TW: Discussion of OCD related to gender and sexuality, intrusive thoughts
My earliest memory is of a mental image that won’t go away. A girl in a white pinafore jumps rope on the sidewalk. She trips and bloodies her knee. I try to keep her from falling, to rectify my thought, but I can’t: the image of a skinned knee inserts itself, persistent. It is impossible to have the thought I want to have. It is impossible not to make the girl trip, although I don’t want to hurt her. The computer game in my head is rigged; I can’t beat it.
I am five, maybe six. The Lutherans haven’t yet asked my mom for more tithing and she hasn’t yet told them to go fuck themselves so she still takes us to church, where I concentrate as hard as I can on the thought I love God but another thought superimposes itself.
I hate God.
I hate God.
I hate God.
This thought is spoken by a voice, a man’s voice, low and growling. He is inside my head, narrating my repetitive interior monologue, so it is difficult to distinguish between us, whether we are, in fact, separate entities or he is me talking to myself. What kind of a person hates God? I probe my consciousness for other signs, other defects, not wanting to miss any cognitive wrongdoings. Does God know I’m thinking such evil things about Him? Does He see into the darkest recesses of my brain, where I make people trip and skin their knees? The knowledge that I am fundamentally wicked churns in my gut, causing my stomach to ache.
In her bit “Obsessive Compulsive Disorder,” comedian Maria Bamford spitballs, “Have you ever had a dark thought, like ooh, what if I licked a urinal? Oh my God, I can’t even believe I thought of that, that probably must mean something about me inherently.” This cognitive distortion is common to those with OCD who, unlike most people, are unable to dismiss disturbing thoughts as arbitrary or to recognize that having a thought is not morally equivalent to acting on it. Bamford spirals further: “What if I were a raper, or a murderer, or a genocider?” Her therapist alter ego asks if she’s ever had trouble spending time with friends because she imagines chopping them up into chunks and bits, having sex with the chunks and bits, and then tossing them over a Cobb salad and feeding it to her parents. “Yes, about a million times!” Bamford retorts. “God, aren’t you even listening?”
OCD exists in the collective consciousness as a caricature, an anal-retentive color-coding his closet, an unintentional jester a la the titular detective in the TV show Monk. A compulsive need for symmetry and a fear of contamination are certainly two frequent manifestations of OCD. Less well-known but no less widespread are intrusive thoughts, which tend toward variations on certain charged themes: violence, sex, religion. OCD feasts on anything taboo, anything involving an inherent level of uncertainty or doubt, and attacks whatever its host holds dear.
Unsurprisingly, religious people with OCD usually suffer from intrusive blasphemous thoughts, also known as scrupulosity. New mothers are often inundated with visions of smothering or drowning their infants. Extreme conscientiousness, exhaustive self-chastening, and an inflated sense of responsibility plague the OCD sufferer. Gentle souls may lose hours of their day retracing routes to ensure they haven’t run over any pedestrians with their car, or worrying that they can cause others to hemorrhage and die by bumping against them on the street.
OCD is a trickster, a shapeshifter, perpetually reinventing itself. By the fifth grade, I had not attended church in half a decade. God and Jesus and the afterlife had ceased to occupy my mental space. The ambiguities of sex and gender replaced them.
On the soccer field during fifth grade gym class, I caught myself looking at the silhouette of a classmate’s breasts. I rationalized that I was just jealous, given the flatness of my own chest. Then a thought arrived: if I were an emperor and had a harem, I would choose her as one of my concubines. Followed by the thought that only lecherous old men objectified women this way, perceiving them as collections of disembodied parts rather than as whole beings. What if I was really a man? How could I know that I wasn’t? The voice inside me was a man. You’re really a man you’re really a man you’re really a man you’re really a man, he snarled ad infinitum. You want to grab her boobs. You want to grab her boobs. You want to grab her boobs.
Every time I closed my eyes from then on, a lurid Mobius strip flashed before me. The problem of where to look became a constant. I avoided looking at other girls and women teachers, even at my mother and grandmother, afraid that my eyes would fall on their breasts or crotches and they would notice. I wanted the images to stop, but still they intruded: while trying to pay attention in class or to finish homework, I would see myself grabbing women. Sexual nightmares turned sleep into a vivid terror, and I woke up each morning feeling like I deserved to die. The mind is cruelly wired: the more we try to suppress a thought, the more it resurges, like a comic book villain whose strength doubles with each hit.
