In all, I only got three sessions because that’s all the Crisis Team are able to offer as they only deal with short term support. If I really wanted, I could have longer term therapy with a psychologist under the primary care mental health, however there is a substantial waiting list for that.

The chap with whom I’ve been working was lovely; I felt that he empathised with what I shared and I never felt judged – he said that I wasn’t mentally ill. His role was to help assess my ability to cope, my capacity to make decisions, and provide tools to help make sure that I don’t end up in hospital again.

Capacity was interesting; I had to demonstrate that I understood fully what I was doing and the possible consequences. He stopped me after a while since I really do know the risks associated with having an operation to remove my testicles.

He asked me a few standard questions used to assess people who have body dysmorphia, which I qualify for only a little bit. There are no standard questions for body integrity disorder/dysphoria, but he said that a lot of what I shared appeared to match that possible diagnosis also, however his role was not to diagnose but to ensure that I understood that any diagnosis I had (or thought I had) was subjective and could be wrong. Why is that significant? Usually, with a body integrity dysphoria if the offending body part is corrected, the issue goes away – hooray for me! However, a dysmorphia cannot be treated in the same way, in other words of I have a dysmorphia the removal of my testicles could result in me transferring my issues into another body part – this would be a problem. I hope that I’m in the dysphoria group!

We also covered coping strategies. There have been two that I’ve used to manage my feelings and the problems in the world around me.

I was taken into hospital because I like to tie my balls up when stressed and completely lost control of what I was doing. Banding is a secretive activity for me, my husband had no idea that I have been doing this on and off for the whole time we’ve been together. We talked about why it’s a coping strategy and how I can break out of it and stop it getting dangerous. The “why” is complex: sometimes I just enjoy it! I like the jeopardy that it might damage my balls. I also think of it as a dress rehearsal for getting rid of them myself. However, my balls have also become scapegoats for all the things wrong in my life; that’s happened since I came out as needing castration and the problems in my relationship becoming critical. The exit strategy from this kind of self-harm is honesty, as the antithesis of the secrecy in the act itself.

My other coping strategy was Shut Down. When faced with difficult or painful situations, especially conflict or anger, I would put myself somewhere else while remaining physically present. I developed this as a way to survive my father’s alcoholism and unpredictable moods. I carried this behaviour into my marriage and whenever I felt any kind of danger – real or imagined – I would just disappear into my own head. Time would pass and I would have only limited memories of what had happened and what had been said, although I’d have the feelings left with me from what my body had experienced. Physiologically, my heart rate and breathing slowed right down. The problem with this strategy is that the situation is not dealt with (my husband felt that he was never heard and that I was largely absent from our relationship), the other problem is that it simply defers the problems, emotions, and feelings associated with them – emotional debt if you like. It’s a completely inappropriate strategy when the other person is well and a better response would be to engage with whatever is being said and the feelings that it brings up. My husband isn’t always well and sometimes things get rough when he’s having a bipolar or PTSD type episode.

What I have found is that I have been unable to Shut Down since this latest coming out as non-binary with this need for castration. My therapist suggested that the banding response to stress was from my emotional brain, whereas the shut down response was from my logical brain, however since this coming out my emotional brain has been in charge, making shutting down impossible. Interesting. My task for recovery is to integrate my emotional and logical brains into a wise brain which can use the power of both sides.

I felt very sad at the end of the session. I might have only seen him three times, but they’d been long sessions (between 2 and 3 hours each) and I had been completely open with him, and he had been nonjudgemental and supportive and kind.