The Riddle of Gender

by Deborah Rudacille

  MARIANNE: But I actually do understand that question, because it’s so core. Those details of daily life. If you get so far as to say, “Okay let’s just pretend that I get to be this guy, where would I go to the bathroom?” Especially when things are organized on that binary gender line … you are transgressing a big rule.

  Q: Maybe we should just have unisex bathrooms.

  KENNARD: But that was one of the things that shot down the ERA, don’t you remember? People get really weirded out about the issue of bathrooms!

  When I finally decided to go through this transition, the thing that really got it for me was that I worked for this bank and had a membership for a health club. So I always wore shirts and ties to work, and then I go to the health club and you have to tell them your name. Okay, I had this female name. Okay, I have to go into the women’s locker room. It sent me right back to high school. It was one of the most traumatic things that ever happened to me. There were these nude women in there, and I was like this. [Mimes shielding his eyes and slinking by I was not looking. The staff person was like, “And here we have the sauna,” and I’m like, “Okay, all right.” I just felt like I can’t go and be in women’s locker rooms anymore. And it was right after that I said, “Okay, I’m taking hormones” and transitioned. So now I have the other problem. I can’t go into the men’s locker room and get naked.

  MARIANNE: There is a certain amount of privilege in walking around the world in a body that fits who you feel like you are. Not just with gender, but with all kinds of things. Not having that privilege makes negotiating the things that are usually much harder.

  KENNARD: Another problem for us is health care. I had gone through menopause at about thirty-seven. And I went to the doctor, and I said, “I think I’m going through menopause,” and he said, “No, you’re too young,” and I said, “No, I don’t think so.” So he does the hormone test, and says, “You are.” And he wants me to take estrogen! Then, when I started on testosterone, I had really bad problems with cramps. So when I started having the cramps, I went to the doctor and he’s like, “You don’t have cramps. It’s colitis.” And I’m like, “No, I’ve finally figured out where my uterus is, and it hurts.”

  Then came the saga of trying to find a gynecologist as a male. I’d call up and say, “I’d like to make an appointment,” and the receptionist would say, “This is gynecology.” And I’d say, “I know that.” And she’d say, “Do you know what we do in gynecology?” And I’d say, “I know what you do in gynecology. Could you just make an appointment with the doctor, please?” So I went to this guy, who did a hysterectomy and he’d never seen an FTM and he’d never heard of it, and he wasn’t very cool at first, but he kind of got okay.

  One day before the surgery, the doctor said, “Do you want to be in a men’s room or a woman’s room?” And I’m like, “You know, here’s the thing. I’m Thomas. If you put me in the woman’s room, she’s going to be like, ‘What is that man doing here?’ And if you put me in a man’s room, I’ll be really uncomfortable with that because I’m having a hysterectomy.” So he said, “I think I’ll get you a private room.” And that’s what we did.

  The last appointment, when we went back there so that he could make sure everything was okay, the receptionist came out into the waiting room and she says, “Miss Thomas Kennard.” So now I have to stand up. The [receptionist] looks at me, she looks at Marianne. We go back to the room and [she] starts talking to Marianne, saying “When was your last period?” Marianne says, “I’m not the patient.” The [receptionist] just kept it up. Marianne said, “I’m not the patient. He’s the patient. He had the hysterectomy. He needs to see the doctor.” The woman just went white.

  MARIANNE: She was an older lady. She was really just afraid. She was freaked out.

  KENNARD: I was really uncomfortable. I said, “You know, I have to go to the men’s room. I can’t even do this.” I said, “Where’s the men’s room?” And she’s like this. [Frozen]

  MARIANNE: She couldn’t even speak. She was afraid.

  KENNARD: So I went out, and when I came back she was gone. Marianne had gotten rid of her. What did you say?

  MARIANNE: I said, “What are you afraid of?” I don’t even remember now exactly what I said. She was terrified.

  Q: I’ve heard a lot about gynecologic problems among transmen.