In bed at night, I conjured images of my body as it was, then imagined myself with a penis and the muscular, furred torso of a man, checking to see which caused my heart to race rabbit-quick, bringing on the nausea and sense of dread I’d come to assume was sexual arousal. Checking the same way another obsessive-compulsive might check the stove knobs or flip a lightswitch on and off. As an eleven-year-old in a conservative suburb in the early aughts, I had a reductive and transphobic notion of what constituted gender identity, but I never found any kind of queerness morally abhorrent. What I feared, as per Martin Buber, was having an I-it relationship to sexuality, the kind inculcated in many cishet men by rape culture and sexualized advertising, rather than the mutual encounter of I-thou.
But falling in love with my best friend in high school wasn’t about her body, though she was also tall and androgynously stunning like Sinead O’Connor. She had a whimsical imagination, could make me laugh until I peed myself, and read Yusuf Komunyakaa poems to me in an empty auditorium. Her presence suffused even the most mundane moments with a sense of magic and adventure. Although my project, my all consuming project, was figuring out my sexual orientation and gender identity, trying to solve myself like a Rubik’s cube, I didn’t identify as bisexual or queer at the time, and like most people, I didn’t know that OCD could manifest as intrusive sexual thoughts. My truth was my desire to be around my friend. To my surprise the thought of intimacy with her didn’t make me anxious in the way that sexual thoughts usually did; instead of brutal, alien, and terrifying, the thought felt warm and pleasurable. She unfortunately did not reciprocate and our friendship disintegrated due to my suicidality and emotional dumping.
In her video “Shame”, doyenne of anti-fascist YouTube Natalie Wynn (better known as Contrapoints) shares her shifting understanding of herself as first genderqueer, then as a trans woman; as bisexual, then straight, and now as a lesbian. She says self-effacingly that coming out twice is careless, but three times is an embarrassment, an attention-grabbing ploy. I first came out as bisexual my sophomore year of college, then as a lesbian, shaving my head and eschewing all femininity in favor of a wardrobe that consisted solely of flannel shirts. Halving myself, presenting only the parts I couldn’t accept, seemed like a path to self-acceptance at the time. The intrusive thoughts didn’t subside and my attraction to men remained. I came out again as bisexual shortly before falling in love with a cishet man I would go on to date for three and a half years.
Old high school friends, we ran into each other on the train. He smiled with recognition and sat down beside me, chatting about the Ursula K. LeGuin book he was reading, and inside me swelled a rare feeling: knowing. At twenty-one, I was still a virgin. Just making out with people could be a fraught experience, with an onslaught of bizarre mental images turning the moment to ash. I had recently been diagnosed with OCD and didn’t believe the diagnosis, which seemed like a too-convenient excuse for the most violent of the thoughts. This witty, essentially kind-hearted man in his Christmas sweater tolerated my compulsive reassurance-seeking, the endless questions with no answers, far past his own threshold. Enfolded by his big body and his seemingly infinite patience for the malware program installed in my brain, I felt human for the first time. Our parents grew close. Fireflies circled joint dinner parties on his family’s patio, and it seemed like he and his people would remain fixtures in my life forever. I wanted our relationship to last more than anything.
Online OCD forums reassured me that intrusive thoughts were the opposite of genuine desires. If someone obsessed over the possibility of being gay, that meant they were straight, and vice versa. I found an OCD specialist, her services cost prohibitive but necessary. Maybe you really are just a lesbian, she’d counter to wean me off my addiction to reassurance and build my tolerance for uncertainty. This method, called Exposure and Response Prevention therapy, temporarily ramps up anxiety in order to decrease obsession over time. Maybe you are going to leave your boyfriend for a woman. Maybe you don’t really love him and your entire relationship is a sham. Maybe you’re not a lesbian, you’re actually a man. Maybe you’ll never be able to know what gender you are for sure. Maybe.
Back in college after two years away, my hair grown out and my closet full of sundresses, I told my friends that I was straight, that my reputed queerness resulted solely from my OCD. Traversing an untraversable line, taking back what couldn’t be unsaid, felt easier than following my therapist’s directions and accepting ambiguity.
Two years after my first boyfriend broke up with me, his emotional reserves having finally been depleted, I began dating and having sex with women. What had previously seemed so charged with the potential for evil-doing now seemed just like sex: sometimes awkward, sometimes ecstatic. I enjoyed it a lot, but no more than I enjoyed sex with men. My obsessive fear of missing out on relationships with men relieved, other fears stepped to the fore.
