A defining moment in our history
Examining disease models of gender identity
Summary:
Gender identity and expression take on different meanings within different systems of thought. Because medical technologies are available to assist in the somatic expression of these identities, several medicalized disease models of the phenomena have developed. This article examines three disease models as typically applied to those who seek feminization:
Psychosexual pathology (Bailey-Blanchard-Lawrence [BBL] model)
The BBL model is the least scientific and most stigmatizing, with roots in the eugenics movement of the 19th century.
Psychopathology (“gender identity disorder” [GID] model)
The GID model is currently considered legitimate within psychological literature and is a required diagnosis to receive access to trans health services in many places. The author reviews several problems with mental illness models, including “childhood gender nonconformity” and “transvestic fetishism,” two other “mental disorders” currently considered legitimate diagnoses. The article makes several analogies, asking readers to consider whether “racial nonconformity” or “religious identity disorder” seem legitimate as well.
Pathology (“birth defect” model)
This third metaphor of impairment describes a physical disorder rather than a mental one. The “order” implied by positioning these traits and behaviors as diseases reinforces heteronormative hierarchies. These models use scientific-sounding terminology to reinforce the social belief that the “purpose” or “function” of sex and sexuality is procreation. This leads to an examination of historic problems with anatomical thresholds for determining sex. The author then draws parallels with other bioethical debates about technologies that disrupt the “natural” order of procreative sexuality. Interest in feminization is stigmatized in many cultures, and the article concludes with some suggestions for ways to consider it independently from models of sin or disease.
Contents:
Introduction
Definitions and thresholds
Sex and sexuality
Eugenics, genetics, degenerates, gender
Dysphoria, disease, disorder, disability, defect
“Paraphilia” and “autogynephilia”
“Transsexual” defined
Gatekeeping versus services on demand
Beyond BBLAcknowledgments
References and notes
Author’s note: This personal viewpoint is not intended to be representative of any side or group participating in these discussions.Download a printer-friendly version: A defining moment in our history (PDF: requires reader)
Interest in feminization, historically revered or feared, has benefited from
advances in science that expand possibilities for its physical expression. These
advances led to scientific models of gender variance, which were positioned
as objective alternatives to the judgmental “sin” models promoted
by some religions. Unfortunately, some allegedly scientific models being used
merely replace metaphors of sin with metaphors of disease and impairment, rather
than using objective scientific language. The time has come to examine these
judgmental models: the assumptions behind their definitions, how they masquerade
as science, their roots in eugenics, their impact on our access to health services,
and their political implications.
The most insidious disease model appears at first glance to be progressive,
even liberal, but on closer examination, it views gender variant behavior in
children and adults as a psychosexual pathology (a fancy way of saying it’s
a sex-fueled mental illness). Though the idea has been around since the 19th
century, new language for this “disorder” was proposed by Ray Blanchard
(1989) and restated by Anne Lawrence (1997) and J. Michael Bailey (2003). Though
the Bailey-Blanchard-Lawrence (BBL) model claims to be non-judgmental in a moral
sense, it is undeniably judgmental in suggesting gender variance is a disease.
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These old school sexologists
still use terminology based on century-old ideas about gender-variant
behavior as a sex-fueled disease.
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These old school sexologists still use terminology based on century-old ideas
about gender-variant behavior as a sex-fueled disease. Their definitions tangle
up several distinct threads about sex and sexuality in our community. Inflammatory
language about transwomen like “man who would be queen,” 1
“man without a penis,” 2 or
“men trapped in men’s bodies” 3
has led to responses in kind about BBL and their apologists, but thankfully,
such polemics are now limited to shrill but secluded fringes of discussions
about untangling the mess they’ve made.
Scientific language evolves with understanding, and scientific discussions
require that words be used with scientific precision. In short, definitions
matter. A definition simultaneously includes and excludes. It affects how people
view our community, especially those who expose problems with existing definitions.
BBL and their apologists mock the evolution of definitions and ideas as “politically
correct,” 4, 5,
6, 7 a term used by guardians of convention
that signals a lack of intellect and contempt for scientific progress. For instance,
Lawrence’s opening salvo brags of being one of the “troublesome people
who are inclined to doubt the conventional wisdom” about transgender
eroticism, then just ten sentences later defends Blanchard’s use of the
inaccurate and offensive term “homosexual transsexual” because it
is “conventional usage in the psychiatric literature.” 8
[emphasis mine]
Specialized definitions for many words in this debate evolved within separate
institutional realms. Though used differently, a term as defined in one field
influences another field, especially as we see attempts to merge biology, psychology,
law, and medicine into biopolitics. 9
Within the current medico-juridical system, clinical thresholds affect legal
thresholds and vice versa.
