Over the past year, and especially since the publication of Switched On by John Elder Robison, there has been a lot of attention around a therapy called TMS (or rTMS–Repetitive Transcranial Stimulation).
It’s something I have deep reservations about but others have written passionately and eloquently on the subject. What I want to consider is why somebody would choose to undergo such a therapy that literally changes their mind.
I’m no stranger to the negative feelings that arise when considering the gap between how I perceive myself and what I see when I look in the mirror: that’s a big factor in my gender dysphoria.
I also know first-hand how it feels to be teased and ridiculed for hand flapping, physical clumsiness, social awkwardness, unusual speech patterns and eclectic interests. I’ve had life-long difficulty making and maintaining interpersonal relationships, and I have times where I feel keenly the lack of people with whom I feel comfortable opening up about my problems and feelings.
I understand the drive to make physical changes to one’s body. After all, I’m in the process of seeking treatment to modify my own body, bringing it into closer alignment with what I see in my mind by erasing or concealing male characteristics and developing female ones.
There are two parts to my gender dysphoria. First there is my need to have other people respond to me as a woman, reinforcing my gender identity. Second there is my need to see my own body physically match the mental image I hold.
So as a trans woman I am actively seeking treatment to make changes to my body. This is in contrast to my feelings about my autism. Both my gender identity and my autistic identity go to the very heart of who I am.
The thing is, although I will happily modify the physical characteristics of my body I wouldn’t consider altering my mind. My neurology is inextricably tied to my identity: I feel that changing my mind would make me into a different person.
There’s a line there. I’ve put a foot over that line a few times, testing the water so to speak. I’ve experienced the effects of drugs that affect the workings of the brain: alcohol, marijuana, amphetamines, SSRIs (anti-depressant).
Some of them have positive aspects. For example, alcohol reduces my social anxiety. But there are negatives too: I make poor decisions under the influence of alcohol because it inhibits my self-control and risk-aversion: I’ve gotten myself into some dangerous situations as a result.
Speed (amphetamine) left me unable to concentrate, marijuana was relaxing but caused mild hallucinations and a degree of paranoia. The SSRIs reduced the intensity of my emotions, leaving me feeling numb: in the end I had trouble focusing and engaging with things in my life.
These were all temporary effects: my mind returned to its usual functioning state in time for which I was grateful. You see, I wasn’t myself when under the influence of any of these drugs.
I guess my point is that given the complexity of the human brain and the way its many regions interact it is not possible to adjust one aspect without affecting others. Just as a particular drug affects a small number of electro-chemical interactions in the brain with wider-reaching side-effects, so a therapy like rTMS that alters a small region must cause knock-on changes across the entire organ.
My opinion is that it is not like tuning an engine, a relatively simple system with a limited degree of interconnection and feedback between its components. It’s more like introducing a foreign species into an existing ecosystem. The effects can be slow to manifest, and predictions are error-prone due to the complexity and chaotic nature of the system.
There is no way to know what other effects rTMS would have. It might reduce my social anxiety, but even if that was all it did it would make me respond differently to people I interact with (like alcohol). And if my thoughts and behavior are changed then I’m no longer the same person.
I don’t want to change who I am: I’m comfortable with my identity as an autistic trans woman with all that entails. Changing my body doesn’t affect my personality, my thoughts: I remain me. Changing my mind makes me into somebody else. I would lose the essence of what makes me this particular unique individual, and the thought of that fills me with dread.
This leads me to suppose that for somebody to even contemplate such a thing they must not like who they are. Internalized self-hatred, blaming their neurology for what they see as their failings. It’s like body dysmorphia projected onto the ego, the sense of self. The antithesis of neurodiversity’s principles; an inability or refusal to accept one’s differences.
I see this as a result of thinking colored by the medical model of autism that sees it in terms of pathological deficits, as opposed to the social model which instead looks to society’s failures to provide suitable accommodations and acceptance as the causes of disability.
There’s nothing wrong with my mind: I have no reason to change it. I can’t say the same for the society I live in.
My Autistic Dance 
Reblogged this on bunnyhopscotch and commented:
Another poignant piece by Alex, sonic worded resonance that I am right now unable to enunciate. My favourite: “I don’t want to change who I am: I’m comfortable with my identity as an autistic trans woman with all that entails. Changing my body doesn’t affect my personality, my thoughts: I remain me. Changing my mind makes me into somebody else. I would lose the essence of what makes me this particular unique individual, and the thought of that fills me with dread.
This leads me to suppose that for somebody to even contemplate such a thing they must not like who they are. Internalized self-hatred, blaming their neurology for what they see as their failings. It’s like body dysmorphia projected onto the ego, the sense of self. The antithesis of neurodiversity’s principles; an inability or refusal to accept one’s differences.