If it was true that I experienced attraction to women- if it wasn’t just an intrusive thought- what else was true? The thoughts of having a more masculine body, which I could once tune out into background static, now throttled my attention. I couldn’t dispel the ghostly physical sensation of a penis slapping against my thigh, or quit poring through the gym selfies of ripped trans men on Instagram. The length of time I’d spent secretly questioning my gender, the fact that expensive therapy and high doses of medication hadn’t resolved this particular obsessive theme, lent credence to what suddenly seemed clear: I’d been a man all along, and my OCD resulted from my inability to confront the truth about myself.
In a fit of adrenaline, I gave all my makeup, dresses, and jewelry to a transfemme acquaintance. I cycled through stages of performative queerness, investing in bowties, snapbacks, and brightly patterned button-downs, making myself over into a cliche. Slipping my first packer into my new TomboyX briefs felt exhilarating and surreal, as if I’d developed the ability to breathe underwater.
Looking in the mirror one night, I heard God say, “your name is Jason.” Rather than an auditory hallucination, the voice paralleled the voice of my OCD, an internal broadcast akin to telepathy. I Googled the meaning of the name Jason and came up with “one who heals.” I liked that.
When I finally stopped injecting testosterone for good after a year and a half on and off, I wasn’t sure whether I felt dysphoric due to the still-wideness of my hips, the fact that strangers consistently called me ma’am despite my not inconsiderable facial hair, or because I had misunderstood myself. When I’d first started transitioning, I felt a terror of detransitioning. The word “detransition” often functions as an anti-trans dog whistle as much as a descriptor of a set of experiences. I didn’t want to become a source of embarrassment to the trans community, or worse, a metonym for hate. Rationally, I knew people were too preoccupied with their own lives to invest much energy into judging me, but I’d watched hours of binary trans Youtubers railing against “transtrenders” and social media began to feel like a panopticon. What if everyone could see the contents of my thoughts, the incessant circular anxieties?
As a stock character in the internet’s imagination, the detransitioner is young and AFAB (Assigned Female At Birth), sociopathically fickle enough to try on transness like a cool band t-shirt. She is immature, attention-seeking, narcissistic and histrionic. The fact that these are misogynist and transphobic stereotypes used to pathologize both young women and trans people, to characterize transitioning as a selfish and navel-gazing act, does not stop many trans people and allies from contending that detransitioners wished, like Rachel Dolezal, to cosplay as oppressed minorities.
This antipathy is not unwarranted: detransitioned people do unfortunately raise trans people’s already considerable barrier to being believed in a cissexist world. The most prominent, divided between Christian fundamentalists and trans-exclusionary radical feminists, spew incredible bigotry. But transphobes would disbelieve trans people even without these stories to co-opt. Instead of creating a culture where people who question their gender, regardless of what conclusions they come to, are seen as deserving of respect and compassion rather than skepticism and scorn, the regurgitation of the attention-seeking narrative allows conservative and gender critical toxicity to dictate the tenor of the conversation.
Uniquely incisive essayist Eula Biss writes of how progressive whites use an alternative ethos to mitigate their privilege: tattoos, piercings, appropriative hairstyles. An equally incisive meme features a photo of a bandaid with the caption “white queers using queerness as a white guilt bandage.” Certainly the tautological tedium of white guilt consumed my brain space, grist for the OCD mill. I had the unconscious backward drive to annihilate my privilege, as if that were even ultimately possible, rather than the maturity to leverage it toward a more equitable world. But this self-centering tendency is a secondary or even tertiary reason for my transition. The primary reason is that I genuinely believed I was a man, and had since fifth grade.
Hormone replacement therapy has improved the lives and mental health of people I love and respect. A dear friend in her sixties says of starting estrogen that it was like her brain had the right food after forty years; another credits testosterone with making him feel like a person for the first time. As with most who undergo HRT, both remain very happy with their transitions. I thought HRT would do the same for me: not that it would solve all my problems or turn me into a different person entirely, but that I would feel more clear-headed, less anxious, more present in my body and environment.
Rock musician Laura Jane Grace recalls in her memoir that she felt like her body was “possessed by warring twin souls: one male, one female, both wanting control.” I thought that the panic and distress that accompanied intrusive thoughts of having a man’s body, the brain fog and sneaking suspicion that my femininity served as a compensatory foil, and the sense of being doubled and split, were all gender dysphoria; that the intrusive thoughts about sexual predation were internalized transphobia and homophobia rather than a common OCD theme shared even among people whose obsessive doubt had never latched onto their gender identity or sexual orientation.
