Gender Identity Dismissal

Political conflict is one of the oldest human games and it never goes out of style chiefly because it’s perpetually self renewing. It’s not a coincidence that the only remotely funny things on Saturday Night Live these days are skits mocking contemporary media and politics. It has an odd quality of breaching new boundaries and regurgitating themes that are centuries old at the same time. Its almost addicting, sport like quality is what drew me into many seemingly pointless arguments on the Internet lately about transgender issues. Yet as I reflect on what happened and what I took away from these debates, I’ve begun to realise that there is, at least for me, some benefit to them. After all, what better crucible to thrash and grind one’s own ideas in than one where they are constantly under assault? Like a planetessimal being shaped and hewn by the random bombardments of an infant solar system, one’s ideas may emerge pockmarked and flawed, yet simultaneously fully formed.

So it is here.

The first conclusion I’ve come to after these many often heated discourses with conservative and anti-feminist men, as well as browsing through this week’s right  wing media is this: the diagnosis of Gender Identity Disorder can no longer do this community any good.

Far from validating us or lending us the touch of Scientific Truth what I have found in the crossfire is a fundamental truth: GID stigmatises and marginalises us. It devalues our words and erases our experiences. It empowers people in white coats to speak for us, our preternatural and perpetual custodians without whose validation we do not exist- no matter how loud, urgent, and insistent our existence may be.

Not long ago when discussing the many foibles of the so-called Men’s Rights movement through the lens of a particularly transphobic article I discussed the phenomenon of the Cis Man’s Burden, which is the cultural belief that trans people are little better than deluded children and that it is the noble duty of a self-respecting cis man (and less often, woman) to do what is best for us and cure us of our mental illness. We do not love ourselves, they say. We don’t love our bodies. Not like they do.

Yet time and again when I have encountered these hideously frustrating sirens of cis supremacy (and often, male supremacy), the slightest scratch tears away the smiling masque to reveal a snarling visage that denies you angrily and recoils in terror at your ‘mutilating’ ways. To claim the smallest bit of the terra firma of your own soul angers them greatly. Visions of hacked off penises fill their minds, and the men among them squeeze their legs together in fear at the thought of what we do.

Never mind protest after protest from our lips; the million and one voices raised up to both allay their fears and assert ourselves.

“That’s not how surgery works.”

“Not every trans person gets SRS.”

“My body, my choice.”

“My relationship with my penis is complicated.”

“But I love my body, why can’t you?”

Tears, joy, anguish, love, fear, rise up like a symphony they will not hear. Cannot hear. Why?

Because to them we are disordered and “Look!” they say “Here in this here DSM is the proof! This isn’t politics, it’s a fact! Gender Identity Disorder! You’re sick!”

Time after time I see it elevated high in an already cis-centric discourse- that simplistic reading of the DSM’s deeply flawed and conceptually troubled diagnosis for trans people. Even the psychiatrists who support the diagnosis would say that reading it as a mental illness is not an apt way of regarding it. But then who can blame the threatened layperson for grabbing onto the D in GID like a solid rock in a roiling tempest of gender uncertainty?

And who really rises to challenge this in the media but the precious few independent trans voices we possess in this community? Who, unchaperoned by some doctor or “expert”, regularly shatters the cis discourse and defiantly insists on existing before the eyes of millions?

This past week I have seen the Washington Times, that sure bastion of white male privilege and cultural conservatism, articulate just that dismissive thought on our mental states when they deemed fit to opine on the upcoming ENDA legislation:

“Similar problems abound in this bill, which treats a conscious decision to choose a new or different sexual identity as if it were an inherent, unavoidable condition. But it’s not. It’s actually a psychological disorder, officially listed as such by the current American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. Our children and our co-workers should not be forced by law to be held hostage to such disorders, nor should employers be forced to have psychologically troubled persons as the public face of their businesses.”

Those words in black and white, words I know in my heart are believed passionately not just by conservatives but by many cis people on the left who hate us or simply do not know better, were the final angrily hammered nails in the coffin of my own naivete about GID.

I had long been in the camp that argued we needed this diagnosis to access health care, and that the movement to end it was dominated largely by white and economically privileged trans people who were not sparing sufficient thought for those who would suffer the most from a revocation of this diagnosis. Part of me still believes that, and I’ll return to that very important issue in a moment.

But let’s look at the reality presently. GID already fails to grant many of us needed healthcare. Advice on how to secure black market hormones abounds precisely because of this systemic problem. Most insurance refuses to cover it, most states in the US have laws explicitly banning Medicaid from covering transgender care.

And what do we get in return? “Proof” that we are a mentally ill community of ‘self mutilators’ and disordered penis-hackers (as always the transmisogynist discourse ensures little to no regard for trans men’s issues. It is the trans woman that is the fixture of cis anxiety, owing to the patriarchal nature of our present culture). In exchange for empowering psychiatrists to speak for us, judge us, control us, and in exchange for a diagnosis which supposedly proves beyond our own sense of knowing that we’re correct about ourselves, we have to accept that people will always see us as mentally ill.