  KENNARD: We all seem to get this problem with the cramps, because of the testosterone. But other than that, I only had menopause early. You’d have to pull teeth to get me to a gynecologist. Going to a gynecologist is like acknowledging that you are really female somehow, and we’re not having any of that. Like, I didn’t know where my uterus was. They made me get a sonogram before my surgery, and they didn’t tell the woman [technician] anything, I guess. And she’s running it over my abdomen, looking over at the monitor, looking at me. She asks me, “Can I ask you a really personal question? Do you have ambiguous genitals?” So I said, “No, I’m just a regular transsexual.”

  Q: And what was her response?

  KENNARD:“Oh, okay.” She was really nice. But then this gynecologist wrote me a note and said that I had to have a mammogram. And I called for the appointment and I went there for it, and they helped every woman in the room. Finally: “Can I help you, sir?” I said, “I have an appointment at two.” And she said, “Well, you don’t have one here, but I’ll find out where it is.” And then she’s like, “Oh, you do have one here.” And we go back, and I said, “Marianne has to go in the room with me.” And I think this woman was a lesbian and she was my age, and she was not happy with the situation.

  MARIANNE: She really wasn’t.

  KENNARD: She said, “No, nobody can go in.” I said, “Marianne has to go in. We have to figure out a way for this to happen.” So I got her in there. But she didn’t give me a thing to cover up. I’m already sensitive, because I’m really hairy. I felt like a freak.

  MARIANNE: And I remember saying, because he was so freaked out, “Maybe we should say something to her, like ‘I’m really uncomfortable with this situation,’” because then the person will usually, even if they are not real keen on it, [it’s] at least an opening for them to maybe become a bit nicer. But you did that, and it didn’t help. She was still very short.

  KENNARD: If you appeal to people’s humanity, especially women, they’re usually okay. I just said, “It’s really hard for me. I feel like a freak. I don’t want to be here.” But it didn’t work with her. It was like I had gone over to the enemy or something. It’s like I was saying before: younger people are much better about it than lesbian women my age.

  Q: Would you mind if we talked a little about your relationship and how you got together and the challenges of being in a relationship with a person who is transitioning?

  MARIANNE: One thing that was helpful was that Tom wasn’t the first trans person that I knew. I was friends with other transpeople and their partners. Some of my friends have been in a situation where they came to know their partner as one gender, as one identity, and then in the context of their relationship that changed, and so they had to make that transition, to give up that identity that they had shared as a couple and transition into a new one. And that is a journey that I really respect. But Tom was already transitioning, and that definitely was an advantage for us as a couple.

  I think that part of transition, no matter what kind of transition, is that it is a selfish process. Speaking as a person who was a sighted person and now I’m losing it and having to learn to be in the world in a whole different way, to me that’s a selfish process. It’s pretty much all I can do sometimes to deal with that. And it’s hard to have something so absorbing in your life, and be a couple. And at the time that Tom was having his transition about gender, I was having a transition about becoming a middle-aged woman, losing my vision, and my children growing up and leaving home. And then Tom had lived in a relationship but in his own space, alone, for a long time. So then there was another transition as we started spending a lot of time mostl
y here. He had this whole apartment to himself. So some of those things are unique to a couple that has a transgender person in it, and definitely there is a part of this process that I can’t enter. It’s a personal process. I can be feeling fine about his body, that I like his body, even as it changes, but he could be having different feelings at different times about his body. And that’s not about me, but it has an effect on me.

  Q: Have you noticed any significant changes in Tom after transition?”

  I wasn’t in a relationship with Tom before, so I don’t know what his communication style was. But we have a really different style of communication, in that mine tended to include more words than his does. And compounded by the problem of losing my vision, I need more words, and talking in a way more than some people might. I also think there is also the whole thing of what Tom refers to as a kind of adolescence. And a lot of guys talk about it that way. It’s very confusing to be in a relationship with someone who is on the one hand six or seven years older than you are, and has gray temples, but also has another adolescent part, trying to figure out things like how to be a man. It is this process you have to go through. Then there’s this whole phenomenon that Tom mentioned of having to talk about it [transition], in a lot of detail. I think it’s really interesting. So there is a way that I really like talking about it, but I also like that more time has passed and he’s had more experience, that if we go into a social situation, there is a range of topics, not just that one.

