Paper presented by Dr Tracie O’Keefe DCH at the Australian Society of Sex Educators, Researchers & Therapists (ASSERT) National Sexology Conference, University of Sydney, Lidcombe, 5-6 December 2004.
Abstract
This discussion paper examines the oppression and exploitation of sex and gender diverse people by the medical and academic establishment. Many people identify as intersex, transsexual, transgender, androgynous or without sex and gender identity. These groups of people over the past 20 years have often been swallowed up and encompassed by the greater label of the queer culture. The material for this discussion is taken from literature, reports from the sex and gender diverse community and from the author’s 30 years’ experience in helping sex and gender diverse people.
Sex diverse people are those who are atypically male or female in their biological primary and secondary sex characteristics. Gender diverse people can be fluid in their sociological gender presentation. People may present with either sex and gender diversity or dysphoria, or a combination of both. For some people, sex and gender presentation does not influence their sexuality or vice versa but for others it might.
Due to the fight that sex and gender diverse people have had and continue to have throughout the world to claim their human rights, they often have to forgo their sexuality in order to avoid being pathologised as suffering from a form of paraphilia. Most societies have also sublimated the emergence of sex and gender diverse people’s sexuality in order to allow them a gradation of negotiated human rights.
There is pressure on sex and gender diverse people to present socially as heterosexual, thereby pandering to homophobia and transphobia. Sexuality identity is an integral part of a person’s ego state, allowing them to enjoy the full spectrum of the human experience. To oppress the sexuality identity of sex and gender diverse people is nothing less than an act of violence against them, which the academic and medical communities currently propagate, disseminate and profit from.
Background
In the book Gender Reversals Gender Cultures (Lang, in Ramet (ed), 1996, p193) wrote:
“Within the majority of North American Indian tribes, there existed – and, in a number of instances, still exists – a cultural construction of more than two genders, allowing the individuals to either take up the gender role of the ‘other’ sex completely, or to mix the culturally defined men’s and women’s roles to varying degrees.”
She went on to say:
“Due to the cultural construction of two or more genders, Western concepts such as ‘transsexual’ and ‘homosexual’ can also not be applied to Native American women-men and men-women: a sexual relationship, for example between two individuals of the same sex, yet not of the same gender is not necessarily considered homosexual in a gender system that provides four or more genders to accommodate individuals who do not feel comfortable with the gender and gender roles assigned to them at birth, the concept of transsexualism, which was developed in a culture that only recognizes and values two genders and sexes, is not applicable.”
In Hermaphrodites and the Medical Intervention of Sex (Dreger, 1998, p177) there is an intersexed person’s story that reports:
“It took months for me to obtain…[all] of my medical records. I learned that I had been born, not with a penis, but with intersexual organs: a typical vagina and outer labia, female urethra, and a very large clitoris. Mind you, ‘large’ and ‘small,’ as applied to intersexual genitals, are judgments which exist only in the mind of the beholder. From my birth until the surgery, while I was [considered a boy], my parents and doctors considered my penis to be monstrously small, as well as lacking a urethra…Then, in the moment that intersex specialist physicians pronounced that my ‘true sex’ was female, my clitoris was suddenly monstrously large.”
This child was then involuntarily subjected to a clitorectomy for no other medical reason than the clinician’s ideas of aesthetics. The operation resulted in a less than satisfactory sex life and that person felt permanently disturbed that they were involuntarily assaulted.
Dreger comments (p 201):
“In the last two hundred years, scientists and medical doctors have come to know a tremendous amount about hermaphroditism. They know much about why some babies arrive in this world with parts that look different from other babies’ parts, and they know of [and employ] a wide variety of techniques designed to change bodies to make them look more ‘typical’. But the accumulation of this knowledge has not taken away the perception that hermaphrodites are strange and troublesome”.
In his book As Nature Made Him, John Colapinto (2000) tells the story of David Reimer. After a botched circumcision as an infant, surgeons decided to try and surgically turn Reimer into a girl. John Money, a clinician in America, then convinced Reimer’s parents to force him to be brought up as a girl. After much maladjustment Reimer eventually began to live as a male again in his teenage years.
Money, knowing that the child was very maladjusted as a female, continued to report academically that he was fine all the way through Reimer’s childhood in order to support Money’s own theory that gender performance is socialised and not genetically determined. Reimer found life very difficult as he tried to deal with what had physically and mentally been done to him and the loss of his penis, eventually committing suicide in 2004 (Colapinto 2000), (Chalmers 2004).
