The Riddle of Gender

by Deborah Rudacille

  As noted previously, researchers eventually realized that prospective candidates for sex reassignment were altering their life histories in order to meet the clinical criteria for “classic” transsexualism, to increase their chances of treatment. Rather than rejecting nonclassic patients outright or acceding to surgery on demand, the Stanford researchers conceived a novel solution. They created a “grooming clinic” for prospective patients, which became a kind of support group, “a group therapy situation in which individuals met on a once-per-month basis to exchange information, opinions, experiences and to mutually share feelings, successes, and failures.” The charm school/support group also enabled the Stanford researchers to develop long-term relationships with attendees and to gain “both time and increasing experience.” As a result of this ongoing follow-up, the staff at the clinic abandoned their previous “rigid and truly unrealistic diagnostic criteria” for transsexualism and developed an alternative diagnosis, “gender dysphoria syndrome.” Gender-dysphoric individuals were described as individuals who were “intensely and abidingly uncomfortable in their anatomic and genetic sex and their assigned gender” and who “functioned far more effectively and comfortably in their gender of choice, as clearly demonstrated by obvious and objective criteria.”

  Following evolving psychiatric opinion, DSM-III TR (Text Revision), released in 1987, includes a third, more expansive, category: “Gender Identity Disorder of Adolescence or Adulthood, Non-Transsexual Type (GIDAANT).” The DSM-III TR authors write that GIDAANT “differs from Transvestic Fetishism in that the cross-dressing is not for the purpose of sexual excitement; it differs from Transsexualism in that there is no persistent preoccupation (for at least two years) with getting rid of one’s primary and secondary sex characteristics and acquiring the sex characteristics of the other sex.”

  In 1994, the diagnosis of transsexualism was deleted from DSM-IV by combining its diagnostic criteria with those of GIDAANT and absorbing GID of childhood into the category. In “Gender Identity Disorder of Childhood, Adolescence or Adulthood,” the expressed desire for surgery now becomes only one of a number of criteria to be taken into consideration when making a diagnosis. The key elements of the diagnosis in both adults and children are “a strong and persistent cross-gender identification” and “a persistent discomfort with his or her sex and sense of appropriateness in the gender role of that sex.” The disturbance must also be sufficiently obvious or intense to cause “clinically significant distress or impairment in social, occupational, or other important areas of functioning.” Clearly, a far greater number of people meet these criteria than meet the more limited criteria for trans-sexualism. In shifting the focus from an expressed desire to change sex to cross-gender identification, distress, and impairment in functioning, the new diagnosis encompasses not only the relatively few individuals who desire sex reassignment, but also the far greater number who are perceived by themselves or by others to express some form of gender variance. However, in the absence of a strong desire for body modification, are the “distress and impairment” experienced by such individuals due to the disorder itself, or are they a consequence of the harassment and social ostracism gender-variant people endure?

  Activists argue that the decision to delete homosexuality as a mental disorder from the seventh printing of the second edition of DSM-III and the subsequent creation of the diagnosis of gender identity disorder was a kind of psychiatric sleight of hand. Although the focus of the diagnosis has changed from deviant desire to subversive identity, the core of the diagnosis remains the same: the individual is not a “normal” male or female, and his or her deviance from the norm is conceived as illness or pathology. The diagnosis of gender identity disorder becomes a particularly troubling matter, activists say, when applied to children and adolescents. Four of the following behaviors must be present to justify a clinical diagnosis of gender identity disorder in children: (a) a repeatedly stated desire to be, or insistence that he or she is, the other sex; (b) in boys, a preference for cross-dressing or simulating female attire, and in girls, an insistence on wearing only stereotypical masculine clothing; (c) a strong and persistent preference for cross-sex roles in make-believe play or persistent fantasies of being the other sex; (d) an intense desire to participate in the stereotypical games and pastimes of the other sex; (e) a strong preference for playmates of the other sex.

  A little boy who enjoys playing with dolls, avoids sports and other rough activities, prefers the company of girls, and says that he wants to take care of babies when he grows up is likely to be diagnosed with gender identity disorder—even though such behavior is perfectly acceptable in girls. “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,” says Katharine Wilson, Ph.D., an advocate for GID reform. “For boys, these include playing with Barbie dolls, homemaking and nurturing role play, and aversion to cars, trucks, competitive sports and ‘rough and tumble’ play. For girls, pathology is implied by playing Batman or Superman, competitive contact sports, ‘rough and tumble’ play, and aversion to dolls or [to] wearing dresses. It is unclear whether the intent of the DSM is to reflect such dated, narrow and sexist gender stereotypes or to enforce them.”