At this juncture I wade into the territory of ableism and the discourse thereof which I’m certainly a good deal less qualified to speak about as I’m coming from a position of privilege. We shouldn’t live in a society where a person can be marginalised by labelling them as “mentally ill,” nor one where anyone is stigmatised as ‘disordered’ and thus ‘abnormal’ and subject to dehumanising or degrading treatment. I hope my effort to undo this diagnosis does not appear ableist. Rather what I want to do is shatter it so that trans people themselves can gain a needed boost in shaping the dialogues around our lives; dialogues that are less medicalised and more humanised. In other words revoking the right of privileged scientists to name us as “other” against our will.

As to the matter of transgender healthcare, Callen-Lorde Community Health Centre, a place near and dear to my own heart, recently had this to say about a new and improved diagnosis for GID which I had initially approved of, called “Gender Incongruence.”

We appreciate the APA’s proposed “Gender Incongruence”(GI) diagnosis is an effort intended to de-stigmatize gender non-conformity and improve transgender-identified people’s access to mental health care. We agree with the intention behind this effort; however, we endorse an alternative viewpoint, based on our years of collective practice knowledge. We believe GI will continue to inappropriately pathologize gender non-conformity, maintain barriers to medically necessary health care, and lend justification to gender based stigmatization and discrimination.”

While Helen Boyd’s beliefs and my own do not always coexist happily, I support her signing onto the Callen-Lorde letter. After many debates I’ve come to realise that what has happened with GID is not simply a matter of misunderstanding or lack of education. It’s, perhaps, the intended effect. To keep us marginalised in a little box where we’re perpetually under the purview (and control) of a patriarchal psychiatric establishment. What I hear time and again from trans people who have found sympathetic doctors and therapists is that those who didn’t give a toss about the diagnosis or the DSM were the best. They treated them as people that were trying to grow and change in accordance with who they knew themselves to be.

By contrast the horror stories I’ve heard have come from trans people who dealt with doctors and psychs for whom the DSM was a bible, whose printed text spoke louder than the voices of their patients and could never be challenged. These doctors were not terribly big on seeing their patients as people. Access to healthcare was restricted all the same, GID or no GID. A trans woman I know in Minnesota, unable to work due to disability, is beholden to the lone psychiatrist in her area who refuses to let her take hormones until her deeply conservative parents agree to the treatment, despite having a GID diagnosis.

She’s 24 years old.

The fact of the matter is that this diagnosis is a sham. Clinging to it is to accept the idea that without psychiatry and the men in white coats we are nothing. It is to accept their whispered warnings of worse things to come if we leave their loveless embrace.

But to steal a phrase from old-guard socialism, the truth is that we have nothing to lose but our chains.

From the Callen-Lorde letter once more:

An inappropriate pathway to transgender-specific medical care: There is legitimate community concern that removal of a mental health diagnosis would limit access to transgender-specific medical care. While a minority has succeeded in using the legal system or in fulfilling their insurer’s requirements for coverage to access care, the majority of people needing transgender-specific medical care are denied coverage. GI maintains these barriers to care. Medical interventions are better substantiated by the use of medical diagnoses, not psychiatric diagnoses. Access to transgender-specific, medically necessary care can be directly and more effectively addressed by utilization of a revised medical diagnosis in the International Classification of Diseases (ICD). The psychiatric needs of transgender people are better addressed by existing psychiatric diagnoses.”

I’m very much inclined to agree. The path to healthcare must be sustained by the agency of the trans person themselves and individual diagnoses tailored to who they are and what their needs are, not a one size fits all lie that stigmatises more than it saves. Already in Britain the GID diagnosis is becoming obsolete as the NHS pledges to provide care with or without it.

Love, not masculinist pseudoscience, is what will ensure we get the care we need. How we will get there, however, is also an important matter. It will not simply ‘happen’ once the diagnosis goes away. We’ll have to fight, we’ll have to build new frameworks of meaning and come up with new theories to give intelligible form to our experiences. It certainly won’t be an easy task but I’m ready to do my part. Many activists, unregarded and forgotten, even by other members of their own community, have already toiled on these issues. I have faith that a post-GID world can be a better one for trans people of all classes.

The fundamental, bedrock truth is and always has been that gender dysphoria was never really about us per se. It’s actually not that different from what a cis LGBQ person might feel in a conservative environment prior to knowing there are others like them out there and people who will love them: the oppressive sense that you ‘know’ you’ll never fit in, never be what your parents want you to be, the fear of losing friends, family, loved ones, status, and one’s sense of place. That does not arise from a discrete condition one may label a ‘disorder.’ It’s an understandable sense of fear, self-loathing, and depression that arises from feeling that to be your true self will make society hate you.

This is what gender dysphoria is.

Yet no matter how many times I explain this, men thrust their fingers angrily at the DSM and hearken to its supposed objectivity, and the alleged scientific truth it brings.

But I know better.

I know my own heart, my body, my spirit, and my life.

I am not sick.

I am not disordered.

I am a trans woman and I’m not going anywhere.

I need no chaperone, no white coated man or woman to act as a walking, talking identity card.

I need only to be.

One thought on “Gender Identity Dismissal

  1. megan April 28, 2010 / 12:04 pm

    I don’t really have anything to add to this, except to say that I agree wholeheartedly. The sooner we’re taken out of the DSM, the better!

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