Bioethics, healthcare policy, and related issues.
Jay Sennet posts his “Trans[sexual] Political Agenda” – a cri du coeur on the subject of outsiders’ cluelessness about the lives of those with non-normative gender status or identity.
Understanding medical personnel who don’t treat us like freaks. Those that do should be excommunicated from their profession. Criminal charges should be vigorously pursued at all times where appropriate. Cheap, barrier free access to healthcare insurance. Retiring the Harry Benjamin Standards of Care. The removal of transsexuality and all trans-related diagnosis from the DSM. A federal requirement that all states must recognize requests for gender changes on birth certificates – no amendments. A permanent ban on the “trans panic defense.” Permanent, federally supported anti-discrimination legislation for employment, credit, public accomodations and anything else the feds can do to protect us from all the asshats and assclowns in the u.s. The creation of legal gender categories other than m or f. Make it legal to carry multiple forms of identification that have “contradictory” gender information. A federal requirement that trans prisoners be sequestered for safety. A criminal category for prisons and mental health institutions that stop hormones of inmates.
He do like to stir shit up.
There is a lot to be said about this material. For one thing, the implications of transsexualism (with or without surgical sex reassignment) for gender identity and gender discrimination have given rise to a bitter running fight between gender-identity-feminists and “gender-is-a-myth”-transsexuals, and between transsexuals who see themselves as adopting a new gender identity, and those who seem themselves as simply abandoning any notion of normative gender. (Briefly: the idea of gender “identity” or gender “reassignment” implicitly depends on the notion that there is such a thing as gender, or that one can “be” the “wrong” gender and then make it right by surgery - which undermines the notion that gender discrimination by definition consists of making normative assumptions about gender. Feminists who want to challenge normative gender identity run up against transsexuals who really do see themselves as seeking to become the “other” gender, and resent being told there is no such thing – and who in turn are resented by other transsexuals who insist on the right to make of gender whatever they choose, and are contemptuous of the older notion of transsexualism as being “a man trapped in a woman’s body” [or vice versa]. Feel free to throw some race and class into the mix if you like. Sheltered het-boys like me are simply cannon fodder in this fight, and are advised to do a lot of lurking.) There are also important parallels to the issue of privileged observers’ obligations to educate themselves about privilege and oppression, and the lives of the oppressed. (Sennet’s post is linked from another post on “disablism”, quoting the famous passage from Audre Lorde about oppressors “evading responsibility for their own actions” by demanding the oppressed “educate them”.) But in addition to the competitive politics of gender, there is the longstanding issue of how the medical community, relied upon by the trans community to assist them in reaching whatever goals they individually have, sees these individuals and either helps or hinders their ambitions.
The medicalization of sex and gender identity is a long story still being uncovered; for the most part it is a history of the gradual awakening of the medical community to the idea that some aspects of biological or psychological deviance were not pathological. This paralleled the growing influence of Freudian psychology, with its emphasis on sexual identity, the slow acquisition of factual information about sex due to the work of Kinsey and Masters & Johnson and others, and the rise of the consumer and patient autonomy movements in healthcare; sexual identity’s breakout was both a part of all these trends and a contributor to them. But it is also a history of condescension, abuse, and a pervasive medical hegemony over patients’ desires and intentions – even in the face of the autonomy movement – that is today still fading. Sennet’s post reflects this: part of his “political agenda” is simple respect and acceptance, which are fairly minimal political goals, but still necessary for gender radicals of whatever stripe (hence his deliberate analogy to the feared “gay agenda” of wingnut lore).
But among the more contentious issues Sennet raises is the question of treatment standards for those who request medical procedures in service of their queer-identity goals. In particular, Sennet demands the complete rejection of the “Harry Benjamin Standards of Care” for the medical process associated with transsexualism. This, and his snarky reference to “Luddite feminists”, clearly marks him as part of the gender-is-a-myth contingent. What exactly is he asking for?
The Harry Benjamin Standards are a much-revised treatment protocol prevalent in much of the medical community involved in performing transsexual procedures, promulgated by the “Harry Benjamin International Gender Dysphoria Association” (and no, I have no idea who Harry was). The conflict at hand should already be clear: Harry and his ilk adhere to the psychological-pathology model of gender identity – “gender dysphoria” is the official DSM diagnostic category for transsexualism current in the mainstream psychiatric profession. It should be noted that this category is regarded as a major step toward humanizing the treatment of transsexualism: it was only in the mid-1970s that ordinary homosexuality was downgraded from a psychiatic illness, and the idea behind “gender dysphoria” today is that it is not the desire to be another gender that is pathological, but rather the discomfort (“dysphoria”) with one’s own gender that is the disease; thus, the desire to change sexes is a rational response to the dysphoric condition, and sex-reassignment surgery is the appropriate treatment. It is under this model that the considerable progress toward medical acceptance of transsexualism and reassignment surgery has been made.
However, even the acceptance of the desire to change sexes as normal requires the belief that there is such a thing as “gender” (because transsexual procedures, while they change biological sex to conform to perceived gender, are really about satisfying the demands of gender). Gender non-normativists (if that’s the right term) reject this binomial categorization – and the Harry Benjamin protocol is grounded in it.
It is also grounded in a sense that it is important to protect patients against making bad decisions about gender reassignment. The Benjamin protocol is the source of the well-known process by which patients first live as the “other” gender, then proceed with hormone treatments to change some sex characteristics, then surgery to make a complete “sex change”. Today, it is much better understood by medical professionals that not all transsexuals want all parts of this process, but it is still a requirement of the protocol that they proceed sequentially through it however far they choose to go, that they participate in pscyhological counseling, and that they receive written recommendations from one professional for the hormone treatments, and from two more for the surgery: all safeguards intended to protect patients from themselves, and all built upon the Frankenstein model of sex identity (i.e., that it’s composed of parts that one assembles bit by bit through medical procedures, until finally it walks and talks like a real model of the thing it’s supposed to be).
For those who see both sex and gender as essentially indeterminate (there are varieties of sexual characteristics, many of them reproductively functional, that do not conform to the “standard” model, while the variety of gender identity options is clearly broader than most people recognize), this entire approach is a sham. Making a “mistake” about gender is more like making a mistake about your diet: surely not everyone’s choices are good ones, but surely also we don’t need a doctor’s certificate to choose steak, ice cream, or both. The existince of a prescriptive (and proscriptive) protocol of this type - however progressive and (relatively) modernized – is merely another affront to patients’ own understanding of their sexual and gender needs and identities. Jumping through the doctors’ hoops to get what you want out of the system is a combination of medical shuck-and-jive and educating the oppressors. Or so the claim goes.
Normally, I’m clear on who’s right and who’s wrong on such disputes, but I’m still in the fearful lurking phase on this one. I’m sympathetic to the feminist claim that there is such a thing as gender (I also agree that gender oppression is really mostly sex-role oppression – the expectation that gender dictates role – which belief also tends to undermine gender, or explain it as part of the oppressive normativity, but that’s not to say that gender doesn’t exist at all). At the same time, I’m sympathetic to all aspects of patient-defined and patient-centered healthcare: both the claim that for some patients, gender is an empty concept and they are free to choose anything from anywhere on the intersecting spectra of sex organs, sexual identities, gender identities, and appearance – and also the claim that some patients are the “wrong” gender and long to be the “right” one. I dont’ want to invalidate any of those perceptions, and don’t feel I hold a position in which I am entitled to be bold enough to do so. I also don’t want my head stuffed up my ass by an angry queer with a penis, breasts, and the keys to both bathrooms at Starbucks.
So I’ll leave this one to others for now. Anyone want to educate this oppressor?
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