Adventures with a Tokyo Headshrinker

So cliche it's almost funny. Almost.

January 26, 2008

So I visited a therapist in Tokyo, a different one from before, with the goal of laying out my situation calmly and logically and asking him for a letter of official psychiatric approval so I can go about getting hormones. Now the complaint I've had about therapists in the past is that they encourage me to talk about myself at length, but then they don't contribute anything to the discussion. If I wanted to hear myself talk I could do that at home, for free. This guy was a little different; he was the first one who would interrupt me before I'd had my say.

Me: [blah blah blah trannie thing--]
Him: May I see your fingernails? I notice you have a tendency to pick at them.
Me: Yeah, I think I have warts on my cuticles, they don't heal right and never have so I'm always picking at them. Anyway, like I was saying--
Him: You seem agitated. Do you always talk this fast?
Me: When I'm paying $130 an hour, yes. So back to the subject at hand--
Him: Do you suffer from insomnia?
Me: Uhh, yeah I did for a while when I was first getting a grasp on the situation. But then I talked with my mother and--
Him: Do you have a history of depression?
Me: ......

And so on it went. He seemed to think that my bout of insomnia (which was over two years ago) was very significant, even referred to it as "the elephant in the room" that we weren't talking about. He was keen to hear about my father's experiences with depression, asked leading questions about whether I considered myself easily distractable and rushed from activity to activity, and then made a bunch of observations that sounded like they'd come straight out of Psychology for Dummies. It didn't take spider sense to tell that he working up to something, even before he hauled the DSM-IV book off the shelf.

"Now I'm going to suggest something, and I don't want you to get angry with me," he said in a deliberately soothing tone of voice, like he thought I was unstable and likely to wig out. "I'm not suggesting that this invalidates the issue of transsexuality, but..."

"You think you've got an incidental diagnosis for me," I said, amused because I do think there's something off with me, even apart from the trannie thing, but he'd been asking the wrong questions to know that. "Go ahead."

In his professional opinion, I was intelligent, charismatic, talented, and hypomanic. Personally, I'd have called it borderline Narcissistic Personality Disorder, but he was the professional and I was just self-diagnosing with Wikipedia. He read off the symptoms for hypomania, literally out of the manual:

Him: Pressured speech, rapid talking;
Me: Because we don't have much time--
Him: Mood highs, mental hyperactivity;
Me: Sleep deprivation makes me manic initially. Trust me, I'll be dragging in a few hours; I would know, six months of insomnia and I was like this every day in my morning classes--
Him: Increase in psychomotor agitation;
Me: I pick at my cuticles under the best of circumstances--
Him: Decreased need for sleep;
Me: For the last time, I am not an insomniac anymore!
Him: Easily distractable. You noticed the moment you came in that the clock was fast.
Me: Well yes, I looked for the clock so that I could keep an eye on it through our session, and it was fifteen minutes ahead.
Him: Don't you see? People with hypomania always try to account for each symptom individually, so they resist getting treatment for it.

Which, really, is the catch-22 trump card -- saying that trying to resist a diagnosis of [whatever] is evidence of it. I quit trying to argue, and that was about when our session ended.

He was still willing to write me the letter, essentially regardless of what he thought of my condition, because he believed (as did I, the one thing we agreed on) that it was my call and not his. He did, however, Strongly Believe that I ought to get treatment for hypomania before making my decision.

I was contemplative when I left, but then when I got down to the street I found myself leaning against a telephone pole and crying.

Because although he clearly hadn't believed me when I told him that I psychoanalyze the hell out of myself, it's true and this wasn't the first time it had occurred to me that something else might be behind my desire to be a man. I could recognize my tendency toward excess and obsession, that I like to go weeks at a time focusing all my energy on one activity. My hobbies go in cycles, Warcraft or reading or writing or translating to the exclusion of all else, until I switch to something else for a while. The possibility had occurred to me that this desire to be a man could be one such temporary obsession, one that I hadn't been able to get over because I hadn't seen it realized -- and of course if I did, only to discover it wasn't what I thought it would be and not what I wanted, it would be too late to go back. Sometimes I wondered if I was pinning my hopes on transitioning as the answer to my weird difficulty with being satisfied in relationships. (Hard to tell, since my trouble was that I wanted to be the man in the relationship, but I wanted my partner to be a man too. Even straight guys who like strong women have notions about the female role in a relationship that didn't sit well on me.) Mostly it was a very rational caution about making permanent decisions in haste, but in the back of my mind I couldn't help worrying that if I were to fix something else wrong with me, perhaps that would "fix" the trannie thing too.

But the thing was, I didn't want to be fixed. I wanted to be a man. This meant so much to me, it had become so much a part of my identity, and it was weirdly painful to think that it could be just some delusion that lithium could cure me of. If I had been offered the choice, on the spot, of a pill that could make me happy with being female or the first of a lifetime's worth of testosterone injections... I had no idea what I'd do. Obviously one is less headache and heartache, but it's not even what I want to want.

Nor did I particularly want to be cured of hypomania either, assuming I even had it -- I like who I am, I like my spontaneity and my manic energy, kthanx. After reading more about hypomania it didn't even sound like something that needs treatment unless it leads to depression, it's just something that gives bright, energetic people heightened periods of creative productivity. Looking at the historical roll-call of geniuses (allegedly) with hypomania, I was perversely pleased to be diagnosed with it and not exactly itching to get medicated off that list.

Incidentally, the conviction that one is special and the desire to be so are symptoms of NPD, not hypomania. Just sayin', is all.

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