Undoing Gender (14 page)

On the other hand, we ought not to underestimate the pathologizing force of the diagnosis, especially on young people who may not have the critical resources to resist this force. In these cases, the diagnosis can be debilitating, if not murderous. And sometimes it murders the soul, and sometimes it becomes a contributing factor in suicide. So, the stakes of this debate are high since it would seem, in the end, to be a matter of life and death, and for some the diagnosis seems to mean life, and for others, the diagnosis seems to mean death. For others too, it may well seem to be an ambivalent blessing or, indeed, an ambivalent curse.

In order to understand how these two understandable positions have emerged, let’s consider first what the diagnosis consists of in the United States and, second, its history and present usages. A diagnosis of gender disorder has to conform to the sway of the
DSM-IV
’s definition of gender dysphoria.
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The last revision to that set of definitions was instituted in 1994. For a diagnosis to be complete, however, psychological tests are needed along with “letters” from therapists providing a diagnosis and vouching that the individual in question can live and thrive in the new sexed identity. The 1994 definition is the result of several revisions, and probably needs to be understood as well in light of the American Psychiatric Association’s (APA) decision in 1973 to get rid of the diagnosis of homosexuality as a disorder and its 1987 decision to delete “ego dystonic homosexuality,” a remaining vestige from the earlier definition. Some have argued that the GID diagnosis took over some of the work that the earlier homosexuality diagnosis performed, and that GID became an indirect way of diagnosing homosexuality as a gender identity problem. In this way, the GID continued the APA’s tradition of homophobia, but in a less explicit way. In fact, conservative groups that seek to “correct” homosexuality, such as the National Association of Research and Therapy of Homosexuality, argue that if you can identify GID in a child, there’s a 75 percent chance that you can predict homosexuality in that person as an adult, a result which, for them, is a clear abnormality and tragedy. Thus, the diagnosis of GID is in most cases a diagnosis of homosexuality, and the disorder attached to the diagnosis implies that homosexuality remains a disorder as well.

The very way that groups such as these conceptualize the relationship between GID and homosexuality is very problematic. If we are to understand GID as based on the perception of enduring gendered traits of the opposite sex, that is, boys with “feminine” attributes, and girls with “masculine” attributes, then the assumption remains that boy traits will lead to a desire for women, and girl traits will lead to a desire for men. In both of these cases, heterosexual desire is presumed, where presumably opposites attract. But this is to argue, effectively, that homosexuality is to be understood as gender inversion, and that the “sexual” part remains heterosexual, although inverted. It is apparently rare, according to this conceptualization, that boy traits in a boy lead to desire for other boys, and that girl traits in a girl lead to desire for other girls. So the 75 percent of those diagnosed with GID are considered homosexual only if we understand homosexuality under the model of gender inversion, and sexuality under the model of heterosexual desire. Boys are still always desiring girls, and girls are still always desiring boys. If 25 percent of those diagnosed with GID do not become homosexual, that would seem to mean that they do not conform to the gender inversion model. But because the gender inversion model can only understand sexuality as heterosexuality, it would seem that the remaining 25 percent would be homosexual, that is, non-conforming to the model of homosexuality as inverted heterosexuality.

Thus, we could argue, somewhat facetiously, that 100 percent of those diagnosed with GID turn out to be homosexual!

Although the joke is irresistible to me only because it would so alarm the National Association of Research and Therapy of Homosexuality, it is important to consider, more seriously, how the map of sexuality and gender is radically misdescribed by those who think within these terms. Indeed, the correlations between gender identity and sexual orientation are murky at best: we cannot predict on the basis of what gender a person is what kind of gender identity the person will have, and what direction(s) of desire he or she will ultimately entertain and pursue. Although John Money and other so-called transpositionalists think that sexual orientation tends to follow from gender identity, it would be a huge mistake to assume that gender identity causes sexual orientation or that sexuality references in some necessary way a prior gender identity. As I’ll try to show, even if one could accept as unproblematic what “feminine” traits are, and what “masculine” traits are, it would not follow that the “feminine” is attracted to the masculine, and the “masculine” to the feminine. That would only follow if we used an exclusively heterosexual matrix to understand desire. And actually, that matrix would misrepresent some of the queer crossings in heterosexuality, when for instance a feminized heterosexual man wants a feminized woman, in order that the two might well be “girls together.” Or when masculine heterosexual women want their boys to be both girls and boys for them. The same queer crossings happen in lesbian and gay life, when butch on butch produces a specifically lesbian mode of male homosexuality. Moreover, bisexuality, as I’ve said before, can’t be reducible to two heterosexual desires, understood as a feminine side wanting a masculine object, or a masculine side wanting a feminine one. Those crossings are as complex as anything that happens within heterosexuality or homosexuality. These kinds of crossings occur more often than is generally noted, and it makes a mockery of the transpositionalist claim that gender identity is a predictor of sexual orientation. Indeed, sometimes it is the very disjunction between gender identity and sexual orientation—the disorientation of the transpositionalist model itself—that constitutes for some people what is most erotic and exciting.