Intrusive thoughts often undermine straight people’s sense of their straightness and gay people’s sense of their gayness. My own ruminative spirals have alternately cast me as a gross misogynist preying upon women or else a vapid straight girl using queer identity for social capital. Trans people with OCD may obsessively doubt their transness. On his blog Let’s Queer Things Up, writer and mental health advocate Sam Dylan Finch recounts how his OCD destroyed his equilibrium: “I’d identified as transgender for four years, and up until the obsessions started, felt secure and happy in my identity. The obsessions didn’t make any sense. It was just a track on a loop that said, ‘What if, what if, what if?’” Defying society’s conception of gender in order to be yourself raises the stakes of achieving perfect certainty. Returning to the personal mismatch of cis womanhood embodied Finch’s worst fear, as my potential capacity for patriarchy embodied mine.
Professional provocateurs like Jesse Singal and Katie Herzog have built their careers upon detransition fear-mongering while positioning themselves as the reasonable middle ground in trans discourse. Their “free-marketplace-of-ideas”, airing-both-sides approach offers fodder to far right politicians such as South Dakota congressman Fred Deutsch, the sponsor of a recently defeated bill that would have criminalized providing transition-related care to trans youth. For the past year I thought that keeping my head down indefinitely constituted the only ethical path forward, because anything I might write about my experience could end up repurposed on an evangelical Christian website. But the conversation regarding detransition is happening regardless of my silence, and it is far less nuanced and productive than the conversation we would ideally be having.
Detransitioners are subjects of Schadenfreude and prurient interest, smug condemnation and treacly pity. The media flattens the complexity and diversity of such stories into a regretful monolith. In reality, when trans people detransition, it’s usually because of the world’s relentless assault: the harassment, the employment discrimination, the lack of social support. Most trans people who detransition later resume transition under more favorable circumstances. Some non-binary people stop taking hormones when they realize that their body is being pushed into a new box that they’re uncomfortable with, or start them intending to stop after a certain period of time. Such departures represent an exploration of more expansive embodiment rather than a “detransition.”
Finally, there are detransitioners who end up reckoning with the fact that their transition was driven by hostility they faced as a gender non-conforming cis person, or else by another underlying mental health issue. I have seen many detransitioners of this type weaponizing their grief and hurt on Twitter, and few in support of the informed consent system that enables adults to obtain hormones and surgery referrals without extensive gatekeeping. Getting yourself wrong so publicly and profoundly is humiliating. Your former community misattributing your motives and viewing your struggle to understand yourself through the most cartoonish, least charitable lens possible is painful. Transitioning can be a deeply isolating experience, one that entails personal and professional losses. Detransitioning, too, is stressful and alienating, and not always offset by the knowledge that those losses have been worth it in the end.
That said, mapping your experience onto another person’s, assuming they will follow your trajectory, is not the same as empathy and care. Constructing an elaborate victimhood narrative which distorts trans activists and trans affirming doctors into villains is not growing toward self-compassion; externalizing blame is not self-forgiveness. Comparing the trans movement to Scientology (an analogy which, as the estranged child of a Scientologist, I find rather egregiously inaccurate) is just absurd.
Carey Callahan, a PTSD sufferer and perhaps the detransitioner with the most online notoriety outside of Christian fundamentalist Walt Heyer, positions herself similarly to Singal and Herzog. In an op-ed for The Economist, she argues against waiving mental health screenings for HRT and surgery referrals. To make her case, she uses the story of a man who, while experiencing psychosis, underwent an orchiectomy (a surgical procedure to remove the testicles) that he later regretted. Callahan is a Trojan horse; due to her anticipation of counterarguments, her article may appear neutral to uninvested parties, but she adamantly opposes medical transition for trans teenagers and believes in excluding trans women from women’s spaces, thus casting women out of their own communities and subjecting them to potential harassment and violence from cis men in bathrooms, locker rooms, shelters, and prison wards.
I resent Callahan’s implication that because her acquaintance who underwent the orchiectomy wishes medical professionals had restricted his agency, the agency of others with disabilities should be restricted too. Unlike people experiencing psychosis, those with OCD tend to retain some level of insight into the irrationality of their thoughts. Still, a steady deluge of intrusive thoughts across a number of years erodes one’s ability to gauge what is real. Yet even when compromised by my OCD, I was still an agent exercising my right to self-determination, and the decisions I made are mine to own.
