favorite photo is a shameless bathroom selife but I’m so happy to finally have my makeup out on the counter and a bow in my curls, having just had them cut for the first time since growing out my “Ivy League,” and think I look super hot! I dunno if I’m gonna get any readers or not (this is my first blog), but if you’re here, I’d love to get your comments! Or you can email me at

Ceci n’est pas un homme.