  I think that’s a struggle that I’ve heard from other partners, friends, and allies close to people in transition. It’s really key that you maintain a boundary, and that you continue to put energy into yourself. You have to hold your own place, and that seems especially important and also difficult to get that balance. And then the other thing is when Tom was really early in transition, we didn’t have the kind of ease that we have now. Because his body had changed, and so the perception on the street of him—how he looks on the outside, how he feels, and who he feels himself to be … there’s no incongruity—they take him as a male. And so when I first started going out with him, those changes weren’t as dramatic yet. If we had been somewhere more rural, not the Castro, not San Francisco, I think that even at that point most people would have taken him as a male. But because of the consciousness here that a woman can look a lot of different ways and a man can look a lot of different ways, there were people who did spot him and see him as female still. And I know that was really hard for him. You have a kind of protectiveness in that you don’t want the person you love to be hurt, and there’s nothing you can do about that.

  Six

  CHILDHOOD, INTERRUPTED

  I wonder what my parents imagined would happen to me in a mental hospital. They wanted the doctors to tame me but they didn’t ask, and the doctors didn’t say, exactly what this process entailed. It was the doctors who came up with the idea that I was “an inappropriate female”—that my mouthy ways were a sign of a deep unease in my female nature and that if I learned tips about eyeliner and foundation, I’d be a lot better off. Who would have told my parents this? Not me. Once I was locked up, I lost interest in holding a meaningful conversation with my parents.

  Daphne Scholinski, The Last Time I WORE A DRESS, Chicago, 1981

  In 1974 millions of Americans were suddenly cured of mental illness when homosexuality was deleted from the Diagnostic and Statistical Manual of Mental Disorders (DSM), often referred to as the “bible” of psychiatry. This reference book, which today runs to nearly nine hundred pages, defines and classifies more than three hundred mental disorders. The DSM is used not only by psychiatrists, but also by courts, schools, and social service agencies in making decisions about matters as varied as child custody, criminal liability, placement in special education classes, and receipt of Social Security benefits. The DSM also profoundly affects the way that we as a society think about mental health and disease. “Defining a mental disorder involves specifying the features of human experience that demarcate where normality shades into abnormality,” write sociologists Herb Kutchins and Stuart Kirk in Making Us Cray, a study of the rhetoric of science in the practice of psychiatry. This boundary shifted dramatically for gay people in the late seventies, after activists inside and outside the psychiatric profession called into question the scientific merit of the diagnosis of homosexuality as a pathology.

  As early as 1956, the psychologist Evelyn Hooker showed that gay men did not exhibit signs of psychopathology in their performance on a series of three testing instruments often used to provide evidence of mental health. After the Stonewall riots, in 1968, gay activists began to picket and disrupt the annual convention of the American Psychiatric Association (APA) and other professional meetings, demanding to be heard. From 1970 to 1974, activists within the psychiatric profession and without forced the profession to examine its basic assumptions about human sexuality and the way that it defined pathology. Ultimately, a majority of APA members conceded that their views on homosexuality were based on moral considerations rather than scientific ones. In 1974, when ballots were mailed to the members of the association asking them to vote on a decision of the board of trustees to delete the homosexuality entry from DSM, 58 percent of the ten thousand psychiatrists who replied voted in favor of the deletion. For a few years, an alternative diagnosis of “ego-dystonic homosexuality” (individuals unhappy with their own homosexuality) was retained, but then this, too, was dropped in the 1987 revision of the DSM.

  The deletion of homosexuality from the manual was viewed as a major victory for gay rights groups, who knew that their revolution would not advance very far as long as homosexuality was certified as a pathology in the DSM, as Kutchins and Kirk note in a chapter chronicling the review process that led to the decision. However, in medicine as in law, the transgendered were left behind when gays and lesbians entered the mainstream. Homosexuality may have been deleted from the DSM, but “gender identity disorder” has taken its place as the diagnosis most frequently assigned to children and adults who fail to conform to socially accepted norms of male and female identity and behavior. “When the DSM-III came out, the first edition without homosexuality, the gay community was so happy and so empowered that by the time the DSM-IV came out, nobody was watching anymore,” activist Dylan (nee Daphne) Scholinski told me in 2004. “Since then the category has just grown broader, mostly because they’ve combined all the old categories.”