Imprecise and idiosyncratic definitions plague this debate. The BBL model declares
transsexual women are men with one of two sexual desires: “homosexual”
(males aroused by males) and “autogynephilic” (males aroused by the
thought or image of themselves as women). Both categories efface our identities
as women, but “autogynephilia” is more problematic in many ways. One
major problem is the tendency for some who embrace the term to look at the etymology
and think it denotes an innocent and happy form of feminist self-esteem: “I
love myself as a woman!” they’ll say. I do too, but that’s not
what this word denotes. When I say, “‘Autogynephilia’ is defined
by its creator as a type of paraphilia,” some say, “Well, that’s
not how I use it.” That’s like saying someone is a pedophile
because she loves children, or that someone is a zoophile because he loves his
pets. Those terms are clinical and legal descriptors. Yes, “pedophile”
literally means “love of children” in Greek, and “autogynephile”
means “love of self as woman,” but both terms are inexorably linked
to their clinical origins as psychosexual pathologies.
Calling oneself or others “autogynephilic” is participating in one’s
own pathologization, and it legitimizes this fake disease when people claim
they don’t have it. BBL are engaging in scientific McCarthyism,
where they claim a hallmark of “autogynephilia” is that those afflicted
will deny it. Any refutation becomes proof they are right, a no-win situation
like asking “when did you stop beating your wife?”
When we say “autogynephilia” is a made-up disease, some mistakenly
think we are claiming erotic interest in feminization is made-up, too. Obviously,
this exists. Many women in our community have been very open and honest about
their erotic interest, 10 yet still
take issue with labeling it a disease. 11
My response to “sexology” is similar to how a person of color might respond to “raceology.” I question anyone who seeks to draw bright lines between nuanced possibilities of sex and sexuality, especially when they claim their attempt is science instead of something arbitrary and subjective. Trying to map a scientific schema onto complex traits and behaviors is like turning an impressionist painting into a paint-by-numbers. Those who fear miscegenation of the sexes or sexualities are just like those racists who use “science” to reinforce socially constructed categories of ethnicity. As Anne Fausto-Sterling notes, “Labeling someone a man or a woman is a social decision. We may use scientific knowledge to help us make the decision, but only our beliefs about gender—not science—can define our sex. Furthermore, our beliefs about gender affect what kinds of knowledge scientists produce about sex in the first place.” 12
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My response to “sexology”
is similar to how a person of color might respond to “raceology.”
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Well, to borrow a phrase, a few troublesome people are inclined to doubt this
conventional wisdom. 17 Many of us question
Lawrence’s claim that sexual desire is “that which moves us most.”
18 We point to our experiences and feel
our identities are what drive us; Wyndzen shows psychology supports our recognition
of how powerful a force “identity” can be. 19
We even question some passages of Darwin and the Bible (at the same time, no
less!). BBL get very upset when highly respected evolutionary biologists like
Roughgarden 20 or Gould 21
question their most deeply-held beliefs about sexual selection and human behavior.
Eugenics, genetics, degenerates, gender
The words “eugenics,” “genetics,” “degenerates,”
and “gender” all derive from the same Greek root meaning “to
produce or bring forth life.” Some sciences and some religions seek to
explain our genesis and control our reproduction of subsequent generations.
New reproductive technologies are ushering in a host of bioethical issues and
raising the specter of a new wave of eugenics, where the genocide (another related
word) will happen before or shortly after conception, after genetic material
is screened for “undesirable” traits. Should people with Down Syndrome
or dwarfism be eliminated from the gene pool? How about intersexed people? If
Bailey’s colleagues find the “gay gene,” 22
should we wipe out sexual minorities, too? What about gender minorities? Will
we see a “transgenocide”? Who decides what’s a disease or a degeneracy?
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Their models of sex
and sexuality originated with doctors and criminologists in the late 19th
century eugenics movement.