Conditions such as OCD, PTSD, body dysmorphia, psychosis, and Borderline Personality Disorder can cause dissociation that mimics gender dysphoria, but can also overlap with gender dysphoria. Some trans people are both dysphoric and neurodivergent, and others don’t experience dysphoria, or experience it to a relatively mild degree. To pretend that gender variant identity is categorically similar to diabetes or a mental illness, and that professional diagnosis should therefore override individual autonomy, is both bigoted and disingenuous. I have compassion for other detransitioners whose lives have been derailed more than mine, but I don’t want to see a system where doctors deploy bad faith arguments to invalidate the self-knowledge of trans people with disabilities, delaying or denying needed healthcare. Restricting access to hormone replacement therapy will not stop medical transition, but instead lead to an uptick in unmonitored, unsafe black market consumption. Because of the lack of trans-affirming doctors, especially in rural areas, many people buy hormones off the deep web from countries that don’t regulate prescriptions.
Endangering gender variant people would not have aided my HRT discernment process. What might truly have helped is if I’d been able to continue seeing the OCD specialist I made some progress with in my early twenties; despite my middle-class upbringing, treatment still exceeded my price range. Universal healthcare, with accessible mental health services, is the solution, not medical paternalism.
Ironically, non-binary people and radical feminists agree upon the fundamental oppressiveness of the gender binary, though they approach this problem from opposing angles. Gender can be both an oppressive construct and an inner truth that is real by virtue of being felt so deeply by many people. Radical feminists would deride these statements as logically inconsistent, but what can be understood solely by human reason, given all our limitations? Presuming to know another person’s gender or to define it for them is ontological arrogance. In the face of what we don’t know, humility is called for, as well as respect for those whose lived experiences differ from our own.
In their essay Neither/Both, non-binary trans writer Tyler Ford describes their gender as “an optical illusion: light me from one angle, and you’ll see a pretty girl; from another, I look like a pretty boy. I am neither, and I am both… what matters to me is that I understand myself.” I often miss the simultaneity I possessed before lasering my beard into relative submission, the ability to shift between a flamboyant masculinity and a more conventional femininity by growing out my facial hair or else shaving it and putting on makeup, but I don’t miss the staring and audible speculation of strangers or the underhanded ways in which employers treated me. Now that my appearance no longer causes confusion or unease, navigating the world has become less complicated, and I understand why some trans people may see me as an erstwhile tourist to a reality they will have to contend with their whole lives.
These days, I am lucky enough to be seeing a highly qualified OCD specialist at the hospital affiliated with my university, my co-payment rendered negligible by student health insurance. Like my previous therapist, he is using Exposure and Response Prevention Therapy to help me manage my current symptoms. Magical thinking is common in people with OCD. As a child I believed I had caused my mother and her boyfriend to break up with my thoughts, and that God would punish me for not picking up other people’s litter. My brain is still an unreliable narrator; now it informs me that I am cursed, that I deserve to be cursed, that when I look up at the clock at exactly 1:03, or a stranger in a #13 jersey passes by the Starbucks where I am working, these coincidences represent a sinister pattern. Thought broadcasting, the sensation that others can hear my thoughts and vice versa, remains my companion. Although these fears, which feel so viscerally real, often destabilize me, they are easier to manage than the fruitless questioning which once robbed me of a core sense of self.
OCD, which seeks impossible certainty, processes the world in polarities. Transitioning and detransitioning finally shattered this black and white paradigm, and my desires no longer feel like an irreconcilable contradiction. Finding the right word to describe themselves empowers many queer people. For me, it’s best to resist the urge to call myself anything. I’ve devoted too much of my life to the dialectical exercise of either wholly identifying or disidentifying with my thoughts, seeking illusory peace in each extreme. Obsession is a lapidary process that produces no jewel; you whittle away at a thing, examine all its angles, and only yield lost time. I am trying everyday to forgive myself for the time lost, and drawing definitive boundaries around how I might love and exist in the world no longer feels important. In that sense, the name Jason still fits: I am one who has healed.
Image Credit: Claude Cahun’s “I Extend My Arms”
Phoebe Rusch has an MFA in fiction from the University of Michigan. Their writing has previously appeared in World Policy Journal online and The Rumpus, among other publications. They are currently a master’s student in special education at the University of Illinois-Chicago. You can find more of their work at www.phoeberusch.com.