Far From the Tree

by Solomon, Andrew

  The revelation threw Joseph into an abrupt and severe depression. Venessia started to call their child Josie. “Josie wouldn’t go outside unless she could go in her girl clothes. I had to decide then, was I willing to leave my marriage to protect Josie? Well, to make Josie be a boy is asking her to commit suicide. I’m not that kind of parent.” By this time, Venessia and Joseph had adopted a younger daughter, Jade, from China. “I’m willing to give Joseph up, and I’m willing to walk away from Jade, which was incredibly hard. But Josie was five and had already paid enough penance for ten lives.” While Venessia was making these calculations, her husband gradually came around. “She had that sparkle,” he said. “I just decided, Josie is here to stay.”

  When I first met Josie, she was eight, and she said, “I’m a girl and I have a penis. They thought I was a boy until I was six. I dressed like a girl. I said, ‘I’m a girl.’ They didn’t understand for the longest time.” Josie was increasingly assertive about her need to be a girl all the time, so one day Joseph agreed to take her to school on the base in a denim skirt with a pink rabbit on it, and pink leggings underneath. The kids were mostly accepting, but their parents were another story. “The next day, there was a screaming crowd outside Josie’s classroom door,” Venessia said. “I was terrified.” In Josie’s own yard, someone snatched her bicycle from her and tossed it into the jungle. “People were throwing things at our house, calling us child molesters,” Venessia said. “Little girls screaming, ‘You’re a fucking faggot.’” The wife of the judge advocate general on base started a petition to remove Josie from school. “It was awful when everyone found out I was a girl,” Josie remembered. “My neighbor Isabelle said she was going to call the police and put me in jail. It made me sad. I thought she was my friend.”

  Venessia allowed Josie to choose her clothes, and every day she shunned the boy clothes. “She wouldn’t go outside without a skirt on,” Venessia said. “But she’s got the biggest smile on her face. Well, I’m going to smile, too. So I did. I was holding her hand tighter than usual, but she just kept on marching.” Before long, Venessia and Joseph had taken her off all her medications. Her asthma, depression, anxiety, and attachment disorder were all gone. But the military told the family to get out of Okinawa, claiming they could not protect Josie; they were reassigned to a base in the Arizona desert.

  Venessia didn’t want Josie at another military school. She located a public school in Tucson with a liberal-leaning principal and enrolled both daughters. But Josie’s teacher refused to call her by a female name and told Josie that Venessia was a “mean mommy” who was forcing her to live as a girl when everyone could see she was a boy. “She was an awful, rude teacher, who didn’t want me at her school,” Josie said. “I got so angry and frustrated.” Venessia said, “Josie’s self-esteem was crushed. She was back to being gloomy.” Josie complained of stomachaches and headaches and fought every day against going to the school, which began sending truancy notices.

  The Romeros moved to another town. Fearing for Josie’s safety, they installed alarm wiring on the windows and doors and bought a Great Dane to intimidate attackers. Venessia sent an e-mail to the principal of the local public school that began, “I’m the proud mother of an eight-year-old transgender daughter.” His head of human resources said, “We follow state laws, and there are no antidiscrimination protections for your child here.” In November, Venessia placed her daughters at a Waldorf school, but, at $20,000 per year, it was impossible on an air force salary. The only option left was homeschooling. Josie said, “I miss going out.” Joseph said, “The isolation is the price we pay to shield her from a world that could harm her.”

  Isolation is not the only difficulty. “I always have the penis problem,” Josie said. “I want to get rid of it. But I think it will hurt. They said I have to be a certain age to take my penis off, when I’m more like fifteen.” Venessia said, “Eighteen. But you’ll be able to take estrogen and grow boobs sooner than that.” Josie explained, “When I’m a mommy, I’ll adopt my babies, but I’ll have boobies to feed them and I will wear a bra, dresses, skirts, and high-heeled shoes.” She seemed equally definite when she told me that she wanted to marry someone with rainbow-colored hair who was beautiful on the inside and the outside. “We’ll get a baby here in Arizona, and then go live in whatever state Jade is in so we can be next-door neighbors,” Josie said. “We’ll live in a tree house. I’ll grow my hair all the way to California.”