The way that the disorder has been taken up by researchers with homophobic aims presupposes the tacit thesis that homosexuality is the damage that will follow from such a sex change, but it is most important to argue that it is not a disorder and that there is a whole range of complex relations to cross-gendered life, some of them may involve dressing in another gender, some of them may involve living in another gender, some of them may involve hormones, and surgery, and most of them involve one or more of the above. Sometimes this implies a change in so-called object choice, but sometimes not. One can become a transman and want boys (and become a male homosexual), or one can become a transman and want girls (and become a heterosexual), or one can become a transman and undergo a set of shifts in sexual orientation that constitute a very specific life history and narrative.

That narrative is not capturable by a category, or it may only be capturable by a category for a time. Life histories are histories of becoming, and categories can sometimes act to freeze that process of becoming.

Shifts in sexual persuasion can be in response to particular partners, so that lives, trans or no, don’t always emerge as coherently heterosexual or homosexual, and the very meaning and lived experience of bisexuality can also shift through time, forming a particular history that reflects certain kinds of experiences rather than others.

The diagnosis of gender dysphoria requires that a life takes on a more or less definite shape over time; a gender can only be diagnosed if it meets the test of time.
⁴
You have to show that you have wanted for a long time to live life as the other gender; it also requires that you prove that you have a practical and livable plan to live life for a long time as the other gender. The diagnosis, in this way, wants to establish that gender is a relatively permanent phenomenon. It won’t do, for instance, to walk into a clinic and say that it was only after you read a book by Kate Bornstein that you realized what you wanted to do, but that it wasn’t really conscious for you until that time. It can’t be that cultural life changed, that words were written and exchanged, that you went to events and to clubs, and saw that certain ways of living were really possible and desirable, and that something about your own possibilities became clear to you in ways that they had not been before. You would be ill-advised to say that you believe that the norms that govern what is a recognizable and livable life are changeable, and that within your lifetime, new cultural efforts were made to broaden those norms, so that people like yourself might well live within supportive communities as a transsexual, and that it was precisely this shift in the public norms, and the presence of a supportive community, that allowed you to feel that transitioning had become possible and desirable. In this sense, you cannot explicitly subscribe to a view that changes in gendered experience follow upon changes in social norms, since that would not suffice to satisfy the Harry Benjamin standard rules for the care of gender identity disorder.

Indeed, those rules presume, as does the GID diagnosis, that we all more or less “know” already what the norms for gender—“masculine” and “feminine”—are and that all we really need to do is figure out whether they are being embodied in this instance or some other. But what if those terms no longer do the descriptive work that we need them to do? What if they only operate in unwieldy ways to describe the experience of gender that someone has? And if the norms for care and the measures for the diagnosis assume that we are permanently constituted in one way or another, what happens to gender as a mode of becoming? Are we stopped in time, made more regular and coherent than we necessarily want to be, when we submit to the norms in order to achieve the entitlements one needs, and the status one desires?

Although there are strong criticisms to be made of the diagnosis— and I will detail some of them below when I turn to the text itself—it would be wrong to call for its eradication without first putting into place a set of structures through which transitioning can be paid for and legal status attained. In other words, if the diagnosis is now the instrument through which benefits and status can be achieved, it cannot be simply disposed of without finding other, durable ways to achieve those same results.

