Gender Identity Disorder and the Price of Passing

Passing. The stated goal of many transsexuals. That is to say, being regarded in everyday society as the gender of one’s choosing, usually with the help of things and behaviors commonly associated with either masculinity or femininity.

While a person’s identity and outward cues should be respected, passing as a goal should be reevaluated. Right now passing effectively silences trans activism, because passing as a biological female or male becomes the ultimate goal rather than demanding that trans individuals be allowed to move outside the binary and establish their own gender roles.

Gender Identity Disorder, the disorder one must be diagnosed with to begin the transitioning process, relies heavily on language and criteria that reinforce the binary. Essentially, the diagnosis of childhood gender identity disorder is a process of singling out the potentially gay or bisexual child and traumatizing him or her in the interests of maintaining the outward signs of heteronormativity.

The Diagnostic and Statistical Manual is the Bible of mental health diagnoses. It has undergone several incarnations, with the language of certain disorders changing, while others have crossed the border from disorder into legitimate lifestyles or choices, depending on one's politics. Homosexuality, for example, remained in the DSM until the most recent revision.

Gender Identity Disorder remains in the DSM and falls into two categories, with one type being diagnosed in childhood, the other in adulthood. The criteria that must be present for a diagnosis to be made raises questions about its validity in the very first paragraph. It states:” There are two components of Gender Identity Disorder, both of which must be present to make the diagnosis. There must be evidence of a strong and persistent gross-gender identification, which is the desire to be, or the insistence that one is of the other sex (Criteria A). This cross-gender identification must not merely be a desire for any perceived cultural advantages of being the other sex. There must also be evidence of persistent discomfort about one’s assigned sex or a sense of inappropriateness in the gender role of that sex (Criteria B). The diagnosis is not made if the individual has a concurrent physical intersex condition (e.g., androgen insensitivity syndrome or congenital adrenal hyperplasia) (Criteria C). To make the diagnosis, there must be evidence of clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criteria D).

On its face, these criteria may seem reasonable. It is certainly true that many transsexuals experience significant distress associated with their gender identification. Yet transsexuals are told that their distress is the result of a mental illness rather than the result of a rigid, binary society.

In many ways the diagnosis, especially that seen in children, is defended because of the child’s symptoms. For example, a gender variant child may experience depression, harmful relationships with peers and family, and social withdrawal. Yet, are these things not the result of a society that is, at its core, still homophobic and transphobic? Much as the bullied child is frequently sent to therapy to learn to deal with the abuse rather than sending the abusers for treatment, the gender variant child undergoes ‘therapy’ to become “happily male or female.” In reality, this happiness comes about because the abuse of a society that values gender conformity ceases once little girls fire up their E-Z-Bake ovens and boys begin playing Cops and Robbers.

In her book Gender Shock, Phyllis Burke outlines many of the cases of Gender Identity Disorder and the trauma that many children went through in order to be 'cured' of their 'inapparopriate' gender behavior. In this example, she talks about a boy named Kraig: "

Kraig was the first child to be treated by Rekers and Lovaas for "deviant sex role behaviors," and the treatment took place both in Kraig's home and at the clinic. Many other young boys would follow in Kraig's treatment path. Rekers and Lovaas go to great lengths to explain why it was important to behaviorally treat a child like Kraig. The first reason was that the child will be scorned by his playmates, and that it is easier to change the child, rather than the society in which he lives. Secondly, the doctors believed Kraig to be at risk for adult transsexualism, transvestism and "some forms of homosexuality." (Homosexuals whose gender identities conform to their sex are not considered to be quite as pathological as those homosexuals whose gender identities do not conform to their sex. Therefore, a gay carpenter is not as sick as a gay hairdresser, and a lesbian nurse is not as sick as a lesbian plumber.)"

This is born out by the criteria for diagnosis: in children, four or more of the following must be present: “1) repeatedly stated desire to be, or insistence that he or she is, the other sex 2) In boys, preference for cross dressing or simulating female attire; in girls, insistence of wearing only stereotypical masculine clothing. 3) Strong and persistent preferences for cross-sex roles in make believe play or persistent fantasies of being the other sex. 4) Intense desire to participate in the stereotypical games and pastimes of the other sex. 5) Strong preference for playmates of the other sex. In adolescents and adults, the disturbance is manifested by symptoms such as a stated desire to be the other sex, frequent passing as the other sex, desire to live or be treated as the other sex, or the conviction that she or he has the typical feelings and reactions of the other sex.”

Within this system there is no room for the trans faggot, the trans bull dyke, or any other non traditional combination of gendered traits. To pass through the gate to hormone replacement therapy and sex reassignment surgery, the transsexual must convince the gatekeeper that they belong in the community of women or men, as evidenced by behaviors and appearances that are highly stereotypical.

The heteronormative society in which all Americans live assumes that male and female necessarily compliment one another, and that sexual and procreative relations between men and women are not just the norm, but are natural. Transsexuals challenge these notions by their very existence, so they are only allowed to change their bodies to fit their inner vision (and thereby relieve the suffering that so frequently accompanies a body vision that does not coincide with physical reality) if the transsexual is willing to undergo a systematic pigeonholing process, wherein they are taught to be heteronormative. Oftentimes the transsexual is encouraged to be even more heteronormative than the average biological representatives of male and female; transsexuals are frequently expected to become the embodiment of their chosen gender’s archetype. (i.e. the most feminine female, the most masculine male.)