  The diagnostic criteria for GID have been steadily broadened in successive revisions of the DSM, critics of the diagnosis point out, and the broadening of the criteria points to its essentially subjective (and disciplinary) character. “Recent revisions of the DSM have made these diagnostic categories increasingly ambiguous, conflicted and overin-clusive,” says Katherine Wilson. “The result is that a widening segment of gender non-conforming youth and adults are potentially subject to diagnosis of psychosexual disorder, stigma and loss of civil liberty.” Wilson and other activists fighting to have GID redefined or removed from the DSM point out that even children who do not express discomfort with their gender identity are now subject to the diagnosis, if significant adults in their life (parents, teachers) feel that their behavior is inappropriate for their gender. “GID of Children is clearly not limited to ego-dystonic subjects. High functioning children may be presumed to meet criteria A and B on the basis of cultural nonconformity alone,” Wilson argues. “A child may be diagnosed with gender identity disorder without ever having stated any desire to be the other sex.” She points out that “overbroad diagnosis contributes to the stigma and undeserved shame that gender nonconforming youth must endure,” and that parents who accept their children’s gender nonconformity “live in fear of persecution by courts, school officials, and government agencies who infer a broad interpretation of GID of Children and seek punitive treatment remedies.”

  Critics of the diagnosis have also pointed out the paradoxical fact that while homosexuality is no longer included in the DSM as a psycho-pathology, research shows that boys diagnosed with GID in childhood are far more likely as adults to identify as gay men than as transsexuals or cross-dressers. They argue that the GID diagnosis is thus being used by parents and clinicians to target children (mostly boys) suspected of being “pre-homosexual.” Although “there are simply no formal empirical studies demonstrating that therapeutic intervention in childhood alters the developmental path toward either transsexual-ism or homosexuality,” according to experts, gender-variant children and adolescents are subject to a range of interventions focused on changing their behavior and self-concept. In a paper titled “The Disparate Classification of Gender and Sexual Orientation in American Psychiatry,” Wilson notes that “American psychiatric perceptions of etiology, distress, and treatment goals for transgendered people are remarkably parallel to those for gay and lesbian people before the declas-sification of homosexuality as a mental disorder in 1973.”

  There is also a clear parallel between the treatment of intersexual children and transgendered children, many allege. Just as the bodies of intersexual children are surgically manipulated to conform to anatomical sexual dimorphism, transgendere
d children are subjected to psychiatric interventions focused on having them conform to socially sanctioned standards of gendered behavior and appearance.

  Transgender youth face formidable challenges. Along with all the other conflicts and confusions associated with adolescence, they must come to terms with a gender identity that all of society tells them is “wrong” or “bad” or “sick.” “No single group has gone more unnoticed by society, or abused and maltreated by institutional powers, than youth with transgender needs and feelings,” say Gianna E. Israel and Donald E. Tarver II, M.D., in their book Transgender Care. “The overwhelming message from family, adult society, and youth peers says that gender nonconformity is a sick, mentally unstable condition to be feared, hated, and ridiculed.” All adolescents struggle to understand and accept their gender and sexuality, but for transgendered kids this is a perilous pursuit, fraught with risk and uncertainty. The pressure to conform to societal expectations of “normal” behavior and appearance comes from all sides—parents, school authorities, the media, and (most daunting for an adolescent) peers. Though there are no Robert’s Rules of gender posted at home, in schools, and in churches, the rules exist and are often harshly enforced by peers, parents, and school authorities.

  People who have never known a lesbian, gay, or transgendered child often assume the child knows exactly who he or she is. Nothing could be farther from the truth. The process of self-realization and self-understanding is often a slow and painful one. People surrounding the child may take note of the child’s gender variance long before the child articulates a sense of being different. In a healthy, accepting environment, the child’s process of self-discovery is facilitated by the emotional support provided by a loving family—even when the family knows little about gender variance per se. Family members simply love the child and respect his or her individuality, without requiring that he or she conform to certain codes of dress and behavior. “If there is any cure for children or youth with gender-identity issues, it can be found in the key words acceptance, androgyny, compromise, and communication. It is important for parents to recognize that all children need to be accepted for what they are, not for what others believe they should be,” say Israel and Tarver.

  But such understanding remains all too rare. “Parents with resources large or small will spend their last penny trying to help their young son or daughter conform to their concept of what is ‘normal,’” according to these researchers. When a family is coping with other Stressors, such as alcoholism, separation and divorce, or financial problems, the gender-variant child is very often scapegoated as the source of the family’s difficulties. The same thing happens in families devoted to maintaining the appearance of perfection. “Because gender-identity conflicts are still perceived as a mental health disorder by uninformed care providers, today’s transgender youth still are at risk of being treated in the same manner gays and lesbians encountered years ago. Sadly, these treatment approaches are little more than abuse, professional victimization, and profiteering under the guise of support for parents’ goals.”