One obvious response to this dilemma is to argue that one should approach the diagnosis
strategically
. One could then reject the truth claims that the diagnosis makes, that is, reject the description it offers of transsexuality but nevertheless make use of the diagnosis as a pure instrument, a vehicle for achieving one’s goals. One would, then, ironically or facetiously or half-heartedly submit to the diagnosis, even as one inwardly maintains that there is nothing “pathological” about the desire to transition or the resolve to realize that desire. But here we have to ask whether submitting to the diagnosis does not involve, more or less consciously, a certain subjection to the diagnosis such that one does end up internalizing some aspect of the diagnosis, conceiving of oneself as mentally ill or “failing” in normality, or both, even as one seeks to take a purely instrumental attitude toward these terms.

The more important point in support of this last argument has to do with children and young adults, since when we ask who it is who would be able to sustain a purely instrumental relation to the diagnosis, it tends to be shrewd and savvy adults, ones who have other discourses available for understanding who they are and want to be. But are children and teens always capable of effecting the distance necessary to sustain a purely instrumental approach to being subjected to a diagnosis?

Dr. Richard Isay gives as the primary reason to get rid of the diagnosis altogether its effect on children. The diagnosis itself, he writes, “may cause emotional damage by injuring the self-esteem of a child who has no mental disorder.”
⁵
Isay accepts the claim that many young gay boys prefer so-called feminine behavior as children, playing with their mother’s clothes, refusing rough and tumble activities, but he argues that the problem here is not with the traits but with “parental admonitions… aimed at modifying this behavior [which] deleteriously affect[s] these boys’ self-regard.” His solution is for parents to learn to be supportive of what he calls “gender atypical traits.” Isay’s contribution is important in many respects, but one clear contribution it makes is that it calls for a reconceptualization of the phenomenon that refuses pathologizing language: he refuses to elevate typical gender attributes to a standard of psychological normality or to relegate atypical traits to abnormality. Instead, he substitutes the language of typicality for normality altogether. Physicians who argue against Isay not only insist that the disorder
is
a disorder, and that the presentation of persistently atypical gender traits in children is a “psychopathology,”
⁶
but they couple this insistence on pathologization with a paternalistic concern for the afflicted, citing how the diagnosis is necessary for insurance benefits and other entitlements. Indeed, they exploit the clear and indisputable need that poor, working class, and middle class trans-aspirants have for medical insurance and legal support to argue not only in favor of keeping the diagnosis on the books but in favor of their view that this is a pathology that must be corrected. So even if the diagnosis is approached as an instrument or vehicle for accomplishing the end goal of transitioning, the diagnosis can still (a) instill a sense of mental disorder on those whom it diagnoses, (b) entrench the power of the diagnosis to conceptualize transsexuality as a pathology, and (c) be used as a rationale by those who are in well-funded research institutes whose aim is to keep transsexuality within the sphere of mental pathology.

Some other solutions have been proposed that seek to ameliorate the pathological effects of the diagnosis by taking it out of the hands of the mental health profession altogether. Jacob Hale argues that this matter should not be mediated by psychologists and psychiatrists; the question of whether and how to gain access to medical and technological resources should be a matter between client and medical doctor exclusively.
⁷
His view is that one goes to the doctor for other kinds of reconstructive surgeries or on other occasions where taking hormones may prove felicitous, and no one asks you a host of questions about your earliest fantasies or childhood practices of play. The certification of stable mental health is not required for breast reduction or menopausal ingestion of estrogen. The required intervention of a mental health professional on the occasion in which one wants to transition inserts a paternalistic structure into the process and undermines the very autonomy that is the basis for the claim of entitlement to begin with. A therapist is asked to worry about whether you will be able, psychologically, to integrate into an established social world characterized by large-scale conformity to accepted gender norms, but the therapist is not asked to say whether you are brave enough or have enough community support to live a transgendered life when the threat of violence and discrimination against you will be heightened. The therapist is not asked whether your way of living gender will help to produce a world of fewer constrictions on gender, or whether you are up to that important task. The therapist is asked to predict whether your choice will lead to postoperative regret, and here your desire is examined for its persistence and tenacity, but little attention is given to what happens to one’s persistent and tenacious desires when the social world, and the diagnosis itself, demeans them as psychic disorders.
⁸