The gender variant child is especially vulnerable to attempts to counsel him or her into behaving more ‘appropriately’ in regards to their assigned sex, rather than their chosen gender characteristics. The gender variant child is usually counseled because he or she is undergoing significant distress due to their transsexuality, or in an effort to discourage future transsexual, gay, lesbian, or bisexual behavior.

Already we are asking one of the central questions of this article in particular and the transsexual movement (if such a thing can be said to truly exist) in general: is the distress, which is very real, the result of an individual set of characteristics that would torment the individual no matter society’s make up, or the result of a society that is still essentially homo and gender phobic? The fact that intersexed individuals, or rather, those individuals possessing physical characteristics of both sexes (ex: an individual possessing both testicles, often non descended, and ovaries, or other physiological combinations) cannot be diagnosed with gender identity disorder, effectively removing them from the realm of transsexuality within the current medical and mental health system. Apparently, if one’s body is already considered variant from the heteronormative notions of male and female, one cannot desire to be a different sex or to present as a different gender. We rely so heavily on heteronormativity that intersexed children are almost always assigned a sex at birth, and are then surgically altered to fit that arbitrary sex. Sometimes this is done without the parent’s knowledge. The diagnosis is therefore inherently flawed because it assigns legitimacy to only males and females.

At no time is room given to the intersexed individual, or the trans fag, or the trans bull dyke. The rigid nature of the diagnosis should inspire concern at the least, for it reinforces the binary as transsexuals pay lip service to the heterenormative stereotypes of what constitutes male or female to relieve the distress they may experience as part of having their chosen identity thwarted and challenged. These criteria essentially silence the transsexual community, as one’s desire to pass as one’s chosen gender is reinforced by the strict binary treatments and proving process the transsexual must undergo.

As trans people, we are uniquely placed to effect change. Our very natures challenge heteronormativity. The GID diagnosis and the process of obtaining HRT and SRS are attempts to assimilate us, which we should reject forcefully. We will not have a voice until we demand a world that respects gender expression. Heteronormativity links genitalia and gender expression inextricably; it is our task to shatter that link. Right now we must satisfy a phalanx of professionals that we can pass as heteronormative, rather than being given the treatments needed to alleviate suffering that arises from body vision versus body reality regardless of how we wish our physical self reflected our mental self. The notion of a non conforming gender identity being classed as a mental illness says much about the state of our society. I am a transsexual, transgendered individual. I am a hermaphrodite, or intersexed. That is my trans identity. Yet I am willing to bet that if I were to try and play the game and receive HRT or SRS to bring my body vision into line with my body reality, I would not be allowed to pass through the gates. By my very nature I cannot be heteronormative enough to satisfy society’s concept of that which is natural. Those transsexuals who focus on passing through the gates above all else do themselves a disservice. While there is much debate over the power of identity politics, as trans people we have no collective identity. The process silences our voices by shrouding us in heteronormativity.

 I propose a few things to better the situation. Gender Identity Disorder should be replaced with Body Vision Incongruity or something to that effect, that suggests that one’s internal vision as it pertains to sexual characteristics is signifigantly different from one’s body reality. When this incongruity causes undue mental and emotional (and sometimes physical, in the case of those who physically attack or sever their genitalia) suffering, the money and care should be provided to alleviate that suffering. Under this system, one’s desired end state would not need to conform to a binary notion of that which is feminine and that which is masculine.

Also, (and here's the scary one, folks) if we truly want to effect change, trans people must come out as trans. Trans people frequently have a common experience, an experience that we can organize around and work to change. When we allow hetero society to tell us that we will only truly be our gender of choice when our genitalia matches our behavior, we lose. Essentially when we submit to SRS, we are paying for the privilege of being heteronormative. Keep in mind that I am not against SRS, but against the way it is currently doled out. As it now stands, we as trans people don’t control whether or not we want to change our genitalia; it is presented to us as the only way to legitimize our feelings of being gender variant and the only way we will be accepted in a heteronormative society. That same society is what inspires us to pass and go “deep stealth,” we must appear to be normative in order to have our selves respected.

If you want to get involved, here are a few starting points:

Blog Against Heteronormativity, and The Transsexual Menace. Blogging is a rapidly expanding phenomenom that allows people of all types a voice. When we speak out it makes a difference. Trans people and others who challenge the binary must be out, loud, and proud for change to occur. The world will not accomodate us, we must fight for our right to exist as we choose. I've included the Transsexual Menace because they are one of the formost orginizations dealing with trans resources and events. They are a great way to begin exploring what it means to be trans, two spirit, gender messy, etc.

* Please note that online dictionary sites should be taken with a grain of salt, as they are often edited by many different people.

Bibliography:

Diagnostic and Statistical Manual IV. 2000. 4th Ed. Washington, DC: American Psychiatric Association.

Bornstein, Kate. 1995. Gender Outlaw: On Men, Women and the Rest of Us. New York: Routlege.

Burke, Phyllis. 1997. Gender Shock. Des Plains, IL: Bantam Doubleday Dell Publishing Group Inc.

Califia, Patrick. 2003. Sex Changes: The Politics of Transgenderism. San Fransisco, CA: Cleis Press.