B.C. on Gender: Medicine and Transgender Politics
The Greatest Cure Ever!
I wonder what it must have been like to have been a homosexual in the early seventies, regularly seeing a psychiatrist for years, only to be told, in 1973, that a vote had been taken, and that you were now normal. Speaking for myself, I'd be a little pissed off.
Actually, I am in an analagous situation, because as a transgendered person, I suffer from a "mental disorder", although no psychiatrist has ever diagnosed me. But after several years of reading about gender theory, I've come to the conclusion that modern psychiatry is wrong. I am not mentally ill; I am just different. I'm patiently awaiting the time when the American Psychiatric Association votes on me...
The Role of Medicine
Ekins and King suggest that "[i]n contemporary industrial societies, the institution of medicine has assumed or been given the task of maintaining" the 'reality' imagined by our normative senses.2 But in granting the medical community the authority to enforce a constructed reality, we have failed to question the validity of that reality.
By way of explanation, let me recount a story. Laura Masters, a Canadian TG once alleged to have called the office of Dr. John Money, whose early work on sex and gender heavily influenced medical perspectives of transgenderism. Laura allegedly said (I'm paraphrasing): "Dr. Money, how did you know that transsexualism was a disorder?" To which she was answered, "What else could it be?"
What else, indeed.
In the extreme, medical treatment of transgendered people requires absolute conformance to normative notions of gender. Catherine Millot, influenced by Janice Raymond, points out that part of the processes for handling M2F transsexuals includes evaluation of the patient in terms of compliance to gender-role norms:
What Millot suggests goes beyond normative senses being applied to TGs -- in fact, the tests of femininity can theoretically be applied to genetic females. The fundamental question that must be asked is this: "do these tests measure a 'natural' notion of femaleness?" For Millot and Raymond, the answer is "no". Drawing upon feminist critique, they argue that the measurable qualities of femaleness are nominal at best, and at worst they are "a purely masculine artefact, a typical male phantasy."4 Thus, they feel, medicine's ability to evaluate a TGs level of integration into the desired gender role is strictly nominal.
Millot, and Raymond especially, go on to argue against the legitamacy of transsexualism, using primarily essentialist arguments, and in those debates, I do not agree with their opinions (I'll talk about Janice Raymond more, later), but I think their implication of the institution of medicine in the perpetuation of societal norms is very interesting.
Depathologization of Transgenderism
I, personally, would like to see transgenderism removed from the domain of psychiatry, as homosexuality was in 1973. This is a very hot topic in TG circles, for many reasons, not the least of which is the fact that if transsexualism is depathologized, then major insurance companies would not have to reimburse the (high) cost of sex-reassignment surgery.
From the Horse's Mouth
I was recently interviewed as part of a Ph.D. thesis. Darryl, the interviewer, brought up the topic of medicine and transgenderism, and the following discussion took place between us:
Standards of Care and the Real Life Test
IMO, very few people live through transgendered teenager-hood without some really big emotional hang-ups, and the institution of psychiatry should be able to aid these people. But, as I made clear, above, the condition that should be treated is not Gender Dysphoria, but rather something comparable to "Transgender Anxiety" or "Ego-Dystonic Transgenderism"7 What remains questionable is whether or not certain processes such as Harry Benjamin's Standards of Care and/or the Real Life Test (RLT) should be part of the psychiatric treatment of these new treatments.
The Bejamin Standards of Care were set in place because hormone therapy causes major changes to the body, and further, SRS is an irreversible operation. Further, as Benjamin states:
As a consequence, Benjamin made the following statement:
As a consequence, Bejamin recommended that the candidate for surgery literally live in the "other" gender role for a period of one year. This is known in TS circles as the Real Life Test (RLT). In Ontario, the Gender Identity Clinic of the Clarke Institute of Psychiatry requires the patient is expected to
Thus, a pre-operative transsexual is expected to carry out a job in an "opposite" gender role for one full year without even the benefit of hormone therapy. As might reasonably be expected, the transition can "expose sex-change candidates to the high likelihood of reprisals from co-workers and, in many cases, from employers."11 Additionally, this type of requirement is unique amongst medical procedures; no other medical procedure require behaviour comparable to the real life test. Is transsexualism really so special as to deserve such a recipe for treatment?
STILL MORE TO COME...
1 Gerald C. Davidson and John M. Neale, Abnormal Psychology (4th Edition) John Wiley & Sons, 1982. p. 309.
2 Richard Ekins and David King, Body Guards, p. 75.
3 Catherine Millot, Horsexe, p. 14
4 ibid, p. 15.
5 Interview with Darryl Hill. I have editted the comments, removing annoying "uhms" and false starts to some sentences.
6 Kate Bornstein. Gender Outlaw. p.62.
7 In DSM III, the classification of homosexuality was removed, and replaced with a condition called Ego-Dystonic Homosexuality. This condition refers to a homosexual person who finds their sexuality to be a source of distress and wishes to become heterosexual.
8 Harry Benjamin, The Standards of Care for Transsexuals, 1979.
10 "Gender Identity Clinic", a pamplet from the Clarke Institute of Psychiatry, as cited in "Extended Informed Consent" by Laura Masters.
11 Laura Masters. "Extended Informed Consent".
Copyright © 1996 by B.C. Holmes. Last updated December 30th, 1996
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