  The DSM serves as a kind of dictionary of psychopathologies. It is used both as a diagnostic tool and as a justification for insurance coverage. Without a DSM diagnosis, insurance companies will not reimburse mental health treatment, either inpatient or outpatient. “DSM is the psychotherapist’s password for insurance coverage,” note Kutchins and Kirk. “All mental health professionals must list a psychiatric diag-nosic label, accompanied by appropriate code number, on their claims for insurance reimbursement.” Since its inception in 1952, the DSM has been revised five times, though the 1980 publication of DSM-III is viewed as the most significant for a number of reasons. First, it is much more comprehensive than previous editions, with many more diagnoses. “The DSM-III Task Force was predisposed to include many new diagnostic categories,” say Kutchins and Kirk. The reason for this was twofold: The practice of psychiatry was moving out of the hospital and into outpatient settings, and practitioners were seeing a much broader range of problems. At the same time, third-party (insurance) coverage was becoming more common, and coverage required a diagnosis. These two factors working together account for the sudden increase in diagnostic categories in the DSM-III—suddenly many more people were susceptible to a DSM diagnosis (and thus eligible for insurance reimbursement for treatment) than previously.

  Kutchins and Kirk’s analysis provides a clue to understanding why homosexuality was stricken from the DSM, while, first, transsexuality, and, later, gender identity disorder became part of the nosology, or system of classification. One of the many profound effects of the gay liberation movement wa
s the sudden shift in the way that gay men and lesbians thought about themselves and their sexual orientation. After Stonewall and the activism that followed in its wake, many people who might once have sought out psychiatrists and therapists hoping to be “cured” of their desires achieved a level of self-acceptance they had previously lacked. They no longer needed the services of psychiatrists because they no longer perceived themselves as ill. Transsexual people faced a far more complicated situation, however. Even if they didn’t consider themselves “sick” per se, they still needed to secure the services of health care providers. They needed endocrinologists and surgeons but, according to the Benjamin Standards of Care, they first needed to spend up to a year in therapy in order to secure the all-important “letter” from their therapist recommending hormones or surgery. They remain locked into the health care system in a way that gays and lesbians are not.

  Dr. Ben Barres of Stanford described this painful conundrum very succinctly in our conversation in 2001. “I have very mixed feelings about this. I think if gay people weren’t victims of societal ignorance and maltreatment, most would be very happy and well-adjusted, whereas I’m not sure that is true for transsexuals, at least most transsexuals that I’ve met who grow up feeling that they are the wrong gender. So there’s a certain amount of pathology. Nevertheless, I don’t think that transgendered people need to be in the DSM any more than gays do. It’s unfair, just as unfair as it was for homosexuals.”

  In DSM-III, published in 1980, “transsexualism” first appeared as a diagnostic category distinct from transvestic fetishism (cross-dressing for purposes of sexual excitement). The diagnosis was limited to “gender dysphoric individuals who demonstrated at least two years of continuous interest in removing their sexual anatomy and transforming their bodies and social roles.” The concept of gender dysphoria was developed by researchers at Stanford who realized that many of the adult patients presenting for treatment did not fit the profile of “classic” transsexualism. Dr. Norman Fisk, clinical instructor of psychiatry at Stanford School of Medicine and codeveloper of the Stanford Gender Identity Clinic, recalls that when the Stanford program was initiated, “due to inexperience and naivete we went about seeking so-called ideal candidates and a great emphasis was placed upon attempting to exclusively treat only classical or textbook cases of transsexualism.” The classical criteria included a lifelong sense or feeling of being a member of “the other sex,” early and persistent cross-dressing without any associated sexual excitement, and a “dislike or repugnance for homosexual behavior,” says Fisk. “We avidly searched for those patients who, if admitting to homosexual behavior at all, insisted that they always adopted a passive role and avoided the stimulation of their own genitals by their partner,” says Fisk.