The hole truth: my gender dysphoria and mysterious phobia

Photograph by Paul Stuart

“So, how have you been feeling?” my therapist, Patricia, inquired. Honestly, I couldn’t believe I was back.

I’d first experienced anxiety like this aged 17. My parents had recently divorced, and I was living in Plymouth with my old-fashioned father. Post-break up, I had less contact with my mother, who until then had been my rock. I was reluctant to tell her – or my father, given his conservative values – about my confusion around my gender identity, or that my effeminacy had made me the target of bullying at my all-boys college.

After classes one day, while scrolling through Twitter, I came across a picture that altered my psyche – and, I’m certain, my entire nervous system – forever: a highly saturated, zoomed-in image of a lotus plant’s seed pod. My screen was filled with its magnified holes. Rationally, I knew this was harmless vegetation, even if the image had been manipulated, the texture heightened to strain the dark and light spaces to their limits, exaggerating its expanse of crevices and pits. And yet some primal part of me couldn’t help but feel threatened. The caption read: “Does this image make you uncomfortable? If so, you might have trypophobia – the fear of tiny holes.”

For months, I couldn’t shake it. I started to notice holes everywhere: in my school trainers, moth-eaten curtains and old, ragged T-shirts. During one sleepless night, I typed “trypophobia help” into Google but found only clickbaity articles sharing the most extreme imagery, this time with clusters of small holes Photoshopped convincingly onto human flesh, edited to provoke panic in those with my condition. I found another post that mentioned exposure therapy, linking to a story about the artist Yayoi Kusama, who overcame her fear of penises by lying in a room filled with soft, phallus-shaped sculptures, apparently.

I was desperate. That same night, I grabbed a packet of pasta tubes from the kitchen, poured them onto my bed and forced myself to lie among them. Penne nestled in the crook of my elbow and around my hips and on my flat, boyish chest. The holes glared, and I tried to glare back, but their wide grins taunted me. An hour passed, and I couldn’t face it any longer. That’s when I knew my attempt had failed. For the remaining months of college, I told no one about this episode. I did, however, inform my mother. She immediately, and understandably, had me referred to a psychiatrist. In Patricia’s office, I spoke openly for the first time about my parents’ separation, and my complex feelings about my gender identity.

“How long have you felt like you aren’t a boy?” she asked. “Since I was about three,” I replied.

“Did you ever tell your mother or father?”

I took a second to think. No, not when I was younger. I could never understand why my mother hadn’t tried to broach it with me. I wanted to dress as a girl all the time. There was my consistent desire to play with girls, never boys. There was my devastation every time my hair was cut short. And there was the day, aged 11 – my first at an all-boys secondary school – that I stole her mascara the minute I got home. I remember my mother walking into my bedroom and asking what the hell I was doing. Even then, we never properly spoke about why I wanted to wear makeup. Before I could give a reason, my mother had walked out. I told Patricia this.

“I see. How did the silence feel afterwards?”

“Empty.”

“And what was that emptiness like?”

I paused again, distracted for the first time by an object in the corner – that statue, which sent my stomach lurching. “Like something had been carved out of me, I suppose. Like a pit in the middle of my stomach.”

I continued seeing Patricia every week for six months in between university classes. I was too embarrassed to tell her what felt like the real source of my madness: the holes. I knew it was her job to onboard my problems, but I couldn’t shake the idea that mine were simply unknowable, too niche. Instead we spoke repeatedly about my childhood – the times I should have received support with my desire to transition but hadn’t. Terrified of the possibility that I might one day have to reveal the real reason for my referral, I preferred to focus on the future: starting hormones, getting surgery and completing my degree. My fear occupied less of a permanent presence in my mind for the following three years. For a while, I felt almost free.

Then one day the terror returned. I was in Brighton to discuss an operation. In the morning I went for a walk on the beach, and that’s where I saw them: the adder stones – holey rocks, too many to count. It was just like that first time I had experienced an episode: alarmed, panicked, wanting to flee. I called my mother, and she told me what I already knew: I had to return to Patricia.

Seafoam green walls. The same statue. For months, the therapy dragged on without progress. I still couldn’t speak of the holes, the beach. It made little sense – I was able to talk openly and intimately about my dysphoria and transition but not this seemingly irrational fear.

In one session, she asked about the surgery and how I’d been feeling, with it now just a week away. Nervous, I replied, about my body changing forever.

“This is also something you’ve wanted for a long time.”

“Yeah, it’s hard to imagine my future without a vagina, honestly.”

The session was coming to a close when she noticed me staring into the corner. “You seem distracted. I’ve noticed you looking at the sculpture in our previous sessions. Are you aware of the expression on your face?”

I was caught off guard. “Oh, it’s nothing. It’s just the holes. They make me uncomfortable sometimes.”

“That’s come up before, hasn’t it?” she said. “Pits, emptiness, the feeling of something being carved out of you. How long have you been experiencing this anxiety?”

I told her everything. About the picture of the lotus plant and the months of anxiety that followed, and that night I took a box of Barilla to bed. Patricia looked nonplussed, then pointed out that it all appeared to have started around (my first) puberty.

“Some think phobias are evolutionary, that they’re the brain’s way of responding to patterns associated with disease or danger. It’s not a very personal theory, though. I think your phobia is about something different.”

I wasn’t sure what she was suggesting until she started talking about my transition.

“Some say phobias can be about repressed desires. You desire to have a vagina. A hole. I think it’s the desire itself you fear.”

Sadness filled up in me, but I wasn’t anxious. Something at last made sense. It was the first time I had spoken about my phobia without doom descending. Tears trickled down my face. How different might things have been if someone had told me that my desires were something to listen to, not suppress; that the parts of me I felt scared of were the parts I needed, to feel whole?

A week later, a nurse summoned me into a white room that contained my future. I paused at the threshold and thought about Kusama’s room of phalluses, and the night I had tried to sleep in a bed made of my fear. Then, as if remaking that bed and lying in it, as determined as the first time, I stepped in, lay down and shut my eyes.