Our Genders are Not Disordered
The following was written in collaboration with my beautiful and talented fiance, Josephine Cross, who is on the EGALE board, though she wanted me to mention that nothing we've written here is EGALE policy or opinion:
There have been some leaks regarding recent revisions to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), particularly concerning GID (aka. Gender Identity Disorder). GID has long been a hot issue among us transsexuals, and it is our intent here to throw a little fuel on the fire.
Ultimately this is an issue of credibility. GID takes credibility from transsexuals and places it squarely in the hands cis people, who not being "mentally ill", are in a much better position to decide what our experiences mean, what our motivations really are, and what is best for us. Really, we're quite lucky.
There are those in the trans community who stand to uphold the diagnosis of GID, and with it the notion that our gender identities are, in fact, disordered. They do this because they fear that without being labeled "mentally ill" by the medical establishment they will not be able to access Hormone Replacement and Gender Reassignment treatments. We would humbly submit that not only is this false, but that the complicity of a significant portion of the trans community with the GID model is, in fact, holding us all back; for so long as our gender identities are pathologized we in the trans community can not expect the respect we deserve. Many of our opponents (in the medical, social conservative, and feminist establishments) often site the fact that GID is a mental disorder to delegitimize our perspectives and rob us of the agency to determine what is done to our bodies.
There are those who see medical transition merely as the enactment of a delusion, and the cooperation of doctors as (at best) complicity with insanity, and (at worst) the outright exploitation and manipulation of the mentally deranged for profit. Continuing on the current course will forever deny us full agency in how we are treated and deny us full access to the dialogue surrounding trans issues. So long as we can be condescended to as "not mentally fit" our concerns will be shut down and shut out by those cis people who continue to steer debate.
And the debate begins with medical treatment and how, it seems some of us are convinced that you must be seriously, dysfunctionally, ill to receive medical treatment. Nothing could be further from the truth; consider pregnancy, birth control, and menopause: All three are routine health matters that often do require intervention to prevent dangerous complications. None of them are considered sicknesses in themselves and any symptoms that arise from them are 'cured' with appropriate treatment. This is the model that we can easily propose for, and has often been used by patient-centered doctors for, transition.
Cis men concerned about the effects of testosterone on their appearance don't need a diagnosis to get appropriate medication to circumvent the effects of androgens on their body, (i.e. baldness) why should trans women be any different in that regard? We are treated this way because the medical establishment, often with our complicity at best, consider transition to be the last ditch treatment of a serious psychological malady instead of a patient making clear and informed choices about their own body.
Further, the pathologization of transsexuality encourages a one-size-fits-all approach to treatment and legal status. The law acts under the assumption that all transsexuals must have a transition which culminates in surgery. This surgery, some of us neither need nor want nor can afford. And yet this prescribed transition is required to be recognized legally as our correct gender. The current diagnostic regime reinforces, and is reinforced by: Laws that affirm that there is only one way to become a man or a woman, (and nothing beyond that binary,) if not assigned such at birth; that the patient does not know themselves better than the psychological profession; and that our gender is something that can be granted or denied by doctors, legislators, and bureaucrats, instead of something that we transsexuals implicitly perceive, no matter when or if we reach the day we can correctly articulate the discomfort we feel with the bodies we've been assigned. However this doesn't have to be the case, and I'm not simply talking pie in the sky.
There are countries that treat transsexuality as part of the normal variance of gender identity. In 2002 when Great Britain affirmed that transsexuals are not mentally ill did funding for SRS drop? No. If anything increased scrutiny has been brought to bear on those doctors and institutions which have attempted to maintain a cissexist model in the face of the will of parliament and the courts. If one section of transition goes unfunded due to a person skirting the public system, other elements of transition often still remain funded. Simply put, publicly funded SRS is available in Britain and those who are unwilling to queue up for hormones are not required to do so as they have other means at their disposal for procurement, including legal online purchase. British transsexuals are treated as individuals with agency who know what is best for them; the support available to them, in funding and availability of treatment, is greater than in any Anglophone country that treats transsexuality as a disease.