J Michael Bailey, Professor of Psychology at Northwestern University USA, in his book The Man Who Would Be Queen (2003), proposes that women of transsexual origin were simply misguided homosexual males. His poorly-written book, printed with the support of the academic system in the USA, outraged the sex and gender diverse community and upon investigation it was found that his research was fraudulent (Conway 2003). He had posed as a clinical psychologist whilst not being registered to do so during the research. He had also promised letters of referral for surgery to transsexual people in order to obtain their personal stories, printed those stories without their permission, and sourced his study participants largely from bars.
This book was hailed as an academic revelation but it was in fact a form of transphobia from a man ill-qualified to investigate in the field and who fraudulently produced research to fit his own theories. This book, which was printed by the National Academic Press, was very quickly exposed as unethical and fraudulent research, but the publisher failed to order its withdrawal.
Germaine Greer, a seasoned academic, in her book The Whole Woman (1998) sought to disempower sex and gender diverse people in a chapter she entitled Pantomine Dames. As the author of The Female Eunuch (1970), a pivotal piece of literature in the development of feminism, one would have expected her to make an effort to understand and appreciate the disenfranchisement that sex and gender diverse people can experience. Instead she sought to exploit them as a group to ridicule in order to propagate her own theories of how women’s history is developing.
Her ridiculing and chastising of transsexuals was done from an evident place of lack of knowledge on the subject, particularly when it came to basic biology. She still, however, seemed to think her academic status allowed her to propagate her own prejudices without having to put in research into the subject. This behaviour is typical of many academics that seek public exposure at the expense of sex and gender people’s reputations, and seek to pigeonhole them as misguided sexual perverts (O’Keefe, 1999).
We live in dangerous times as the world’s politics in many places are moving to the right. With a rise of religious influences, the law, medicine, politics, psychology, and cultural norms set back the cause of sexual freedom for many. George Bush Jr. is now in office for the second term of his American presidency, a confirmed homophobe and transphobe (CNN.com, 2004). In differing American states legal gay marriages are being dissolved by political bigots with extreme religious views. Sex and gender diverse people have little continuity throughout America of what sex they really are, with this varying from state to state. They can be regarded legally as and are often treated as homosexuals of their original birth sex; which gives them no real footing to explore their real sexuality.
With no social healthcare system, America is a place where many sex and gender dysphoric people frequently end up in the sex industry to finance their hormones and surgeries. Many get stuck in the poverty trap, being perceived as social misfits, mentally disturbed, and sexual deviants (Blumenstein 2003).
In Australia on 30 June, 2004, Mission Australia, a Christian organisation that receives government funds to provide short-term stay facilities for the homeless, obtained an exemption under section 126A of the Anti-Discrimination Act of 1977 to refuse service to non-operative transsexual women. This exemption affected three women’s refuges in Sydney: Woman’s Place, Lou’s Place and Women in Supported Housing (WISH).
The Anti-Discrimination Board (ADB) received requests for consultation by the Gender Centre, Australia’s largest assistance centre for sex and gender diverse people, and from Sex And Gender Education (SAGE), a civil rights organisation for sex and gender diverse people to be consulted on any exemption in the law. (Mission Australia 2004).
The Attorney General granted the exemption on the recommendation of the ADB without community consultation. The legal representative of the ADB told the author that the ADB had no legal obligation to consult any community no matter who they were (Meeting between SAGE, a representative of the Aids Council of New South Wales (ACON), the Gender Centre and the ADB, NSW, Australia, 2004) (Telephone conversation between author and legal representative of the ADB November 2004).
Mission Australia put its case to the ADB that it believed some of its female service users would fear that they would be raped by sex and gender diverse female persons, namely non-operative transsexuals.
The exemption was railroaded through by the ADB in secret, not informing leaders in the gender community. After the exemption was in place leaders in the gender community were told by the president of the ADB that the department was short of funds and it probably would not have funds to invest reversing the decision (Meeting between SAGE, a representative of the Aids Council of New South Wales (ACON), the Gender Centre and the ADB, NSW, Australia, 2004).
Mission Australia, with one of its patrons being a female psychiatrist, demonised transsexual people by refusing service to the most vulnerable of any of society’s unfortunates: the homeless, non-operative, probably jobless transsexual women who may have drug problems or even HIV issues. They took sex and gender issues of transsexual clients living as women and turned them into the characterisation of being potential rapists because of their own religious prejudices.