  When the parents’ goal of having a “normal” child conflicts with the child’s goal of self-understanding and self-realization, the child may wind up either in a coercive therapeutic relationship focused on transforming him or her into a socially acceptable boy or girl, or, when the child refuses to conform, out on the streets. Even when parents are supportive, other adults and peers can be vicious. “Children with gender issues frequently are regarded as unruly or disruptive in the classroom and more often than not are punished, expelled or otherwise made an example by school administrators,” note Israel and Tarver. Official disapproval, combined with the teasing, harassment, and general ostracism that many gender-variant children and adolescents suffer at the hands of peers, can make school such a hostile environment that many transgendered kids drop out. The mother of Gwen (born Eddie) Araujo—the seventeen-year-old murdered in Newark, California, in October 2002—told reporters that her child had dropped out of high school because of unending harassment. “People were really mean to him at school. He really tried, but no one accepted him,” said Sylvia Guerrero.

  In March 2003, I spoke to Alyn Liebeman, an eighteen-year-old self-described trannyboy activist, who comes from an Orthodox/ Conservative Jewish family in Los Angeles. Liebeman’s background—Jewish, upper-middle class—could not be more different from that of Gwen Araujo’s, and yet he suffered many of the same indignities perpetrated on Araujo. At the time that I spoke to Liebeman, he was waiting to hear from the Ivy League schools to which he had applied for college admission—Harvard, Brown, Princeton, and others. Liebeman is highly gifted and has been enrolled in programs for gifted students since the second grade. He has always been one of the brightest kids in his class. Yet from the start of his school career, Liebeman says, he was harassed, isolated, and singled out for punishment not only by his peers, but also by school administrators, who often blamed him for the abuse other kids heaped upon him. “I had no friends,” he says simply. “I was a loner. I didn’t fit in.” When he was verbally and sometimes physically assaulted by other students, “I was blamed by administrators for being different. They would tell me that if I would just conform, this wouldn’t happen.”

  On one occasion, when he was in sixth grade, “I got beaten up by two eighth-graders while doing pull-ups at the pull-up bar in the gym. They chased me, pummeled me. I went to the security guard, who said, ‘What did you do to start this?’” The principal at the school to whom Liebeman and his mother appealed after the incident occurred said, “If you had long hair and wore nail polish, this wouldn’t have happened.” After this incident, the principal suspended Liebeman, not the perpetrators. Liebeman and his parents considered filing a lawsuit against the school, but, Liebeman says, his mother didn’t want to “put me in the limelight” and make him any more of a target than he already was. So the harassment continued. In eighth grade, “eight kids surrounded me and beat me up. We filed a police report on all eight, but nothing happened.”

  Even worse than the physical abuse, Liebeman says, was the constant harassment. “I was called ‘Pat’ a lot in middle school,” he says, referring to the ambiguously gendered character on Saturday Night Live. “I’ve been called butch, dyke, queer, homo, fag, and she-he-it (shit).” Students who knew him from middle school spread the word about Liebeman on the first day of high school, thus ensuring that he would be isolated and harassed there as well. “I had no friends,” he said. “No one would talk to me. I got really depressed. Normally I’m an outgoing person, but I got very withdrawn.” When he did find a friend in the high school gifted program, a boy who thought that he himself might be gay or bisexual, the two of them were together targeted by other students. “We wrote notes back and forth, and the kids I knew from middle school wrote stuff from the notes on the board.” Liebeman describes himself as “suicidal” during ninth grade.

  His family became concerned when his report card came back with five Ds and an F, Liebeman says. At that point, he came out as a lesbian to his family and “built some allies” in the high school administration. He eventually founded a gay/straight alliance at his school. “We had five members in our first year,” he recalls, “and we literally met in a closet—ironic!” As a result of his leadership in the school group, Liebeman attended a queer student conference in Los Angeles. The conference proved to be a turning point for him. “It was the first time I ever met a transgendered person,” he says. “I already knew that I was trans, but I was confused and afraid to admit it. I talked to this guy at the meeting and went to a session called ‘Trans 101.’ On the way home, my mom asked me what sessions I attended, and when I told her about that one, she pulled the car over on the side of the road and basically freaked out.” After overcoming her denial, Liebeman’s mother and other family members, including his uncle and grandparents, eventually came around and supported him. “The only ones who don’t know about me now” are his ultra-Orthodox relatives in Israel, he
says. This family support helped Liebeman get through the last years of high school. “In eleventh grade, socially it got better, though the emotional and verbal abuse was still pretty bad,” he says. On one occasion, the school’s gay/straight alliance created a display case during Pride Week. The case was vandalized, with swastikas scratched into the glass. Liebeman and other members of the alliance received intimidating notes from students and teachers. “Some of the right-wing born-again teachers actually signed their notes,” he marvels. “We got a lot of negative feedback from the faculty, but the administration was somewhat supportive. Their attitude is ‘We’re allowing you to be here, but we ‘re not going to do anything to protect you,’” he says.