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As evidenced by BBL’s metaphors of disorder and disease, people can only express ideas in the language they have available. Their models of sex and sexuality originated with doctors and criminologists in the late 19th century eugenics movement, and BBL’s ideas haven’t evolved much from the influential works that shape their thinking. After Darwin’s Origin of the Species (1859) came Francis Galton’s Hereditary Genius (1869). Following ideas in that book, Galton coined the term “eugenics” in 1883, which melded with the emerging fields of criminology and sexology. Though the term “eugenics” is now rightfully associated with Nazism, a few modern adherents hope to usher in an “Age of Galton.” Bailey and Blanchard are charter members of a conservative-run eugenics discussion group devoted to this pursuit. 23
Three physicians who were Galton contemporaries are central to the BBL worldview:
Richard Freiherr von Krafft-Ebing, who wrote Psychopathia Sexualis (1886);
Havelock Ellis, who wrote The Criminal (1889) and Sexual Inversion
(1897); and Magnus Hirschfeld (coiner of both “transvestite” and “transsexual”),
who in 1897 founded Germany’s Scientific Humanitarian Committee, whose
motto was “justice through science.” Like BBL, these doctors genuinely
believed that social ostracism of sexual minorities would be eliminated through
science, but we all know what happened next in Germany. These doctors’
“scientific” models were imbued with eugenic paternalism (they believed
homosexuals had a pathology and were unfit for procreation), and they claimed
those who engaged in non-procreative sex were biologically different. By mid-century,
Hirschfeld’s institute had been destroyed, and persecuted minorities had
been rounded up and murdered based on “scientific” models that claimed
groups like Jews, gays, and other persecuted minorities were “degenerate,”
biologically distinct, and a threat to “social hygiene.”
Lest we think this is an isolated phenomenon that only happened in Nazi Germany,
in America, disability and race took center stage in the eugenics movement,
24 which focused on sterilization and
birth control for the “unfit.” 25
In Canada during the same period, the focus was immigrants, and the method of
control was psychiatry. A physician named Charles Kirk Clarke oversaw the two
largest Canadian asylums before accepting Canada’s top mental-health post.
Clarke advocated eugenic policies to limit the immigration and marriage of the
“defective.” He also used psychiatric diagnoses to incarcerate new
citizens. Foreign-born patients were 50% of his institutionalized population,
including political activists, homosexuals, and other “defectives.”
26
Clarke’s sociobiological leanings are still alive and well at the institution
named after him, The Clarke Institute in Toronto, where Ray Blanchard works.
27 There, Kurt Freund and Blanchard
used Freund’s controversial plethysmograph to delineate deviance. 28
Though the quack device is just a lie detector for the penis (open to manipulation
and interpretation by both subject and observer), they used it extensively to
separate homosexual from “non-homosexual,” and later to do sex experiments
on “male gender dysphorics, paedophiles , and fetishists,” which they
lumped together, yet divided into homosexual and “non-homosexual.”
29
In historic diagnoses for sex problems, homosexuality and masturbation were
“diseases” that could strike either sex, but other problems were gendered
degeneracy: women who had “too much” interest in straight sex had
the now-discredited disease “nymphomania,” while men who had “too
little” interest in it were inverts or perverts, a still legitimate disease
category called “paraphilia.”
Dysphoria, disease, disorder, disability, defect
According to my medical records, I am mentally ill. The psychiatry industry’s
Diagnostic and Statistical Manual of Mental Disorders (DSM) alleges that
I am afflicted with “gender identity disorder” (GID). Before that,
I had “childhood gender nonconformity,” from their special “kids’
menu” of mental disorders. Others with an interest in feminization get
diagnosed with the “disorder” of “transvestic fetishism.”
30 For many years, some in our community
have relied on mental illness models as a form of validation. I ascribe to the
view that “psychiatric diagnoses are stigmatizing labels, phrased to resemble
medical diagnoses and applied to persons whose behavior annoys or offends others.
‘Mental illness’ is not something a person has, but is something [a
person] does or is.” 31
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Imagine a mental illness
diagnosis for “racial nonconformity” or “religious identity
disorder.”
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I suppose I had a “dis-ease,” an uneasiness, a dysphoria about the
sorts of social and sexual expression I was allowed in the gender roles assigned
to me at birth. I did not conform until it became clear in 7th grade that the
other option was ever-increasing ostracism and violence, but since when is non-conformity
a disease? Imagine a mental illness diagnosis for “racial nonconformity”
or “religious identity disorder.”