  Later, Venessia said to me, “I wouldn’t put Josie through surgery until she was emotionally ready for the physical pain, but if she were, I would absolutely do it right now.” Venessia plans to give Josie puberty blockers, which stop the production of testosterone and estrogen. “She won’t have testosterone ravaging her body,” Venessia said. “So she’ll never get an Adam’s apple or facial hair. She’ll never look like a man in a dress.” Venessia found a doctor in Tucson who was willing to work on this protocol. Joseph persuaded the department of records to issue a new birth certificate for Josie, with her correct name and gender. But Venessia also deliberately kept toys for boys around the house, saying, “I don’t want her to feel like she’s proving she’s a girl by playing with Barbies all the time.”

  Most trans children I encountered were living stealth. I was struck that many of these kids had gone from one discrepancy—living in an anatomical gender that was anathema to them—to another—living in a gender that did not match their body. Josie’s openness had come at high cost, but she struck me as more truly free than many other trans children. Josie has become an activist. It’s a hard role to imagine for someone who is eight and still thinks she may live in a tree house, but this strange jumble of hypermaturities and childishness was her core. When I met her, she had just been filmed by National Geographic for her second documentary; she has met with members of Congress and the governor of Arizona. I wondered to what degree Joseph and Venessia shared—or, indeed, manufactured—this activist bent, but Venessia, who had considered the wisdom of having her daughter stealth at least in some contexts, asked rhetorically, “What’s the first thing Josie says? ‘Hi, my name is Josie. I’m eight. I’m transgender. Who are you?’”

  In 2009, Kim Pearson, by then a friend of the family, was chosen for a community service award but was unable to attend the ceremony; she asked Josie to accept the award on her behalf. Seven hundred people were in the audience. “She turns to me on the podium,” Venessia remembered. “She whispered, ‘Mommy, I have really big stage frightfulness right now.’ But she whispered right into the microphone. Everyone laughed, and that relaxed her.” Josie ad-libbed her speech and got a standing ovation. “Josie’s very fragile, very emotional,” Venessia said. “But Josie wants to change the world.”

  Venessia noted, “Little boys don’t go around saying they’re little girls without good reason. They’re trusting you to listen, and we didn’t know how. The other day she said, ‘Mommy, why did you want me to be a boy?’ That killed me. I told her, ‘I didn’t understand and I’m really sorry.’ She said, ‘It’s okay, Mommy. I love you, and everything’s so good now.’”

  • • •

  Gender is among the first elements of self-knowledge. This knowledge encompasses an internal sense of self, and, often, a preference for external behaviors, such as dress and type of play. Gender identity’s etiology, however—posited to lie in genetics, in uterine androgen levels, in early social influences—remains obscure. Heino Meyer-Bahlburg, a professor of psychology at Columbia University who specializes in gender variance, has described numerous possible biological mechanisms, and said that as many as four hundred rare genes and epigenetic phenomena may be involved, genes associated not with hormone regulation, but with personality formation. “The view we have of the brain now is like those wonderful pictures of earth that the first astronauts took from the moon,” said Norman Spack, associate professor of pediatrics at Harvard University and a leading endocrinologist in the field. “You can see the continents, the oceans, the weat
her systems. When you can read the license plates, we’ll know what causes gender nonconformity.” Like autism, gender nonconformity seems far more prevalent than ever before; as with autism, whether the condition is actually more frequent or simply more recognized is unclear.