It is also short sighted to think that the GID issue is confined only to the issue of medical treatment. The trans community is faced with myriad social issues, ranging from job discrimination, to airport security, to access to public services such as womens and homeless shelters. These are all important issues which deserve our attention, but as persons labeled with a mental disorder we loose valuable traction against those opponents who seek to undermine our positions, or even demonize us.
Mental illness, in The West, has a history of being used to justify stripping certain undesirable groups of their basic human rights. Take a look, for example, at employment discrimination. Numerous studies, like the one conducted by Citizens Advice in Britain in 2004, found that the mentally ill were denied benefits, treated poorly by companies, and unfairly denied employment. Sound familiar? Part of the transphobic attitudes of society aren't transphobic at all; they're bundled in with ablist rhetoric that is especially visceral and pronounced when the disability is considered mental.
Alberta, especially, does not have a proud history of treating those it believes to be mentally ill with the basic rights and agency they deserve. The forcible sterilizations conducted by the Social Credit Government were, much like the decision to cut SRS funding and then ramp up health care spending the next year, policies designed to make it not just unwelcoming, but unhealthy, to be the kind of person that the government believes to be dysfunctional.
And this attitude is spread by those who hate on both the misoginist right, purging trans men and women from any position in 'respectable society', and the radical feminist left, denying us, now already marginalized, safe spaces in which we can live our lives authentically. Take the following quotation written by a columnist based in Toronto:
"Some fundamental points. There is no such thing as a transsexual. There is no such thing as a man in a women s body or a woman in a man s body. There are, however, some very sick people whose deep mental illness deserves our compassion and care. Any man who wants to have his genitals surgically removed and some grotesque imitation of a female organ put in its place requires years of therapy and medication. Or, frankly, needs to put in hard weeks work fifty times a year so that he stops concocting neurotic nightmares and gets with leading a meaningful life."
And compare it with another, written by another Toronto columnist.
"What makes a woman? If a man cuts off his penis, pumps himself full of hormones, gets silicone breasts and electrolysis, and stuffs his feet into high heels, is he/she a woman?
Being female is a complicated mixture of physiology, cultural conditioning and lived experience - or even, as one academic thesis would have it, "a political category created through oppression.'' Out of politeness, I'd be willing to call that surgically altered person a woman and use the feminine pronoun. But a part of me will always feel outraged that "woman'' could be defined as an outward set of physical characteristics - lack of penis, fake breasts - along with an ultra-sexist "female impersonator'' style of clothing and gesture."
Could you spot the difference? The right-winger, Michael Coren, Toronto Sun, is the one who said 'get a job' while the left winger, Michele Landsberg, Toronto Star, called women an oppressed class. Really, that's about it; they both believe that we're seriously ill, incompetent, and that the people with real sanity and moral clarity should be making the decisions on our behalf. It's time to deny them their favorite trope and banish both the fiction of our insanity and their decency.
We are not, however, saying that transsexuals do not have a condition which benefits from medical treatment, as we specified earlier, nor are we saying that we should press forward without first proposing an alternative diagnosis; quite the contrary.
What we need is a new model which frames the issue not as an identity disorder, but rather as a stress-related disorder, contingent upon a mind-body dissonance. We fully support psychotherapist Hershel Russel when he recommends that we replace "Gender Identity Disorder" with Gender Expression Deprivation Disorder. The problem is, after all, not that somebody has an "incorrect" gender identity, but rather that the individual is suffering distress due to anatomical and social factors which are contrary to their sense of self. Such a diagnosis would act to dispel the myth that transsexuals are deluded without diminishing the necessity for medical treatment.
Ultimately, we in the trans community need to realize we can have our cake and eat it too, that dignity and respect and depathologization is not exclusive from a recognized need for medical support, in fact the two are rather tightly linked. When transsexuality was seen as a psychosis we got treated with electroshock; now that it's seen as a neurosis, we get treated with a seemingly eternal equivocation. When we fight to ensure that transsexuality is not treated as a disease, we will get agency, empathy, and most importantly, equality.