Disease models affect the kinds of knowledge produced by those who use them.
Bem called sex researchers’ preoccupation with the causes of homosexuality
“scientifically misconceived and politically suspect” because embedded
in their preoccupation with causality is the idea that something went wrong
that needs to be diagnosed and fixed. 32
The situation is no different when we look at how sex researchers study transgender
persons. BBL are what Ordover calls “biological apologists” who look
to the body for absolute truths. A major medicalization of homosexuality occurred
in the 1990s, in response to AIDS (a disease which led to renewed interest in
a “gay gene” and later a “gay germ” disease model of homosexuality).
33 While Bailey was drawing federal
funds to isolate homosexuality the way others looked for HIV, nobody was looking
for the “straight gene” or “straight germ.” Like a good
eugenicist who believes biology is destiny and genetics dictate human behavior,
Bailey started linking gender roles to genetic discussions: “childhood
gender nonconformity does not appear to be an indicator of genetic loading for
homosexuality.” 34 Is gender genetic?
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Almost everyone who
is attracted to the concept of “autogynephilia” identifies through
metaphors of impairment.
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Despite these problems, many in our community embrace a disease metaphor. Lawrence
intones about “symptoms” of transsexualism, its “clinical course,”
the benefits of “palliative treatment.” 35
Lawrence then magnanimously claims that “everyone has a right to self-define,”
yet asserts that those who disagree with Lawrence’s diagnosis aren’t
being very honest with themselves or others. A “palliative treatment”
helps symptoms while leaving the disease uncured, and the uncured disease can
be a personal and political identity. In her important series of scientific
criticisms of Blanchard, Wyndzen cites studies on self-verification where people
“assimilated their illnesses into their identities.” 36
Almost everyone who is attracted to the concept of “autogynephilia”
identifies through metaphors of impairment. Many participants in the main “‘autogynephilia’
support” newsgroup are on public assistance, which seems related to their
fears about removal of gender variance from the DSM. They fear subsidized medical
services will be denied if there is no mental illness classification. But what
do they think will happen if there is differential diagnosis that claims their
subgroup does all this to indulge an autoerotic interest? Should insurance companies
give out high heels as “palliative treatment” for shoe fetishists?
As Lawrence notes, “There are many human behaviors that look like the
same thing, but really aren't.” 37
Previous medical attempts to catalogue behavior like Lawrence’s were not
only pathologizing, but insulting: People like Lawrence were “transvestitic
applicants for sex reassignment” 38
who are “aging” 39 and “distressed,”
40 suffering from “pseudotranssexualism”
41 a “non-transsexual” variant
of “gender identity disorder” (GIDAANT), 42
and “iatrogenic artifact.” 43
Many notable “borderline” cases are doctors: Renee Richards, Anne
Lawrence, Gregory/Gloria Hemingway. They may epitomize these published observations.
They all self-treated, vacillated, and “detransitioned” to varying
degrees, and all three challenge existing diagnostic categories. 44
If interest in feminization is an iatrogenic artifact (a disease made up by
doctors), wouldn’t doctors be the best evidence of that? Further, why would
Dr. Marci Bowers transition without incident in the same hospital group that
forced Anne Lawrence to resign? Do they really have the same “disease”?
I have never heard Dr. Bowers have to assert she’s a “real” transsexual,
as Dr. Lawrence has.
I do not defer to people just because they are clinicians. My work fighting
quacks and consumer fraud has put me in touch with countless “experts”
who have no business in science or medicine. Some “expert” will probably
diagnose my questioning “experts” as “authority nonconformity”
or some other made-up disease to undermine my credibility. After all, my questioning
the legitimacy of “autogynephilia” is evidence I’m afflicted
with it. To refute that kind of argument, we need to contextualize the term.
“Paraphilia” and “autogynephilia”
The term “paraphilia” first appeared in 1923, in a book prepared
for doctors and criminologists by physician Wilhelm Stekel. 45
Over eighty years later, BBL collaborator Simon LeVay still calls paraphilias
“illnesses that need treatment.” 46
“Paraphilia” is the psychiatric term for problematic sexual desire
or behavior. The current name for this alleged mental disorder first appeared
in the DSM in 1980. 47 It describes
“paraphilia” as “recurrent, intense sexually arousing fantasies,
sexual urges, or behaviors involving
(1) nonhuman objects
(2) the suffering or humiliation of oneself or one's partner, or
(3) children or other non-consenting persons….