I see this as a result of thinking colored by the medical model of autism that sees it in terms of pathological deficits, as opposed to the social model which instead looks to society’s failures to provide suitable accommodations and acceptance as the causes of disability.”
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Thank you for sharing my thoughts xoxo
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I agree there is no obligation to change anything in your case, autism and being trans are all part of the human tapestry and why would you want to change that? But is there any scientific evidence that it works, (whether you want it to or not)? I ask because there are some people whose minds need to be changed. Paedophiles, sociopaths etc? They are part of the human tapestry I could happily live without.
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Hi Jules. The examples you mention are outside the scope of TMS therapy, and I’d not expect such people to elect to undergo treatments without duress–I’m writing about what would induce someone to willingly choose to alter what makes them who they are.
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Point taken. The whole thing looks questionable to say the very least.
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Why is one dysmorphia more valid than another? Neurological weaknesses in abilities in particular, are not personality, ego, sense of self, etc. So it makes no sense to describe hating the inability to do what one wants and needs, as self-hatred. What if someone wants their neurological aptitude to match what their mind perceives of their intended actions and goals? There’s no model of anything. There’s just reality, which includes individuals not liking failure and limited success due to insufficient facilities, while others get success with ease.
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Body Dysmorphia (Body Dysmorphic Disorder, BDD) is a conviction that one’s body differs from what is observed–it has parallels to the distorted body image that is often a cause of anorexia nervosa. Gender Dysphoria (not dysmorphia) is different in that a person with the condition has an accurate view of their own body. Although BDD and GD appear superficially similar they are very different. In BDD a person does not see their body as it is in reality; in GD they do. Treatments shown to have the best outcomes differ between the two: as an anxiety disorder BDD is most successfully treated by CBT (Cognitive Behavioral Therapy) or SSRI medication. On the other hand, the optimum treatment for GD is to live as their self-identified gender, often with the help of medical treatment to transition.
Autism can present in a number of ways that mean we face obstacles in day-to-day life: it can be a disability. The paradigm that is the social model of disability sees these obstacles as failures of society to adequately accommodate all its members. There are already many accommodations that most people take for granted: adjustable seats in cars, a range of sizes of ready-to-wear clothing, street lighting. But there are people who need additional accommodations, and those should be provided as a matter of course. That is how equal access can be provided, and the fact that it is not is society’s failing.
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Billy are you separating reality from emotions? In 2 (related) ways- one that there is no connection and the other that emotions do not exist?
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We all know what emotions are involved in this. I think you’re trying to distract others from going into the issues.
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Why did say that? It was a legitimate question. I am very upset you would respond that way.
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“What if someone wants their neurological aptitude to match what their mind perceives of their intended actions and goals?”
This is something I’m pretty comfortable presuming that most people–autistic, disabled, and not–experience to some degree at some point in their lives.
The vast, vast majority of people will come to a point, in regard to something in their lives, where they’ll recognize that they don’t have the abilities they want or need. Some of those abilities are things that they can work towards gaining, but some might not be.
Some people are going to work relentlessly towards gaining them, and some are going to turn back, choose another path, or adjust their expectations for what success has to look like.
There’s no magic pill for anyone for this.
I know everything just looks easier for non-autistic people. In SOME ways, it actually is. In some ways, we actually do have bigger, harder gaps to bridge between what we want to be able to do and what we ever will actually be able to.
But like, pretty much everyone actually does experience some kind of mismatch between their abilities and what they want.
Only for us is “experimental, possibly irreversible, possibly incredibly damaging medical treatment” seen as a potential viable option.
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I think anyone who lacks abilities they want and need should have a chance to get them through technology. I think it’s apparent that science is only getting better at understanding the problems and devising improvements with precision that would minimize risk.
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I tend to agree. I think informed, consenting adults should have access to safe and effective therapies that they want access to, and I think new technology has a lot of promise for people with some of the most troublesome communication challenges of autism.
My beef is when autism, itself, is seen as so inherently undesirable that dangerous, largely untested procedures are pushed as treatment by people who don’t remotely understand enough about autism, for incredibly vulnerable, desperate people. Including parents, who are often willing to subject their children to some of the most dangerous, dehumanizing nonsense out there for the remotest hope of getting a non-autistic or “recovered” child.
Autism presents a lot of really complicated difficulties. I think we should have better therapies available.
But currently what we have is a professional belief system so fixated on autism as inherently wrong and bad that practically *anything* is justified as an attempt to “treat” or cure or prevent it, even if it’s dangerous or damaging to autistic people, without really understanding autism or the social pressures and prejudices that work against autistic people
at all.
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And it’s *still* vital to understand that there is no magic pill. Technology has the potential to bring a lot of relief and increased autonomy and choices to disabled people. But it can’t just bestow abilities on a person.
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