Elizabeth Riley, the manager of the Gender Centre and Norrie May-Welby of ACON, described relations between the ADB and the sex and gender diverse community as being the worst they had been for a decade (Meeting between SAGE, ACON, the Gender Centre and the ADB, NSW, Australia, 2004).
Also in Australia John Howard as the Prime Minister has almost a carte blanche manifesto with a political majority where he seeks to push the rights of heterosexuals over the rights of all other people (World Socialist Website 2004). His government seeks to prohibit gay couples from marrying their partners and adopting children from aboard, and this will include sex and gender diverse people who identify as gay in any form; however if they identified as heterosexual they would be allowed to marry and adopt (Wearing 2004).
The New Gender Recognition Bill (McNab 2004) in England only allows heterosexual transsexuals to marry after transition. Should a sex and gender diverse person refuse to divorce a pervious married partner after transition then they will be unable to change their birth certificate. The government fears the danger that they may appear to be gay and married after transition – all this from a government headed by Tony Blair who proposes to support the family establishment (Hartley-Brewer, 2000).
Discussion
The acquisition of any liberty and equality is always accompanied by stereotyping. The Jew in occupying Israel to escape displacement became the enemy of the displaced Palestinians. The wild silverback mountain gorilla in being listed as an endangered species became a zoned amusement for tourists to domesticate. Women in becoming wage-earners of the world have also become the slaves of capitalism. And so, sex and gender diverse people, in asking for free medical care from governments and insurance companies, have become medicalised and pathologised as psychiatric freaks and dysfunctional human beings.
Governments and insurance companies never give medical funds without first seeing evidence of disease. Sex and gender dysphoria are indeed very debilitating experiences that can render a person deeply unhappy and unable to function and they may even lead to suicide. Sometimes they can be resolved with psychotherapy and for the cases where that does not happen, the person may wish to undergo medical procedures to change their body to express partly or wholly another sex and gender expression.
Some sex and gender diverse people may see their condition or state of being as illness, but many do not, seeing it as sex and gender diversity. The problem now, however, is that the price that sex and gender diverse people have to pay is that they are being asked to define themselves by mainly medical validation. This has come about for three main reasons:
Firstly the medical profession got wind of a money earner – that is, treating transsexuals became very profitable and was also able to offer a considerable amount of kudos to many who sought to define themselves as experts in the field. A similar thing happened when the medical profession started to dominate the reproductive lives of women in the second half of the 19th century.
Freud and his counterparts pegged women’s mood changes as hysteria and a form of pathology. Surgeons sought to cure the natural process of the menopause by the introduction of mass hysterectomies (Pope, 2001). And women’s reproductive rights were overruled by the unethical prognoses of male doctors. Women were seen as neither intellectually nor morally capable of deciding their own fates. So In parallel the sex and gender diverse community has become the highly paying dysfunctional patient and both clinician and patient collude in a folie a deux that uses pathology to excuse choice.
Secondly feminism and masculinity studies sought to define, redefine, claim and reclaim what it was, is and should be to be male or female. Consequently the bridge of unisexism, that rose in the 20th century to find commonalities between men and women, as we move into the 21st century wavers. Fanaticism and the right wing seek to re-polarise the sexes. Governments prostitute themselves for votes by allowing religious persecution against sex and gender diverse people. Whilst governments may accept that sex and gender diversity may be due to a medical condition in some cases, the persecution they allow is on the grounds of proposed immorality.
In cases where the issues of the persecution of the sexuality of sex and gender people comes up, governments retreat into the Pontius Pilot position of we know it’s wrong to crucify you but it’s popular. Issues on sexuality are one of the greatest difficulties for any government because they fear right-wing backlashes at the ballot box and there are few votes in sexually liberated sex and gender diverse people’s rights. So committees and quangos are concocted to make sex and gender diverse people medicalised or immoral in order to make them manageable, but rarely sexually liberated.
Thirdly the sex and gender diverse political freedom lobby has blindly in desperation thrown itself into the medical model as a refuge from persecution. The cry of “We can’t help it we have a medical condition” is the stock-in-trade phrase used by some gender freedom lobbyists to ask for health funds for hormones and surgery. The phrase is also used to escape the criticism of being seen as anything other than normal. It is an acquiescence of “fitting in” by the means of a medical condition: a doctor’s note that excuses the individual’s behavior that might challenge male and female stereotypes and offend bigots.