The behavior, sexual urges or fantasies cause clinically significant distress
in social, occupational, or other important areas of functioning” 48
Some people who identify with the diagnosis of “autogynephilia” chime
in at this point and say, “Well, then I don’t have a
paraphilia, because I don’t think I have a problem.”
The most recent version of DSM was revised just for them—it says this illness
can be diagnosed even if the person does not experience any subjective distress
or impaired functioning. 49 LeVay notes:
“This is quite a significant shift; it emphasizes that psychiatrists may
go beyond responding to clients' complaints and may use their expertise for
other purposes, such as protecting society from sex crimes.” 50
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A scientific or reasonable
discussion of “autogynephilia” is like a scientific discussion
of horoscopes: there’s no science to discuss, only pseudoscience.
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“Autogynephilia” is not a behavioral model, it describes a sex-fueled
mental illness that lumps gender variance in with sex crimes. BBL believe that
paraphilias cluster, meaning that they believe that “autogynephiles”
are more likely to be aroused by children, corpses, excrement and other illegal
and socially unacceptable things. This diagnosis was widely ignored after Blanchard
first suggested it in the Journal of Nervous and Mental Disease in 1989.
51 By the end of his series of papers,
Blanchard was shoehorning other behaviors into his model with crackpot variants
like “partial autogynephilia.” 52
However, Blanchard and his colleagues had enough influence in this rarely-studied
subspecialty to get “autogynephilia” mentioned in the DSM. 53
The work would have remained an obscure intradisciplinary skirmish until Lawrence
found Blanchard’s articles in 1997, during a time of great need. A year
earlier, Lawrence’s erotic interest in ritualized genital modification
led to indulging that interest. 54 Lawrence
had taken “physician, heal thyself” to heart previously, and after
yet another failed “cure” in the form of vaginoplasty, Lawrence’s
fascination did not wane. In 1997, a lack of social acceptance at work (described
in one account as “bizarre behavior”) 55
and an incident where Lawrence examined an unconscious patient for signs of
ritualized genital modification ended a respected career. 56
Discovering Blanchard was clearly revelatory for Lawrence, who now had a diagnosis
to explain what happened. Suddenly, this forgotten diagnosis had a vocal and
influential champion. I dismantle the pseudoscience behind “autogynephilia”
in a longer essay elsewhere. 57
A scientific or reasonable discussion of “autogynephilia” is like
a scientific discussion of horoscopes: there’s no science to discuss, only
pseudoscience. Yes, both concepts exist, but that does not mean either are legitimate
science. Some people have a need to create an identity based on a worldview
where people are predictable based on vague, unproven categories that arbitrarily
assign traits to everyone, imposing order onto an unpredictable and incomprehensibly
complex world.
BBL have proposed several definitions for “transsexual” that include
people not previously considered within that definition. Their definitions view
gender variance through the lens of disordered sexual desire. Bailey defines
“transsexual” as anyone who has “the desire to become a member
of the opposite sex.” 58 They do
not have to act on this desire—“only serious thoughts” are enough
to qualify. 59 This model reflects Bailey’s
definitions of sexual orientation: someone is a homosexual whether they act
on their desire or not. Lawrence believes transsexuality is “fundamentally
about changing one's anatomy, or sex; and that sometimes it may have little
to do with gender identity, or with gender role.” 60
Some do this “not primarily because they have a gender problem, but because
they have a sex problem, and indeed a sexual problem… the expression of
a paraphilia” 61 Blanchard says
he’s reluctant to label children as “transsexual,” 62
which is reminiscent of the “pre-homosexual” language used by his
homophobic counterparts in “gay cure” groups like NARTH. 63
Blanchard’s colleague Ken Zucker is a vocal advocate of reparative therapy
for gender-variant children, and he considers transsexuality “a bad outcome.”
64 In fact, Bailey has noted that unchecked,
this disease could spread: a world tolerant of gender-variant children “might
well come with the cost of more transsexual adults.” 65
Echoing Lawrence’s strict anatomical construction of “transsexual,”
a quaint aphorism claims, “If you aren’t a transsexual before surgery,
you are after.” Really? What about David Reimer or others surgically altered
as children who do not identify as transsexual? 66
Conflicting definitions occur within any demographic grouping. Extremist separatists
from both sides of any constructed binary often create unlikely alliances: for
instance, “people of color” and “African-American” are terms
debated by both ethnic separatists and conservatives. 67
In our community, pluralist concepts like “queer” or “transgender”
are debated in circles where distinctions between gay men and transwomen, or
between crossdressing and transsexualism, are very important.