  The nongenetic biological arguments are confusing. The synthetic estrogen diethylstilbestrol (DES), developed in 1938 and used until the early 1970s to prevent miscarriage, has had many adverse effects on both males and females exposed to it in utero. A 2002 survey of members of the DES Sons Network found an extraordinary 50 percent rate of transgenderism; this supports the hypothesis that gestational hormone levels can trigger cross-gender identity. Scientists have also expressed concern about endocrine disruptors (EDCs), a class of chemicals found in everything from food to floor polish to packing materials. EDCs are known to be responsible for an increasing incidence of deformities in amphibian reproductive systems; researchers have speculated that they might be responsible for the increasing incidence of genital abnormalities and atypical gender identity in human beings.

  In 1991, Georges Canguilhem, a historian of science who worked on the concept of mutation, wrote, “Diversity is not disease; the anomalous is not the pathological.” Being trans is without question anomalous; the relentlessly debated question is whether it is also pathological. Gender identity disorder was introduced as a medical category in 1980. The DSM-IV requires that four of the following five symptoms be present for a diagnosis in children: strong and persistent cross-gender identification, defined as the desire to be, or the insistence that one is, of the other sex; persistent discomfort about one’s assigned sex or a sense of inappropriateness in the gender role of that sex, often manifested in cross-dressing of some kind; an inclination toward cross-sex roles in make-believe play, with fantasies of being the other sex; a constant wish to participate in the stereotypical games and pastimes of the other sex; a preference for playmates of the other sex. Boys diagnosed with GID commonly prefer feminine clothing and hairstyles, often are mothers when they play house, avoid rough-and-tumble play and athletics, and are interested in female fantasy figures such as Snow White. Girls diagnosed with GID often have intensely negative responses to being asked to wear dresses, prefer short hair, are often mistaken for boys, seek out rough-and-tumble play, enjoy sports, and choose fantasy figures such as Batman. In an age when women can work in construction and men can marry other men, the notion of a medically enshrined, “Batman vs. Snow White” typology of gender identity seems reductive, yet it still has considerable currency in the medical literature. The diagnosis is specified as inapplicable to anyone with an intersex condition.

  Whereas most children will play at an early age with toys suitable to either gender, trans kids often refuse the toys associated with their natal sex. Meyer-Bahlburg describes these children as “pervasively gender atypical from birth.” A scale of gendered behavior ranks people as very masculine at one end and very feminine at the other. Typical boys are 3.5 to 5 standard deviations in the direction of masculinity, and the girls are the same number of deviations toward femininity. But trans kids will tend to be 7 to 12 deviations from the norm in the direction away from their birth gender. In other words, natal males become more female than most females, while natal females become more male than most males. “It’s almost like their play is a political statement,” Spack said. Adults with GID show clinically significant distress or impairment in social and occupational functioning. Some children who have gone undiagnosed will manifest the syndrome during puberty or afterward; conversely, only a quarter of children given a GID diagnosis will show full cross-gender identification in adolescence. In other words, sometimes their play means nothing about their future identity and sometimes it means everything. This is why decisions about how to raise them are so fraught.

  Many professionals who work with trans children believe that the society at large is failing them. Kelly Winters, founder of GID Reform Advocates, has written, “Behaviors that would be ordinary or even exemplary for gender conforming boys and girls are presented as symptomatic of mental disorder for gender nonconforming children,” meaning that what is deemed healthy in a girl is considered a symptom of psychiatric illness in a boy. Activists have spoken of the GID diagnosis being used not only to prevent natal boys from identifying as girls and natal girls from identifying as boys, but also to stigmatize or prevent effeminate homosexuality and butch lesbianism. Stephanie Brill added, “A male child who says, ‘I must be a girl because only girls want to do these things,’ is not showing evidence of being transgender; he’s showing evidence of sexism.” Gerald Mallon and Teresa DeCrescenzo, social workers with experience in this community, complain that natal boys are given “the sports corrective,” and natal girls, “the etiquette corrective.” At the 2009 meeting of the American Psychiatric Association, protestors gathered at a “Reform GID Now!” demonstration. Diane Ehrensaft, of the Child and Adolescent Gender Center in Berkeley, California, where she specializes in children with gender identity issues, said, “The mental health profession has been consistently doing harm to children who are not ‘gender normal,’ and they need to retrain.”