Every month I get people coming into my consulting rooms talking about medical doctors and practitioners of psychological and psychotherapeutic therapies who have tried to dissuade the client from their desired course of sex and gender identity. These practitioners are often noted academics with outdated models of sexuality. Invariably they are driven by either philosophical exclusivity or by religious beliefs that see anything other than a bipolar model of sex, gender and sexuality as illness or moral bankruptcy. They are profoundly unaware of their ignorance and in denial about their bullying and malpractice.
Dangers for Clinicians
In the climate of today Western medical and psychological practitioners are faced with ever increasing threats of being sued for malpractice. Therefore helping people who present themselves to health practitioners with a sense of sex and gender dyphoria often becomes a process of treating by numbers according to the Harry Benjamin International Gender Dysphoria Association (HBIGDA) Standards of Care (2004).
The very name of the HBIGDA itself is oppressive because it assumes pathology, not diversity. If a person remains pathologised on their medical records for the rest of their lives, it leaves them with a social stigma and little confidence to have a sexuality of which they can be proud.
The DSM4 categorisation of gender dyshoria [302.85 Gender Identity Disorder in Adolescents or Adults] is inept and dangerously informs a naive practitioner about how to identify a gender variance or dysfunction. It takes no account of variables like cultural components, ever changing sociological perspectives, personal development and psychodynamic exploration. It ignores that sex and gender diverse people may have a sexuality which can be something to celebrate.
The major stumbling block, however, is that medical and psychological practitioners have limited ways of seeing sex and gender expression. Clinical training does not include anthropological, cultural, and sociological perspectives on sex and gender expression. This leaves practitioners with only pathological windows to view their clients who deviate from the average sex and gender expression. This ignorance leads to oppression of variance in sex and gender expression and disempowerment of the client. It further leads to the suppression, omission and sublimation of the sexuality of sex and gender diverse people. Academia dramatically fails medics and healthcare workers in their training on sex, gender and sexuality expression.
Recent emerging law suits against clinicians working in the field of sex and gender diversity using a bipolar male and female ideology closely linked to hetrosexualism as the only true model have been inevitable. When medicine, academia and psychology play god and try to dictate the human condition to their clients it is a loaded gun that will always eventually go off in their faces. When these disciplines ignore the research of anthropologists and sociologists that teach us that there is no true sex or gender, simply an ever floating diversity arrived at through a physical, individual and sociological perspective, they ignore important variables and equations that make up part of the human experiences of sexual happiness and satisfaction.
Sex and gender diverse people often go through difficult times establishing their sex and gender identities. Part of being able to develop a whole rewarding life is to feel safe in being able to explore one’s own sexuality. Medical, psychological, and healthcare practitioners, alongside academics, can cause enormous damage to the psyche of sex and gender diverse people when they carelessly make assumptions about that client group. The denial, sublimation and ridicule of the sexuality and sexuality development of sex and gender diverse people by those professionals is nothing less than an act of violence.
Recommendations
Educators in medicine, psychology and the caring professions need to more widely educate their students about the diversity of sexuality that is separate from sex and gender diversity. They also need to consult the sex and gender diverse communities to invite them into their classroom to tell trainees about themselves, including their sexualities.
Intersex people’s genitals should no longer be mutilated after birth to fit into the artificial aestheticism of urologists and gynecologists. Intersex people need to be allowed to choose to have medical treatment and surgery if that is right for them, with all the risks plainly explained to them. The fact that surgery may result in sexual dysfunction always needs to be stated.
Clinicians would be wise never to diagnose and foist upon the client the label of gender dysphoria, because such a pronunciation will inevitably come back to haunt them at a later stage, should a client have a change of heart. Having a psychotherapist help the client explore their issues is a wise way to help those clients choose a path that is right for them. If a client wishes to label themselves as dysphoric, a clinician can support what they are describing about their own experiences. Each client needs to be fully cognisant with the personal responsibility of those choices unless they are non-compos-mentis.
The sexuality of sex and gender diverse people should not be pathologised simply because the person may have altered or is altering their body through choice. Their sense of celebration about their sexuality should be supported and celebrated, not ignorantly confused with sex and gender identity issues. An emergence and development of that evolving sexuality can be encouraged, giving the person a sense of confidence at least equal to the kind of sexual journey that ordinary people celebrate; and there are clinicians and academics throughout the world who help sex and gender people do just that in a positive and affirmative way.