Lawrence insists the few who embrace this diagnosis “do not declare ourselves
sick.” 68 Not morally sick, anyway,
but physically sick. Lawrence’s self-descriptions have remarkable parallels
with descriptions of binge-and-purge cycles among crossdressers who hate their
behavior, or those “afflicted” with “unwanted homosexuality”:
“The loneliness and disconnection from others that typically accompany
autogynephilia [sic] are a large part of what makes this condition feel
like genuine paraphilia (i.e., a “disorder”) to many of us who experience
it (and I'm including myself here) and not merely a “benign variant”
form of human sexuality.” 69 Swap
“autogynephilia” with the word “homosexuality,” and Lawrence’s
comment would feel right at home in a NARTH publication. Lawrence’s “problem”
is not self-love, but self-hate.
For those of us who view “gender” and “sex” as socially
constructed, transsexualism can’t be separated from its social component.
Phenotype can trump genotype; gender expression can trump anatomy. Those who
need to use anatomy as evidence of their identity have failed in gaining acceptance
within a social or institutional framework. Everyone has a right to self-identify,
but if others don’t accept that proclaimed identity, we must either accept
their lack of acceptance, or work to change their minds. People can legislate
rights, but not acceptance. That has to be earned.
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Audre Lorde said “Your
silence will not protect you.” I say your anatomy will not protect
you, either.
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Audre Lorde said “Your silence will not protect you.” 70
I say your anatomy will not protect you, either. Legal and medical models based
on anatomical benchmarks for “male” and “female” will inevitably
conflict and fail. Sexists who wish to efface the identities of women like me
can always find a physiological or behavioral reason to say I am “‘really’
a man,” and some of the worst offenders are “helping professionals”
and people in our community. They echo the racists who came up with “scientific”
schemes to determine who was “‘really’ black,” or heterosexists
like BBL who create ways to determine who is “‘really’ gay.”
Gatekeeping versus services on demand
Much of my early activism was informed by sex-positive, pro-choice feminism.
We passed out condoms and “Just Say Yes” sex-ed books at Chicago Public
Schools, and we defended clinics from Operation Rescue. One of our major initiatives
was family planning services (including abortion) that were “safe, free
and on demand.” I have always seen parallels between family planning and
transition-related medical services, both of which were once only available
through back alley clinics and black market sources. Women in our community
died from this, and still die from illegal and unregulated products and procedures
because of our legal status. I believe controlling our bodies is a fundamental
human right. If someone wishes to undergo a vasectomy, vaginal rejuvenation,
abortion, facial tattoo, piercings, tongue splittings, facial feminization,
breast implants, mastectomy etc., I believe these procedures should be available
to anyone who is willing to sign a release. I find it quite telling that our
surgical procedures and abortion both face similar challenges, since both involve
altering one’s capacity to reproduce.
Psychiatric gatekeeping only works for those who are unwilling or unable to
find easier and faster ways. Before the internet, most young people got what
they needed through extralegal networks (many poor people still do), and anyone
who had the means would skip gatekeeping altogether and jet off to an exotic
locale, as it had been done for many years before the gender clinics began imposing
controls. At the apex of the gender clinic system, only those willing to endure
a process akin to criminals at a parole hearing took that route—people
who would say whatever the gatekeeper wanted to hear in order to get what they
desired. 71 Ironically, many who tried
to get around gatekeeping during their own involvement now insist it remain
in place. 72 Lawrence, who is fond of
quoting Audre Lorde, 73 must have missed
“The master’s tools will never dismantle the master’s house.”
74 Gatekeeping also appeals to those
who don’t get much validation except from gatekeepers. The acceptance letter
becomes about the only acceptance they get. Not only is getting a vagina a status
symbol and evidence of identity for this tiny group, but “beating the system”
is a status symbol, too (which might also explain the correlation between online
“‘autogynephilia’ support” and welfare support).
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With gatekeeping, we
end up with people like BBL controlling access to services in exchange
for money or sex.