  Other activists, however, rail against the possibility of losing the diagnostic category. In The Riddle of Gender, Deborah Rudacille writes, “The diagnosis legitimizes the range of hormonal and surgical interventions that have provided relief to thousands of transsexual and transgendered people. Activists who argue that the ‘medical model’ of gender variance ‘pathologizes human diversity’ tend to miss this point. Without some sort of diagnosis, sex reassignment becomes nothing more than a kind of extreme cosmetic surgery/body enhancement, or in the view of critics, a fad, a fashion, a ‘craze.’” GID’s presence in the DSM facilitates insurance coverage for the psychological support transgender people may require; William Narrow, the research director for the DSM-5, has said, “The harm of retention is stigma, and the harm of removal is potential loss of access to care.” The task at hand, he continued, is “to create a situation where access can be not only available but increased, and discrimination can be reduced.” This quandary echoes the experience of deaf people and dwarfs, who may not care for the disability label yet need it to secure accommodations and services.

  Surgical and endocrine interventions for transgender people, however, are seldom eligible for reimbursement and tax deductibility. Many transgender people would like to see their condition classified as a physical condition, which would resolve that problem. Michele Angello, a PhD therapist specializing in gender identity issues, has pointed out that if something can be fixed with a physical transformation, it shouldn’t be categorized as a mental health condition. Some activists maintain that trans, like pregnancy, is a medical condition but not a disease. The AMA has issued a resolution that they “support health insurance coverage for treatment of gender identity disorder as recommended by a physician,” which leaves the door open for bodily or psychological interventions. Reclassification as an endocrine or neurocognitive condition could be achieved by developing a new listing in the ICD (the International Statistical Classification of Diseases) of the World Health Organization.

  As long as GID is classed as a mental illness, professionals will try to cure it, and parents will refuse to accept it. It is time to focus on the child rather than on the label. Edgardo Menvielle, a psychiatrist at Children’s National Medical Center, said, “The goal is for the child to be well adjusted, healthy, and have good self-esteem. What’s not important is molding their gender.” It seems right to prioritize each child’s mental health over a system that makes universal predictions about what should constitute happiness or what values are healthy. Menvielle does not see trans children as being automatically disordered; he does see them as being at risk. Peggy Cohen-Kettenis, a professor of gender development who works in Amsterdam, has likewise attempted “to diagnose and treat functional problems (such as separation anxiety, disorganized parenting, and depression), so regardless of which gender the child ulti
mately exhibits, the family is well.” In other words, gender identity should not obscure underlying problems, and such problems should not interfere with addressing gender identity.

  Most Deaf people don’t take exception to being called deaf; most people with intellectual disabilities raise no objection to the term Down syndrome; yet gender identity disorder infuriates the people it ostensibly describes, to a degree and extent that transcends semantics. Most conditions in this book entail a positive model of identity and a negative model of disorder. While no one wants to be put in a stigmatized diagnostic category, most people fight the stigma rather than the category. Those who think of deafness or autism as identities can do so even if others call them disorders. GID suggests not simply that trans people have a disorder, but that their identity itself is the disorder. This is a dangerous standpoint. We all have multiple identities, and most of us regret some of them, but identity is who we are. The law of identity is among the first precepts of philosophy; it states that everything is the same as itself. Aristotle explained that “the single cause” as to “why the man is man or the musician musical” is simply “because each thing is inseparable from itself.” Locke declares that our most fundamental knowledge is “a man is a man.” Undermining anyone’s personal tautology by suggesting that he should not, in fact, be himself sabotages whatever he might become. The GID designation bespeaks an agenda of terminating identity. You can seek better ways to manifest identity, but you can’t ask any class of people to discard their identity itself. The twentieth century reached its nadir with attempts to free the world of Jewish identity, Tutsi identity, or the many identities that communism suppressed. The practice of obliterating identities does not work at this macro level; it does not work well at the micro level, either.