Sex and gender diverse people come in many differing kinds of combinations that can include intersexed people, transsexual, transgendered, transvestite, androgynous, without sex and gender identity, and a continuum of ever changing and developing linguistic descriptions of sex and gender experience. Their exploration of their sexuality is sometimes separate from their sex and gender issues and sometimes not, but they are often at the frontline of exploring the infinite dynamics of sexuality and could wisely be respected for the journey that they make.
Bibliography
American Psychiatric Association (APA), Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. APA, USA 2000-06.
Allport, Gordon, The Nature of Prejudice. Addison Wesley, UK & New York, 1981.
Bailey, J Michael, The Man Who Would Be Queen. Joseph Henry Press, USA, 2003.
Blumenstein, Rosalyne, Branded T.1st Books, USA, 2003.
Barker, Phil & Stevenson, Chris, The Construction of Power and Authority in Psychiatry. Butterworth Heinemann, Oxford & USA, 2000.
Colapinto, John, As Nature Made Him. Quartet Books, London 2000.
Dreger, Alice Domurat, Hermaphrodites and the Medical Intervention of Sex. Harvard University Press, USA & London, 1998.
Freud, Sigmund, New Introductory Lectures on Psychoanalysis (2). Penguin Books, UK & New York, 1981.
Freud, Sigmund, Sexuality (3). UK & New York, 1976.
Freud, Sigmund & Breuer, Joseph, Studies on Hysteria (3). Penguin Books, UK & New York, 1974.
Greer, Germaine, The Female Eunuch. McGraw Hill, USA, 1970.
Greer, Germaine, The Whole Woman. Anchor Books, USA & UK, 1998.
Mead, Margaret, Male and Female. Morrow Quill Paperbacks, New York, 1963.
Mead, Margaret, Sex and Temperament in Three Primitive Societies. Penguin Books, USA & UK, 1950.
O’Keefe, Tracie, Sex, Gender & Sexuality: 21st Century Transformations. Extraordinary People Press, London, 1999.
Pope, Alexandra, Wild Genie: The Healing Power of Menstruation. Milner, Australia 2001.
Ramet, Sabina Petra (Ed), Gender Reversals Gender Cultures: Anthropological and Historical Perspectives. Routledge, New York, 1996.
Wilchins, Riki Anne, Read My Lips: Sexual Subversion and the End of Gender, Firebrand Books, New York, 1997.
Papers
Conway, Lynn An Investigative Report Into The Publication of J Michael Bailey’s Book on Transsexualism by the National Academies. Internet posting, 2003.
ai.eecs.umich.edu/people/conway/TS/LynnsReviewOfBaileysBook1.html
Mission Australia NSW Community Services, Transgender Policy, Australia, 2004.
Internet Postings
Burns, Christine, NWU to Discipline J Michael Bailey in Secret. Wednesday 1 December, 2004, 6.41am. To Press for Change News Distribution www.pfc.org.uk/pfclists
CNN.com (Internet News Service) Bush Calls For Ban on Same-Sex Marriages, Democrats: President Using Amendment Issue For Re-election Bid. Wednesday, February 25, 2004 Posted: 5:05 AM EST (1005 GMT).
Harry Benjamin International Gender Dysphoria Association, Inc, (HBIGDA) Standards of Care, http://www.hbigda.org/ 2004
Head, Mike, Australia: Howard’s Senate Victory Fuels Coalition Tensions. World Socialist Website News & Analysis: Australia & South Pacific, 19 November 2004.
McNab,Claire, The New Gender Recognition Bill (Preparations for Gender Recognition pfc-news@lists.pfc.org.uk, 28.5.2004.
Newspapers & Periodicals
Chalmers, Katie, Sad End to Boy/Girl Life. Winnipeg Sun, 10 May 2004.
Hartley-Brewer, Julia, No 10 Media Truce as Blairs Return. The Guardian August 30, 2000.
Wearing, Myles, Adoption Ban Looming. Sydney Star Observer, Issue 739, 11.04.2004.
Meetings
Meeting between Elizabeth Riley, manager of the Gender Centre, Norrie May-Welby for the Aids Council of New South Wales (ACON) and Sex and Gender Education (SAGE), a political lobbying group for sex and gender diverse people, Tracie O’Keefe for SAGE, and a representative of the Anti-Discrimination Board (ADB) of New south Wales, Australia, 22.1.2004.
Telephone conversation between Tracie O’Keefe and legal representative of the ADB November 2004.
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