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I should note that I had a great therapist who helped me immensely. I probably
would have gone even without being required. Therapy and support should be encouraged,
but voluntary, and without the stigma of disease, in the way that someone questioning
their spiritual beliefs might find therapy helpful without needing their spiritual
journey labeled as a “religious identity disorder.” With gatekeeping,
we end up with people like BBL controlling access to services in exchange for
money or sex. “Sexology” is an unregulated activity in most states,
meaning anyone could set up shop as a sexologist or sex therapist. Bailey, Lawrence,
and others have all used their “sexologist” credentials to gain easier
access to sex partners. Some dismiss this as OK because they sign our little
permission slips so we can get medical services. Call me old-fashioned, but
I don’t feel it’s ethical or scientific for gatekeepers and sex researchers
to have sex with clients and research subjects. I also don’t want my tax
dollars federally subsidizing the sex life of a self-hating tranny-chaser like
Bailey, so he can meet women like me and later claim we “have the brains
of men but the genitals of women” 75
or are prone to criminal activity and sexual promiscuity.
Here’s my question: why not cut out these middlemen and simply request
and receive services? If people go to their physician and say they are depressed
or anxious, the doctor believes their self-report and suggests options. Why
can’t it be that simple for us?
Replacing GID as the principal diagnostic means for obtaining medical service
is considered a top health priority in our community. Citing a progressive San
Francisco program, the National Coalition for LGBT Health states: “There
is a great need for more such programs that avoid GID as a requirement for access…
this [requirement] results in many transgender people avoiding the psychiatric
diagnosis process altogether, and not accessing medically regulated Trans Health
Services.” 76 The interest itself
isn’t the problem, it’s the anxiety and depression caused by depriving
its expression. 77 If in some cases
hormones and surgery help relieve anxiety and depression, they should be available
as an effective, time-tested option.
Roughgarden notes: “Their bogus categories and made-up diseases are intended
to subordinate, not to describe.” 78
Until we get away from this childlike dependence and deference to so-called
“experts” simply because they take our money or don’t kick us
out of their offices, our accommodation in healthcare and law will not be fully
realized.
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BBL will be regarded
as an interesting curiosity from the waning years when our community was
considered disordered and diseased.
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People like BBL rarely admit they are wrong, because they are very concerned
about their academic legacy (which mirrors their beliefs about offspring). They
will spend the rest of their lives fighting tooth and nail to defend their words
and actions, but in the end BBL will be regarded as an interesting curiosity
from the waning years when our community was considered disordered and diseased
because of our interest in feminization, in whatever form that interest might
take. Luckily, we don’t have to convince them they are wrong; we just have
to convince everyone else.
We need to embrace judgment-free models to describe these phenomena. I hereby
suggest the phrase that leads off this article: interest in feminization
(IF) and the subset erotic interest in feminization (EIF) as umbrella
terms without the stigma of disease. It encompasses not only our community,
but anyone regardless of motivation, affectional orientation, or gender assigned
at birth. Change “F” to “M” in the acronym for the F to
M folks. I can think of a laundry list of problems with this proposed terminology,
but this article is part of an ongoing evolution of ideas. I’ll leave the
definitive statements to those who fancy themselves “experts” who
claim they know “the truth.” My thoughts here won’t be the end
of old ways of thinking, but with luck, it will spark some new ones, where we
describe ourselves and our identities without the stigma of sin and disease.
From the day in April 2003 when Professor Lynn Conway began an investigation into Bailey’s book, 79 it was clear that this was a defining moment for our community. We mobilized all around the world as never before. 80 We made sure this book did not become another Transsexual Empire. 81 BBL underestimated everything about us, from our numbers, 82 to our intelligence, 83 to our ever-strengthening network, to the direct contact we have with our youngest and most vulnerable, to our influential positions in every career and profession, to our ability to effect positive change. 84 This isn’t just evolution, it’s revolution. We’re replacing sin and disease with pride and strength, and this is only the beginning.
Los Angeles
September 2004
The author would like to thank Drs. Madeline Wyndzen and Nancy Ordover for
key insights and research that informed this article.
Please note: Anne Lawrence is notorious for removing website materials as soon as comments in them become difficult to defend. While every effort has been made to keep up-to-date links, some materials may no longer be available online.
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Transsexual Road Map > BBL Clearinghouse > A Defining Moment
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